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General Medicine > Commonly Used Drugs > Flashcards

Commonly Used Drugs Flashcards

1
Q

Warfarin - target INR

A

2-3 except for mechanical mitral valve 2.5-3.5

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2
Q

INR 4.5-10 and no bleeding in a patient on warfarin

A

Stop warfarin
Consider reasons for elevated INR
Vit K is usually unnecessary

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3
Q

INR >10 and no bleeding in a patient on warfarin

A

Stop warfarin
Administer 3-5mg vit K orally or IV
Measure INR in 12-24 hours
Resume warfarin at reduced dose once INR approaches therapeutic range

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4
Q

High bleeding risk (eg recent major bleed or major surery) in the setting of high INR in a patient on warfarin. What else can you give in addition to vit K?

A

Prothrombinex-VF 15-30 IU/kg

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5
Q

INR >1.5 with life-threatening (critical organ) bleeding in a patient on warfarin

A

Stop warfarin
Vit K 5-10mg IV
Prothrombinex-VF 50 IU/kg IV
FFP 150-300mL

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6
Q

INR >2 with clinically significant bleeding (not life threatening) in a patient on warfarin

A

Stop warfarin
Vit K 5-10mg IV
Prothrombinex-VF 35-50 IU/kg IV

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7
Q

Any INR with minor bleeding in a patient on warfarin

A

Stop warfarin

Repeat INR following day and adjust to maintain INR in the target therapeutic range

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8
Q

Brand name for dabigatran?

A

Pradaxa

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9
Q

Brand name for rivaroxaban?

A

Xarelto

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10
Q

Brand name for apixaban?

A

Eliquis

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11
Q

Which of the novel anticoagulants are listed for stroke prevention in non-valvular AF with at least one additional stroke risk factor?

A

dabigatran, rivaroxaban, apixaban
Careful with Cr Cl for all, careful with age and body weight with apixaban and beware of those with higher risk of bleeding with Pradaxa

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12
Q

Which new anticoagulants are listed for the prevention of VTE in THR and TKR?

A

All of them: dabigatran, rivaroxaban, apixaban

Varying length of protocol

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13
Q

Which novel anticoagulants are TGA approved for the treatment of DVT or PE?

A

rivaroxaban only

15mg BD for 3 weeks then 20mg daily

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14
Q

Which of the novel anticoagulants is TGA approved for the prevention of recurrent VTE?

A

rivaroxaban only

20mg daily

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15
Q

Empiric treatment options for symptomatic UTI?

A

Trimethoprim 300mg daily for 3 days (non pregnant)
Cephalexin 500mg q12h for 5 days
Amoxycillin with clavulanate 500/125mg q12h for 5 days
Nitrofuratoin (if resistance to antimicrobials above) 100mg q12h for 5 days

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16
Q

ESBL (what is it) and how can you empirically treat it?

A

Extended-spectrum beta-lactamase producing isolate more likely in patients recently hospitalised, aged care, recently used Abs, DM, old age and recent travel in past 6 months to Southeast Asia
Tx with meropenem 500 to 1000mg IV q8h with ID advice

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17
Q

Antibiotic prophylaxis for frequent recurrent UTIs

A

Trimethoprim 150mg nocte

Cephalexin 250mg nocte

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18
Q

Which are the only oral drugs available for infections caused by Pseudomonas aeruginosa?

A

Quinolones

19
Q

Empirical therapy of symptomatic UTI in pregnant women?

A

Cephalexin 500mg q12h for 5 days
Nitrofuration 100mg q12h for 5 days
Amoxycillin+clavulanate 500/125mg q12h for 5 days

20
Q

Empiric therapy for line sepsis?

A

Usually coag neg staph or staph aureus
Send line tip and two sets of blood samples from another site for cultures
Gent 4 to 7mg/kg IV for first dose plus Vanc IV

21
Q

Empiric therapy for severe pyelonephritis

A

Gent IV plus amox/ampicillin 2g IV q6h (if penicillin hypersensitivity use Gent as single drug)
If Gent contraindicated use ceftriaxone 1g IV daily or cefotaxime 1g IV q8h

22
Q

Initial drug treatment of acute uncomplicated vulvovaginal candidiasis

A

Clotrimazole 10% vaginal cream as a single dose at night
Nystatin 5g vaginal cream q12h for 7 days
Fluconazole oral 150mg single dose

23
Q

1st, 2nd, 3rd line drug tx for uncomplicated hypertension

A

ACEi - perindopril erbumine 2 to 8mg daily
ARB - irbesartan 400 to 800mg daily
Ca Channel blocker - amlodipine 2.5 to 10mg daily or diltiazem CR 180 to 360mg daily or
verapamil SR 120 to 480mg daily
Thiazide diuretics - indapamide/ hydrochlorothiazide
B-blockers not recommended as first line therapy (atenolol 25-100mg orally, daily or metoprolol 25-100mg orally, BD)

24
Q

1st, 2nd, 3rd line drug tx for URTI

A

Majority - no tx unless lots of clinical features of S pyogenes present OR
Pts 2-25yrs old with sore throat in Indigenous communities
Pts of any age with existing rheumatic heart disease
Pts with scarlet fever
In which case tx is phenoxymethylpenicillin 500mg q12h PO for 10 days or if low compliance benzathine penicillin 900mg IM as single dose. If hypersensitive to penicillins give cephalexin 1g q12h for 10 days and if immediate hypersensitivity use azithromycin 500mg daily for 5 days

25
Q

1st, 2nd, 3rd line drug tx for depression

A

SSRI eg citalopram 20mg mane up to 40mg
SNRI eg venlafaxine 75mg mane up to 375mg
Mirtazapine 15 to 30mg nocte up to 60mg

26
Q

1st, 2nd, 3rd line drug tx for type II diabetes

A
  1. Metformin
  2. Metformin + GLP-1 agonist (liraglutide) or DPP-4 inhibitor (sitagliptin/vildagliptin) OR
  3. Metformin + basal insulin OR
  4. Metformin + sulfonylurea (glicazide, slipizide) (plus others such as acarbose/ thiazolidinediones if exogenous insulin avoidance is primary concern)
  5. Basal bolus insulin regimen
    Check TGA licensed combinations
27
Q

1st, 2nd, 3rd line drug tx for dyslipidaemia

A
  1. Statins eg atorvastatin 10 to 80mg daily
  2. Ezetimibe 10mg daily
  3. Bile acid binding resins eg cholestyramine
  4. Fenofibrate 145 mg daily reduce dose in renal impairment
28
Q

1st, 2nd, 3rd line tx for OA

A
  1. Paracetamol 1g q6h or 1.33g tds up to 4g max/24hrs
  2. NSAID
  3. Topical NSAID
  4. Intraarticular corticosteroids
29
Q

1st, 2nd, 3rd line tx for GORD

A
  1. PPI eg esomeprazole 20mg daily (30mins to 1hr prior to meal) or pantoprazole 40mg same as above
  2. Surgery
30
Q

1st, 2nd, 3rd line tx for asthma

A
  1. SABA PRN
  2. ICS (low dose) plus SABA PRN
  3. ICS+LABA (low dose) plus SABA PRN
  4. ICS+LABA (med to high dose) plus SABA PRN
31
Q

1st, 2nd, 3rd line tx for anxiety

A
  1. SSRI eg citalopram 10mg to max 40mg
  2. Duloxetine 30mg daily to max 120mg daily
  3. Venlafaxine CR 75mg orally mane post food to max dose 225mg daily
32
Q

1st, 2nd line drug tx for dermatitis

A

Face and Flexures
1. Hydrocortisone 1% daily or BD until dermatitis settles and switch to emollient
2. Desonide 0.05% lotion daily until settles and switch to emollient
Elsewhere
1. Betamethasone valerate 0.02% or 0.05%
2. Betamethasone dipropionate 0.05%

33
Q

1st, 2nd, 3rd line tx for sleep disturbance

A
  1. Sleep hygiene
  2. Psychological/ behavioural therapy
  3. Temazepam 10mg nocte, zolpidem CR 6.25mg bedtime
  4. Melatonin prolonged release 2mg bedtime
34
Q

1st, 2nd, 3rd line empiric tx for gastroenteritis with severe disease

A
  1. Ciprofloxacin 500mg q12h for 3 days
  2. Norfloxacin 400mg q12h for 3 days
  3. If SE Asia consider azithromycin 500mg daily for 3 days
  4. If IV - ceftriaxone 2g IV for 3 days (but not for pts who develop diarrhoea after 48 hrs in hosp - consider C diff then)
35
Q

1st, 2nd, 3rd line tx for acute AF

A
  1. Rhythm control - cardioversion with amiodarone 150 to 300mg IV infusion over 20 mins to 2 hrs OR D/C cardioversion
  2. Rate control - atenolol 25mg to 100mg daily or metoprolol 25mg to 100mg BD
    (or digoxin)
    WITH prophylaxis against VTE dalteparin 120units/kg up to 10,000 units S/C BD or enoxaparin 1mg/kg SC BD or heparin infusion
36
Q

1st, 2nd, 3rd line oral contraception

A
  1. Levlen/Microgynon 30 - ethinyloestradiol 30 and levonorgestrel 150
  2. If acne - Diane-35 or Estelle-35 - ethinyloestradiol 35 and cyproterone 2000
  3. Yasmin - ethinyloestradiol 30 and drospirenone 3000
37
Q

List alternatives to oral contraception

A

NuvaRing
Implanon
Mirena
Copper IUD

38
Q

BP targets in uncomplicated hypertension

A
39
Q

BP targets in pts with associated end-organ damage or clinical conditions (stroke/TIA, CAD, diabetes, albuminuria)

A

130/80

40
Q

Non-pharmacological measures to reduce BP (in conjunction with pharm)

A 
Smoking cessation
Physical activity
Reduce alcohol
Moderate sodium restriction
Healthy eating
Weight reduction
Management of OSA
41
Q

Drug tx of osteoporosis

A
  1. Correct vit D and calcium first and continue supplementation throughout
  2. Bisphosphonate eg alendronate 70mg once weekly on empty stomach OR risendronate 35mg once weekly on empty stomach (or 150mg once monthly on empty stomach) OR zoledronic acid 5mg IV over 15mins once per year (remain upright for 30 mins post taking bisphosphonates)
  3. Denosumab 60mg SC once every 6 months
42
Q

What antihypertensives should not be combined?

A

B-blocker with verapamil/diltiazem (risk of heart block)

ACEI + ARB

43
Q

Triple whammy?

A

ACEi/ARB + diuretic + NSAID

General Medicine (5 decks)

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