Communicating information Flashcards by Lewis Liversedge

Indications for allopurinol

As ULT to ALL Patients following FIRST ATTACK of gout

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Adverse effects of Allopurinol

Severe cutaneous adverse reaction (SCAR)
Drug reaction w/ eosinophillia
SJS

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Patients should stop allopurinol immediately if they develop:

RASH

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Allopurinol interactions (3):

Azathioprine

(NOT LISTED IN BNF)
Cyclophosphamide - reduces renal clearance = marrow toxicity
Theophylline - inhibits breakdown leading to increase in concentration

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Drug used first line in ischaemic heart disease

ASPIRIN

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Drugs which Aspirin potentiates:

Oral hypoglycaemics
Warfarin
Steroids

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CCB NEVER to be given with Beta-blocker

Verapamil

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Which CCB may cause constipation

Verapamil

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Verapamil effect on cardiac function

Negatively inotropic

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CCB which can cause flushing

Dihydropyridines

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Where do dihydropyridines (amlodipine, Nifedipine etc.) act

PERIPHERAL vascular smooth muscle more than myocardium thus do not worsen heart failure but may cause ankle swelling

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Adverse effect of this drug cause an increase in ‘everything’

Ciclosporin

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the ‘everything’ increased with Ciclosporin

Fluid, BP, K+, Hair, gums, glucose

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Digoxin - when is monitoring required

Only when toxicity is suspected - within 8-12 hours of last dose

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Symptoms of digoxin toxicity

Generally unwell, lethargy, nausea & vomitting, anorexia, confusion
Yellow-green vision
gynaecomastia
Arrhythmias

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Precipitants to Digoxin toxicity

HYPOKALAEMIA - digoxin binds to ATPase pump at same site as K, thus without K+, digoxin binds more easily
Renal failure
Hypomagnesaemia, hypercalcaemia, hypernatreamia
Drugs which cause hypokalaemia

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Which common antibiotic is contraindicated in Myasthenia Gravis

Gentamicin

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Monitoring of Gentamicin

Both peak (1 hour after administration) and trough levels (just before the next dose) are measured

If trough dose is high the INTERVAL between doses should be increased

If the peak level is high, the DOSE should be decreased

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Unfractionated heparin mechanism

Forms a complex which inhibits thrombin, factors Xa, IXa, XI, XII.

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LMWH mechanism

Increases the action of antithrombin III on factor Xa

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Electrolyte disturbance with Heparin

HYPERKALAEMIA
(by reversible aldosterone inhibition)

Heparin and LMWH monitoring

Heparin: aPTT
LMWH: Anti-factor Xa (although routine monitoring not required)

Lithium toxicity - therapeutic range

0.4-1.0
Toxicity generally occurs at >1.5

Features of lithium toxicity

Coarse tremor
Hyperreflexia
Acute confusion
polyuria
seizure
coma

Drug precipitants of Lithium toxicity

DIURETICS (esp. Thiazides) ACE inhibitors NSAIDS Metronidazole

Macrolide adverse effects (MACRO

Motility issues Arrhythmia Cholestatic jaundice Rash Ototoxicity/eOsinophillia

Which drugs should be stopped while taking macrolide

STATINS - increased risk of myopathy and rhabdomyolysis due to P450 inhibition

Adverse effects of metformin

GI upset V common - intolerable in 20% Reduced B12 absorption Lactic acidosis with severe liver disease or renal failure

Which drug should be stopped if there is tissue hypoxia (MI, sepsis, AKI, severe dehydration)

Metformin

When should metformin be stopped in the context of CKD

eGFR < 30 ml/min Dose reviewed at eGFR < 45 ml/min

How long should metformin be stopped for following administration of iodine containing x-ray media

On the day of the procedure and for subsequent 48 hours

Paracetamol overdose: Mx. if <1 hour

<1 hour = activated charcoal NAC

Salicylate poisoning

Urinary alkalinization w/ IV bicarbonate

Opiate overdose

Naloxone

Benzodiazepine overdose mx.

Flumazenil

TCA overdose mx.

IV bicarbonate (may reduce risk of seizures and arrhythmias in severe toxicity)

As well as those on Nitrates and nicornadil and those experiencing hypotension, in whom else is PDE-5i contraindicated in

Pts. w/ recent stroke or myocardial infarction - wait 6 months

Viagra (the blue pill) causes what visual disturbance

Blue vision

Drugs to be used in caution for pts. w/ obstructive lung diseases

NSAIDs B-blockers Adenosine (use verapamil as alternative)

Drugs which may exacerbate heart failure (4)

Thiazolidinediones - pioglitazone absolute CI = fluid retention Verapamil - negative inotropic effects NSAIDs/glucocorticoids - cause fluid retention (low dose aspirin is exception as benefits outweigh risks) Class I antiarrhythmics - flecainide = negative inotropic and pro-arrhythmic effect

Drugs to avoid in renal failure

Antibiotics: Tetracycline, nitrofurantoin NSAIDs Lithium Metformin

Antibiotics likely to accumulate in CKD - need dose adjustment:

Most incl. penicillins, cephalosporins, vancomycin, gentamicin, streptomycin

Prescribing in pregnancy: harmful antibiotics

Tetracyclines Aminoglycosides - gentamicin etc. Sulphonamides and trimethoprim Quinolones

Drugs to avoid in pregnancy: 2 X Antihypertensives: 1 X cholesterol drugs 1 X diabetic drug

ACEIs/ARBS Statins Sulfonylureas Warfarin

Adverse effects of QUINOLONES - Ciprofloxacin, Levofloxacin

Lower seizure threshold TENDON damage - incl. rupture Cartilage damage Lengthens QT interval

Which two classes of antibiotic prolong the QT interval

Macrolides and Quinolones

What is Tamoxifen

Selective oestrogen receptor modulator (SERM)

What is Tamoxifen used in:

Management of oestrogen receptor positive breast cancer

Side effects of tamoxifen

Menstrual disturbance: vaginal bleeding, amenorrhoea Hot flushes VTE Endometrial cancer

Trastuzumab - used in? Side effects: Flu-like symptoms and diarrhoea common Cardiotoxicity

HER2 positive breast cancer

Drugs likely to accumulate in CKD

Most antibiotcs Digoxin MTX Sulphonylureas Furosemide Opioids