Communicating information Flashcards
Indications for allopurinol
As ULT to ALL Patients following FIRST ATTACK of gout
Adverse effects of Allopurinol
Severe cutaneous adverse reaction (SCAR)
Drug reaction w/ eosinophillia
SJS
Patients should stop allopurinol immediately if they develop:
RASH
Allopurinol interactions (3):
Azathioprine
(NOT LISTED IN BNF)
Cyclophosphamide - reduces renal clearance = marrow toxicity
Theophylline - inhibits breakdown leading to increase in concentration
Drug used first line in ischaemic heart disease
ASPIRIN
Drugs which Aspirin potentiates:
Oral hypoglycaemics
Warfarin
Steroids
CCB NEVER to be given with Beta-blocker
Verapamil
Which CCB may cause constipation
Verapamil
Verapamil effect on cardiac function
Negatively inotropic
CCB which can cause flushing
Dihydropyridines
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
Adverse effect of this drug cause an increase in ‘everything’
Ciclosporin
the ‘everything’ increased with Ciclosporin
Fluid, BP, K+, Hair, gums, glucose
Digoxin - when is monitoring required
Only when toxicity is suspected - within 8-12 hours of last dose
Symptoms of digoxin toxicity
Generally unwell, lethargy, nausea & vomitting, anorexia, confusion
Yellow-green vision
gynaecomastia
Arrhythmias
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
Which common antibiotic is contraindicated in Myasthenia Gravis
Gentamicin
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
Unfractionated heparin mechanism
Forms a complex which inhibits thrombin, factors Xa, IXa, XI, XII.
LMWH mechanism
Increases the action of antithrombin III on factor Xa
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
