Contra-indications

Question 1

Drugs that aggravate psoriasis (6)

Answer 1

• beta blockers
• lithium
• antimalarials (chloroquine)
• NSAIDs
• ACE inhabitors
• infliximab

Question 2

Drugs to use with caution in ischaemic heart disease (3)

Answer 2

• NSAIDs
• Oestrogens - COCP or HRT
• verenicline (nicotine replacement)

Question 3

Drugs which reactivate TB

Answer 3

• corticosteroids
• infliximab

Question 4

CI for phosphodiesterase type V (PDE5) inhibitor (for erectile dysfunction)

Answer 4

AKA sildenafil (viagra)

• nitrates/related drugs (i.e nicorandil)
• hypotension
• recent stroke or MI (6mo)

Question 5

Quinolone abx CI (2)

Answer 5

• pregnant/breastfeeding
• G6PD

Question 6

What drug not to px with verapamil

Answer 6

beta blockers
(can cause heart block)

Question 7

Drugs not to use in heart failure

Answer 7

• CCB (verapamil, diltiazem - negatively inotropic)

Question 8

Why use beta-blockers with caution in diabetics

Answer 8

• slight impairement of glucose tolerance
• can interfere with metabolic and autonomic responses to hypoglycaemia

Question 9

Risk from interaction of macrolide abx and steroids

Answer 9

macrolides inhibit cP450 that metabolizes statins
= incr risk of myopathy and rhabdomyolysis

= stop statins during course of macrolides (i.e clarithromycin and azithromycin)

Question 10

CIs to metformin + explaination + management (3)

Answer 10

potential for causing lactic acidosis with severe liver disease or renal failure, therefor CI in

• CKD: reduced dose if creat >130/eGFR <45; stop if creat >150/eGFR <30
• period of tissue hypoxia (recent MI, sepsis, AKI, severe dehydration)
• iodine-containing contrast: risk of renal impairment – discontinue on day of procedure + 48hrs after