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Drugs > Contra-Indications and Interactions > Flashcards

Contra-Indications and Interactions Flashcards

1
Q

Antacids

A

Can reduce serum concentration of ACEi’s, some Abx, digoxin, levothyroxine and PPI’s

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2
Q

H2 antagonists

A

Reduce dose in CKD and can disguise symptoms of gastric cancer

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3
Q

PPI

A

Reduces effect of clopidogrel

Can disguise symptoms of gastric cancer and can increase risk of osteoporotic #

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4
Q

Loperamide

A

Avoid in acute UC/bloody diarrhoea and in possibility of C-diff

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5
Q

Laxatives

A

Do not use in obstruction

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6
Q

Aminosalicylate

A

Don’t use in children < 2 or in renal impairment

Have pH resistant coating so affected by gastric pH modifying drugs (PPI)

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7
Q

Antiemetics

A

Risk of side effects increased when prescribed with antipsychotics

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8
Q

Loop Diuretics

A

Effects drugs that are renally excreted

Contraindicated in severe hypovolaemia/dehydration and caution in hepatic encephalopathy

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9
Q

Thiazide diuretics

A

Avoid in hypokalaemia/natraemia
Can precipitate acute gout attacks - increases uric acid levels
Effectiveness reduced by NSAIDs

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10
Q

Potassium Sparing Diuretics

A

Contraindicated in severe renal impairment, hyperkalaemia, addisons and pregnant women
Caution when using other K+ elevating drugs - ACE/ARB

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11
Q

Beta Blockers

A

Do not use in heart block, reduce dose in hepatic failure and dont use with non-dihydropyridine Ca blockers

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12
Q

Calcium Blockers

A

Caution in those with poor LV function, avoid in AV node conduction delay and unstable angina
Do not use non-dihy…… with B-blockers

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13
Q

ACE inhibitors/ AT1 Blockers

A

Avoid in those with Renal Artery Stenosis and pregnancy/ breastfeeding
Low doses in CKD
Avoid using with other K+ elevating drugs and risk of renal failure increased when used with NSAIDs

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14
Q

Nitrates

A

Contraindicated in severe aortic stenosis and if hemodynamically unstable

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15
Q

Cardiac Glycosides

A

Contraindicated in 2nd degree hear block
Do not use if risk of ventricular arrythmias, reduce dose in renal failure
Duiretics, amiodarone, Ca blockers and quinine can all increase risk of toxicity

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16
Q

Amiodarone

A

Only use when risk/benefits are balances as can be dangerous particularly in severe hypotension, heart block and active thyroid disease
Increases plasma levels of digoxin, diltiazem and verapamil

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17
Q

Aspirin

A

Not used in < 16yrs due to Reye’s syndrome
Avoided in 3rd trimester of pregnancy
Caution in peptic ulceration and can cause acute attack of gout

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18
Q

Clopidogrel

A

Caution in renal/hepatic impairment

CP450 metabolised

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19
Q

Heparin/NOACs

A

Use in caution with other anticoagulants

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20
Q

Warfarin

A

Do not give in 1st trimester of pregnancy

Low therapeutic dose and CP450 metabolised

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21
Q

Statins

A

Caution in hepatic and renal impairment and pregnant/breasfeeding women

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22
Q

Beta-2-agonists

A

B-blockers reduce effectiveness

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23
Q

Anticholinergics

A

Caution in those at risk of Angle Closure Glaucoma as can cause rise in IOP

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24
Q

Corticosteoids

A

Use with NSAIDs increases risk of peptic ulceration + GI bleeding
Enhances hypokalaemia in those taking B2 agonists
CP450 metabolised

25
Q

Theophylline

A

Contraindicated in porphyria
Smoking and alcohol increase clearance
CP450 metabolised

26
Q

O2

A

Can disturb fine balance between hypoxia and hypercapnia in those with T2 resp failure - leading to rise in blood CO2

27
Q

Insulin

A

Increased risk of hypo in renal impairment

28
Q

Sulphonylureas

A

Reduce dose in hepatic impairment
Risk of hypo increased when used with other anti-diabetic drugs
Efficacy reduced by prednisolone, thiazides and loop diuretics as increase blood glucose

29
Q

Biguanides

A

Contraindicated in severe renal impairment, caution in hepatic impairment
Withhold in acute alcohol intoxication and caution in chronic alcohol
Withhold for 48yrs post IV contrast

30
Q

Thyroxine

A

In hypopituitarism, must administer corticosteroids first to avoid addisonian crisis
GI absorption reduced by antacids, calcium and iron salts

31
Q

Carbimazole

A

Contraindicated in haematological/hepatic condition

Vit K antagonist so can enhance anticoagulative effects

32
Q

Bisphosphonates

A

Avoid in severe renal impairment, hypocalcaemia and upper GI disorders
Absorption reduced with antacids, calcium and iron salts

33
Q

Mineralocorticoids

A

Contraindicated in systemic infections, myasthenia gravis, increased eye pressure, cataracts, hypertension,
Caution when used with theophylline, loop and thiazide diuretics as all reduce K+

34
Q

Penicillin

A

Reduce dose in severe renal impaiment

They reduce renal excretion of methotrexate and enhance warfarin effect

35
Q

Cephalosporins

A

Caution in epilepsy and reduce dose in renal impairment.

Enhances effect of warfarin and can increase nephrotoxicity of aminoglycosides

36
Q

Trimethoprim

A

Contraindicated in 1st trimester of pregnancy - foetal abnormalities
Used in caution in folate deficiency and reduce dose in renal impairment

37
Q

Nitrofurantoin

A

Do not use in near term pregnancy/ babies < 3months

Contraindicated in patients with renal impairment

38
Q

Tetracyclines

A

Dont use in pregnancy, breastfeeding, < 12 yrs or in renal impairment
Do not give within 2 hrs of iron, antacids or calcum as prevent absoption

39
Q

Aminoglycosides

A

Avoid in myasthenia Gravis
Ototoxicity more likely if used with loop diuretics or vancomycin
Nephrotoxicity more likely if used with cyclosporin or vancomycin

40
Q

Macrolides

A

Caution in renal/hepatic impairment

CP450 inhibitor

41
Q

Quinolones

A

Calcium and antacids reduce absorption
CP450 inhibitor
Use with NSAIDs increases risk of seizures and use with prednisolone increase risk of tendon rupture

42
Q

Metronidazole

A

CP450 metabolised

Inhibits acetaldehyde dehydrogenase which clears alcohol metabolites so no alcohol to be drunk

43
Q

Glycopeptides

A

Dose adjustement in elderly and renal impairment

Increased risk of toxicity when prescribed with aminoglycosides, loop diuretics or ciclosporins

44
Q

NSAIDs

A

Aspirin and corticosteroids increase risk of GI ulceration
Anticoagulants and SSRI’s increase risk of bleeding
ACEi’s and diuretics increase risk of renal impairment
Reduce efficacy of antihypertensives and duiretics

45
Q

Codeine

A

Caution in sever respiratory disease, reduce dose in renal/hepatic impairment and the elderly
Do not use with other sedating drugs

46
Q

Morphine

A

Reduce dose in hepatice failure and renal impairment and elderly
Do not give in resp failure or biliary colic

47
Q

Paracetamol

A

Overdose can lead to liver failure due to saturation of pathway leading to build up of NAPQI

48
Q

Xanthine-Oxidase Inhibitors

A

Reduce dose in severe hepatic/renal impairment
Reduces efficacy of mercaptopurine + azathioprine as require xanthine oxidase for metabolism
Use with amoxicillin increase risk of rash
Use with ACEi’s and thiazides increase risk of hypersensitivity

49
Q

Alpha Blockers

A

Contraindicated if already postural hypotension

50
Q

5-alpha-reductase inhibitors

A

Do not use in pregnancy (or even come into contact with) as can cause abnormal development of male external genitalia

51
Q

L-dopa

A

Do not use with antipsychotics or metoclopramide as effects contradictory

52
Q

Phenytoin

A

Reduce dose in hepatic impairment

In utero exposure associated with craniofacial abnormalities and reduced IQ

53
Q

Carbamazepine

A

In utero exposure associated with neural tube defects, cardiac and urinary abnormalities and cleft palate
Contraindicated in previous Antiepileptic Hypersensitivity syndrome

54
Q

Sodium Valproate

A

Avoid in women of childbearing age and in 1st trimester as related to foetal abnormalities
Avoid in severe hepatic/ renal abnormalities
Inhibits CP450

55
Q

Tricyclics

A

Caution in elderly, those at risk of CV disease and epilepsy and those with constipation, prostatic hypertrophy or raised IOP

56
Q

SSRI’s

A

Dose reduction in hepatic impairment
Gastroprotection needed if also taking NSAIDs
Do not prescribe with other drugs that prolong QT interval

57
Q

Benzodiazepines

A

Reduce dose in elderly
Avoid in significant resp/neuro impairment
Avoid in liver failure

58
Q

Acetylcholinesterase Inhibitors

A

Do not use whilst driving, breastfeeding or pregnant
Itraconazole, erythromycin and fluoxetine inhibit metabolism
Can interfere with anticholinergic medications such as atropine, amitriptyline and codeine

Drugs (5 decks)

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