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Drugs > Contraindications > Flashcards

Contraindications Flashcards

1
Q

H2 antagonists

A

Renal failure - because they are excreted by the kidneys

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2
Q

Symptoms of gastric cancer might be disguised by

A

H2 antagonists and PPIs

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3
Q

Loperamide

A

Acute UC and C. difficile - inhibition of peristalsis may increase risk of megacolon & perforation - therefore wait until aetiology is known before prescribing to someone in hospital

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4
Q

Laxatives

A

Suspected intestinal obstruction - could induce perforation

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5
Q

Aminosalicylates

A

Aspirin hypersensitivity - aspirin is an aminosalicylate

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6
Q

Metoclopramide and Domperidone

A

GI obstruction or perforation as these drugs promote gastric emptying

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7
Q

Extrapyramidal side effects of anti-emetics (D2 antagonists) are more common in

A

Children & young adults - AVOID

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8
Q

Loop diuretics

A 
Severe hypovolaemia or dehydration
Severe hypokalaemia
Severe hyponatraemia
Gout - inhibit uric acid excretion
Renal failure - nephrotoxic
Pregnancy
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9
Q

Thiazide diuretics

A

Hypokalaemia
Hyponatraemia
Gout - reduce uric acid excretion
Addison’s disease

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10
Q

Potassium-sparing diuretics

A

Hyperkalaemia
Hypovolaemia
Severe renal impairment

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11
Q

B-blockers

A

Asthma - can precipitate bronchospasm
Second- or third-degree heart block
Pregnancy

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12
Q

Verapamil and Diltiazem

A

Poor LV function - worsen heart failure
AV nodal conduction delay - may provoke complete heart block
Pregnancy

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13
Q

Amlodipine and Nifedipine

A

Unstable angina - vasodilation causes reflex increase in contractility and HR, and therefore increases O2 demand
Severe aortic stenosis
Pregnancy

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14
Q

ACE inhibitors

A

Renal artery stenosis
AKI
Pregnancy + Breastfeeding

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15
Q

ARBs

A

Renal artery stenosis
AKI
Pregnancy + Breastfeeding

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16
Q

Nitrates

A

Severe aortic stenosis - CV collapse because heart unable to increase cardiac output sufficiently through the narrowed valve to maintain pressure in the now dilated vasculature
Hypotension

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17
Q

Digoxin

A

Second or third degree heart block - worsens conduction abnormalities
Ventricular arrhythmias
Renal failure (reduced dose)
Low Na, Mg, Ca - increased risk of digoxin toxicity

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18
Q

Amiodarone

A

Heart block
Severe hypotension
Active thyroid disease

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19
Q

Aspirin

A 
<16yrs old - risk of Reye's syndrome
Aspirin or NSAID hypersensitivity
Peptic ulceration (prescribe with PPI)
Gout - may trigger acute attack
Pregnancy (third trimester) - premature closure of ductus arteriosus
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20
Q

Clopidogrel

A

Active bleeding

7 days before surgery or invasive procedures

21
Q

Heparins

A

Those at risk of bleeding
Invasive procedures
Renal impairment (may accumulate) - use UFH

22
Q

Warfarin

A

Immediate risk of haemorrhage (e.g. surgery)
Liver disease (less metabolism so risk of over-anticoagulation)
Pregnancy (foetus development and maternal bleeding)

23
Q

Rivaroxaban

A 
Active bleeding or at risk
Malignant neoplasms
Oesophageal varices
Recent eye or brain surgery/haemorrhage
Pregnancy + breastfeeding
24
Q

Statins

A

Hepatic impairment
Renal impairment (excretion by kidneys)
Pregnant - cholesterol needed for development
Breastfeeding

25
Q

B2 agonists

A

CV disease - tachycardia may provoke angina or arrhythmias

26
Q

Why must long-acting B2 agonists be used in combination with an inhaled corticosteroid

A

Without this they are associated with asthma deaths

27
Q

Anti-cholinergics

A

Angle closure glaucoma - rise in IOP

Arrhythmias

28
Q

Corticosteroids

A

Infection

Children - can suppress growth

29
Q

Oxygen

A

Type 2 respiratory failure (e.g. severe COPD) - they develop responses to persistent hypoxaemia + hypercapnoea, so exposure to high O2 concentrations can disturb this adaptive state and cause a rise in CO2 blood concentration - this leads to respiratory acidosis, depressed consciousness + tissue hypoxia

30
Q

Amitriptyline

A

People at risk of AEs - elderly with CV disease or epilepsy

31
Q

SSRIs

A

People at risk of AEs - epilepsy, peptic ulcer, hepatic impairment
Young people - increased risk of self-harm + suicidal thoughts so prescribed by specialists only

32
Q

Benzodiazepines

A

Respiratory impairment
Neuromuscular disease
Liver failure
Elderly (reduced dose)

33
Q

Dopaminergic drugs

A

Elderly & psychiatric disease (caution) - risk of confusion + hallucinations
CV disease - risk of hypotension

34
Q

Anti-convulsants

A 
Hepatic impairment (reduced dose)
Pregnancy - especially sodium valproate
35
Q

Penicillins

A

Penicillin allergy
Renal impairment (dose reduction)
C. difficile risk (amoxicillin)
Flucloxacillin-related hepatotoxicity

36
Q

Cephalosporins + Carbapenems

A

Penicillin allergy (or carbapenem or cephalosporin)
C. difficile risk
Epilepsy - carbapenems
Renal impaitment (reduced dose)

37
Q

Trimethoprim

A

Pregnancy (first-trimester)
Folate deficiency
Renal impairment (dose reduction)
Neonates + elderly + HIV - more susceptible to AEs

38
Q

Nitrofurantoin

A

Pregnancy (towards term)
Babies <3months
Renal impaitment
Not suitable for chronic use due to AEs

39
Q

Tetracyclines

A

Pregnancy + breastfeeding

Renal impairment

40
Q

Aminoglycosides (Gentamicin)

A

Myasthenia gravis - can impair NM transmission
Neonates + elderly
Renal impairment

41
Q

Macrolides

A 
Macrolide sensitivity (different to penicillin)
Severe renal or hepatic impairment (elimination)
42
Q

Ciprofloxacin

A

Seizure risk
Patients still growing
At risk of QT prolongation (e.g. electrolyte disturbance, CV disease)

43
Q

Metronidazole

A 
Liver disease (reduced dose)
Alcohol - inhibits acetaldehyde dehydrogenase, which is responsible for clearing the intermediate alcohol metabolite acetaldehyde from the body
44
Q

Vancomycin

A

Needs to be closely monitored in all patients, but reduced dose to avoid toxicity in:

  • Renal impairment
  • Elderly
45
Q

NSAIDs

A 
Severe renal impairment
-Heart failure
-Liver failure
-NSAID hypersensitivity
If unavoidable, use low dose for:
-Prior peptic ulcer
-GI bleeding
-CV disease
46
Q

Strong opioids

A 
Respiratory failure
Biliary colic - worsens pain due to spasm
Reduced dose:
- Elderly
- Renal or hepatic impairment
47
Q

Weak opioids

A

Severe respiratory failure
Reduced dose in elderly, renal or hepatic impairment
Seizures - tramadol lowers threshold

48
Q

Paracetamol

A

Chronic alcohol use - increased NAPQI production
Malnutrition or low weight
Severe hepatic impairment

49
Q

Allopurinol

A

Do not start during acute attacks of gout
Hypersensitivity to allopurinol
Liver or renal impairment

Drugs (6 decks)

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