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Top 100 Drugs > Contraindications > Flashcards

Contraindications Flashcards

1
Q

5α reductase inhibitors

finasteride

A

❌ Pregnant

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2
Q

α-blockers

doxazosin, tamsulosin, alfuzosin

A

⚠️ Postural hypotension

💊 Beta-blockers to avoid first-dose hypotension

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3
Q

Acetylcholinesterase inhibitors

donepezil, rivastigmine

A

⚠️ Asthma
⚠️ COPD
⚠️ High risk of developing peptic ulcers
⚠️ Rivastigmine may worsen Parkinson’s

❌ Heart block
❌ Sick sinus syndrome

💊 NSAIDs
💊 Corticosteroids
💊 Antipsychotics
💊 Beta-blockers

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4
Q

Activated charcoal

A

⚠️ Reduced level of consciousness (unless airway protected)
⚠️ Persistent vomiting
⚠️ Reduced gut motility

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5
Q

Adenosine

A

⚠️ COPD
⚠️ Heart transplant patients

❌ Hypotension
❌ Coronary ischaemia
❌ Decompensated heart failure
❌ Asthma

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6
Q

Adrenaline

epinephrine

A

✅ No contraindications in cardiac arrest

⚠️ Heart disease

💊 Beta-blockers

❌ Areas supplied by an end-artery

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7
Q

Aldosterone antagonists

spironolactone, eplerenone

A

⚠️ Pregnant/lactating women

❌ Severe renal impairment
❌ Hyperkalaemia
❌ Addison’s disease

💊 Potassium-elevating drugs e.g. ACE inhibitors, ARBs

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8
Q

Alginates and antacids

gaviscon, peptac

A

⚠️ Thickened milk preparations

⚠️ Renal failure

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9
Q

Allopurinol

A

⚠️ Renal impairment
⚠️ Hepatic impairment

❌ Acute attacks of gout
❌ Recurrent skin rash
❌ Severe hypersensitivity to allopurinol

💊 Azathioprine
💊 ACE inhibitors

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10
Q

Aminoglycosides

gentamicin, amikacin, neomycin

A

⚠️ Renal impairment
⚠️ Neonates
⚠️ Elderly patients

💊 Loop diuretics
💊 Vancomycin
💊 Ciclosporin
💊 Cephalosporins

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11
Q

Aminosalicylates

mesalazine, sulfasalazine

A

❌ Aspirin hypersensitivity

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12
Q

Amiodarone

A

⚠️ Severe hypotension
⚠️ Heart block
⚠️ Active thyroid disease

💊 Digoxin
💊 Diltiazem
💊 Verapamil

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13
Q

ACE inhibitors

ramipril, lisinopril, perindopril

A

⚠️ Pregnant
⚠️ Breastfeeding
⚠️ CKD

❌ Renal artery stenosis
❌ Acute kidney injury

💊 Potassium-elevating drugs
💊 NSAIDs

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14
Q

Angiotensin receptor blockers

losartan, candesartan, irbesartan

A

⚠️ Pregnant
⚠️ Breastfeeding
⚠️ CKD

❌ Renal artery stenosis
❌ Acute kidney injury

💊 Potassium-elevating drugs
💊 NSAIDs

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15
Q

Antidepressants

tricyclics; amitriptyline, lofepramine

A 
⚠️ Elderly 
⚠️ Epilepsy 
⚠️ Cardiovascular disease
⚠️ Prostatic hypertrophy 
⚠️ Glaucoma
⚠️ Constipation

❌ Monoamine oxidase inhibitors

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16
Q

Antidepressants

venfalaxine, mirtazapine

A

⚠️ Elderly
⚠️ Hepatic impairment
⚠️ Renal impairment
⚠️ Arrhythmias

💊 Other antidepressants

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17
Q

Antiemetics - dopamine D2-receptor antagonists

metoclopramide, domperidone

A 
⚠️ Children
⚠️ Young adults
⚠️ Hepatic impairment 
⚠️ Intestinal obstruction
⚠️ Parkinson's disease

❌ Neonates
❌ Cardiac conduction abnormalities
❌ Bowel perforation
❌ Dopaminergic agents for Parkinson’s

💊 Antipsychotics
💊 Drugs that prolong the QT interval
💊 CYP inhibitors

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18
Q

Antiemetics - histamine H1-receptor antagonists

cyclizine, cinanrizine, promethazine

A

⚠️ Hepatic encephalopathy

⚠️ Prostatic enlargement

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19
Q

Antiemetics - serotonin 5-HT3-receptor antagonists

ondansetron, granisetron

A

⚠️ Prolonged QT interval

💊 Drugs that prolong the QT interval

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20
Q

Antifungal drugs

nystatin, clotrimazole, fluconazole

A

⚠️ Liver disease
⚠️ Moderate renal impairment

❌ Pregnant

💊 Drugs that are metabolised by CYP enzymes 
💊 Carbamazepine
💊 Warfarin 
💊 Diazepam 
💊 Simvastatin 
💊 Sulphonylureas
💊 Clopidogrel
💊 Drugs that prolong the QR interval
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21
Q

Antihistamines - H1-receptor antagonists)

cetirizine, loratadine, fexofenadine, chlorpgenamine

A

⚠️ Severe liver disease

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22
Q

Antimotility drugs

loperamide, codeine phosphate

A

⚠️ Acute UC
⚠️ C. difficile colitis
⚠️ Acute bloody diarrhoea

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23
Q

Antimuscarinics - bronchodilators

ipratropium, tiotropoium, glycopyrronium, aclidinium

A

⚠️ Angle-closure glaucoma
⚠️ Arrhythmias
⚠️ Urinary retention

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24
Q

Antimuscarinics - cardiovascular and GI uses

atropine, hyoscine butylbromide, glycopyrronium

A

⚠️ Angle-closure glaucoma

⚠️ Arrhythmias

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25
Q

Antimuscarinics - GU uses

oxybutynin, tolterodine, solifenacin

A 
⚠️ Angle-closure glaucoma 
⚠️ Arrhythmias
⚠️ Urinary retention 
⚠️  Elderly
⚠️  Dementia

❌ Urinary tract infection

💊 Tricyclic antidepressants

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26
Q

Antipsychotics - 1st generation (typical)

haloperidol, chlorpromazine, prochlorperazine

A

⚠️ Elderly
⚠️ Dementia
⚠️ Parkinson’s

💊 Drugs that prolong the QT interval

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27
Q

Antipsychotics - 2nd generation (atypical)

quetiapine, olanzapine, risperidone, clozapine

A

⚠️ Cardiovascular diseases

❌ Severe heart disease
❌ Neutropenia

💊 Dopamine-blocking antiemetics
💊 Drugs that prolong the QT interval

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28
Q

Antiviral drugs

aciclovir

A

⚠️ Pregnant women
⚠️ Breastfeeding
⚠️ Severe renal impairment

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29
Q

Antiplatelet drugs - ADP-receptor antagonists

clopidogrel, ticagrelor, prasugrel

A

⚠️ Elective surgery
⚠️ Renal and hepatic impairment

❌ Active bleeding

💊 CYP inhibitors and inducers
💊 Antiplatelet drugs
💊 Anticoagulants
💊 NSAIDs

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30
Q

Antiplatelet drugs

aspirin

A

⚠️ Peptic ulceration
⚠️ Gout

❌ Children under 16
❌ Aspirin hypersensitivity
❌ Third trimester of pregnancy

💊 Antiplatelet drugs
💊 Anticoagulants

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31
Q

Azathioprine

A

⚠️ Reduced TPMT activity
⚠️ Renal impairment
⚠️ Hepatic impairment
⚠️ Pregnancy

❌ Absent TPMT activity

💊 Allopurinol
💊 Trimethoprim
💊 Warfarin

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32
Q

β-blockers

bisoprolol, atenolol, propanolol, metoprolol, carvedilol

A

⚠️ Heart failure
⚠️ Haemodynamic instability
⚠️ Hepatic failure

❌ Asthma
❌ Heart block
❌ Verapamil
❌ Diltiazem

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33
Q

β2-agonists

salbutamol, terbutaline, salmeterol, formoterol, indacaterol

A

⚠️ Cardiovascular disease

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34
Q

Benzodiazepines

diazepam, temazepam, lorazepam, chlordiazepoxide, midazolam

A

⚠️ Elderly
⚠️ Respiratory impairment
⚠️ Neuromuscular disease
⚠️ Liver failure

💊 CYP inhibitors
💊 Amiodarone
💊 Fluconazole

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35
Q

Bisphosphonates

alendronic acid, disodium pamidronate, zoledronic acid

A

⚠️ Smokers
⚠️ Dental disease

❌ Severe renal impairment
❌ Hypocalcaemia
❌ Upper GI disorders

💊 Calcium salts
💊 Antacids

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36
Q

Calcium and vitamin D

calcium carbonate, calcium gluconate, colecalciferol, alfacalcidol

A

❌ Hypercalcaemia

💊 Sodium bicarbonate

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37
Q

Calcium channel blockers

amlodipine, nifedipine, dilitiazem, verapamil

A

⚠️ Poor left ventricular function
⚠️ AV nodal conduction delay

❌ Unstable angina
❌ Severe aortic stenosis
❌ Beta-blockers

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38
Q

Carbamazepine

A

⚠️ Pregnancy
⚠️ Hepatic disease
⚠️ Renal disease
⚠️ Cardiac disease

❌ Antiepileptic hypersensitivity syndrome

💊 Warfarin 
💊 Oestrogens 
💊 Progestogens
💊 Macrolides
💊 Antipsychotics
💊 Tramadol
39
Q

Cephalosporins and carbapenems

cefalexin, cefotazime, meropenem, ertapenem

A

⚠️ At risk of C. difficile infection
⚠️ Epilepsy
⚠️ Renal impairment

❌ Allergy
❌ Anaphylactic reaction

💊 Valproate

40
Q

Chloramphenicol

A

⚠️ Hepatic impairment

❌ Hypersensitivity reactions 
❌ Bone marrow disorders
❌ Third trimester of pregnancy 
❌ Breastfeeding 
❌ Children <2 years
41
Q

Corticosteroids (glucocorticoids) - inhaled

beclometasone, budesonide, fluticasone

A

⚠️ History of pneumonia

⚠️ Children

42
Q

Corticosteroids (glucocorticoids) - systemic

prednisolone, hydrocortisone, dexamethasone

A

⚠️ Infection
⚠️ Children

💊 NSAIDs
💊 B2-agonists
 Theophylline
💊 Loop or thiazide diuretics
💊 Phenytoin
💊 Carbamazepine 
💊 Rifampicin
43
Q

Corticosteroids (glucocorticoids) - topical

hydrocortisone, betamethasone

A

⚠️ Infection

⚠️ Facial lesions

44
Q

Digoxin

A

⚠️ Renal failure
⚠️ Hypokalaemia
⚠️ Hypomagnesaemia
⚠️ Hypercalcaemia

❌ Second-degree heart block
❌ Intermittent complete heart block
❌ Ventricular arrhythmias

45
Q

Dipeptidylpeptidase-4 inhibitors

sitagliptin, linagliptin, saxagliptin

A

⚠️ Elderly (>80)
⚠️ History of pancreatitis
⚠️ Moderate-to-severe renal impairment

❌ Hypersensitivity
❌ T1DM
❌ Ketoacidosis

💊 Other anti-diabetics increase risk of hypoglycaemia
💊 Prednisolone
💊 Thiazide
💊 Loop diuretics

46
Q

Direct oral anticoagulants (DOACs)

apixaban, dabigatran, edoxaban, rivaroxaban

A

⚠️ Hepatic disease
⚠️ Renal disease

❌ Active, clinically significant bleeding
❌ Risk factors for major bleeding 
❌ Pregnancy
❌ Breastfeeding 
❌ Rifampicin
❌ Phenytoin

💊 Other antithrombotic agents increase risk of bleeding
💊 Macrolides
💊 Protease inhibitors
💊 Fluconazole

47
Q

Loop diuretics

furosemide, bumetanide

A

⚠️ Hepatic encephalopathy
⚠️ Hypokalaemia
⚠️ Hyponatraemia
⚠️ Gout

❌ Hypovolaemia
❌ Dehydration

💊 Lithium
💊 Digoxin
💊 Aminoglycosides

48
Q

Thiazide and thiazide-like diuretics

bendroflumethiazide, indapamide, chlortalidone

A

⚠️ Hyponatraemia
⚠️ Gout

❌ Hypokalaemia

💊 Loop diuretics

49
Q

Dopaminergic drugs for Parkinson’s disease

levodopa as co-careldopa/co-beneldopa, ropinirole, premipexol

A

⚠️ Elderly
⚠️ Cognitive or psychiatric disease
⚠️ Cardiovascular disease

💊 First-generation antipsychotics
💊 Metoclopramide

50
Q

Fibrinolytic drugs

alteplase, streptokinase

A

❌ Bleeding
❌ Intracranial haemorrhage
❌ Previous streptokinase treatment

💊 Anticoagulants and antiplatelets increase risk of haemorrhage

51
Q

Gabapetin and pregablin

A

⚠️ Renal impairment

💊 Sedating drugs

52
Q

Heparins and fondaparinux

enoxaparin, dalteparin, fondaparinux, unfractioned heparin

A 
⚠️ Clotting disorders
⚠️ Severe uncontrolled hypertension
⚠️ Recent surgery or trauma 
⚠️ Invasive procedures
⚠️ Renal impairment
53
Q

Insulin

insulin aspart, insulin glargine, biphasic insulin, soluble insulin

A

⚠️ Renal impairment

54
Q

Iron

ferrous fumarate, ferrous sulfate

A

⚠️ Intestinal disease
⚠️ Atopic predisposition

💊 Can reduce absorption of levothyroxine and bisphosphonates

55
Q

Lamotrigine

A

⚠️ Hypersensitivity to other antiepileptic drugs
⚠️ Hepatic impairment

💊 Carbamazepine
💊 Phenytoin
💊 Oestrogens
💊 Rifampicin
💊 Protease inhibitors
💊 Valproate
56
Q

Laxatives - osmotic

lactulose, macrogol, phosphate enema

A

⚠️ Heart failure
⚠️ Ascites
⚠️ Electrolyte disturbances

❌ Intestinal obstruction

57
Q

Laxatives - stimulant

senna, bisacodyl, glycerol suppositories, docusate sodium

A

⚠️ Haemorrhoids
⚠️ Anal fissures

❌ Intestinal obstruction

58
Q

Leukotriene receptor antagonists

montelukast

A

⚠️ Asthma

59
Q

Levetiracetam

A

⚠️ Renal impairment

60
Q

Lidocaine

A

⚠️ Reduced cardiac output

61
Q

Macrolides

clarithromycin, erythromycin, azithromycin

A

⚠️ Severe hepatic impairment
⚠️ Severe renal impairment

❌ Macrolide hypersensitivity

💊 Warfarin
💊 Statins 
💊 Amiodarone 
💊 Antipsychotics
💊 Quinine
💊 Quinolone antibiotics 
💊 SSRIs
62
Q

Metformin

A

⚠️ Renal impairment
⚠️ Hepatic impairment
⚠️ Acute alcohol intoxication
⚠️ Chronic alcohol abuse

❌ Severe tissue hypoxia
❌ Acute kidney injury

💊 IV contrast media

63
Q

Methotrexate

A

⚠️ Abnormal liver function

❌ Pregnancy
❌ Severe renal impairment

💊 NSAIDs
💊 Penicillins
💊 Trimethoprim
💊 Clozapine

64
Q

Metronidazole

A

⚠️ Severe liver disease

❌ Alcohol

💊 Warfarin

65
Q

Naloxone

A

⚠️ Opioid dependence

⚠️ Palliative care

66
Q

Nitrates

isosorbide mononitrate, glyceryl trinitrate

A

❌ Severe aortic stenosis
❌ Haemodynamic instability
❌ Hypotension
❌ Phosphodiesterase inhibitors

67
Q

Nitrofurantoin

A

❌ Pregnant women towards term
❌ Babies in the first 3 months of life
❌ Renal impairment

68
Q

NSAIDs

naproxen, ibuprofen, etoricoxib

A

⚠️ Peptic ulcer disease
⚠️ GI bleeding
⚠️ Cardiovascular disease
⚠️ Renal impairment

❌ Severe renal impairment
❌ Heart failure
❌ Liver failure

💊 Aspirin
💊 Corticosteroids
💊 Anticoagulants
💊 SSRIs
💊 ACE inhibitors 
💊 Diuretics
69
Q

Oestrogens and progestogens

combined ethinylestradiol products, desogestrel

A

⚠️ Family history of VTE
⚠️ Cardiovascular disease

❌ Personal history of VTE
❌ Breast cancer
❌ Known thrombogenic mutation

💊 Rifampicin
💊 Carabamazepine
💊 Lamotrigine

70
Q

Opioids - strong

morphine, oxycodone

A 
⚠️ Hepatic failure
⚠️ Renal impairment 
⚠️ Elderly
⚠️ Respiratory failure
⚠️ Biliary colic
⚠️ In combi with other sedating drugs
71
Q

Opioids - weak/moderate

tramadol, codeine, dihydrocodeine

A 
⚠️ Significant respiratory disease
⚠️ Renal impairment
⚠️ Hepatic impairment
⚠️ Elderly 
⚠️ Other sedating drugs

❌ Uncontrolled epilepsy

💊 Drugs that lower seizure threshold e.g. antipsychotics
💊 Serotonergic drugs
💊 SSRIs
💊 Tricyclic antidepressants
💊 Tramadol
72
Q

Paracetamol

A

⚠️ Chronic excessive alcohol use
⚠️ Malnutrition
⚠️ Low body weight
⚠️ Severe hepatic impairment

73
Q

Penicillins

benzylpenicilin, phenoxymethylpenicillin

A

⚠️ Renal impairment

❌ Penicillin allergy

💊 Methotrexate

74
Q

Penicillins - antipseudomonal

piperacilllin with tazobactam - tazocin

A

⚠️ C. difficile infection
⚠️ Moderate/severe renal impairment

❌ Penicillin allergy

💊 Methotrexate

75
Q

Penicillins - broad-spectrum

amoxicillin, co-amoxiclav

A

⚠️ C. difficile infection
⚠️ Penicillin-associated liver injury
⚠️ Severe renal impairment

❌ Penicillin allergy history

76
Q

Penicillins - penicillinase-resistant

flucloxacillin

A

⚠️ C. difficile infection
⚠️ Renal failure
⚠️ Hepatic impairment

❌ Penicillin allergy history
❌ Prior flucloxacillin-related hepatotoxicity

💊 Methotrexate

77
Q

Phosphodiesterase (type 5) inhibitors

sildenafil

A

⚠️ Hepatic impairment
⚠️ Renal impairment

❌ Stroke
❌ Acute coronary syndrome
❌ Cardiovascular disease

💊 Nitrates
💊 Nicorandil
💊 Vasodilators
💊 Amiodarone
💊 Diltiazem
💊 Fluconazole
78
Q

Prostaglandin analogue of eye drops

latanoprost, bimatoprost

A

⚠️ Aphakia/pseudoaphakia

⚠️ Iritis, uveitis or macular oedema

79
Q

Protein pump inhibitors

lansoprazole, omeprazole, pantoprazole

A

⚠️ Osteoporosis

💊 Clopidogrel

80
Q

Quinine

quinine sulfate

A

⚠️ Hearing or visual loss
⚠️ First trimester of pregnancy
⚠️ Glucose-6-phosphate dehydrogenase deficiency

💊 Drugs that prolong the QT interval (amiodarone, antipsychotics, quinolones, macrolides, SSRIs)

81
Q

Quinolones

ciprofloxacin, moxifloxacin, levofloxacin

A

⚠️ Seizures
⚠️ Children
⚠️ QT prolongation

💊 Theophylline
💊 NSAIDs
💊 Prednisolone
💊 Drugs that prolong the QT interval (amiodarone, antipsychotics, quinine, macrolides, SSRIs)

82
Q

Serotonin 5HT1-receptor agonists

sumatriptan

A 
❌ Coronary artery disease
❌ Cerebrovascular disease
❌ Hemiplegic migraines
❌ Basilar migraines 
❌ Monoamine oxidase inhibitors (tramadol, SSRIs and tricyclic antidepressants)
83
Q

Sex hormone antagonists for breast cancer

tamoxifen, anastrozole, letrozole

A 
❌ Pregnancy
❌ Lactation
❌ Pre-menopausal women
❌ Warfarin
❌ Fluoxetine
❌ Paroxetine
84
Q

Statins

simvastatin, atorvastatin, pravastatin, rosuvastatin

A 
⚠️ Renal impairment 
⚠️ Hepatic impairment 
⚠️ Pregnant
⚠️ Breastfeeding
⚠️ Amiodarone
⚠️ Diltiazem
⚠️ Itraconazole
⚠️ Macrolides
⚠️ Amlodipine
85
Q

Sulphonylureas

glicazide

A

⚠️ Hepatic impairment
⚠️ Renal impairment
⚠️ Increased risk of hypoglycaemia

86
Q

Tetracyclines

doxycycline, lymecycline

A

⚠️ Children 12 and under
⚠️ Renal impairment

❌ Pregnancy
❌ Breastfeeding

87
Q

Thyroid hormones

levothyroxine, liothyronine

A

⚠️ Coronary artery disease

⚠️ Hypopituitarism

88
Q

Trimethoprim

trimethoprim, co-trimoxazole

A 
⚠️ Folate deficiency
⚠️ Renal impairment 
⚠️ Neonates
⚠️ Elderly 
⚠️ HIV infection

❌ First trimester of pregnancy

89
Q

Valproate (valproic acid)

sodium valproate, valproic acid

A

⚠️ Hepatic impairment
⚠️ Severe renal impairment

❌ Women of child-bearing age
❌ Conception
❌ First trimester of pregnancy

💊 Lamotrigine
💊 Warfarin
💊 Carbamazepine
💊 Phenytoin
💊 Macrolides
💊 Protease inhibitors
💊 Antipsychotics
💊 Tramadol
90
Q

Vancomycin

A

⚠️ Renal impairment
⚠️ Elderly

💊 Aminoglycosides
💊 Loop diuretics
💊 Ciclosporin

91
Q

Vitamins

folic acid, thiamine, hydroxocobalamin, phytomenadione

A

⚠️ Co-existing vitamin B12 and folate deficiency

92
Q

Warfarin

A

⚠️ Liver disease

❌ Immediate risk of haemorrhage
❌ Pregnancy

💊 Phenytoin
💊 Carbamazepine
💊 Rifampicin
💊 Fluconazole
💊 Macrolides
93
Q

Z-drugs

zopiclone, zolpidem

A

⚠️ Elderly

❌ Obstructive sleep apnoea
❌ Respiratory muscle weakness
❌ Respiratory depression

💊 Macrolides
💊 Phenytoin
💊 Rifampicin

Top 100 Drugs (4 decks)

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