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Yr 4 - Drugs > Corrections 2 > Flashcards

Corrections 2 Flashcards

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1
Q

How often should digoxin levels be monitored?

A

Digoxin level is not monitored routinely, except in suspected toxicity.

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2
Q

Management of hypomagnesaemia?

A

If <0.4, or tetany, arrhythmias, or seizures–> IV magnesium sulphate

If >0.4 –> oral magnesium salts

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3
Q

What is a key side effect of oral magnesium salts?

A

Diarrhoea

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4
Q

Features of hypomagnesaemia?

A

Features may be similar to hypocalcaemia:

  • paraesthesia
  • tetany
  • seizures
  • arrhythmias
  • decreased PTH secretion → hypocalcaemia
  • ECG features similar to those of hypokalaemia
  • exacerbates digoxin toxicity
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5
Q

What is a key feature on an ECG in TCA overdose?

A

QRS widening, due to sodium channel blockade.

This can be associated with ventricular arrhythmias and cardiac arrest.

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6
Q

What is Ethylene glycol?

A

Ethylene glycol is a type of alcohol used as a coolant or antifreeze

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7
Q

Management for Ethylene glycol toxicity?

A

fomepizole (this is an inhibitor of alcohol dehydrogenase)

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8
Q

Management of carbon monoxide poisoning?

A

Hyperbaric oxygen

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9
Q

Which NSAID is associated with a significantly increased risk of cardiovascular events?

A

Diclofenac

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10
Q

Contraindications of diclofenac?

A

1) ischaemic heart disease

2) peripheral arterial disease

3) cerebrovascular disease

4) congestive heart failure (New York Heart Association classification II-IV)

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11
Q

In patients with MI secondary to cocaine use, what should they be given as part of acute (ACS) treatment?

A

IV benzodiazepines

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12
Q

Give 3 drug causes of gingival hyperplasia

A

1) phenytoin

2) ciclosporin

3) calcium channel blockers (especially nifedipine)

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13
Q

Why should verpamil not be used alongside beta blockers?

A

As may cause heart block

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14
Q

Which CCB is most negatively inotropic?

A

Verapamil

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15
Q

Which CCBs result in ankle swelling?

A

Nifedipine, amlodipine & felodipine

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16
Q

Why can nifedipine result in reflex tachycardia?

A

Due to peripheral vasodilation

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17
Q

Name the inducers of the P450 system (6)

A

Carbamazepine
St John’s Wort
Chronic alcohol intake
Rifampicin
Barbiturates: phenobarbitone
Smoking

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18
Q

Name the inhibitors of the P450 system (9)

A

Erythromycin
Ciprofloxacin
Sodium valproate
Acute alcohol intake
Isoniazid
Amiodarone
Imidazoles: ketoconazole, fluconazole
SSRIs: fluoxetine, sertraline
Allopurinol

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19
Q

Management of heparin-induced thrombocytopenia (HIT)?

A

Switch to direct thrombin inhibitor e.g. argatroban

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20
Q

Is bleeding more common with LMWH or UH in those with severe renal impairment?

A

LMWH

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21
Q

Anticoagulant of choice in those with severe renal impairment?

A

UH

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22
Q

Organophosphates stimulate sympathetic and parasympathetic nervous systems.

However, in clinical practice and in typical scenarios, what presentation predominates?

A

Overstimulation of the parasympathetic system predominates.

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23
Q

Key features of organophosphate poisoning: DUMBELS

A

D - defaecation & diaphoresis

U - urinary incontinence

M - miosis (pupil constriction)

B - bradycardia

E - emesis

L - lacrimation

S - salivation

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24
Q

How do organophosphates affect HR?

A

Bradycardia

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25
Q

What is a key side effect of diclofenac?

A

Significantly increased risk of cardiovascular events compared with other NSAIDs.

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26
Q

Contraindications for diclofenac?

A

ischaemic heart disease
peripheral arterial disease
cerebrovascular disease
congestive heart failure

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27
Q

Which NSAIDs have the best cardiovascular risk profiles?

A

Naproxen & low dose ibuprofen

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28
Q

What is the Yellow Card scheme?

A

The standard way to report adverse reactions to medications

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29
Q

What should be reported in the Yellow Card scheme?

A

1) all suspected adverse drug reactions for new medicines (identified by the black triangle symbol)

2) all suspected adverse drug reactions occurring in children, even if a medicine

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30
Q

What is a black triangle drug?

A

A black triangle indicates that the medication is new to the market, or that an existing medicine is being used for a new reason or by a new route of administration.

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31
Q

What is the most appropriate time to take blood samples for therapeutic monitoring of digoxin levels?

A

At least 6 hours after last dose

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32
Q

What is the most appropriate time to take blood samples for therapeutic monitoring of phenytoin levels?

A

Immediately before next dose

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33
Q

How can amiodarone affect the thyroid?

A

Hypothyroidism and thyrotoxicosis

34
Q

In patients with HTN and gout requiring a 2nd antihypertensive (after ACEi), what is recommended next?

A

Amlodipine.

35
Q

Why are thiazide-like diuretics not indicated in gout?

A

Thiazide-like diuretics can lead to hyperuricemia and therefore exacerbate the incidence of gout in patients who are already diagnosed or at high risk.

36
Q

In amiodarone induced hypothyroidism, what is the management?

A

Continue amiodarone and add levothyroxine

37
Q

Which CCB is most likely to precipitate pulmonary oedema in a patient with known chronic heart failure?

A

Verapmil –> egative inotropic effects, meaning it decreases the strength of heart muscle contraction.

38
Q

How does digoxin toxicity affect K+?

A

Hyperkalaemia

39
Q

How does digoxin toxicity lead to hyperkalaemia?

A

As digoxin inhibits the Na-K pump, so less potassium can be pumped into cells, and thus, extracellular potassium increases.

40
Q

Relationship between potassium levels and digoxin?

A

Hypokalaemia predisposes to digoxin toxicity.

Digoxin toxicity results in hyperkalameia.

41
Q

How may digoxin toxicity affect appetite?

A

Loss of appetite and interest in food (anorexia)

42
Q

When is immediate acetylcysteine treatment indicated in paracetamol overdose with presentation 8-24 hours after ingestion?

A

If overdose was more than 150 mg/kg, even if the plasma-paracetamol concentration is not yet available

43
Q

What is 1st line for patients with ischaemic heart disease?

A

Aspirin

44
Q

How long should you wait after starting metformin before increasing dose?

A

1 week

45
Q

What is a key side effect of ethambutol (TB drug)?

A

Optic neuritis –> visual acuity testing before and during treatment

46
Q

What investigation should be done before starting Herceptin (Trastuzumab)? Why?

A

ECHO - as cardiotoxicity is a common side effect

47
Q

What is a common cause of drug-induced urticaria?

A

Aspirin (and other salicylates)

48
Q

What is the most important antidote in organophosphate poisoning?

A

Atropine

49
Q

Role of atropine in organophosphate poisoning?

A

It competitively limits cholinergic activation

50
Q

What investigation should be done before using flecainide?

A

ECHO - to look for signs of structural heart disease.

51
Q

What routine monitoring is there for patients on digoxin?

A

No routine monitoring

52
Q

Features of organophosphate poisoning?

Meumonic: SLUD

A

Salivation
Lacrimation
Urination
Defecation/diarrhoea

CVS: hypotension, bradycardia
Also: small pupils, muscle fasciculation

53
Q

How does salicylate poisoning affect acid base balance?

A

First causes respiratory alkalosis, then metabolic acidosis

54
Q

What routine monitoring is required for LMWH?

A

No routine monitoring, but in special situations (e.g. obesity, renal impairment or pregnancy), monitoring of Factor Xa levels can be done.

55
Q

Management of widened QRS or arrythmia in TCA overdose?

A

IV bicarb

56
Q

What class of medication is amiloride?

A

Potassium sparing diuretic –> epithelial sodium channel blocker

57
Q

Is bleeding more common with LMWH or UH among patients with severe renal impairment?

A

LMWH

58
Q

If the patient is opioid naive, what is the usual starting dose of immediate release morphine (oramorph)?

A

5mg PRN up to 4 hourly

59
Q

What is the conversion of codeine dose to morphine?

A

Divide by 10

60
Q

When is it appropriate to convert a patient from co-codamol to morphine?

A

If the patient has been on maximum strength co-codamol (30/500mg two tablets QDS), then it is appropriate to convert this to modified release morphine.

61
Q

If a patient has been on 30/500mg two tablets QDS of co-codamol, convert this to a morphine MST dose

A

30/500mg –> use the 30mg (as this is codeine dose)

30x2 = 60mg (as patient is taking 2 tablets)

60x4 = 240mg (as QDS)

240/10 = 24mg PO morphine

/2 = 12mg MST BD

Round to 10mg MST BD

62
Q

What should all patients on modified release morphine have?

A

Immediate release morphine available PRN for breakthrough pain.

63
Q

A patient with lung cancer and bone metastases is taking MST 40mg bd, movicol and ibuprofen.

Over the last week he has required on average 3 doses of 10mg of oramorph for break through pain in his chest. The oramorph works well for the pain after about ½ hour and he has no adverse effects.

What are 2 suitable management plans?

A

1) Titrate dose upwards by 30-50% increments

40x2=80
80x1.3 = 104mg
104/2 =52 –> round to 50mg BD (new dose)

OR

40x2=80mg
80x1.5=120mg
120/2=60mg BD (new dose)

2) Add daily oramorph dose to background dose

3x10=30mg
80+30=110
110/2 = 55mg BD (new dose)

64
Q

What is the 1st line opioid for patients with moderate renal impairment?

A

Oxycodone

eGFR <50 –> use oxygodone

65
Q

If the eGFR is <12, what is the 1st line opioid?

A

Alfentanil or fentanyl.

66
Q

What is the conversion between morphine and oxycodone?

A

Divide the morphine dose by 2 to calculate oxycodone dose.

67
Q

What is the mechanism of action of octreotide used to treat acromegaly?

A

Somatostatin analogue that blocks the production of GH.

68
Q

What medications can be used to manage an oculogyric crisis? (2)

A

Benzotropine or procyclidine

69
Q

Top 3 medications for motion sickness?

A

1) Hyoscine (e.g. transdermal patch): most effective but use is limited due to side effects

2) Non-non-sedating antihistamines –> cyclizine > promethazine

70
Q

Management of taking aspirin in a dental procedure?

A

continue taking anti-platelets as normal

71
Q

What is important in patients with symptomatic caustic ingestion (i.e. bleach)?

A

Endoscopy & CT scan

72
Q

1st line management of methanol poisoning?

A

Fomepizole or ethanol

Haemodialysis

73
Q

1st line management of ethylene glycol poisoning?

A

Fomepizole (an inhibitor of alcohol dehydrogenase)

74
Q

where is ethylene glycol found?

A

E.g. antifreeze

75
Q

What class of diuretics can precipitate lithium toxicity?

A

Thiazides

76
Q

Which antihypertensive can cause peripheral vasodilation which may result in reflex tachycardia?

A

Nifedipine

77
Q

1st line management of organophosphate insecticide poisoning?

A

IV atropine

78
Q

Which diuretics may cause precipitation of digoxin toxicity?

A

Thiazides

79
Q

The following symbol appears in the British National Formulary: PoM

What does it mean?

A

Prescription only medicine

80
Q

Management of suspected digoxin toxicity?

A

Temporarily cease digoxin, remeasure conc within 8-12 hours after last dose

81
Q
A

Yr 4 - Drugs (8 decks)

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