Data interpretation

Question 1

what drug classes are contraindicated in asthma?

Answer 1

• NSAIDs
• beta-blockers
• mild - cholingeric drugs, ACEi

Question 2

what drugs are associated with low neutrophils?

Answer 2

clozapine (anti-psychotic)

carbimazole (anti-thyroid)

Question 3

what drugs are associated with thrombocytopenia?

Answer 3

• number of drugs can reduce production but penicillamine especially (RA Tx)
• heparin - increases destruction

Question 4

what sort of drug considerations are there for sodium disturbance?

Answer 4

• low sodium - see if diuretics
• high sodium - consider if too much IV saline, IV preparations with high sodium or effervescent medications

Question 5

what medications are associated with potassium disturbance?

Answer 5

• hypokalaemia - loop and thiazide diuretics
• hyperkalaemia - potassium sparing diuretics and ACEi

Question 6

what drugs are assocaited with AKI?

Answer 6

• antibiotics esp. gentamicin, vancomycin, tetracyclines
• ACEi
• NSAIDS

Question 7

what drugs are associated with hepatitis/cirrhosis?

Answer 7

• paracetamol OD
• statins
• rifamipcin

Question 8

what drugs cause cholestasis?

Answer 8

• flucloxacillin
• co-amoxiclav
• nitrofurantoin
• steroids
• sulphonylureas

Question 9

how to alter levothyroxine dose?

Answer 9

• TSH < 0.5 mIU/L - decrease dose
• TSH 0.5 - 5 mIU/L - no change in dose
• TSH > 5 mIU/L - increase dose

Question 10

what some common drugs have a narrow therapeutic window and therefore need monitoring?

Answer 10

• Digoxin
• Theophylline
• Lithium
• Phenytoin
• Antibiotics - gentamicin, vancomycin

Question 11

what are features of digoxin toxicity?

Answer 11

Confusion, nausea, visual halos, arrhythmias

Question 12

features of lithium toxicity

Answer 12

Early - tremor

Intermediate - tired

Late - arrhythmias, seizures, coma, renal failure, diabetes insipidus

Question 13

features of phenytoin toxicity

Answer 13

Gum hypertrophy, ataxia, nystagmus, peripheral neuropathy, teratogenicity

Question 14

features of gentamicin and vancomycin toxicity

Answer 14

Ototoxicity, nephrotoxicity

Question 15

summarise gentamicin prescribing

Answer 15

• renal function + weight to get dose
• healthy - 5 -7 mg/kg OD
• renal failure - 1mg/kg 12 hourly
• endocarditis - 1mg/kg 8 hourly

Question 16

summarise monitoring for once daily gentamicin regimes

Answer 16

uses nomogram - different ones for different doses

• Changing dose depending on nomogram plotting
• Point in q24h area → keep dose every 24 hours
• Point in q36h area → change to 36 hourly dosing
• Point in q48h area → change to 48 hourly dosing
• Point over q48h area → repeat gentamicin level, only re-dose when concentration is < 1mg/L

Question 17

what are the nomograms for OD gentamicin regimes?

Answer 17

• 7mg/kg - Hartford
• 5mg/kg - Urban and Craig

Question 18

summarise monitoring divided dose regimes of gentamicin treatment

Answer 18

use peak (1hr after) and trough ( just before next dose)

Question 19

managing raised INR on warfarin

Answer 19

MAJOR BLEED

• stop warfarin
• 5-10 mg IV vitamin K
• Prothrombin complex

INR 5-8

• not bleeding - omit warfarin for 2 days and then reduce dose
• minor bleeding - omit warfarin + 1-5 mg IV vit. K

INR > 8

• not bleeding - omit warfarin + PO 1-5mg vit. K
• minor bleeding - omit warfarin + 1-5 mg IV vit. K