Drug contraindications Flashcards
Aortic stenosis containdicated drugs
Anything that reduces peripheral afterload as this will reduce coronary perfusion pressure while the heart still has a fixed afterload (the stenosis) to overcome.
ACE-I
GTN
CCB- Dihydro
Tetracyclins cant be used in children under the age of
12
Quinolones cant be used with this drug because it increases the risk of tendon rupture
steroids
When tazocin cant be used this is used instead in cases of neutropenic sepsis or severe pneumonia that’s not responding
meropenem
If the patient has renal impairment and you are treating a UTI this drug won’t work
Trimethoprim as it increases creatinine and so competes with it and wont get into the urine
Opioids and Benzos
Not a good idea for COPD and liver disease
- respiratory depression –> T2RF
- liver disease - not metabolised –> hepatic encephalopathy
Which laxatives cant you give to bowel obstruction?
Which should you avoid in children and the elderly and why?
- Osmotic and stimulant
- Diet changes and isphagula hulk/bulk forming because they need to drink lots of water with it and this is unlikely to occur, these patients are best started on an osmotic (or osmotic and stimulant in elderly/adults)
Diclofenac or naproxen has more contraindications?
Diclofenac
- risk of MI (uncommon)
- contraindicated in heart failure, and loads more
Triptans and what drug should be avoided?
SSRIs
SSRIs and what drug should be avoided?
Warfarin or heparin. Start patient on amytriptylline instead
Omeprazole or lansoprazole more interactions?
Omeprazole. omeprazole reduces the effectivenesss of clopidogrel
Trastuzumab cannot be used, if the patient has a history of
cardiovascular disease, as it can cause weakening of the heart muscle (cardiomyopathy) or heart failure. similar to pioglitazones
rituximab which infection do you have to screen for?
hepatititis B
because - In chronic Hepatitis B (HBV) infection, the virus can remain in a latent or inactive state within the liver, primarily in the form of covalently closed circular DNA (cccDNA) within hepatocytes.
B cells contribute to the control of HBV infection through the production of neutralizing antibodies against viral antigens (e.g., HBsAg) that help prevent reinfection of hepatocytes by circulating virus particles.
Latent HBV infection can be maintained if B cells generate antibodies at a level sufficient to keep the virus in check without completely clearing it, partly due to the virus’s ability to evade immune detection within infected cells.
Regulatory B cells (Bregs) might also contribute by modulating the immune response, limiting excessive inflammation and helping to maintain a balance where the virus persists in a low-profile latent state, avoiding full activation or complete elimination.
rituximab is an anti-lymphocyte monoclonal antibody that cause lysis of B lymphocytes.
nsaids. which are contraindicated in heart failure and why?
nsaids
- why diclofenic is bad for heart failure and all NSAIDS in general is because of their action on COX2 - usually COX2 increases the GFR - increasing water and sodium loss. But when you inhibit this more renin is released and more water and sodium are reasborbed. But Diclofenic is the strongest for this, and also therefore has more vasoconstrictive effects hence why its association with stroke and thrombosis (as the lumen narrows are atheromas are more likely to break off)
- Naproxen is generally considered safer than diclofenac becauseit has a lower risk of cardiovascular events and gastrointestinal (GI) issues as it has less effect on COX2.
vancomycin and thiazides?
theyre okay.
caution furosemide and vancomycin
alcohol and metronidazole?
for 48hr after Stoppung metronidazole
alcohol and clopidogrel?
allowed but might irritate the stomach more so keep to <14 units
if headache is still there affter first dose of sumatriptan can you give another ??
wait for 30 minutes for it to take effect
if it responded to the first dose but symptoms recur then give a second dose but wait a MINIMUM of 2 hours.
MAX DOSE 40mg/day
pneumonia is a common adverse effect of Trelegy Ellipta®inhaler, which results from the fluticasone component. Common infections include lower and upper respiratory tract infections, bronchitis, pharyngitis, rhinitis, sinusitis, nasopharyngitis and urinary tract infection as well as influenza and candidiasis of the mouth and throat.This is therefore the most likely adverse effect.These adverse effects are commonin patients takingTrelegy Ellipta®for the treatment ofCOPD. Inhaled corticosteroids should only be continued for the treatment of COPD where there is clear evidence of benefit. If no benefit is seen after a trial of inhaled corticosteroid it should be stopped
seretide does the same.
do you need to stop ramipril before surgery
if you look on ‘ramipril’ it wont give you the answer. You have to look on treatment summaries: Surgery and long-term medication and here it will tell you yes you do.
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin-II receptor antagonists can be associated with severe hypotension after induction of anaesthesia; these drugs may need to be discontinued 24 hours before surgery.
do you need to stop aspirin before surgery
In patients with stable angina, perioperative aspirin should be only continued where there is a high thrombotic risk (e.g. patients with a recent acute coronary syndrome, coronary artery stents, or an ischaemic stroke).
again to find this information if you look on ‘aspirin’ it wont give you the answer. You have to look on treatment summaries: Surgery and long-term medication and here it will tell you yes you do.
acutely unwell, what medicaitons do you need to stop?
any that cause AKI
any that cause immunosuppression if infection risk
SGLT2 INHIBITORS - THIS INCLUDES COVID/COLDS ETC!!! - HUGE RISK OF NORMOGLYCEMIC KETOACIDOSIS = TAKE HOME MESSAGE !
Any pain in genital area/odd smell = forneirs gangrene !
Prophylactic LMWH given within 6hr of epidural?
no, wait at least 12 hours! sometimes 24hr
According to NICE, you should wait at least 12 hours after a prophylactic dose of low-molecular-weight heparin (LMWH) before placing an epidural or removing an epidural catheter. If you’re taking a therapeutic dose of LMWH, you should wait at least 24 hours before placing an epidural or removing an epidural catheter.
