Drug contraindications

Question 1

Aortic stenosis containdicated drugs

Answer 1

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

Question 2

Tetracyclins cant be used in children under the age of

Answer 2

12

Question 3

Quinolones cant be used with this drug because it increases the risk of tendon rupture

Answer 3

steroids

Question 4

When tazocin cant be used this is used instead in cases of neutropenic sepsis or severe pneumonia that’s not responding

Answer 4

meropenem

Question 5

If the patient has renal impairment and you are treating a UTI this drug won’t work

Answer 5

Trimethoprim as it increases creatinine and so competes with it and wont get into the urine

Question 6

Opioids and Benzos

Answer 6

Not a good idea for COPD and liver disease
- respiratory depression –> T2RF
- liver disease - not metabolised –> hepatic encephalopathy

Question 7

Which laxatives cant you give to bowel obstruction?
Which should you avoid in children and the elderly and why?

Answer 7

1. Osmotic and stimulant
2. 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)

Question 8

Diclofenac or naproxen has more contraindications?

Answer 8

Diclofenac
- risk of MI (uncommon)
- contraindicated in heart failure, and loads more

Question 9

Triptans and what drug should be avoided?

Answer 9

SSRIs

Question 10

SSRIs and what drug should be avoided?

Answer 10

Warfarin or heparin. Start patient on amytriptylline instead

Question 11

Omeprazole or lansoprazole more interactions?

Answer 11

Omeprazole. omeprazole reduces the effectivenesss of clopidogrel

Question 12

Trastuzumab cannot be used, if the patient has a history of

Answer 12

cardiovascular disease, as it can cause weakening of the heart muscle (cardiomyopathy) or heart failure. similar to pioglitazones

Question 13

rituximab which infection do you have to screen for?

Answer 13

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.

Question 14

nsaids. which are contraindicated in heart failure and why?

Answer 14

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.

Question 15

vancomycin and thiazides?

Answer 15

theyre okay.
caution furosemide and vancomycin

Question 16

alcohol and metronidazole?

Answer 16

for 48hr after Stoppung metronidazole

Question 17

alcohol and clopidogrel?

Answer 17

allowed but might irritate the stomach more so keep to <14 units

Question 18

if headache is still there affter first dose of sumatriptan can you give another ??

Answer 18

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

Question 19

Answer 19

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.

Question 20

Answer 20

Question 21

do you need to stop ramipril before surgery

Answer 21

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.

Question 22

do you need to stop aspirin before surgery

Answer 22

Patients taking antiplatelet medication or an oral anticoagulant present an increased risk for surgery. In these circumstances, the anaesthetist and surgeon should assess the relative risks and decide jointly whether the antiplatelet or the anticoagulant drug should be stopped or replaced with heparin (unfractionated) or low molecular weight heparin therapy. 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.

Question 23

acutely unwell, what medicaitons do you need to stop?

Answer 23

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 !

Question 24

Prophylactic LMWH given within 6hr of epidural?

Answer 24

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.

Question 25

Warfarin before surgery

Answer 25

stop 5 days before surgery
bridge from 3 days with LMWH
restart and stop this 24hr before surgery
If INR >1.5 give PCC

* restarting after surgery requires LMWH again to help warfarin reach theurapeutic levels (72hr major surgery, 48hr post partum, others 12-24hr) 
* When warfarin is restarted after brief discontinuation to enable INR to fall back within target range i.e., not due to surgery, it can be restarted at an appropriately reduced dose. If, however, warfarin is stopped for an extended period like with surgery, the patient will need to be restarted as previously described.

Question 26

When to stop LMWH before surgery?

Answer 26

depends on the indication and the type of surgery. Not sure where to find this on the BNF.

Question 27

When to bridge with LMWH before surgery if usually on warfarin?

Answer 27

so warfarin takes 2 days to work and 2 days to stop

so stop warfarin 5 days before surgery
start LMWH 3 days before surgery
stop LMWH 24hr before surgery (as it is being given as treatment vs prophylaxis. When given as prophylaxis it can be stopped 12 hours before)

Question 28

What to do for emergency surgery if on warfarin?

Answer 28

PCC - Immediate reversal
if surgery can be delayed 6hr give IV vit K

Question 29

How long does it take for oral vit K to work vs IV?

Answer 29

oral - 24 hours
iv - 6 hours

Question 30

What diabetic drug can’t you give to someone with history of retinopathy?

Answer 30

semaglutide = ozempic
Sudden worsening of vision due to sudden glucose drop i think

Also risk of pancreatitis

Question 31

ivabradine. Before you start it what do you need to measure?

Answer 31

HR and must be over 75 as it can cause sinus brady.