Drug Infos Flashcards
What are the side effects of Aminosalicylates?
- Blood disorders
- Lupus - Like Syndrome
What are the monitoring requirements for Aminosalicylates?
- Suspected Blood disorder, monitor Blood count, stopped if suspicion.
- Renal function; Before starting, 3 months then annually
What is the patient and cared advice for aminosalicylates?
- Report any unexplained bleeding, bruising, purpura, sore throat, fever or malaise
What are the side effects of Azathioprine?
- Hypersensitivity reactions (dizziness, vomiting, diarrhoea, fever, hypotension, renal dysfunction; immediate withdrawal
- Neutropenia and Thrombocytopenia
- Nausea
What are the monitoring requirements for Azathioprine (converted to mercaptopurine)?
- TPMT activity before starting; risk of myelosuppression increased
- Full blood counts; weekly for first 4 weeks then every 3 months
What are the patient and carer advice for Azathioprine?
Report signs + symptoms of bone marrow suppression ; bruising, bleeding, infection.
What are the side effects of Amiodarone?
- Corneal microdeposits
- Thyroid disorders (hypo -and hyperthyroidism
- Phototoxic reactions (Blue/grey marks)
- Hepatoxicity
- Pulmonary toxicity
What are the monitoring requirements for Amiodarone?
- Serum potassium (before treatment)
- TFTs before treatment + every 6 months
- LFTs before treatment + every 6 months
- Chest X-Ray
What are the Patient and Carer advice for Amiodarone?
- Shield skin from sunlight (during treatment and several months after) ; use wide spectrum sunscreen
- Hepatotoxicity (nausea+vomiting, dark urine, abdominal pain, jaundice); discontinue
- Report symptoms of shortness of breath + coughing
What are the side effects of Digoxin?
- Bradycardia
- GI disturbances
- Rashes
- Dizziness
- Visual disturbances (Blurred/Yellow vision)
What are the monitoring requirements for Digoxin?
- Renal Function
- Plasma-Digoxin concentration 1.5 - 3 mcg/L
- Check plasma concentration at least 6 hours after a dose
- Reduce Digoxin dose by half when given with: Amiodarone, Dronedarone, Quinine
- Hypokalaemia
- Hypomagnesaemia
- Hypercalcaemia
What are the Patient and Carer advice for digoxin?
- Seek advice if side effects particularly Bad -
What are the intrinsic sympathomimetic activity (ISA) Beta-Blockers?
When are they useful?
PACO - Pindolol, Acebutolol, Celiprolol, Oxprenolol
- They cause less bradycardia and coldness of the extremities
What are the water soluble beta-blockers?
CANS - Celiprolol, Atenolol, Nadolol, Sotalol
- Less likely to enter brain causing less sleep disturbance
Water soluble beta-blockers are excreted by the kidney - reduce dose if patient is renally impaired.
Which Beta blockers should be taken OD due to their long duration?
BCAN - Bisoprolol, Celiprolol, Atenolol, Nadolol
Which Beta-blockers are cardio selective and are preferred in asthmatic patients?
BAMAN - Bisoprolol, Atenolol, Metoprolol, Acebutolol, Nebivolol
Why should beta blockers and thiazide diuretics be avoided together?
- increased risk of hypotension
- avoided in uncomplicated hypertension in patients with diabetes or in those at high risk of developing diabetes.
- contraindicated in diabetes - so cardioselective preferred
When should Lercanidipine be taken?
What should should prescriber remember when prescribing Nifedipine?
- Take 30 to 60 mins before food
- Prescriber should specify the brand when prescribing MR preparations
When should statins not be started?
When patient is at increased risk of muscle effects - if baseline creatine kinase concentration is more than 5 times the upper limit
more than 5 times the upper limit - statin should not be started
raised but < 5 times the upper limit - statin should be started at lower dose
Statin suspected cause of myopathy + Creatine Kinase (CK) concentration is elevated = discontinue treatment
What should be checked before starting statin therapy?
- Check thyroid function - hypothyroidism is a reversible cause of dyslipidaemia
Is contraception required during stating therapy?
YES - during treatment and for 1 month afterwards
Can Statin be used during pregnancy?
- Should be avoided in pregnancy; congenital anomalies
What are the important dose adjustments for simvastatin?
Bezafibrate and Ciprofibrate - Maximum 10mg daily
Amiodarone, Amlodipine and Ranolazine - Maximum 20mg daily
Verapamil, Diltiazem - Maximum 20mg daily
Ticagrelor - Maximum 40mg daily
Which antipsychotics cause the most EPSEs?
- Fluphenazine, Trifluoperazine, Prochloperazine, Haloperidol, Benperidol
Which antipsychotics cause the most sexual dysfunction?
BROH- Benperidol, Risperidone, Olanzapine, Haloperidol
Which antipsychotics cause the least sexual dysfunction?
AQ - Aripiprazole and Quetiapine
Which drug cause the most Hyperprolactinaemia?
RAF - Risperidone, Amisulpride, First-generation
Which drug is the least Hyperprolactinaemia?
AACQ - Aripiprazole, Asenapine, Clozapine, Quetiapine
Which drug cause the most hypotension?
Clozapine and Quetiapine
What are the side effects of Clozapine?
- Neuroleptic malignant syndrome
- Constipation
- Hypersalivation
- Drows- Dizz, N+V
- Blood disorder
- Cardiac problems
- weight gain
- decreased appetite
What are the monitoring requirements for Clozapine?
- Prolactin ( start, 6 months, yearly)
- Blood lipids + weight (every 3 months for 1st year, yearly after)
- Fasting glucose (start, every 1 month, every 4 to 6 months
- Persistent tachycardia - prompt observation (if myocarditis or cardiomyopathy suspected- discontinue permanently)
Leucocyte + Blood counts - must be normal before starting
Leucocyte + Blood counts - monitor counts every week for 18 weeks, then every 2 weeks for 1 year, then every 4 weeks.
What are the Patient and Carer advice for clozapine?
- Fever, increased heart rate + sweating (contact doctor)
- Constipation develops - seek medical advice before next dose
- Inform or inquire when adjusting smoking habits
What is the Patient and Carer Advice for Clindamycin?
- Diarrhoea (C DIFF)
- Take with a full glass of water
What are the side effects of metronidazole?
- N+V
- Furring of tongue
- Taste disturbance
- Sore mouth
What are the patient and Carer advice for metronidazole?
- Take with or after food
- avoid Alcohol (disulfram-like reaction - N+V); do not drink while taking and for 48 hrs after finishing
Should phenoxypenicilin be taken with food?
- take on empty stomach one hour before or two hours after food
What are the Patient and Carer advice for Flucloxacillin?
- take on empty stomach (one hour before or two hours after food)
- look out for signs of hepatotoxicity and cholestatic jaundice
What are the common side effects of Macrolides? (clarithromycin, erythromycin)
- Taste disturbances
- Tooth and tongue discolouration
What are the side effects of Quinolones?
- QT prolongation
- Tendon damage
- Neurological reactions
- Psychiatric reactions
- Hypersensitivity
- N + V
- Diarrhoea
avoid exposure to excessive sunlight (during treatment and for 48 hours after treatment
What are the Patient and Carer advice for quinolones?
Do not drink milk or take antacids or vitamin supplements containing iron or zinc , for two hours before or two hours after taking quinolones (reduces effectiveness)
Avoid taking NSAIDs
What may happen when NSAIDs is taking at the same time as quinolones?
- quinolones may induce convulsions
- taking Nsaids at the same time may induce them
What is the dietary interaction associated with tetracyclines?
- Do not take with indigestion remedies or medicines containing iron or zinc 2 hours before or after
Demeclocyclines, Oxytetracyclines, Tetracyclines - avoid taking with milk
What are the important safety information for Rifampicin?
- N+V, Headaches, Thrombocytopenia
- Discolours soft contact lenses
- Discolours urine orange/red
- Take on empty stomach, an hour before or two hours after food
What are the important safety information for Ethambutol?
- Hyperuricaemia, Nerve disorders, Visual impairment
- visual acuity (snellen chart); if renally impaired avoid ethambutol (increases risk of optic nerve damage)
- Discontinue therapy immediately if any sign of developed vision impairment and promptly seek further advice.
what are the safety information for pyrazinamide?
- Hepatotoxicity
- Discontinue and seek immediate medical attention if persistent N+V, malaise or jaundice
What are the important safety information for Isoniazid?
- Damage to peripheral nerves (numbness + tingling in hands and feet) ; pyridoxine co-administered
- Hepatic disorders
- N+V
- Peripheral neuropathy
Avoid tyramine rich foods ( mature cheeses, salami, pickled herring, some beers, lagers or wines) - tachycardia
Avoid histamine rich foods (mature cheeses, fish from scombroid family - tuna, mackarel + salmon) - tachycardia
Which antipsychotic causes the most Hyperglycaemia?
- Clozapine, Risperidone, Olanzapine, Quetiapine
Which antipsychotic causes the least Hyperglycaemia?
First gens ( particularly fluphenazine and haloperidol )
Amisulpride
Aripiprazole
Which antipsychotic cause the most weight gain?
Clozapine, Olanzapine
Which antipsychotics have the most cardiovascular side effects?
Haloperidol, Pimozide
A patient has her first unprovoked epileptic seizure, or single isolated seizure, how long can they not drive for?
Six months
A patient experiencing epileptic attacks whilst asleep and awake, when can they start driving again?
Reapply if attacks only while asleep for last THREE years
When can a patient who is having epileptic attacks whilst only asleep start driving again?
Reapply if ONE year since first attack
How does Azathioprine interact with Allopurinol and ACE inhibitors?
- Reduce dose of Azathioprine/ mercaptopurine (1/4 of the usual dose) with concomitant allopurinol use = toxic levels
- Increased risk of anaemia and/or leucopenia with Ace inhibitors
What is the interaction between Pomelo juice and ciclosporin?
Pomelo juice is predicted to increase ciclosporin exposure
What is the interaction between Purple grape juice and Ciclosporin?
Purple grape juice is predicted to decrease ciclosporin exposure
What is the interaction between allopurinol and ace inhibitors?
- increased risk of leucopenia
What are the drugs that cause Hyperkalaemia, when administered together with Ace inhibitors?
- Heparin
- Ciclosporin
- Trimethoprim
- Heparins
Which Ace inhibitor is given BD and which one is given 30-60 minutes before food?
BD - Captopril
30-60 minutes before food - Perindopril
When should ACE inhibitors be stopped?
- Ace inhibitors should be stopped if liver transaminases are 3 times normal or jaundice occurs - can lead to cholestatic jaundice and hepatic failure
What can Labetolol cause?
- Can cause Liver damage
Which beta blockers are used to reduce mortality in MI?
- MAP Metoprolol , Atenolol, Propranolol
What is the interaction between CCBs and domperidone?
- Increases the risk of QT - prolongation when give with domperidone
What drugs, when administered together with diuretics may prolong QT interval and may cause torsade de pointes?
- Amiodarone
- Citalopram
- Haloperidol
- Macrolides (Clarithromycin, Erythromycin)
they all cause hypokalemia
How do Thiazides diuretics affect diabetes?
-Thiazides and related diuretics can exacerbate diabetes, gout and systemic lupus erythematosus
