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PSA > Drug side effects/electrolyte imbalances > Flashcards

Drug side effects/electrolyte imbalances Flashcards

1
Q

Name some nephrotoxic drugs?

A 
Aminoglycosides 
ACE-I
ARB
Diuretics 
Lithium salts 
NSAIDs/aspirin 
radiocontrast media 
Immunosupressants (ciclosporin + tacrolimus)
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2
Q

what fluids should be prescribed in non-complicated AKI (with no acidosis)?

A

500ml bolus NaCl (0.9%) over 30 mins

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3
Q

what fluids should be prescribed in AKI with acidosis?

A

500ml bolus sodium bicarbonate (1.26%)

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4
Q

which drugs are liver toxic?

A 
paracetamol 
co-codamol 
co-amoxiclav + flucloxacillin 
NSAIDs
anti0TB drugs 
methotrexate
amiodarone 
aspirin
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5
Q

what should be prescribed in a patient with AF, heart failure and ejection fraction of less than 35?

A

digoxin

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6
Q

what cannot be prescribed alongside BB?

A

verapamil - risk of complete heart block (CCB)

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7
Q

what is a well-known liver associated side effect of flucloxacillin?

A

cholestatic jaundice- reaction is not dose dependent and occurs up to 2 months post treatment

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8
Q

what level of paracetamol can cause liver damage?

A

150mg/kg in less than 1 hour

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9
Q

antiodote for paracetamol overdose?

A

acetylcysteine

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10
Q

which drugs are liver enzyme inducers?

A

PC BRAS:

phenytoin, carbamazepine, barbiturates, rifampicin, alcohol (chronic excess) sulphonylureas. Others: topiramate, St John’s Wort, and smoking.

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11
Q

what cautions must be taken when prescribing carbamazepine?

A

ask patient about contraception - carbamazepine induces metabolizing enzymes in the liver which lead to reduced conc of oestrogen and progesterones rendering them less effective (barrier protection needed until after 4 weeks stopping treatment)

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12
Q

name the drugs that are enzymes inhibitors?

A

AO DEVICES:

allopurinol, omeprazole, disulfiram, erythromycin, valproate, isoniazid, ciprofloxacin, ethanol (acute intoxication), sulphonamides. Others: grapefruit juice, amiodarone, and SSRIs (fluoxetine, sertraline).

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13
Q

what cautions must be taken when prescribing erythromycin?

A

cannot be co-prescribed with tacrolimus as it greatly increases the conc of tacrolimus x6

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14
Q

which drug interacts with warfarin?

A

erythromycin - increases antiocagulant effect
fluconazole
NSAIDs

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15
Q

when does the peak pharmaceutical effect of warfarin occur?

A

48-72hrs

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16
Q

what is the target INR?

A

2-3

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17
Q

which drugs should be avoided when taking warfarin?

A 
erythromycin 
fluconazole
amiodarone 
NSAIDs
STATINS!
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18
Q

what foods should be avoided when taking warfarin?

A

vitamin K rich- leafy vegetables and cranberry juice

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19
Q

what are the monitoring requirements for digoxin?

A

does not need to be routinely monitored

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20
Q

how is digoxin excreted?

A

renally - affected by renal function

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21
Q

what factors may predispose to digoxin toxicity?

A

hypokalaemia and elderly

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22
Q

when should a dose level be taken when monitoring digoxin plasma levels?

A

at least 6 hours after last dose

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23
Q

what is the therapeutic range for lithium?

A

0.4-1

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24
Q

when can lithium serum levels be measured?

A

12 hours post dose, at least 4 days after starting treatment

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25
Q

what is the difference between lithium carbonate and lithium citrate?

A

carbonate- tablet
citrate- liquid form

200mg carbonate is equal to 509g citrate

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26
Q

what is the advice when switching between brands of lithium?

A

patients should remain on the same brand as far as possible and lithium should be prescribed WITH THE BRAND NAME

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27
Q

What should be prescribed alongside methotrexate?

A

folic acid

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28
Q

what should be given if methotrexate toxicity occurs?

A

rescue folic acid therapy

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29
Q

which drugs cause hypokalaemia?

A 
insulin 
salbutamol 
laxatives 
loop diuretics 
antibacterials
glucocorticoid therapy 
theophylline
30
Q

management of hypokalaemia??

A

check Mg

infusion of potassium chloride and sodium chloride together

31
Q

what is the definition of hypokalaemia?

A

<3.5 mmol/L

32
Q

what are the symptoms/signs of hyperkalaemia?

A 
muscle weakness
vomiting 
nausea 
ECG changes
cardiac arrest
33
Q

what are some drug causes of hyperkalaemia?

A 
ACE-I, ARB
potassium sparing diuretics 
digoxin
NSAID's
penicillins 
renal failure + dietary intake - non drug causes
34
Q

management of hyperkalaemia?

A

calcium gluconate
nebulised salbutamol
Insulin + 5% glucose
calcium resonium

35
Q

what are the target levels of glucose before a meal?

A

4-7mmol/L

36
Q

what is the target level of glucose after a meal?

A

<9 mmol/L

37
Q

how should insulin be prescribed?

A

BRAND NAME

38
Q

Indications for gentamycin?

A

surgical infection prophylaxis
bacterial endocarditis
neutropenic sepsis
gram -ve and +ve

39
Q

how should gentamycin be monitoried?

A

6-14 hours after dose

40
Q

indications for vancomycin?

A

gram +ve

41
Q

how should vancomycin be monitored?

A

trough level on 2nd day between the 3rd and 6th dose

42
Q

how is vancomycin given?

A

1g every 12 hours over 60 mins

43
Q

S/E of vancomycin?

A

red man syndrome if given too quickly

44
Q

monitoring requirements of amiodarone?

A

TFT every 6 months

45
Q

monitoring requirements of levothyroxine?

A

6-8 weeks at first, then annually once stable

46
Q

what does the COCP interact with?

A

rifampicin + carbamazepine (and any metabolzing inducers)

47
Q

what is the interactions between verapamil and BB?

A

amplified effects

48
Q

what is the interaction between aminoglycosides and diuretics?

A

both cause otoxicity

49
Q

what is the interaction between warfarin and NSAID’s?

A

both cause a GI bleed

50
Q

what does St John’s wort interact with?

A

warfarin
COCP
antidepressants

51
Q

what is the adverse reaction that can occur with statins?

A

rhabdomyolysis

52
Q

what drugs may have an ADR in G6PD?

A 
nitrofurantoin 
anti-malarials 
quinolone antimicrobials 
rasburicase
sulphonamides (co-trimoxazole)
53
Q

which drugs require monitoring?

A

lithium
warfarin
methotrexate
clozapine (agranulocytosis)

54
Q

what must ciprofloxacin not be taken with?

A

a glass of milk

55
Q

how should levothyroxine be administered if a dose is missed?

A

restarted at a lower dose- to prevent CO failure

56
Q

examples of DOAC’s?

A

dabigatran, rivaroxaban, apixaban, and edoxaban

57
Q

what is the antidote for DOAC’s

A

not licensed

58
Q

what are the benefits of DOAC’s?

A

fixed doses
no routine monitoring
rapid onset of action
combination of renal and hepatic clearance

59
Q

how should DOAC’s be started?

A

stop LMWH and start NAOC at the time of the next dose

60
Q

how to reverse the effect of unfractionated heparin?

A

short duration effect so can stop infusion

protamine

61
Q

what should be checked after starting unfractionated heparin?

A

APTT shouuld be checked 4-6 hours after starting

62
Q

when should anticoagulants be given?

A

prophylaxis of DVT/PE, arterial thromboembolism

treatment of acute DVT or PE

63
Q

what are the types of anticoagulants?

A

warfarin
rivaroxiban, apixiban, dabigatran
heparins
fondaparinux

64
Q

what should be co-prescribed when starting warfarin?

A

LMWH should be co-prescribed for first 5 days as takes a while for the warfarin to exert its effects

65
Q

what drugs interact with warfarin?

A 
amiodarone 
antibiotics 
antidepressants 
atiplatelets
antifungals - azole 
statins 
NSAIDS
opiates
thyroid medications - increase INR

rifampicin + antiepileptics - reduce INR

66
Q

signs of benzodiazepine overdose?

A

hypotension
hypovolaemia
hyporeflexia

67
Q

what should be given in benzodiazepine overdose?

A

flumazenil

68
Q

what should be given in iron ovrdose?

A

desferroxamine

69
Q

what can be given in opiate overdose?

A

naloxone

70
Q

symptoms of iron overdose?

A 
nausea
vomiting 
diarrhoea 
haematemesis 
rectal bleeding 
GI ulceration
CVS collapse
71
Q

management of anaphylaxis?

A

500 micograms of adrenaline (0.5ml in 1:1000)
10mg chlorphenamine
200mg hydrocortisone
IV or inhaled salbutamol

prednisolone to follow up for 3 days + antihistamine

72
Q

management of serious reaction with ithcing and widespread urticaria but no laryngeal oedema?

A

oral chlorphenamine 4mg

PSA (3 decks)

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