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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
what is the difference between lithium carbonate and lithium citrate?
carbonate- tablet citrate- liquid form 200mg carbonate is equal to 509g citrate
26
what is the advice when switching between brands of lithium?
patients should remain on the same brand as far as possible and lithium should be prescribed WITH THE BRAND NAME
27
What should be prescribed alongside methotrexate?
folic acid
28
what should be given if methotrexate toxicity occurs?
rescue folic acid therapy
29
which drugs cause hypokalaemia?
``` insulin salbutamol laxatives loop diuretics antibacterials glucocorticoid therapy theophylline ```
30
management of hypokalaemia??
check Mg | infusion of potassium chloride and sodium chloride together
31
what is the definition of hypokalaemia?
<3.5 mmol/L
32
what are the symptoms/signs of hyperkalaemia?
``` muscle weakness vomiting nausea ECG changes cardiac arrest ```
33
what are some drug causes of hyperkalaemia?
``` ACE-I, ARB potassium sparing diuretics digoxin NSAID's penicillins renal failure + dietary intake - non drug causes ```
34
management of hyperkalaemia?
calcium gluconate nebulised salbutamol Insulin + 5% glucose calcium resonium
35
what are the target levels of glucose before a meal?
4-7mmol/L
36
what is the target level of glucose after a meal?
<9 mmol/L
37
how should insulin be prescribed?
BRAND NAME
38
Indications for gentamycin?
surgical infection prophylaxis bacterial endocarditis neutropenic sepsis gram -ve and +ve
39
how should gentamycin be monitoried?
6-14 hours after dose
40
indications for vancomycin?
gram +ve
41
how should vancomycin be monitored?
trough level on 2nd day between the 3rd and 6th dose
42
how is vancomycin given?
1g every 12 hours over 60 mins
43
S/E of vancomycin?
red man syndrome if given too quickly
44
monitoring requirements of amiodarone?
TFT every 6 months
45
monitoring requirements of levothyroxine?
6-8 weeks at first, then annually once stable
46
what does the COCP interact with?
rifampicin + carbamazepine (and any metabolzing inducers)
47
what is the interactions between verapamil and BB?
amplified effects
48
what is the interaction between aminoglycosides and diuretics?
both cause otoxicity
49
what is the interaction between warfarin and NSAID's?
both cause a GI bleed
50
what does St John's wort interact with?
warfarin COCP antidepressants
51
what is the adverse reaction that can occur with statins?
rhabdomyolysis
52
what drugs may have an ADR in G6PD?
``` nitrofurantoin anti-malarials quinolone antimicrobials rasburicase sulphonamides (co-trimoxazole) ```
53
which drugs require monitoring?
lithium warfarin methotrexate clozapine (agranulocytosis)
54
what must ciprofloxacin not be taken with?
a glass of milk
55
how should levothyroxine be administered if a dose is missed?
restarted at a lower dose- to prevent CO failure
56
examples of DOAC's?
dabigatran, rivaroxaban, apixaban, and edoxaban
57
what is the antidote for DOAC's
not licensed
58
what are the benefits of DOAC's?
fixed doses no routine monitoring rapid onset of action combination of renal and hepatic clearance
59
how should DOAC's be started?
stop LMWH and start NAOC at the time of the next dose
60
how to reverse the effect of unfractionated heparin?
short duration effect so can stop infusion | protamine
61
what should be checked after starting unfractionated heparin?
APTT shouuld be checked 4-6 hours after starting
62
when should anticoagulants be given?
prophylaxis of DVT/PE, arterial thromboembolism | treatment of acute DVT or PE
63
what are the types of anticoagulants?
warfarin rivaroxiban, apixiban, dabigatran heparins fondaparinux
64
what should be co-prescribed when starting warfarin?
LMWH should be co-prescribed for first 5 days as takes a while for the warfarin to exert its effects
65
what drugs interact with warfarin?
``` amiodarone antibiotics antidepressants atiplatelets antifungals - azole statins NSAIDS opiates thyroid medications - increase INR ``` rifampicin + antiepileptics - reduce INR
66
signs of benzodiazepine overdose?
hypotension hypovolaemia hyporeflexia
67
what should be given in benzodiazepine overdose?
flumazenil
68
what should be given in iron ovrdose?
desferroxamine
69
what can be given in opiate overdose?
naloxone
70
symptoms of iron overdose?
``` nausea vomiting diarrhoea haematemesis rectal bleeding GI ulceration CVS collapse ```
71
management of anaphylaxis?
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
management of serious reaction with ithcing and widespread urticaria but no laryngeal oedema?
oral chlorphenamine 4mg

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