Drugs

Question 1

What other drug should be prescribed if BB are being used for hypertension in phaeochromocytoma?

Answer 1

Phenoxybenzamine - to reduce risk of hypertensive crisis

Question 2

When is esmolol used?

Answer 2

Cardioselective, short duration of action.

Supraventricular arrhythmias, sinus tachycardia or hypertension.

Question 3

When is sotalol used?

Answer 3

Non-cardioselective

Prophylaxis in paroxysmal supraventricular arrhythmias.

Suppression of ventricular ectopic beats and non-sustained ventricular tachycardia.

Question 4

Which are the water-soluble BB?

Answer 4

Atenolol
Celiprolol
Nadolol
Sotalol

Question 5

What is an advantage of water-soluble BB?

Answer 5

Less likely to cross BBB, so less likely to cause sleep disturbance + nightmares.

Question 6

What is a disadvantage of water-soluble BB?

Answer 6

Excreted by kidney.

Dose reduction required in renal impairment.

Question 7

Which BBs cause less bradycardia and coldness of the extremities due to intrinsic sympathomimetic activity?

Answer 7

Celiprolol
Pindolol
Aceburolol
Oxprenolol

Question 8

Which BB have a longer duration of action so can have OD dosing?

Answer 8

Atenolol
Bisoprolol
Celiprolol
Nadolol

Question 9

Which BB are cardioSELECTIVE (not specific) ?

Answer 9

Atenolol
Bisoprolol
Metoprolol
Nebivolol

Question 10

What are 9 BB side effects?

Answer 10

Fatigue 
Bradycardia
GI disturbance 
Dry eyes 
Erectile dysfunction
Coldness of extremities 
Sleep disturbance/nightmares 
Hypoglycaemia / hyperglycaemia 
Masked symptoms of hypoglycaemia.

Question 11

When are BB contraindicated (10)?

Answer 11

Second/third degree heart blocks 
Uncontrolled diabetes 
Uncontrolled HF 
Asthma 
Bradycardia 
Metabolic acidosos 
Severe peripheral arterial disease 
Phaeochromocytoma 
Sick sinus syndrome 
Prinzmetal's angina

Question 12

What should you monitor before starting amiodarone?

Answer 12

Thyroid function (T3, T4 and TSH)
LFT
Potassium
Chest x-ray

Question 13

What should you monitor when using amiodarone?

Answer 13

Thyroid functions tests (every 6 months)
LFT (every 6 months)
IV use - ECG monitoring

Question 14

What are SEs of amiodarone?

Answer 14

Skin reactions 
Corneal microdeposits 
Thyroid function changes 
Hepatotoxicity 
Pulmonary toxicity

Question 15

What should you counsel the patient when prescribed amiodarone?

Answer 15

Phototoxicity
Driving impairment (dur to corneal microdeposits)
When prescribed concurrently with sofosbuvir - know signs of bradycardia and heart block.

Question 16

What is the most common SE of verapamil?

Answer 16

Constipation

Question 17

What are common SE associated with dihydropyridine CCBs?

Answer 17

Flushing, headache, ankle oedema.

Question 18

Which are rate limiting CCB?

Answer 18

Verapamil

Diltiazem

Question 19

Which are dihydropyridine CCBs?

Answer 19

Amlodipine, felodipine, nimodipine, lacidipine etc.

Question 20

What are 3 MHRA alerts associated with bisphosphonates?

Answer 20

• Risk of atypical femoral fractures - pts should report thigh, hip or groin pain.
• Osteonecrosis of the jaw (higher risk with IV in cancer pts) - should have dental check ups
• Osteonecrosis of the external auditory canal - associated with long term therapy (>2 years). Risk factors: steroid use, chemotherapy, infection, ear operation, cotton-bud use. Report any pain or discharge from ear.

Question 21

What are 5 counselling points for bisphosphonates?

Answer 21

Atypical femoral fractures
Patients should be advised to report any thigh, hip, or groin pain during treatment with a bisphosphonate.

Osteonecrosis of the jaw
During bisphosphonate treatment patients should maintain good oral hygiene, receive routine dental check-ups, and report any oral symptoms.

Osteonecrosis of the external auditory canal
Patients should be advised to report any ear pain, discharge from ear or an ear infection during treatment with a bisphosphonate.

Dizziness can occur - warn about skilled tasks

Oesophageal reactions: stop taking and see doctor if dysphagia, heatburn, pain on swallowing etc. Stand/sit up for 30 mins after taking, take 30 mins before breakfast.