Exam III : ADR (HARM-Wrestling) Flashcards
Table III, GI and other bleeds (3):
Vit. K Antagonist (VKA) users with history of bleeding or with unstable INR with supra therapeutic peaks greater than/equal to _____ require intensified INR monitoring.
Vit. K Antagonist (VKA) users with history of bleeding or with unstable INR with supra therapeutic peaks greater than/equal to 6 require intensified INR monitoring.
Table III, GI and other bleeds (3):
If possible, NSAIDS are avoided if:
a) patients are older than 70 years (Grade 1C)
b) patients have a history of one or more UGIEs (Grade 1B)
c) patients have a history of diverticular disease or lower gastrointestinal bleeding (Grade 1B)
d) the addition of the NSAID will result in a high-dose level of the NSAID or in the combination of two different NSAIDs (Grade 1B)
e) patients will be treated concurrently with a VKA, selective COX-2 inhibitor, systemic corticosteroid, low-dose aspirin, clopidogrel,
prasugrel (Grade 1B); heparin/LMWH (Grade 1C); SSRI or spironolactone (Grade 2B)
f) patients have heart failure, diabetes mellitus (Grade 1B) or severe rheumatoid arthritis (Grade 1C)
Table III, GI and other bleeds (3):
Adequate gastric protection by means of a PPI is needed when NSAID users:
a) have a history of one or more UGIEs (Grade 1B)
b) are older than 70 years (Grade 1C)
c) have two or more of the following risk factors (Grade 1C):
-are 60–70 years of age
-need long-term treatment with a high-dose level of the NSAID
-are treated simultaneously with another medicine that increases the risk of gastrointestinal complications (VKA, aspirin, clopidogrel,
prasugrel, systemic corticosteroid, SSRI, spironolactone, high doses of heparin/LMWH)
-have serious co-morbidity (such as severe rheumatoid arthritis, heart failure or diabetes)
Table III, GI and other bleeds (3):
Adequate gastric protection by means of a PPI is needed when low-dose aspirin, clopidogrel and prasugrel users:
a) have a history of one or more UGIEs (Grade 1B)
b) are at least 60 years of age and treated simultaneously with two or more other medications that increase the risk of gastrointestinal
complications (VKA, NSAID, selective COX-2 inhibitor, clopidogrel, prasugrel, high doses of heparin/LMWH, oral corticosteroid, SSRI
and/or spironolactone) [Grade 1C]
c) are at least 70 years of age and are treated simultaneously with one other medication that increases the risk of gastrointestinal
complications (VKA, NSAID, selective COX-2 inhibitor, clopidogrel, high doses of heparin/LMWH, oral corticosteroid, SSRI and/or
spironolactone) [Grade 1C]
d) are at least 80 years of age (Grade 1C)
Table III, GI and other bleeds (3):
Selective COX-2 inhibitors are contraindicated for patients with established _____ or _____ and their application in patients with peripheral arterial disease or risk factors for heart disease (such as hypertension, hyperlipidaemia, diabetes and smoking, or peripheral arterial disease) should be kept as low and as short as possible
Selective COX-2 inhibitors are contraindicated for patients with established ischaemic heart disease or stroke and their application in
patients with peripheral arterial disease or risk factors for heart disease (such as hypertension, hyperlipidaemia, diabetes and smoking,
or peripheral arterial disease) should be kept as low and as short as possible
Table III, Electrolyte disturbances, renal dysfunction and heart failure (4):
When a thiazide diuretic is started, or when its dose level is increased, the sodium level should be checked in the first 5–9 days if (Grade 1C):
a) the patient is at least 80 years of age
b) the patient is at least 70 years of age and also uses an SSRI, venlafaxine or a related drug, NSAID, carbamazepine or loop diuretic
Table III, Electrolyte disturbances, renal dysfunction and heart failure (4):
If a potassium-losing diuretic is started, potassium and creatinine levels are checked beforehand if (Grade 1C):
a) the patient is at least 70 years of age
b) one of the following situations applies:
the potassium-losing diuretic is combined with a potassium-sparing diuretic there is an increased risk of hypokalaemia or an increased risk from hypokalaemia (e.g. pre-existent hypokalaemia, cardiac
arrhythmia or coronary heart disease) the potassium-losing diuretic is combined with digoxin in the absence of a potassium-sparing agent (RASI, renin inhibitor or
potassium-sparing diuretic)
Table III, Electrolyte disturbances, renal dysfunction and heart failure (4):
If a RASI or renin inhibitor is started, potassium and creatinine levels are checked beforehand if:
a) the patient is at least 70 years of age (Grade 1C)
b) there is an increased risk of hyperkalaemia or an increased risk from hyperkalaemia (e.g. heart failure, cardiac conduction disorder, diabetes, renal insufficiency, simultaneous use of a potassium-sparing diuretic [Grade 1B]; simultaneous use of a thiazide diuretic and loop diuretic [Grade 1C])
Table III, Electrolyte disturbances, renal dysfunction and heart failure (4):
When the user of a RASI is at increased risk of hyperkalaemia, the prescribing of _____ should be avoided if this is in any way possible (Grade 1B)
When the user of a RASI is at increased risk of hyperkalaemia, the prescribing of NSAIDs (including COX-2 selective inhibitors) should be avoided if this is in any way possible (Grade 1B)
Table III, Electrolyte disturbances, renal dysfunction and heart failure (4):
In patients with existing renal insufficiency, one should take into consideration that most _____ may further compromise renal function through accumulation of an active metabolite. Dose adjustment is not necessary for fosinopril and for most AT1 antagonists
(with the exception of olmesartan) [Grade 1B]
In patients with existing renal insufficiency, one should take into consideration that most ACE inhibitors may further compromise renal function through accumulation of an active metabolite. Dose adjustment is not necessary for fosinopril and for most AT1 antagonists
(with the exception of olmesartan) [Grade 1B]
