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BNF 72/74 > EXTRA- High Risk Drugs > Flashcards

EXTRA- High Risk Drugs Flashcards

1
Q

What’s amiodarone t1/2? As a result of this what may be required?

A

About 50days

Loading doses may be required

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2
Q

Monitoring requirements for amiodarone

A 
Thyroid function 
LFTs 
Serum potassium 
Chest X-ray 
ECG (with IV use)
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3
Q

Warning signs of amiodarone

A 
Hypo/hyperthyroidism 
Impaired vision 
Photophobia 
SoB or cough 
Liver disease (jaundice)
Tremor & peripheral neuropathy 
Phototoxic skin reactions e.g slate grey skin
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4
Q

Amiodarone counselling points

A

Shield skin from sunlight and for several months after stopping treatment
May be dazzled by headlights at night
Clinical effects can occur up to a year after stopping

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5
Q

Amiodarone + simvastatin interaction

A

Increased risk of myopathy

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6
Q

Amiodarone increases the plasma concentrations of what drugs

A 
Coumarins 
Dabigatran 
Digoxin 
Flecainide 
Phenindione 
Phenytoin
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7
Q

Why is there potential for drug interactions even when amiodarone is stopped

A

Cos of its long half life

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8
Q

Monitoring requirements for antihypertensives

A

Blood pressure
Heart rate
Renal function
Serum electrolytes

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9
Q

Grapefruit juice increases the plasma concentrations of what antihypertensives

A

Ivabradine
Aliskiren
CCB

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10
Q

Therapeutic range for carbamazepine

A

4-12mg/L

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11
Q

Monitoring for carbamazepine

A

FBC
Renal function
Liver function

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12
Q

Toxicity signs for carbamazepine

A 
Incoordination 
Blurred vision 
Diplopia 
Drowsiness 
Nystagmus 
Ataxia 
Arrhythmias 
N&v 
Diarrhoea 
Hyponatraemia
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13
Q

Signs of blood disorders with carbamazepine

A

E.g leukopenia, thrombocytopenia (fever, sore throat, unexplained bruising or bleeding)

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14
Q

Symptoms of antiepileptic hypersensitivity syndrome that can occur with e.g carbamazepine

A

Fever
Rash
Swollen lymph nodes

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15
Q

You get increased plasma concentrations of carbamazepine with what 6 drugs

A 
Acetazolamide 
Cimetidine 
Clarithromycin 
Erythromycin 
Fluoxetine 
Isoniazid
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16
Q

What three drugs decrease carbamazepine levels

A

Phenytoin
Rifabutin
St. John’s wort

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17
Q

Carbamazepine decreases the plasma concentration of what 7 classes of drug

A 
Antipsychotics 
Corticosteroids 
Coumarins 
Eplerenone 
Oestrogens 
Progestogens 
Simvastatin
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18
Q

The carbamazepine anticonvulsant effect is antagonised by what

A

Mefloquine

Antipsychotics

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19
Q

Reaction between orlistat and antiepileptics (e.g carbamazepine)

A

Increased risk of convulsions

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20
Q

Side effects of chemotherapy

A 
Extravasation 
N&V 
Bone marrow suppression 
Oral mucositis 
Neurotoxicity (vinkaalkaloids) 
Cardiotoxicity (anthracyclines) 
Diarrhoea 
Fatigue
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21
Q

Monitoring requirements for ciclosporin

A 
FBC 
LFT 
Serum electrolytes (K, Mg) 
Blood lipids,
Renal function 
BP 
Dermatological and physical exam
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22
Q

Warning signs for ciclosporin

A 
Neurotoxicity 
Blood disorders
Liver toxicity 
Nephrotoxicity 
Hypertension 
Headache 
Gingival hyperplasia
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23
Q

Actions required for ciclosporin

A 
Hypertension is common
No live vaccines 
Brand specific 
Avoid exposure to UV light
Avoid high potassium diet and grapefruit juice
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24
Q

Ciclosporin does what to plasma concentrations of digoxin

A

Increases it

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25
Q

Ciclosporin + statin interaction

A

Myopathy

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26
Q

What drugs decrease the plasma concentration of ciclosporin

A 
Carbamazepine 
Orlistat 
Phenobarbital 
Phenytoin 
Rifampicin 
SJW
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27
Q

Increased risk of hyperkalaemia if you have ciclosporin and what?

A

ACEI
ARB
aldosterone antagonist

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28
Q

Monitoring for corticosteroids

A 
BP
Blood lipids
Serum K
Body weight and height 
Bone mineral density 
Blood glucose 
Eye exam 
Adrenal suppression
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29
Q

Warning signs of corticosteroids

A 
Paradoxical bronchospasm
Symptoms of uncontrolled asthma 
Frequent courses of antibiotics 
Adrenal suppression 
Immunosuppression 
Psychiatric reactions
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30
Q

Signs of adrenal suppression

A 
Nausea 
Vomiting 
Weight loss 
Fatigue 
Headache 
Muscular weakness
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31
Q

Therapeutic range of digoxin

A

1-2mcg/L

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32
Q

Monitoring for digoxin

A 
Serum electrolytes (hypo K, Mg, Ca) potentiates toxicity 
Renal function 
Heart rate (maintain at greater than 60 bpm)
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33
Q

Warning signs for digoxin

A

Cardiac (arrhythmias/heart block)
Neurological
GI
Visual (blurred/yellow vision)

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34
Q

You get increased digoxin levels with what drugs

A 
Alprazolamiodarone 
Ciclosporin 
Diltiazem 
Itraconazole 
Lercanidipine 
Macrolides 
Mirabegron 
Nicardipine 
Nifedipine 
Quinine 
Spironolactone 
Verapamil
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35
Q

True or false: SJW increases plasma conc of digoxin

A

False it decreases it

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36
Q

Concomitant administration of what drugs with digoxin can cause hypokalaemia thus increasing toxicity?

A

Acetazolamide
Amphotericin
Loop diuretic
Thiazides & related

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37
Q

Drugs that impair renal function can affect the plasma digoxin concentration - give two examples of drugs that impair renal function

A

NSAIDs

ACEI

38
Q

Monitoring for diuretics

A

BP
Serum electrolytes
Weight (as a measure of fluid loss)

39
Q

Warning signs for diuretics

A

Heaviness in centre of chest
Water retention
Depression
Extreme tiredness, thirst or excessive urination
Irregular heartbeat, muscle weakness, nausea
Gout

40
Q

Increased risk of hyperkalaemia when potassium sparing diuretics or aldosterone antagonists given with what meds?

A 
ACEI 
ARB
Ciclosporin 
Potassium salts 
Tacrolimus
41
Q

Hypokalaemia cause by acetazolamide, loop, thiazides increases the risk of ventricular arrhythmias when given with what

A

Amisulpride
Atomoxetine
Pimozide
Sotalol

42
Q

Hypokalaemia caused by diuretics increases the risk of cardiac toxicity with what specific class of drug

A

Cardiac glycosides

43
Q

Clarithromycin and itraconazole increases the plasma concentration of what diuretic

A

Eplerenone

44
Q

Plasma concentration eplerenone is reduced by what drugs

A 
Carbamazepine 
Phenobarbital 
Phenytoin 
Rifampicin 
SJT
45
Q

Increased risk of ototoxicity when you give loop diuretics with what 3 drugs

A

Aminoglycosides
Polymixins
Vancomycin

46
Q

Therapeutic range for gentamicin and target trough conc

A

5-10mg/L (3-5mg/L for endocarditis)

Trough: <2mg/L (<1mg/L in endocarditis)

47
Q

Monitoring requirements for gentamicin

A

Renal function

Auditory and vestibular function

48
Q

True or false: pt must be fluid restricted when starting an aminoglycoside

A

False! Must ensure adequate hydration

49
Q

Increased risk of nephrotoxicity when aminoglycosides are given with what

A

Ciclosporin
Tacrolimus
Vancomycin

50
Q

Increased risk of ototoxicity when aminoglycosides given with what

A

Loop diuretics

Vancomycin

51
Q

Monitoring for insulin

A

Blood glucose

HBA1C

52
Q

Warning signs for insulin

A

Recurring hypos
Signs of DKA
Symptoms of liver toxicity, heart failure, pancreatitis
Ulceration of foot tissue

53
Q

List some drugs that may lower insulin requirements

A 
Oral antidiabetic meds
ACEI
MAOIs
Salicylates
Sulphonamide abx
54
Q

Substances that may increase insulin requirements

A 
Corticosteroids 
Diuretics
Sympathomimetics (ephedrine, salbutamol, terbutaline)
Thyroid hormones 
Oral contraceptives
55
Q

Two things that can potentiation and/or weaken insulin activity

A

Beta blockers

Alcohol

56
Q

Max concentration of IV K+ ?

A

40mmol/litre

57
Q

How is IV potassium given and what is required

A

SLOW IV infusion

Needs ECG and electrolyte monitoring

58
Q

Recommended maximum rate of K+ IV infusion

A

20mmol / hour

59
Q

Therapeutic range for lithium

A

0.4-1 mmol/L

60
Q

Monitoring requirements for lithium

A

Lithium conc
Renal function
Cardiac function
Thyroid function

61
Q

Interaction between lithium + amiodarone

A

Increased risk of ventricular arrhythmias

62
Q

Lithium + what drugs increases toxicity

A 
ACEI/ARBs
Diuretics 
NSAIDs
Metronidazole 
SSRIs 
TCAs
63
Q

Lithium + what drugs results in increased risk of neurotoxicity

A 
Methyldopa 
Phenytoin 
Carbamazepine 
Diltiazem 
Verapamil
64
Q

Lithium plus what drugs can increase risk of extrapyramidal side effects

A 
Clozapine 
Haloperidol 
Sulpiride 
Phenothiazines 
Risperidone 
Flupentixol 
Zuclopenthixol
65
Q

Methotrexate monitoring

A

FBC
Renal function
Liver function

66
Q

Methotrexate warning signs

A 
GI toxicity e.g stomatitis 
Liver toxicity 
Blood disorders 
Pulmonary toxicity 
Preganancy and breast feeding
67
Q

What increases the plasma concentration and risk of hepatotoxicity when given with MTX

68
Q

Excretion of MTX is reduced by what drugs

A 
NSAIDs 
Penicillins 
Ciprofloxacin 
Doxycycline 
Tetracycline
Sulfonamides 
Ciclosporin 
PPI
Leflunomide
69
Q

MTX plus what increases risk of haematological toxicity

A

Sulfamethoxazole (co-trimox) or trimethoprim

70
Q

NSAIDs + quinolones

A

Increased risk of convulsions

71
Q

NSAIDs + coumarins and phenindione

A

Possible enhanced anticoagulant effect

72
Q

NSAIDs increase the effects of what oral antidiabetic class

A

Sulfonylureas

73
Q

NSAIDs may reduce the excretion of what two drugs

A

Lithium

Methotrexate

74
Q

NSAIDs increased risk of nephrotoxicity when given with what drugs?

A

Ciclosporin
Tacrolimus
Diuretics

75
Q

Monitoring for NSAIDs

A

BP
Renal function
Liver function
Haemoglobin

76
Q

Monitoring for opiates

A

Pain

Sedation

77
Q

Warning signs for opiates

A 
Respiratory depression 
Bradycardia, hypotension
Extreme sleepiness
Reduce concentration 
Cyanosis 
Vivid dreams 
Convulsions 
Pinpoint pupils
78
Q

Opiates + alcohol

A

Enhanced hypotensive and sedative effects

79
Q

Tramadol enhances the anticoagulant effects of what

80
Q

Rifampicin can decrease the effects of what opiates

A 
Fentanyl 
Morphine 
Codeine 
Methadone 
Alfentanyl
81
Q

Opiates + MAOIs

A

CNS excitation or depression

82
Q

Warning signs for oral antiplatelets

A 
Chronic GI bleeding 
Heaviness in centre of chest 
Severe itching or rash 
Unusual bruising or bleeding 
Pregnancy or breastfeeding
83
Q

Clopidogrel antiplatelet effects are reduced by which PPIs?

A

Omeprazole

Esomeprazole

84
Q

What’s the therapeutic range of phenytoin

85
Q

True or false: small changes in dose/missed dose / change in drug absorption can result in marked change in plasma drug concentration of phenytoin

A

True- non linear relationship

86
Q

Monitoring requirements for phenytoin

A 
Serum conc
ECG + BP with IV 
LFT 
FBC
Serum folate 
Vitamin D
87
Q

How is phenytoin metabolised

A

Hepatic metabolism

88
Q

Warning signs for phenytoin

A 
Toxicity 
Skin disorders 
Blood disorders
Suicidal thoughts 
Low vitamin D
89
Q

Toxicity signs of phenytoin

A 
Nystagmus 
Ataxia 
Slurred speech 
Hyperglycaemia 
Diplopia 
Blurred vision
90
Q

Equivalents of phenytoin sodium and phenytoin base

A

Phenytoin sodium 100mg

Phenytoin base 92mg

91
Q

What drugs reduce the plasma concentrations of phenytoin

A 
Rifampicin 
SJW
theophylline 
Itraconazole 
Ciclosporin

BNF 72/74 (17 decks)

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