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High risk drugs > High risk drugs > Flashcards

High risk drugs Flashcards

1
Q

Which beta blockers do not cause nightmares (4 points)

A 
Water-soluble beta-blockers:
atenolol
celiprolol hydrochloride
nadolol
sotalol hydrochloride
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2
Q

True or false:

Methotrexate can be continued if the patient develops diarrhoea

A

FALSE
Manufacturer advises withdraw treatment if stomatitis or diarrhoea develops—may be first sign of gastro-intestinal toxicity

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3
Q

The dose of which drug should be reduced when given concurrently with azathioprine/mercaptopurine

A

Allopurinol

Xanthine oxidase inhibitor

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4
Q

What drug class does ciclosporin belong to

A

It is a calcineurin inhibitor

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5
Q

True or false:

Ciclosporin is not known to be nephrotoxic

A

FALSE

It is markedly nephrotoxic
BNF

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6
Q

Which calcineurin inhibitor has a a greater incidence of nephrotoxicity:

Ciclosporin or Tacrolimus

A

Tacrolimus

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7
Q

True or false:

Sirolimus is a calcineurin inhibitor

A

FALSE

It is a non-calcineurin inhibiting immunosuppressant

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8
Q

What are the six points of the cytotoxic drug handling guidelines

A
  1. Only reconstituted by trained personnel
  2. PPE should be worn
  3. Eyes should be protected
  4. Pregnant staff should avoid exposure to cytotoxics
  5. Monitor staff exposure to cytotoxics
  6. Can only reconstitute in designated pharmacy areas
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9
Q

Oral mucositis is more common with which cytotoxics ?

3 points

A

Fluorouracil

Methotrexate

Anthracyclines (e.g. doxorubicin)

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10
Q

_________, a cytotoxic drug side effect, occurs secondary to spontaneous or treatment related rapid destruction of malignant cells

A

Tumour lysis syndrome

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11
Q

Features of tumour lysis syndrome

4 points

A

HYPERkalaemia and HYPERuricemia

HYPOcalcaemia and HYPOphosphatemia

These may lead to renal damage

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12
Q

Which two cytotoxics do NOT cause bone marrow suppression

A

Vincristine and Bleomycin

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13
Q

True or false:

Cytotoxic chemotherapy increases VTE risk

A

True

Though it may also be a complication of the cancer itself

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14
Q

Mildly, moderately or highly emetogenic:

Fluorouracil and Vinca-alkaloids

A

Mildly

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15
Q

Mildly, moderately or highly emetogenic:

Doxorubicin, cyclophosphamide (low and intermediate dose), high dose methotrexate

A

Moderately

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16
Q

Mildly, moderately or highly emetogenic:

Platinum based chemo, dacarbazine, high dose cyclophosphamide

A

Highly

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17
Q

Which class of cytotoxics are known to be cardiotoxic

A

Anthracyclines e.g. doxorubicin

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18
Q

How long should chemoprevention with tamoxifen last for familial breast cancer

A

Maximum 5 years

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19
Q

Monitoring for amiodarone

5 points

A 
TFTs 
LFTs
K+ (causes hypokalaemia)
CXR (looking for pulmonary toxicity)
ECG
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20
Q

True or false:

Amiodarone can cause phototoxic skin reactions

A

TRUE

May cause a slate grey discolouration of the skin

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21
Q

True or false:

SOB or cough may be a sign of amiodarone toxicity

A

TRUE

Amiodarone causes pulmonary toxicity

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22
Q

Counselling points for amiodarone

A

Avoid direct sunlight. Use a wide spectrum sunscreen

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23
Q

Amiodarone May increase the concentration of which drugs

4 points

A

Coumarins (eg warfarin)

Digoxin

Flecainide

Phenytoin

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24
Q

True or false:

The effects of amiodarone stop immediately upon discontinuation

A

FALSE

due to its long half life (~50 days) the effects and potential for interactions can last for weeks-months after stopping treatment

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25
Q

What effect do ACE inhibitors and ARBs have on electrolytes

A

They cause hyperkalaemia

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26
Q

Abnormal U & Es in patients on ACE inhibitors and ARBs is a sign of _____________

A

Renal artery stenosis

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27
Q

True or false:

ACE inhibitors abs ARBs can cause jaundice

A

TRUE

they may also cause a marked elevation of hepatic enzymes

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28
Q

What are the signs of neuroleptic malignant syndrome

5 points

A

Hyperthermia

Fluctuating consciousness

Tachycardia

Labile BP

Muscle rigidity

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29
Q

Increased of EPSEs when antipsychotics are taken with:

2 points

A

Amantadine

Metoclopramide

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30
Q

True or false:

Patients taking antipsychotics should be counselled to avoid direct sunlight

A

TRUE

Photosensitisation can occur with high doses

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31
Q

What effect does the interaction between azathioprine and warfarin have

A

Decreased effect of warfarin = increased risk of blood clots

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32
Q

Azathioprine dose needs to be reduced by ______ in patients also taking allopurinol. Why?

A

Reduce by 1/4

Allopurinol inhibits the enzyme that metabolises AZ = increased risk of toxicity

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33
Q

How many categories of Antiepileptics are there?

Which category has to be prescribed by brand ?

A

3 categories

Category 1 prescribed by brand

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34
Q

What is the therapeutic range for carbamazepine

A

4 - 12 mg/L

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35
Q

What parameters need to be monitored for patients treated with carbamazepine
(3 points)

A

FBC
U & Es
LFTs

36
Q

Which electrolyte disturbance can be caused by carbamazepine

A

Hyponatraemia

37
Q

What are the signs of neutropenic sepsis (associated with chemotherapy)

(5 points)

A

Fever - 2 temp readings of greater than or equal to 37.5°C

Flu like symptoms

Unexplained bruising or bleeding

Diarrhoea and or vomiting (uncontrolled)

Mouth ulcers - prevent eating and drinking

38
Q

True or false:

Ciclosporin needs to be prescribed by brand

A

TRUE

39
Q

What kind of vaccines need to be avoided in those taking long term corticosteroids

A

LIVE vaccines

Because steroids cause immunosuppression

40
Q

True or false:

Corticosteroids are not known to cause electrolyte disturbances

A

FALSE

They may cause hypokalaemia especially alongside other drugs that reduce K+
E.g diuretics

41
Q

True or false:

Different medicinal forms of digoxin are bio equivalent

A

FALSE

See BNF for conversion

42
Q

Therapeutic range for Gentamicin

A) Peak
B) Trough

A

A) 5-10 mg/L (or 3-5 mg/L in endocarditis)

B) < 2 mg /L (or < 1 mg/L in endocarditis)

43
Q

True or false: Penicillins are not known to cause blood disorders

A

FALSE

This is a rare side effect that may be caused by penicillins and their derivatives (e.g. penicillamine used to treat autoimmune diseases such as RA)

44
Q

For how long must effective contraception be used (both M and F) after stopping methotrexate ?

A

At least 6 months

45
Q

Therapeutic range for Lithium

A
  1. 4 - 1 mmol/ L

0. 8 - 1 mmol/L for acute episodes of mania

46
Q

True or false:

Lithium does not need to be prescribed by brand

A

FALSE

Patients must be maintained on the same brand of Li as they have varying levels of bioavailability

47
Q

True or false:

Li interacts with antipyschotic drugs

A

TRUE

It increases the risk of EPSEs

48
Q

Which drug classes increase the risk of Li toxicity

4 points

A

NSAIDs
ACE inhibitors/ARBs
SSRIs
TCAs

49
Q

What is the nature of the interaction between Li and NSAIDs

A

NSAIDs decreases the renal clearance of Li = increased Li levels = increased risk of toxicity

50
Q

True or false:

Li is not known to cause thyroid abnormalities

A

FALSE

Hypothyroidism is a sign of lithium toxicity

51
Q

How often should serum Li be monitored

A

Weekly until stable
Then 3 monthly for a year
Thereafter 6 monthly

52
Q

Why should people on Lithium avoid a low salt diet

A

Li+ is similar to Na+ and the body cannot differentiate between the two. Low Na+ intake leads to increased absorption of Li+ which increases the risk of toxicity

53
Q

How long after Lithium dose do you need to wait before taking samples

A

Li samples should be taken 12 hours after the dose

54
Q

How often should monitoring occur for those on methotrexate

A

Every 1-2 weeks until stable

Then every 2 - 3 months

55
Q

True or false:

If patients develop a cough or dypnoea while taking methotrexate they should seek immediate medical attention

A

TRUE

Methotrexate causes pulmonary toxicity. These are signs of pneumonitis.

56
Q

Which drugs are known to reduce the renal excretion of methotrexate ?
(2 points)

A

Penicillins

NSAIDs

57
Q

What is the nature of the interaction between methotrexate and phenytoin

A

Phenytoin is also an anti-folate drug so additive depletion of folate levels if given alongside methotrexate

58
Q

What parameters need monitoring in those on long term NSAIDs

4 points

A
  1. BP (especially after a dose change)
  2. Renal function
  3. LFTs
  4. Hb (in those with risk factors for GI bleeds)
59
Q

True or false:

NSAIDs decrease blood pressure alongside anti-HTN drugs

A

FALSE

NSAIDs antagonise the hypotensive effects of antihypertensives

60
Q

Oral NSAIDs should be taken ______ or ________ food

A

With or just after

61
Q

Therapeutic level for phenytoin

A

10 - 20 mg/L

62
Q

Which parameters need monitoring with phenytoin use

5 points

A

1) Serum phenytoin
2) ECG and BP
3) LFTs
4) FBC
5) Folate and vitamin D

63
Q

Patients with liver impairment may show early signs of phenytoin toxicity
Why ?

A

Phenytoin is highly protein bound. In liver impairment, less protein is produced so there is more free phenytoin = increased toxicity

64
Q

What are the signs of phenytoin toxicity

5 points

A 
Ataxia 
Confusion 
Slurred speech 
Hyperglycemia 
Vision changes
65
Q

True or false:

Different formulations of phenytoin are bioequivalent

A

FALSE

They are not bioequivalent. Patient needs to be maintained on the same brand

66
Q

Therapeutic range for theophylline

A

10 - 20 mg/L

67
Q

Monitoring requirements for theophylline

2 points

A

Plasma theophylline concentration

K+

68
Q

Does theophylline cause hypo or hyper -kalaemia

A

HYPO

69
Q

Signs of theophylline toxicity

5 points

A
  1. Vomiting
  2. Tachycardia
  3. Arrhythmias
  4. Severe hypo-K+
  5. Convulsions
70
Q

What is the nature of the interaction between theophylline and B2 agonists

A

Both cause hypokalaemia -this is potentially serious

71
Q

What is the major route of elimination of theophylline

A

Hepatic

72
Q

Does smoking increase or decrease theophylline levels

A

Decreases - smoking is an enzyme inducer. Patients need to tell their doctor if they are planning to stop smoking as this affects drug levels and may lead to toxicity

73
Q

What is the trough therapeutic range for vancomycin

A

10 - 15 mg/ml

74
Q

What is the major route of elimination of vancomycin

A

Renal

70-90% is excreted unchanged in the urine

75
Q

_____ and _____ can occur if vancomycin is administered too quickly

A

Hypotension

Anaphylaxis

76
Q

Vancomycin major interactions :

A

Increased Ototoxicity and Nephrotoxicity with loop diuretics, aminoglycosides and ciclosporin

77
Q

How long must effective contraception be used for after stopping oral retinoids

A

1 month

Pregnancy must also be excluded 1 month after stopping

78
Q

What is the maximum dose of isotretinoin per course ?

How long is the course ?

A

Maximum 150 mg/kg per course

Given for at least 16 weeks

79
Q

True or false:

Retinoids can cause suicidal thoughts

A

TRUE

Psychiatric changes are a known side effect of retinoids

80
Q

How does renal/hepatic impairment affect the use of oral retinoids

A

Reduce initial dose in renal impairment

Avoid in hepatic impairment

81
Q

True or false:

Warfarin can be used during pregnancy

A

FALSE

Do not use especially in the 1st and 3rd trimesters. Can cross the placenta = increased risk of foetal malformations

82
Q

True or false:

Warfarin should not be used by breastfeeding women

A

FALSE

It is not present in large amounts in milk so appears to be safe

83
Q

What parameters should be monitored in those taking sodium valproate
(2 points)

A

LFTs

FBC

Note: therapeutic drug monitoring is not needed

84
Q

How should treatment with sodium valproate be withdrawn

A

Reduce dose gradually over at least 4 weeks

85
Q

True or false:

Valproate can cause SCARs

A

TRUE

This includes SJS

86
Q

True or false:

Valproate is not known to cause weight gain

A

FALSE

87
Q

Which tetracycline requires LFT monitoring and when would this be required?

A

Minocycline

Monitor every 3 months if the treatment is lasting longer than 6 months

High risk drugs (2 decks)

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