High Risk Drugs Flashcards
Which is not a side effect of Amiodarone
1) Corneal
2) Pulmonary
3) Hepatotoxicity
4) Phototoxicity
5) Neuropathy
6) Thyroid
7) Renal ✔
8) QTc
Which is not monitoring required for Amiodarone
1) TFT
2) LFT
3) eGFR ✔
4) Potassium
5) Chest x-ray
6) BP + ECG
7) Annual eye test
What are the main types of interaction with Amiodarone
1) Bradycardia with ‘vir’s
2) QTc drugs
3) Amiodarone inhibits CYP
4) Myopathy with statins
5) Grapefruit juice increases concentration
What is the loading dose of Amiodarone
- 200mg TD for 7 days
- 200mg BD for 7 days
- 200mg OD thereafter
What monitoring is not required with Digoxin
- Us and Es
- LFTs ✔
- Heart rate
- Serum concentration if implicated
What is the normal and toxic range for digoxin
1) 1 - 2mcg/L and 1.5-3mcg/L ✔
2) 10-20mg/L and 20-25mg/L
3) 0.4-1mcg/L and 1.5-3mcg/L
How often after a dose should digoxin concentration be measured?
1)At least 6 hours
What is not a sign of digoxin toxicity
1) Bradycardia
2) Tachycardia ✔
3) Blurred or yellow vision
4) Confusion
5) nausea, vomiting, abdominal pain
6) Skin rash
Which is not a risk predisposing digoxin toxicity
1) Hypokalaemia
2) Hypomagnesaemia
3) Hypoxia
4) Hypercalcaemia
5) Hypocalcaemia ✔
6) Renal impairment
What are the main interactions of digoxin
1) Hypokalaemia causing drugs
2) CYP Inducers and Inhibitors
3) Drugs that cause renal impairment
What is an appropriate serum Lithium concentration for a prophylaxis dose or elderly patient
-0.4-1mmol/L
What is an appropriate Lithium concentration for a patient with acute mania or who has relapsed?
-0.8-1mmol/L
How long after a dose should Lithium concentration be taken
1) 6 hours
2) 18 hours
3) 12 hours ✔
Over how long should Lithium be withdrawn
1) 4 weeks ✔
2) 4 months
3) 6 weeks
Which is not a sign of Lithium toxicity
1) Renal issues
2) extrapyramidal effects and coarse tremor
3) Visual issues
4) CNS issues and drunk-like behaviour
5) GI issues
6) Liver toxicity ✔
Which is not a side effect of Lithium
1) thyroid disorders
2) Renal impairment
3) Benign intracranial hypertension
4) Jaundice ✔
5) QTc
6) Decreased seizure threshold
7) Rhabdomyolysis
Why is fluctuating salt intake dangerous with Lithium
-Hyponatraemia predisposes toxicity
Which of the following is not an interaction with Lithium
1) QTc/Hypokalaemia causing drugs
2) Neurotoxic and serotonergic drugs
3) NSAIDs, diuretics and other drugs that reduce renal clearance
4) Sodium Bicarbonate decreases concentration
5) Drugs that cause Hyponatraemia
6) Drugs that cause hyperkalaemia ✔
7) Drugs that cause extrapyramidal effects
8) Drugs affecting salt balance (antacids, soluble products)
Lithium is safe in pregnancy and breastfeeding, true or false
False - unsafe in both
Outline Lithium serum concentration monitoring
- Monitor weekly until stable
- Then 3 monthly for 12 months
- Then 6 monthly thereafter
- Or 3 monthly if high risk
What type of seizures can Phenytoin worsen
-Absence and myoclonic
What is the serum concentration for phenytoin
1) 10-20mg/L and 6-15mg/L if reduced protein binding ✔
2) 0.4-1mcg/L and 0.8-1mcg/L if reduced binding
3) 4-12mg/L and 2-8mg/L in reduced binding
Which is not a side effect of phenytoin
1) Blood dyscrasias and bone marrow suppression
2) Rash
3) Change in appearance
4) Decreased vitamin D levels
5) Hepatotoxicity
6) Suicidal ideation
7) Antifolate effects
8) renal impairment ✔
9) Hepatotoxicity
10) AEHS
100mg phenytoin sodium is equivalent to how much phenytoin base
92mg
Which is false about fosphenytoin
1) It is a phenytoin prodrug
2) It can be given orally ✔
3) It can be given IM and IV
4) Prescriptions must state phenytoin sodium equivalent
5) IV use can cause severe CVS reactions
6) 1.5mg fosphenytoin = 1mg phenytoin sodium
What are the main phenytoin interactions
1) CYP Inducer
2) CYP metabolite
3) Drugs that lower seizure threshold
Which types of seizures does carbamazepine not worsen
1) Atonic
2) Tonic clonic ✔
3) Clonic
4) Myoclonic
When should carbamazepine concentration be measured
1) After 6 hours
2) After 12 hours
3) After 1-2 weeks ✔
What should the concentration of carbamazepine be
1) 4-12MG/l ✔
2) 0.4-1mcg/L
3) 10-20mg/L
Which is not a side effect of carbamazepine
1) Blood dyscrasias and bone marrow suppression
2) Rash
3) Hypernatremia ✔
4) AEHS
5) Hepatotoxicity
6) Suicidal ideation
7) Neurotoxic
8) Hyponatraemia
9) Hepatotoxicity
Which is not a sign of carbamazepine toxicity
1) Lack of coordination
2) Hyponatraemia
3) Visual disorders
4) Arrhythmias
5) GI issues
6) Ataxia
7) Alertness increased ✔
Which is not an interaction with carbamazepine
1) CYP Inducer
2) CYP metabolite
3) Hyponatraemia causing drugs
4) Hepatotoxic drugs
5) Seizure threshold lowering drugs
6) Hyperkalaemia causing drugs ✔
Carbamazepine and Phenytoin must be prescribed by brand (Category 1), true or false
True
Sodium valproate must be prescribed by brand, true or false
False, but it is a category 2 so should generally be
What type of seizures is valproate first line for
Generalised
Which is not a side effect of valproate
1) Hepatotoxicity
2) Prolonged prothrombin time
3) Blood dyscrasias and bone marrow suppresssion
4) Pancreatitis
5) Decreased vitamin D
6) Renal failure ✔
7) Weight gain
Sodium valproate is a CYP inducer, like carbamazepine and phenytoin, true or false
False, it is an inhibitor
Which is not a side effect of theophylline
1) Neurotoxicity
2) Hypokalaemia
3) Muscular issues ✔
4) CVS and GI effects
5) Hyperuricaemia
What should the concentration of theophylline be
1) 4-12MG/l
2) 0.4-1mcg/L
3) 10-20mg/L ✔
When should theophylline concentration be measured
-After 5 days, or 3 after a dose change. Take sample 4-6 hours after a dose
If someone was vomiting, with arrhythmias, dilated pupils, hypokalaemia, hyperglycaemia and convulsions, which drug would this indicate toxicity of?
1) Phenytoin
2) Digoxin
3) Theophylline ✔
4) Carbamazepine
5) Valproate
Which would not increase theophylline concentration
1) Caffeine
2) Heart failure
3) Smoking ✔
4) Viral infection
5) CYP Inhibitors
6) Hepatic impairment
Which would not decrease theophylline concentration
1) Smoking
2) Caffeine ✔
3) Alcohol
4) CYP Inducers
