High Risk Drugs

Question 1

Which is not a side effect of Amiodarone

Answer 1

1) Corneal
2) Pulmonary
3) Hepatotoxicity
4) Phototoxicity
5) Neuropathy
6) Thyroid
7) Renal ✔
8) QTc

Question 2

Which is not monitoring required for Amiodarone

Answer 2

1) TFT
2) LFT
3) eGFR ✔
4) Potassium
5) Chest x-ray
6) BP + ECG
7) Annual eye test

Question 3

What are the main types of interaction with Amiodarone

Answer 3

1) Bradycardia with ‘vir’s
2) QTc drugs
3) Amiodarone inhibits CYP
4) Myopathy with statins
5) Grapefruit juice increases concentration

Question 4

What is the loading dose of Amiodarone

Answer 4

• 200mg TD for 7 days
• 200mg BD for 7 days
• 200mg OD thereafter

Question 5

What monitoring is not required with Digoxin

Answer 5

• Us and Es
• LFTs ✔
• Heart rate
• Serum concentration if implicated

Question 6

What is the normal and toxic range for digoxin

Answer 6

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

Question 7

How often after a dose should digoxin concentration be measured?

Answer 7

1)At least 6 hours

Question 8

What is not a sign of digoxin toxicity

Answer 8

1) Bradycardia
2) Tachycardia ✔
3) Blurred or yellow vision
4) Confusion
5) nausea, vomiting, abdominal pain
6) Skin rash

Question 9

Which is not a risk predisposing digoxin toxicity

Answer 9

1) Hypokalaemia
2) Hypomagnesaemia
3) Hypoxia
4) Hypercalcaemia
5) Hypocalcaemia ✔
6) Renal impairment

Question 10

What are the main interactions of digoxin

Answer 10

1) Hypokalaemia causing drugs
2) CYP Inducers and Inhibitors
3) Drugs that cause renal impairment

Question 11

What is an appropriate serum Lithium concentration for a prophylaxis dose or elderly patient

Answer 11

-0.4-1mmol/L

Question 12

What is an appropriate Lithium concentration for a patient with acute mania or who has relapsed?

Answer 12

-0.8-1mmol/L

Question 13

How long after a dose should Lithium concentration be taken

Answer 13

1) 6 hours
2) 18 hours
3) 12 hours ✔

Question 14

Over how long should Lithium be withdrawn

Answer 14

1) 4 weeks ✔
2) 4 months
3) 6 weeks

Question 15

Which is not a sign of Lithium toxicity

Answer 15

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 ✔

Question 16

Which is not a side effect of Lithium

Answer 16

1) thyroid disorders
2) Renal impairment
3) Benign intracranial hypertension
4) Jaundice ✔
5) QTc
6) Decreased seizure threshold
7) Rhabdomyolysis

Question 17

Why is fluctuating salt intake dangerous with Lithium

Answer 17

-Hyponatraemia predisposes toxicity

Question 18

Which of the following is not an interaction with Lithium

Answer 18

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)

Question 19

Lithium is safe in pregnancy and breastfeeding, true or false

Answer 19

False - unsafe in both

Question 20

Outline Lithium serum concentration monitoring

Answer 20

• Monitor weekly until stable
• Then 3 monthly for 12 months
• Then 6 monthly thereafter
• Or 3 monthly if high risk

Question 21

What type of seizures can Phenytoin worsen

Answer 21

-Absence and myoclonic

Question 22

What is the serum concentration for phenytoin

Answer 22

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

Question 23

Which is not a side effect of phenytoin

Answer 23

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

Question 24

100mg phenytoin sodium is equivalent to how much phenytoin base

Answer 24

92mg

Question 25

Which is false about fosphenytoin

Answer 25

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

Question 26

What are the main phenytoin interactions

Answer 26

1) CYP Inducer
2) CYP metabolite
3) Drugs that lower seizure threshold

Question 27

Which types of seizures does carbamazepine not worsen

Answer 27

1) Atonic
2) Tonic clonic ✔
3) Clonic
4) Myoclonic

Question 28

When should carbamazepine concentration be measured

Answer 28

1) After 6 hours
2) After 12 hours
3) After 1-2 weeks ✔

Question 29

What should the concentration of carbamazepine be

Answer 29

1) 4-12MG/l ✔
2) 0.4-1mcg/L
3) 10-20mg/L

Question 30

Which is not a side effect of carbamazepine

Answer 30

1) Blood dyscrasias and bone marrow suppression
2) Rash
3) Hypernatremia ✔
4) AEHS
5) Hepatotoxicity
6) Suicidal ideation
7) Neurotoxic
8) Hyponatraemia
9) Hepatotoxicity

Question 31

Which is not a sign of carbamazepine toxicity

Answer 31

1) Lack of coordination
2) Hyponatraemia
3) Visual disorders
4) Arrhythmias
5) GI issues
6) Ataxia
7) Alertness increased ✔

Question 32

Which is not an interaction with carbamazepine

Answer 32

1) CYP Inducer
2) CYP metabolite
3) Hyponatraemia causing drugs
4) Hepatotoxic drugs
5) Seizure threshold lowering drugs
6) Hyperkalaemia causing drugs ✔

Question 33

Carbamazepine and Phenytoin must be prescribed by brand (Category 1), true or false

Answer 33

True

Question 34

Sodium valproate must be prescribed by brand, true or false

Answer 34

False, but it is a category 2 so should generally be

Question 35

What type of seizures is valproate first line for

Answer 35

Generalised

Question 36

Which is not a side effect of valproate

Answer 36

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

Question 37

Sodium valproate is a CYP inducer, like carbamazepine and phenytoin, true or false

Answer 37

False, it is an inhibitor

Question 38

Which is not a side effect of theophylline

Answer 38

1) Neurotoxicity
2) Hypokalaemia
3) Muscular issues ✔
4) CVS and GI effects
5) Hyperuricaemia

Question 39

What should the concentration of theophylline be

Answer 39

1) 4-12MG/l
2) 0.4-1mcg/L
3) 10-20mg/L ✔

Question 40

When should theophylline concentration be measured

Answer 40

-After 5 days, or 3 after a dose change. Take sample 4-6 hours after a dose

Question 41

If someone was vomiting, with arrhythmias, dilated pupils, hypokalaemia, hyperglycaemia and convulsions, which drug would this indicate toxicity of?

Answer 41

1) Phenytoin
2) Digoxin
3) Theophylline ✔
4) Carbamazepine
5) Valproate

Question 42

Which would not increase theophylline concentration

Answer 42

1) Caffeine
2) Heart failure
3) Smoking ✔
4) Viral infection
5) CYP Inhibitors
6) Hepatic impairment

Question 43

Which would not decrease theophylline concentration

Answer 43

1) Smoking
2) Caffeine ✔
3) Alcohol
4) CYP Inducers