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GPHC Exam 2021/22 > High Risk Drugs > Flashcards

High Risk Drugs Flashcards

1
Q

Loading dose for amiodarone

A

200mg TDS 7 days
200mg BD 7 days
200mg daily maintenance

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2
Q

Side effects & sign of toxicity with amiodarone

A 
***Pulmonary toxicity***
Corneal micro deposits - reversible 
Phytotoxicity -Grey discolouration 
Hypo/hyper thyroidism 
HEPATIC

Tremor
Sleep disturbance
Arrythmia
Nausea

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3
Q

Monitoring Amiodarone & duration

A 
LFTs 
Thyroid - before & every 6 months 
Potassium - before treatment 
Chest X-ray - before 
ECG
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4
Q

Patient advice with Amiodarone

A

Shield from sunlight & use wide spectrum sun cream
Warn drivers dazzled from headlights at night
Warn pt clinical effects may occur few months after stopping treatment - long half life 60-142days

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5
Q

Interaction of amiodarone

Enzyme inhibitor

A

Amiodarone & warfarin - amiodarone inhibit warfarin metabolism - enhanced anticoagulantion effect

Amiodarone & b blocker - increased risk of bradycardia, AV block and myocardial depression

Amiodarone & lithium - risk of arrhythmia

Amiodarone & ciclosporin & digoxin - plasma concentration ciclosporin & digoxin increased by amiodarone

Orlistat - reduces plasma conc of amiodarone

Statin - increased myopathy

AVOID GRAPEFRUIT JUICE

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6
Q

Digoxin therapeutic range

Cardiac glycosides - used in AF, tachycardia & heart failure
Increases force of myocardial contraction

A

0.8 - 2mcg/L

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7
Q

Digoxin monitoring

A

Electrolytes - K+, Mg+ and Ca+
Heart rate
Renal function

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8
Q

Which electrolyte causes digoxin toxicity?

A

Potassium
HYPOkalaemia

Manage by potassium sparing diuretic or potassium supplement to increase potassium

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9
Q

Symptoms of digoxin toxicity?

A

Cardiac block, arrhythmia
Lethargy, weakness, confusion
N&V, abdominal pain, diarrhoea
Blurred vision - YELLOW vision

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10
Q

Interactions of Digoxin

A

Amiodarone - plasma conc of digoxin increased by amiodarone

Erythromycin - plasma conc of digoxin increased by erythromycin

Rifampicin - plasma conc of digoxin reduced

Diuretics - toxicity if HYPOkalameia occurs

CCB - plasma conc of digoxin increased by ccb

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11
Q

Therapeutic range for Lithium?

Treats - mania, bipolar, recurrent depression

A

0.4-1 mmol/L

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12
Q

Lithium monitoring

THYROID

A

Lithium concentration - every 3 months
Renal & Thyroid - every 6-12 months
Cardiac function

Maintain sodium levels - hyponatraemia

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13
Q

Toxic symptoms of lithium?

A 
Fine tremor 
Nystagmus 
Hypothyroidism 
Hypertension 
Slurred speech 
Convulsions 
Blurred vision
Confusion
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14
Q

Counselling points of Lithium

A 
Same brand 
Maintain sodium levels 
OTC interactions - Gaviscon 
Avoid alcohol 
Driving - sleepy 
Do not stop unless told by DR
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15
Q

Lithium interactions

A

ACEi & NSAIDS, metronidazole, SSRI, excretion of lithium reduced by ace results lithium toxicity

Diuretics - sodium depletion hyponatraemia

Amiodarone - risk of ventricular arrhythmia

EPS - clozapine , haloperidol, risperidone, flupentixol

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16
Q

Monitoring of methotrexate?

A

FBC - blood dycrasias
LTFS - report abdominal pain, jaundice, dark urine test before treatment
Pulmonary - cough, fever, shortness of breath
Renal - toxic

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17
Q

Counselling point for methotrexate?

A

Pregnancy - wait 6 months before attempting to conceive & protection whilst on treatment

Annual flu vaccine - NOT LIVE

Avoid NSAID, IBUPROFEN, aspirin - if given rx monitor concentration closely

Folic acid - prevent methotrexate included mucositis or myleosupression. Not given at same time

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18
Q

Methotrexate interactions

A

Acitretin - risk of hepatotoxity

NSAIDS, penicillin, ciprofloxacin, doxycycline, tetracycline, sufonamides, cicosporin , PPI, lefunomide, aspirin

Haematological toxicity - co-trimoxazole & trimethoprim

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19
Q

Therapeutic range for Phenytoin?

A

10 to 20mg/L

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20
Q

Monitoring Phenytoin?

A 
Serum concentration 
ECG 
Blood pressure 
Liver function 
FBC
Vitamin D
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21
Q

Symptoms of toxicity Phenytoin?

With or after food

A 
Hyperglycaemia, blurred vision 
Skin rash disorders 
Blood disorders - fever, sore throat, brushing, bleeding, mouth ulcers 
Excessive hair - on face 
Constipation 
Low vit D - rickets, osteomalacia
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22
Q

Interactions Pheytoin

A

NSAIDs - effects of phenytoin enhanced

Amiodarone - inhibits metabolism of phenytoin

Warfarin - phenytoin accelerate metabolism of warfarin

Cimetidine - inhibits metabolism of phenytoin

Fluoxetine - plasma conc of phenytoin increased by fluoxetine

Inducers - reduce plasma conc phenytoin

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23
Q

Therapeutic range for Theophylline?

A

10-20mg\L

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24
Q

Monitoring for Theophylline?

A

Plasma concentration
Lung function
Serum potassium

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25
Symptoms of Theophylline | Hyperglycaemia
``` Tachycardia HYPOkalameia Hyperglycaemia Agitation Conclusion ``` Chest - wheeze, tight chest, cough
26
Theophylline councelling?
OTC - avoid fluconazole & Brand only Inform GP before starting/ stopping smoking
27
Theophylline interactions
Quinolones - risk of convulsions St. John/rifampicin - conc of theophylline reduced Fluconazole/macrolide/contraception- conc of theophylline increased Beta 2 agonist - HYPOkalameia Diuretics /steroids - severe asthma potentiated
28
Warfarin INR takes 48-72hrs for anticoagulation effect to develop fully
Bleeding major or minor INCREASED INR - stop warfarin - vit k IV - restart warfarin INR less 5 - repeat if INR still high after 24h No bleed INR LOW - risk of clot INR >8 stop warfarin ORAL vit k restart warfarin INR <5 INR 5-8 - withhold 1 -2 doses of warfarin Reduce maintenance dose Measure INR 2-3days after
29
Antidote for Warfarin?
Phytomenadione
30
Dose of warfarin?
Begin - 5-10mg first day measure 1-2 days Maintenance - 3-9mg take same time each day Monitor - every 3 months
31
Warfarin monitoring
INR | Renal function
32
Side effects of warfarin?
Calciphylaxis - painful rash | Alopecia, drop in packed cell (haematocrit), purple toes, jaundice , hepatic dysfunction
33
Counselling of Warfarin?
Take same time each day, avoid major dietary changes (vegs and salad) same portion everyday Report signs of bleeding Avoid alcohol Avoid cranberry juice pomegranate juice = increase INR Avoid - Miconazole oral gel = bleeding
34
Interactions of Warfarin?
Anticoagulation effect increase - bleeding AMOX - monitor INR & adjust dose - NSAIDS - SSRI - fluconazole - statins - metronidazole - macrolides - CHANGE RX - ciprofloxacin - cranberry juice Anticoagulation effect reduced - clot - St. John’s wort - antiseptic meds - rifampicin - alcohol Anticoagulant effect antagonised - vit k
35
Carbamazepine therapeutic range?
4-12mg/L
36
Monitoring for Carbamazepine?
FBC Renal function Liver function
37
Symptoms of toxicity carbamazepine?
``` Hyponatraemia Arrhythmia Blurred vision Drowsiness N&v - diarrhoea ``` ``` Leukopenia Thrombocytopenia - sore throat, bruising Skin - ulcers, rash Hepatic disorder Fever, rash, swollen lymph nodes ```
38
Counselling for carbamazepine ?
Brand only - cat 1 Driving - inform DVLA if 1 seizure wait 12 months before can drive OTC - avoid ibuprofen, orlistat (risk of convulsion), contraceptives (effect reduced by carbamazepine)
39
Interactions of Carbamazepine?
Inhibitors - plasma conc increased - macrolides - fluoxetine Inducers - plasma conc decreased - phenytoin - rifabutin - St. John’s wort Carbamazepine reduces plasma conc of statin, contraception, steroids, eplerenone and antipsychotics
40
Azathioprine monitoring
Full blood count Renal function Liver function TPMT - before initiation to check, if low or absent level pt will be at risk of myelosuppression Reduce dose in elderly
41
Symptoms of azathioprine
Hypersensitive - fever, myalgia, rash, diarrhoea, dizziness Hypotension N&V Unexplained bruising bleeding infection
42
Gentamicin Indication? | Aminoglycosides
Endocarditis Sepsis Meningitis Pneumonia
43
Therapeutic range gentamicin?
Peak post dose 5-10mgL (3 to 5mg/L for endocarditis) Trough Pre dose <2mg /L (<1mg for endocarditis)
44
Monitoring gentamicin?
Plasma Renal Auditory & vestibular function Blood samples taken 1h after admin IV OR IM & just before next dose
45
Symptoms of Gentamicin? | Keep hydrated
Increased risk of ototoxicity (with loop diuretics & vancomycin) Nephrotoxicity ( cephalosporin, vancomycin, cyclosporin, NSAIDS
46
Vancomycin therapeutic range? Cdiff treatment
10-20mgL
47
Vancomycin monitoring?
``` FBC Renal Liver Urinalysis Auditory ```
48
Vancomycin symptoms?
Auditory - tinnitus, vertigo, dizziness STOP RED MAN SYNDROME (no flu symptoms just red rash) Blood disorder - fever, sore throat, neutropenia, thrombocytopenia Nephrotoxicity - increased serum creatinine
49
Vancomycin interactions
Auditory - loop, cyclosporin, amino glycosides (gentamicin)
50
Tacrolimus monitoring? Treats prevention of organ rejection following organ transplant
``` Blood pressure FBC ECG Fasting blood glucose Renal Liver Potassium level ```
51
Tacrolimus symptoms? | Hyperglycaemia
``` Tremor headache Blood disorders - skin Liver toxicity Hyperglycaemia Nephrotoxicity CVD - cardiac disorders arrhythmia, high blood pressure ```
52
Tacrolimus Counselling?
53
Tacrolimus interaction?
54
Antipsychotic monitoring
``` FBC urea & electrolytes Liver Fasting blood glucose Blood lipids Blood pressure Weight ECG ```
55
Antipsychotic monitoring
56
Antipsychotic interaction
57
Azathioprine Interactions Avoid live vaccine W/ traclimus too
Give 25% 1/4 usual dose of azathioprine with allopurinol
58
Sodium Valproate Monitoring
Liver FBC weight BMI
59
Sodium Valproate symptoms?
N&V Liver toxicity Loss of seizure control Suicidal thought
60
Sodium valproate counselling
61
Sodium valproate Interactions
62
Steroids monitoring
63
Steroids symptoms
64
Steroids counselling
65
Steroids interactions
66
Ferrous sulphate side effect?
Constipation Black stools TAKE AFTER FOOD - reduces GI effects Vit c helps to increase amount of iron metabolised by body AVOID magnesium hydroxide - impairs iron
67
Spironolactone & Furosemide
Hyponatraemia
68
SSRI & amiodarone
Hyperkalameia
69
Wounds & dressings
70
Which DPP4i has less effect on renal function?
Linagliptin
71
Safe guarding four principles?
1) Neglet 2) emotional abuse 3) physical abuse 4) sexual abuse
72
Impetigo which treatment? | Once on antibiotics can go back to school work after 2 days of treatment
Bollus - oral anitobotic | Non bollus local no spread - topical
73
GPHC registration Purpose - encourage professionals think about how they meet standards pharmacy professional
6 4 CPD entries plus 1 peer discussion & 1 reflective account 2 planned activity in the 4 entries
74
Which laxative not to be taken before bed?
Bulk - isphagula husk Needs a lot of fluid Also not suitable for dehydrated patient
75
Folic 5mg
Pregnancy Weight , mobility’s Can supply doesn’t need blood test prior to rx
76
Pseudoephrine & MOAi
Hypertensive crises
77
Pseudoephrine & beta blocker
Increased hypertension
78
Steroids short term & long term side effects
Short - psychosis, depression, GI Long term - cataract, osteo, weight

GPHC Exam 2021/22 (4 decks)

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