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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
Q

Symptoms of Theophylline

Hyperglycaemia

A 
Tachycardia 
HYPOkalameia 
Hyperglycaemia 
Agitation
Conclusion

Chest - wheeze, tight chest, cough

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26
Q

Theophylline councelling?

A

OTC - avoid fluconazole &
Brand only
Inform GP before starting/ stopping smoking

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27
Q

Theophylline interactions

A

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

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28
Q

Warfarin INR

takes 48-72hrs for anticoagulation effect to develop fully

A

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

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29
Q

Antidote for Warfarin?

A

Phytomenadione

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30
Q

Dose of warfarin?

A

Begin - 5-10mg first day measure 1-2 days
Maintenance - 3-9mg take same time each day
Monitor - every 3 months

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31
Q

Warfarin monitoring

A

INR

Renal function

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32
Q

Side effects of warfarin?

A

Calciphylaxis - painful rash

Alopecia, drop in packed cell (haematocrit), purple toes, jaundice , hepatic dysfunction

33
Q

Counselling of Warfarin?

A

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
Q

Interactions of Warfarin?

A

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
Q

Carbamazepine therapeutic range?

36
Q

Monitoring for Carbamazepine?

A

FBC
Renal function
Liver function

37
Q

Symptoms of toxicity carbamazepine?

A 
Hyponatraemia 
Arrhythmia 
Blurred vision
Drowsiness 
N&v - diarrhoea 
Leukopenia 
Thrombocytopenia - sore throat, bruising 
Skin - ulcers, rash 
Hepatic disorder 
Fever, rash, swollen lymph nodes
38
Q

Counselling for carbamazepine ?

A

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
Q

Interactions of Carbamazepine?

A

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
Q

Azathioprine monitoring

A

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
Q

Symptoms of azathioprine

A

Hypersensitive - fever, myalgia, rash, diarrhoea, dizziness

Hypotension

N&V

Unexplained bruising bleeding infection

42
Q

Gentamicin Indication?

Aminoglycosides

A

Endocarditis
Sepsis
Meningitis
Pneumonia

43
Q

Therapeutic range gentamicin?

A

Peak post dose
5-10mgL (3 to 5mg/L for endocarditis)

Trough Pre dose
<2mg /L (<1mg for endocarditis)

44
Q

Monitoring gentamicin?

A

Plasma
Renal
Auditory & vestibular function

Blood samples taken 1h after admin IV OR IM & just before next dose

45
Q

Symptoms of Gentamicin?

Keep hydrated

A

Increased risk of ototoxicity (with loop diuretics & vancomycin)

Nephrotoxicity ( cephalosporin, vancomycin, cyclosporin, NSAIDS

46
Q

Vancomycin therapeutic range?

Cdiff treatment

47
Q

Vancomycin monitoring?

A 
FBC
Renal 
Liver 
Urinalysis 
Auditory
48
Q

Vancomycin symptoms?

A

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
Q

Vancomycin interactions

A

Auditory - loop, cyclosporin, amino glycosides (gentamicin)

50
Q

Tacrolimus monitoring?

Treats prevention of organ rejection following organ transplant

A 
Blood pressure 
FBC
ECG
Fasting blood glucose 
Renal
Liver 
Potassium level
51
Q

Tacrolimus symptoms?

Hyperglycaemia

A 
Tremor headache 
Blood disorders - skin 
Liver toxicity 
Hyperglycaemia 
Nephrotoxicity 
CVD - cardiac disorders arrhythmia, high blood pressure
52
Q

Tacrolimus Counselling?

53
Q

Tacrolimus interaction?

54
Q

Antipsychotic monitoring

A 
FBC 
urea & electrolytes 
Liver 
Fasting blood glucose 
Blood lipids 
Blood pressure 
Weight 
ECG
55
Q

Antipsychotic monitoring

56
Q

Antipsychotic interaction

57
Q

Azathioprine Interactions
Avoid live vaccine
W/ traclimus too

A

Give 25% 1/4 usual dose of azathioprine with allopurinol

58
Q

Sodium Valproate Monitoring

A

Liver
FBC
weight
BMI

59
Q

Sodium Valproate symptoms?

A

N&V
Liver toxicity
Loss of seizure control
Suicidal thought

60
Q

Sodium valproate counselling

61
Q

Sodium valproate Interactions

62
Q

Steroids monitoring

63
Q

Steroids symptoms

64
Q

Steroids counselling

65
Q

Steroids interactions

66
Q

Ferrous sulphate side effect?

A

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
Q

Spironolactone & Furosemide

A

Hyponatraemia

68
Q

SSRI & amiodarone

A

Hyperkalameia

69
Q

Wounds & dressings

70
Q

Which DPP4i has less effect on renal function?

A

Linagliptin

71
Q

Safe guarding four principles?

A

1) Neglet
2) emotional abuse
3) physical abuse
4) sexual abuse

72
Q

Impetigo which treatment?

Once on antibiotics can go back to school work after 2 days of treatment

A

Bollus - oral anitobotic

Non bollus local no spread - topical

73
Q

GPHC registration

Purpose - encourage professionals think about how they meet standards pharmacy professional

A

6
4 CPD entries plus 1 peer discussion & 1 reflective account

2 planned activity in the 4 entries

74
Q

Which laxative not to be taken before bed?

A

Bulk - isphagula husk
Needs a lot of fluid

Also not suitable for dehydrated patient

75
Q

Folic 5mg

A

Pregnancy
Weight , mobility’s

Can supply doesn’t need blood test prior to rx

76
Q

Pseudoephrine & MOAi

A

Hypertensive crises

77
Q

Pseudoephrine & beta blocker

A

Increased hypertension

78
Q

Steroids short term & long term side effects

A

Short - psychosis, depression, GI

Long term - cataract, osteo, weight

GPHC Exam 2021/22 (4 decks)

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