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High Risk Drugs Flashcards

1
Q

Which factors govern the choice of antibiotics?

A

Allergy, renal impairment, hepatic impairment, susceptibility to infection/complications, severity of illness, route of administration, female, culture and sensitivity

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2
Q

What is an important side effects of penicillins

A

Hypersensitivity reactions: important side effect can cause rashes and anaphylaxis which can be fatal. Patients who are allergic to one will be allergic to all. Cross-sensitivity with cephalasporins can occur

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3
Q

What should happen in the case of a penicillin allergy?

A

History of anaphylaxis or rash after admin should not be given it again in future. All anaphylactic reactions should be referred to a and e and patients told to stop tx

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4
Q

What can occur with co-amoxiclav

A

Cholestatic jaundice either during or shortly after use. More common in patients over 65 and men. Jaundice is self limiting and rarely fatal.

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5
Q

What is a common interaction with amoxicillin?

A

Methotrexate

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6
Q

When is flucloxacillin usually used?

A

Ottis externa, impetigo and cellulitis

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7
Q

What can occur with flucloxacillin?

A

Very rarely cholestatic jaundice and hepatitis. Administration for more than 2 weeks and increasing age are risk factors. Should not be used in patients with a hx of hepatic dysfunction associated with flucloxacillin

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8
Q

What are is the cautionary advisory label for flucloxacillin?

A

Take on an empty stomach. An hour before or two hours after food

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9
Q

What is the cautionary advisory label for pen v?

A

Take on an empty stomach. An hour before or two hours after food

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10
Q

What is an issue with cephalosporins?

A

They can encourage rapid overgrowth of some microorganisms that are neither eliminated nor inhibited by therapy eg mrsa or c.diff

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11
Q

What can decrease the absorption of tetracyclines?

A

Antacids, aluminium, calcium, iron, magnesium and zinc salts

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12
Q

What are the contraindications for tetracyclines?

A

Deposition of tetracyclines in growing bones and teeth causes staining and should not be given to children under 12 or pregnant/breast feeding women

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13
Q

What can tetracyclines cause during the first trimester?

A

Effects on skeletal development

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14
Q

What can tetracyclines cause during the second or third trimester?

A

Discolouration of teeth

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15
Q

Which tetracyclines can be taken with milk?

A

Doxycycline
Lymecycline
Monocycline

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16
Q

Which tetracyclines should be taken on an empty stomach?

A

Demeclocycline
Oxytetracycline
Tetracycline

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17
Q

Which tetracyclines can be taken with milk?

A

Doxycycline, Lymecycline, minocycline

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18
Q

What is the general advice with tetracyclines?

A

Do not take iron or zinc containing medications 2 hours before or after
sit upright
whole glass of water

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19
Q

What is the patient advice for dymecycline and doxycycline?

A

Protect the skin from sunlight/UV light

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20
Q

What is a significant side effect of erythromycin?

A

Nausea, vomitting and diarrhoea. Can be reduced by giving 250mg qds

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21
Q

Which macrolide causes fewer gi side effects?

A

Clindamycin

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22
Q

What is azithromycin used for?

A

Prophylaxis in chronic resp conditions 3x a week

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23
Q

Discuss the use of clindamycin?

A

Well concentrated in the bone, recommend for joint and bone infections. Associated with potentially fatal collits

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24
Q

What are the contraindications of nitrofurantoin?

A

Not at full term in pregnancy, not in egfr below 45

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25
What is a common side effect for nitrofurantoin?
Can discolour urine brown
26
When should nitrofurantoin be taken?
With food, or just after a meal
27
What should patients/carers look out for with long term tx with trimethoprim?
Blood disorders: fever, sore throat, rash, mouth ulcers, bruising, bleeding
28
Can trimethoprim be used in pregnancy?
Risk of teratogenicity in the first trimester
29
What is a side effect of trimethoprim?
Hyperkalaemia
30
What are the cautionary advisory labels for metronidazole?
- avoid alcohol - take with or just after food - do not chew or crush - swallow with a glass of water
31
What are the cautions with quinolones?
- epilepsy - can induce seizures even in patients not susceptible to them and taking NSAIDs at the same time can increase the risk - avoid exposure to sunlight - tendon damage common in over 60s/ concomitant use of ccs/nsaids
32
What are the cautionary advisory labels for ciprofloxacin?
Do not take milk, indigestion remedies, or medicines containing iron or zinc, 2 hours before or after you take this medicine Swallow this medicine whole. Do not chew or crush
33
How are aminoglycosides administered?
They are given IV as not absorbed from the gut
34
What toxicity can aminoglycosides cause?
Renal, oto
35
Who can get chloramphenicol otc?
2+, not usually pregnancy/breast feeding
36
What can chloramphenicol cause if given systemically?
Severe haematological adverse effects
37
Which medications can increase the INR with warfarin?
SSRIS, PPIs, statins. Enxyme inhibitors: erythromycin, miconazole, amiodarone, cimetidine
38
Which medications can decrease INR?
St johns wart, carbamazepine, rifampicin, phenytoin
39
How can NSAIDs affect warfarin?
Do not necessarily after INR but bleed risk increases significantly. same for antiplatelets
40
What can cranberry juice do to warfarin?
Enhance the anticoagulant effect
41
What is the starting dose of dabigatran?
150mg bd reduced dose based on age, renal impairment, bleed risk
42
What is the starting dose of apixaban?
- in AF 5mg bd - tx of dvt 10mg bd then 5mg bd - prophylaxis dvt 2.5mg bd
43
What is the starting dose of edoxoban?
60mg daily 30mg if less than 60kg or renal impairment
44
What is the starting dose of rivaroxban
- af 20mg od - tx dvt - 15mg for 7 days then 20mg od - prophylaxis dvt 10mg od increasing to 20
45
Which drugs increase the risk of haemhorrage with DOACs?
NSAIDs, anticoagulants, antiplatelets, SSRIS, steroids
46
Which drugs increase the plasma conc of noac?
Antifungals, diltiazem, verapamil, amiodarone, dronaderone
47
Which drugs decrease the plasma conc of doacs?
Rifampacin, carbamazepine, phenytoin, phenobarb, st johns wort
48
What is the antidote for dabigatran?
Idarucizumab
49
What is the antidote for rivoroxaban/apixaban
Andexant alfa
50
Which drug is given for for primary prevention in high risk pts
Aspirin unlicensed is considered in 10 year risk over 20%.
51
Which antiplatelet is given as secondary prevention in stroke/ TIA
Clopidogrel
52
Which antiplatelet is given as secondary prevention following MI
DAPT (Aspirin + x) ticragrelor in medically managed clopidogrel in surgery
53
Which antiplatelet is used in angina?
aspirin
54
Which antiplatelet is used in acute coronary syndromes?
DAPT
55
What is stage 1 htn?
140/90 to 159/99 clinic or 135/85 to 149/94 ambulatory
56
What is stage 2 htn?
160/100 to 180/120mmHg clinic or over 150/95mmHg ambulatory
57
What is the bp target for <80 with treated htn
below 140/90 mmHg
58
What is the bp target for >80
below 150/90 mmHg
59
What is the bp target in diabetes
140/80 in diabetes (130/80 if kidney, eye damage)
60
What are the side effects of acei?
Vasodilation, first dose hypotension, falls risk, dry cough, hyperkalaemia, angiodema, aki, protective in diabetes but avoid in renal artery stenosis
61
What are the side effects of ccb?
Vasodilation, ankle swelling, flushing, grapefruit juice, amlodipine and simv interaction and falls risk
62
When are diuretics used in caution
Gout diabetes and egfr less than 30
63
When should methotrexate be avoided?
NSAIDs, trimethoprim, penicllins, abx, ppi stop in infection
64
What is the monitoring for methotrexate?
- full blood count, renal and liver function tests repeated every 1-2 weeks until therapy stabilised, then every 2-3 months - report any signs of blood disorders, liver toxicity, GI effects and respiratory effects
65
Which NSAIDs have the lowest risk of cv events
Naproxen and ibuprofen
66
Which nsaid has the highest risk of cv event
Diclofenac
67
When should ibuprofen not be given
Asthma, AKI, chicken pox
68
What are common interactions with NSAIDs
DOAC, SSRI, lithium, methotrexate lithium, warfarin
69
Which contraceptive methods are highly effective?
IUD, implant, sterilisation
70
Which category of antiepileptic is carbamazepine?
Category 1
71
What are the risks with carbamazepine?
Dose dependent teratogenicity, hepatic impairment, blood dyscrasias, increased risk of suicidal behaviour
72
Which supplement should be given with carbamazepine?
Vitamin D
73
Which category is phenytoin
1
74
What are the risks with phenytoin?
Blood dyscrasias, increased risk of suicidal idealation
75
Which category is phenobarbital?
1
76
Which schedule is phenobarbital?
Sched 3 but exception to emergency supply rule
77
What are the risks with phenobarb?
dose-dependent teratogenicity, blood dyscrasia, suicidal behaviour
78
What is the recommended blood level for carbamazepine?
4-12mg/L
79
What is the recommended blood level for phenytoin?
10-20 (40-80) adults 6-15 (25-60) up to 3 months
80
What is the recommended blood level for phenobarb?
15-40mg/l
81
What are the risks of digoxin
Hypokalaemia can predispose toxicity
82
What are the symptoms of digoxin toxicity
n&v, diarrhoea, fatigue, malaise, confusion, delirium, yellow vison, hyperkalaemia
83
What is the target blood conc of digoxin?
0.8-2 do not let hr fall below 60bpm take blood levels 6 hours post dose
84
How must lithium be prescribed?
By brand
85
Can lithium affect the qt interval
yes
86
What are the symptoms of lithium toxicity
thirst, frequent urination, muscle weakness, impaired coordination, drowsiness, V&D, blurred vision Toxicity is made worse by sodium depletion – diuretics, ACEI, ARB, NSAIDs
87
What are the target blood levels for lithium and when should they be taken?
take 12 hours post dose 0.4-1mmol/l 0.8-1 in patients with hx of relapse
88
How should theophylline be prescribed?
By brand
89
What is the target blood conc of theophylline
10-20
90
How should ciclosporin and tacrolimus be prescribed?
by brand.
91
What is the patient advice for ciclosporin?
Avoid exposure to uv light, interacts with cyp, avoid grapefruit juice, measure levels 12 hours after ose.
92
What are the adverse effects of ciclosporin
liver impairment, hypertension, dyslipidaemia, hyperkalaemia, hypomagnesaemia
93
What is the advice with tacrolimus
Avoid uv light exposure, avoid grapefruit and pomegranate juice, measure levels 12 hours post dose
94
What is curative chemotherapy?
Chemotherapy for a cure, used in acute leukaemia
95
What is adjuvant chemotherapy?
Given after definitive tx such as surgery or radiotherapy
96
what is Neoadjuvant chemo?
Given prior to definitive tx to facilitate the procedure
97
What is palliative chemo?
Used to control symptoms and improve quality of life
98
What are the adverse effects of chemo
Fatigue myelosuppression increased risk of infection nausea and vomitting loss of appetitie alopecia diarrhoea or constipation neuropathy allergy hearing loss urine discolouration tumour lysis syndrome
99
Discuss myelosuppression and chemo
Defined as reduced production of: erythrocytes, white cells, platelets commonly occurs 7-10 days after tx takes 20 days to recover
100
How do you treat low erythrocytes
Anaemia - treat with blood transfusions
101
How do you treat a reduction in wbc
G csf
102
what is a sign of reduced platelets
Thrombocytopenia, bruising and bleeding
103
What is neutropenic sepsis and how is it managed
Neutropenia with elevated temperature. medical emergency, give empirical broad spec according to local guidelines
104
Which antiemetics are given in chemo
ondansertron, dexamethasone, metoclopramide, arepitant
105
How often should hba1c be measured?
Every 3-6 months
106
What is the hba1c target for diabetes managed with dieet/single drug
48mmol/mol
107
What is the hba1c target for patients treated with a hypoglycaemic agent
53mmol/mol
108
What is the hba1c target for type 2 diabetics after first/second intensification of tx
53mmol/mol
109
Should diabetic patients be taking a statin?
Yes, atorvastatin 20mg
110
Should type 1 diabetics receive a statin?
Offer statin treatment with atorvastatin 20 mg for the primary prevention of CVD if the person: Is older than 40 years of age, or Has had diabetes for more than 10 years, or Has established nephropathy, or Has other CVD risk factors (such as obesity and hypertension). For all other adults with type 1 diabetes, consider statin treatment with atorvastatin 20 mg for the primary prevention of CVD.
111
Should type 1 diabetics with established cvd receive a statin?
Yes. atorvastatin 80mg
112
What should be given to type 2 diabetics with a qrisk over 10?
sglt2i once tolerated on metformin
113
What is the max dose of metformin?
2g daily with meals
114
When is metformin contraindicated
Less than 30, caution below 45
115
What is a risk of metformin?
Lactic acidosis
116
Which antidiabetic agent is useful in renal impairment
dpp4 - gliptin
117
What are the side effects of gliptins
gi disturbances, pancreatitis, peripheral oedema, urti, nasopharyingitis, sinusitits, myalgia
118
When should gliptins be avoided
history of pancreatitis, severe hf
119
When should pioglitazone be avoided?
hf, bladder cancer, elderly, pregnancy
120
What can pioglitazone cause
Bladder cancer, heart problems, liver toxicity, bone fractures
121
What are the main side effects of sulphonylureas
Hypoglycaemia, can encourage weight gain, hypos
122
When are sglt2-i indicated?
Heart failure, qrisk 10%+
123
What is the mhra alert for sglt2 i
Watch out for ketoacidosis, test ketones symptoms - n&v, thirst, fatigue, abdo pain, drowsiness, confusion
124
What are the side effects of sulphonylureas
Hypoglycaemia, hypotension, uti
125
when should sulphonylureas be avoided?
pregnancy
126
When should dapagliflozin be avoided?
Avoid in egfr less than 60ml/minute
127
When should canagliflozin be avoided?
Only start if egfr above 60, and decrease to 100mg if egfr 45-60
128
what is the pre prandial glucose target
4-7mmol/l
129
What is the post-prandial glucose target
5-9 type 1 <8.5 type 2
130
When are once daily insulin regimes indicated
eg lantus type 2 diabetes
131
What is the active ingredient in humalog and how long does it take to work
Insulin lispro. extremely rapid acting, typically witihin 15 mins
132
What is the active ingredient in novorapid and how long does it take to work
Extremeley fast acting, 10-20 mins and will last for 3-5 hours
133
What is in humalog mix/novomix
Short and long acting
134
What kind of insulin is lantus
Long acting
135
What kind of insulin is levemir
Long acting, slightly shorter duration of action than lantus, so typically taken twice a day
136
What are the examples of glp-1
Exenatide and liraglutide
137
When are glp 1 used?
BMI over 35
138
What can glp1 cause
weight loss and hba1c reduction
139
What are the side effects of glp1
gi disturbance, gord, decreased appetitie, pancreatitis, renal impairment
140
What are the symptoms of diabetic ketoacidosis
Weight loss, polyuria, polydispia, vomitting, fatigue, sweet smelling breath
141
What are the risk factors for dka
dehyrdation, acute illness, surgery, low carb diet
142
What is the first choice opioid
morphine, oxy second line
143
When is oxycodone indicated
egfr less than 30
144
When is alfentanil indicated
egfr less than 10
145
What are the side effects of opioids
constipation, drowsiness, respiratory depression, serotonin syndrome, tolerance addiction
146
What is given for opioid overdose
naloxone

PRE REG (24 decks)

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