Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PRE REG > High Risk Drugs > Flashcards

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a common interaction with amoxicillin?

A

Methotrexate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When is flucloxacillin usually used?

A

Ottis externa, impetigo and cellulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What can decrease the absorption of tetracyclines?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What can tetracyclines cause during the first trimester?

A

Effects on skeletal development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What can tetracyclines cause during the second or third trimester?

A

Discolouration of teeth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which tetracyclines can be taken with milk?

A

Doxycycline
Lymecycline
Monocycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which tetracyclines should be taken on an empty stomach?

A

Demeclocycline
Oxytetracycline
Tetracycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which tetracyclines can be taken with milk?

A

Doxycycline, Lymecycline, minocycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the patient advice for dymecycline and doxycycline?

A

Protect the skin from sunlight/UV light

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is a significant side effect of erythromycin?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which macrolide causes fewer gi side effects?

A

Clindamycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is azithromycin used for?

A

Prophylaxis in chronic resp conditions 3x a week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Discuss the use of clindamycin?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the contraindications of nitrofurantoin?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is a common side effect for nitrofurantoin?

A

Can discolour urine brown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

When should nitrofurantoin be taken?

A

With food, or just after a meal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What should patients/carers look out for with long term tx with trimethoprim?

A

Blood disorders: fever, sore throat, rash, mouth ulcers, bruising, bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Can trimethoprim be used in pregnancy?

A

Risk of teratogenicity in the first trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is a side effect of trimethoprim?

A

Hyperkalaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the cautionary advisory labels for metronidazole?

A
  • avoid alcohol
  • take with or just after food
  • do not chew or crush
  • swallow with a glass of water
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the cautions with quinolones?

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the cautionary advisory labels for ciprofloxacin?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How are aminoglycosides administered?

A

They are given IV as not absorbed from the gut

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What toxicity can aminoglycosides cause?

A

Renal, oto

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Who can get chloramphenicol otc?

A

2+, not usually pregnancy/breast feeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What can chloramphenicol cause if given systemically?

A

Severe haematological adverse effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Which medications can increase the INR with warfarin?

A

SSRIS, PPIs, statins. Enxyme inhibitors: erythromycin, miconazole, amiodarone, cimetidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Which medications can decrease INR?

A

St johns wart, carbamazepine, rifampicin, phenytoin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How can NSAIDs affect warfarin?

A

Do not necessarily after INR but bleed risk increases significantly. same for antiplatelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What can cranberry juice do to warfarin?

A

Enhance the anticoagulant effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the starting dose of dabigatran?

A

150mg bd
reduced dose based on age, renal impairment, bleed risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is the starting dose of apixaban?

A
  • in AF 5mg bd
  • tx of dvt 10mg bd then 5mg bd
  • prophylaxis dvt 2.5mg bd
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the starting dose of edoxoban?

A

60mg daily
30mg if less than 60kg or renal impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is the starting dose of rivaroxban

A
  • af 20mg od
  • tx dvt - 15mg for 7 days then 20mg od
  • prophylaxis dvt 10mg od increasing to 20
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Which drugs increase the risk of haemhorrage with DOACs?

A

NSAIDs, anticoagulants, antiplatelets, SSRIS, steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Which drugs increase the plasma conc of noac?

A

Antifungals, diltiazem, verapamil, amiodarone, dronaderone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Which drugs decrease the plasma conc of doacs?

A

Rifampacin, carbamazepine, phenytoin, phenobarb, st johns wort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is the antidote for dabigatran?

A

Idarucizumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is the antidote for rivoroxaban/apixaban

A

Andexant alfa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Which drug is given for for primary prevention in high risk pts

A

Aspirin unlicensed is considered in 10 year risk over 20%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Which antiplatelet is given as secondary prevention in stroke/ TIA

A

Clopidogrel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Which antiplatelet is given as secondary prevention following MI

A

DAPT (Aspirin + x)
ticragrelor in medically managed
clopidogrel in surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Which antiplatelet is used in angina?

A

aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Which antiplatelet is used in acute coronary syndromes?

A

DAPT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is stage 1 htn?

A

140/90 to 159/99 clinic or 135/85 to 149/94 ambulatory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is stage 2 htn?

A

160/100 to 180/120mmHg clinic or over
150/95mmHg ambulatory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is the bp target for <80 with treated htn

A

below 140/90 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is the bp target for >80

A

below 150/90 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is the bp target in diabetes

A

140/80 in diabetes (130/80 if kidney, eye damage)

60
Q

What are the side effects of acei?

A

Vasodilation, first dose hypotension, falls risk, dry cough, hyperkalaemia, angiodema, aki, protective in diabetes but avoid in renal artery stenosis

61
Q

What are the side effects of ccb?

A

Vasodilation, ankle swelling, flushing, grapefruit juice, amlodipine and simv interaction and falls risk

62
Q

When are diuretics used in caution

A

Gout diabetes and egfr less than 30

63
Q

When should methotrexate be avoided?

A

NSAIDs, trimethoprim, penicllins, abx, ppi
stop in infection

64
Q

What is the monitoring for methotrexate?

A
  • 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
Q

Which NSAIDs have the lowest risk of cv events

A

Naproxen and ibuprofen

66
Q

Which nsaid has the highest risk of cv event

A

Diclofenac

67
Q

When should ibuprofen not be given

A

Asthma, AKI, chicken pox

68
Q

What are common interactions with NSAIDs

A

DOAC, SSRI, lithium, methotrexate lithium, warfarin

69
Q

Which contraceptive methods are highly effective?

A

IUD, implant, sterilisation

70
Q

Which category of antiepileptic is carbamazepine?

A

Category 1

71
Q

What are the risks with carbamazepine?

A

Dose dependent teratogenicity, hepatic impairment, blood dyscrasias, increased risk of suicidal behaviour

72
Q

Which supplement should be given with carbamazepine?

A

Vitamin D

73
Q

Which category is phenytoin

A

1

74
Q

What are the risks with phenytoin?

A

Blood dyscrasias, increased risk of suicidal idealation

75
Q

Which category is phenobarbital?

A

1

76
Q

Which schedule is phenobarbital?

A

Sched 3 but exception to emergency supply rule

77
Q

What are the risks with phenobarb?

A

dose-dependent teratogenicity, blood dyscrasia, suicidal behaviour

78
Q

What is the recommended blood level for carbamazepine?

A

4-12mg/L

79
Q

What is the recommended blood level for phenytoin?

A

10-20 (40-80) adults
6-15 (25-60) up to 3 months

80
Q

What is the recommended blood level for phenobarb?

A

15-40mg/l

81
Q

What are the risks of digoxin

A

Hypokalaemia can predispose toxicity

82
Q

What are the symptoms of digoxin toxicity

A

n&v, diarrhoea, fatigue, malaise, confusion, delirium, yellow vison, hyperkalaemia

83
Q

What is the target blood conc of digoxin?

A

0.8-2
do not let hr fall below 60bpm
take blood levels 6 hours post dose

84
Q

How must lithium be prescribed?

A

By brand

85
Q

Can lithium affect the qt interval

A

yes

86
Q

What are the symptoms of lithium toxicity

A

thirst, frequent urination, muscle weakness, impaired
coordination, drowsiness, V&D, blurred vision
Toxicity is made worse by sodium depletion – diuretics, ACEI,
ARB, NSAIDs

87
Q

What are the target blood levels for lithium and when should they be taken?

A

take 12 hours post dose
0.4-1mmol/l
0.8-1 in patients with hx of relapse

88
Q

How should theophylline be prescribed?

A

By brand

89
Q

What is the target blood conc of theophylline

A

10-20

90
Q

How should ciclosporin and tacrolimus be prescribed?

A

by brand.

91
Q

What is the patient advice for ciclosporin?

A

Avoid exposure to uv light, interacts with cyp, avoid grapefruit juice, measure levels 12 hours after ose.

92
Q

What are the adverse effects of ciclosporin

A

liver impairment, hypertension, dyslipidaemia, hyperkalaemia, hypomagnesaemia

93
Q

What is the advice with tacrolimus

A

Avoid uv light exposure, avoid grapefruit and pomegranate juice, measure levels 12 hours post dose

94
Q

What is curative chemotherapy?

A

Chemotherapy for a cure, used in acute leukaemia

95
Q

What is adjuvant chemotherapy?

A

Given after definitive tx such as surgery or radiotherapy

96
Q

what is Neoadjuvant chemo?

A

Given prior to definitive tx to facilitate the procedure

97
Q

What is palliative chemo?

A

Used to control symptoms and improve quality of life

98
Q

What are the adverse effects of chemo

A

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
Q

Discuss myelosuppression and chemo

A

Defined as reduced production of:
erythrocytes, white cells, platelets
commonly occurs 7-10 days after tx
takes 20 days to recover

100
Q

How do you treat low erythrocytes

A

Anaemia - treat with blood transfusions

101
Q

How do you treat a reduction in wbc

A

G csf

102
Q

what is a sign of reduced platelets

A

Thrombocytopenia, bruising and bleeding

103
Q

What is neutropenic sepsis and how is it managed

A

Neutropenia with elevated temperature. medical emergency, give empirical broad spec according to local guidelines

104
Q

Which antiemetics are given in chemo

A

ondansertron, dexamethasone, metoclopramide, arepitant

105
Q

How often should hba1c be measured?

A

Every 3-6 months

106
Q

What is the hba1c target for diabetes managed with dieet/single drug

A

48mmol/mol

107
Q

What is the hba1c target for patients treated with a hypoglycaemic agent

A

53mmol/mol

108
Q

What is the hba1c target for type 2 diabetics after first/second intensification of tx

A

53mmol/mol

109
Q

Should diabetic patients be taking a statin?

A

Yes, atorvastatin 20mg

110
Q

Should type 1 diabetics receive a statin?

A

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
Q

Should type 1 diabetics with established cvd receive a statin?

A

Yes. atorvastatin 80mg

112
Q

What should be given to type 2 diabetics with a qrisk over 10?

A

sglt2i once tolerated on metformin

113
Q

What is the max dose of metformin?

A

2g daily with meals

114
Q

When is metformin contraindicated

A

Less than 30, caution below 45

115
Q

What is a risk of metformin?

A

Lactic acidosis

116
Q

Which antidiabetic agent is useful in renal impairment

A

dpp4 - gliptin

117
Q

What are the side effects of gliptins

A

gi disturbances, pancreatitis, peripheral oedema, urti, nasopharyingitis, sinusitits, myalgia

118
Q

When should gliptins be avoided

A

history of pancreatitis, severe hf

119
Q

When should pioglitazone be avoided?

A

hf, bladder cancer, elderly, pregnancy

120
Q

What can pioglitazone cause

A

Bladder cancer, heart problems, liver toxicity, bone fractures

121
Q

What are the main side effects of sulphonylureas

A

Hypoglycaemia, can encourage weight gain, hypos

122
Q

When are sglt2-i indicated?

A

Heart failure, qrisk 10%+

123
Q

What is the mhra alert for sglt2 i

A

Watch out for ketoacidosis, test ketones
symptoms - n&v, thirst, fatigue, abdo pain, drowsiness, confusion

124
Q

What are the side effects of sulphonylureas

A

Hypoglycaemia, hypotension, uti

125
Q

when should sulphonylureas be avoided?

A

pregnancy

126
Q

When should dapagliflozin be avoided?

A

Avoid in egfr less than 60ml/minute

127
Q

When should canagliflozin be avoided?

A

Only start if egfr above 60, and decrease to 100mg if egfr 45-60

128
Q

what is the pre prandial glucose target

A

4-7mmol/l

129
Q

What is the post-prandial glucose target

A

5-9 type 1
<8.5 type 2

130
Q

When are once daily insulin regimes indicated

A

eg lantus
type 2 diabetes

131
Q

What is the active ingredient in humalog and how long does it take to work

A

Insulin lispro. extremely rapid acting, typically witihin 15 mins

132
Q

What is the active ingredient in novorapid and how long does it take to work

A

Extremeley fast acting, 10-20 mins and will last for 3-5 hours

133
Q

What is in humalog mix/novomix

A

Short and long acting

134
Q

What kind of insulin is lantus

A

Long acting

135
Q

What kind of insulin is levemir

A

Long acting, slightly shorter duration of action than lantus, so typically taken twice a day

136
Q

What are the examples of glp-1

A

Exenatide and liraglutide

137
Q

When are glp 1 used?

A

BMI over 35

138
Q

What can glp1 cause

A

weight loss and hba1c reduction

139
Q

What are the side effects of glp1

A

gi disturbance, gord, decreased appetitie, pancreatitis, renal impairment

140
Q

What are the symptoms of diabetic ketoacidosis

A

Weight loss, polyuria, polydispia, vomitting, fatigue, sweet smelling breath

141
Q

What are the risk factors for dka

A

dehyrdation, acute illness, surgery, low carb diet

142
Q

What is the first choice opioid

A

morphine, oxy second line

143
Q

When is oxycodone indicated

A

egfr less than 30

144
Q

When is alfentanil indicated

A

egfr less than 10

145
Q

What are the side effects of opioids

A

constipation, drowsiness, respiratory depression, serotonin syndrome, tolerance addiction

146
Q

What is given for opioid overdose

A

naloxone

PRE REG (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions