Brainscape's Knowledge GenomeTM

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


See full index

Miscellaneous FT > HIGH RISK DRUGS > Flashcards

HIGH RISK DRUGS Flashcards

1
Q

Therapeutic range for Amikacin/Gentamicin
When do you measure the trough level

A

6-12 hours after the dose was adminstered.

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

Therapeutic range for Carbamazepine

A

4-12 mg/L (20-50 μmole/L)

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

Therapeutic range for Digoxin

A

0.7-2 mcg/L

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

Therapeutic range for Lithium

A

0.4-1 mmol/L (Lower end of maintenance therapy and elderly) and 0.8-1.0 mmol/L acute episodes of mania and patient who have previously relapsed or have sub-syndromal symptoms

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

Therapeutic range for Phenobarbital

A

15-40 mg/L (60-180 μmol/L)

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

Therapeutic range for Phenytoin

A

10–20mg/L (or 40–80 micromol/L).

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

Therapeutic range for Theophylline

A

10-20 mg/L (55-110 μmol/L)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Therapeutic range for Vancomycin

A

Pre-dose (trough): 10-20 mg/L aim <10mg/L; 14-20 mg/L trough concentration with pathogens with MIC greater than or equal to 1mg/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Therapeutic window for lithium

A

A serum lithium level of 0.4-1mmol/L is suitable for people who are being prescribed lithium for the first time.
Higher serum lithium levels (0.8–1.0 mmol/L) are suitable for people who have relapsed previously while taking lithium, or who still have sub-threshold symptoms with functional impairment while receiving lithium.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q
A

Lithium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Mrs Q goes to her doctor reporting that she has been feeling sick, lethargic and quite confused. At night, she says that she has been seeing strange halos around the lights at home.

A

B. Halos characteristic of digoxin toxicity

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

A 76 year old man was admitted with pyrexia, confusion, and rigors associated with positive blood cultures for Enterococcus species. A ventricular demand pacemaker had been implanted three years previously for atrial fibrillation with symptomatic ventricular pauses. His medical history included myocardial infarction, pulmonary embolism, and non-insulin dependent diabetes mellitus. As the duration of endocarditis was greater than three months, microbiological advice was (in accordance with American Heart Association guidelines) to continue this regimen for a total of six week. Seven days postoperatively, the patient experienced impaired hearing. Patient was dehydrated fatigued and not passing urine.

A

Gentamicin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Emily reports waking up this morning with a severe headache that has persisted throughout the day. She also experienced episodes of blurred vision. Her blood pressure is 160/95 mmHg and she is currently on blood pressure medications

A

Ciclosporin: The most common relates to renal vasoconstriction and a salt dependent hyper- tension with a tendency towards extracellular fluid vol- ume expansion.

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

An immunosuppressant that causes gingival hyperplasia

A

Ciclosporin (tacrolimus cause less severe and so it is not noted).
Reason: Bacterial plaque appears to be a contributory factor, and the severity of gingival overgrowth is directly proportional to the degree of plaque buildup and plaque-induced inflammation. Decreased cation dependant folic acid (FA) active transport within gingival fibroblasts causes reduced FA uptake by the cells, causing changes in the metabolism of matrix metalloproteinases and inability to activate collagenase. This results in an accumulation of connective tissue and collagen due to a lack of collagenase.

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

An anticonvulsant that causes gingival hyperplasia

A

Phenytoin

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

F

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

Mrs T normally takes carbamazepine. Which of the above side-effects should she urgently report to her doctor?

A

H

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

What are side effects associated with carbamazepine that warrants reporting immediately

A

Blood hepatic or skin disorder….

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the indications for Phenytoin?

A

Tonic-clonic clonic seizures, Focal seizures, Prevention and treatment of seizures during or following neurosurgery or severe head injury.

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

How does Phenytoin cause Vit D deficiency?

A

In the pathogenesis of AED-induced bone disease, a central role is played by the pharmacokinetic interaction between the AEDs and vitamin D: the enzyme inducers carbamazepine, phenobarbital, phenytoin, and primidone can activate the pregnane X receptor, which then upregulates expression of the 24-hydroxylases

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

Which anti-epileptic is associated with hypocalcaemia and hyperphosphotemia?
A. Lamotrigine
B. Phenobarbital
C. Phenytoin
D. Carbamazepine

A

C

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

Which anti-epileptic is associated with hyponatremia?
A. Lamotrigine
B. Phenobarbital
C. Phenytoin
D. Carbamazepine

A

D

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

In what situations would you withdraw phenytoin and why?

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

Before starting Phenytoin what test are performed

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

What monitoring is required whilst patient is on Phenytoin

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

What are the signs and symptoms of Phenytoin toxicity?

A

At concentrations >20 mg/mL nystagmus is observed in Phenytoin toxicity. Concentrations greater than 30 mg/L ataxia and slurred speech is more pronounced.

26
Q

Which adverse effect associated with phenytoin is long term side effect?
A. Aplastic anaemia
B. Liver damage
C. Gingival hyperplasia
D. Osteoporosis

A

D and C

27
Q

Which adverse effects requires discontinuation with regards to phenytoin ?
A. Rash
B. Osteoporosis
C. Folate deficiency
D. Hirsutism

A

(A) SJS

28
Q

Which interactions leads to increase level of phenytoin as well as increased risk of aplastic anaemia?
A. Amiodarone
B. Ciclosporin
C. Boceprevir
D. Digoxin
E. Diltiazem
F. Co-trimoxazole

A

f

29
Q

Which interaction leads to increase in phenytoin concetration?
A. Amiodarone
B. Ciclosporin
C. Boceprevir
D. Digoxin
E. Diltiazem
F. Co-trimoxazole

A

A, C, F, E (inhibitors)

30
Q

What are the contraindications associated with Phenytoin?

A
31
Q

What factors require dose to be adjusted with Phenytoin and why?

A

Hypoalbuminemia, uraemia and pregnancy because serum albumin levels are altered and Phenytoin is highly protein bound (>80%).

32
Q

What is the indication for hydroxychloroquine sulphate? And dose.

A

Active RA; 200-400mg OD

33
Q

What is the MHRA warning concerning hydroxychloroquine?

A

hERG analogue binding to the rectifier potassium channel preventing repolarisation of the cardiac tissue and prolonging hyperpolarization.

34
Q

Before patient is started on hydroxychloroquine what baseline test are required before it is started?

A
  • Albumin (drug bind preferentially to alpha-acid glycoprotein and albumin)
    • ALT/AST: Drug associated is metabolised in the liver and associated at high doses to increased reactive oxygen species
    • FBC
    • Height /Weight: ptx weight can affect the dosing and BMI
    • Vaccination status: MAO is to depress immune system in rheumatological disease therefore it can potentiate other infections occurring
    • CrCl
      Vaccination status
35
Q

Which vaccination status is NOT required for starting hydroxychloroquine?
A. Hepatitis B
B. HIV
C. Hepatitis C
D. Chlamydia

A

D

36
Q

Which interaction did MHRA issue warning concerning the use together?
A. Azithromycin + Hydroxychloroquine
B. Warfarin + Citalopram
C. Valproate+ Digoxin
D. Metronidazole + Warfarin

A
37
Q

Which interaction is most Likely increases risk of to increase the risk of retinotoxicity?
A. Gentamicin + Amoxicillin
B. Hydroxychloquine +Tamoxifen
C. Simvastatin + Clopidogrel
D. Digoxin + Amiodarone

A

B
Reason Hydroxychloroquine binds to rods and cons of the eye increasing melanin and affecting visual acuity whilst tamoxifen acts as glutamate receptor antagonist in retinal pigment epithelium leading to degeneration of axonal cells.

38
Q

What monitoring is required for Hydroxychloroquine?

A

Annual monitoring (including fundus autofluorescence and spectral domain optical coherence tomography) eye is recommended in all patients who have taken hydroxychloroquine for longer than 5 years.

39
Q

In terms of dosing for hydroxychloroquine for obese patient do you use the actual body weight or ideal?

A

Ideal body weight to avoid excessive dosage.

40
Q

What is the target level of glucose in patients with type 1 diabetes/children upon waking, before meals, post prandial?

A
41
Q

What is the target blood-glucose concentration when driving?

A

5 mmol/L when driving

42
Q

Draw table giving the values for the heading below for: Rapid acting insulin, soluble insulin, Intermediate insulin, Long acting insulin, Biphasic insulin

A
43
Q

Which one out of this list is a rapid acting insulin brand?
A. Fiasp
B. Novomix
C. Lantus
D. Abasaglar
E. Toujeo
F. Humolog
G. Apidra
H. Humulin M3
I. Detemir

A

A. Fiasp: Aspart
F. Humolog: Lispro

44
Q

Which one from this list is biphasic insulin preparation?
A. Fiasp
B. Novomix
C. Lantus
D. Abasaglar
E. Toujeo
F. Humolog
G. Apidra
H. Humulin M3
I. Detemir

A

H
B

45
Q

Which one from this list contains glargine?
A. Fiasp
B. Novomix
C. Lantus
D. Abasaglar
E. Toujeo
F. Humolog
G. Apidra
H. Humulin M3
I. Detemir

A

C

46
Q

What is the mechanism of hydroxycarbamide?

A

Hydroxycarbamide is anti-neoplastic agent; it is analogue of urea. It is a potent inhibitor of ribonucleotide reductase, the enzyme involved in the transformation of ribonucleosides into deoxyribonucleosides for DNA synthesis.

47
Q

What are the indications for hydroxycarbamide?

A

Polycythaemia vera
Essential thrombocythemia
Chronic myeloid leukaemia
Sickle cell anaemia

48
Q

In what scenario must hydroxycarbamide dose be decreased by 50% ?
A. During pregnancy
B. In sickle cell when eGFR is <30 mL/min/1.73 m2
C. In fever
D. When started on ramipril

A

B; according to NICE BNF

49
Q

Why does hydroxycarbamide increase urate levels and requires monitoring ?

A

Hydroxycarbamide increases the levels of urea and uric acid due to inhibition of DNA synthesis. Purine metabolism produces uric acid.

50
Q

What are the side effects of hydroxycarbamide? +why

A

Skin hyper-pigmentation- increased deposition of melanocytes.
Myelosuppression- due to its inhibition of erythroid progenitors and it concentrates preferentially in erythrocytes and leukocytes.
Hepatotoxicity: due to anti-neoplastic action.
Severe interstial pneumonia: due to anti-neoplastic activity
Mucositis

51
Q

What monitoring is required whilst on hydroxycarbamide?

A

FBC: Concentrates in erythrocytes and is anti-neoplastic agent
eGFR: Excretion of drug is important
LFT: Can cause acute liver toxicity
Urate
U&E
Reticulocyte count

52
Q

Which test is considered in patient at risk of infection when starting hydroxycarbamide?
A. Hepatitis B
B. Hepatitis A
C. Varicella voster
D. Chylamdia

A

A

53
Q

When there is dose change or patient is newly started on hydroxycarbamide how often is monitoring?
A. First 4 weeks then if stable fortnightly for 8 weeks
B. First 6 weeks, then if stable, every 10 weeks
C. First 2 weeks, then if stable, every 3 weeks
D. Every week for 8 weeks then once stable every 2-3 months

A

A

54
Q

Can be hydroxycarbamide be put into dosette box?

A

NO- cytotoxic drugs are not kept in dosette box

55
Q

Which drug is commonly associated with proteinuria?
A. leflunomide
B. D-penicillamine
C. Methotrexate
D. Dexamethasone

A

B

56
Q

Signs of proteinuria when on D-Penicillamine requires what clinical action?
A. Temporary withdrawal for 2 weeks
B. Urgent referral and discontinuation of drug
C. Reduction of dose
D. Do nothing

A

B: because it is a sign of immune-mediated nephropathy.

57
Q

Signs of rash appearing 1 year after treatment of D-penicillamine requires what clinical action?
A. Temporary withdrawal for 2 weeks
B. Urgent referral and discontinuation of drug
C. Reduction of dose
D. Do nothing

A

C (BNF)

58
Q

In what clinical situation would D-Penicillamine be withdrawn?

A
59
Q

What monitoring is required when patient is on D-Penicllimiamine?

A

FBC including platelets, U&E 1-2 weeks for the first 2 months then every 4 weeks to detect blood disorder or proteinuria.

60
Q

Signs of reduction in platelet count whilst patient is being treated on D-Penicillamine requires what action?
A. Temporary withdrawal for 2 weeks
B. Urgent referral and discontinuation of drug
C. Reduction of dose
D. Temporary withdrawal then re-introduction at lower dosage and then possible gradual increase.

A

D

61
Q

88) Miss E has been told to be vigilant for signs of overdose, which of the following is NOT a sign of
theophylline overdose?
A agitation
B constricted pupils
C hypokalaemia
D restlessness
E vomiting

A

B

62
Q

89) 40 male, prescribed amiodarone and has reduced his dose down to 200mg daily for the
treatment of arrhythmia, he has developed corneal microdeposits and is concerned that his vision is
going to deteriorate if he continues treatment. Which of the following is the most appropriate
advice to give this patient?
A corneal microdeposits are sign of amiodarone toxicity, he should discontinue treatment
immediately and seek prompt medical attention
B corneal microdeposits should not interfere with vision but are irreversible
C corneal microdeposits rarely interfere with vision but he may be dazzled by headlights when
driving at night
D corneal microdeposits commonly develop into optic neuropathy so treatment with amiodarone
should not continue past 5 years
E corneal microdeposits are sign of optic neuritis, so he should book an appointment with optician
ASAP

A

D

63
Q

Which side effect associated with Carbimazole can be easily treated OTC

A

Miscellaneous FT (12 decks)

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