High Risk Drugs

Question 1

amiodarone, amlodipine, statin

Answer 1

statin (20mg max)
amlodipine (10mg max)

Question 2

Insuline Rule

Answer 2

Short-Acting: 25 MAX
Intermediate-Acting: 30 MAX
Long-Acting: 50 MAX

Units must be spelt out, Insulin must be prescribed/dispensed by brand

Question 3

Hypertension/Anti-Hypertensives

Answer 3

Hypertension Case Finding Service (Pharmacy Scheme): pts over the age of 40/check BP/give advice

No Medications and is either stage 1(140/90)/stage 2(160/110)=>lifestyle advice+ABPM (daytime hours)/home BPM=>24 hrs (ABPM), (HBPM) come back within 1 week

stage 3 (180/110)

Hypertension+Afro Caribbean

give ARB

Question 4

Infections/Antibiotics

Answer 4

Pyelonephritis: inflammation of the kidneys, upper UTI

UTI
2 types: upper (pyelonephritis) and lower (cystitis)

Upper UTI: 1st=>trimethoprim, 2nd: cephalexin, 3rd: amox, co-amoxiclav 4th: ciproflaxacin (fluroquinolones to be tried last, quinolones always last line to reduce risk of artic aneurysm, tendon damage alone w/corticosteroids, QT prolongation, seizures alone and w/NSAIDs, interacts with warfarin to increase risk of bleeding)

F, 16-65 yrs: Cystitis=>sodium citrate/postassium citrate for 48 hrs, rx 1st line: nitro, 2nd: trimethoprim, 3rd: amox/ceph

M, send to A/E

Pregnancy…

Penicillin/Cephalosporins/Carbapenams: all related

Human/Animal
1st: co-amox
2nd: metrondazole+doxy (12+)
Less than 12, 2nd line: macrolides

Scratches/Insect Bite
1st: fluclox
2nd: clarithro or doxy

Question 5

Blue Man Syndrome

Answer 5

Amiodarone (Narrow Therapeutic Index, photosensitive, affects potassium by decreasing, causes both hypo/hyperthyroidism)

Monitoring: chest xray, electrolytes (K+), LFTs, ECG (if amiodarone given via IV), thyroid function

Question 6

*Type II Diabetic, Metformin/Ramipril/Simvastatin, *HF, *eGFR=40 (declining kidneys)

Answer 6

recent HF=>Q-Risk increases significantly=>expected to be 10%+=>add drug that reduces risk of CVD=>SGLT-2 inhibitor

eGFR under 30 stop metformin
stop Dapa under 15
eGFR 45

Question 7

Over 80, recent stroke, T2DM

Answer 7

All patients regardless of age who have had a stroke: 130/80

Without meds: 140/90
with meds: 135/85

T2DM: <140/90

T1DM, Renal, ACR: >70, <130/80; <70, <140/90

Co-morbidities

Question 8

Digoxin

Answer 8

affected by electrolyte imbalances (high calcium, low potassium, low magnesium, low oxygen)

avoid IM administration

yellow/blurry vision

Question 9

Liver toxicity

Answer 9

Dark urine, jaundice, nausea, fatigue

Lab tests: high bilirubin=>yellowing, high AST/ALT

Methotrexate: photosensitive, blood disorder, neumomytis (respiratory), liver, stomatitis

Question 10

Community-Aquired Pneumonia (CAP)

Answer 10

Low: 1st, amox, 2nd: clarithro, erythro

Medium: 1st, amox, if atypical pathogen add macrolide, 2nd clarithro, 3rd, doxy

High: 1st, co-amox

**allergic to meropenam
Levofloaxacin alternative

Question 11

Microbes

Answer 11

Endocarditis, Staphylococci=>fluclox

endocarditis can also be treated with 1st line: gentamicin

Answer 12

AF=>arrhythmias=>coagulastion=>DVT/PE/Stroke=>anticoagulant

Question 13

Beta-Blockers

Answer 13

side effects

Question 14

When to stop meds before surgery

Answer 14

warfarin: 5 days
COC: 4 weeks
HRT: 4-6 weeks

Question 15

Stroke Symptoms

Question 16

Fluoxetine/Carbamazepine+SV

Answer 16

hyponatraemia

Question 17

Osteoporosis

Answer 17

Biphosphonates

Question 18

Medications by Brand

Answer 18

Cat 1 Epilepsy
Insulin
Enoxaparin
Lithium
Heparins
Tildiazem
Tacrolimus
Ciclosporin

Question 19

Monitoring

Answer 19

Methotrexate: FBC, LFT, RFT

Ace: renal, electrolytes

Question 20

NSAID+DOAC

Answer 20

bleeding

Question 21

Theophylline+Corticosteroids

Answer 21

Hypokalaemia

Other drugs that cause hypokalaemia: beta agonist, theophylline, diuertics, corticosteroids, laxative abuse

Question 22

HASBLED/Orbit>CHADVASC

Question 23

Ciclosporin

Answer 23

interacts with grapefruit
must stick to same brand