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BNF GPhC > High Risk Drugs > Flashcards

High Risk Drugs Flashcards

1
Q

What is Carbimazole used for?

A

Hyperthyroidism

Report any sore throat, ulcers, fever, malaise, bleeding with Carbimazole

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2
Q

What is the difference between:

Agranulocytosis

Thrombocytopenia

Blood Dyscrasias

A

Agranulocytosis: WBC’s go down; sore throat, fever, malaise all symptoms

Thrombocytopenia: Platelets go down: blood very thin: unexplained bleeding/ bruising. Can be from Heparins

Blood Dyscrasias:Entire blood profile goes down; symptoms of both of the above, this is why we report both sets of symptoms with some drugs

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3
Q

What is the loading dose of Amiodarone?

A

200mg TDS for 7 days

200mg BDfor 7 days

Then 200mg OD from there on (maintenance)

Why load? Long half life (50 days)means it would take ages to reach therapeutic levels. Also meansinteractions can still occur months after stopping.

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4
Q

Symptoms of Aspirin Overdose (5)

A

Tinnitus

Hyperventilation

Deafness

Vasodilation

Sweating

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5
Q

Why is rifampicin considered High Risk do you think?

Rifampicin is one of the TB drugs

A

Many interactions- as it is an enzyme Inducer, it induces ALL of the CYP enzymes: decreases efficacy of COC’s

HEPATOTOXIC: Monitor LFTs, counsel on liver toxicity signs,stop if:

Persistent Nausea
Vomiting
Malaise
Jaundice

Also colours urine/ body fluids/ soft contact lenses red/ orange

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6
Q

What monitoring is needed with Rifampicin?

A

LFT’s before starting- continue to monitor if on prolonged therapy

Renal function before starting

FBC if on prolonged therapy

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7
Q

Which class of antibiotics do we need to use with caution in EPILEPTICS?

A

Quinolones-

Ciprofloxacin, Levofloxacin

These lower seizure threshold!

Particularly if used with theophylline

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8
Q

Why do we need to check albumin levels with warfarin?

A

Warfarin is highly protein bound to albumin- if this is low there may be issues transporting it round the body

need to monitor both renal and liver function with warfarin

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9
Q

People stable on warfarin- how often is INR checked?

A

Every 3 months

Unless changes in clinical status occur e.g. diarrhoeaand vomitting

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10
Q

What (quite unpleasant)side effects are associated with Amiodarone use, what signs should patients look out for? (7)

A

BCTPH
Nausea and vomitting and taste disurbance

Thyroid function- Hypo and Hyperthyroidism through action of IODINE in the drug

Phototoxic skin reactions: burning sensation, erythema, slate grey skin discolouration

Pulmonary toxicity- persisitent SOB/ Cough

Tremor- peripheral neuropathy- numbness in hands and feet

Corneal microdepositis in eyes- dazzled by headlights- common SE: this is reversibleonce drug stopped

Liver toxicity: Jaundice

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11
Q
A
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12
Q

What 5 things needmonitoring at baselinewith Amiodarone?

A

LFT’s- Hepatotoxicity a risk

THYROID FUNCTION- hyper/hypothyroidism

Serum Potassium!!!! before starting

Chest X-ray- pulmonary toxicity

ECG with IV use

LFT’s and TFT’s need monitoring after 6 months too!

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13
Q

What is Amiodarone used for?

A

Treatment of

Both supraventricular and ventricularArrhythmias

Ventricular fibrilation, ventricular tachycardia

Usually used when other drugs failed as quite a nasty drug

Rhythm control as part of pharmacological cardioversion in AF

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14
Q

Methotrexate inhibits dihydrofolate reductase and therefore reduces folate in the body. What drug has to be given with methotrexate as supplementation to prevent its nasty side effects, and when?

A

For prevention of methotrexate induced horrible side effects in Chron’s/ RA:

Folic acid 5mg ONCE WEEKLY- dose to be taken on a DIFFERENT DAY to methotrexate

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15
Q

Methotrexate may lead to blood disorders (most significantly neutropenia and increased infection risk)through BONE MARROW SUPPRESSION. Its anti- folate propertied may explain how it suppresses bone marrow…

A

Bone marrow is where the body creates new cells. Cell division requires folate in order to occur.

Since folate deficiency limits cell division, erythropoiesis, production ofred blood cells, WBC, neutrophils etc is suppressed in the bone marrow when methotrexate is taken as it is anti- folate. This is the same story as with Trimethoprim/ Co- trimoxazole and Phenytoinas these are also anti-folate- Avoid use together!

Production of RBC’s beinghindered also leads tomegaloblastic anemia, which is characterized by large immature red blood cells that cannot divide.

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16
Q

What monitoring does Methotrexate require?

A

Renal function

LFT’s

FBC (due to blood disorder risk)

These should be 1-2 weekly until dose stabilised then 2-3 monthly thereafter

Exclude pregnancy- pregnancy test before starting?

Avoid in hepatic impairment and reduce dose in renal impairment unless severe- then avoid.

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17
Q

What is Methotrexate used for?

A

Main use in:

Rhumatoid Arthritis

Severe Chron’s (Inflammatory Bowel Disease)

Severe Psoriasis

It is cytotoxic- stops cell division- part of chemotherapy

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18
Q

What are the Methotrexate warning signs

A

Blood disorder: Bone marrow suppression- sore throat, ulcers, fever, rash

Liver toxicity- N&V, abdominal pain,dark urine,Jaundice

Gastro-intestinal toxcitiy: stomatitis, GI upset (sore mouth first symptom)

Pulmonary Toxicity- persistentSOB, cough

PREGNANCY & Breastfeeding- its anti-folate so avoid!!- contraception needed during treatment and for 3 months after stopping

WITHDRAW TREATMENT IF ANY OF THESE OCCUR

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19
Q

What OTC med’s can increase the risk of Methotrexate toxicity?

A

NSAIDS/ ASPIRIN !!
Reduce methotrexate excretion in kidney

As do penicillins!

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20
Q

A patient comes in complaining of mouth sores, they think it may be cold sores. After further questioning you find out they are on Methotrexate. What do you do?

A

Advise they seek medical attention ASAP

Mouth sores may be a sign of stomatitis (inflammation of mouth) which is the first sign of Gastro-intestinal toxicity associated with Methotrexate!

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21
Q

A patient asks for some Lozenges as they are experiencing a very sore throat. You find out they are on Methotrexate. What do you do?

A

Seek medical attention ASAP

Sore throat is most common side of blood disorders with Methotrexate

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22
Q

Patients can sometimes overdose on Methotrexate as they get confused that it is Just once weekly dosing. What are the symptoms? what is methotrexate toxicity treated with?

A

Renal impairment

Liver impairment

Headache, seizures, coma

Treatment: FOLINIC ACID- rescues normalcells from methotrexate effects

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23
Q

What happens when Baclofen (used for pain of muscle spasms in palliative care/ trauma) issuddenly withdrawn? What if itis given with ACE inhibitors or Beta blockers?

A

Suddenly withdrawn: hyperactivity, hyperthermia, hallucinations, convulsions

Enhanced Hypotensive effects with ACEi/ Beta blockers

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24
Q

Which NOAC is contra-indicated in patients with a Prosthetic valve?

A

DABIGATRAN

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25
Q
A

ORLISTAT (Alli)

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26
Q

What needs monitoring with Vancomycin (4)?

A

Full blood count: can cause both LOW PLATELETS and LOW NEUTROPHILS (Neutropenia)

Renal function- Nephrotoxic- Urinalysis, CrCl used for dosing

Hearing function in the elderly

Plasma concentration

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27
Q

What needs monitoring with Gentamicin?

A

Renal function

Hearing function

Plasma concentration

NB: differs to vancomycin as do not need to monitor FBC- does not cause neutropenia/ low platelets

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28
Q

Which antihypertensive drugs require the SAME BRAND to be maintained?

A

Diltiazem

Nefedipine

(Both CCB’s)

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29
Q

Which CCB cannot be used in both Supraventricular and Ventricular arrhythmias?

A

VERAPAMIL

Used for Supraventricular only

Verapamil NOT to be used in Ventricular Arrhythmias

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30
Q

Ciclosporin (an immunosuppressant drug) has many interactions. This is because it is toxic to many organs, so any drug effecting each of those organs will be contra-indicated with ciclosporin use. What toxicitys can it cause (5)?

A

Neurotoxicity (CNS- tremor, convulsions, encephalopathy)

Liver toxicity (jaundice, N&V, abdo pain, dark urine)

Nephrotoxicity (kidney)

Blood toxicity/ disorders (fever, sore throat, ulcers, bleeding)

Hypertension- BP needs monitoring regularly

Patient should report any of these signs

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31
Q

What type of vaccines are Ciclosporin and Tacrolimus Contra-indicated with?

A

Live vaccines

Live vaccines can, in some situations, cause severe or fatal infections in immunosuppressed individuals due to extensive replication of the vaccine strain that the immune system cannot fight off.

Same goes with high dose corticosteroids: these can suppress the immune system so avoid live vaccines

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32
Q

What should patients on corticosteroids be told with regards to chickenpox/ measels?

A

If they have not have these before, avoid any exposure to anyone with these as they can contract very severe forms of these if they do.

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33
Q

Why is an eye exam needed with corticosteroid use?

A

Risk of eye problems:

Glaucoma- look for intraocular pressure

Corneal thinning

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34
Q

What drugs can increase the risk of someone developing gout (build up of uric acid)?

A

Diuretics– clears excess fluid out of body butthe remaining fluid is more concentrated;increases the risk of developing the crystals that causegout

Beta-blockersand ACE inhibitors

low-dose aspirin– used to reduce the risk ofblood clots

niacin–used to treat high cholesterol

ciclosporin– used to treat conditions such aspsoriasis

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35
Q

What are the symptoms of gout?

What are the dietary risk factors of gout?

A

Build up of uric acid causing:

suddenattack ofsevere painin one or morejoints, typically big toe.

joint feeling hot and very tender,swellingin and around the affected joint

Dietary risk factors:high in meat and seafood and high in beverages sweetened with fructosepromotes higher levels of uric acid, also alcohol.

Phospohorus can help cure gout:Banana is a rich source of phosphorus.

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36
Q

What is the main symptom of Hypokaleamia?

What drugs can cause hypokaleamia?

A

Ventricular Arrhythmias

(Hyperkaleamia can also cause arrhythmias!)

Thiazide, thiazide-like and Loop diuretics

Sotalol

Salbutamol

Amisulpiride

Atomoxetine (used for ADHD)

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37
Q

Can you inject potassium chloride 20% w/v straight?

A

No- must be diluted first with sodium chloride 0.9%
Must be given by slow infusion

Monitor ECG- rapid infusion would be toxic to heart and arrhythmias occur

Need to the patient is weeing enough- contraindicated in anuria (absence of urination) as potassium would build up

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38
Q

What could black stools or coffee groung vomit be suggestive of with NSAIDs? What about Iron deficient aneamia?

A

GI bleeding

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39
Q

What are the following indicative of with NSAID therapy?

Unexplained weight loss

difficulty swallowing

nausea or vomiting

bloating

burping or acid reflux- recent onset dyspepsia

A

Peptic ulcer

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40
Q

What could swollen ankles indicated with NSAID therapy?

A

Kidney failure

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41
Q

Which NSAID is now contra-indicated in patients with a cardiac disease history/ risk of CV disease?

A

Diclofenac

The new treatment advice applies to systemic formulations (ie, tablets, capsules, suppositories, and injection available both on prescription and via a pharmacy, P); it does not apply to topical (ie, gel or cream) formulations of diclofenac.

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42
Q

What electrolyte disturbance could NSAIDs effectively cause?

A

NSAIDs can damage the kidneys (AKI)

This can in turn lead to HYPERKALEAMIA

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43
Q

A dose increase for an opioid should be no more than __% of the last dose

A

No more than 50%

Due to risk of overdose

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44
Q

Aside from their use in pain, what else can strong Opioids be used for?

A

Relief of breathlessness in palliative care

Relief of breathlessness and anxiety in acute pulmonary oedema (alongside oxygen, furosemide, nitrates)- Myocardial infarction

But do not give them in respiratory failure!

Suprising when they can cause respiratory depression! This is because they reduce cardiac work and oxygen demand- hence their use in Myocardial Infarction.

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45
Q

What side effects do opioids have on the skin?

A

They cause histamine release- this can cause ITCHING and urticaria (hives/ nettle rash), also sweating

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46
Q

Biliary colicis atype of pain related to the gallbladder that occurs when a gallstone obstructs the cystic duct and the gallbladder contracts. Should we use opioids for this pain?

A

No- opioids can worsen the pain due to sphincter spasm

47
Q

How is chronic pain usually managed with strong opioids?

A

Oral route first:
Start with an immediate release solution such as Oramorph

Then once optimal dose found- switch to modified release (MST Continus- administered BD [12 hourly])

For breakthrough pain, immediate release (Oramorph) morphine at a dose of 1/6 the usual.

48
Q

Why must codeine/ dihydrocodeine never be given via the IV route?

A

Can cause a severe reaction similar to anaphylaxis (but not allergy based)

49
Q

Which opioid should be avoided in epileptics?

A

Tramadol: it lowers the seizure threshold

Avoid with other drugs that lower seizure threshold: SSRI’s, TCA’s, quinolones, theophylline

50
Q

What is heaviness in the centre of the chest likely to indicate?

A

Heart attack

51
Q

How should oral antiplatelets be administered?

A

With or just after food (to protect stomach)

Except for Dipyridamole: 30 to 60 mins before food

52
Q

Why is Tacrolimus such a high risk drug? What can it cause?

Hint: Similar to Ciclosporin. Both toxic to many organs

A

Neurotoxicity (CNS)- tremor, headache

Nephrotoxicity

Eye disorders (ciclosporin not toxic to eyes)

Blood disorders- report fever, sore throat, ulcers etc

Skin disorders- rash

Hyperglycaemia

Liver toxicity

53
Q

What dietary substances should patients on Tacrolimus / Ciclosporin avoid?

A

Avoid a diet high in Potassium (as these can BOTH cause Hyperkaleamia)

Avoid grapefruit juice- Increases plasma concentrations of these as its an enzyme inhibitor

54
Q

What drugs can cause Hyperkaleamia?

A

Ace inhibitors/ ARBs

Potassium sparing diuretics (spironolactone + eplerenone)

Ciclosporin and Tacrolimus (immunosuppressants)

NSAIDs

55
Q

What do we use to treat hyperkaleamia?

A

Calcium gluconate

The priority is to stabilise the heart: do not want it to arrest due to fatal cardiac arrhythmias

Then sort out hyperkaleamis:

IV insulin or salbutamol as temporary measures to drive K+ back into cells

If its severe- use Heamodialysis

Why not use diuretics, as these cause hypokaleamia too?- as diuretics will effect fluid balance. do not want to put any more strain on the heart.

56
Q

What should a patient do if they miss a warfarin dose?

A

Do not double up!

If later that evening- take dose. If next day- skip dose

57
Q

Why are beta blockers used with caution in diabetes?

A

Can mask hypoglyceamia:

beta blockers blunt the of adrenalin: if someone becomes hypoglycemia adrenalin doesnt kick in and they dont get warning symptoms. Sweating is the only symptom that still shows.

Canalso prevent adrenalin from stimulating the liver to make glucose, and therefore may make the hypoglycemia more severe

58
Q

Why are beta blockers cautioned in asthma and COPD?

A

Risk of bronchospasm

If absolutely need one: choose a cardio selective BB like Bisoprolol

59
Q

Why do we get a dry cough with Ace inhibitors and not ARB’s?

A

ARB’s do not increase bradykinin levels, because they do not inhibit ACE

60
Q

Why are NSAID’s cautioned in asthma, what can they cause?

A

Bronchospasm- does not happen to every asthmatic.

61
Q

Which diuretics can exacerbate diabetes?

A

Thiazides (most likely)
Loop diuretics

Due to hyperglyceamia side effect!

62
Q

What do we need to monitor with diurectic use?

A

Electrolytes:
Na +

K +

Mg +

Renal function

Uric acid levels (risk of gout)

Hyperglyceamia- can exacerbate diabetes

Hypotension- BP lowering effects

63
Q

When do we use simvastatin at a max dose of 10mg?

A

With fibrate use in combo: massive risk of myopathy

+ Bezafibrate

+ Ciprfibrate

Do not use gemfibrozil at all- risk of Rhabdomylosis too great

64
Q

Which oral antidiabetic carries the least risk of Hypoglyceamia?

A

Metformin

65
Q

What vitamin deficiency can Metformin cause?

A

Vitamin B12 (cobalamin)

Symptoms of deficiency:

neuropathy (numbness, pain, or tingling in hands or feet)

Anaemia-

extreme tiredness (fatigue)

lack of energy (lethargy)

breathlessness

pale skin

66
Q

Ace inhibitors have some protective and some negative effects on the Kidneys. When are they contra- indicated?

A

Bilateral Renal artery stenosis - they will make it progress into renal failure

Less effect on Unilateral renal artery stenosis

Best to avoid in patients with known or suspected RENOVASCULAR disease

67
Q

What is the max daily dose of Codeine?

How long must intervals between doses be?

,Max number of days OTC?

A

240mg daiy

6 hour intervals

3 days OTC

68
Q

What drug causes ‘Purple glove syndrome’ skin diseasein which the extremities becomeswollen, discoloured and painful

A

Phenytoin if given IV

69
Q

What are the CI of lithium?

A 
Addison’s disease
Cardiac insufficiency 
Dehydration 
Low Na+ diet 
Untreated hypothyroidism
70
Q

What are cautions of lithium?

A 
Avoid abrupt withdrawal 
Cardiac disease 
Concurrent ECT (May lower seizure threshold)
Epilepsy
Qt prolongation 
Can exacerbate psoriasis
71
Q

What is the association with long term use of lithium?

A

Thyroid disorders
Mild cognitive and memory impairment
Patients should b maintained on lithium after 3-5 years only if benefit is ther.

72
Q

What are the signs of overdose of lithium?

A

-GI disturbances:(vomiting and diarrhoea)
-visual disturbances (blurred vision)
-CNS disturbances: (fine tremors increasing to coarse, confusion, drowsiness, lack of co-ordination, restlessness, stupor, high Na+, incontinence)
Severe overdosage:( >2mmol/L)
Seizures
Cardiac arrhythmia (bradycardia, heart block)
BP changes
Circulatory failure
Renal failure
Coma
Sudden death
STOP TREATMENT IMMEDIATELY

73
Q

What is the conception, contraception advice and pregnancy advice with lithium?

A

Effective contraception during treatment

Avoid during pregnancy, especially in the 1st trimester (risk of teratogenicity and cardiac abnormalites)

74
Q

What are the serum level monitoring requirements of lithium?

A

-Serum concs: 0.4-1mmol/L
(lower end of the range for maintenance and the elderly)
Blood samples should be taken 12 hours.
0.8-1mmol/L: acute episodes of mania and relapse patients and sub-syndromal symptoms

75
Q

When should serum levels of lithium be measured?

A
  • Weekly after initiation and after each dose change until concs are stable.
  • Then every 3 months thereafter.
76
Q

What are the other factors that should be monitored for lithium?

A

Asses renal, cardiac, and thyroid function before treatment initiation.
Cardiac function- regularly
ECG is recommended in patient with CVD or risk factors.
FBC can be measured before treatment
-BMI or body weight, serum electrolytes, thyroid, eGFR before starting and every 6 months.

77
Q

What advice should be given when stopping lithium treatment?

A

Do not stop immediately unless told by dr.
Dose should be reduced gradually over at least 4 weeks (preferably over 3 months)
Abrupt withdrawal increases risk of relapse.

78
Q

What are the patient/career advice for lithium?

A

-Patients should stay on one brand
-They have have the treatment pack
-Keep constant and adequate salt and water intake (especially if they have an infection or during hot spells)
-Avoid otc NSAIDs, alcohol and Na+ containing antacids
-Risk of feeling sleepy- be careful when driving.
Report signs of benign intracranial HTN, hypothyroidism, renal dysfunction

79
Q

What drugs increase the toxicity of lithium?

A 
ACEI, ARBS
Loop diuretics, thiazides 
NSAIDS
K + sparing diuretics 
SSRIs (and CNS effects)
TCAs
Aldosterone antagonists
Metronidazole (MAY increase risk of toxicity)
80
Q

What drug increases risk of ventricular arrhythmias For lithium?

A

Amiodarone

81
Q

What drugs increase the risk of neurotoxicity of lithium?

A 
Methyldopa
Phenytoin
Carbamazepine 
Diltiazem
Verapamil
82
Q

What is the target rage for carbamazepine?

A

4-12mg/L measure after 1-2 weeks therapy

83
Q

What are the monitoring requirements of carbamazepine?

A

FBC
Renal function
Liver function

84
Q

What are the warning signs of carbamazepine?

A

Toxicity: incoordination, blurred vision, Diplopia (double vision), Nystagmus, Ataxia, Arrhythmia, N + V, Low Na+, Diarrhoea. STOP TREATMENT!
Blood disorders: leucopenia, thrombocytopenia (fever sore throat, fever, bruising)
Skin disorders: Toxic epidermal necrolysis (rash)
Hepatic disorders
Antiepiletic hypersensitivity syndrome: feve, rash, swollen lymph nodes.

85
Q

What is the major route of Elimination of carbamazepine?

A

Hepatic metabolism

Cyp450 enzyme inducer

86
Q

Which vitamin is recommended in carbamazepine and phenytoin? And for which type of patients?

A 
Vit D 
Consider in patients:
-who are immobilised for long periods 
-have inadequate sun exposure
-have inadequate dietary intake
87
Q

Which pre-treatment screening test is recommended in both carbamazepine and phenytoin and why?

A

Test for HLA-B*1502 allele in patients of Han Chinese or Thai origin due to the risk of SJS

88
Q

For the treatment of bipolar disorder, what is the withdrawal advice for carbamazepine?

A

Gradual withdrawal over at 4 weeks

89
Q

What are the patient/ career advice with carbamazepine?

A
  • report any warning signs to the doctor immediately
  • same brand all the time: (CATEGORY 1, like phenytoin, primidone, phenobarbital)
  • DVLA advice
90
Q

What drugs increase the levels of carbamazepine?

A 
Cimetidine
Clarithromycin 
Erythromycin 
Isoniazid 
Fluoxetine
91
Q

What drugs decrease the levels of carbamazepine?

A

phenytoin
Rifabutin
St. John’s wort

92
Q

What drugs does carbamazepine reduce the levels of?

A 
Antipsychotics 
Corticosteriods 
Coumarins
Eplerenone 
Oestrogens + progesterones 
Simvastatin
93
Q

What is the drug interaction between orlistat and carbamazepine?

A

Increased risk of convulsions

94
Q

What are the target ranges of ciclosporin?

A

Depends on clinical situation and indication for treatment.

95
Q

What are the monitoring requirements of ciclosporin?

A

-Ciclosporin blood serum levels- refer to local guidance
-Full blood count
-LFTs
-Serum K+ (risk of hyperkalaemia)and Mg2+
-eGFR
-BP: DISCONTINUE if HTN develops and cannot be controlled by antihypertensives
-Blood lipids (cholesterol)
In long-term MGT of nephrotic syndrome, perform renal biopsies EVERY YEAR

96
Q

When treating severe psoriasis or atopic dermatitis with ciclosporin, what are the monitoring requirements and how many times should it be tested?

A

Measure:
-Dermatological and physical examinations
-eGFR, creatitine (renal function) - EVERY 2 WEEKS for first 3 months, then EVERY MONTH, then. Every 4-8 weeks
-BP
Measure ALL at least TWICE before initiation

97
Q

What ids the MHRA/CHM advice on ciclosporin

A

Patient should be kept on the same brand.

Switching can lead to clinically significant blood serum levels

98
Q

What are the warning signs of ciclosporin?

A
  • Neurotoxicity (tremor, headache, encephalopathy)
  • blood disorders
  • liver toxicity
  • nephrotoxicity (e.g. elevated serum creatinine concs)
  • vomiting, drowsiness, tachycardia
  • HTN
  • Headache
  • Gingivial hyperplasia.
99
Q

What are the patient/carer advice for ciclosporin?

A
  • HTN is a common SE: have regular BP monitoring
  • warn patients not to receive live vaccines
  • patient should excessive exposure to UV light. Broad spec sunscreen should be used.
  • Patients with atopic dermatitis should avoid the use of UVB or PUVA.
  • AVOID high K+ diet and grapefruit juice.
  • oral solution formulations can be taken with orange or apple juice to improve taste.
100
Q

What is the further information in relation to adrenal suppression and corticosteroids?

A

Abrupt withdrawal after long term use can lead to adrenal insufficiency, hypotension and death.
-patients on long term steroids should have a steroid treatment card

101
Q

What is the further information in relation to infections and corticosteroids?

A
  • Prolonged use increased suspectiblity to infections and severity of infections.
  • serious infections
102
Q

What is the target range for phenytoin?

A

10-20mg/L (40-80micromol/L)

103
Q

What do you do if a patient is given enteral feeding and is taking phenytoin at the same time?

A

Interrupt enteral feeding for 2 hours BEFORE AND AFTER dose

104
Q

What are the signs and symptoms of phenytoin toxicity?

A

SNACHD

  • Slurred speech
  • Nystagmus
  • Ataxia
  • Confusion
  • Hyperglycaemia
  • Diplopia
105
Q

What are the patient and carers advice for phenytoin in relation to SEs?

A

Blood and skin disorders can occur.
Seek IMMEDIATE medical attention for leucopenia, anaemia, fever, sore throat, mouth ulcers, unexplained bleeding
Skin (SJS): rash, toxic epidermal necrolysis

106
Q

What are the specific SEs with oral use of phenytoin?

A
  • Electrolyte imbalance
  • Vit D deficiency
  • pneumonicitis
107
Q

Can phenytoin cause renal or hepatic impairment and what are the instructions?

A

HEPATIC IMPAIRMENT

-Reduce dose to avoid toxicity

108
Q

How does azathioprine work?

A

It’s metabolised to mercaptopurine

109
Q

What is the dose adjustment when azathioprine is given with allopurinol?

A

Reduce azathioprine dose to 1/4 (one-quarter)

110
Q

What are the monitoring requirements of azathioprine?

A

-monitor for toxicity throughout treatment
-monitor full blood count WEEKLY for the first 4 weeks, then reduce down to at least every 3 months - this is ESSENTIAL for signs of myelosuppression
-TPMT activity measure B4 INITIATION (thiopurine methyltransferase).
Low activity = HIGH risk of myelosuppression
Zero activity = AVOID

111
Q

What are the main SEs in azathioprine?

A
  1. Neutropenia and thrombocytopenia (bleeding, bruising)
  2. Hypersensitivity reactions (malaise, dizziness, vomiting, diarrhoea, fever, rash, myalgia, HYPOtension, renal dysfunction)WITHDRAW
  3. N+V (Nausea is common early on in the treatment. Usually resolves after a few weeks without alternating the dose)
    MODERATE nausea can be managed by dividing dose, taking doses after food, prescribing antiemetics, temporarily reducing dose
112
Q

What are the dose requirements for elderly when taking azathioprine?

A

Reduce the dose in elderly

113
Q

When azathioprine is used to treat rheumatoid arthritis when do you WITHDRAW?

A

When N+V or diarrhoea occurs it may be appropriate to STOP

BNF GPhC (48 decks)

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