High-risk drugs Flashcards
1
Q
Amiodarone side-effects
A
- Avoid in bradycardia and heart block
- Corneal microdeposits- STOP if vision impaired!
- Thyroid disorders- due to iodine content, can cause both hypo/hyper
- Pulmonary toxicity
- Hepatotoxicity
- Photosensitivity- avoid sunlight exposure and use sunscreen
- Blue-grey syndrome
2
Q
Amiodarone monitoring
A
- Thyroid function tests
- Liver function tests
- Potassium levels
- Chest X-Ray- before treatment
- Annual eye examination
3
Q
Amiodarone interactions
A
- Drugs that cause hypokalaemia
- Drugs that cause QT prolongation
- Drugs that cause** bradycardia**
- It’s a CYP450 inibitor, so will interact with Warfarin, statins, etc.
- Grapefruit juice
- DIGOXIN! - Need to half the dose of Digoxin
4
Q
Amiodarone dose
A
- Loading dose: 200mg TDS for 7 days, then 200mg BD for 7 days
- Maintenance dose: 200mg OD
5
Q
Digoxin therapeutic range
A
0.7 - 2.0 ng/L
Toxicity= “sick and slow”
So signs/symptome= vomitting, dizziness, confusion, bradycardia, blurred/yellow vision
6
Q
Digoxin Interactions
A
- Beta-blockers
- CYP450 Inducers AND Inhibitors
- TCA
- Drugs that cause hypokalaemia
7
Q
Warfarin target
A
2.5, unless:
* Recurrent VTEs
* Mechanical heart valve
(Then, it would be 3.5)
8
Q
INR- what to do if too high?
A
- Major bleed: Stop Warfarin. +IV phytomenadione and dried prothrombin
- INR >8 , minor bleeding: Stop Warfarin. +IV phytomenadione
- INR >8 , no bleeding: Stop Warfarin. + oral phytomenadione
- INR 5-8 , minor bleeding: Stop Warfarin. +IV phytomenadione
- INR 5-8 , no bleeding: Withold 1-2 doses of Warfarin
Restart warfarin when INR < 5
9
Q
Warfarin interactions
A
- Leafy greens (contain Vitamin K, which is antidote)
- Cranberry/ Pomegrante juice (increases INR)
- Miconazole/ OTC Daktarin (increases INR)
- CYP450 inducers (decreases INR)
- CYP450 inhibitors (increases INR)
