HIGH RISK DRUGS Flashcards
What is the mechanism of action of METHOTREXATE
Inhibits enzyme dihydrofolate reductase that is essential for the synthesis of purines and pyrimidine
What are the side effects of methotrexate
- Anaemia
- Diarrhoea
- GI discomfort
- Headache
What is the monitoring needed for Methotrexate
FBC, Renal and Liver function every 1-2 weeks until stabilized then every 2-3 months
How long does it take to have an anti-inflammatory effect from NSAIDs?
Up to 3 weeks
Ibuprofen doses in children?
3-5 months = 50mg / 8 hours
6-11 months = 50mg / 6-8 hours
1-3 years = 100mg / 6-8 hours
4-6 years = 150mg / 6-8 hours
7-9 years= 200mg / 6-8 hours
10-11 years= 300mg / 6-8 hours
What happens if people have poor adherence with narrow therapeutic drugs
Missed doses can impact control, e.g. patients can have seizures if non compliant with antiepileptics
Signs of Lithium toxicity?
- Tremor
- Slurred speech
- Confusion
- Seizures
Signs of Digoxin toxicity ?
- Nausea
- Visual disturbances
- Arrhythmias
Why are opioids high risk?
> Narrow therapeutic index
Respiratory depression
Interpatient variability
CNS depression
Dependence and tolerance
Is it appropriate to give an opioid naive patient fentanyl / buprenorphine patches?
No
High risk of overdose
Patches are long acting so their effects cannot be reverse if toxicity occurs
Signs of opioid overdose
Pinpoint pupils
Respiratory depression
Unresponsiveness
Cyanosis
How does Valproate work?
Increases the conc of GABA in the brain and inhibits voltage-gated sodium and calcium channels
What are the contraindications of Valproate
-Pregnancy: teratogenic effects
-Liver disease: risk of hepatotoxicity
-Pancreatitis
What are the types of chemotherapy
> Alkylating agents
Antimetabolites
Hormonal therapies
Mitotic inhibitors
Targeted therapies
Topoisomerase inhibitors
How do alkylating agents work
Interfere with DNA replication in cancer cells
How do antimetabolites work
By mimicking the building blocks of DNA and RNA so disrupts cell division
Common side effects of chemotherapy?
-Bone marrow suppression
- Hair loss
- Mucositis
-Nausea and Vomiting
- Peripheral neuropathy
What technique is used for parenteral drugs?
ASEPTIC TECHNIQUE
-Sterilising equipment
-Working in clean areas
- Wearing PPE
Parenteral drugs bypass natural barriers and so they are more prone to introducing infection not handled carefully
Different classes of antibiotics?
- Beta lactams
- Aminoglycosides
- Tetracyclines
- Macrolides
- Fluoroquinolones
