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BNF/Pre-Reg 2017-2018 > High Risk Drugs 2: The Remix > Flashcards

High Risk Drugs 2: The Remix Flashcards

1
Q

What high risk drugs can cause hypo/hyperthyroidism? (2)

A

Ltihium (0.4-1.0, 0.8-1.0 manic)

Amiodarone (Pulmonary tox, Peripheral neuropathy, photophobia/skin reactions, eye deposits)

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2
Q

What high risk drugs can cause photophobia/phototoxic reactions? (3)

A

Amiodarone (Pulmonary tox, Peripheral neuropathy, photophobia/skin reactions, eye deposits)

Phenobarbital (10-40mg/L, hallucinations, memory problems/behavioural issues in children)

Tacrolimus (hyperglycaemia, renal and liver tox, rash, blood issues)

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3
Q

What high risk drugs are associated with drowsiness? (2)

A

Carbamazepine (4-12mg/L, hyponatraemia)

Ltihium (0.4-1.0, 0.8-1.0 manic)

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4
Q

What are the distinguishing side effects of amiodarone? (5)

A

Grey skin

Phototoxicity

Shortness of breath due to pulmonary toxicity - shared with methotrexate and some other cytotoxics

Peripheral neuropathy - see other cytotoxics as well
.
Reversible corneal deposits

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5
Q

What are the distinguishing side effects of carbamazepine? (3)

A

4-12mg/L

Hyponatraemia

Thrombocytopenia

Antiepileptic syndrome

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6
Q

What are the distinguishing side efects of digoxin? (4)

A

Mental confusion
Blurred yellow vision
Psychosis
Anorexia

In states of hypokalemia, or low potassium, digoxin toxicity is actually worsened because digoxin normally binds to the ATPase pump on the same site as potassium. When potassium levels are low, digoxin can more easily bind to the ATPase pump, exerting the inhibitory effects.

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7
Q

What are the distinguishing side effects of lithium? (3)

A

Fine tremor -> coarse tremor

Mucle weakness (also digoxin)

Intracranial hypertension - persistent headaches etc.

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8
Q

What is the distinguishing side effect for gentamicin?

A

peak 5-10mg/L, endo: 3-5mg/l

trough <2mg/L, endo: <1mg/L

  1. Hearing impairment/ototoxicity
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9
Q

What are the distinguishing side effects of vancomycin? (3)

A

10-15mg/L
15-20mg/L for endo/MRSA

  1. Vertigo/dizziness
  2. Flushing/Red man syndrome
  3. I guess phlebitis?
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10
Q

What are the distinguishing side effects of phenobarbital? (5)

A
  1. Halluncinations
  2. Impaired memory
  3. Megaloblastic anaemia (High MCV, low Hb)
  4. Osteomalacia
  5. Depression
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11
Q

What are the distinguishing side effects of phenytoin? (6)

A

10-20mg/L
1. Slurred speech

  1. Hyperglycaemia (also theophylline + tacrolimus)
  2. Suicidal thoughts? (Phenobarbital: depression)
  3. Low vitamin D –> rickets, osteoporosis, linked to anti-folate action? idk
  4. Rash/epidermal necrolysis (also with warfarin tho?)
  5. Non-linear kinetics
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12
Q

What are the distinguishin side effects of theophylline? (4)

A

10-20mg/L

Think caffeine overdose yo.

  1. Dilated pupils
  2. Restless (akasthasia)
  3. Intractable vomiting (maybe not so much with too many coffees..)
  4. Convulsions (less specific?)
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13
Q

What are the distinguishing side effects of tacrolimus? (3)

A
  1. Neurotoxic - tremor/headache
  2. Hyperglyceamia (theophylline and phenytoin)
  3. Cardiotoxicity
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14
Q

High risk drugs with therapeutic levels of 10-20mg/L (2)

A

Theophylline, 2 days SS, 4-6 hours post dose.

Phenytoin, 7-28 days SS, pre-dose.

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15
Q

High risk drugs with monitoring of renal function (6)

A
  1. Carbamazepine + Liver
  2. Digoxin
  3. Lithium
  4. Gentamicin
  5. Vancomycin
  6. Tacrolimus + Liver
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16
Q

High risk drugs with monitoring of liver function (5)

A
  1. Amiodarone
  2. Carbamazepine + Renal
  3. Phenobarbital
  4. Phenytoin
  5. Tacrolimus + Renal
17
Q

High risk drugs with monitoring of serum potassium (5)

A
  1. Tacrolimus
  2. Theophylline (hypokalaemia)
  3. Vancomycin
  4. Digoxin
  5. Amiodarone
18
Q

High risk drugs which require FBC

A
  1. Carbamazepine
  2. Vancomycin + auditory function [as does gent but not FBC with gent]
  3. Phenobarbital
  4. Phenytoin
  5. Tacrolimus (not actuall sure)
19
Q

Why can aminoglycosides, amphotericin, pentamidinem, gentamicin, tobramycin and viomycin cause hypomagnesemia?

A

They block magnesium resorption in the loop of henle.

20
Q

What electrolyte disturbances do PPI cause?

A

C. diff
Hyponatraemia
Hypomagnesia

21
Q

What electrolyte imbalances predispose to digoxin toxicity?

A

Low Mg
Low K
High Ca
Hypoxia

22
Q

How do cisplatin and ciclosporin both cause hypomagnesemia?

A

They both stimulate renal magnesium excretion.

BNF/Pre-Reg 2017-2018 (144 decks)

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