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High risk drugs Flashcards

1
Q

Loading Dose of amiodarone

A

200mg TDS for 7 days, then 200mg bd for 7 days

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2
Q

Maintenance dose amiodarone

A

200mg

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3
Q

Side effects of amiodarone

A 
Bradycardia/blue
Interstitial lung disease
Thyroid
Corneal/cutaneous
Hepatic/hypotension
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4
Q

Monitoring of amiodarone before

A

TFTs
Serum potassium
Chest xray

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5
Q

Monitoring on amiodarone

A

LFTS
TFTs every 6 months
eCG
Symptoms can continue for several weeks after discontinuation

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6
Q

Warfarin and amiodarone

A

Increased anticoagulant effect of warfarin

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7
Q

Beta blockers and amiodarone

A

Increased risk of bradycardia, AV block and myocardial depression

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8
Q

Amiodarone and lithium

A

Risk of ventricular arrhythmias

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9
Q

Amiodarone and digoxin

A

Increased digoxin concentration

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10
Q

Digoxin mechanism

A

cardiac glycoside

Increases myocardial contraction and reduces conductivity in AV node

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11
Q

Optimum plasma concentration digoxin

A

1-2 mcg/L

1.5-3 indicates toxicity

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12
Q

Digoxin monitoring

A

serum electrolytes esp potassium

renal function

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13
Q

Toxicity of digoxin

A

Made worse by hypokalaemia

Managed by giving potassium sparing diuretic

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14
Q

Digoxin side effects

A

Nausea and vomiting
Blurred or yellow vision
Confusion or delirium

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15
Q

Digoxin and erythromycin

A

Increased digoxin concentration

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16
Q

Digoxin and rifampicin

A

Reduced digoxin concentration

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17
Q

Digoxin and St John’s Wort

A

Reduced digoxin concentration

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18
Q

Digoxin and diuretics

A

Increased toxicity of digoxin if hypokalaemia occurs with loops and thiazides

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19
Q

Digoxin and CCBs

A

Increased digoxin concentration

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20
Q

Lithium serum concentration

A

0.4-1 mmol/L

Above 1.5mmol/L fatal/toxic

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21
Q

Lithium toxicity

A 
Levels
Increased urination
Tremor and thirst
Hair thinning and hypothyroidism
Interactions
Upset stomach
Muscle weakness
Skin effect - acne or psoriasis
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22
Q

Lithium monitoring

A

Lithium conc every 3 months
U&Es and TFTs every 6-12 months
Maintain sodium concentrations

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23
Q

Lithium counselling

A

Maintain adequate fluid intake

Avoid dietary changes with sodium

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24
Q

Lithium and ACE inhibitors

A

Excretion of lithium reduced by ACE inhibitors – Risk of lithium toxicity

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25
Q

Lithium and NSAIDS

A

Excretion of lithium reduced by NSAIDS – Risk of lithium toxicity

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26
Q

Lithium and diuretics

A

Excretion of lithium reduced

27
Q

Toxic signs of methotrexate

A

Blood dyscraisas
Liver toxicity
Pulmonary toxicity

28
Q

Monitoring of methotrexate

A

LFTS

U&es before starting

29
Q

Dose of methotrexate

A

7.5mg once weekly

Max weekly dose of 20mg

30
Q

Methotrexate and NSAIDS

A

Monitor dose of methotrexate as dose can be increased

Avoid OTC preparations

31
Q

Methotrexate and folic acid

A

5mg folic acid to prevent methotrexate-induced mucositis or myelosuppression

32
Q

Side effects of methotrexate

A

GI bleeding and ulceration

Hepatotoxicity

33
Q

Indication of phenytoin

A

Epilepsy (all except absence) and neuropathic pain

34
Q

Phenytoin concentration

A

10-20mg/L

Small dose may increase plasma conc excessively

35
Q

Phenytoin monitoring

A

FBC and LFTs

36
Q

Phenytoin side effects

A 
P450 interactions
Hirsuitism
Enlarged gums
Nystagmus
Yellow staining of skin
Teratogenicity
Osteomalacia
interfere with B12 metabolism
Neuropathies
37
Q

Phenytoin counselling

A

Blood dyscraisa
Skin disorders
Take with or after food

38
Q

Phenytoin and NSAIDS

A

Effect of phenytoin enhanced

39
Q

Phenytoin and wafarin

A

Accelerates metabolism of wafarin

40
Q

Phenytoin and cimetidine

A

Inhibits metabolism of phenytoin

41
Q

Phenytoin and fluoxetine

A

Increased concentration of phenytoin

42
Q

Phenytoin and st johns wort

A

Reduced plasma conc of phenytoin

43
Q

Phenytoin and NSAIDS

A

Effects enhanced by NSAIDS

44
Q

Plasma concentration of theophylline

A

10-20mg/L

45
Q

Theophylline side effects

A 
Tremor
Heart arrhythmias
Electrolyte imbalance- hypokalaemia
Oxidase inhibitor 
Pain in abdomen
Heachaches, insomnia and seizures
46
Q

Theophylline monitoring

A

Plasma theophylline conc
Lung function test
serum potassium

47
Q

Theophylline and quinolones

A

Increased risk of convulsions

48
Q

Theophylline and St Johns wort

A

Plasma conc of theophylline reduced

49
Q

Theophylline and rifampicin

A

Plasma conc of theophylline reduced

50
Q

Theophylline and cimetidine

A

Plasma conc of theophylline increased

51
Q

Theophylline and fluconazole

A

Plasma conc of theophylline reduced

52
Q

Warfarin loading dose

A

10mg

53
Q

Warfarin side effects

A 
Haemorrhage
Rash
Bruising 
Bleeding
Alopecia
Unexplained drop in haematocrit
Skin necrosis
Purple toes
jaundice
hepatic toxicity
54
Q

Warfarin counselling

A

Avoid dietary changes
Same time each day
Report bleeding etc

55
Q

Warfarin and NSAIDS

A

Enhanced anticoagulation

56
Q

Wafarin and fluconazole

A

Enhanced anticoagulation

57
Q

Wafarin and statins

A

Enhanced anticoagulation

58
Q

Wafarin and cipro/metronidazole/ clarithromycin

A

Enhanced anticoagulation

59
Q

Wafarin and griseofulvin

A

reduced anticoagulation

60
Q

warfarin and antiepileptic

A

reduced anticoagulation

61
Q

warfarin and alcohol

A

Dependent on consumption

62
Q

warfarin and cranberry juice

A

Enhanced anticoagulation

63
Q

wafarin and vitamin K

A

anticoagulant effect antagonised by vit k

Pre-registration flashcards (6 decks)

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