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Inori Pre Reg > High Risk Drugs > Flashcards

High Risk Drugs Flashcards

1
Q

Amiodarone is hepatotoxic or renal toxic?

A

Hepato

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2
Q

Amiodarone can cause neurological side effects as well, symptoms?

A 
Tremor
Peripheral neuropathy (development of numbness and tingling in hands and feet)
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3
Q

Other side effects of amiodarone?

A

Arrhythmias
Nausea
Skin recations (burning sensation followed by erythema, grey skin discolouration on light exposed areas)
Neurological side effects

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4
Q

Contraindications of amiodarone?

A

Thyroid dysfunction
Iodine sensitivity
Heart block

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5
Q

What to monitor for amiodarone?

A 
Thyroid function
LFTs
Serum potassium cocn.
Chest xray
ECG
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6
Q

Advice on amiodarone to pts?

A

Skin stuff

Pt may be dazzled by headlights at night so be careful when driving

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7
Q

Main interactions of amiodarone?

A

Antiepileptcs=increased conc.
Avoid CCBs and BBs=increased risk of cardio depression, AV block
Avoid grapefruit juice
Increase Anticoagulant effects of warfarin, dabigatran,
Increased plasma conc. Of digoxin and ciclosporin
Lithium increases risk of arrhythmia
Statin increased risk of myopathy
Increased risk of arrhythmia with QT prolongation drugs

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8
Q

Vancomycin is active aginst what kind of bacteria?

A

Aerobic & Anaerobic gram positives

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9
Q

Side effects of vancomycin if administered too quickly?

A

Hypotention

Anaphylaxis

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10
Q

Therapeutic range of vancomycin?

A

Trough of 10-15mg/L

15-20mg/L if endocarditis or less sensitive strains of MRSA or complicated infections caused by S. Aureus

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11
Q

When to take vancomycin therapeutic serum cocn?

A

Immediately before the fourth dose or after 48hrs of therapy

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12
Q

Monitoring required for vancomycin?

A 
Serum potassium
FBC
Renal function
Auditory fucntion in elderly
Urinalysis

Hepatic

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13
Q

What affect does amiodarone have on potassium?

A

Hypokalaemia can be severe

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14
Q

How long does it take for warfarin to work?

A

48-72hrs to act fully

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15
Q

How frequently do you have to assess INR?

A

Every 3 months

More frequently if signs of bleeding, N&V or illness

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16
Q

INR should be within what of units of the target value?

A

0.5units

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17
Q

What condition needs a target INR of 2.5?

A 
Treatment of DVT and PE
AF
cardioversion
Mitral stenosis
Dilated cardiomyopathy
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18
Q

What condition needs an INR of 3.5?

A

Recurrent DVT and PE

Mechanical prosthetic heart valve

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19
Q

Monitoring for warfarin?

A

INR
Liver (can cause hepatic impairment and hepatically excreted) & renal (pts with renal impairment have a higher risk of haemorrhagicc and ischemic events)
FBC
BP
Thyroid function (hyper or hypo thyroidism can alter warfarin efficacy)

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20
Q

Warfarin and pregnancy?

A

Teratogenic so need contraception

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21
Q

Side effects of warfarin?

A

Bleeding
Painful skin rasg
Blue or purple tie syndrome

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22
Q

Main stuff that can increase the effects of warfarin?

A 
Cranberry and pomegranate juice
Antifungals esp miconazole which has a MHRA warning
Chloramphenicol
Metronidazole
Macrolides
Steroids
SSRIS
statins (esp fluvastatin and rosuvastatin)
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23
Q

Main stuff that can decrease effects of warfarin?

A 
Vit K (food supplements, enteral feeds, large amounts of green veg or green tea)
Major changes in diet esp salads and veg
Alcohol consumption
St John's wart must be avouded
Carbamazepine
Phenytoin
Rifampicin
Griseofulvin
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24
Q

Gender pt advice on warfarin?

A

Take at same time each day
Take missed doses as normal the next day, don’t double any missed doses
Ensure pt has an oral Anticoagulant pack with a record booklet alert card and yellow book
Ensure pts understand different warfarin strength and colours
Advise pt to inform GP if any changes in diet or medication

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25
Q

Therapeutic range of gentamicin for multiple daily dose regimens?

A

1hr peak serum conc should be 5-10mg/L
(3-5mg/L for endocarditis)
Pre dose trough conc should be below 2mg/L (below 1mg/L for endocarditis)

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26
Q

What to monitor with gentamicin

A

Plasma conc
Renal function
Auditory and vestibular function

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27
Q

Serum aminoglycosides conc must be determined in?

A

Elderly
Renal impairment
If high doses, Obesity and in cystic fibrosis

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28
Q

Side effects of gentamicin?

A 
Antibiotic associated colitis
Blood disorders
Deoression
Neurotoxicity
Vestibular damage
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29
Q

Pt action required for gentamicin?

A

Ensure pt is hydrated and drinking adequate fluid to prevent dehydration before starting treatment

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30
Q

Signs of GI bleed?

A

Black stool

Coffee ground vomit

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31
Q

Monitoring requirements for NSAIDs?

A 
BP (esp after dose changes)
Renal function
Liver function
HB in pts at risk of bleeding
Signs of oedema like swollen ankles and feet
Signs of GI bleeds
Iron deficient anaemia
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32
Q

Signs of iron deficient anaemia?

A 
Suggests chronic GI bleeding
Fatifue
Dizziness
Pale skin
SOB
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33
Q

Advise on NSAIDs?

A

Always take with food to protect stomach

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34
Q

Important interactions of NSAIDs?

A

Quinolones = increased risk of convulsion
Possible enhanced effects of Sulfonylureas
NSAIDs antagonise hypotensive effect of BBs, CCBs, ACEi, angiotensin 2 antagonists, alpha blockers and nitrates

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35
Q

Overdose signs of Opioids?

A

Coma
Respiratory deoression
Pinpoint pupils

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36
Q

What opioid increases effects of warfarin?

A

Tramadol

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37
Q

What happens when Opioids and alcohol are mixed?

A

Increased sedation and hypotensive effect

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38
Q

Ciclosporin is hepatotoxic or Nephrotoxic?

A

Markedly Nephrotoxic

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39
Q

Ciclosporin contra indications?

A

Uncontrolled BP
Malignancy
Uncontrolled infections

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40
Q

What electrolyte disturbances does ciclosporin cause?

A

Hyperkalaemia

Magnesium

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41
Q

Monitoring requirements for ciclosporin?

A 
FBC
Liver function
Kidney
Serum electrolytes
Blood lipids
BP (regularly) bc hypertention is a common side effect 
Dermatological and physical examination
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42
Q

Is ciclosporin Nephrotoxic or hepatotoxic?

A

Nephrotoxic

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43
Q

Side effects of ciclosporin?

A 
Diarrhoea
Decreased appetite
GI discomfort
Skin reactions
Flushing
Vomiting
Encephalopathic
Blood disorders
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44
Q

Warning signs of ciclosporin?

A 
Neurotoxicity (tremor, headache, encephalopathy, confusion, convulsions)
Blood disorders
Liver toxicity
Nephrotoxicity
Hypertension
Headache
Gingivial hyperplasia
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45
Q

Important interactions of ciclosporin?

A

Enzyme inducers and inhibitors

Increased risk of digoxin toxicity
Increased risk of myopathy with statins
Increased risk of Nephrotoxicity and Hyperkalaemia

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46
Q

Patient advise on ciclosporin?

A

Avoid sunlight
Do not receive immunisation with live vaccines
Avoid high potassium diet and grapefruit juice
Can be taken with orange or apple juice to improve taste
Stick to the same brand

47
Q

Side effects of tacrolimus?

A 
Greater neurotoxicity that ciclosporin
Cardiomyopathy reported = CV disorders 
Hyoerglycaemia
Nephrotoxicity
Eye disorders
Skin disorders
Blood disorders
Liver toxicity
Hyperkalaemia
48
Q

Monitoring for tacrolimus?

A

Mains are Liver and renal function

BP
ECG
Fasting blood glucose cocn.
Serum electrolytes esp potassium

49
Q

Pt advise on tacrolimus?

A 
Protect skin from sun
Drowsiness can affect driving
Prescribe by brand
No live vaccine
No high potassium diet and avoid grapefruit juice
50
Q

Mode of action of methotrexate?

A

Inhibits dihydrofolate reductase

51
Q

Side effects of methotrexate?

A

Blood disorder
Liver toxicity
Respiratory effects
GI toxicity like stomatitis

52
Q

Monitoring requirements for methotrexate?

A

FBC
renal
liver every 1-2wks until stabilised then every 2-3months

53
Q

Pt advise on methotrexate?

A

Avoid NSAIDs and aspirin
Contraception
Advise on annual flu but avoid live vaccine

54
Q

Contraception advise on methotrexate?

A

Use during and for at least 6 months after treatment in both men and women

55
Q

Important interactions with methotrexate?

A

Increased risk of toxicity with NSAIDs, PPIs
Increased risk of toxicity with certain antibiotics
Increased risk of haematological toxicity when given with Co trimoxazole

56
Q

Which antibiotics can cause increased toxicity with methotrexate?

A

Penicillin
Ciprofloxacin
Doxycycline
Tetracycline

57
Q

Action time of thiazide diuretics?

A

Act within 1-2hrs after effects last for 12-24hrs

58
Q

Risk of Hypokalaemia is greater in loop or thiazide?

A

Thiazide

59
Q

Hypokalaemia can lead to what in hepatic failure esp in alcoholic cirrhosis?

A

Encephalopathy

60
Q

Mode of action of digoxin?

A

Positive ionotropic effect (myocardial contraction)
&
Negative chronotropic effect (reduced HR)

61
Q

How is digoxin dose determined?

A

Ventricular rate at rest and renal function

Should not fall below 60BPM persistently

62
Q

Response time of digoxin?

A

Response may fake several hours so not suitable for rapid HR control

63
Q

Digoxin has a long or short half life?

A

Long so maintenance dose given OD

Can divide higher doses into BD to prevent nausea

64
Q

Digoxin toxicity signs?

A

Cardiac = Arrhythmias
GI = Diarrhoea, Dizziness, Nausea, Vomiting
Skin reactions
Vision disorders blurred or yellow

65
Q

Monitoring with digoxin?

A

Plasma conc.
Serum electrolytes
Renal function
HR

66
Q

What increases digoxin plasma cocn?

A 
Ciclosporin
Enzyme inhibitors
Mirabegron
Rate control CCBs
Spironolactone
67
Q

Important interactions of digoxin?

A

Drugs that impair renal function can affect the plasma digoxin cocn like NSAIDs and ACEi

68
Q

Signs and symotoms of pancreatitis?

A

Abdominal pain
Nausea
Vomiting

69
Q

What drugs cause pancreatitis?

A

Sodium valproate

Pioglitazone

70
Q

Contra indications of lithium?

A

Dehydratiom
Low sodium diet
Untreated hypothyroidism
Addisons disease

71
Q

Pt advise in lithium?

A

Avoid abrupt withdrawal
Keep on same brand
Review dose in diarrhoea, elderly, vomiting, surgery and intercurrent infection
Keep a constant and adequate salt and water intake (esp if they have an infection)
OTC interactions
Risk of driving

72
Q

Side effects of lithium?

A

QT prolongation, arrhythmia

Long term use has been associated with Thyroid disorder and mild cognitive and memory impairment

Tremort
Abdominal discomfort
Angiodema
Electrolyte imbalance
Hypothyroidism 
Weight gain
Leucocytosis
Skin reactions
Vertigo
73
Q

Lithium in pregnancy and BF?

A

BF needs to be avoided as present in milk and risk of toxicity

Avoid in preg esp in first trimester bc risk of teratogenicity and cardiac abnormalities

Dose may need to be increased in second and third trimesters but on delivery return abruptly to normal

74
Q

Monitoring requirements with lithium

A

Serum conc. Weekly after initiation and each dose change until stable then every 3 months

Before initiation, cardiac, Thyroid and renal, BMI, FBC and electrolytes

75
Q

Therapeutic range of lithium?

A
  1. 4 - 1.0mmol/L for maintenance therapy and elderly pts

0. 8-1.0mmol/L for acute episodes of mania and for pts who have previously relapsed

76
Q

When to take lithium blood sample?

A

12hrs after dose

77
Q

Major route of elimination of lithium?

A

Renally

Freely filtered at glomerulus with 80% reabsorbed

78
Q

How to do treatment cessation with lithium?

A

Reduce gradually over a period of at least 4wks to 3 months

If lithium is stopped or to be discontinued abruptly, consider changing therapy to an atypical Antipsychotics or Valproate

79
Q

What drugs increase lithium conc?

A

ACEi and Angion,
all diuretics,
NSAIDs
Antiepileptcs = increased risk of neurotoxicity

80
Q

Increase risk of neurotoxicity when taken with lithium?

A

Antiepileptcs
Methyldopa
Rate limiting CCBs

81
Q

Increased risk of EPS when taken with lithium?

A 
Clozapine
Haloperidol
Sulpiride
Phenothiazines
Risperidone
Fluoentixol
Zuclopenthixol
82
Q

What type of epilepsy do you have to avoid carbamazepine?

A

Absence
Tonic and clonic
Myoclonic
As may exacerbate

83
Q

Therapeutic range of carbamazepine?

A

4-12 mg/L

20-50micromol/L

84
Q

Side effects of carbamazepine?

A

Common = headache, ataxia, drowsiness, N&V, blurred vision, allergic skin reactions
(more common at the start of treatment, can be reduced by using MR preps)

Blood disorders = leucopenua and thrombocytopenia
Skin disorders
Hepatic disorders
Anti epileptic hypersensitivity syndrome

85
Q

Symptoms of antiepileptc hypersensitivity syndrome?

A

Fever
Rash
Swollen lymph nodes

86
Q

Monitoring requirements of carbamazepine?

A

FBC
Liver
Renal

87
Q

What’s the relationship between dose and plasma drug conc of Phenytoin?

A

Non linear relationships

Small changes in dose or missed dose and Chnage in absorption can result in marked change in plasma drug conc.

88
Q

Therapeutic range of phenytoin?

A

10-29mg/L

89
Q

Side effects of phenytoin?

A

Blood disorders
Skin disorders like rash = discontinue
Suicidal thoughts
Low vit D levels which can lead to rickets and osteomalacia

90
Q

What is rickets?

A

Affects bone development in children

It causes bone pain, poor growth and soft, weak bones which can lead to bone deformities

91
Q

What is osteomalacia?

A

Soft bones

92
Q

Toxicity signs of phenytoin?

A 
Nystagmus
Ataxia
Slurred speecg
Hyperglycaemua
Diplooia
Blurred vision
Confusion
93
Q

What to monitor with phenytoin?

A 
FBC
Liver function = phenytoin is highly protein bound so liver impairment and elderly can show early signs of toxicity 
BP & ECG
Serum cocn.
Vit D levels
Serum folate

Serum conc, ECG and BP esp with IV use

94
Q

Interaction between ohenytoj. And trimethoprim?

A

Increased antifolate effect so be ware

95
Q

What is theophylline?

A

A xanthine used as bronchodilator in asthma and stable COPD

96
Q

How is theophylline metabised?

A

Liver

97
Q

Therapeutic range of theophylline?

A

10-20mg/L

98
Q

What condition can lead to increased theophylline conc?

A

HF
Hepatic impairment
Viral infection

99
Q

What condition can decrease theophylline cocn?

A

Smokers

Alcohol

100
Q

Monitoring requirements for theophylline?

A

Serum potassium

Plsma cocnc.

101
Q

Caution in theophylline?

A 
CV disease
Elderly can increase plasma theophylline cocnc.
Fever
Hypertention
Peptic ulcer
Risk of Hypokalaemia
102
Q

Side effects of theophylline?

A 
Serious Hypokalaemia with B2 agonist
Anxiety
Tremor
Vomiting and diarrhoea
Nausea
Arrhythmia
GI probs
Skin recations
Sleep disorder
103
Q

Important interactions of theophylline?

A

Serious Hypokalaemia with beta 2 agonists
Increased risk of convulsions with quinolonrs
Smoking
Theophylline decreases lithium conc.

104
Q

Toxicity signs of theophylline?

A 
Vomiting
Agitation
Restkessness
Dilated oupils
Tachycardia
Hyperglycaemia
Severe hypokalaemia
Convulsions
Arrhythmia
105
Q

Monitoring requirements for Antiplatelets?

A

Renal
Liver
Signs of bleeding
GI ulcers

106
Q

Dipyridamole pt advise?

A

Discard MR caps 6wks after opening OP

Take 30-60mins before food

107
Q

What can decrease the efficacy of clopidogrel?

A

Antifungals
SSRIs
PPIs like omeprazole and esomeprazole

108
Q

Warning signs of ACEi and Angio?

A

Dizziness, Light-headedness, blurred vision = postural hyootention

Jaundice

Abnormal renal function
Anuria, confusion, N&V and dehydration = AKI

109
Q

How long can a ACE cough last after stopping the drug?

A

8-12wks

110
Q

Sick days rule in hypertensive?

A

Stop
Esp when experiencing diarrhoea or vomiting unless minor
Or fever, swears and shaking to prevent dehydration which can lead to AKI

111
Q

What can masks sings of Hypoglycaemia?

A

BBs

Alcohol

112
Q

Signs of Hypoglycaemia?

A 
Shaking and trembling
Sweating
Pins and needles in lips and tongue
Hunger
Palpitations
Headache 
Double vision

More serious are:
Difficulty concentrating
Confusion, unconsciousness, change of behaviour
Slurring of speech and convulsions

113
Q

What increase the risk of Hypoglycaemia?

A

Fibrates
Oral antidiabetics
ACEi
MAOIS

Inori Pre Reg (22 decks)

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