High risk drugs part 1

Question 1

Co-amoxiclav

Answer 1

Cholestatic jaundice

• More common over 65 + men
• Self limiting
• Treatment should not exceed 14 days

Question 2

Amoxicillin

Answer 2

Interacts w MTX - hepatotoxicity

Question 3

Flucloxacillin

Answer 3

Cholestatic + hepatitis if admin for >2 weeks

Caution: hepatic impairment

Question 4

Cephalosporins + pen allergy

Answer 4

0.5-6.5% of pen sensitive patients will also be allergic to the cephalosporins

Question 5

Erythromycin

Answer 5

Significant N, V + diarrhoea - red dose

Clarithromycin - fewer GI effects

Question 6

Clindamycin

Answer 6

Abx colitis - middle age + elderly women

Question 7

Nitrofurantoin

Answer 7

Can be used in pregnancy except at term

Avoid eGFR <45

Discolour urine brown

Question 8

Trimethoprim

Answer 8

LT prophylaxis: recognise signs of blood disorder

Hyperkalaemia

Question 9

Quinolones

Answer 9

Caution: epilepsy

Induces seizures, taking NSAIDs inc risk

Avoid sunlight

Tendon damage: >60, corticosteroids/NSAIDs

Question 10

Warfarin

Answer 10

Avoid in pregnancy, but used in BF

INR inc: SSRIs, PPIs, Statins

Cranberry juice: Enhances anticoagulant effect

Question 11

CCB

Answer 11

Dihydropyridine: amlodipine, nifedipine

Verapamil and diltiazem: reduces CO,
slows HR – avoid in HF and with BBs

Affected by grapefruit juice except amlodipine & diltiazem

Question 12

MTX

Answer 12

FBC, renal + LFT every 1-2 weeks til stable + every 2-3 months

Question 13

NSAIDs

Answer 13

CV events

• Naproxen + ibuprofen lowest risk
• Diclofenac highest risk

Question 14

Anti-epileptic Brands

Answer 14

Category 1: phenytoin, carbamazepine, phenobarbital, primidone

Category 2 (remain on same brand depends on pt, seizure activity): valproate, lamotrigine, clobazam, clonazepam, topiramate

Category 3: levetiracetam, gabapentin, pregab