Important drug information Flashcards
Recommended times to take diuretics
In the morning + early afternoon to avoid nocturia
When is it best to take the first dose of ACEi or ARBs?
Before bed to reduce hypotension
Which anti-hypertensive should electrolytes and renal functioning be monitored for?
ACEi and ARBs - creatinine, eGFR and K+
Who can prescribe amiodarone?
Senior staff (unless at a cardiac arrest when a bolus injection is given)
What drink should patients on amiodarone avoid?
Grapefruit juice
When should aspirin be taken?
After food to avoid gastric irritation
Should aspirin be used for primary or secondary prevention of vascular events?
Secondary - the absolute risk of serious vascular events is low and benefits are outweighed by risk of serious bleeding
Route of administration for heparin
Subcutaneous injection
When is warfarin usually administered?
Around 6pm once daily for consistent effects on the INR taken the following morning
What is the INR?
International normalised ratio - prothrombin time of someone on warfarin divided by that of a non-warfarin control - should be 2.0-3.0 in AF and VTE
What should patients needing immediate anticoagulation start with?
Heparin (fast onset) + Warfarin
What do warfarin patients carry with them?
Yellow book - acts as an alert to their warfarin therapy and is use to record doses, blood tests, treatment indication and duration
When are statins usually administered?
Once daily in the evening, as they have greater effect when dietary intake is at its lowest
Why should grapefruit juice be avoided with statins?
It inhibits cytochrome P450, so increases risks of adverse effects
When prescribing a nebuliser what must you always indicate?
Whether the nebuliser should be driven by oxygen (asthma) or air (COPD)
What is a reservoir mask?
Critical illness or sats <85%:
Bag that is continuously filled by incoming oxygen supply, containing at least 60-80% oxygen at a rate of 15L/min
What is a venturi mask?
Patients in chronic Type 2 respiratory failure:
A blend of oxygen with air at a fixed ratio. The oxygen concentration (28%) + flow rate are indicated by the colour of the device
What are nasal cannulae?
Patients who need oxygen but are not critically ill:
Deliver variable oxygen concentrations at 2-6L/min
What should be indicated when prescribing O2?
Target O2 sats range:
94-98% in most patients
88-92% in Type 2 failure
Why should only a small quantity of amitriptyline be supplied?
Reduce risk of overdose, especially in suicidal people
How long should SSRIs be prescribed for after symptoms of depression have gone?
6 months or 2 years for recurrent depression
Which benzodiazepine is used for which indication?
Seizures: IV diazepam or lorazepam
Alcohol withdrawal: diazepam (long-acting)
Sedation: midazolam (short-acting)
Insomnia + anxiety: temazepam
Why should DA therapy not be stopped suddenly?
Deterioration in symptom control and may precipitate neuroleptic malignant syndrome (fever, muscular rigidity, altered mental state)
What should be discussed with females taking anticonvulsants?
Contraception + pregnancy
What are the driving rules for epilepsy?
Do not drive unless seizure free for 12 months or for 6 months after changing or stopping treatment
What is the benefit of newer anti-convulsants?
Lamotigrine + Levetiracetam (Keppra) may be better tolerated (but no evidence they are more effective)
What time of day should amitriptyline be taken and why?
Night time because it causes sleepiness (can get a hangover effect the next morning)
Which cardiac drug can be used to treat anxiety?
Propanolol - up to 3x per day (but BP must be monitored)
