Interactions

Question 1

Which drugs may exacerbate CHF?

Answer 1

NSAIDs, COX-2, Thiazolidinediones

Question 2

What do statins interact with?

Answer 2

Erythromycin/clarithromycin

Fibrate

Question 3

Which drugs may worsen constipation?

Answer 3

CCBs, anticholinergics, calcium

Question 4

Which drugs lower seizure thresholds?

Answer 4

Neuroleptics, tramadol, quinolones (e.g. ciprofloxacin, levofloxacin etc)

Question 5

Foods rich in vitamin E and K, which interact with warfarin

Answer 5

Kiwi, broccoli, spinach, chickpeas, nuts, apples

Question 6

Foods rich in potassium and what do they interact with?

Answer 6

Bananas, oranges, leafy green vegetables

Interact with ACEIs, ARBs and K-sparing diuretics

Question 7

Foods which alter pH and what drugs do they interact with?

Answer 7

Milk, cheese, soy, yoghurt, chicken, turkey

Interact with antibiotics, thyroid meds, digoxin and diuretics

Question 8

Foods which interact with the cytochrome P450 system and which drugs these interact with

Answer 8

Grapefruit, cranberry, orange and apple

Statins, antihistamines

Question 9

If you are prescribing someone opioids, what should you start them on prophylactically?

Answer 9

Lactulose or senna

Question 10

Side effects of steroids in old people

Answer 10

Osteoporosis

Steroid induced diabetes

Question 11

What can interfere with the absorption of levothyroxine?

Answer 11

Calcium can interfere with the absorption of levothyroxine

Question 12

Problems with NSAIDs/COX 2 in old people?

• risks
• what do they interact with
• what can you give instead?

Answer 12

Increase risk of GI haemorrhage
Decrease GFR
Interact with diuretics and blood pressure medications

-try give paracetamol instead

Question 13

If a patient has a side effects from a medication, or even if you only suspect that it is a side effect, where should you report it to?

Answer 13

The yellow card scheme

Question 14

What was the F.A.M.E trial?

Answer 14

Federal study of adherence to medications in the elderly - looked at patients on multiple meds and introduced regular follow up and customised blister packs (big improvement seen)

Question 15

Which antibiotic especially interacts with warfarin?

Answer 15

Clarithromycin
(reduces first pass metabolism of warfarin by inhibiting the cytochrome P450 system - can therefore lead to accumulation of warfarin and increased INR)

Question 16

Side effects of memantine

Answer 16

HEADACHE
Constipation
CNS: psychosis, and rarely, suicidal ideation
Abnormal gait
Hypertension

Question 17

These drugs may precipitate asthma attack

Answer 17

NSAIDs, beta-blockers

Question 18

Aspirin and analgesics?

Answer 18

Avoid prescribing aspirin with NSAIDs - increases risk of adverse effects

Question 19

Aspirin and anti-depressants?

Answer 19

Increased risk of bleeding with SSRIs and venlaxafine

Question 20

Aspirin and methotrexate?

Answer 20

try to avoid prescribing together as aspirin reduces excretion of methotrexate

Question 21

ACEi/ARBs and ciclosporin?

Answer 21

Increases risk of hyperkalaemia

Question 22

ACEi/ARBs and diuretics?

Answer 22

Enhance hypotensive effect

Question 23

Which blood pressure medication do you need to be careful with when giving lithium?

Answer 23

ACEi/ARBs and lithium - increases lithium levels

Question 24

Potassium supplements and ACEi/ARBs?

Answer 24

Increases risk of severe hyperkalaemia