List of 15 Drugs for MCQ Flashcards
What is Ceftazidime?
- cephalosporin antibiotic
- given IV
- used for pseudomonas lung infections in CF
- used for complicated UTIs
What is the initial dose and frequency for a patient with an eGFR of 40mL/min for Ceftazidime?
reduce if the creatinine clearance is 50mL/,om pr ;ess
What are the directions for giving Ceftazidime?
IV infusions - intermittently or via drip
- Glucose 5% or 10%
- NaCL 0.9%
- dissolve 2mg in 10mL
- single doses over 1g via IV route only
What two patients groups can Ceftazidime not be given to?
- contraindicated in those with a cephalosporin OR cautioned in those to penicillin OR other β-lactam hypersensitivity
- cautioned in those with renal impairment as it is really excreted
What are four adverse effects of Ceftazidime and how can they be monitored?
- abdominal pain/diarrhoea/vomiting /pseudomembranous enterocolitis
- thrombocytosis/thrombocytopeinia (monitor platelets)
- anaphylactic reaction/angio-oedema (monitor reaction, avoid in those with Hx of sensitivity)
- nephritis/acute kidney injury - RARE
Can Ceftazidime be used in pregnancy or when breastfeeding?
- not harmful if pregnant
- present in low concentrations in breastmilk, but appropriate for use
What is Gentamicin?
- IV antibiotic
- aminoglycoside
- can be used for meningitis, endocarditis, pneumonia, sepsis
What is the initial dose and frequency for a patient with an eGFR of 40mL/min for Gentamicin?
once daily, high dose regimen of ahminoglycosides should be AVOIDED in those with CrCL less than 20mL/min
those with renal impairment - serum concentrations HAVE to be monitored
those with renal impairment - the interval between doses might need to be increased and/or a reduction in dose
NEPHROTOXICITY common with this drug
What are the directions for giving Gentamicin?
IV infusion - intermittently of via drip
- Glucose 5%
- NaCl 0.9%
- 50-100mL given over 20-30 minutes
What two patients groups can Gentamicin not be given to?
contraindicated:
- myasthenia gravis
- those with ear problems
cautioned:
- auditory disorders
- muscular weakness
- renally impaired
What are four adverse effects of Gentamicin and how can they be monitored?
MAIN for Aminoglycosides
- OTOTOXICITY
- NEPHROTOXICITY
- skin reactions
- tinnitus (ears!) OTOTOXICITY
- nausea/vomiting
Can Gentamicin be used in pregnancy or when breastfeeding?
2nd/3rd Trimester
- risk of auditory/vestibular nerve damage
- avoided unless essential
- IF given, serum conc monitoring essential
What is Sodium Valproate?
- used in epilepsy (anti-epileptic)
- teratogenic
- C/I for women of childbearing age unless on the PPP
What is the initial dose and frequency for a patient with an eGFR of 40mL/min for Sodium Valproate?
- reduce dose
What are the directions for giving Sodium Valproate?
IV injection - give over 3-5 mins
IV infusion
- Glucose 5%
- NaCl 0.9%
What two patients groups can Sodium Valproate not be given to?
C/I
- acute porphyrias (liver)
- hepatic dysfunction
- urea cycle disorders (hyperammonaemia)
- pregnant women
Caution
- Liver Toxicity (monitor liver enzymes, LFTs)
What are four adverse effects of Sodium Valproate and how can they be monitored?
pancreatitis - abdominal pain, nausea & vomiting
blood dyscrasias/disorders
- bruising, bleeding
- thrombocytopeinia,
liver function/disorders
- hepatic disorders
- encephalopathy
- jaundice
- malaise
- drowsiness
- anorexia
- oedema
Can Sodium Valproate be used in pregnancy or when breastfeeding?
NOPE
- not used for epilepsy unless there’s NO OTHER suitable treatment
breastfeeding
- risk of haematological disorders in breast-fed newborns and infants
What is Hydrocortisone?
- a steroid with glucocorticoid and mineralocorticoid activity
- given orally for asthma, eczema, inflammation
- given IV for hypersensitivity reactions, adrenocortical insufficiency, severe IBD
What is the initial dose and frequency for a patient with an eGFR of 40mL/min for Hydrocortisone?
undertaken with caution
What are the directions for giving Hydrocortisone?
for IV use:
- Glucose 5%
- NaCl 0.9%
What two patients groups can Hydrocortisone not be given to?
C/I
- live virus vaccines for those receiving immunosuppressive doses of hydrocortisone
- systemic infection
- AVOID THOSE WITH CHICKENPOX/MEASLES, severe risk
Cautions - extensive, match the side effects
What are four adverse effects of Hydrocortisone and how can they be monitored?
electrolyte imbalance
- POTASSIUM
- fluid retention
osteoporosis/fractures
dyslipidaemia/diabetes
adrenal suppression
- eye exams, cataracts
- fatigue
psychiatric reactions (systemic, high dose)
Can Hydrocortisone be used in pregnancy or when breastfeeding?
benefit of treatment outweighs the risk in pregnancy & when breast feeding
longer-term treatment more problematic than shorter term
fluid retention should be monitored closely
What is Amiodarone?
Class III Anti-dysrhythmic Drug
- used for both supra ventricular and ventricular arrhythmias
What are the directions for giving Amiodarone?
IV
- Glucose 5%
- 250mL over 20-120 mins
- not diluted to less than 600mcg/mL
- NOT NaCL
What two patients groups can Amiodarone not be given to?
C/Is
- severe conduction disturbances
- heart-block
- sinus bradycardia
- injection for cardiomyopathy
- bolus in congestive heart failure
- avoid in severe resp. failure
Cautions
- heart failure
- hypokalaemia - check potassium
- bradycardia
- acute porphyrias
What are four adverse effects of Amiodarone and how can they be monitored?
- arrhythmias
- hepatic disorders (test transaminases)
- hyper/hypo-thyroidism (check thyroid)
- respiratory disorders (pulmonary toxicity)
- skin reaction (phytotoxicity), avoid sunlight unless wearing high factor sunscreen
- corneal micro deposits, blurred vision
- hypokalaemia
Can Amiodarone be used in pregnancy or when breastfeeding?
Pregnancy - ONLY use if no alternative, possible risk of neonatal goitre (thyroid)
Breastfeeding - AVOID, risk of neonatal hypothyroidism from release of iodine
What is Salbutamol?
B2 Agonist
used in Asthma & COPD
What are the directions for giving Salbutamol?
IV
- Glucose 5%
- NaCl 0.9%
Nebulisation
- NaCl 0.9%
What two patients groups can Salbutamol not be given to?
C/Is
- pre-eclampsia
- Hx of cardiac disease/myocardial ischaemia
Cautions
- hypokalaemia (serious side effect of Β2 agonist therapy)
- IV use in pre-eclampsia
- arrhythmias
- diabetes - risk of hyperglycaemia and ketoacidosis
- QT-interval prolongation
What are four adverse effects of Salbutamol and how can they be monitored?
- arrhythmia
- palpitations
- headache
- tremor
- hypokalaemia
- nausea
- hyperglycaemia
- muscle cramps
Can Salbutamol be used in pregnancy or when breastfeeding?
take as normal if pregnant OR breastfeeding
What is Parecoxib?
selective COX-2 inhibitor
NSAID
IV used for acute post-op pain - injectable
What is the initial dose and frequency for a patient with an eGFR of 40mL/min for Parecoxib?
AVOID if possible or use with caution
lowest effective dose should be used for the shortest possible duration
those with Cr CL <30mL/min or particularly susceptible to water retention - lowest possible dose 20mg
mild-moderate renal impairment, no dose reduction necessary
What two patients groups can Parecoxib not be given to?
C/Is
- active GI bleeding/ulceration
- IBD
- ischaemic heart disease
- heart failure
Cautions
- allergic disorders
- any type of cardiac impairment/risk of
- dehydration
- elderly
- history of cardiac failure
- history of GI disorders
- hypertension
- oedema
What are four adverse effects of Parecoxib and how can they be monitored?
- constipation, GI discomfort, nausea (less so because IV)
- dyspepsia & ulceration
- hypokalaemia
- serious skin reactions - Steven Johnson’s Syndrome
- renal function
Can Parecoxib be used in pregnancy or when breastfeeding?
AVOID in the 3rd Trimester - contraindicated
- 1st & 2nd Trimester avoid unless absolutely necessary
AVOID in those breast-feeding
What are the directions for giving Parecoxib?
only injected with
- NaCl 0.9%
- Glucose 5%
- NaCl 0.45% + Glucose 5%
What is Omeprazole?
a PPI
- used for prevention of GI ulcers
- used for GORD
What are the directions for giving Omeprazole?
for IV use reconstitute with 100mL of
- Glucose 5%
- NaCl 0.9%
intermittent infusion - 40mg over 20-30 mins
stable infusion - 6 hrs in Glucose 5% or 12 hrs in NaCl 0.9%
What two patients groups can Omeprazole not be given to?
Cautions
- those at high risk of osteoporosis
- elderly (osteoporosis)
What are four adverse effects of Omeprazole and how can they be monitored?
- can increase the risk of fractures
- can increase the risk of a C diff infection
- MHRA - low risk of SCLE (monitor skin for lesions)
- can mask the symptoms of gastric cancer
- abdominal pain, constipation, diarrhoea, nausea & vomiting
- bone fractures
- hypomagnesaemia - monitor magnesium
- SCLE (skin)
Can Omeprazole be used in pregnancy or when breastfeeding?
NOT known to be harmful in pregnancy
Present in milk but NOT known to be harmful when breastfeeding
What is Infliximab?
IV Infusion Drug for Inflammatory related conditions
- Crohn’s disease
- Arthritis
- Ulcerative Colitis
- Plaque Psoriasis
Tumour Necrosis Factor Alpha (TNF-a) inhibitors (monoclonal antibodies)
What two patients groups can Infliximab not be given to?
C/I
- moderate or severe heart failure
- severe infections (dampens down the immune system)
Cautions
- patients to be up-to-date with immunisation schedule
- check for active & latent TB before treatment
- mild heart failure
- development of malignancy
What are the directions for giving Infliximab?
- Give intermittently in NaCl 0.9%
- start infusion within 3 hours of reconstitution
- 100mg in 10mL water for injection first, then to final volume of 250mL
- give through low protein-binding filter
What are four adverse effects of Infliximab and how can they be monitored?
- hypersensitivity reactions within 1-2 hrs after infusion
- monitor for Hep B infections
- monitor for signs of TB - cough, weight loss, fever
- blood disorders - monitor for fever, sore throat, bruising or bleeding
- increased risk of dizziness
- monitor skin for non-melanoma skin cancer
Can Infliximab be used in pregnancy or when breastfeeding?
use only if essential in pregnancy
amount present in breastmilk to small to be harmful
What is Metformin?
1st line pharmacological treatment in Type 2 Diabetes
What is the initial dose and frequency for a patient with an eGFR of 40mL/min for Metformin?
avoid if eGFR less than 30mL/min
dose reduction in moderate renal impairment
renal function monitoring needed
What two patients groups can Metformin not be given to?
C/Is
- acute metabolic acidosis (lactic & diabetic ketoacidosis)
- avoid if eGFR less than 30mL/min
Cautions - risk factors for acidosis
- chronic stable heart failure
- drugs that can impair renal function
- stop treatment if dehydration occurs
What are four adverse effects of Metformin and how can they be monitored?
- abdominal pain, diarrhoea, GI disorders, nausea, vomiting (can divide doses/start slow/take with meals)
- hepatitis
- lactic acidosis
- vitamin B12 absorption decreased
Can Metformin be used in pregnancy or when breastfeeding?
can be used in pregnancy (and used for gestational diabetes)
can be used during breast-feeding
What is Pioglitazone?
used as add-in treatment for Type 2 Diabetes
What two patients groups can Pioglitazone not be given to?
C/I
- those with/history of heart failure
- active/past history of bladder cancer (assess for risk before treatment, particularly in the elderly)
- uninvestigated haematuria
Cautions
- increased risk factors for heart failure or bladder cancer
What are four adverse effects of Pioglitazone and how can they be monitored?
- MHRA: closely monitor for signs of heart failure
- haematuria, dysuria, urinary urgency should be reported immediately (bladder cancer)
- bone fractures
- visual impairment
- increased weight
- hepatic impairment - monitor liver function and symptoms of liver toxicity (abdominal pain, fatigue, dark urine)
Can Pioglitazone be used in pregnancy or when breastfeeding?
AVOID in pregnancy, toxic in animal studies
AVOID in breastfeeding, present in milk
What is Zoledronic Acid?
an IV bisphosphonate - used for Osteoporosis and other skeletal disorders
What are the directions for giving Zoledronic Acid?
osteoporosis
- IV infusion over at least 15 minutes
What is the initial dose and frequency for a patient with an eGFR of 40mL/min for Zoledronic Acid?
avoid in Paget’s disease, treatment of post-menopausal osteoporosis and osteoporosis in men if eGFR less than 35mL/min
avoid in treatment of tumour-induced hypercalcaemia if serum creatinine above 400mmol/L
dose adjustments needed in malignancies of the bone - if eGFR 30-40 mL/min 3mg
What two patients groups can Zoledronic Acid not be given to?
cautions
- elderly (especially those with GI disease or bleeding)
- atypical femoral fractures
- cardiac disease
- those taking other drugs that affect renal function
What are four adverse effects of Zoledronic Acid and how can they be monitored?
MHRA: atypical femoral fractures
- patients to report thigh, hip or groin pain during treatment
- re-evaluate need after 5 years or more
MHRA: osteonecrosis of the jaw (particularly with IV) ]
- dental check ups needed
- maintain good oral hygiene
- report any symptoms, pain swelling, non-healing sores
MHRA: osteonecrosis of the external auditory canal
- ear symptoms, chronic ear infections to be reported
Can Zoledronic Acid be used in pregnancy or when breastfeeding?
Avoid in pregnancy, toxic in animal studies
Avoid - no information available
What is Granisetron?
seretonin receptor antagonist
- used for IV chemo/post-op nausea and vomiting
What are the directions for giving Granisetron?
Intravenous Infusion, give intermittently - Sodium Chloride 0.9% - Glucose 5% dilute up to 3mL in 20-50mL give over 5 mins
What two patients groups can Granisetron not be given to?
Cautions
- subacute intestinal obstruction
- susceptibility to QT prolongation (including electrolyte disturbances)
What are four adverse effects of Granisetron and how can they be monitored?
- constipation
- headache
- diarrhoea
- insomnia
- QT interval prolongation
- extrapyramidal symptoms
Can Granisetron be used in pregnancy or when breastfeeding?
Avoid in pregnancy
Avoid - no info available
What is Ciprofloxacin?
Quinolone Antibiotic
What is the initial dose and frequency for a patient with an eGFR of 40mL/min for Ciprofloxacin?
dose reductions needed if eGFR between 30-60mL/min
What two patients groups can Ciprofloxacin not be given to?
C/Is
- patients with history of tendon disorders
- patients over 60 years of age are more prone to tendon damage
Cautions
- prolongs the QT interval
- conditions that predispose to seizures (epilepsy)
- conditions of the heart
What are four adverse effects of Ciprofloxacin and how can they be monitored?
- CONVULSIONS may occur with IV use (and taking NSAIDs at the same time)
- TENDON DAMAGE may occur with IV use
- AORTIC ANEURYSM AND DISSECTION small risk with IV use
- QT interval prolongation
Can Ciprofloxacin be used in pregnancy or when breastfeeding?
Avoid in pregnancy - shown to cause arthropathy
Manufacturer advises to avoid in breastfeeding
What is Furosemide?
Loop Diuretic
- inhibits reabsorption from the ascending limb of the loop of Henle
- used for oedema/hypertension
What are the directions for giving Furosemide?
IV should not exceed 4mg/min
- single doses of up to 80mg may be administered
- lower rate needed in renal impairment
What is the initial dose and frequency for a patient with an eGFR of 40mL/min for Furosemide?
- high doses/rapid intravenous administration can cause tinnitus and deafness
- high doses of loop diuretics can occasionally be needed in renal impairment
What two patients groups can Furosemide not be given to?
C/Is
- renal failure due to nephrotoxic/hepatotoxic drugs
- severe hypokalaemia
- severe hyponatraemia
Cautions
- can exacerbate diabetes
- hypotension/hypovolaemia
- hypokalaemia - use potassium-sparing diuretics
- urinary retention due to enlarged prostate
What are four adverse effects of Furosemide and how can they be monitored?
- dizziness
- electrolyte imbalance
- auditory disorder & tinnitus with rapid IV infusion
- acute kidney injury
- diabetes
Can Furosemide be used in pregnancy or when breastfeeding?
Not to be used to treat gestational hypertension
Amount too small to be harmful. May inhibit lactation.
