Major Drug Side-effects & Monitoring Flashcards

1
Q

Major side effects of TB Treatment

A

Rifampicin – Hepatitis, rashes, febrile reaction, orange/red secretions (N.B. contact lenses),
many drug interactions including warfarin and
OCP

Isoniazid – Hepatitis, rashes, peripheral
neuropathy, psychosis

Pyrazinamide – Hepatitis, rashes, vomiting,
arthralgia

Ethambutol – Retrobulbar neuritis

Therefore, MUST do a baseline visual acuity test and LFT’s which must be monitored
closely

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2
Q

Enzyme inhibitors

A
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Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol..binge drinking
Chloramphenicol
Erythromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole
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3
Q

Enzyme inducers

A
Barbituates
St. John’s wort
Carbamazepine
Rifampin
Alcohol (chronic)
Phenytoin
Griseofulvin
Phenobarbital
Sulfonylureas
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4
Q

Amiodorone

A

Pulmonary fibrosis, liver and thyroid dysfunction, optic neuritis

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5
Q

Azathioprine

A

More side effects if TPMT enzyme deficient

Can cause very severe bone marrow suppression if allele is deficient or absent

Drug interaction with allopurinol

Oftenusedasasteroidsparingagent

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6
Q

Anti-TNF therapy

A

Needs DAS assessment (according to NICE)

All brands are parenteral

Increased risk of infection with intracellular pathogens

Reactivation of TB

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7
Q

Drug contraindicated in psoriasis due to a recognised association with erythroderma

A

Chloroquine

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8
Q

Chloroquine ADRs

A

Retinopathy and corneal opacities, deafness, photosensitivity, hair discolouration and alopecia

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9
Q

Drug monitoring - Statins

A

LFTs at baseline, 3 months and 12 months

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10
Q

ACE inhibitors drug monitoring

A

U&E prior to treatment
U&E after increasing dose
U&E at least annually

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11
Q

Amiodorone drug monitoring

A

TFT, LFT, U&E, CXR prior to treatment

TFT, LFT every 6 months

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12
Q

Methotrexate drug monitoring

A

FBC, LFT, U&E

Every week until stable and then every 2-3months

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13
Q

Azathioprine drug monitoring

A

FBC, LFT before treatment
FBC weekly for the first 4 weeks
FBC, LFT every 3 months

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14
Q

Lithium drug monitoring

A

TFT, U&E prior to treatment then every 6 months

Lithium levels weekly until stabilised then every 3 months

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15
Q

Sodium valproate monitoring

A

Sodium valproate LFT LFT, FBC before treatment

LFT ‘periodically’ during first 6 months

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16
Q

Morphine breakthrough dose

A

Breakthrough dose = 1/6th of daily morphine dose

17
Q

When to discontinue statins

A

Treatment with statins should be discontinued if serum transaminase concentrations rise to and persist at 3 times the upper limit of the reference range.

18
Q

Drugs to avoid in renal failure

A

antibiotics: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin

19
Q

What must you check before starting azathioprine treatment and to prevent what?

A

Azathioprine - check thiopurine methyltransferase deficiency (TPMT) before treatment

Thiopurine methyltransferase (TPMT) deficiency is present in about 1 in 200 people and predisposes to azathioprine related pancytopaenia