Managing Drug Interactions & ADR's: Nsaids, Warfarin, Opioids 3 Flashcards
list the top 5 drugs known to cause ADRs
1) NSAIDs: 29.6%
2) Diuretics: 27.3%
3) Warfarin: 10.5%
4) ACEIs/A2RAs: 7.7%
5) Antidepressants and lithium: 7.1%
6) Beta-blockers: 6.8%
7) Opioids: 6.0%
8) Digoxin: 2.9%
9) Prednisolone: 2.5%
10) Clopidogrel: 2.4%
explain the significance of ADRs From NSAIDs and outline the guidance for prescribing them
1) 12,000 hospital admissions per year due to GI adverse events, 2,000 deaths, NSAIDs kill 1 in 1,200 people who take them for two months or more and big cost to NHS £250 million a year
2) High risk: piroxicam, ketoprofen, ketorolac
- intermediate risk: indometacin, diclofenac, naproxen
- lowest risk: ibuprofen
3) lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long term treatment should be reviewed periodically
- selective inhibitors of COX2 providelower risk of GI problems then non-selective NSAIDS
Apart from GI disturbances what other side effects can NSAIDs have on the body?
1) Kidney: Oedema, Renal failure
2) CNS disorders: Headache, dizziness, depression, drowsiness
3) Liver: Elevation of liver enzymes:
- Alanine Transaminase (ALT)
- Aspartate Transaminase (AST)
4) Blood: Thrombocytopenia, Aplastic anaemia.
5) Skin: Rashes, Stevens-Johnson syndrome
6) Respiratory: Worsening of asthma
how do you manage ADRs linked to NSAIDS (6)
Minimise GI damage from NSAIDs:
1) Paracetamol for analgesia
2) Use NSAIDs associated with a low risk e.g. ibuprofen, at the lowest recommended dose
3) Do not to use more than one oral NSAID at a time
4) Identify patients at risk : Elderly, History of ulcers
5) Prophylaxis with Proton Pump Inhibitor (PPI – e.g. Omeprazole)
6) Patient counselling: Take with /after food - (cautionary and advisory label number 21)
what ADRs can warfarin produce?
1) GI bleeding
2) haematuria
3) high INR
4) haematoma
how can pharmacists manage ADRs with regards to warfarin?
1) Anticoagulant alert card
2) insure patients on anticoagulants have received appropriate written and verbal info at the start
3) with repeat dispensing check the patient is having their INR monitored
4) check for clinically significant interactions and ensure doses are in mg not number of tablets
When prescribing, dispensing or administering opioid medicines what should a healthcare practitioner confirm?
1) Dose
2) Formulation
3) Frequency of administration
4) Any other analgesic medicines prescribed for the patient
5) Ensure where a dose increase is intended, that the calculated dose is safe for the patient. Not normally more than 50% higher than the previous dose
When administering opioid medicines what should a healthcare practitioner ensure the patient is familiar with if its a new medication?
1) The usual starting dose
2) Frequency of administration
3) Standard dosing increments
4) Symptoms of overdose
5) Common side effects of that medicine and formulation.
what are the side effects of Digoxin Toxicity?
1) Nausea
2) Visual Disturbances
3) Heart Block
4) Arrhythmias
outline how you can manage Digoxin toxicity?
1) Stop digoxin
2) Check level of drug
3) Check Urea & Electrolytes
4) Monitor Heart Rate and Pulse
5) Check for Drug Interactions
give examples of Serious blood, cardiovascular, CNS and GI Reactions
1) Blood- Bone marrow dyscrasias, Coagulopathies
2) cardiovascular-Arrythmias,Hypertension
3) CNS- Hallucinations, Epilepsy
4) GI - Haemorrhage, Hepatic dysfunction
give examples of Serious immunological, metabolic and Muscoskeletal Reactions
1) Immunological- Anaphylaxis, Vasculitis
2) Metabolic- acidosis, Hyperkalaemia
3) Muscoskeletal- Osteomalacia, Pathological fracture
give examples of Serious renal, Reproduction Respiratory and skin Reactions
1) renal- Renal dysfunction, Urinary retention
2) Reproduction- Infertility, Congenital abnormalities
3) Respiratory- Respiratory failure, Thromboembolism
4) Skin- Angioedema, Epidermal necrolysis
