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PSA > Managing the Risks of Prescribing > Flashcards

Managing the Risks of Prescribing Flashcards

1
Q

what is the definition for a adverse drug reaction

A

an adverse event where it is suspected to be caused by a drug

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2
Q

Type A (augmented) ADRs

A
  • dose related
  • common, predictable,
  • related to the pharmacology
  • unlikely to be fatal
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3
Q

Type B (bizarre) ADRs

A
  • not dose related
  • uncommon, unpredictable
  • not related to the pharmacology
  • often fatal
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4
Q

drug food interaction with ACEi

A

pts who have swapped their dietary salt for potassium containing salt e.g.LoSalt

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5
Q

what does grapefruit juice do

A

inhibit CYP3A4

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6
Q

aminoglycosides and loops diuretics

A

additive effect causing ototoxicity

pharmacodynamic reaction

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7
Q

lithium salts and ramipril

A

a reduction in the excretion of lithium can cause toxicity

pharmacokinetics reaction

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8
Q

rifampicin and COCP

A

pharmacokinetic reaction

rifampicin induces cytochrome P450 which can reduce the effectiveness of oestrogens and progestogens

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9
Q

Verapamil and BB

A

pharmacodynamic reaction

both are negative inotropes –> bradycardia, hypotension, asystole

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10
Q

warfarin and NSAIDs

A

pharmacodynamic

warfarin increases risk of GI haemorrhage

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11
Q

warfarin and macrolide abx: clarithromycin, erythromycin

A

pharmacokinetic

increases INR

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12
Q

needs emergency contraception and is on carbamazepine. What do u give?

A

1st line: copper coil

2nd line: double dose levonorgestrel because carbamazepine is a CP450 enzyme inducer

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13
Q

inducer of the CP450 system

A

rifampicin
St john’s wort
phenytoin, carbamazepine

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14
Q

inhibitors of CYP system

A

erythromycin
grapefruit juice
cranberry juice

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15
Q

how often should pts be monitored following a dose change of levothyroxine

A

6-8w

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16
Q

how often should pts be monitored who are prescribed a maintenance dose of levothyroxine

A

annually

17
Q

what should be monitored when on amiodarone

A

TFT

18
Q

what should be monitored when on digoxin

A

HR

19
Q

what should be monitored when on gentamicin

A

plasma conc

20
Q

what should be monitored when on methotrexate

A

FBC

21
Q

possible drug causes of hypokalaemia

A
  • laxatives
  • prednisolone
  • insulin
  • loop diuretics
  • salbutamol
  • gentamicin, amphotericin
  • Bendroflumethiazide
  • theophylline
22
Q

what is the max conc of potassium chloride via peripheral rout

A

40mmol/litre

23
Q

which drugs can cause hyperkalaemia

A
  • ACEi
  • acute digoxin overdose
  • angiotensin-II receptor blockers
  • heparin + LMWH
  • NSAIDs
  • Penicillins
  • K sparing diuretics
  • trimethoprim
24
Q

monitoring with gentamicin

A

plasma drug concentration is usually measured 18–24 hours
after the first dose (trough level).

The next dose should only be
administered if these have fallen to a safe level with a low risk of toxicity
(e.g. gentamicin <1 mg/mL).

If the plasma concentration is too high, the
next dose should be withheld until repeat levels indicate that it is safe to
give.

25
Q

sx of gentamicin toxicity

A
  • tinnitus/ deaf
  • N+V
  • renal dysfunction
  • colitis
  • stomatitis
  • blood dyscrasias
26
Q

vancomycin infusion administration

A

infuse over at least 60min

27
Q

what is red man syndrome

A

caused by vancomycin if infused rapidly

28
Q

vancomycin moniotring

A

measure levels after 36-72hr (3-6 doses)

29
Q

patients with hyperthyroidism require higher or lower doses of warfarin

A

lower

30
Q

true or false:

ibuprofen should be avoided in pts taking warfarin

A

true

31
Q

true or false:

the anticoagulant effect of warfarin can be enhanced by fluconazole

A

true

32
Q

true or false:

the anticoagulant effect of warfarin is increased by amiodarone

A

true

33
Q

what drug antagonises warfarin

A

phytomenadione

34
Q

when should yo measure plasma digoxin conc

A

when you suspect toxicity

35
Q

if amiodarone therapy is added to digoxin therapy, what should you do to the dose of digoxin

A

halve it

36
Q

sx of digoxin toxicity

A

similar signs to clinical deterioration

37
Q

which drug shold yo be brand specific

A

lithium

38
Q

lithium toxicity is excaberbated by the low conc of which electrolyte

A

sodium

39
Q

which abx sholdn’t be prescribed with methotrexate

A

trimethoprim

PSA (6 decks)

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