Mixed Qs Flashcards
Furosemide & bumetanide (loops) interactions
Gentamicin + furosemide
Lithium + furosemide
NSAID + furosemide
Phenytoin + furosemide
Ototoxicity / nephrotoxicity
Lithium toxicity
HF
Diuretic effect reduced
Can Loops (furosemide or bumetanide) cause pancreatitis ?
Yes can also cause gout, diabetes, deafness, cramps
Which of the following eye drops cause brown pigmentation, blepharitis, dry mouth/ drowsiness? blepharoconjunctivitis?
Betaxolol
Brinzolamide
Latanoprost
Brimodine
Latanoprost- brown pigmentation
Betaxolol- blepharoconjunctivitis
Brinzolamide- blepharitis
Brimodine- dry mouth, drowsiness
Which antibiotics cause c diff?
Clindamycin
Cephalosporins
Broad spectrum penicillin
Fluoroquinolones
PPIs
With amiodarone every 6 months you should do what monitoring?
Thyroid
before start of treatment + 6 months + 12 months after stopping treatment
Liver function before start of treatment + 6 months
Chest X-ray before treatment
K before treatment
Does beclometasone inhaler need to be prescribed by brand ?
Yes such as Qvar/ clenil
Can inhaled corticosteroids be taken during pregnancy?
Yes as normal
When should a steroid card with beclometasone be provided ?
Prolonged high doses > 1000mcg
Interaction
nitrate + sildenafil
Severe HYPOtension or Myocardial infarction
Interaction with grapefruit ?
Clopidogrel
Felodipine
Amiodarone
Sertraline
Simvastatin
Amlodipine
Interaction ciprofloxacin + methotrexate
methotrexate toxicity
Interactions
Trimethoprim + ciclosporin
Nephrotoxicity
Many drugs should be given on the day of surgery even when the patient is nil by mouth. Which medications should you omit?
OMIT:.
NSAIDs
ACEi
AIIRAs
Diuretics
Antiplatelets /anticoagulants
Lithium
meds not essential in the short term. eg. vitamins, iron, laxatives,
osteoporosis treatment, liquid antacid medicines (eg gaviscon), HRT, anti- histamines,
herbal remedies or homeopathic medicines
Diabetic alt meds need to be prescribed
colchicine dosing for gout
500mcg 2-4 times a day until symptoms relieved
max 6mg /course
do not repeat course within 3 days
Lithium can cause hypo/hyperthyroidism, so do not confuse with lithium toxicity symptoms
lithium toxicity= vomiting diarrhea
visual disturbances
incontinence (polyurea)
fine tremor
confusion/drowsiness
hypernatremia
seizures
bradycardia
cardiac arrhythmias
Hydroxychloroquine used in malaria and RA
safety info- risk of CVD events
Retinopathy- monitoring required annually if been on medication for 5 years
QT prolongation
UPPER Respiratory tract infection
what do you to give Adults? pregnancy? children?
Lower RTI- Amoxycillin, doxycycline Clarithromycin
Adults- phenoxymethylpenicillin
allergic then clarithromycin
Pregnancy - Erythromycin
Children-phenoxymethylpenicillin
allergic then clarithromycin
How often should the safety and efficacy of pioglitazone be reviewed?
risk of bladder cancer, review every 3-6 months
patients should be advised to report promptly any hematuria, dysuria, urinary urgency during treatment
discontinue if jaundice occurs
HF= discontinue
Leflunomide used in RA
ESSENTIAL to be on contraception 2 years AFTER treatment for women and 3 months for men
Hepatotoxic!
Can you give hydrocortisone to be applied on ears or infected skin?
Hydrocortisone can be applied to the ears not the face.
It can be used in irritant dermatitis but not on infected or broken skin
Strength of adrenaline for different age groups
Adrenaline injection 1mg/ml
0-6m 100-150 mcg
6m 150 mcg
6 yrs 300mcg
12+ 500mcg
repeated after 5 minutes if necessary
If INR is above 8 regardless of bleeding or not
Then give repeated dose of Phytomenadione if INR still too high AFTER 24 hours
however, if INR is below 8, no repeat doses of Phytomenadione, just wait to restart once INR falls below 5
What is the wash out period for sertraline?
Sertraline - 2 week washout period
SSRI- 1 week wash out period
MAOIs require 2 weeks washout period
Moclobemide requires no washout period
Fluoxetine- 5 weeks
Imipramine, clomipramine- 3 weeks
TCAs- 1-2 weeks
Hypersalivation can be treated with hyoscine ____?
hyoscine hydrobromide provided the patient isn’t at risk from additive antimuscarinic side effects of hyoscine + clozapine
which sweeteners are sugar free?
ALL the ol’s
mannitol
sorbitol
xylitol
CD2
Methylphenidate (ADHD)
Specify brand
Concerta XL
Equasym XL
Medikinet XL
Stunt growth (children)
Weight loss, decrease appetite
HTN
Tic
Alopecia
Patient on cyclophosphamide and gets UTIs etc
why is Mesna prescribed?
Mesna used to treat cytotoxic induced urethral toxicity
Can Antimuscarinics be given in gastro-intestinal obstruction?
Antimuscarinics are contraindicated in gastro-intestinal obstruction, urinary retension, paralytic ileus, toxic megalon, urinary retention, significant bladder outflow obstuction
Darifenacin
Fesoterodine
Oxybutynin
Tamsulosin
Tolterodine
Trospium
when to avoid Nitrofurantoin?
Trimethoprim?
Nitrofurantoin- avoid at term
Trimethoprim avoid at 1st trimester
Interaction
Lithium + Furesomide
hypokalaemia
Does Filgrastim (stimulates production of neutrophils) cause hyper or hypo uricemia?
HYPERuricemia
Avoid in pregnancy
Topiramate (antiepileptic)
Vision disorders
Patient on ACE inhibitor in
combination with NSAIDs
Patient on ACE inhibitor which in
combination with NSAIDs
increases risk of kidney injury.
DAMN
Diuretics
ACEi/ARBS/ aminoglycosides
Metformin
NSAIDs
On metformin (one drug)
hypoglycaemic agent (sulfonylureas) or 2 and more drugs
< 48mmol
<53 mmol
Which statins are taken anytime during the day?
Atorvastatin or Rosuvastatin
interaction
Alcohol + atorvastatin
Hepatotoxicty
How old do you have to be to take domperidone for N+V ?
domperidone 10mg TID
>12 years
>35kg
max 1 week
side effect- dry mouth
metoclopramide 10mg TID
>18
max 5 days
(IV dose should only be administered as slow bolus over 3 minutes)
Tiaprofenic acid + cystitis?
Due to reports of severe cystitis, the CSM has recommended that tiaprofenic acid
should not be given to patients with urinary tract disorders. Topical NSAIDs can be
used to substitute or supplement paracetamol for knee or hand osteoarthritis. If
paracetamol and/or topical NSAIDs are ineffective, consider oral NSAIDs or weak
opioids
How do you administer drugs likely to cause extravasation?
central line
where is GTN patch placed in respect to cannula and why?
place distal to cannula to improve patency of the vessel in patient with small veins
Evidence Hierarchy
Systematic reviews
Meta analysis
RCT
Cohort
Interaction-
methotrexate + trimethoprim
Nephrotoxicity
Both antifolates, so reduction in folate means methotrexate side effects thus concurrent use of trimethoprim and methotrexate can also increase the risk of nephrotoxicity
HTN: second line for anyone >55 or Afro caribbean is
1st line CCB
2nd line ACE/ARB
ARB preferred in Afro-carribean
NSAID + prednisolone
GI complications
Ferritin level range?
15-200
WBC
4 -11
Total cholesterol
< or equal to 5
which drugs should be stopped when patient is sick?
D iuretic
A CE/ARB
M etformin
N SAID
S GLT2
hypoglycaemic? <4 mmol/L
15-20 g of fast acting carbohydrate
3/4 heap tea spoons of sugar dissolved in water
4-7 glucose tablets
150-200ml pure fruit juice
missed dose of lithium
more than 6 hours then skip missed dose and take usual dose at usual time
Interaction
metronidazole + warfarin
increased risk of bleeding
Mastitis in pregnancy
1st line
10-14 days
flucloxacillin
pen allergy = erythromycin
LITHIUM monitoring
Lithium beet it!
BMI
Electrolytes
EGFR
Thyroids
6 months
Methotrexate monitoring
Faryal makhdoom 3 kids
F BC
R enal
L iver
1-2 weeks intially
2-3 months once stable
Amiodarone monitoring
c hest x ray
u potassium
L iver every 6 months
T hyroids every 6 months
Statin monitoring
H bA1c
U and Es
L iver
T thyroid
Liver 3m and 12m
Ck above 5 -don’t start
Liver above 3 -stop
Nystatin dose
1ml QDS a day AFTER food - 7 days
Continue for 48 hours after condition resolved
Vidagliptin
Liver + pancreatitis counselling
Risk factors for developing AKI
65+
eGFR<60
Heart failure
Liver disease
Diabetes
Hx of AKI
Oliguria
Sepsis
Dementia
Hypovalaemia
DAMN
Aminoglycosides
Iodine based contrast media within past week
Hx of urological obstruction
Deteriorating early warning scores
Yellow fever vaccine
Do not give to immunosuppressed HIV infected individuals
Single dose
Live attenuated vaccine
Tamoxifen OD
Reduces risk of breast cancer
Increases risk of endometrial cancer
Increases risk of DVT - swollen leg
Paroxetine reduces effectiveness of tamoxifen
Common side effect is hot flush
Acyclovir
800 mg 5 times a day for 7 days
Varicella zoster (chickenpox)
Herpes zoster (shingles)
MAOIs interactions
The following predispose patients to hypertensive crisis when
used with MAOI:
Tyramine rich foods
Ephedrine and pseudoephedrine
Levodopa
Stimulants g methylphenidate and amphetamine
The following predispose patients to serotonin syndrome
when used with MAOI:
Tramadol
Other antidepressants
The following predispose patients to CNS excitation or
depression when used with MAOI:
Tramadol
Pholcodine
Opioids
Avoid the above during MAOI treatment and for 14 days
after stopping the MAOI
Migraine
Migraine treatment
Triptan
Migraine prophylaxis
P ropanolol
A mitriptyline
T opiramate (teratogenic)
ductus arteriosus
Indometacin or ibuprofen can be used to close the ductus arteriosus
Omeprazole fights with mESsI
W arfarin
M ethotrexate
E someprazole
C lopidogrel
c
I
Talopram
Hypothyroidism
Levothyroxine
Liothyronine - emergency 🚨
Methotrexate interaction
Faryal
Peng actually Needs to chill out
NSAIDs
Penicillins Amoxicillin 🚨
Trimethoprim
Omeprazole
Citalopram
Increase dose of Morphine to max dose
Daily dose 100mg
Max 1/2
Min 1/3
100 * 0.5 = 50
50 + 100 = 150mg
