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PRE-REG-Thuri > MONITORING REQS, ADR INTERACTIONS > Flashcards

MONITORING REQS, ADR INTERACTIONS Flashcards

1
Q

What are statin monitoring during initiation?

A

LFT/Lipid profile 3 months after initiation + 12 months.

No need to monitor LFT routinely as no evidence beneficial.

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2
Q

What statin monitoring needs to happen before starting it?

A

ALT/AST
BP
BMI
HDL/ non-HDL cholesterol
Serum Creatinine (clearance) OR eGFR
TSH
Total cholesterol

Consider: HBA1C, FBC, creatine Kinase.

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3
Q

What baseline lithium monitoring is needed before starting?

A

Body weight/ BMI
Cardiac function/ ECG
eGFR
FBC
Calcium
TFH
U+E

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4
Q

What baseline lithium monitoring needed after initiation?

A

Lithium level = 3 monthly
TFT tests + egfr/u + e , Weight, BMI, + calcium =6 monthly

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5
Q

When is lithium monitoring done in high risk patients?

A

3 monthly

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6
Q

What 7 criteria make patients high risk for lithium + require more monitoring?

A

65 and over

Taking drugs interact with lithium
Impaired renal function

impaired thyroid
raised calcium
change in sodium level or fluid intake
poor symptom control
last level was 0.8mmol/L or higher

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7
Q

What is MTX pre screening?

A

Exclude pregnancy before treatment

FBC, RENAL, LFT

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8
Q

What baseline ACEi monitoring needed before starting?

A

BP
eGFR
potassium + sodium
Urea

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9
Q

What ACEi monitoring needed after initiation?

A

Renal profile (eGFR/potassium) = 3 weeks after starting

BP = yearly

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10
Q

What monitoring req needed for antipsychotics (Olanzapine) annually?

A

FBC
Renal
LFT
HBA1c
Lipid profile
Prolactin
ECG

Physical health check

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11
Q

What happens to patients with hypoproteinaemia?

A

Reduced protein binding

Increased free drug for protein bound drugs so toxicity

e.g. pred, NSAID, warfarin, phenytoin

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12
Q

What is menadiol?

A

Water soluble vit K- helps prevent vit K deficiency in fat malabsorption syndroms

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13
Q

What 2 drugs can build up if reduced bile excretion?

A

Fusidic acid + rifampicin excreted can build up

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14
Q

What 3 types of drugs can cause hepatic coma?

A

Drugs causing hypokalaemia

Constipating drugs

sedating drugs

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15
Q

What is tx for hepatic encephalopathy?

A

Lactulose

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16
Q

What 2 drugs can increase fluid retention + cause oedema?

A

NSAID

Steroids

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17
Q

What are some signs of liver toxicity?

A

Jaundice

Abd pain

N +V
Malaise

Weight loss

dark urine

Pale/ clay stools

Confusion

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18
Q

What class of drugs are hepatotoxic?

A

Labetalol

statin

valproate

amiodarone

co-amox + fluclox

MTX
Paracetamol

Tetracyclines

Carbamazepine

Ketaconazole

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19
Q

Sertraline + grapefruit juice?

A

Grapefruit juice moderately increases the exposure to Sertraline. Manufacturer advises avoid.

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20
Q

grapefruit juice + quetiapine?

A

Increases exposure

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21
Q

What immunosupressants interact with grapefruit?

A

Ciclosporin

tacrolimus

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22
Q

What does liver impairment lab results show?

A

High ALT, AST, ALP, GGT, Bilirubin.

Low albumin

High INR

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23
Q

List some nephrotoxic drugs?

A

MTX

Nsaids

ACEI

Aminoglycosides/ salicylates

Cephalosporins

Lithium

Tetracyclines

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24
Q

List signs of AKI?

A

N +V

dehydration

ankle swlling

reduced urin output

fatigue

High BP

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25
Q

What 4 drugs to stop in SICK day rules?

A

Diuretics
ACEi
Metformin
Nsaids

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26
Q

When to start meds after AKI?

A

When patient well

24-48 hrs after eating + drinking

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27
Q

What 3 drugs colour urine red?

A

/ co dantramer

doxorubicin

levodopa

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28
Q

What drug colours urine red/ orange

A

Rifampicin

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29
Q

What drug colours urine orange?

A

Sulfasalazine

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30
Q

What 2 drugs colour urine yellow/brown?

A

Nitro

Senna

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31
Q

What 2 drug colours urine pink?

A

Phenindione

nefopam

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32
Q

What drug colours urine blie?

A

Triamterene
cimetidine - green/blue

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33
Q

What drugs colour urine brown?

A

Prostaglandin analogues

Entacapone (red/brown)

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34
Q

What opioid is an alternative to morphine?

A

Oxycodone

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35
Q

How much morphine make up diamorphine?

A

1/3 dose of morphine

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36
Q

What to do when switching opioid due to hyperalgesia?

A

Reduce by 25-50%

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37
Q

What are 3 opioid SEs?

A

Constipation

N+ V

Dry mouth

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38
Q

What is used for opioid induced constipation?

A

Senna + lactulose or co- danthramer

or Methylnaltrexone

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39
Q

What is used in paliative patients for N+ V caused by opioids?

A

Metoclopramide or haloperidol -4 to 5 days

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40
Q

What is used for anorexia in palliative?

A

Dexamethasone, prednisolone

stop after 1-2 weeks if no benefit

41
Q

What is used for bowel colic in palliative?

A

hyoscine butylbromide

42
Q

What is used for capillary bleeding in palliative?

A

Tranexamic acid

43
Q

What is used for convulsions due to cerebral tumor in palliative?

A

Phenytoin or carbamazepine

44
Q

What is used for dysphagia in palliative?

A

dexamethasone

45
Q

What is used for fungating tumours in palliative?

A

Metronidazole

46
Q

What is used for hiccup due to gastric distension in palliative?

A

metoclopramide, anti-flatulent like peppermint oil
or PPI

47
Q

What is used for muscle spasm in palliative?

48
Q

What is used for intractable coughs in palliative?

A

acetylcysteine in wet cough

Dry cough - citric acid or morphine

49
Q

What is used for agitation in palliative?

50
Q

What is used for itching in palliative?

51
Q

How to reduce dose for elderly?

52
Q

Why do elderly have reduced hepatic metabolism?

A

Reduced liver volume

53
Q

what to give elderly for pain in rheumatoid arthritis?

A

Paracetamol or low dose NSAID first

54
Q

what drug classes cause sedation and have driving warnings?

A

Baclofen

Antihistamines

opioids
TCA
Benzos
Levodopa

55
Q

What class of drugs cause hypoglycaemia?

A

Sulphonylureas

insulin

56
Q

What class of drugs cause hypotension?

A

A blockers

dopamine receptor agonists

57
Q

What is ADR?

A

Unwanted or harmful reaction after taking drug under normal condition of use which is related to drug use.

58
Q

Where to report ADR?

A

Yellow card scheme

59
Q

What to give for biosimilar meds/vaccine when reporting ADR?

A

Brand + batch number

60
Q

What does black triangle mean?

A

IDs newly licensed medicines that require additional monitoring.

Kept for 5 years

61
Q

Where are medication errors reported?

A

National reporting learning system

62
Q

What are 4 medical devices which can be reported?

A

dental or surgical materials, IUD, and contact lens fluids

63
Q

In what 4 cases to report ADR?

A

Newer drugs/vaccines

Med errors

medical devices

defective/fake meds

64
Q

What is rare SE proportion?

A

1 in 10000

65
Q

What is a drug allergy?

A

Clinical features of immune reaction

NOT only GI effect

66
Q

What are 5 symptoms of Immediate, rapidly-evolving DRUG reactions?

A

Anaphylaxis, with erythema, urticaria or angioedema. hypotension, bronchospasm

67
Q

What are 5 symptoms of Non-immediate drug reactions, without systemic involvement?

A

Cutaneous reactions, e.g. widespread red macules and/or papules, or, fixed drug eruption (localised inflamed skin)

68
Q

What are 5 symptoms of Non-immediate reactions, with systemic involvement?

A

Cutaneous reactions with systemic features

TENS/SJS

AGEP

69
Q

When does Non-immediate reactions, with systemic involvement occure?

A

3 days to 6 weeks of 1st exposure or 3 days after 2nd

70
Q

When do Non-immediate drug reactions, without systemic involvement occur?

A

6-10 days after 1st exposure or 3 days after 2nd

71
Q

What drugs can cause dry mouth?

A

Antimuscarinics

opioids

diuretics
antidepressants/antihistamines/ antipsychotics

72
Q

What drug stains teeth brown?

A

Chlorhexidine

73
Q

What drugs can alter taste?

A

Lithium

ACEI
amiodarone

carbimazole

Metformin

metronidazole

zopiclone

74
Q

What 7 drugs can cause myelosupression?

A

DMARD - MTX

Anti-epileptics - carbamazepine, lamotrigine, phenytoin

Abx - chloramphenicol , co-trimoxazole, Linezolid

Imunosuppressants -AZA, cytotoxics

Clozapine, carbimazole

75
Q

What are 2 symptoms of thrombocytopenia?

A

Bruising, bleeding

76
Q

What abx rarely reports teeth staining?

A

Co-amoxiclav

77
Q

What 4 drug classes can cause photosensitisation?

A

Anitfungal - voriconazole

tetracyclines

cotrimoxazole, quinolones

anti-malarials

Others - amiodarone, phenothiazine, antipsychotics, tacrolimus, Benzoyl peroxide, vit A/ isotretinoin.

78
Q

3 drugs causing contact sensitisation?

A

MTX

Chlorpromazine

Cytotoxics

79
Q

What 3 cytotoxic can cause thromboembolism?

A

Bleomycin

Vinca alkaloids

Tamoxifen

80
Q

How does phenobarbital affect breastfeeding ?

A

Inhibits infant’s sucking reflex

81
Q

How does bromocriptine affect breastfeeding ?

A

Inhibits lactation

82
Q

What does neonate mean?

83
Q

What does infant mean?

A

28 days - 2 years

84
Q

What does child mean=?

A

2 years- 12 years

85
Q

What is renal impairment equation for children over 1 years?

A

40 x height/ serum creatine

86
Q

What is off licensed?

A

Not licensed for use in UK - no MA

87
Q

What is Off label?

A

Licensed in uk but use is outside recommendation

88
Q

What syringe to give if dose smaller than 5ml?

A

Oral syringe

89
Q

What happens if benzyl alcohol used in neonates?

A

Fatal toxic syndrome

90
Q

What is expiry of extemp prep?

A

4 weeks expiry when stored 15-25 degrees

91
Q

What is biosimilar?

A

Medicine existing to original one. Not the same by similar

92
Q

What does injections using isotonic solutions increase?

A

Precipitation with giving more than 1 drug

93
Q

What 5 drugs can be mixed with diamorphine?

A

Dexa

hyoscine

Levomepromazine

midazolam

metoclopramide

94
Q

What are 3 incompatible infusions?

A

Amino acids

Mannitol

sodium bicarbonate

95
Q

What is monitored in sodium valproate?

A

LFT before therapy + first 6 months

FBC

96
Q

What are 4 MHRA alerts for sodium valproate?

A

Suicidal tendencies
Full pack dispensing

valproate must NOT be started in new patients (male or female) aged under 55 years, unless two specialists independently consider.

contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met.

ARAF

97
Q

What does long term lithium use do?

A

thyroid disorders and mild cognitive and memory impairment

98
Q

how is frequency lithium monitoring done in new patients

A

serum-lithium monitoring should be performed weekly after initiation + after each dose change until concentrations are stable, then every 3 months for the 1st year, + every 6 months after

PRE-REG-Thuri (44 decks)

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