MONITORING REQS, ADR INTERACTIONS Flashcards by thurica jeyaselan

What are statin monitoring during initiation?

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

No need to monitor LFT routinely as no evidence beneficial.

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What statin monitoring needs to happen before starting it?

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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What baseline lithium monitoring is needed before starting?

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

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What baseline lithium monitoring needed after initiation?

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

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When is lithium monitoring done in high risk patients?

3 monthly

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

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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What is MTX pre screening?

Exclude pregnancy before treatment

FBC, RENAL, LFT

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What baseline ACEi monitoring needed before starting?

BP
eGFR
potassium + sodium
Urea

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What ACEi monitoring needed after initiation?

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

BP = yearly

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What monitoring req needed for antipsychotics (Olanzapine) annually?

FBC
Renal
LFT
HBA1c
Lipid profile
Prolactin
ECG

Physical health check

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What happens to patients with hypoproteinaemia?

Reduced protein binding

Increased free drug for protein bound drugs so toxicity

e.g. pred, NSAID, warfarin, phenytoin

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What is menadiol?

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

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What 2 drugs can build up if reduced bile excretion?

Fusidic acid + rifampicin excreted can build up

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What 3 types of drugs can cause hepatic coma?

Drugs causing hypokalaemia

Constipating drugs

sedating drugs

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What is tx for hepatic encephalopathy?

Lactulose

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What 2 drugs can increase fluid retention + cause oedema?

NSAID

Steroids

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What are some signs of liver toxicity?

Jaundice

Abd pain

N +V
Malaise

Weight loss

dark urine

Pale/ clay stools

Confusion

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What class of drugs are hepatotoxic?

Labetalol

statin

valproate

amiodarone

co-amox + fluclox

MTX
Paracetamol

Tetracyclines

Carbamazepine

Ketaconazole

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Sertraline + grapefruit juice?

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

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grapefruit juice + quetiapine?

Increases exposure

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What immunosupressants interact with grapefruit?

Ciclosporin

tacrolimus

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What does liver impairment lab results show?

High ALT, AST, ALP, GGT, Bilirubin.

Low albumin

High INR

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List some nephrotoxic drugs?

MTX

Nsaids

ACEI

Aminoglycosides/ salicylates

Cephalosporins

Lithium

Tetracyclines

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List signs of AKI?

N +V

dehydration

ankle swlling

reduced urin output

fatigue

High BP

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What 4 drugs to stop in SICK day rules?

Diuretics ACEi Metformin Nsaids

When to start meds after AKI?

When patient well 24-48 hrs after eating + drinking

What 3 drugs colour urine red?

/ co dantramer doxorubicin levodopa

What drug colours urine red/ orange

Rifampicin

What drug colours urine orange?

Sulfasalazine

What 2 drugs colour urine yellow/brown?

Nitro Senna

What 2 drug colours urine pink?

Phenindione nefopam

What drug colours urine blie?

Triamterene cimetidine - green/blue

What drugs colour urine brown?

Prostaglandin analogues Entacapone (red/brown)

What opioid is an alternative to morphine?

Oxycodone

How much morphine make up diamorphine?

1/3 dose of morphine

What to do when switching opioid due to hyperalgesia?

Reduce by 25-50%

What are 3 opioid SEs?

Constipation N+ V Dry mouth

What is used for opioid induced constipation?

Senna + lactulose or co- danthramer or Methylnaltrexone

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

Metoclopramide or haloperidol -4 to 5 days

What is used for anorexia in palliative?

Dexamethasone, prednisolone stop after 1-2 weeks if no benefit

What is used for bowel colic in palliative?

hyoscine butylbromide

What is used for capillary bleeding in palliative?

Tranexamic acid

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

Phenytoin or carbamazepine

What is used for dysphagia in palliative?

dexamethasone

What is used for fungating tumours in palliative?

Metronidazole

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

metoclopramide, anti-flatulent like peppermint oil or PPI

What is used for muscle spasm in palliative?

Baclofen

What is used for intractable coughs in palliative?

acetylcysteine in wet cough Dry cough - citric acid or morphine

What is used for agitation in palliative?

Midazolam

What is used for itching in palliative?

emmolient

How to reduce dose for elderly?

50%

Why do elderly have reduced hepatic metabolism?

Reduced liver volume

what to give elderly for pain in rheumatoid arthritis?

Paracetamol or low dose NSAID first

what drug classes cause sedation and have driving warnings?

Baclofen Antihistamines opioids TCA Benzos Levodopa

What class of drugs cause hypoglycaemia?

Sulphonylureas insulin

What class of drugs cause hypotension?

A blockers dopamine receptor agonists

What is ADR?

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

Where to report ADR?

Yellow card scheme

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

Brand + batch number

What does black triangle mean?

IDs newly licensed medicines that require additional monitoring. Kept for 5 years

Where are medication errors reported?

National reporting learning system

What are 4 medical devices which can be reported?

dental or surgical materials, IUD, and contact lens fluids

In what 4 cases to report ADR?

Newer drugs/vaccines Med errors medical devices defective/fake meds

What is rare SE proportion?

1 in 10000

What is a drug allergy?

Clinical features of immune reaction NOT only GI effect

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

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

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

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

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

Cutaneous reactions with systemic features TENS/SJS AGEP

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

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

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

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

What drugs can cause dry mouth?

Antimuscarinics opioids diuretics antidepressants/antihistamines/ antipsychotics

What drug stains teeth brown?

Chlorhexidine

What drugs can alter taste?

Lithium ACEI amiodarone carbimazole Metformin metronidazole zopiclone

What 7 drugs can cause myelosupression?

DMARD - MTX Anti-epileptics - carbamazepine, lamotrigine, phenytoin Abx - chloramphenicol , co-trimoxazole, Linezolid Imunosuppressants -AZA, cytotoxics Clozapine, carbimazole

What are 2 symptoms of thrombocytopenia?

Bruising, bleeding

What abx rarely reports teeth staining?

Co-amoxiclav

What 4 drug classes can cause photosensitisation?

Anitfungal - voriconazole tetracyclines cotrimoxazole, quinolones anti-malarials Others - amiodarone, phenothiazine, antipsychotics, tacrolimus, Benzoyl peroxide, vit A/ isotretinoin.

3 drugs causing contact sensitisation?

MTX Chlorpromazine Cytotoxics

What 3 cytotoxic can cause thromboembolism?

Bleomycin Vinca alkaloids Tamoxifen

How does phenobarbital affect breastfeeding ?

Inhibits infant's sucking reflex

How does bromocriptine affect breastfeeding ?

Inhibits lactation

What does neonate mean?

0-28 DAYS

What does infant mean?

28 days - 2 years

What does child mean=?

2 years- 12 years

What is renal impairment equation for children over 1 years?

40 x height/ serum creatine

What is off licensed?

Not licensed for use in UK - no MA

What is Off label?

Licensed in uk but use is outside recommendation

What syringe to give if dose smaller than 5ml?

Oral syringe

What happens if benzyl alcohol used in neonates?

Fatal toxic syndrome

What is expiry of extemp prep?

4 weeks expiry when stored 15-25 degrees

What is biosimilar?

Medicine existing to original one. Not the same by similar

What does injections using isotonic solutions increase?

Precipitation with giving more than 1 drug

What 5 drugs can be mixed with diamorphine?

Dexa hyoscine Levomepromazine midazolam metoclopramide

What are 3 incompatible infusions?

Amino acids Mannitol sodium bicarbonate

What is monitored in sodium valproate?

LFT before therapy + first 6 months FBC

What are 4 MHRA alerts for sodium valproate?

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

What does long term lithium use do?

thyroid disorders and mild cognitive and memory impairment

how is frequency lithium monitoring done in new patients

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