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Pre-Registration Pharmacy > Nervous System - High > Flashcards

Nervous System - High Flashcards

1
Q

What is the drug of choice for patients with severe Alzheimer’s disease?

A

Memantine hydrochloride

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1
Q

What are the first line options for the treatment of mild-moderate Alzheimer’s disease?

A
  • Donepezil
  • Galantamine
  • Rivastigmine
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2
Q

Which drug class does memantine belong to?

A

NMDA receptor antagonists

(Dopaminergic)

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3
Q

What are the MHRA warnings associated with the use of antiepileptics?

A
  • Risk of suicidal thoughts and behaviours (August 2008)
  • Updated advice on switching between manufacturers products (November 2017)
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4
Q

Which MHRA risk category is Carbemazepine in?

A

Category 1

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5
Q

Which MHRA risk category is phenytoin in?

A

Category 1

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6
Q

Which MHRA risk category is phenobarbital in?

A

Category 1

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7
Q

Which MHRA risk category is primidone in?

A

Category 1

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8
Q

Which MHRA risk category is clonazepam in?

A

Category 2

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9
Q

Which MHRA risk category is clobazam in?

A

Category 2

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10
Q

Which MHRA risk category is lamotrigine in?

A

Category 2

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11
Q

Which MHRA risk category is sodium valproate in?

A

Category 2

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12
Q

Which MHRA risk category is topiramate in?

A

Category 2

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13
Q

Which MHRA risk category is gabapentin in?

A

Category 3

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14
Q

Which MHRA risk category is pregabalin in?

A

Category 3

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15
Q

Which MHRA risk category is levetiracetam in?

A

Category 3

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16
Q

What are the categories assigned by the MHRA to antiepileptic drugs and what do they signifiy?

A
  • Catgeory 1 - Patients must be mainatined on a manufacturer’s specific product
  • Category 2 - Patients can be switched but factors such as seizure frequency, treatment history, and potential implications should be considered and discussed with the patient beofre switching to another product
  • Category 3 - It is unnecessary for patients to be maintained on a specific manufacturer’s product
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17
Q

How should treatment with antiepileptic drugs be stopped?

A

Withdrawn gradually under specialist supervision to prevent rebound seizures.

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18
Q

Which antiepileptics can be used during pregnancy?

A

Levetiracetam and lamotrigine

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19
Q

What is the difference between focal and generalised seizures?

A
  • Focal - signals originate in one part of the brain
  • Generalised - All areas of the brain are affected by an abnormal electrical impulse
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20
Q

What are the first line options for the treatment of focal seizures, with or without secondary generalisation?

A

Carbemazepine
OR
Lamotrigine

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21
Q

What is the first line option for the treatment of tonic-clonic seizures?

A

Sodium valproate

Lamotrigine (monotherapy or adjunct) where valproate not appropriate

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22
Q

What are the first line options for the treatment of absence seizures?

A

Ethosuximide
OR
Sodium valproate

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23
Q

What are the first line options for the treatment of myoclonic seizures?

A

Sodium valproate
OR
Levetiracetam
OR
Topiramate

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24
Q

What is the first line option for the treatment of atonic and tonic seizures?

A

Sodium valproate

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25
Q

Which seizure types is carbepazepine not recommended in?

A

Tonic-clonic
Atonic and tonic
Absense
Myoclonic

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26
Q

Which seizure type is carbemazepine the second-line treatment option for?

A

Focal seizures

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27
Q

What is ethosuximide a first line treatment for?

A

Absence seizures

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28
Q

What are pregabalin and gabapentin indicated for?

A
  • Focal seizures
  • Neuropathic pain
  • Pregabalin is indicated for treatment of generalised anxiety disorder
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29
Q

What type of seizure is the use of gabapentin and pregabalin not recommended in?

A

Tonic-clonic
Atonic and tonic
Myoclonic
Absense

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30
Q

What are the types of generalised seizures?

A
  • Tonic-clonic
  • Atonic and tonic
  • Absence
  • Myoclonic
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31
Q

What is lamotrigine the first line treatment option for?

A
  • Focal seizures
  • Primary and secondary tonic-clonic seizures (where sodium valproate has been unsuccessful)
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32
Q

How does lamotrigine interact with other antiepileptic drugs?

A
  • Sodium valproate increases lamotrigine plasma concentration
  • Enzyme inducing antiepileptics decrease lamotrigine serum concentrations
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33
Q

What is levetiracetam indicated for?

A

Focal seizures as monotherapy and adjunct

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34
Q

What is phenobarbital indicated for?

A

Focal seizures
Tonic-clonic seizures

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35
Q

What is primidone metabolised into?

A

Phenobarbital

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36
Q

What type is seizures is phenytoin indicated for?

A

Focal seizures
Tonic-clonic seizures

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37
Q

Which type of seizures can phenytoin exacerbate?

A

Absence seizures
Myoclonic seizures

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38
Q

What type of seizures is topiramate indicated for?

A

Focal seizures
Tonic-clonic seizures

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39
Q

Sodium valproate is the first line choice for epilepsy with which seizure types?

A

Tonic-clonic
Myoclonic
Atonic-tonic

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40
Q

How should seizures lasting longer than 5 minutes be treated?

A

IV lorazepam

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41
Q

If seizures fail to respond to initial treatment after 25 minutes, what action should be taken?

A

Phenytoin or phenobarbital should be used and emergency services should be contacted

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42
Q

If seizures fail to respond to treatment 45 minutes after onset, what action should be taken?

A

IV midazolam should be used or another anaesthesia

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43
Q

What are the MHRA warnings are associated specifically with the use of gabapentin?

A
  • (Neurontin) Risk of severe respiratory depression (October 2017)
  • Risk of abuse and dependence: New scheduling requirements (April 2019)

Levels of propylene glycol, acesulfame K and saccharin sodium may exceed daily intake limits if high doses oral solution (Bosemont brand) are given to adolescents or adults with low body weight (39-50kg)

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44
Q

What is the MHRA warning specifically associated with the use of sodium valproate?

A

Contraindicated in women and girls of child bearing potential unless conditions of pregnancy prevention prgramme are met (April 2018)

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45
Q

List some enzyme inducing drugs

A
  • Carbemazepine
  • Rifampicin
  • Phenytoin
  • Phenobarbitone
  • Sulphonylureas
  • Griseofulvin
  • St John’s wort
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46
Q

List some enzyme inhibiting drugs

A
  • Metronidazole
  • Sodium valproate
  • Erythromycin
  • Isoniazid
  • Cimetidine
  • Chloramphenicol
  • Ciprofloxacin
  • Omeprazole
  • Sulfonamides
  • Ketoconazole
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47
Q

List some drugs that have an anticholinergic burden

A
  • Amitriptyline
  • Paroxetine
  • Chorphenamine
  • Promethazine
  • Olanzapine
  • Quetiapine
  • Solifenacin
  • Tolterodine
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48
Q

What are the most commonly prescribed acetylcholinesterase inhibitors?

A

Donepezil
Rivastigmine

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49
Q

What are the acetylcholinestaerase inhibitors indicated for?

A
  1. Mild to moderate Alzheimer’s
  2. Mild to moderate Parkinson’s (rivastigmine)
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50
Q

What are some important adverse effects associated with the use of acetylcholinesterase inhibitors?

A
  • GI upset
  • Exacerbation of asthma and COPD symptoms
  • Peptic ulcers
  • Bradycardia
  • Heart block
  • Hallucinations
  • Altered behaviour
  • Neuroleptic malignant syndrome
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51
Q

When should acetylcholinesterase inhibitors be used with caution?

A
  • Asthma and COPD
  • Peptic ulcers
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52
Q

When should the use of acetylcholinesterase inhibitors be avoided?

A
  • Bradycardia
  • Heart block
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53
Q

Which drugs do acetylcholinesterase inhibitors interact with an to what extent?

A
  • NSAIDs - increased risk of ulcers and GI blleds
  • Corticosteroids - increased risk of ulcers and GI bleeds
  • Beta-blockers - increased risk of bradycardia and heart block
  • Antipsychotics - increased risk of neuroleptic malignant syndrome
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54
Q

Which drug class does donepezil belong to?

A

Acetylcholinesterase inhibitors

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55
Q

Which drug class does rivastigmine belong to?

A

Acetylcholinesterase inhibitors

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56
Q

What is phenobarbital indicated for?

A

All types of seizures except absence seizures

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57
Q

Whe should phenobarbital be used with caution?

A
  • Elderly
  • Acute porphyrias (avoid)
  • Respiratory depression
  • Alcohol abuse
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58
Q

Is phenobarbital an enzyme inducer or inhibitor?

A

Inducer

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59
Q

Which drug shares cross-sensitivity with phenobarbital?

A

Carbemazepine

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60
Q

What are some important adverse effects associated with the use of phenobarbital?

A
  • Hepatic disorders
  • Bone disorders
  • Agranulocytosis
  • Changes in mood
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61
Q

What are some adverse effects associated with the use of phenytoin?

A
  • Blood disorders
  • Skin disorders
  • Bone disorders
  • Cardiac disorders
  • Respiratory disorders
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62
Q

What is are some key points when counselling a patient on the use of phenytoin?

A

Important that they recognise the signs and symptoms of blood and skin disorders

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63
Q

Can phenytoin be used in pregnancy and breastfeeding?

A

Pregnancy - no
Breastfeeding - yes

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64
Q

Phenytoin may exacerbate which kinds of seizures?

A

Absence
Myoclonic

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65
Q

How does phenytoin affect enteral feeding regimens?

A

Enteral feed needs to be interupted 2 hours before and after dose

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66
Q

Which demographic of patients can phenytoin not be used in and why?

A

Those of Han chinese or Thai origin - increased risk of Stevens-Johnson’s syndrome

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67
Q

What monitoring requirements are there for the use of phenytoin?

A

FBCs

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68
Q

What class of drugs do phenobarbital and primidone belong to?

A

Barbiturates

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69
Q

What is the MHRA warning associated with the use of benzodiazepines?

A

Benzodiazepines and opioids: Risk of potentially fatal respiratory depression (March 2020)

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70
Q

What are sodium valpraote and valproic acid indicated for?

A
  1. Prophylaxis of seizures in epilepsy
  2. Status epilepticus where a benzodiazepine has been unsuccessful
  3. Bipolar disorder
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71
Q

Prophylaxis of which types of seizure is sodium valproate the first line treatement for?

A

Focal
Tonic-clonic
Absence
Myoclonic

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72
Q

What are the important adverse effects associated with the use of valproate?

A
  • GI upset
  • Neurological and psychiatric effects
  • Thrombocytopenia
  • Severe liver injury
  • Bone marrow failure
  • Pancreatitis
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73
Q

When is the use of sodium valproate contraindicated?

A
  • Women of child bearing potential
  • Pregnancy, particularly in the first trimester
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74
Q

Which drugs interact with valproate?

A
  • Drugs that are metabolised by CYP enzymes (warfarin etc)
  • Enzyme inhibitors - increase the toxicity and risk of adverse effects
  • Enzyme inducers - lower the efficacy valproate and increase risk of seizures
  • Drugs that lower the seizure threshold (antipsychotics and tramadol)
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75
Q

How is sodium valproate metabolised?

A

By hepatic CYP enzymes

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76
Q

What are the key points when counselling a patient on the use of sodium valproate?

A
  1. GI upset is transient and will likely pass in a few days
  2. Aware of signs and symptoms of liver and blood abnormalities
  3. Discuss pregnancy and contraception
  4. Patient cannot drive unless thay have been seizure free for 12 months and for 6 months after switching or stopping treatment
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77
Q

What are the clinical indications for the use of carbemazepine?

A
  1. Seizure prophylaxis
  2. Trigeminal neuralgia
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78
Q

Which seizure type is the use of carbemazepine not recommended in?

A

Myoclonic
Absence

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79
Q

What are the important adverse effects associated with the use of carbemazepine?

A
  • Antiepileptic hypersensitivity syndrome
  • GI upset
  • Neurological effects
  • Oedema
  • Hyponatraemia

Carbemazepine causes oedema and hyponatraemia through antidiuretic hormone-like effects

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80
Q

When should carbemazepine be used with caution?

A
  • Renal impairment
  • Hepatic impairment
  • Cardiac disease
  • Pregnancy
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81
Q

When is the use of carbemazepine contraindicated?

A

In patients with a history of antiepileptic hypersensitivity syndrome

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82
Q

Is carbemazepine an enzyme inucer or inhibitor?

A

Inducer

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83
Q

Which drugs interact with carbemazepine and to what extent?

A
  • Drugs that are metabolised by CYP enzyme such as warfarin, oestrogen and progestogens
  • CYP inhibitors - increase risk of adverse effects and toxicity
  • Other antiepileptics
  • Drugs that lower the seizuere threshold such as antipsychotics an tramadol
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84
Q

How should carbemazepine be initiated?

A

Started at a low dose of 100 - 200mg OD/BD then increased gradually (max 1.6g)

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85
Q

What are the clinical indications for the use of lamotrigine?

A
  1. Prophylaxis of focal, tonic-clonic, and absence seizures in epilepsy
  2. Bipolar depression
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86
Q

What are the important adverse effects associated with the use of lamotrigine?

A
  • Headache
  • Drowsiness
  • Blurred vision
  • GI upset
  • Skin rash
  • Hypersensitivity reactions
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87
Q

When is a dose reduction of lamotrigine necessary and why?

A

Patients with hepatic impairment as lamotrigine is metabolised by glucuronidation

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88
Q

Can lamotrigine be used in pregnancy?

A

Yes

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89
Q

Which drugs interact with lamotrigine and to what extent?

A
  • Drugs that induce glucuronidation such as carbemazepine, oestrogens, rifampicin, and protease inhibitors - cause lamotrigine concentrations to fall
  • Valproate inhibits glucuronidation and as such causes the concentration of lamotrigine to rise increasing the risk of toxicity
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90
Q

What should happen to the dose of lamotrigine if it is being coprescribed with a drug that causes glucuronidation?

A

It should be doubled

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91
Q

How is lamotrigine typically dosed?

A

Started at 25mg OD
Increased 2-weekly intervals up to 200mg

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92
Q

What should happen to the dose of lamotrigine if it is taken concurrently with valproate?

A

It should be halved or taken on alternative days

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93
Q

How is lamotrigine unique as a treatment for bipolar disorder?

A

It effectively treats bipolar depression without increasing the risk of switch to mania

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94
Q

What are the clinical indications for the use of levetiracetam?

A
  1. Prophylaxis of focal seizures
  2. Status epilepticus when first line benzodiazepine was ineffective

It can also be used for the treatment ofmyoclonic and tonic0clonic seizures

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95
Q

What are the advantages of using levetiractem compared to other antiepileptics?

A

It is relatively well tolerated, and most patients only suffer from mild adverse effects or none at all.
It also has very few clinically significant interactions with other drugs such as hormonal contraception, warfarin, and other antiepileptc drugs

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96
Q

Can levetiracetam be used during pregnancy and breastfeeding?

A

Yes

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97
Q

When is a dose adjustment of levetiracetam required?

A

In renal impairment

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98
Q

What is a typical dosing regimen of levetiracetam?

A

Starting dose of 500mg BD
Increased to 1g after 2 weeks (max 1.5g BD)

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99
Q

What is the dose equivalance between oral and IV levetiracetam

A

They are the same

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100
Q

What are gabapentin and pregabalin indicated for?

A
  1. Add-ons for the prophylaxis of focal seizures in epilepsy
  2. First line options for neuropathic pain
  3. Pregabalin is licensed in generalised anxiety disorder
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101
Q

What are the main adverse effects associated with the use of gabapentin and pregabalin?

A

Drowsiness
Dizziness
Ataxia

These improve after a few weeks of treatment

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102
Q

When should both gabapentin and pregabalin be dose adjusted?

A

In renal impairment

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103
Q

Which drugs interact with gabapentin and pregabalin and to what effect?

A

Their sedating effect maybe exacerbated by other sedating drugs such as benzodiazepines
Other than that they have relatively few significant clinical indications

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104
Q

How should gabapentin and pregabalin be initiated?

A

They should be started at a low dose and gradually titrated up to reduce adverse effects

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105
Q

Between gabapentin and pregabalin, which has an effect on urine dipstick testsing?

A

Gabapentin can cause false positives for proteins on urine dipstick tests

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106
Q

What are the most commonly prescribed benzodiazepines?

A

Chlordiazepoxide
Lorazepam
Diazepam
Temazepam
Midazolam

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107
Q

What are the clinical indications for the use of benzodiazepines?

A
  1. First line management of seizures and status epilepticus
  2. Fisrt line management of alcohol withdrawal reactions
  3. Sedation for intervention procedures
  4. Short-term treatment of severe or distressing anxiety or insomnia
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108
Q

What are the important adverse effects associated with the use of benzodiazepines?

A
  • Drowsiness
  • Dependence
  • Withdrawal reactions
  • Small chance of cardiorespiratory depression
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109
Q

Which benzodiazepine is the best choice for the treatment of alcohol withdrawal in a patient with liver failure and why?

A

Lorazepam as it depends less on liver elimination and therefore has a lesser chance of causing hepatic encephalopathy

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110
Q

In which patient demographic should benzodiazepines be used with particular caution and why?

A

The elderly as they are more susceptible tothe effects of benzodiazepines

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111
Q

When should the use of benzodiazepines be avoided?

A
  • Liver failure
  • Respiratory impairment
  • Neuromuscular disease
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112
Q

Which drugs interact with benzodiazepines and to what effect?

A
  • Other drugs with sedating effects such as opioids and alcohol
  • CYP inhibitors such as metronidazole
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113
Q

For the treatment of alcohol withdrawal is it best to use a long- or short-acting benzodiazepine?

A

Long

Such as chlordiazepoxide, lorazepam, and diazepam

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114
Q

For the treatment of epilepsy is it best to use a long- or short-acting benzodiazepine?

A

Long

Usually lorazepam

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115
Q

For sedation is it best to use a long- or short-acting benzodiazepine?

A

Short

Such as midazolam

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116
Q

What duration of action is ideal in a benzodiazepine used to treat anxiety and insomnia?

A

Intermediate

Tenazepam

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117
Q

Which drug is a specific antagonist of benzodiazepines?

A

Flumazenil

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118
Q

Why is the use of flumazenil rarely indicated?

A

It should not be used to reverse benzodiazepine-induced sedation in suspected overdose as it may precipitate seizures, which having blocked the action of the benzodiazepines will extremely difficult to treat

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119
Q

What is the NHS Never Event regarding midazolam?

A

Mis-selection of high strength midazolam during conscious sedation (January 2018)

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120
Q

What is a typical dose of chlordiazepoxide for the treatment of alcohol withdrawal?

A

10 - 40mg QD
Reduced over 5 - 7 days

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121
Q

What are the first line options for the treatment of ADHD?

A

Methylphenidate
Lisdexamfetamine

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122
Q

What schedule of CD is methylphenidate?

A

Schedule 2

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123
Q

What drug is sold under the brand name Delmosart?

A

Methylphenidate

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124
Q

What drug is sold under the brand name Concerta?

A

Methylphenidate

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125
Q

What drug is sold under the brand name Medikinet?

A

Methylphenidate

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126
Q

When is the use of methylphenidate contraindicated?

A
  • Cardiovascular disease
  • Hyperthyroidism
  • Psychosis
  • Anorexia
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127
Q

What drug is sold under the brand name Elvanse?

A

Lisdexamfetamine

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128
Q

What schedule of CD is lisdexamfetamine?

A

Schedule 2

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129
Q

Can either methylphenidate or lisdexamfetamine be used in pregnancy or breastfeeding?

A

No

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130
Q

What is the next line option for the treatment for patients in whom stimulants have been ineffective or are unsuitable for the treatment of ADHD?

A

Guanfacine

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131
Q

Which drug class does guanfacine belong to?

A

Alpha2-adrenoreceptor agonists

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132
Q

What needs to be monitored in patients receiving treatment with guanfacine?

A
  • QT interval
  • Hypotension
  • Bradycardia
  • Arrythmia
  • BMI
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133
Q

Which drugs are used to treat acute episodes or mania and hypomania?

A

Olanzapine
Haloperidol
Quetiapine
Risperidone

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134
Q

Which drugs are used for the prophylaxis of mania and hypomania?

A

Lithium
Valproate

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135
Q

What does lithium interact with and to what extent?

A

ACE inhibitors - increases the risk of lithium toxicity

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136
Q

What are the clinical indications for the SSRIs?

A
  1. Depression
  2. Panic disorder
  3. OCD
137
Q

What are the important adverse effets associated with the use of SSRIs?

A
  • GI upset
  • QT prolongation
  • Increased bleeding risk
  • Serotonin syndrome
  • Lower seizure threshold
  • Hyponatraemia

Withdrawal side effects - GI upset, flu-like symptoms, and sleeplessness

138
Q

When should SSRIs be used with caution?

A
  • History of peptic ulcers
  • Epilepcy
139
Q

Which drugs cannot be given alongside SSRIs?

A
  • Monoamine oxidase inhibitors
  • Serotinergic drugs
140
Q

Which drugs interact with SSRIs and to what extent?

A
  • Serotinergic drugs and MAO inhibitors - precipitate serontin syndrome
  • Aspirin and NSAIDs - increased risk of bleeding
  • Anticoagulants - increased risk of bleeding
  • Drugs that prolong QT (amiodarone, antipsychotics, quinine, quinolones, macrolides)
141
Q

Which SSRI has the lowest chance of withdrawal side effects?

A

Fluoxetine

Half life - 14 days

142
Q

What is the most commonly prescribed tricyclic antidepressant?

A

Amitriptyline

143
Q

Which drug class does venlafaxine belong to?

144
Q

What are the clinical indications for the use of tricyclic antidepressants?

A
  1. Second-line treatment for depression
  2. Neuropathic pain (unlicensed)
145
Q

What are the important adverse effects associated with the use of tricyclic antidepressants?

A
  • Antimuscarinic effects such as dru mouth and urinary retention
  • Sedation
  • Hypotension
  • Arrythmias
  • QT prolongation
  • Convulsions
  • Breast changes
  • Extrapyramidal symptoms
146
Q

Use of tricyclic antidepressants can make which conditions worse?

A
  • Prostatic hypertrophy
  • Glaucoma
  • Constipation
147
Q

When should tricyclic antidepressants be used with caution?

A
  • Elderly
  • Epilepsy
  • Cardiovascular disease
148
Q

Which drugs interact with tricyclic antidepressants and to what extent?

A
  • MAO inhibitors - increased risk of hypertension, hyperthermia, and serotonin syndrome
  • Antimuscarinics - enhanced effects
  • Antihypertensives - enhanced hypotensive effects
  • Sedatives - enhanced effects
149
Q

Which tricyclic antidepressant has a lesser adverse effect profile than the rest of the drugs in the class?

A

Lofepramine

150
Q

What is a typical dose of amitriptyline for the treartment of neuropathic pain?

151
Q

What is atypical strting dose of amitriptyline for the treatment of depression?

152
Q

What is good practice with regards to the supply of tricyclic antidepressants such as amitriptyline?

A

Supply a short course - usually 2 weeks

153
Q

Which drug class does mirtazapine belong to?

A

Tetracyclic antidepressants

154
Q

What are the clinical indications for the use of venlafaxine?

A
  1. Second-line in depression where SSRIs have been unsuccessful
  2. Generalised anxiety disorder
155
Q

What are the clinical indications for the use of mirtazapine?

A
  1. Second-line in depression where the SSRIs have been unsuccessful
  2. Sedation in elderly
156
Q

Is venlafaxine is associated with a higher or lower incidence of adverse effects than other antidepressants?

157
Q

What are some important adverse effects associated with the use of venlafaxine?

A
  • GI upset
  • Neurological effects
  • Hyponatraemia
  • Serotonin syndrome
  • QT prolongation
158
Q

What arethe important adverse effects associated with the use of mirtazapine?

A
  • Agranulocytosis
  • GI upset
  • Sedation
  • Hyponatraemia
  • Seotonin syndrome
159
Q

When should venlafaxine be used with caution?

A
  • Elderly
  • Arrythmias
  • Renal and hepatic impairment
160
Q

Which drugs interact with venlafaxine and to what extenet?

A
  • Antidepressants such as SSRIs increse risk of serotonin syndrome
161
Q

What is a typical dose of venlafaxine?

A

37.5mg BD (titrated up 375mg MDD)

162
Q

Is mirtazapine more sedating at a higher or lower dose?

163
Q

What is the key point when counselling patients on the use of mirtazapine?

A

Be aware of signs of infection such as sore throat and seek urgent medical care if they begin to experience any

164
Q

What are the most commonly prescribed Dopamine D2-receptor antagonists

A

Metoclpramide
Domperidone

165
Q

Which dopamine receptor antagonist can be used in patients with Parkinson’s disease?

A

Domperidone

Domperidone does not cross the BBB

166
Q

What are the clinnical indications for the use of dopamine receptor antagonists?

A

Treatment of nausea and vomiting, but particularly in the context of reduced gut motility

167
Q

What are the important adverse effects associated with the use of metoclopramide?

A
  • Diarrhoea
  • ## Extrapyrimadal symptoms (oculofyric crisis)
168
Q

What are the important adverse effects associated with the use of domperidone?

A
  • Diarrhoea
  • QT prolongation
169
Q

When is the use of metoclopramide contraindicated?

A
  • Neonate, children, and adults at increased risk of side effects
  • Parkinson’s disease
  • GI obstruction
170
Q

When is the use of domperidone contraindicated?

A
  • Cardiac condution abnormalities
  • Severe hepatic impairment
  • GI obstruction
171
Q

Which drugs interact with domperidone and to what effect?

A
  • Antipsychotics - increase the risk of extrapyramidal effects
  • Dopaminergic drugs used to treat Parkinson’s
172
Q

Which drugs interact with domperidone and to what effect?

A
  • Drugs that prolong the QT interval (amiodarone, antipsychotics, fluconazole, quinine, quinolones, macrolides, SSRIs, venlafaxine)
  • Enzyme inhibiting drugs (metronidazole, macrolides, omeprazole, sulfonamides, ketoconazole)
173
Q

What is the ideal maximum duration for the use of metoclopramide?

174
Q

What is the standard starting dose for both metoclopramide and domperidone?

A

10mg 8 hrly

175
Q

Where long term use of metoclopramide is necessary, which other drug can be used in combination in an alternating regimen?

A

Erythromycin

176
Q

What are the most commonly prescribed H1-receptor antagonists indicated for nausea and vomiting?

A

Cyclizine
Cinnarizine
Promethazine

177
Q

Which drug class does cyclizine belong to?

A

H1-receptor antagonists (antihistamines)

178
Q

What are cyclizine, cinnarizine, and promethazine indicated for?

A

Treatment of nausea and vomiting, particularly in the conext of motion sickness and vertigo

179
Q

What are the important adverse effects associated with the use of antihistamines used for the treatment of nausea and vomiting?

A
  • Drowsiness
  • Anticholinergic effects such as dry mouth and throat
  • Tachycardia + palpitations (IV use)
180
Q

Is cyclizine sedating or non-sedating?

A

Sedating

It is the least sedating of the sedating antihistamines

181
Q

Which drugs interact with cyclizine and to what effect?

A
  • Other sedating drugs such as benzodiazepines and opioids
  • Ipratropium andtiotropium - anticholinergic effects enhanced
182
Q

What is the MHRA warning associated with the use of metoclopramide?

A

Risk of neurological adverse effects - restriction of dose and duration of use (August 2013)

183
Q

What is the MHRA warning associated with the use of metoclopramide?

A

Lack of efficacy in children; reminder of contraindications in adults and adolescents

184
Q

What is the minimum age of a patien who can receive domperidone?

A

12 years old

185
Q

Which drug class does ondansetron belong to?

A

Serotonin 5-HT3-receptor antagonists

186
Q

Which drug class does granisetron belong to?

A

5-HT3-receptor antagonists

187
Q

What are the 5-HT3-receptor antagonists indicated for?

A

Treatment of nausea and vomiting, particularly in the context of anaesthesia and chemotherapy

188
Q

What are the important adverse effects associated with the use of ondansetron and granisetron?

A

Adverse effects are rare but:
- QT prolongation
- Diarrhoea
- Constipation
- Headaches

189
Q

What is the main warning for use associated with the 5-HT3-receptor antagonists?

A

QT prolongation

190
Q

Which drugs interact with ondansetron and granisetron and to what effect?

A

Other drugs that prolong the QT interval such as amiodarone, fluconazole, quinine, quinolones, macrolides, SSRIs, venlafaxine, and tricyclic antidepressants

191
Q

What is the typical starting dose of ondansetron?

A

4 - 8mg 12hrly

192
Q

Can ondansetron be used to treat morning sickness?

193
Q

What are the main constituents of co-careldopa?

A

Levodopa
Carbidopa

194
Q

What are the main constituents of co-beneldopa?

A

Levodopa
Benserazide

195
Q

What are the most commonly prescribed Dopamine agonist drugs?

A

Ropinirole
Pramipexole

196
Q

What is levodopa indicated for?

A
  1. Parkinson’s disease
  2. Management of secondary Parkinsonism
197
Q

What are the dopamine agonists indicated for?

A
  1. Early Parkinson’s disease where they are preferred over levodopa preparations
198
Q

What are the important adverse effects associated with the use of all dopaminergic drugs?

A
  • Nausea
  • Drowsiness
  • Confusion
  • Hallucinations
  • Hypotension
199
Q

Which drugs interact with dopaminergic drugs?

A
  • 1st and 2nd generation antipsychotics
  • Metoclopramide
200
Q

Which drug is sold under the brand name Madopar?

A

Co-beneldopa

201
Q

Which drug is sold under the brand name Sinemet?

A

Co-careldopa

202
Q

When should dopaminergic drugs be used with caution?

A
  • Elderly
  • Cognitive or psychiatric disease
  • Hypotension
203
Q

Name some first-genertion antipsychotics

A

Haloperidol
Prochlorperazine
Chlorpromazine

204
Q

Which drug class does haloperidol beliong to?

A

First-generation antipsychotic

205
Q

Which drug class does prochlorperazine belong to?

A

First-generation antipsychotic

206
Q

Which drug class chlorperazine belong to?

A

First-generation antipsychotic

207
Q

What are the first-generation antipsychotics indicated for?

A
  1. Urgent treatment of psychomotor agitation
  2. Schizophrenia
  3. Bipolar disorder
  4. Nausea and vomiting, particularly in the context of palliative care
208
Q

What are the important adverse effects associated with the use of first-generation antipsychotics?

A
  • Extrapyramidal effects
  • Neuroleptic malignancy syndrome
  • Tardive dyskinesia
  • Drowsiness
  • Hypotension
  • QT prolongation
  • Hyperprolactinaemia
209
Q

When should first generation antipsychotics be used with caution or avoided?

A
  • Caution in the elderly
  • Avoided in dementia
  • Avoided in Parkinson’s
210
Q

Which drugs interact with antipsychotics?

A

Interactions with first-gen antipsychotics are extensive, but the most prominent are those that extend the QT interval

211
Q

What is the MHRA warning associtaed with the use of haloperidol?

A

Reminder of risks when used elderly patients for the acute treatment of delirium (December 2021)

212
Q

List some of the second-generation antipsychotics

A

Quetiapine
Olanzapine
Risperidone
Clozapine

213
Q

What are the second-generation antipsychotics indicated for?

A
  1. Urgent treatment of psychomotor agitation
  2. Bipolar disorder
  3. Schizophrenia
214
Q

What are the first-generation antipsychotics indicated for that second-generation are not?

A

Treatment of nausea and vomiting

Palliative care

215
Q

What are the MHRA warnings associated with the use of clozapine?

A
  • Risk of potentially fatal bowel obstruction, faecal impactation, and paralytic ileus (October 2017)
  • Monitoring serum concentrations for toxicity (August 2020)
216
Q

Which drug class does clozapine belong to?

A

Second-gen antipsychotics

217
Q

What are the important adverse effects associated with the use of clozapine?

A
  • Agranulocytosis
  • Myocarditis and cardiomyopathy
  • Intestinal obstruction
  • QT prolongation
  • Extrapyramidal effects
  • Sedation
  • Diabetes
218
Q

What are the important adverse effects associated with the use of second-generation antipsychotics?

A
  • Sedation
  • Extrapyramidal effects
  • QT prolongation
  • Diabetes
219
Q

When should the use of clozapine be avoided?

A
  • Cardiovascular disease
  • Neutropenia
220
Q

When should second-generation antipsychotics be used with caution?

A

Cardiovascular disease

221
Q

Concurrent use of which drugs should be avoided during the use of second-generation antipsychotics?

A

Dopmaine blocking antiemetics (metaclopramide and donperidone)
Drugs that prolong the QT interavl (amiodarone, other antipsychotics, quinine, quinolones, fluconazole, macrolides, SSRIs, venlafaxine)

222
Q

What are the indications for the strong opioids?

Morphine and oxycodone

A
  1. Rapid relief of acute severe pain
  2. Relief of chronic pain
  3. Relief of breathlessness in end of life care
  4. Relief of breathlessness and anxiety in acute pulmonary oedema
223
Q

Which drugs are used alongside morphine in the treatment of acute pulmonary oedema?

A

Furosemide
Oxygen
Nitrates

224
Q

```

~~~

What are the important adverse effects associated with the use of strong opioids?

A
  • Respiartory depression
  • Nausea and vomiting
  • Constipation
  • Pupillary constriction
  • Neurological depression
  • Dependence
225
Q

When is a dose reduction required for strong opioids?

A
  • Elderly
  • Renal impairment
  • Hepatic impairment
226
Q

When is the use of morphine contraindicated?

A
  • Respiratory depression
  • Head injury
  • Raised intracranial pressure
  • Paralytic ileus
227
Q

What are the MHRA warnings associated with the use of morphine?

A
  • Risk of potentially fatal respiratory depression (March 2020)
  • Risk of dependence and addiction (September 2020)
228
Q

Concurrent use of which drugs should be avoided during treatment with morphine?

A

Other sedating drugs (benzodiazepines, antipsychotics, tricyclic antidepressants)

229
Q

When is the use of oxycodone preferrable to morphine?

A

When morphine has not been tolerated and patients with renal imapirment (eGFR < 30)

230
Q

The dose of morphine used for breakthrough analgesia is usually proportionate to how much of the total daily dose?

231
Q

What are the most commonly prescribed weak opioids?

A

Tramadol
Codeine
Dihydrocodeine

232
Q

What are the weak opioids indicated for?

A

Mild to moderate pain

233
Q

Which drugs are on the final rung of the WHO pain ladder?

A

Morphine and oxycodone

234
Q

Which drugs are on the second rung of the WHO pain ladder?

A

Weak opioids:
- Codeine
- Tramadol
- Dihydrocodeine

235
Q

Which drugs are on the first rung of the WHO pain ladder?

A

Paracetamol
NSAIDs

236
Q

What are the important adverse effects associated with the use of weak opioids?

A
  • Respiratory depression (overdose)
  • Neurological depression (overdose)
  • Constipation
  • Nausea and vomiting
237
Q

Can codeine and dihydrocodeine be given intravenously?

A

No, this results in an anaphylaxis-like reaction

238
Q

Which opioid is associated with lowering the seizure threshold?

239
Q

When do the weak opioids need to be used with caution?

A
  • Elderly
  • Renal impairment
  • Hepatic impairment
240
Q

Which drugs interact with the tramadol and to what effect?

A
  • Other sedating medication (benzodiazepines, antipsychotics, tricyclic antidepressants)
  • Drugs that lower the seizure threshold (antipsychotics)
  • Other serotoniergic drugs such as SSRIs and tricyclic antidepressants - increased risk of serotonin syndrome
241
Q

What are the clinical indications for the use of paracetamol?

A
  1. First-line for acute and chronic pain
  2. Fever and its associated symptoms
242
Q

When should paracetamol be used with caution?

A

In those at an increased risk of liver toxicity

243
Q

Which drugs interact with paracetamol and to what effect?

A

Paracetamol has very few clinically significant interactions.
CYP inducing drugs do however increase the risk of liver toxicity after overdose

244
Q

What is the typical dose of paracetamol for every route?

A

0.5 - 1grams
4 - 6hrly (Max 4g daily)

245
Q

What is the antidote for paracetamol overdose?

A

N-acetylcysteine

246
Q

When is the use of lithium contraindicated?

A
  • LLow sodium diet
  • Addison’s disease
  • Cardiac disease
  • Dehydration
247
Q

Can lithium be used in pregnancy and breastfeeding?

A

Pregnancy - Avoid in 1st trimester / can be used in 2nd and 3rd but requires dose adjusting
Breastfeeding - Avoid

248
Q

What adverse effects are associated with the long-term use of lithium?

A
  • Thyroid disorders
  • Memory impairment
  • Mild cognitive impairment
249
Q

What are the important adverse effects associated with the use of lithium?

A
  • QT prolongation
  • Arrythmias
  • Atroventricular block
  • Cardiomyopathy
  • Hyperglycaemia
250
Q

What are the signs and symptoms of lithium overdose?

A
  • GI disturbances
  • Muscle weakness
  • Tremor
  • Abnormal reflexes
  • Hypernatraemia
  • Arrythmias and heartblock
  • Renal failure
  • Coma
  • Death
251
Q

What are the monitoring requirements during the use of lithium?

A
  • Serum concentrations should be measured 12 hours after each dose
  • Maintenance therapy - target range of 0.4 - 1 mmol/L
  • Acute management of manic episodes - target range of 0.8 - 1 mmol/L
252
Q

What are the key points when counselling a patient on the use of lithium?

A
  • Be aware of the signs and symptoms of toxicity such as hypothyroidism, renal dysfuntion, and benign intracranial hypertension
  • Information about lithium information pack, including alert card and serum tracking book
253
Q

Which drug class is the first line option in depression?

254
Q

Hyponatraemia is more commonly associated with which class of antidepressants?

255
Q

What are the treatment options available when a patient does not respond to an SSRI?

A
  • Increase in dose, change to another SSRI, or switching to mirtazapine
  • Second-line choices include lofepramine, moclobemide, and reboxetine
  • Tricyclic antidepressants or venlafaxine should only be used in severe depression
  • MAOIs should only be initiated by specialists
256
Q

What are the signs and symptoms of serotonin syndrome?

A
  1. Neuromuscular hyperactivity
  2. Autonomic dysfunction
  3. Altered mental state
257
Q

Which drug class does duloxetine?

258
Q

Name the irreversible MAOIs

A
  • Isocarboxazid
  • Phenelzine
  • Tranylcypromine
259
Q

Name the reversible MAOI

A

Moclobemide

260
Q

How long after treatment with MAOIs needs to be taken before starting any other antidepressants?

261
Q

What is the MHRA warning associated with the use of SSRIs and SNRIs?

A

Small increased risk of postpartum haemorrhage when used in the month before delivery (January 2021)

262
Q

Which side effects are associated with the use of all antipsychotic medications?

A
  • Hyperprolactinaemia
  • Cardiovascular effects
  • Sexual dysfunction
  • Hypotension
  • Hyperglycaemia and diabetes
  • Weight gain
  • Neuroleptic malignant syndrome
263
Q

How should a patient with Parkinson’s disease be switched from one levodopa/dopa-decarboxylase inhibitor preparation (co-careldopa) to another (co-beneldopa)?

A

The previous levodopa formulation needs to be discontinued for at least 12 hourd be starting the next preparation

264
Q

When switching a patient from MR levodopa to dispersible co-beneldopa what should happen to the dosage?

A

Dose of dispersible co-beneldopa should be 30% less than the previous levodopa formulation

265
Q

Which drugs are available for the treatment of post-operative nausea and vomiting?

A

A combination of 2x antiemetics that have different mechanisms of action:
- Serotonin receptor antagonists (ondansetron + granisetron)
- Dexamethasone
- Haloperidol
- Cyclizine
- Prochlorperazine

266
Q

What age and above is the use of cyclizine licensed in?

A

6 years old and older

267
Q

What is the MHRA warning associated with the use of ondansetron?

A

Small increased risk of oral clefts following use in the first 12 weeks of pregnancy

268
Q

What is the special hazard regarding aspirin and warfarin?

A

Concurrent use of the two together increases bleed risk by 1.5 to 2 times without offering any clinical benefit for stroke or cardiovascular events

269
Q

How often do fentanyl patches need to be changed?

270
Q

What schedule of drug is Tramadol?

A

Schedule 3

271
Q

A MAOI should not be started until:

A
  • At least 2 weeks since a previous MAOI has been stopped
  • At least 1 or 2 weeks since tricyclic has been stopped (3 weeks for clomipiramine and imipramine)
  • At least 1 week since SSRI has been stopped (5 weeks in the case of fluoxetine)
272
Q

When is the use of naproxen contraindicated?

A

Heart failure

273
Q

What strength of paracetamol should be dispensed when the prescription is for a paediatric oral mixture or suspension?

274
Q

What is the paracetamol dosing for a child of 1 - 2 months of age?

A

30 - 60mg 8hrly PRN (Max 60mg/kg/day)

275
Q

What is the paracetamol dosing for a child of 3 - 5 months of age?

A

60mg every 4 - 6hrs (Max QD)

276
Q

What is the paracetamol dosing for a child of 6 - 23 months of age?

A

120mg every 4 - 6hrs (Max QD)

277
Q

What is the paracetamol dosing for a child of 2 - 3 years of age?

A

180mg every 4 - 6hrs (Max QD)

278
Q

What is the paracetamol dosing for a child of 4 - 5 years of age?

A

240mg every 4 - 6 hrs (Max QD)

279
Q

What is the paracetamol dosing for a child of 6 - 7 years of age?

A

240mg - 250mg every 4 - 6hrs (Max QD)

280
Q

What is the paracetamol dosing for a child of 8 - 9 years of age?

A

360mg - 375mg every 4 - 6hrs (Max QD)

281
Q

What is the paracetamol dosing for a child of 10 - 11 years of age?

A

480mg - 500mg every 4 - 6hrs (Max QD)

282
Q

What is the paracetamol dosing for a child of 12 - 15 years of age?

A

480mg - 750mg every 4 - 6hrs (Max QD)

283
Q

What is the paracetamol dosing for a child of 16 - 17 years of age?

A

500mg - 1000mg every 4 - 6hrs (Max QD)

284
Q

What schedule of drug is buprenorphine?

A

Schedule 3

285
Q

What is the MHRA warning associated with the use of codeine?

A

Restricted use in children due to reports of morphine toxicity (July 2013)

286
Q

What schedule of drug is codeine?

A

Schedule 5

287
Q

What are the MHRA warnings associated with the use of fentanyl?

A
  • Life-threatening exposure and fatal opioid toxicity from accidental exposure, particularly in children (October 2018)
  • Transdermal fentanyl patches for non-cancer pain: Do not use in opioid naive patients (September 2020)
288
Q

What schedule of drug is fentanyl?

A

Schedule 2

289
Q

What is a typical dose of morphine for the management of acute or chronic pain?

A

5 -10mg every 4hrs

290
Q

What schedule of drug is morphine?

A

Schedule 2

291
Q

What schedule of drug is oxycodone?

A

Schedule 2

292
Q

What schedule drug is pethidine?

A

Schedule 2

293
Q

What schedule drug is tapentadol?

A

Schedule 2

294
Q

What is the MHRA warning associated with the use of tapentadol (PALEXIA)?

A

Risk of seizures and reports of serotonin syndrome when co-administered with other medicines (January 2019)

295
Q

When should tapentadol be used with caution?

A

Epilepsy
Concurrent use with other drugs that lower seizure threshold (SSRIs, tricyclics, antpsychotics)
Other serontinergic medicines (SSRIs, tricyclics, antipsychotics)

296
Q

What are the first line options for the treatment of acute migraine?

A

Aspirin
Ibuprofen
serotonin receptor agonists (‘triptans’)

297
Q

What are the treatment options for migraine in patients presenting with vomiting?

A

SC sumatriptan
Nasal zolmitriptan
Diclofenca sodium

298
Q

What is the recommended treatment option for patients in whom monotherapy has been unsuccessful for the treatment of migraine?

A

Sumatriptan and naproxen

299
Q

Which antiemetics can be used for the treatment of migraine / N+V in migraine?

A

Metoclopramide
Prochlorperazine
Domperidone (where metoclopramide not tolerated)

300
Q

What is the first line option for the prophylaxis of episodic or chronic migraines?

A

Propranolol

301
Q

What is the second line option for the prophylaxis of episodic or chronic migraines where beta-blockers have been unsuccessful or are not appropriate?

302
Q

What are the options for prophylaxis of mentrual migraines?

A

Frovatriptan
Zolmitriptan
Naratriptan

303
Q

When is the use of sumatriptan contraindicated?

A
  • Ischaemic heart disease
  • Hypertension
  • Peripheral vascular disease
  • Myocardial infarction
  • Coronary vasospasm
304
Q

Is sumatriptan available over the counter?

A

No, it is a POM

305
Q

What drug is given for trigeminal neuralgia?

A

Carbemazepine

306
Q

What are the first line options for the treatment of neuropathic pain?

A

Amitriptyline / Nortriptyline
Pregabalin / Gabapentin

Nortriptyline is unlicensed for the treatment of neuropathic pain

307
Q

When and for how long can benzodiazepines be used for the treatment of anxiety an insomnia?

A

When either is severe or disabling
4 weeks maximum duration

Use for ‘mild’ anxiety is unacceptable

308
Q

When should the Z-drugs be prescribed in caution and when should their use be avoided?

A
  • Caution in the elderly
  • Avoid in obstructive sleep apnoea
  • Avoid in respiratory muscle weakness
  • Avoid in respiratory depression
309
Q

Which drugs interact with the zopiclone and zolpidem and to what effect?

A
  • Antihistamines - enhanced sedative effects
  • Benzodiazepines - enhanced sedative effects
  • Antihypertensives - enhanced hypotensive effects
  • CYP inhibitors - enhanced sedation
  • CYP inducers - decreased sedation/efficacy
310
Q

What are the typical doses for zopiclone and zolpidem?

A

Zopiclone - 7.5mg ON
Zolpidem - 10mg ON

Doses should be halved in the elderly

311
Q

Use of Z-drugs is not recommended past what duration?

A

4 weeks, as dependence/withdrawal can develop

312
Q

What action needs to be taken if a patient has missed 3 days of their regular prescribed opioid maintenance therapy?

A

Dose might need to be reduced due to decreased tolerance

313
Q

What schedule of drug is methadone?

A

Schedule 2

314
Q

What is the main cardiac-associated warning with the use of methadone?

A

Risk of QT prolongation

315
Q

What schedule of CD is midazolam

A

Schedule 3

316
Q

What schedule of CD is temazepam?

A

Schedule 3

317
Q

What schedule of CD is gabapentin?

A

Schedule 3

318
Q

What schedule of CD is pregabalin?

A

Schedule 3

319
Q

What schedule of CD is zopiclone?

A

Schedule 4

320
Q

How long are invoices for POMs on a private prescription retained for?

320
Q

What schedule of CD is zolpidem?

A

Schedule 4

321
Q

What are the two sub groups of Schedule 4 CDs?

A

Sch 4.i (CD BENZ POM)
Sch 4.ii (CD ANAB POM)

322
Q

What are the most commonly prescribed NSAIDs?

A
  • Ibuprofen
  • Aspirin
  • Naproxen
  • Diclofenac
  • Etoricoxib
323
Q

What are the clinical indications for the use of NSAIDs?

A
  1. Mild to moderate pain as monotherapy or adjunct with paracetamol
  2. Treatment of pain associated with inflammation (rheumatoid arthritis, severe osteoarthritis, and acute gout)
324
Q

What are the important adverse effects associated with the use of NSAIDs?

A
  • GI toxicity
  • Renal impairment
  • Cardiovascular events (MI/stroke)
  • Bronchospasm
  • Angioedema
  • Fluid retention
325
Q

When do NSAIDs need to be used with caution?

A
  • History of peptic ulcer
  • Historyof GI bleed
  • Cardiovascular disease
  • Renal impairment
326
Q

When should the use of NSAIDs be avoided?

A
  • Severe renal impairment
  • Heart failure
  • Renal impairment
  • Known NSAID hypersensitivity
327
Q

Which drugs interact with NSAIDs and to what effect?

A
  • Aspirin - increased risk of peptic ulceration
  • Corticosteroids - increased risk of peptic ulceration
  • SSRIs - increased bleeding risk
  • Venlafaxine - increased bleeding risk
  • Anticoagulants - increased bleeding risk
  • ACEIs - increased risk of renal impairment
  • Diuretics - increased risk of renal impairment
  • Antihypertensives - decreased efficacy of most antihypertensives
328
Q

What is commonly prescribed alongside NSAIDs?

329
Q

What is the dosing of ibuprofen in childen 1 -2 months of age?

A

5mg/kg 3 - 4 times day

330
Q

What is the dosing of ibuprofen in childen 3 -5 months of age?

A

50mg TDS (Max 30mg/kg/day)

331
Q

What is the dosing of ibuprofen in childen 6 -11 months of age?

A

50mg TDS - QD (Max 30mg/kg/day)

332
Q

What is the dosing of ibuprofen in childen 1 - 3 years of age?

A

100mg TDS (Max 30mg/kg/day)

333
Q

What is the dosing of ibuprofen in childen 4 - 6 years of age?

A

150mg TDS (Max 30mg/kg/day)

334
Q

What is the dosing of ibuprofen in childen 7 - 9 years of age?

A

200mg TDS (Max 30mg/kg/day OR 2.4g/day)

335
Q

What is the dosing of ibuprofen in childen 10 - 11 years of age?

A

300mg TDS (Max 30mg/kg/day OR 2.4g/day)

336
Q

What is the dosing of ibuprofen in childen 12 - 17 years of age?

A

Initially 300 - 400mg TDS - QD
Maintenance of 200 - 400mg TDS
(Max 600mg QD)

337
Q

What is the MHRA warning asssociated with the use of ibuprofen?

A

Potential risks following prolonged use after 20 weeks of pregancy (June 2023)

338
Q

Is ibuprofen safe in pregnancy and breastfeeding?

A
  • It should be avoided in the first and second trimesters of pregnancy
  • It is safe in breastfeeding
339
Q

What needs to be monitored during the use of clozapine?

A

Neutrophils and leukocytes

Pre-Registration Pharmacy (20 decks)

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