other bits: prescribing elderly/ paeds/ ADR / Medical emergencies Flashcards
2 stimulant laxatives
C/IX?
bisacodyl
senna
=> bowel obstruction
2 osmotic laxatives
C/IX
macrogol
lactulose
=> bloating / dehydrated
1 Softener laxative
docusate
laxative for opioid induced constipation?
osmotic + stimulant eg: macrogol + senna
analgesia for T2DM neuropathic pain eg: pins and needles?
gabapentin
analgesia for shingles?
PARACETAMOL
then neuropathic pain relief
what to be cautious of when prescribing paracetamol in elderly?
dose reduction if < 50kg
eg: 500mg QDS
post operative pain ladder
- paracetamol
- codeine / dihydrocoedine
- regular / PRN MST( modified release)
- regular PRN immediate release MST oral
- transdermal patch eg: fentanly
normal bisoprolol drug range
1.25mg -> 20mg
normal drug range for metformin
starting dose 500mg
normal drug range for statin
10mg -80mg
drugs to stop with abnormal LFTs?
nsaids
rifampicin
steroids
enzyme inducers
PC BARS
Phenytoin
carbamezapine
barbituates
alcohol - chronic
rifampicin
sulfonyurea
enzyme inhibitors
AO DEVICES
allopurinol / amiodarone
ompeprazol
disulfiram
erythromycin
valproate
isoniazide
ciprofloxacin
ethanol - acute
SSRI
which parkinsons medication can be given thoruhg NG tube crushed?
immediate release ROPINIROLE
electrolyte disturbance to consider for cause of confusion
hypoNa -> check diuretics!
if the pre dose (trough) concentration of gentamicin is high you change the…..
if the post dose (peak) concentration is high the ….
interval between doses must be increaed eg: 8 hour ->12 hours
the dose must be increased
interactions with MTX
3
nsaids => low platelet count
trimethoprim -> bone marrow suppression
PPI -> increase level of mTX (inhibtor of p450)
common drugs that cause ototoxicty
gentamicin
vancomycin
fuorsemide IV rapid
bumetanide
4Cs abx causing c.diff
other cause 1?
cephalosporins eg: ceftriaxone/ cefalaxin
clindamycin
co-amoxiclav
ciprofloxacin
PPI
antidote for opioid toxicity
IM Naloxone 400mcg every 2-3 mins
mx of neuroepileptic malignant syndrome
bromocriptine
dantrolene
symptoms of neuroepileptic malignnat syndrome
diffuse rigidity
reduced reflexes
normal pupils
comes on gradually
= assoicated with antipsychotics
where to find the side effects of antiphyschotics
psychoses
example of anitpsychotics cause weight gain / lipid rise / diabetes
onlazapine = atypical
what to do if get ankle swelling on CCB?
stop CCB - not related to dose!
what drugs increase the risk of tendon rupture eg: achilles?
what increases the risk on that medication?
ciprofloxacin eg: quinolones
increased risk if on steroids
ADR of quinolones eg: cipro
reduces seizure threshold
prolongs QT
tendon rutpure
what diabetic drug increases risk of eugylcaemic DKA?
SGLT2
what medication should you stop before surgery? 7
ACEi
ARB
Diuretics eg: furosemide / butemanide / thiazide/ spironolactone
Anticoagulants + Antiplatelets
HRT + COCP
Lithium
nsaids
medications to continue in surgery examples? 9
thyroid medication
epilepsy medication
PD medication
cardiac or anti HTN (except ACE/ARB/ Diuretics) eg: CCB
inhalers
PPIs
antidepressants
streoids
immunosupressants/ cancer drugs
anxiety medication eg: benzo
what 3 diabetic medication should you stop day of surgery?
Metformin
- OD / BD = continue
- TDS = stop lunchtime dose
Sulfonyurea eg: glicazide (hypoG)] = omit the morning dose
SGLT2 inhibtors = omit on the day
All other medication take as normal on day of the surgery. + day before
mx of dyspepsia
PPI
important information to provide for metformin?
signs and sx of lactic acidosis eg: SOB, muscle crmapls, abdo pain, hypothermia
important info to provide for sulfonlureas
s&S of hypoglycaemia
higher risk in elderly or renal impairment
important info for SGLT2
look out for s&s of euglycaemic DKA even if BM is normal
important info to give patients for DOACS?
RAPID fall in drug levels if miss dose (short half lief)
important information for clozapine
risk of agranulocytosis
diabetic sick day rules with insulin
take insulin / increase even if not eating too much otherwise risk of DKA
BLOOD glucose increases when unwell
important information for sodium valproate
teratogenic + needs contraception
which has a higher risk of breast cancer combined or oestrogen only HRT?
combined
important infor for nicotine replacement therapy
BG monitoring
INR > 1.5 on the day of before surgery what should be given?
oral Vitamin 5
NB: LMWH only required if history of AF related stroke or TIA
what % rise in creatinine is expected when starting acei?
management?
<20%
no further inx or change in ppx
what % should you increase long acting insulin if blood glucose is not contorlled?
10%
what drug is contradincated in severe peripheral vascular disease?
beta blockers = peripheral vasoconstriction and worsen ischaemia in PVD
NB: ACEi also cautioned in severe PVD eg: cirtical ischaemia
2 drugs that can exacerbate biventricula heart failrue
steroid
diltiazem / verampil
side effects of bisphosophonates
loose stools
dyspepsia
how long can it take antidepressants take to work?
up to 6 weeks
ADR of GLP1 analogues - common!
vomitting
if miss lithium dose what do you do?
measure lithium concentration and adjust lithium dose accordingly
normal lithium level
0.4-1
contraception most effective with enzyme inducers>
IUD
depo injection
when is monitoring taken for digxoin?
6 hours post dose
what worsens digoxin toxicity
hypoK
mx of digoxin toxicity
correct hypoK (reverse tick sign on ecg)
digoxin level
abdo pain and on carbimazole?
pancreatitis
drugs that cause agranulocytosis 3
clozapine
carbimazole
phenytoin
raised CK due to statin managmenet?
hold statin
- reduce lower dose / restart/ another statin
if gentsmicin level falls on the line what do you do?
increaes interval
alternative for ppi if low sodium
famotidine
