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Board Exam - Part One > PBS top 100 drugs > Flashcards

PBS top 100 drugs Flashcards

1
Q

Adrenaline (epinephrine) Epipen

A

CLASS:

Sympathomimetic

INDICATIONS:

Anaphylactic reaction

DOSE:

150mcg (<20kg) - 300mcg (>20kg) SC stat

MONITORING:

Response, airways, DRABC

COUNSELLING:

Tell everyone you know what you’re allergic to and educate. Keep 2 Epipens at all times.

Call 000
Note expiry.
Remove cap - ‘Blue to the sky, orange to the thigh’.
Hold in for 10 secs and then massage for 10 secs. - can pierce clothes - avoid seam

Available S3. Store 15-25˚C. Check solution is clear before administering. Repeat after 5 min if no response.

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2
Q

Alendronate

A

CLASS:

Bisphosphate

INDICATIONS:

Paget’s disease

Osteoporosis prevention/tx

DOSE:

Osteo - 10mg daily OR 70mg weekly

Pagets - 40mg daily for 6 months

(comes in 10mg, 40mg, 70mg, combo packs)

MONITORING:

BMD

renal function

dental health

vitamin D and Calcium levels

COUNSELLING:

Swallow whole with a full glass of water first thing in AM 30 mins before breakfast.
Remain upright for at least 30 mins

Ensure weekly tablet taken on same day every week

L4a - no antacids, iron, calc w/i 2 hours of dose

Inform dr if new/worsening heartburn or musculoskel pain

Can -> NVD, headaches

Ensure regular dental checkups

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3
Q

Allopurinol

A

CLASS:

Xanthine oxidase inhibitor (reduces uric acid production/urate levels)

INDICATIONS:

Gout

Chronic symptomatic hyperuricemia

Prev tumour lysis syndrome

DOSE:

100mg(starting) - 600mg daily (MAX:900mg)

(Comes in 100mg, 300mg)

MONITORING:

Renal function
Liver function
Urate levels
For gout flares

COUNSELLING:

Take with food to reduce GI upset

Drink plenty of water to prevent urate crystals in kidneys

  • L5* many interactions - check before taking any new meds/herbals
  • L12* Can make dizzy initially - see how you feel before driving

Can -> NVD, taste disturbance

Inform dr/stop mmediately if rash develops

Should not be commenced during flare (unless on appropirate flare cover), can increase attacks initially (does not mean tx failure), continue taking even through flares

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4
Q

Alprazolam

A

CLASS:

Benzodiazepine (short acting 6-12 hours)

INDICATIONS:

Anxiety

Panic disorder

DOSE:

  1. 5-4mg daily in 3-4 doses (MAX 10mg)
    * (Comes in 0.25, 0.5, 1, 2mg)*

MONITORING:

Sedation, respiratory rate, falls risk

Tolerance, dependence, diversion, duration of tx

Renal and liver func (reduce dose)

Blood counts

COUNSELLING:

L1 - sedation, see how you feel before driving
Alcohol/other sedatives will increase this effect

Ideally only for use ST and PRN

L9 - If have been taking long term, do not stop suddenly, dose titration required.

Can -> drowsiness, confusion, hypersalivation, ataxia, sexual dysfunction

Withdrawal effects = anxiety, dysphoria, insomnia, aggitation

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5
Q

Amiodarone

A

CLASS:

Antiarrhythmic

INDICATIONS:

Tx/proph of refractory tachyarrhythmias 2dary to AF, SVT(supraventicular tachy)

DOSE:

100-400mg daily (maint)

OR

(loading) 200mg tds, then 200mg bd
* (Comes in 100mg, 200mg)*

MONITORING:

Eye examination

Thyroid function

ECGs

chest xray

liver function

FBE

electrolyte balance

drug conc (TDM)

COUNSELLING:

  • L5* - many interactions check before new drugs/herbals
  • L8* - photosensitivity
  • L18* - no grapefruit

Can -> exacerbation of arrhythmia, pulmonary toxicity, thyroid dysfunction, coneal microdeposits (regular testing is important)

Can also cause NV, taste disturbance, blue-grey skin pigmentation and vivid dreams

Has a long half life - so symptoms can take months/years to occur after starting and stop after ceasing

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6
Q

Amitripyline

A

CLASS:

Tricyclic Antidepressant

INDICATIONS:

Major depression

Nocturnal enuresis, urinary incontinence

Neuropathic pain

Migraine proph

DOSE:

25-150mg (MAX 300mg) -depression

Lower doses (ie10mg) for migrain and incont

(Comes in 10mg, 25mg, 50mg)

MONITORING:

BP, ECG (qt prolong)

suicidal thoughts, worsening of symptoms

clinical effect

liver func (dose reduction)

serotonin toxicity

COUNSELLING: L1, L5, L9, L13, L16

L1 - sedation. caution driving. take at night

Takes time to start working - start seeing difference in 1-2 weeks, full effect up to 8 weeks
Can make you feel worse before better - tell someone you’re on it to help monitor your mood, see dr if issue

Can -> drowsy, blurred vision, dry mouth, constipation, urinary retention (antislud) - these should go away

Can -> weight gain

L9 - do not stop suddenly. see dr for weaning plan

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7
Q

Amlodipine

A

CLASS:

Dihydropyridine Calcium channel blocker

INDICATIONS:

Hypertension

Angina

DOSE:

  1. 5-10mg once daily
    * (Comes in 5mg, 10mg, combos)*

MONITORING:

BP

liver function

peripheral oedema (doesn’t respond to diruetics)

COUNSELLING: L9, L12*, L18

Take every day, it’s important to take even if you can’t feel it working.
Can take 2 weeks to reduce BP effectively
L9 - do not stop suddenly

L18 - Avoid grapefruit

Can -> dizziness, headache, flushing (these should go away)

Tell dr if ankles swollen

Does come in combo if needed

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8
Q

Amoxicillin

A

CLASS:

Penicillin Antibiotic

INDICATIONS:

CAP

Ear infections

Sinusitis

UTI

H. pylori

DOSE:

250-1000mg TDS
or
1g BD

Paed: 7.5-25mg/kg (MAX 500mg) TDS

(Comes in 250mg, 500mg, 1g, 25mg/ml, 50mg/ml, 100mg/ml)

MONITORING:

Response to therapy

Sensitiviy/resistance

Signs of allergy

Hepatic/renal func, FBC tx>10days

COUNSELLING:

Take with/without food (with food if GI upset)
Space doses evenly
Complete course

Can -> NVD, widespread rash

Look out for signs of allergy (swelling, diff breathing) - see dr

Suspension: fridge, shake, d28

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9
Q

Amoxycillin with Clavulanic acid

A

CLASS:

Penicillin antibiotic + beta-lactamase inhibitor

INDICATIONS:

HAP

Epididymo-orchitis , PID, UTI

Bite injuries

Ear infection (if amox hasnt worked)

Sinusitis

DOSE:

500mg/125mg-875mg/125mg BD (can up lower dose to TDS)

Paed: 7.5-20mg/kg (max500) TDS
or
22.5mg/kg (max 875) BD

(Comes in 500/125mg, 875/125mg, 125/31.25mg/5mL, 400/57mg/5mL)

MONITORING:

For allergy

hepatic/renal func, FBC tx>10days

Clin effect, sensitivity, resistance

COUNSELLING:

Space doses evenly

Best absorbed with food

Can -> NVD, widespread rash

If swelling/diff breathing cease and see dr

Suspension: fridge, shake, d28

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10
Q

Anastrozole

A

CLASS:

Aromatase inhibitor - hormonal antineoplastic (reduce tissue oestrogen conc)

INDICATIONS:

Hormone receptor-positive breast ca in post menopausal

DOSE:

1mg once dialy

MONITORING:

BMD, Vit D, Calcium, VitD+Cal supplements

Regular screening/cancer status

COUNSELLING: L12, 21, LA

Can -> hot flushes, vag dryness, weakness, rash, headache, naus, diarr, joint/muscle pain, periph oedema, carpal tunnel

Ensure adequate vit D and calc intake (may need supple)

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11
Q

Apixaban

A

CLASS:

Factor Xa inhibitor anticoagulant

INDICATIONS:

Prev VTE post knee/hip replacement

Tx acute VTE + Proph of subsequent VTE

Non-valvular AF (to prev stroke/embolism)

DOSE:

Post knee/hip replace
2.5mg BD for 10-14 (knee) or 32-38(hip) days

VTE treat
10mg bd for 7 days, then 5mg bd

Subs VTE proph
2.5mg BD

AF
5mg BD

MONITORING:

Signs of bleeding

Leg pain or swelling/presence of emboli

Renal function

Other meds

Renal func

COUNSELLING:

Take at same time everyday - use calender?
With or without food

  • L10b* - do not take aspirin or other NSAIDS
  • L18 -* avoid grapefruit

Look out for signs of bleeding (nosebleeds, unexpalined bruises, coffee coloured vomit, dark stools, discoloured urine) or bleeding that wont stop.
If you notice leg pain, swelling, feel weak, dizzy, SOB - see dr immediately

This medication doesn’t have a reversal to stop bleeding like warfarin - take care not to sustain serious injuries and go to ED if you do. Consider med alert bracelet or card in wallet.

Inform all health professionals you are taking this (dentists, pods, drs, pharmacists) and check with them before taking any new meds/herbals as there are many interactions

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12
Q

Aspirin

A

CLASS:

NSAID analgesic, antiplatelet

INDICATIONS:

Acute coronary syndrome

Hx of symptomatic atherosclerosis

Pain, infl, fever

DOSE:

antiplatelet - 100mg daily

analgesic - 300-900mg q4-6h (MAX 4g daily)

MONITORING:

Signs of bleeding or PUD

renal/liver function

Salicylate allergy or NSAID bronchospasm (esp in asthma)

COUNSELLING:

L9 - Take every day, do not stop suddenly

Do not double up with other NSAIDs (if using high dose)

Look out for signs of bleeding (coffee coloured vom, nosebleed, unexpl bruising, discoloured urine, dark stools)

Experience abdo pain, indigestion inform dr

Inform health professionals youre on it (may need to stop before surgery)

Should not be given to <16yo (Reye’s syndrome)

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13
Q

Aspirin plus Dipyrimadole

A

CLASS:

Dual antiplatelet

INDICATIONS:

Secondary prev of ischaemic stroke and TIA

DOSE:

CR 25mg aspirin/200mg dipyri BD

(Comes in 25/200mg CR, 200mg CR-dipyri only)

MONITORING:

Signs of bleeding or PUD

renal/liver function

Salicylate allergy or NSAID bronchospasm (esp in asthma)

COUNSELLING:

Take every day, swallow whole

L16 - can cause dizziness

Look out for signs of bleeding (coffee coloured vom, nosebleed, unexpl bruising, discoloured urine, dark stools)

Experience abdo pain, indigestion inform dr

Inform health professionals youre on it (may need to stop before surgery)

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14
Q

Atenolol

A

CLASS:

Selective beta 1 Beta-blocker

INDICATIONS:

HTN

Angina

Tachyarrhythmias

MI

Migraine proph

DOSE:

25mg-100mg daily

(Comes in 50mg)

MONITORING:

BP

Can worsen heart failure at start

Renal func

COPD, asthma (exacerbate)
Diabetes (mask hypogly)
Raynaud’s phenomenon (exacerb)
(But less likely in atenolol)

COUNSELLING: L9, L12*

L12 - May cause drowsy/dizzy when first starting - caution driving and standing. May feel lethargic for first few days

Take everyday - not a med you can feel working
L9 - Do not stop suddenly

Can -> cold extremities

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15
Q

Atorvastatin

A

CLASS:

HMG-CoA reductase inhibitor (statin)

INDICATIONS:

Hypercholesteraemia

HTN patients with addit heart disease risk factors

DOSE:

10-80mg once daily

(Comes in 10, 20, 40, 80mg, combos)

MONITORING:

Lipid levels (HDL, LDL, triglycerides)

Liver function, aminotransferase levels

Renal func

Myopathy, creatine kinase conc

COUNSELLING: L18, L21

Take at the same time each day (long acting, doesn’t matter what time)

Keep an eye on lipid levels. Combine with healthy lifestyle to reduce risk of heart disease.

L18 - Avoid grapefruit

If you experience unexplained muscle pain/weakness dark urine - see dr

Can -> mild GI upset, headache, sleep disturbance

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16
Q

Azathioprine

A

CLASS:

Immunosuppressant

INDICATIONS:

Prev organ trans rejection

Immune/inlfam diseases (rheum arth, IBS, lupus)

DOSE:

Org trans - 2-5mg/kg day 1, the 1-3mg/kg daily in 1-2 doses

Inflam dis - 1-3mg/kg daily in 1-2 doses

(Comes as 25mg, 50mg)

MONITORING:

FBC (leucopenia, anaemia)

liver/renal func

Signs of infection

COUNSELLING: L8, L21

Swallow whole. Take with food (to reduce stomach upset)

  • L21 -* handle with care if administering (cytotoxic)
  • L8 -* photosensitivity

Tell dr if signs of bleeding or infection

Can -> NVD, alopecia

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17
Q

Azithromycin

A

CLASS:

Macrolide antibiotic

INDICATIONS:

Chlamydial infection

Streptococcol pharyngitis/tonsilitis

CAP

Prev/tx of MAC (mycobacterium avium complex) inf

typhoid

Traveller’s diarrhoea

DOSE:

1g stat (chlam)
or
250mg-500mg daily

(Comes as 500mg)

MONITORING:

For allergic reaction

Clearing of infection, sensitivity, resistance

Hepatic func

ECG (torsades de pointes, QT prolong)

COUNSELLING:

Take with or without food.

Complete course

Can -> NVD

Inform dr if baby gets irritable or vomiting if feeding while taking azith (infantile hypertrophic pyloric stenosis

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18
Q

Betamethasone cream

A

CLASS:

Corticosteroid
Moderate (valerate) and Potent (dipropionate)

INDICATIONS:

Inflammatory skin conditions (eg eczema and psoriasis)

DOSE:

Diproprionate 0.05%
(Diprosone, Eleuphrat)

Valerate 0.02%, 0.05%, 0.1%
(Antroquoril, Betnovate)

Apply daily-BD (note: 0.02% up to QID)

MONITORING:

Clinical effect, skin atrophy

For infection

Duration of tx

Compliance to non-pharma advice

COUNSELLING:

Apply after bathing. Allow sufficient time to absorb before applying moisturiser (doesn’t matter which to apply first)

Not for long term use - only for flares

May make skin sensitive when first using

Do not apply to broken or infected skin

Ensure following non-pharma advice (ie: no soap, irritants/triggers, plenty of moisturiser)

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19
Q

Bisoprolol

A

CLASS:

Beta blocker (cardioselective beta-1)

INDICATIONS:

HTN

Angina

Tachyarrhythmias

MI

Heart failure

Migraine proph

DOSE:

  1. 25-10mg once daily
    * (Comes in 1.25mg, 5mg, 10mg)*

MONITORING:

BP, heart rate, ECG

Can worsen heart failure at start - ensure stable on other therapies (ie acei) before starting bisop for heart failure

Renal func

COPD, asthma (exacerbate)
Diabetes (mask hypogly)
Raynaud’s phenomenon (exacerb)
(But less likely in bisoprolol)

COUNSELLING: L9, L12*

L12 - May cause drowsy/dizzy when first starting - caution driving and standing. May feel lethargic for first few days

Take everyday - not a med you can feel working
L9 - Do not stop suddenly

Can -> cold extremities

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20
Q

Budesonide plus Eformoterol

A

CLASS:

(Symbicort)

Inhaled corticosteroid plus LABA

INDICATIONS:

Asthma preventer and reliever

COPD

DOSE:

100mcg/6mcg - 400mcg/12mcg BD
(400/12 inhaler only suitable for COPD)

MONITORING:

Lung function - FEV1, peak flow

Inhaler technique

Compliance

Exacerbations/need for relievers

Asthma/COPD management plan

COUNSELLING: L14

This medication must be used everyday to work properly

Ensure correct inhaler technique (turbuhaler or rapihaler)

L14 - Rinse mouth out with water after each use

Can be used as a reliever

Can -> sore throat/voice horsness, oral thrush, tremours, palps, headache

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21
Q

Buprenorphine

A

CLASS:

Partial opioid agonist

INDICATIONS:

Chronic Pain (patches)

Acute pain (sublingual)

Opioid dependence (sublingual film)

DOSE:

Acute pain SL - 200-400mcg q6-8h prn

Chronic pain patch - 5mcg-40mcg/hour weekly

Opioid depend - 2-32mg daily

Comes in SL 200mcg, patch 5mcg/h, 10mcg/h, 20mcg/h, 30mcg/h, 40mcg/h
Subutex 0.4mg, 2mg, 8mg
Suboxone (w/ naloxine) 2/0.5mg, 8/2mg

MONITORING:

Effect on pain relief

Sedation, respiratory depression, falls risk

Renal, hepatic function

Skin reaction

Constipation

Dependence, diversion, tolerance

COUNSELLING:

Patch is applied once weekly - same day each week.
Can write date on patch or calender

Apply to unbroken, clean, dry, hairless skin on upper torso (if necessary, do not SHAVE hair, trim only).

Remove old patch before applyingnew one. Rotate patch site to minimise skin irration

Avoid patch direct exposure to heaters, electric blankets, etc as can increase dose released.

Know how to dispose safely.

L1 - sedation. can be increased by alcohol

Can cause constipation so stay hydrated and ensure fibre intake.

Can -> skin irritation (patch), NV,

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22
Q

Bupropion

A

CLASS:

Selective dopamine and noradrenaline re-uptake inhibitor

INDICATIONS:

Nicotine dependence

DOSE:

150mg daily (starting) - BD

(Comes in 150mg SR - Zyban SR)

MONITORING:

Neuropsychiatric symptoms, changes in mood/behaviour, thoughts of suicide

Response to therapy/progress

Renal and hepatic function

BP (if comb with NRT)

Contraind if hx of siexures

COUNSELLING: L5, L12*, L16*, LA

Plan a quite date and start buprop 7 days before that (takes time for it to be effective)

  • LA -* Swallow whole
  • L12/16 -* Can make you drowsy and dizzy be carefull getting up and see how you feel before driving while your body gets used to medication

Can -> insomnia, nightmares, diff concentrating, tremor, headache, dry mouth, constipation
(note some of these can be related to stopping smoking

If you notice rash, swelling, diff breath - stop and see dr imm

Limit alcohol intake - can increase risk of unpleasant effect

Can use NRT alongside - improves quit rate

*Can -> false positives in urine tests (ie amphetamine)

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23
Q

Cabergoline

A

CLASS:

Ergot-derived dopamine agonist

INDICATIONS:

Parkinson’s disease

Hyperprolacinemia, prevent onset of lactation

DOSE:

0.5mg-3mg once daily
or
1mg stat (prev of lact)

MONITORING:

Fibrotic disorders (bc ergot deriv)

hepatic function

Cardio evaluations

Behavioural changes - impulse disorder

Movement improvement

COUNSELLING: L12*, L16

Take with food, starting at night

L12/16 - Can cause dizzy/drowsy, careful standing and see how you fee before driving

Can -> leg cramps, NV, constipation, headache, periph oedema, sudden sleep onset

Inform dr if behavioural changes, can also effect impulse control

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24
Q

Calcipotriol

A

CLASS:

Topical vitamin D analogue

INDICATIONS:

Plaque psoriasis

DOSE:

Apply BD (can use less after init period) until improved

Comes in 0.005% cream (Daivonex), plus combo w/betameth0.05%(Daivobet)

MONITORING:

Hypercalcaemia (rare at rec doses) avoid use psoriasis extensive (too much exposure)

Skin improvement, skin irritation

COUNSELLING:

Apply to affected area(s) - not for face or extensive psoriasis (no more than 100g/week)

Wash hands after application to avoid transfer to other areas.
Do not use occlusive dressings.

Do not mix with other products (can destroy calcipotriol)

May need to use for 4-6 weeks for max improvement. Stop once improved recommence when next flare

L8 - photosensitivity

Can -> mild irritated skin after application

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25
Calcitriol
**CLASS**: 1,25-dihydroxycholecalciferol, acvitve form of vitamin D **INDICATIONS**: Regulates calcium homeostatis and bone metabolism Tx of osteoporosis Prev corticosteroid-induced osteopor Tx of hypocalcaemia in hypoparathyroidism, rickets, chronic renal dialysis **DOSE**: 0.25microg daily (up to 1mcg in hypoparathy, rickets) *Comes in 0.25mcg (Sical)* **MONITORING**: Plasma calcium levels, Urinary calcium and phosphate Cease if hypercal Renal function **COUNSELLING**: *L5* Do not take calcium supps or other Vitamin D supps Follow dr rec re: dairy intake Tell dr if NV, constipation, headache, frequent urination, tiredness, thirst
26
Candesartan
**CLASS**: Angiotensin 2 receptor antagonist (Sartan) **INDICATIONS**: HTN Chronic Heart failure - part of therapy instead of ACEI **DOSE**: 8mg-32mg once daily *(Comes in 4, 8, 16, 32mg, combos)* **MONITORING**: BP Electrolyte balance (esp potassium - caution supps and pot sparing diuretics) Renal func (caution triple whammy) Dehydration **COUNSELLING**: *L11,L12\*, L16\*, L21* Take everyday, wont nec feel it working Monitor BP regularly. Can take 4-6 weeks to improve BP *L11 -* do not take potassium supplements Avoid NSAIDs *L12/16 -* Can cause drowsy/dizzy when starting - caution driving/standing If swelling, diff breathing - stop, see dr (angioedema)
27
Carbemazepine
**CLASS**: Antiepileptic Mood stabiliser **INDICATIONS**: Epilipsy - partial and generalised seizures Trigeminal neuralgias (neuropathic pain) Bipolar disorder **DOSE**: Epil - 200mg-1200mg daily (in div doses) (MAX 2g) Trig neur - 100-800mg daily in div doses (MAX1.2g) Bipolar - 400mg-1.6g(MAX) daily in div doses (note: CR given BD) * Comes in 100mg, 200mg, 200mg CR, 400mg CR. (Tegretol), 20mg/mL* **MONITORING**: Clinical effect (seizures, pain, mood) Compliance Changes in behaviour, mood, thoughts of suicide Plasma conc (opt dosing or susp toxicity) FBC (blood dyscrasias/bone marrow supp) Rash, hypersensitivity Sedation, eyes BMD. VitD/Calc supps hepatic func **COUNSELLING**: *L5, 9, 12\*, 18, 21, B* Swallow whole (if CR) * LB -* Take with food to reduce stom upset * L9 -* Take every day- do not stop suddenly *L12 -* Can make drowsy/blurred vision - see how you feel before driving Limit alcohol can increase effects of ETOH *L18 -* avoid grapefruit Can -\> visual disturbance, dry mouth, constipation, NV, rash Tell dr if rash, sore throat, ulcers, bleeding, fever Can reduce efficacy of COC, vag ring, progest OC, etonogestrel implant (rod) -seek other forms
28
Carbimazole
**CLASS**: Antithyroid drug **INDICATIONS**: Grave's disease Thyroid storm ST before thyroid surg or before/after radioactive iodine tx **DOSE**: Hyperthyr - 10-60mg daily (init), 2.5-40mg daily(maint) - div doses Thyr storm - 60-80mg daily in div doses -grad reduced *Comes in 5mg (Neo-mercazole)* **MONITORING**: FBC (agranulocytosis) Hepatic function Thyroid function (TSH) **COUNSELLING**: Can -\> itch, mild rash in first 8 weeks (antihist may help), NV, arthralgia, headache Tell dr if fever, sore throat, ulcer, rash, abdo pain, jaundice
29
Carvedilol
**CLASS**: Non-selective beta-blocker (alpha1, beta1, beta2 receptors) **INDICATIONS**: HTN Chronic heart failure **DOSE**: HTN - 12.5-50mg daily HF - 3.125-25 BD (can 50mgBD if \>85kg) Comes in 3.125, 6.25, 12.5, 25, 50mg **MONITORING**: BP, heart rate, ECG Can worsen heart failure at start - ensure stable on other therapies (ie acei) before starting carved for heart failure Regular Opthalmic review hepatic func COPD, asthma (exacerbate) Diabetes (mask hypogly) Raynaud's phenomenon (exacerb) (esp since non selective) **COUNSELLING**: *L9, 12\*, 16* L12 - May cause drowsy/dizzy when first starting - caution driving and standing. May feel lethargic for first few days Take everyday - not a med you can feel working L9 - Do not stop suddenly Can -\> cold extremities, visual disturbance If you develop yellowing, dark urine, flu-like symptoms see dr Antihyperglycaemics may need adjustment
30
Ceftriaxone
**CLASS**: Cephalosporin antibacterial **INDICATIONS**: Empirical pneumonia, bact meningitis Gonoccocol inf, PID, Epididymo-orchitis (sexually acquired) Septicaemia Salmonella, typhoid **DOSE**: 1-2g daily (MAX 4g daily) *Comes in 500mg inj, 1g inj, 2g inj* **MONITORING**: Hypersensitivity, allergy Renal func Clin effect, sensitivity, resistance FBC if tx\>10days **COUNSELLING**: Incompatible with Ca - do not give with ca-cont solutn Can -\> NVD, pain at inj site, headache, dizzy
31
Celecoxib
**CLASS**: COX-2 selective NSAID **INDICATIONS**: RA OA Pain due to dysmenorrhoea or injury **DOSE**: 100-200mg BD (higher dose ST only) *Comes in 100mg, 200mg* **MONITORING**: Analgesic effect - if not working, try another Signs of bleeding Dehydration Renal/hepatic function BP, CVD risk Full blood count if chronic use **COUNSELLING:** *L10a, 12\** With or without food * L12 -* Can cause drowsy when first start * L10a -* No more than one aspirin, don't double up on NSAIDs Be aware of signs of bleeding, dyspepsia Do not take if dehydrated, ensure adequate fluid intake
32
Cephalexin
**CLASS**: Cephalosporin antibiotic **INDICATIONS**: Staphylcoccal, streptococcal inf in mild pen allergy UTI, epididymo-orchitis (non-sex) **DOSE**: 250-500mg QID or 500-1000mg BD MAX 4g daily Paed - 6.25-12.5mg/kg (MAX500mg) QID *Comes in 250mg, 500mg, 25mg/mL, 50mg/mL* **MONITORING**: Renal func Allergy Clin eff, sensitivity, resistance, superinfection FBC and neurotox in longterm tx/high doses **COUNSELLING**: With or without food - can take with food if GI upset Until all finished Susp: Fridge, shake, d28 Can -\> NVD Look out for signs of allergy
33
Chloramphenicol
**CLASS**: Broad spectrum antibiotic **INDICATIONS**: Bacterial conjunctivitis Infec proph post surgery/trauma **DOSE**: drops: 1 drops q2h for 2 days, then QID for 5 days oint: TDS * Comes in 0.5% drops, 1% oint* **MONITORING**: Clearing of infection Worsening of symptoms Visual changes **COUNSELLING**: Wash hands before and after Complete course Ensure knows how to admin eye drops Do not wear contacts during tx D28, don't share eyedrops Nonpharma - don't scratch/touch, cut nails, contagious - stay away from school until discharge gone
34
Ciprofloxacin
**CLASS**: Quinolones **INDICATIONS**: Salmonella Shingellosis Comp UTIs, epididymo-orchitis, prostatitis Bone, joint inf febrile neutropenia CF infections **DOSE:** 250-750mg BD *Comes in 250,500,750mg (C-flox, Ciprol)* **MONITORING**: Renal func Clinical effect, sens, resist Tendon damage ECG - QT prolong **COUNSELLING**: *L3b, 4a, 5, 8, 12* Empty stomach (abs better), drink plenty of fluids Complete course * L4 -* Avoid dairy, antacid, iron,zinc, calc supps within 2 hrs of dose * L8 -* Photosensitivity * L12 -* drowsy, caution driving Can increase effects of caffiene If any unexplained tendon pain, stop and see dr
35
Citalopram
**CLASS**: Selective serotonin reuptake inhibitor **INDICATIONS**: Major depressive disorder **DOSE**: 20-40mg once daily (10mg init in elderly) *Comes in 10, 20, 40mg (Celepram, Citalo)* **MONITORING:** Clinical effect. Worsening of symptoms Movement disorders Electrolyte balance (esp Na) Serotonin tox **COUNSELLING**: *L5, 9, 12* Can take a couple weeks before notice changes and up to 8 weeks for max effect. Can make symptoms worse before better, monitor mood and see dr if symptoms severe. Best taken in morning - can cause sleep disturbance. Take everyday even if feeling better. *L9 -* don't stop suddenly, gradual tapering required * L12 -* Can make drowsy init - caution driving * L5 -* Many med/herbal interactions - tell dr/pharm you are taking this. Know signs of serotonin tox Can -\> NV, headache, insomnia, aggitation, dry mouth sexual dysfunction, weight change
36
Clarithromycin
**CLASS:** Macrolide antibiotic **INDICATIONS**: Prev/tx mycobacterium avium complex H. pylori LRTI **DOSE**: 250-500mg BD MAX 1g BD *Comes in 250mg, 500mg (Klacid), 50mg/mL* **MONITORING**: Clinical effect Allergy ECG - QT prolongation, torsades de points Renal Ototoxicity **COUNSELLING**: With or without food. Complete course *L5 -* many interactions Can -\> NV, taste disturbance, superinfection
37
Clomiphene
**CLASS**: Synthetic ovulatory stimulant **INDICATION**: Anovulatory infertility **DOSE**: 25-150mg once daily for 5 days *Comes in 50mg* **MONITORING**: Visual disturbance Liver function BMI Pregnancy (stop if not pregs after 6 cycles) Ovarian hyperstimulation **COUNSELLING**: *L12* *L12 -* Can drowsy - caution driving Tell dr if causes visual disturbances Can -\> hot flushes, NV, revers ovarian enlarg, abnorm uterine bleeding
38
Clopidogrel
**CLASS**: p2Y12 antagonist, Antiplatelet **INDICATION**: Hx of symptomatic atherosclerosis ACS (with aspirin) **DOSE**: 75mg daily (can loading dose 300mg) *Comes in 75mg, 300mg, combo w aspitin* **MONITORING**: Signs of bleeding Hepatic function **COUNSELLING**: *L9, 10a, 18* With or without food. * L9 -* Take everyday do not stop suddenly * L10a* - no more than one aspirin, NSAIDS increase bleeding risk * L18 -* avoid grapefruit (decreases efficacy) Know signs of bleeding Can -\> rash, diarrhoea, GI ulcer
39
Codeine
**CLASS**: Opioid analgesic **INDICATION**: Pain Cough suppression Diarrhoea **DOSE**: 30-60mg q4-6h. MAX 240mg/24hrs *Comes in 30mg, 5mg/mL, combo with aspirin or para or ibu* **MONITORING**: Clinical effect Sedation, resp dep (caution COPD), falls risk Constipation Renal/hepatic imp Tolerance, dependence, abuse Withdrawal symp if long term Some ppl poor and ultrametabolisers **COUNSELLING**: *L1 (if\>20mg dose)* *L1 -* sedation Constipation (plenty fluid/fibre, lax?) Can -\> NV, dry mouth when first using Only for short term use - can cause dependence Not for \<12yo
40
Colchicine
**CLASS**: Gout medication (reduces inflam reaction to urate crystals) **INDICATION**: Pain relief during gout attack Proph of gout attack (also to prev flares during first 6 months of ULT) Familial Mediterranean fever **DOSE**: Flare - 1mg stat, then 500mcg 3hrs later Proph - 500mcg daily - BD *Comes in 500mcg (Colgout, Lengout)* **MONITORING**: Renal/hepatic func (dose reduction) GI effects Full blood count (agranulocytosis, leucopenia) Creatin kinase (rhabdomyalgia) (better choice in HF cf nsaids) **COUNSELLING**: *L5, 18,* If attack - start at earliest sign of attack, can take para while waiting to work. use icepack * L5 -* many interactions * L18 -* avoid grapefruit Stop taking if severe vom, diar, muscle pain/tender, numbness/tingling, unusual bleeding, infection -see dr
41
Cyproterone plus ethinylestradiol
**CLASS**: COC **INDICATION**: Androgenisation and contraception in these women **DOSE**: 1 tablet daily (2mg cyproterone/35mcg ethinylestradiol) *Comes as Diane, Estelle, Brenda, Juliet* **MONITORING**: BP Risk factors for VTE or stroke (ie over 35, smoking, obese) Cervical cancer screening Compliance **COUNSELLING**: Make sure you know which are the active and which are the inactive (different brands recommend starting on inactive pills, some brands on active Take 1 tab at same time every day (24 hour window) If no preceeding horm cont: start with active pill w/i first 5 days of period starting for immediate contraception (otherwise use extra prec for first 7 days of *active* If changing from another COC start taking active pills day after stopping old pill (on any day of cycle) – adit acontracep not required If changing from POP: start active pills without any interval – use adit cont for first seven days of active While taking inactive pill, you will get a withdrawal bleed (but not everyone gets this) Can -\> Spotting, irregular bleeding (to be expected for first 3 months), mood changes, breast tenderness If notice leg pain, swelling, diff breathing - see dr Some medicines, vomiting, diarrhoea reduce effectiveness If vom/diar in 2 hrs of taking pill, take another asap If \<24 hours late taking active – take asap, contraception NOT affected If \>24hr late taking pill: take as soon as remembered (even if 2 pills taken at once) Continue pill and use addit contracep until you have taken 7 days of active in a row **If missed pill was in last 7d,** skip placebo pills **If pill was missed in first 7 days** of active (ie: have not had seven consecutive actives – Use addit cont for next 7 days of taking active - If sex was had, take morning after pill
42
Dabigatran
**CLASS**: Direct thrombin inhibitor anticoagulant **INDICATION**: Prev VTE post knee/hip replacement Tx acute VTE + prev of subsequent VTE AF - prev stroke/emboli **DOSE**: Post knee/hip - 110mg stat, then 220mg once daily (10 daysfor knee, 28-35 for hip) AF/acuteVTE/subs prev- 150mg bd (110mg BD for \>75yo/bleed risk/renal imp) *Comes in 75mg, 110mg, 150mg (Pradaxa)* **MONITORING**: Renal/hepatic function Clotting/bleeding risk Signs of bleeding **COUNSELLING**: Swallow whole (opening cap can increase bleeding risk) Take at same time everyday - mark calendar/record *L10b -* do not take aspirin or other NSAIDS while on this Tell dr pharmacist before starting any new meds/herbals Let any health prof (inc dentist, pods) you are taking this Know signs of bleeding Med alert bracelet/wallet card? Signs of clot - leg pain, swelling, diff breathing -\> ED
43
Desvenlafaxine
**CLASS**: Serotonin and Noradrenaline Reuptake Inhibitor (SNRI) **INDICATION**: Major depressive disorder **DOSE**: 50mg CR - 200mg CR(max) once daily *Comes in 50mg CR, 100mg CR (Pristiq, desfax)* **MONITORING**: Clinical effect Changes in mood Renal func BP Serotonin tox Electrolytes (esp Na) **COUNSELLING**: *L5, 9, 12* Swallow whole. In the morning (insomnia) *L9 -* Take every day. do not stop suddenly Can take take 2 weeks before effect, 8 weeks for full effect *L12 -* can make you drowsy init - caution driving Can -\> naus, constipation, dry mouth, insomnia, headache, sex dys, decreased appetite
44
Dexamphetamine
**CLASS**: CNS psychostimulant **INDICATION**: ADHD narcalepsy **DOSE**: ADHD - 2.5mg - 40mg (in div doses if \>5mg) Narc - 10mg-60mg daily in div doses **MONITORING**: Abuse/diversion BP, cardio status psychiatric status height/weight (poss slow growth in kids) Tics **COUNSELLING**: *L5, 12* *L12 -* Can cause drowsy /dizzy Can -\> NVD, dry mouth, loss of appetite, anxiety, aggitation, headache, palpitations, insomnia If insomnia an issue, avoid taking after early afternoon Do not continue if no effect after optimising treatment
45
Diazepam
**CLASS**: Benzodiazepine **INDICATION**: ST for anxiety Muscle spasm Acute etoh withdrawal status epilepticus **DOSE**: 1-10mg TDS *Comes in 2mg, 5mg (Antenex, Valpam, Valium)* **MONITORING**: Tolerance, dependence, diversion Sedation, falls risk Hepatic/renal func Blood counts Withdrawal **COUNSELLING**: *L1/1a, 9* L1/1a - sedation, sedation into next day Can increase effects of ETOH Not for long term If long term, don't stop suddenly, taper off slowly toreduce withdraw symp Can -\> light headed, dry mouth, headache, visual disturbance, dependence
46
Diclofenac
**CLASS**: NSAID (non selec COX 1 and 2) **INDICATION**: Inflam pain - RA, OA, menstrual pain, injury **DOSE**: tab: 25-50mg TDS - MAX200mg daily gel: 1% tds-qid, 2%bd Comes in 12.5, 25, 50mg (tabs), 12.5, 25, 50, 100mg (supps), 1%, 2% (gel), fixeddose w/ misoprostol **MONITORING**: Pain relief Signs of bleeding BP, cardiovascular monitoring renal/liver function (aminotransferase) GI distubane (dyspep, bleeds) Blood count COPD/asthma/hypersensitivity **COUNSELLING**: *L10a, 12\*, B* Swallow whole with food L12 - can make drowsy Ensure adequate fluids - do not take if dehydrated L10a - no aspirin or other NSAIDs Know bleeding signs Leg pain, swelling, chest pain, SOB -\> ED Can -\> nausea, dyspep, salt/fluid reten
47
Digoxin
**CLASS**: Antiarrhythmic **INDICATION**: AF and atrial flutter Heart failure **DOSE**: 62.5 - 250mcg once daily Can loading dose - 125-500mcg q4-6h *Comes in 62.5mcg, 250mcg* **MONITORING**: ECG, HR Renal function Digoxin level Dig tox (fatigue, malaise, NVD, dizzy, delirium) Electrolyte abnorm and thyroid func (can affect conc) **COUNSELLING**: *L5* *L5 -* Many interactions Can -\> NVD, visual dist, drowsy/dizzy, rash
48
Diltiazem
**CLASS**: Non-dihydropyridine Calcium Channel Blocker **INDICATION**: Angina HNT (CR only) AF/flutter DOSE: Angina/AF - 30mgIR tds-qid (max 360daily) - 180mg CR-360mg CR daily HTN - 180-360mg CR daily Comes in 60mg ir, 180mg CR, 240mg CR, 360mg CR **MONITORING**: Hepatic function BP Symptom control **COUNSELLING**: L5, 9, 12\* Swallow whole every day L9 - do not stop suddenly L12- drowsy when first starting Can -\> headache, flushing, dizziness, periph oedema (inform dr) L5 - many interactions Keep eye on BP, will take a couple weeks to reduce HTN
49
Domperidone
**CLASS**: Dopamine antgonist antiemetic **INDICATION**: NV Gastroparesis (idiopathic or diabetic) Lactation stimulation **DOSE**: 10-20mg tds-qid (MAX 80/day) *Comes in 10mg (motilium)* **MONITORING**: ECG (QT) hepatic/renal function **COUNSELLING**: L18 NV - use for up to 1 week Gastpar - for up to 4 weeks Can -\> dry mouth, headache, drowsiness Is prokinetic - can increase rate of abs of other meds
50
Donepezil
**CLASS**: Anticholinesterase inhibitor **INDICATION**: Alzheimer's **DOSE**: 5mg-10mg once daily *Comes in 5mg, 10mg (Aricept, Arazil)* **MONITORING**: Clinical effect Disease progression Tolerability **COUNSELLING**: L12, 16 L12/16 - drowsy/dizzy Can -\> NVD, dyspepsia, headache, insomnia, vivid dreams (10mg more ass with s/e's) Give in evening unless vivid dreasm/insomnia occur
51
Dothiepin
**CLASS:** Tricyclic antidepressant **INDICATION:** Major depression **DOSE:** 25-150mg daily. MAX 300mg *comes in 25mg, 75mg (Dothep)* **MONITORING:** Psychiatric stability (Can manic in bipo, fatal in OD) Serotonin toxicity ``` Cardiovascular problems (QT prolong, can exac angina, can cause heart block, BP) ``` Weight Ocular pressure can -\> angle closure glaucoma Seizure threshold hyperthyroidism (enhanced response) **COUNSELLING:** Can get blurred vision, dry mouth, drowsy - should go away Can dizzy on standing Caution driving Increase effects of alcohol Do not stop suddenly Can interact with may meds/herbals Can take a few weeks before it starts working. Be aware of how you're feeling and see doctor/someone if feelings become overwhelming
52
Doxycyline
**CLASS** Tetracycline antibiotic **INDICATIONS** Acne, Rosacea CAP, bronchitis, sinusitis Chlamydial inf, PID, epididymo-orchitis (sex aq) Proph malaria Q fever **DOSE** 100mg 1-2x daily or 50-100mg once daily (acne) *Comes in 50mg, 100mg* **MONITORING** Allergy Clin eff renal/hepatic func superinfection Contraind in \<8 (bone defor, teeth discolor, enamal displasia) Caution with tx with oral retinoids (inc risk of benign intracranial hypertension) **COUNSELLING** Swallow whole take with food/glass of milk (reduce stom upset) and large glass of water Remain upright for at least 30 min (take in morning) No zinc, iron, calc, antacid in 2 hrs of dose Photosensitivity Can -\> GI upset
53
Duloxetine
**CLASS** Serotonin and Noradrenaline Reuptake Inhibitor **INDICATIONS** Major depression Gen anxiety disorder Painful diabetic peripheral neuropathy Neuropathic pain (not first line though, less eff than TCAs) **DOSE** 30-60mg once daily MAX 120mg daily (this dose used in gen anxiety dis) Comes in 30mg, 60mg **MONITORING** Psych stability (inc suicidal thoughts, clinical eff, can induce manic ep if used in bipolar) Sero tox BP Electrolytes (hyponat) Bleeding risk Ocular pressure (angle-closure glaucoma) Seizure risk Renal/hepatic impair **COUNSELLING** Swallow caps whole Take with food Best in morning (insomnia) Do not stop suddenly Can make drowsy/dizzy caution driving Many interactions Can -\> GI upset, dry mouth, sweating, urinary reten, headache, insomnia, sex dysf
54
Dutasteride
**CLASS** 5-alpha-reductase inhibitors **INDICATIONS** benign prostatic hyperplasia when prostate \>30-40cm **DOSAGE** 500microg once daily Comes in 500mcg (Avodart) and combo with tamsulosin cr (Duodart) **MONITORING** Side effects Clinical effect Prostate specific antigen (PSA) (increase means inves for prostate cancer Breast tissue changes (poss link with breast ca) Caution handling by women/pregwomen **COUNSELLING** Swallow whole (contents are throat irritating) Can -\> sexual dysfunction, poor semen qual/infertility Note: dutas has a long half life (3-5 weeks) If using as single agent, can take 6 months before improvement and 12-18 months for full effect If taking combo with tamsulosin: Take with food (to reduce s/es CAn cause ortho hypo
55
Tamsulosin
**CLASS** Selective alpha-blocker **INDICATIONS** Benign prostatic hyperplasia **DOSAGE** 400microg once daily Comes in 400mcg (Flomaxtra) and combo with dutasteride **MONITORING** BP (high risk hypoten) Tx with other antihyp and volume depletions (both inc risk of hypoten) Need for cataract surg (inc risk of intraop floppy iris syndrome) Renal/hepatic func Improv of BPH symp oedema **COUNSELLING** Swallow whole Can cause drowsy/dizzy caution standing, driving, machinery Tell opthalm you are taking/have taken this med if you are going to have cataract surg Can -\> headache, nasal congest, blurred vision, dry mouth, urin incon, NV, mood changes Will start working in 48 hours, full effect in 4-6 weeks
56
Enoxaparin
**CLASS** Low molecular weight heparin **INDICATIONS** Prev VTE in surg patients/bedridden pts Tx of venous thrombosis Prev extracorporeal thrombosis during haemodialysis Tx of acute STEMI, non-STEMI, unstable angina **DOSAGE** Prev VTE: 20mg - 40mg once daily (dep on risk, renal func) Tx VTE: 1mg/kg BD - 1.5mg/kg once daily (dep on risk) (1mg/kg once daily if poor renal func) **MONITORING** Bleeding and clotting risk Renal/hepatic function Need for surgery or spinal injection Ability to administer **COUNSELLING** Injected subcut Ensure they know how to use/dispose Rotate site, can cause irritation/bruising at injection site More risk of bleeding, bruising Know signs of bleeding / clotting - tell dr Tell dr/health prof you are on this
57
Erythromycin
**CLASS** Macrolide **INDICATIONS** RTI Rheumatic fever Legionnaires disease Campylobacter enteritis Chlamydial infections Acne Rosacea **DOSAGE** *(Note: 400mg ethyl succinate = 250mg base)* Base: 250-500mg BD-QID (Max 4g daily) ``` Ethyl succ: 400mg q6h (Max 4g daily) ``` Comes in 250mg base (Eryc), 400mg ethyl succinate (E-Mycin), 40mg/ml (eth succ), 80mg/ml (eth succ) **MONITORING** Clin eff ECG (QT pro, tor d po) - esp with eryth and clarith Drug interactions (esp eryth, clarith) Infantile hypertrophic pyloric stenosis Ototox Superinf FBC (blood dyscrasias) Allergy Hep function renal func **COUNSELLING** Base: best abs on empty stomach (can take with food if stom upset) Take until all taken Can -\> GI upset Tell dr if allergy, hearing issues (esp if high dose), severe vom/diar, infant irritable/vom Many interactions
58
Escitalopram
**CLASS** Selective serotonin reuptake inhibitor **INDICATIONS** Marjor depression gen anxiety dis social phobia OCD **DOSAGE** 10-20mg once daily *comes in 10mg, 20mg (Esipram, Lexapro)* **MONITORING** Clin effect Psych stability (increased suic ideation, can induce manic ep in bipolar) Serotonin tox hepatic func Electrolytes (hyponoat) risk of bleeding ocular pressure (angle-closure glaucoma) Compliance QT prolong Getting counselling/non-pharma support EPSE **COUNSELLING** Best taken once daily in the morning Take regularly - do not stop suddenly Can take a few weeks to start working - full effect in around 8 weeks. Stay aware of how you feel and talk to dr/someone if start feeling really down or things become overwhelming drowsy/dizzy - caution driving Many interactions - tell dr/healthprof youre on it Can -\> gi upset, dry mouth, headache, dizziness, weight changes, sexual dysfunction
59
Esomeprazole
**CLASS** Proton pump inhibitor **INDICATIONS** GORD Zollinger-Ellison syndrome H pylori eradication Tx / prev NSAID ulcer/dyspepsis Prev pep ulcer rebleeding **DOSAGE** 20-40mg once daily Zollinger-Ellison synd: 40mg BD H. Pylori: 20mg BD **MONITORING** Clin effect Review maint therapy (cease/reduce dose?) Gastric bleeds ? inc risk of enteric inf/pneumonia ``` Fracture risk (long term use) consider cal or vit d suppl ``` B12 levels (long term use) Rule out gastric carcinoma Hepatic func **COUNSELLING** Swallow whole Gen well tolerated but can -\> GI disturbance, drowsy, insom, dry mouth Tell dr if signs of gastric bleed (dark stool, coffee ground vom)
60
Etanercept
**CLASS** TNF-alpha antagonists **INDICATIONS** Rheumatoid arthritis Psoriatic arthritis Juvenile idiopathic arthritis Plaque psoriasis **DOSAGE** SC 50mg once weekly or SC 25mg twice weekly **MONITORING** FBC (blood dyscrasia) Infection Malignancies Liver/renal func heart failure, resp disease (can worsen) Vaccinations (some can't be given, consider immunising beforehand) **COUNSELLING** Contact dr immediately if signs of infection, bleeding, fever Some vaccines can't be given Can -\> injection site reaction, allergic reaction, abdo pain, dyspep In RA- benefit after 1-12 weeks of tx
61
Exenatide
**CLASS** Glucagon-like peptide 1 analogue (GLP-1) **INDICATIONS** T2DM **DOSAGE** SC-5-10mcg BD or SC 2mg once weekly *Comes in 5mcg, 10mcg (Byetta), 2mg (Bydureon)* **MONITORING** BSL, HbA1c, disease progression hypoglycaemia tolerability (GI disturb) pancreatitis renal func **COUNSELLING** Ensure know how to admin/dispose Rotate inj site Know signs of hypogly Reg check bsl, Hba1c Can -\> gi upset (should improve), dyspepsia, GORD, abdo pain, inj site reaction, taste disturbance Tell dr if you dev unexplained severe abdo pain
62
Ezetimibe
**CLASS** Cholesterol absorption inhibitor **INDICATION** Hypercholesterolaemia **DOSE** 10mg once daily *Comes in 10mg (Ezetrol), combo with atorv or simva (Atozet or Vytorin)* **MONITORING** Lipid profile (HDL, LDL, triglycerides) Myopathy, creatine kinase Pancreatitis Cholelithiasis (gall stones) Mood in elderly Hepatic function **COUNSELLING** Take every day wont feel it working Check lipids reg Non-pharma advice Tell dr if develop unexplained muscle pain, weakness

Board Exam - Part One (3 decks)

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