Pharmacy Facts Flashcards
What is cimetidine used for and what side effect is associated with high doses?
H2 Receptor Antagonist
Used for Gastric Ulcers
High doses lead to associated with Gynaecomastia and Impotence
Which antipsychotics have the highest risk of weight gain?
1) Olanzapine
2) Clozapine
Which out of these painkillers would you give to a breastfeeding mother….Ibuprofen or Codeine?
Ibuprofen
Breastfeeding should be avoided with codeine use.
What is the cautionary label for ciprofloxacin?
DOES LIKE MILK - Do not take indigestion remedies, or medicines containing iron or zinc, 2 hours before or after you take this medicine
Doxy
Lym
Mino
OTHER FLUOROQUINOLONES
CDOT - Do not take MILK, indigestion remedies, or medicines containing iron or zinc, 2 hours before or after you take this medicine
Cipro
Demeclo
Oxytetra
Tetra
Azithromycin - Do not take indigestion remedies 2 hours before or after you take this medicine
Which antibiotics do you need to take with a full glass of water?
CD
Clindamycin
Doxycycline
Which antibiotics do you need to protect yourself from sunlight?
Doxycycline - Has label
Other tetracyclines - No label
Ciproflaxacin and other fluoroquinolones - 48 hours after use also! - No label
Which antibiotics do you need to take WITH OR AFTER FOOD?
MC(mcdonalds) food NP (no problem)
Metronidazole
Clarithromycin MR
Nitrofurantoin
Pivmecillinam
Which antibiotics to take 1 hour before or 2 hours after food.
ID FFART PAc
Isoniazid
Demeclocycline
Flucloxacillin, Fosfomycin
Rifampicin
Tetracycline + Oxytetracycline
Phenoxymethylpenicillin
Azithromycin caps
What can long term PPIs lead to?
MHRA: Systemic Lupus Erythematosus
Osteoporosis
Increase fracture risk
Hypomagnesemia
C.diff
Mask signs of gastric cancer
B12 deficiency
What are the main side effects of ACE inhibitors?
Hyperkalaemia
Dry cough
First dose hypotension - give at night
Can ACE inhibitors cause alopecia?
YES! - prob dont need to know but it is listed in the BNF as a common side effect.
When are ACE inhibitors contraindicated?
Angioedema
w/ Aliskeren when EGFR < 60
What is the maximum supply of ephedrine and pseudoephedrine per transaction?
720mg Pseudoephedrine
180mg Ephedrine
Cannot sell together.
Max 1 pack
Are sulphonureas associated with weight loss?
NO - WEIGHT GAIN!
When are sulphonureas contraindicated?
Diabetic ketoacidosis
Acute porphyrias
Why does amiodarone cause thyroid dysfunction?
Has a high iodine content
When should ACE inhibitors be discontinued?
Unbearable dry cough
Angioedema
Jaundice
How long do you need contraception after stopping methotrexate?
3 MONTHS for BOTH MEN AND WOMEN
Can you have grapefruit juice with simvastatin?
No
Can you have grapefruit juice with nifedipine?
No
What is levothyroxine absorption impacted by?
Calcium and Iron
Dose to be taken preferably 30–60 minutes before breakfast, caffeine-containing liquids (e.g. coffee, tea), or other medication.
Manufacturers advise separation of 4 hours between levothyroxine and iron/calcium compounds.
What is the cautionary label with metformin?
Take with food
When is tendon rupture with fluoroquinolones more likely?
Patients over 60 years of age
Concomitant use of corticosteroids
What are the MHRA warnings for fluoroquinolones?
Should not be used first line
Suicidal thoughts and behaviour
Long lasting and disabling irreversible side effects
Aortic aneurism
Heart valve regurgitation
What adverse effects is pioglitazone associated with?
Heart failure
Bladder cancer
Bone fractures
What is the maximum days supply of isotretinoin?
30 days
If Isotretinoin is prescribed on the 1st July, when is the last day the patient can pick up the medication?
7th July
8th = expired
For how many days do you need contraception after stopping isotretinoin?
1 MONTH
For how many days do you need contraception after stopping Acitretin?
1 month before and 3 years after
What is needed when Isotretinoin is given to someone under 18?
2 independent prescribers must agree on treatment initiation in patients under 18 years
How many days is a course of isotretinoin?
12 weeks
Can you donate blood on Isotretinoin?
NO! Avoid blood donation during treatment and for at least 1 MONTH after treatment
When would you discontinue Isotretinoin?
Risk of pancreatitis if triglycerides above 9 mmol/litre—discontinue if uncontrolled hypertriglyceridaemia or pancreatitis.
Discontinue treatment if skin peeling severe or haemorrhagic diarrhoea develops.
Visual disturbances require expert referral and possible withdrawal.
Psychiatric side-effects could require expert referral.
A patient is taking methotrexate and is taking amoxicillin for CAP….what do you do?
Interaction!
Withhold methotrexate until amoxicillin course is complete.
What drug is given with Isoniazid and why?
Pyridoxine (B6)
Peripheral neuropathy
How do you give vinka-alkoloids?
Intravenously!!!!!!!!
Intrathecal = straight prison
Can vincristine cause red urine?
No -
RED CLS
Rifampicin
Entacapone
Dantron
Clofazimine
Levodopa
Senna
What are category 1 epileptics and can you switch brands?
CP3
Carbamazepine
Phenytoin
Phenobarbital
Primidone
NO SWITCHING
For which seizures is carbamazepine mainly used for?
Focal seizures
Consider lamotrigine or levetiracetam as first-line
What is the therapeutic range of carbamazepine
4 - 12 mg/L measured after 1–2 weeks
What is the MHRA warning for all antiepileptics?
Risk of suicidal thoughts and behaviour
What is the pre-treatment screening for carbamazepine and phenytoin
HLA allele - thai and chinese - SJS
What is the therapeutic range of phenytoin?
10-20 mg/L
Can you give phenytoin in pregnancy?
Yes but need contraception
Continue 1 MONTH after stopping
How would you give emergency contraception with a patient on carbamazepine?
Give copper IUD
or
Double levonorgestrel dose
What is the therapeutic range of phenobarbital?
15–40 mg/L
What are the side effects of betablockers?
Cold extremities
Mask signs of hypoglycaemia
Nightmares
Provoke asthma
Bradycardia
Which betablockers don’t give nightmares?
Water CANS
Celiprolol
Atenolol
Nadalol
Sotalol
Which betablockers don’t cause cold extremities?
Ice PACO
Pindolol
Acebutolol
Celiprol
Oxprenolol
Which beta blockers are cardio selective?
BAtMAN
Bisoprolol
Atenolol
Metoprolol
Acebutolol
Nebivolol
Can trimethoprim and heparin cause hypokalaemia?
NO
They cause hyperkalaemia
What is the maximum dose of simvastatin with amlodipine?
20mg
What is the maximum dose of simvastatin with ciclosporin?
AVOID
Max 10mg Atorvastatin
What is the maximum simvastatin dose with fibrates?
10mg
What is the maximum simvastatin dose with verapamil, diltiazem and some other CYP3A4 inhibitors?
20mg
What is the maximum dose of simvastatin with ticagrelor?
40mg
Can you give statins in pregnancy?
No
What is the maximum dose of atorvastatin and ….vir drugs
20mg
Are statins needed at end of life?
No - as reduce 10 year CVD mortality risk
What do you do with a patient on concomitant warfarin and fluconazole?
Monitor INR
What is the maximum dose of citalopram in patients over 65 or with hepatic impairment?
20mg
Which antihypertensives are suitable in pregnancy?
Labetalol
Nifedipine
Methyldopa
Which laxative is a stool softener and stimulant?
Docusate
Which laxative would you avoid in IBS?
Lactulose as can cause bloating
What is first line for constipation in pregnancy?
Ispaghula husk
How would you treat constipation in children?
If faecal impaction is not present (or has been treated), the child should be treated promptly with a laxative. A macrogol (such as macrogol 3350 with potassium chloride, sodium bicarbonate and sodium chloride) is preferred as first-line management, with the dose adjusted according to symptoms and response. If the response is inadequate add a stimulant laxative, or change to a stimulant laxative if the first-line therapy is not tolerated. If stools remain hard, lactulose or another laxative with softening effects, such as docusate sodium should be added.
What are SGLT-2 inhibitors associated with?
DKA
UTIs
Which PPIs should you avoid with clopidogrel?
Omeprazole and Esomeprazole
Decrease the action of clopidogrel.
What is pyrazinamide commonly used for and what are its side effects?
TB
RIPE (2 months) RI (4 months) total 6 months treatment
Liver disorders
GOUT - can induce hyperuricemia and contraindicated in acute gout flare up
Which antidiabetic drug can be used to treat polycystic ovary syndrome?
Metformin
At what time do you take montelukast?
Night
What are long acting insulins and how long do they last?
Glargine (lantus)
Detemir (levemir)
24 hours
Which DPP4 is safest for the heart?
Saxagliptin
Vildagliptin should be avoided in severe heart failure
Alogliptin should be avoided in moderate to severe heart failure.
Can you use ACE inhibitors in pregnancy?
NO! ACE inhibitors should be avoided
in pregnancy unless essential.
They may adversely affect fetal
and neonatal blood pressure
control and renal function; skull
defects and oligohydramnios have
also been reported.
Is St Johns Wart an enzyme inducer or enzyme inhibitor?
Enzyme inducer
What does QT prolongation cause?
Torsade de pointes (life threatening ventricular arrhythmia)
Which medications cause QT prolongation?
Anti ABCDDEFH
Anti-Arrhythmics (amiodarone, sotalol)
Anti-Biotics (fluoroquinolones, macrolides)
Anti-Psychotics (haloperidol, thloridazine, chlorpromazine,risperidone)
Anti-Depressants (SSRIs, citalopram, SNRI- Venlafaxine, TCAs)
Anti-Emetics (Ondansetron)
Anti-Fungals (Fluconazole)
Anti-Histamines (Loratidine)
Others:
Malaria - Quinines
Methedone
Donepazil
LOW POTASSIUM, OLDER AGE AND FEMALE GENDER ARE INCREASED RISK FACTORS
What are the symptoms of serotonin syndrome?
Fever, sweating, confusion, diarrhoea, abnormal movements
In what gender is mefloquine more likely to cause psychiatric side effects?
Women
Which drugs cause hypercalcemia?
Lithium
Tamoxifen
Thiazides
Which tests are used to detect thromboembolism?
Wells Score
D-Dimer
Which drugs are used to reduce the viscosity of sputum in COPD and Cystic Fibrosis?
Carbocysteine / N-acetylcysteine
Which drug is used for paracetamol overdose?
N-acetylcysteine
Restores hepatic glutathione.
If someone has drank poison what do you give?
Activated charcoal is
recommended within 1 hour of
ingesting a poison and works by
adsorbing molecules onto its
surface.
What are the signs of hyperkalaemia?
Arrhythmias
Muscle Weakness
Nausea
DIARRHOEA
HYPOKALEMIA CAUSES CONSTIPATION
How would you treat supraventricular tachycardia?
1) This will often terminate spontaneously or with reflex vagal stimulation such as a Valsalva manoeuvre, immersing the face in ice-cold water, or carotid sinus massage; such manoeuvres should be performed with ECG monitoring.
2) If reflex vagal stimulation unsuccessful give IV adenosine
3) If IV adenosine unsuccessful give IV verapamil - DO NOT GIVE VERAPAMIL WITH BETABLOCKERS!!!!!!!!!!!!!!!
Can you use Gaviscon (sodium alginate, sodium bicarbonate) in pregnancy and breastfeeding?
YEAH BOY!
Which potassium sparing diuretic is most likely to cause gynecomastia?
Spironolactone
Eplerenone has a lower incidence of gyno.
Give examples of aminoglycosides and what are the main adverse effects?
Nephrotoxicity and Ototoxicity
Contraindicated in myasthenia gravis
mitochondrial mutations most likely to have ototoxicity
Amikacin, Gentamicin
Do SSRIs lower seizure threshold?
Yes
Do SSRIs lower the risk of bleeding?
No - Increase risk of bleeding
What is the main electrolyte disturbance that can be caused by SSRIs?
Hyponatremia
What are the signs and symptoms of hyponatremia?
Headache
Confusion
Nausea
Disordered speech
Hallucinations
What antidepressant can be used to prevent chronic tension type headaches?
Low dose amitriptyline
10mg OD
Which drug is contraindicated with allopurinol?
Azathioprine
What is allopurinol used for?
Prophylaxis of gout
When should allopurinol be stopped?
Hypersensitivity
Skin rash
What is first line for glaucoma?
360 laser ting
What is the minimum age you can use Loperamide?
8+
What is metoclopramide used for and what is the maximum duration?
Metoclopramide can be used in
the treatment and prevention of
nausea and vomiting with a
recommended duration of 5 days
to minimise the occurrence of
extrapyramidal side effects.
How many fluconazole tablets do you use to treat vaginal candidiasis?
One 150mg capsule
How do you use oral nystatin?
Hold in the mouth for as long as
possible, with gargling and
swishing, after which it can be
swallowed.
What are the side effects of antimuscarinic drugs e.g. ipatropium?
Cant see, Cant Pee, Cant Sit, Cant Spit
Which drug would you give instead of tolterodine in patients with urinary insufficiency?
Mirabegron - less anticholinergic
How long can omeprazole 20mg be used for OTC?
14 days
18+
If a patient has not tried anything what is the first line treatment?
Increasing fibre intake (oats,
spinach and almonds) and
drinking lots of fluid and exercising
more are the first steps in treating
constipation.
What is the mechanism of action of bulk forming laxatives e.g. ispaghula?
Bulk-forming laxatives such as
Ispaghula husk and sterculia act
by retaining water in the gut and
increase faecal mass; stimulating
peristalsis.
THEREFORE DRINK LOTS OF WATER WHEN USING THESE.
Which drugs are renowned for causing constipation (5)?
VACOM
Verapamil
Amitriptyline
Clozapine
Opioids
Methyldopa
What are the main drugs on ACB scale?
Look at picture
What is the minimum age and BMI for orlistat?
Orlistat reduces fat absorption
and can be sold to adults over 18
years of age with a BMI > 28 kg/m2.
Have to lose 5% bodyweight to continue longer than 12 weeks
Take with food TDS but avoid with meals low in fat.
Can you give tetracyclines to a pregnant lady?
No
Can you give tetracyclines to a 11 year old?
No - tooth discolouration
What is the main side effect to look out for with ivabradine (HF/ANGINA) ?
Blurred vision
Luminous Phenomena (spots and flashes)
What is the main side effect to look out for with nicorandil?
Ulceration - skin, mucosal, eye, GI
What is the main side effect to look out for with carbimazole?
Carbimazole may cause bone
marrow suppression.
Treatment should be stopped
promptly and patients should be
asked to report symptoms and
signs suggestive of an infection,
such as a sore throat.
What is the recommended alcohol units for men and women?
14
Why is folic acid taken in pregnant women and what is the dosing instructions?
Folic acid supplementation during
pregnancy reduces the risk of
neural tube defects, including
spina bifida.
The recommended dose is 400
micrograms daily, ideally starting
at least one month before
conception and continuing for the
first 12 weeks of pregnancy
Can you give an emergency supply of pregabalin?
NO
SCHEDULE 2 and 3 emergency supply is prohibited
Can you give an emergency supply of midazolam?
NO -_- its Schedule 3
Can you give emergency supply of morphine 10mg/5ml
Yes - CD5
How do you wash a spacer?
Warm soapy water and air dry ONCE a month
Replace every 12 months
Towel drying interferes with electrostatic charge.
Which NSAIDs are preferred in ischaemic heart disease?
Ibuprofen 1.2g
Naproxen 1g
DICLOFENAC WORST
COX and High Dose Ibuprofen contraindicated.
What are the MHRA warnings for bisphosphonates?
Hypocalcaemia
Atypical femoral fractures,
Osteonecrosis of the jaw
Osteonecrosis of the external auditory canal.
Take Vit D and Calcium with it.
What are the four schedule 3 drugs that require safe custody?
Buprenorphine
Temazapam
Flunitrazepam
Diethylpropion
What is the minimum age of mebendazole?
2
Cant use also in pregnancy and breastfeeding
How long should hygiene measures be continued in threadworm infection?
6 weeks
What is the maximum days supply for lorazepam?
30 days (schedule 4)
Schedule 2,3 and 4 maximum 30 days supply
Diazepam is requested by prescriber for emergency supply, how many days supply would you give as a maximum and when must the prescription be received?
5 days supply
72 hours
What is the minimum age for miconazole gel?
4 months
A patients mother asks if her son can take ibuprofen for fever during chicken pox, what’s your answer and why?
No - linked to development of secondary skin infections known as necrotising fasciitis.
You are an independent prescriber and want to prescribe an anti-emetic for a patient. His current medications are Co-careldopa. You have the option of prescribing metoclopramide, prochlorperazine and domperidone, which one do you prescribe?
Low dose domperidone
metoclopramide and prochlorperazine can worsen parkinsonism.
Do phenytoin and phenobarbitone cause hair loss?
NO they cause excess hair growth.
Does sodium valproate cause hair loss?
Yes, with curly regrowth
Which drugs cause gingival hyperplasia?
PCN
Phenytoin
Ciclosporin
Nifedipine
