Practice Tidbits Flashcards
Which drugs should be avoided in heart failure?
- Thiazolidinediones (eg. pioglitazone) → causes fluid retention
- Verapamil → negative inotropic effect
- NSAIDs/glucocorticoids → fluid retention (low-dose aspirin an exception)
- Class I antiarrhythmics (eg. fleicanide) → negative inotropic + proarrhythmic effect
Steroid side-effects
- Endo → hyperglycaemia, diabetes, weight gain, hirsuitism, hyperlipid
- Cushing’s syndrome → moon face, buffalo hump, striae
- MSK → osteoporosis, myopathy, avascular necrosis femoral head
- Immunosuppression + neutrophilia
- Psych → insomnia, mania, depression, psychosis
- GI → peptic ulcers, acute pancreatitis
- Eye → glaucoma, cataracts
- Growth suppression in children
- Intracranial HTN
- Fluid retention + HTN
Which drugs are harmful in pregnancy?
- Abx → tetracyclines / aminoglycosides / sulphonamides + trimethoprim / quinolones
- ACEi + ARBs
- Statins
- Wafarin
- Sulfonylureas
- Retinoids
- Cytotoxic agents
- Antiepileptics → valproate / carbamazepine / phenytoin
Bisphosphonates are analogues of pyrophosphate, a molecule which decreases demineralisation in bone. They inhibit osteoclasts by reducing recruitment and promoting apoptosis.
What are adverse effects of bisphosphonates?
- Oesophageal rxns → oesophagitis / ulcers
- Osteonecrosis of jaw
- Inc risk of atypical stress fractures of proximal femoral shaft (w/ alendronate)
- Acute phase response → fever / myalgia / arthralgia
- Hypocalcaemia → due to reduced calcium efflux from bone
How should bisphosphonates be taken?
- Whole with plenty of water while sitting or standing
- To be taken on an empty stomach at least 30 mins before breakfast (or another oral medicine)
- Patient should stand or sit upright for at least 30 mins after taking tablet
Which antibiotics increase risk of C. Diff?
- Cephalosporins
- Fluoroquinolones
- Amoxicillin
- Clindamycin
What must PRN prescriptions specify?
Maximum dose
Should ischaemic stroke patients be given VTE prophylaxis?
Not until 2 months after the stroke
Which 2 cardiac drugs, if prescribed together, increase risk of asystole?
- Verapamil + beta-blocker
- Avoid prescribing both together
By which route is insulin given?
- All insulin = S/C
- Except sliding scales using short-acting insulin (Actrapid or Novorapid) = given IV
What are sick-day rules for long-term steroids?
Increase steroids
Which other drug should be avoided if taking methotrexate?
- Trimethoprim
- As both are folate antagonists
Which antibiotic is first-line for uncomplicated UTI?
- Nitrofurantoin
- Unless renal impairment, then use trimethoprim
Which drugs should be avoided in glaucoma?
Anti-cholinergics
Which drug for depression?
- Citalopram
- Or any other SSRI
Which sneakier drugs contain penicillin?
- Co-amoxiclav (Augmentin)
- Tazocin
Which drugs cause hyperlipidaemia?
- Thiazides
- Olanzapine
- Lamivudine
What is the choice of VTE prophylaxis in pregnancy?
- LMWH eg. Enoxaparin
- Avoid DOACs + warfarin
Which opioid should be given in renal impairment?
Oxycodone
Which dopamine antagonist is safe in Parkinson’s?
- Domperidone
- Doesn’t cross BBB
What is a side-effect of tetracyclines?
Photosensitivity
When should you be weary of smokers?
- Smoking induces CYP450 drugs
- Watch out for narrow index drugs
ECG finding with TCA overdose?
QRS Prolongation
How does SSRI withdrawal present?
- Flu-like symptoms
- Nausea
- Fatigue
- Insomnia
Which SSRI has the lowest risk of withdrawal symptoms?
Fluoxetine
What is the treatment for neutropenic sepsis?
Tazocin
Treatment for non-genital warts?
Salicyclic acid
What needs to be checked for monitoring for isotretinoin?
Urine hCG
What should be done if a depressed patient develops mania?
- Stop antidepressant
- Start antipsychotic (haloperidol, quetiapine, olanzapine, risperidone)
Which drugs prolong QTc?
Treatment for tardive dyskinesias?
Tetrabenazine
Treatment for 2o parkinsonisms, dystonia, akithesias?
Procyclidine
Steroids for asthma management?
- Prednisolone for moderate
- Hydrocortisone for severe
When should metformin be avoided?
In renal impairment (creatinine >150)
What other drug should one be weary of if a patient is allergic to aspirin?
Sulfasalazine
Interactions: NSAIDs and methotrexate?
- Use with caution
- But no absolute contraindication
How do you measure the efficacy of beta blockers?
Heart rate
Which electrolyte needs monitoring pre-amiodarone?
Potassium
Which two drugs beginning with ‘a’ can cause bone marrow suppression?
Azathioprine + Allopurinol
How does lithium toxicity present?
Tremor → Lethargy → Arrhythmias / Seizures / Coma / Renal failure
Which drugs impact lithium excretion and hence can precipitate toxicity?
- ACEi
- Thiazides
- NSAIDs
Can you give metformin in chronic renal impairment?
- Caution if eGFR 30-45
- Avoid if eGFR < 30
What is the drug for immediate dyspepsia relief?
- Gaviscon / Alginates
- Magnesium carbonate (Antacid)
How do you monitor for antibiotic efficacy in pneumonia?
Resp rate
How do you monitor the efficacy of DKA treatment?
Serum ketones (<0.6)
Which anti-emetic can have antimuscarinic SEs?
Cyclizine
Which haemtological drugs can contribute to hyperkalaemia?
Heparins
Important SE of tacrolimus?
Hyperkalaemia
Breakthrough pain for pt on transdermal fentanyl?
Spray PRN
INR goal pre-operatively?
- < 1.5
- If > 1.5 → give phytomenadione
When is the suicide risk greatest with SSRI treatment?
First 4 weeks
Topiramate in relation to CYP450?
- Enzyme inducer
- Reduces efficacy of POP
- Use alternative methods of contraception until 4wks after cessation of topiramate
Important GI side-effect of co-amoxiclav?
Choleastatic jaundice
Do you stop ACEi if the pt’s serum creatinine rises?
- Tolerate < 20% rise
How do you measure efficacy for heart failure treamtent?
Exercise tolerance
Important adverse effects of ciclosporin?
- Hypertension
- Nephrotoxicity
- Hyperkalaemia
Are steroids safe in pregnancy?
- Oral and inhaled steroids are safe
- But avoid tiotropium
First-line SSRIs?
- Citalopram
- Sertraline
- Fluoxetine
Which SSRI in co-morbid patients?
Sertraline
How to treat IDA in pregnancy?
Ferrous Sulfate
Methotrexate monitoring?
- FBC, LFT + U+Es 1-2wkly until stable
- Then 2-3 monthly
Amiodarone: impact on CYP450 enzymes?
An enzyme inhibitor
Which drugs cause a transaminitis (ALT rise)?
- NSAIDs
- Amiodarone
- Paracetamol
- Statins
Which drugs cause an increased ALP, an dhence a cholestatic picture?
- Co-amoxiclav
- Erythromycin
- Chlorpromazine
- Hormonal contraception
Which DOAC to avoid in renal failure?
Dabigatran
Which drugs to avoid when taking statins?
Enzyme inhibitors
DKA Treatment?
- 50 U human soluble insulin (Actrapid)
- in 50mL 0.9% Sodium Chloride
- Fixed rate 0.1 unit/kg/hr
- For fluids, if not hypotensive → 1L / 1 hr
Signs of digoxin toxicity?
- Confusion
- Non-infective diarrhoea
- Nausea
- Bradycardia
Treatment for ascites?
- 1st line → spironolactone
- 2nd line → furosemide
IECOPD - oral or IV steroids?
Oral if patient can swallow
Folic acid doses in pregnancy?
- Standard → 0.4mg daily 12wks
- High risk → 5mg daily 12wks
- Deficiency → 5mg daily 12wks or to term
A common side effect of parkinsons drugs?
Postural hypotension
Drug to reduce risk of bleeding with varices?
Propranolol
When do you stop metformin?
- Following MI
- Risk of lactic acidosis
Warfarin bleeding rules
Post-operative complications
Laxatives
Basal-bolus insulin
