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*Medicine: Prescribing > Practice Tidbits > Flashcards

Practice Tidbits Flashcards

1
Q

Which drugs should be avoided in heart failure?

A
  • 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
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2
Q

Steroid side-effects

A
  • 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
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3
Q

Which drugs are harmful in pregnancy?

A
  • Abx → tetracyclines / aminoglycosides / sulphonamides + trimethoprim / quinolones
  • ACEi + ARBs
  • Statins
  • Wafarin
  • Sulfonylureas
  • Retinoids
  • Cytotoxic agents
  • Antiepileptics → valproate / carbamazepine / phenytoin
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4
Q

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?

A
  • 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
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5
Q

How should bisphosphonates be taken?

A
  • 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
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6
Q

Which antibiotics increase risk of C. Diff?

A
  • Cephalosporins
  • Fluoroquinolones
  • Amoxicillin
  • Clindamycin
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7
Q

What must PRN prescriptions specify?

A

Maximum dose

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8
Q

Should ischaemic stroke patients be given VTE prophylaxis?

A

Not until 2 months after the stroke

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9
Q

Which 2 cardiac drugs, if prescribed together, increase risk of asystole?

A
  • Verapamil + beta-blocker
  • Avoid prescribing both together
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10
Q

By which route is insulin given?

A
  • All insulin = S/C
  • Except sliding scales using short-acting insulin (Actrapid or Novorapid) = given IV
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11
Q

What are sick-day rules for long-term steroids?

A

Increase steroids

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12
Q

Which other drug should be avoided if taking methotrexate?

A
  • Trimethoprim
  • As both are folate antagonists
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13
Q

Which antibiotic is first-line for uncomplicated UTI?

A
  • Nitrofurantoin
  • Unless renal impairment, then use trimethoprim
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14
Q

Which drugs should be avoided in glaucoma?

A

Anti-cholinergics

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15
Q

Which drug for depression?

A
  • Citalopram
  • Or any other SSRI
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16
Q

Which sneakier drugs contain penicillin?

A
  • Co-amoxiclav (Augmentin)
  • Tazocin
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17
Q

Which drugs cause hyperlipidaemia?

A
  • Thiazides
  • Olanzapine
  • Lamivudine
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18
Q

What is the choice of VTE prophylaxis in pregnancy?

A
  • LMWH eg. Enoxaparin
  • Avoid DOACs + warfarin
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19
Q

Which opioid should be given in renal impairment?

A

Oxycodone

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20
Q

Which dopamine antagonist is safe in Parkinson’s?

A
  • Domperidone
  • Doesn’t cross BBB
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21
Q

What is a side-effect of tetracyclines?

A

Photosensitivity

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22
Q

When should you be weary of smokers?

A
  • Smoking induces CYP450 drugs
  • Watch out for narrow index drugs
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23
Q

ECG finding with TCA overdose?

A

QRS Prolongation

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24
Q

How does SSRI withdrawal present?

A
  • Flu-like symptoms
  • Nausea
  • Fatigue
  • Insomnia
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25
Q

Which SSRI has the lowest risk of withdrawal symptoms?

A

Fluoxetine

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26
Q

What is the treatment for neutropenic sepsis?

A

Tazocin

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27
Q

Treatment for non-genital warts?

A

Salicyclic acid

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28
Q

What needs to be checked for monitoring for isotretinoin?

A

Urine hCG

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29
Q

What should be done if a depressed patient develops mania?

A
  • Stop antidepressant
  • Start antipsychotic (haloperidol, quetiapine, olanzapine, risperidone)
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30
Q

Which drugs prolong QTc?

A
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31
Q

Treatment for tardive dyskinesias?

A

Tetrabenazine

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32
Q

Treatment for 2o parkinsonisms, dystonia, akithesias?

A

Procyclidine

33
Q

Steroids for asthma management?

A
  • Prednisolone for moderate
  • Hydrocortisone for severe
34
Q

When should metformin be avoided?

A

In renal impairment (creatinine >150)

35
Q

What other drug should one be weary of if a patient is allergic to aspirin?

A

Sulfasalazine

36
Q

Interactions: NSAIDs and methotrexate?

A
  • Use with caution
  • But no absolute contraindication
37
Q

How do you measure the efficacy of beta blockers?

A

Heart rate

38
Q

Which electrolyte needs monitoring pre-amiodarone?

A

Potassium

39
Q

Which two drugs beginning with ‘a’ can cause bone marrow suppression?

A

Azathioprine + Allopurinol

40
Q

How does lithium toxicity present?

A

Tremor → Lethargy → Arrhythmias / Seizures / Coma / Renal failure

41
Q

Which drugs impact lithium excretion and hence can precipitate toxicity?

A
  • ACEi
  • Thiazides
  • NSAIDs
42
Q

Can you give metformin in chronic renal impairment?

A
  • Caution if eGFR 30-45
  • Avoid if eGFR < 30
43
Q

What is the drug for immediate dyspepsia relief?

A
  • Gaviscon / Alginates
  • Magnesium carbonate (Antacid)
44
Q

How do you monitor for antibiotic efficacy in pneumonia?

A

Resp rate

45
Q

How do you monitor the efficacy of DKA treatment?

A

Serum ketones (<0.6)

46
Q

Which anti-emetic can have antimuscarinic SEs?

A

Cyclizine

47
Q

Which haemtological drugs can contribute to hyperkalaemia?

A

Heparins

48
Q

Important SE of tacrolimus?

A

Hyperkalaemia

49
Q

Breakthrough pain for pt on transdermal fentanyl?

A

Spray PRN

50
Q

INR goal pre-operatively?

A
  • < 1.5
  • If > 1.5 → give phytomenadione
51
Q

When is the suicide risk greatest with SSRI treatment?

A

First 4 weeks

52
Q

Topiramate in relation to CYP450?

A
  • Enzyme inducer
  • Reduces efficacy of POP
  • Use alternative methods of contraception until 4wks after cessation of topiramate
53
Q

Important GI side-effect of co-amoxiclav?

A

Choleastatic jaundice

54
Q

Do you stop ACEi if the pt’s serum creatinine rises?

A
  • Tolerate < 20% rise
55
Q

How do you measure efficacy for heart failure treamtent?

A

Exercise tolerance

56
Q

Important adverse effects of ciclosporin?

A
  • Hypertension
  • Nephrotoxicity
  • Hyperkalaemia
57
Q

Are steroids safe in pregnancy?

A
  • Oral and inhaled steroids are safe
  • But avoid tiotropium
58
Q

First-line SSRIs?

A
  • Citalopram
  • Sertraline
  • Fluoxetine
59
Q

Which SSRI in co-morbid patients?

A

Sertraline

60
Q

How to treat IDA in pregnancy?

A

Ferrous Sulfate

61
Q

Methotrexate monitoring?

A
  • FBC, LFT + U+Es 1-2wkly until stable
  • Then 2-3 monthly
62
Q

Amiodarone: impact on CYP450 enzymes?

A

An enzyme inhibitor

63
Q

Which drugs cause a transaminitis (ALT rise)?

A
  • NSAIDs
  • Amiodarone
  • Paracetamol
  • Statins
64
Q

Which drugs cause an increased ALP, an dhence a cholestatic picture?

A
  • Co-amoxiclav
  • Erythromycin
  • Chlorpromazine
  • Hormonal contraception
65
Q

Which DOAC to avoid in renal failure?

A

Dabigatran

66
Q

Which drugs to avoid when taking statins?

A

Enzyme inhibitors

67
Q

DKA Treatment?

A
  • 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
68
Q

Signs of digoxin toxicity?

A
  • Confusion
  • Non-infective diarrhoea
  • Nausea
  • Bradycardia
69
Q

Treatment for ascites?

A
  • 1st line → spironolactone
  • 2nd line → furosemide
70
Q

IECOPD - oral or IV steroids?

A

Oral if patient can swallow

71
Q

Folic acid doses in pregnancy?

A
  • Standard → 0.4mg daily 12wks
  • High risk → 5mg daily 12wks
  • Deficiency → 5mg daily 12wks or to term
72
Q

A common side effect of parkinsons drugs?

A

Postural hypotension

73
Q

Drug to reduce risk of bleeding with varices?

A

Propranolol

74
Q

When do you stop metformin?

A
  • Following MI
  • Risk of lactic acidosis
75
Q

Warfarin bleeding rules

A
76
Q

Post-operative complications

A
77
Q

Laxatives

A
78
Q

Basal-bolus insulin

A

*Medicine: Prescribing (13 decks)

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