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
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
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
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
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
6
Q
Which antibiotics increase risk of C. Diff?
A
- Cephalosporins
- Fluoroquinolones
- Amoxicillin
- Clindamycin
7
Q
What must PRN prescriptions specify?
A
Maximum dose
8
Q
Should ischaemic stroke patients be given VTE prophylaxis?
A
Not until 2 months after the stroke
9
Q
Which 2 cardiac drugs, if prescribed together, increase risk of asystole?
A
- Verapamil + beta-blocker
- Avoid prescribing both together
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
11
Q
What are sick-day rules for long-term steroids?
A
Increase steroids
12
Q
Which other drug should be avoided if taking methotrexate?
A
- Trimethoprim
- As both are folate antagonists
13
Q
Which antibiotic is first-line for uncomplicated UTI?
A
- Nitrofurantoin
- Unless renal impairment, then use trimethoprim
14
Q
Which drugs should be avoided in glaucoma?
A
Anti-cholinergics
15
Q
Which drug for depression?
A
- Citalopram
- Or any other SSRI
16
Q
Which sneakier drugs contain penicillin?
A
- Co-amoxiclav (Augmentin)
- Tazocin
17
Q
Which drugs cause hyperlipidaemia?
A
- Thiazides
- Olanzapine
- Lamivudine
18
Q
What is the choice of VTE prophylaxis in pregnancy?
A
- LMWH eg. Enoxaparin
- Avoid DOACs + warfarin
19
Q
Which opioid should be given in renal impairment?
A
Oxycodone
20
Q
Which dopamine antagonist is safe in Parkinson’s?
A
- Domperidone
- Doesn’t cross BBB
21
Q
What is a side-effect of tetracyclines?
A
Photosensitivity
22
Q
When should you be weary of smokers?
A
- Smoking induces CYP450 drugs
- Watch out for narrow index drugs
23
Q
ECG finding with TCA overdose?
A
QRS Prolongation
24
Q
How does SSRI withdrawal present?
A
- Flu-like symptoms
- Nausea
- Fatigue
- Insomnia
25
Which **SSRI** has the lowest risk of withdrawal symptoms?
Fluoxetine
26
What is the **treatment** for **neutropenic** **sepsis**?
Tazocin
27
Treatment for non-genital warts?
Salicyclic acid
28
What needs to be checked for monitoring for **isotretinoin**?
Urine hCG
29
What should be done if a **depressed** patient develops **mania**?
* _Stop_ **antidepressant**
* _Start_ **antipsychotic** (haloperidol, quetiapine, olanzapine, risperidone)
30
Which drugs **prolong** **QTc**?
31
Treatment for **tardive** **dyskinesias**?
Tetrabenazine
32
Treatment for 2o parkinsonisms, dystonia, akithesias?
Procyclidine
33
Steroids for asthma management?
* **Prednisolone** for moderate
* **Hydrocortisone** for severe
34
When should **metformin** be avoided?
In **renal** **impairment** (creatinine \>150)
35
What other drug should one be weary of if a patient is **allergic** to **aspirin**?
Sulfasalazine
36
Interactions: NSAIDs and methotrexate?
* Use with caution
* But no absolute contraindication
37
How do you measure the efficacy of beta blockers?
Heart rate
38
Which **electrolyte** needs monitoring pre-amiodarone?
Potassium
39
Which **two drugs** beginning with '**a**' can cause bone marrow suppression?
Azathioprine + Allopurinol
40
How does **lithium** **toxicity** present?
Tremor → Lethargy → Arrhythmias / Seizures / Coma / Renal failure
41
Which drugs impact **lithium** **excretion** and hence can precipitate toxicity?
* ACEi
* Thiazides
* NSAIDs
42
Can you give **metformin** in chronic **renal** **impairment**?
* Caution if eGFR 30-45
* _Avoid if eGFR \< 30_
43
What is the drug for **immediate** dyspepsia relief?
* Gaviscon / Alginates
* Magnesium carbonate (Antacid)
44
How do you monitor for antibiotic efficacy in pneumonia?
Resp rate
45
How do you monitor the **efficacy** of **DKA** treatment?
Serum ketones (\<0.6)
46
Which anti-emetic can have antimuscarinic SEs?
Cyclizine
47
Which **haemtological** drugs can contribute to **hyperkalaemia**?
Heparins
48
Important SE of **tacrolimus**?
Hyperkalaemia
49
**Breakthrough** **pain** for pt on transdermal fentanyl?
Spray PRN
50
**INR** goal pre-operatively?
* \< 1.5
* If \> 1.5 → give phytomenadione
51
When is the **suicide** risk greatest with **SSRI** treatment?
First 4 weeks
52
**Topiramate** in relation to CYP450?
* Enzyme inducer
* Reduces efficacy of POP
* Use alternative methods of contraception until 4wks after cessation of topiramate
53
Important GI side-effect of **co-amoxiclav**?
Choleastatic jaundice
54
Do you stop **ACEi** if the pt's serum creatinine rises?
* Tolerate \< 20% rise
55
How do you measure **efficacy** for **heart** **failure** treamtent?
Exercise tolerance
56
Important adverse effects of ciclosporin?
* Hypertension
* Nephrotoxicity
* Hyperkalaemia
57
Are **steroids** safe in **pregnancy**?
* Oral and inhaled steroids are safe
* But avoid tiotropium
58
First-line SSRIs?
* Citalopram
* Sertraline
* Fluoxetine
59
Which SSRI in co-morbid patients?
Sertraline
60
How to treat **IDA** in pregnancy?
Ferrous Sulfate
61
Methotrexate **monitoring**?
* FBC, LFT + U+Es 1-2wkly until stable
* Then 2-3 monthly
62
**Amiodarone**: impact on CYP450 enzymes?
An enzyme _inhibitor_
63
Which **drugs** cause a **transaminitis** (ALT rise)?
* NSAIDs
* Amiodarone
* Paracetamol
* Statins
64
Which **drugs** cause an increased ALP, an dhence a **cholestatic** picture?
* Co-amoxiclav
* Erythromycin
* Chlorpromazine
* Hormonal contraception
65
Which **DOAC** to avoid in renal failure?
Dabigatran
66
Which drugs to avoid when taking statins?
Enzyme inhibitors
67
**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
68
Signs of **digoxin** **toxicity**?
* Confusion
* Non-infective diarrhoea
* Nausea
* Bradycardia
69
Treatment for **ascites**?
* 1st line → spironolactone
* 2nd line → furosemide
70
IECOPD - oral or IV steroids?
Oral if patient can swallow
71
Folic acid doses in pregnancy?
* Standard → 0.4mg daily 12wks
* High risk → 5mg daily 12wks
* Deficiency → 5mg daily 12wks or to term
72
A common side effect of parkinsons drugs?
Postural hypotension
73
Drug to reduce risk of bleeding with varices?
Propranolol
74
When do you stop metformin?
* Following MI
* Risk of lactic acidosis
75
Warfarin bleeding rules
76
Post-operative complications
77
Laxatives
78
Basal-bolus insulin
