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preliminary chapters Flashcards

1
Q

Drugs interacting with grapefruit juice

A

enzyme INHIBITOR

CVS: SCAR

  • statins
  • ccbs
  • amiodarone/dronedarone
  • ranolazine

CNS

  • quetiapine
  • sertraline

Immunosuppressants

  • tacrolimus
  • ciclosporin

OTHER:

  • colchicine
  • pd5i i.e. sildenafil
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2
Q

How many half lives before a drug reaches steady state

A

x5

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3
Q

Signs of nephrotoxicity

A 
reduced urine output
odema
dehydration
NAV
fatigue
hypertension
confusion
backache
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4
Q

Nephrotoxic drugs

A

5A - aminoglycosides, aminosalicylates, ACEi, aciclovir, amphotericin B

3C - cyclophosphamide, ceph, ciclosporin

2T - tetracyclines, tacrolimus

LMNQV - lithium, MTX, NSAIDS, quinolones, vancomycin

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5
Q

risk factor for AKI

A

dehydration

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6
Q

meds to stop during illnesses resulting in dehydration (vom, diarrhoea, fever, sweats)

A

DAMN

  • diuretics (dehyd and electrolyte disturbances)
  • ACEi (reduce egfr + nephrotoxic)
  • metformin (increased LA risk in RI)
  • NSAIDS (nephrotoxic, reduce eGFR, water and sodium retention)
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7
Q

when to restart sick day meds

A

24-48hrs after normal eating and drinking

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8
Q

drugs that stain urine red

A 
dantron (co-danthrusate)
doxorubicin
levodopa (body secretions)
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9
Q

drugs that stain urine red-orange

A

rifampicin (body secretions)

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10
Q

drugs that stain urine orange

A

sulfasalazine (body secretions)

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11
Q

drugs that stain urine yellow-brown

A

nitrofurantoin

senna

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12
Q

drugs that stain urine pink-orange

A

phenindione

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13
Q

drugs that stain urine blue

A

triamterene

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14
Q

drugs that stain urine/stools black/tarry

A

iron

bismuth

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15
Q

drugs that stain urine brown

A

PG analogues e.e. latanoprost can cause brown pigmentation of iris

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16
Q

analgesic of choice in palliative care

A

morphine

ALT:
oxy
stronger - hydromorphone/methadone
patches - fentanyl/bup
parenteral - diamorphine
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17
Q

breakthrough pain

A

1/6-1/10 of total daily dose every 2-4 hours prn

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18
Q

PO to Parenteral (IV/IM/SC)

A

half dose of oral morphine

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19
Q

diamorphine is equivalent to

A

third of oral dose of morphine

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20
Q

why is diamorphine preferred over morphine for the parenteral route

A

more soluble = large dose in small volume

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21
Q

when switching to patches due to hyperalgesia, reduce opioid dose by

A

25-50%

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22
Q

Managing opioid induced constipation

A

-faecal softener + stimulant

senna + lactulose or co-danthramer/danthrusate

methylnaltrexone

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23
Q

methylnaltrexone drug class

A

opioid receptor antagonist

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24
Q

Managing opioid induced NAV

A

metoclopramide
haloperidol

MAX 4-5 days

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25
Q

Managing opioid induced dry mouth

A
  • good oral hygiene

- artificial saliva

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26
Q

Managing opioid induced dry mouth CANDIDIASIS

A

nystatin
oral miconazole
fluconazole

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27
Q

Treating neuropathic pain

A

TCAD
Anti epi
ketamine last resort - under supervision

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28
Q

Treating pain due to nerve compression

A

Dexamethasone

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29
Q

Treating bone metastases

A

radiotherapy
bisphosphonate
strontium ranelate

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30
Q

Treating anorexia

A

Prednisolone/dexamethasone increases appetite/weight gain

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31
Q

Treating secretions

A

SC hyoscine/glycopyrronium

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32
Q

Treating bowel colic

A

loperamide

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33
Q

Treating capillary bleeding

A 
tranexamic acid (antifibrinolytic)
adrenaline
vit K in prolonged clotting in liver disease
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34
Q

Treating convulsions due to uraemia/cerebral tumour

A

phenytoin
CBZ
SC midazolam

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35
Q

Treating dysphagia due to tumour obstruction

A

dexamethasone

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36
Q

Treating fungating tumours

A

metronidazole

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37
Q

Treating dyspnoea

A

PO morphine (reduces respiratory drive to relieve breathlessness)

w/ anxiety - diazepam

bronchospasm/obstruction - corticosteroids

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38
Q

Treating gastric distension

A

antacid + antiflatulent + prokinetic (i.e. domperidone before meals)

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39
Q

Treating hiccup due to gastric distension

A

antacid + antiflatulent

FAILURE
+metoclopramide

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40
Q

Treating insomnia

A

BDZ

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41
Q

Treating intractable coughs

A

moist inhalation

PO morphine

AVOID methadone linctus as it can accumulate

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42
Q

Treating muscle spasms

A

diazepam

baclofen

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43
Q

Treating NAV

A

first line in advanced cancer:
prokinetic antiemetic

Haloperidol
Levomepromazine
Cyclizine
Metoclopramide
Dexamethasone
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44
Q

Treating pruritis

A

Emollients

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45
Q

Treating obstructive cholestatic jaundice

A

colestyramine

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46
Q

Treating headache due to raised intracranial pressure

A

dexamethasone

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47
Q

Treating restlessness/confusion

A

haloperidol

levomepromazine

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48
Q

what long acting SU should be avoided in 65+

A

glibenclamide

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49
Q

Treating gravitational oedema in elderly

A

AVOID DIURETICS

raise/move legs or wear stockings

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50
Q

Maintenance dose of digoxin in elderly

A

125mcg daily

62.5mcg in renal disease

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51
Q

Reporting ADR

A

YELLOW CARD SCHEME

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52
Q

When to report ADR

A
  • Newer drugs/vaccines (upside down triangle for 5 years)
  • Medication errors (also to national reporting learning system)
  • Medical devices e.g. IUD, contact lens fluid, dental or surgical materials
  • Defective medicines/Fake meds - report to defective medicines report centre division of MHRA
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53
Q

onset of anaphylaxis

A

<1 hour after drug exposure

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54
Q

onset of cutaneous reaction to drug

A

non immediate without systemic involvement

6-10 days after 1st exposure

OR 3 days after 2nd exposure

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55
Q

onset of non immediate reactions WITH systemic involvement

A

3days - 6 weeks after first exposure

56
Q

nature of non immediate reactions WITH systemic involvement

A
  • cutaneous reactions with systemic features
  • toxic epidermal necrolysis/SJS
  • acute generalised exanthematosous pustulosis
57
Q

nature of cutaneous reaction to drug

A

widespread red macules +/or papules OR localised inflamed skin

58
Q

drugs causing oral ulcers

A 
ACEi
NSAID
Nicorandil
Pancreatin
Cytoxics (MTX)
59
Q

drugs causing oral candidiasis

A

cortocosteroids

60
Q

drugs causing brown staining of teeth

A

chlorhexidine

61
Q

drugs causing black staining of teeth

A

liquid iron

62
Q

drugs causing yellow/grey staining of teeth

A

tetracyclines

63
Q

drugs causing osteonecrosis of jaw

A

bisphosphonates

64
Q

drugs causing gingival hypertrophy

A

ciclosporin
nifedipine
phenytoin

65
Q

drugs causing dry mouth

A 
AMs
APs
AHs
ADs
opioids
diuretics
66
Q

drugs causing taste disturbances

A 
ACEi
amiodarone
carbimazole
clarithromycin
Lithium
Metformin
Metronidazole
Zopiclone
67
Q

Drugs causing blood dyscrasias

A

DMARDs

AEs - CBZ/Ethosux/Phenytoin/Lamotrigine

ABs - trimethoprim/dapsone/chloramphenicol/linezolid

Immunosuppressants

Antifolates - MTX/trimethoprim/phenytoin

Aminosalicylates/carbimazole/clozapine/mirtazepine

68
Q

Drugs causing photosensitivity

A

Antifungals - voriconazole
Tetracyclines
Selphonamide
Quinolones

Hydroxychlorophine
Amiodarone
Phenothiazines
Tacrolimus

Topical NSAIDs
Benzoyl peroxide
Isotretinoin
Vitamin A

69
Q

Drugs causing contact sensitisation

A

MTX
Chlorpromazine
Cytotoxics

70
Q

Drugs causing QT prolongation

A

APs - Pimozide/Halo/Quet

ADs - SSRIs(cit/escit), TCADs, Vanlaflaxine

Sotalol/Ami

CNS - methadone, Li, 5HT1aA, 5HT3A, domp, meto, quinine

Macrolides, Hydroxychloroquine, quinolones, -conazoles

71
Q

Risk factors for QT prolongation

A 
Age
Female
Cardiac disease
Bradycardia
HypoK, HypoMg, HypoCa
72
Q

Drugs causing hypokalaemia

A 
Loop/Thiazide diuretics
Corticosteroids
Beta2Ag
Theophylline
Stimulant lax
Amphoteracin B
73
Q

Drugs causing bradycardia

A 
BB
Amiodarone
RLCCBs
Digoxin
Clonidine
AMs
TCADs
AChEi
74
Q

Drugs causing antimusc effects

A 
AMs
TCADs
AHs
APs
Atropine & Clozapine
75
Q

Drugs causing peripheral neuropathy

A

Amiodarone
Phenytoin
Isoniazid
Metronidazole

76
Q

Drugs causing serotonin syndrome

A 
5Ht1A Agonists e.g. sumatriptan
5HT3A e.g. granisetron
ADs - TCADS/MOAi/SSRI
MAOBi - selegiline
SJW
77
Q

Drugs causing ototoxicity

A

Aminoglycosides
Glycopeptides
Loop diuretics

78
Q

Drugs causing lower seizure threshold

A 
Quinolones
Mefloquine
SSRIs
APs
Tramadol
Theophylline
Lithium
Baclofen
Amphetamines
79
Q

Drugs causing increased potassium

A 
ACEi/ARB
Aldosterone antag e.g. spir
NSAIDS
Tacrolimus
Triamterene
Trimethoprim
80
Q

Drugs causing reduced potassium

A 
Theophylline
Amphoteracin B
B2 ag
Corticosteroidse
Diuretics
Stimulant laxatives
81
Q

Drugs causing hyponatraemia

A 
CBZ
diuretics
ADs
NSAIDs
Desmopressin
82
Q

Risk of taking teratogenic drugs in 1st trimester

A

Teratogenicity occurs in first trimester

Congenital abnormalities

83
Q

Risk of taking certain drugs in 2nd/3rd trimester

A

growth & development

84
Q

Risk of taking certain drugs at term

A

obstetric complications and effects on the baby

85
Q

Teratogenic drugs

A

Antifolates - MTX & trimeth

Statins

Tetracyclines

PGA - misoprosol

ACEi/ARB

Isotretinoin

Lithim

Valproate

Warfarin - congenital malformations, fetal and nneonatal haemorrhage

Chloramphenicol

Aspirin/NSAIDs - early closure of ductus arteriosus

Topiramate (cleft palate)

Finasteride v(feminisation of male fetus)

Quinolones (arthropathy)

Aminoglycosides (auditory and vestibular damage in 2/3 trimester)

86
Q

Drugs affecting breast feeding

A

High amounts in breast milk:

ethosuximide
lamotrigine
fluvastatin

Inhibiting sucking reflex:

phenobarbital

Inhibiting lactation

bromocriptine

87
Q

preterm neonate

A

born <37 weeks

88
Q

term neonate

A

born 37 weeks-42 weeks

89
Q

post-term neonate

A

born >42 weeks

90
Q

Neonate

A

0-28 days

91
Q

infant

A

28 days-24 months

92
Q

child

A

2-12 years

93
Q

adolescent

A

12-18 years

94
Q

Dosing in overweight children

A

use ideal body weight

95
Q

neonate eGFR

A

30xheight / serum creatinine

96
Q

> 1 year eGFR

A

40xH / serum creatinine

97
Q

unlicensed

A

no license in UK

no MA

98
Q

off label

A

licensed in UK but outside MA

99
Q

What injection route should be avoided in children

A

IM - painful

100
Q

Which injection excipient should be avoided in children

A

benzyl alcohol

101
Q

benzyl alcohol excipient side effect

A

fatal toxic syndrome

102
Q

what excipient should nbe avoided in renal failure

A

propylene glycol

103
Q

freshly prepared

A

<24 hours before use

104
Q

recently prepared

A

4 weeks expiry when stored 15-25 degrees

105
Q

biologic

A

derived from biological source using biotechnology e.g. MAB/insulin

106
Q

biosimilar

A

similar to existing originator biologic

active substance is similar and clinically equivalent

Not the same as a generic

e.g. absalgar (biosimilar of insuline glargine)

prescribe by brand name

107
Q

contraindications to SC route

A

prochlorperazine
chlorpromazine
diazepam

injection site reactions

108
Q

Injections dissolved in WFI

A

hypotonic = more pain

lower osmotic pressure than blood

109
Q

injections dissolved in physiological saline

A

NaCl 0.9% isotonic - more similar osmotic pressure to blood

increased precipitation when given with more than one drug

110
Q

drugs compatible with diamorphine

A

cyclizine <10ml/ml <24hrs - avoid precip

haloperidol <2ml/ml <24hrs - avoid precip

Dexamethasone
hyoscine
levomepromazine
metoclopramide
midazolam
111
Q

when to discontinue infusion

A

<24 hrs

cloudiness

crystallisation

change of colour

sign of interaction/contamination

112
Q

In an IV infusion, what must you not add drugs to

A

blood products
mannitol
sodium bicarb

113
Q

Excipients that give rise to incompatibility in infusions

A

amino acids
mannitol
sodium bicarb

114
Q

significant loss of potency of drugs occurs in infusions when

A

when added to large volume infusions

115
Q

undesirable to mix BL-ABs with what and why?

A

proteinaceous materials

immunogenic and allergenic conjugates may form

116
Q

What must you not add to IV fat emulsions

A

ABs & electrolytes

coalescence of fat globules
separation of phases

= increased possibility of embolism

117
Q

the acceptable limit for admixtures where degradation occurs without forming toxic substances

A

time taken for 10% decomp

from addition to admin to guarantee good drug potency and compatibility

118
Q

what injections must be protected from light

A

dacarbazine
sodium nitroprusside

minimise oxidation

119
Q

continuous infusion

A

diluted in large volume over long time

120
Q

intermittent infusion

A

diluted in small volume over short time

121
Q

intermittent infusion uses

A

incompatible/stable products over time e.g. ampicillin/amoxx

122
Q

When are drip tubes used for addition of drugs

A

for cytotoxic drugs

minimise extravasion

123
Q

hypoproteinaemia

A

reduced protein binding = more free drug = toxicity

warfarin
phenytoin
NSAIDS
prednisolone

124
Q

malabsorption of fat soluble vits

A

ADEK

125
Q

vit K deficiency

A

increased risk of bleeding

126
Q

Menadiol

A

water soluble vit k analogue used in fat malabsorption diseases

127
Q

reduced bile excretion

A

intrahepatic/extrahepatic obstructive jaundice

fusidic acid and rifampicin accumulate as they are excreted in bile acid

128
Q

prescribing in liver impairment

A

impaired drug metab - reduce dose

hypoproteinaemia

reduced blood clotting

malabsorption of fat sol vits

reduced bile excretion

129
Q

hepatic encephalopathy

A

constipating drugs e.g. opioids/TCADs

sedatives e.g. opioids/AHs/BDZ/Z drugs

drugs causing hypocalaemia e.g. loop/thiazide diuretics

130
Q

hepatic encephalopathy treatment

A

lactulose

131
Q

what drugs exacerbate oedema and ascites in liver disease

A

NSAIDs

corticosteroids

132
Q

hepatotoxic drugs

A 
APs
amiodarone
cbz
co-amox
cyproterone
dantrolene
fluconazole
flucloxacillin
isoniazid
itraconazole
ketoconazole
labetolol
leflunamide
MTX
paracetamol
phenothiazine
pioglitazone
rifampicin
statins
tetracyclines
valproate
zafirlukast
133
Q

signs of hepatotoxicity

A

jaundice

ab pain

NAV

malaise

weight loss

pruritus

dark urine

pale stools

drowsy/confusion

134
Q

enzyme inhibitors

A

SICKFACES.COM

sodium valproate
isoniazid
cimetidine
ketoconazole
fluconazole
alcohol
chloramphenicol
erythromycin
sulphonamide
ciprofloxacin
omeprazole
metronidazole
135
Q

enzyme inducers

A

BS CRAP GPS

barbiturates
SJW

CBZ
rifampicin
alcohol
phenytoin

griseofulvin
phenobarbital
sulphonylureas

extra bnf flashcards (6 decks)

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