prescribing Flashcards
Common SE of oral cortiscosteroids e.g. beclometasone?
sore mouth due to oral candidiasis as local suppression of cellular immune response
can then cause odynophagia & altered taste
common SE of broad spectrum abx e.g. amoxicillin?
sore mouth
diuretics that can cause hypokalaemia?
loop: furosemide, bumetanide
thiazide: bendruflumethiazide, indapamide
caution of SE of amiodarone
hypokalaemia
what happens to diabetes medications before surgery?
oral metformin: stop –> cause lactic acidosis
use sliding scale: hourly blood glucose monitoring to adjust hourly dose of insulin for much tighter control
common adverse effects of ACEi e.g. ramipril
persistent dry cough, hyperkalaemia, increase in serum creatinine
may have profound hypotension when first dose
may cause AKI, cholestatic jaundice/hepatitis
angioedema, hypersensitivity rxns
NSAID + ACEi interaction can cause hyperkalaemia
name a situation where prophylactic heparin is contraindicated
acute ischaemic stroke: risk of bleeding into stroke
What should you be cautious of when prescribing NSAIDs?
NSAID:
no urine e.g. renal failure
systolic dysfunction e.g. HF - can worsen HF due to release of vaso-constrictive mediators
asthma
indigestion, headache
dyscrasia: clotting abnormality
*aspirin is NAID but ok in renal failure, HF, asthma
treatment for haemophilia A? What is its function
desmopressin: boost factor VIII levels
most important 2 treatments in anaphylaxis
adrenaline 500mcg = 0.5ml of 1:1000, IM
high flow oxygen
first line treatment for DVT?
apixaban, rivaroxaban
is aspirin an NSAID?
what SE can aspirin cause?
yes
is also an antiplatelet
GI ulcers/bleeding, iron-def anaemia
bronchospasm: CONTRAINDIC in ASTHMA
what main common adverse effects can rampiril cause?
hyperkalaemia
increase serum creatinine
dry cough
first dose: hypotension
What drugs can cause urinary retention?
morphine/opioids
antichocholinergics: antipsychotic, antidepressant,
anticholinergic resp agents, detrusor relaxants benzodiazepines NSAIDs CCB antihistamine general anaesthetics alpha-adrenoceptor agonists alcohol
Common side effects of gentamicin
nephrotoxicity, tinnitus/impaired hearing, skin rxns
what common drug may clarithromycin interact with?
simvastatin: metab by cytochrome p450
clarithromycin interacts with many drugs metabolised via cytochrome p450 system
Name some side effects/cautions to take for lithium therapy
impaired renal function
nephrotic syndrome, nephrogenic DI
COmmon SE of HRT
sodium/fluid retention –> rise BP
diuretic causing hypokalaemia
thiazides
loop diuretic
meds that can cause hyperkalaemia
spirinolactone ramipril NSAID: dicofenac sodium dalteparin tacrolimus metformin
which meds are normally taken at night?
statins
amitriptyline
what is vitamin K called on BNF?
phytomenadione
managing over anticoag:
INR <6
reduce warfarin dose
managing over anticoag:
INR 6-8:
withhold warfarin for 2 days then reduce dose
managing over anticoag:
INR >8:
if minor bleeding with INR>5?
wtihhold warfarin + give 1-5mg oral vit K
if minor bleeding with INR>5: give IV isntead of oral vit K 1-3mg
hypoglycaemia treatment
deliver 10-20g glucose
Glucose 20% IV 15min, 50-100ml OR
glucose 10% 100-200ml
bm <4 + conscious: glucojuice bottles <4 + confused: glucogel in gums/cheecks <4 + unconscious: IV glucose im glucagon: NOT if alcohol, malnutrition once conscious: sugar drinks, meal
nephrotoxic drugs
ACEi/ARB, NSAIDs, aminoglycosides: gentamicin, contrast media, metformin accumulate in renal dysfunction, some diuretics e.g. furosemide, spironolactone
allopurinol
medications causing confusion
benzodiazepine
analgesics: narcotics, NSAIDs
glucocorticoid
anticonvulsants, antiparkinsonian
29 y/o: tremor, nausa. Stopped drinking alcohol 2 days ago. PMH: heavy alcohol consumption, appears anxious. What to give?
chlordiazepoxide
what to give if 1 day before surgery, INR >1.5?
phytomenadione - vit k 1-5mg
what must you monitor for pt on ciclosporin?
renal function: creatinine
most serious adverse effect is nephrotoxicity, hypertension due to vasoconstrictive effects on renal arterioles
renal fx monitoring > FBC (leucopenia, thrombocytopenia)
what change in cholesterol level is considered adequate treatment following statin?
> 40% reduction in non-HDL cholesterol
which anti-emetic is contra-indicated in PD
metoclopramide
what is the antidote for heparin?
protamine
what medications are contra-indicated in peripheral vascular disease?
beta blocker: cause vasoconstriction
ACEi cautioned in severe PVD e.g. critical ischaemia
5 y/o: fever, sore throat, runny nose, red throat, strawberry tongue, enlarged tonsils no exudate, swollen LN in neck, blanching macular red rash over trunk/back/upper/lower limbs = ? dx
how to treat?
scarlet fever
phenoxymethylpenicillin
prescribing opioids:
If pt has poor renal function, what may be considered?
oxycodone
avoidmorphine in renal impairment
what medications exhibit anti-cholinergic activity?
antidepressants antipsychotics anti-emetics anti-histamines benzodiazepines
when prescribed tgt: may contribute to confusion, cog impairment, falls
meds that cause hyperglycaemia
steroids 2nd gen antipsychotics e.g. olanzapine tacrolimus BB thiazides
meds that cause hypontraemia
SSRI e.g. citalopram, fluoxetine
carbamazepine
PPI
meds that cause long QTc
F: <70
M: <470
antipsychotics, antidepressants, anti-emetics
BB, anti-arrhythmics: flecainide (Na), amiodarone (K+)
some abx: cipro, erythro
what drugs need to be stopped befor surgery?
COCP, HRT lithium K+ sparing diuretics, ACEi anticoag, antiplatelets oral hypoglycaemic drugs, insulin
sodium valproate isoniazid cimetidine ketoconazole fluconazole alcohol: binge chloramphenicol erythromycin sulphonamides: e.g. sulfasalazine ciprofloxacin omeprazole metronidazole allopurinol disulfiram
enzyme inhib or inducers?
CYP450 enzyme inhibitors: increase e.g. warfarin activity
st john's wort carbamazepine rifampicin alcohol: chronic phenytoin phenobarbitone sulphonylureas
enzyme inhib or inducers?
CYP450 enzyme inducers: decrease e.g. warfarin activity
what common drugs interact with lithium and can cause toxicity?
ACEi
diuretic: thiazide; spirinolactone better diuretic with lithium
NSAID
drugs causing hyponatraemia
SSRI: citalopram, fluoxetine
PPI
carbamazepine
what abx to use for CAP if allergic to amox?
clari or erythromycin
what abx to use for HAP?
Within 5 days of admission: co-amoxiclav or cefuroxime
More than 5 days after admission: piperacillin with tazobactam OR a broad-spectrum cephalosporin (e.g. ceftazidime) OR a quinolone (e.g. ciprofloxacin)
Treatment of C diff: 1st line, 2nd line:
metronidazole
then vancomycin
what to give in neuroleptic malignant syndomr?
Dopamine agonist: bromocriptine, dantrolene
what to give in serotonin syndrome?
serotonin antag: cyproheptadine, chlorpromazine
benzo, ivf…
Tx of EPSE (e.g. haloperidol), oculogyric crisis, acute dystnonic rxn
procyclidine
tx for mod - severe tardive dyskinesia
tetrabenazine
contraindic: depression, HD
what’s the value of lithium where it becomes fatal?
> 1.5mmol
0.4-1
