Prescribing Flashcards
What dose of statin is used for primary and secondary prevention of cardiovascular disease?
Primary: 20 mg atorvastatin
Secondary: 80 mg atorvastatin
NOTE: rosuvastatin is a potent statin that is more likely to cause statin-induced myopathy
What dose of oral metronidazole is used to treat C. difficile infection?
400 mg every 8 hours for 10-14 days
Alternative: 500 mg every 8 hours
IMPORTANT: oral vancomycin should be used if it is a second episode of C. difficile colitis
What dose of omeprazole is used for peptic ulcers, gastro-oesophageal reflux and the prevention of ulcers?
Omeprazole 20 mg OD (usually for 4-8 weeks)
What is the first-line treatment option for cellulitis?
Oral flucloxacillin 0.5-1g QDS for 5-7 days then review
2nd line: oral clarithromycin 250 mg BD for 7–14 days (up to 500 mg BD for severe infections)
Which dose of cyclizine is used in nauseated patients?
Cyclizine 50 mg 8-hourly IM/IV/oral
WARNING: can cause fluid retention so avoid in heart failure
What is the maximum dose of PRN paracetamol?
Paracetamol 1 g every 6 hours (maximum 4 g/day)
Which PRN pain relief should be given for patients with mild pain?
Codeine 30 mg up to 6-hourly
Which regular medication should be prescribed for patients with severe pain?
Co-codamol 30/500, 2 tablets every 6-hours
WARNING: pay attention to how much paracetamol a patient is taking if they are taking PRN co-codamol and regular paracetamol
Which PRN medication should be prescribed for severe pain?
Morphine sulphate 10 mg up to 6-hourly
Which medications are used first-line in neuropathic pain?
Amitriptyline 10 mg oral nightly
Pregabalin 75 mg oral 12-hourly
What dose of ibuprofen should be used for pain?
Ibuprofen 400 mg 8-hourly
What is the dividing factor for dosing when switching patients from oral codeine to oral morphine?
Divide by 10
Same with oral tramadol to oral morphine
For patients with advanced and progressive disease who are in pain, what should be prescribed provided there are no comorbidities?
20-30 mg modified-release oral morphine (or immediate-release based on patient preference) - e.g. 15 mg BD
With 5 mg immediate-release oral morphine for breakthrough pain
If a patient on 30 mg morphine sulphate BD is switched onto a syringe driver, what dose of subcutaneous morphine should be given?
30 mg in 24 hours
NOTE: if changing to SC morphine from oral morphine, the dose should be divided by 2 or 3
NOTE: if changing to SC diamorphine, it should be divided by 3
What should be coprescribed in patients who develop pneumonia after influenza?
Flucloxacillin (cover S. aureus)
What does 1% mean with regards to weight/volume calculations? (e.g. 1% lidocaine)
1 g in 100 mL (i.e. 10 mg in 1 mL)
What does PReSCRIBER stand for?
Patient details (name, DOB and hospital number)
Reaction (e.g. allergy)
Sign the front of the chart
Contraindications to each drug
Route
IV fluids necessary?
Blood clotting prophylaxis necessary?
Anti-Emetic necessary?
Relief from pain?
What is the starting dose of ramipril and lisinopril in heart failure?
Ramipril: 1.25 mg OD
Lisinopril/Enalapril: 2.5 mg OD
When should ACE inhibitors be taken?
In the evening/night as it can cause postural hypotension
What dose of verapamil is used for rate control in atrial fibrillation?
40 mg 8-hourly
What is the usual daily starting dose of levothyroxine in hypothyroidism?
50-100 mcg
NOTE: in elderly patients and patients with comorbidities, a starting dose of 25 mcg OD may be used
What is the usual dose of amlodipine used for hypertension?
5 mg OD
Maximum of 10 mg OD
NOTE: it does not need to be taken at night
Which medications are usually taken at night?
Statins
Amitryptiline
ACEi
NOTE: atorvastatin can be taken at any time of the day
What is an appropriate starting regime of analgesia for palliative patients?
20-30 mg per day of modified-release morphine + 5 mg morphine for breakthrough pain
Outline the rules for converting doses of opioids.
Oral codeine –> oral morphine = divide by 10
Oral tramadol –> oral morphine = divide by 10
Oral morphine –> oral oxycodone = divide by 1.5-2
Oral morphine –> SC morphine = divide by 2
Oral morphine –> SC diamorphine = divide by 3
Which opioids are preferred in CKD?
Alfentanil, buprenorphine and fentanyl
NOTE: the same drug should be used for maintenance and break-through pain (e.g. fentanyl 50 mcg/actuation nasal spray in each nostril repeated after 10 mins if required)
Which analgesic should you prescribe to a patient with renal colic?
IM diclofenac 75 mg
How big should the breakthrough dose of morphine be?
1/6 of the daily dose
What is the starting dose of methotrexate for rheumatoid arthritis?
7.5 mg weekly
5 mg folic acid should be co-prescribed, to be taken more than 24 hours after the methotrexate dose
NOTE: methotrexate is available in 2.5 mg pills
List some p450 inducers.
PC BRAS: Phenytoin Carbamazepine Barbiturates Rifampicin Alcohol (chronic excess), Sulphonylureas St John's Wort
List some p450 inhibitors.
AOI DEVICES
Allopurinol
Omeprazole
Imidazoles (ketoconazole, fluconazole)
Disulfiram Erythromycin Valproate Isoniazid Ciprofloxacin Ethanol (acute intoxication) Sulphonamides
What are some adverse drug reactions associated with gentamicin and vancomycin?
Nephrotoxicity
Ototoxicity
Which antibiotics are particularly notorious for causing C. difficile colitis?
Cephalosporins
Ciprofloxacin
List some adverse effects of ACE inhibitors.
Hypotension
Electrolyte abnormalities (hyperkalaemia)
AKI
Dry cough
List some adverse effects of beta-blockers.
Hypotension Bradycardia Wheeze in asthmatics Worsens acute heart failure (drops CO) Worsen plaque psoriasis
List some adverse effects of CCBs.
Hypotension
Tachycardia
Peripheral oedema
Flushing
List some adverse effects of heparins.
Haemorrhage (especially if renal failure or < 50 kg)
Heparin-induced thrombocytopaenia
List some adverse effects of aspirin.
Haemorrhage
Peptic ulcers
Tinnitus
List some adverse effects of digoxin.
GI:
Nausea and vomiting
Diarrhoea
Visual:
Blurred vision
Xanthopsia (yellow-green visual perception)
Neurological:
Confusion
Drowsiness
List some adverse effects of amiodarone.
Interstitial lung disease
Thyroid disease
Grey skin
Corneal deposits
List some adverse effects of lithium.
Early - tremor
Intermediate - tiredness
Late - arrhythmias, seizures, coma, renal failure, diabetes insipidus
List some adverse effects of statins.
Myalgia - r/v if CK >5x upper limit of normal
Abdominal pain
Increased ALT/AST - r/v if transaminases >3x upper limit of normal
Rhabdomyolysis
List some common drugs that have a narrow therapeutic index.
Warfarin
Digoxin
Phenytoin
Theophylline
Which commonly used medications should be stopped before surgery?
Antiplatelets
Anticoagulants
COCP
Lithium (omit the day before surgery)
What is the usual daily dose of alendronic acid?
10 mg
NOTE: 70 mg can be given WEEKLY in patients with post-menopausal osteoporosis
List some commonly used classes of medication that cause indigestion.
NSAIDs
Steroids
Bisphosphonates
What is the usual treatment dose of enoxaparin?
1.5 mg/kg
NOTE: 40 mg is the prophylactic dose
Which medications can reduce renal excretion of lithium?
ACE inhibitors
Diuretics (particularly thiazides)
NSAIDs
NOTE: if diuretics must be used in a patient on lithium, use loop diuretics
What is the target range for TSH in a patient with hyperthyroidism?
0.5-5.0 microIU/L
When might you expect fluid input to be greater than fluid output in a patient?
Correction of dehydration
Renal failure
What are the daily maintenance requirements of fluid and potassium when NBM?
Fluid: 3 L (i.e. 1 L per 8 hours)
K+: 40-60 mmol
So, 1 L 0.9% saline/0.15% KCl over 8 hours
25–30 ml/kg/day of water and
approximately 1 mmol/kg/day of potassium, sodium and chloride
and
approximately 50–100 g/day of glucose to limit starvation
ketosis
Which type of fluid should be used for maintenance in adults who are NBM?
Provided biochemistry is normal, they should have:
1 L of 0.9% saline
2 L 5% dextrose
Every 24 hours with 40-60 mmol KCl per day
What is the first-line diabetic medication in patients with CKD?
Gliclazide (sulphonylurea)
Metformin cannot be used if GFR < 30 ml/min
What is the normal starting dose of amitryptyline?
10 mg
Which antibiotic commonly interacts with statins and how should you deal with it?
Clarithromycin
It is a CYP3A4 inhibitor and it increases the toxicity of statins.
So, statins should be stopped during the course of clarithromycin.
Which medication can give immediate relief for patients with dyspepsia?
Magnesium carbonate 10 mL TDS
What is a major contraindication for using lactulose?
Bloating
What are some major contraindications for using Senna?
Colitis and cramps
What is the main difference between the side-effects of codeine and tramadol?
Codeine - constipation
Tramadol - agitation/hallucinations
NOTE: both of them cause typical opioid side-effects (respiratory depression, reduced consciousness, pinpoint pupils)
What dose of codeine is typically used for the management of pain?
30 mg 6-hourly
NOTE: maximum daily dose is 240 mg
What is the best way of measuring the therapeutic effect of an aminophyline infusion?
Oxygen saturations will improve
What is the best way of measuring tacrolimus levels in transplant patients?
Trough level before the morning or evening dose (aim for 6-10 ng/mL)
What is the target pre-dose trough concentration for vancomycin?
10-15 mg/L
List some common side-effects of calcium channel blockers.
Neuro:
Dizziness
Drowsiness
Headache
Cardio:
Palpitations
Tachycardia
Gastro:
Abdominal pain
Nausea
Vomiting
Skin:
Flushing
peripheral oedema
Skin reactions
Outline the management of high INR in patients on warfarin.
MAJOR BLEEDING: Stop warfarin + IV 5 mg vit K + PCC (or FFP)
INR > 8.0 + minor bleeding: stop warfarin + IV 1-3 mg vit K + restart warfarin when INR < 5
INR > 8 + no bleeding: stop warfarin + 1-5 mg oral vit K + restart warfarin when INR < 5
INR 5-8 + minor bleeding: stop warfarin + IV 1-3 mg vit K + restart warfarin when INR < 5
INR 5-8 + no bleeding: withhold 1 or 2 doses of warfarin + reduce subsequent maintenance dose
When should diuretics be taken and why?
Any time except the evening because they will be up all night peeing
Which commonly used NSAID is NOT nephrotoxic?
Aspirin
NOTE: it also rarely worsens asthma
Which type of bladder stabilising drugs should be avoided in myasthenia gravis?
Anti-cholinergic (e.g. oxybutynin, solifenacin)
Use mirabegron/duloxetine instead
Which medication can be given as a one-off for acute anxiety?
2 mg diazepam PO
Which parameter is important to monitor in patients on digoxin?
Serum creatinine
It is mainly excreted renally, so patients with renal dysfunction are at risk of digoxin toxicity
Which parameter is important to check at baseline and monitor in patients receiving sodium valproate?
LFTs (ALT)
Valproate is associated with hepatotoxicity
What should you keep an eye on when giving a patient IV aminophylline?
ECG - it can precipitate cardiac arrhythmias
What should be checked to identify theophylline toxicity?
Serum theophylline level (18 hours after commencing treatment)
Target: 10-20 mg/L
NOTE: aminophylline is a stable mixture of combined theophylline and ethylenediamine
When does enoxaparin require dose-adjustment?
eGFR < 30 mL/min
Weight < 50 kg
Which commonly used diabetes drugs can cause hypoglycaemia?
Insulin
Sulphonylureas (e.g. gliclazide)
Thiazolidinediones (e.g. pioglitazone)
List some drugs that cause urinary retention?
Opioids Anticholinergics General anaesthetics, Alpha-adrenoceptor agonists, Benzodiazepines (e.g. diazepam), Non-steroidal anti-inflammatory drugs (e.g. ibuprofen), Calcium-channel blockers, Antihistamines, Alcohol.
List drugs classes that can cause confusion.
Opioids (e.g. morphine) Metoclopramide Anticholinergics (e.g. oxybutynin, tiotropium) Glucocorticoids (e.g. prednisolone) Antibiotics (e.g. co-amoxiclav) Diazepam Antipsychotics Antidepressants Anticonvulsants Beta-blockers
How should the dosing of gentamicin be changed if the peak and trough concentrations are too high?
Peak too high –> reduce the dose
Trough too high –> increase interval between doses (giving more time for clearance)
Higher the dose, the higher the peak
Name two different LMWHs and their prophylactic and treatment doses.
Tinzaparin: 4500 U (prophylactic), 175 U/kg (treatment)
Enoxaparin: 40 mg (prophylactic), 1.5 mg/kg (treatment)
NOTE: enoxaparin 40 mg = 4000 U
List some drugs that contribute to hyperkalaemia.
ACE inhibitors/ARB Heparins (inhibit aldosterone synthesis) Tacrolimus Spironolactone/amiloride NSAIDs
When should aspirin be stopped before surgery?
7 days
How should patients on warfarin be advised ahead of elective surgery?
Stop warfarin 5 days before surgery
If INR > 1.5 on the day before surgery, give 1-5 mg vitamin K PO
Which monitoring parameter may rise slightly in patients started on ACE inhibitors?
Creatinine - but a rise < 20% is no cause for concern and treatment should continue (repeat U&E after 1 week)
What is the best gauge of whether chronic heart failure treatment (i.e. ACE inhibitors, beta-blockers) are working?
Exercise tolerance
How should the usual dose of insulin in a type 1 diabetic be changed if their blood glucose is being deranged due to the use of steroids?
Increase insulin dose by 10%
When should patients be reviewed after starting a statin?
Measure total cholesterol, LDL and HDL 3 months after starting treatment
Aim for > 40% reduction in non-HDL cholesterol
If failed to achieved –> discuss adherence, consider increasing dose
What medication should you prescribe for a mild CAP?
Amoxicillin 500 mg TDS for 5 days
Penicillin allergy: clarithromycin 500 mg BD for 5 days
What medication should you prescribe for a HAP?
Piperacillin with tazobactam (aka tazocin) 4.5 g TDS IV
How should acute dystonic reactions be treated?
Procyclidine
Which steroid should be given to patients with an acute exacerbation of COPD?
30 mg prednisolone OD for 5 days
Describe the interaction between warfarin and clarithromycin.
Clarithromycin increases the effect of warfarin (thereby leading to a rise in INR)
How should patients be advised after missing one pill?
Take the missed pill and continue as per usual
They will be protected anywhere in the cycle
Which diabetes drug used to lower lipids does simvastatin interact with leading to myotoxicity?
Gemfibrozil
What should be checked and corrected before starting amiodarone?
Serum potassium
Because amiodarone can cause hypokalaemia
How is phenytoin monitored?
Trough level
Therapeutic at 10-20 mg/L
What are the main risks of using metoclopramide?
Cardiac conduction disorders as it causes QTc prolongation (e.g. electrolyte disturbances)
Extra-pyramidal side-effects (avoid if already on an antipsychotic)
What dose of aciclovir should be used to treat shingles in adults?
800 mg 5 times daily for 7 days
List some common drugs that can cause ankle oedema.
CCBs (e.g. amlodipine)
Naproxen
What should you do with a patient’s normal long- and short-acting insulin regimes when you start treating them for DKA?
Stop short-acting
Continue long-acting
Place on fixed-rate insulin infusion
How should you advise patients to take loperamide?
4 mg followed by 2 mg after each loose stool up to a maximum of 16 mg/24 h
What monitoring is required in patients taking ciclosporin?
Liver and kidney function
NOTE: it is not myelotoxic
Which opioid is safe to use in mild to moderate renal impairment?
Oxycodone - it is mainly metabolised by the liver
In a patient with DKA, what range of serum K+ warrants giving fluids with KCl?
3.5-5.5 mmol/l - use 0.9% saline + 40 mmol/L of potassium replacement
Name a commonly used NSAID that can cause hepatitis.
Diclofenac
What is the maximum rate at which fluids containing potassium can be given through a peripheral cannula?
10 mmol/hour
NOTE: rates above 20 mmol/hour needs cardiac monitoring
How many mmol of KCl are in 1 L of 0.3% potassium?
40 mmol
How should long-term prednisolone dose be changed in patients who are acutely unwell?
Double it
What is the dose of nebulised adrenaline that should be given in severe croup?
400 micrograms/kg
Why shouldn’t diltiazem and verapamil be used in heart failure?
Worsens fluid retention
NOTE: if AF in heart failure, digoxin should be used
Which anti-epileptic is safest to use in pregnancy?
Lamotrigine
Which are the best anti-epileptics for focal epilepsy?
Lamotrigine
Carbamazepine
In which patients with newly diagnosed T2DM should you avoid using metformin?
Underweight (as it causes appetite suppression)
Creatinine > 150 umol/L (risk of lactic acidosis)
In these scenarios, use gliclazide instead
What should be checked before starting treatment with atypical antipsychotic drugs?
Fasting blood glucose
How do you manage a Parkinson’s disease patient who is nil by mouth?
Get an urgent SALT assessment
Consider inserting NG tube
Consider prescribing rotigotine patch
Which medications can be used to reduce secretions in palliative care?
Glycopyrronium
Hyoscine
NOTE: these are usually SC injections
List some medications that exacerbate heart failure.
NSAIDs (fluid retention) Glucocorticoids (fluid retention) Verapamil and diltiazem (negative inotrope and fluid retention) Pioglitazone (fluid retention) Flecainide Cyclizine (fall in cardiac output)
How do you convert from morphine to alfentanil and fetanyl?
Morphine –> Alfentanil (divide by 30)
Alfentanil –> Fentanyl (divide by 5)
Breakthrough fentanyl = 1/8th of daily dose
Which medications should be stopped before surgery?
Insulin Lithium Anticoagulants/antiplatelets COCP/HRT K+ sparing diuretics and ACE inhibitors Oral hypoglycaemics (metformin) Perindopril and other ACE inhibitors
Which commonly used drugs should be avoided in peripheral vascular disease?
Beta-blockers
ACE inhibitors
Which medication can be used as an alternative to LMWH in patients with VTE and a phobia of needles?
Apixaban 10 mg BD for 7 days
Which medication is used for agitation in palliative care?
Midazolam
NOTE: haloperidol should be used for patients with hallucinations
Which types of seizures can be treated with sodium valproate?
Tonic
Generalised
Absence (also ethosuximide)
Myoclonic
TAGM
Describe the equivalent doses between prednisolone and hydrocortisone.
5 mg prednisolone = 20 mg hydrocortisone
What is the maximum dose of lidocaine that can be administered as local anaesthetic?
3 mg/kg without adrenaline
7 mg/kg with adrenaline
In which patients should 5% dextrose be avoided?
Stroke - increased risk of cerebral oedema
Unless maintaining glucose at 5-15mmol/L
Which courses of steroids require weaning?
More than 40 mg prednisolone daily for 1 week
More than 3 weeks treatment
Repeated courses
Which antibiotic is usually used for surgical prophylaxis?
Ceftriaxone 2 g IV stat
How should a patient be switched from an insulin infusion to SC insulin?
VRIII should be stopped at breakfast or evening meal only (not at midday meal)
Administer usual dose of mixed insulin.
Allow patient to eat meal as normal.
Stop intravenous insulin infusion 30 minutes later.
Common side effect of furosemide
Dizziness from dehydration
Which vaccinations are recommended in pregnant patients?
Pregnant women are advised to have a whooping cough vaccination and a flu vaccination during pregnancy
Low TSH
Normal T4 levels
For a patient treated on levothyroxine
Reduce the dose of levothyroxine by 25mg as the TSH is being suppressed
Which Abx for UTIs is safe to use throughout pregnancy?
Cefalexin 500mg PO twice daily for 7 days
Which drugs are classed as weak opioids?
Codeine, Dihydrocodeine or Tramadol
In AKI which T2DM drug should be stopped?
Metformin
Advice on taking bisphosphonates
Swallowed whole with water while sitting or standing.
On an empty stomach at least 30 minutes before breakfast (or another oral medicine)
Should stand or sit upright for at least 30 minutes after
tablet
How often should a patient be monitored if they are taking prednisolone?
Patients should be reviewed regularly, every 3 months or within one week of a change in dose
of prednisolone
Before administering adenosine what should you warn patients
They will experience chest discomfort and a sensation that people describe as ‘feeling like they are about to die’
What would you prescribe for oral candidiasis?
Miconazole oral gel
What drugs commonly cause dyslipidemia?
Thiazide diuretics are well-recognised causes of dyslipidaemia. Thiazides inhibit lipoprotein
lipase in capillaries which leads to an increase in the circulating concentration of VLDL and other
triglyceride-rich circulating lipoproteins.
A patient develops a dry cough on ACEi, what should they start as a replacement?
ARB
Why should patients starting metronidazole avoid alcohol?
Patients taking metronidazole may experience a disulfiram-like reaction when they drink alcohol.
Mx of urticaria
Cetirizine Hydrochloride 10 mg oral once a day
Mx of Scabies
Permethrin 5% Cream 1 application topical STAT
What drug when prescribed with sertraline increases your risk of serotonin syndrome?
Sumatriptan
How often should a young T1DM patient check their blood glucose?
Children and young people with diabetes should be advised to self-monitor their blood glucose,
by performing at least five capillary blood glucose tests per day. Note that more frequent testing
may be needed during periods of physical activity and during intercurrent illnesses.
Which class of diabetic medications can increase your risk of UTIs?
Gliflozins (e.g. dapagliflozin) increase your chances of developing a UTI as they lower blood
sugar by increasing excretion of glucose in the urine. The high levels of urinary glucose which
acts as a good medium for bacterial growth, increasing the risk of UTI
Two common side effects of tamoxifen
VTEs
Hot flushes
Drugs that worsen psoriasis
trauma
alcohol
drugs: beta-blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
withdrawal of systemic steroids
Monitoring requirements for Leflunomide
FBC and LFTs every 2 weeks
Management of Impetigo
1st line: topical Fusidic Acid
2nd line: oral flucloxacillin
Common side effects of Prednisolone
Fluid retention
Abdo pain
Indigestion
Monitoring requirements starting methotrexate
Monitor:
FBC, U&Es and LFTs every 1–2 weeks until therapy stabilised
Thereafter patients should be monitored every 2–3 months.
Anti tussive used in palliative care
chlorpromazine or haloperidol
Which anticoagulant causes hyperkalaemia?
Heparins (e.g. dalteparin)
When should you avoid nitrofurantoin?
eGFR < 45
INR > 1.5 the day before a surgery. Mx?
Phytomenadione (Vit K) 2mg PO
How would you manage a transient rise in blood glucose in a diabetic caused by corticosteroids?
An increase in the dose of insulin by 10% rather than adding another type of insulin such as act rapid
The expected decrease in non HDL cholesterol when treated with an adequate dose of statins
After three months >40% decrease
When should you test gentamicin levels?
6-14 hours after the first dose
These are the values on the X axis of the chart
How can you calculate how a unit of insulin would affect a patients blood glucose?
100/ daily insulin intake = number of mmol per unit of insulin
Target blood glucose for a patient going into surgery
Usually 6-10
Which drugs are contraindicated in patients with PVD?
Beta - adrenoreceptor blockers (atenolol)
ACEi (cautioned)
Drugs that increase the risk of thrush
Antibiotics
Systemic steroids
How long should you treat scarlet fever for and what drug?
Phenoxymethylpenicillin 125mg PO 6 hrly
10 days
Target INR for a mechanical heart valve?
3-4
How can you find information about morphine to fentanyl conversions
Prescribing in palliative care section
Analgesia for a patient currently in labour
Nitrous oxide
Treatment for hyperphosphataemia
Calcium carbonate
Chlamydia treatment in pregnancy
Erythromycin
What urine output should make you suspect the polyuric phase of recovery from aki?
Urine output >200mL/h
What needs to be monitored at baseline and thereafter with olanzapine?
Baseline lipids, then every 3 months, then annual
ECG to establish QTc one week after starting
Sick day rules for steroids?
Double them
How to prescribe laxatives like senna?
As 2 tablets
Or sachets
Which drugs should be prescribed by brand name?
Modified release calcium channel blockers
HRT
Drugs safe to use during breastfeeding?
antibiotics: penicillins, cephalosporins, trimethoprim
endocrine: glucocorticoids (avoid high doses), levothyroxine*
epilepsy: sodium valproate, carbamazepine
asthma: salbutamol, theophyllines
psychiatric drugs: tricyclic antidepressants, antipsychotics**
hypertension: beta-blockers, hydralazine
anticoagulants: warfarin, heparin
digoxin
Drugs not safe to use during breastfeeding?
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides psychiatric drugs: lithium, benzodiazepines aspirin carbimazole methotrexate sulfonylureas cytotoxic drugs amiodarone
Drugs which decrease serum potassium?
Thiazide diuretics
Loop diuretics
Acetazolamide
Drugs which increase serum potassium?
ACE inhibitors Angiotensin-2 receptor blockers Spironolactone Potassium sparing diuretics (amiloride, triamterene) Potassium supplements (Sando-K, Slow-K)
What reaction can NAC cause and how does it occur?
anaphylactoid reaction (non-IgE mediated mast cell release)
Symptoms of cholinergic toxicity?
Salivation Lacrimation Urination Diaphoresis GI distress Emesis
Symptoms of anti-cholinergic toxicity?
Hot as a hare Dry as a bone Blind as a bat Red as a beet Mad as a hatter
Which medications are usually given weekly?
Bisphosphonates
Methotrexate
Digoxin monitoring?
at least 6 hrs post-dose
Which meds are likely to worsen seizure control?
alcohol, cocaine, amphetamines ciprofloxacin, levofloxacin aminophylline, theophylline bupropion methylphenidate (used in ADHD) mefenamic acid
Drugs CI in asthma?
NSAIDs
beta-blockers
adenosine
Which drugs should be used with caution in patients with ischaemic heart disease?
NSAIDs
oestrogens: e.g. combined oral contraceptive pill, hormone replacement therapy
varenicline
When to transfuse in IDA?
Severely symptomatic
Hb <70 or <80 if ischaemic heart disease
1st line medication for GAD?
SSRI
What predisposes to digoxin toxicity?
Hypokalaemia
What should be monitored during phenytoin loading?
ECG - arrhythmias
What electrolyte imbalance do thiazides cause?
Hyponatraemia
Hypokalaemia
Hypercalcaemia
Which medications can reduce hypoglycaemic awareness?
Beta-blockers
How to reduce the dose if trough levels are too high for gentamicin?
Increase the interval between doses
What is the correction factor with regards to insulin and how do you calculate it?
Correction factor = effect of 1 unit of insulin on BM
CF = 100/total daily insulin dose
Allows you to figure out how much extra rapid acting insulin to prescribe
What needs replacing first in refeeding syndrome? What can you use?
Phosphate
Phosphate polyfusor
How to prescribe frequency of oxygen?
Continuous
How can you dose oxygen?
If non-rebreathe: flow rate in L/min
If venturi: percentage on the mask
What should you do about contraception if someone is taking an enzyme inducer?
Change to a contraceptive method not affected by enzyme inducers during tx and for at least 4 weeks afterwards
What percentage solution of KCl contains 40mmol of potassium?
0.3%
Which abx for UTI can be co-prescribed with methotrexate?
Nitrofurantoin
Scarlet fever tx?
Phenoxymethylpenicillin
What to do if 1 COCP missed at any point in cycle?
take the last pill even if it means taking two pills in one day and then continue taking pills daily, one each day
no additional contraceptive protection needed
What to do if 2 COCP missed in week 1 (day 1-7)?
Take last pill (even if 2 on one day)
Emergency contraception if sex in pill free interval or week 1
What to do if 2 COCP missed in week 2 (day 8-14)?
Take last pill (even if 2 on one day)
Don’t need emergency contraception
What to do if 2 COCP missed in week 3 (day 15-21)?
Take last pill (even if 2 on one day)
Finish pills in current pack
Omit pill free break and start new pack next day
Which method of emergency contraception makes the POP less effective for 5 days?
Levonelle
What to do if 1 traditional POP (3 hours) or desogestrel POP (12 hours) missed?
Take missed pill
If more than one pill missed - just replace one missed pill
Use additional contraception for 48 hours
If sex during pill free interval needs emergency contraception
Important complication to watch out for in patients on SSRIs prescribed a new medication?
Serotonin syndrome
e.g. addition of tramadol
What BP would require HRT to be stopped?
160/95
When should the effect of HRT be reviewed?
3 months after starting tx
