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Preliminary chapters > Prescribing in hepatic + renal impairment > Flashcards

Prescribing in hepatic + renal impairment Flashcards

1
Q

Characteristics of Chronic liver disease

A

Oedema
- Build up of fluid in body: usually lower legs + ankles

Ascites
- Build up of fluid in lining of abdomen (peritoneal cavity)

Exacerbated by: NSAIDs, corticosteroids

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2
Q

Hepatotoxic drugs

A
  • Amiodarone
  • Carbamazapine
  • Co-amoxiclav
  • Flucloxacillin
  • Isoniazid
  • Azole
  • Methotrexate
  • Rifampicin
  • Statins
  • Tricyclines
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3
Q

Signs and symptoms of hepatotoxicity

A
  • Jaundice
  • Abdominal pain
  • N+V
  • Weight loss
  • Pruritus
  • Dark urine
  • Pale stools
  • Lab: inc liver enzymes
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4
Q

LFT

A
  • Hepatocellular damage → HIGH ALT + AST
  • Cholestatic/obstructive jaundice → HIGH ALP + GGT
  • Jaundice → HIGH bilirubin
  • Severe liver disease → LOW albumin
  • Liver failure → HIGH prothrombin time/INR
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5
Q

AKI

A

Risk factor: dehydration, eGFR <60ml/min

Sick day rules: restart 24-28hrs after normal eating + drinking

  • Diuretic (exacerbate dehydration + electrolyte imbalance)
  • ACE/ARB (nephrotoxic + red eGFR)
  • Metformin (risk of lactic acidosis)
  • NSAIDS (nephrotoxic + red eGFR)
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6
Q

Nephrotoxic drugs

A
  • ACEi/ARB
  • Ciclosporins
  • Methotrexate
  • NSAIDs
  • Aminoglycosides
  • Aminosalicylates
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7
Q

Signs + symptoms of AKI

A
  • Red urine output
  • N+V
  • Confusion + drowsiness
  • Abdominal pain
  • Lab: inc serum creatinine + red eGFR + CrCl
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8
Q

eGFR

A
  • 90: normal/high
  • <90: mild
  • <60: mild/moderate
  • <45: moderate/severe
  • <30: severe
  • <15: kidney failure
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9
Q

Enzyme inhibitors

A

Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol (binge)
Chloramphenicol
Erythromycin + clarithromycin
Sulphonamide
Ciprofloxacin
Omeprazole
Metronidazole
Trimethoprim

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10
Q

Enzyme inducers

A

Barbituates
St John’s Wort
Carbamazapine
Rifampicin
Alcohol (chronic)
Phenytoin

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11
Q

Grapefruit juice interactions

A

Inhibits CYP3A4 → inc plasma conc

  • CVS: amiodarone, dihydropyridine CCB, statins, verapamil
  • CNS: sertraline, quetiapine
  • Immunosuppressants: tacrolimus, ciclosporin
  • Other: phosphodiesterase-type 5 inhibitors, colchicine
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12
Q

Drugs that colour urine: red

A
  • Dantron
  • Doxorubicin
  • Levodopa (bodily secretions)
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13
Q

Drugs that colour urine: orange

A
  • Rifampicin (bodily secretions)
  • Sulfasalazine (bodily secretions)
  • Co-danthrusate
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14
Q

Drugs that colour urine: yellow/brown

A
  • Nitrofurantoin
  • Senna
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15
Q

Drugs that colour urine: pink/orange

A

Phenindione

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16
Q

Drugs that colour urine: blue

A

Triamterene

17
Q

Drugs that colour urine: pink/red

A

Nefopam

Preliminary chapters (4 decks)

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