Prescribing in Patients with Conditions

Question 1

What drugs are contraindicated in heart failure?

Answer 1

• Thiazolidinediones: pioglitazone is contraindicated as it causes fluid retention
• Verapamil: negative inotropic effect
• NSAIDs/Glucocorticoids: should be used with caution as they cause fluid retention
• Class I antiarrhythmics; flecainide (negative inotropic and proarrhythmic effect)

Question 2

What drugs are may worsen epilepsy?

Answer 2

• Alcohol, cocaine, amphetamines
• Ciprofloxacin, levofloxacin
• Aminophylline, theophylline
• Buproprion
• Methylphenidate (used in ADHD)
• Mefenamic acid

Question 3

What drugs may provoke seizures when being withdrawn?

Answer 3

• Benzodiazipines
• Baclofen
• Hydroxyzine

Question 4

Other drugs may worsen epileptic seizure control?

Answer 4

P450 inhibitors/inducers

Question 5

What medications should be used with caution in ischaemic heart disease?

Answer 5

• NSAIDs
• Oestrogens: e.g. combined oral contraceptive pill, hormone replacement therapy
• Varenicline (Rx to stop smoking)

Question 6

What drugs should be avoided in renal failure?

Answer 6

• Antibiotics: tetracycline, nitrofurantoin
• NSAIDs
• Lithium
• Metformin

Question 7

What drugs might accumulate in renal failure and thus need dose adjustments?

Answer 7

• Most antibiotics including penicillins, cephalosporins, vancomycin, gentamicin, streptomycin
• Digoxin
• Atenolol
• Methotrexate
• Sulphonylureas
• Furosemide
• Opioids

Question 8

What drugs are relatively safe in renal failure?

Answer 8

• Antibiotics: erythromycin, rifampicin
• Diazepam
• Warfarin