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Medicine Year 5 > Prescribing safety assessment > Flashcards

Prescribing safety assessment Flashcards

1
Q

List drugs which can cause urinary retention

A
  • Opioid analgesia, especially post-op
  • Anticholinergics - antipsychotics, antidepressants, respiratory anti-muscarinics, detrusor relaxants
  • General anaesthetics
  • Alpha-adrenoreceptor agonists
  • Benzodiazepines
  • NSAIDs
  • Calcium-channel blockers
  • Antihistamines
  • Alcohol
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2
Q

List drugs which can cause confusion

A
  • Opioids, benzodiazepines, Z-drugs
  • Anticholinergics - antipsychotics, antidepressants, respiratory anti-muscarinics, detrusor relaxants
  • Anticonvulsants
  • Histamine H2 receptor antagonists
  • Digoxin
  • Beta-blockers
  • Steroids
  • NSAIDs
  • Antibiotics - fluoroquinolones
  • Lithium
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3
Q

Monitoring required for statins

A

Liver enzymes measured pre-treatment, at 3 months and at 12 months

If transaminases raised but within 3x upper limit of normal no need to stop statin
If more than 3x upper limit of normal should discontinue

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4
Q

When should gentamicin concentration be measured?

A

Trough levels - just before next dose

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5
Q

If peak gentamicin concentration and trough gentamicin concentration are increased, how should the gentamicin prescription be adjusted?

A

Decrease dose, increase interval between doses

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6
Q

Drug of choice for symptoms of acute heart failure (oedema, SOB)

A

IV furosemide

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7
Q

Management for hypoglycaemia with reduced consciousness

A

IV glucose 20% - 50-100ml over 15 minutes
(10% if not available - 100-200ml over 15 minutes)

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8
Q

Oral antibiotic for moderate - severe acne

A

Lymecycline
Oxytetracycline
Tetracycline

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9
Q

List drugs which can cause hyperkalaemia

A

ACE inhibitors
ARBs
Potassium-sparing diuretics
Heparins
Beta-blockers
Digoxin
NSAIDs
Cyclosporin
Tacrolimus

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10
Q

List drugs which should be stopped prior to surgery and when they should be stopped

A

Antiplatelets - stop 7-10 days prior to surgery, use LMWH/UFH instead if high risk
Combined hormonal contraceptive - stop 4 weeks prior to surgery (major elective surgery, surgery involving immobilisation of lower limbs, surgery to pelvis) and use alternative contraceptive
HRT - stop 4-6 weeks prior to surgery (major surgery under general anaesthesia)
Oral anti-hyperglycaemics - sometimes omit doses?

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11
Q

List drugs which can cause hyperglycaemia

A

Steroids
Thiazide diuretics
Antipsychotics
Phenytoin
Protease inhibitors
Cyclosporin
Tacrolimus

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12
Q

List drugs which can cause hyponatraemia

A

SSRIs
Thiazide diuretics (+ other diuretics)
Antipsychotics
Carbamazepine
Others (less common) - opioids, ACEi, ARBs, PPIs, anticonvulsants, amiodarone, theophylline, dopamine antagonists, antidiabetics, NSAIDs, MDMA, desmopressin, oxytocin

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13
Q

Management of acute alcohol withdrawal

A

Long-acting benzodiazepine - chlordiazepoxide, diazepam
(+ lorazepam if seizures occur)

Prevention of Wernicke’s - IV pabrinex then oral thiamine

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14
Q

List drugs which can cause hypoglycaemia

A

Insulin
Sulphonylureas - highest risk of oral antihyperglycaemics
Other oral antihyperglycaemics (DDP-4 inhibitors, pioglitazone, metformin, SGLT2 inhibitors, GLP-1 mimetics) usually low risk but can contribute when combined

Others:
Beta-blockers
Fluoroquinolones
ACE inhibitors

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15
Q

How should contraception be managed in a woman taking the COCP and a liver enzyme-inducing drug concurrently?

A

Use alternative contraception for duration of treatment and until 4 weeks after enzyme-inducing drug stopped

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16
Q

How should contraception for a woman taking a teratogenic drug be managed?

A

Preferred method is copper or progestogen coil

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17
Q

List drugs which can precipitate/worsen heart failure

A

NSAIDs
Anaesthesia
Oral antihyperglycaemics - metformin, pioglitazone, DPP-4 inhibitors
Antiarrhythmics - flecainide, dronedarone
Alpha blockers - doxazosin
Calcium channel blockers - diltiazem, verapamil, nifedipine
Antifungals - intraconazole, amphotericin B
Chemotherapy - doxorubicin, cyclophosphomide, mitomycin
Biologics
Antiepileptics - carbamazepine
Citalopram
Antiparkinsons
Antipsychotics - clozapine
Lithium
Hydroxychloroquine

18
Q

List drugs that can cause cough

A

ACE inhibitors
Beta-blockers
NSAIDs
Calcium channel blockers

19
Q

List drugs that can cause oedema

A

Calcium channel blockers - amlodipine, nifedipine, felodipine
Insulin
Pioglitazone
NSAIDs
Steroids
Sex hormones e.g. COCP, HRT
Antipsychotics
Bisphosphonates
Chemotherapy
Anticonvulsants - gapapentin, pregabalin
MAOIs

20
Q

List drugs which can cause hypokalaemia

A

Diuretics - thiazide + loop
Beta-agonists e.g. salbutamol, salmeterol
Insulin
Theophylline
Steroids
Laxatives
Antibiotics - penicillin, aminoglycosides
Antifungals - amphotericin B
Aciclovir
Verapamil overdose

21
Q

List drugs that can cause myopathy

A

Statins (+ drugs which interact with and increase exposure to statins)
Steroids
Immunosuppressants
Antibiotics - ciprofloxacin, norfloxacin, ofloxacin
Chemotherapy agents - docetaxel, vincristine
Bisphosphonates

22
Q

List drugs which commonly cause diarrhoea

A

PPIs
H2 receptor antagonists
SSRIs
Antibiotics
Metformin, sulphonylureas
Methotrexate
Iron
NSAIDs
Magnesium containing antacids

23
Q

List drugs that commonly cause dyspepsia

A

Aspirin
NSAIDs
Iron
Antibiotics
Alpha-blockers
Antimuscarinics
Benzodiazepines
Beta-blockers
Bisphosphonates
Calcium channel blockers
Steroids
Nitrates
Theophylline
Tricyclic antidepressants

24
Q

List drugs that commonly cause bradycardia

A

Beta-blockers
Calcium channel blockers
Alpha-blockers
Digoxin
Phenytoin
Tricyclic antidepressants
Lithium

25
Q

List drugs that can cause bleeding

A

Anticoagulants - heparin, warfarin, DOACs
Antiplatelets - aspirin, clopidogrel, dipyridamole, prasugrel, ticlopidine
NSAIDs
SSRIs/SNRIs

+ Drugs that interact with and increase exposure (e.g. warfarin and liver enzyme inhibitors)

26
Q

List drugs that commonly cause constipation

A

Opiates
Anticholinergics
Antimuscarinics
Antimotility e.g. loperamide
Antipsychotics e.g. clozapine
Benzodiazepines
Iron
Tricyclic antidepressants
Antihistamines

27
Q

List drugs which should be witheld/altered in AKI

A

Drugs which can cause renal toxicity:
Contrast media
ACEi
NSAIDs
Diuretics
ARBs
Bisphosphonates
Colchicine

Drugs which may accumulate due to reduced renal excretion and cause toxicity:
Opioids
Benzodiazepines
Antibiotics - aminoglycosides, penicillins, tetracyclines, trimethoprim, vancomycin
Antifungals - amphotericin, fluconazole
Antivirals - aciclovir, ganciclovir
Phenytoin
Pregabalin, gapapentin
Levetiracetam
Hypoglycaemis
Calcineurin inhibitors - ciclosporin, tacrolimus
Methotrexate
Allopurinol
Antihistamines
Antipsychotics
Digoxin
Statins, fibrates
Lithium
LMWH
Warfarin

Risk of hyperkalaemia:
Trimethoprim
ACEi/ARBs
Potassium-sparing diuretics
Calcineurin inhibitors - ciclosporin, tacrolimus
Digoxin

28
Q

When is oxycodone used instead of morphine for pain management?

A

Morphine not tolerated e.g. nausea, anorexia, GI discomfort
Severe renal failure - GFR below 30

29
Q

Describe a typical analgesia regimen for pain in palliative care

A

Initially titrate dose of regular immediate-release morphine
Breakthrough doses of immediate-release morphine given at one tenth to one sixth of regular 24-hour dose, repeated 2-4 hourly as required
Can also use nasal, buccal or sublingual fentanyl for breakthrough
Once pain controlled can be switched to equivalent modified- release morphine with 12-hourly or 24-hourly administration

Can give continuous subcutaneous infusion of morphine (or diamorphine) if patient becomes unable to swallow

Can give transdermal fentanyl or buprenorphine, not used for acute pain or rapidly changing analgesia requirements as long time to steady state, with immediate-release morphine or nasal/buccal/sublingual fentanyl given for breakthrough pain

30
Q

Describe VTE prophylaxis for surgical patients

A

Pharmacological prophylaxis for patients undergoing general or orthopaedic surgery

LMWH suitable for all general/orthopaedic - dalteparin, enoxaparin (dose and regimen dependent on risk level)
UFH better if renal impairment

Specific regimens for elective knee and hip replacements

31
Q

Describe VTE prophylaxis for medical patients

A

Acutely ill and high risk VTE - pharmacological prophylaxis with LMWH or fondaparinux for a minimum of 7 days

If renal impairment - LMWH or UFH

32
Q

Describe VTE prophylaxis for pregnant patients

A

LMWH started 4-8 hours post-birth/miscarriage/termination, continued for minimum of 7 days if risk of VTE outweights risk of bleeding

33
Q

Resuscitation fluids adult

A

500ml 0.9% saline in less than 15 minutes

250ml if heart/renal failure

34
Q

Maintainance fluids adult

A

25-30ml/kg/day of fluid
1mmol/kg/day sodium, potassium, chloride
50-100g/day glucose

(need more if losses e.g. vomiting, diarrhoea, will need extra potassium if deplete)

e.g. 25-30ml/kg/day 0.18% sodium chloride in 4% glucose with potassium added

35
Q

Which fluids should be given with a variable rate insulin infusion for diabetic patients undergoing surgery?

A

Potassium chloride with glucose and sodium chloride

36
Q

Maintainence fluids for children

A

100ml/kg for 1st 10kg
50ml/kg for next 10kg
20ml/kg for further weight

Fluid of choice is usually 0.9% saline with 5% glucose, usually given with 20mmol of potassium (pre-mixed)

37
Q

Resuscitation fluids for children

A

10ml/kg 0.9% saline

38
Q

Rehydration fluids for children

A

Calculate deficit - weight x % dehydration x 10

Total requirement = maintenance + replacement of deficit + replacement of ongoing losses

39
Q

Target INR for patients taking warfarin undergoing surgery

A

Less than 1.5 - give oral vitamin K if INR 1.5 or higher

Can give bridging LMWH if high risk for VTE

40
Q

List common drugs which require therapeutic monitoring

A

Antiepileptics - carbamazepine, phenobarbitol, phenytoin, sodium valproate

Antibiotics - gentamicin, tobramycin, vancomycin

Lithium

Theophylline

Clozapine

41
Q

List drugs which can cause urinary retention

A

Tricyclic antidepressants
Anticholinergics
Opioids
NSAIDs
Disopyramide

42
Q

List drugs which can cause lung fibrosis

A

Amiodarone
Cytotoxics - bleomycin
Immunosuppressants - methotrexate, sulfasalazine
Nitrofurantoin
Dopamine receptor agonists - bromocriptine, cabergoline, pergolide

Medicine Year 5 (12 decks)

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