Prescribing Safety Assessment: Answers from Papers Flashcards
What drugs affect lithium excretion?
Diuretics (in particular thiazides), NSAIDs, ACEI. Loop are best diuretics if have to give.
Main contraindications for stimulant laxatives?
Cramps (may be obstruction) or colitis
When to take stimulant laxatives?
At night!
When not to use osmotic or softener laxatives?
If already feel bloated then not osmotic, and if have soft stool then softener will not help!
A group of patients that should not use cyclizine?
Those with heart failure as can worsen fluid overload; metoclopramide better in these patients
Treating mild allergic reaction?
Give anti-histamine but no need for steroids or adrenaline
Two diuretic types causing hypokalaemia?
Thiazide and loop
Dosing interval for the first-line anti-emetics?
8 hourly! (Cyclizine and metoclopramide)
Citalopram dosing for elderly?
Maximum dose for over 65 is 20mg!
How long should you continue iron supplementation for?
Should give until Hb in normal range then for a further three months to replenish stores!
Who gets blood transfusion in IDA?
Only those who are severely symptomatic and cannot wait for effects of iron supplements (or cannot tolerate), or those with Hb <70 (higher in IHD)
A cause of leukocytosis with normal CRP?
Being on steroids
Which patients should ACEI be avoided in?
Aortic stenosis (particularly if severe/symptomatic)
Firstline antibiotic in otitis media in children?
Amoxicillin, with co-amox reserved for those with unresponsive or severe infection. Clarithro if penicillin allergic.
Drugs to avoid in myasthenia gravis?
Those with anti-muscarinic i.e. anti-cholinergic burden as will exacerbate myasthenia
First-line antibiotic in epiglottitis?
Cefotaxime
What is the aim of LMWH in VTE?
Prevents the clot enlarging while the body breaks it down, rather than thrombolysing it
When is thrombolysis indicated in DVT?
Never!
Best drug for acute severe anxiety?
Benzos e.g. diazepam; any would have been acceptable
Choosing drugs for managing anxiety?
Benzos in the young, haloperidol in the elderly (becaues of dystonic reactions)
Key bloods to monitor in digoxin?
Serum creatinine (as will have increased risk of toxicity in renal dysfunction) and potassium (as hypokalaemia increases toxicity)
Key blood at baseline in valproate?
ALT (hepatotoxic)
Monitoring initially for clozapine?
First 18 weeks = weekly FBC
Key thing to monitor for phenytoin infusion?
ECG as can cause arrhythmias. No point monitoring plasma phenytoin during infusion, but check it afterwards
What would be useful to check for after two weeks of fluoxetine?
A rash (may warn of coming systemic reaction). Check for suicidal ideation, not for mood assessment.
Adverse effects for oestrogen-containing oral contraceptives?
Headaches, weight gain, irritability
Are B-blockers stopped pre-operatively?
No
Which patients is enoxaparin dose-adjusted for?
EGFR <30 and weight under 50kg!
How do heparins cause hyperkalaemia?
Inhibit aldosterone synthesis
When are antiplatelets stopped for surgery?
Usually 7 days before (unless have recent vascular stenting, in which case hold off surgery until crucial antiplatelet period has finished)
Allopurinol in renal dysfunction?
Can accumulate so limit dose in renal dysfunction
How often should thyroxine be taken?
Daily!
What EGFR would preclude nitrofurantoin?
<45
Usual length of UTI treatment for men?
7 days
First-line treatment for alcohol withdrawal?
Chlordiazepoxide
Key instruction for taking rivaroxaban?
Take with food! (To improve absorption)
Efficacy of oral progestogen-only preparations and enzyme inducers?
Question used topiramate. These drugs decrease the efficacy of the contraceptive so should switch to an alternative method until 4 weeks post-drug
Is sedation a side effect of B-blockers?
No! Cause fatigue but not sedation
Hepatic side effect of co-amox?
Can cause cholestatic jaundice, particularly in over 65s and men!
What should you do if get small rise in creatinine after starting ACEI?
If small (<20%), this is to be expected, so does not require investigation or change in prescription
Best way to monitor beneficial effects of furosemide for heart failure after two days?
Weight, not RR, as this is confounded by too many other factors
Best way to monitor beneficial effects of perindropril for HF after one month?
Exercise tolerance
Most serious side effects of ciclosporin (and therefore things to check at baseline)?
Causes hypertension and nephrotoxicity, so check BP and U&E at baseline then monitor every 2 weeks until stable
Appropriate way to manage insulin dose if have transient hyperglycaemia?
Increase by 10%
What determines successful statin treatment and therefore no need for dose adjustment?
If, after 3 months, non-HDL cholesterol has decreased by >40% then dose is fine
Drugs causing urinary retention?
Anticholinergics, general anaesthetics, alpha-adrenoreceptor agonists, benzos, NSAIDs, CCBs, antihistamines, alcohol, opioids
Drugs causing confusion?
Opiods, anticholinergics, antipsychotics, antidepressants, anticonvulsants, metoclopramide
