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MCQ 1 > Prescription Medicines > Flashcards

Prescription Medicines Flashcards

1
Q

Allopurinol indication and dosage

A

Gout treatment and prevention of progression

100mg OD, increasing by 100mg every 4 weeks until target serum urate is reached (<0.36mmol/L)

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2
Q

Allopurinol mechanism of action

A

Inhibits xanthine oxidase, reducing the production of uric acid

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3
Q

Allopurinol adverse effects

A

Hypersensitivity syndrome

Severe idiosyncratic rection (skin reaction, eosinophilia + multi-organ involvement) - usually within 2-6 weeks of initiation. Associated with thiazide diuretics

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4
Q

Allopurinol interactions and contraindications

A

Azathioprine - avoid concurrent use. If cannot be avoided, use 1/3 to 1/3 of azathioprine dose

Mercaptopurine - DO NOT USE

Both cause bone marrow toxicity

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5
Q

Allopurinol precautions + safety in special populations

A

Prior to initiation consider testing for HLAB*5801 in selected patients (Koreans with Stage or worse CKD, Han Chinese + Thai irrespective of renal function)

Dose adjustment required in renal impairment

Reduce dose in hepatic impairment

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6
Q

Allopurinol advice and self-care

A

Monitor serum urate levels every 4 weeks until the target level is reached. Then blood tests every 3-6 months to check serum urate levels and kidney function

Take with food and a large glass of water

Encourage exercise, staying hydrated, caffeinated drinks, low-fat milk products and a good diet

Avoid lots of red meat, alcohol and sugary drinks

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7
Q

Amiodarone indication and dosage

A

Rhythm control

200mg TDS for 1 week, then 200mg BD for 1 week then 200mg OD. Titrate to the lowest effective dose

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8
Q

Amiodarone mechanism of action

A

Potassium channel blocker in cardiac tissues prolongs the refractory period so the cell is less excitable

Metabolised by CYP3A4 and CYP2C8

Absorption and bioavailability are variable between people

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9
Q

Amiodarone interactions and contraindications

A

Avoid drugs that also increase the chance of QT prolongation

Contraindicated Iodine sensitivity

CYP drugs

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10
Q

Amiodarone adverse effects

A

Photosensitivity, blue-grey skin discolouration, blurred vision, dry eyes, thyroid toxicity, pulmonary fibrosis, arrhythmias, increased LFTs

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11
Q

Amiodarone precautions and safety in special populations

A

Use with caution in hepatic impairment (risk of accumulation and toxicity)

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12
Q

Amiodarone advice and self-care

A

Pulmonary function and electrolyte (potassium) tests should be performed prior to initiation

LFT and thyroid function tests should be performed before treatment and every 6 months thereafter

Protect yourself from sunlight

Contact your doctor if experiencing cough, difficulty breathing, or feeling unwell that you can’t explain

Grapefruit juice may interfere with the medication

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13
Q

Colchicine indication and dosage

A

Acute gout and short-term prophylaxis

Acute: initially 1mg, followed by 500mcg 1 hour later (max 1.5mg per course)

Short-term prophylaxis: 500mcg once or twice daily for 3-6 months while urate-lowering therapy is introduced.

Max 2.5mg in 24 hours, 6mg over 4 days

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14
Q

Colchicine mechanism of action

A

Binds to tubulin during mitosis, inhibiting phagocytosis and causing cell death.

Does not decrease urate production, increase renal urate excretion or possess any analgesic properties

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15
Q

Colchicine adverse effects

A

NARROW THERAPEUTIC INDEX

Early warning signs: nausea, vomiting, abdominal pain, diarrhoea

Delayed symptoms (24-72 hours after indigestion): tachypnoea, electrolyte disorders, hypovolemia, haematological effects, seizure, shock, coagulopathy….

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16
Q

Colchicine interactions and contraindications

A

CYP3A4 and P-glycoprotein inhibitors (statins, azole antifungals, macrolides, grapefruit juice)

Chemotherapy agents have an additive effect on cell division

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17
Q

Colchicine precautions and safety in special populations

A

Renally cleared - dose adjustment may be required

Avoid if CrCl <10mL/min

Use with caution in GI and cardiac conditions

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18
Q

Dabigatran indication and dosage

A

Stroke, AF, TIA, HF, VTE

Typically 150mg BD

In DVT/PE treatment: starts after 5 days of heparinisation

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19
Q

Dabigatran adverse effects

A

Dyspepsia, nausea, diarrhoea, abdominal pain, dysphagia

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20
Q

Dabigatran interactions and contraindications

A

Ketoconazole, quinidine and clarithromycin increase the concentration of dabigatran (increasing the risk of bleed)

Amiodarone and verapamil contraindicated. If needed, reduce the dose of dabigatran or dose at different times of the day and monitor closely

Rifampicin, St John’s wort, phenytoin and carbamazepine reduce the efficacy of dabigatran

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21
Q

Dabigatran precautions and safety in special populations

A

Renally cleared - CrCl 30-50 reduce to 110mg

Do not give if below 30mL/min

In the elderly (75-80) reduce the dose to 110mg BD regardless of renal function

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22
Q

Dabigatran advice and self care

A

Take with food and a large glass of water

Remain upright for at least 30 minutes after taking

Monitor for signs of bleeding

Avoid NSAIDs

Do not open capsules

Keep in foils until taking

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23
Q

Dabigatran mechanism of action

A

Competitive and reversible inhibition of thrombin (factor 2)

Essentially mops up thrombin and stops the process of clot formation.

Prodrug

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24
Q

Tetracyclines indication and dosage

A

Respiratory infections (chronic bronchitis, CAP), STIs, acne

Acne: Minocycline 100mg daily in 1-2 divided doses. Doxycycline 50-100mg OD. 4-6 months duration

CAP: Doxycycline 200mg stat then 100mg OD

Susceptible infections: 100mg BD (both)

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25
Q

Tetracyclines mechanism of action

A

Bind to 30s ribosomal subunit, inhibiting binding of amino acid tRNA, inhibiting protein formation required for cell division.

Broad spectrum bacteriostatic

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26
Q

Tetracyclines adverse effects

A

GI disturbances, calcium chelation, photosensitivity

May cause hypersensitivity reactions

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27
Q

Tetracyclines interactions and contraindications

A

Metal collators (binds to metal instead and decreases absorption)

Isotretinoin and oral vitamin A treatment (benign intracranial hypertension)

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28
Q

Tetracyclines precautions and safety in special populations

A

Monitor patients on anticoagulants

Neither require renal dose adjustment

Use with caution in hepatic impairment (hepatic metabolism)

Avoid in pregnancy/breastfeeding and children under 12

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29
Q

Tetracyclines advice and self-care

A

Take with food and a large glass of water

Remain standing for at least 30 minutes after taking

Swallow whole (oesophagitis)

Avoid dairy, metal-containing antacids and iron supplements for 2 hours

Protect yourself from sunlight

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30
Q

Enoxaparin indication and dosage

A

Prophylaxis of VTE, treatment of angina/MI, prevention of thrombus formation

Dose varies.

Prophylaxis: 20-40mg SC q24h

Treatment: 1-1.5mg/kg q12-24h

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31
Q

Enoxaparin mechanism of action

A

Binds to antithrombin 3 (ATIII), predominantly to anti Xa

Reversal agent is protamine sulphate (partial reversal)

32
Q

Enoxaparin adverse effects

A

Pain, itch, haemorrhage

33
Q

Enoxaparin interactions and contraindications

A

NSAIDs, herbal extracts (garlic, ginkgo, ginseng)

34
Q

Enoxaparin precautions and safety in special populations

A

Renally cleared. No dose adjustments required for those CrCl >30mL/min

35
Q

Enoxaparin advice and self-care

A

Do not get any new tattoos or piercings

Rotate injection sites

Report any signs of bleeding

36
Q

Febuxostat indication and dosage

A

Gout

80mg OD, if after 2-4 weeks serum uric acid greater than 0.36mmol/L increase to 120mg OD

37
Q

Febuxostat mechanism of action

A

Inhibits xanthine oxidase, reducing the production of uric acid (second-line to allopurinol)

38
Q

Febuxostat adverse effects

A

Diarrhoea, nausea, elevated liver enzymes, oedema, headache and rash

Rarely: hepatotoxicity or severe hypersensitivity (most often in the first few weeks of treatment) E.g SJS, toxic epidermal necrolysis, urticaria and anaphylaxis)

39
Q

Febuxostat interactions and contraindications

A

Azathioprine and mercaptopurine cause bone marrow toxicity (same as allopurinol)

40
Q

Febuxostat precautions and safety in special populations

A

Can use in renal impairment (metabolised by liver) but caution in patients eGFR <30mL/min/1.73m2 due to a lack of safety data

Avoid in patients with moderate or severe hepatic impairment (no dosing information available)

Baseline LFTs are recommended prior to starting and periodically thereafter

Caution in IHD and CHF (associated increased risk of CV and all-cause mortality)

41
Q

Febuxostat advice and self-care

A

Encourage exercise, staying hydrated, caffeinated drinks, low-fat milk products and a good diet

Avoid lots of red meat, alcohol and sugary drinks

42
Q

Imiquimod indication and dosage

A

Genital warts: Apply thinly 3x weekly (alternate days) then have 2 days treatment-free until lesions resolve for up to 16 weeks

Actinic keratosis: Apply 3 times weekly for 4 weeks OR twice weekly for 6 weeks. Repeat if necessary after a break of 4 weeks (maximum 2 courses)

Superficial basal cell carcinomas: Apply to lesion and 1cm beyond it for 5 days of the week for 6 weeks. Review by week 3 and adjust frequency if necessary.

43
Q

Imiquimod mechanism of action

A

Stimulates the immune system to release cytokines.

44
Q

Imiquimod adverse effects

A

Local inflammation (itching, burning. Means it is working.

Rarely: headache, fatigue, flu-like illness

45
Q

Imiquimod interactions and contraindications

A

Not suitable for internal genital warts, immunosuppressed.

Do not apply to broken skin (eczema, acne, psoriasis) or mucosal membranes

46
Q

Imiquimod advice and self-care

A

Clean hands before and after application

Avoid broken skin

Wash off before sexual contact - may damage latex condoms and diaphragms

47
Q

Metformin indication and dosage

A

T2DM + gestational diabetes: Initially 250-500mg 1-2 times daily, increased as tolerated to 2g daily in divided doses. Maximum daily dose 3g T2DM, 2.5g GDM

PCOS: Initially 500mg with breakfast for 1 week, then 500mg BD for 1 week, then 1.5-1.7g daily in 2-3 divided doses.

48
Q

Metformin mechanism of action

A

Decreases gluconeogenesis and increases peripheral utilisation of glucose

49
Q

Metformin adverse effects

A

GI effects (nausea, indigestion, abdominal cramps, bloating, diarrhoea)

Vitamin B deficiency

Rarely: lactic acidosis

50
Q

Metformin precautions and safety in special populations

A

Avoid in severe hepatic impairment

Do not use if CrCl >15mL/min

15-30 max 500mg, 30-60 max 1g, 60-120 max 2g

51
Q

Metformin advice and self-care

A

Take with food

Limit alcohol intake - may affect blood sugar

Withheld before and after surgery

52
Q

Methotrexate indication and dosage

A

RA, crohn’s, psoriasis (inflammatory conditions) chemotherapy.

ONCE WEEKLY. Absoloute max of 25mg

53
Q

Methotrexate mechanism of action

A

Inhibits folic acid production important for new cell formation.

Also has anti-inflammatory properties

54
Q

Methotrexate adverse effects

A

Stomatitis

GI: nausea, diarrhoea, vomiting

Bone marrow suppression (can be reduced with folic acid supplementation).

Rarely: pulmonary fibrosis, pneumonitis, cirrhosis, blood disorders

55
Q

Methotrexate interactions and contraindications

A

Contraindicated: infection, alcoholism, peptic ulcer disease, poor nutritional status, recent exposure to herpes zoster infection

Avoid alcohol (effect on liver)

Trimethoprim and co-trimoxazole - significantly increases the risk of bone marrow aplasia and should be avoided. Increased risk also with penicillins and tetracyclines.

Avoid live vaccines (but not the flu)

Aspirin and other NSAIDs: careful monitoring

56
Q

Methotrexate precautions and safety in special populations

A

Do not use in pregnancy or breastfeeding - teratogenic

Avoid in severe hepatic impairment

Reduce dose in renal impairment, avoid in severe.

57
Q

Methotrexate advice and self-care

A

Make sure you know it is WEEKLY dosing

Folic acid supplementation

Effective contraception

1-2 standard drinks once or twice a week is fine.

Regular monitoring of FBC (bone marrow suppression), LFTs (liver toxicity)

Advise doctor of any suggestive infection, especially sore throat

58
Q

Simvastatin indication and dosage

A

Hyperlipidaemia: 10-20mg OD at night. Adjusted at intervals of at least 4 weeks (Max 80mg)

Prevention of CV events: Initially 20-40mg OD at night. Adjusted at intervals of at least 4 weeks (Max 80mg)

59
Q

Simvastatin mechanism of action

A

Inhibit HMG CoA reductase, reducing the production of cholesterol AND increases LDL clearance.

Low bioavailability and short half-life

60
Q

Simvastatin adverse effects

A

Myopathy, rhabdomyolysis, increased risk of new-onset diabetes

61
Q

Simvastatin interactions and contraindications

A

Contraindications: itraconazole, ketoconazole, erythromycin, clarithromycin, cylosporin, gemfibrozil.

Dose reduction required: fibrates, terbinafine and colchicine.

Grapefruit and its juices

62
Q

Simvastatin precautions and safety in special populations

A

Contraindicated in pregnancy and breastfeeding

Myopathy risk increased in older adults, females, uncontrolled hypothyroidism, diabetes and renal impairment.

63
Q

Simvastatin advice and self-care

A

Be aware of signs of muscle pain and report to doctor

Grapefruit and its juices may interfere

64
Q

Terbinafine indication and dosage

A

Fungal infections (tinea pedis, corporis, cruris).

Oral: 250mg OD for 2-6 weeks

Topical: Apply thinly 1-2 times daily for up to 2 weeks and review.

65
Q

Terbinafine mechanism of action

A

Inhibits squalene epoxidase, preventing ergosterol synthesis.

Fungicidal

Metabolised in liver, excreted in urine

66
Q

Terbinafine adverse effects

A

Generally well tolerated. Low incidence of GI distress, headache or rash.

Serious but rare: hepatotoxicity and SJS, toxic epidermal necrolysis, blood disorders.

67
Q

Terbinafine interactions and contraindications

A

Rifampicin decreases concentration

Cimetidine (h2 antagonist) and fluconazole increases concentration.

Has an effect on flecainide, beta-blockers, MAOIs, SSRIs TCAs

68
Q

Terbinafine precautions and safety in special populations

A

Do not use in hepatic failure or pregnancy/breastfeeding

Dose adjustment for renal impairment. Do not use <20mL/min

69
Q

Terbinafine advice and self-care

A

Monitor hepatic function and CBC 4-6 weeks after initiation.

70
Q

Zoledronic acid/ Zoledronate indication and dosage

A

Osteoporosis, prevention of fractures, hypercalcaemia of malignancy.

IV infusion 4-5mg over at least 15 minutes usually once a year

71
Q

Zoledronic acid mechanism of action

A

Inhibits bone resorption by osteoclasts, increasing the bone density

72
Q

Zoledronic acid adverse effects

A

GI disturbances: heartburn, abdominal pain, oesophageal

Musculoskeletal pain

Osteonecrosis of the jaw (rare)

73
Q

Zoledronic acid interactions and contraindications

A

Hypocalcaemia contraindicated

Avoid NSAIDs

74
Q

Zoledronic acid precautions and safety in special populations

A

Do not give to pregnant or breastfeeding women

Avoid in severe hepatic impairment

Avoid if CrCl >30mL/min

75
Q

Zoledronic acid advice and self-care

A

Drink plenty of water before and after infusion

You may experience flu-like symptoms afterwards

Maintain good oral hygiene

MCQ 1 (2 decks)

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