Prescription Review

Question 1

What are some medications contraindicated in pregnancy?

Answer 1

Ibuprofen is CI.

Lansoprazole is also recommended to be avoided however omeprazole is not known to be harmful.

Question 2

What are some drugs that can cause constipation?

Answer 2

Co-codamol is an opioid based analgesia and can cause constipation.

Ferrous sulphate.

Question 3

What drug is associated to cause osteoporosis?

Answer 3

Oral corticosteroids can reduce bone mass when used in the long term and osteoporosis is a well recognised complication.

Question 4

What other drug besides steroids can cause bone loss?

Answer 4

Loop diuretics (furosemide) increase the kidney’s excretion of calcium.

PPIs (omeprazole) can increase the risk for bone loss and fractures when used at high doses for more than a year.

Note: Thiazide diuretics protect against bone loss!

Question 5

What is the dose of aspirin and clopidogrel given after MI?

Answer 5

When a pt is admitted with a MI they are given a loading dose of Aspirin (300mg) and Clopidogrel. This is at a high dose to achieve platelet inhibition asap. However after the initial loading, the doses of Aspirin and Clopidogrel are both 75mg daily.

Question 6

Side effects for GTN spray?

Answer 6

Glyceryl trinitrate is useful for treatment of angina by causing vasoilation. However this is associated with SEs of:

• Dizziness
• Hypotension
• Headache

Question 7

What drugs can increase the risk of C. difficile diarrhoea?

Answer 7

• Omeprazole

- Clindamycin

Question 8

Which drugs can cause hypothyroidism?

Answer 8

• Lithium

- Amiodarone (can cause both hyper- and hypothyroidism)

Question 9

What drug can precipitate lithium toxicity?

Answer 9

Diuretics (bendroflumethiazide) are a common precipitator of lithium toxicity.

Question 10

Which drug is best used to relieve postoperative nausea and vomiting?

Answer 10

Cyclizine.

Metoclopramide has limited efficacy.

Question 11

Common drug causes of hyponatraemia?

Answer 11

• SSRIs
• Carbamazepine
• PPIs
• ACEi
• Diuretics
• Haloperidol
• NSAIDs

Bendroflumethiazide and Citalopram (SSRI) are well known to cause hyponatraemia.

Question 12

Name an antihistamine that causes drowsiness?

Answer 12

Promethazine. Older generation antihistamine hence more likely to cause sedatior than other newer drugs such as cetirizine.

Question 13

What dose of folic acid and when is it given for patients on MTX?

Answer 13

MTX and folic acid should be given weekly, not daily. The recommended amount of folic acid is 5mg once weekly - usually the day following the methotrexate dose.

Question 14

Drugs which are considered high risk of increasing the likelihood of falls?

Answer 14

• Anti-depressants
• Anti-psychotics
• Antimuscarinics
• Dopaminergic drugs (Parkinsonian drugs are well known for causing postural hypotension)

Moderate risk:

• ACEi
• Diuretics
• Opiate analgesics
• Antihistamines

Question 15

Penicillin drugs to be aware of for patients with penicillin allergy?

Answer 15

Types of penicillin:

• phenoxymethylpenicillin
• benzylpenicillin
• flucloxacillin
• amoxicillin
• ampicillin
• co-amoxiclav (Augmentin)
• co-fluampicil (Magnapen)
• piperacillin with tazobactam (Tazocin)
• ticarcillin with clavulanic acid (Timentin)

Question 16

What medications are usually taken at night?

Answer 16

• Statins

- Amitriptyline

Question 17

What drugs are normally taken weekly?

Answer 17

• Bisphosphonates
• Methotrexate

Bisphosphonates are available in both oral and intravenous form. Some preparations are daily, some weekly and others monthly. However, the vast majority of patients you will see in normal practice will be taking oral alendronate (alendronic acid) weekly.

Nearly all the patient who are prescribed methotrexate take it weekly. Due to the potentially toxic nature of this drug it is extremely important mistakes are avoided in terms of frequency.

Question 18

What drug can cause ankle swelling (oedema)?

Answer 18

• Amlodipine (CCB)

- Naproxen (NSAID)

Question 19

What drugs can cause bradycardia?

Answer 19

• Beta blocker

- Digoxin (if dose is too high)

Question 20

What drugs can cause hyperkalaemia?

Answer 20

• Eplerenone (potassium sparring diuretic)
• Ciclosporin
• ACEi
• Tacrolimus
• Dalteparin (and all Heparins can contribute to hyperkalaemia because of inhibition of aldosterone synthesis).

Question 21

What drugs can cause dyspepsia?

Answer 21

• Alendronic acid

- Prednisolone

Question 22

What drugs can cause diarrhoea?

Answer 22

• Alendronic acid

- Lansoprazole (All PPIs)

Question 23

What medications can cause confusion?

Answer 23

Fentanyl (opioids)
Temazepam (benzodiazepine)
Trazodone

Question 24

Medication that is contra-indicated in ischaemic leg ulcers?

Answer 24

Atenolol.

B adrenoreceptor blockers can cause peripheral vasoconstriction and worsen ischaemia in PVD,

Question 25

Two medication that can worsen biventricular failure?

Answer 25

Prednisolone and CCB (diltiazem)

Question 26

Drugs that can predispose to candida infection?

Answer 26

Corticosteroids (prednisolone)

Antibiotics

Question 27

Antibiotic for scarlet fever? (fever, macular red rash, strawberry tongue, red throat)

Answer 27

Phenoxymethylpenicillin PO 125mg PO 6-hourly for 10 days.

Question 28

What is the target INR for mechanical heart valve?

Answer 28

3.5 (range 3 -4)

Question 29

How long should antiplatelets be stopped before surgery?

Answer 29

Antiplatelet agents like aspirin are usually stopped up to 7 days before surgery.

Question 30

What medications should be withheld until renal function improves?

Answer 30

• ACEi and ARBs are nephrotoxic and should be stopped whenever AKI arises.
• Allopurinol can accumulate in renal dysfunction

Question 31

Medications that can cause confusion in patients with reduced renal clearance?

Answer 31

Co-codamol
Diazepam
Prednisolone

Steroids can cause confusion particularly in the elderly.