Prescription review Flashcards
What drugs should you STOP if there’s an AKI
Lithium
NSAIDs
ACEi
Meformin
ABXs-> tetracyclines & nitro
what drugs should you adjust dose if there’s an AKI
Methotrexate
Digoxin
B-blockers
Furosemide
ABXs
What do you have to do with these drugs in an AKI:
Warfarin
Diazepam
Eyrthromycin
Rifampicin
Nothing
Leave them alone eh
what ABXs are suicidal in renal failure
tetracyloines (e.g. doxycycilne)
nitro
too much of these can cause what SEs…
- K-sparring diuretics
- thiazide diurectics
- loop diuretics
ALL cause dehydration
- HYPERkalemia
2 & 3 HYPOkalameia
What drugs do these commonly interact with:
- ACEi
- Wafarin
- NSAIDs
- statins
What do all these drugs have in common:
CCBs
Salbutmol (SABAs)
NSAIDs
Gent & vanc (aminoglycosides)
All common causes of SEs
So fucking guess them
if you get some weired SEs, what drug is most likely the culprit
The one most recently started lol
What part of the BNF do you look at for mangement of ADRs & poisoning shite
Poisonings & emergency treatment
On aspirin or NSAIDs
Has asthma
Gets nasal polyps
What triad is this
SAMTERs
Hence why you try not use NSAIDs in asthma, only can’t be used in like 10% so vast majority are sound
What drugs can worsen asthma & COPD?
(so fucking stop/avoid them eh)
NSAIDs
B-blockers
Adenosine
What drugs can cause urine retention?
(so fucking stop/avoid them eh)
TCAs & Anticholinergics
Opioids
NSAIDs
What drugs can bugger glucose control
Thiazides
Steroids
Anti-psychoics
What drugs can casue pulomnary fibrosis
Methotrexate
Amiodarone
Sulfazalzine
Nitro
what are the causes of an AKI
- Pre-renal
- Intrsinic
- Post-renal
1.
Dehydation
Hypovolemia
Renal artery stenosis
2.
Drugs (ACEi & NSAIDs)
Renal tubular acidosis
Ischemia
Infectoin & inflammation
3.
Tumours
Strictures
Stones
BPH & prostate ca
3.
Causes of jaundice
- pre-hepatic
- hepatic
- post-hepatic
1.
Haemolysis
Gilberts
2.
Hepatitis
Cancer
Cirrhosis
3.
Stones
Tumours
PBC & PSC
Drugs (ABXs, steroids)
what drugs cause drug-induced cholestasis
Steoirds
Antibiotics
Fluclox
Co-amox
Nitro
if you get bradycardia as a result of digoxin, what should you do
Fucking stop it
for prescription review questions, what are like the main things to check?
Allergies (peniclliin & Abxs)
Contraindications (asthma, parkinsons, peptic ulver)
SEs
Too much paracetamol
Wrong dose (too much/not enough)
Wrong frequency
Wrong route
Wrong time of day
when should you NEVER prescibe diuretics
at night time
or esle they’ll piss the fucking bed
if a pt complains of indigestion, what drugs shoudl you stop like
NSAIDS
Steroids
What SEs are these most likely to cause
- aspirin & NSAID
- ACEi , NSAID, vanc & gent
- diuretics
- Pioglitazone
- Metformin, aspirin
- Morphine sulphate
- morphine & metoclopramide
- drowsiness
- bradycardia
- haematemesis
- AKI
- dehydration
- hypoglycemia
- fucked liver
- constipation & urine retention
- confusion (in old bugger)
- TCAs & opioids
- B-blockers, CCBs, Digoxin & Donepazil
Donepazil is obvs a drug used to treat Alzheimers, what is a potential SE
Bradycardia
what drugs should you withlold if eGFR takes a plumit
ACEi
ARBs
Diuretics
If a patient is showing signs of sepsis, what drug in particlar whould you be worried about
You should stop it eh
Methotrexate
cause of the risk of neutropenic sepsis
a pt gets worseing heart failure symptoms
what drugs could be responsible
Steroids
NSAIDs
CCBs (verapapil)
why might you see an contraceptive pill on a bloke’s prescripton chart
he got his and his’ wifes meds mixed up lol
Not really progressive is it
what is important to check regarding drugs for blood clot prophylaxis
Right dose?
Treatment vs prophylactic
is ‘1mg of paracetamol’ ever right?
Fuck no
Only ever prescribed as 1g or 500mg
if someone has like chronic pain and TENS is an option, what should you just do
Pick it
if a patient is completely fine and got no sympomts, but their bloods are fucking off the rails, what should you do
Send for another blood test lol
clearly they’re sound
what drugs increases the risk of lithium toxicity?
ACEi & diurectics
they both decrease lithium excretion
What drugs should you stop if any of the following occur:
heamoptysis
acute ischemic stroke
GI bleeding
bleeding of any sort really
Drugs that increase fucking bleeding
Warfarin
Aspirin
Heparin
When should you stop taking steroids?
If there’s any -> STEROIDS
Stomach ulces
Thin skin
oEdema
Right heart failrue
Osteoporosis
Infection
Diabetes
Syndrome (Cushings)
Only if the steroid is the cause, otherwise if a pt is sick you double the fuckign dose
When should you stop taking NSAIDS
If there’s any -> NSAID
No urine
Systolic dysfunction (heart failure)
Asthma
Indigestion
Dyscarisa (fucked blood)
what drug might be fatal in an old geezer who’s hypotensize
B-blocker
what is the most common prescription error
Omission on admission
Forgetting to add the drug on the clerking sheet lol
what are considered as the ‘high risk’ drugs that you should always guess when in doubt
NSAIDs
Steroids
Anti-coags
Anti-pscyhotics
Insulin
what is always essential to check
very fuckign basic
but q might try and catch you out
the pt’s fucking name
If a pt has a low HR and is on both CCB and B-blocker, what should you do
Just stop the one
if you stop both they’ll get like rebound tachycardia
what ABxs should be avoided in penicllin allergies
Amox & co-amox
Flucloxaccin
Pippercilin & tazobactam (Tazocin)
is ciprofloxacin safe to use in a penicllin allergy?
It absolutley is
why are P450 enzyme inducers/inhibitors important
Cause most drugs are metabolised by this enzyme in the liver
influences if the drug is gonna be more/less active
very important for the likes of warfarin
what affect fo enzyme INDUCERS have on other drugs
the inducer increases the acttivity of P450 enzyme
so the metabolism of the inducer is increased
causing the Metabolsim of other drugs to decrease
so other drug shave a DECREASED effect
What affect do enzyme INHIBITORS have on other drugs
(e.g. warfarin)
the inhibitor decreases the acttivity of P450 enzyme
so the metabolism of the inhibitor is decreases
metabolism of other drugs is increased
so other drug shave an INCREASED effect
What are the enzyme INDUCERS
PC BRAS
Phenytoin
Carbamazapine
Barbituates
Rifampicin
Alcohol
Sulphonylureas
What are the enzyme INHIBITORS
AO DEVICES
Allopurinol & Amiodarone
Omeprazole
Disulfarum
Erthyromycin
Valporate
Isoniazid
Ciprofloxacin
Ethanol
Sulphonamides & Sertaline
Are sulphonamides enzyme inducers or inhibitors
also give examples
Inhibitors
Trimethoprim
Sulfazalazine
Is grapefruit juice an enxyme inducer or inhibitor?
Inhibitor
what part of the BNF might you find shite like hyperkalaemia
“Electrolyte Imbalance”
Are barbituates enzyme inducers or inhibitors?
also, what type of drug are they?
Inducers
Seadatives
Warfarin & P450 enzyme
- what should you do to the warfarin dose if an enzyme INDUCER is precribed alongside
- what should you do to the warfarin dose if an enzyme INHIBITOR is precribed alongside
1. INCREASE DOSE
So theres an increased metabolism of the inducer
which decreases metabolism of warfarin
so warfarin has less effect
dose needs to go up
2. DECREASE DOSE
So theres a decreassed metabolism of the inhibtior
which increases metabolism of warfarin
so warfarin has more of an effect
dose needs to go down
INHIBITORS = INHIBIT the dose of warfarin
if the q is about contraception & HRT, and they are on a progesterone only and wanna change, what shoudl you give
A COMBINED one
Just put down levonorgestrel and that’ll be you
you’re wanting to prescribe an ABx for a UTI
They have an eGFR of <45
What drug can’t you use
Nitro
Nitro fucks the kidneys eh
for Qs that ask which is the serious drug error, what do you always look for
wrong units, dose, route…
contraindications
interactions
allergies
what analgesic can cause sertotonin syndrome if used alongside SSRIs like citalopram
Tramadol
what drugs are usually prescribed weekly, so if you see an OD next to them then it’s clearly wrong
methorexate
biophosphonates
what sorta age and sex of a pt will deffo influence a drug if it’s part of the question
young females
might be on a teratogenic eh
are SSRIs safe to use in the ealry stages of pregnancy
absolutely not
if you have poor renal function, should you stop allopurinol
fuck yes
whats more likely to fuck up your liver, metformin or methotrexate
Methotrexate
what type of anti-hypertensive can’t be described if there’s ischemic ulcers
b-blockers
if somone is on two loop diurectics or one loop and one thiazide, what shoudl you do
stop one eh
