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Prescription Review Flashcards

1
Q

Drugs that cause hyperkalaemia?

A

ACEi, ARBs, antifungals, CCBs, penicillin, cyclosporine, digoxin, spironolactone, heparins, mannitol, glucose, NSAIDS, pentamidine, tacrolimus, heparins, trimethoprim

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2
Q

Drugs that cause hypokalaemia?

A

fold acid, exogenous insulins, diuretics, aminophylline, theophylline amphotericin B, salbutamol, laxatives, sodium bicarbonate, corticosteroids, verapamil (in overdose), fludrocortisone, mannitol, senna

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3
Q

When to avoid nitrofurantoin?

A

Chronic kidney disease

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4
Q

Drugs that cause hyponatraemia?

A

Thiazide diuretics, diuretics, citalopram, TCAs, PPIs, opioids, ACEi, amiodarone, anticonvulsants eg. carbamazepine, sodium valproate, theophylline, NSAIDs, metoclopramide, heparin, haloperidol, opioids, cyclophosphamide

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5
Q

Drugs that cause hypernatraemia?

A

diuretics, sodium bicarbonate, corticosteroids, oestrogens, lithium, tolvaptan

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6
Q

Drugs that can cause hyperglycaemia?

A

Ciprofloxacin, corticosteroids, octreotide,

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7
Q

Loop diuretics adverse reactions?

A

(e.g. furosemide): dehydration, renal impairment, hypokalaemia.

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8
Q

Non-steroidal anti-inflammatory drugs adverse reactions?

A

gastrotoxicity, renal impairment, hypertension.

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9
Q

Opioid analgesics (e.g. morphine) ADRs?

A

constipation, confusion, drowsiness, urinary retention.

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10
Q

Enzyme inhibitors?

A

SICKFACES.COM G
Sodium valproate, isoniazid, ketoconazole, fluconazole, alcohol bniging, clarithromycin, erythromycin, sulphonadmies, ciprofloxacin, omeprazole, metronidazole, grapefruit juice

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11
Q

Enzyme inducers?

A

SCRAP G/ PC BRAS
Sulphonylureas, phenytoin, phenobarbitol, st john’s wort, smoking, carbamazepine, rifampicin, alcohol, griseofulvin

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12
Q

Don’t give omeprazole and clopidogrel

A
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13
Q

Emergency hypoglycaemia?

A

10% glucose, 150ml over 15 minutes

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14
Q

Emeregency hypercalcaemia?

A

0.9% sodium chloride
1L over 4 hours

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15
Q

5% glucose with what level of potassium chloride?

A

0.15%

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16
Q

Causes of diarrhoea?

A

Methotrexate + flucloxacillin

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17
Q

Statin therapy guidelines?

A

<40% reduction in non-HDL cholesterol after 3months = consider increasing the dose

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18
Q

Drugs to stop in AKI?

A

diuretics, ACEi, ARBs, NSAIDs, gentamicin, vancomycin, amphotericin B, cyclophosphamide, contrast media

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19
Q

4 medications for secondary prevention of cardiovascular disease?

A

Ramipirl, aspirin, ticagrelor, atorvastatin

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20
Q

Drugs to stop prior to surgery?

A

Insulin
Lithium
Anticoagulants/antiplatelets
COCP
Potassium sparing diuretic (spironolactone)
ACEi
Oral hypoglycaemic

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21
Q

Drugs to be continued during surgery?

A

SHE CANT STOP
steroids, HIV, epilepsy, calcium channel blockers, ATT, NTG, thiazides, statins, thyroid drugs, OCP, propanolol

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22
Q

Drugs To Stop prior to surgery?

A

These commonly stopped medications can be remembered as ‘CHOW’.

Clopidogrel – stopped 7 days prior to surgery due to bleeding risk; aspirin and other anti-platelets can often be continued and minimal effect on surgical bleeding
Hypoglycaemics – see ‘Diabetes Mellitus’ below
Oral contraceptive pill (OCP) or Hormone Replacement Therapy (HRT) – stopped 4 weeks before surgery due to DVT risk. Advise the patient to use alternative means of contraception during this time period.
Warfarin* – usually stopped 5 days prior to surgery due to bleeding risk and commenced on therapeutic dose low molecular weight heparin
Surgery will often only go ahead if the INR <1.5, so you may have to reverse the warfarinisation with PO Vitamin K if the INR remains high on the evening before
*Direct Oral AntiCoagulants (DOACs), such as Rivaroxaban, Apixaban, or Edoxaban, will also need stopping pre-operatively, however the duration of this depends on the type used

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23
Q

Drugs to alter prior to surgery?

A

Subcutaneous insulin – may be switched to variable rate intravenous insulin infusion (VRIII), as discussed below
Long-term steroids – must be continued, due to the risk of Addisonion crisis if stopped
If the patient cannot take these orally, switch to intravenous (a simple conversion rate is 5mg PO prednisolone = 20mg IV hydrocortisone)

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24
Q
  • Bowel obstruction nausea:
A

o 1st  ‘Drip & suck’
 Relieves nausea effectively if pressure build-up is present

o 2nd  IV cyclizine, ondansetron
 Metoclopramide is contraindicated

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25
Treatment in insomnia?
o Zopiclone 7.5mg ON
26
When must rivaroxaban be taken?
With food
27
Starting treatment (opioids in palliative care?
o 15mg MR morphine (MST), PO BD (total of 30mg) o 5mg IR oromorph, PO PRN
28
o Opioids in CKD
 GFR 30-60  oxycodone  GFR <30  alfentanil, fentanyl, buprenorphine
29
Ongoing treatment opiates palliative care?
o Starting doses for oromorph is 2.5-5mg, 4-hourly o Increase by 1/3rd (30-50%) if pain not 90% relieved o Breakthrough doses = 1/6th of total morphine in 24 hours
30
Bony metastasis pain treatment?
1st: Analgesics 2nd: Bisphosphonates 3rd: Radiotherapy
31
Max NSAID dose?
NSAID = dose 400mg (max 2.4g)
32
* Avoid in heart failure?
o Thiazolidinediones (pioglitazone)  fluid retention o NSAIDs/glucocorticoids caution: fluid retention [75mg aspirin exception] o Verapamil  negative inotropic effect o Class I antiarrhythmics (flecainide)  negative inotropic and proarrhythmic effects
33
Drugs for insomnia?
o 1st line: Z-drugs (Zopiclone) o 2nd line / severe insomnia: BDZ (Nitrazepam; 2-4w)
34
o Hypernatraemic / hypoglycaemic fluids?
5% dextrose
35
* T1DM monitoring
adult (≥4x/day incl. before meals, before bed); child (≥5x/day)
36
Targets for T1DM?
o Waking target of 5-7mmol/L o Other targets of 4-7mmol/L
37
Insulin diabetic: surgery rules?
o If glucose >12mmol/L, capillary blood ketones >3 or urine ketones +++  delay surgery o If glucose 4-12mmol/L  proceed with surgery
38
Adjusting insulin regimen
o Adjusting basal/bolus regimens:  High/low before breakfast / at night  increase/decrease evening long acting  High/low before lunch / dinner / bed  increase/decrease rapid acting in meal before o Adjusting BD pre-mixed / intermediate regimens:  High/low before bed AND before breakfast  increase/decrease evening insulin  High/low before lunch AND before evening meal  increase/decrease morning insulin o Adjusting ON regimens:  High/low before breakfast  increase/decrease insulin o Adjusting OM regimens:  High/low before lunch AND before evening meal  increase/decrease insulin
39
Sulphonylureas; SE & CI?
* SEs: weight gain, hypoglycaemia * CI: ketoacidosis; Caution: high BMI, G6PDD
40
Thiazolidinedione eg. PIOGLITAZONE
* SEs: weight gain (peripheral), abnormal LFTs, bladder cancer, osteoporosis (# risk) * CI: HF, bladder cancer (query, past, present)
41
Gliptins
* Good addition to metformin if the patient is overweight * CI: ketoacidosis; Caution: eGFR <45 (reduce dose, but can be used in renal failure)
42
Metformin + SGLT-2i EMPAGLIFLOZIN)
* SEs: euglycaemic DKA, urosepsis/infections, Fournier’s gangrene, angioedema * CI: DKA, eGFR <60 (CKD 4, 5; mx: sitagliptin, gliclazide); Caution: complicated UTI
43
When to add GLP-1
 GLP-1 added if BMI >35 (as it can help with WL) or if insulin unacceptable
44
Respiratory failure
 T1 RF (low/normal PaCO2, low O2)  T2 RF (high PaCO2, low O2)
45
* Heartburn (immediate relief):
o Short-term relief  Magnesium carbonate, 10mL, PO, TDS
46
o HAP tx?
 Non-severe (NICE) Co-amoxiclav / doxycycline  Severe (NICE) Piperacillin/tazobactam
47
Prophylactic dose anticoagulation?
LMWH (dalteparin, enoxaparin or tinzaparin) unless renal failure then unfractioned heparin
48
Hypocalcaemia tx?
calcium gluconate 10% 10ml IV
49
Symptoms of hypocalcaemia?
CATs go numb – Convulsions, Arrythmias, Tetany, Numbness also Trousseau's sign and Chvostek’s sign ECG features? QT prolongation
50
Treatment of hypercalcaemia?
0.9% sodium chloride, 1000ml over 4h
51
ECG in hypercalcaemia?
shortened QT
52
Hyperkalaemia treatment?
calcium gluconate 10% 30ml IV Short-term – insulin + glucose, salbutamol Long-term – calcium polystyrene sulfonate, loop diuretics, dialysis
53
Hypokolaemia treatment
0.3% potassium chloride, 1000ml over 4h
54
Addisonian crisis treatment?
hydrocortisone 100mg IM or IV
55
Meningitis in community: pen allergic?
cefoxatime 1g IM
56
Gonorrhoea vs chlamydia onset?
Gonorrhoea = 1-5 days Chlamydia = 7-21 days
57
Gonorrhoea treatment?
Azithromycin stat + ceftriaxone IM stat♀️
58
Chlamydia treatment?
Azithromycin stat♀️ or doxycycline
59
Drugs most likely to cause oral candidiasis?
Steroids Antibiotics Immunosuppressants
60
Treatment of oral candidiasis?
Nystatin drops
61
Symptoms of serotonin syndrome:
Confusion Agitation Muscle twitching Sweating/shivering Diarrhoea Seizures Arrythmias Unconsciousness
62
Which medications can cause galactohorrhoea?
Citalopram, metoclopramide, olanzapine
63
Drugs to avoid in PD?
Metoclopramide and olanzapine Typical and atypical antipsychotics Antiemetics and antidepressants such as phenelzine and tranylcypromine
64
Drugs that impair renal function?
candesartan, gentamicin and naproxen
65
Neuroleptic malignnat syndrome?
Altered mental status (i.e. confusion), fever, muscular rigidity, and dysautonomia (i.e. autonomic instability) Muscle rigidity, pupil dilation, fever, tachycardia, hypertension
66
Serotonin syndrome
Altered mental status: may present as anxiety, restlessness, disorientation, or agitation Sweating Fever Vomiting Diarrhoea
67
Acute dystonia treatment?
procylidine
68
Tx for tardive dyskinesia?
Tetrabenazine
69
Treatment for acute dyspepsia relief?
Magnesium carbonate
70
When to do a V/Q Scan?
if allergy to contrast or renal failure
71
Oesophageal varices tx?
#1 terlipressin IV + endoscopic therapy (EVL) + antibiotic #2 TIPS Sengstaken-Blakemore tube if uncontrollable Propranolol + EVL (every 2 weeks until variceal obliteration)
72
Peptic ulcer abrupt treatment?
Endoscopic therapy ± blood transfusion + PPI IV
73
Tendonitis cause?
Ciprofloxacin can cause tendonitis and tendon rupture (in this case achilles tendonitis) and should be stopped immediately
74
Oculogyric crisis tx?
Procyclidine
75
What is Oculogyric crisis?
Dystonic reaction to certain drugs or medication Features: restlessness, agitation, involuntary upwards eye movements Causes: Phenothiazines (eg. Chlorpromazine, levomepromazine) Haloperidol Metoclopromide Postencephalitic Parkinson’s disease (viral illness that causes degeneration of nerve cells in the substantia nigra)
76
What should be stopped before all cataract surgery?
Tamsulosin
77
When is Pioglitazone contraindicated?
heart failure
78
Drugs resulting in urinary retention
Anticholinergic properties: Anti-psychotics Antidepressants Anti-histamines Alpha-adrenergic agonists: methyldopa Opioids: Mu agonistic action → increased sympathetic tone of bladder neck sphincter NSAIDs: inhibit prostaglandin-mediated detrusor muscle contraction
79
What are the 4Hs and 4Ts?
Hypovolaemia Hypoxia Hyper/hypokalaemia and metabolic disorders Hyper/hypothermia Toxicity Tension pneumothorax Tamponade (cardiac) Thromboembolism – MI or PE
80
Drugs that can cause diarrhoea?
Co-amoxiclav, lansoprazole, methotrexate, bisoprolol
80
Ciprofloxacin side effects?
81
Which drugs can cause hearing loss?
Aspirin + furosemide Loop diuretics (furosemide) Aminoglycosides (gentamicin) Aspirin (only in toxic doses) Cytotoxics (cisplatin, carboplatin)
82
Causes of drowniess/confusion?
Benzos, opiates, antimuscarinics?
83
Treatment for hypoglycaemia?
10% glucose = 10g in 100ml (150-200ml) 20% glucose = 20g in 100ml (75-100ml)
84
When should steroids be taken?
Evening
85
Which drugs can cause osteoporosis?
Prednisolone, PPIs including omeprazole GnRH agonists (buserelin, goserelin etc)
86
Drugs which increase the risk of falls?
Benzodiazepines Antidepressants (particularly TCAs and SNRIs) Monoamine oxidase inhibitors Most antipsychotics Opiates Most antihypertensives (particularly diuretics and alpha-blockers)
87
pancreatitis risk?
Exenatide and sitagliptin
88
Drugs to stop in AKI?
‘Stop the DAMN drugs’ Diuretics ACEi/ARB Metformin NSAIDs
89
Which drugs can derange glucose level?
Steroids, bendroflumethiazide
90
Indapamide 2.5mg OD Perindopril 4mg once only Rivaroxaban 20mg PO BD Amlodipine 10mg PO OD Citalopram 10mg PO OD Simvastatin 40mg PO OD Paracetamol 4mg QDS Which 2 are most likely to cause hyponatraemia?
Indapamide Citalopram
91
When should be warfarin be stopped before surgery?
Warfarin should be stopped 5 days before elective surgery
92
Drug linked to deafness?
Furosemide
93
Drugs linked with ototoxicity?
Gentamicin Bumetanide Furosemide (rapid ad. / renal impairment) vancomycin
94
Drugs that cause dehydration?
Spironolactone, bendroflumethiazide
95
Hyperkalaemia?
Eplerenone and Ciclopsporin
96
Drugs that cause bradycardia?
Beta blockers, digoxin
97
How to monitor dehydration resolving?
Blood pressure
98
Heart failure treatment monitoring
Exercise tolerance
99
Resuscitation fluid for children?
20ml/kg over 15 minutes
100
dyspepsia
bisphosphonates, SSRIs, NSAIDs, steroids
101
gingival hyperplasia
phenytoin, tacrolimus and CCBs
102
Carbamazepine se?
hyponatraemia
103
Theophylline monitoring?
Theophylline: monitor for signs of tachycardia
104

Year 6 (26 decks)

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