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Year 6 > Prescription Review > Flashcards

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
Q

Treatment in insomnia?

A

o Zopiclone 7.5mg ON

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26
Q

When must rivaroxaban be taken?

A

With food

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27
Q

Starting treatment (opioids in palliative care?

A

o 15mg MR morphine (MST), PO BD (total of 30mg)
o 5mg IR oromorph, PO PRN

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28
Q

o Opioids in CKD

A

 GFR 30-60  oxycodone
 GFR <30  alfentanil, fentanyl, buprenorphine

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29
Q

Ongoing treatment opiates palliative care?

A

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

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30
Q

Bony metastasis pain treatment?

A

1st: Analgesics
2nd: Bisphosphonates
3rd: Radiotherapy

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31
Q

Max NSAID dose?

A

NSAID = dose 400mg (max 2.4g)

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32
Q
  • Avoid in heart failure?
A

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

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33
Q

Drugs for insomnia?

A

o 1st line: Z-drugs (Zopiclone)
o 2nd line / severe insomnia: BDZ (Nitrazepam; 2-4w)

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34
Q

o Hypernatraemic / hypoglycaemic fluids?

A

5% dextrose

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35
Q
  • T1DM monitoring
A

adult (≥4x/day incl. before meals, before bed); child (≥5x/day)

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36
Q

Targets for T1DM?

A

o Waking target of 5-7mmol/L
o Other targets of 4-7mmol/L

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37
Q

Insulin diabetic: surgery rules?

A

o If glucose >12mmol/L, capillary blood ketones >3 or urine ketones +++  delay surgery
o If glucose 4-12mmol/L  proceed with surgery

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38
Q

Adjusting insulin regimen

A

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

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39
Q

Sulphonylureas; SE & CI?

A
  • SEs: weight gain, hypoglycaemia
  • CI: ketoacidosis; Caution: high BMI, G6PDD
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40
Q

Thiazolidinedione eg. PIOGLITAZONE

A
  • SEs: weight gain (peripheral), abnormal LFTs, bladder cancer, osteoporosis (# risk)
  • CI: HF, bladder cancer (query, past, present)
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41
Q

Gliptins

A
  • Good addition to metformin if the patient is overweight
  • CI: ketoacidosis; Caution: eGFR <45 (reduce dose, but can be used in renal failure)
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42
Q

Metformin + SGLT-2i EMPAGLIFLOZIN)

A
  • SEs: euglycaemic DKA, urosepsis/infections, Fournier’s gangrene, angioedema
  • CI: DKA, eGFR <60 (CKD 4, 5; mx: sitagliptin, gliclazide); Caution: complicated UTI
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43
Q

When to add GLP-1

A

 GLP-1 added if BMI >35 (as it can help with WL) or if insulin unacceptable

44
Q

Respiratory failure

A

 T1 RF (low/normal PaCO2, low O2)
 T2 RF (high PaCO2, low O2)

45
Q
  • Heartburn (immediate relief):
A

o Short-term relief  Magnesium carbonate, 10mL, PO, TDS

46
Q

o HAP tx?

A

 Non-severe (NICE) Co-amoxiclav / doxycycline
 Severe (NICE) Piperacillin/tazobactam

47
Q

Prophylactic dose anticoagulation?

A

LMWH (dalteparin, enoxaparin or tinzaparin) unless renal failure then unfractioned heparin

48
Q

Hypocalcaemia tx?

A

calcium gluconate 10% 10ml IV

49
Q

Symptoms of hypocalcaemia?

A

CATs go numb – Convulsions, Arrythmias, Tetany, Numbness also Trousseau’s sign and Chvostek’s sign
ECG features? QT prolongation

50
Q

Treatment of hypercalcaemia?

A

0.9% sodium chloride, 1000ml over 4h

51
Q

ECG in hypercalcaemia?

A

shortened QT

52
Q

Hyperkalaemia treatment?

A

calcium gluconate 10% 30ml IV
Short-term – insulin + glucose, salbutamol
Long-term – calcium polystyrene sulfonate, loop diuretics, dialysis

53
Q

Hypokolaemia treatment

A

0.3% potassium chloride, 1000ml over 4h

54
Q

Addisonian crisis treatment?

A

hydrocortisone 100mg IM or IV

55
Q

Meningitis in community: pen allergic?

A

cefoxatime 1g IM

56
Q

Gonorrhoea vs chlamydia onset?

A

Gonorrhoea = 1-5 days
Chlamydia = 7-21 days

57
Q

Gonorrhoea treatment?

A

Azithromycin stat + ceftriaxone IM stat♀️

58
Q

Chlamydia treatment?

A

Azithromycin stat♀️ or doxycycline

59
Q

Drugs most likely to cause oral candidiasis?

A

Steroids
Antibiotics
Immunosuppressants

60
Q

Treatment of oral candidiasis?

A

Nystatin drops

61
Q

Symptoms of serotonin syndrome:

A

Confusion
Agitation
Muscle twitching
Sweating/shivering
Diarrhoea
Seizures
Arrythmias
Unconsciousness

62
Q

Which medications can cause galactohorrhoea?

A

Citalopram, metoclopramide, olanzapine

63
Q

Drugs to avoid in PD?

A

Metoclopramide and olanzapine
Typical and atypical antipsychotics
Antiemetics and antidepressants such as phenelzine and tranylcypromine

64
Q

Drugs that impair renal function?

A

candesartan, gentamicin and naproxen

65
Q

Neuroleptic malignnat syndrome?

A

Altered mental status (i.e. confusion), fever, muscular rigidity, and dysautonomia (i.e. autonomic instability)
Muscle rigidity, pupil dilation, fever, tachycardia, hypertension

66
Q

Serotonin syndrome

A

Altered mental status: may present as anxiety, restlessness, disorientation, or agitation
Sweating
Fever
Vomiting
Diarrhoea

67
Q

Acute dystonia treatment?

A

procylidine

68
Q

Tx for tardive dyskinesia?

A

Tetrabenazine

69
Q

Treatment for acute dyspepsia relief?

A

Magnesium carbonate

70
Q

When to do a V/Q Scan?

A

if allergy to contrast or renal failure

71
Q

Oesophageal varices tx?

A

1 terlipressin IV + endoscopic therapy (EVL) + antibiotic

#2 TIPS
Sengstaken-Blakemore tube if uncontrollable
Propranolol + EVL (every 2 weeks until variceal obliteration)

72
Q

Peptic ulcer abrupt treatment?

A

Endoscopic therapy ± blood transfusion + PPI IV

73
Q

Tendonitis cause?

A

Ciprofloxacin can cause tendonitis and tendon rupture (in this case achilles tendonitis) and should be stopped immediately

74
Q

Oculogyric crisis tx?

A

Procyclidine

75
Q

What is Oculogyric crisis?

A

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
Q

What should be stopped before all cataract surgery?

A

Tamsulosin

77
Q

When is Pioglitazone contraindicated?

A

heart failure

78
Q

Drugs resulting in urinary retention

A

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
Q

What are the 4Hs and 4Ts?

A

Hypovolaemia
Hypoxia
Hyper/hypokalaemia and metabolic disorders
Hyper/hypothermia
Toxicity
Tension pneumothorax
Tamponade (cardiac)
Thromboembolism – MI or PE

80
Q

Drugs that can cause diarrhoea?

A

Co-amoxiclav, lansoprazole, methotrexate, bisoprolol

80
Q

Ciprofloxacin side effects?

81
Q

Which drugs can cause hearing loss?

A

Aspirin + furosemide
Loop diuretics (furosemide)
Aminoglycosides (gentamicin)
Aspirin (only in toxic doses)
Cytotoxics (cisplatin, carboplatin)

82
Q

Causes of drowniess/confusion?

A

Benzos, opiates, antimuscarinics?

83
Q

Treatment for hypoglycaemia?

A

10% glucose = 10g in 100ml (150-200ml)
20% glucose = 20g in 100ml (75-100ml)

84
Q

When should steroids be taken?

85
Q

Which drugs can cause osteoporosis?

A

Prednisolone, PPIs including omeprazole
GnRH agonists (buserelin, goserelin etc)

86
Q

Drugs which increase the risk of falls?

A

Benzodiazepines
Antidepressants (particularly TCAs and SNRIs)
Monoamine oxidase inhibitors
Most antipsychotics
Opiates
Most antihypertensives (particularly diuretics and alpha-blockers)

87
Q

pancreatitis risk?

A

Exenatide and sitagliptin

88
Q

Drugs to stop in AKI?

A

‘Stop the DAMN drugs’
Diuretics
ACEi/ARB
Metformin
NSAIDs

89
Q

Which drugs can derange glucose level?

A

Steroids, bendroflumethiazide

90
Q

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?

A

Indapamide
Citalopram

91
Q

When should be warfarin be stopped before surgery?

A

Warfarin should be stopped 5 days before elective surgery

92
Q

Drug linked to deafness?

A

Furosemide

93
Q

Drugs linked with ototoxicity?

A

Gentamicin
Bumetanide
Furosemide (rapid ad. / renal impairment)
vancomycin

94
Q

Drugs that cause dehydration?

A

Spironolactone, bendroflumethiazide

95
Q

Hyperkalaemia?

A

Eplerenone and Ciclopsporin

96
Q

Drugs that cause bradycardia?

A

Beta blockers, digoxin

97
Q

How to monitor dehydration resolving?

A

Blood pressure

98
Q

Heart failure treatment monitoring

A

Exercise tolerance

99
Q

Resuscitation fluid for children?

A

20ml/kg over 15 minutes

100
Q

dyspepsia

A

bisphosphonates, SSRIs, NSAIDs, steroids

101
Q

gingival hyperplasia

A

phenytoin, tacrolimus and CCBs

102
Q

Carbamazepine se?

A

hyponatraemia

103
Q

Theophylline monitoring?

A

Theophylline: monitor for signs of tachycardia

Year 6 (26 decks)

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