Prescription review Flashcards
Patient has increased breathlessness and difficulty walking.
Ix - Na 134, K 6.1, eGFR 58
O/E - signs of acute pulmonary oedema
Meds: Bisoprolol 5mg PO OD Citalopram 60mg PO OD Eplenerone 25mg PO OD Furosemide 80mg PO OD Hydralazine 25mg PO 12hrly Isosorbide mononitrate (m/r) 30mg PO OD Neoral (ciclosporin) 150mg PO 12hrly Rabeprazole sodium 20mg PO OD
Two prescriptions mostly likely to cause her hyperkalaemia
One drug that contains a serious drug error
Hyperkalaemia
- Eplenerone - aldosterone antagonist
- Ciclosporin
Dosing error
- Citalopram - the maximum dose in the elderly is 20MG DAILY.
List of medications: Adcal D3 Alendronic acid Lansoprazole Paracetamol Prednisolone Salbutamol Tiotropium bromide
Select 2 prescriptions likely causing her indigestion
Select 2 prescriptions most likely to be a cause of her loose stools
Indigestion - prednisolone, alendronic acid (directly irritates upper GI tract and symptoms not improved by PPIs)
Loose stools:
Alendronic acid - can cause diarrhoea
Lansoprazole - all PPIs can cause loose stools and diarrhoea
Amlodipine Aqueous cream Digoxin Hydromol ointment Lisinopril Naproxen Nebivolol Paracetamol Warfarin sodium Zopiclone
Two drugs causing ankle swelling
Two drugs causing bradycardia
Ankle swelling:
Amlodipine
Naproxen
Bradycardia:
Nebivolol - beta blocker
Digoxin
Drugs to avoid in pregnancy
- Abx - tetracyclines, aminoglycosides, sulphonamides, quinolones, trimethoprim (1st trimester), nitro (3rd trimester)
- ACE, ARBs
- Statins
- Warfarin
- Sulfonylurea
- Retinoids (incl. topical)
- Cytotoxic agents
Safest anti-epileptics to give in pregnancy
Lamotrigine
Carbamazepine
Drugs to AVOID in breastfeeding
- Abx - cipro, tetracycline, chloramphenicol, sulphonamides
- Psych - lithium, benzos
- Aspirin
- Carbimazole
- Methotrexate
- Sulfonylureas
- Cytotoxic drugs
- Amiodarone
Drugs that cause hyperkalaemia from the following: Atorvastatin Co-amoxiclav Dalterparin sodium Lactulose Mycophenolate Oxycodone Paracteamol Prochlorperazine Ramipril Tacrolimus (prograf)
- Dalterparin - all heparins contribute to hyperkalaemia due to inhibition of aldosterone synthesis
- ACE inhibitors
- Tacrolimus - most likely due to reduced potassium excretion
Important things to consider when reviewing Tacrolimus prescription
Look at the specified BRAND used and then work out the doses required (kidney, heart and liver transplant, etc. may have different doses)
Surgery - when should anti-platelets be stopped?
7 days before surgery
Which two drugs should be stopped in AKI until renal function recovers?
Levemir (insulin) Allopurinol Amitryptilline Aspirin Bisoprolol Candesartan Omperazole Paracetamol
Allopurinol - accumulates in renal dysfunction (BNF advises 100mg max daily until renal function improves)
Candesartan - nephrotoxic in AKI
Drug that contributes to hyperglycaemia
Prednisolone (glucocorticoids)
Key drugs that cause HYPOnatraemia
Thiazide diuretics
Citalopram (SIADH)
ACE inhibitors (think of lowering sodium and increasing potassium!)
Maximum daily doses of citalopram in
- Normal ‘healthy’ adults
- Elderly (over 65)
- Hepatic impairment
- 40mg
- 20mg
- 20mg
Antibiotic that should not be taken with statins
Macrolides (clarithromycin, erythromycin, azithromycin) - macrolides inhibit cyto P450 isoenzyme that metabolises statins
Drugs that cause urinary retention
- MORPHINE/opiods - esp in post-op period
- Anticholinergics - e.g. antipsychotics, antidepressants, antimuscarinics (incl resp agents), detrusor relaxants
- Anaesthetics (general)
- Alpha-adrenoreceptor blockers
- Benzodiazepines
- NSAIDs
- CCBs
- Antihistamines
- Alcohol
