PSA Flashcards
Drugs contraindicated in asthmatics and COPD patients
- Beta Blockers
- NSAIDs
- Adenosine
What are exacerbating factors of psoriasis?
- trauma
- alcohol
- drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
- withdrawal of systemic steroids
What medications could exacerbate heart failure? Contraindicated
- VERAPAMIL - negative inotropic effect
- NSAIDs/GLUCOCORTICOIDS - should be used with caution as they cause fluid retention, low-dose aspirin is an exception - many patients have coexistent CVD and benefits of taking aspirin outweigh risks
- Thiazolidinediones, PIOGLITAZONE is contraindicated as it causes fluid retention
- Class I antiarrhythmics - Flecainide
What two drugs should never be prescribed together as it may cause life-threatening bradycardias?
Beta Blockers and Verapamil
What medications are usually prescribed weekly in the UK?
- Bisphosphonates - Alendronate (alendronic acid)
- Methotrexate
Also folic acid IF methotrexate is also being prescribed, or as a prophylaxis of folate deficiency in patients receiving parenteral nutrition, otherwise in other scenarios it is given daily
What are some common side effects of sulfonylureas (gliclazide)?
Hypoglycaemia
Weight gain
Hyponatraemia secondary to SIADH
Should be avoided in pregnancy and breastfeeding
What are some examples of osmotic laxatives?
Lactulose - draws water from body into bowel to soften stool, then it makes stool easier to pass
Macrogols
Rectal phosphates
What are some examples of stimulant laxatives?
Senna
Bisacodyl
Sodium Picosulfate
Glycerol
What drugs are contraindicated in pregnancy?
TERATOWA
Other drugs not mentioned in picture:
statins
sulfonylureas
cytotoxic agents
What antibiotics are contraindicated in pregnancy?
- Tetracyclines
- Aminoglycosides (gentamicin)
- sulphonamides and trimethoprim
- quinolones
What are some factors that may potentiate warfarin?
- liver disease
- P450 enzyme inhibitors
- cranberry juice
- drugs which displace warfarin from plasma albumin, e.g. NSAIDs
- inhibit platelet function: NSAIDs
P450 enzyme inhibitors:
- Antibiotics: ciprofloxacin, clarithromycin/erythromycin
- Amiodarone
- Allopurinol
- Imidazoles: ketoconazole, fluconazole
- SSRIs: fluoxetine, sertraline
- Sodium valproate
- Omeprazole
- Isoniazid
What are the adrenaline doses in anaphylaxis?
What drugs CAN you give in women who are breastfeeding?
SPLASH, Sodium Valproate, Penicillins, Levothyroxine, Antipsychotics (apart from clozapine), Salbutamol, Heparin
- antibiotics: penicillins, cephalosporins, trimethoprim
- endocrine: glucocorticoids (avoid high doses), levothyroxine*
- epilepsy: sodium valproate, carbamazepine
- asthma: salbutamol, theophyllines
- psychiatric drugs: tricyclic antidepressants, antipsychotics (apart from clozapine)
- hypertension: beta-blockers, hydralazine
- anticoagulants: warfarin, heparin
- digoxin
What are drugs that should be AVOIDED in women who are breastfeeding?
LAMBASTS - Lithium, Aspirin, Methotrexate, Benzo’s, Amiodarone, Sulphonamides, Tetracyclines, Sulfonylureas
- antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
- psychiatric drugs: lithium, benzodiazepines
- aspirin - risk of Reye’s syndrome in the baby
- carbimazole
- methotrexate
- sulfonylureas
- cytotoxic drugs
- amiodarone
What are some common side effects of Adenosine?
Chest pain
Bronchospasm
Transient flushing
What is a common side effect of amlodipine?
Ankle swelling
What is important to remember about Augmentin (co-amoxiclav) and Tazocin?
They are both penicillin containing antibiotics
What two classes of drugs commonly cause hyperglycaemia?
Steroids (dexamethasone commonly)
Thiazide diuretics
What 3 situations would you do a gradual withdrawal of corticosteroids?
- received more than 40mg prednisolone daily for more than one week
- received more than 3 weeks treatment
- recently received repeated courses
What is the paracetamol overdose management?
Patients who present within 1 hour may benefit from activated charcoal to reduce absorption of the drug
Acetylcysteine should be given if:
- there is a staggered overdose or there is doubt over the time of paracetamol ingestion, regardless of the plasma paracetamol concentration
- the plasma paracetamol concentration is on or above a single treatment line joining points of 100 mg/L at 4 hours and 15 mg/L at 15 hours, regardless of risk factors of hepatotoxicity
What 2 medications are usually taken at night?
The following medications are usually taken at night:
- statins
- amitriptyline
What is an absolute contraindication to starting COCP in women aged 35 and over?
Smoking more than 15 cigs a day
What are the most common enzyme inducers?
PC BRAAS:
- Phenytoin
- Carbamazepine
- Barbiturates
- Rifampicin
- Alcohol (chronic)
- Sulphonylureas
Enzyme activity increases, drug concentration decreases
OR
CRAP GPS induce
- *C**arbamazepine
- *Ri**fampicin
- *A**lcohol (chronic)
- *P**henytoin
- *G**riseofulvin
- *P**henobarbitol
- *S**ulphonyureas
What are the most common enzyme inhibitors?
AODEVICES:
- Allopurinol
- Omeprazole
- Disulfiram
- Erythromycin
- Valproate
- Isoniazid
- Ciprofloxacin
- Ethanol (acute intoxication)
- Sulphonamides
OR
SICKFACES.COM =common cytochrome P450 inhibitors
- *S**odium valproate
- *I**soniazid
- *C**imetidine
- *K**etoconazole
- *F**luconazole
- *A**lcohol & Grapefruit juice & Amiodarone
- *C**hloramphenicol
- *E**rythromycin
- *S**ulfonamides
- *C**iprofloxacin
- *O**meprazole
- *M**etronidazole
What are the drugs to stop before surgery?
I LACK OP
- Insulin
- Lithium
- Anticoagulants/antiplatelets
- COCP/HRT
- K+ sparing diuretics
- Oral hypoglycaemics
- Perindopril and other ACEi
PReSCRIBER mnemonic
Patient details
Reaction (allergy plus the reaction)
Sign chart
Check for Contraindications
Route for each drug
Prescribe IV fluids (if needed)
Prescribe Blood clot prophylaxis (if needed)
Prescribe antiEmetic (if needed)
Prescribe pain Relief (if needed)
How should you take oral bisphosphonates like alendronate?
Current BNF advice on how to take oral bisphosphonates is:
Tablets should be swallowed whole with plenty of water while sitting or standing; to be taken on an empty stomach at least 30 minutes before breakfast (or another oral medicine); patient should stand or sit upright for at least 30 minutes after taking tablet
What is given in a heparin overdose?
Protamine Sulphate
What drugs may worsen seizure control in patients with epilepsy?
- alcohol, cocaine, amphetamines
- ciprofloxacin, levofloxacin
- aminophylline, theophylline
- bupropion
- methylphenidate (used in ADHD)
- mefenamic acid
medications such as benzodiazepines, baclofen and hydroxyzine may provoke seizures whilst they are being withdrawn.
Other medications may worsen seizure control by interfering with the metabolism of anti-epileptic drugs (i.e. P450 inducers/inhibitors)
What is 1 in 10,000 adrenaline the same as?
1g in 10,000ml
or
1000mg in 10,000ml
1 % lidocaine has how much active ingredient per 100ml
1 % lidocaine has 1 g per 100 ml
This is equivalent to 10 mg/ml (i.e. 0.01 g/ml)
What is oxybutynin for urge incontinence contraindicated in?
Elderly at risk of falls
Patients with closed-angle glaucoma
How does dalteparin (and all heparins) cause hyperkalaemia?
Through inhibition of aldosterone synthesis
How does Tacrolimus cause hyperkalaemia?
Through reduced potassium excretion
Things that can cause an AKI, or exacerbate and worsen renal function
ACEi/ARBs
Diuretics
NSAIDs
Aminoglycosides
Metformin, Lithium, Digoxin - May have to be stopped in AKI as increased risk of toxicity (but doesn’t usually worsen AKI itself)
Allopurinol max daily dose 100mg
Before prescribing Nitrofurantoin, what should you check?
If eGFR is less than 45ml/min/1.73min2 as, Nitrofurantoin should be avoided if eGFR is less than 45
What is Onychomycosis (also known as tinea unguium)?
Fungal infection of the nail
Indapamide (thiazide-like diuretic) adverse effects
Diuresis
Palpitations
How does clarithromycin cause torsades de pointes?
Clarithromycin can prolong the QT interval in patients with a pre-existing predisposition, such as electrolyte disturbances like hypokalaemia
When prescribing HRT, what consideration do you have to take into account when choosing which option to prescribe?
If the patient still has an intact uterus, indicating she will need endometrial protection, therefore, oral oestrogen therapy alone is not suitable
What electrolyte disturbances can omeprazole cause?
Hyponatraemia
Hypomagnesaemia
What is the Yellow Card Scheme and should you report adverse drug effects?
The Yellow Card Scheme is vital in helping the Medicines and Healthcare products Regulatory Agency (MHRA) monitor the safety of all healthcare products in the UK to ensure they are acceptably safe for patients and users
For established medicines and vaccines you should report all serious suspected ADRs, even if the effect is well recognised
What instance can cyclizine be used as an anti-emetic?
Mechanical bowel obstruction - so there is a physical blockage
Can be used to help nausea and vomiting in mechanical bowel obstruction
What is the difference between mechanical and functional blockage?
There are two types of small bowel obstruction: functional — there is no physical blockage, however, the bowels are not moving food through the digestive tract
Mechanical - there is a blockage preventing the movement of food
When is Haloperidol used for nausea and vomiting?
For cases where there is a metabolic cause, like hypercalcaemia or renal failure
OR
Opioid-induced vomiting
When is ondansetron used for nausea and vomiting?
In patients after an operation
OR
In patients using cytotoxics
When should you stop metformin in a patient?
If there eGFR is less than 30 ml/minute/1.73 m2
This is because it can provoke lactic acidosis
In all cases of acute asthma in adults, what should you prescribe at least?
From BNF:
In all cases of acute asthma, patients should be prescribed an adequate dose of oral prednisolone
Continue usual inhaled corticosteroid use during oral corticosteroid treatment
Parenteral hydrocortisone or intramuscular methylprednisolone are alternatives in patients who are unable to take oral prednisolone
What is co-amilofruse?
Potassium sparing diuretic
What drug reduces the absoprtion of alendronic acid?
Calcium and vitamin D are commonly prescribed with alendronic acid
Calcium salts can reduce the absorption of alendronic acid and therefore should not be taken at the same time of day
Bisphosphonates administration guidance:
- swallowed whole with plenty of water
- taken while sitting or standing
- taken on an empty stomach
- taken at least 30 minutes before breakfast or another oral medicine, and
- patients should stand or sit upright for at least 30 minutes after taking the tablet
What is the preferred antidepressant for moderate and severe depression in children and young people?
Fluoxetine
What acne drug can’t be prescribed in primary care?
Oral isotretinoin
How does digoxin toxicity present?
Digoxin toxicity presents with:
confusion
headaches
diarrhoea
nausea, vomiting
dizziness
Arrhythmias, heart block, and visual disturbances can occur
Coloured vision is characteristic
What are some side-effects of bisoprolol?
- bronchospasm
- headache
- fatigue
- sleep disturbances
- sexual dysfunction
- vertigo
What drug can cause acute dystonic reactions?
Metaclopramide
can cause acute dystonic reactions involving facial and skeletal muscle spasms and oculogyric crisis
It is because it crosses blood-brain barrier
Which antipsychotic most likely to cause hyperprolactinaemia?
Risperidone most likely to induce hyperprolactinemia, causes a dose-related increase in prolactin concentration
Aripiprazole, clozapine, olanzapine,and quetiapine cause little or no elevation of prolactin concentration
What is the first line treatment for constipation in kids?
Macrogols
Black, tarry stools is a side effect of what drug?
NSAIDs
Drug-induced jaundice is a side effect of what drugs?
rifampicin
paracetamol
isoniazid
chlorpromazine
methyldopa
What is Bupropion?
Antidepressant drug which is also given to relieve the symptoms of nicotine withdrawal
Bupropion should be avoided in people with a history of seizures
Phosphodiesterase type-5 inhibitors (Sildenafil), are contraindicated with what?
Contraindicated in patients taking nitrates as they can cause severe hypotension
Which contraception requires a yearly routine check for blood pressure and body mass index?
Combined oral contraceptive pill
When should patients who use sublingual GTN call an ambulance if chest pain still persists?
Call 999, if their pain has not settled after 10 minutes of using two doses of the spray
What scenarios would patients with T2DM have to self-monitor blood glucose levels?
- On insulin
- Evidence of hypoglycaemic episodes
- On oral medication that may increase their risk of hypoglycaemia while driving or operating machinery, like gliclazide
- Pregnant, or planning to become pregnant
When administering phenytoin IV, what should you do to avoid cannula site inflammation?
Solutions for injection are very alkaline and may cause injection site reactions; to avoid local venous irritation, each infusion should be preceded and followed by an injection of sterile physiological saline through the same needle or catheter
What is Fosphenytoin?
Fosphenytoin is the prodrug of phenytoin and should be prescribed in terms of ‘phenytoin sodium equivalents’ (PE); fosphenytoin sodium 1.5 mg = phenytoin sodium 1 mg
You should find out how much phenytoin the patient has already received and subtract this from the dose calculated for fosphenytoin
What are side effects of Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol?
Rifampicin = Red-orange urine/tears
Isoniazid = Peripheral Neuropathy
Pyrazinamide = hyperuricaemia causing gout, arthralgia
Ethambutol = Optic Neuritis and red/green colour blindness
What two drugs can be used as a last resort to for the pharmacological treatment of severe agitation and psychosis? These medications are suggested when all other measures fail - what are these other measures?
Haloperidol
Lorazepam
Recommended if all other measures fail:
- Verbal and non-verbal de-escalation techniques have failed
- The Person is a danger to themselves or others
- The cause of delirium is known and being treated
- The benefits outweigh the risks
- Continual monitoring is in place
When are hormonal contraceptives contraindicated in women?
Current or past breast cancer - due to increased exposure to oestrogen is a risk factor for breast cancer
Give copper coil
When is the copper coil contraindicated?
In patients with endometrial cancer
What class of drug is amiloride?
Potassium sparing diuretic
What drugs can cause pulmonary fibrosis?
- Antibiotics - especially nitrofurantoin
- Amiodarone
- Chemotherapy
- Methotrexate
What are the two common side effects of metformin?
GI disturbances
Lactic Acidosis
What are the issues surrounding metformin and going for a scan with contrast dye?
There is a risk of metformin causing lactic acidosis when used with contrast dye
What drugs are some common causes of hyponatraemia?
SSRIs
Loop and thiazide diuretics
ACEi
PPIs
Carbamazepine
Haloperidol
NSAIDs
