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PSA Flashcards

1
Q

Drugs contraindicated in asthmatics and COPD patients

A
  1. Beta Blockers
  2. NSAIDs
  3. Adenosine
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2
Q

What are exacerbating factors of psoriasis?

A
  1. trauma
  2. alcohol
  3. drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
  4. withdrawal of systemic steroids
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3
Q

What medications could exacerbate heart failure? Contraindicated

A
  1. VERAPAMIL - negative inotropic effect
  2. 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
  3. Thiazolidinediones, PIOGLITAZONE is contraindicated as it causes fluid retention
  4. Class I antiarrhythmics - Flecainide
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4
Q

What two drugs should never be prescribed together as it may cause life-threatening bradycardias?

A

Beta Blockers and Verapamil

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5
Q

What medications are usually prescribed weekly in the UK?

A
  1. Bisphosphonates - Alendronate (alendronic acid)
  2. 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

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6
Q

What are some common side effects of sulfonylureas (gliclazide)?

A

Hypoglycaemia

Weight gain

Hyponatraemia secondary to SIADH

Should be avoided in pregnancy and breastfeeding

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7
Q

What are some examples of osmotic laxatives?

A

Lactulose - draws water from body into bowel to soften stool, then it makes stool easier to pass

Macrogols

Rectal phosphates

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8
Q

What are some examples of stimulant laxatives?

A

Senna

Bisacodyl

Sodium Picosulfate

Glycerol

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9
Q

What drugs are contraindicated in pregnancy?

A

TERATOWA

Other drugs not mentioned in picture:

statins

sulfonylureas

cytotoxic agents

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10
Q

What antibiotics are contraindicated in pregnancy?

A
  • Tetracyclines
  • Aminoglycosides (gentamicin)
  • sulphonamides and trimethoprim
  • quinolones
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11
Q

What are some factors that may potentiate warfarin?

A
  • 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
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12
Q

What are the adrenaline doses in anaphylaxis?

A
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13
Q

What drugs CAN you give in women who are breastfeeding?

A

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
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14
Q

What are drugs that should be AVOIDED in women who are breastfeeding?

A

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
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15
Q

What are some common side effects of Adenosine?

A

Chest pain

Bronchospasm

Transient flushing

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16
Q

What is a common side effect of amlodipine?

A

Ankle swelling

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17
Q

What is important to remember about Augmentin (co-amoxiclav) and Tazocin?

A

They are both penicillin containing antibiotics

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18
Q

What two classes of drugs commonly cause hyperglycaemia?

A

Steroids (dexamethasone commonly)

Thiazide diuretics

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19
Q

What 3 situations would you do a gradual withdrawal of corticosteroids?

A
  1. received more than 40mg prednisolone daily for more than one week
  2. received more than 3 weeks treatment
  3. recently received repeated courses
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20
Q

What is the paracetamol overdose management?

A

Patients who present within 1 hour may benefit from activated charcoal to reduce absorption of the drug

Acetylcysteine should be given if:

  1. there is a staggered overdose or there is doubt over the time of paracetamol ingestion, regardless of the plasma paracetamol concentration
  2. 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
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21
Q

What 2 medications are usually taken at night?

A

The following medications are usually taken at night:

  • statins
  • amitriptyline
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22
Q

What is an absolute contraindication to starting COCP in women aged 35 and over?

A

Smoking more than 15 cigs a day

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23
Q

What are the most common enzyme inducers?

A

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
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24
Q

What are the most common enzyme inhibitors?

A

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
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25
Q

What are the drugs to stop before surgery?

A

I LACK OP

  • Insulin
  • Lithium
  • Anticoagulants/antiplatelets
  • COCP/HRT
  • K+ sparing diuretics
  • Oral hypoglycaemics
  • Perindopril and other ACEi
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26
Q

PReSCRIBER mnemonic

A

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)

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27
Q

How should you take oral bisphosphonates like alendronate?

A

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

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28
Q

What is given in a heparin overdose?

A

Protamine Sulphate

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29
Q

What drugs may worsen seizure control in patients with epilepsy?

A
  • 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)

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30
Q

What is 1 in 10,000 adrenaline the same as?

A

1g in 10,000ml

or

1000mg in 10,000ml

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31
Q

1 % lidocaine has how much active ingredient per 100ml

A

1 % lidocaine has 1 g per 100 ml
This is equivalent to 10 mg/ml (i.e. 0.01 g/ml)

32
Q

What is oxybutynin for urge incontinence contraindicated in?

A

Elderly at risk of falls

Patients with closed-angle glaucoma

33
Q

How does dalteparin (and all heparins) cause hyperkalaemia?

A

Through inhibition of aldosterone synthesis

34
Q

How does Tacrolimus cause hyperkalaemia?

A

Through reduced potassium excretion

35
Q

Things that can cause an AKI, or exacerbate and worsen renal function

A

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

36
Q

Before prescribing Nitrofurantoin, what should you check?

A

If eGFR is less than 45ml/min/1.73min2 as, Nitrofurantoin should be avoided if eGFR is less than 45

37
Q

What is Onychomycosis (also known as tinea unguium)?

A

Fungal infection of the nail

38
Q

Indapamide (thiazide-like diuretic) adverse effects

A

Diuresis

Palpitations

39
Q

How does clarithromycin cause torsades de pointes?

A

Clarithromycin can prolong the QT interval in patients with a pre-existing predisposition, such as electrolyte disturbances like hypokalaemia

40
Q

When prescribing HRT, what consideration do you have to take into account when choosing which option to prescribe?

A

If the patient still has an intact uterus, indicating she will need endometrial protection, therefore, oral oestrogen therapy alone is not suitable

41
Q

What electrolyte disturbances can omeprazole cause?

A

Hyponatraemia

Hypomagnesaemia

42
Q

What is the Yellow Card Scheme and should you report adverse drug effects?

A

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

43
Q

What instance can cyclizine be used as an anti-emetic?

A

Mechanical bowel obstruction - so there is a physical blockage

Can be used to help nausea and vomiting in mechanical bowel obstruction

44
Q

What is the difference between mechanical and functional blockage?

A

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

45
Q

When is Haloperidol used for nausea and vomiting?

A

For cases where there is a metabolic cause, like hypercalcaemia or renal failure

OR

Opioid-induced vomiting

46
Q

When is ondansetron used for nausea and vomiting?

A

In patients after an operation

OR

In patients using cytotoxics

47
Q

When should you stop metformin in a patient?

A

If there eGFR is less than 30 ml/minute/1.73 m2

This is because it can provoke lactic acidosis

48
Q

In all cases of acute asthma in adults, what should you prescribe at least?

A

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

49
Q

What is co-amilofruse?

A

Potassium sparing diuretic

50
Q

What drug reduces the absoprtion of alendronic acid?

A

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
51
Q

What is the preferred antidepressant for moderate and severe depression in children and young people?

A

Fluoxetine

52
Q

What acne drug can’t be prescribed in primary care?

A

Oral isotretinoin

53
Q

How does digoxin toxicity present?

A

Digoxin toxicity presents with:

confusion

headaches

diarrhoea

nausea, vomiting

dizziness

Arrhythmias, heart block, and visual disturbances can occur

Coloured vision is characteristic

54
Q

What are some side-effects of bisoprolol?

A
  1. bronchospasm
  2. headache
  3. fatigue
  4. sleep disturbances
  5. sexual dysfunction
  6. vertigo
55
Q

What drug can cause acute dystonic reactions?

A

Metaclopramide

can cause acute dystonic reactions involving facial and skeletal muscle spasms and oculogyric crisis

It is because it crosses blood-brain barrier

56
Q

Which antipsychotic most likely to cause hyperprolactinaemia?

A

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

57
Q

What is the first line treatment for constipation in kids?

A

Macrogols

58
Q

Black, tarry stools is a side effect of what drug?

A

NSAIDs

59
Q

Drug-induced jaundice is a side effect of what drugs?

A

rifampicin

paracetamol

isoniazid

chlorpromazine

methyldopa

60
Q

What is Bupropion?

A

Antidepressant drug which is also given to relieve the symptoms of nicotine withdrawal

Bupropion should be avoided in people with a history of seizures

61
Q

Phosphodiesterase type-5 inhibitors (Sildenafil), are contraindicated with what?

A

Contraindicated in patients taking nitrates as they can cause severe hypotension

62
Q

Which contraception requires a yearly routine check for blood pressure and body mass index?

A

Combined oral contraceptive pill

63
Q

When should patients who use sublingual GTN call an ambulance if chest pain still persists?

A

Call 999, if their pain has not settled after 10 minutes of using two doses of the spray

64
Q

What scenarios would patients with T2DM have to self-monitor blood glucose levels?

A
  1. On insulin
  2. Evidence of hypoglycaemic episodes
  3. On oral medication that may increase their risk of hypoglycaemia while driving or operating machinery, like gliclazide
    1. Pregnant, or planning to become pregnant
65
Q

When administering phenytoin IV, what should you do to avoid cannula site inflammation?

A

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

66
Q

What is Fosphenytoin?

A

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

67
Q

What are side effects of Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol?

A

Rifampicin = Red-orange urine/tears

Isoniazid = Peripheral Neuropathy

Pyrazinamide = hyperuricaemia causing gout, arthralgia

Ethambutol = Optic Neuritis and red/green colour blindness

68
Q

What two drugs can be used as a last resort for the pharmacological treatment of severe agitation and psychosis? These medications are suggested when all other measures fail - what are these other measures?

A

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
69
Q

When are hormonal contraceptives contraindicated in women?

A

Current or past breast cancer - due to increased exposure to oestrogen is a risk factor for breast cancer

Give copper coil

70
Q

When is the copper coil contraindicated?

A

In patients with endometrial cancer

71
Q

What class of drug is amiloride?

A

Potassium sparing diuretic

72
Q

What drugs can cause pulmonary fibrosis?

A
  • Antibiotics - especially nitrofurantoin
    • Amiodarone
  • Chemotherapy
  • Methotrexate
73
Q

What are the two common side effects of metformin?

A

GI disturbances

Lactic Acidosis

74
Q

What are the issues surrounding metformin and going for a scan with contrast dye?

A

There is a risk of metformin causing lactic acidosis when used with contrast dye

75
Q

What drugs are some common causes of hyponatraemia?

A

SSRIs

Loop and thiazide diuretics

ACEi

PPIs

Carbamazepine

Haloperidol

NSAIDs

PSA (8 decks)

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