PSA Contraindications, side effects and cautions

Question 1

Drugs that increase bleeding Warfarin Heparin

Answer 1

Shouldn’t be given to patients who are bleeding, suspected to be bleeding, or at risk of bleeding

Question 2

Prophylactic heparin

Answer 2

acute ischemic stroke: risk of bleeding into stroke

Question 3

Warfain

Answer 3

INR is increased by enzyme inhibitors

Question 4

Steroids

Answer 4

STEROIDS
Stomach ulcers
Thin skin
oEdema
Right and left heart failure
Osteoporosis
Infection
Diabetes
Cushing's Syndrome

Question 5

NSAIDs

Answer 5

NSAIDs
No Urine (renal failure)
Systolic dysfunction
Asthma (avoid unless strictly necessary)
Indigestion
Dyscrasia (clotting abnormality)

Question 6

Antihypertensives

Answer 6

-Hypotension
-Bradycardia (BB); Electrolyte disturbance (ACEI and diuretics)
-ACE: cough
BB wheeze in asthma, worsen HF
CCB: peripheral oedema and flushing
Diuretics can cause renal failure: Loop cause gout, K sparing cause gynecomastia

Question 7

Compression stockings

Answer 7

peripheral arterial disease

Question 8

Metoclopramide

Answer 8

Avoid in Parkinson's disease
Young women (under 20), low weight (risk of dyskinesia)

Question 9

Constipation

Answer 9

Stop all opioid derived drugs

Question 10

Methotrexate cautions

Answer 10

Don’t use trimethoprim, cotrimoxazole or other folate antagonists with methotrexate (pancytopenia, neutropenic crisis)
STOP methotrexate when septic
Regular WBC monitoring is required

Question 11

Diuretics causing hyperkalemia

Answer 11

Potassium-sparing

ACEI

Question 12

Diuretics causing hypokalemia

Answer 12

Loop diuretics

Thiazides

Question 13

Acute stroke

Answer 13

should not be having heparin for 2 months

Question 14

Verapamil

Answer 14

NOT to be used with a beta-blocker due to risk of bradycardia and asystole, and hypotensionon

Question 15

COCP

Answer 15

Migraine with aura (increased risk of stroke)

Question 16

Insulin

Answer 16

Is always SC except for sliding scales using short-acting Insulin

Question 17

BB

Answer 17

Contraindicated in asthmatics

Question 18

Causes of neutropenia

Answer 18

Clozapine and carbimazole

Question 19

Causes of low platelets

Answer 19

Heparin

penicillamine

Question 20

Causes of hyponatreamia

Answer 20

Diuretics

Question 21

Causes of hypokalaemia

Answer 21

Loop and thiazide

Question 22

Causes of hyperkalaemia

Answer 22

Potassium sparing diureticc

ACEI

Question 23

Drugs causing hepatitis/cirrhosis

Answer 23

Paracetamol OD
Statins
Rifampicin

Question 24

Drugs causing Cholestasis

Answer 24

Flucloxacillin
Augmentin
Nitrofurantoin
Steroid
Sulphonylureas

Question 25

ACEI in pregnancy

Answer 25

Teratogenic, switch to labetalol

Question 26

Tamoxifen cautions

Answer 26

Increases the risk of endometrial cancer Increased efficacy of warfarin and caused high INR Increased risk of VTE

Question 27

Sulphonylurea cautions

Answer 27

Higher risk of hypoglycemia- should not miss meals

Question 28

Long term steroids cautions

Answer 28

``` increased risk of DM risk of osteoporosis small risk of gastric irritation never stop suddenly if on a long course risk of HTN ```

Question 29

Drugs that cause SIADH

Answer 29

Carbamazepine | antipsychotics

Question 30

Drugs to stop before surgery

Answer 30

``` Antiplatelts anticoagulants COCP Oral hypoglycaemics the day before surgery Insulin Lithium the day before surgery ```

Question 31

Drugs NOT to stop before surgery

Answer 31

Beta-blockers Calcium channel blockers corticosteroids

Question 32

Thiazides can cause...

Answer 32

gout

Question 33

Lithium excretion

Answer 33

is significantly reduced by ACEI, diuretics, and NSAIDs

Question 34

Caution with stopping antiepileptic drugs

Answer 34

Should never be abruptly stopped unless toxic

Question 35

Changes to insulin when unwell

Answer 35

Increased insulin doses due to increased basal blood glucose

Question 36

Failure to rotate insulin injection sites

Answer 36

Results in lipodystrophy and varies the quantity of insulin absorbed

Question 37

Effect of alcohol on blood glucose

Answer 37

Excessive alcohol intake results in life-threatening hypoglycemia

Question 38

Changes to steroids during sepsis

Answer 38

double the dose of long term steroids

Question 39

Aminophylline toxicity

Answer 39

tachycardia and even fatal tachyarrhythmias

Question 40

Contraindications for omeprazole

Answer 40

clopidogrel interacts with omeprazole | this would be stopped unless post-MI with stent insertion

Question 41

CCB

Answer 41

Can cause constipation

Question 42

Mirtazapine

Answer 42

convulsions

Question 43

Oral hypoglycemics to avoid in elderly

Answer 43

glibenclamide (long-acting and risk of hypoglycemia)

Question 44

Statins

Answer 44

cause muscle aches but don't discontinue if mild

Question 45

Dose changes in Addisons

Answer 45

Elevated glucocorticoid requirements because of minor illness or trauma (2-3 times usual dose) moderate to severe illness or trauma dose increased to 50-100 mg 2-4 times daily fludrocortisone may be continued at the usual dose

Question 46

Cautions with asthma treatment in children

Answer 46

Avoid corticosteroids especially at higher doses | Dry powder devices are difficult for children to use