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PSA Revision > PSA Drug Interactions > Flashcards

PSA Drug Interactions Flashcards

1
Q

Antibiotics

Gentamicin and Vancomycin (2)

A
  • Ototoxic
  • Nephrotoxic
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2
Q

Antibiotics

All bread spectrum (most commonly cephlasporins and ciprofloxacin)

A
  • C.diffe
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3
Q

ACEi (4)

A

Hypotension
Hyperkalaemia (and hyponatraemia)
AKI
Dry cough

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4
Q

B-blockers (4 + 1 common Q)

A

Hypotension
Bradycardia
common = fatigue
Worsens asthma (wheeze)
Worsens acute HF (helps chronic)

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5
Q

CCB (5) 4 and 1 rare

A

Hypotension
Bradycardia
Peripheral odema
flushing
Angiodema

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6
Q

Heparins
- classic - common in (2)
-

A

Haemorrhage (esp. in renal failure or <50kg)
heparin induced thromboctopaenia

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7
Q

Warfarin (1 but counter-intuitively)

A
  • Haemorrhage (Counter-intuitively warfarin has a pro-thrombotic effect initially and therefore LMWH should be commenced at the same time to cover this)
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7
Q

  • (think about class)
  • in large doses…
A
  • Haemorrhage
  • peptic ulcer and gastritis
  • tinnitus in large dose
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8
Q

-
-
-
- Very rogue one!

A
  • Nausea
  • Vom and diarrhoea
  • blurred vision
  • confusion and drowsy
  • xanthopsia (disturbance of visions seeing yellow and green but also halo vision)
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9
Q

Amioderone
- biggie
-
- rogue
- rogue

A
  • Interstitial lung disease
  • thyroid disease (hypo and hyper)
  • grey skin
  • corneal deposit
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10
Q

Lithium
Early -
Intermediate -
Late (5)

A

Early - tremor
Intermediate - tired
Late (5)
- seizure
- SIADH
- coma
- renal failure
- arrhythmia

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11
Q

Haloperidol (2)

A

Dyskenesia (acute dystonic reactions - invol. erratic writhing movements)
Drowsy

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12
Q

Clozapine (Spell it)

A

C - constipation
L - lower seizure threshold
O -
Zzz- sedation
A - argranulocytosis
P -
I -
N - Neutropeania
E - ecg changes

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13
Q

Dexamethasone and pred
STEROIDS

A

S- stomach ulcer
T - thin skin
E - oedema
R - R and L sided HF
O - osteoperosis
I - infection (inc. candida)
D - diabetes (actually hypergycaemia)
S - syn of cushings

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14
Q

Fludocortisone
1 due to…

A

hypertension due to sodium and water retention

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15
Q

NSAIDs
ibuprofin
N
S
A
I
D

A

N - no urine (AKI)
S - systolic dysfunction (HF)
A - asthma
I - Indigestion
D - dyscrasia (clotting abnormality)

16
Q

Simvistatin (4)
common =
rare but need to know =
-
- LFTs show…

A

common = myalgia
rare but need to know = rhabdomylosis
- Abdo pain
- LFTs show… rise in AST/ALT

17
Q

MAnagement of statin induced myalgia
1.
2.

list the statins in most myalgia likely to least

pravastatin
simvastatin
fluvostatin
atorvastatin

A
  1. exclude rhabdomyolysis
  2. if CK >2000
    do they need statin?
    reduce dose or stop
    switch to other statin with lessmyalgia properties

simvastatin (most)
atorvastatin
pravastatin
fluvostatin (least)

18
Q

Drugs with a narrow therapeutic index and therefore are at risk o toxic levels or sub-therapeutic levels (4)

A

Digoxin
Lithium
Phenytoin
Theophllyine

19
Q

If stem says acidotic behaviour or low GCS think….

A
  • Antihypertensives (hypotension
  • Anti-diabetic drugs (hypoglycaemia)

metformin!

20
Q

cytochrome P540 inducers (need more drug)

cytochrome P450 inhibitors (at risk of Overdose!)

A

Inducers:
P phenytoin
C carbamezapine
B barbituates
R rifampicin
A alcohol (long term)
S sulphlyureas

Inhibitors:
A Allopurinol
O omeprazole
D disulfiram
E erythromycin
V valproate
I isoniozid
C cirprofloxacin
E ethanol (short term)
S sulphonamides

21
Q

two classic anti-hypertensives that SHOULD NOT be put together and why?

A

B-blokcer and CCB thats not ratelimiting
eg.
Bisoprolol and verapamil or dilitazem

profound bradycardia and hypotension!

22
Q

is cranberry juice and P450 inducer or inhibitor?

A

INHIBITIOR!

23
Q

Classic drug interactions which causes these presentations

  1. GI bleed caused by peptic ulcer
  2. Lactic acidosis
  3. Increased anti-coag
    on a drug as well as…
  4. Hypertensive crisis
  5. Sweating, flushing N+V
  6. sedation (3)
A
  1. GI bleed caused by peptic ulcer
    too many NSAIDs - ibuprofin, aspirin
  2. Lactic acidosis
    metformin
  3. Increased anti-coag
    on a drug as well as… acute alcohol or chonic alcohol use
  4. Hypertensive crisis
    Monoamine oxidise inhibitors (isocarboxazid, phenelzine, selegiline, and tranylcypromine)
  5. Sweating, flushing N+V
    metronidozole and disulfiram
  6. sedation (3)
    benzo
    barbituates
    opioids
24
Q

physiology of how ACEi and NSAIDs affect the afferent and efferent tubules leading to AKI

avoid co-prescribing them

A

ACEi
They relax the efferent (exiting) tubule which drops the filtration pressure and thus drops GFR

NSAIDs
Inhibit prostaglandins which are responsible for dilating the afferent (arriving) vessels. Inhibiting this dilation means a decrease in blood flow to the kidney thus increasing AKI risk

25
Q

name some K+ sparing diuretics

A

Amiloride
Sprinolactone

26
Q

Management when INR is too high:

PSA Revision (6 decks)

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