PSA passmed Flashcards
which drugs in rheumatology are prescribed weekly?
bisphosphonates
methotrexate
Drugs to be avoided if pt has epilepsy
alcohol, cocaine, amphetamines ciprofloxacin, levofloxacin aminophylline, theophylline bupropion methylphenidate (used in ADHD) mefenamic acid
drugs that decr K
Thiazide diuretics
Loop diuretics
Acetazolamide
drugs that incr K
ACE inhibitors Angiotensin-2 receptor blockers Spironolactone Potassium sparing diuretics (amiloride, triamterene) Potassium supplements (Sando-K, Slow-K)
meds to avoid in heart failure
thiazolidinediones*: pioglitazone is contraindicated as it causes fluid retention
verapamil: negative inotropic effect
NSAIDs**/glucocorticoids: should be used with caution as they cause fluid retention
class I antiarrhythmics; flecainide (negative inotropic and proarrhythmic effect)
labour induction medical no.1
Dinoprostone vaginal tablet
depression and stress incontinence
duloxetine
if pt’s eGFR is low, nitrofurantoin is unsuitable/ ineffective because of inadequate urine conc and risk of peripheral neuropathy.
can prescribe getamicin
pt with hx of epilepsy then depressive sx
Mx
not SSRIs or TCA= they incr risk of seizures by antagonising effect of valproate.
AKI drugs to alter: Metformin and Sitagliptin
if eGFR is <30 metformin should be avoided- incr risk of lactic acidosis
Sitagliptin i 1’ eliminated via renal route and requires dose reduction to 25mg OD if eGFR is <30.
Drugs that can cause CNS toxicity
Amitriptylline, citalopram and Tramadol
P450 inducer (reduced anticoag effect) e.g.
rifampicin
Drugs to avoid in the elderly
Glibenclamide- long acting sulfonylurea- higher risk of hypoglycaemia
Lorazepam- benzo- ince the risk of confusion and ataxia leading to falls
prochlorperazine (antipsychotic)- avoid in elderly its with dementia- incr risk of mortality/ stroke/ TIA
lithium toxicity can be aggravated by
hyponatraemia- body retains lithium which is an ion similar to sodium
Ace-i and loop diuretics increase the loss of NA- tf incr retention of Li.
NSAIDs can incr the risk of Li toxicity by reducing the exertion of Li due to fluid retention
folic acid in pregnancy duration
upto 12 weeks
sulfasalazine skin change
orange yellow discoloration
amiodarone skin change
slate grey appearance
medications that can cause sleep disturbance
B blockers esp lipid soluble ones can cause sleep disturbances with nightmares
Steroids can cause insomnia and nightmares. TCA can also cause sleep disturbance.
anti epileptic hypersensitivity syndrome cause
phenytoin
strontium ranelate can cause
severe allergic reactions- drug rash with eosinophilia and systemic sx
drugs with incr risk of toxicity due to hypoalbuminaemia
prednisone, omeprazole, phenytoin and letrozole are all bound to plasma albumin.
It is prednisone and phenytoin that can cause probs due to incr in the conc of a free drug
Medications that reduce anti platelet effect of clopidogrel
omeprazole and fluoxetine
Drugs that incr risk of simvastatin related myopathy- rhabdomyolysis
CCB- incr plasma conc
Drugs that should be used with caution in its with G6PD
aspirin <1g/day. gliclazide, nitrofurantoin and quinine
Drugs that should be used with caution in its with G6PD
aspirin <1g/day. gliclazide, nitrofurantoin and quinine
drugs that cause ototoxicity
furosemide
vancomycin
drugs that cause constipation
buscopan
ferrous fumarate
Drugs to stop before surgery
Acei/ARB= 24 hours before Wafarin 5 dys before Clopidogrel 7 days before COCP 4-6wks before Lithium 2 days
Drugs to stop day of surgery
Metformin
Insulin
Gliclazide
with ileus avoid constipating drugs
e.g. Clozapine, hyoscine and amitriptyline
prolong QT interval
escitalopram domperidone odansetron Methadone quinolone
dry mouth
TCA
antipsychotics- risperidone
clozapine major SE
agranulocytosis
vigabatrin visual SE
visual field defect
isotretinoin SE visual
dryness of the eyes w/ blepharitis/ conjunctivitis
amiodarone visual SE
reversible corneal deposits present with night glare and may affect the pt’s ability to drive in the dark
primary angle closure glaucoma precipitators
amitriptyline or chlorphenamine
primary angle closure glaucoma precipitators
amitriptyline or chlorphenamine
pioglitazone
rare reports of liver toxicity- discontinue if jaundice appears
incr risk of HF when combined with insulin
small risk of bladder ca= haematuria, dysuria or urgency
methotrexate to look out for
lung problems and liver problems
methotrexate to look out for
lung problems and liver problems
Creon how to take
best taken with food and should be taken immediately after it has been mixed with food
prostaglandin analogue e.g. latanoprost SE
brown pigmentation of eyes
causes thickening of the lashes
prostaglandin analogue e.g. latanoprost SE
brown pigmentation of eyes
causes thickening of the lashes
medications that may exacerbate heart failure
thiazolidinediones*: pioglitazone is contraindicated as it causes fluid retention
verapamil: negative inotropic effect
NSAIDs**/glucocorticoids: should be used with caution as they cause fluid retention
class I antiarrhythmics; flecainide (negative inotropic and proarrhythmic effect)
medications that may exacerbate heart failure
thiazolidinediones*: pioglitazone is contraindicated as it causes fluid retention
verapamil: negative inotropic effect
NSAIDs**/glucocorticoids: should be used with caution as they cause fluid retention
class I antiarrhythmics; flecainide (negative inotropic and proarrhythmic effect)
prednisolone LT SE
proximal muscle weakness
prednisolone LT SE
proximal muscle weakness
sodium valproate SE
weight gain & hair loss- top two
liver toxicity
Pancreatitis
drugs that cause renal impairment
ciclosporin (Neoral)
Contrast
SE of levodopa rx
postural hypotension
discolouration of urine
peripheral oedema drug causes
CCB
NSAIDs
Diazepine positing rx
flumazenil
opiod therapy SE
bradypnoea
resp depression
urinary retention
opiod therapy SE
bradypnoea
resp depression
urinary retention
sodium fusidate SE
hepatobiliary disorders
Digoxin toxicity
1) nausea and vomiting- early signs
2) yellow vision
Amiodarone can incr the dose of digoxin
Digoxin toxicity
1) nausea and vomiting- early signs
2) yellow vision
Amiodarone can incr the dose of digoxin
olanzapine and clozapine monitoring 6mnth
blood lipids and weight
Erythromycin affect on wafarin
inhibits the metabolism tf INR increases and risk of haemorrhage
erythromycin with simvastatin
inhibits the metabolism of simvastatin, incr risk of statin related myopathy. Good to withhold simvastatin during rx with erythromycin- this does not cause harm to the pt as this is a LT preventative measure.
SE of TB rx
ethambutol- eyes
Isoniazid- peripheral neuropathy
liver function should be checked before intiating
Labetalol and liver damage
severe hepatocellular damage has been reported with labetalol- reversible
should be given alternative such as nifedipine
tumour lysis syndrome rx
rasburicase IV
tumour lysis syndrome rx
rasburicase IV
drugs that cause urinary retention
Anticholinergics (eg, antipsychotic drugs, antidepressant agents, anticholinergic respiratory agents, detrusor relaxants), General anaesthetics, Alpha-adrenoceptor agonists, Benzodiazepines (e.g. diazepam), Non-steroidal anti-inflammatory drugs (e.g. ibuprofen), Calcium-channel blockers, Antihistamines, Alcohol.
drugs that cause urinary retention
Anticholinergics (eg, antipsychotic drugs, antidepressant agents, anticholinergic respiratory agents, detrusor relaxants), General anaesthetics, Alpha-adrenoceptor agonists, Benzodiazepines (e.g. diazepam), Non-steroidal anti-inflammatory drugs (e.g. ibuprofen), Calcium-channel blockers, Antihistamines, Alcohol.
drugs that cause confusion
Anticholinergics (eg, antipsychotic drugs, antidepressant agents, anticholinergic respiratory agents, detrusor relaxants),
Antipsychotics,
Antidepressants,
Anticonvulsants.
Less common causes (Histamine H2 receptor antagonists, digoxin, beta-blockers, corticosteroids, non-steroidal anti-inflammatory agents and antibiotics.k
drugs that cause confusion
Anticholinergics (eg, antipsychotic drugs, antidepressant agents, anticholinergic respiratory agents, detrusor relaxants),
Antipsychotics,
Antidepressants,
Anticonvulsants.
Less common causes (Histamine H2 receptor antagonists, digoxin, beta-blockers, corticosteroids, non-steroidal anti-inflammatory agents and antibiotics.
alendronic acid SE
discomfort in the retrosternal area- alert damage to lower oesophagus and should be discontinued
alendronic acid SE
discomfort in the retrosternal area- alert damage to lower oesophagus and should be discontinued
methotrexate SE
pneumonitis
leucopenia
methotrexate SE
pneumonitis
leucopenia
peripheral vascular disease CI
B blockers
Ace-i
peripheral vascular disease CI
B blockers
Ace-i
gradual withdrawal of steroids if
- received more than 40mg prednisolone daily for more than one week
- received more than 3 weeks treatment
- recently received repeated courses
medications that worsen psoriasis
beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
medications that worsen psoriasis
beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
sotalol can prolong the Qt interval
Tricyclic antidepressants, selective serotonin uptake inhibitors and haloperidol are psychiatric drugs known to cause QTc prolongation.
sotalol can prolong the Qt interval
Tricyclic antidepressants, selective serotonin uptake inhibitors and haloperidol are psychiatric drugs known to cause QTc prolongation.
Drug causes of raised prolactin
metoclopramide, domperidone
phenothiazines
haloperidol
very rare: SSRIs, opioids
drugs that prolong the QT interval
Quetiapine
chlorpromazine
-both antipsychotics
Sotalol- antiarrythmic
Carvedilol- BB
associated with bone loss
fureosemide
PPI- omeprozole
erythema multiforme SE
pheytoin carbamazepine valproate lamotrigine penicillinn sulphonamides aspirin allopurinol hydralazine cimetidine
pruitus due to biliary problems
colestyramine
methotrexate and trimethoprim together
toxicity and bone marrow suppression
to lower portal HTN
propanolol
abd ascites
spironolactone
drugs that can exacerbate hyponatraemia
carbamazepine
citalopram
lasoprazole
GTN SE
dizziness
hypothension
headache
GTN SE
dizziness
hypothension
headache
management of DKA
when K is between 3.5-5.5 to use 40mmol of K supplement
