PSA/Pharm Flashcards
what is the treatment for acute dystonia/oligouric crisis?
procyclidine 10 mg iv STAT
what cardiovascular medications are contraindicated in peripheral vascular disease?
all - beta-blockers because they reduce peripheral limb perfusion through action on the adrenergic system
severe PVD - also avoid ACE-I
what are some commonly used mediations that worsen congestive heart failure?
- calcium-channel blockers
- NSAIDs
- DPP-4 inhibitors (sitagliptin)
- alpha-blockers (doxazosin)
- anti-arrhythmics (sotalol, flecanide, disopyramide)
name the commonly used thiazides and thiazide-like diuretics
- bendroflumethiazide
- hydrochlorothiazide
- indapamide
- chlorthalidone
- metolazone
name the common used cardioselective calcium channel blockers
- verapamil
- diltiazem
name the common peripherally acting calcium channel blockers
- amlodipine
- nifedipine
- nimodipine
which antibiotics should be avoided when a patient is on methotrexate?
trimethoprim and fluroquinolones
what medication seriously increased the risk of myotoxicity when given in combination with a statin?
gemfibrozil
what should be checked before starting a patient on spironolactone or eplerenone?
serum potassium
what should be told to patients on methotrexate?
- blood disorders (infections, bleeding, anaemia, ulcers)
- liver toxicity (dark urine, nausea and vomiting)
- respiratory effects (shortness of breath)
- NSAIDs - should be avoided, but not absolutely CI
- teratogenicity - both men and women should be on contraception for the duration of treatment and 3 months after stopping
which NSAIDs have the highest and lowest CV risk associated?
highest - coxibs and diclofenac
lowest - naproxen
what is the mechanism of action of thiazide diuretics?
what are the common side effects of thiazide diuretics?
inhibiting sodium reabsorption in the distal convoluted tubule through the Na-Cl symporter. potassium is lost as a result of more Na reaching the DCT and collecting ducts
common:
- dehydration & postural hypotension
- hyponatraemia, hypokalaemia, hypercalcaemia
- gout
- impotence
rare:
- photosensitive rash
- thrombocytopenia
- agranulocytosis
- pancreatitis
what are the main serious side effects of NSAIDs?
- worsening of asthma
- increased risk of thromboembolic (MI or CVA) events
- increased risk of GI-ulceraiton and haemorrhage
- worsened if drinking alcohol in moderate quantities concurrently
what are the fluid and electrolyte requirements for an adult in 1 day?
what is the minimum urine output target?
fluid - 40 mL/kg
Na+ - 2 mmol/kg
K+ - 1 mmol/kg
0.5 mL/kg/hour
…do not exceed an infusion rate of 10 mmol/hr K+
what a suitable dose of any LMWH for treatment of VTE?
what are the treatment doses of rivaroxaban and apixaban for VTE?
enoxaparin - 1.5 mg/kg OD s/c every day until adequate oral anticoagulation is established
rivaroxaban - 15 mg BD for 21 days taken with food
apixaban - 10 mg BD for 7 days, then 5 mg BD
what medication can lead to gingival hyperplasia?
ciclosporin
phenytoin
CCBs
what are the starting and monitoring requirements for warfarin?
what finding would be a contraindication to starting warfarin?
measure PT and baseline LFTs, do not hold off the first dose while waiting for PT to come back from the lab
measure the PT and calculate the INR
PT > 5 x ULN then do not use warfarin
what are the monitoring requirements for methotrexate?
what are the side effects?
what is the conception advice?
what drugs should be avoided while on methotrexate?
- low-dose = LFTs
- high-dose = LFTs and FBC and U&E
myelosupression, liver cirrhosis, pulmonary fibrosis, pneumonitis, mucositis
- *women**: avoid pregnancy for at least 3 months following MTX therapy
- *men:** use effective contraception for at least 3 months following MTX therapy
trimethoprim and co-trimoxazole (TMP/SMX)
what are the monitoring requirements for lithium?
what are the target and acceptable levels?
lithium levels - check every 3 months, taken 12 hours after last dose (trough)
TFTs and U&E checked every 6 months
- *target**: 0.8-1.0
- *acceptable:** 0.4-1.2
what blood test is used to monitor 5-aminosalycylic acids (5-ASAs)?
U&Es
what are the side effects common to sulfa drugs?
- rashes
- oligospermia
- headache
- Heinz body anaemia
- megaloblastic anaemia
- lung fibrosis
what are the side effects common to 5-ASA drugs?
- GI disturbance
- agranulocytosis
- pancreatitis
- mesalazine >>> sulphasalazine
- interstitial nephritis
what are the adverse affects of amiodarone?
what are the monitoring requirements?
- slate-grey appearance
- thyroid dysfunction
- corneal deposits
- pulmonary fibrosis/pneumonitis
- liver fibrosis (ALT > AST)
- photosensitivity
- thrombocytopenia at injection sites
- bradycardia
- *prior to treatment:** TFTs, LFTs, U&E, CXR
- *every 6 months:** TFTs and LFTs
what is the impact of NSAIDs on heart failure?
NSAIDs worsen heart failure by causing fluid retention, increasing blood pressure and increasing the afterload on an already strained heart
heart failure worsened by NSAIDs
why should 5% glucose not be given to an alcoholic at risk of wernicke’s encephalopathy immediately?
when malnourished, all the glucose in the body is diverted to the brain for energy. thiamine is a co-factor for OxPhos.
introducing systemic glucose increases the whole body demand for thiamine, so it is diverted away from the brain, leading decreased cerebral oxidative phosphorylation.
fill the patient up with thiamine (Pabrinex) first, then give glucose
what are the starting and monitoring requirements of statin medications?
get lipid profile (obviously) and LFT before starting
LFTs at 3 and 12 months after starting
AST/ALT is more than 3x ULN, stop and restart at a lower dose
transaminase rise of less than 3x ULN - do not stop medication
what is the rare but serious liver side effect of statins?
cholestatic hepatitis (raised ALP and liver damage)
which diuretic worsens gout?
thiazides
which antibiotics increase the chances of statin-induced myopathy?
macrolides - erythromycin/clarithromycin
what proportion of patients will not tolerate AZA therapy?
what are the common side effects?
what is the uncommon and serious side effect of AZA?
what medication should you try next in a patient with IBD?
33% of patients will not tolerate AZA
GI side effects, hair loss and skin rash
red cell aplasia, pancytopenia
6-mercaptopurine
what is the side effect of AZA that is more likely to occur in patients with low TMPT levels/deficiency?
myelosupression
which tests are needed if you suspect digoxin toxicity?
ECG and renal function (looking for raised creatinine or hypokalaemia)
digoxin level
though there is no absolute number for this. the likelihood of toxicity increases as concentrations rise, but toxicity is indicated by the degree of hypokalaemia
which drugs are directly hepatotoxic?
i.e. give raise transaminases without ALP rise
paracetamol overdose
statins
rifamipicin
which drugs give a cholestatic hepatitis?
co-amoxiclav and flucloxacillin
nitrofurantoin
steroids
sulfonylureas
what is the rule for calculating the expected PaO2 from the FiO2?
[FiO2 - 10] = expected PiO2
what medication can result in a downward-sloping ST segment depression in all leads?
digoxin
what are the main ototoxic drugs?
- aminoglycosides
- loop diuretics
- platinum-based chemotherapy
which medication should be avoided in myasthenia gravis?
anti-cholinergics..
i.e. oxybutynin for urinary incontinence
when should thiazides be taken?
in the morning
if you prescribe at night then the patient will wake up having to pee
what is the dosing schedule for common anti-emetics?
metoclopramide and cyclizine
given TDS/8-hourly
which is the anti-emetic dopamine blocker than can be used in parkinson’s disease?
domperidone, as it does not cross the BBB
metaclopramide should not be used in Parkinson’s
what are the common drugs that precipitate bronchospasm in asthmatics?
beta-blockers, NSIADs and adenosine
note: 10-20% of asthmatics are sensitive
if they’ve been on it before without a problem then they can stay on NSAIDs
risk is increased in patients who are middle-aged or those with nasal polyps
what is the definition and treatment of a severe flare of UC?
opening bowels >6 times/day and systemically unwell
IV hydrocortisone 100 mg QDS/6-hourly
what is the definition of a major bleed on warfarin?
i.e. requiring PCC
bleeding causing hypotension or into a confined space (skull)
what are the sick day rules for T1DM patients with regards to insulin?
needs to increase the dose of insulin, otherwise will run a higher risk of DKA
after how many days should you review the antibiotic therapy for acute otitis media?
5 days
after how many days should you review the antibiotic therapy for acute epiglottitis?
3 days
what is first line treatment for GAD?
citalopram/escitalopram/fluoxetine
what is the first line treatment for depression in adults?
citalopram/escitalopram/fluoxetine/fluvoxamine/paroxetine
what is the monitoring requirement before you start valproate?
liver function tests
what is the monitoring requirement for clozapine?
FBC checked weekly for at least the first 18 weeks
what is the monitoring for phenytoin?
ECG and blood pressure
what is the best marker to monitor the response of a pneumonia to antibiotic therapy?
respiratory rate
return to normal indicates that the respiratory failure is resolved.
ABG would be preferable, but is invasive so RR is often easiest
which diuretic is associated with hyponatraemia?
thiazides
dose for paracetamol?
1g qds
dose for ibuprofen?
200-400 mg tds
dose for codeine?
30-60 mg qds
dose for co-codamol?
8/500 mg qds
30/500 qds
or ‘co-codamol 8/500 mg 2 tablets qds’
dose for cyclizine?
50 mg tds
dose for metaclopramide?
total 30-100
typically 10 mg tds
amoxicillin
500 mg tds
dose for clarithromycin
500 mg bd
dose for lansoprazole
15-30 mg od
dose for omeprazole
20-40 mg od
dose for aspirin
secondary prevention
75 mg od
treatment 300 mg od
dose for clopidogrel
75 mg od secondary prevention
300 mg od treatment
dose for simvastatin
10-80 mg ON
start at 40 mg ON if the patient has diabetes or established atherosclerotic cardiovascular disease
dose for atenolol
25-100 mg od
dose for ramipril
1.25-10 mg od
dose for bendroflumethiazide
2.5 mg od
give in the morning!
dose for furosemide
20 mg od - 80 mg bd
can be much higher for renal patients
dose for amlodipine
5-10 mg od
dose for levothyroxine?
25-200 mcg od
dose for metformin?
500 mg od - 1 g bd
which drugs worsen seizure control in patients with epilepsy?
- alcohol, cocaine, amphetamines
- cirpfloxacin, levofloxacin
- aminophylline, theophylline
- bupropion
- methylphenidate
- mefenamic acid
what is the rule for dose of oral morphine for breakthrough pain in palliative care?
take 1/6th of daily oral morphine dose for breakthrough pain
which opioids are best used in renal impairment?
fentanyl or oxycodone
what is the effect of ciclosporin on electrolytes?
hyperkalaemia
hyperglycaemia and hyperuricaemia
how do you treat vulvovaginal candidiasis?
what is the difference in pregnancy?
topical/PV clotrimazole
must be prolonged treatment… 7 days usually rather than a single dose
T1DM in DKA
usually on a basal-bolus
what do you do with their regular insulin? is the treatment with fixed-rate or variable-rate insulin for the DKA?
stop the short acting
keep the long-acting insulin as normal
start them on fixed-rate insulin of 0.1 U/kg/hr
what is the advice for patients when treating with loperamide for acute diarrhoea?
loperamide should be taken after each loose stool
care not to exceed the maximum dose (16 mg/24 hrs)
what is the dose adjustment of insulin when a T1DM patient starts taking steroids for treatment of another disease?
increase the dose by 10%
