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Finals pharmacology new > PSA: prescription review > Flashcards

PSA: prescription review Flashcards

1
Q

dosing methotrexate

A

Rheumatology: dose range 5-25mg once weekly

Gastroenterology: Starting dose – 25mg once weekly for 16 weeks

Maintenance dose – 15mg once weekly
Always prescribe methotrexate in multiples of the 2.5mg tablet strength

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2
Q

what are the most common cytochrome p450 inducers. what does this mean?

A

increased enzyme activity –> decreased drug concentration as it is metabolised quickly

PC BRAS

Phenytoin
Carbamazepine
Barbituates
Rifampicin
Alcohol (chronic excess)
Sulphonylureas

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3
Q

what are the most common cytochrome p450 inhibitors. what does this mean?

A

decreased enzyme activity –> increased drug concentrations as not metabolsied quickly

AODEVICES

Allopurinol
Omeprazole
Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol (Acute intoxication)
Sulfonamides

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4
Q

what antibiotic is contraindicated with methotrexate?

A

trimethoprim

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5
Q

how does ibruprofen cause aki

A

inhibits prostaglandin synthesis –> reduces renal artery diameter (and blood flow) and therefore causes reduced perfusion

can also cause AIN

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6
Q

how does rampiril cuase aki?

A

decreases angiotensin 2 which is responsible for preserving eGFR

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7
Q

what is the impact of diuretics on sodium?

A

all diuretics can cause hyponautraemia,

although when they contribute to dehydration, sodium may increase causing hypernautraemia

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8
Q

what electrolyte derangement do thiazide diuretics cuase

A

hypokalameia

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9
Q

what electrolyte derangement foes ACEi cause?

A

hyperkalaemia

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10
Q

what electrolyte derangement do loop diuretics cause

A

hypokalaemia

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11
Q

what analgesics to avoid in asthma

A

nsaids

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12
Q

most common SE amlodipine

A

ankle oedema

(clue = echo normal)

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13
Q

interactions between calcium channels and beta blockers?

A

non-dihydropyridine CCBs such as dilatizem and verapamil are contraindicated due to the risk of severe bradycardia and LV failure. This is because non-dihydropyridine calcium channel blockers slow conduction at the SA and AV nodes.

The dihydropyridine calcium channel blockers (amlodipine, nifedipine, lercanidipine) are safe to take with beta-blockers as they are primarily peripheral vasodilators.

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14
Q

what drugs may cause fourniers gangrene

A

SGLT2 inhibitors eg dapagliflozin

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15
Q

pregnancy and chloramphenicol

A

can cause the potentially fatal severe reaction - grey baby syndrome

avoid all forms (topical and oral)

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16
Q

what drugs should be stopped in aki

A

rampiril
metformin

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17
Q

what diabetes drug doesn’t have a risk of hypoglycaemia

A

metformin

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18
Q

in metabolic acidosis, which drug should be held

A

metformin

Metformin itself can cause lactic acidosis, and as a result, if a patient is in a state of metabolic acidosis it should be held whilst the acidosis is corrected.

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19
Q

common reasons that drugs that are contraindicated in severe renal impairment?

A

narrow therapeutic range and therefore accumulate eg lithium

Damage to kidneys –> aki

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20
Q

drugs causing hyponautraemia

A

inreased sodium out
- diuretics

increased water in…
“SIADH cannot void”
SSRIs (eg sertraline) and sulphonylureas (eg gliclazide)
Indomethacin and Inhibitors (ACEi and PPI)
Antidepressants (eg tricyclics)
Diuretics
Haloperidol
Cannot: cyclophosphamide, carbamazepine
Void: vincristine

hypnotics (such as temazepam)

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21
Q

dosing sertraline depression

A

Initially 50 mg once daily,

then increased in steps of 50 mg at intervals of at least 1 week if required; maintenance 50 mg once daily; maximum 200 mg per day.

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22
Q

features seretonin syndrome

A

Neuromuscular excitation
hyperreflexia
myoclonus
rigidity

autonomic nervous system excitation
hyperthermia
sweating

altered mental state
Confusion

23
Q

causes seretonin syndrome

A

antidepressants: SSRI, SNRI, TCA, MAOI

Drugs causing SS esp when interacting with others:
- lithium
- tramadol, pethidine
- St John’s Wort

recreational:
- ecstasy
- amphetamines

24
Q

management seretonin syndrome

A

supportive including IV fluids
benzodiazepines
more severe cases are managed using serotonin antagonists such as cyproheptadine and chlorpromazine

25
Q

elderly patient on antidepressant, dosing error?

A

some antidepressants eg escitalopram, have a lower dose for elderly patients

escitalopram should be given at a maximum dose of 10mg per day for elderly patients.

26
Q

if a pt on lithium has levels <04 what do you do?

A
  • check complicance
  • consider factors that may affect plasma lithium levels (e.g. excess fluid intake, drug interactions, brand change)

+ increase the dose slightly eg by 100mg

27
Q

typical lithium starting dose

A

Lithium 400mg ON

28
Q

what change to medications do you need to make, addisons and infection

A

double dose of hydrocortisone

29
Q

what abs is CI during treatment of overactive bladder with botulism toxin

A

gentamicin

30
Q

what anti-diabeties drug is CI in bladder cancer

A

Pioglitazone is associated with a small increased risk of bladder cancer and is contraindicated in patients with active bladder cancer or a past history of bladder cancer.

31
Q

what drugs are prescribed in micrograms and therefore can be a massive prescribing error if done in mg

A

FFLAND

Folic acid
Fludrocortisone
Levothyroxine
Atropine
Digoxin
Naloxone

32
Q

adverse effect hydroxycloriquine

A

Long-term use of hydroxychloroquine can lead to retinopathy known as ‘Bull’s eye maculopathy’. Common symptoms include central vision loss (central scotoma), change in color vision and visual distortions.

33
Q

dosing atorvostatin

A

priamary prevention 20mg

secondary prevention 80mg

34
Q

why is cyclizine not reccomended in the elderly

A

Cyclizine has anticholinergic properties, which is why regular use is not recommended, particularly in the elderly. Agitation is a rare side effect, most commonly observed at higher doses.

35
Q

clarithromycin plus atorvastatin equals

A

Macrolide antibiotics such as clarithromycin and erythromycin act to increase the side effects of statins such as atorvastatin. A rare side effect is rhabdomyolysis (muscle breakdown) which results in an elevation of creatine kinase released from the damaged muscle.

36
Q

what drugs affect the haemodynamics and therefore can cause renal aki

A

NSAIDs cause afferent vasoconstriction

ACEi and ARBs cause efferent vasodilation

These reduce the pressure gradient and therefore reduce eGFR

37
Q

what drugs are nephrotoxic

A

Acute tubular necrosis causing drugs: (AVRG)
Aminoglycosides
Vancomycin
Radio contrast
Gentamicin

Acute interstitial nephritis causing drugs: (PPN)
PPI
Penicillin
NSAID

38
Q

what drugs should you hold during aki

A

DAMN

Diuretics
ACEi/ARB/Antibiotics esp aminoglycosides
Metformin, lithium, digoxin, opiates (narrow TW) (may have to be stopped)
NSAIDs

39
Q

why do you soemtimes stop metformin in aki

A

increased risk of toxicity (but doesn’t usually worsen AKI itself)

40
Q

what drugs should be stopped around the time of surgery?

A

I LACK OP

Insulin
Lithium
Anticoagulants/antiplatelets
COCP/HRT
K-sparing diuretics
Oral hypoglycaemics
Perindopril and other ACEi

41
Q

when should COCP/HRT be stopped - surgery

A

4w before

42
Q

when should lithium be stopped - surgery

A

day before

43
Q

when should potassium sparing diuretics amd ACEi be stopped - surgery

A

day of surgery

44
Q

safety considerations NSAIDS

A

NSAIDS

No urine (ie renal fialure/aki)
Systolic dysfucntion (ie heart failure)
Asthma
Indigestion
Dyscrasia (clotting abnormality)

45
Q

diabetes medications and surgery

A

NBM therefore metformin stopped - risk of lactic acidosis

other oral hypoglycaemics can cause hypoglucaemia so these are stopped too

sliding scale should be started whereby hourly blood glucose monitoring adjusts the hourly dose of insulin

46
Q

corticosteroids and surgery

A

at induction of anaestehsia, give iv steroids

if on long term corticosteroids as these pts often ahve adrenal atrophy therefore wont be able to mount a big enough stress response to surgery

47
Q

sick day rules steroids

A

double the dose

48
Q

if a pt is on paracetamol, what should you check

A

DOSE!!! look for co-codamol co-prescribed etc

49
Q

trap paracetamol max dosing

A

if pt <50kg, max dose is 500mg 6 hourly !!!

50
Q

alendronic acid prescription

A

10mg od or 70mg weekly

51
Q

when to withold antihypertensives

A

when hypotensive, aki, cold peripheries etc

52
Q

causes of oral candidiasis drugs

A

steroids
abx
immunocompromised

53
Q

drugs which increase risk of falls

A

benzos
antidep - particualrly TCA and SNRI
MAOI
antipsychotics
opiates
antihypertensives

Finals pharmacology new (37 decks)

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