random drug facts

Question 1

ACEi common s/e

Answer 1

dry cough due to accumulation of bradykinin via reduced degradation by ACE

hyperkalaemia - reduced aldosterone production, reduced potassium excretion

reducing renal blood flow by inhibiting angiotensin-II which preserved GFR

Question 2

ibuprofen s/e

Answer 2

gastric inflammation and ulceration - inhibition of prostaglandins needed for gastric mucosal protection from acid

also cuz of that reduced renal diameter and blood flow, reducing kidney perfusion and function

Question 3

antimuscarinic tox + elderly

Answer 3

confusion in elderly

tox - pupillary dilation, loss of accommodation, dry mouth, tachycardia (after transient Brady)

Question 4

methotrexate and NSAIDs

Answer 4

caution due to risk of increased nephrotoxicity

Question 5

asthma and NSAIDs

Answer 5

bronchoconstriction

Question 6

trimethoprim and methotrexate

Answer 6

direct contraindication as both folate antagonists -> BM toxicity

may lead to pancytopenia and neutropenic sepsis

Question 7

methotrexate and active infection

Answer 7

withheld, as missing one dose should not affect control due to long half life

Question 8

diuretics and potassium

Answer 8

hypokalaemia - loop + thiazide like

hyperkalaemia - potassium sparing + ACEi

Question 9

prophylactic enoxaparin + stroke

Answer 9

not post acute ischaemic stroke - risk of haemorrhagic transformation

Question 10

verapamil and BB

Answer 10

severe cardiodepression - so don’t use together

Question 11

when should you not use stimulant laxatives?

Answer 11

eg: Senna, bisocodyl

if suspected bowel obstruction do not use and increases risk of perforation

Question 12

when is best to use stool softener?

Answer 12

eg: docusate

if hard stool on DRE

Question 13

when should you not use osmotic laxatives?

Answer 13

eg: lactulose, macrogol

if patient already bloated or dehydrated do not use, as drawn water out from large bowel

Question 14

when would you prefer bulking laxatives?

Answer 14

eg: ispaghula husk

inadequate fibre intake, not when bloated as takes 72h to work

Question 15

what laxatives would you give if patient on opioids?

Answer 15

osmotic + stimulants

avoid bulk forming

Question 16

what specific about loops diuretics must you know regarding the ototoxicity?

Answer 16

• rapid IV administration of furosemide increases risk
• if impaired renal function bumetanide increases deafness risk

Question 17

what are some common ototoxic drugs worth knowing?

Answer 17

gentamicin
bumetanide
furosemide
vancomycin

Question 18

what are the 4 C’s that increase C.diff risk?

Answer 18

clindamycin
co-amoxiclav
ciprofloxacin
cephalosporin - ceftriaxone and cefalexin

Question 19

what drugs cause constricted pupils?

Answer 19

heroine
opioids
codeine
hydrocodone

Question 20

what drugs cause red eyes?

Answer 20

weed
cocaine
benzo
depressants

Question 21

what drugs cause dilated pupils?

Answer 21

amphetamines
methamphetamines
cocaine
hallucinogens
speed

Question 22

what are CYP450 inducers?

Answer 22

carbamezapine
barbituates
phenytoin
rifampicin
pioglitazone

Question 23

what are CYP450 inhibitors?

Answer 23

omeprazole
amiodarone
SSRI
grapefruit juice
cimentadine (cement stops)
macrolide (erythro and clarythro)

Question 24

what are some important information to be aware of with metformin?

Answer 24

risk of lactic acidosis - look for signs
dyspnoea, muscle cramps, abdo pain

Question 25

what are some important information to be aware of with sulfonylureas?

Answer 25

signs of hypoglycaemia *higher risk in renal impairment and elderly

Question 26

what are some important information to be aware of with SGLT2i?

Answer 26

risk of DKA even if glucose normal

Question 27

most important thing about insulin? *when unwell

Answer 27

when unwell higher insulin resistance so higher basal doses may be needed *increases DKA risk

Question 28

what are some common side effects of anti-psychotics?

Answer 28

photosensitisation drowsiness alcohol effects enhanced

Question 29

common lithium info?

Answer 29

report toxicity, hypothyroidism and renal dysfunction benign intracranial hypertension maintain adequate fluid and avoid dietary changed or increase in salt AVOID NSAIDs

Question 30

clozapine info?

Answer 30

agranulocytosis - risk of infection

Question 31

sodium valproate info?

Answer 31

teratogenic effective contraception

Question 32

what medications to be aware of in asthma and COPD?

Answer 32

NSAIDs - 10-20% experience worsening asthma, increased risk in those with nasal polyps *if no alt give risks and trial BB - bronchospasm, nebivolol more cardioselective so may be better adenosine - contraindicated, use verapamil if needed

Question 33

what does warfarin do?

Answer 33

inhibits synthesis of vitamin K dependent clotting factors (2,7,9 and 10) - this prolongs PT from which INR is derived (higher the PT higher the INR) - normal INR is 1

Question 34

What is important to communicate regarding insulin regime?

Answer 34

when unwell, blood glucose increases, higher basal dose required otherwise DKA when patients have reduced oral intake risk of hypo high so decrease insulin intake