SCRIPT modules Flashcards
what drug causes ‘red man syndrome’
vancomycin when injected as bolus (too rapid)
what drugs are assoc w worsening gouts?
thiazides (hyperuric)
which drugs can exacerbate existing urticaria?
NSAIDs
someone gets angio-oedema on a longstanding ACEi. what can you switch them to?
ARB
give an example of a first gen cephalosporin
cefalexin
give two examples of third gen cephalosporins
cefotaxime
ceftriaxone
which kind of cephalosporins are worse at cross reacting with penicillin ?
first generation (e.g. cefalexin)
in penicillin allergy, which drugs are CONTRAINDICATED?
Penicillin and first gen cephalosporins
in pen allergy, which drugs are CAUTIONED?
third gen cephalosporins, monobactams, carbapenems
how long should anaphylaxis pts be observed before discharge?
6-12hrs
what reduces risk of radiocontrast reaction?
pre-dosing w corticosteroids and anti-histamine
what drug can you give for mild/mod allergic reactions?
chlorphenamine 4mg
500mcg IM adrenaline for adult with anaphylaxis. what about a child <12? <6?
<12: 300mcg
<6: 150mcg
whats the dose of IM chlophenamine in anaphylaxis?
10mg IM chlorphenamine
whats the dose of IM hydrocortisone in anaphylaxis?
200mg IM hydrocortisone
name 3 big CYP inducers
rifampicin
st johns wort
phenytoin/phenobarbital/carbamazepine
what does rifampicin do to the conc of drug in blood
decreases plasma concs.
its a CYP inducer
what does carbamazepine do the conc of drug in plasma
decreases plasma concs.
its a CYP inducer
what does TOBACCO do conc of drugs in plasma
decreases plasma concs.
its a CYP inducer
name 2 drugs that are CYP inhibitors
azole antifungals
erythromycin
name 2 foods that are CYP inibitors
grapefruit
cranberry juice
what does fluconazole do to conc of drug in plasma?
increases plasma concs.
its a CYP inhibitor
what does erythromycin do to conc of drug in plasma?
increases plasma conc.
its a CYP inhibitor
rifampicin and COCP?
decreases effectiveness of pill
carbamazepine and morning after pill?
you need to double the dose
grapefruit juice effects which drugs?
statins, CCBs, anti-arryhtmics
what minimum urine output should you aim for on fluids?
0.5ml/kg/hr
what is a normal urine output/?
1.5-2.5 litres
1ml/kg/hr
what is the only time you could give vancomycin orally?
to treat C diff
its not absorbed in GI tract
when should levothyroxine be given?
in morn before breakfast
what is the half life of morphine sulfate?
4hrs
how often do timolol eye drops for glaucoma need to be administered?
12hrly
what can aid absorption of iron salts?
vit C
what is the antidote to iron overdose?
IV desferrioxamine
gives you red wee
what is posh name for vit K?
phytomenadione
what is the half life of naloxone?
20-40 mins
what metabolic disturbance does salicylate overdose cause?
metabolic acidosis
venlafaxine does what to ECG
increase QT interval
autonomic instability, hyperthermia, sweating, rhabdomyolysis, diarrhoea, tremor, and altered mental state are all features of…
serotonin syndrome
two types of stimulant
cocaine
amfetamines
(MDMA and ecstasy are types of amfetamine)
which illicit drug causes INTENSE vasoconcstriction which can lead to MI, stroke, aortic dissection?
cocaine
effects of chronic cocaine use/?
perforation of nasal septum
CSF rhinorrhoea (thin cribriform plate)
myocardial fibrosis
should you leave trailing zeros?
no. and avoid decimal points where poss.
e. g. write 500mcg instead of 0.5 mg
what 3 pieces of info do you need to include when prescribing PRN?
- max dose
- minimum dose interval
- the indication
what does medicine reconciliation involve?
verification - check the durg Hx correct
clarification - check it against current list of meds prescribed in hosp
reconciliation - document any discrepancies
levothyroxine is stopped. can you just bang it back onto its original dose?
have to titrate back up again gradually. otherwise can precipitate angina, palpitations and HF
do ACEis need titrating back up if theyre stopped?
yes
is garlic anticoagulant?
yes
what can you look at in a pts back of drugs to give you a good idea of adherence?
dispensing date
what kind of drugs wont the nomad include?
variable doses (e.g. warfarin), PRNs, liquids
what is a good source of info for a pt on warfarin?
yellow oral anticoagulation book
what dose is the brown tab of warfarin?
1mg
what dose is the blue tab of warfarin ?
3mg
what’s the liquid lithium?
lithium citrate
what the tablet lithium?
lithium carbonate
are lithium citrate and lithium carbonate equivalent?
NO
why do you have to prescribe lithium by brand name?
the bioavailability varies
0.4-1 mmol/L is the range for
serum lithium concentration
when do you measure serum lithium concentation?
week after initiation
every week until stabilised
every 3 months on maintenance
what tests should be monitored on lithium? (5)
ECG TFT U&E Ca BMI
how often should ECG, TFT, U&E, Ca and BMI be monitored on lithium?
every 6 months
why do you need to check TFTs on lithium?
hypothyroidism
why do you need to check BMI on lithium?
weight gain
why do you need to check U&Es on lithium?
can impair renal function
is also renally excreted so ishew
why do you need to check Ca on lithium?
hypercalcaemia
what does NPIS stand for (contact them for advice)?
national poisons information service
name three drugs that lithium interacts with.
ACE-is
NSAIDs
diuretics
–> affect renal excretion - toxicity
how much folic acid do you need to take with methotrexate?
5mg once weekly
not on same day as methotrexate!
what needs monitoring w methotrexate?
FBC
LFT
U&E
also - CXR
when do you monitor FBC, U&E and LFT on methotrexate?
baseline, every 1-2wks until stabilised, every 3 months after
why do you do CXR with methotrexate?
pulm toxicity (pneumonitis)
basline and then repeat if symptoms emerge
give me 3 signs of methotrexate toxicity
lymphopena
thrmbocytopenia (abnormal bruising)
GI bleed
patients who are folate deficient, and who are co-prescribed NSAIDs, are at increased risk of….
methotrexate toxicity
give me 3 drugs that interact w methotrexate
trimethoprim!
aspirin and NSAIDs
ciprofloxacin and penicillins
also corticosteroids
what drug, prescribed alongside methotrexate, increases the risk of agranulocytosis?
clozapine
do you omit methotrexate in acute infection?
yes
name two antibiotics that warfarin interacts with
erythromycin and clarithromycin
CYP inhibitors
(increase the anticoag effect)
maintenance doses of warfarin vary considerably. can be anything from
1-15mg!
what is the starting dose for SLOW LOADING regimen of warfarin
3mg
what is the starting dose for the RAPID LOADING regimen of warfarin
5-10mg
when is the peak pharmacological effect of warfarin?
2-3days
once stable dose and INR achieved, monitoring can be how often?
every 3 months
name three CONTRAINDICATIONS to warfarin
pregnancy
haemorrhagic stroke
severe liver/renal disease
name five CAUTIONS to warfarin
frequent fallers recent ischaemic stroke hx GI bleed /peptic ulcer breastfeeders recent surgery
how does amiodarone interact w warfarin
increases anticoag
how does ibuprofen interact w warfarin
increase GI bleed risk (and increases anticoag)
how does fluconazole interact w warfarin
increases anticoag
how does simvastatin interact w warfarin
increases anticoag
how does omeprazole interact w warfarin
increases anticoag
if someone is ALCOHOL DEPENDANT how does it affect warfarin
decreases anticoag
name 3 things that DECREASE the anticoag effect of warfarin
green leafy veg
alcohol dependence
st john’s wort
the greater the INR, the greater risk of
bleeding and bruising
which drug increases the force of contraction whilst slowing the heart down?
digoxin
what are the indications for digoxin?
HF
AF (supraventricular arrhythmias)
what organ excretes digoxin?
kidneys
so renal function influences dosing/ toxicity risk
the concentration of which drug should be 0.8 - 2
digoxin
you monitor the U&E on digoxin. for what two reasons is this super important?
hypokalaemia (increases risk of toxicity / myocardial instability)
eGFR - renally excreted
what bloods do you monitor on digoxin?
U&E
name 3 long acting insulins
Levemir
Lantus
Tresiba
in t2dm, NICE recommends starting insulin when?
if HbA1c elevated consistently above 75
Name two rapid acting insulins
NovoRapid
Humalog
when do you take rapid acting insulin?
just before or WITH a meal
when do you take short acting insulin?
20 mins before meal
name two short acting insulins
Actrapid
Humulin S
Actrapid and Humulin S are what kind of insulins?
short acting
NovoRapid and Humalog are what kind of insulins?
rapid acting
Insulatard and Humulin I are what kind of insulin?
medium acting
what kind of insulin is Humulin M3?
mixed medium acting - biphasic (short acting and long acting)
do you ever give mixed insulins at bedtime?
no never
how often do you give long acting insulin?
once daily.
consistent delivery throughout with no peak
name two medium acting insulins
insulatard and humulin I
name a mixed medium acting biphasic insulin
Humulin M3
what is target HbA1c for elderly pts at risk of hypos
<58
what is the basal bolus regimen?
intermediate or long acting once or twice a day
PLUS
bolus injections of short/rapid before meals
what is the once daily regimen?
one long acting insulin in morn
or one intermed at night
depending when u get spikes
what is the twice daily regimen?
biphasic mixed insulin twice a day before breakfast and evening meal
who is continuous subcut insulin infusion for?
type 1s if get loads of hypos or sugars uncontrolled
and theresa may
risk of insulin pump?
DKA rapidly if pump fails
what pt education programmes are there for type 1s?
DAFNE
BGAT (bm awareness)
what pt education programmes are there for type 2s?
DESMOND
what is the optimal blood glucose reading ?
4-7mmol/L
in the UK, what is strength of most insulins?
100 units / mL
what two aspects cause symptoms of hypo?
adrenergic and neuroglycopenic
pt’s bm is 2. they are co-operating. rx?
glucotab / lucozade
pt’s bm is 2. they are conscious but unable to co-operate. rx?
glucogel in mouth. repeat until two tubes finished.
pt’s bm is 2. they are unconscious. you have IV access. rx?
IV 20% glucose 100ml over 20 mins
pt’s bm is 2. they are unconscious. you don’t have IV access. rx?
IM glucagen 1mg
you’re treating DKA. the bm has come down and is now <14. what do you give as well as insulin?
IV 10% glucose and Kcl 20mmol
how often should BMs be monitored on IV insulin?
hourly
when do you use IV insulin (3)?
DKA
during surgery
when cant eat / drink if vom
