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Prescribing > Side Effects and Contraindications > Flashcards

Side Effects and Contraindications Flashcards

1
Q

If NSAIDs are contraindicated in gout give?

A

oral colchicine
if that is also contraindicated give steroids

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2
Q

Pharmacodynamic is

A

what the drug does to the body

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3
Q

Pharmacokinetic is

A

what the body does to the drug

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4
Q

Accrete D3 can affect absorption of? What should you do?

A

thyroxine
wait 2hrs between taking these medicines

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5
Q

Name a drug that decreases the effectiveness of clopidogrel?

A

omeprazole

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6
Q

What drug causes a disulfiram reaction when taken with alcohol?

A

metronidazole

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7
Q

Patients who have an immediate hypersensitivity to penicillin should also not be prescribed?

A

cephalosporins

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8
Q

Name 6 groups of drugs that can impair glucose tolerance?

A

thiazides, furosemide (less common)
steroids
tacrolimus, ciclosporin
interferon-alpha
nicotinic acid
antipsychotics

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9
Q

Name 5 groups of drugs that may cause urinary retention?

A

tricyclic antidepressants e.g. amitriptyline
anticholinergics e.g. antipsychotics, antihistamines
opioids
NSAIDs
disopyramide

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10
Q

Name 5 groups of drugs that may cause lung fibrosis?

A

amiodarone
cytotoxic agents: busulphan, bleomycin
anti-rheumatoid drugs: methotrexate, sulfasalazine
nitrofurantoin
ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)

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11
Q

List side effects of all the TB drugs?

A

Rifampicin - stains body secretions orange/ pink, reduces effectiveness of many drugs including the COCP
Isoniazid - causes peripheral neuropathy, must be prescribed with pyridoxine (vitamin B6)
Pyranzamide - causes painful joints and gout
Ethambutol - can cause vision problems

Rifampicin, isoniazid and pyranzamide all cause hepatotoxicity

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12
Q

2 drugs that are prescribed for emergency contraception

A

Levonelle which is levonorgestrel
Ella One which is ulipristal acetate

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13
Q

Is warfarin contraindicated in pregnancy?

A

yes - should not be prescribed

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14
Q

Which anti-diabetic drug in contraindicated in patients with heart failure?

A

Pioglitazone - it causes fluid retention which can exacerbate heart failure

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15
Q

3 groups of drugs that should be given in caution to patients with asthma?

A

NSAIDs
beta-blockers
adenosine

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16
Q

List 4 medications that may exacerbate heart failure?

A
  1. thiazolidinediones
    pioglitazone is contraindicated as it causes fluid retention
  2. verapamil or dilitiazem
    negative inotropic effect
  3. NSAIDs/glucocorticoids
    should be used with caution as they cause fluid retention
    low-dose aspirin is an exception - many patients will have coexistent cardiovascular disease and the benefits of taking aspirin easily outweigh the risks
  4. class I antiarrhythmics
    flecainide (negative inotropic and proarrhythmic effect)
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17
Q

Are ACEi safe in pregnancy?

A

no

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18
Q

Flecanide should not be used to cardiovert patients in AF who?

A

have structural heart disease
instead use amiodarone

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19
Q

Drugs that can exacerbate psoriasis?

A

beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab

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20
Q

List some drugs that may worsen seizure control in patients with epilepsy?

A

alcohol, cocaine, amphetamines
ciprofloxacin, levofloxacin
aminophylline, theophylline
bupropion
methylphenidate (used in ADHD)
mefenamic acid

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21
Q

2 safe anti epileptic drugs in pregnancy?

A

lamotrigine and levetiracetam

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22
Q

Side effects of salbutamol?

A

Tremor, tachycardia, hypokalaemia, muscle cramps, headaches, nervous tension

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23
Q

List some drugs that can cause hypokalaemia?

A

Loop and thiazide diuretics
Salbutamol
Thiazide like diuretics
Insulin
Theophylline, aminophylline (other methylxanthines)
Laxatives (particularly in chronic use)

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24
Q

When do you start allopurinol in someone with gout?

A

wait 2 weeks after an acute attack
if they are already on allopurinol you can continue that through an attack

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25
Q

Drug not to take with allopurinol?

A

azathioprine

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26
Q

Aspirin should not be used in children under sixteen _______ exception is _______

A

risk of Reyes syndrome
exception is in Kawasaki disease where benefit thought to outweigh risk

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27
Q

Is digoxin level monitored routinely?

A

no - only when suspected toxicity
if toxicity is suspected, digoxin concentrations should be measured within 8 to 12 hours of the last dose

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28
Q

Presentation of digoxin toxicity?

A

generally unwell, lethargy, nausea & vomiting, anorexia, confusion, yellow-green vision
arrhythmias (e.g. AV block, bradycardia)
gynaecomastia

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29
Q

yellow green vision?

A

digoxin toxicity

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30
Q

Classic precipitant of digoxin toxicity?

A

hypokalaemia
this could be due to thiazide diuretic

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31
Q

Drug that increases risk of digoxin toxicity?

A

thiazide diuretics that cause hypokalaemia

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32
Q

2 adverse effects of gentamicin?

A

ototoxicty
nephrotoxicity

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33
Q

What condition is gentamicin contraindicated in?

A

myasthenia gravis - can precipitate a myasthenic crisis

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34
Q

Side effects vs toxic effects of lithium?

A
  • Side effects: dry mouth, strange taste, polydipsia, polyuria, tremor, hypothyroidism, long term reduced renal function, nephrogenic diabetes insipidus, weight gain
  • Toxic effects: vomiting, diarrhoea, ataxia, coarse tremor, drowsiness/ altered consciousness, convulsions, coma
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35
Q

List some drugs that can cause prolongation of the QT interval?

A

citalopram
macrolide antibiotics
sotalol
flecanide
antipsychotics
amiodarone

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36
Q

2 common side effects of amlodipine?

A

headache and ankle swelling

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37
Q

side effects of metformin?

A

GI upset is common - nausea, anorexia, diarrhoea
lactic acidosis is rare but should be aware of

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38
Q

If GI side effects of metformin are intolerable should try?

A

modified release metformin

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39
Q

Contraindications to PDE5 inhibitors?

A

patients taking nitrates and related drugs such as nicorandil
hypotension
recent stroke or myocardial infarction (NICE recommend waiting 6 months)

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40
Q

5 drugs to avoid completely in renal failure?

A

antibiotics: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin

41
Q

Drugs most likely to accumulate in renal failure and need dose adjustment?

A

Drugs likely to accumulate in chronic kidney disease - need dose adjustment
most antibiotics including penicillins, cephalosporins, vancomycin, gentamicin, streptomycin
digoxin, atenolol
methotrexate
sulphonylureas
furosemide
opioids

42
Q

Name 7 drugs that can cause hyperkalaemia?

A

potassium sparing diuretics (spironolactone and epleronone) dalteparin, tacrolimus, ACEi, ARBs, NSAIDs, trimethoprim

43
Q

Antiplatelets are usually stopped how many days prior to surgery?

44
Q

In the elderly glucocorticoids can cause?

45
Q

4 drugs that can cause hyponatraemia?

A

SSRIs, trazadone, carbamazepine and thiazide diuretics

46
Q

Nitrofurantoin should be avoided if eGFR <

47
Q

Topiramate reduces

A

the effectiveness of the oral contraceptive pill

48
Q

Beta blockers can cause

A

erectile dysfunction

49
Q

Name some drugs that can cause cholestatic jaundice?

A

COCP
lots of antibiotics including flucloxacillin and co-amoxiclav

50
Q

Creatinine rise with ACEi?

A

a small rise in creatinine of < 20% is expected when starting an ACEi and this does not require investigation or change in prescription

51
Q

What may precipitate lithium toxicity?

A

dehydration
renal failure
drugs: diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole.

52
Q

What is a drug that may cause low platelets?

A

heparin can cause drug induced thrombocytopenia

53
Q

Sick day rules six groups of drugs to stop?

A

ACE inhibitors
ARBs
NSAIDs
Diuretics
Metformin
SGLT 2 inhibitors

54
Q

3 side effects of furosemide?

A

hypokalaemia, postural hypotension and gout

55
Q

4 conditions to avoid beta blockers in?

A

asthma
heart block
myasthenia gravis
peripheral vascular disease

56
Q

3 drugs to avoid in patients with renal artery stenosis?

A

NSAIDS
ACEi
ARBS

57
Q

2 heart failure prescriptions that can cause a decline in renal function?

A

ACE inhibitors and loop diuretics (loop diuretics more than thiazides because these are powerful diuretics and more likely to cause dehydration)

58
Q

2 side effects of epleronone and spironolactone?

A

gynaecomastia and hyperkalaemia

59
Q

Describe statins and muscle problems?

A

Statin induced myalgia is common and okay however if a patient develops muscle cramps/ weakness they need to stop the medication and contact their GP. This is because that can be a sign of myositis. Myositis is a dose dependent toxicity so the patient may be able to go back on the statin at a lower dose with guidance from the GP.

60
Q

3 contraindications for HRT?

A

angina
history of MI
previous or current breast cancer

61
Q

Important side effect of lamotrigine?

A

Steven johnson syndrome

62
Q

Interaction between phenytoin and the pill?

A

reduces effectiveness of the pill

63
Q

Oxybutynin is an anticholinergic so can cause

A

constipation and urinary retention

64
Q

Increased risk of myopathy in statins with what antibiotic?

A

erythromycin

65
Q

What is important to note about eGFR and nitrofurantoin?

A

A reduced renal function will result in a lower urinary concentration of nitrofurantoin and may result in failure of the treatment

66
Q

Is trimethoprim safe for breastfeeding?

67
Q

In acutely ill patients oxygen saturations target is?

68
Q

Effect of rifampicin on warfarin?

A

decreases anticoagulant effect so INR decreases

69
Q

Effect of cranberry juice on warfarin?

A

increases the anticoagulant effect of warfarin so INR rises

70
Q

Importance of dentist when starting bisphosphonates?

A

bisphosphonates can cause osteonecrosis of the jaw and patients should see a dentist before starting and ensure they regularly attend their checkups

71
Q

Trazadone can cause?

A

hyponatraemia

72
Q

What drug can unmask symptoms of angina/ heart problems?

A

levothyroxine as heart suddenly working faster

73
Q

Omeprazole reduces the effectiveness of clopidogrel so what should you do?

A

prescribe lansoprazole instead which has no effect

74
Q

Is glucose gel okay in someone who is unconsciousness with hypo?

A

no - dont know if airway is compromised so they need glucagon or IV glucose

75
Q

Name a drug that is contraindicated in severe peripheral vascular disease e.g. someone who has arterial ulcers?

A

beta blockers

76
Q

Name 2 drug groups that can interact to increase statin toxicity and risk of myopathy?

A

macrolide antibiotics e.g. clarithromycin and erythromycin
gemfibrozil

77
Q

Important thing to tell both men and women on methotrexate?

A

it is teratogenic and should use contraception and avoid conception for 6 months after taking it
this is guidance for both men and women

78
Q

What must you check when starting amiodarone and why?

A

Must check serum potassium as if a patient is hypokalaemia and started on amiodarone they are more likely to have an arrhythmia

79
Q

If someone gets statin myopathy what do you do in relation to the statin?

A

stop statin, if symptoms resolve and CK returns to normal restart at a lower dose

80
Q

A beta blocker is contraindicated with what drugs?

A

verapamil and dilitiazem

81
Q

SSRI plus an opioid ?

A

risk of serotonin syndrome

82
Q

What can fluoroquinolones increase risk of?

A

tendonitis and rupture - usually achilles tendonitis most likely as this is weight bearing

83
Q

2 examples of fluoroquinolones?

A

ciprofloxacin and levofloxacin

84
Q

Methotrexate plus diclofenac?

A

should be avoided as increases risk of toxicity

85
Q

Risk of antipsychotics and smoking?

A

smoking alters levels of the antipsychotic so if someone suddenly stops smoking on an antipsychotic can get toxicity and increased EPS

86
Q

Effect of diuretics on diabetes?

A

furosemide and thiazides can increase risk of diabetes worsening

87
Q

When is metoclopramide used in caution?

A

uncorrected electrolyte abnormalities
cardiac conduction abnormalities
parkinsonism or someone on an antipsychotic

cyclizine in these situations would be preferred

88
Q

Side effect of PPIs?

A

can cause loose stool and diarrhoea

89
Q

2 drugs that can cause bradycardia?

A

digoxin
beta blockers

90
Q

2 drugs that can cause ankle swelling?

A

amlodipine
naproxen

91
Q

In who is all hormonal contraception contraindicated in?

A

anyone with history of breast cancer

92
Q

What forms of contraception are appropriate for patients on anti epileptics?

A

DMPA
IUD
IUS
barrier methods

93
Q

Symptoms of serotonin syndrome?

A
  • Symptoms include: agitation, confusion, muscle twitching, sweating, shivering, diarrhoea
  • Severe symptoms: seizures, arrhythmias and unconsciousness
94
Q

Describe digoxin and renal function?

A

Although digoxin accumulates in renal failure (so should therefore consider stopping due to increased risk of toxicity) it is not usually a cause of decreased renal function

95
Q

Describe metformin and renal function?

A

can cause a bit of a drop in renal function but not a big one to consider vs other more obvious in a multiple choice setting
however metformin should be stopped when someone is significantly unwell or has renal impairment (it is contraindicated in those with renal impairment)

96
Q

List some drug causes of erythema multiforme?

A

Antibiotics - erythromycin, nitrofurantoin, sulfonamide, tetracyclines
Anti-epileptics
NSAIDs
Some vaccinations

97
Q

Amiodarone and levothyroxine?

A

likely increased risk of thyroid dysfunction - BNF advises to avoid

98
Q

What type of drug is carvedilol?

A

beta blocker

99
Q

Do you need to hold aspirin in an AKI?

A

if a 75mg dose no
doses over 300 may need to hold

Prescribing (11 decks)

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