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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
Drug not to take with allopurinol?
azathioprine
26
Aspirin should not be used in children under sixteen _______ exception is _______
risk of Reyes syndrome exception is in Kawasaki disease where benefit thought to outweigh risk
27
Is digoxin level monitored routinely?
no - only when suspected toxicity if toxicity is suspected, digoxin concentrations should be measured within 8 to 12 hours of the last dose
28
Presentation of digoxin toxicity?
generally unwell, lethargy, nausea & vomiting, anorexia, confusion, yellow-green vision arrhythmias (e.g. AV block, bradycardia) gynaecomastia
29
yellow green vision?
digoxin toxicity
30
Classic precipitant of digoxin toxicity?
hypokalaemia this could be due to thiazide diuretic
31
Drug that increases risk of digoxin toxicity?
thiazide diuretics that cause hypokalaemia
32
2 adverse effects of gentamicin?
ototoxicty nephrotoxicity
33
What condition is gentamicin contraindicated in?
myasthenia gravis - can precipitate a myasthenic crisis
34
Side effects vs toxic effects of lithium?
* 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
35
List some drugs that can cause prolongation of the QT interval?
citalopram macrolide antibiotics sotalol flecanide antipsychotics amiodarone
36
2 common side effects of amlodipine?
headache and ankle swelling
37
side effects of metformin?
GI upset is common - nausea, anorexia, diarrhoea lactic acidosis is rare but should be aware of
38
If GI side effects of metformin are intolerable should try?
modified release metformin
39
Contraindications to PDE5 inhibitors?
patients taking nitrates and related drugs such as nicorandil hypotension recent stroke or myocardial infarction (NICE recommend waiting 6 months)
40
5 drugs to avoid completely in renal failure?
antibiotics: tetracycline, nitrofurantoin NSAIDs lithium metformin
41
Drugs most likely to accumulate in renal failure and need dose adjustment?
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
Name 7 drugs that can cause hyperkalaemia?
potassium sparing diuretics (spironolactone and epleronone) dalteparin, tacrolimus, ACEi, ARBs, NSAIDs, trimethoprim
43
Antiplatelets are usually stopped how many days prior to surgery?
7 days
44
In the elderly glucocorticoids can cause?
confusion
45
4 drugs that can cause hyponatraemia?
SSRIs, trazadone, carbamazepine and thiazide diuretics
46
Nitrofurantoin should be avoided if eGFR <
45
47
Topiramate reduces
the effectiveness of the oral contraceptive pill
48
Beta blockers can cause
erectile dysfunction
49
Name some drugs that can cause cholestatic jaundice?
COCP lots of antibiotics including flucloxacillin and co-amoxiclav
50
Creatinine rise with ACEi?
a small rise in creatinine of < 20% is expected when starting an ACEi and this does not require investigation or change in prescription
51
What may precipitate lithium toxicity?
dehydration renal failure drugs: diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole.
52
What is a drug that may cause low platelets?
heparin can cause drug induced thrombocytopenia
53
Sick day rules six groups of drugs to stop?
ACE inhibitors ARBs NSAIDs Diuretics Metformin SGLT 2 inhibitors
54
3 side effects of furosemide?
hypokalaemia, postural hypotension and gout
55
4 conditions to avoid beta blockers in?
asthma heart block myasthenia gravis peripheral vascular disease
56
3 drugs to avoid in patients with renal artery stenosis?
NSAIDS ACEi ARBS
57
2 heart failure prescriptions that can cause a decline in renal function?
ACE inhibitors and loop diuretics (loop diuretics more than thiazides because these are powerful diuretics and more likely to cause dehydration)
58
2 side effects of epleronone and spironolactone?
gynaecomastia and hyperkalaemia
59
Describe statins and muscle problems?
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
3 contraindications for HRT?
angina history of MI previous or current breast cancer
61
Important side effect of lamotrigine?
Steven johnson syndrome
62
Interaction between phenytoin and the pill?
reduces effectiveness of the pill
63
Oxybutynin is an anticholinergic so can cause
constipation and urinary retention
64
Increased risk of myopathy in statins with what antibiotic?
erythromycin
65
What is important to note about eGFR and nitrofurantoin?
A reduced renal function will result in a lower urinary concentration of nitrofurantoin and may result in failure of the treatment
66
Is trimethoprim safe for breastfeeding?
yes
67
In acutely ill patients oxygen saturations target is?
94-98%
68
Effect of rifampicin on warfarin?
decreases anticoagulant effect so INR decreases
69
Effect of cranberry juice on warfarin?
increases the anticoagulant effect of warfarin so INR rises
70
Importance of dentist when starting bisphosphonates?
bisphosphonates can cause osteonecrosis of the jaw and patients should see a dentist before starting and ensure they regularly attend their checkups
71
Trazadone can cause?
hyponatraemia
72
What drug can unmask symptoms of angina/ heart problems?
levothyroxine as heart suddenly working faster
73
Omeprazole reduces the effectiveness of clopidogrel so what should you do?
prescribe lansoprazole instead which has no effect
74
Is glucose gel okay in someone who is unconsciousness with hypo?
no - dont know if airway is compromised so they need glucagon or IV glucose
75
Name a drug that is contraindicated in severe peripheral vascular disease e.g. someone who has arterial ulcers?
beta blockers
76
Name 2 drug groups that can interact to increase statin toxicity and risk of myopathy?
macrolide antibiotics e.g. clarithromycin and erythromycin gemfibrozil
77
Important thing to tell both men and women on methotrexate?
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
What must you check when starting amiodarone and why?
Must check serum potassium as if a patient is hypokalaemia and started on amiodarone they are more likely to have an arrhythmia
79
If someone gets statin myopathy what do you do in relation to the statin?
stop statin, if symptoms resolve and CK returns to normal restart at a lower dose
80
A beta blocker is contraindicated with what drugs?
verapamil and dilitiazem
81
SSRI plus an opioid ?
risk of serotonin syndrome
82
What can fluoroquinolones increase risk of?
tendonitis and rupture - usually achilles tendonitis most likely as this is weight bearing
83
2 examples of fluoroquinolones?
ciprofloxacin and levofloxacin
84
Methotrexate plus diclofenac?
should be avoided as increases risk of toxicity
85
Risk of antipsychotics and smoking?
smoking alters levels of the antipsychotic so if someone suddenly stops smoking on an antipsychotic can get toxicity and increased EPS
86
Effect of diuretics on diabetes?
furosemide and thiazides can increase risk of diabetes worsening
87
When is metoclopramide used in caution?
uncorrected electrolyte abnormalities cardiac conduction abnormalities parkinsonism or someone on an antipsychotic cyclizine in these situations would be preferred
88
Side effect of PPIs?
can cause loose stool and diarrhoea
89
2 drugs that can cause bradycardia?
digoxin beta blockers
90
2 drugs that can cause ankle swelling?
amlodipine naproxen
91
In who is all hormonal contraception contraindicated in?
anyone with history of breast cancer
92
What forms of contraception are appropriate for patients on anti epileptics?
DMPA IUD IUS barrier methods
93
Symptoms of serotonin syndrome?
* Symptoms include: agitation, confusion, muscle twitching, sweating, shivering, diarrhoea * Severe symptoms: seizures, arrhythmias and unconsciousness
94
Describe digoxin and renal function?
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
Describe metformin and renal function?
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
List some drug causes of erythema multiforme?
Antibiotics - erythromycin, nitrofurantoin, sulfonamide, tetracyclines Anti-epileptics NSAIDs Some vaccinations
97
Amiodarone and levothyroxine?
likely increased risk of thyroid dysfunction - BNF advises to avoid
98
What type of drug is carvedilol?
beta blocker
99
Do you need to hold aspirin in an AKI?
if a 75mg dose no doses over 300 may need to hold

Prescribing (11 decks)

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