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High Risk Drugs > Tdm Drugs > Flashcards

Tdm Drugs Flashcards

1
Q

Which foods interact with warfarin

A

Vitamin k- green tea, green vegetables
Pomegranate juice
Alcohol

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2
Q

Patients on warfarin should report nose bleeds lasting longer than…

A

10 mins

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3
Q

Inr target for warfarin

A

Normally 2-3.5

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4
Q

Risks of warfarin

A

Calciphylaxis
Haemorrhage
Avoid 48 hours post partum
Wocbp- teratogenic

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5
Q

Interaction of warfarin

A

Doacs to treat hepatitis C

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6
Q

Monitor for warfarin

A

LFT FBC clotting screen before start

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7
Q

Lithium target

A

0.4-1 mmol/L

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8
Q

Monitoring for lithium

A

Serum conc
Renal function, electrolytes
ECG
Fbc
Tfts
Bmi

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9
Q

If lithium serum function is over 2

A

Seizures, coma, renal failure, arrhythmia, bp changes, circulatory failure

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10
Q

Monitor symptoms of lithium toxicity like

A

Gi visual and cns disturbance
Tremor, muscle weakness
Hypothyroidism, renal dysfunction, benign intracranial hypertensikn

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11
Q

Important interactions of lithium

A

Antispychotics- increase EPS
Increased risk of toxicity- ACEi, ARB, loop diuretics, k sparing diuretics, nsaids, thiazide like diuretics, SSRI, metronidazole (hyperkalaemia)
Neurotoxicity- methyldopa, phenytpin, carbemazepine, diltiazem, verapamil

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12
Q

Lithium when dispensing

A

Ensure same brand as normal
Adequate salt and water intake essential

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13
Q

Dioxin target conc

A

1-2mcg/l

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14
Q

Dioxin electrolyte imbalances

A

Decreases k
Decreases mg
Increases calcium

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15
Q

Monitoring digoxin

A

Electrolytes
Renal function
Hr

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16
Q

Amiodaeone with digixin

A

Decrease dioxin dose by half

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17
Q

Which drugs increase digoxin levels

A

Diltiazem verapamil nifedipine
Quinine
Spironolactone

18
Q

Which drugs reduces conc of digoxin

A

St John’s wort

19
Q

Which drugs increase risk of digixin toxicity

A

Nephrotoxic drugs and those that cause hypokalamia

20
Q

Warnings of digoxin toxicity

A

Arrhythmia heart block ❤️
Neurological signs-weakness, lethargy, dizziness, headache, confusion, psychosis
Gi- anorexia, n&v , diargoea, abdo pain
Visual- blurred/ yellow vision

21
Q

Theophylline target levels

A

10-20 mg/L
Or 55-110mcmol/L

22
Q

theophylline toxicity looks like

A

Vomiting, throwing up blood, agitation, restlessness, dilated pupils, tachycardia, arrythmias hyperglycaemia, severe hypokalaemia, convulsions,

23
Q

Counselling for theophylline

A

Check with hcp before taking new medication
Inform gp if stop or start smoking
Maintain same brand

24
Q

What should you monitor with theophylline

A

Potassium levels
Plasma theophylline levels

25
Q

Interactions of theophylline

A

Hypokalaemia- beta 2 agonists, corticosteroids, diuretics
Increased concentration- diltiazem, verapamil cimetidine, ciprofloxacin, estrogen, erythromycin
Increased risk of convulsions with quinolones
Reduced theophylline concs with carbazepine, phenytoin

26
Q

What do you monitor with methotrexate

A

Fbc
Renal
Liver

27
Q

Antidote to methotrexate

A

Folinic acid

28
Q

Methotrexate causes

A

Blood dyscrasias- bone marrow supression
Gi toxicity- stomatitis
Liver toxicity
Pulmonary toxicity- pneumonitis, cough, sob
Teratogenicity- contraception for 6 mo

29
Q

Interactions of methotrexate

A

Acitretin- hepatotoxicity
Nsaids and penicillin reduce excretion of methotrexate
Increased toxicity with doxycycline, tetracycline, cuprofloxacin, PPIs
Trimethoprim- haematological toxicity

30
Q

Which otcs need to be avoided with methotrexate

A

Nsaids and aspirin

31
Q

Counselling points methotrexate

A

Photosensitivity
Once a week, take folic acid a different day

32
Q

Target conc phenytoin

33
Q

What we monitoring for phenytoin

A

Serum conc
Ecg and BP
LFT
FBC
folate and vitamin d

34
Q

Phenytoin toxicity looks like

A

Rem of eyes, difficult balancing, slurred speech, hyperglycaemia, double vision, blurred vision, confusion

35
Q

Warnings for phenytoin

A

Skin disorders- rash, toxicity epidermal necrolysis
Blood disorders- fever, sore throat, bruising
Suicidal thoughts
Low vitamin d

36
Q

Interactions of phenytoin

A

Increased levels- amiodarone , diltiazem, fluconazole, miconazole, trimethoprim, metronidazole, clarithromyxin,
Reduced levels- rifampicin, St John’s wort, theophylline, itraconazole, ciclosporin

37
Q

Ciclosporin councelling

A
  • Maintain specific brand
  • avoid live vaccines
  • avoid UV
  • Avoid high k and grapefruit juice
38
Q

Monitoring for ciclosporin

A

Fbc
Electrolytes- k, mg
LFTs
Renal
Lipids
Bp

39
Q

Toxicity types ciclosporin

A

Neurotoxicity- tremor, headache, encephalopathy, drowsy
Blood toxicity- infection, sore throat, bleeding
Liver toxicity
Nephrotoxicity
Tachycardia and hypertension

40
Q

Interactions with ciclosporin

A

Increased conc- grapefruit juice, antifungal, diltiazem, clarithromycin, erythromycin,
Reduced conc- carbemazepine, orlistat, phenobarbital, phenytoin, rifampicin, St John’s wort

High Risk Drugs (8 decks)

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