Therapeutics and polypharmacy (2) Flashcards
Main domains 7 step method medication review (7)
- Aims → what matter’s to patient
Needs:
- Identify essential drug therapy
- Does the patient take unnecessary drug therapy?
- Effectiveness → are therapeutic objectives being achieved?
- Safety → does the pt have SEs? Does the pt know what to do if they are ill?
- Cost-effectiveness → is the drug cost-effective?
- Patient centeredness → is pt willing and able to take drug therapy as intended?
What to ask in AIMS in 7 - steps medication review?
What to ask in NEEDs in 7 - steps medication review?
What to ask in Effectiveness in 7 - steps medication review?
What to ask in Safety in 7 - steps medication review?
What to ask in Cost-Effectiveness in 7 - steps medication review?
What to ask in Patient-centerdeness in 7 - steps medication review?
16 year old girl presents following an intentional drug overdose 2 days ago.
She is jaundiced, lethargic, vomiting
- What drug did she overdose on?
- What’s the treatment?
Paracetamol OD
Treatment: N-acetylcysteine
A 40 year old woman with a background history of anxiety and insomnia presents with confusion; drowsiness and respiratory rate of 8
- What drug did she OD on?
- Treatment
Benzodiazepines OD
Treatment: Flumazenil
A 23 year old male IVDU presents to A+E with pin point pupils, respiratory rate of 5 and seizures.
- What drugs did he overdose on?
- Treatment?
Opioids OD
Treatment: Naloxone
A 26 year old female presents with nausea and vomiting; disorientation, with a respiratory rate of 30
- What drug did she OD on?
- Treatment
Salicylates OD
Treatment: urine alkalization
A 35 year old man presents with a pulse of 120, a respiratory rate of 30, BP 180/100, and altered mental status.
- What did he OD on?
- Treatment?
Methanol OD
Treatment: Ethanol
A 76 year old man presents with a 2 week history of fluctuating conscious level following a fall
- Drug OD on?
- Treatment
Warfarin OD
Treatment: vitamin K
A 52-year-old lady with a long history of depression present with confusion; dilated pupils; dry mouth; palpitations and urinary incontinence. Pulse 100 bpm
- Drug OD on?
- Management
OD on TCAs
Management:
- Benzodiazepines
- Sodium bicarbonate
- Dopamine/norepinephrine
A 56 year old lady with type 2 diabetes presents with decreased appetite; dizziness; lethargy and weakness
- Drug OD on
- Management
Sulfanyrueas OD
Management:
Dextrose bolus or infusion Glucagon
Why ACE inhibitors are considered as teratogenic drugs?
- Renal dysfunction
- renal tubular dysgenesis
- decreased skull ossification
What and why antiepileptics are considered as teratogenic?
- Phenytoin → foetal hydantoin syndrome (craniofacial abnormalities, IUGR, learning disability)
- Carbamazepine (neural tube defects)
- Sodium valproate (neural tube defects)
Why Cytotoxic drugs are teratogenic?
- multiple defects
- miscarriage
Why Diethylstilboestrol is teratogenic?
- Clear cell carcinoma of vagina
- cervix after in-utero exposure
Diethylstilboestrol is a synthetic oestrogen
Why aminoglycosides are teratogenic?
deafness
