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
Why androgens (danazol) are teratogenic?
Musculinisation of female foetus
Why retinoids are teratogenic?
Abnormalities:
- Craniofacial
- cardiac
- CNS
Why warfarin is teratogenic?
Foetal warfarin syndrome:
- congenital heart defects
- IUGR
- facial defects
- pectus carinatum
- agenesis of corpus callosum
Why lithium is teratogenic?
CVS defects
Why thalidomide is teratogenic?
- Limb-shortening defects
- renal malformations
- congenital heart disease
What’s Trazadone used for?
SEs
Trazadone
- anti-depressant (mostly used in patient with dementia in psycho-geriatrics)
Class: serotonin receptor antagonist and reuptake inhibitors (SARIs)
SEs: confusion, sedation (therefore it’s better to prescribe it in as low dose as possible)
What’s wrong in amlodipine + statin?
This may cause myopathy
- reduce the dose of one if the other one is at high dose
How do we monitor Heart Failure and responsiveness for its treatment?
ECHO and ejection fraction measurement
Salbutamol in HF
Salbutamol can worsen HF as it’s negative inotrope (heart muscle work less strongly)
(2) common SEs of Co-Beneldopa
Co- Beneldopa → Parkinson’s drug
SEs (common): postural hypotension, stains urine red
What are the drugs in a ‘fibrates’ class used for?
used as adjuncts to statins (in hyperlipidaemia) if control with only statins fails
