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SCRIPT 4 > Toxic tablets > Flashcards

Toxic tablets Flashcards

1
Q

whats the target inr for most px with af

A

2.5

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2
Q

true or false, erythromycin can increase the INR of patients that are taking warfarin?

A

true

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3
Q

true or false, there is an interaction between warfarin and macrolide antimicrobials?

A

true

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4
Q

warfarin is taken daily usually at same time, when

A

evening

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5
Q

what is the daily dose of warfarin adjusted to?

A

INRwa

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6
Q

rfarin is available in which 4 strengths

A

500mcg, 1mg, 3mg 5mg

WBBP

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7
Q

what is colour of 500mcg warfarin?

A

white

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8
Q

what is the colour of 1mg warfarin?

A

brown

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9
Q

what is the colour of 3mg warfarin?

A

blue

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10
Q

what is the strength of pink warfarin?

A

5mg

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11
Q

why are loading doses of warfarin often required to achieve pharmacological effect quickly?

A

highly protein bound and long half life

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12
Q

what effect can hyperthyroidism have on warfarin and why?

A

may require reduced doses of warfarin because it increases the metabolism of clotting factors

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13
Q

why does the peak pharmacological effect of warfarin take several days to develop?

A

time taken for degradation of pre formed carboxylated clotting factors

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14
Q

what is the risk of concomitant use of ibuprofen and warfarin?

A

bleeding due to GI irritation

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15
Q

contraindications for warfarin

A

hypersensitivity
haemorhhagic stroke
clinically signif bleeding
preg (1st and 3rd trim)
severe liver/ renal imp

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16
Q

what effect does fluconazole have on warfarin?

A

inhibits metabolism so anticoagulant effect increased

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17
Q

what effect does amiodarone have on warfarin?

A

potentiates anticoagulant effect

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18
Q

true or false, patients taking warfarin do not need to avoid cranberry juice?

A

false

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19
Q

what effect might alcohol have on INR , which might mean that continous alcohol consumption sitmulates hepatic enzymes increasing warfarin metabolism?

A

increased

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20
Q

what effect does st johns wort have on INR?

A

decrease

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21
Q

higher inr, greater risk of ses such as 2

A

bruising
haemorrhage

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22
Q

how to manage raised inr 4

A

stop warfarin/ reduce dose
reverse anticoag if needed
investigate cause
consider risks/ benefits of continuing tx

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23
Q

reversal agent for warfarin?

A

phytomenadione

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24
Q

true or false, warfarin should be precsribed in number of tabs and not milligrams?

A

false

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25
Q

what is digoxin (ntr) indicated for the management of?

A

hf

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26
Q

true or false, digoxin should be reduced in renal dysfunction to avoid toxicity?

A

true

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27
Q

digoxin is given by mouth at what daily dose regimen?

A

OD

28
Q

what are the 3 different ways that digoxin loading can occur in patients?

A

rapid oral, slow oral and parenteral

29
Q

digoxin plasma levels do not routinely need to be measured due to the fact that heart rate and pulse can be measured to indicate therapeutic effect. In what circumstances would it be measured?

A

suspected tox

30
Q

what is the target conc of digoxin inmcg/L?

A

0.8-2

31
Q

is digoxin renally or hepatically excreted?

A

renally

32
Q

which electrolyte imbalance increases the risk of digoxin toxicity as the myocardium is more sensitive to the effects of digitalis toxicity?

A

hypokalemia

33
Q

what effect does amiodarone have on plasma conc of digoxin?

A

inc

34
Q

what effect does amiodarone have on plasma conc of digoxin?

A

inc

35
Q

what effect does erythromycin have on plasma conc of digoxin?

A

inc

36
Q

what effect does verapamil have on plasma conc of digoxin?

A

inc

37
Q

what effect does spironolactone have on plasma conc of digoxin?

A

inc

38
Q

what effect do st johns wort and rifampicin have on plasma conc of digoxin?

A

dec

39
Q

list some of the signs and symptoms of digoxin toxicity

A

anorexia
nausea
vomiting
diarrhoea
palpitations
syncope

40
Q

serum lithium conc should be measured 12h post dose after at least how many days?

A

4

41
Q

lithium carbinate 200mg is equivalent to what strength of lithium citrate in mg?

A

509

42
Q

out of lithium carbonate and citrate which is the oral tablet (the other is the oral liquid)?

A

carbonate

43
Q

true or false you do not need to be brand specific when prescribing lithium?

A

false

44
Q

what is the target serum lithium conc in mmol/l?

A

0.4-1

45
Q

AEs of Lithium

A

fine hand tremor
weight gain
nausea
metal taste
diarrhea
diabetes insipidus
urinary changes: polydipsia…

46
Q

lithium toxicity signs symptoms

A

severe hand tremor
vomiting
blurred vision
muscle weakness
seizures
renal

47
Q

drugs affecting renal elim of Li/ elec imbalance can affect serum li levels, name 4 classes

A

aceis
diuretics
nsaids
Na containing compounds eg movicol

48
Q

how often should cardiac function be monitored for patients on lithium and why?

A

regularly because it can cause ecg changes

49
Q

how often should all the following parameters be measured for patients taking lithium?

thyroid function
renal function
calcium
bmi

A

every 6 months

50
Q

why should thyroid function be measured every 6 months in patients on lithium?

A

can cause hypothyroidism with long term use

51
Q

why should renal function be monitored every 6 months in patients on lithium?

A

renally excreted
so accumulates in dysfunction
long term use can impair renal function

52
Q

why should calcium be monitored every 6 months in patients on lithium?

A

risk of hypercalcaemia

53
Q

why should bmi be measured every 6 months in patients taking lithium?

A

causes weight gain

54
Q

how often is it recommended to measure serum lithium concentration?

A

every 3 months

55
Q

the max dose for mtx should not exceeed X mg weekly for non cancer treatment?

A

25

56
Q

what different parameters are to monitored in patients that are on mtx?

A

fbc
lfts
renal function
cxr

57
Q

signs and symptoms of mtx tox

A

lymphopenia
thrombocytopenia
pallor
nausea vom
gi bleed
dysuria/ anuria

58
Q

mtx is indicated for what 4

A

malignant disease
psoriasis
rheumatic disease
crohns

59
Q

rescue therapy for mtx tox, what 3 steps

A
  1. stop mtx
  2. consult haematologist/ toxicologist
  3. give folinic acid rescue therapy
60
Q

what should px on mtx be advised to report

A

abnormal bruising

61
Q

routine monitoring for li therapy includes what 5

A

serum li conc
thyroid and renal func
bmi
calcium

62
Q

what electrolyte disturbance is likely to exacerbate li toxicity

A

hyponatraemia

63
Q

How often should the plasma-digoxin concentration be monitored during chronic therapy to reduce the risk of toxicity?

A

Only measure if toxicity is suspected

64
Q

After initiating digoxin, or following a dose change, the full therapeutic effect will not be seen for hm days

A

8-10

65
Q

st johns wart interacts w warfarin to cause inc/dec in inr?

A

dec

66
Q
A

SCRIPT 4 (5 decks)

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