tricyclics, tamoxifen, heparin, lorazepam, haloperidol, ACEi

Question 1

sedative tricyclic examples

Answer 1

• amitriptyline
• clomipramine
• dosulepin

Question 2

less sedative tricyclic examples

Answer 2

• imipramine
• nortriptyline
• lofepramine

Question 3

adverse effects of tricyclics

Answer 3

blockade of antimuscarinic receptor:

• dry mouth
• constipation
• urinary retention
• blurred vision

Blockade of H1 and α1 receptors:

• sedation
• hypotension
• prologation of QT + QRS
• convulsions, hallucinations, mania
• breast changes, sexual dysfunction

Question 4

TCA overdose effects

Answer 4

severe hypotension, arrhythmias, convulsions, coma

and respiratory failure

Question 5

TCA sudden withdrawal sx

Answer 5

GI upset, neuro + influenza-like sx and sleep disturbance

Question 6

TCA should not be given with what drug

Answer 6

monoamine oxidase inhibitors

Question 7

what is venlafaxine

Answer 7

SNRI

serotonin and noradrenaline reuptake inhibitor

Question 8

what is mirtazapine

Answer 8

antagonist of inhibitory pre-synaptic α2-adrenoceptors.

Question 9

how does venlafaxine and mirtazipine work

Answer 9

Both drugs increase availability of monoamines for

neurotransmission

Question 10

important adverse effects of venlafaxine and mirtazipine

Answer 10

• GI upset
• headache, abnormal dreams, convulsopms
• Suicidal thoughts and behaviour

Question 11

when should mirtazapine be taken

Answer 11

at night ot minimus its sedative effects

Question 12

the most common adverse effects of statins

Answer 12

headache and GI disturbance

Question 13

more serious effects of statins

Answer 13

myopathy

rhabdomyolysis

rise in ALT

Question 14

important interactions with statins

Answer 14

The metabolism of statins is reduced by cytochrome P450
inhibitors, such as amiodarone, diltiazem, itraconazole, macrolides

amlodipine

Question 15

when are statins taken

Answer 15

evening, as there is some evidence

that they have a greater effect when dietary intake is at its lowest.

Question 16

what should pts on statins avoid drinking

Answer 16

grapefruit juice

Question 17

how should efficacy of statins be monitored

Answer 17

checking target cholesterol levels are achieved

Question 18

for safety, what should be measured at baseline and again at 3 and 12 months when on a statin

Answer 18

ALT

check TFT before starting

Question 19

methotrexate adverse effects

Answer 19

• mucosal damage
  (e. g. sore mouth, gastrointestinal upset)
• bone marrow
  suppression (neutropenia and an
  increased risk of infection)

Question 20

long term use of methotrexate can result in what

Answer 20

hepatic cirrhosis or pulmonary fibrosis

Question 21

important interaction of methotrexate

Answer 21

e toxicity is more likely if it is prescribed with drugs that
inhibit its renal excretion, e.g. NSAIDs, penicillins

Co-prescription
with other folate antagonists, e.g. trimethoprim and phenytoin,
increases the risk of haematological abnormalities

Question 22

prescription of methotrexate

Answer 22

once weekly

IV or intrathecal

Folic acid 5 mg can be prescribed to be
taken on the 6 days where methotrexate is not taken

Question 23

monitoring with methotrexate

Answer 23

full blood count, liver and renal function before starting
treatment, then 1–2 weekly until treatment is established and
2–3 monthly thereafter

Question 24

what should pts on tamoxifen be warned of

Answer 24

• the risk of endometrial cancer and told to report relevant symptoms promptly
• symptoms of thromboembolism and advised to report sudden breathlessness and any pain in the calf of one leg.

Question 25

name some LMWH

Answer 25

dalteparin and

enoxaparin

Question 26

what is Fondaparinux

Answer 26

synthetic compound that is similar to

heparin

Question 27

communication to pt about LMWH and fondaparinux

Answer 27

• avoid activities that may increase their risk of bleeding: contact sports
• inform healthcare professionals they come into
  contact with that they are taking anticoagulants.
• train patients how to self-administer SC injections.
• discuss the risks and benefits of anticoagulation

Question 28

heparin +fondaparinux: what blood tests should be checked

Answer 28

FBC + renal profile

In prolonged therapy (>4 days), platelet count should be monitored

Question 29

how should IV lorazepam be given

Answer 29

diluted with an equal volume of water for injections or sodium chloride 0.9%.

Question 30

important adverse effects of ACEi

Answer 30

• persistent dry cough
• hypotension
• hyperkalaemia
• renal failure
• angioedema/ anaphylactoid reaction

Question 31

when is it best to take ACEi

Answer 31

best to take the first dose

before bed to reduce symptomatic hypotension.

Question 32

communication about ACEi

Answer 32

avoid NSAIDs

Question 33

what should you check before starting ACEi

Answer 33

electrolytes and renal function

Repeat these 1–2 weeks into treatment and
after increasing the dose

Question 34

ACEi: Biochemical changes can be tolerated

provided they are within what certain limits

Answer 34

creatinine concentration
should not rise by more than 30%, the eGFR should not fall by more
than 25%, and the potassium concentration should not rise above
6.0 mmol/L.