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Pharmacy Pre-Registration > Ultimate BNF > Flashcards

Ultimate BNF Flashcards

1
Q

Amiodarone indication

A

Arrythmias

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2
Q

Amiodarone dosage

A

200mg td 7 days
200mg bd 7 days
200mg od continue

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3
Q

Amiodorone Side effects

A 
Reversible corneal deposits, Phototoxicity,
Jaundice, Slate grey discolouration,
Taste disturbance, Vomiting,
Hyper/Hypothyroidism, Pulmonary toxicity
Nausea, Tremor, Sleep disorder
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4
Q

Amiodarone monitoring

A 
LFT
Thyroid function test before and 6 monthly
Serum Potassium concentration before
Chest X ray before
ECG/Resuscitation during IV
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5
Q

Half life Amiodarone

A

Weeks/months

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6
Q

Amiodarone interactions

A

Warfarin inhibited by, (anticoagulant effect up)
BB, (bradycardia, AV block, Myocardial depression)
Lithium, (Ventricular arrhythmias)
Digoxin conc increase by,

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7
Q

Digoxin indication

A

Cardiac Glycoside used in AF, AF, tachycardias, HF

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8
Q

Digoxin mechanism action

A

Positive ionotrope - increases force of myocardial contraction,
reduces conductivity within AV node

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9
Q

Desired serum concentration Digoxin

A

1-2mcg/L

toxic = 1.5-3

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10
Q

Digoxin monitoring

A

Serum electrolytes (potassium) and renal function

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11
Q

Risks of Digoxin and management of risks

A 
Digitalis toxicity (esp elderly)
Made worse by hypokalaemia so give Potassium sparing diuretics or potassium supplements
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12
Q

Side effects of Digoxin

A

Nausea, Vomiting, Diarrhoea, Dizziness, Blurred vision

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13
Q

Digoxin interacts with

A

These increase Digoxin plasma conc:
Amiodarone, Erythromycin, Calcium Channel blockers
These decrease Digoxin plasma conc:
Rifampacin, SJW

If hypokalaemia occurs with Loop/Thiazide risk toxicity

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14
Q

Lithium indication

A

Mania, Bipolar disorder, Recurrent depression

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15
Q

Desired Lithium serum concentration

A
  1. 4-1mmol/Litre

1. 5mmol and above is toxic

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16
Q

Lithium toxicity presents as

A

Tremor, Ataxia (shake), Dysarthria (speech problem), Nystagamus (rapid involuntary eye movements), Renal impairment, Convulsions, Blurred vision

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17
Q

Monitoring on Lithium

A

Lithium serum conc (3months)
Renal/Thyroid function (6-12 months)
Maintain sodium levels

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18
Q

Counselling with Lithium

A

Adequate fluid intake, avoid diet’s sodium increase or decrease

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19
Q

Interaction of Lithium

A

Excretion of Lithium reduced by: ACEI, Loops/Thiazides, probably NSAIDs
Risking toxicity/sodium depletion with Diuretics

Amiodarone: Ventricular arrhythmias

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20
Q

Methotrexate indication

A

Rheuatoid Arthiritis, Crohns, Malignant disease, Psoriasis

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21
Q

Problems with methotrexate and how to spot them

A

Blood dyscrasias: Sore throat, signs of infection, bruising, mouth ulcers
Liver toxicity/cirrhosis: Nausea, voimiting, abdominal discomfort, dark urine
Pulmonary toxicity: SOB, cough, fever

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22
Q

Methotrexate monitoring

A

FBC

LFT (and renal)

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23
Q

Methotrexate interactions

A

Increased methotrexate with Aspirin, NSAIDs

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24
Q

Dose of methotrexate

A

7.5mg once weekly (max 20mg/week)

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25
Q

Side effects of methotrexate

A

GI Ulcer, bleeding, hepatotoxicity

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26
Q

Other problems with methotrexate

A

Folate antagonist, give Folic Acid 5mg (not at the same time)
This prevents Methotrexate-induced mucositis, myelosuppression

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27
Q

Phenytoin indication

A

Epilepsy (not absence), neuropathic pain

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28
Q

Desired serum Pheytoin concentration

A

10-20mg/L

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29
Q

Monitoring with Phenytoin

A

FBC, LFT

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30
Q

Side effects of Phenytoin

A

Nausea, vomiting, constipation, gingival hypertrophy, rash, acne, hirsutis (coarse pigmented hair on face), Coarse poo, blood/skin disorders

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31
Q

Counselling with Phenytoin

A

Report signs of blood/skin disorders: Fever, Sore throat, rash, mouth ulcers, bruising, bleeding, Leucopenia

Take with or after food

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32
Q

Phenytoin interacts with

A 
NSAIDs enhances effects,
Warfarin metabolism accelerated,
Amiodarone inhibits metabolism,
Cimetidine inhibits metabolism,
Fluoxetine increases plasma conc,
SJW reduces plasma conc,
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33
Q

Theophylline indication

A

Bronchodilator for Asthma, COPD

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34
Q

Desired Theophylline plasma concentration

A

10-20mg/L

Over 20 = severe side effects

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35
Q

Theophylline side effects

A

Tachycardia, Palpitation, Nausea, GI, Headache, Convulsions

RISK: Hypokalaemia

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36
Q

Theophylline monitoring

A

Plasma conc, Lung function test

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37
Q

Theophylline interacts with

A

Quinolones: Convulsions
Plasma conc reduced by: SJW, Rifampacin
Plasma conc increased by: Cimetidine, Fluconazole

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38
Q

Warfarin indication

A

Anticoagulant (48 - 72 hours for full effect)

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39
Q

What are the risks with Warfarin INR

A

Too high INR: bleeding (stop warfarin)

Too low INR: Blood clotting (increase dose)

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40
Q

Dose of Warfarin

A

Initial dose 10mg, 3-9mg maintenance thereafter

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41
Q

Side effects of Warfarin

A

Haemorrhage, Rash, Hypersensitivity, Alopecia, Diarrhoea, Drop in haematocrit (packed cell volume), Purple toes, skin necrosis, Jaundice, Hepatic dysfunction

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42
Q

Warfarin monitoring

A

INR, Renal function

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43
Q

Warfarin Counselling

A

Take same time each day, avoid diet change (especially salads/vegetables), report signs of bleeding/bruising

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44
Q

Warfarin interacts with

A

Anticoagulant effect enhanced by: NSAIDs, Fluconazole, Statins, Ciprofloxacin, Erthyromycin, Metronidazole, Cranberry Juice
Anticoagulant effect reduced by: Griseofulvin, SJW, Antiepileptics
Anticoagulant effect anatgonised by Vitamin K
Anticoagulant control effected by Alcohol

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45
Q

Enzyme inhibitors

A

Sodium Valproate, Isoniazid, Cimetidine, Ketoconazole, Fluconazole, Amiodarone, Ciproflaxacin, Erythromycin, SJW, Omeprazole, Metronidazole, Grapefruit
Fluoxetine, Cranberry juice

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46
Q

Enzyme inducers

A

Carbamazapine, Rifampacin, Alcohol (chronic), Phenobarb/Primidone, Griseofulvin, Phenytoin, Sulfonylureas, Smoking, SJW

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47
Q

Alcohol interactions

A

Metronidazole: reaction like Disulfiram
Warfarin: Anticoagulant control effected
MAOI: Beverage containing tyramine - hypertensive crisis
Mirtazapine/TCA: increase sedative effect

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48
Q

What effect do enzyme inhibitors have

A

inhibit (decrease) metabolism of other drugs therefore increasing their conc

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49
Q

What effect do enzyme inducers have

A

Increase (induce) metabolism of other drugs therefore decreasing their conc/effect

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50
Q

COC interactions

A

Enzyme inducers - condom 4-8 weeks/tricylcing with 50mcg for 3-4 packs + 4 day pill free
Rifampacin/Rifabutin so potent - use IUD

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51
Q

Sympathomimetic (Pseudoephedrine) interactions

A

MAOI: Hypertensive crisis
BB: hypertension risk

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52
Q

Orlistat interactions

A

plasma conc Amiodarone reduced
Acarbose = GI effects
Ciclosporin absporption reduced
Anticoagulant effect - monitor

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53
Q

When H Pylori suspected

A

Confirm

PPI + 2AB bd (clarithromycin + Amox/Metronidazole)

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54
Q

Hypertension in

A

ACEI/ACE2 -> BB

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55
Q

Hypertension >55 White or Afro-Caribbean

A

CaCB -> Thiazide

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56
Q

Treatment for HF

A

ACEI + BB
Low dose Spiranolactone = reduce symptoms, mortality
Digoxin - improve symptoms, exercise tolerance

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57
Q

How does Colestyramine work

A

Bile acid sequestrant - binds bile acid and promotes cholesterol to turn into bile acids

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58
Q

Counselling with Colestyramine

A

Give other drugs one hour before or 4 - 6 hours after

Colesevelam/statin same time ok

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59
Q

Tiotropium indicated for

A

COPD not asthma

Antimuscarinic bronchodilator

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60
Q

Metocloperamide guidance

A

> 18 Nausea Vomiting only 10mg td 3days
Dose by weight
Only post op, radio induced, chemo, symptomatic/migraine vomiting

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61
Q

Domperidone guidance

A

Small serious risk of cardiac side effects
Only for Nausea Vomiting, lowest dose (>12 10mg td), 1 week
Contraindicated in heart and hepatic problems

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62
Q

Treatment of migraine

A

Acute: Aspirin, Paracetamol (both sol), NSAIDS + anti-emetic (domperidone, metocloperamide, phenothiazine, antihistamine)
5HT1receptoor agonists - Naratriptan, Sumatriptan

Prophylaxis: BB (propanolol) bring HR down especially if anxiety too, Pizotifen, Valproic Acid, Sodium Valproate, Topiramate, TCA, Gabapentin, (Lithium/Oxygen cluster)

NOT recommended Clonidine - insomnia/depression

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63
Q

Meningitis treatment

A

Urgent transfer to hospital + Benzylpenicillin/Cefotaxime

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64
Q

Lower UTI treatment

A

Trimethoprim/Nitrofuantoin
Amoxcillin/Cephlosporin
3 - 7 days

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65
Q

TB treatment

A

2 months initial phase: Isoniazid, Rifampacin, Pyrazinamide, Ethambutol (colour blindness)
4 months: Isoniazid, Rifampacin

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66
Q

High anaerobic activity

A

Metronidazole

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67
Q

Insulin admin

A

SC injection but soluble insulin IV - urgent

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68
Q

Who needs insulin

A

Diabetes Type 1 and 2
Ketoacidosis and for people who have rapid onset of symptoms, substantial weight loss, weakness, ketonuria (ketones in urine), first degree relative with diabetes

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69
Q

Tell me about short acting Sulphonylureas

A

Gliclazide, Tolbutamide
Increase insulin secretion B cells
Patients not overweight/metformin contraindicated

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70
Q

Tell me about long acting Sulphonylureas

A

Chlorpropamide, Glibenclamide

Higher chance hypoglycaemia, avoid in elderly

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71
Q

Tell me about Metformin

A

Biguanide, first line
Decreases glucogenesis and increases peripheral utilisation of glucose
No weight gain/no hypoglycaemia

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72
Q

Tell me about Pioglitazone/Rosiglitazone

A

Decrease peripheral insulin resistance

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73
Q

Tell me about Acarbose

A

Delays digestion and absorption of starch and sucrose
Inhibits alpha glucosidases
Add on therapy
Soft stools, farting, diarrhoea, abdodicomfort
-no point giving anatacid
Tablets chewed with first mouthful/liquid right before food
Carry glucose because risk hypoglycaemia

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74
Q

Who should carry glucose with them

A

Patients on Insulin, Sulphonylureas, Acarbose

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75
Q

What is Diabetic Ketoacidosis

A

A life threatening hyperglycaemic emergency

Nausea, Vomiting, Abdopain, Extreme thirst, Blurred vision

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76
Q

How is Ketoacidosis treated

A

IV Soluble insulin,
IV NaCl fluid replacement
IV KCl so no hypokalaemia (from insulin)

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77
Q

Cause of hypoglycaemia

A

Too much insulin, too little carbohydrate, delayed meal, too much exercise, hot weather, stress, alcohol

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78
Q

Symptoms of hypoglycaemia

A

Tremor, Sweating, Anxiety, Paleness, Irritability, Faint feeling, stomach ache, headache, tingling sensation, blur vision

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79
Q

Treatment of hypoglycaemia

A

Give some sugar after carbohydrate snack

If unconscious: IV glucose/Glucagon injection. When conscious carbohydrate snack

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80
Q

Hypoglycaemia major caution with

A

BB - mask symptoms

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81
Q

Why are ACEI used in diabetes

A

for diabetic nephropathy in type 2 diabetes, minimise decline in renal function

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82
Q

Risk of Levothyroxine

A

If metabolism increases too much: Diarrhoea, nervousness, rapid pulse, insomnia, tremor, angina pain (if latent MI)
If this happens - reduce/withhold dose for 1-2 days then restart again

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83
Q

Corticosteroids indications include

A

Addison’s disease - replacement therapy, Acute Adrenal insufficiency, hypopitruitism, anti-inflammatory treatment, immunosuppression

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84
Q

Prolonged use of corticosteroids leads to

A

increased susceptibility to infections/severity infections

Adrenal suppression, psychiatric reactions, growth restriction children

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85
Q

Avoid contact with what when on steroids

A

Chicken pox: unless patient has had them then they are at risk if oral/parenteral treatment of severe chicken pox
Measles - avoid people

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86
Q

How long to mention you’ve been on steroids

A

one year after finishing

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87
Q

When is withdrawal tapered

A

Systemic treatment with corticosteroids longer than 3 months
short course within a year of long course
Other possible cause adrenal suppression
>40mg prednisolone (equivalent)
had many doses in evening (mimicked diurnal rhythm)
>3weeks treatment

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88
Q

HRT for

A

treat menopausal symptoms: Vaginal atrophy, vasomotor instability (heat, sweating) and menopausal osteoarthiritis
For

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89
Q

What risks are associated with HRT

A

Breast cancer (within 1-2 years, stops after 5 yrs stopping)
Endometrial cancer (add progestogen 10/28 days if uterus)
Ovarian cancer (especially with combined use/oestrogen only HRT)
DVT/PE
Stroke (especially Tibolone)
CHD (especially starting 10 years after menopause)

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90
Q

HRT and contraception

A

HRT doesn’t provide contraception so in women

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91
Q

When to stop HRT immidiately

A

Sudden severe Chest pain, Sudden breathlessness, unexplained swelling/pain in calf one leg, severe stomach pain, hepatitis, jaundice, liver enlargement, BP >160/95, long immobility, contraindicated, neurological effects (unusual severe long headache, loss vision, disturbance in hearing, dysphagia, fainting attack, collapse, first time seizure, weakness, motor disturbance, numbness)

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92
Q

Bisphosphonates are used for what and what is the dosage

A

Alendronic Acid, Disodium Etidronate, Riserdronate sodium)
Reduce bone turnover - treat osteoporosis/cortico induced osteoporosis
Alendronic Acid 70mg once week for postmenopausal oseteoporosis

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93
Q

How do COCs work

A

Oestrogen and progestogen changes endometrial and inhibits ovulation (progestogen less)
Progestogen inhibits fallopian tube motiliy, thickens cervical mucous - hostile to sperm

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94
Q

Risks with COCs

A

DVT especially first year (increased with age, obesity, by travelling (GCS/exercise), immobility)
Breast cancer, cervical cancer more so. Less ovarian, endometrial cancer risk)

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95
Q

Missed COCs

A

24 hours take ASAP take active pill
2 pills missed: active + condom 7 days - omit pill free if these run past end of packet (especially if from first 7 pills)

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96
Q

Vomiting and diarrhoea with COCs

A

If vomit/diarrhoea >24 hours - condoms 7 days

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97
Q

Counselling for first time user of COC

A

Take on day 1 of menstruation

If > 4days, 7 days condom

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98
Q

COC to POP

A

Complete whole pack, start without 7 day break otherwise 7 days condom

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99
Q

POP to COC

A

Day 1 menstruation

Amenorrhoea - start any time with 7 days condom

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100
Q

Starting Contraceptive after child birth, abortion, miscarriage

A

3 weeks after birth (thrombosis/breakthrough bleeding risk before this) if > 3 weeks condom 7 days
After abortion, miscarriage - start same day

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101
Q

Who are POPs more suitable for

A

COC contraindicated - older women, heavy smokers, hypertension, heart disease, diabetics, migraine sufferers

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102
Q

Starting POP

A

Start day 1, 1od at same time each day

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103
Q

Missed pill POP

A

> 3hrs, 2 days condom (12hrs desogestrel)

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104
Q

Vomiting and diarrhoea with POPs

A

within 2 hours take another one, if >3hr - 2 days condom

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105
Q

Risks with POPs

A

Breast cancer

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106
Q

Acute attack of Gout treat with

A

NSAID (high dose): Diclofenac, Etoricoxib, indometacin, ketoprofen, naproxen, sulindac
Colchine

NOT Aspirin, Allopurinol, Uricosurics - these 2 prophylactic, start 1-2 weeks after acute attack settled

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107
Q

NSAIDs selective, non-selective and GI

A

Selective: Etoricoxib, Celecoxib - least s.e
Non-selective: Azapropazone (highest), Ibuprofen (least)
Intermediate s.e: Piroxicam, Ketoprofen, Indometacin, Naproxen, Diclofenac

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108
Q

NSAIDs and Asthma

A

Can worsen asthma - bronchospasm s.e.

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109
Q

Cardio risk NSAIDs

A

More with selective

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110
Q

Renal risk in NSAIDs

A

caution, can impair

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111
Q

HF and NSAIDs

A

Contraindicated

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112
Q

NSAIDs and peptic ulcers

A

contraindicated unless imperative need (severe RA) give them a PPI

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113
Q

Side effects of Mg containing antacids

A

Laxative effect. Belching (CO2 liberated)

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114
Q

Side effects of Aluminum containing antacids

A

Constipation

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115
Q

Side effects of Hyoscine (antimuscarinic)

A

Constipation, Transient Bradycardia, Reduced bronchial secretions, Urinary urgency and retention, Dilatation of pupils (problematic for patients with angle closure glaucoma), Photophobia, Dry mouth, Flushing, Dryness of the skin

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116
Q

Side effect H2 Receptor Antagonists

A

Diarrhoea, GI disturbance, Altered Liver Function Tests, Headache, Dizziness, Rash, Tiredness

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117
Q

Side effects of PPI

A

GI disturbance, headache

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118
Q

Side effect liquid paraffin

A

anal seepage, granulomatous reactions (especially from the emulsion), lipoid pneumonia and interference with the absorption of fat-soluble vitamins

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119
Q

Side effect Thiazides

A

Mild GI disturbance, Postural hypotension, Altered plasma lipid concentrations, Hypokalaemia, Hyponatraemia (low sodium in the blood), Hypomagnesaemia, Hypercalcaemia, Hyperglycaemia, Hyperuricaemia and Gout (uric acid). Less common – impotence.

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120
Q

Side effect Loops

A

Mild GI disturbance (nausea), Hypotension, Hypokalaemia, Hyponatraemia (low sodium in the blood), Hypomagnesaemia, Hypocalcaemia, Hyperglycaemia (less common than with thiazides), Hyperuricaemia, Gout (uric acid).

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121
Q

Side effects Potassium Sparing Diuretics

A

Hyperkalaemia

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122
Q

Side effects BB

A

GI disturbance, Bradycardia, Heart Failure, Hypotension, Peripheral vasoconstriction (cold hands and feet), Bronchospasm, Dyspnoea, Headache, Fatigue, Sleep disturbance (Nightmares), Sexual dysfunction, Pins and needles, Dizziness, Interference with glucose tolerance

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123
Q

Side effects ACEI

A

profound hypotension and renal impairment, Persistent dry cough, Angioedema, Rash, Pancreatitis, Upper Respiratory symptoms, GI disturbances, Altererd LFTs (jaundice), Hyperkalaemia, Hypoglycaemia, Blood disorders, Taste disturbance.

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124
Q

Side effects Angiotensin II Receptor Blockers

A

Dizziness (if taking high dose diuretics as well), Hyperkalaemia (occasional), Angioedema (occasional).

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125
Q

Side effects Nitrates

A

Postural Hypotension, Tachycardia, Throbbing Headache, Dizziness, Flushing.

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126
Q

Side effects CaCB

A

Oedema (ankles)

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127
Q

Side effects of Aspirin

A

Bronchospasm, Gastro-intestinal bleeding (PPI can be added)

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128
Q

Side effects Statins

A

Myositis, Myalgia and Myopathy (Muscle Effects) - Serious, Liver toxicity, GI disturbance (flatulence, abdominal pain)

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129
Q

Side effects Beta2 agonists

A

Fine tremor, Nervous tension, Headache, Muscle cramps, Palpitations, hypokalaemia.

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130
Q

Side effects Antimuscarinic Bronchodilators (Ipratropium, Tiotrpium)

A

Dry mouth

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131
Q

Side effects inhaled corticosteroids

A

Oral candidiasis, Hoarseness, Adrenal suppression

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132
Q

Side effects antihistamines

A

Antimuscarinic side effects – urinary retention, dry mouth, blurred vision, constipation and sedation with the older generation

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133
Q

Side effects Benzodiazepines

A

Drowsiness, Light-headedness the next day, Amnesia, In elderly: Confusion and ataxia, Dependence.

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134
Q

Side effects Chlorpromazine

A

Marked Sedative effects, Moderate antimuscarinic effects, Moderate extrapyramidal effects

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135
Q

Side effects Prochlorperazine

A

Marked Extrapyramidal effects, fewer sedative effects, fewer antimuscarinic effects

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136
Q

Side effects Atypical Antipsychotics (Amisulpiride, Olanzapine)

A

Weight gain, Dizziness, Postural hypotension, Extra-pyramidal effects (usually mild), Hyper-glycaemia and diabetes

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137
Q

Side effects TCA

A

Dry mouth, Sedation, Blurred vision, Constipation, Nausea, Difficulty with urination, Cardiovascular side effects, Sweating, Tremor, Rashes, Hypersensitivity reactions, Confusion, Suicidal behaviour

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138
Q

Side effects SSRI

A

Gastro-intestinal effects, Anorexia/weight loss or opposite, Hypersensitivity reactions, Urticaria, Angioedema, Anaphylaxis, Arthralgia, Myalgia, Photosensitivity

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139
Q

Side effects Mirtazapine

A

Increased appetite and weight gain, oedema, sedation, nausea, vomiting, dizziness, headache – which commonly lead to the need for withdrawal but this should be done over several weeks

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140
Q

Side effects Venlaflaxine

A

GI disturbance, headache, anxiety, dizziness, sleep disturbance – which commonly lead to the need for withdrawal but this, should be done over several weeks

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141
Q

Side effects Orlistat

A

oily leakage from rectum, flatulence, faecal urgency, liquid or oily stools, faecal incontinence, abdominal distension and pain (minimised by reduced fat intake), tooth and gingival disorders, respiratory infections, fatigue, anxiety, headache, menstrual disturbance, UTI, hypoglycaemia

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142
Q

Side effects of Metocloperamide

A

Extrapyramidal s.e.

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143
Q

Side effects of 5HT1 agonists (Naratriptan, Sumitriptan)

A

Tingling, heat, heaviness, pressure, or tightness of any part of the body, flushing, dizziness, weakness

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144
Q

Side effects Opioids

A

Nausea, vomiting, constipation, dry mouth, biliary spasm, respiratory depression in larger doses

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145
Q

Side effects of Penicillins (Flucloxacillin, Amoxicillin, Ampicillin, Co-amoxiclav, Co-fluampicil)

A

Hypersensitivity reactions can be fatal (uticaria, fever, joint pains, rashes, angioedema, anaphylaxis)

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146
Q

Side effects Cephlasporins (Cefaclor, Cefalexin)

A

Hypersensitivity reactions (0.5-6.5% of penicillin allergic patients will also be allergic to cephalosporins), diarrhoea and antibiotic associated colitis (more likely with higher doses), nausea, vomiting, abdominal discomfort, headache, liver problems.

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147
Q

Side effects of Tetracyclines (Tetracyline, Doxycycline, Lymecycline, Minocycline, Oxytetracycline)

A

nausea, vomiting, diarrhoea, Dysphagia, oesophageal irritation

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148
Q

Side effects of Aminoglycosides (Gentamicin, Neomycin)

A

Ototoxicity (inner ear or balance of hearing toxicity) and nephrotoxicity

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149
Q

Side effects of macrolides (Erythromycin)

A

Nausea, vomiting, abdominal discomfort and diarrhoea (Clarithromycin - also dyspepsia and tongue/tooth discolouration. Smell and taste disturbances).

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150
Q

Side effects Clindamycin

A

Diarrhoea (discontinue treatment as associated with fatal antibiotic associated colitis), abdominal discomfort, oesophageal ulcers

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151
Q

Side effects Trimethoprim

A

GI effects, pruritus, rashes, hyperkalaemia

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152
Q

Side effects Rifampacin

A
  • GI effects (diarrhoea – antibiotic associated colitis reported, anorexia, nausea, vomiting), hepatic disorders, coloured bodily fluids (urine red)
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153
Q

Side effects Metronidazole

A

GI effects, taste disturbance, furred tongue, oral mucositis, and anorexia

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154
Q

Side effects Quinolones (ciprofloxacin)

A

Nausea, vomiting, dyspepsia, abdominal pain, diarrhoea, headache, dizziness, rash, sleep disturbances.

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155
Q

Side effects Nitrofurantoin

A

Anorexia, nausea, vomiting, diarrhoea, acute and chronic pulmonary reactions.

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156
Q

Side effects Terbinafine

A

Abdominal discomfort, anorexia, nausea, diarrhoea, headache, rash and urticaria

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157
Q

Side effects Insulin

A

fat hypertrophy at injection site, hypoglycaemia (heavy sweating, shakiness, dizziness, visual disturbance, tingling of hands and lips, speech disturbance)

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158
Q

Side effects Sulphonylureas

A

Weight gain, GI effects (nausea, vomiting, diarrhoea, constipation), hypoglycaemia.

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159
Q

Side effects Biguanides (Metformin)

A

Anorexia, nausea, vomiting, diarrhoea, abdominal pain, metallic taste, vitamin B12 deficiency

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160
Q

Side effects Levothyroxine

A

Diarrhoea, vomiting, angina pain, arrhythmias, palpitation, tachycardia, tremor, restlessness, excitability, insomnia, headache, flushing, sweating, fever, heat intolerance, weight loss, muscle cramps, transient hair loss in children

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161
Q

Side effects Carbimazole

A

nausea, mild GI disturbance, headache, rash, bone marrow suppression (neutropenia, agranulocytosis)

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162
Q

Side effects Oral Corticosteroids

A

Euphoria, nightmares, insomnia, irritability, mood lability, suicidal thoughts, psychotic reactions, immunosupression, adrenal suppression

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163
Q

Side effects mineralocorticoids

A

Hypertension, sodium and water retention, potassium and calcium loss.

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164
Q

Side effects Glucocorticoids

A

Diabetes, osteoporosis, muscle wasting and weakness, peptic ulceration and perforation, Cushing’s syndrome (moon face, striae, acne occurs with higher doses and is reversal on withdrawal), growth suppression in children, GI effects, menstrual irregularities, hirsutism, weight gain, increased susceptibility to infection, insomnia, glaucoma, uticaria, skin atrophy, myocardial rupture following MI or congestive heart failure, hypersensitivity, thromboembolism, nausea, malaise, hiccups, headache, vertigo

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165
Q

Side effects of COCs

A

Nausea, vomiting, abdominal cramps, changes in body weight, liver impairment, hepatic impairment, fluid retention, and hypertension

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166
Q

Side effects POPs

A

Menstrual irregularities, nausea, vomiting, headache, dizziness, breast discomfort, depression, skin disorders, disturbance of appetite, weight changes, changes in libido.

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167
Q

Side effects NSAIDs

A

GI discomfort, nausea, diarrhoea, bleeding and ulceration, hypersensitivity (bronchospasms), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbance, photosensitivity, blood disorders, fluid retention, renal failure

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168
Q

Side effects Methotrexate

A

anorexia, abdominal discomfort, dyspepsia, GI ulceration and bleeding, diarrhoea plus many more

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169
Q

Drugs that Colour Urine (and what colour)

A 
Dantron (co-danthramer) - red
Sulfasalazine - orange
Triamterene (potassium sparing) - Blue in some lights
Rifampacin - orange/red
Nitrofurantoin - Orange/brown
Levodopa - dark red
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170
Q

Which drugs cause sensitisation/phototoxicity

A

Chlorpromazine - contact and photo: avoid contact, do not crush, handle solution with care + avoid sunglight
Amiodarone - Phototoxicity/slate grey discolouration. Shield skin from light during treatment and several months after. Wide spectrum sunscreen.
Doxycycline - photosensitivity
Azapropazone (NSAID) - photosensitivity

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171
Q

CSM warning for Sucralfate

A

Bezoar formation. Extra care - enteral feed/predisposing condition (delayed gastric emptying)

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172
Q

CSM warning for Pancreatin

A

High strength - certain recommendations in CF

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173
Q

CSM warning for BB

A

not in asthma - rarely cardioselective BB given with caution (including eye drops)

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174
Q

CSM warning for Sotalol

A

only fro ventricular arrythmias/prophylaxis supraventricular arrythmias
NOT for Angina, hypertension, thyrotoxicosis, secondary prevention after MI - stop for these gradually

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175
Q

CSM warning Heparin

A

Hyperkalaemia. More likely if diabetes, chronic renal failure, acidosis, high plasma potassium, pt taking potassium sparing drugs, >7 days treatment

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176
Q

CSM warning for Lipid lowering drugs

A

Rhabdomyolysis with fibrates/statins especially renal impairment/hypothyroidism
Concomitant use with increase plasma statin increase risk of muscle toxicity

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177
Q

CSM warning for Salbutamol

A

Hypokalaemia from beta2 agonists (measure plasma conc in severe asthma)
Especially use concomitantly with Theophylline and its derivatives, corticosteroids, diuretics, hypoxia

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178
Q

CSM warning for inhaled corticosteroids

A

Monitor height

Spacer device

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179
Q

CSM warning for Leukotriene receptor antagonists

A

Chrug-Strauss syndrome (severe asthma with high eosinophil count) occurs especially when reduction/withdrawal concomitant oral corticosteroid
Advise patient to report eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, or peripheral neuropathy

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180
Q

CSM warning for Bee and Wasp Allergen extract/Grass and tree pollen extracts

A

Cardiopulmanary resuscitation facilities must be immidiately available
Monitor patient closesly after each injection

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181
Q

CSM warning for Benzodiazapines

A

Indicated for short term relief (2-4weeks) for anxiety which is bad causing problems
In mild anxiety inappropriate
Insomnia when its really bad

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182
Q

CSM warning for Antipsychotics and Stroke

A

Olanzapine and Risperidone are associated with an increased risk of stroke in elderly parients with dementia

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183
Q

CSM warning for Clozapine

A

a. Withdrawal b. Agranulocytosis c. Myocarditis and Cardiomyopathy d. GI obstruction

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184
Q

CSM warning for Hyponatraemia and antidepressants

A

All but SSRI more

Watch out for drowsy, confusion, convulsion

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185
Q

Depression in children CSM

A

Fluoxetine only

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186
Q

CSM warning for Fluvoxamine

A

AVOID Fluvoxamine + Theophylline/Aminophylline

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187
Q

CSM warning for Paroxetine

A

Of all SSRi most extrapyramidal effects (and orofacial dystonias) and withdrawal symptoms
20mg daily for depression, SAD, GAD, PTSD
40mg daily for PD and OCD
Higher doses not effective

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188
Q

CSM warning for Sumatriptan

A

Not for use in IHD or Prinzmental’s Angina
Do not use with ergotamine
NOT for IV
Driving
No response initial dose - don’t take another dose for same attack

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189
Q

CSM warning for Lamotrigine

A

Serious skin reaction - SJS/Toxic epidermal necrolysis
Rash associated with hypersenstivity syndrome and usually first 8 weeks
Withdraw if rash/hypersensitivity signs
Risks: use with Valproate/Higher initial dose than recommended/faster dose escalation than recommended

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190
Q

CSM warning for Topiramate

A

acute myopia with secondary angle-closure glaucoma within one month usually
Also reported: Choroidal effusions -> anterior displacement of lens/iris
If raise IOP, try reduce and stop use

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191
Q

CSM warning for Vigabatrin

A

visual defects from 1 month - several years

Visual field test before treatment and 6 month intervals (available for

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192
Q

CSM warning for Dopamine Receptor Agonists

A

Ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, lisuride and pergolide) associated with pulmonary/retroperitoneal/pericardial fibrotic reactions
Before treatment get erythrocyte sedimentation rate, serum creatinine and chest X-ray
Watch out for Patients should be monitored for dyspnoea, persistent cough, chest pain, cardiac failure, and abdominal pain or tenderness

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193
Q

CSM warning for Buproprion (Zyban)

A

Contraindicated if history of seizure/eating disorder/CNS tumour/experience acute symptoms of alcohol/benzo withdrawal
Not if pt risk of seizures unless smoking cessation benefit very high
Seizure threshold lowered by use with: antidepressants, antimalarials [such as mefloquine and chloroquine], antipsychotics, quinolones, sedating antihistamines, systemic corticosteroids, theophylline, tramadol
and also with alcohol abuse, history of head trauma, diabetes, and use of stimulants and anorectics

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194
Q

CSM warning for Flucloxacillin

A

Cholestatic jaundice and hepatitis - several weeks after especially had for >2weeks/older/risk factors
Don’t use if history hepatic dysfunction with Fluclox
Use with caution in patients with hepatic impairment
Find out if hypersensitivity reaction to beta lactam antibacterials

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195
Q

CSM warning for Co-amoxiclav

A

Cholestatic jaundice during/short after. Esp over 65yo and men. Usually self limiting not troublesome
Liver toxicity
Use only for indication at correct dose. NOT >14 days

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196
Q

CSM warning for Linezolid

A

Haemotopoetic disorders: thrombocytopenia, anaemia, leucopenia, and pancytopenia – simultaneous decrease in the blood cells
Monitor weekly FBC especially if >14days, have myelosuppression, using other drugs which cause effect haemoglobin/blood counts/plateley function, have renal impairment
Optic neuropathy especially >28days
Report visual impairment

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197
Q

CSM warning for Co-trimoxazole

A

SJS, Blood dyscrasias, bone marrow suppression, agranulocytosis
Use only when good reason

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198
Q

CSM warning for Quinolones

A

Tendon damage within 48hrs.
Contraindicated in history tendon disorder, elderly, risk increased with corticosteroids, discountinue if tendinitis suspected
Arthropathy in children in weight bearing joints (animals) so NOT recommended in children/growing adolescent unless justifiable/short term
Convulsions risk - don’t give if history (NSAID increases risk)

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199
Q

What are Quinolones used for in childen

A

NOT recommended but used in:
Nalidixic acid -UTIs in children over 3 months
Ciprofloxacin - pseudomonal infections in CF >5
treatment/prophylaxis of inhalational anthrax

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200
Q

CSM warning for Amphotericin B

A

Anaphylaxis from IV therefore test dose observe patient for 30 mins
If had previous adverse reaction and treatment essential give prophylactic antipyretic and hydrocortisone

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201
Q

CSM warning for Itraconazole

A

HF - caution in pt at risk of HF/high dose/long course/older/cardiac disease/negative iontropic drugs (eg CaCB)

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202
Q

CSM warning for Ketoconazole

A

Fatal hepatotoxicity especially >10days
biochemical and clinical monitoring
Not used by mouth for superficial fungal infections

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203
Q

CSM warning for Mefloquine (Lariam)

A

Warn travellers of adverse effects: nausea, vomiting, diarrhoea, abdominal pain, dizziness, loss of balance, headache, and sleep disorders
- if get these then use alternative antimalarial
PIL always provided

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204
Q

CSM warning for Carbimazole

A

Bone marrow suppression - stop immediately

Confirm no sign of infection (sore throat) -> do a WBC count, if neutropenia stop immediately

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205
Q

CSM warning for Steroids

A

Chickenpox
Withdrawal
Pregnancy
BF

206
Q

CSM warning for Desmopressin

A 
hyponatraemic convulsions (occurs when dehydrated/low sodium in blood)
Warning of avoiding fluid overload and swimming in patients treated for primary noturnal enuresis
Stop taking during episodes of vomiting/diarrhoea
207
Q

CSM warning for Medroxyprogesterone acetate (Depo-Provera)

A

When other methods of contraception inappropriate
Women - benefits of use beyond 2 years evaluate against risk due to reduction in bone mineral density reports
If Osteoporosis risk - consider alternative

208
Q

CSM warning for Spermicidal contraceptives

A

petroleum jelly (Vaseline), baby oil, oil based vaginal and rectal preparations - damage latex condom/diaphragm and have less protection from STD

209
Q

CSM warning for Co-Cyrindiol (Dianette)

A

VT more in these than COC
severe acne which has not responses to oral AB
moderate - severe hirsutism
Not solely for contraception
Contraindicated if FH of VT
Women with acne/hirsutism usually have high CVD risk

210
Q

CSM warning for Cytotoxic drugs

A
  1. Trained personnel should reconstitute cytotoxics
  2. Reconstitution should be carried out in designated areas
  3. Protective clothing (including gloves) should be worn
  4. The eyes should be protected and means of first aid should be specified
  5. Pregnant staff should not handle cytotoxics
  6. Adequate care should be taken in the disposal of waste material, including syringes, containers, and absorbent material.
211
Q

CSM warning for Tacrolimus (prophylaxis organ rejection)

A

Cardiomyopathy in children

Monitor carefully

212
Q

CSM warning for Tamoxifen

A

Thromboembolism - report breathlessness/pain in calf of one leg
endometrial cancer but benefit outweighs risk
20mg daily substantailly increases survival in early breast cancer

213
Q

CSM warning for Thiamine IV

A

serious allergic ADR

214
Q

CSM warning for NSAIDs and Asthma

A

NSAID can worsen asthma

215
Q

CSM warning for Tiaprofenic acid

A

severe cystitis
Not if pt has UT disorder. Stop if urinary symptoms develop - report to doctor (eg. increased frequency, nocturia, urgency, pain, blood in urine)

216
Q

CSM warning for Methotrexate

A
  1. Blood count (bone marrow suppression - especially older, renal impairment, other antifolate drug
  2. Liver toxicity (cirrhosis - NOT if LFTs/biopsy bad: CHECK. Restart when better)
  3. Pulmonary toxicity (especially RA. Report: dyspnoea, cough, fever. Stop if pneumonitis)
  4. Aspirin/NSAIDs: Avoid self medication. Monitor dose.
217
Q

CSM warning for Baclofen

A

Abrupt withdrawal = serious side effects

Gradual reduction over 1-2 weeks

218
Q

CSM warning for Co-cyprindiol

A

VT more frequently in women taking this than COC

Only for severe acne, hirsutism

219
Q

Counselling points with Antacids

A

a. They are best taken when symptoms occur or are expected, usually between meals or at bedtime. b. They should preferably not be taken at the same time as other drugs since they may impair absorption. c. Antacids can damage enteric coatings on tablets. d. The words ‘low Na+’ added after some preparations indicates a sodium content of less than 1mmol per tablet or 10ml dose. This is directed for people with hypertension

220
Q

Counselling points with Ispaghula

A

Preparations that swell in contact with liquid should always be carefully swallowed with water and should not be taken immediately before going to bed

221
Q

Counselling points with Liquid Paraffin

A

should not be taken immediately before going to bed

222
Q

Counselling points with Salbutamol inhalation

A

Advise patients not to exceed the stated dose. If a previously effective dose of inhaled salbutamol fails to provide at least 3 hours relief, a doctor’s advice should be obtained as soon as possible

223
Q

Counselling points with CFC-free inhalers

A

Patients receiving CFC-free inhalers should be reassured about their efficacy and counselled that aerosol may feel and taste different

224
Q

Counselling points with Ipratropium

A

Acute angle-closure glaucoma reported with nebulised Ipratropium, particularly when given with nebulised salbutamol (and possibly other beta2 agonists). Care is needed to protect patient’s eyes from nebulised drug or from drug powder

225
Q

Counselling points with Corticosteroid inhaler

A

The risk of oral candidiasis can be reduced by rinsing the mouth with water after using the inhaler or by using a spacer device

226
Q

Counselling points with Nitrates

A

Tolerance: Patients on long acting nitrates can rapidly develop tolerance (reduce therapeutic effect). Reducing the nitrate concentration in the blood for 4 to 8 hours each day usually maintains effectiveness e.g. by giving twice daily preparations after 8 hours then after 16 hours

227
Q

Counselling points with GTN sublingual tabs

A

GTN tablets should be supplied in glass containers of not more than 100 tablets, closed with a foil-lined cap, and containing no cotton wool wadding (i.e. the original container). They should be discarded after 8 weeks. They should be placed under the tongue to dissolve. Dosing is ‘when required’

228
Q

Counselling points with GTN spray

A

Spray one to two doses under the tongue then close mouth. This should relieve the pain within a minute or so. If no improvement after 5 minutes then use it again. If no improvement, then use again after 5 more minutes. Then if no improvement despite using the spray 3 times within 15 minutes, call an ambulance

229
Q

Counselling points with MAOI including Linezolid

A

avoid large amounts of Tyramine-rich foods as it can cause a hypertensive crisis. An early warning symptom may be a throbbing headache. The danger of interaction persists for up to 2 weeks after treatment with MAOIs is discontinued. Tyramine rich foods include mature cheese, pickled herring, broad bean pods, Bovril, Oxo, Marmite or any similar meat or yeast extracts, undistilled alcohol beverages, and fermented soya bean products. Patients also need to avoid stale or ‘going off’ foods and stick to eating fresh foods. Alcoholic drinks need to be avoided (including drinks with low alcohol content). Note that no tyramine at all can cause hypotension

230
Q

Counselling points with Carbamazepine/Oxcarbamazepine

A

Blood, Hepatic and Skin disorders reported

231
Q

Counselling points with Ethosuximide

A

Blood disorders

232
Q

Counselling points with Lamotrigine

A

Blood and Skin reactions

233
Q

Counselling points with Pheytoin

A

Blood and Skin disorders

234
Q

Counselling points with Topiramate

A

Myopia with secondary angle-closure glaucoma.

235
Q

Counselling points with Sodium Valproate

A

Liver toxicity, Blood or Hepatic disorders and Pancreatitis (Patients need to know how to recognise signs of pancreatitis – abdominal pain, nausea and vomiting)

236
Q

Counselling points with Vigabatrin

A

visual field defects

237
Q

Counselling points with Parkinson’s disease

A

Co-careldopa, Co-beneldopa, Dopamine receptor agonists: Excessive daytime sleep, sudden onset sleep
Therefore driving/machinery

238
Q

Counselling points with Disulfiram

A

Patients should be aware of unpredictable and occasionally severe nature disulfiram-alcohol interactions. Reactions can occur within 10 minutes and last several hours which may require oxygen therapy. Patients should not ingest alcohol at all and should be warned of possible presence of alcohol in liquid medicines, remedies, tonics, foods and even toiletries (alcohol should be avoided at least one week after therapy has stopped)

239
Q

Counselling points with Malaria prophylaxis

A

Travellers need to be warned about the importance of avoiding mosquito bites and importance of taking prophylaxis regularly and importance of immediate visit to doctor if ill within one year and especially within 3 months of return

240
Q

Counselling points with Insulin

A
  1. Wash hands before using a blood glucose monitor.
  2. Absorption problems: hot climate/exercise increase the absorption. Cold climate/cool skin reduce it. Absorption is most rapid from abdomen, slowest from the thigh.
  3. Avoid diabetic foods - healthy diet is more important. Diabetic foods substitute sorbitol - occasional treat.
  4. Check feet daily and wear appropriate footwear. Do not treat any foot conditions yourself – consult a chiropodist or doctor.
  5. Be aware of retinopathy.
  6. Sick day rules: Common illness can upset diabetic control. Consult urgent medical help immediately if vomiting, drowsiness or deep rapid breathing occurs. Do not stop taking insulin or oral hypoglycaemics. Test blood glucose every 2 to 4 hours. Drink plenty of fluids to prevent dehydration. If not able to eat then take Lucozade or sugar containing drinks.
  7. Travelling: cool bag. On long haul flights, inject before eating and carry extra carbohydrates. Test more regularly.
241
Q

Counselling points with Acarbose

A

Tablets should be chewed with first mouthful of food or swallowed whole with a little liquid immediately before food. To counteract possible hypoglycaemia, patients receiving insulin or a sulphonylurea as well as acarbose need to carry glucose (but not sucrose – acarbose interferes with sucrose absorption

242
Q

Counselling points with Alendronic acid

A

Tablets should be swallowed whole with plenty of water while sitting or standing; to be taken on an empty stomach at least 30 minutes before breakfast (or another oral medicine); patient should stand or sit upright for at least 30 minutes after taking tablet. Also, patients should stop taking tablets and seek medical attention if they develop symptoms of oesophageal irritation such as Dysphagia, new or worsening heartburn, pain on swallowing or retrosternal pain

243
Q

Counselling points with Etidronate disodium (didronel)

A

– Avoid food for at least 2 hours before and after oral treatment, particularly calcium containing products such as milk; also avoid iron, mineral supplements and antacids

244
Q

Counselling points with Risedronate

A

Tablets should be swallowed whole with plenty of water while sitting or standing; to be taken on an empty stomach at least 30 minutes before breakfast (or another oral medicine); patient should stand or sit upright for at least 30 minutes after taking tablet. Granules should be stirred into a glass of water and after dissolution complete taken immediately

245
Q

Counselling points with Prazosin

A

First dose effect – where the first dose may cause collapse due to hypotensive effect (therefore should be taken on retiring to bed). Patient should be warned to lie down if symptoms such as dizziness, fatigue or sweating develop, and to remain lying down until they are abate completely

246
Q

Counselling points with Ciclosporin

A

(potent immunosuppressant e.g. for organ transplantation – brand Neoral) – Total daily dose should be taken in 2 divided doses. Avoid grapefruit or grapefruit juice for one hour before dose. For oral solution - Mix the solution with orange juice (or squash) or apple juice (to improve taste) or with water immediately before taking (and rinse with more to ensure total dose). Do not mix with grapefruit juice. Keep the medicine measure away from other liquids (including water)

247
Q

Counselling points with Isotretinoin

A

Warn patient to avoid wax epilation (risk of epidermal stripping), dermabrasion, and laser skin treatment (risk of scarring) during treatment and for at least 6 months after stopping; patient should avoid exposure to UV light (including sunlight) and use sunscreen and emollient (including lip balm) preparations from the start of treatment. Take tablets with or after food

248
Q

Counselling points for Penicillin V, Flucloxacillin, Ampicillin

A

9: regular Intervals and complete the course.
23: an hour before food or on an empty stomach.

249
Q

Counselling points for Amoxicillin

A

Unlike Ampicillin, absorption is not affected by the presence of food. Label 9: regular Intervals and complete the course

250
Q

Counselling points for Cephalosporins (Cefaclor, Cefalexin)

A

Label 9: regular Intervals and complete the course.

251
Q

Counselling points for Tetracycline, Oxytetracycline

A

Label 7: Do not take milk, indigestion remedies, or medicines containing iron or zinc at the same time of day as this medicine (prevents absorption of the antibiotic and should be taken 2-3 hours apart) Label 9: regular Intervals and complete the course. Label 23: an hour before food or on an empty stomach

252
Q

Counselling points for Doxycycline

A

Label 6: Do not take indigestion remedies or medicines containing iron or zinc at the same time of day as this medicine. Label 9: regular Intervals and complete the course. Label 11: Avoid exposure of skin to direct sunlight or sun lamps. Label 27: With plenty of water. C: Capsules should be swallowed whole with plenty of fluid during meals while sitting or standing

253
Q

Counselling points for Lymecycline

A

Label 6: Do not take indigestion remedies or medicines containing iron or zinc at the same time of day as this medicine. Label 9: regular Intervals and complete the course.

254
Q

Counselling points for Minocycline

A

Label 6: Do not take indigestion remedies or medicines containing iron or zinc at the same time of day as this medicine. Label 9: regular Intervals and complete the course. C: Tablets or capsules should be swallowed whole with plenty of fluid during meals while sitting or standing

255
Q

Counselling points for Erythromycin

A

Label 5: Do not take indigestion remedies at the same time of day as this medicine.(should be taken 2-4 hours apart) Label 9: regular Intervals and complete the course. Label 25: swallowed whole, not chewed.

256
Q

Counselling points for Clindamycin

A

Label 9: regular Intervals and complete the course. Label 27: with plenty of water. C: Patients should discontinue immediately and contact the doctor if diarrhoea develops; capsules should be swallowed with a glass of water.

257
Q

Counselling points for Trimethoprim

A

Label 9: regular Intervals and complete the course. C: Watch out for signs of blood dyscrasias i.e. sore throat

258
Q

Counselling points for Rifampacin

A

Label 8: Do not stop taking this medicine except on your doctor’s advice. Label 14: This medicine may colour the urine. Label 22: Half to one hour before food. C: Watch out for signs of liver toxicity i.e. nausea, vomiting, malaise, jaundice.

259
Q

Counselling points for Metronidazole

A

Label 4: Warning. Avoid alcoholic drink. Label 9: regular Intervals and complete the course. Label 21: with or after food. Label 25: swallowed whole, not chewed. Label 27: with plenty of water

260
Q

Counselling points for Ciprofloxacin

A

Label 7: Do not take milk, indigestion remedies, or medicines containing iron or zinc at the same time of day as this medicine. Label 9: regular Intervals and complete the course. Label 25: swallowed whole, not chewed. C: Driving – may impair performance of skilled tasks e.g. driving. Effects are enhanced by alcohol

261
Q

Counselling points for Nitrofurantoin

A

Label 9: regular Intervals and complete the course. Label 14: This medicine may colour the urine. Label 21: with or after food.

262
Q

DRUGS THAT REQUIRE COUNSELLING ON REPORTING SORE THROAT – RISK OF BLOOD DYSCRASIAS

A

Aminosalicylates (e.g. Mesalazine, Sulfasalazine) FBC and drug stopped if blood dyscrasias suspicion
Mirtazapine, Carbamazepine, Ethosuximide, Phenytoin, Sodium valproate, Co-trimoxazole, Trimethoprim, Carbimazole, Gold (RA), Penicillamine (RA), Methotrexate, Azathioprine (transplant recipient) Bone marrow suppression - report signs of bone marrow suppression e.g. inexplicable bruising, bleeding or infection.

263
Q

HEPATOTOXIC DRUGS

A

Labetalol (lab testing needed at first symptom - if found stop and not restarted)
Sodium Valproate first 6 months/multiple antiepileptic therapies. Monitor liver function
Rifampicin/Isoniazid - Report persistent nausea, vomiting, malaise or jaundice
Ketoconazole/Itraconazole - Report anorexia, nausea, vomiting, fatigue, abdominal pain, jaundice or dark urine develop
Pioglitazole/Rosiglitazole - rarely
Cyproterone (Prostate cancer treatment) - Direct hepatic toxicity; including jaundice, hepatitis and hepatic failure
Leflunomide (RA)
Methotrexate
Halothane (anaesthesia)

264
Q

Drugs with warning cards

A

Lithium
Warfarin
MAOI’s
Steroids

265
Q

DRUGS WHERE THE SAME BRAND NEEDS TO BE PRESCRIBED

A 
Lithium
Theophylline and Aminophylline 
Diltiazem and Nifedipine
Mesalazine
Aminosalicylates
266
Q

Driving warnings with

A

Epilepsy - seizure free for one year. If night attacks only - no awake attacks 3 years
Diabetes - notify DVLA. Driving is not permitted when hypoglycaemic episodes occur. check blood glucose before driving and at 2 hour intervals on long journeys.
If hypoglycaemia: stop the vehicle in a safe place, switch off the ignition move from drivers seat, eat or drink a suitable source of sugar and wait and check again after 45 mins

267
Q

Drugs not stopped during surgery

A 
Anti-epileptics
Anti-Parkisonsoniun
Antipsychotics and Anxiolytics
Bronchodilators
CVD (K sparing/ACE/ACE2/BB stopped)
Drugs for dependence
Glaucoma drugs
Immunosuppressants 
Progestogen only contraceptives
Thyroid/antithyroid drugs
268
Q

Drugs stopped for surgery

A

COCs - 4 weeks before till 2 weeks after. Not minor.
MAOI withdraw slowly. Interacts with pethidine
TCA - no need to but risk arrhythmia/hypotension
Lithium - 24 hour before. Not minor.
Aspirin/Anti-coagulant - assess and replace
ACE/ACE2
K sparing
Insulin - normal dose at night. Infusion of glucose, potassium, insulin on sliding scale early morning. When pt eats start SC insulin before breakfast and stop IV 30 mins later

269
Q

Drugs used during surgery

A 
Anaesthetics, Analgesics
H2 receptor antagonits/PPI
Antimuscarinic (lung secretions)
Benzodiazepines - DRIVING risk
Antibiotics
Neuromuscular blocking drugs
Anticholinesterases - to reverse neuromuscular blocking drugs
specific antagonists - to reverse unwanted eg respiratory depression
270
Q

What to avoid in pregnancy

A

Soft and blue veined cheeses
All types of pâté (and any liver products)
Raw eggs, partially raw eggs – e.g. homemade
mayonnaise.
Raw meat
Fish - shark, swordfish, marlin
Alcohol - 1st/2nd teratogenic, growth restriction, 3rd withdrawal
Smoking - causes vasoconstriction, hypoxia, low birth weight, premature birth or perinatal birth
Caffeine - 2 cups.day otherwise risk miscarriage/stillbirth

271
Q

Misoprostol and pregnancy

A

Avoid in all trimesters - induces abortion and teratogenic

272
Q

PPI and pregnancy

A

Omeprazole

273
Q

H2 antagonists and pregnancy

A

avoid unless essential

274
Q

Loperamide and pregnancy

275
Q

Antacids and pregnancy

A

Gaviscon ok but not if high sodium

276
Q

Laxatives and pregnancy

A

Bulk-forming laxatives ok (Fybrogel)
Osmotic laxatives Lactulose ok. Avoid macrogols
Stimulant laxatives - bisacodyl/senna if stimulant effect needed

277
Q

Haemorrhoids and pregnancy

A

local ok

not steroids

278
Q

Hypertension and pregnancy

A

Labetalol, Methyldopa, Nifedepine MR

279
Q

Heparin and pregnancy

A

LMWH preferred - enoxaparin not harmful

280
Q

Warfarin and pregnancy

A

teratogenic - not 1st trimester

281
Q

Statins and pregnancy

282
Q

Inhaled bronchodilators and pregnancy

283
Q

Inhaled corticosteroids and pregnancy

A

risks asthma > side effects
Intra-uterine growth restriction (prolonged/systemic treatment)
Required during labour - monitor (risk fluid retention)

284
Q

Epilepsy and pregnancy

A

Benefit treat >risk to foetus - monitor
More risk if more than one drug
Give folate supplements (neural tube defects)
Prophylactic vitamin K stops bleeding problems (delivery) and injection at birth stops AE problems
BF OK

285
Q

Analgesics and pregnancy

A

Paracetamol if needed

NOT aspirin/NSAIDs

286
Q

Opioid analgesics and pregnancy

A

NOT in 3rd trimester - neonatal respiration depressed/withdrawal and gastric stasis/inhalation pneumonia in mother

287
Q

Treating morning sickness

A

Promethazine (antihistamine) short term, first line

Prochlorperazine/metocloperamide second line

288
Q

Which antibiotics are not known to be harmful during pregnancy

A

Penicillins, Cephalosporins, Erythromycin, Clindamycin

289
Q

Tetracycline and pregnancy

A

1st trimester - skeletal problems

2nd/3rd - dental discolouration/maternal hepatotoxicity

290
Q

Aminoglycosides and pregnancy

A

audiorty and vestibular nerve damage especially Streptomycin. Least with Gentamycin, Tobramycin. Avoid but if given monitor

291
Q

Macrolides (not erythromycin) and pregnancy

A

Avoid unless essential

292
Q

Co-trimoxazole and pregnancy

A

teratogenic 1st trimester

293
Q

Trimethoprim and pregnancy

A

folate antagonist, teratogenic

294
Q

Rifampacin and pregnancy

A

1st trimester teratogenic

3rd neonatal bleeding risk

295
Q

Metronidazole and pregnancy

A

avoid high dose

296
Q

Quinolones and pregnancy

A

avoid - joint disorder

297
Q

Nitrofurantoin and pregnancy

A

neonatal haemolysis 3rd trimester

298
Q

Insulin and pregnancy

A

Insulin required might go up in 2nd/3rd trimester
SA: Insulin aspart/lispro ok
LA: Insulin Isophane/Detemir

299
Q

Finasteride and pregnancy

A

avoid. Feminisation of male foetus
Excreted in semen - use condom
Child bearing age - avoid handling crushed/broken tabs

300
Q

COCs and pregnancy

A

3 weeks after childbirth (thrombosis risk if earlier)

301
Q

POPs and pregnancy

A

3 weeks after childbirth (risk breaththrough bleeding)

302
Q

Cystisis and pregnancy

A

Refer UTI. Avoid sodium bicarbonate/citrate

Potassium citrate ok

303
Q

Methotrexate and pregnancy

A

avoid, use contraception even 3 months after for men/women

304
Q

Drugs to avoid in breast feeding

A

Bromocriptine (dopamine receptor agonist) suppresses lactation
COC not recommended in breast feeding because oestrogens have adverse effects on lactation – POP preferred.
Metronidazole - bitter metallic milk taste.
Aspirin - Avoid - Reye’s syndrome.
Lithium - Avoid - toxicity in infant.

305
Q

Tetracycline contraindicated in

306
Q

Quinolones contraindicated in

A

joint disorders in children - avoid

307
Q

Aspirin contraindicated in

308
Q

NSAID contraindicated in

A

history of sensitivity to aspirin

309
Q

Salicylate salt products (Bonjela, Bonjela cool) contraindicated in

310
Q

Normal Blood pressure

311
Q

Non-diabetic high blood pressure

312
Q

Diabetic high blood pressure

313
Q

Normal pulse

A

60 - 80 (up to 100 beats/min)

314
Q

INR is what and what is the target

A

International Normalised Ratio
2 - 3.5 in DVT/AF etc
Too high INR - reduce warfarin dose - bleeding risk
Too low INR - increase warfarin dose - coagulation risk

315
Q

Normal Blood glucose range

A

4 - 7 mmol/Litre before meal, 7 fasting is high

316
Q

Cholesterol targets

A

Total: 1.0mmol/L

317
Q

Alcohol units

A

A large Glass of wine (250ml) = 3 units
A standard Glass of wine (175ml) = 2 units
A small Glass of wine (100ml) = 1 unit
Half a pint of 3.5% beer, lager, cider = 1 unit
A single shot of 40% spirit (25ml) = 1 unit
A single measure of whiskey = 1 unit
A standard measure Port, Sherry (50ml) = 1 unit

318
Q

BMI levels

A

BMI less than 18.5 – underweight
BMI between 18.5 and 24.9 – normal weight
BMI between 25.0 and 29.9 – overweight
BMI 30.0 or above – obese

319
Q

Sodium levels

A

136 – 146mmol/L

320
Q

Potassium levels

A

3.5 – 5.1mmol/L

321
Q

Calcium levels

A

2.15 – 2.5mmol/L

322
Q

Magnesium levels

A
  1. 7 is hypomagnesia

1. 5 - 2.5mmol/L

323
Q

Urea levels

A

2.5 – 6.4mmol/L

324
Q

Cr Clearance

A

Men: 97 – 140ml/min
Women: 85 – 125ml/min

325
Q

PC means

A

Presenting complaint

326
Q

PMH means

A

Past medical history

327
Q

SH means

A

Social history

328
Q

DHx means

A

Drug history

329
Q

O/E means

A

on examination

330
Q

CVS means

A

BP and pulse

331
Q

R/S

A

Respiratory system

332
Q

GIT

333
Q

Hospital charts contain what information

A

Patient Details
Allergies section
Drugs for ‘once only’ or ‘pre-anaesthetic medication’
MEDICATIONS SECTION
Drug and strength (Date, Route [PO, top, inh, sc, iv, im], Time of day, Dose according to the time of day [x means dose given], Additional instructions [e.g. pc – after food]
‘As required’ medicines e.g. paracetamol
Intravenous and subcutaneous infusions

334
Q

Drugs likely to be abused

A 
Codeine Linctus
Kaolin and Morphine
Gees Linctus
Do-Do Chesteze
Laxatives (Senna, Bisacodyl)
Antihistamines for temporary sleeplessness
Solvents
335
Q

G6PD deficiency can lead to

A

Acute haemolytic anaemia

336
Q

What are the risks of G6PD deficiency

A

Different effects in different people
Manufacturers don’t test this
Risk are dose related
Raw fava beans/broad beans can cause

337
Q

Drugs with definite risk of haemolysis in G6PD deficiency

A 
Dapsone
Methylene blue
Nitrofurantoin
Primaquine
Quinolones
Sulphonamides
338
Q

Drugs with possible risk of haemolysis in most G6PD deficient individuals

A

Aspirin
Chloroquine
Menadione
Quinine

339
Q

Prescriptions charges are exempt for

A

Anyone in Scotland, Northern Ireland, Wales
England: Cancer, cancer side effects, permanent fistual that needs dressing, Addison’s disease (hypoadrenalism), Diabetes, Underactive thyroid, myasthenia gravis, Epilepsy, Continuing disability, Pregnancy (maternity exemption certificate)

340
Q

Stages of renal impairments

A

> 90: Normal, stage 1
60-89: Mild, stage 2
30-59: Moderate, stage 3 (30-44:3B, 45-59:3A)
15-29: Severe - Stage 4

341
Q

What is part ix of the drug tariff

A

List of appliances, dressing, incontinence pads, stoma bags, chemical reagents which can be prescribed on NHS

342
Q

what is part xviiA of the drug tariff

343
Q

what is part xviib/1 of the drug tariff

344
Q

what is part xviib/2 of the dryg tariff

A

nurse/pharmacist/optom independent prescribers

345
Q

Professional fee is

A

charges for services, 90p/Rx

PPA pay professional fee plus price of drug

346
Q

Category A is

A

widely available, easily reimbursed

347
Q

Category C is

A

Reimburse branded if no generic

348
Q

Category M is

A

Readily available, money back is low

349
Q

Category E is

A

extemp prep, charge ingredients

350
Q

Haemoglibin range

A

Males: 13 - 18
Females: 11.5 - 16.5

351
Q

Iron range

A

Male: 65-176

Female 50-170

352
Q

CReactiveProtein levels

353
Q

Normal temperature

354
Q

Normal HbA1c

A

48-59mmol/ml

355
Q

Normal neutrophil range

A

2.5 - 7.5 x10^9

356
Q

Platelets range

357
Q

RBC normal levels

358
Q

Normal lymphocytes range

A

1.3 - 3.5 x10^9

359
Q

Calcium levels

A

2.15 - 2.5

360
Q

Recent POM to P meds

A

Omeprazole 10mg od/bd >18yo
Chloramphenicol drops 1drop every 2 hours->then 4 hours, 5 days >2yo
Chloramphenicol ointment 3 - 4 times a day in fridge 28days
Amirolofine - Once/week. Toe 9-12month, finger 6 month
Azithromycin - chlamydia. >16, 1g dose
Tranexamic acid 2td, 4 days
Tamsulosin for benign prostatic hyperplasia for men 45 - 75. Use 2 weeks if improve another 4 weeks
Sumatriptan 18 - 65. 2/24hrs
Orlistat - >18, >28 BMI. 1td after food Max 180mg

361
Q

Avoid what with Omeprazole

A

Ketoconazole, itraconazole, cilostazol

Monitor Warfarin, Diazepam, Phenytoin

362
Q

Avoid Chloramphenicol if

A

ACGlaucoma, Blood disorder, Bone marrow suppression, Pregnancy, BF

363
Q

Avoid Amirolofine if

364
Q

Avoid Tranexamic acid if

A

Warfarin, pregnancy, contraceptive pill

365
Q

Refer sale of Tamsulosin if

A

Diabetes, Renal imp, Hepatic imp, Postural Ht, Prostate surgery, pain on urination, cloudy/bloody urine, allergy, hypersensitivity, incontinence, leak urine

366
Q

Avoid what with Tamsulosin

A

Antihypertensives

367
Q

Refer Orlistat if

A

Taking acarbose/levothyroxine/amiodorone/anti-epileptics, HT, Hypercholesterol, >6month use, hasn’t worked for 12 weeks

368
Q

Orlistat contraindicated if

A

Pregnant, BF,

369
Q

Patient wants access to PMR

A

Their right under Data Protection act however request made in writing to data controller - shown in 40 days. Can charge

370
Q

Max units of alchohol per day and week for men and women

A

Men: 4units/day, 21units/week
Women: 3units/day, 14units/week

371
Q

What is an accountable officer responsible for

A

CD, staff training CD/driver

Can not authorise self to be witness for destruction

372
Q

What is a superintendent

A

Responsible for training staff and that the pharmacy meets professional and legal requirements

373
Q

COSHH is

A

Control of substances hazardous to health
Law requires exposure is minimised
Find out what hazards are and how to prevent from harming health

374
Q

CHIP is

A

Chemicals (Hazard Information and Packaging for Supply) Regulations
Relates to labelling/packaging of hazardous substances

375
Q

What is the cycle of behavioural change

A

Precontemplation -> contemplation -> Preparation -> Action -> Maintenance -> relapse

376
Q

What is clinical governance

A

An essential service based on good practice and learning from mistakes
A process of accountability, auditing, clinical effectiveness, CPD, patient/public involvement where underperformance is remedied, risks/staff managed
Aim to improve quality of patient care

377
Q

Audit must be

A

done 2/year

One practice based, one primary care (health) based

378
Q

Freshly prepared rules are

A

Made in 24 hours, dispensed within 7 days

379
Q

Recently prepared rules are

A

Not stored more than 4 weeks

Kept at 15-25degrees

380
Q

Give an example of a binder

381
Q

Give an example of a sweetner

382
Q

Give an example of a antimicrobial

A

methylparaben/benzyl alchohol

383
Q

Give an example of a diluent

384
Q

Give an example of a gelling agent

385
Q

What is an essential service

A

Nationally agreed

386
Q

What is an advanced service

A

Nationally agreed

387
Q

What is a Enhanced service

A

Locally agreed

388
Q

What types of alcohol are there

A

Completely denatured alcohol, Industrially denatured alcohol, Trade specific denatured alcohol (pharmacists don’t deal with this)

389
Q

What is a quality assurance cycle

A 
Internal audit (employer trying to improve),
external audit (inspector microbial control),
exception report (Produce microbial count over years), MHRA inspection (QA, water cycle and clothing check)
390
Q

What is an audit

A

Process of quality improvement which seeks to improve patient care and outcomes and performances are reviewed to highlight what is being done and should be done
Principle based on adhering to policy and procedures which are in place
Come under clinical governance

391
Q

What is an appraisal

A

Formal assessment of employees over time

Under clinical governance

392
Q

An observational study is

A

when you observe effect factor with no influence over what happens

393
Q

An experimental study is

A

When you introduce an intervention

394
Q

What kind of observational study are there

A
  1. Cohort

2. Case control study

395
Q

What kind of experimental study are there

A
  1. Randomised control trial

2. Controlled clinical trial

396
Q

What is a cohort study

A

Observe what happens to a group of people with Vs without variable

397
Q

What is a case control study

A

Within similar groups:
Identify people with problem
Identify people without problem

Can the differences be due to something else?

398
Q

What is a RCT

A

Random one group with intervention
Random one group without intervention/placebo

Most reliable. Time consuming and expensive

399
Q

What is a Controlled Clinical trial

A

Choose one group with intervention
Choose one group without intervention/placebo

Possibility of bias

400
Q

What is a systematic review

A

Identify, appraise, select, synthesise ALL high quality studies relevant to the question

401
Q

What is a single blind experiment

A

Participant doesn’t know if treatment or placebo.

Testers know

402
Q

What is a double blind experiment

A

Participant and testers don’t know if treatment or placebo.

403
Q

What is a meta-analysis

A

Combines different studies.

2nd most reliable

404
Q

What is parallel groups study

A

Each group has treatment. A and B get drug X

405
Q

What is a cross over study

A

Each group get several treatments

406
Q

What is a longitudinal study

A

Study subject over a long time - follow up after 2 years

407
Q

What is a cross sectional study

A

Study but no follow up

408
Q

What is the Cochrane website

A

Register of all control trials and data based clinical trials

409
Q

What is PubMed

A

search engine giving access to medicines database of references

410
Q

What is NHS evidence

A

Government funded resource info based on best practice guide

411
Q

What is NICE

A

The National Institute for Health and Care Excellence

Recommends appropriate treatment and care for people with specific disease/condition based on best available evidence

412
Q

What is the BNF

A

British National Formulary

List of all medicines based of efficacy, safety and cost effectiveness of drugs

413
Q

A GPhC inspector can

A
  1. Issue improvement warning
  2. Impose conditions
  3. Close pharmacy - if patient safety concern
414
Q

Amitriptyline used for

A

Depression, Neuropathic pain UNLICENSED 75mg at night

415
Q

Amitriptyline contraindicated in

416
Q

Which Beta-blockers are used in asthma

A

Cardioselective: Bisoprolol, ATenolol, Metoprolol, Acebutalol, Nebivolol.

417
Q

Which Beta-blockers give no nightmares

A

Celiprolol, Atenolol, Nadaolol, Sotalol

418
Q

Side effect of Ferrous sulphate and what to do

A

Black stools

Constipation - change to ferrous gluconate

419
Q

Watch out for what with Glucosamine

A

Interation with Warfarin

Coating is from shell fish - allergy

420
Q

Avoid Atorvastatin in

A

preg/BF/liver disease/alcohol

421
Q

Atorvastatin side effects

A

Muscle pain/weakness, headache, GI

422
Q

Simvastatin side effects

A

Muscle pain/weakness, jaundice, liver disease

423
Q

Indications of Metformin

A

Diabetes, Polycystic Ovary Syndrome

424
Q

Lansoprazole side effects

A

nausea, vomiting, constipation, headache

425
Q

tell me about Senna

A

Can’t get on NHS
In excess - diarrhoea, low electrolytes, dehydrated, abdocramp
Contraindicated in intestinal blockage/obstruction

426
Q

What is vitamin D2

A

Ergocalciferol

427
Q

What is Vitamin D3

A

Colecalciferol - Desunin, Fultium D3

428
Q

Calcium + Vit D3 exists as

A

Adcal, Calceos, Calcichew, Calcipros

429
Q

How does vitamin D work

A

Activated in kidneys therefore renal impairment check (Creatinine, Urea, Calcium if nausea and vomiting)
Also lower diet sodium, protein and increase water

430
Q

What counselling with Fucibet

A

Steroid. Once weekly. Sparingly - skin thinning.

431
Q

Panoxyl (2.5/5%) side effects and warning

A

bleach clothing, red skin (stop), if other side effects switch lower
Avoid exposure to sunlight

432
Q

If Oxytetracycline and Iron

A

Leave 2 hour gap

Oxy - 2 hr - iron

433
Q

Which statins at any time

A

Atorvastatin, Rosuvastatin

434
Q

Which statins at night

A

Pravastatin, Simvastatin, Fluvastatin

435
Q

Levothyroxine dosage

A

50-100mg in morning 30 mins before breakfast/caffeine increase by 25 - 50

436
Q

Side effecs of levothyroxine

A

excess dosing makes hyperthyroidism: Dairrhoea, vomiting, flushing, sweating, palpitation, hands tremor
Also when Carbimazole underdosed

437
Q

Dose of Carbimazole

A

15-40mg initially. 5-15mg maintanance

438
Q

Side effects of Carbimazole

A

excess dosing makes hypothyroidismCold, tired, weight gain, constipation
Also when levothyroxine underdosed

439
Q

Carbimazole and Propylthiouracil not given if

A

Bone Marrow Suppression

440
Q

Propylthiouracil monitor

A

hepatotoxicity

441
Q

Hyperthyroidism in pregnancy

A

Propylthiouracil first then Carbimazole second line

BF both ok - monitor

442
Q

Osteoporosis treatment

A

Aledronic acid -> Raloxifen -> Strontium/teriparatide

443
Q

Disodium Etidronate counselling

A

No food before/after 2 hours, especially calcium

444
Q

Strontium CSM warning

A

Drug rash with eosinophillia and systemic symptoms (DRESS)
Starts with rash, fever, swollen glands, increased WBC. Effects liver, kidneys and lungs
Report any skin rash
Don’t restart

445
Q

Bisphosphonates monitoring

A

correct calcium levels before giving

446
Q

Bisphosphonates counselling

A

increase vitamin D/calcium, avoid alcohol, do weight burning exercise and keep a healthy diet, stop smoking

447
Q

Avoid fish in

A

Hypothyroidism (iodine)

448
Q

Colchine side effects

A

Diarrhoea, Vomiting ->STOP

Muscle weakness

449
Q

Counselling with Colchine

A

Increase intake of purine (fish etc)
increase liver, greens, leafy vegetables, peas
Because of low uric acid

450
Q

Glaucoma treatment

A

Timolol, Latanoprost, Bimatoprost, Travopost, Brimodine, Acetazalomide/Brinzolamide

451
Q

BB (for eye) time dosage, contraindications and side effects

A

Morning + Evening
Contra: Asthma (exception), tachycardia, HF
side effects: Burning, itching, stinging sensation

452
Q

Name some Prostaglandins

A

Latanoprost, Bimatoprost, Travapost

Use them at night

453
Q

Side effect of Prostaglandins

A

Brown pigmentation, Eye colour change, lengthening of eye lash, pain, pinkage

454
Q

Which sympathomimetics used for Glaucoma

A

Brimonidine bd

455
Q

Miotics used in Glaucoma, dose, side effects and contraindications

A

Pilocarpine - up to qd
side effects: Blurred vision, driving at night problematic, pupil small
Avoid in asthmatics, hypertension, CVD

456
Q

Carbonic Anhydrases used in Glaucoma, dose, side effects and contraindications, monitoring

A

Acetazalomide/Brinzolamide. 2-3 times a day.
Contraindicated in hepatic/renal impairment
Side effects: Blood disorder, rash, electrolyte disturbance, acidosis
Monitor blood count

457
Q

Elderly and Glaucoma consideration

A

Combination product

458
Q

If more than one drop medication to take

A

leave 10 mins in between each

459
Q

Dry eyes treatment

A 
Hypromellose (contact prescriber if no dose)
Carbomers,
Simple eye ointment (parafin)
Saline drops,
sodium hyaluronate,
Carmellose,
Acetylcysteine

All four times a day
NO contact lenses
Diet - omega3 fish

460
Q

What to monitor when treating dry eyes

A

Corneal deposits, scarring, infection

Photophobia, red, pain = refer

461
Q

Epilepsy and pregnancy dose adjustment

A

Levetiracitam, Pregabalin, valproate(increase dose), lamotrigine (increase dose)
Take at different times

462
Q

Topiramate side effects

A

Spotting between periods

Myopia

463
Q

Lithium Carbonate side effects

A

Tired, thyroid problems, memory impairment, sodium depletion

464
Q

Olanzapine side effects

A

Fatigue, weight gain, sleepy, hyperglycaemia, diabetes
Avoid alcohol
Antimuscarinic side effects ->procyclidine

465
Q

Pizotifen side effects

A

Dry mouth, drowsy, dizzy, Nausea, increased apetite, weight gain

466
Q

Mirtazapine side effects

A

sedation, antimuscarinic, blood disorders (sore throat)

Not

467
Q

Withdrawal of Mirtazapine

A

Gradual or else: Dizzy, headache, hirsutism, anxiety, agitation

468
Q

Trigeminal Neuralgia treatment

A

Carbamazapine, Phenytoin (IV as fosphenytoin) - small doses initially to reduce s.e. eg dizziness
Monitor blood counts and electrolytes

469
Q

Neuropathic pain treated with

A

Amitriptyline (dry mouth so give hard boil sweet/pineapple/ice/SF chewing gum)
Pregabalin 150mg om and 450mg at night (sleepy, drowsy side effect)

470
Q

Morphine side effects

A

Nausea, Vomiting, Hypotension, respiratory depression (even with patch), bradycardia, tachycardia, palpitation, postural HT, Drowsy
long term: Adrenal gland suppression, lower libido, erectile dysfunction, hypogonadism

471
Q

No nebulisation in

A

paradoxical bronchospasm

472
Q

Side effects and contraindications of Mucolytics

A

Rash, GI bleed

NOT in crohns/UC/ulcer

473
Q

Antimuscarinics in COPD dose, side effects

A

(spiriva) 1 times a day or (ipatropium) 3-4 times a day

side effects: high blood pressure, glaucoma, urinary retension

474
Q

Isosorbide mononitrate risk and how to deal with it

A

Tolerance so space out which lowers side effects like headache
8 hour gap between 1st and 2nd dose

475
Q

Simvastatin reduced to max 20mg with

A

Diltiazem, Amiodorone, Amlodopine, Verapamil

476
Q

Simvastatin reduced to max 10mg with

A

Bezafibrate, Ciprofibrate

477
Q

Side effects of Digoxin

A

fatigue, muscle pain, irregular heart beat

478
Q

Cod liver oil interacts with

479
Q

What can effect INR

480
Q

Why low salt diet in heart failure

A

HF =accumulation of fluid =weight gain

add on Pravastatin

481
Q

Thiazide side effects

A

Hypokalaemia, postural HT, Diabetes control lost, Gout

482
Q

Monitoring with Thiazides

A

Electrolytes, renal, BP

483
Q

Side effects of BB

A

Bronchospasm, Bradycardia, Blood glucose

484
Q

Monitoring with BB

A

HR, Creatinine urea, BP, electrolytes

485
Q

ACEI monitorying

A

electrolytes, renal function (6 months)

486
Q

Side effects of ACEI

A

Persistent dry cough, postural HT, renal impairment (especially with NSAIDs)
1st dose at night

487
Q

Side effects of ACE2

A

Postural HT, Dizzy, Hyperkalaemia, angiodema

488
Q

ACE2 monitoring

A

electrolytes, renal function, BP and serum potassium

489
Q

CaCb side effects

A

Flushing, ankle swelling, headache, can exacerbate angina

Bradycardia, HT with Verapamil/Diltiazem

490
Q

Monitoring with CaCB

491
Q

Contraindication with CaCB

A

Grapefruit juice

492
Q

Alpha blockers side effects

A

Hypotension, dizzy, faint, oedema, postural HT

493
Q

Alpha blockers monitoring

494
Q

Which drugs effect the gut

A

Aluminium, Antimuscarinics, Antidepressants, Carbamazapine, Gabapentin, Phenytoin, Sedative antihistamines, Opioid, diuretics, Calcium, Iron

495
Q

A ciliac is a person

A

intolerant of wheat, rye, barley hence GF only

496
Q

What is diverticulitis

A

Mucosal balooning in colon

497
Q

What is Zollinger Ellison and how is it treated

A

Hypersecretion of acid therefore hyperacidity/peptic ulcer

PPI>H2

498
Q

What can cause a stomach ulcer

A

NSAIDs, Nifedipine, depression, stress

499
Q

Side effect of PPI

A

GI disturbance, headache, dizzy

500
Q

Side effect of H2

A

GI disturbance, headache, dizzy, rash, tiredness

501
Q

Side effect of bismuth containing Antacid

A

Black stools

502
Q

Dyspepsia caused by

503
Q

Side effects of Aminosalicylates

A

Nausea, vomiting, diarrhoea, SJS, pancreatitis, blood disorders, purpura, rare myalgia, alopecia, headache, joint pain

504
Q

Monitor Aminosalicylates

A

Blood count, renal, sore throat, bleeding, malaise, bruising

505
Q

Side effects of Steroids

A

Weight gain, Diabetes, Sleep, Fluid retension, Glaucoma, Osteoporosis, Cataracts

506
Q

Azathiprine side effects

A

vomit, diarrhoea, rash, fever

507
Q

Azathioprine monitoring

A

Blood count, renal, sore throat, bleeding, malaise, bruising, liver

508
Q

Side effects of ciclosporin

A

Hyperkalaemia, HT, Gingival hyperplasia

509
Q

Monitoring with ciclosporin

A

Kidney, liver, HT, potassium, magnesium

510
Q

Side effects infliximumab

A

Nausea, vomiting, abdo pain, dyspepsia

511
Q

Monitoring with infliximumab

A

Hepatic/renal monitoring, TB(=cough, fever, weight loss)

512
Q

Diet in Ulcerative Colitis

A

Avoid fats, cheese, milk, smoking

Try fish oils

Pharmacy Pre-Registration (5 decks)

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