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Core Drug Lists > Year 4 Core Drugs > Flashcards

Year 4 Core Drugs Flashcards

1
Q

Benzoyl peroxide

Indications and dose?

A

Acne vulgaris
To the skin
1-2 times a day

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2
Q

Side effects of benzoyl peroxide

A

Skin reactions and facial swelling

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3
Q

Ciclosporin - drug action

A

Ciclosporin inhibits production and release of lymphokines, thereby suppressing cell-mediated immune response.

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4
Q

Indications for ciclosporin

A

Severe acute ulcerative colitis refractory to corticosteroid treatment
Severe active rheumatoid arthritis (administered on expert advice)
Short-term treatment of severe atopic dermatitis where conventional therapy ineffective or inappropriate (administered on expert advice)
Severe psoriasis where conventional therapy ineffective or inappropriate (administered on expert advice)
Organ transplant/ bone marrow transplant
Nephrotic syndrome

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5
Q

Contra-indications For ciclosporin - when used by eye

A

Active or suspected ocular or peri-ocular infection; ocular or peri-ocular malignancies or premalignant conditions

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6
Q

Contraindications of ciclosporin - With systemic use

A

Malignancy (in non-transplant indications); uncontrolled hypertension (in non-transplant indications); uncontrolled infections (in non-transplant indications)

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7
Q

Cautions of ciclosporin - systemic use

A

Elderly—monitor renal function; hyperuricaemia; in atopic dermatitis, active herpes simplex infections—allow infection to clear before starting (if they occur during treatment withdraw if severe); in atopic dermatitis, Staphylococcus aureus skin infections—not absolute contra-indication providing controlled (but avoid erythromycin unless no other alternative); in psoriasis treat, patients with malignant or pre-malignant conditions of skin only after appropriate treatment (and if no other option); in uveitis, Behcet’s syndrome (monitor neurological status); lymphoproliferative disorders (discontinue treatment); malignancy

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8
Q

Cautions of ciclosporin - eye use

A

Glaucoma—limited information available; history of ocular herpes—no information available

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9
Q

For ciclosporin
General side-effects:
Common or very common

A

Eye inflammation

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10
Q

For ciclosporin
Specific eye side-effects:
Common or very common

A

Eye discomfort; eye disorders; vision blurred

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11
Q

For ciclosporin
Specific oral side-effects:
Common or very common

A

Appetite decreased; diarrhoea; electrolyte imbalance; fatigue; fever; flushing; gastrointestinal discomfort; gingival hyperplasia; hair changes; headaches; hepatic disorders; hyperglycaemia; hyperlipidaemia; hypertension; hyperuricaemia; leucopenia; muscle complaints; nausea; paraesthesia; peptic ulcer; renal impairment (renal structural changes on long-term administration); seizure; skin reactions; tremor; vomiting

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12
Q

For ciclosporin
Specific parenteral use side-effects:
Common or very common

A

Appetite decreased; diarrhoea; electrolyte imbalance; fatigue; fever; flushing; gastrointestinal discomfort; gingival hyperplasia; hair changes; headaches; hepatic disorders; hyperglycaemia; hyperlipidaemia; hypertension; hyperuricaemia; leucopenia; muscle complaints; nausea; paraesthesia; peptic ulcer; renal impairment (renal structural changes on long-term administration); seizure; skin reactions; tremor; vomiting

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13
Q

Uncommon ciclosporin side effects

A

Anaemia; encephalopathy; oedema; thrombocytopenia; weight increased

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14
Q

Rare/very rare ciclosporin side effects

A

Gynaecomastia; haemolytic anaemia; idiopathic intracranial hypertension; menstrual disorder; multifocal motor neuropathy; muscle weakness; myopathy; pancreatitis

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15
Q

Pregnancy For ciclosporin

With systemic use:

A

Crosses placenta; manufacturer advises avoid unless potential benefit outweighs risk—toxicity in animal studies.

By eye - Manufacturer advises avoid unless potential benefit outweighs risk—no information available.

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16
Q

Ciclosporin and breast feeding

A

Avoid - present in milk

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17
Q

Therapeutic drug monitoring of ciclosporin

A

Monitor whole blood ciclosporin concentration (trough level dependent on indication—consult local treatment protocol for details).

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18
Q

Monitoring of patient parameters For ciclosporin

With systemic use

A

Dermatological and physical examination, including blood pressure and renal function measurements required at least twice before starting treatment for psoriasis or atopic dermatitis.

Monitor liver function.

Monitor serum potassium, especially in renal dysfunction (risk of hyperkalaemia).

Monitor serum magnesium.

Measure blood lipids before treatment and after the first month of treatment.

In psoriasis and atopic dermatitis monitor serum creatinine every 2 weeks for first 3 months then every month.

Investigate lymphadenopathy that persists despite improvement in atopic dermatitis.

Monitor kidney function—dose dependent increase in serum creatinine and urea during first few weeks may necessitate dose reduction in transplant patients (exclude rejection if kidney transplant) or discontinuation in non-transplant patients.

Monitor blood pressure—discontinue if hypertension develops that cannot be controlled by antihypertensives.

In long-term management of nephrotic syndrome, perform renal biopsies at yearly intervals.

In rheumatoid arthritis measure serum creatinine at least twice before treatment. During treatment, monitor serum creatinine every 2 weeks for first 3 months, then every month for a further 3 months, then every 4–8 weeks depending on the stability of the disease, concomitant medication, and concomitant diseases (or more frequently if dose increased or concomitant NSAIDs introduced or increased).

Monitor hepatic function if concomitant NSAIDs given.

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19
Q

Ciclosporin - with oral use:

Direction for administration

A

Manufacturer advises mix solution with orange or apple juice, or other soft drink (to improve taste) immediately before taking (and rinse with more to ensure total dose). Do not mix with grapefruit juice.

Total daily dose should be taken in 2 divided doses.

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20
Q

Ciclosporin eye drops - directions for administration

A

Manufacturer advises keep eyes closed for 2 minutes after using eye drops to increase local drug action and reduce systemic absorption.

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21
Q

Ciclosporin - drug counselling

A

Patients and carers should be counselled on the administration of different formulations of ciclosporin.

Manufacturer advises avoid excessive exposure to UV light, including sunlight. In psoriasis and atopic dermatitis, avoid use of UVB or PUVA.

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22
Q

Folic acid - indications

A

Folate-deficient megaloblastic anaemia

Prophylaxis of folate deficiency in patients receiving parenteral nutrition/dialysis

Prevention of neural tube defects - low risk (400micrograms daily - until week 12 of pregnancy)

Prevention of neural tube defects (in those in the high-risk group - 5mg daily)

In those with sickle cell disease, 5mg daily throughout pregnancy

Prevention of methotrexate-induced side-effects in rheumatic disease/ Crohn’s/ severe psoriasis

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23
Q

Cautions of folic acid

A

Should never be given alone for pernicious anaemia or other megaloblastic anaemias caused by vitamin B12 deficiency (may precipitate subacute combined degeneration of the spinal cord)

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24
Q

Folic acid side effects

A

Abdominal distension; appetite decreased; flatulence; nausea; vitamin B12 deficiency exacerbated

25
Q

Methotrexate - indications + dose

A

Severe Crohn’s disease

Maintenance of remission of severe Crohn’s disease

Moderate + Severe active rheumatoid arthritis

Neoplastic diseases

Severe psoriasis - specialist use only

26
Q

Important safety info - methotrexate

A

Patients given methotrexate, by any route, for non-cancer treatment should not be given more than their intended weekly dose.

Weekly dosing!

27
Q

Weekly Dosing of methotrexate

A

To avoid error with low dose methotrexate, it is recommended that:

the patient or their carer is carefully advised of the dose and frequency and the reason for taking methotrexate and any other prescribed medication (e.g. folic acid);
only one strength of methotrexate tablet (usually 2.5 mg) is prescribed and dispensed;
the prescription and the dispensing label clearly show the dose and frequency of methotrexate administration;
the patient or their carer is warned to report immediately the onset of any feature of blood disorders (e.g. sore throat, bruising, and mouth ulcers), liver toxicity (e.g. nausea, vomiting, abdominal discomfort, and dark urine), and respiratory effects (e.g. shortness of breath).

28
Q

MHRA/CHM advice: Methotrexate once-weekly for autoimmune diseases: new measures to reduce risk of fatal overdose due to inadvertent daily instead of weekly dosing (September 2020)

A

Methotrexate should be taken once a week in autoimmune conditions and, less commonly, in some cancer therapy regimens. A European review highlighted continued reports of inadvertent overdose due to more frequent dosing (including daily administration), which has resulted in some fatalities. Subsequently, new measures have been implemented by the MHRA.

29
Q

Contra-indications for methotrexate

A

Active infection; ascites; immunodeficiency syndromes; significant pleural effusion

30
Q

Cautions - methotrexate

A

Photosensitivity—psoriasis lesions aggravated by UV radiation (skin ulceration reported); dehydration (increased risk of toxicity); diarrhoea; extreme caution in blood disorders (avoid if severe); peptic ulceration (avoid in active disease); risk of accumulation in pleural effusion or ascites—drain before treatment; ulcerative colitis; ulcerative stomatitis

31
Q

Blood count - caution in methotrexate use

A

Bone marrow suppression can occur abruptly; factors likely to increase toxicity include advanced age, renal impairment, and concomitant use with another anti-folate drug (e.g. trimethoprim). Manufacturer advises a clinically significant drop in white cell count or platelet count calls for immediate withdrawal of methotrexate and introduction of supportive therapy.

32
Q

Methotrexate + stomatitis/diarrhoea

A

Manufacturer advises withdraw treatment if stomatitis or diarrhoea develops—may be first sign of gastro-intestinal toxicity.

33
Q

Liver toxicity + methotrexate

A

Liver cirrhosis reported. Manufacturer advises treatment should not be started or should be discontinued if any abnormality of liver function or liver biopsy is present or develops during therapy. Abnormalities can return to normal within 2 weeks after which treatment may be recommenced if judged appropriate. Persistent increases in liver transaminases may necessitate dose reduction or discontinuation.

34
Q

Pulmonary toxicity + methotrexate

A

Pulmonary toxicity may be a special problem in rheumatoid arthritis. Manufacturer advises patients to seek medical attention if dyspnoea, cough or fever develops; monitor for symptoms at each visit—discontinue if pneumonitis suspected.

35
Q

Side-effects For methotrexate
Common or very common

With intrathecal use

A

Necrotising demyelinating leukoencephalopathy; neurotoxicity

36
Q

Side-effects For methotrexate
Common or very common
Oral use

A

Anaemia; appetite decreased; diarrhoea; drowsiness; fatigue; gastrointestinal discomfort; headache; increased risk of infection; leucopenia; nausea; oral disorders; respiratory disorders; skin reactions; throat ulcer; thrombocytopenia; vomiting

37
Q

Side-effects For methotrexate
Common or very common
Parenteral use

A

Anaemia; appetite decreased; chest pain; cough; diarrhoea; drowsiness; dyspnoea; fatigue; fever; gastrointestinal discomfort; headache; leucopenia; malaise; nausea; oral disorders; respiratory disorders; skin reactions; throat complaints; thrombocytopenia; vomiting

38
Q

Uncommon methotrexate side effects

A

Agranulocytosis; alopecia; arthralgia; bone marrow disorders; chills; confusion; cystitis; depression; diabetes mellitus; dysuria; fever; gastrointestinal disorders; haemorrhage; healing impaired; hepatic disorders; myalgia; neoplasms; nephropathy; osteoporosis; photosensitivity reaction; rheumatoid arthritis aggravated; seizure; severe cutaneous adverse reactions (SCARs); vasculitis; vertigo; vulvovaginal disorders

39
Q

Why is folic acid given with methotrexate?

A

Give folic acid to reduce side-effects. Folic acid decreases mucosal and gastrointestinal side-effects of methotrexate and may prevent hepatotoxicity; there is no evidence of a reduction in haematological side-effects.

40
Q

Treatment with … … may be required in acute toxicity (methotrexate)

A

Treatment with folinic acid (as calcium folinate) may be required in acute toxicity.

41
Q

Methotrexate + contraception

A

Manufacturer advises effective contraception during and for at least 6 months after treatment in men and women.

42
Q

Pregnancy + methotrexate

A

Avoid (teratogenic; fertility may be reduced during therapy but this may be reversible).

43
Q

Methotrexate + breast feeding

A

Discontinue breast-feeding—present in milk.

44
Q

Pre-treatment screening - methotrexate

A

Exclude pregnancy before treatment.

Patients should have full blood count and renal and liver function tests before starting treatment.

45
Q

Monitoring of patient parameters
In view of reports of blood dyscrasias (including fatalities) and liver cirrhosis with low-dose methotrexate patients should:

A

have full blood count and renal and liver function tests repeated every 1–2 weeks until therapy stabilised, thereafter patients should be monitored every 2–3 months.
be advised to report all symptoms and signs suggestive of infection, especially sore throat
Local protocols for frequency of monitoring may vary.

Treatment with folinic acid (as calcium folinate) may be required in acute toxicity.

46
Q

Patient + carer advise - methotrexate

A

Patients and their carers should be warned to report immediately the onset of any feature of blood disorders (e.g. sore throat, bruising, and mouth ulcers), liver toxicity (e.g. nausea, vomiting, abdominal discomfort and dark urine), and respiratory effects (e.g. shortness of breath).

Patients should be advised to avoid self-medication with over-the-counter aspirin or ibuprofen.

Patients should be counselled on the dose, treatment booklet, and the use of NSAID

47
Q

A… should be provided to patients on once-weekly dosing

A

A patient alert card should be provided to patients on once-weekly dosing

48
Q

Acetazolamide indications

A

Reduction of intra-ocular pressure in open-angle glaucoma,
Reduction of intra-ocular pressure in secondary glaucoma,
Reduction of intra-ocular pressure perioperatively in angle-closure glaucoma
Glaucoma
Epilepsy

49
Q

Contra-indications of Acetazolamide

A

Adrenocortical insufficiency; hyperchloraemic acidosis; hypokalaemia; hyponatraemia; long-term administration in chronic angle-closure glaucoma

50
Q

Cautions - Acetazolamide

A

Avoid extravasation at injection site (risk of necrosis); diabetes mellitus; elderly; impaired alveolar ventilation (risk of acidosis); long-term use; pulmonary obstruction (risk of acidosis); renal calculi

51
Q

General side-effects of acetazolamide

Common or very common

A

Haemorrhage; metabolic acidosis; nephrolithiasis; sensation abnormal

52
Q

General side-effects of acetazolamide - less common/rare

A

Uncommon

Bone marrow disorders; depression; dizziness; electrolyte imbalance; hearing impairment; hepatic disorders; leucopenia; nausea; renal colic; renal impairment; renal lesions; severe cutaneous adverse reactions (SCARs); skin reactions; thrombocytopenia; tinnitus; urinary tract discomfort; urine abnormalities; vomiting

Rare or very rare

Anaphylactic reaction; appetite disorder; confusion; diarrhoea; fatigue; fever; flushing; headache; irritability; libido decreased; paralysis; photosensitivity reaction; seizure

Frequency not known

Agranulocytosis; drowsiness; myopia; polyuria; suicidal behaviours; taste altered; thirst

53
Q

Specific side effects of acetazolamide - uncommmon/rare

A

Osteomalacia - uncommon

Rare - Ataxia; hyperglycaemia; hypoglycaemia; renal tubular necrosis

54
Q

Acetazolamide is a sulfonamide derivative; blood disorders, rashes, and other sulfonamide-related side-effects occur occasionally—patients should be told to report any unusual …

A

Acetazolamide is a sulfonamide derivative; blood disorders, rashes, and other sulfonamide-related side-effects occur occasionally—patients should be told to report any unusual skin rash.

55
Q

If electrolyte disturbances and metabolic acidosis occur with acetazolamide, these can be corrected by administering ….

A

If electrolyte disturbances and metabolic acidosis occur, these can be corrected by administering bicarbonate.

56
Q

Allergy and cross-sensitivity For acetazolamide

Contraindicated if history of…

A

Allergy and cross-sensitivity
Allergy and cross-sensitivity For acetazolamide
Contraindicated if history of sulfonamide hypersensitivity.

57
Q

Pregnancy and Acetazolamide

A

Manufacturer advises avoid, especially in first trimester (toxicity in animal studies).

58
Q

Renal impairment - Acetazolamide

A

Avoid—risk of metabolic acidosis.

59
Q

Monitoring of patient parameters with acetazolamide

A

Monitor blood count and plasma electrolyte concentrations with prolonged use.

Core Drug Lists (12 decks)

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