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ΩΩ 4 Bateman - PSA + Pharmacology > 4 Prescribing In Special Circumstances > Flashcards

4 Prescribing In Special Circumstances Flashcards

(52 cards)

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1
Q

WHAT IS THE EVIDENCE FOR LIVER DYSFUNCTION?

A
  1. Spider Naevi
  2. Clubbing
  3. Jaundice
  4. Loss of secondary sexual hair
  5. Gynaecomastia
  6. Ascites
  7. Splenomegaly
  8. Peripheral Oedema
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2
Q

What is the Child Pugh score?

A

Marker for liver cirrhosis severity

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3
Q

Which of these medicationsis toxic to the liver and what do they cause?

Digoxin

Aspirin

Paracetamol

Echinacea

Flucloxacillin

A

Digoxin - Not toxic continue treatment

Aspirin - Toxic but essential treatment

Paracetamol - Toxic but only acutely

Echinacea - Unlikely to cause liver injury, discontinue

Flucloxacillin - Likely causing cholestatic jaundice, Discontinue

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4
Q

Which drugs can cause cholestatic hepatitis?

A
  1. Co-amoxiclav
  2. Flucloxacillin
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5
Q

Which drugs cause cirrohsis and fibrosis of the liver?

A
  1. Methotrexate
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6
Q

Which drug can cause steato hepatitis?

A

Amiodarone

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7
Q

Which drugs cause ideosynchratic hepatitis?

A
  1. NSAIDs
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8
Q

What is the dose of paracetamol needed to cause liver damage?

A

150 mg/kg in less than one hour

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9
Q

What molecule stop paracetamol cuasing toxicity to the liver?

A

Gluthathione

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10
Q

What is the antidote to paracetamol poisoning?

A

N-acetylcystiene

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11
Q

How do you decide if a patient needs treatment for paracetamol poisoning?

A
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12
Q

When is okay not to treat a patinet with a paracetamol overdose?

A
  1. The plasma-concentration is undetectable
  2. The patinet is asymptomatic
  3. LFTs, serum creatinine and INR are all normal
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13
Q

What are the two different phases of metabolsim?

A
  1. Phase 1
    Cytochrome P450 - oxidation
  2. Phase 2
    Conjugation
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14
Q

Which drugs are advised to have a dose reduction if in hepatic impairment?

A
  1. Fluoxetine
  2. Nifedipine
  3. Phenytoin
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15
Q

What can a patient develop if they are liver cirrhosis?

What can this do?

A
  1. Portosystemic shunts
  2. Can increase the bioavailability of drugs
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16
Q

What are some examples of CYP450 inducers?

A
  1. Carbemazepines
  2. Rifampicin
  3. Alcohol
  4. Phenytoin
  5. Griseofulvin
  6. Phenobarbitone
  7. Sulphonylureas
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17
Q

What are examples of CYP450 inhibitors?

A
  1. Sodium valproate
  2. Isoniazid
  3. Cimetidine
  4. Ketoconazole
  5. Fluconazole
  6. Alcohol & Grapefruit juice
  7. Chloramphenicol
  8. Erythromycin
  9. Sulfonamides
  10. Ciprofloxacin
  11. Omeprazole
  12. Metronidazole
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18
Q

What drugs are used with caution in encephalopathy?

A
  1. Cause sedation (e.g. benzodiazepines)
  2. Cause agitation (e.g. antipsychotics)
  3. Cause constipation (e.g. opioid analgesics)
  4. Cause electrolyte disturbances (e.g. diuretics)
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19
Q

What durgs are used with caution with clotting abnormalities?

A
  1. Cuase thrombocytopenia (e.g. sodium valporate)
  2. Increase the risk of bleeding (e.g. anticoagulants, antiplatelets)
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20
Q

What drugs are used with caution in ascites and varices?

A
  1. NSAIDs
  2. Anticoagulants
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21
Q

AS YOU GET OLDER WHAT HAPPENS TO THE CONCENTRATION OF WATER AND FAT IN THE BODY?

Study These Flashcards
A
  1. Decrease in body weight
  2. Decrease in amount of water in the body
  3. Increase in amount of fat in the body
22
Q

As you get older how does this effects the distribution of drugs?

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A
  1. Absorption of lipid soluble drugs will increase
  2. Absorption of water soluble drugs will decrease
23
Q

What happens to CYP450 enzymes and blood flow to the liver as you get older?

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A
  1. Reduction in the enzymes
  2. Reduction in blood flow
24
Q

Does a Digoxin dose need to be increased or decreased as you get older?

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A
  1. Digoxin needs to be decreased
25
What are some receptor and cellular changes in elderly?
26
What are the medicaitons that can ause hypotension in the elderly?
1. Alpha blockers 2. Antihypertensives 3. Antidepressants 4. Beta-blockers 5. Diuretics 6. Hypnotics 7. Nitrates
27
What the measurement for postural drop?
\>20 mmHg
28
What are some examples of drugs that can cause hypothermia in the elderly?
1. **Cause sedation** Benzodiazepines Tricyclic antidepressants (TCAs) Opioid analgesics 2. **Impair awareness of temperature** Chlorpromazine 3. **Decreae mobility** Antipsychotics Antiparkinsonian drugs Hypnotic 4. **Cause vasodilation** Vasodilator antihypertensives (e.g. amlodipine)
29
Which drug is common for causing peripheral oedema?
Calcium channel blocker
30
What are some examples of drugs that could increase dizziness in the elderly?
1. **Postural hypotension drugs** Amlodopine + Ramipril 2. **Confusion and falls drugs** Diazepam
31
Which drugs can cause altered cognition in the elderly?
1. Anticholinergics 2. Antihistamines 3. Beta-blockers 4. Hypnotics 5. Opioid analgesics 6. Tricyclic antidepressants
32
Which class of drugs have a high risk of causing repiratory depression in the elderly?
Benzodiazepines
33
What are the common adverse drug reactions in antimuscarinics?
1. Memory loss 2. Urinary retention 3. Constipation 4. Exacerbation of glaucoma
34
What are the common adverse drug reactions for hyponotics/anxiolytics?
1. Falls 2. Confusion 3. Postural hypotension
35
What are the common adverse drug reactions for NSAIDs?
1. GI bleeding 2. Fluid retention
36
What are the common adverse drug reaction for opioid analgesics?
1. Constipation 2. Drowsiness 3. Falls
37
What class of drug can exaccerbate angle-closed glaucoma?
TCAs
38
What is the acronym for prescribing in the elderly?
1. **M**inimise number of drugs used 2. **A**lternatives 3. **S**tart low and go slow 4. **T**itrate therapy 5. **E**ducate the patient 6. **R**eview regularly
39
If a patinet is on long term NSAIDs what also do they need to be prescribed?
PPI
40
What drug should be prescribed for patinets on a long term steroid?
1. Bisphosphonates
41
What vaccines should patients over 65 recieve?
1. Annual influenza 2. Single dose of pneumococcal
42
WHAT SHOULD OPTIMAL PRESCRIBING TO CORRECT AN AKI INVOLVE?
1. Correct hypovolaemia 2. Minimise renal hypoperfusion 3. Treat other causes, such as sepsis 4. Avoid the use of (or withdraw) nephrotoxic agents; and 5. Consider drugs that are renally excreted and may need adjustment
43
What are examples of drugs that are nephrotoxic?
1. Aminoglycosides 2. Amphotericin 3. Cytotoxic Chemotherapy 4. Diuretics 5. Immunosuppresants 6. Lithium salts 7. NSAIDs/COX-2 inhibitors 8. Radiocontrast media 9. Other nephrotoxic agents
44
What are some pathological states that are nephrotoxic?
1. Hypoperfusion 2. Sepsis 3. Rhabdomyolysis 4. Hepatorenal syndrome
45
when should you not use a model to estimate renal function?
1. Extremes of weight 2. Children 3. Pregnancy 4. Catabolic states
46
What substances control the GFR?
1. Prostaglandins 2. Angiotensin II
47
What should you monitor in patients with an AKI?
1. Pulse 2. Blood pressure 3. O2 sats
48
What signs should you be looking for when checking for fluid balance?
1. Pulmonary oedema 2. Fluid overload
49
What is the target blood pressure for individuals with CKD and an ACR under 70 mg/mol?
\<140/90 mmHg
50
What is the target blood pressure for patients with CKD and an ACR \>70 mg/mol?
\<130/80 mmHg
51
When would you switch from a thiazide diuretic to a loop diuretic?
When there is oedema
52
MATCH THE INTERVENTIONS TO EXPLANATION?

ΩΩ 4 Bateman - PSA + Pharmacology (8 decks)

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