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

4 Prescribing In Special Circumstances Flashcards

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?

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?

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?

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?

A
  1. Digoxin needs to be decreased
25
Q

What are some receptor and cellular changes in elderly?

A
26
Q

What are the medicaitons that can ause hypotension in the elderly?

A
  1. Alpha blockers
  2. Antihypertensives
  3. Antidepressants
  4. Beta-blockers
  5. Diuretics
  6. Hypnotics
  7. Nitrates
27
Q

What the measurement for postural drop?

A

>20 mmHg

28
Q

What are some examples of drugs that can cause hypothermia in the elderly?

A
  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
Q

Which drug is common for causing peripheral oedema?

A

Calcium channel blocker

30
Q

What are some examples of drugs that could increase dizziness in the elderly?

A
  1. Postural hypotension drugs
    Amlodopine + Ramipril
  2. Confusion and falls drugs
    Diazepam
31
Q

Which drugs can cause altered cognition in the elderly?

A
  1. Anticholinergics
  2. Antihistamines
  3. Beta-blockers
  4. Hypnotics
  5. Opioid analgesics
  6. Tricyclic antidepressants
32
Q

Which class of drugs have a high risk of causing repiratory depression in the elderly?

A

Benzodiazepines

33
Q

What are the common adverse drug reactions in antimuscarinics?

A
  1. Memory loss
  2. Urinary retention
  3. Constipation
  4. Exacerbation of glaucoma
34
Q

What are the common adverse drug reactions for hyponotics/anxiolytics?

A
  1. Falls
  2. Confusion
  3. Postural hypotension
35
Q

What are the common adverse drug reactions for NSAIDs?

A
  1. GI bleeding
  2. Fluid retention
36
Q

What are the common adverse drug reaction for opioid analgesics?

A
  1. Constipation
  2. Drowsiness
  3. Falls
37
Q

What class of drug can exaccerbate angle-closed glaucoma?

A

TCAs

38
Q

What is the acronym for prescribing in the elderly?

A
  1. Minimise number of drugs used
  2. Alternatives
  3. Start low and go slow
  4. Titrate therapy
  5. Educate the patient
  6. Review regularly
39
Q

If a patinet is on long term NSAIDs what also do they need to be prescribed?

A

PPI

40
Q

What drug should be prescribed for patinets on a long term steroid?

A
  1. Bisphosphonates
41
Q

What vaccines should patients over 65 recieve?

A
  1. Annual influenza
  2. Single dose of pneumococcal
42
Q

WHAT SHOULD OPTIMAL PRESCRIBING TO CORRECT AN AKI INVOLVE?

A
  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
Q

What are examples of drugs that are nephrotoxic?

A
  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
Q

What are some pathological states that are nephrotoxic?

A
  1. Hypoperfusion
  2. Sepsis
  3. Rhabdomyolysis
  4. Hepatorenal syndrome
45
Q

when should you not use a model to estimate renal function?

A
  1. Extremes of weight
  2. Children
  3. Pregnancy
  4. Catabolic states
46
Q

What substances control the GFR?

A
  1. Prostaglandins
  2. Angiotensin II
47
Q

What should you monitor in patients with an AKI?

A
  1. Pulse
  2. Blood pressure
  3. O2 sats
48
Q

What signs should you be looking for when checking for fluid balance?

A
  1. Pulmonary oedema
  2. Fluid overload
49
Q

What is the target blood pressure for individuals with CKD and an ACR under 70 mg/mol?

A

<140/90 mmHg

50
Q

What is the target blood pressure for patients with CKD and an ACR >70 mg/mol?

A

<130/80 mmHg

51
Q

When would you switch from a thiazide diuretic to a loop diuretic?

A

When there is oedema

52
Q

MATCH THE INTERVENTIONS TO EXPLANATION?

A

ΩΩ 4 Bateman - PSA + Pharmacology (8 decks)

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