6. Safe drug use

Question 1

duloxetine

Answer 1

SNRI

Question 2

Metformin

Answer 2

Diabetes

Question 3

Types of insulin

Answer 3

Novorapid insulin

Abasaglar insulin

Question 4

Omeprazole

Answer 4

PPI

Question 5

nebivolol

Answer 5

beta blocker

Question 6

isosorbide mononitrate

Answer 6

nitrate, vasodilator

Question 7

Furosemide

Answer 7

antidiuretic

Question 8

Simvastatin

Answer 8

statin

Question 9

Beclomethasone

Answer 9

synthetic corticosteroid

Question 10

co-codamol

Answer 10

opioid analgesic

Question 11

gabapentin

Answer 11

neuropathic analgesic

GABA inhibitor

Question 12

mycophenolate mofetil

Answer 12

anti-inflammatory

reversible inhibitor of inosine monophosphate dehydrogenase

Question 13

prenisolone

Answer 13

glucocorticoid

Question 14

codeine phosphate

Answer 14

analgesic

Question 15

Creon

Answer 15

Mix of lipase, protease and amylase

Question 16

Hydroxocobalamin

Answer 16

Vitamin B12 analogue

Question 17

carbamazepine

Answer 17

anticonvulsant

Question 18

phenytoin

Answer 18

anticonvulsant

Question 19

phenytoin

Answer 19

anticonvulsant

Question 20

CYP450 inducers

Answer 20

carbamezapine
phenytoin
rifampicin
chronic alcohol

SLOW EFFECT

Question 21

CYP450 inhibitors

Answer 21

Amiodarone
ciprofloxacin
erythromycin/clarithromycin
metronidazole
fluconazole
isoniazid
Acute alcohol
Grapefruit juice
RAPID EFFECT

Question 22

isoniazid

Answer 22

Abx - TB

Question 23

fluconazole

Answer 23

antifungal

Question 24

Drug metabolism

Answer 24

Phase 1 - if prodrug activates it, if not, inactivates it or makes it toxic.

• Oxidation by CYP450
• Reduction
• hydrolysis (esterases)

phase 2 - makes it soluble by conjugating it - glucuronidation, acetylation, sulfation, methylation

Eliminated in urine or bile

Question 25

aminophylline

Answer 25

theophylline and ethylenediamine in a 2:1 ratio. Used to treat lung conditions

Question 26

What happens if you add a cytochrome p450 inhibitor to a drug metabolised by cyp450

Answer 26

if drug has a narrow therapeutic window e.g. warfarin, aminophylline, then there is POTENTIAL FOR AN ADVERSE DRUG INTERACTION

Question 27

What is an adverse drug reaction?

Answer 27

any undesirable experience that happened while taking a drug that is suspected to be caused by the drug/drugs

Question 28

ADR of aspirin/NSAID

Answer 28

GI discomfort or ulceration

Question 29

Citalopram ADR

Answer 29

(SSRI) | hyponatraemia

Question 30

Furosemide ADR

Answer 30

hypokalaemia

Question 31

alendornic acid ADR

Answer 31

oesophagitis/ulceration

Question 32

Aspirin ADR

Answer 32

Dyspepsia, haemoorhage

Question 33

Bisoprolol

Answer 33

bradycardia, hypotension

Question 34

bumetanide

Answer 34

(sulfamyl diuretic) | electrolyte disturbs

Question 35

clarithromycin

Answer 35

QT interval prolongation

Question 36

Co-amoxiclav

Answer 36

Allergic reaction

Question 37

Gentamicin

Answer 37

Tinnitus, nephrotoxicity

Question 38

Insulin

Answer 38

hypoglycaemia

Question 39

Morphine

Answer 39

vomiting, resp depression

Question 40

Salbutamol

Answer 40

Hypokalaemia, palpitations

Question 41

Warfarin

Answer 41

haemorrhage, alopecia

Question 42

Top ADR causes

Answer 42

``` NSAIDS 29.6% Diuretics - 27.3% Warfarin - 10.5% ACE 7.7% Antidepressants 7.1% Beta blockers 6.8% Opiates 6.0% Digoxin 2.9% Prednisolone 2.5% Clopidogrel 2.4% Insulin Antibiotics ```

Question 43

What is highest priority to heck before prescribing antibiotics: ``` Allergy status Blood culture results Medication hx Recent antibiotic courses Renal function ```

Answer 43

Allergy status!!

Question 44

Which of the following is safe to use in someone with penicillin allergy? ``` Amoxicillin Co-amoxiclav Doxycycline Piperacillin & tazobactam Ceftriaxone ```

Answer 44

Doxycycline (a tetracycline) Amox, co-amox, piperacillin and tazobactam are all penicillins and cefrtiaxone is a cephalosporin (also a beta-lactam)

Question 45

Comorbidities

Answer 45

Hepatic, cardiac, renal function | is pt pregnant or breastfeeding?

Question 46

Hepatic function

Answer 46

how is drug handled? does it rely on hepatic metabolism? morphine sulfate methotrexate

Question 47

Renal excreted drugs

Answer 47

penicillins aminoglycosides glycopeptides morphine sulfate Creatinine clearance for aminoglycosides check eGFR check reference guidance