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ADR Flashcards

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1
Q

SE of thiazides?

A

dyslipidaemia (inhibits lipoprotein lipase in capillaries  more lipoproteins), gout

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2
Q

SE of Ciprofloxacin?

A

Tinnitus

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3
Q
  • ACEi + NSAIDs can result in what?
A

AKI

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4
Q
  • ACEi (i.e. carvedilol) + K-sparing diuretic (i.e. amiloride) can cause what?
A

Hyperkalaemia

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5
Q

Digoxin side effects?

A

o SEs: N&V, blurred vision, xanthopsia (disturbed yellow/green vision incl. ‘halo’ vision)
o MoA: antagonises K+ at myocyte Na/K-ATPase limiting Na+ influx  Ca2+ accumulates inside the cell, prolonging the action potential  lowing of heart rate
 Hypokalaemia  enhances digoxin effect
 Hyperkalaemia  reduces digoxin effect

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6
Q

What can’t be given alongside trimethoprim?

A

Methotrexate

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7
Q

Side effects of amiodarone?

A

hyper/hypothyroid, skin greying, corneal deposits
o Mx: withhold amiodarone if thyrotoxic

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8
Q

Alcohol + metformin?

A

lactic acidosis

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9
Q

ETOH excess + wafarin?

A

Excessive anticoagulation (bleeding risk)

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10
Q

Alcohol + metronidazole/disulfiram?

A

Sweating, flushing, N&V

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11
Q

IV fluid choice if hypernatraemic/hypoglycaemic?

A

5% dextrose

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12
Q

IV fluid choice if ascites?

A

Human albumin solution (HBS)

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13
Q

IV fluid choice if bleeding shock

A

Blood transfusion (crystalloid first if no blood available)

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14
Q

Resuscitation fluid:

A

o Sodium chloride 0.9%
o 500mL bolus  250-500mL PRN bolus (if HF and still fluid deplete, use 500mL)
o Over 15 minutes

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15
Q

When should you give an ACEi?

A

In the evening

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16
Q

Insulin requirements with steroids?

A

Increased

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17
Q

When to decrease insulin?

A

Alcohol, reduced calories, reduced renal function

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18
Q

COCP rules when having surgery?

A

Stop 4 weeks before and start 2 weeks after

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19
Q

First line for vasomotor symptoms in menopause?

A

SSRIs eg. fluoxetine

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20
Q

What statin should be taken in the evening?

A

Simvastatin

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21
Q

What drugs can’t be taken alongside statins?

A

macrolides (clarithromycin, erythromycin)

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22
Q

SEs of statins?

A

Myositis

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23
Q

Statin Monitoring

A

o Baseline bloods:
 Full lipid profile (non-fasting)
 LFTs
 TSH
 U&Es
 CK (only if persistent, generalised, unexplained muscle pains  if ≥5x ULN, repeat after 7/7):
* RFs: CKD, hypothyroid, FHx/PMHx of hereditary muscular disorders, history of unexplained muscle pain, liver disease, ETOH excess, ≥70yo w/ polypharmacy
* If still ≥5x ULN, do not offer statin
* If <5x ULN, offer statin at a reduced dose
 HbA1c (for high risk of DM patients)
o 3 months:
 Full lipid profile (non-fasting)
 LFTs
 HbA1c (for high risk of DM patients)
o 6 months:
 LFTs

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24
Q

Effect of warfarin and statins?

A

High INR (only in some people)

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25
When to stop a statin when looking at the LFT results?
IF >3x the upper limit of normal (ALT/AST)
26
When should a statin be stopped?
-Severe muscle pains -Creatinine kinase >5x ULN -Prescribing macrolides -LFTs >3x ULN
27
How do you treat delirium aggression?
IM haloperidol (give lorazepam in Parkinson's)
28
Aggression medical treatment?
Oral lorazepam first line, IM lorazepam second line
29
Alcohol avoidance is recommended with which drugs?
ABx (metronidazole, doxycycline) Benzodiazepines sedating antihistamines Fluoxetine Disulfiram Statins (must stay within limits Warfarin
30
Treatment for neuropathic pain?
o 1st line neuropathic pain:  Amitriptyline (10mg oral nightly)  Pregabalin (75mg oral 12-hourly) o 1st line diabetic neuropathy  duloxetine (60 mg oral daily)
31
Drugs to avoid in heart failure?
o Thiazolidinediones (pioglitazone) - fluid retention o NSAIDs/glucocorticoids - caution: fluid retention [75mg aspirin exception] o Verapamil - negative inotropic effect o Class I antiarrhythmics (flecainide) - negative inotropic and proarrhythmic effects
32
Drugs to take at night?
Statins, amitrytiptiline
33
Treatment for insomnia?
o 1st line: Z-drugs (Zopiclone) o 2nd line / severe insomnia: BDZ (Nitrazepam; 2-4w)
34
When do you consider blood tranfusion for iron deficiency ?
* Severely symptomatic * Hb <70g/L  Raises Hb by 10g/L per unit given
35
What is the first line management for iron deficiency anaemia?
o 1st line: ferrous sulphate, 200mg, PO, TDS [take with food]  Given until Hb normal + further 3 months to replace stores  Consider SE as a cause of non-compliance if Hb not rising (constipation, black tarry stools)  Reduce to BD if side effects are prominent and reassess in 2-4 weeks
36
Liver enzymes and drugs: ALT : ALP >5
 Paracetamol  NSAIDs  Statins  Amiodarone
37
Liver enzymes and drugs: ALT : ALP <2
 Co-amoxiclav  Erythromycin  Chlorpromazine  Hormonal contraception
38
Liver enzymes and drugs: ALT : ALP 2-5
 Phenytoin  Sulphonamides  Carbamazepine
39
Steroid side effects?
 Stomach ulcers  Thin skin (easy bruising)  (O)edema  Right (and left) heart failure  Osteoporosis  Infection  Diabetes  Syndrome (Cushing’s)
40
NSAID cautions and CIs?
 No urine (renal failure)  Systolic dysfunction  Asthma  Indigestion  Dyscrasia of the blood (clotting abnormality)
41
What to stop in acute HF?
Beta Blocker
42
Drugs that increase bleeding (aspirin, heparin, warfarin) not to be given to those?
 Suspected of bleeding  At risk of bleeding * Prolonged PT in liver disease * Acute ischaemic stroke (haemorrhagic transformation; ≤2 months)  On enzyme inhibitors (i.e. erythromycin) and warfarin
43
Which antihypertensives can cause bradycardia?
BB and CCBs
44
Which antihypertensives can cause Electrolyte disturbances?
ACEi, diuretics
45
* CCBs side effects?
peripheral oedema, flushing
46
* Diuretics side effects?
renal failure, gout (loop diuretics), gynaecomastia (spironolactone)
47
First line for nausea?
 1st line (most cases)  Cyclizine, 50mg 8-hourly, IM/IV/oral * SE: fluid retention (not for HF)  2nd line  Metoclopramide, 10mg 8-hourly, IM/IV/oral * Avoid in Parkinson’s (DA antagonist) – use domperidone (does not cross BBB) * Avoid in young women (risk of dyskinesia i.e. acute dystonia)
48
Beware of warfarin and which antibiotic?
+ ciprofloxacin / erythromycin
49
o Neutropenic sepsis can be caused by what?
Piptazobactam (Tazocin) + Gentamicin
50
digoxin SE and what to not give alongside?
o Arrhythmia + hypotension, (no BB or non-DHP as can cause hypotension)
51
Prescription review pneumonic?
* PReSCRIBER o Patient details (3 identifying factorsOR addressograph) o Reaction (allergy + reaction to drug) o Sign the front of the chart o check for Contraindications to each drug o check Route for each drug o prescribe IV fluids if needed o prescribe Blood clot prophylaxis if needed o prescribe anti-Emetics if needed o prescribe pain Relief if needed
52
Ciprofloxacin side effect?
Tinnitus
53
SE of Metoclopramide?
Exacerbates parkinsonism (crosses BBB, unlike domperidone)
54
K+-sparing diuretics SE?
Hyperkalaemia
55
Loop diuretics SE?
Hypokalaemia, gout
56
Trimethoprim SE?
Neutropenic sepsis
57
Opiates SE?
Constipation Urinary retention
58
Thiazolidinedione SE?
Fluid retention
59
Enoxaparin (heparin) SE?
Bleeding (≤2m after a stroke)
60
Amiodarone SE?
Hyper/hypothyroid Corneal deposits Skin greying
61
barbiturates, opioids, BDZs + alcohol = what?
o Sedation
62
* ACEi + NSAIDs = ?
AKI
63
metronidazole, disulfiram + ETOH = ?
o Sweating, flushing, N&V
64
MAO-I, RIMA + ETOH = ?
o Hypertensive crisis
65
Upper gastrointestinal bleeding caused by alcohol and what?
Aspirin, NSAIDs
66
Monitoring with ciclosporin?
U&Es monitoring regularly required. Every 2 weeks for first 3 months
67
What is required alongisde steroids?
Gastroprotection and bone protection (regular BM monitoring also required)
68
1st line for diabetic neuropathy?
Duloxetine - 60mg oral daily
69
Which medications should be taken in the evening?
Statins and amitriptyline
70
which DOAC must be taken with food?
Rivaroxaban
71
Which DOAC must be taken whole?
Dabigatran
72
Safest SSRI in IHD?
Sertraline
73
Communication points for SSRIs?
* NEVER STOP SUDDENLY * MAY WORSEN SYMP TOMS BEFORE IMPROVING THEM * MAY TAKE A FEW WEEKS TO WORK * WORKS BEST WITH ADJUNCTS LIKE TALKING THERAPY
74
SSRI SEs?
Safest in IHD: Sertraline ~ think safe ticker * SSRI <18s – Fluoxetine * SEs: GI upset, peptic ulcer, insomnia, reduced libido
75
Methotrexate monitoring
Monitor FBC, renal and liver function (reports of blood dyscrasias (any disease of the blood) and liver cirrhosis)
76
Dabigatran is the only reversible DOAC, with what agent?
idarucizumab
77
Management of stable popliteal aneurysm?
femoral-distal bypass (indications: S/S, in vivo thrombus, >2cm aneurysm)  Indications for bypass surgery generally… aneurysm, trauma, occlusion
78
Management of acute popliteal aneurysm?
Embolectomy ± femoral-distal bypass
79
o RFs of AAA?
HTN, smoking, hypercholesterolaemia, gender (males have inc. risk, but females have inc. rupture risk)
80
Screening for AAA?
o Screening = males ≥65yo  single abdominal USS:  3 – 4.5 fu scan in 12 months  4.5 – 5.5 fu scan in 3 months  >5.5 2ww referral to vascular
81
Ix for AAA?
o 1st  USS abdomen (always 1st line for diagnosis) o 2nd  CTA/CT (required for pre-operative planning)  MRA/MRI (if contrast allergy) o Other: ESR (raised), CRP, FBC, BC
82
* Complications (AAA)?
Rupture, embolism (trash foot), thrombus, DVT (pressure), fistulation
83
Medical management for AAA?
Statins, aspirin, BP management
84
When is surgery performed electively for AAA?
Aneurysms growing >1cm in one year, aneurysms lager than 5.5cm at screening
85

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