Flashcards in BNF- Guidance on Prescribing Deck (57)
What does "non-proprietary" mean?
Should biological medicines be prescribed by brand?
When are oral syringes provided for liquid medicines?
When the doses are not in multiples of 5mL
Sugar free preparations do not contain what 3 excipients?
Fructose, sucrose, glucose
True or false:
Preparations containing hydrogenated glucose syrup e.g. sorbitol are classed as sugar-free?
No evidence that they cause dental caries
The excipient benzyl alcohol is associated with what in neonates?
Fatal toxic syndrome
Polyoxyl castor oils, used as vehicles in intravenous injections, carries the risk of what?
Severe anaphylactoid reactions.
What is the problem with propylene glycol if its elimination is impaired, e.g. in renal failure, in neonates and young children?
Can cause adverse effects
What two drugs may interact with propylene glycol? (Hint: alcohol interactants)
Metronidazole and disulfram
For extemp products:
1. If the BP direction states that a preparation must be "freshly prepared", within how many hours must it be made before issued for use?
2. If the direction that a preparation should be "recently prepared" indicates that deterioration is likely if the preparation is stored for longer than how many weeks?
1. Made within 24 hours of being issued
2. About 4 weeks at 15–25￮ C.
Prescriptions for drugs used for contraceptive purposes (but which are not promoted as contraceptives) may need to be marked in handwriting with what symbol?
What does a black triangle next to a drug mean and how long is this retained for?
The black triangle symbol identifies newly licensed medicines that require additional monitoring by the European Medicines Agency. Products usually retain a black triangle for 5 years, but this can be extended if required.
All suspected reactions for black triangle drugs should be reported to MHRA
In terms of statistics, what does a very common side effect mean?
Greater than 1 in 10
In terms of statistics, what does a common side effect mean?
1 in 100 to 1 in 10
In terms of statistics, what does an uncommon side effect mean?
1 in 1000 to 1 in 100
In terms of statistics, what does a rare side effect mean?
1 in 10,000 to 1 in 1000
In terms of statistics, what does a very rare side effect mean?
Less than 1 in 10,000
What would be examples of immediate, rapidly-evolving reactions (<1 hour after drug administration)?
- Anaphylaxis, with erythema, urticaria or angioedema, and hypotension and/or bronchospasm.
-Urticaria or angioedema without systemic features
-Exacerbation of asthma e.g. with non-steroidal anti-inflammatory drugs (NSAIDs)
What would be examples of non-immediate drug reactions without systemic involvement (6-10 days after drug administration)?
Cutaneous reactions e.g. localised inflamed skin
What would be examples of non-immediate drug reactions with systemic involvement (3 days - 6 weeks after drug administration)?
- Cutaneous reactions with systemic features, e.g. drug reaction with eosinophilia and systemic signs (DRESS) or drug hypersensitivity syndrome (DHS), characterised by widespread red macules, papules or erythroderma, fever, lymphadenopathy, liver dysfunction or eosinophilia
- Toxic epidermal necrolysis or Stevens–Johnson syndrome
- Acute generalised exanthematous pustulosis (AGEP)
What drugs are capable of causing oral ulceration?
Cytotoxics, ACE inhibitors, gold, nicorandil, NSAIDs, pancreatin, penicillamine, proguanil hydrochloride, and protease inhibitors.
Aspirin tablets allowed to dissolve in the sulcus for the treatment of toothache can lead to what?
White patch then ulceration
Lichenoid eruptions are associated with which drugs?
ACE inhibitors, NSAIDs, methyldopa, chloroquine,oral antidiabetics, thiazide diuretics,and gold.
Brown staining is a common side effect of which mouthwash?
How can this be removed?
Iron salts in liquid form can do what to the teeth?
Stains enamel black
Permanent staining of the teeth is common with which antibiotic class?
What age group is affected and what are the contraindications?
Under 12 years
C/I in pregnancy, BF, under 12 years
Osteonecrosis of the jaw is associated with what drug class?
Excessive ingestion of fluoride leads to what?
Dental fluorosis - white spots on teeth
Gingival hyperplasia (overgrowth of the gum) is associated with which drugs?
Phenytoin, ciclosporin, nifedipine (and other CCBs)