Competency Exam Flashcards
(149 cards)
1
Q
Dose of apixaban for AF stroke prevention?
A
> 30: 5mg BD
15-29: 2.5mg BD
To reduce to 2.5mg BD if at least 2 factors:
- Body weight <= 60kg
- SCr >= 133
- Age 80yo and above
1
Q
What are the INR targets for Warfarin for the various conditions?
A
2-3 for everything, except mechanical mitral heart valve 2.5-3.5
2
Q
Dose for dabigatran for AF stroke prevention?
A
> 30: 150mg BD
<30: dont use
To reduce to 110mg BD if:
- 80yo and above OR
- concurrently using verapamil
3
Q
Dose for rivaroxaban for AF stroke prevention?
A
> 50: 20mg OD
30-50: 15mg OD
<30: dont use
4
Q
Dose for apixaban for treatment of VTE?
A
10mg BD x 1 week, then 5mg BD
(no renal dosing adjustments)
5
Q
Dose for dabigatran for treatment of VTE?
A
Can only use after at least 5 days of parenteral treatment.
> 30: 150mg BD
<30: dont use
To reduce to 110mg BD if :
- 80yo and above OR
- concurrently using verapamil
6
Q
Dose for rivaroxaban for treatment of VTE?
A
> 30: 15mg BD x 3 weeks, then 20mg OD
<30: dont use
7
Q
Dose for apixaban for VTE prophylaxis for pts who underwent knee/hip replacement surgery?
A
2.5mg BD (no renal dosing adjustments)
8
Q
Dose for dabigatran for VTE prophylaxis?
A
> 50: 220mg OD
30-50: 150mg OD
<30: dont use
9
Q
Dose for rivaroxaban for VTE prophylaxis?
A
> 30: 10mg OD
<30: dont use
10
Q
Dose of enoxaparin for VTE treatment?
A
1mg/kg Q12H
If <30: 1mg/kg Q24H
11
Q
Dose of enoxaparin for VTE prophylaxis?
A
40mg OD
If <30: 30mg OD
12
Q
How to switch from enoxaparin to DOACs?
A
Clexane > Apixaban: start at next dose of clexane
Clexane > Riva / dabi: start within 2h prior to next dose of clexane
13
Q
How to switch from clexane to warfarin?
A
For treatment of VTE: overlap warfarin with clexane until INR >= 2 and for at least 5 days
14
Q
What are the monitoring parameters for the different anticoagulants?
A
- Warfarin: INR
- Unfractionated heparin: aPTT
- LMWH: Anti-Xa
15
Q
When will you consider to give lower doses of warfarin?
A
- Age>70yo
- Weight < 50kg
- Elevated baseline INR or low platelet count
- Disease states with increased warfarin sensitivity
16
Q
At maintenance phase, what is the warfarin titration guide?
A
10% change in dose > INR change by 1
17
Q
How much can stopping warfarin for one day reduce the INR?
A
0.2-0.5
18
Q
When do I review pt’s INR after making changes to their maintenance dose of warfarin?
A
2 weeks (to allow INR to stabilise and make further adjustments as necessary).
19
Q
What is an example of a clinically significant drug interaction for DOACs?
A
Dabigatran: P-gp substrate
Rivaroxaban, Apixaban: CYP3A4 substrate, P-gp substrate
Carbamazepine induces P-gp and CYP3A4.
Induce P-gp > increase efflux
Induce CYP3A4 > increase metabolism
HENCE, reduced efficacy of DOAC.
Category X interaction for all three DOACs.
20
Q
Dose of unfractionated heparin for treatment of VTE?
A
80units/kg IV bolus > 18u/kg/h continuous IV infusion
(no renal adjustments needed)
21
Q
Target aPTT for unfractionated heparin?
A
1.5-2.5x the control value
22
Q
Metabolism of warfarin?
A
Substrate of CYP1A2 (minor), CYP2C19 (minor), CYP2C9 (major), CYP3A4 (minor);
23
Q
What CYP interactions are there for St Johns Wort?
A
CYP inducer
24
Common factors that can affect the INR?
- Acute alcohol increases INR, chronic alcohol decreases INR
- hyperthyroid increases INR, hypothyroid decreases INR
- vit K rich foods decrease INR
- 3 Gs (garlic, gingko, ginger) increases bleeding risk (increase INR)
- Ginseng decreases INR
25
When is bridging anticoagulation indicated?
Pt is at high risk of thromboembolism (eg, atrial fibrillation with a high stroke risk score or recent stroke or transient ischemic attack, venous thromboembolism within 3 months, history of thromboembolism during interruption in therapy) /
Mechanical heart valve
26
How to bridge using Clexane?
- Stop warfarin ~5 days before procedure (assuming that target INR is 2-3 and pt INR is within range)
- SUBQ: 1 mg/kg every 12 hours; a reduced dose of 40 mg every 12 hours may be considered when bleeding is a concern; start enoxaparin ~3 days prior to the procedure when INR is subtherapeutic; the last dose of enoxaparin is administered ~24 hours before the planned procedure. Enoxaparin may be resumed ≥24 hours after procedures with low bleeding risk and ≥48 to 72 hours after procedures with high bleeding risk. Continue enoxaparin until warfarin has been resumed and INR is therapeutic
27
Starting dose and target dose of Entresto for HFrEF?
Starting dose: 50-100mg BD
Target dose: 200mg BD
(double dose after 1-2 weeks)
28
Starting dose and target dose of carvedilol for HFrEF?
Starting dose: 3.125mg BD
Target dose: if <=85kg: 25mg BD; >85kg: 50mg BD
(double every 2 weeks)
29
Starting dose and target dose of bisoprolol for HFrEF?
Starting dose: 1.25mg OD
Target dose: 10mg OD
(double every 2 weeks)
30
Starting dose and target dose of spironolactone for HFrEF?
Starting dose: 12.5-25mg OD
Target dose: 25-50mg OD
(double every 4 weeks)
31
Starting dose and target dose of eplerenone for HFrEF?
Starting dose: 25mg OD
Target dose: 50mg OD
(Double every 4 weeks)
32
Starting dose/target dose of dapa for HFrEF?
10mg OD
33
Starting dose/target dose of empa for HFrEF?
10mg OD
34
What is baclofen used for?
It is a skeletal muscle relaxant.
- Hiccups (off-label)
- Muscle spasm or musculoskeletal pain
- Spasticity
35
What medication should be spaced apart from enteral feeding?
Phenytoin (decrease phenytoin absorption). Space 1-2h apart.
36
What vitamins are good for pressure injury?
Vitamin C and Zinc
37
What medication is a/w SIADH?
All antidepressants, mostly SSRIs, possibly lower risk with agomelatine, mirtazapine, bupropion.
>>> Monitor serum Na
38
What makes up the allergy triad?
Asthma, allergic rhinitis, atopic dermatitis (eczema)
39
How to classify allergic rhinitis?
Intermittent: < 4 days a week OR < 4 consecutive weeks
vs
Persistent: >= 4 days a week AND 4 consecutive weeks
Mild: Normal sleep, no impairment of activities, AND no troublesome sx
Moderate-severe: Disturbed sleep, impairment of daily activities, OR having troublesome sx
40
What is the treatment for mild, intermittent allergic rhinitis?
Second gen oral antihistamine, administered regularly or as needed
41
What is the treatment for moderate-severe intermittent or mild persistent allergic rhinitis?
Intranasal corticosteroid nasal spray (takes time to work, can add on oral second gen antihistamine)
42
Which steroid nasal sprays are POM with exemption?
Nasacort (triamcinolone acetate), Nasonex (mometasone furoate), Avamys (Fluticasone furoate)
Max supply: 3 months, min age 18yo, max daily dose is 2 sprays into each nostril OD
(Flixonase is P only - fluticasone propionate)
PIL says indicated for only adults > 18yo.
Dose: 2 sprays into each nostril OD (max 2 sprays into each nostril BD)
43
How long does INC take to work?
Onset can be seen in a few hours, but peak benefits may require several days to weeks. Typically takes 3-7 days for sx relief to occur >> must continuously use it in first week of treatment.
44
When to discard intranasal corticosteroids?
Discard 2 months after opening for Nasacort and Avamys.
45
What are the strengths of topical decongestants for oxymetazoline?
Adults and children > 6yo: 0.05% Q8-12H
1-6yo: 0.025% Q8-12H
4 weeks - 1yo: 0.01% Q8-12H
(GSL item)
Do not use > 5 days to prevent rebound congestion.
46
Non-pharmacologcial advice for allergic rhinitis?
In allergic rhinitis, avoidance of potential allergens is important regardless of
medication taken 60
a. Animal dander
i. Remove the pet from the house, or from the bedroom
ii. Install HEPA filter and use air filters
b. Dust mites
i. Clean beddings and furniture covers in warm water with detergent, or use
dryer on hot setting
ii. Lower indoor humidity to <50%, by using low settings on humidifier
c. Cockroaches
i. Clean the house regularly, and empty the garbage daily
ii. In cases of severe infestations, seek professional exterminator
d. Indoor mould
i. Clean surfaces with dilute bleach solution
ii. Fix water leakages
47
48
What electrolytes predispose to AF?
Low K and low Mg; High Ca
49
Pharmacological agents for rate control in AF?
1. If no comorbidities / hypertension / HFpEF:
first line: beta blocker or NDCCB
2. HFrEF:
first line: beta blocker
3. Severe COPD or asthma:
first line: NDCCB
2nd line agents:
digoxin (reduce HR), amiodarone
Lenient HR target of <110
50
Which beta blockers are cardioselective for B-1 receptors in the heart?
Atenolol, betaxolol, bisoprolol, metoprolol, nebivolol
51
What are common agents used for rhythm control in AF?
Amiodarone, sotalol
52
Does hyperthyroidism increase the risk for AF?
Yes
53
When to use what agent for rhythm control in AF?
If none or minimal signs of structural heart disease -> can use everything
CAD, HFpEF, significant valvular disease -> amiodarone, sotalol
HFrEF -> amiodarone
54
What is the CHA2DS2 VASc score?
C - congestive heart failure
H - hypertension
A2- age 75yo and above -> 2
65-74 -> 1
D - diabetes
S2 - stroke / TIA / thromboembolism
V - vascular disease (CAD / prev MI / PAD / aortic plaque)
A - age
Sc- female is 2, male is 1
55
Factors in HAS-BLED?
Hypertension > 160
Abnormal liver / kidney
Stroke
Bleeding tendency
Labile INR
Elderly >65yo
Drug / alcohol
If HASBLED >=3 -> higher bleeding tendency
56
How to manage over anticoagulation of warfarin?
If INR 4-5: withhold warfarin and check INR after 24h
5-9: omit next 1-2 doses and check INR after 24h. OR give Vit K PO 1-3mg
>9: Omit warfarin and give vit K PO 3-5mg
Recheck INR after 6h then daily for 3 days
57
Anticoagulation for stroke prevention in AF?
If prosthetic mechanical heart valves or moderate-severe mitral stenosis > use warfarin.
CHADVASC 0 in men or 1 in women: don’t need
CHADVASC 1 in men or 2 in women: if factor is age 65-74, then treat.
CHADVASC 2 in men or 3 in women and above: treat.
58
What to take note for beta blockers?
- Impaired glucose control in diabetes (a/w new onset diabetes)
- Masks sx of hypoglycaemia (tremor, irritability, palpitations) > only sweating is unaffected
59
CI of beta blockers?
- acute de compensated HF
- uncontrolled bronchospastic disease
60
CI of NDCCB?
hfref
61
What are the signs and sx of digoxin toxicity?
CNS: dizziness, mental disturbances, headache, confusion, delirium, hallucinations
GI: nausea, vomiting, diarrhea, anorexia
Ocular: blurred or yellow vision
62
Antidote for digoxin toxicity?
Digibind (digoxin immune Fab)
63
What is a notable DDI for digoxin?
Amiodarone - increases digoxin level
64
Side effects of amiodarone?
- hypo or hyper thyroid
- eye problems - optic neuritis, corneal microdeposits
- nerve: numbness
- skin: blue grey colouring of skin
- lungs: pulmonary fibrosis
- liver: heptatotoxicity
- prolonged QTC
65
Side effects of sotalol?
- QTc prolongation
CI:
- bronchial asthma or related bronchospastic conditions
- long QT (baseline > 450)
- decompensated HF
- CrCl < 40
66
NYHA classification for HF?
NYHA I: no limitation of physical activity. ordinary physical activity does not cause sx of HF
NYHA II: slight limitation of physical activity. comfortable at rest, but ordinary physical activity results in sx of HF
NYHA III: marked limitation of physical activity. comfortable at rest, but less than ordinary physical activity causes sx of HF.
NYHA IV: unable to carry on any physical activity without sx of HF, or sx at rest.
67
ACC/AHA stages of HF?
Stage A: at high risk for HF but without structural heart disease or sx of HF.
(high risk: HTN, CHD, DM, alcoholism, or strong family history)
structural heart disease: LV hypertrophy, dilation, fibrosis, old MI
Stage B: structural heart disease but without signs or sx of HF
Stage C: structural heart disease with prior or current symptoms of HF
Stage D: refractory HF requiring special interventions
68
What are the benefits of the four pillars of HF?
ARNI: mortality and morbidity benefit
BB: Mortality and morbidity benefit
SGLT2i: mortality and morbidity benefit (benefit seen in eGFR>=20 for empa; for dapa if egfr <25, do not initiate can continue)
MRA: Mortality and morbidity benefit (spironolactone and eplerenone: egfr<30: do not use)
Digoxin: only hospitalisation benefit (no mortality benefit)
69
Role of nitrate + hydralazine in HF?
Nitrate is a venous dilator > reduce preload. Hydralazine is an arteriolar dilator > reduce after load.
(useful in african americans)
70
Role of ivabradine in HF?
- Reduce HF hospitalisation
- must be in sinus rhythm and HR >= 70
Dose: 5mg BD
71
Treatment of STEMI?
DAPT - aspirin with clopi/ticagrelor x 1 year duration
If have AF, aspirin + clopi (never ticagrelor) x 1 month with OAC (warfarin or DOAC) > SAPT + OAC x 1 year > OAC lifelong.
High intensity statin regardless of baseline LDL
ACEi/ARB started if BP can tolerate and if there is underlying diabetes, CKD, or HFrEF
Beta blockers as long as HR and BP can tolerate.
72
Pharmacological therapy for stable angina?
- first line is beta blockers (reduce oxygen demand) - all can be used; cardioselective agents to reduce SE (mortality and morbidity benefit)
- calcium channel blockers increase coronary blood flow and also reduce oxygen demand by reducing contractility and HR (NO MORTALITY and morbidity benefit)
- nitrates (dilate coronary arteries) —- AVOID sildenafil use within 24h and tadalafil use within 48h
73
What is a problem with use of nitrates?
Nitrate tolerance - maintain free interval of 10-12h a day
74
Other medications to be started for stable angina patients?
- Aspirin 100mg OM
- Alternative anti anginals:
75
How to use ranolazine as alternative anti angina?
Ranolazine
- Increase exercise time
- NO effect on BP or HR
- Add on therapy
- Dose: 375mg BD, then to 500mg BD
- causes QTc prolongation
- CI: hepatic cirrhosis, pre existing QTc,CrCl < 30
76
How to use trimetazidine as alternative anti anginal?
- Dose: 20mg TDS
- SE: GI
- CI: PD, motion disorders, CrCl<30
77
How to use ivabradine as alternative anti anginal?
- Must be in normal sinus rhythm and HR >= 70
- 5mg BD, increase to 7.5mg BD
- Avoid if CrCl < 15
- Causes Afib > d/c if it occurs
78
how much can one anti hypertensive drug lower BP?
10/5mmHg
79
What is the statin therapy for different 10 year CVD risk?
Very high risk (>=20%): high intensity statin > target 1.8
High risk (7.5-20): moderate intensity statin > target 2.6
Moderate risk: 5-7.5: suggest if very high LDL eg >4.14 > target 2.6
Low risk; <5: do not treat > target 3.0
80
When to recheck LDL and ALT?
8 weeks
81
How much doubling statin dose can reduce LDL?
6-7%
82
Adding ezetimibe to statin can reduce LDL by how much?
up to 25%
83
When to use TG lowering agents?
For high risk pts already optimised on statin, start fibrate if fasting TG > 2.3 ;
If TG > 4.5 start fibrate
84
Dose of fenofibrate?
Starting dose: 100mg/day
Max dose: 400mg/day
85
Dosing of statins?
(refer to statin intensity table)
86
How to manage mild acne?
- BPO (2.5-10%) OR
- Topical retinoids (tretinoin 0.025-0.1%) ; Adapalene 0.1-0.3% OR
- Topical combination of BPO + Topical Abx +/- topical retinoid
87
How to treat moderate acne?
- BPO+Topical abx or retinoid OR BPO + topical abx + topical retinoid
- Oral abx + topical retinoid + BPO
Choice of oral abx: doxycycline > erythromycin > minocycline > co-trimoxazole
Consider COC if also desire contraception.
Oral isotretinoin if necessary
88
How to treat severe acne?
- oral abx + BPO + topical retinoid / topical abx
- oral isotretinoin
89
Dose of oral isotretinoin?
Initiate at 0.5mg/kg/day, increase to 1mg/kg/day
90
How long to see effect from adapalene?
Worsen initially when starting treatment.
8-12 weeks.
(6 weeks for tretinoin)
91
Counselling points for isotretinoin?
- Take with or after food
- Transient worsening during first month, should clear 1-2 months after initiation
- Cannot take with tetracycline
- Avoid taking Vit A supplement (can worsen dryness)
- Cannot donate blood during and one month after treatment
- Female contraception one month before, during, and up to 6 weeks after d/c
- Males: don’t share medication with female friends, semen not significant
- Dryness of lips, eyes and skin
- Avoid exposure to sunlight
- Avoid cosmetic skin treatments during and at least 6 months after last dose
- Liver function test and lipids test before initiation, one month after and 3 months after
92
What are some common agents causing SJS/TENS?
- Anti convulsants: lamotrigine, carbamazepine, phenytoin, phenobarbitone
- Allopurinol
- Sulfonamides (co trimoxazole, sulfasalazine)
93
What allele is a/w SJS/TENS for carbamazepine?
HLA-B*1502
94
What allele is a/w allopurinol hypersensitivity?
HLA-B*5801
95
What are examples of steroids in the different classes?
Group 1 (ultra high potency) - Clobetasol propionate (POM)
Group 2 (high potency) - Betamethasone dipropionate ointment, mometasone fuorate ointment
Group 3 (high potency) - betamethasone dipropionate cream, betamethasone valerate ointment
Group 4 (medium potency) - hydrocortisone aceponate, mometasone furoate cream, lotion
Group 5 (Lower mid potency) - betamethasone valerate cream, desonide ointment
Group 6 (low potency) - desonide cream, lotion ; betamethasone valerate lotion
Group 7 (lowest potency) - hydrocortisone acetate, betamethasone cream 0.025%
96
Treatment for eczema?
Mainstay is corticosteroid. 1 finger tip unit > 2 palm size of BSA
Moisturizer.
Topical calcineurin inhibitor eg tacrolimus (POM) - apply BD (side effect of transient burning sensation)
97
POM with exemption status for steroids?
Max daily dose: Usually BD
Max supply: 15g (1 tube)
Minimum age: 18yo
98
How to treat seborrhic dermatitis?
First line: ketoconazole shampoo (leave on for at least 5 min before washing off, use twice weekly for 2-4 weeks, followed by once. week or every two weeks as maintenance)
Alternatives: coal tar, zinc pyrithione, selenium sulfide, salicylic acid, hydrocortisone
99
What hair loss condition can be treated in the community?
Androgenetic alopecia
100
What treatment can be used for androgentic alopecia?
Topical minoxidil.
Dose: 1mL BD
MPHL - 5%, FPHL - 2%
101
Counselling points for minoxidil?
- Apply to scalp, not hair
- Dry scalp before using
- Allow 2-4h for drug to penetrate the scalp
- Apply 2-4h before sleep to allow drying and avoid spreading to other body sites
- Do not use hairdryer after application as it will reduce effectiveness of the drug
- Hair grooming styling products can be applied after minoxidil is dried up, will not affect effectiveness
- Takes at least 4 months for 2% and 2 months for 5% for visible effect.
- Stop this medication for at least 24h before and after hair procedures eg hair dye or hair perm to avoid chemical interactions
- If you stop treatment, will go back to pre treatment state over 3-4 months
102
Alternative treatment for hair loss for men?
Finasteride 1mg OD
(improvement occurs after 3 months)
>>> teratogenic!!!
103
What are some products in the community pharmacy that can be used for insect bites?
- Soov Bite (lignocaine - LA and cetrimide - antiseptic)
- Egoderm cream (Ichthammol - anti inflammatory and anti itch)
104
How to manage plaque psoriasis?
First line:
- Corticosteroids
- Coal tar
- Add salicylic acid for thick plaques (should not be used with calcipotriol as salicylic acid inactivates it)
Second line
- Vit D derivatives eg calcipotriol
- Tacrolimus
- Anthralin
105
Cold sores caused by what virus?
Herpes simplex virus 1
106
How to treat cold sores?
Topical acyclovir cream 5x a day x 5-10 days. Each application spaced 4 hours apart.
Max supply is 1 tube (2g)
No minimum age > Can give if 6yo and above
107
What virus causes warts?
Human papilloma virus (HPV)
108
How to treat warts?
Topical salicylic acid (apply OD, may take 6-12 weeks to resolve)
109
Important things for sun care?
SPF 30 and above;
Sun protection factor:
time to get burnt with sunscreen / time to get burnt without sunscreen
110
How is absorption different in children?
- longer gastric emptying time > slower absorption by oral route
- enhanced transdermal and SC absorption
111
How is distribution different in children?
- total body water is increased in children
- decrease in protein binding
112
how to calculate BSA?
square root (height x weight / 3600)
113
What is the max dose in pediatric pharmacy?
Adult dose
114
Dose of paracetamol for children?
PO/PR: 10-15mg/kg Q4-6H (max 75mg/kg/day cap at 4g)
115
Dose of ibuprofen for children?
6 months and above:
5-10mg/kg Q6-8H (max 40mg/kg/day, 400mg single dose)
>12yo, > 40kg;
PO 200-400mg Q6-8H
116
Dose of diclofenac for children?
>= 1 yo:
PO/PR: 0.5-2mg/kg/day in 2-3 divided doses
117
When to use paracetamol and when to use ibuprofen?
Start with paracetamol if temp < 38.5;
Start with NSAID if
- temp > 38.5 OR
- fever does not subside 1-2h after taking paracetamol
118
Dose of chlorpheniramine for children?
>6 months: 0.35mg/kg/day TDS
119
Can promethazine be used in children?
Not recc for children < 2yo due to respiratory depression.
2 years old and above:
0.2-0.5mg/kg TDS (useful for cough, nausea and vomiting)
120
Dose of cetirizine for children?
2-5yo:
2.5mg OD (may increased to 2.5mg BD or 5mg OD)
6 years old and above:
5mg BD or 10mg OD
121
Strength of oxymetazoline for children?
<1 : 0.01%
1-6: 0.025%
>6: 0.05%
122
Treatment of blocked nose in children?
Avoid oral decongestants, recommend topical decongestant.
123
Dose of acetylcysteine for children?
2-5yo: 1 sachet (100mg) TDS
6yo and above: 2 sachets TDS
124
Dose of bromhexine for children?
2-5yo: 2mg TDS
6-12yo: 4mg TDS
>12: 8mg TDS
125
Dose of ORS for children?
1-2 sachets TDS
126
Dose of smecta for children diarrhea?
- Natural adsorbent - adsorb virus, bacteria, toxins > protects intestinal mucosa
Dose: >2yo: 1 sachet TDS
** Not to be used chronically
(contains trace amount of lead)
127
What is an example of probiotics used in children?
Lactobacillus (LactoGG) - does not stop diarrhea but reduces severity and duration of diarrhea
0.5-1 capsule a day
128
is loperamide encouraged in children?
no, very rare because afraid of infectious diarrhea. mainstay is ORS and probiotics.
129
Dose of lactulose for children?
0.5mL/kg Q12-24H (takes up to 48h to work)
130
Dose of macrogol/PEG (forlax) for children?
- preferred as compared to lactulose in children
- adults and children 8 years and above: 1-2 sachets in the morning, space at least 2h from other medications (onset 24-96h)
CI in fructose intolerance
suitable in diabetes
131
Dose of glycerin suppository in children?
Comes as 2g supp.
1 month to 1 yr: half supp
> 1-12yo: 1 supp
> 12yo: 2 supp
onset is 15-30 mins
132
Dose of fleet for children?
>2yo: pediatric fleet
>12yo: adult fleet
133
If given on different days, how long to space apart live vaccines?
28 days
134
What to note for distribution in elderly?
Distribution:
- reduced albumin > affects highly bound drugs, not significant since CL will increase proportionately
- reduced total body water > Vd decreased for water soluble drugs like aminoglycosides and digoxin > adjust doses down
- increased body fat relative to muscle (increased Vd of fat soluble drugs > longer apparent half life eg diazepam)
135
What is considered to be renally impaired for pregnant women?
SCr > 80
136
drug factors that favour transfer into breast milk?
- low MW
- low protein binding
- high lipid solubility
- ionize in breast milk and remains trapped there
137
What RID is generally considered compatible with breastfeeding?
<10%
138
What are drugs which can increase and decrease milk supply?
Dopamine antagonists can increase milk supply:
Domperidone and metoclopramide
Dopamine agonists used to suppress lactation:
Cabergoline
139
Other substances that can reduce milk supply?
- alcohol
- diuretics eg hydrochlorothiazide and furosemide
- dopaminergic agents eg amantadine and PD drugs
- estrogen supplements and COC
- pseudoephedrine
140
safest option for pregnant women with blocked nose?
oxymetazoline nasal spray
141
SSRI of choice in pregnancy?
sertraline
142
Antihypertensives compatible with breastfeeding?
Nifedipine LA, enalapril
143
Antihypertensives that can be used during pregnancy?
Labetalol
Nifedipine LA
144
First line therapy for diabetes in pregnancy?
- Regular insulin (actrapid) and insulin NPH (insulatard)
- Metformin is ok
- Glibenclamide (risk of hypo)
145
How to treat dyslipidemia in pregnancy?
Just stop the statin and resume after.
146
Which abx are preferred in pregnancy?
- beta lactams
- fosfomycin
147
How to manage DM meds after delivery?
- if not breastfeeding -> resume pre pregnancy meds
- if breastfeeding -> metformin plus minus insulin (must decrease insulin dose)
if gestational case: stop all tx and check OGTT
148
Targets for diabetes?
HBA1C 7
FGB 7
PPG 10
