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DRUGS Flashcards

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1
Q

CYP450
what is the effect of an enzyme inducer?

A

increases cytochrome P450 enzyme activity, hastening the metabolism of other drugs

makes other drugs less effective as they are metabolised quicker. Therefore other drugs may require a dose increase

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2
Q

CYP450
what is the effect of an enzyme inhibitor?

A

decreases cytochrome P450 enzyme activity, meaning there will be increased levels of other drugs

increases the effectiveness of other drugs as they are metabolised slower so have higher concentrations in the body. Therefore other drugs may require a dose reduction.

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3
Q

CYP450
what are the most common enzyme inducers?

A

CRAP GPS

  • carbamazepine
  • rifampicin
    Alcohol (chronic excess)
  • Phenytoin
  • Griseofulvin
  • Phenobarbitone
  • Sulfonylureas (gliclazide)
  • Smoking
  • St johns wort
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4
Q

CYP450
what are the most common enzyme inhibitors?

A

SICKFACES.COM
- sodium valproate
- isoniazid
- cimetidine
- ketoconazole
- fluconazole
- acute alcohol (+grapefruit juice), allopurinol, amiodarone
- chloramphenicol
- erythromycin
- sulphonamides, Sertraline
- ciprofloxacin
- omeprazole
- metronidazole

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5
Q

CYP450
what is the effect of adding an enzyme inhibitor in patients taking warfarin?

A
  • causes rise in INR (are excessively anticoagulated)
  • warfarin dose needs reducing
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6
Q

TOPICAL MEDICATIONS
how are topical drugs commonly prescribed?

A

in fingertip units (FTUs)

1 FTU = from tip of adult finger to first crease

it provides enough to treat one side of both hands

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7
Q

which drugs can cause lung fibrosis?

A

amiodarone
cytotoxic agents
methotrexate, sulfasalazine
nitrofurantoin
dopamine receptor agonists (bromocriptine, cabergoline, pergolide)

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8
Q

which drugs can cause urinary retention?

A

TCAs (amitriptyline)
anticholinergics
opioids
NSAIDs
disopyramide

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9
Q

WARFARIN
how is dose monitored?

A

through INR

for most conditions INR is 2.5 (for mechanical heart valves INR is usually 3)

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10
Q

WARFARIN
what are the contraindications?

A
  • hypersensitivity
  • haemorrhagic stroke
  • clinically significant bleeding
  • pregnancy
  • severe liver disease
  • severe renal impairment
  • within 72hrs of major surgery, with severe risk of bleeding
  • concomitant drug treatment (where high risk of bleeding)
  • within 48hrs postpartum
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11
Q

WARFARIN
what are common food interactions?

A

DECREASE INR
- food rich in vitamin K (liver, green leafy veg)
- alcohol dependence
- st john’s wort

INCREASE INR
- moderate alcohol
- cranberry juice
- grapefruit juice

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12
Q

WARFARIN
what are common drug interactions?

A

MOST INCREASE INR
- amiodarone
- antibiotics (erythromycin, clarithromycin, trimethoprim etc)
- SSRIs, mirtazapine
- aspirin, clopidogrel
- tramadol
- statins
- levothyroxine
- PPIs

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13
Q

WARFARIN
what are the side effects?

A
  • haemorrhage
  • teratogenic (can be used in breastfeeding)
  • skin necrosis
  • purple toes
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14
Q

WARFARIN
how do you manage high INR in major bleeding?

A
  1. stop warfarin
  2. give 5mg IV phytomenadione (vit K)
  3. prothrombin complex concentrate (if unavailable, give FFP)
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15
Q

WARFARIN
how do you manage minor bleeding with INR >8.0?

A
  1. stop warfarin
  2. give 1-3mg IV phytomenadione (vit K)
  3. repeat IV phytomenadione (vit K) if INR is still to high after 24hrs
  4. restart warfarin when INR < 5.0
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16
Q

WARFARIN
how do you manage no bleeding with INR > 8.0?

A
  1. stop warfarin
  2. 1-5mg oral phytomenadione (vit K)
  3. repeat dose if INR still too high after 24hrs
  4. restart warfarin when INR < 5.0
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17
Q

WARFARIN
how do you manage minor bleeding with INR 5.0-8.0?

A
  1. stop warfarin
  2. give 1-3mg IV phytomenadione (vit K)
  3. restart warfarin when INR < 5.0
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18
Q

WARFARIN
how do you manage no bleeding with INR 5.0-8.0?

A

withhold 1 or 2 doses of warfarin
reduce subsequent maintenance dose

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19
Q

WARFARIN
what is some important patient information?

A
  • requires contraception if child-bearing age
  • know signs of over coagulation
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20
Q

DIGOXIN
what is the monitoring?

A
  • not routinely monitored unless in suspected toxicity
  • if toxicity is suspected, digoxin concentrations are measured within 8-12hrs (at least 6hrs after) of the last dose
  • monitor renal function in renal impairment
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21
Q

DIGOXIN
what are the features of digoxin toxicity?

A
  • generally unwell
  • lethargy
  • N&V
  • anorexia
  • confusion
  • yellow-green vision
  • arrythmias
  • gynaecomastia
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22
Q

DIGOXIN
what can precipitate digoxin toxicity?

A
  • hypokalaemia
  • increasing age
  • renal failure
  • MI
  • hypomagnesaemia, hypercalcaemia, hypernatremia, acidosis
  • hypothermia
  • hypothyroidism
  • drugs
  • hypoalbuminaemia
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23
Q

DIGOXIN
what drugs can precipitate toxicity?

A
  • amiodarone
  • quinidine
  • verapamil
  • diltiazem
  • spironolactone
  • ciclosporin

drugs with cause hypokalaemia
- thiazides
- loop diuretics

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24
Q

DIGOXIN
how do you manage toxicity?

A
  1. stop digoxin
  2. correct arrhythmias
  3. monitor potassium
  4. digibind
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25
LITHIUM what is the range for lithium concentration?
0.4-1 mmol/L
26
LITHIUM when should you measure lithium concentration?
12 hours post dose measure weekly until dose stabilised and then every 3 months
27
LITHIUM what are the monitoring requirements?
BEFORE TREATMENT - ECG EVERY 6 MONTHS - U&Es - renal function - calcium - TFTs - BMI
28
LITHIUM what are the side effects?
- N&V - diarrhoea - nephrotoxicity - hypothyroidism - weight gain - idiopathic intracranial hypertension - leucocytosis - hyperparathyroidism + hypercalcaemia
29
LITHIUM what are the interactions?
RAISE LITHIUM CONCENTRATION - ACE inhibitors - diuretics - NSAIDs REDUCE CONCENTRATION - movicol
30
LITHIUM what is it important to note when prescribing lithium?
should prescribe by brand
31
LITHIUM what concentrations does toxicity occur at?
typically >1.5 mmol/L
32
LITHIUM what may precipitate lithium toxicity?
- dehydration - renal failure - diuretics (especially thiazides) - ACEi / ARBs - NSAIDs - metronidazole
33
LITHIUM what are the features of lithium toxicity?
- coarse tremor - hyperreflexia - acute confusion - polyuria - seizure - coma
34
METHOTREXATE how is it prescribed?
- once weekly - folic acid 5mg on a different day it is omitted in acute infection or AKI
35
METHOTREXATE what is the monitoring?
BEFORE TREATMENT - FBC - U&Es - LFTs - CXR recommended repeated weekly until dose stabilised then every 2-3 months
36
METHOTREXATE what are the interactions?
- aspirin - ciprofloxacin - clozapine - corticosteroids - penicillins - NSAIDs - trimethoprim + co-trimoxazole
37
METHOTREXATE what are common prescription errors?
- wrong dose interval (ONCE WEEKLY) - failure to prescribe folic acid (5mg) - failure to specify tablets (supply in 2.5mg) - wrong length of supply (8-12 weeks before review) - prescribing trimethoprim alongside - failure to monitor blood tests - failure to omit during acute infection or AKI
38
METHOTREXATE what are the signs of toxicity?
- lymphopenia - thrombocytopenia - pallor - N&V - GI bleed - dysuria/anuria
39
METHOTREXRATE what is the management of toxicity?
- stop methotrexate - consult haem/toxicologist - give folinic acid
40
POTASSIUM what is the maximum concentration of potassium for IV infusion?
40 mmol/L
41
POTASSIUM what is the the maximum rate of infusion for potassium?
10 mmol/hr
42
GENTAMICIN how are doses calculated?
using actual body weight (ABW) unless patient's weight is >20% heavier than ideal body weight (IBW) then IBW is used dose is 5mg/kg/day
43
GENTAMICIN when are the peak and trough levels taken?
peak = 1 hour after administration trough = just before next dose
44
GENTAMICIN how would you alter the dose if the trough level is too high?
the interval between the doses should be increased
45
GENTAMICIN how would you alter the dose if the peak level is too high?
the dose should be increased
46
GENTAMICIN what are the side effects?
- ototoxicity - nephrotoxicity
47
GENTAMICIN what are the contraindications?
myasthenia gravis
48
VANCOMYCIN what can occur with rapid infusion of vancomycin?
vancomycin flushing syndrome - an erythematous rash that occurs on face, neck and upper torso
49
VANCOMYCIN when should levels be measured?
after 36-72hrs (after 3-6 doses)
50
PHENYTOIN when should phenytoin levels be monitored?
- do not need to be routinely monitored trough levels immediately before dose should be checked if: - adjustment of phenytoin dose - suspected toxicity - detection of non-adherence
51
BISPHOSPHONATES what are the side effects?
- oesophagitis - osteonecrosis of the jaw - increased risk of atypical stress fractures - acute phase response (fever, myalgia + arthralgia)
52
BISPHOSPHONATES what is the patient advice for taking bisphosphonates?
- should be swallowed on an empty stomach - should be sitting or standing for 30 mins after - should be taken at least 30 mins before breakfast (or other oral medication)
53
BISPHOSPHONATES should you prescribe calcium and vitamin D alongside bisphosphonates?
- calcium should only be prescribed if dietary intake is inadequate - vitamin D supplements are normally given
54
BISPHOSPHONATES when should they be stopped?
stop after 5 yrs if the following apply - <75 yrs old - femoral neck T-score >-2.5 - low risk according to FRAX/NOGG
55
STATINS what are the side effects?
- myopathy - liver impairment - increased risk of intracerebral haemorrhage in pts who have already had a stroke
56
STATINS what are the risk factors for myopathy?
- advanced age - female - low BMI - presence of multisystem disease e.g. DM
57
STATINS what are the contraindications?
- macrolides (erythromycin + clarithromycin) = statins must be stopped during macrolide antibiotic treatment - pregnancy
58
STATINS what doses are given?
primary prevention = 20mg OD secondary prevention = 80mg OD
59
STATINS when should you advice patients to take statins?
at night
60
PENICILLINS which antibiotics contain penicillin?
- phenoxymethylpenicillin - benzylpenicillin - flucloxacillin - amoxicillin - ampicillin - co-amoxiclav (augmentin) - co-fluampicil (magnapen) - piperacillin with tazobactam (tazocin) - ticarcillin with clavulanic acid (timentin)
61
PENICILLIN if a person is allergic to penicillin, which other type of antibiotic are they more likely to be allergic to as well?
cephalosporins
62
CORTICOSTEROIDS what are the side effects?
STEROIDS - Stomach ulcers - Thin skin - oEdema - Right and left heart failure - Osteoporosis - Infection (including candida) - Diabetes (commonly causes hyperglycaemia) - cushing's Syndrome
63
CORTICOSTEROIDS what are the sick day rules?
double doses of corticosteroids during illness
64
CORTICOSTEROIDS what is some important information to tell patients?
do not suddenly stop taking corticosteroids
65
ACE INHIBITORS what are the side effects?
- cough - AKI - hyperkalaemia - first dose hypotension
66
ACE INHIBITORS what are the contraindications?
- avoid in pregnancy/breastfeeding - renovascular disease - aortic stenosis - hyperkalaemia
67
ACE INHIBITORS what is the monitoring?
U&Es before treatment starts + after increasing dose acceptable changes - up to 30% increase of creatinine from baseline - potassium increase up to 5.5mmol/L
68
ARBs what is the monitoring?
U&Es before treatment + after dose increase
69
CCBs what are the side effects?
- flushing - ankle swelling - bradycardia - hypotension - constipation (verapamil)
70
CCBs what medication should verapamil not be given alongside?
beta-blockers as it may cause heart block
71
THIAZIDE DIURETICS what are the side effects?
- dehydration - postural hypotension - hypokalaemia - hyponatraemia - hypercalcaemia - gout - impaired glucose tolerance - impotence
72
LOOP DIURETICS what are the side effects?
- hypotension - hyponatraemia - hypokalaemia - hypomagnesaemia - ototoxicity - hypocalcaemia - renal impairment (from dehydration _ direct toxic effect) - hyperglycaemia - gout
73
SPIRONOLACTONE what is a side effect specific to spironolactone?
gynaecomastia
74
75
ASPIRIN what are the side effects?
- haemorrhage - peptic ulcers - gastritis - tinnitus in large doses
76
DIGOXIN what are the side effects?
- N&V - diarrhoea - blurred vision - confusion + drowsiness - yellow/green vision (with halo vision)
77
AMIODARONE what are the side effects?
- interstitial lung disease (pulmonary fibrosis) - thyroid disease (both hypo/hyper) - skin greying - corneal deposits
78
NSAIDS what are the side effects?
NSAID - No urine (renal failure) - Systolic dysfunction (heart failure) - Asthma - Indigestion (any cause) - Dyscrasia (clotting abnormality)
79
which drugs have a narrow therapeutic range?
- warfarin - digoxin - phenytoin
80
which drugs cause hypertensive crisis?
monoamine oxidase inhibitors (e.g. phenelzine)
81
which drugs cause sedation?
- barbiturates - opioids - benzodiazepines
82
which medications cause sweating, flushing, nausea and vomiting?
metronidazole disulfiram
83
ANTICOAGULANTS how is LMWH monitored?
anti-factor Xa
84
ANTICOAGULANTS what is the antidote for overdose of LMWH?
protamine sulphate
85
ANTICOAGULANTS what is the monitoring for unfractioned heparin?
aPTT
86
ANTICOAGULANTS what is the antidote to an overdose of unfractioned heparin?
protamine sulphate
87
ANTICOAGULANTS what is the monitoring for DOACs?
clinically monitored (for clinical signs of overcoagulation)
88
ANTICOAGULANTS what is the antidote for overdose of DOACs?
andexet alpha (for most) idarucizumab
89
ANTICOAGULANTS what is the monitoring for warfarin?
INR
90
ANTICOAGULANTS what is the antidote to overdose of warfarin?
vitamin K
91
INSULIN give an example of a rapid acting insulin?
insulin aspart (novorapid)
92
INSULIN give an example of a short acting insulin
actrapid humilin S
93
INSULIN give an example of an intermediate acting insulin
humilin I
94
INSULIN give an example of a long acting insulin
levemir lantus or toujeo tresiba
95
INSULIN give an example of a mixed biphasic insulin
humalog mix humilin M3 novomix
96
ORAL HYPOGLYCAEMICS what are the side effects of biguanides (e.g. metformin)?
- nausea - diarrhoea - lactic acidosis (take care if eGFR < 45, stop if eGFR < 30)
97
ORAL HYPOGLYCAEMICS what is the effect of metformin on weight?
neutral
98
ORAL HYPOGLYCAEMICS what are the side effects of sulphonylureas (e.g. gliclazide)?
hypoglycaemia
99
ORAL HYPOGLYCAEMICS what is the effect of sulphonylureas (e.g. gliclazide) on weight)
increase weight
100
ORAL HYPOGLYCAEMICS what are the side effects of pioglitazone?
- oedema - heart failure - post-menopausal OP - bladder cancer
101
ORAL HYPOGLYCAEMICS what is the effect of pioglitazone on weight?
increases weight
102
ORAL HYPOGLYCAEMICS what are the side effects of DPP4i (e.g. sitagliptin)?
- pancreatitis - nasopharyngitis
103
ORAL HYPOGLYCAEMICS what is the effect of DPP4i (e.g. sitagliptin) on weight?
neutral
104
ORAL HYPOGLYCAEMICS what are the side effects of SGLT-2i (-gliflozins)?
- euglycemic DKA - genital infections
105
ORAL HYPOGLYCAEMICS what is the effect of SGLT-2i (-gliflozins) on weight?
neutral
106

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