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Ebm Flashcards

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1
Q

How does grapefruit interact with amlodipine

A

Grapefruit increase hypotension

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2
Q

How does grapefruit interact with statins

A

Grapefruit increases muscle pain

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3
Q

How does excessive leafy green vegetables interact with warfarin

A

Excessive leafy green vegetables decrease INR

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4
Q

How does St John worts interact with contraceptives

A

St John worts increases metabolism of COC

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5
Q

Pharmacodynamic Interactions can be antagonist or synergistic

Which is the interaction between levodopa and risperidone

A

Antagonist

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6
Q

Pharmacodynamic Interactions can be antagonist or synergistic

Which is the interaction between propanolol and salbutamol

A

Antagonistic

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7
Q

Pharmacodynamic Interactions can be antagonist or synergistic

Which is the interaction between warfarin and DOACs

A

Synergistic

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8
Q

Pharmacodynamic Interactions can be antagonist or synergistic

Which is the interaction between anticoagulants and NSAIDs

A

Synergistic

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9
Q

Pharmacodynamic Interactions can be antagonist or synergistic

Which is the interaction between NSAIDs and Antiplatelet

A

Synergistic

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10
Q

Pharmacodynamic Interactions can be antagonist or synergistic

Which is the interaction between opioids and benzodiazepines

A

Synergistic

Respiratory depression

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11
Q

Describe the interaction between Ciprofloxacin and calcium supplements

And can you fix it

A

It is a pharmacokinetic interaction affecting absorption
It causes chelation

A 2 hour gap should be kept

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12
Q

Describe the interaction between phenytoin and albumin

A

It is a pharmacokinetic interaction affecting distribution

Phenytoin is protein bound so if a patient has hypoalbuminaemia, there’s more free drug resulting in toxicity

Can result in CKD, malnutrition, nephrotoxic syndrome

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13
Q

Describe an pharmacokinetic interaction that affects metabolism

A

Enzyme inducers and enzyme inhibitors

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14
Q

Give an example of an cyp2c9 inhibitor

A

Miconazole

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15
Q

What is sulphonylureas

Inducer or inhibitor?

A

CYP3A4 inducer

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16
Q

What is smoking

Inducer or inhibitor?

A

CYP3A4 inducer

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17
Q

What is carbamazepine

Inducer or inhibitor?

A

CYP3A4 inducer

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18
Q

What is rifampicin

Inducer or inhibitor?

A

CYP3A4 inducer

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19
Q

What is alcohol

Inducer or inhibitor?

A

CYP3A4 inducer

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20
Q

What is phenytoin

Inducer or inhibitor?

A

CYP3A4 inducer

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21
Q

What is Griseofulvin

Inducer or inhibitor?

A

CYP3A4 inducer

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22
Q

What is phenobarbital

Inducer or inhibitor?

A

CYP3A4 enzyme inducer

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23
Q

What is cimetidine

Inducer or inhibitor?

A

CYP3A4 inhibitors

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24
Q

What is Azoles

Inducer or inhibitor?

A

CYP3A4 inhibitors

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25
What is antibiotics Inducer or inhibitor?
CYP3A4 inhibitors
26
What is grapefruit Inducer or inhibitor?
CYP3A4 inhibitors
27
What is omeprazole Inducer or inhibitor?
CYP3A4 inhibitors
28
What is sodium Valporate Inducer or inhibitor?
CYP3A4 inhibitors
29
Name a pharmacokinetic interaction that affecting elimination
Digoxin and verapamil
30
What are 5 ways in which drug interactions can be managed
1. Switch one of the potentially interacting drugs 2. Minimise the interaction by leaving 2-3 hours between the drugs 3. Alter the dose of one of the drugs 4. Increase monitoring 5. Mitigate the risks e.g. providing GI Protection
31
DOACs are high risk drugs, what is their MOA
Direct selective reversible inhibitor of factor xa
32
DOACs are high risk drugs, which DOAC has side effects of a headache
Rivaroxaban
33
What are the 4 side effects associated with all DOACs
Anaemia Haemorrhage Nausea Skin reactions
34
What are the contraindications of DOACs A A H R G R
Active bleeding Anti-phospholipid syndrome High risk malignancies Recent brain and spine injury GI ulcers Recent surgeries
35
What is the MHRA warning for DOACs
Recognise signs and symptoms of bleeding - bruising - blood in stools or vomit -Prolonged bleeding -Gingival bleeding - coffee ground vomit - Heavier menstrual cycle
36
Who must you never give DOACs to
People with antiphospholipid syndrome
37
Describe the diagnosis and treatment of VTE
1. Look at the wells score, if 2 points or more than DVT is likely 2. A proximal leg vein ultrasound should be done within 4 hours > positive= DVT = start anticoagulant > negative = do d-dimer test 3. If d-dimer test is positive = start anticoagulant
38
39
Describe the diagnosis and treatment of pulmonary embolism
1. If wells score is more than 4 2. Send patient to CT pulmonary angiogram, give interim anticoagulant while waiting 3. If CTPA positive = diagnose PE If CTPA negative = do proximal leg vein ultrasounds
40
When giving warfarin what must you do
Bridge with low molecular weight heparin
41
If a patient requires a DOAC but is renally impaired or has cancer, what would be appropriate
Apixaban Rivaroxaban For 5 days
42
What are the key interactions of DOACs
DOACs metabolised by CYP3A4 enzyme and transported by p-gp so inhibitors increase bleeding risk and inducers decrease conc of DOACs Other anticoagulants NSAIDs SSRI, SNRI
43
Which NSAIDS have the greatest GI risk
THINK PKK piroxicam, ketoprofen, ketoraolac
44
Which NSAIDS have an intermediate GI risk There’s 4
indometacin diclofenac naproxen high dose ibuprofen 2.4g od
45
How do you decrease the GI risk of NSAIDs
Taking one NSAID at a time Do not use it in combination with aspirin or alcohol Use selective COX 2 inhibitors
46
Which NSAIDS have the highest risk of heart attack and stroke
COX 2 inhibitors
47
Which NSAID is neutral and so has a lower thrombotic risk
Naproxen
48
Does low dose ibuprofen(1.2g or less daily) increase the risk of myocardial infarction
No, it does not increase MI risk
49
What is MHRA warning of NSAIDS
Not suitable for pregnancy after 20 weeks due to oligohydramnios and constriction of ductus arteriosus
50
What are the key interactions of NSAIDs A A A D M L C S C
Anticoagulant Alcohol ACEi, ARBs Diuretics Methotrexate Lithium Corticosteroids SSRIs Cyclosporin
51
Chemotherapy agents are described as narrow therapeutic drugs. What does this mean
little difference between therapeutic dose and toxicity
52
What are the common side effects of chemotherapy agents E O T H B A
Extravasation of IV drugs Oral mucositis Tumour lysis syndrome Hyperuricaemia Bone marrow suppression Alopecia
53
How do you prevent oral mucositis caused by fluorouracil, methotrexate and anthracyclines
Good oral hygiene Sucking on ice chips
54
How do you prevent hyperuricaemia caused by chemotherapy
Give allopurinol or rasburicase
55
What are the key interactions of chemotherapy
Live vaccines e.g. nasal flu vaccine, typhoid, BCG, Varicella Increased anticoagulant effect e.g. DOACs CYP450 inducers and inhibitors
56
What are the MHRA warnings for Vinca Alkaloids
Should not be given via IV
57
What MHRA warning is associated with Doxorubicin
Formulations are not bioequivalent and can be fatal
58
What are the red flag symptoms associated with methotrexate
Sore throat Rash —> leukopenia, thrombocytopenia, increased infection risk
59
What is MHRA warning and advise associated with methotrexate
Patients should be advised to take it ONCE WEEKLY, not daily Photosensitivity Avoid exposure to UV light at 11am-3om Use SPF 50 and wear protective clothing
60
Blood count and bone marrow suppression is a caution for methotrexate, what are the risk factors for this How do you handle this caution
Risk factors are advanced age, renal impairment, using trimethoprim Methotrexate should be withdrawn if WBC or platelet count is reduced significantly
61
GI toxicity is a caution for methotrexate, what are the risk factors for this How do you handle this caution
Risk factors are stomatitis and diarrhoea Withdrawal treatment
62
Photosensitivity is a caution for methotrexate, what are the risk factors for this
Those with psoriasis as it can worsen
63
Liver toxicity is a caution for methotrexate, what are the risk factors for this How do you treat/prevent this
Risk factor = those with liver cirrhosis Do LFT before starting to make sure liver function is normal
64
Pulmonary toxicity is a caution for methotrexate, what are the risk factors for this How do you treat/prevent this
Risk factors = special concern in those with RA Do X Rays and monitor for dyspnoea, cough, fever Discontinue if pneumonia is suspected
65
What are the key interactions for methotrexate N A T L
NSAIDs Antibiotics Trimethoprim Live vaccines
66
What are the common side effects of Valporate [4]
Nausea Weight gain Drowsiness Hair loss
67
What are the 3 severe side effects associated with Valporate
Liver toxicity Pancreatitis Thrombocytopenia
68
What is the management of side effects caused by Valporate
Gradual withdrawal
69
What is MHRA warning and advice for sodium Valporate
Teratogenic and thrombocytenia Advise - men should use condoms even 3 months after treatment cessation - sore throat is a side of thrombocytenia - must given in its original packet - not given to men under 55 - appropriate contraceptives = IUD, Depoprovera - no sperm donation - abrupt withdrawal —> status epilepticus
70
What monitoring is done for a patient on Valporate
LFT = at start and 6 months FBC = Pre treatment and pre surgery
71
3 contradictions for Valporate A S M
Acute porphyria Severe hepatic dysfunction Mitochondrial disorders
72
5 interactions with Valporate
Carbamazepine, phenytoin = enzyme inducers so reduce conc of Valporate Increased exposure of lamotrigene Alcohol and LMWH = increased hepatotoxicity

High Risk Drugs (2 decks)

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