Essentials Flashcards
1
Q
CYP3A4 inhibitors
A
SEV =
Azole antifungals (ketoconazole, itraconazole SEV, fluconazole MOD), Macrolides (Clarythromycin, Erythromycin), Protease inhibitors (Ritonavir, Nirmatrelvir-Ritonavir aka Paxlovid)
MOD = Amiodarone, rlCCBs, Ciprofloxacin, Cimetidine, Ciclosporin, Grapefruit juice
WEAK = Buprenorphine, Cimetidine, Omeprazole, Ranolazine, Tacrolimus, Ticagrelor, Valproic acid, Amlodipine, Azithromycin
2
Q
CYP3A4 inducers
A
SEV = Rifampicin, Phenytoin, Carbamazepine
MOD = St. John’s Wort, Glucocorticoids, Topiramate, Primidone, Barbiturates, Clobazam
3
Q
CYP3A4 substrates
A
Sensitive = Statins, Losartan, CCBs (rlCCBs, Amlodipine, Felodipine, Nifedipine)
TCAs, Z-drugs, Warfarin, Amiodarone, Domperidone, Ondansetron, Propranolol, Chlorphenamine, Donepezil
Sex steroids (Finas, Estra, Ethin, Prog, Test)
BZDs (Dia, Mida, Clona)
Steroids (Dex, Hydro, Flutic, Bude)
Antidepressants (Sert, Cital, Mirtaz, Venla, Traz)
Antipsychotics (Halo, Aripip, Risp, Quet)
Opioids (Al/Fent, Bupr, Code, Methadone, Tram)
Montelukast, Salmeterol, Lidocaine, Eplerenone, Sildenafil, Tadalafil
4
Q
Paracetamol doses
A
All q4-6h
Calpol infant 2m-6y 120mg/5mL
2-3m >4kg >37w 2.5mL (60mg)
3-6m 2.5mL (60mg)
6-24m 5mL (120mg)
2-4y 7.5mL (180mg)
4-6y 10mL (240mg)
Calpol 6+ 250mg/5mL
6-8y 5mL (250mg)
8-10y 7.5mL (375mg)
10-12y 10mL (500mg)
12-16y 10-15mL (500-750mg)
16+ 10-20mL (500-1000mg)
5
Q
Paracetamol dose reductions
A
<50kg = 500mg max dose
Renal (<30mL/min) + IV = 1g q6h
Hepatic = 1g TDS (500mg TDS I’d also <50kg)
6
Q
How much stronger is sublingual fentanyl than oral morphine
A
PO Morphine 10mg : SL Fentanyl 100mcg
100 X Stronger
7
Q
Dose conversion between PO Morpine and SC/IV
A
PO Morphine 10mg : SC/IV Morphine 5mg
2 X Stronger
8
Q
Converting PO Morphine to Codeine / Dihydrocodeine / Tramadol
A
PO Morphine 10mg : 100mg of each
10 X Stronger
9
Q
Morphine to Codeine / Dihydrocodeine / Tramadol
A
PO Morphine 10mg : 100mg of each
10 X Stronger
10
Q
Morphine to Oxycodone
A
PO Morphine 10mg : PO Oxycodone 6.6mg
1.5 X Stronger
To SC/IV Oxycodone 5mg so 2 X Stronger
11
Q
Safest opioid in pregnancy and breastfeeding
A
Dihydrocodeine
12
Q
Opioid affecting seizures
A
Tramadol
13
Q
Ibuprofen dosing
A
100mg/5mL
1-2m 5mg/kg TDS-QDS
3-5m 2.5mL (50mg) >5kg TDS only use for 24h
6-12m 2.5mL (50mg) TDS-QDS only use for 72h
1-3y 5mL (100mg) TDS
4-6y 7.5mL (150mg)
7-9y 10mL (200mg)
10-11y 15mL (300mg)
12+ 15-20mL (300-400mg) TDS-QDS
14
Q
Drugs that make your urine blue or green
A
Amitriptyline
Cimetidine
Indometacin
Promethazine
15
Q
Drugs that turn your urine brown
A
Metronidazole
Nitrofurantoin
Phenytoin
16
Q
Drugs that turn your urine orange
A
Rifampicin
Sulfasalazine
17
Q
Drugs that turn your urine pink
A
Doxorubicin
Daunorubicin
Nefopam
Phenytoin
18
Q
Drugs that turn your urine yellow
A
Nitrofurantoin
Senna
Sulfasalazine
Tolcapone
Vitamin B
19
Q
Drugs that turn your urine red
A
Co-danthramer
Chlorpromazine
Doxorubicin
Daunorubicin
Entacapone
Levodopa
Rifampicin
Rifaximin
Senna
20
Q
Adrenaline dosing in anaphylaxis
A
<6m 100-150mcg
6m-5y 150mcg
6-11y 300mcg
12-17y 500mcg (300mcg if pre-puberty)
Adult 500mcg
Into the upper thigh
Repeat dose 5mins later, call 999 after 10mins and keep giving doses until requirement met
21
Q
Ultra rapid insulins
A
Fiasp (Aspart) flextouch
Lyumjev (Lispro) Kwikpen
22
Q
Rapid acting insulins
A
Novorapid (Aspart) flexpen
Humalog (Lispro) Kwikpen 100/200
Apidra (Glulisine) solostar
23
Q
Short acting insulin
A
Soluble human insulins:
Actrapid flex pen/ vial
Humulin S vial
24
Q
Intermediate acting insulin
A
Isophane insulins:
Innolet (Insulatard)
Humulin I Kwikpen
25
Long acting insulins
Levemir (Detemir) flexpen
Lantus (Glargine) solostar
Abasaglar (Glargine) kwikpen
Tresiba (Degludec) flextouch 100/200
Toujeo (Glargine) solostar 300
26
Biphasic insulins
Novomix 30 (isophane 30/aspart 70) Flexpen
Humalog mix 25 (lispro 25/ protamine lispro 75) Kwikpen
Humalog mix 50 (lispro 50/ protamine lispro 50) Kwikpen
27
Opioids reversal agent
Naloxone
28
Benzodiazepines reversal agent
Flumenazil
29
Heparin reversal agent
Protamine sulfate
30
Aspirin reversal agent
Platelet concentrate infusion
Or desmopressin
31
Warfarin reversal agent
Vitamin k aka phytomenadione
32
DOACs reversal agent
Adexanet alfa for Apixaban Edoxaban and Rivaroxaban
Idarucizumab for Dabigatran
33
Paracetamol reversal agent
N-Acetylcysteine
34
N-Acetylcysteine dosing for paracetamol overdose
150mg/kg 1h then 50mg/kg 4h then 100mg/kg 16h
35
What is the licensed minimum age for Pseudoephedrine
12+
36
What is the licensed minimum age for Guaifenisin
2+
37
What is the licensed minimum age for
Benzocaine ear drops
2+
38
What is the licensed minimum age for Otrivine (Xylometolazine) for nasal congestion
6+
39
What is the licensed minimum age for sodium bicarbonate ear drops for ear wax
5+
40
What is the licensed minimum age for sodium cromoglicate eye drops for allergic conjunctivitis
2+
41
What is the licensed minimum age for carbomer eye gel for dry eyes
2+
42
What is the licensed minimum age for Anbesol and EMLA formulations of Lidocaine
Anbesol 5months +
EMLA 3months +
43
What is the licensed minimum age for bonjela
16+
choline salicylate
44
What is the licensed minimum age for aciclovir aka zovirax
All ages
45
What is the licensed minimum age for gaviscon adult
12+
46
What is the licensed minimum age for peptac
6+
47
What is the licensed minimum age for stimulant laxatives
12+
48
What is the maximum pack size of stimulant laxatives OTC
20
49
What is the licensed minimum age for peppermint oil
15+
50
What is the licensed minimum age for mebeverine
18+
51
What is the licensed minimum age for canesten and what drugs can be in canesten
16+
Fluconazole or clotrimazole
52
What is the licensed minimum age for daktarin and daktarin gold
Daktarin contains miconazole all ages
Daktarin gold is Ketoconazole 18+
53
What advice would you give OTC regarding steroid creams
Don’t use on face
54
What warning comes with emollients
Flammable
55
What is the licensed minimum age for hydrocortisone cream and ointment otc
Ointment is POM
Cream 10+
Dermacort
56
What is the licensed minimum age for eumovate cream
Clobetasone 12+
57
What is the licensed minimum age for mepyramine
Anthisan bite and sting 2+
58
What is the licensed minimum age for benzoyl peroxide
Acnecide 12+
59
What strength of ibuprofen gel is available otc and at what age
5% 12+ P med
10% POM
60
What is the licensed minimum age for hyoscine hydro bromide
Kwells 4+
61
What is the licensed minimum age for loperamide otc
Imodium 12+
62
What is the licensed minimum age for germaloids
12+
Zinc oxide and lidocaine
63
What is the licensed minimum age for anusol and HC
18+
Zinc oxide, bismuth oxide, balsam peru
HC also contains hydrocortisone and benzyl benzoate
64
What is the difference between the different benylins
Benylin (Diphenhydramine + Levomenthol) 6+
Benylin infant (glycerol) 3months+
Benylin chesty cough (Guaifenasin) 6+
Benylin dry cough and sore throat (Glycerol + Sucrose) 1+
Benylin dry cough (Dextromethorphan) 12+
65
What is the licensed minimum age for Solpadeine plus and max
Solpadeine plus (Paracetamol, Codeine, Caffeine) 12+
Solpadeine max (Paracetamol, Codeine) 12+
66
What is the licensed minimum age for nurofen
Ibuprofen 3months+
67
What is the licensed minimum age for stugeron
Cinnarazine 5+
68
What is the licensed minimum age for avomine
Promethazine 5+
69
What is the licensed minimum age for migraleve
12+
Paracetamol, Codeine, Buclizine
70
What is the licensed minimum age for Beconase nasal spray
18+
Beclometasone
71
What is the licensed minimum age for piriton
Chlorphenamine 1+
72
What is the licensed minimum age for piriteze
Cetirizine 6+
73
What is the licensed minimum age for clarityn
Loratadine 2+
74
What is the licensed minimum age for Sudafed
Pseudoephedrine 12+
75
Max Sudafed purchase otc
720mg
76
What is the licensed minimum age for difflam rinse, spray and lozenge
Benzydamine
12+ rise
6+ spray
6+ lozenge
77
What is the licensed minimum age for lemsip
Paracetamol, caffeine, phenylephrine
16+
78
What is the licensed minimum age for night nurse
Paracetamol, promethazine, dextromethorphan
79
What is carbocysteine contraindicated in
Active peptic ulceration
80
What laxative should be avoided in IBS
Lactulose as it causes bloating
81
What must be administered with isoniazid and why
Pyridixine B vitamin to reduce peripheral neuropathy
82
Which antibiotic requires visual function monitoring if treatment will last longer than 28 days
Linezolid can cause severe optic neuropathy
83
Docusate max dose
500mg daily in divided doses
Low dose is 100mg BD
High dose is 200mg BD
Never seen more than 400mg given
84
What laxative colours the urine pink
Co-danthramer
85
What Parkinson’s medicine can colour the urine a reddish-brown
Entacapone
Levodopa is just red not brown
86
Treatment with what drug can delay the need for Levodopa in parkinson’s
Selegiline
87
What Parkinson’s med is cautioned in heart failure and why
Amantadine exacerbates oedema
88
What Parkinson’s med can cause alopecia
Selegiline
89
Fat soluble vitamins
ADEK
90
Drugs that can cause Neutropenia
Aminosalicylates, phenothiazines, clozapine, valproate, carbamazepine, Ethosuximide, phenytoin, atovaquone, cefalosporins, chloramphenicol, chloroquine, ciprofloxacin, metronidazole, Sulfasalazine, carbimazole, ibuprofen, allopurinol, colchicine, methotrexate, penicillins
91
Drugs that damage the lungs
Amiodarone, ACEi, beta blockers, protamine, ergot D2 agonists, NSAIDs, methotrexate, nitrofurantoin, infliximab
92
Drugs that cause C.diff
Clindamycin, Ciprofloxacin, Co-amoxiclav, Cefalosporins, PPIs
93
Max dose of loperamide
16mg in 2 divided doses
High output stoma can be 16mg BD
94
Max dose lorazepam
2mg/24h
95
What are the risks associated with potassium permanganate tablets
For dilution then external use only in the treatment of cleansing eczematous wounds and reactions
Risk of fatal ingestion
96
What schedule is midazolam
3
97
What schedule is temazepam
3
98
What schedule is buprenorphine
3
99
What schedule is secobarbital
2
100
What schedule is phenobarbital
3
101
What schedule is primidone
3
102
Counselling point for latanoprost
Can change eye colour and reduce orbital fat making eyes look sunken in
103
Vitamin D deficiency symptoms
Thick painful joints
Bowed legs
Soft weak bones
104
What are the two stages of scalp psoriasis topical treatments
1st coal tar shampoo (T-gel, Caporsal, Alphosyl)
2nd Ketoconazole shampoo (Nizoral)
105
Which antihistamine has multiple daily dosing
Acrivastine
106
Carbocysteine contraindications
Active peptic ulcer disease
107
Carbocysteine contraindications
Active peptic ulcer disease
108
What does an inspiratory wheeze indicate
Bronchospasm
SABA / LABA
109
What does an expiratory wheeze indicate
Secretions/ mucous
Saline nebules/ carbocysteine/ acetylcysteine
110
What vaccine would a patient with Asplenia get
Pneumococcal
111
Food poisoning symptoms
Vomit, diarrhoea, malaise, intermittent recurrent GI irritation or pain
112
Cystitis symptoms
Painful urination (burning/stinging) aka Dysuria
Frequent urination polyuria for frequency not amount
Small amounts of urine aka oliguria
Dark urine
Smelly urine
113
What non-drugs does warfarin interact with
Green leafy vegetables that contain vitamin K, this includes green tea, not mint tea
Cranberry
Grapefruit
Garlic
Alcohol
Black licorice
Ginger
Ginkgo biloba
St. John’s wort
Turmeric
Omega 3 supplements
114
What dose would warrant slower steroid withdrawal
Equivalent or more than 40 mg prednisolone for longer than 1 week
115
Methotrexate supply restrictions
Only 2.5mg tablets
Dose and frequency must be on dispensing label and counselled to the patient
Extra meds like folic acid and patient counselling on them
No MDU
Counsel patient on blood disorders (sore throat, bruising, mouth ulcers), liver toxicity (N&V, Abdo discomfort, dark urine), respiratory effects (SoB)
116
Which antidepressants can lower the seizure threshold
SSRIs, TCAs, MAOi
117
Patient has bleeding gums what action to take
Do they take Amlodipine or Phenytoin known to cause gingivinal hyperplasia
If not recommend flossing to reduce bleeding
118
Drugs unsafe in Porphyria
Anabolics, Antidepressants, Barbiturates, Contraceptives, HRT, azole antifungals, NNRTIs and Protease inhibitor HIV treatments, Progestogens, Sulfonylureas, Taxanes, AEPs apart from gabas and L drugs, All non-cef UTI treatments, rlCCBs
Alcohol, Amiodarone, Artemether with lumefantrine, Chloramphenicol, Clindamycin, Erythromycin, Indapamide, Oxybutynjn, Risperidone, Spironolactone, Tamoxifen
119
Drugs that can cause lupus
Isoniazid, Hydralazine, Infliximab, Adalimumab, Etanercept, Quinidine, AEPs, Chlorpromazine, Methyldopa, Sulfasalazine,
120
Drugs that can induce migraines
Contraceptives
Heart medications
NSAIDs
Paracetamol
Analgesia
Caffeine
Triptans
Sleep aids
121
What does a cobalt allergy contraindicate
Vitamin B12 formulations made with it
122
What age are erectile dysfunction medications licensed in
All ages
123
Hypothyroidism symptoms
Fatigue, weight gain, constipation, menstrual irregularities, depression, dry skin, cold intolerance, widespread hair loss
124
Hyperthyroidism symptoms
Sweating, Goitre, hyperactivity, sleep disturbance, fatigue, palpitations, anxiety, heat intolerance, increased appetite, unintentional weight loss, diarrhoea
125
Naproxen otc age range
15-50
126
Colchicine interactions
If taking a CYP3A4 inhibitor 1/2 colchicine dose
127
From what age can threadworm be treated otc
2y
128
Which inhalers have extra fine particles
Some Beclometasone pMDI inhalers
Qvar, Kelhale
Combined Beclometasone and formoterol
Luforbec, Fostair
129
Which inhalers are good for the environment
DPIs (turbohaler, accuhaler, breezhaler, easyhaler, ellipta, genuair, handihaler, NEXThaler, spiromax)
Soft mist inhalers (Spiriva respimat)
Breath actuated (autohaler, easibreathe)
130
Lidocaine for teething otc age
5-6m brand dependent
131
Teething treatment pathway
1st self care (rub gum with clean finger, bite cool object, cuddle, reassure, remove excess saliva to avoid infection and rash)
2nd OTC paracetamol/ ibuprofen
3rd lidocaine if 6m+
132
What does Hutchinson’s sign indicate
Shingles
133
Can NSAIDs be used in preganancy
Avoid from week 20
134
Can benzydamine (Corsodyl) be used in pregame y
Avoid throughout
135
Drugs that cause Steven johnson syndrome
AEPs (category 1 and Lamotrigine)
AntiPsych (Haloperidol, Quetiapine, Risperidone)
Abx (Penicillins, Cefs, Quinn’s, Aminoglycosides)
Allopurinol
Sulfonamides (Sulfasalazine, Co-trimoxazole)
Paracetamol
NSAIDs
Contrast media
136
Differentials between Scarlet fever, chickenpox, oral thrush, hand foot and mouth disease, shingles, HSV
Chickenpox rash is disseminated (widespread) and itchy
Shingles is unilateral and confined to a dermatome aka along a nerve in a line from spine
Hand foot and mouth is only located here with low fever and oral lesions
Oral thrush can be scraped off and covers tongue like a rug
Scarlet fever is usually patches or a strawberry tongue with sandpaper disseminated rash and fever and flushing
HSV confined to small patch +/- fever
137
Licensed age for chloramphenicol otc
2y+
138
What should be monitoried with pseudoephedrine
CI <6y
CI if uncontrolled HTN, SEV Renal disease
Can cause PRES, RCVS, SJS, MI
Seek attention if SEV headache, N&V, Confusion, Seizures, Vision
139
Chlorphenamine age range
6y+
140
Medicine licensed for PCOS and Diabetes
Metformin
141
Which chemotherapy not myelosuppressive
Vinka alkaloids
142
Which chemotherapy worst for N&V
Cisplatin
143
BMI ranges
Underweight <18.5
Healthy 18.5-24.9
Overweight 25-29.9
Obese 30-39.9
Morbidly obese >40
144
What conditions does the NMS cover
Asthma, COPD
T2DM
HTN, High cholesterol, HF, ACS, AF, VTE, Stroke/TIA, Coronary heart disease
OP, Gout
Glaucoma
Epilepsy, PD
Urinary incontinence/ retention
145
Hypothyroid bloods
High TSH
Low T3/4
146
Hyperglycaemia symptoms
Excess urine polyuria
Excess thirst polydipsia
Unexplained weight loss
Excess Fatigue
Blurred vision
Nausea
Headache
Regular genital thrush infections due to glucose in urine
147
Hypoglycaemia symptoms
Excess hunger
Clamminess
Shaking
Sweating
Confusion
Coma
Nocturnal hypoglycaemia warrants dose adjustments
Sleep disturbance
Night sweats
Fatigue in morning
148
What supplements should be avoided in pregnancy
Cod liver oil has A in
Vitamin A - Retinol teratogenic
149
Patient takes methotrexate how long before conception, how long stay on contraception
6m
150
What electrolytes does bendroflumethiazide affect
Hypocalcaemia
Hyponatraemia
Hypokakaelmia
151
Long term risks of PPIs
C.diff
Fractures
Hypomagnesaemia
CAP
152
Which PPI GSL
Esomeorazole 20mg GR tabs as Nexium Control
Omeprazole 10-20mg GR caps
153
Paracetamol dose for a 4 month old child
2.5mL QDS of 120mg/5mL
154
Paracetamol dose for an 18 month old child
5mL QDS of 120mg/5mL
155
Paracetamol dose for a 1 year old child
5mL QDS of 120mg/5mL
156
Paracetamol dose for a 3.5y old child
7.5mL QDS of 120mg/5mL
157
Paracetamol dose for a child that turns 4 in a week
7.5mL QDS of 120mg/5mL
158
Paracetamol dose for a 4 year old child
10mL QDS of 120mg/5mL
159
Paracetamol dose for a 5 year old child
10mL QDS of 120mg/5mL
160
Paracetamol dose for a 6 year old child
5mL QDS of 250mg/5mL
161
Paracetamol dose for an 8 year old child
7.5mL QDS of 250mg/5mL
162
Paracetamol dose for a 9 year old child
7.5mL QDS of 250mg/5mL
163
Paracetamol dose for a 10 year old child
10mL QDS of 250mg/5mL
164
Paracetamol dose for a 12 year old child
10-15mL QDS of 250mg/5mL
165
Paracetamol dose for a 13 year old child
10-15mL QDS of 250mg/5mL
166
Paracetamol dose for a 14 year old child
10-15mL QDS of 250mg/5mL
167
Paracetamol dose for a 15 year old child that weighs 38kg
10mL QDS of 250mg/5mL
168
Paracetamol dose for a 15 year old child that weighs 50kg
10-15mL QDS of 250mg/5mL
169
Paracetamol dose for a 15 year old child that weighs 42kg
10-15mL QDS of 250mg/5mL
170
Paracetamol dose for a 16 year old child
10-20mL QDS of 250mg/5mL
171
Paracetamol dose for a 16 year old child that weighs 39kg
10mL QDS of 250mg/5mL
172
Paracetamol dose for a 17 year old child
10-20mL QDS of 250mg/5mL
173
Paracetamol dose for an 18 year old
10-20mL QDS of 250mg/5mL
174
Paracetamol dose for a 19 year old that weighs 38kg
10mL QDS of 250mg/5mL
175
Paracetamol dose for a 17 year old that weighs 50kg with a renal function of 22mL/min
10-20mL q6h of 250mg/5mL
176
Ibuprofen dose for a 12 week old child weighing 6kg
2.5mL TDS of 100mg/5mL for max 24h
177
Ibuprofen dose for a 26 week old child
2.5mL TDS-QDS of 100mg/5mL for max 72h
178
Ibuprofen dose for a 50 week old child
2.5mL TDS-QDS of 100mg/5mL for max 72h
179
Ibuprofen dose for a 9 month old child
2.5mL TDS-QDS of 100mg/5mL for max 72h
180
Ibuprofen dose for a 1 year old child
5mL TDS of 100mg/5mL
181
Ibuprofen dose for a 52 week old child
5mL TDS of 100mg/5mL
182
Ibuprofen dose for an 18 month old child
5mL TDS of 100mg/5mL
183
Ibuprofen dose for a 3.5 year old child
5mL TDS of 100mg/5mL
184
Ibuprofen dose for a 4 year old child
7.5mL TDS of 100mg/5mL
185
Ibuprofen dose for a 5 year old child
7.5mL TDS of 100mg/5mL
186
Ibuprofen dose for a 6 year old child
7.5mL TDS of 100mg/5mL
187
Ibuprofen dose for a 7 year old child
10mL TDS of 100mg/5mL
188
Ibuprofen dose for an 8 year old child
10mL TDS of 100mg/5mL
189
Ibuprofen dose for a 9 year old child
10mL TDS of 100mg/5mL
190
Ibuprofen dose for a 10 year old child
15mL TDS of 100mg/5mL
191
Ibuprofen dose for an 11.5 year old child
15mL TDS of 100mg/5mL
192
Ibuprofen dose for a 12 year old child
15-20mL TDS-QDS of 100mg/5mL
193
Ibuprofen dose for a 14 year old child
15-20mL TDS-QDS of 100mg/5mL
194
Ibuprofen dose for a 13 year old that weighs 35kg
15-20mL TDS-QDS of 100mg/5mL
195
Ibuprofen dose for a 15 year old
15-20mL TDS-QDS of 100mg/5mL
196
Ibuprofen dose for a 16 year old
15-20mL TDS-QDS of 100mg/5mL
197
A patient with AF and a mechanical valve taking Warfarin with a target INR of 3-4 has their INR checked in clinic it’s 5.5 what do you do
Hold 1-2 doses of warfarin and reduce the patients maintenance dose
198
A patient with AF and a mechanical valve taking Warfarin with a target INR of 3-4 has their INR checked in clinic it’s 7 what do you do
Hold 1-2 doses of Warfarin and reduce their maintenance dose
199
A patient with AF and a mechanical valve taking Warfarin with a target INR of 3-4 has their INR checked in clinic it’s 4.5 what do you do
Reduce maintenance dose and recheck INR
200
A patient with AF and a mechanical valve taking Warfarin with a target INR of 3-4 has their INR checked in clinic it’s 10 what do you do
Stop warfarin
Give vitamin K IV preparation Orally off label and repeat vitamin K if INR still high in 24h
Restart warfarin when INR <5
201
A patient with AF and a mechanical valve taking Warfarin with a target INR of 3-4 presents to hospital with heartburn and coffee ground vomit. They have their INR checked it’s 8 what do you do
Stop warfarin
Give IV Vit K, repeat dose in 24h if INR still high
Restart warfarin when INR <5
202
A patient with AF and a mechanical valve taking Warfarin with a target INR of 3-4 presents to hospital with heartburn and coffee ground vomit. They have their INR checked it’s 6 what do you do
Stop warfarin
Give IV Vit K STAT
Restart warfarin when INR <5
203
Warfarin loading regimen
10mg OD 2d or 5mg BD 2d
5mg OD if frail, old, low weight, liver impairment, cardiac failure, high bleed risk
AF 1-2mg OD starting slow loading over 3-4w
Once 2 INR in range 24h apart maintenance dose is 3-9mg unless AF
204
Drugs that cause Steven Johnson syndrome
Allopurinol in high doses
Antipsychotics - halo, quet, risp
Carbamazepine
Lamotrigine
Oxicam NSAIDs
Barbiturates
Sulfasalazine
Co- Trimoxazole
Paracetamol
Penicillins, Cefs, Quins, Aminoglycosides
