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What is Carbimazole used for?


Report any sore throat, ulcers, fever, malaise, bleeding with Carbimazole


What is the difference between:



Blood Dyscrasias

Agranulocytosis: WBC's go down; sore throat, fever, malaise all symptoms

Thrombocytopenia: Platelets go down: blood very thin: unexplained bleeding/ bruising. Can be from Heparins

Blood Dyscrasias: Entire blood profile goes down; symptoms of both of the above, this is why we report both sets of symptoms with some drugs


What is the loading dose of Amiodarone?

200mg TDS for 7 days

200mg BD for 7 days

Then 200mg OD from there on (maintenance)

Why load? Long half life (50 days) means it would take ages to reach therapeutic levels. Also means interactions can still occur months after stopping.


Symptoms of Aspirin Overdose (5)








Why is rifampicin considered High Risk do you think?

(Rifampicin is one of the TB drugs)

Many interactions- as it is an enzyme Inducer, it induces ALL of the CYP enzymes: decreases efficacy of COC's

HEPATOTOXIC: Monitor LFTs, counsel on liver toxicity signs, stop if:

Persistent Nausea

Also colours urine/ body fluids/ soft contact lenses red/ orange


What monitoring is needed with Rifampicin?

LFT's before starting- continue to monitor if on prolonged therapy

Renal function before starting

FBC if on prolonged therapy



Which class of antibiotics do we need to use with caution in EPILEPTICS?


Ciprofloxacin, Levofloxacin

These lower seizure threshold! 

Particularly if used with theophylline


Why do we need to check albumin levels with warfarin?

Warfarin is highly protein bound to albumin- if this is low there may be issues transporting it round the body

need to monitor both renal and liver function with warfarin 


People stable on warfarin- how often is INR checked?

Every 3 months


Unless changes in clinical status occur e.g. diarrhoea and vomitting 


What (quite unpleasant) side effects are associated with Amiodarone use, what signs should patients look out for? (7)

Nausea and vomitting and taste disurbance

Thyroid function- Hypo and Hyperthyroidism through action of IODINE in the drug

Phototoxic skin reactions: burning sensation, erythema, slate grey skin discolouration

Pulmonary toxicity- persisitent SOB/ Cough

Tremor- peripheral neuropathy- numbness in hands and feet

Corneal microdepositis in eyes- dazzled by headlights- common SE: this is reversible once drug stopped 

Liver toxicity: Jaundice



What 5 things need monitoring at baseline with Amiodarone?

LFT's- Hepatotoxicity a risk

THYROID FUNCTION- hyper/hypothyroidism 

Serum Potassium!!!! before starting

Chest X-ray- pulmonary toxicity

ECG with IV use

LFT's and TFT's need monitoring after 6 months too!


What is Amiodarone used for?

Treatment of

Both supraventricular and ventricular Arrhythmias

Ventricular fibrilation, ventricular tachycardia

Usually used when other drugs failed as quite a nasty drug

Rhythm control as part of pharmacological cardioversion in AF


Methotrexate inhibits dihydrofolate reductase and therefore reduces folate in the body. What drug has to be given with methotrexate as supplementation to prevent its nasty side effects, and when?

For prevention of methotrexate induced horrible side effects in Chron's/ RA:

Folic acid 5mg ONCE WEEKLY- dose to be taken on a DIFFERENT DAY to methotrexate


Methotrexate may lead to blood disorders (most significantly neutropenia and increased infection risk) through BONE MARROW SUPPRESSION. Its anti- folate propertied may explain how it suppresses bone marrow...

Bone marrow is where the body creates new cells. Cell division requires folate in order to occur. 

 Since folate deficiency limits cell division, erythropoiesis, production of red blood cells, WBC, neutrophils etc is suppressed in the bone marrow when methotrexate is taken as it is anti- folate. This is the same story as with Trimethoprim/ Co- trimoxazole and Phenytoin as these are also anti-folate- Avoid use together! 

Production of RBC's being hindered also leads to megaloblastic anemia, which is characterized by large immature red blood cells that cannot divide. 


What monitoring does Methotrexate require?

Renal function


FBC (due to blood disorder risk)

These should be 1-2 weekly until dose stabilised then 2-3 monthly thereafter

Exclude pregnancy- pregnancy test before starting?

Avoid in hepatic impairment and reduce dose in renal impairment unless severe- then avoid. 


What is Methotrexate used for?

Main use in:

Rhumatoid Arthritis

Severe Chron's (Inflammatory Bowel Disease)

Severe Psoriasis

It is cytotoxic- stops cell division- part of chemotherapy 



What are the Methotrexate warning signs 

Blood disorder: Bone marrow suppression- sore throat, ulcers, fever, rash

Liver toxicity- N&V, abdominal pain, dark urine, Jaundice

Gastro-intestinal toxcitiy: stomatitis, GI upset (sore mouth first symptom)

Pulmonary Toxicity- persistent SOB, cough

PREGNANCY & Breastfeeding- its anti-folate so avoid!!- contraception needed during treatment  and for 3 months after stopping



What OTC med's can increase the risk of Methotrexate toxicity?

Reduce methotrexate excretion in kidney 

As do penicillins!


A patient comes in complaining of mouth sores, they think it may be cold sores. After further questioning you find out they are on Methotrexate. What do you do?

Advise they seek medical attention ASAP

Mouth sores may be a sign of stomatitis (inflammation of mouth) which is the first sign of Gastro-intestinal toxicity associated with Methotrexate!


A patient asks for some Lozenges as they are experiencing a very sore throat. You find out they are on Methotrexate. What do you do?

Seek medical attention ASAP

Sore throat is most common side of blood disorders with Methotrexate


Patients can sometimes overdose on Methotrexate as they get confused that it is Just once weekly dosing. What are the symptoms? what is methotrexate toxicity treated with?

Renal impairment

Liver impairment

Headache, seizures, coma

Treatment: FOLINIC ACID- rescues normal cells from methotrexate effects



What happens when Baclofen (used for pain of muscle spasms in palliative care/ trauma) is suddenly withdrawn? What if it is given with ACE inhibitors or Beta blockers?

Suddenly withdrawn: hyperactivity, hyperthermia, hallucinations, convulsions

Enhanced Hypotensive effects with ACEi/ Beta blockers


Which NOAC is contra-indicated in patients with a Prosthetic valve?





What needs monitoring with Vancomycin (4)?

Full blood count: can cause both LOW PLATELETS and LOW NEUTROPHILS (Neutropenia)

Renal function- Nephrotoxic- Urinalysis, CrCl used for dosing

Hearing function in the elderly 

Plasma concentration


What needs monitoring with Gentamicin?

Renal function 

Hearing function

Plasma concentration

NB: differs to vancomycin as do not need to monitor FBC- does not cause neutropenia/ low platelets 


Which antihypertensive drugs require the SAME BRAND to be maintained?



(Both CCB's)


Which CCB cannot be used in both Supraventricular and Ventricular arrhythmias?


Used for Supraventricular only


Verapamil NOT to be used in Ventricular Arrhythmias


Ciclosporin (an immunosuppressant drug) has many interactions. This is because it is toxic to many organs, so any drug effecting each of those organs will be contra-indicated with ciclosporin use. What toxicitys can it cause (5)?

Neurotoxicity (CNS- tremor, convulsions, encephalopathy)

Liver toxicity (jaundice, N&V, abdo pain, dark urine)

Nephrotoxicity (kidney)

Blood toxicity/ disorders (fever, sore throat, ulcers, bleeding)

Hypertension- BP needs monitoring regularly

Patient should report any of these signs