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High risk drugs Flashcards

(43 cards)

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1
Q

what are the monitoring requirements for vancomycin?

A 
FBC
Serum potassium
Auditory function 
Renal function
Urinalysis
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2
Q

What is the Target serum concentration for vancomycin?

A

10 - 15 mg/L for normal infection

15-20 mg/L for more serious infections

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3
Q

What are the warning sings of vancomycin?

A 
Ototoxicity
Nephrotoxicity 
Hypokalaemia 
Thrombophlebitis 
Red man syndrome 
Blood disorders such as thrombocytopenia or neutropenia
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4
Q

What are common interactions of vancomycin?

A

Increased risk of nephrotoxicity and ototoxicity if given with gentamicin, loop diuretics or ciclosporins

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5
Q

What bacteria is vancomycin commonly used against?

A

Gram positive aerobic and anaerobic bacteria including MRSA

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6
Q

What bacteria is gentamicin commonly used against?

A

Pseudomonas aeruginosa

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7
Q

What are the serum gentamicin concentration targets for single dose and multiple dose treatments?

A

Single dose:

  • Peak is 5 -10mg/L
  • Trough is <2mg/L

Multiple dose:

  • Peak is 3-5mg/L
  • Trough is <1mg/L
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8
Q

What are the common warning signs of gentamicin?

A 
Nephrotoxicity 
Ototoxicity 
Thrombophlebitis 
Nausea and Vomiting 
C. Diff 
Blood disorders
Seizures
Peripheral neuropathy
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9
Q

What are the common interactions of gentamicin?

A

Increased risk of ototoxicity with loops and vancomycin

Increased risk of nephrotoxicity with ciclosporin, platinum chemotherapy, cephalosporins or vancomycin

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10
Q

In which patients should amiodarone be avoided?

A

Heart block
Hypotension
Active thyroid disease

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11
Q

What are the monitoring requirements of amiodarone?

A

LFT before starting treatment and every six month
Thyroid levels before starting treatment and every six month
Renal function
Chest X-ray
Serum K/Mg levels- can result in hyper
Eye test once a year

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12
Q

What are the warning signs of amiodarone?

A 
Hypo/Hyper thyrodism 
Skin toxicity i.e. burns or grey skin discolouration 
Phototoxicity 
SOB 
Liver disease 
Neuropathy 
Bradycardia
Taste disturbances
N/V
Sleep disorders
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13
Q

What are the usual therapeutic doses of digoxin?

A 
AF= 125-250mcg OD
HF= 62.5-125mcg OD
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14
Q

What are the target serum concentration of digoxin?

A

1 to 2 mcg

Dose measured after 6hrs of administration

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15
Q

What are the monitoring requirements of digoxin?

A 
Electrolytes (hypo Mg/K/Ca can increase the risk of digoxin toxicity)
Liver function 
Kidney function 
Heart rate (can't fall below 60 Bpm)
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16
Q

What are the warning sings of digoxin?

A 
GI disturbances i.e. NV
Visual disturbances i.e. yellow vision
Bradycardia 
Rash 
Dizziness
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17
Q

What conditions are CI with digoxin?

A

Second-degree Heart block
Intermittent complete heart block
Ventricular arrhythmias

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18
Q

What drugs interact with digoxin can result in increased risk of hypokalaemia ?

Study These Flashcards
A

Loops and thiazide diuretics

19
Q

What drugs interact with digoxin can result in increased digoxin toxicity?

Study These Flashcards
A

Amiodarone
CCB
Spironolactone
Quinine

20
Q

What is phenytoin serum concentration target?

21
Q

What are the monitoring requirements of phenytoin?

Study These Flashcards
A

Liver function because phenytoin is highly protein bound
Vitamin D- phenytoin increases metabolism of vitamin D
FBC
Serum concentration
Phenytoin is an antifolate so folate concetration

22
Q

What are the toxicity signs of phenytoin?

Study These Flashcards
A 
CV collapse
Respiratory depression
Suicidal thoughts
Skin disorders
Blood disorders
Nystagmus 
Ataxia 
Low vitamin D- can result in osteomalacia "softening of the bones"
Slurred speech
Diplopia
Slurred speech
23
Q

What is carbamazepine serum concentration target?

Study These Flashcards
A

4-12mg/L measured before administration of next dose

24
Q

What are the warning sings of carbamazepine toxicity?

Study These Flashcards
A 
IHANDBAG
Incoordination 
hyponatraemia 
Ataxia 
Nystagmus 
Drowsiness
Blurred vision 
Arrhythmia 
GI disturbances

+ Oedema

25
What are the serum lithium concentration targets?
0. 4 to 1 mg/l 0. 4mg/l for elderly 1. 5+ is toxic
26
What are the warning sings of lithium toxicity?
``` Apathy Restlessness Vomiting Diarrhoea Ataxia Hypernatremia Visual disturbances Cardiac arrhythmia Seizures ```
27
What are the monitoring requirements for lithium?
``` FBC Cardiac Renal Thyroid BMI Serum electrolyte i.e. sodium ```
28
What is the warfarin target for new onset VTE, AF, post MI?
2.5
29
What is the warfarin target for recurrent VTE or mechanical prosthetic heart valves?
3.5
30
What are the colours of the warfarin tablets?
``` 0.5mg = white 1mg= brown 3mg= blue 5mg= pink ```
31
How long is the duration of treatment with warfarin for isolated calf DVT?
6 weeks
32
How long is the duration of treatment with warfarin for provoked DVT?
3 months
33
How long is the duration of treatment with warfarin for unprovoked DVT?
3months +
34
What are the warning signs of warfarin?
``` Signs of excessive bleeding Purple toes Rash/ Skin necrosis Diarrhoea/Vomiting Headaches/ Confusion Signs of thrombosis ```
35
What are the monitoring requirements of warfarin?
``` Clotting screen Liver function Renal function FBC BP Thyroid function ```
36
What is the plasma theophylline concentration target?
10-20mgL | Measured after starting or dose adjustment
37
What causes an increase in plasma theophylline concentration?
Heart failure Hepatic impairment Viral infections
38
What causes a decrease in plasma theophylline concentration?
Smoking | Alcohol
39
What are the warning signs of theophylline toxicity?
``` Hypokalaemia Hyperglycaemia Convulsion Hematemesis - throwing up blood Cardiac arrythmias Dilated pupils Restlessness Agitation Vomiting ```
40
What are the monitoring requirements of ciclosporins?
``` FBC Liver function Serum electrolytes Blood lipids Renal function Dermatological/ Physical examination ```
41
What are the warning signs of ciclosporins?
``` Liver toxicity Nephrotoxicity Neurotoxicity blood disorders hypertension Headache Gingival hyperplasia - overgrowth of gum Hyperkalaemia ```
42
What are the monitoring requirements for tacrolimus?
``` Blood glucose levels Liver function Kidney function Eyes Blood pressure ECG ```
43
What are the warning signs for tacrolimus toxicity?
``` Hyperglycaemia Hyperkalaemia Hyponatraemia Photophobia Liver toxicity Blood disorders CV disorders ```

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