MHRA 50

Question 1

MHRA Clozapine

Answer 1

• Clozapine and other antipsychotics need monitoring for toxicity
• Potential fatal risk of intestinal obstruction, faecal impaction and paralytic ileus

Question 2

MHRA Quinine

Answer 2

QT prolongation

Question 3

MHRA Eryromycin

Answer 3

• QT prolongation
• Pyloric stenosis

Question 4

mhra Febuxostat

Answer 4

• Increased CV risks
• Serious hypersensitivity reactions

Question 5

MHRA MACROGOL

Answer 5

Risk of aspiration

PEG laxatives and starch based thinkers; potential interactive effect when mixed, leading to an increased risk of aspiration

Question 6

MHRA loperamide

Answer 6

Cardiac effects with high doses

Question 7

PPI MHRA

Answer 7

Proton pump inhibitors (PPIs): very low risk of subacute cutaneous lupus erythematosus (September 2015)

Question 8

MHRA Finasteride

Answer 8

rare reports of depression and suicidal thoughts

Question 9

Aminoglycosides/ gentamicin

Answer 9

• increased risk of deafness in patients with mitochondiral mutations
• Histamine related adverse drug reactions

Question 10

MHRA hydrochlorothiazide

Answer 10

Hydrochlorothiazide: risk of non-melanoma skin cancer, particularly in long-term use

Question 11

MHRA pioglitazone

Answer 11

• CV safety
• Bladder cancer

Question 12

MHRA montelukast

Answer 12

Risk of neuropsychiatric reactions

Question 13

MHRA ullipristal acetate

Answer 13

Ulipristal acetate 5 mg (Esmya®): further restrictions due to risk of serious liver injury

Question 14

MHRA Etonogestrel

Answer 14

Nexplanon® (etonogestrel) contraceptive implants: new insertion site to reduce rare risk of neurovascular injury and implant migration

Question 15

MHRA beclometasone

Answer 15

Beclometasone dipropionate CFC-free pressurised metered-dose inhalers (Qvar® and Clenil Modulite®) are not interchangeable and should be prescribed by brand name;

Question 16

Quinolones mHRA

Question 17

MHRA bisphosphonates

Answer 17

• Atypical femoral fractures
• Osteonecrosis of jaw
• Osteonecrosis of external auditory canal

Question 18

Denosumab MHRA

Answer 18

Same as bisphosponates +

Denosumab (Xgeva®) for giant cell tumour of bone:
Risk of clinically significant hypercalcaemia following discontinuation of treatment (June 2018).
Denosumab (Xgeva®) for advanced malignancies involving bone:
New primary malignancies reported more frequently compared to zoledronic acid (zoledronate) in clinical study data (June 2018).
Denosumab 60 mg (Prolia®):
Increased risk of multiple vertebral fractures after stopping or delaying ongoing treatment (August 2020).
Denosumab 60 mg (Prolia®):
Contraindicated in patients under 18 years due to risk of serious hypercalcaemia.

Question 19

MHRA domperidone

Answer 19

Not for under 12 or weighing less than 35Kg due to lack of efficacy

Question 20

MHRA ondaesteron

Answer 20

Small increased risk of oral clefts following the first 12 weeks of pregnancy

Question 21

MHRA levothyroxine

Answer 21

Stick to same brand if experience symptoms when switching

Question 22

MHRA Insulin

Answer 22

• Overdose due to abbreviations/ incorrect device
• Risk of cutaneous amyloidosis at injection site
• Risk of severe harm and death due to withdrawing insulin from pen devices

Question 23

Warfarin MHRA

Answer 23

Reports of calciphylaxis

Question 24

MHRA amiodarone

Answer 24

Sofosbuvir with daclatasvir; sofosbuvir and ledipasvir (May 2015); simeprevir with sofosbuvir (August 2015): risk of severe bradycardia and heart block when taken with amiodarone

Question 25

MHRA flucox

Answer 25

Cholestatic jaundice and hepatitis may occur very rarely, up to two months after. No more than 2 weeks of treatment

Question 26

MHRA potassium permanganate

Answer 26

Risk of death or serious harm from accidental ingestion

Question 27

MHRA gabapentin

Answer 27

Risk of severe respiratory depression

Question 28

MHRA Pregabalin

Answer 28

- Severe resp depression - Risks during preg - Risk of abuse and dependence

Question 29

MHRA IUD

Answer 29

Risk of uterine perforation

Question 30

MHRA tacrolimus

Answer 30

Brand specific

Question 31

MHRA amphotericin B

Answer 31

Liposomal and lipid complex formulations- name change to reduce medication errors

Question 32

IV iron MHRA

Answer 32

Serious hypersensitivity reactions with IV iron

Question 33

MHRA ciclosproin

Answer 33

BRAND specific

Question 34

Hydoxyzine MHRA

Answer 34

QT prolongation

Question 35

MHRA corticosteorids

Answer 35

Chorioretinopathy

Question 36

Isotretinoin MHRA

Answer 36

- Avoid in preg (must have PPP) - Rare reports of erectile dysfunction and decreased libido - Suicidal Thoughts

Question 37

MHRA Chlorphenamine

Answer 37

Not for under 6

Question 38

MHRA cannaglifozin

Answer 38

- Not under the age of 6 - Higher risk of lower limb amputation (mainly toes)

Question 39

MHRA SGLT2

Answer 39

- Risk of DKA - Monitor ketones in blood during treatment interruption for surgical procedure or acute serious medical illness - Fournier gangrene

Question 40

MHRA carbimazole

Answer 40

- Risk of acute pancreatitis - Increased risk of congenital malformation - use effective contraception - Neutropenia and agranulocytosis

Question 41

MHRA codeine

Answer 41

- Not under 12 DUE TO TOXICITY

Question 42

MHRA opioids

Answer 42

- BDZ and opioids reminder of potential to cause fatal resp depression - Risk of dependence and addiction

Question 43

MHRA SV

Answer 43

- PPP

Question 44

MHRA pMDI

Answer 44

Pressurised metered dose inhalers (pMDI): risk of airway obstruction from aspiration of loose objects

Question 45

MHRA metoclopramide

Answer 45

- Risk of neurological adverse effects - Max 5 days

Question 46

MHRA topiramate

Answer 46

Risk of neurodevelopment and cleft plate

Question 47

MHRA linezolid

Answer 47

- Optic neuropathy - Blood disorders

Question 48

MHRA SSRI/SNRI in post partum

Answer 48

Small increased risk of post partum haemorrhage when used in the month before delivery

Question 49

MHRA hydroxychloroquine

Answer 49

- Interaction with macrolides increasing the risk of CV events - Reminder of psychiatric reactions

Question 50

MHRA DOACs

Answer 50

- Increased risk of recurrent thrombotic events with APS (use warfarin) - Reminder of bleeding risk, including availability of reversal agents