Mixed Qs Flashcards by Desiree (CS) at Brainscape

Furosemide & bumetanide (loops) interactions

Gentamicin + furosemide
Lithium + furosemide
NSAID + furosemide
Phenytoin + furosemide

Ototoxicity / nephrotoxicity
Lithium toxicity
HF
Diuretic effect reduced

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Can Loops (furosemide or bumetanide) cause pancreatitis ?

Yes can also cause gout, diabetes, deafness, cramps

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Which of the following eye drops cause brown pigmentation, blepharitis, dry mouth/ drowsiness? blepharoconjunctivitis?

Betaxolol
Brinzolamide
Latanoprost
Brimodine

Latanoprost- brown pigmentation
Betaxolol- blepharoconjunctivitis
Brinzolamide- blepharitis
Brimodine- dry mouth, drowsiness

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Which antibiotics cause c diff?

Clindamycin
Cephalosporins
Broad spectrum penicillin
Fluoroquinolones
PPIs

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With amiodarone every 6 months you should do what monitoring?

Thyroid
before start of treatment + 6 months + 12 months after stopping treatment
Liver function before start of treatment + 6 months

Chest X-ray before treatment
K before treatment

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Does beclometasone inhaler need to be prescribed by brand ?

Yes such as Qvar/ clenil

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Can inhaled corticosteroids be taken during pregnancy?

Yes as normal

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When should a steroid card with beclometasone be provided ?

Prolonged high doses > 1000mcg

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Interaction
nitrate + sildenafil

Severe HYPOtension or Myocardial infarction

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Interaction with grapefruit ?

Clopidogrel
Felodipine
Amiodarone
Sertraline
Simvastatin
Amlodipine

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Interaction ciprofloxacin + methotrexate

methotrexate toxicity

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Interactions
Trimethoprim + ciclosporin

Nephrotoxicity

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Many drugs should be given on the day of surgery even when the patient is nil by mouth. Which medications should you omit?

OMIT:.
NSAIDs
ACEi
AIIRAs
Diuretics
Antiplatelets /anticoagulants
Lithium
meds not essential in the short term. eg. vitamins, iron, laxatives,
osteoporosis treatment, liquid antacid medicines (eg gaviscon), HRT, anti- histamines,
herbal remedies or homeopathic medicines
Diabetic alt meds need to be prescribed

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colchicine dosing for gout

500mcg 2-4 times a day until symptoms relieved
max 6mg /course
do not repeat course within 3 days

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Lithium can cause hypo/hyperthyroidism, so do not confuse with lithium toxicity symptoms

lithium toxicity= vomiting diarrhea
visual disturbances
incontinence (polyurea)
fine tremor
confusion/drowsiness
hypernatremia
seizures
bradycardia
cardiac arrhythmias

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Hydroxychloroquine used in malaria and RA

safety info- risk of CVD events
Retinopathy- monitoring required annually if been on medication for 5 years
QT prolongation

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UPPER Respiratory tract infection
what do you to give Adults? pregnancy? children?

Lower RTI- Amoxycillin, doxycycline Clarithromycin

Adults- phenoxymethylpenicillin
allergic then clarithromycin

Pregnancy - Erythromycin

Children-phenoxymethylpenicillin
allergic then clarithromycin

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How often should the safety and efficacy of pioglitazone be reviewed?

risk of bladder cancer, review every 3-6 months

patients should be advised to report promptly any hematuria, dysuria, urinary urgency during treatment

discontinue if jaundice occurs

HF= discontinue

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Leflunomide used in RA

ESSENTIAL to be on contraception 2 years AFTER treatment for women and 3 months for men

Hepatotoxic!

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Can you give hydrocortisone to be applied on ears or infected skin?

Hydrocortisone can be applied to the ears not the face.

It can be used in irritant dermatitis but not on infected or broken skin

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Strength of adrenaline for different age groups

Adrenaline injection 1mg/ml
0-6m 100-150 mcg
6m 150 mcg
6 yrs 300mcg
12+ 500mcg

repeated after 5 minutes if necessary

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If INR is above 8 regardless of bleeding or not

Then give repeated dose of Phytomenadione if INR still too high AFTER 24 hours

however, if INR is below 8, no repeat doses of Phytomenadione, just wait to restart once INR falls below 5

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What is the wash out period for sertraline?

Sertraline - 2 week washout period
SSRI- 1 week wash out period

MAOIs require 2 weeks washout period
Moclobemide requires no washout period

Fluoxetine- 5 weeks
Imipramine, clomipramine- 3 weeks
TCAs- 1-2 weeks

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Hypersalivation can be treated with hyoscine ____?

hyoscine hydrobromide provided the patient isn’t at risk from additive antimuscarinic side effects of hyoscine + clozapine

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which sweeteners are sugar free?

ALL the ol's mannitol sorbitol xylitol

CD2 Methylphenidate (ADHD) Specify brand Concerta XL Equasym XL Medikinet XL

Stunt growth (children) Weight loss, decrease appetite HTN Tic Alopecia

Patient on cyclophosphamide and gets UTIs etc why is Mesna prescribed?

Mesna used to treat cytotoxic induced urethral toxicity

Can Antimuscarinics be given in gastro-intestinal obstruction?

Antimuscarinics are contraindicated in gastro-intestinal obstruction, urinary retension, paralytic ileus, toxic megalon, urinary retention, significant bladder outflow obstuction Darifenacin Fesoterodine Oxybutynin Tamsulosin Tolterodine Trospium

when to avoid Nitrofurantoin? Trimethoprim?

Nitrofurantoin- avoid at term Trimethoprim avoid at 1st trimester

Interaction Lithium + Furesomide

hypokalaemia

Does Filgrastim (stimulates production of neutrophils) cause hyper or hypo uricemia?

HYPERuricemia Avoid in pregnancy

Topiramate (antiepileptic)

Vision disorders

Patient on ACE inhibitor in combination with NSAIDs

Patient on ACE inhibitor which in combination with NSAIDs increases risk of kidney injury. DAMN Diuretics ACEi/ARBS/ aminoglycosides Metformin NSAIDs

On metformin (one drug) hypoglycaemic agent (sulfonylureas) or 2 and more drugs

< 48mmol <53 mmol

Which statins are taken anytime during the day?

Atorvastatin or Rosuvastatin

interaction Alcohol + atorvastatin

Hepatotoxicty

How old do you have to be to take domperidone for N+V ?

domperidone 10mg TID >12 years >35kg max 1 week side effect- dry mouth metoclopramide 10mg TID >18 max 5 days (IV dose should only be administered as slow bolus over 3 minutes)

Tiaprofenic acid + cystitis?

Due to reports of severe cystitis, the CSM has recommended that tiaprofenic acid should not be given to patients with urinary tract disorders. Topical NSAIDs can be used to substitute or supplement paracetamol for knee or hand osteoarthritis. If paracetamol and/or topical NSAIDs are ineffective, consider oral NSAIDs or weak opioids

How do you administer drugs likely to cause extravasation?

central line

where is GTN patch placed in respect to cannula and why?

place distal to cannula to improve patency of the vessel in patient with small veins

Evidence Hierarchy

Systematic reviews Meta analysis RCT Cohort

Interaction- methotrexate + trimethoprim

Nephrotoxicity Both antifolates, so reduction in folate means methotrexate side effects thus concurrent use of trimethoprim and methotrexate can also increase the risk of nephrotoxicity

HTN: second line for anyone >55 or Afro caribbean is

1st line CCB 2nd line ACE/ARB ARB preferred in Afro-carribean

NSAID + prednisolone

GI complications

Ferritin level range?

15-200

WBC

4 -11

Total cholesterol

< or equal to 5

which drugs should be stopped when patient is sick?

D iuretic A CE/ARB M etformin N SAID S GLT2

hypoglycaemic? <4 mmol/L

15-20 g of fast acting carbohydrate 3/4 heap tea spoons of sugar dissolved in water 4-7 glucose tablets 150-200ml pure fruit juice

missed dose of lithium

more than 6 hours then skip missed dose and take usual dose at usual time

Interaction metronidazole + warfarin

increased risk of bleeding

Mastitis in pregnancy

1st line 10-14 days flucloxacillin pen allergy = erythromycin

LITHIUM monitoring

Lithium beet it! BMI Electrolytes EGFR Thyroids 6 months

Methotrexate monitoring Faryal makhdoom 3 kids

F BC R enal L iver 1-2 weeks intially 2-3 months once stable

Amiodarone monitoring

c hest x ray u potassium L iver every 6 months T hyroids every 6 months

Statin monitoring

H bA1c U and Es L iver T thyroid Liver 3m and 12m Ck above 5 -don’t start Liver above 3 -stop

Nystatin dose

1ml QDS a day AFTER food - 7 days Continue for 48 hours after condition resolved

Vidagliptin

Liver + pancreatitis counselling

Risk factors for developing AKI

65+ eGFR<60 Heart failure Liver disease Diabetes Hx of AKI Oliguria Sepsis Dementia Hypovalaemia DAMN Aminoglycosides Iodine based contrast media within past week Hx of urological obstruction Deteriorating early warning scores

Yellow fever vaccine

Do not give to immunosuppressed HIV infected individuals Single dose Live attenuated vaccine

Tamoxifen OD

Reduces risk of breast cancer Increases risk of endometrial cancer Increases risk of DVT - swollen leg Paroxetine reduces effectiveness of tamoxifen Common side effect is hot flush

Acyclovir 800 mg 5 times a day for 7 days

Varicella zoster (chickenpox) Herpes zoster (shingles)

MAOIs interactions

The following predispose patients to hypertensive crisis when used with MAOI: Tyramine rich foods Ephedrine and pseudoephedrine Levodopa Stimulants g methylphenidate and amphetamine The following predispose patients to serotonin syndrome when used with MAOI: Tramadol Other antidepressants The following predispose patients to CNS excitation or depression when used with MAOI: Tramadol Pholcodine Opioids Avoid the above during MAOI treatment and for 14 days after stopping the MAOI

Migraine

Migraine treatment Triptan Migraine prophylaxis P ropanolol A mitriptyline T opiramate (teratogenic)

ductus arteriosus

Indometacin or ibuprofen can be used to close the ductus arteriosus

Omeprazole fights with mESsI

W arfarin M ethotrexate E someprazole C lopidogrel c I Talopram

Hypothyroidism

Levothyroxine Liothyronine - emergency 🚨

Methotrexate interaction Faryal Peng actually Needs to chill out

NSAIDs Penicillins Amoxicillin 🚨 Trimethoprim Omeprazole Citalopram

Increase dose of Morphine to max dose Daily dose 100mg

Max 1/2 Min 1/3 100 * 0.5 = 50 50 + 100 = 150mg