Module 1 Notable Drugs List (incomplete- see Anika's deck)

Question 1

DOMPERIDONE:
Indication?

Answer 1

Nausea and Vomiting.
Gastroparesis.

Question 2

DOMPERIDONE:
Class?

Answer 2

Dopamine Antagonist Anti-emetic

Question 3

DOMPERIDONE:
Notable Precautions/contraindications?

Answer 3

• PROLONGED QT INTERVAL- Contraindicated in patients with a prolonged QT interval as domperidone may increase the QT interval at high concentrations
  *Use in patients with CARDIAC DISEASE, e.g. heart failure or significant electrolyte disturbances.
• Use with strong CYP3A4 inhibitors (clarithromycin, erythromycin, diltiazem…)
• Intermediate/severe hepatic and renal states

Question 4

DOMPERIDONE:
Info on which demographics can/can’t use domperidone.

Answer 4

• Elderly Warning - Risk of arrhythmias and/or sudden cardiac death may be increased, due to prolonged QT Interval.
• AVOID use in children
• AVOID use in pregnant women
• Safe in breastfeeding

Question 5

DOMPERIDONE:
ADRs?

Answer 5

COMMON = Dry mouth, headache
Rare= EPSE, allergic reactions, prolonged QT interval

Question 6

DOMPERIDONE:
Dosing?

Answer 6

Nausea and vomiting:
Adult, oral 10 mg 3 times daily for up to 1 week. Max dosage is 30mg p/day

Question 7

DOMPERIDONE:
Monitoring Requirements?

Answer 7

Nothing specifically noted about monitoring, however, practice points indicate:
“avoid using domperidone where possible; concerns about its safety continue to be raised by Australian and international regulatory agencies”. So implies need for monitoring, particularly in vunerable demographics.

Question 8

METOCLOPRAMIDE:
Indications?

Answer 8

• Nausea and vomiting
• including chemotherapy induced N & V
• Gastric stasis (e.g. after gastric surgery, diabetic gastroparesis)

Question 9

METOCLOPRAMIDE:
Class:

Answer 9

Dopamine Antagonist Anti-emetic

Question 10

METOCLOPRAMIDE:
Precautions?

Answer 10

• Parkinson’s disease—avoid if possible as symptoms may worsen; domperidone is preferred.
• Depression—avoid long-term use as mental state may worsen.

Question 11

METOCLOPRAMIDE:
Warnings surrounding who can and can’t use?

Answer 11

• Adults < 20 y/o (increased EPSE risk)
• Renal - Reduce dose if CrCl <10 mL/minute (EPSE common)
• Elderly (particularly women) - avoid high doses/prolonged use, increased ADRs
• Contraindicated in children <1 y/o, not recommended for any children
• Pregnancy and breastfeeding safe

Question 12

METOCLOPRAMIDE:
ADRs

Answer 12

COMMON - akathisia, dizziness, drowsiness, headache
RARE- agranulocytosis, arrhythmias

Question 13

METOCLOPRAMIDE:
Standard dosage

Answer 13

• Maximum treatment length 5 DAYS
• Weight dependant dose
• Total daily dose should not exceed 0.5 mg/kg or 30 mg (whichever is less).
• > 60 kg, 10 mg 3 times daily.
• 30–60 kg, 5 mg 3 times daily.
• Administration advice
  Give IV injection over at least 3 minutes to minimise transient agitation and restlessness.

Question 14

METOCLOPRAMIDE:
Dosing variations:

Answer 14

• Chemotherapy-induced nausea and vomiting
  Dose may vary according to local protocols and include higher doses
• Renal impairment
  CrCl <10 mL/minute, initially halve dose.

Question 15

ONDANSETRON:
Class/Mode of Action:

Answer 15

5HT3 Antagonist Antiemetic

Question 16

ONDASETRON:
Indication:

Answer 16

Nausea and vomiting:
* associated with cancer chemotherapy
* radiotherapy-induced
* postoperative (PONV)
*If they weren’t given an antiemetic to prevent the PONV, first-line treatment is prescribing of a serotonin 5HT3 antagonist via IV e.g. ondansetron 4mg

Question 17

ONDANSETRON:
Precautions

Answer 17

• Hepatic - Reduce dose in severe impairment.
• Elderly- Reduce maximum IV dose if age >75 years (due to increased risk of prolonged QT interval)
• Pregnancy- May be used if other drugs are inadequate; Ondansetron is preferred out of 5HT3 antagonists, but there is conflicting evidence that indicates malformations in 1st trimester

Question 18

ONDANSETRON:
ADRs?

Answer 18

COMMON- constipation, headache, dizziness
RARE-transient visual disturbances (blurred vision from rapid IV) EPSE, seizures

Question 19

ONDANSETRON:
Interactions

Answer 19

potent CYP3A4 inducers, tramadol, SSRIs, SNRIS

Question 20

ONDANSETRON:
Dosage?

Answer 20

Postoperative nausea and vomiting:
Adult - Prevention, IV/IM 4 mg at induction or oral 16 mg 1 hour before anaesthesia.
Treatment, IV/IM 4 mg single dose. Doses up to 8 mg have been used.

Chemotherapy:
Adult- Highly emetogenic, initially, IV 8–12 mg (maximum 16 mg; maximum 8 mg if age >75 years) immediately before chemotherapy or oral 16–24 mg 1–2 hours before chemotherapy.

Severe hepatic impairment
Do not exceed 8 mg daily.

Question 21

DEXAMETHASONE:
Class/Mode of Action

Answer 21

Corticosteroid

Question 22

DEXAMETHASONE:
Indication

Answer 22

Antiemetic
PONV
Chemotherapy-induced N & V
Cerebral Oedema
Some respiratory disorders, such as acute asthma and croup due antiinflammatory properties of drug

Question 23

DEXAMETHASONE:
Precautions

Answer 23

• Infections - due to the immunosuppressant nature of the drug, we need to consider patients with a history of recurrent infections.
• Children - Chronic use of corticosteroids (at pharmacological doses) may retard growth
• Pregnancy - Considered safe to use at the lowest effective dose for the shortest possible time.

Question 24

DEXAMETHASONE:
ADRs

Answer 24

COMMON - transient itching, burning or tingling in the perineal area. Adrenal suppression, Hypertension, hypokalaemia, hyperglycaemia. Infection.
RARE- peptic ulceration, hypersensitivity reactions

Question 25

DEXAMETHASONE:
Dosage

Answer 25

PONV: Acts as PREVENTATIVE. Give before induction of anaesthesia.
Adult, IV 4–10 mg.
Child >1 month, IV 0.1–0.2 mg/kg (maximum 8 mg).
CHEMO:
Adult, oral/IV 4–20 mg 30 minutes before chemotherapy. If delayed emesis is anticipated, follow with 8 mg orally once or twice daily for 2–4 days.

Question 26

DEXAMETHASONE:
Practice Points

Answer 26

Take with or after food to avoid stomach upset

Question 27

DEXAMETHASONE:
Monitoring requirements

Answer 27

• measure blood glucose, electrolytes, lipids, weight and BP at baseline, then monitor regularly during treatment
• Watch for infection
• Consider need for withdrawing treatment gradually as abrupt withdrawal can result in adrenal crisis

Question 28

PEPPERMINT OIL:
Indications

Answer 28

Anti spasmodic for use in IBS for abdominal pain.

Question 29

PEPPERMINT OIL:
Class

Answer 29

Drugs effecting gastrointestinal motility

Question 30

AMOXICILLIN:
Indication (specific to course)

Answer 30

Penicillin antibiotic used in the treatment of H.Pylori infection

Question 31

AMOXICILLIN:
Precautions

Answer 31

Allergies, renal impaired patients (could lead to electrolyte disturbances and neurotoxicity)

Question 32

AMOXICILLIN:
ADRs

Answer 32

COMMON- generally well tolerated, however most common presentations are diarrhoea and nausea.
RARE- electrolyte disturbances (hypernatraemia or hypokalaemia due to sodium content of high parenteral doses)