Pharmacology Flashcards
(31 cards)
Which medications are known to cause gingival hyperplasia (ie overgrowth of the gums)?
Phenytoin
Calcium channel blockers e.g nifedipine
Ciclosporin
Which are the most common medications to cause hyponatraemia?
- Diuretics of any type but especially thiazide diuretics
- SSRIs - worse culprit of which is Citalopram - are the antidepressant category most associated with hyponatraemia
- Antipsychotics - can cause multiple electrolyte abnormalities including low Na e.g haloperidol, phenothiazine
- Carbamazepine
what medications commonly cause low B12?
metformin
COCP
PPIs
Histamine antagonists
What do BNF guidelines suggest to do with elevated INR in patients on warfarin?
INR 5-8 - no bleeding - withhold 1-2 doses of warfarin and then restart warfarin at lower maintenance dose.
INR 5-8 w/ minor bleeding - stop warfarin, give slow IV injection of phytomenadione (Vit K1) and don’t restart warfarin until INR < 5.
INR > 8 with no bleeding - stop warfarin, give phytomenadione orally (off-license), repeat the vit K after 24 hrs if INR still high after 24 hrs. Restart warfarin once INR <5.
INR >8 with minor bleeding - stop warfarin, give IV phytomenadione, repeat after 24 hrs if INR still too high. Restart warfarin once INR < 5.
If major bleeding = stop warfarin, give IV phytomenadione, give dried prothrombin complex (or FFP if not available, but less effective)
What does the black triangle mean when it is next to a drug in the BNF?
It means newly licensed medication
Most drugs have the black triangle for 5 years after licensing during which time they are subject to additional monitoring from the European Medicines Agency. ALL reactions (even if not considered serious) should be reported for black triangle drugs to the MHRA
What monitoring is recommended for patient’s on sodium valproate?
BMI, FBC and LFTs before starting
FBC & LFTs repeated after 6 months and annually thereafter
If valproate causes a rise in liver markers, often transient but monitor closely until returns to normal
Which prescriptions would be marked with ABPS?
Special food and beauty/toileting products that are approved for NHS prescription.
Includes
Special infant formulas e.g for CMPA
Artificial saliva spray for those with dry mouth as a result of a medical condition
Gluten-free bread for coeliacs
Body washes for eczema
Camaflaging makeup for those with disfiguring skin conditions
What are schedule 1 control drugs?
These are recreational drugs that are NOT used for medical use - LSD, cannabis, ecstasy-type drugs
What are schedule 2 control drugs?
Opioids
Stimulants e.g amfetamines, methylphenidate
Cannabis-products designed for medical use
Ketamine
What are schedule 3 control drugs
Pregabalin
Gabapentin
Tramadol
Barbiturates
Midazolam & Temazepam
What are schedule 4 control drugs?
Benzodiazepines (other than Midazolam and Temazepam which are schedule 3)
Zopiclone / Zolpidem
Schedule 4 do NOT need same prescription requirements as schedules 2 and 3 (ie don’t need to state total number in words and figures, however still max number of days supply 30 and prescription still only valid for 28 days after signed.
For how long do pharmacies need to keep prescriptions of controlled drugs?
Need to be kept for 2 years for schedule 2, 3 and 4
In which circumstances is it required to apply for a personal input/output license from the home office when carrying controlled drugs abroad?
Patients (or doctors) require a personal input / output license from the home office if they are travelling WITH > 3 MONTHS SUPPLY OR FOR LONGER THAN 3 MONTHS with schedule 2, 3 or 4 drugs
To which bodies should adverse reactions as a result of medication errors be reported?
Local risk management system (LRMS)
or
Yellow Card Scheme
The BNF describes side effects ranging from very common to very rare. What incidence is associated with each of these categories?
Very common = 1 in 10 or more
Common = between 1 in 10 to 1 in 100
Uncommon = between 1 in 100 to 1 in 1,000
Rare = between 1 in 1,000 to 1 in 10,000
Very rare = less than 1 in 10,000
Rarely, medication use can present with a reaction in the form of Steven-Johnsons syndrome / Toxic epidermal necrosis. How did this present and which population is especially at risk of this?
Presents with initial flu-like symptoms and then widespread, rapidly spreading blistering rash with peeling of the skin and mucosal membrane involvement
Emergency admission required
Common culprits = antibiotics (especially penicillin based or Co-Trimoxazole), anti-epileptic medications, NSAIDs, allopurinol but any medicine can in theory cause it
HIV PATIENTS ARE AT A 100X GREATER RISK OF SJS
What dental risk are those on Bisphosphonates at especial risk of and what check-up is therefore advised in ALL patients before starting these medications?
OSTEONECROSIS OF THE JAW
(risk is higher in those on bisphosphonates for bone pain in cancer rather than for osteoporosis purposes)
All pts starting in bisphosphonates should have dental check-up prior to starting or ASAP after starting
Which medications can cause gingival hyperplasia (gum overgrowth)?
Phenytoin
Calcium channel blockers
under what age is there a LEGAL requirement to include the age on the prescription?
< 12 yrs
(but good to practice to include age on all paediatric prescriptions)
Which drugs, are heavily protein bound and hence risk toxicity in the event of hypoalbuminaemia e.g in liver disease?
Prednisolone
Phenytoin
(heavily protein bound, risks toxicity in low albumin states)
Which medications can exacerbate hepatic encephalopathy in advanced liver disease?
Sedating drugs
Opioids
Diuretics that cause low K
Drugs that cause constipation
Which medications can exacerbate oedema / ascites in advanced liver disease?
NSAIDS
Steroids
can exacerbate fluid retention
In which circumstances should creatinine clearance be used as a predictor of renal function in prescribing rather than eGFR?
For DOACs!!
For toxic drugs / those with narrow therapeutic range that are mainly renally excreted
For elderly
For those with extreme of muscle mass
What equation can be used to calculate creatinine clearance from serum creatinine levels?
Cockroft & Gault formula
