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preliminary chapters Flashcards

(135 cards)

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1
Q

Drugs interacting with grapefruit juice

A

enzyme INHIBITOR

CVS: SCAR

  • statins
  • ccbs
  • amiodarone/dronedarone
  • ranolazine

CNS

  • quetiapine
  • sertraline

Immunosuppressants

  • tacrolimus
  • ciclosporin

OTHER:

  • colchicine
  • pd5i i.e. sildenafil
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2
Q

How many half lives before a drug reaches steady state

A

x5

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3
Q

Signs of nephrotoxicity

A 
reduced urine output
odema
dehydration
NAV
fatigue
hypertension
confusion
backache
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4
Q

Nephrotoxic drugs

A

5A - aminoglycosides, aminosalicylates, ACEi, aciclovir, amphotericin B

3C - cyclophosphamide, ceph, ciclosporin

2T - tetracyclines, tacrolimus

LMNQV - lithium, MTX, NSAIDS, quinolones, vancomycin

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5
Q

risk factor for AKI

A

dehydration

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6
Q

meds to stop during illnesses resulting in dehydration (vom, diarrhoea, fever, sweats)

A

DAMN

  • diuretics (dehyd and electrolyte disturbances)
  • ACEi (reduce egfr + nephrotoxic)
  • metformin (increased LA risk in RI)
  • NSAIDS (nephrotoxic, reduce eGFR, water and sodium retention)
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7
Q

when to restart sick day meds

A

24-48hrs after normal eating and drinking

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8
Q

drugs that stain urine red

A 
dantron (co-danthrusate)
doxorubicin
levodopa (body secretions)
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9
Q

drugs that stain urine red-orange

A

rifampicin (body secretions)

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10
Q

drugs that stain urine orange

A

sulfasalazine (body secretions)

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11
Q

drugs that stain urine yellow-brown

A

nitrofurantoin

senna

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12
Q

drugs that stain urine pink-orange

A

phenindione

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13
Q

drugs that stain urine blue

A

triamterene

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14
Q

drugs that stain urine/stools black/tarry

A

iron

bismuth

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15
Q

drugs that stain urine brown

A

PG analogues e.e. latanoprost can cause brown pigmentation of iris

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16
Q

analgesic of choice in palliative care

A

morphine

ALT:
oxy
stronger - hydromorphone/methadone
patches - fentanyl/bup
parenteral - diamorphine
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17
Q

breakthrough pain

A

1/6-1/10 of total daily dose every 2-4 hours prn

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18
Q

PO to Parenteral (IV/IM/SC)

A

half dose of oral morphine

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19
Q

diamorphine is equivalent to

A

third of oral dose of morphine

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20
Q

why is diamorphine preferred over morphine for the parenteral route

A

more soluble = large dose in small volume

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21
Q

when switching to patches due to hyperalgesia, reduce opioid dose by

A

25-50%

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22
Q

Managing opioid induced constipation

A

-faecal softener + stimulant

senna + lactulose or co-danthramer/danthrusate

methylnaltrexone

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23
Q

methylnaltrexone drug class

A

opioid receptor antagonist

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24
Q

Managing opioid induced NAV

A

metoclopramide
haloperidol

MAX 4-5 days

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25
Managing opioid induced dry mouth
- good oral hygiene | - artificial saliva
26
Managing opioid induced dry mouth CANDIDIASIS
nystatin oral miconazole fluconazole
27
Treating neuropathic pain
TCAD Anti epi ketamine last resort - under supervision
28
Treating pain due to nerve compression
Dexamethasone
29
Treating bone metastases
radiotherapy bisphosphonate strontium ranelate
30
Treating anorexia
Prednisolone/dexamethasone increases appetite/weight gain
31
Treating secretions
SC hyoscine/glycopyrronium
32
Treating bowel colic
loperamide
33
Treating capillary bleeding
``` tranexamic acid (antifibrinolytic) adrenaline vit K in prolonged clotting in liver disease ```
34
Treating convulsions due to uraemia/cerebral tumour
phenytoin CBZ SC midazolam
35
Treating dysphagia due to tumour obstruction
dexamethasone
36
Treating fungating tumours
metronidazole
37
Treating dyspnoea
PO morphine (reduces respiratory drive to relieve breathlessness) w/ anxiety - diazepam bronchospasm/obstruction - corticosteroids
38
Treating gastric distension
antacid + antiflatulent + prokinetic (i.e. domperidone before meals)
39
Treating hiccup due to gastric distension
antacid + antiflatulent FAILURE +metoclopramide
40
Treating insomnia
BDZ
41
Treating intractable coughs
moist inhalation PO morphine AVOID methadone linctus as it can accumulate
42
Treating muscle spasms
diazepam | baclofen
43
Treating NAV
first line in advanced cancer: prokinetic antiemetic ``` Haloperidol Levomepromazine Cyclizine Metoclopramide Dexamethasone ```
44
Treating pruritis
Emollients
45
Treating obstructive cholestatic jaundice
colestyramine
46
Treating headache due to raised intracranial pressure
dexamethasone
47
Treating restlessness/confusion
haloperidol | levomepromazine
48
what long acting SU should be avoided in 65+
glibenclamide
49
Treating gravitational oedema in elderly
AVOID DIURETICS raise/move legs or wear stockings
50
Maintenance dose of digoxin in elderly
125mcg daily 62.5mcg in renal disease
51
Reporting ADR
YELLOW CARD SCHEME
52
When to report ADR
- Newer drugs/vaccines (upside down triangle for 5 years) - Medication errors (also to national reporting learning system) - Medical devices e.g. IUD, contact lens fluid, dental or surgical materials - Defective medicines/Fake meds - report to defective medicines report centre division of MHRA
53
onset of anaphylaxis
<1 hour after drug exposure
54
onset of cutaneous reaction to drug
non immediate without systemic involvement 6-10 days after 1st exposure OR 3 days after 2nd exposure
55
onset of non immediate reactions WITH systemic involvement
3days - 6 weeks after first exposure
56
nature of non immediate reactions WITH systemic involvement
- cutaneous reactions with systemic features - toxic epidermal necrolysis/SJS - acute generalised exanthematosous pustulosis
57
nature of cutaneous reaction to drug
widespread red macules +/or papules OR localised inflamed skin
58
drugs causing oral ulcers
``` ACEi NSAID Nicorandil Pancreatin Cytoxics (MTX) ```
59
drugs causing oral candidiasis
cortocosteroids
60
drugs causing brown staining of teeth
chlorhexidine
61
drugs causing black staining of teeth
liquid iron
62
drugs causing yellow/grey staining of teeth
tetracyclines
63
drugs causing osteonecrosis of jaw
bisphosphonates
64
drugs causing gingival hypertrophy
ciclosporin nifedipine phenytoin
65
drugs causing dry mouth
``` AMs APs AHs ADs opioids diuretics ```
66
drugs causing taste disturbances
``` ACEi amiodarone carbimazole clarithromycin Lithium Metformin Metronidazole Zopiclone ```
67
Drugs causing blood dyscrasias
DMARDs AEs - CBZ/Ethosux/Phenytoin/Lamotrigine ABs - trimethoprim/dapsone/chloramphenicol/linezolid Immunosuppressants Antifolates - MTX/trimethoprim/phenytoin Aminosalicylates/carbimazole/clozapine/mirtazepine
68
Drugs causing photosensitivity
Antifungals - voriconazole Tetracyclines Selphonamide Quinolones Hydroxychlorophine Amiodarone Phenothiazines Tacrolimus Topical NSAIDs Benzoyl peroxide Isotretinoin Vitamin A
69
Drugs causing contact sensitisation
MTX Chlorpromazine Cytotoxics
70
Drugs causing QT prolongation
APs - Pimozide/Halo/Quet ADs - SSRIs(cit/escit), TCADs, Vanlaflaxine Sotalol/Ami CNS - methadone, Li, 5HT1aA, 5HT3A, domp, meto, quinine Macrolides, Hydroxychloroquine, quinolones, -conazoles
71
Risk factors for QT prolongation
``` Age Female Cardiac disease Bradycardia HypoK, HypoMg, HypoCa ```
72
Drugs causing hypokalaemia
``` Loop/Thiazide diuretics Corticosteroids Beta2Ag Theophylline Stimulant lax Amphoteracin B ```
73
Drugs causing bradycardia
``` BB Amiodarone RLCCBs Digoxin Clonidine AMs TCADs AChEi ```
74
Drugs causing antimusc effects
``` AMs TCADs AHs APs Atropine & Clozapine ```
75
Drugs causing peripheral neuropathy
Amiodarone Phenytoin Isoniazid Metronidazole
76
Drugs causing serotonin syndrome
``` 5Ht1A Agonists e.g. sumatriptan 5HT3A e.g. granisetron ADs - TCADS/MOAi/SSRI MAOBi - selegiline SJW ```
77
Drugs causing ototoxicity
Aminoglycosides Glycopeptides Loop diuretics
78
Drugs causing lower seizure threshold
``` Quinolones Mefloquine SSRIs APs Tramadol Theophylline Lithium Baclofen Amphetamines ```
79
Drugs causing increased potassium
``` ACEi/ARB Aldosterone antag e.g. spir NSAIDS Tacrolimus Triamterene Trimethoprim ```
80
Drugs causing reduced potassium
``` Theophylline Amphoteracin B B2 ag Corticosteroidse Diuretics Stimulant laxatives ```
81
Drugs causing hyponatraemia
``` CBZ diuretics ADs NSAIDs Desmopressin ```
82
Risk of taking teratogenic drugs in 1st trimester
Teratogenicity occurs in first trimester Congenital abnormalities
83
Risk of taking certain drugs in 2nd/3rd trimester
growth & development
84
Risk of taking certain drugs at term
obstetric complications and effects on the baby
85
Teratogenic drugs
Antifolates - MTX & trimeth Statins Tetracyclines PGA - misoprosol ACEi/ARB Isotretinoin Lithim Valproate Warfarin - congenital malformations, fetal and nneonatal haemorrhage Chloramphenicol Aspirin/NSAIDs - early closure of ductus arteriosus Topiramate (cleft palate) Finasteride v(feminisation of male fetus) Quinolones (arthropathy) Aminoglycosides (auditory and vestibular damage in 2/3 trimester)
86
Drugs affecting breast feeding
High amounts in breast milk: ethosuximide lamotrigine fluvastatin Inhibiting sucking reflex: phenobarbital Inhibiting lactation bromocriptine
87
preterm neonate
born <37 weeks
88
term neonate
born 37 weeks-42 weeks
89
post-term neonate
born >42 weeks
90
Neonate
0-28 days
91
infant
28 days-24 months
92
child
2-12 years
93
adolescent
12-18 years
94
Dosing in overweight children
use ideal body weight
95
neonate eGFR
30xheight / serum creatinine
96
>1 year eGFR
40xH / serum creatinine
97
unlicensed
no license in UK | no MA
98
off label
licensed in UK but outside MA
99
What injection route should be avoided in children
IM - painful
100
Which injection excipient should be avoided in children
benzyl alcohol
101
benzyl alcohol excipient side effect
fatal toxic syndrome
102
what excipient should nbe avoided in renal failure
propylene glycol
103
freshly prepared
<24 hours before use
104
recently prepared
4 weeks expiry when stored 15-25 degrees
105
biologic
derived from biological source using biotechnology e.g. MAB/insulin
106
biosimilar
similar to existing originator biologic active substance is similar and clinically equivalent Not the same as a generic e.g. absalgar (biosimilar of insuline glargine) prescribe by brand name
107
contraindications to SC route
prochlorperazine chlorpromazine diazepam injection site reactions
108
Injections dissolved in WFI
hypotonic = more pain lower osmotic pressure than blood
109
injections dissolved in physiological saline
NaCl 0.9% isotonic - more similar osmotic pressure to blood increased precipitation when given with more than one drug
110
drugs compatible with diamorphine
cyclizine <10ml/ml <24hrs - avoid precip haloperidol <2ml/ml <24hrs - avoid precip ``` Dexamethasone hyoscine levomepromazine metoclopramide midazolam ```
111
when to discontinue infusion
<24 hrs cloudiness crystallisation change of colour sign of interaction/contamination
112
In an IV infusion, what must you not add drugs to
blood products mannitol sodium bicarb
113
Excipients that give rise to incompatibility in infusions
amino acids mannitol sodium bicarb
114
significant loss of potency of drugs occurs in infusions when
when added to large volume infusions
115
undesirable to mix BL-ABs with what and why?
proteinaceous materials immunogenic and allergenic conjugates may form
116
What must you not add to IV fat emulsions
ABs & electrolytes coalescence of fat globules separation of phases = increased possibility of embolism
117
the acceptable limit for admixtures where degradation occurs without forming toxic substances
time taken for 10% decomp from addition to admin to guarantee good drug potency and compatibility
118
what injections must be protected from light
dacarbazine sodium nitroprusside minimise oxidation
119
continuous infusion
diluted in large volume over long time
120
intermittent infusion
diluted in small volume over short time
121
intermittent infusion uses
incompatible/stable products over time e.g. ampicillin/amoxx
122
When are drip tubes used for addition of drugs
for cytotoxic drugs minimise extravasion
123
hypoproteinaemia
reduced protein binding = more free drug = toxicity warfarin phenytoin NSAIDS prednisolone
124
malabsorption of fat soluble vits
ADEK
125
vit K deficiency
increased risk of bleeding
126
Menadiol
water soluble vit k analogue used in fat malabsorption diseases
127
reduced bile excretion
intrahepatic/extrahepatic obstructive jaundice fusidic acid and rifampicin accumulate as they are excreted in bile acid
128
prescribing in liver impairment
impaired drug metab - reduce dose hypoproteinaemia reduced blood clotting malabsorption of fat sol vits reduced bile excretion
129
hepatic encephalopathy
constipating drugs e.g. opioids/TCADs sedatives e.g. opioids/AHs/BDZ/Z drugs drugs causing hypocalaemia e.g. loop/thiazide diuretics
130
hepatic encephalopathy treatment
lactulose
131
what drugs exacerbate oedema and ascites in liver disease
NSAIDs | corticosteroids
132
hepatotoxic drugs
``` APs amiodarone cbz co-amox cyproterone dantrolene fluconazole flucloxacillin isoniazid itraconazole ketoconazole labetolol leflunamide MTX paracetamol phenothiazine pioglitazone rifampicin statins tetracyclines valproate zafirlukast ```
133
signs of hepatotoxicity
jaundice ab pain NAV malaise weight loss pruritus dark urine pale stools drowsy/confusion
134
enzyme inhibitors
SICKFACES.COM ``` sodium valproate isoniazid cimetidine ketoconazole fluconazole alcohol chloramphenicol erythromycin sulphonamide ciprofloxacin omeprazole metronidazole ```
135
enzyme inducers
BS CRAP GPS barbiturates SJW CBZ rifampicin alcohol phenytoin griseofulvin phenobarbital sulphonylureas

extra bnf flashcards (6 decks)

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