PSA: prescription review Flashcards by Ailsa Jones

dosing methotrexate

Rheumatology: dose range 5-25mg once weekly

Gastroenterology: Starting dose – 25mg once weekly for 16 weeks

Maintenance dose – 15mg once weekly
Always prescribe methotrexate in multiples of the 2.5mg tablet strength

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what are the most common cytochrome p450 inducers. what does this mean?

increased enzyme activity –> decreased drug concentration as it is metabolised quickly

PC BRAS

Phenytoin
Carbamazepine
Barbituates
Rifampicin
Alcohol (chronic excess)
Sulphonylureas

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what are the most common cytochrome p450 inhibitors. what does this mean?

decreased enzyme activity –> increased drug concentrations as not metabolsied quickly

AODEVICES

Allopurinol
Omeprazole
Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol (Acute intoxication)
Sulfonamides

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what antibiotic is contraindicated with methotrexate?

trimethoprim

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how does ibruprofen cause aki

inhibits prostaglandin synthesis –> reduces renal artery diameter (and blood flow) and therefore causes reduced perfusion

can also cause AIN

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how does rampiril cuase aki?

decreases angiotensin 2 which is responsible for preserving eGFR

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what is the impact of diuretics on sodium?

all diuretics can cause hyponautraemia,

although when they contribute to dehydration, sodium may increase causing hypernautraemia

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what electrolyte derangement do thiazide diuretics cuase

hypokalameia

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what electrolyte derangement foes ACEi cause?

hyperkalaemia

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what electrolyte derangement do loop diuretics cause

hypokalaemia

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what analgesics to avoid in asthma

nsaids

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most common SE amlodipine

ankle oedema

(clue = echo normal)

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interactions between calcium channels and beta blockers?

non-dihydropyridine CCBs such as dilatizem and verapamil are contraindicated due to the risk of severe bradycardia and LV failure. This is because non-dihydropyridine calcium channel blockers slow conduction at the SA and AV nodes.

The dihydropyridine calcium channel blockers (amlodipine, nifedipine, lercanidipine) are safe to take with beta-blockers as they are primarily peripheral vasodilators.

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what drugs may cause fourniers gangrene

SGLT2 inhibitors eg dapagliflozin

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pregnancy and chloramphenicol

can cause the potentially fatal severe reaction - grey baby syndrome

avoid all forms (topical and oral)

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what drugs should be stopped in aki

rampiril
metformin

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what diabetes drug doesn’t have a risk of hypoglycaemia

metformin

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in metabolic acidosis, which drug should be held

metformin

Metformin itself can cause lactic acidosis, and as a result, if a patient is in a state of metabolic acidosis it should be held whilst the acidosis is corrected.

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common reasons that drugs that are contraindicated in severe renal impairment?

narrow therapeutic range and therefore accumulate eg lithium

Damage to kidneys –> aki

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drugs causing hyponautraemia

inreased sodium out
- diuretics

increased water in…
“SIADH cannot void”
SSRIs (eg sertraline) and sulphonylureas (eg gliclazide)
Indomethacin and Inhibitors (ACEi and PPI)
Antidepressants (eg tricyclics)
Diuretics
Haloperidol
Cannot: cyclophosphamide, carbamazepine
Void: vincristine

hypnotics (such as temazepam)

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dosing sertraline depression

Initially 50 mg once daily,

then increased in steps of 50 mg at intervals of at least 1 week if required; maintenance 50 mg once daily; maximum 200 mg per day.

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features seretonin syndrome

Study These Flashcards

Neuromuscular excitation
hyperreflexia
myoclonus
rigidity

autonomic nervous system excitation
hyperthermia
sweating

altered mental state
Confusion

causes seretonin syndrome

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antidepressants: SSRI, SNRI, TCA, MAOI

Drugs causing SS esp when interacting with others:
- lithium
- tramadol, pethidine
- St John’s Wort

recreational:
- ecstasy
- amphetamines

management seretonin syndrome

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supportive including IV fluids
benzodiazepines
more severe cases are managed using serotonin antagonists such as cyproheptadine and chlorpromazine

elderly patient on antidepressant, dosing error?

some antidepressants eg escitalopram, have a lower dose for elderly patients escitalopram should be given at a maximum dose of 10mg per day for elderly patients.

if a pt on lithium has levels <04 what do you do?

- check complicance - consider factors that may affect plasma lithium levels (e.g. excess fluid intake, drug interactions, brand change) + increase the dose slightly eg by 100mg

typical lithium starting dose

Lithium 400mg ON

what change to medications do you need to make, addisons and infection

double dose of hydrocortisone

what abs is CI during treatment of overactive bladder with botulism toxin

gentamicin

what anti-diabeties drug is CI in bladder cancer

Pioglitazone is associated with a small increased risk of bladder cancer and is contraindicated in patients with active bladder cancer or a past history of bladder cancer.

what drugs are prescribed in micrograms and therefore can be a massive prescribing error if done in mg

FFLAND Folic acid Fludrocortisone Levothyroxine Atropine Digoxin Naloxone

adverse effect hydroxycloriquine

Long-term use of hydroxychloroquine can lead to retinopathy known as 'Bull's eye maculopathy'. Common symptoms include central vision loss (central scotoma), change in color vision and visual distortions.

dosing atorvostatin

priamary prevention 20mg secondary prevention 80mg

why is cyclizine not reccomended in the elderly

Cyclizine has anticholinergic properties, which is why regular use is not recommended, particularly in the elderly. Agitation is a rare side effect, most commonly observed at higher doses.

clarithromycin plus atorvastatin equals

Macrolide antibiotics such as clarithromycin and erythromycin act to increase the side effects of statins such as atorvastatin. A rare side effect is rhabdomyolysis (muscle breakdown) which results in an elevation of creatine kinase released from the damaged muscle.

what drugs affect the haemodynamics and therefore can cause renal aki

NSAIDs cause afferent vasoconstriction ACEi and ARBs cause efferent vasodilation These reduce the pressure gradient and therefore reduce eGFR

what drugs are nephrotoxic

Acute tubular necrosis causing drugs: (AVRG) Aminoglycosides Vancomycin Radio contrast Gentamicin Acute interstitial nephritis causing drugs: (PPN) PPI Penicillin NSAID

what drugs should you hold during aki

DAMN Diuretics ACEi/ARB/Antibiotics esp aminoglycosides Metformin, lithium, digoxin, opiates (narrow TW) (may have to be stopped) NSAIDs

why do you soemtimes stop metformin in aki

increased risk of toxicity (but doesn't usually worsen AKI itself)

what drugs should be stopped around the time of surgery?

I LACK OP Insulin Lithium Anticoagulants/antiplatelets COCP/HRT K-sparing diuretics Oral hypoglycaemics Perindopril and other ACEi

when should COCP/HRT be stopped - surgery

4w before

when should lithium be stopped - surgery

day before

when should potassium sparing diuretics amd ACEi be stopped - surgery

day of surgery

safety considerations NSAIDS

NSAIDS No urine (ie renal fialure/aki) Systolic dysfucntion (ie heart failure) Asthma Indigestion Dyscrasia (clotting abnormality)

diabetes medications and surgery

NBM therefore metformin stopped - risk of lactic acidosis other oral hypoglycaemics can cause hypoglucaemia so these are stopped too sliding scale should be started whereby hourly blood glucose monitoring adjusts the hourly dose of insulin

corticosteroids and surgery

at induction of anaestehsia, give iv steroids if on long term corticosteroids as these pts often ahve adrenal atrophy therefore wont be able to mount a big enough stress response to surgery

sick day rules steroids

double the dose

if a pt is on paracetamol, what should you check

DOSE!!! look for co-codamol co-prescribed etc

trap paracetamol max dosing

if pt <50kg, max dose is 500mg 6 hourly !!!

alendronic acid prescription

10mg od or 70mg weekly

when to withold antihypertensives

when hypotensive, aki, cold peripheries etc

causes of oral candidiasis drugs

steroids abx immunocompromised

drugs which increase risk of falls

benzos antidep - particualrly TCA and SNRI MAOI antipsychotics opiates antihypertensives

PSA: prescription review Flashcards

(53 cards)