Toxic tablets

Question 1

whats the target inr for most px with af

Answer 1

2.5

Question 2

true or false, erythromycin can increase the INR of patients that are taking warfarin?

Answer 2

true

Question 3

true or false, there is an interaction between warfarin and macrolide antimicrobials?

Answer 3

true

Question 4

warfarin is taken daily usually at same time, when

Answer 4

evening

Question 5

what is the daily dose of warfarin adjusted to?

Answer 5

INRwa

Question 6

rfarin is available in which 4 strengths

Answer 6

500mcg, 1mg, 3mg 5mg

WBBP

Question 7

what is colour of 500mcg warfarin?

Answer 7

white

Question 8

what is the colour of 1mg warfarin?

Answer 8

brown

Question 9

what is the colour of 3mg warfarin?

Answer 9

blue

Question 10

what is the strength of pink warfarin?

Answer 10

5mg

Question 11

why are loading doses of warfarin often required to achieve pharmacological effect quickly?

Answer 11

highly protein bound and long half life

Question 12

what effect can hyperthyroidism have on warfarin and why?

Answer 12

may require reduced doses of warfarin because it increases the metabolism of clotting factors

Question 13

why does the peak pharmacological effect of warfarin take several days to develop?

Answer 13

time taken for degradation of pre formed carboxylated clotting factors

Question 14

what is the risk of concomitant use of ibuprofen and warfarin?

Answer 14

bleeding due to GI irritation

Question 15

contraindications for warfarin

Answer 15

hypersensitivity
haemorhhagic stroke
clinically signif bleeding
preg (1st and 3rd trim)
severe liver/ renal imp

Question 16

what effect does fluconazole have on warfarin?

Answer 16

inhibits metabolism so anticoagulant effect increased

Question 17

what effect does amiodarone have on warfarin?

Answer 17

potentiates anticoagulant effect

Question 18

true or false, patients taking warfarin do not need to avoid cranberry juice?

Answer 18

false

Question 19

what effect might alcohol have on INR , which might mean that continous alcohol consumption sitmulates hepatic enzymes increasing warfarin metabolism?

Answer 19

increased

Question 20

what effect does st johns wort have on INR?

Answer 20

decrease

Question 21

higher inr, greater risk of ses such as 2

Answer 21

bruising
haemorrhage

Question 22

how to manage raised inr 4

Answer 22

stop warfarin/ reduce dose
reverse anticoag if needed
investigate cause
consider risks/ benefits of continuing tx

Question 23

reversal agent for warfarin?

Answer 23

phytomenadione

Question 24

true or false, warfarin should be precsribed in number of tabs and not milligrams?

Answer 24

false

Question 25

what is digoxin (ntr) indicated for the management of?

Answer 25

hf

Question 26

true or false, digoxin should be reduced in renal dysfunction to avoid toxicity?

Answer 26

true

Question 27

digoxin is given by mouth at what daily dose regimen?

Answer 27

OD

Question 28

what are the 3 different ways that digoxin loading can occur in patients?

Answer 28

rapid oral, slow oral and parenteral

Question 29

digoxin plasma levels do not routinely need to be measured due to the fact that heart rate and pulse can be measured to indicate therapeutic effect. In what circumstances would it be measured?

Answer 29

suspected tox

Question 30

what is the target conc of digoxin inmcg/L?

Answer 30

0.8-2

Question 31

is digoxin renally or hepatically excreted?

Answer 31

renally

Question 32

which electrolyte imbalance increases the risk of digoxin toxicity as the myocardium is more sensitive to the effects of digitalis toxicity?

Answer 32

hypokalemia

Question 33

what effect does amiodarone have on plasma conc of digoxin?

Answer 33

inc

Question 34

what effect does amiodarone have on plasma conc of digoxin?

Answer 34

inc

Question 35

what effect does erythromycin have on plasma conc of digoxin?

Answer 35

inc

Question 36

what effect does verapamil have on plasma conc of digoxin?

Answer 36

inc

Question 37

what effect does spironolactone have on plasma conc of digoxin?

Answer 37

inc

Question 38

what effect do st johns wort and rifampicin have on plasma conc of digoxin?

Answer 38

dec

Question 39

list some of the signs and symptoms of digoxin toxicity

Answer 39

anorexia nausea vomiting diarrhoea palpitations syncope

Question 40

serum lithium conc should be measured 12h post dose after at least how many days?

Answer 40

4

Question 41

lithium carbinate 200mg is equivalent to what strength of lithium citrate in mg?

Answer 41

509

Question 42

out of lithium carbonate and citrate which is the oral tablet (the other is the oral liquid)?

Answer 42

carbonate

Question 43

true or false you do not need to be brand specific when prescribing lithium?

Answer 43

false

Question 44

what is the target serum lithium conc in mmol/l?

Answer 44

0.4-1

Question 45

AEs of Lithium

Answer 45

fine hand tremor weight gain nausea metal taste diarrhea diabetes insipidus urinary changes: polydipsia...

Question 46

lithium toxicity signs symptoms

Answer 46

severe hand tremor vomiting blurred vision muscle weakness seizures renal

Question 47

drugs affecting renal elim of Li/ elec imbalance can affect serum li levels, name 4 classes

Answer 47

aceis diuretics nsaids Na containing compounds eg movicol

Question 48

how often should cardiac function be monitored for patients on lithium and why?

Answer 48

regularly because it can cause ecg changes

Question 49

how often should all the following parameters be measured for patients taking lithium? thyroid function renal function calcium bmi

Answer 49

every 6 months

Question 50

why should thyroid function be measured every 6 months in patients on lithium?

Answer 50

can cause hypothyroidism with long term use

Question 51

why should renal function be monitored every 6 months in patients on lithium?

Answer 51

renally excreted so accumulates in dysfunction long term use can impair renal function

Question 52

why should calcium be monitored every 6 months in patients on lithium?

Answer 52

risk of hypercalcaemia

Question 53

why should bmi be measured every 6 months in patients taking lithium?

Answer 53

causes weight gain

Question 54

how often is it recommended to measure serum lithium concentration?

Answer 54

every 3 months

Question 55

the max dose for mtx should not exceeed X mg weekly for non cancer treatment?

Answer 55

25

Question 56

what different parameters are to monitored in patients that are on mtx?

Answer 56

fbc lfts renal function cxr

Question 57

signs and symptoms of mtx tox

Answer 57

lymphopenia thrombocytopenia pallor nausea vom gi bleed dysuria/ anuria

Question 58

mtx is indicated for what 4

Answer 58

malignant disease psoriasis rheumatic disease crohns

Question 59

rescue therapy for mtx tox, what 3 steps

Answer 59

1. stop mtx 2. consult haematologist/ toxicologist 3. give folinic acid rescue therapy

Question 60

what should px on mtx be advised to report

Answer 60

abnormal bruising

Question 61

routine monitoring for li therapy includes what 5

Answer 61

serum li conc thyroid and renal func bmi calcium

Question 62

what electrolyte disturbance is likely to exacerbate li toxicity

Answer 62

hyponatraemia

Question 63

How often should the plasma-digoxin concentration be monitored during chronic therapy to reduce the risk of toxicity?

Answer 63

Only measure if toxicity is suspected

Question 64

After initiating digoxin, or following a dose change, the full therapeutic effect will not be seen for hm days

Answer 64

8-10

Question 65

st johns wart interacts w warfarin to cause inc/dec in inr?

Answer 65

dec