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Flashcards in Ultimate BNF Deck (512)
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1

Amiodarone indication

Arrythmias

2

Amiodarone dosage

200mg td 7 days
200mg bd 7 days
200mg od continue

3

Amiodorone Side effects

Reversible corneal deposits, Phototoxicity,
Jaundice, Slate grey discolouration,
Taste disturbance, Vomiting,
Hyper/Hypothyroidism, Pulmonary toxicity
Nausea, Tremor, Sleep disorder

4

Amiodarone monitoring

LFT
Thyroid function test before and 6 monthly
Serum Potassium concentration before
Chest X ray before
ECG/Resuscitation during IV

5

Half life Amiodarone

Weeks/months

6

Amiodarone interactions

Warfarin inhibited by, (anticoagulant effect up)
BB, (bradycardia, AV block, Myocardial depression)
Lithium, (Ventricular arrhythmias)
Digoxin conc increase by,

7

Digoxin indication

Cardiac Glycoside used in AF, AF, tachycardias, HF

8

Digoxin mechanism action

Positive ionotrope - increases force of myocardial contraction,
reduces conductivity within AV node

9

Desired serum concentration Digoxin

1-2mcg/L
(toxic = 1.5-3)

10

Digoxin monitoring

Serum electrolytes (potassium) and renal function

11

Risks of Digoxin and management of risks

Digitalis toxicity (esp elderly)
Made worse by hypokalaemia so give Potassium sparing diuretics or potassium supplements

12

Side effects of Digoxin

Nausea, Vomiting, Diarrhoea, Dizziness, Blurred vision

13

Digoxin interacts with

These increase Digoxin plasma conc:
Amiodarone, Erythromycin, Calcium Channel blockers
These decrease Digoxin plasma conc:
Rifampacin, SJW

If hypokalaemia occurs with Loop/Thiazide risk toxicity

14

Lithium indication

Mania, Bipolar disorder, Recurrent depression

15

Desired Lithium serum concentration

0.4-1mmol/Litre
(1.5mmol and above is toxic)

16

Lithium toxicity presents as

Tremor, Ataxia (shake), Dysarthria (speech problem), Nystagamus (rapid involuntary eye movements), Renal impairment, Convulsions, Blurred vision

17

Monitoring on Lithium

Lithium serum conc (3months)
Renal/Thyroid function (6-12 months)
Maintain sodium levels

18

Counselling with Lithium

Adequate fluid intake, avoid diet's sodium increase or decrease

19

Interaction of Lithium

Excretion of Lithium reduced by: ACEI, Loops/Thiazides, probably NSAIDs
Risking toxicity/sodium depletion with Diuretics

Amiodarone: Ventricular arrhythmias

20

Methotrexate indication

Rheuatoid Arthiritis, Crohns, Malignant disease, Psoriasis

21

Problems with methotrexate and how to spot them

Blood dyscrasias: Sore throat, signs of infection, bruising, mouth ulcers
Liver toxicity/cirrhosis: Nausea, voimiting, abdominal discomfort, dark urine
Pulmonary toxicity: SOB, cough, fever

22

Methotrexate monitoring

FBC
LFT (and renal)

23

Methotrexate interactions

Increased methotrexate with Aspirin, NSAIDs

24

Dose of methotrexate

7.5mg once weekly (max 20mg/week)

25

Side effects of methotrexate

GI Ulcer, bleeding, hepatotoxicity

26

Other problems with methotrexate

Folate antagonist, give Folic Acid 5mg (not at the same time)
This prevents Methotrexate-induced mucositis, myelosuppression

27

Phenytoin indication

Epilepsy (not absence), neuropathic pain

28

Desired serum Pheytoin concentration

10-20mg/L

29

Monitoring with Phenytoin

FBC, LFT

30

Side effects of Phenytoin

Nausea, vomiting, constipation, gingival hypertrophy, rash, acne, hirsutis (coarse pigmented hair on face), Coarse poo, blood/skin disorders