Ultimate BNF Flashcards
(512 cards)
1
Q
Amiodarone indication
A
Arrythmias
2
Q
Amiodarone dosage
A
200mg td 7 days
200mg bd 7 days
200mg od continue
3
Q
Amiodorone Side effects
A
Reversible corneal deposits, Phototoxicity, Jaundice, Slate grey discolouration, Taste disturbance, Vomiting, Hyper/Hypothyroidism, Pulmonary toxicity Nausea, Tremor, Sleep disorder
4
Q
Amiodarone monitoring
A
LFT Thyroid function test before and 6 monthly Serum Potassium concentration before Chest X ray before ECG/Resuscitation during IV
5
Q
Half life Amiodarone
A
Weeks/months
6
Q
Amiodarone interactions
A
Warfarin inhibited by, (anticoagulant effect up)
BB, (bradycardia, AV block, Myocardial depression)
Lithium, (Ventricular arrhythmias)
Digoxin conc increase by,
7
Q
Digoxin indication
A
Cardiac Glycoside used in AF, AF, tachycardias, HF
8
Q
Digoxin mechanism action
A
Positive ionotrope - increases force of myocardial contraction,
reduces conductivity within AV node
9
Q
Desired serum concentration Digoxin
A
1-2mcg/L
toxic = 1.5-3
10
Q
Digoxin monitoring
A
Serum electrolytes (potassium) and renal function
11
Q
Risks of Digoxin and management of risks
A
Digitalis toxicity (esp elderly) Made worse by hypokalaemia so give Potassium sparing diuretics or potassium supplements
12
Q
Side effects of Digoxin
A
Nausea, Vomiting, Diarrhoea, Dizziness, Blurred vision
13
Q
Digoxin interacts with
A
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
Q
Lithium indication
A
Mania, Bipolar disorder, Recurrent depression
15
Q
Desired Lithium serum concentration
A
- 4-1mmol/Litre
1. 5mmol and above is toxic
16
Q
Lithium toxicity presents as
A
Tremor, Ataxia (shake), Dysarthria (speech problem), Nystagamus (rapid involuntary eye movements), Renal impairment, Convulsions, Blurred vision
17
Q
Monitoring on Lithium
A
Lithium serum conc (3months)
Renal/Thyroid function (6-12 months)
Maintain sodium levels
18
Q
Counselling with Lithium
A
Adequate fluid intake, avoid diet’s sodium increase or decrease
19
Q
Interaction of Lithium
A
Excretion of Lithium reduced by: ACEI, Loops/Thiazides, probably NSAIDs
Risking toxicity/sodium depletion with Diuretics
Amiodarone: Ventricular arrhythmias
20
Q
Methotrexate indication
A
Rheuatoid Arthiritis, Crohns, Malignant disease, Psoriasis
21
Q
Problems with methotrexate and how to spot them
A
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
Q
Methotrexate monitoring
A
FBC
LFT (and renal)
23
Q
Methotrexate interactions
A
Increased methotrexate with Aspirin, NSAIDs
24
Q
Dose of methotrexate
A
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
31
Counselling with Phenytoin
Report signs of blood/skin disorders: Fever, Sore throat, rash, mouth ulcers, bruising, bleeding, Leucopenia
Take with or after food
32
Phenytoin interacts with
```
NSAIDs enhances effects,
Warfarin metabolism accelerated,
Amiodarone inhibits metabolism,
Cimetidine inhibits metabolism,
Fluoxetine increases plasma conc,
SJW reduces plasma conc,
```
33
Theophylline indication
Bronchodilator for Asthma, COPD
34
Desired Theophylline plasma concentration
10-20mg/L
| Over 20 = severe side effects
35
Theophylline side effects
Tachycardia, Palpitation, Nausea, GI, Headache, Convulsions
| RISK: Hypokalaemia
36
Theophylline monitoring
Plasma conc, Lung function test
37
Theophylline interacts with
Quinolones: Convulsions
Plasma conc reduced by: SJW, Rifampacin
Plasma conc increased by: Cimetidine, Fluconazole
38
Warfarin indication
Anticoagulant (48 - 72 hours for full effect)
39
What are the risks with Warfarin INR
Too high INR: bleeding (stop warfarin)
| Too low INR: Blood clotting (increase dose)
40
Dose of Warfarin
Initial dose 10mg, 3-9mg maintenance thereafter
41
Side effects of Warfarin
Haemorrhage, Rash, Hypersensitivity, Alopecia, Diarrhoea, Drop in haematocrit (packed cell volume), Purple toes, skin necrosis, Jaundice, Hepatic dysfunction
42
Warfarin monitoring
INR, Renal function
43
Warfarin Counselling
Take same time each day, avoid diet change (especially salads/vegetables), report signs of bleeding/bruising
44
Warfarin interacts with
Anticoagulant effect enhanced by: NSAIDs, Fluconazole, Statins, Ciprofloxacin, Erthyromycin, Metronidazole, Cranberry Juice
Anticoagulant effect reduced by: Griseofulvin, SJW, Antiepileptics
Anticoagulant effect anatgonised by Vitamin K
Anticoagulant control effected by Alcohol
45
Enzyme inhibitors
Sodium Valproate, Isoniazid, Cimetidine, Ketoconazole, Fluconazole, Amiodarone, Ciproflaxacin, Erythromycin, SJW, Omeprazole, Metronidazole, Grapefruit
Fluoxetine, Cranberry juice
46
Enzyme inducers
Carbamazapine, Rifampacin, Alcohol (chronic), Phenobarb/Primidone, Griseofulvin, Phenytoin, Sulfonylureas, Smoking, SJW
47
Alcohol interactions
Metronidazole: reaction like Disulfiram
Warfarin: Anticoagulant control effected
MAOI: Beverage containing tyramine - hypertensive crisis
Mirtazapine/TCA: increase sedative effect
48
What effect do enzyme inhibitors have
inhibit (decrease) metabolism of other drugs therefore increasing their conc
49
What effect do enzyme inducers have
Increase (induce) metabolism of other drugs therefore decreasing their conc/effect
50
COC interactions
Enzyme inducers - condom 4-8 weeks/tricylcing with 50mcg for 3-4 packs + 4 day pill free
Rifampacin/Rifabutin so potent - use IUD
51
Sympathomimetic (Pseudoephedrine) interactions
MAOI: Hypertensive crisis
BB: hypertension risk
52
Orlistat interactions
plasma conc Amiodarone reduced
Acarbose = GI effects
Ciclosporin absporption reduced
Anticoagulant effect - monitor
53
When H Pylori suspected
Confirm
| PPI + 2AB bd (clarithromycin + Amox/Metronidazole)
54
Hypertension in
ACEI/ACE2 -> BB
55
Hypertension >55 White or Afro-Caribbean
CaCB -> Thiazide
56
Treatment for HF
ACEI + BB
Low dose Spiranolactone = reduce symptoms, mortality
Digoxin - improve symptoms, exercise tolerance
57
How does Colestyramine work
Bile acid sequestrant - binds bile acid and promotes cholesterol to turn into bile acids
58
Counselling with Colestyramine
Give other drugs one hour before or 4 - 6 hours after
| Colesevelam/statin same time ok
59
Tiotropium indicated for
COPD not asthma
| Antimuscarinic bronchodilator
60
Metocloperamide guidance
>18 Nausea Vomiting only 10mg td 3days
Dose by weight
Only post op, radio induced, chemo, symptomatic/migraine vomiting
61
Domperidone guidance
Small serious risk of cardiac side effects
Only for Nausea Vomiting, lowest dose (>12 10mg td), 1 week
Contraindicated in heart and hepatic problems
62
Treatment of migraine
Acute: Aspirin, Paracetamol (both sol), NSAIDS + anti-emetic (domperidone, metocloperamide, phenothiazine, antihistamine)
5HT1receptoor agonists - Naratriptan, Sumatriptan
Prophylaxis: BB (propanolol) bring HR down especially if anxiety too, Pizotifen, Valproic Acid, Sodium Valproate, Topiramate, TCA, Gabapentin, (Lithium/Oxygen cluster)
NOT recommended Clonidine - insomnia/depression
63
Meningitis treatment
Urgent transfer to hospital + Benzylpenicillin/Cefotaxime
64
Lower UTI treatment
Trimethoprim/Nitrofuantoin
Amoxcillin/Cephlosporin
3 - 7 days
65
TB treatment
2 months initial phase: Isoniazid, Rifampacin, Pyrazinamide, Ethambutol (colour blindness)
4 months: Isoniazid, Rifampacin
66
High anaerobic activity
Metronidazole
67
Insulin admin
SC injection but soluble insulin IV - urgent
68
Who needs insulin
Diabetes Type 1 and 2
Ketoacidosis and for people who have rapid onset of symptoms, substantial weight loss, weakness, ketonuria (ketones in urine), first degree relative with diabetes
69
Tell me about short acting Sulphonylureas
Gliclazide, Tolbutamide
Increase insulin secretion B cells
Patients not overweight/metformin contraindicated
70
Tell me about long acting Sulphonylureas
Chlorpropamide, Glibenclamide
| Higher chance hypoglycaemia, avoid in elderly
71
Tell me about Metformin
Biguanide, first line
Decreases glucogenesis and increases peripheral utilisation of glucose
No weight gain/no hypoglycaemia
72
Tell me about Pioglitazone/Rosiglitazone
Decrease peripheral insulin resistance
73
Tell me about Acarbose
Delays digestion and absorption of starch and sucrose
Inhibits alpha glucosidases
Add on therapy
Soft stools, farting, diarrhoea, abdodicomfort
-no point giving anatacid
Tablets chewed with first mouthful/liquid right before food
Carry glucose because risk hypoglycaemia
74
Who should carry glucose with them
Patients on Insulin, Sulphonylureas, Acarbose
75
What is Diabetic Ketoacidosis
A life threatening hyperglycaemic emergency
| Nausea, Vomiting, Abdopain, Extreme thirst, Blurred vision
76
How is Ketoacidosis treated
IV Soluble insulin,
IV NaCl fluid replacement
IV KCl so no hypokalaemia (from insulin)
77
Cause of hypoglycaemia
Too much insulin, too little carbohydrate, delayed meal, too much exercise, hot weather, stress, alcohol
78
Symptoms of hypoglycaemia
Tremor, Sweating, Anxiety, Paleness, Irritability, Faint feeling, stomach ache, headache, tingling sensation, blur vision
79
Treatment of hypoglycaemia
Give some sugar after carbohydrate snack
| If unconscious: IV glucose/Glucagon injection. When conscious carbohydrate snack
80
Hypoglycaemia major caution with
BB - mask symptoms
81
Why are ACEI used in diabetes
for diabetic nephropathy in type 2 diabetes, minimise decline in renal function
82
Risk of Levothyroxine
If metabolism increases too much: Diarrhoea, nervousness, rapid pulse, insomnia, tremor, angina pain (if latent MI)
If this happens - reduce/withhold dose for 1-2 days then restart again
83
Corticosteroids indications include
Addison's disease - replacement therapy, Acute Adrenal insufficiency, hypopitruitism, anti-inflammatory treatment, immunosuppression
84
Prolonged use of corticosteroids leads to
increased susceptibility to infections/severity infections
| Adrenal suppression, psychiatric reactions, growth restriction children
85
Avoid contact with what when on steroids
Chicken pox: unless patient has had them then they are at risk if oral/parenteral treatment of severe chicken pox
Measles - avoid people
86
How long to mention you've been on steroids
one year after finishing
87
When is withdrawal tapered
Systemic treatment with corticosteroids longer than 3 months
short course within a year of long course
Other possible cause adrenal suppression
>40mg prednisolone (equivalent)
had many doses in evening (mimicked diurnal rhythm)
>3weeks treatment
88
HRT for
treat menopausal symptoms: Vaginal atrophy, vasomotor instability (heat, sweating) and menopausal osteoarthiritis
For
89
What risks are associated with HRT
Breast cancer (within 1-2 years, stops after 5 yrs stopping)
Endometrial cancer (add progestogen 10/28 days if uterus)
Ovarian cancer (especially with combined use/oestrogen only HRT)
DVT/PE
Stroke (especially Tibolone)
CHD (especially starting 10 years after menopause)
90
HRT and contraception
HRT doesn't provide contraception so in women
91
When to stop HRT immidiately
Sudden severe Chest pain, Sudden breathlessness, unexplained swelling/pain in calf one leg, severe stomach pain, hepatitis, jaundice, liver enlargement, BP >160/95, long immobility, contraindicated, neurological effects (unusual severe long headache, loss vision, disturbance in hearing, dysphagia, fainting attack, collapse, first time seizure, weakness, motor disturbance, numbness)
92
Bisphosphonates are used for what and what is the dosage
Alendronic Acid, Disodium Etidronate, Riserdronate sodium)
Reduce bone turnover - treat osteoporosis/cortico induced osteoporosis
Alendronic Acid 70mg once week for postmenopausal oseteoporosis
93
How do COCs work
Oestrogen and progestogen changes endometrial and inhibits ovulation (progestogen less)
Progestogen inhibits fallopian tube motiliy, thickens cervical mucous - hostile to sperm
94
Risks with COCs
DVT especially first year (increased with age, obesity, by travelling (GCS/exercise), immobility)
Breast cancer, cervical cancer more so. Less ovarian, endometrial cancer risk)
95
Missed COCs
24 hours take ASAP take active pill
2 pills missed: active + condom 7 days - omit pill free if these run past end of packet (especially if from first 7 pills)
96
Vomiting and diarrhoea with COCs
If vomit/diarrhoea >24 hours - condoms 7 days
97
Counselling for first time user of COC
Take on day 1 of menstruation
| If > 4days, 7 days condom
98
COC to POP
Complete whole pack, start without 7 day break otherwise 7 days condom
99
POP to COC
Day 1 menstruation
| Amenorrhoea - start any time with 7 days condom
100
Starting Contraceptive after child birth, abortion, miscarriage
3 weeks after birth (thrombosis/breakthrough bleeding risk before this) if > 3 weeks condom 7 days
After abortion, miscarriage - start same day
101
Who are POPs more suitable for
COC contraindicated - older women, heavy smokers, hypertension, heart disease, diabetics, migraine sufferers
102
Starting POP
Start day 1, 1od at same time each day
103
Missed pill POP
> 3hrs, 2 days condom (12hrs desogestrel)
104
Vomiting and diarrhoea with POPs
within 2 hours take another one, if >3hr - 2 days condom
105
Risks with POPs
Breast cancer
106
Acute attack of Gout treat with
NSAID (high dose): Diclofenac, Etoricoxib, indometacin, ketoprofen, naproxen, sulindac
Colchine
NOT Aspirin, Allopurinol, Uricosurics - these 2 prophylactic, start 1-2 weeks after acute attack settled
107
NSAIDs selective, non-selective and GI
Selective: Etoricoxib, Celecoxib - least s.e
Non-selective: Azapropazone (highest), Ibuprofen (least)
Intermediate s.e: Piroxicam, Ketoprofen, Indometacin, Naproxen, Diclofenac
108
NSAIDs and Asthma
Can worsen asthma - bronchospasm s.e.
109
Cardio risk NSAIDs
More with selective
110
Renal risk in NSAIDs
caution, can impair
111
HF and NSAIDs
Contraindicated
112
NSAIDs and peptic ulcers
contraindicated unless imperative need (severe RA) give them a PPI
113
Side effects of Mg containing antacids
Laxative effect. Belching (CO2 liberated)
114
Side effects of Aluminum containing antacids
Constipation
115
Side effects of Hyoscine (antimuscarinic)
Constipation, Transient Bradycardia, Reduced bronchial secretions, Urinary urgency and retention, Dilatation of pupils (problematic for patients with angle closure glaucoma), Photophobia, Dry mouth, Flushing, Dryness of the skin
116
Side effect H2 Receptor Antagonists
Diarrhoea, GI disturbance, Altered Liver Function Tests, Headache, Dizziness, Rash, Tiredness
117
Side effects of PPI
GI disturbance, headache
118
Side effect liquid paraffin
anal seepage, granulomatous reactions (especially from the emulsion), lipoid pneumonia and interference with the absorption of fat-soluble vitamins
119
Side effect Thiazides
Mild GI disturbance, Postural hypotension, Altered plasma lipid concentrations, Hypokalaemia, Hyponatraemia (low sodium in the blood), Hypomagnesaemia, Hypercalcaemia, Hyperglycaemia, Hyperuricaemia and Gout (uric acid). Less common – impotence.
120
Side effect Loops
Mild GI disturbance (nausea), Hypotension, Hypokalaemia, Hyponatraemia (low sodium in the blood), Hypomagnesaemia, Hypocalcaemia, Hyperglycaemia (less common than with thiazides), Hyperuricaemia, Gout (uric acid).
121
Side effects Potassium Sparing Diuretics
Hyperkalaemia
122
Side effects BB
GI disturbance, Bradycardia, Heart Failure, Hypotension, Peripheral vasoconstriction (cold hands and feet), Bronchospasm, Dyspnoea, Headache, Fatigue, Sleep disturbance (Nightmares), Sexual dysfunction, Pins and needles, Dizziness, Interference with glucose tolerance
123
Side effects ACEI
profound hypotension and renal impairment, Persistent dry cough, Angioedema, Rash, Pancreatitis, Upper Respiratory symptoms, GI disturbances, Altererd LFTs (jaundice), Hyperkalaemia, Hypoglycaemia, Blood disorders, Taste disturbance.
124
Side effects Angiotensin II Receptor Blockers
Dizziness (if taking high dose diuretics as well), Hyperkalaemia (occasional), Angioedema (occasional).
125
Side effects Nitrates
Postural Hypotension, Tachycardia, Throbbing Headache, Dizziness, Flushing.
126
Side effects CaCB
Oedema (ankles)
127
Side effects of Aspirin
Bronchospasm, Gastro-intestinal bleeding (PPI can be added)
128
Side effects Statins
Myositis, Myalgia and Myopathy (Muscle Effects) - Serious, Liver toxicity, GI disturbance (flatulence, abdominal pain)
129
Side effects Beta2 agonists
Fine tremor, Nervous tension, Headache, Muscle cramps, Palpitations, hypokalaemia.
130
Side effects Antimuscarinic Bronchodilators (Ipratropium, Tiotrpium)
Dry mouth
131
Side effects inhaled corticosteroids
Oral candidiasis, Hoarseness, Adrenal suppression
132
Side effects antihistamines
Antimuscarinic side effects – urinary retention, dry mouth, blurred vision, constipation and sedation with the older generation
133
Side effects Benzodiazepines
Drowsiness, Light-headedness the next day, Amnesia, In elderly: Confusion and ataxia, Dependence.
134
Side effects Chlorpromazine
Marked Sedative effects, Moderate antimuscarinic effects, Moderate extrapyramidal effects
135
Side effects Prochlorperazine
Marked Extrapyramidal effects, fewer sedative effects, fewer antimuscarinic effects
136
Side effects Atypical Antipsychotics (Amisulpiride, Olanzapine)
Weight gain, Dizziness, Postural hypotension, Extra-pyramidal effects (usually mild), Hyper-glycaemia and diabetes
137
Side effects TCA
Dry mouth, Sedation, Blurred vision, Constipation, Nausea, Difficulty with urination, Cardiovascular side effects, Sweating, Tremor, Rashes, Hypersensitivity reactions, Confusion, Suicidal behaviour
138
Side effects SSRI
Gastro-intestinal effects, Anorexia/weight loss or opposite, Hypersensitivity reactions, Urticaria, Angioedema, Anaphylaxis, Arthralgia, Myalgia, Photosensitivity
139
Side effects Mirtazapine
Increased appetite and weight gain, oedema, sedation, nausea, vomiting, dizziness, headache – which commonly lead to the need for withdrawal but this should be done over several weeks
140
Side effects Venlaflaxine
GI disturbance, headache, anxiety, dizziness, sleep disturbance – which commonly lead to the need for withdrawal but this, should be done over several weeks
141
Side effects Orlistat
oily leakage from rectum, flatulence, faecal urgency, liquid or oily stools, faecal incontinence, abdominal distension and pain (minimised by reduced fat intake), tooth and gingival disorders, respiratory infections, fatigue, anxiety, headache, menstrual disturbance, UTI, hypoglycaemia
142
Side effects of Metocloperamide
Extrapyramidal s.e.
143
Side effects of 5HT1 agonists (Naratriptan, Sumitriptan)
Tingling, heat, heaviness, pressure, or tightness of any part of the body, flushing, dizziness, weakness
144
Side effects Opioids
Nausea, vomiting, constipation, dry mouth, biliary spasm, respiratory depression in larger doses
145
Side effects of Penicillins (Flucloxacillin, Amoxicillin, Ampicillin, Co-amoxiclav, Co-fluampicil)
Hypersensitivity reactions can be fatal (uticaria, fever, joint pains, rashes, angioedema, anaphylaxis)
146
Side effects Cephlasporins (Cefaclor, Cefalexin)
Hypersensitivity reactions (0.5-6.5% of penicillin allergic patients will also be allergic to cephalosporins), diarrhoea and antibiotic associated colitis (more likely with higher doses), nausea, vomiting, abdominal discomfort, headache, liver problems.
147
Side effects of Tetracyclines (Tetracyline, Doxycycline, Lymecycline, Minocycline, Oxytetracycline)
nausea, vomiting, diarrhoea, Dysphagia, oesophageal irritation
148
Side effects of Aminoglycosides (Gentamicin, Neomycin)
Ototoxicity (inner ear or balance of hearing toxicity) and nephrotoxicity
149
Side effects of macrolides (Erythromycin)
Nausea, vomiting, abdominal discomfort and diarrhoea (Clarithromycin - also dyspepsia and tongue/tooth discolouration. Smell and taste disturbances).
150
Side effects Clindamycin
Diarrhoea (discontinue treatment as associated with fatal antibiotic associated colitis), abdominal discomfort, oesophageal ulcers
151
Side effects Trimethoprim
GI effects, pruritus, rashes, hyperkalaemia
152
Side effects Rifampacin
- GI effects (diarrhoea – antibiotic associated colitis reported, anorexia, nausea, vomiting), hepatic disorders, coloured bodily fluids (urine red)
153
Side effects Metronidazole
GI effects, taste disturbance, furred tongue, oral mucositis, and anorexia
154
Side effects Quinolones (ciprofloxacin)
Nausea, vomiting, dyspepsia, abdominal pain, diarrhoea, headache, dizziness, rash, sleep disturbances.
155
Side effects Nitrofurantoin
Anorexia, nausea, vomiting, diarrhoea, acute and chronic pulmonary reactions.
156
Side effects Terbinafine
Abdominal discomfort, anorexia, nausea, diarrhoea, headache, rash and urticaria
157
Side effects Insulin
fat hypertrophy at injection site, hypoglycaemia (heavy sweating, shakiness, dizziness, visual disturbance, tingling of hands and lips, speech disturbance)
158
Side effects Sulphonylureas
Weight gain, GI effects (nausea, vomiting, diarrhoea, constipation), hypoglycaemia.
159
Side effects Biguanides (Metformin)
Anorexia, nausea, vomiting, diarrhoea, abdominal pain, metallic taste, vitamin B12 deficiency
160
Side effects Levothyroxine
Diarrhoea, vomiting, angina pain, arrhythmias, palpitation, tachycardia, tremor, restlessness, excitability, insomnia, headache, flushing, sweating, fever, heat intolerance, weight loss, muscle cramps, transient hair loss in children
161
Side effects Carbimazole
nausea, mild GI disturbance, headache, rash, bone marrow suppression (neutropenia, agranulocytosis)
162
Side effects Oral Corticosteroids
Euphoria, nightmares, insomnia, irritability, mood lability, suicidal thoughts, psychotic reactions, immunosupression, adrenal suppression
163
Side effects mineralocorticoids
Hypertension, sodium and water retention, potassium and calcium loss.
164
Side effects Glucocorticoids
Diabetes, osteoporosis, muscle wasting and weakness, peptic ulceration and perforation, Cushing’s syndrome (moon face, striae, acne occurs with higher doses and is reversal on withdrawal), growth suppression in children, GI effects, menstrual irregularities, hirsutism, weight gain, increased susceptibility to infection, insomnia, glaucoma, uticaria, skin atrophy, myocardial rupture following MI or congestive heart failure, hypersensitivity, thromboembolism, nausea, malaise, hiccups, headache, vertigo
165
Side effects of COCs
Nausea, vomiting, abdominal cramps, changes in body weight, liver impairment, hepatic impairment, fluid retention, and hypertension
166
Side effects POPs
Menstrual irregularities, nausea, vomiting, headache, dizziness, breast discomfort, depression, skin disorders, disturbance of appetite, weight changes, changes in libido.
167
Side effects NSAIDs
GI discomfort, nausea, diarrhoea, bleeding and ulceration, hypersensitivity (bronchospasms), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbance, photosensitivity, blood disorders, fluid retention, renal failure
168
Side effects Methotrexate
anorexia, abdominal discomfort, dyspepsia, GI ulceration and bleeding, diarrhoea plus many more
169
Drugs that Colour Urine (and what colour)
```
Dantron (co-danthramer) - red
Sulfasalazine - orange
Triamterene (potassium sparing) - Blue in some lights
Rifampacin - orange/red
Nitrofurantoin - Orange/brown
Levodopa - dark red
```
170
Which drugs cause sensitisation/phototoxicity
Chlorpromazine - contact and photo: avoid contact, do not crush, handle solution with care + avoid sunglight
Amiodarone - Phototoxicity/slate grey discolouration. Shield skin from light during treatment and several months after. Wide spectrum sunscreen.
Doxycycline - photosensitivity
Azapropazone (NSAID) - photosensitivity
171
CSM warning for Sucralfate
Bezoar formation. Extra care - enteral feed/predisposing condition (delayed gastric emptying)
172
CSM warning for Pancreatin
High strength - certain recommendations in CF
173
CSM warning for BB
not in asthma - rarely cardioselective BB given with caution (including eye drops)
174
CSM warning for Sotalol
only fro ventricular arrythmias/prophylaxis supraventricular arrythmias
NOT for Angina, hypertension, thyrotoxicosis, secondary prevention after MI - stop for these gradually
175
CSM warning Heparin
Hyperkalaemia. More likely if diabetes, chronic renal failure, acidosis, high plasma potassium, pt taking potassium sparing drugs, >7 days treatment
176
CSM warning for Lipid lowering drugs
Rhabdomyolysis with fibrates/statins especially renal impairment/hypothyroidism
Concomitant use with increase plasma statin increase risk of muscle toxicity
177
CSM warning for Salbutamol
Hypokalaemia from beta2 agonists (measure plasma conc in severe asthma)
Especially use concomitantly with Theophylline and its derivatives, corticosteroids, diuretics, hypoxia
178
CSM warning for inhaled corticosteroids
Monitor height
| Spacer device
179
CSM warning for Leukotriene receptor antagonists
Chrug-Strauss syndrome (severe asthma with high eosinophil count) occurs especially when reduction/withdrawal concomitant oral corticosteroid
Advise patient to report eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, or peripheral neuropathy
180
CSM warning for Bee and Wasp Allergen extract/Grass and tree pollen extracts
Cardiopulmanary resuscitation facilities must be immidiately available
Monitor patient closesly after each injection
181
CSM warning for Benzodiazapines
Indicated for short term relief (2-4weeks) for anxiety which is bad causing problems
In mild anxiety inappropriate
Insomnia when its really bad
182
CSM warning for Antipsychotics and Stroke
Olanzapine and Risperidone are associated with an increased risk of stroke in elderly parients with dementia
183
CSM warning for Clozapine
a. Withdrawal b. Agranulocytosis c. Myocarditis and Cardiomyopathy d. GI obstruction
184
CSM warning for Hyponatraemia and antidepressants
All but SSRI more
| Watch out for drowsy, confusion, convulsion
185
Depression in children CSM
Fluoxetine only
186
CSM warning for Fluvoxamine
AVOID Fluvoxamine + Theophylline/Aminophylline
187
CSM warning for Paroxetine
Of all SSRi most extrapyramidal effects (and orofacial dystonias) and withdrawal symptoms
20mg daily for depression, SAD, GAD, PTSD
40mg daily for PD and OCD
Higher doses not effective
188
CSM warning for Sumatriptan
Not for use in IHD or Prinzmental's Angina
Do not use with ergotamine
NOT for IV
Driving
No response initial dose - don't take another dose for same attack
189
CSM warning for Lamotrigine
Serious skin reaction - SJS/Toxic epidermal necrolysis
Rash associated with hypersenstivity syndrome and usually first 8 weeks
Withdraw if rash/hypersensitivity signs
Risks: use with Valproate/Higher initial dose than recommended/faster dose escalation than recommended
190
CSM warning for Topiramate
acute myopia with secondary angle-closure glaucoma within one month usually
Also reported: Choroidal effusions -> anterior displacement of lens/iris
If raise IOP, try reduce and stop use
191
CSM warning for Vigabatrin
visual defects from 1 month - several years
| Visual field test before treatment and 6 month intervals (available for
192
CSM warning for Dopamine Receptor Agonists
Ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, lisuride and pergolide) associated with pulmonary/retroperitoneal/pericardial fibrotic reactions
Before treatment get erythrocyte sedimentation rate, serum creatinine and chest X-ray
Watch out for Patients should be monitored for dyspnoea, persistent cough, chest pain, cardiac failure, and abdominal pain or tenderness
193
CSM warning for Buproprion (Zyban)
Contraindicated if history of seizure/eating disorder/CNS tumour/experience acute symptoms of alcohol/benzo withdrawal
Not if pt risk of seizures unless smoking cessation benefit very high
Seizure threshold lowered by use with: antidepressants, antimalarials [such as mefloquine and chloroquine], antipsychotics, quinolones, sedating antihistamines, systemic corticosteroids, theophylline, tramadol
and also with alcohol abuse, history of head trauma, diabetes, and use of stimulants and anorectics
194
CSM warning for Flucloxacillin
Cholestatic jaundice and hepatitis - several weeks after especially had for >2weeks/older/risk factors
Don't use if history hepatic dysfunction with Fluclox
Use with caution in patients with hepatic impairment
Find out if hypersensitivity reaction to beta lactam antibacterials
195
CSM warning for Co-amoxiclav
Cholestatic jaundice during/short after. Esp over 65yo and men. Usually self limiting not troublesome
Liver toxicity
Use only for indication at correct dose. NOT >14 days
196
CSM warning for Linezolid
Haemotopoetic disorders: thrombocytopenia, anaemia, leucopenia, and pancytopenia – simultaneous decrease in the blood cells
Monitor weekly FBC especially if >14days, have myelosuppression, using other drugs which cause effect haemoglobin/blood counts/plateley function, have renal impairment
Optic neuropathy especially >28days
Report visual impairment
197
CSM warning for Co-trimoxazole
SJS, Blood dyscrasias, bone marrow suppression, agranulocytosis
Use only when good reason
198
CSM warning for Quinolones
Tendon damage within 48hrs.
Contraindicated in history tendon disorder, elderly, risk increased with corticosteroids, discountinue if tendinitis suspected
Arthropathy in children in weight bearing joints (animals) so NOT recommended in children/growing adolescent unless justifiable/short term
Convulsions risk - don't give if history (NSAID increases risk)
199
What are Quinolones used for in childen
NOT recommended but used in:
Nalidixic acid -UTIs in children over 3 months
Ciprofloxacin - pseudomonal infections in CF >5
treatment/prophylaxis of inhalational anthrax
200
CSM warning for Amphotericin B
Anaphylaxis from IV therefore test dose observe patient for 30 mins
If had previous adverse reaction and treatment essential give prophylactic antipyretic and hydrocortisone
201
CSM warning for Itraconazole
HF - caution in pt at risk of HF/high dose/long course/older/cardiac disease/negative iontropic drugs (eg CaCB)
202
CSM warning for Ketoconazole
Fatal hepatotoxicity especially >10days
biochemical and clinical monitoring
Not used by mouth for superficial fungal infections
203
CSM warning for Mefloquine (Lariam)
Warn travellers of adverse effects: nausea, vomiting, diarrhoea, abdominal pain, dizziness, loss of balance, headache, and sleep disorders
- if get these then use alternative antimalarial
PIL always provided
204
CSM warning for Carbimazole
Bone marrow suppression - stop immediately
| Confirm no sign of infection (sore throat) -> do a WBC count, if neutropenia stop immediately
205
CSM warning for Steroids
Chickenpox
Withdrawal
Pregnancy
BF
206
CSM warning for Desmopressin
```
hyponatraemic convulsions (occurs when dehydrated/low sodium in blood)
Warning of avoiding fluid overload and swimming in patients treated for primary noturnal enuresis
Stop taking during episodes of vomiting/diarrhoea
```
207
CSM warning for Medroxyprogesterone acetate (Depo-Provera)
When other methods of contraception inappropriate
Women - benefits of use beyond 2 years evaluate against risk due to reduction in bone mineral density reports
If Osteoporosis risk - consider alternative
208
CSM warning for Spermicidal contraceptives
petroleum jelly (Vaseline), baby oil, oil based vaginal and rectal preparations - damage latex condom/diaphragm and have less protection from STD
209
CSM warning for Co-Cyrindiol (Dianette)
VT more in these than COC
severe acne which has not responses to oral AB
moderate - severe hirsutism
Not solely for contraception
Contraindicated if FH of VT
Women with acne/hirsutism usually have high CVD risk
210
CSM warning for Cytotoxic drugs
1. Trained personnel should reconstitute cytotoxics
2. Reconstitution should be carried out in designated areas
3. Protective clothing (including gloves) should be worn
4. The eyes should be protected and means of first aid should be specified
5. Pregnant staff should not handle cytotoxics
6. Adequate care should be taken in the disposal of waste material, including syringes, containers, and absorbent material.
211
CSM warning for Tacrolimus (prophylaxis organ rejection)
Cardiomyopathy in children
| Monitor carefully
212
CSM warning for Tamoxifen
Thromboembolism - report breathlessness/pain in calf of one leg
endometrial cancer but benefit outweighs risk
20mg daily substantailly increases survival in early breast cancer
213
CSM warning for Thiamine IV
serious allergic ADR
214
CSM warning for NSAIDs and Asthma
NSAID can worsen asthma
215
CSM warning for Tiaprofenic acid
severe cystitis
Not if pt has UT disorder. Stop if urinary symptoms develop - report to doctor (eg. increased frequency, nocturia, urgency, pain, blood in urine)
216
CSM warning for Methotrexate
1. Blood count (bone marrow suppression - especially older, renal impairment, other antifolate drug
2. Liver toxicity (cirrhosis - NOT if LFTs/biopsy bad: CHECK. Restart when better)
3. Pulmonary toxicity (especially RA. Report: dyspnoea, cough, fever. Stop if pneumonitis)
4. Aspirin/NSAIDs: Avoid self medication. Monitor dose.
217
CSM warning for Baclofen
Abrupt withdrawal = serious side effects
| Gradual reduction over 1-2 weeks
218
CSM warning for Co-cyprindiol
VT more frequently in women taking this than COC
| Only for severe acne, hirsutism
219
Counselling points with Antacids
a. They are best taken when symptoms occur or are expected, usually between meals or at bedtime. b. They should preferably not be taken at the same time as other drugs since they may impair absorption. c. Antacids can damage enteric coatings on tablets. d. The words ‘low Na+’ added after some preparations indicates a sodium content of less than 1mmol per tablet or 10ml dose. This is directed for people with hypertension
220
Counselling points with Ispaghula
Preparations that swell in contact with liquid should always be carefully swallowed with water and should not be taken immediately before going to bed
221
Counselling points with Liquid Paraffin
should not be taken immediately before going to bed
222
Counselling points with Salbutamol inhalation
Advise patients not to exceed the stated dose. If a previously effective dose of inhaled salbutamol fails to provide at least 3 hours relief, a doctor’s advice should be obtained as soon as possible
223
Counselling points with CFC-free inhalers
Patients receiving CFC-free inhalers should be reassured about their efficacy and counselled that aerosol may feel and taste different
224
Counselling points with Ipratropium
Acute angle-closure glaucoma reported with nebulised Ipratropium, particularly when given with nebulised salbutamol (and possibly other beta2 agonists). Care is needed to protect patient’s eyes from nebulised drug or from drug powder
225
Counselling points with Corticosteroid inhaler
The risk of oral candidiasis can be reduced by rinsing the mouth with water after using the inhaler or by using a spacer device
226
Counselling points with Nitrates
Tolerance: Patients on long acting nitrates can rapidly develop tolerance (reduce therapeutic effect). Reducing the nitrate concentration in the blood for 4 to 8 hours each day usually maintains effectiveness e.g. by giving twice daily preparations after 8 hours then after 16 hours
227
Counselling points with GTN sublingual tabs
GTN tablets should be supplied in glass containers of not more than 100 tablets, closed with a foil-lined cap, and containing no cotton wool wadding (i.e. the original container). They should be discarded after 8 weeks. They should be placed under the tongue to dissolve. Dosing is ‘when required’
228
Counselling points with GTN spray
Spray one to two doses under the tongue then close mouth. This should relieve the pain within a minute or so. If no improvement after 5 minutes then use it again. If no improvement, then use again after 5 more minutes. Then if no improvement despite using the spray 3 times within 15 minutes, call an ambulance
229
Counselling points with MAOI including Linezolid
avoid large amounts of Tyramine-rich foods as it can cause a hypertensive crisis. An early warning symptom may be a throbbing headache. The danger of interaction persists for up to 2 weeks after treatment with MAOIs is discontinued. Tyramine rich foods include mature cheese, pickled herring, broad bean pods, Bovril, Oxo, Marmite or any similar meat or yeast extracts, undistilled alcohol beverages, and fermented soya bean products. Patients also need to avoid stale or ‘going off’ foods and stick to eating fresh foods. Alcoholic drinks need to be avoided (including drinks with low alcohol content). Note that no tyramine at all can cause hypotension
230
Counselling points with Carbamazepine/Oxcarbamazepine
Blood, Hepatic and Skin disorders reported
231
Counselling points with Ethosuximide
Blood disorders
232
Counselling points with Lamotrigine
Blood and Skin reactions
233
Counselling points with Pheytoin
Blood and Skin disorders
234
Counselling points with Topiramate
Myopia with secondary angle-closure glaucoma.
235
Counselling points with Sodium Valproate
Liver toxicity, Blood or Hepatic disorders and Pancreatitis (Patients need to know how to recognise signs of pancreatitis – abdominal pain, nausea and vomiting)
236
Counselling points with Vigabatrin
visual field defects
237
Counselling points with Parkinson's disease
Co-careldopa, Co-beneldopa, Dopamine receptor agonists: Excessive daytime sleep, sudden onset sleep
Therefore driving/machinery
238
Counselling points with Disulfiram
Patients should be aware of unpredictable and occasionally severe nature disulfiram-alcohol interactions. Reactions can occur within 10 minutes and last several hours which may require oxygen therapy. Patients should not ingest alcohol at all and should be warned of possible presence of alcohol in liquid medicines, remedies, tonics, foods and even toiletries (alcohol should be avoided at least one week after therapy has stopped)
239
Counselling points with Malaria prophylaxis
Travellers need to be warned about the importance of avoiding mosquito bites and importance of taking prophylaxis regularly and importance of immediate visit to doctor if ill within one year and especially within 3 months of return
240
Counselling points with Insulin
1. Wash hands before using a blood glucose monitor.
2. Absorption problems: hot climate/exercise increase the absorption. Cold climate/cool skin reduce it. Absorption is most rapid from abdomen, slowest from the thigh.
3. Avoid diabetic foods - healthy diet is more important. Diabetic foods substitute sorbitol - occasional treat.
4. Check feet daily and wear appropriate footwear. Do not treat any foot conditions yourself – consult a chiropodist or doctor.
5. Be aware of retinopathy.
6. Sick day rules: Common illness can upset diabetic control. Consult urgent medical help immediately if vomiting, drowsiness or deep rapid breathing occurs. Do not stop taking insulin or oral hypoglycaemics. Test blood glucose every 2 to 4 hours. Drink plenty of fluids to prevent dehydration. If not able to eat then take Lucozade or sugar containing drinks.
7. Travelling: cool bag. On long haul flights, inject before eating and carry extra carbohydrates. Test more regularly.
241
Counselling points with Acarbose
Tablets should be chewed with first mouthful of food or swallowed whole with a little liquid immediately before food. To counteract possible hypoglycaemia, patients receiving insulin or a sulphonylurea as well as acarbose need to carry glucose (but not sucrose – acarbose interferes with sucrose absorption
242
Counselling points with Alendronic acid
Tablets should be swallowed whole with plenty of water while sitting or standing; to be taken on an empty stomach at least 30 minutes before breakfast (or another oral medicine); patient should stand or sit upright for at least 30 minutes after taking tablet. Also, patients should stop taking tablets and seek medical attention if they develop symptoms of oesophageal irritation such as Dysphagia, new or worsening heartburn, pain on swallowing or retrosternal pain
243
Counselling points with Etidronate disodium (didronel)
– Avoid food for at least 2 hours before and after oral treatment, particularly calcium containing products such as milk; also avoid iron, mineral supplements and antacids
244
Counselling points with Risedronate
Tablets should be swallowed whole with plenty of water while sitting or standing; to be taken on an empty stomach at least 30 minutes before breakfast (or another oral medicine); patient should stand or sit upright for at least 30 minutes after taking tablet. Granules should be stirred into a glass of water and after dissolution complete taken immediately
245
Counselling points with Prazosin
First dose effect – where the first dose may cause collapse due to hypotensive effect (therefore should be taken on retiring to bed). Patient should be warned to lie down if symptoms such as dizziness, fatigue or sweating develop, and to remain lying down until they are abate completely
246
Counselling points with Ciclosporin
(potent immunosuppressant e.g. for organ transplantation – brand Neoral) – Total daily dose should be taken in 2 divided doses. Avoid grapefruit or grapefruit juice for one hour before dose. For oral solution - Mix the solution with orange juice (or squash) or apple juice (to improve taste) or with water immediately before taking (and rinse with more to ensure total dose). Do not mix with grapefruit juice. Keep the medicine measure away from other liquids (including water)
247
Counselling points with Isotretinoin
Warn patient to avoid wax epilation (risk of epidermal stripping), dermabrasion, and laser skin treatment (risk of scarring) during treatment and for at least 6 months after stopping; patient should avoid exposure to UV light (including sunlight) and use sunscreen and emollient (including lip balm) preparations from the start of treatment. Take tablets with or after food
248
Counselling points for Penicillin V, Flucloxacillin, Ampicillin
9: regular Intervals and complete the course.
23: an hour before food or on an empty stomach.
249
Counselling points for Amoxicillin
Unlike Ampicillin, absorption is not affected by the presence of food. Label 9: regular Intervals and complete the course
250
Counselling points for Cephalosporins (Cefaclor, Cefalexin)
Label 9: regular Intervals and complete the course.
251
Counselling points for Tetracycline, Oxytetracycline
Label 7: Do not take milk, indigestion remedies, or medicines containing iron or zinc at the same time of day as this medicine (prevents absorption of the antibiotic and should be taken 2-3 hours apart) Label 9: regular Intervals and complete the course. Label 23: an hour before food or on an empty stomach
252
Counselling points for Doxycycline
Label 6: Do not take indigestion remedies or medicines containing iron or zinc at the same time of day as this medicine. Label 9: regular Intervals and complete the course. Label 11: Avoid exposure of skin to direct sunlight or sun lamps. Label 27: With plenty of water. C: Capsules should be swallowed whole with plenty of fluid during meals while sitting or standing
253
Counselling points for Lymecycline
Label 6: Do not take indigestion remedies or medicines containing iron or zinc at the same time of day as this medicine. Label 9: regular Intervals and complete the course.
254
Counselling points for Minocycline
Label 6: Do not take indigestion remedies or medicines containing iron or zinc at the same time of day as this medicine. Label 9: regular Intervals and complete the course. C: Tablets or capsules should be swallowed whole with plenty of fluid during meals while sitting or standing
255
Counselling points for Erythromycin
Label 5: Do not take indigestion remedies at the same time of day as this medicine.(should be taken 2-4 hours apart) Label 9: regular Intervals and complete the course. Label 25: swallowed whole, not chewed.
256
Counselling points for Clindamycin
Label 9: regular Intervals and complete the course. Label 27: with plenty of water. C: Patients should discontinue immediately and contact the doctor if diarrhoea develops; capsules should be swallowed with a glass of water.
257
Counselling points for Trimethoprim
Label 9: regular Intervals and complete the course. C: Watch out for signs of blood dyscrasias i.e. sore throat
258
Counselling points for Rifampacin
Label 8: Do not stop taking this medicine except on your doctor’s advice. Label 14: This medicine may colour the urine. Label 22: Half to one hour before food. C: Watch out for signs of liver toxicity i.e. nausea, vomiting, malaise, jaundice.
259
Counselling points for Metronidazole
Label 4: Warning. Avoid alcoholic drink. Label 9: regular Intervals and complete the course. Label 21: with or after food. Label 25: swallowed whole, not chewed. Label 27: with plenty of water
260
Counselling points for Ciprofloxacin
Label 7: Do not take milk, indigestion remedies, or medicines containing iron or zinc at the same time of day as this medicine. Label 9: regular Intervals and complete the course. Label 25: swallowed whole, not chewed. C: Driving – may impair performance of skilled tasks e.g. driving. Effects are enhanced by alcohol
261
Counselling points for Nitrofurantoin
Label 9: regular Intervals and complete the course. Label 14: This medicine may colour the urine. Label 21: with or after food.
262
DRUGS THAT REQUIRE COUNSELLING ON REPORTING SORE THROAT – RISK OF BLOOD DYSCRASIAS
Aminosalicylates (e.g. Mesalazine, Sulfasalazine) FBC and drug stopped if blood dyscrasias suspicion
Mirtazapine, Carbamazepine, Ethosuximide, Phenytoin, Sodium valproate, Co-trimoxazole, Trimethoprim, Carbimazole, Gold (RA), Penicillamine (RA), Methotrexate, Azathioprine (transplant recipient) Bone marrow suppression - report signs of bone marrow suppression e.g. inexplicable bruising, bleeding or infection.
263
HEPATOTOXIC DRUGS
Labetalol (lab testing needed at first symptom - if found stop and not restarted)
Sodium Valproate first 6 months/multiple antiepileptic therapies. Monitor liver function
Rifampicin/Isoniazid - Report persistent nausea, vomiting, malaise or jaundice
Ketoconazole/Itraconazole - Report anorexia, nausea, vomiting, fatigue, abdominal pain, jaundice or dark urine develop
Pioglitazole/Rosiglitazole - rarely
Cyproterone (Prostate cancer treatment) - Direct hepatic toxicity; including jaundice, hepatitis and hepatic failure
Leflunomide (RA)
Methotrexate
Halothane (anaesthesia)
264
Drugs with warning cards
Lithium
Warfarin
MAOI’s
Steroids
265
DRUGS WHERE THE SAME BRAND NEEDS TO BE PRESCRIBED
```
Lithium
Theophylline and Aminophylline
Diltiazem and Nifedipine
Mesalazine
Aminosalicylates
```
266
Driving warnings with
Epilepsy - seizure free for one year. If night attacks only - no awake attacks 3 years
Diabetes - notify DVLA. Driving is not permitted when hypoglycaemic episodes occur. check blood glucose before driving and at 2 hour intervals on long journeys.
If hypoglycaemia: stop the vehicle in a safe place, switch off the ignition move from drivers seat, eat or drink a suitable source of sugar and wait and check again after 45 mins
267
Drugs not stopped during surgery
```
Anti-epileptics
Anti-Parkisonsoniun
Antipsychotics and Anxiolytics
Bronchodilators
CVD (K sparing/ACE/ACE2/BB stopped)
Drugs for dependence
Glaucoma drugs
Immunosuppressants
Progestogen only contraceptives
Thyroid/antithyroid drugs
```
268
Drugs stopped for surgery
COCs - 4 weeks before till 2 weeks after. Not minor.
MAOI withdraw slowly. Interacts with pethidine
TCA - no need to but risk arrhythmia/hypotension
Lithium - 24 hour before. Not minor.
Aspirin/Anti-coagulant - assess and replace
ACE/ACE2
K sparing
Insulin - normal dose at night. Infusion of glucose, potassium, insulin on sliding scale early morning. When pt eats start SC insulin before breakfast and stop IV 30 mins later
269
Drugs used during surgery
```
Anaesthetics, Analgesics
H2 receptor antagonits/PPI
Antimuscarinic (lung secretions)
Benzodiazepines - DRIVING risk
Antibiotics
Neuromuscular blocking drugs
Anticholinesterases - to reverse neuromuscular blocking drugs
specific antagonists - to reverse unwanted eg respiratory depression
```
270
What to avoid in pregnancy
Soft and blue veined cheeses
All types of pâté (and any liver products)
Raw eggs, partially raw eggs – e.g. homemade
mayonnaise.
Raw meat
Fish - shark, swordfish, marlin
Alcohol - 1st/2nd teratogenic, growth restriction, 3rd withdrawal
Smoking - causes vasoconstriction, hypoxia, low birth weight, premature birth or perinatal birth
Caffeine - 2 cups.day otherwise risk miscarriage/stillbirth
271
Misoprostol and pregnancy
Avoid in all trimesters - induces abortion and teratogenic
272
PPI and pregnancy
Omeprazole
273
H2 antagonists and pregnancy
avoid unless essential
274
Loperamide and pregnancy
ORS ok
275
Antacids and pregnancy
Gaviscon ok but not if high sodium
276
Laxatives and pregnancy
Bulk-forming laxatives ok (Fybrogel)
Osmotic laxatives Lactulose ok. Avoid macrogols
Stimulant laxatives - bisacodyl/senna if stimulant effect needed
277
Haemorrhoids and pregnancy
local ok
| not steroids
278
Hypertension and pregnancy
Labetalol, Methyldopa, Nifedepine MR
279
Heparin and pregnancy
LMWH preferred - enoxaparin not harmful
280
Warfarin and pregnancy
teratogenic - not 1st trimester
281
Statins and pregnancy
avoid
282
Inhaled bronchodilators and pregnancy
ok
283
Inhaled corticosteroids and pregnancy
risks asthma > side effects
Intra-uterine growth restriction (prolonged/systemic treatment)
Required during labour - monitor (risk fluid retention)
284
Epilepsy and pregnancy
Benefit treat >risk to foetus - monitor
More risk if more than one drug
Give folate supplements (neural tube defects)
Prophylactic vitamin K stops bleeding problems (delivery) and injection at birth stops AE problems
BF OK
285
Analgesics and pregnancy
Paracetamol if needed
| NOT aspirin/NSAIDs
286
Opioid analgesics and pregnancy
NOT in 3rd trimester - neonatal respiration depressed/withdrawal and gastric stasis/inhalation pneumonia in mother
287
Treating morning sickness
Promethazine (antihistamine) short term, first line
| Prochlorperazine/metocloperamide second line
288
Which antibiotics are not known to be harmful during pregnancy
Penicillins, Cephalosporins, Erythromycin, Clindamycin
289
Tetracycline and pregnancy
1st trimester - skeletal problems
| 2nd/3rd - dental discolouration/maternal hepatotoxicity
290
Aminoglycosides and pregnancy
audiorty and vestibular nerve damage especially Streptomycin. Least with Gentamycin, Tobramycin. Avoid but if given monitor
291
Macrolides (not erythromycin) and pregnancy
Avoid unless essential
292
Co-trimoxazole and pregnancy
teratogenic 1st trimester
293
Trimethoprim and pregnancy
folate antagonist, teratogenic
294
Rifampacin and pregnancy
1st trimester teratogenic
| 3rd neonatal bleeding risk
295
Metronidazole and pregnancy
avoid high dose
296
Quinolones and pregnancy
avoid - joint disorder
297
Nitrofurantoin and pregnancy
neonatal haemolysis 3rd trimester
298
Insulin and pregnancy
Insulin required might go up in 2nd/3rd trimester
SA: Insulin aspart/lispro ok
LA: Insulin Isophane/Detemir
299
Finasteride and pregnancy
avoid. Feminisation of male foetus
Excreted in semen - use condom
Child bearing age - avoid handling crushed/broken tabs
300
COCs and pregnancy
3 weeks after childbirth (thrombosis risk if earlier)
301
POPs and pregnancy
3 weeks after childbirth (risk breaththrough bleeding)
302
Cystisis and pregnancy
Refer UTI. Avoid sodium bicarbonate/citrate
| Potassium citrate ok
303
Methotrexate and pregnancy
avoid, use contraception even 3 months after for men/women
304
Drugs to avoid in breast feeding
Bromocriptine (dopamine receptor agonist) suppresses lactation
COC not recommended in breast feeding because oestrogens have adverse effects on lactation – POP preferred.
Metronidazole - bitter metallic milk taste.
Aspirin - Avoid - Reye’s syndrome.
Lithium - Avoid - toxicity in infant.
305
Tetracycline contraindicated in
306
Quinolones contraindicated in
joint disorders in children - avoid
307
Aspirin contraindicated in
308
NSAID contraindicated in
history of sensitivity to aspirin
309
Salicylate salt products (Bonjela, Bonjela cool) contraindicated in
310
Normal Blood pressure
120/80
311
Non-diabetic high blood pressure
140/90
312
Diabetic high blood pressure
130/80
313
Normal pulse
60 - 80 (up to 100 beats/min)
314
INR is what and what is the target
International Normalised Ratio
2 - 3.5 in DVT/AF etc
Too high INR - reduce warfarin dose - bleeding risk
Too low INR - increase warfarin dose - coagulation risk
315
Normal Blood glucose range
4 - 7 mmol/Litre before meal, 7 fasting is high
316
Cholesterol targets
Total: 1.0mmol/L
317
Alcohol units
A large Glass of wine (250ml) = 3 units
A standard Glass of wine (175ml) = 2 units
A small Glass of wine (100ml) = 1 unit
Half a pint of 3.5% beer, lager, cider = 1 unit
A single shot of 40% spirit (25ml) = 1 unit
A single measure of whiskey = 1 unit
A standard measure Port, Sherry (50ml) = 1 unit
318
BMI levels
BMI less than 18.5 – underweight
BMI between 18.5 and 24.9 – normal weight
BMI between 25.0 and 29.9 – overweight
BMI 30.0 or above – obese
319
Sodium levels
136 – 146mmol/L
320
Potassium levels
3.5 – 5.1mmol/L
321
Calcium levels
2.15 – 2.5mmol/L
322
Magnesium levels
0. 7 is hypomagnesia
| 1. 5 - 2.5mmol/L
323
Urea levels
2.5 – 6.4mmol/L
324
Cr Clearance
Men: 97 – 140ml/min
Women: 85 – 125ml/min
325
PC means
Presenting complaint
326
PMH means
Past medical history
327
SH means
Social history
328
DHx means
Drug history
329
O/E means
on examination
330
CVS means
BP and pulse
331
R/S
Respiratory system
332
GIT
Gut
333
Hospital charts contain what information
Patient Details
Allergies section
Drugs for ‘once only’ or ‘pre-anaesthetic medication’
MEDICATIONS SECTION
Drug and strength (Date, Route [PO, top, inh, sc, iv, im], Time of day, Dose according to the time of day [x means dose given], Additional instructions [e.g. pc – after food]
‘As required’ medicines e.g. paracetamol
Intravenous and subcutaneous infusions
334
Drugs likely to be abused
```
Codeine Linctus
Kaolin and Morphine
Gees Linctus
Do-Do Chesteze
Laxatives (Senna, Bisacodyl)
Antihistamines for temporary sleeplessness
Solvents
```
335
G6PD deficiency can lead to
Acute haemolytic anaemia
336
What are the risks of G6PD deficiency
Different effects in different people
Manufacturers don't test this
Risk are dose related
Raw fava beans/broad beans can cause
337
Drugs with definite risk of haemolysis in G6PD deficiency
```
Dapsone
Methylene blue
Nitrofurantoin
Primaquine
Quinolones
Sulphonamides
```
338
Drugs with possible risk of haemolysis in most G6PD deficient individuals
Aspirin
Chloroquine
Menadione
Quinine
339
Prescriptions charges are exempt for
Anyone in Scotland, Northern Ireland, Wales
England: Cancer, cancer side effects, permanent fistual that needs dressing, Addison's disease (hypoadrenalism), Diabetes, Underactive thyroid, myasthenia gravis, Epilepsy, Continuing disability, Pregnancy (maternity exemption certificate)
340
Stages of renal impairments
>90: Normal, stage 1
60-89: Mild, stage 2
30-59: Moderate, stage 3 (30-44:3B, 45-59:3A)
15-29: Severe - Stage 4
341
What is part ix of the drug tariff
List of appliances, dressing, incontinence pads, stoma bags, chemical reagents which can be prescribed on NHS
342
what is part xviiA of the drug tariff
Dental
343
what is part xviib/1 of the drug tariff
nurse
344
what is part xviib/2 of the dryg tariff
nurse/pharmacist/optom independent prescribers
345
Professional fee is
charges for services, 90p/Rx
| PPA pay professional fee plus price of drug
346
Category A is
widely available, easily reimbursed
347
Category C is
Reimburse branded if no generic
348
Category M is
Readily available, money back is low
349
Category E is
extemp prep, charge ingredients
350
Haemoglibin range
Males: 13 - 18
Females: 11.5 - 16.5
351
Iron range
Male: 65-176
| Female 50-170
352
CReactiveProtein levels
0.8mg/L
353
Normal temperature
37
354
Normal HbA1c
48-59mmol/ml
355
Normal neutrophil range
2.5 - 7.5 x10^9
356
Platelets range
150-400
357
RBC normal levels
77 - 95
358
Normal lymphocytes range
1.3 - 3.5 x10^9
359
Calcium levels
2.15 - 2.5
360
Recent POM to P meds
Omeprazole 10mg od/bd >18yo
Chloramphenicol drops 1drop every 2 hours->then 4 hours, 5 days >2yo
Chloramphenicol ointment 3 - 4 times a day in fridge 28days
Amirolofine - Once/week. Toe 9-12month, finger 6 month
Azithromycin - chlamydia. >16, 1g dose
Tranexamic acid 2td, 4 days
Tamsulosin for benign prostatic hyperplasia for men 45 - 75. Use 2 weeks if improve another 4 weeks
Sumatriptan 18 - 65. 2/24hrs
Orlistat - >18, >28 BMI. 1td after food Max 180mg
361
Avoid what with Omeprazole
Ketoconazole, itraconazole, cilostazol
| Monitor Warfarin, Diazepam, Phenytoin
362
Avoid Chloramphenicol if
ACGlaucoma, Blood disorder, Bone marrow suppression, Pregnancy, BF
363
Avoid Amirolofine if
364
Avoid Tranexamic acid if
Warfarin, pregnancy, contraceptive pill
365
Refer sale of Tamsulosin if
Diabetes, Renal imp, Hepatic imp, Postural Ht, Prostate surgery, pain on urination, cloudy/bloody urine, allergy, hypersensitivity, incontinence, leak urine
366
Avoid what with Tamsulosin
Antihypertensives
367
Refer Orlistat if
Taking acarbose/levothyroxine/amiodorone/anti-epileptics, HT, Hypercholesterol, >6month use, hasn't worked for 12 weeks
368
Orlistat contraindicated if
Pregnant, BF,
369
Patient wants access to PMR
Their right under Data Protection act however request made in writing to data controller - shown in 40 days. Can charge
370
Max units of alchohol per day and week for men and women
Men: 4units/day, 21units/week
Women: 3units/day, 14units/week
371
What is an accountable officer responsible for
CD, staff training CD/driver
| Can not authorise self to be witness for destruction
372
What is a superintendent
Responsible for training staff and that the pharmacy meets professional and legal requirements
373
COSHH is
Control of substances hazardous to health
Law requires exposure is minimised
Find out what hazards are and how to prevent from harming health
374
CHIP is
Chemicals (Hazard Information and Packaging for Supply) Regulations
Relates to labelling/packaging of hazardous substances
375
What is the cycle of behavioural change
Precontemplation -> contemplation -> Preparation -> Action -> Maintenance -> relapse
376
What is clinical governance
An essential service based on good practice and learning from mistakes
A process of accountability, auditing, clinical effectiveness, CPD, patient/public involvement where underperformance is remedied, risks/staff managed
Aim to improve quality of patient care
377
Audit must be
done 2/year
| One practice based, one primary care (health) based
378
Freshly prepared rules are
Made in 24 hours, dispensed within 7 days
379
Recently prepared rules are
Not stored more than 4 weeks
| Kept at 15-25degrees
380
Give an example of a binder
lactose
381
Give an example of a sweetner
sorbitol
382
Give an example of a antimicrobial
methylparaben/benzyl alchohol
383
Give an example of a diluent
Cellulose
384
Give an example of a gelling agent
gelatine
385
What is an essential service
Nationally agreed
386
What is an advanced service
Nationally agreed
387
What is a Enhanced service
Locally agreed
388
What types of alcohol are there
Completely denatured alcohol, Industrially denatured alcohol, Trade specific denatured alcohol (pharmacists don't deal with this)
389
What is a quality assurance cycle
```
Internal audit (employer trying to improve),
external audit (inspector microbial control),
exception report (Produce microbial count over years), MHRA inspection (QA, water cycle and clothing check)
```
390
What is an audit
Process of quality improvement which seeks to improve patient care and outcomes and performances are reviewed to highlight what is being done and should be done
Principle based on adhering to policy and procedures which are in place
Come under clinical governance
391
What is an appraisal
Formal assessment of employees over time
| Under clinical governance
392
An observational study is
when you observe effect factor with no influence over what happens
393
An experimental study is
When you introduce an intervention
394
What kind of observational study are there
1. Cohort
| 2. Case control study
395
What kind of experimental study are there
1. Randomised control trial
| 2. Controlled clinical trial
396
What is a cohort study
Observe what happens to a group of people with Vs without variable
397
What is a case control study
Within similar groups:
Identify people with problem
Identify people without problem
Can the differences be due to something else?
398
What is a RCT
Random one group with intervention
Random one group without intervention/placebo
Most reliable. Time consuming and expensive
399
What is a Controlled Clinical trial
Choose one group with intervention
Choose one group without intervention/placebo
Possibility of bias
400
What is a systematic review
Identify, appraise, select, synthesise ALL high quality studies relevant to the question
401
What is a single blind experiment
Participant doesn't know if treatment or placebo.
| Testers know
402
What is a double blind experiment
Participant and testers don't know if treatment or placebo.
403
What is a meta-analysis
Combines different studies.
| 2nd most reliable
404
What is parallel groups study
Each group has treatment. A and B get drug X
405
What is a cross over study
Each group get several treatments
406
What is a longitudinal study
Study subject over a long time - follow up after 2 years
407
What is a cross sectional study
Study but no follow up
408
What is the Cochrane website
Register of all control trials and data based clinical trials
409
What is PubMed
search engine giving access to medicines database of references
410
What is NHS evidence
Government funded resource info based on best practice guide
411
What is NICE
The National Institute for Health and Care Excellence
| Recommends appropriate treatment and care for people with specific disease/condition based on best available evidence
412
What is the BNF
British National Formulary
| List of all medicines based of efficacy, safety and cost effectiveness of drugs
413
A GPhC inspector can
1. Issue improvement warning
2. Impose conditions
3. Close pharmacy - if patient safety concern
414
Amitriptyline used for
Depression, Neuropathic pain UNLICENSED 75mg at night
415
Amitriptyline contraindicated in
CVD
416
Which Beta-blockers are used in asthma
Cardioselective: Bisoprolol, ATenolol, Metoprolol, Acebutalol, Nebivolol.
417
Which Beta-blockers give no nightmares
Celiprolol, Atenolol, Nadaolol, Sotalol
418
Side effect of Ferrous sulphate and what to do
Black stools
| Constipation - change to ferrous gluconate
419
Watch out for what with Glucosamine
Interation with Warfarin
| Coating is from shell fish - allergy
420
Avoid Atorvastatin in
preg/BF/liver disease/alcohol
421
Atorvastatin side effects
Muscle pain/weakness, headache, GI
422
Simvastatin side effects
Muscle pain/weakness, jaundice, liver disease
423
Indications of Metformin
Diabetes, Polycystic Ovary Syndrome
424
Lansoprazole side effects
nausea, vomiting, constipation, headache
425
tell me about Senna
Can't get on NHS
In excess - diarrhoea, low electrolytes, dehydrated, abdocramp
Contraindicated in intestinal blockage/obstruction
426
What is vitamin D2
Ergocalciferol
427
What is Vitamin D3
Colecalciferol - Desunin, Fultium D3
428
Calcium + Vit D3 exists as
Adcal, Calceos, Calcichew, Calcipros
429
How does vitamin D work
Activated in kidneys therefore renal impairment check (Creatinine, Urea, Calcium if nausea and vomiting)
Also lower diet sodium, protein and increase water
430
What counselling with Fucibet
Steroid. Once weekly. Sparingly - skin thinning.
431
Panoxyl (2.5/5%) side effects and warning
bleach clothing, red skin (stop), if other side effects switch lower
Avoid exposure to sunlight
432
If Oxytetracycline and Iron
Leave 2 hour gap
| Oxy - 2 hr - iron
433
Which statins at any time
Atorvastatin, Rosuvastatin
434
Which statins at night
Pravastatin, Simvastatin, Fluvastatin
435
Levothyroxine dosage
50-100mg in morning 30 mins before breakfast/caffeine increase by 25 - 50
436
Side effecs of levothyroxine
excess dosing makes hyperthyroidism: Dairrhoea, vomiting, flushing, sweating, palpitation, hands tremor
Also when Carbimazole underdosed
437
Dose of Carbimazole
15-40mg initially. 5-15mg maintanance
438
Side effects of Carbimazole
excess dosing makes hypothyroidismCold, tired, weight gain, constipation
Also when levothyroxine underdosed
439
Carbimazole and Propylthiouracil not given if
Bone Marrow Suppression
440
Propylthiouracil monitor
hepatotoxicity
441
Hyperthyroidism in pregnancy
Propylthiouracil first then Carbimazole second line
| BF both ok - monitor
442
Osteoporosis treatment
Aledronic acid -> Raloxifen -> Strontium/teriparatide
443
Disodium Etidronate counselling
No food before/after 2 hours, especially calcium
444
Strontium CSM warning
Drug rash with eosinophillia and systemic symptoms (DRESS)
Starts with rash, fever, swollen glands, increased WBC. Effects liver, kidneys and lungs
Report any skin rash
Don't restart
445
Bisphosphonates monitoring
correct calcium levels before giving
446
Bisphosphonates counselling
increase vitamin D/calcium, avoid alcohol, do weight burning exercise and keep a healthy diet, stop smoking
447
Avoid fish in
Hypothyroidism (iodine)
448
Colchine side effects
Diarrhoea, Vomiting ->STOP
| Muscle weakness
449
Counselling with Colchine
Increase intake of purine (fish etc)
increase liver, greens, leafy vegetables, peas
Because of low uric acid
450
Glaucoma treatment
Timolol, Latanoprost, Bimatoprost, Travopost, Brimodine, Acetazalomide/Brinzolamide
451
BB (for eye) time dosage, contraindications and side effects
Morning + Evening
Contra: Asthma (exception), tachycardia, HF
side effects: Burning, itching, stinging sensation
452
Name some Prostaglandins
Latanoprost, Bimatoprost, Travapost
| Use them at night
453
Side effect of Prostaglandins
Brown pigmentation, Eye colour change, lengthening of eye lash, pain, pinkage
454
Which sympathomimetics used for Glaucoma
Brimonidine bd
455
Miotics used in Glaucoma, dose, side effects and contraindications
Pilocarpine - up to qd
side effects: Blurred vision, driving at night problematic, pupil small
Avoid in asthmatics, hypertension, CVD
456
Carbonic Anhydrases used in Glaucoma, dose, side effects and contraindications, monitoring
Acetazalomide/Brinzolamide. 2-3 times a day.
Contraindicated in hepatic/renal impairment
Side effects: Blood disorder, rash, electrolyte disturbance, acidosis
Monitor blood count
457
Elderly and Glaucoma consideration
Combination product
458
If more than one drop medication to take
leave 10 mins in between each
459
Dry eyes treatment
```
Hypromellose (contact prescriber if no dose)
Carbomers,
Simple eye ointment (parafin)
Saline drops,
sodium hyaluronate,
Carmellose,
Acetylcysteine
```
All four times a day
NO contact lenses
Diet - omega3 fish
460
What to monitor when treating dry eyes
Corneal deposits, scarring, infection
| Photophobia, red, pain = refer
461
Epilepsy and pregnancy dose adjustment
Levetiracitam, Pregabalin, valproate(increase dose), lamotrigine (increase dose)
Take at different times
462
Topiramate side effects
Spotting between periods
| Myopia
463
Lithium Carbonate side effects
Tired, thyroid problems, memory impairment, sodium depletion
464
Olanzapine side effects
Fatigue, weight gain, sleepy, hyperglycaemia, diabetes
Avoid alcohol
Antimuscarinic side effects ->procyclidine
465
Pizotifen side effects
Dry mouth, drowsy, dizzy, Nausea, increased apetite, weight gain
466
Mirtazapine side effects
sedation, antimuscarinic, blood disorders (sore throat)
Not
467
Withdrawal of Mirtazapine
Gradual or else: Dizzy, headache, hirsutism, anxiety, agitation
468
Trigeminal Neuralgia treatment
Carbamazapine, Phenytoin (IV as fosphenytoin) - small doses initially to reduce s.e. eg dizziness
Monitor blood counts and electrolytes
469
Neuropathic pain treated with
Amitriptyline (dry mouth so give hard boil sweet/pineapple/ice/SF chewing gum)
Pregabalin 150mg om and 450mg at night (sleepy, drowsy side effect)
470
Morphine side effects
Nausea, Vomiting, Hypotension, respiratory depression (even with patch), bradycardia, tachycardia, palpitation, postural HT, Drowsy
long term: Adrenal gland suppression, lower libido, erectile dysfunction, hypogonadism
471
No nebulisation in
paradoxical bronchospasm
472
Side effects and contraindications of Mucolytics
Rash, GI bleed
| NOT in crohns/UC/ulcer
473
Antimuscarinics in COPD dose, side effects
(spiriva) 1 times a day or (ipatropium) 3-4 times a day
| side effects: high blood pressure, glaucoma, urinary retension
474
Isosorbide mononitrate risk and how to deal with it
Tolerance so space out which lowers side effects like headache
8 hour gap between 1st and 2nd dose
475
Simvastatin reduced to max 20mg with
Diltiazem, Amiodorone, Amlodopine, Verapamil
476
Simvastatin reduced to max 10mg with
Bezafibrate, Ciprofibrate
477
Side effects of Digoxin
fatigue, muscle pain, irregular heart beat
478
Cod liver oil interacts with
Warfarin
479
What can effect INR
Codeine
480
Why low salt diet in heart failure
HF =accumulation of fluid =weight gain
| add on Pravastatin
481
Thiazide side effects
Hypokalaemia, postural HT, Diabetes control lost, Gout
482
Monitoring with Thiazides
Electrolytes, renal, BP
483
Side effects of BB
Bronchospasm, Bradycardia, Blood glucose
484
Monitoring with BB
HR, Creatinine urea, BP, electrolytes
485
ACEI monitorying
electrolytes, renal function (6 months)
486
Side effects of ACEI
Persistent dry cough, postural HT, renal impairment (especially with NSAIDs)
1st dose at night
487
Side effects of ACE2
Postural HT, Dizzy, Hyperkalaemia, angiodema
488
ACE2 monitoring
electrolytes, renal function, BP and serum potassium
489
CaCb side effects
Flushing, ankle swelling, headache, can exacerbate angina
| Bradycardia, HT with Verapamil/Diltiazem
490
Monitoring with CaCB
HR and BP
491
Contraindication with CaCB
Grapefruit juice
492
Alpha blockers side effects
Hypotension, dizzy, faint, oedema, postural HT
493
Alpha blockers monitoring
BP
494
Which drugs effect the gut
Aluminium, Antimuscarinics, Antidepressants, Carbamazapine, Gabapentin, Phenytoin, Sedative antihistamines, Opioid, diuretics, Calcium, Iron
495
A ciliac is a person
intolerant of wheat, rye, barley hence GF only
496
What is diverticulitis
Mucosal balooning in colon
497
What is Zollinger Ellison and how is it treated
Hypersecretion of acid therefore hyperacidity/peptic ulcer
PPI>H2
498
What can cause a stomach ulcer
NSAIDs, Nifedipine, depression, stress
499
Side effect of PPI
GI disturbance, headache, dizzy
500
Side effect of H2
GI disturbance, headache, dizzy, rash, tiredness
501
Side effect of bismuth containing Antacid
Black stools
502
Dyspepsia caused by
Nitrates
503
Side effects of Aminosalicylates
Nausea, vomiting, diarrhoea, SJS, pancreatitis, blood disorders, purpura, rare myalgia, alopecia, headache, joint pain
504
Monitor Aminosalicylates
Blood count, renal, sore throat, bleeding, malaise, bruising
505
Side effects of Steroids
Weight gain, Diabetes, Sleep, Fluid retension, Glaucoma, Osteoporosis, Cataracts
506
Azathiprine side effects
vomit, diarrhoea, rash, fever
507
Azathioprine monitoring
Blood count, renal, sore throat, bleeding, malaise, bruising, liver
508
Side effects of ciclosporin
Hyperkalaemia, HT, Gingival hyperplasia
509
Monitoring with ciclosporin
Kidney, liver, HT, potassium, magnesium
510
Side effects infliximumab
Nausea, vomiting, abdo pain, dyspepsia
511
Monitoring with infliximumab
Hepatic/renal monitoring, TB(=cough, fever, weight loss)
512
Diet in Ulcerative Colitis
Avoid fats, cheese, milk, smoking
| Try fish oils
