Weak topics

Question 1

Age range for OTC supply of naproxen

Answer 1

15-50

Question 2

Which CCBs should be avoided in heart failure?

Answer 2

All except amlodipine due to depression of cardiac function and symptom exacerbation.

Question 3

Name some key warfarin interactions

Answer 3

• Alcohol - CYP450 inhibitor & inducer, both hepatotoxic, increased bleeding risk. Avoid heavy drinking.
• Amiodarone - CYP450 inhibitor (bleeding), monitor INR closely.
• All antibiotics & infection- can affect INR either way.
• Co-trimoxazole - CYP450 inhibitor.
• Metronidazole - CYP450 inhibitor.
• Erythromycin and Clarithromycin - CYP450 inhibitor.
• SSRI/SNRI/TCA/Mirtazapine - bleeds.
• Aspirin and NSAIDs - bleeds.
• Azole antifungals e.g., fluconazole, miconazole (even oral gel) - CYP450 inhibitor.
• Cranberry juice, grapefruit juice - increased INR.
• Corticosteroids - increased INR.
• Direct-acting antivirals for Hep C e.g., boceprevir
• Tamoxifen - increased INR.
• Levothyroxine - increased INR.
• CRAPGPS - CYP inducers
• Vitamin K complexes/diet - reduced INR.

Question 4

What strength are pink warfarin tablets?

Answer 4

5mg

Question 5

What strength are white warfarin tablets?

Answer 5

0.5mg

Question 6

What strength are brown warfarin tablets?

Answer 6

1mg

Question 7

What strength are blue warfarin tablets?

Answer 7

3mg

Question 8

Key DMARD adverse effects

Answer 8

• D - Hair loss (Drops out)
• M - myelosuppression/bone marrow suppression
• A - Hypersensitivity/rash/Allergic reaction
• R - Renal and hepatic toxicity
• Damaged lungs and nerves (Pulmonary toxicity and Neuropathy)

Question 9

MTX monitoring

Answer 9

Every 2 weeks until stable for 6 weeks initially or after dose change, then monthly for 3 months, then at least every 12 weeks:
* FBC
* Renal function
* LFTs: ALT and/or AST and albumin

Question 10

Azathioprine monitoring

Answer 10

Every 2 weeks until stable for 6 weeks initially or after dose change, then monthly for 3 months, then at least every 12 weeks:
* FBC
* Renal function
* LFTs: ALT and/or AST and albumin

Question 11

Sulfasalazine monitoring

Answer 11

Every 2 weeks until stable for 6 weeks initially or after dose change, then monthly for 3 months, then at least every 12 weeks:
* FBC
* Renal function
* LFTs: ALT and/or AST and albumin

Question 12

Tacrolimus monitoring

Answer 12

Every 2 weeks until stable for 6 weeks initially or after dose change, then monthly for 12 months, then may reduce to every 3 months:
* FBC
* Renal function
* LFTs: ALT and/or AST and albumin
* Blood glucose
* BP

Question 13

Which drugs require PPP and why?

Answer 13

• Topiramate - congenital malformation, low birth weight, autism, ADHD, and intellectual disability.
• Valproate - spina bifida, facial/skull abnormalities (e.g., cleft lip/palate), organ malformation (including when taken by father - wait 3 months)
• Oral retinoids e.g., isotretinoin, Acitretin - foetal malformation
• Thalidomide - life-threatening birth defects (including when taken by father)