What Do I Have To Remember? Flashcards
(42 cards)
What do I have to remember for Amiodarone? (Side effects, excretion, monitoring, interactions)
Side effects: QT PROLONGATION, corneal microdeposits, hypo/hyperthyroidism [contains iodine]
Excretion: Hepatic
Monitoring: 6 monthly LFTs, TFTs. Baseline LFTs, TFTs, potassium, chest x-ray, ECG (IV)
Interactions: QT PROLONGATION, Simvastatin (20MG MAX)
CYP INHIBITOR/SUBSTRATE
(affected by CYP3A)
antiretrovirals, macrolides (mycins), RL CCBs,antifungals, grapefruit juice, pioglitazone, St John’s Wort, Antiepileptics
What do I have to remember for digoxin? (side effects, dosing, monitoring, interactions)
Loading dose is required. Therapeutic range: 1-2mcg/L
Side effects:
- Cardiac arrhythmias and heart block
- neurological: weakness, confusion, headache, dizziness
- GI - anorexia
- BLURRY/YELLOW VISION
Monitoring:
electrolytes (HYPOkalaemia, HYPOmagnaesemia, HYPERcalcaemia),
renal function,
plasma-digoxin (at least 6 hours post dose),
heart rate (>60bpm)
Interactions:
- Drugs that increase digoxin: Amiodarone, Bupropion, RL CCBs, Itraconazole, Macrolides (mycins), Spironolactone, Trazodone, Trimethoprim
- St John’s Wort: reduces digoxin
- PPIs: hypomagnaesemia, digoxin tox risk, omeprazole can increase digoxin
- Diuretics: hypokalaemia - cardiac tox
- Drugs that affect renal function: NSAIDs, ACEis
What do I need to remember for heparins? (Cautions, antidote, side effects, pregnancy)
Pregnancy:
Can be used in pregnancy
Stop on the onset of labour to prevent haemorrhage
Antidote:
Reversal agent is protamine sulfate
Side effects:
Risk of heparin induced thrombocytopenia and Hyperkalaemia
Cautions:
Caution in patient with diabetes, chronic renal failure, acidosis or on drugs like potassium-sparing diuretics
What do I need to remember for warfarin? (Monitoring, side effects, interactions)
Side effects:
- haemorrhagic stroke
- rash, skin necrosis, purple toes
- diarrhoea and vomiting (leads to poor absorption)
- DVT/PE
Monitoring:
INR - alternate day at start, then longer, up to every 12 weeks, LFTs, U+Es, FBC, BP, TFTs
Interactions:
CYP SUBSTRATE: CYP Inducers and Inhibitors
What do I need to remember for aspirin? (Cautions)
Contraindicated in under 16 and in breastfeeding (Reyes syndrome)
What do I need to remember for antiplatelets? (Side effects, monitoring, counselling, interactions)
Side effects: hypersensitivity, heaviness in centre of chest, risk of haemorrhage in pregnancy
Monitoring: LFTs, U+Es
Counselling: take with or after food
Interactions:
CYP2c SUBSTRATE
- increased risk of bleeding: antifungals, carbazepines, cimetidine, ciprofloxacin, NSAIDs, SSRIs, MTX, and anticoagulants
What do I need to remember about the treatment of hypertension in diabetes?
Regardless of the BP, first line is an ACEi or ARB but use with caution in renal impairment (risk of hyperkalaemia)
You would use an ARB in a person of African-Caribbean origin as ACEi is less effective in these populations
What do I need to remember about antihypertensives? (Interactions)
Interactions:
RL CCBs, amlodipine, ranolazine and high dose statins have an increase risk of myopathy. Recommend reducing Simvastatin to 20mg in these cases.
Don’t give ivabradine, aliskerin or CCBs with grapefruit juice
What do I need to remember for ACEis/ARBs? (Cautions, side effects)
Side effects: HYPERkalaemia, anaphylactics reactions (avoid in dialysis patients), hepatic effects (jaundice)
Cautions:
- HYPOVOLAEMIA
- high dose diuretics
- hypotension
- hyponatraemia
- unstable heart failure
- known renal disease
What do I need to remember about statins?
Interstitial lung disease, report any pulmonary symptoms
Hypothyroidism, correct before starting
Monitoring: LFTs (statins can alter these) at baseline, 3 months and 12 months, blood glucose at baseline and 3 monthly
What do I need to remember for Antiepileptics? (Side effects, DVLA, Preg+BF)
There is a risk of developing suicidal thought and behaviours.
Antiepileptic hypersensitivity syndrome: FATAL - carbamazepine, lacosamide, lamotrigine, oxcarbazepine, phenobarbital, phenytoin, primidone, rufinamide)
Barbiturates take months to withdraw.
DVLA instructions on driving: you can drive if you have a 3 year history of no daytime seizures, only nighttime.
If medication is changed then advice is to not drive for 6 months afterwards
Pregnancy: topiramate can cause cleft palate if taken during first trimester.
Breastfeeding: monitor for sedation, feeding difficulties, adequate weight gain and developmental milestones.
Note withdrawal can occur if child stops breastfeeding abruptly
What do I need to remember for carbamazepine?
Toxicity: incoordination, blurry vision, double vision, nystagmus, ataxia, arrthymias, N+V, diarrhoea, HYPONATRAEMIA
Side effects: blood disorders, skin reactions, HEPATIC disorders (increase dose in advanced liver disease), AeHS
Report any bleeding or bruising, any fever, rash, GI upset or jaundice
Monitoring: FBC, U+Es, LFTs, plasma conc (2 weeks after start)
Interactions: CYP INDUCER
- increased convulsions: orlistat
- decreased conc: phenytoin, rifabutin, St John’s Wort
- increased conc: acetazolamide, cimetidine, macrolides (mycins)
- reduces the conc of: antipsychotics, corticosteroids, warfarin, eplerenone, oestrogen and progestogen and Simvastatin
What do I need to remember for lamotrigine?
Lamotrigine can cause blood disorder - watch for fever, anaemia, bruising or infection
Lamotrigine can cause serious skin reactions, watch for purplish rash within first 8 weeks. Exacerbated by valproate, initially high doses of Lamotrigine, and more rapid dose escalation.
What do I need to remember for Topiramate?
Acute myopathy secondary to close angle glaucoma - typically occurs within 1 month of start
If raised ocular pressure occurs - seek specialist advice and reduce down Topiramate as rapidly as feasible - no abrupt stop
What do I need to remember for sodium valproate?
Liver toxicity - occurs in first 6 months, monitor LFTs every 6 months until they return to normal
Discontinue if abnormally prolonged prothrombin time persists or if there are signs of toxicity
Persistent vomiting and abdo pain, anorexia, jaundice and loss of seizure control
What do I need to remember for vigabatrin? (side effects)
Can cause visual field defects - varies from 1 month to years after start
Usually persists despite cessation.
Visual field testing at baseline and 6 monthly.
Advise to report any new visual symptoms and refer immediately to ophthalmologist.
What do I need to remember for Benzodiazepines? (overdose and counselling)
Overdose: drowsiness, ataxia, dysarthria, nystagmus, and occasionally respiratory depression, and coma.
Antidote: Activated charcoal within 1 hour of ingestion provided the patient is awake and the airway is protected.
Counselling:
Paradoxical increase in hostility and aggression
Avoid in elderly due to increased risk of confusion leading to falls and injury.
What do I have to remember for Atomoxetine? (monitoring, ADRs)
Monitoring:
Pulse, BP, Psychiatric Symptoms, Appetite, Weight, Height - baseline, 6 monthly, on initiation and following each dose adjustment
Monitor for appearance or worsening of anxiety, depression or tics, history of seizures.
Risk of Hepatic disorders, seek medical attention
Risk of suicidal thoughts and behaviours, report to GP
What do I need to remember for Dexamfetamine / Lisdexamfetamine? (ADRs)
Tics and Torette’s syndrome - discontinue if occur, monitor weight and height may occur during prolonged therapy
What do I need to remember for Lithium? (dosing, side effects, monitoring, interactions)
Therapeutic Range: 0.4-1mmol/L (lower end for maintenance and elderly) 0.8-1mmol/L (acute mania and relapse
Overdose: Seizure, coma, renal failure, arrythmias, blood pressure changes, circulatory failure
Side effects:
- Increased GI Disturbances
- Blurred vision
- CNS Disturbances - drowsiness, unsteadiness, confusion
- Fine-course tremor, muscle weakness
- signs and symptoms of hypothyroidism, renal dysfunction and benign intracranial hypertension
Monitoring:
U+Es, TFTs, Cardiac function - every 6 months
Lithium conc - weekly then every 3 months once stable
Interactions:
- QT PROLONGATION
- Toxicity risk: Antihypertensives, NSAIDs, Aldosterone Antagonists, Metronidazole, SSRIs, Tricyclics
- Risk of neurotoxicity: Methyldopa, Phenytoin, Carbamazepine, RL CCBs
- Increased risk of Extrapyramidal SEs: Antipsychotics
What do I need to remember for Lithium? (Cautions, Counselling)
Long term use associated with thyroid disorders and mild cognitive and memory impairment. Needs careful monitoring of thyroid, cardiac and renal function every 6 months. Serum lithium measured weekly then every 3 months when stable.
Keep on same brand of lithium
Toxicity is worse with sodium depletion so keep a consistent diet and water intake to avoid lithium conc changes
Avoid NSAIDs and Alcohol
What do I need to remember for MAOIs? (examples, counselling, withdrawal)
Phenelzine
Have a dangerous interaction with tyramine rich food. It can cause a dangerous rise in BP. Advise to eat only fresh food and avoid food that’s suspected to be stale or ‘going off’. Especially with meat, fish, and poultry. Avoid game, alcohol and ‘low alcohol’ drinks.
Start any new antidepressants 2 weeks after stopping MAOIs.
Withdrawal Symptoms:
Agitation, irritability, ataxia, movement disorders, insomnia, drowsiness, vivid dreams, cognitive impairment, and slowed speech, occasionally hallucinations and paranoid delusions. Taper over at least 4 weeks.
What do I need to remember for SSRIs?
Citalopram, Escitalopram, Paroxetine, Sertraline, Mirtazapine, and Venlafaxine is not recommended in under 18s.
Fluoxetine, though safe in children is still associated with risk of suicidal thoughts and ideation.
Cautions:
Avoid in poorly controlled epilepsy - discontinue if convulsions develop
Cardiac disease, diabetes, susceptibility to close-angle glaucoma, history of mania
Overdose:
N+V, agitation, tremor, nystagmus, drowsiness, and sinus tachycardia. Convulsions may occur
Withdrawal:
GI Distrubance, paraesthesia, electric shock sensation in CNS, tinnitus, sleep disturbance, influenza- like symptoms
What drugs are licensed for over 2, and 6 months?
2 months: Lyclear cream
4 months: Daktarin oral gel
6 months: Hedrin and Lyclear cream rinse
