*Chapter 9 Qs

Question 1

ACEi: ADR

Answer 1

ACE-i can cause renal impairment, so measure serum creatinine before any dose titration. Also causes hyperkalaemia + hyponatraemia – but checking K+ more important as abnormalities can cause fatal arrhythmias.

Question 2

Beta-blockers: ADR

Answer 2

• Beta-blockers cause fatigue*
• – do not cause heat intolerance (actually cold extremities), tremor (actually treat essential + anxiety-related tremor), HTN (actually more likely to cause hypotension), tachycardia (actually bradycardia).*

Question 3

Naproxen:ADR

Answer 3

• Naproxen is an NSAID – inhibits prostaglandin synthesis needed for gastric mucosal protection from acid – so increases risk of GI inflammation + ulceration.*
• Corticosteroids inhibit gastric epithelial renewal, thus predisposing to ulceration.*

Question 4

Diclofenac:ADR

Answer 4

• Diclofenac + another NSAIDs can → AKI, by affecting renal haemodynamics or via acute interstitial nephritis (more likely if pre-existing renal impairment).*
• ACE-i + NSAID shouldn’t be co-prescribed. ACE-i relax efferent blood vessels (eFF off i.e. leave kidney) while NSAIDs relax afferent vessels = excessive pressure drop.*

Question 5

Methotrexate and ?WHAT ABX may result in an ADR

Answer 5

Trimethoprim = folate antagonist, like methorexate. Never give together as additive toxicity risk = BM suppression, pancytopenia + neutropenic sepsis.

Question 6

Amiloride: ADR

Answer 6

Amiloride = K+ sparing diuretic. ACE-i + K+ sparing diuretic = potential hyperkalaemia, so monitor electrolytes regularly, especially after dose changes.

Question 7

Warfarin and ?WHAT ABX may result in an ADR

Answer 7

• All antibiotics listed here potentially interact with warfarin – but potentially serious interaction indicated in BNF by black dot – this is erythromycin.*
• NB: Augmentin = Co-amoxiclav.*

Question 8

What to do with a pt on warfarin and an INR > 8

Answer 8

INR over 8 + haematuria = stop warfarin, give vitamin K by slow IV injection

Question 9

Steps in Management Anaphylactic shock due to a drug e.g co-amoxiclav

Answer 9

Stop the insult

ABCDE: throat swelling-> secure airway first.

IM adrenaline (not beneficial without patent airway.)

Question 10

Management of drug induced hypoglycaemia

Answer 10

• Hypoglycaemia.*
• Conscious patient = 10-20g glucose by mouth.*
• Unconscious = glucose IV 20% (not 50% as extravasation injury + viscous).*
• Drug-induced hypoglycaemia must be managed in hospital as hypoglycaemic effects can persist for many hours.*
• IM/IV/SC glucagon usually for unconscious patient where no IV access.*
• Metformin less likely to cause hypoglycaemia than sulphonylyureas.*