1
Q
bmaMost common SE of Mg salts
A
Diarrhoea
2
Q
Metformin with diarrhoea
A
If metformin is not tolerated due to GI side-effects, try a modified-release formulation before switching to a second-line agent
3
Q
What drug precipitate azathiptine toxicity
A
Allopurinol
Causes Bone marrow failure
4
Q
CCB SE
A
headache, flushing, ankle oedema
5
Q
Beta blocker overdose
A
if bradycardic then atropine
in resistant cases glucagon may be used
6
Q
SE of TB meds
A
Rifampicin
hepatitis, orange secretions
Isoniazid
Injures nerves and liver
peripheral neuropathy: prevent with pyridoxine (Vitamin B6)
Pyrazinamide
P for Painful joints and liver Problems
Gout
Hepatitis
Ethambutol
Optic neuritis
7
Q
When should metformin be stopped
A
GFR <30
Recent MI, AKI, sepsis
8
Q
Mx of OD of benzo
A
Flumazenil
9
Q
Mx of OD of TCA
A
IV bicarb
Indicated if QRS >100 ms or ventricular arrhythmias
10
Q
Mx of heparin OD
A
Protamine sulphate
11
Q
Mx of iron OD
A
Desferrioxamine
12
Q
Mx of organophosphate OD
A
Atropine
13
Q
Mx of methanol poisoning
A
fomepizole or ethanol
haemodialysis
14
Q
Meds causing digoxin toxicity
A
Thiazides
Diltiazem
Amiodarone, verapamil
Ciclopsoirn
Spiro
15
Q
How heparin is monitored
A
APTT
16
Q
Effect on baby if on lithium
A
Ebstein
17
Q
Monitoring bloods on statin, ace, amiodarone, methotraxate, azathioprine, lithium, valproate, glitazones
A
Statin-lft
Amiodarone- Tft, lft
Meth- fbc, let, u+e
Aza- fbc, lft
Lithium- lithium, tft,u+e
Valproate- fbc, lft
GLitazone- lft
18
Q
Meds CI in HF
A
thiazolidinediones
pioglitazone is contraindicated as it causes fluid retention
verapamil
negative inotropic effect
NSAIDs/glucocorticoids
19
Q
Amiodarone SE
A
Amiodarone is a BITCH
Blue skin discolouration/Brady
Interstitial lung disease
Thyroid dysfunction (hypo- or hyperthyroidism)
Corneal microdeposits (causing glare, night vision issues)
Hepatotoxicity
20
Q
St John’s Wort P450
A
Inducer
21
Q
Tamoxifen SE
A
menstrual disturbance: vaginal bleeding, amenorrhoea
hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects
venous thromboembolism
endometrial cancer
22
Q
Medications held in AKI
A
ACEi ARB
Metformin
Diuretics
NSAIDs
23
Q
Inducers of P450
A
SCRAP GP
S – Smoking
C – Carbamazepine (antiepileptic)
R – Rifampicin
a – alcohol (enic use)
P – Phenytoin (antiepileptic)
G – Griseofulvin
P – Phenobarbitone (barbiturate)
S – St John’s Wort
24
Q
HRT prescription
A
Perimenopause (less than 12 months)- cyclical
continuous combined HRT if they have:
taken cyclical combined for at least 1 year or
it has been at least 1 year since their LMP or
it has been at least 2 years since their LMP, if they had premature menopause
Transdermal to reduce VTE
25
Aspirin MOA
non reversible COX 1 and 2 inhibitor
26
Drug induced photosensitivity
thiazides
tetracyclines, sulphonamides, ciprofloxacin
amiodarone
27
Break through analgesia prescription
1/6th total dose
28
CI to sildenafil
Concurrent use with nitrates (e.g. nicorandil, GTN)
Recent stroke or myocardial infarction (avoid for 6 months)
29
SE of diabetic meds
Metformin- GI
Sulfonylurea- hypoglycaemia
Glitazone- weight gain
GLiptins- pancreatitis
30
Drug induced thrombocytopenia
Quinine
Quinidine
Co-trimoxazole
Vancomycin
31
Ix before starting on trastuzumab
an echo is usually performed before starting treatment
32
Salicylate OD
hyperventilation (centrally stimulates respiration)
tinnitus
lethargy
sweating, pyrexia*
33
Visual changes secondary to drugs
blue vision: Viagra ('the blue pill')
yellow-green vision: digoxin
34
Liver transplant after paracetamol OD criteria
Arterial pH < 7.3, 24 hours after ingestion
or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy
35
What should be prescribed with isoniazid
pyridoxine
36
Quinilone SE
Lower seizure threshold
Tendon damage
Lengthen QT
37
What can precipitate lithium toxicity
dehydration
renal failure
drugs: diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole.
38
Drugs causing ocular problems
Cataracts
steroids
Corneal opacities
amiodarone
indomethacin
Optic neuritis
ethambutol
amiodarone
metronidazole
Retinopathy
chloroquine, quinine
39
Antiplatelets before dental procedure
Take as normal
40
When is nitro CI
CKD 3
41
Tx of antifreeze poisoning
Fomepizole
42
When are paracetamol levels measured after ingestion
4 hours
43
Azathioprine in pregnancy
Safe to use
44
Methotrexate SE
“Meth kills cells, lungs, and liver.”
Myelosuppression → affects rapidly dividing cells
Liver cirrhosis → Liver toxicity
Pneumonitis → rare but serious lung side effect
45
Sulphalazine SE
“Sulfa = Sperm, Skin, and Spleen (Heinz bodies).”
Rashes
Oligospermia (reversible infertility in men)
Heinz body anaemia (oxidative haemolysis in G6PD deficiency)
Interstitial lung disease (rare)
46
Hydroxychloroquine SE
Hydroxy-eye-chloroquine”
Retinopathy (dose- and duration-dependent!)
Corneal deposits
47
Gold SE
Gold in urine = proteinuria”
Proteinuria (risk of nephrotic syndrome)
48
Leflunomide SE
Liver, lung (Interstitial lung disease), HTN
49
Prednisilone SE
Cataracts
Ulcers
Skin thinning, Striae
Hypertension
Infection risk
Necrosis of bone (osteoporosis/avascular necrosis)
Glucose intolerance (diabetes)
50
Penicillamine SE
Proteinuria
Worsening myasthenia gravis
Think: Peni-cilla- mya is “Silly” → attacks kidneys and muscles.
51
Rules with lithium monitoring
when checking lithium levels, the sample should be taken 12 hours post-dose
after starting lithium levels should be performed weekly and after each dose change until concentrations are stable
once established, lithium blood level should 'normally' be checked every 3 months
after a change in dose, lithium levels should be taken a week later and weekly until the levels are stable.
thyroid and renal function should be checked every 6 months
52
Drugs causing ocular problems
🔹 S – Steroids → Cataracts
🟡 S = Steroids = Sun (blinding cloudiness)
🎯 Think: "S for Steroids → S for Sight gets blurry"
🔹 C – Corneal Opacities → CIA
👁️ Cornea = “CIA agents hiding behind fogged glasses”
Corneal opacities caused by:
Chloroquine (sometimes)
Indomethacin
Amiodarone
🔹 O – Optic Neuritis → EAM
🔥 "Fire in the cable" (optic nerve)
Inflammation = visual loss, pain on movement
Drugs:
Ethambutol (most important!)
Amiodarone
Metronidazole
🎯 Mnemonic: EAM sets the optic nerve aflame
🔹 R – Retinopathy → CQ
📸 Retina = camera film damaged by toxic light
Drugs:
Chloroquine
Quinine
🎯 Mnemonic: “CQ attacks the camera” (Retina)
53
Drugs that cause gynaecomastia
Some Drugs Create Funny Growing Sacks
Spiro
Digoxin
Cimetidine
Finasteride
GnrH agonist- goserelin
Steroids- anabolic
54
CHADSVASc score
CHF
HTN
Age- 2- >75- 2
DM
Stroke- 2
Vascular disease
Sex
Score- 1 male- consider
2 or more- AC
55
Oral to SC morphine
divide by 2
56
Breakthrough calculation for pall care
Breakthrough is 1/6 of total
57
Morphine to oxycodone
Divide by 1.5
58
Codeine/tramadol to morphine
Divide by 10
59
Morphine to SC fentanyl
5 mg = 25 micrograms
60
Transdermal patches to morphine
a transdermal fentanyl 12 microgram patch equates to approximately 30 mg oral morphine daily
a transdermal buprenorphine 10 microgram patch equates to approximately 24 mg oral morphine daily.
61
Meds causing erythema multiforme
Skin Can Peel After New Outbreak
Sulphonamides
Carbamazepine
Penecillin
Allopurinol
NSAID
OCP
62
Cause of gingival hypertrophy
PACC the gums
Phenytoin
AML
Ciclosporin
CCB
63
When to tx HTN
ABPM/HBPM >= 135/85 mmHg (i.e. stage 1 hypertension)
treat if < 80 years of age AND any of the following apply; target organ damage, established cardiovascular disease, renal disease, diabetes or a 10-year cardiovascular risk equivalent to 10% or greater
ABPM/HBPM >= 150/95 mmHg (i.e. stage 2 hypertension)
offer drug treatment regardless of age
64
Mx of lithium tremor in range
Reassure the patient that a mild fine tremor is a common benign side effect.
Non-pharmacological measures:
Reduce caffeine intake
Avoid triggers (stress, fatigue)
If tremor is persistent and troublesome:
Consider adding a beta-blocker, typically propranolo
65
Meds causing gout
"Painful Feet Can Ache After Certain Treatment"
Painful Pyrazinamide (TB drug)
Feet Furosemide (loop diuretic)
Can Ciclosporin
Ache Alcohol
After Aspirin (low-dose)
Certain Cytotoxic agents (e.g. chemo)
Treatment Thiazide diuretics
66
Drugs causing galactorrhoea
Having Many Children Drink (you know, extra milk)
Haloperidol Metoclopramide Chlorpromazine Domperidone
67
Meds causing erythema nodosum
penicillins
sulphonamides
combined oral contraceptive pill
68
UTI med CI in CKD 3
Nitro
69
Which NSAID is CI in heart disease
Diclofenac
70
When should clopi be held before surgery
7 days
71
Thiazides and kidney stones
Decrease urine Ca
Decrease calcium kidney stones
72
SE of taking too much pyridoxine
Peripheral neuropathy
73
Potential interactions with donepezil
Any rate limiting drug
74
Valproate SE
V Vomiting (GI upset, nausea)
A Appetite ↑ and weight gain
L Liver toxicity (monitor LFTs)
P Pancreatitis (rare but serious)
R Reversible hair loss (alopecia)
O Oedema
A Ataxia (tremor, unsteadiness)
T Teratogenicity (neural tube defects)
E Encephalopathy (due to hyperammonemia)
75
SE of amlodipine, nifedipine
Flushing, headache, ankle swelling
76
SE of verapamil
Heart failure, constipation, hypotension, bradycardia, flushing
77
SE of diltiazem
Hypotension, bradycardia, heart failure, ankle swelling
78
Inhibitors of P450
SICK FACES
S Sodium valproate
I Isoniazid
C Cimetidine, cipro, clari
K Ketoconazole (and other azoles like fluconazole)
F Fluoxetine (SSRI)
A Amiodarone, Acute alcohol use
C Ciprofloxacin
E Erythromycin (macrolide)
S Sertraline (SSRI)
79
Test with carbimazole
FBC as causes agranulocytosis
80
HTN tx in DM
ACE inhibitors eg. ramipril should be used first-line for treating hypertension in diabetics, exceptions to this are people of Afro-Caribbean origin and women for whom there is a possibility of becoming pregnant.
81
BB SE
bronchospasm
cold peripheries
fatigue
sleep disturbances, including nightmares
erectile dysfunction
82
Drugs causing ototoxicity
Aminoglycoside antibiotics (.g. gentamicin, streptomycin) – cause cochlear and vestibular toxicity, often irreversible.
Loop diuretics (e.g. furosemide, bumetanide) – usually reversible hearing loss, especially with rapid IV administration or high doses.
Platinum-based chemotherapy agents (e.g. cisplatin, carboplatin) – cause dose-dependent sensorineural hearing loss.
Salicylates (e.g. high-dose aspirin) – typically cause reversible tinnitus and hearing loss.
Quinine and related drugs – may cause reversible tinnitus and hearing impairment.
83
Mx of Raynaud's
CCB
84
Organophosphate sx and mx
inhibition of acetylcholinesterase leading to upregulation of nicotinic and muscarinic cholinergic neurotransmission.
(mnemonic = SLUD)
Salivation
Lacrimation
Urination
Defecation/diarrhoea
cardiovascular: hypotension, bradycardia
also: small pupils, muscle fasciculation
Management
atropine
85
What does haloperidol worsen
Parkinsons
86
High INR and bleeding on warfarin Mx
Major bleeding - IV Vit K 5mg and Prothrombin complex concentrate
Minor bleeding - IV vit K 1-3mg
No bleeding & INR >8 - PO vit K 1-5mg
No bleeding and INR 5-8 - withhold 1 or 2 doses
General points:
- Withhold warfarin until INR <5
- can repeat vitamin k administration after 24 hours if INR remains elevated
87
Electrolyte abnormality with phenytoin
Low Ca
88
Drugs to avoid whilst breastfeeding
BREAST CML
Benzo
Retinoids
Estrogen
Amiodarone, aspirin
Sulphomides, sulfonylurea
Tetracycline
Cipro, Chloramphenicol, Carbimazole
Methotrexate
Lithium
89
Drugs worsening psoriasis
B — Beta-blockers
L — Lithium
A — Antimalarials (chloroquine, hydroxychloroquine)
N — NSAIDs
C — ACE inhibitors
I — Infliximab
90
Sulfonylurea on day of surgery
omit on the day of surgery
exception is morning surgery in patients who take BD - they can have the afternoon dose
91
Amiodarone monitoring
Baseline
TFTs, LFTs, U&Es, CXR, ECG
Every 6 months: TFTs, U&Es, LFTs
92
When to use each type of antiemetic
🌀 Reduced gastric motility Metoclopramide, Domperidone (pro-kinetics)
🧪 Chemically mediated
Ondansetron, Haloperidol, Levomepromazine
🫃 Visceral/serosal
Cyclizine, Levomepromazine, Hyoscine (anti-cholinergic)
🧠 Raised intracranial pressure Cyclizine, Dexamethasone
🦻 Vestibular
Cyclizine
🧍 Cortical (anticipatory)
Lorazepam (short-acting benzodiazepine)
93
Medication more likely to cause hyponatraemia ARB or SSRI
SSRI- as inhibiting ADH via SIADH is more potent especially in elderly than ARB inhibiting RAAS
94
Hiccups in pall care
Hiccups in palliative care - chlorpromazine or haloperidol
95
Drugs to avoid in pregnancy
SAFER WoMAnT
Sodium Valproate/statin/sulfonulurea
ACE
Fluroquinilones
Epileptics- only phenytoin, phenobarbital
Retinoids
Warfarin
Methotrexate
Aminoglycosides
Tetracycline
96
Which antibiotic lowers seizure threshold
Cipro
97
What should be prescribed with Isoniazid
Pyridoxine
98
Entanercept SE
Demyelination
Reactivation of TB
99
Those viable for pneumococcal one off vaccine
Asplenia or splenic dysfunction
Chronic respiratory disease:
COPD, bronchiectasis, cystic fibrosis, interstitial lung disease
Asthma only if on oral steroids at immunosuppressive doses
Chronic heart disease:
Ischaemic heart disease requiring medication/follow-up
Heart failure
Congenital heart disease
Controlled hypertension alone is NOT an indication
Chronic kidney disease stages 4 or 5, nephrotic syndrome, kidney transplant recipients
Chronic liver disease including cirrhosis and chronic hepatitis
Diabetes mellitus requiring medication
Immunosuppression due to disease or treatment (all HIV stages included)
Cochlear implants
Cerebrospinal fluid leaks
100
Meds causing swelling of lips and tongue
ACEi- angioedema
101
Patient unable to tolerate alendrotnic acid
Risendronate
Then next consider IV zol or denosumab
102
Triptans vs SSRI effect
Serotonin syndrome
103
Amiodarone SE
BITCH
Blue skin discolouration
Interstitial lung disease
Thyroid dysfunction (hypo- or hyperthyroidism)
Corneal microdeposits (causing glare, night vision issues)
Hepatotoxicity
104
MOA of smoking cessation medication
Buproprion = norepinephrine + dopamine reuptake inhibitor and nicotinic antagonist.
Varenicline = nicotinic receptor partial agonist.
105
Diabetic drugs day of surgery
assume day of surgery:
Metformin - omit lunchtime dose only if TDS
Sulfonylurea (gliclazide) - omit any morning dose
SGLT inhibitor (empaglifozin) - omit day of surgery
OD insulin - reduce dose by 20% day before and day of surgery
BD insulin - 50% morning dose day of surgery
106
When should you start statin in T1DM
Older than 40 years of age
Have had diabetes for more than 10 years
Have established nephropathy
Have other CVD risk factors (such as obesity and hypertension)
107
PD med most likely to cause hallucinations
Dopamine agonists eg Ropinirole
108
Drugs causing lung fibrosis
FIBRA
Furatoin
Immuno- bleo
Bromo
Rheumatoid
Amiodarone
amiodarone
cytotoxic agents: busulphan, bleomycin
anti-rheumatoid drugs: methotrexate, sulfasalazine
nitrofurantoin
ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)
109
When are bisphosphonates CI
GFR <35
110
Age to take triptans
Sumatriptan nasal spray is only licensed in children >12 years of age. Oral sumatriptan is not licensed in people <18 years old.
111
Tx of neuropathic pain
first-line treatment*: amitriptyline, duloxetine, gabapentin or pregabalin
if the first-line drug treatment does not work try one of the other 3 drugs
in contrast to standard analgesics, drugs for neuropathic pain are typically used as monotherapy, i.e. if not working then drugs should be switched, not added
tramadol may be used as 'rescue therapy' for exacerbations of neuropathic pain
112
PPI with clopi
Lansoprazole
113
Antiemetic in migraine
Metoclopramide
Also helps with stasis allowing better absorption of drugs
114
Antidote to amitriptyline
IV bicarb if QRS changes
As TCA
115
Which abx to avoid with methotrexate
Trim and Cotrim
116
Carbamazepine in breast feeding
Okay to continue
117
When should you avoid amitriptyline
In BPH
118
Antimalarial causing psych issues
Mefloquine
119
Anitmalarials CI in epilepsy
Mefloquine
Cholorquine
Both taken weekly
120
MOA of tamoxifen and common SE
Selective oEstrogen Receptor Modulator (SERM) which acts as an oestrogen receptor antagonist and partial agonist- blocks growth in breast cells
SE are from systemic Oestrogen receptor blocker including hot flushes
In bone ER agonist- protecting
121
What increase of creatinine and K is acceptable after starting ACEi
30%- creatinine
K up to 5.5
122
Meds causing thrombocytopenia
quinine
abciximab
NSAIDs
diuretics: furosemide
antibiotics: penicillins, sulphonamides, rifampicin
anticonvulsants: carbamazepine, valproate
heparin
PLATES
Penicillin, Loop, Aspirin, enzyme inducer, TB-rifampicin, sulphonamides
QCVH
123
Mx of TIA if unable to tolerate clopi
Aspirin
124
What do antipsychotics increase the risk of in elderly
VTE and strokem
125
Mx of Benzo addiction
switching patients from their current benzodiazepine to an equivalent dose of diazepam. This is because diazepam has a long half-life and active metabolites
Reduce diazepam dose gradually every 2-3 weeks by 2–2.5 mg increments
time needed for withdrawal can vary from 4 weeks to a year or more
126
Sulphonylurea SE
Hypoglycaemia
Weight gain
Cholestasis
Thrombocytopenia
127
Mx of methanol and ethylene glycol OD
Fomepizole
128
Timings of taking iron with levo
Should be taken 4 hours apart
129
MOA of statins
Inhibit HMG CoA - rate limiting step of intrinsic cholesterol formation
130
Antidepressant associated with prolonged QT
Citalopram
131
Meds causing cholestasis
combined oral contraceptive pill
antibiotics: flucloxacillin, co-amoxiclav, erythromycin*
anabolic steroids, testosterones
phenothiazines: chlorpromazine, prochlorperazine
sulphonylureas
FACTS
Fibrates/Phenothiazines
Abx
COCP
Testosterones
Steroids/Sulphonureas
132
aWhat is bupropion CI in
Epilepsy, pregnancy and breast feeding
133
Alternative tx for CHF if gynae symptoms from Spiro
Eplerenone
134
Mx of aspirin OD causing severe metabolic acidosis resistant to treatment
Haemodyalsis
Indications for haemodialysis in salicylate overdose
serum concentration > 700mg/L
metabolic acidosis resistant to treatment
acute renal failure
pulmonary oedema
seizures
coma
135
CI to sildenafil
patients taking nitrates and related drugs such as nicorandil
hypotension
recent stroke or myocardial infarction (NICE recommend waiting 6 months)
136
Antiemetic causing raised prolactin
Prochlorperazine
137
Medication causing anal ulceration
Nicorandil
138
Meds for delirium
1st line haloperidol
other options: chlorpromazine, levomepromazine
139
Monitoring LFT with statin
LFTs at baseline, 3 months and 12 months
None routine after
140
Opioids safe in poor renal function
alfentanil, buprenorphine and fentanyl
141
What level renal function to avoid morphine
Use morphine cautiously if eGFR ≥30 ml/min
Avoid morphine if eGFR <30 ml/min; consider oxycodone or other opioids like fentanyl, alfentanil, or buprenorphine
142
Carbergoline SE
Pulmonary fibrosis
143
Meds to aid with orthostatic hypotension
Fludrocortisone
Midrodine
144
CI to using triptans
patients with a history of, or significant risk factors for, ischaemic heart disease or cerebrovascular disease
145
NNT calculation
1/(Absolute risk reduction)
ARR = CER - EER
146
How much is a unit of alcohol
10ml
147
How is TPN administered
peripherally inserted central catheter
148
When to refer to coroners
Sudden, unexpected, or unexplained
Violent or unnatural (including accidents, suicide, homicide)
Occurred during or following surgery or medical treatment where the cause is uncertain
In custody or state detention (e.g. prison, police custody, psychiatric detention)
Due to industrial disease or poisoning
Where the identity of the deceased is unknown
149
oral morphine sulphate 20mg four times a day along with codeine 30mg four times a day
What breakthrough of morphine
2 x 20 +80
30 x 4 =120/10= 12c
80+12=92 /6 = 15
150
Minimum time to wait for paracetamol level
4 hours
151
Toxins amenable to dialysis
BLAST
B – Barbiturates
L – Lithium
A – Alcohols (methanol, ethylene glycol)
S – Salicylates
T – Theophylline
152
Features of Salicylate (Aspirin) Overdose and mx
Mixed respiratory alkalosis and metabolic acidosis
Hyperventilation
Tinnitus
Nausea and vomiting
Hypo- or hyperglycaemia
Activated charcoal
Urinary alkalinisation with IV bicarbonate
Haemodialysis if severe
153
TCA overdose features and mx
Early: dry mouth, dilated pupils, blurred vision
Later: arrhythmias, metabolic acidosis, seizures, coma
ECG findings
Sinus tachycardia
QRS > 100 ms (seizure risk), > 160 ms (arrhythmia risk)
Prolonged QTc
IV sodium bicarbonate
154
Lithium OD features
Coarse tremor
Ataxia, hyperreflexia
Nystagmus
Acute kidney injury
155
Mx of lithium OD
Mild/moderate: IV 0.9% NaCl
Haemodialysis if:
Lithium > 5 mmol/L
Lithium > 4 mmol/L + renal failure
Severe symptoms (↓ GCS, seizures, arrhythmia)
156
Quinine OD features
Tinnitus, flushing
Nausea, vomiting
Complications
Arrhythmias
Hypoglycaemia (↑ insulin secretion)
Flash pulmonary oedema
ECG
Widened QRS, prolonged QTC
157
Methanol features
Intoxication
Optic neuritis → blindness
158
How to confirm CO
ABG: measure carboxyhaemoglobin
Normal < 3%
Smokers < 10%
159
Anti emetic in palliative care
Levomepromazine
160
Anticipatory Medications
Pain
First-line
eGFR > 30: morphine sulfate
eGFR < 30: fentanyl or alfentanil
Breathlessness
First-line
eGFR > 30: morphine sulfate
eGFR < 30: fentanyl or alfentanil
Nausea and Vomiting
First-line
Levomepromazine
Agitation and Anxiety
First-line
Midazolam
Respiratory Secretions
First-line
Hyoscine butylbromide
161
Monitoring ACEi
Baseline: UEs, BP.
Then 1-2 weeks
When stable
Every 3-6 months
Creatinine: A total increase of < 30% is acceptable, if > 30% reduce dose/withdraw and consider ?RAS.
162
Tests with statins
Lipid profile, LFTs, HbA1c, renal function, TSH
Lipid profile at 3 months
If non-HDL ↓ <40%, consider dose increase
LFTs: at 3 months, then at 12 months
163
Levothyroxine monitoring
TSH every 3 months until stable (2 similar results)
Then yearly TSH
164
Monitoring of methotrexate and azathioprine
FBC, U&Es, LFTs
Every 2 weeks for the first 6 weeks,
then every month for 3
165
Monitoring for valproate
Baseline
FBC, LFTs, BMI
After 6 months: FBC, LFTs, BMI
Then yearly
166
Apixaban monitoring
Baseline
FBC, U&Es, LFTs, clotting screen
Monitoring
Yearly: FBC, U&Es, LFTs
Every 6 months if >75 years or renal impairment
167
Glitazones monitoring
LFTs
Contraindicated if ALT >2.5× ULN
Monitoring
LFTs periodically
168
Screening in allopurinol
Screen for HLA-B*58:01 allele in patients of Han Chinese, Thai, or Korean origin
These groups are at increased risk of Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TENS)
169
Drugs to avoid in MG
Gentamicin
Quinolones
Macrolides
170
When does COCP provide protection
Prescribing Advice
If started in first 5 days of the cycle → immediate contraceptive protection
If started later → use additional protection for 7 days
171
Overdose drunk, ataxia, slurred speech, acute renal failure, and a high anion gap metabolic acidosis
ethylene glycol poisoning
Give fomepizole
172
Mx of paracetamol OD
Acute overdose: single ingestion within 1 hour
Staggered overdose: taken in more than one go over >1 hour
Activated charcoal if within 1 hour and dose >150 mg/kg
Check bloods 4 hrs
Attending 8–24 hours post-ingestion
Check bloods immediately
If dose >150 mg/kg → start NAC while awaiting results
If <150 mg/kg → wait for levels, start NAC if above line or liver injury
Attending > 24 hours post-ingestion
Take bloods including paracetamol level
Start NAC only if:
Paracetamol detectable
ALT > 2× ULN or INR > 1.3
Staggered Overdose
Always start NAC immediately
173
Anticipatory medications - Pain and Breathlessness.
eGFR > 30 - 1st Line: Morphine sulfate
eGFR < 30 - 1st Line: Fentanyl/alfentanil
174
Drugs causing urinary retention
Terminate DAN’s (urine) Output
TCAs
Disopyramide
Anticholinergics
NSAIDs
Opiates
175
Causes fo hypomagnesaemia
Mnemonic
Hypomagnasaemia causes: Aches, Cramps, Dizziness and PalPItations
Causing drugs
Aminoglycosides (e.g. gentamicin)
Cisplatin
Diuretics (furosemide, bumetanide)
PPIs (omeprazole, lansoprazole)
176
Drugs causing glucose intolerance
Mnemonic
DiaBetic Nick’s Sugar InTolerance
Causing drugs
Diuretics (furosemide, thiazides)
Beta blockers
Nicotinic acid
Steroids (prednisolone, dexamethasone)
Interferon-alpha
Tacrolimus, ciclosporin
177
Drugs causing pulmonary fibrosis
Mnemonic
Check if your patients with fibrosis have NESCARs on their lungs..
Causing drugs
Nitrofurantoin
Ergot-derived dopamine agonists (bromocriptine, cabergoline, pergolide)
Sulfasalazine
Cytotoxics (especially bleomycin)
Amiodarone
Rheumatoid drugS(methotrexate)
178
Drugs causing photosensitivity
Mnemonic
STan’s TAN
Causing drugs
Sulfonamides (sulfamethoxazole, sulfasalazine, co-trimoxazole)
Thiazides and loop diuretics
Tetracyclines and quinolones
Amiodarone
NSAIDs (naproxen, piroxicam)
179
Drugs causing Drug-Induced Urticaria
ACE inhibitors (ramipril, lisinopril, captopril)
Aspirin, NSAIDs
180
Cyproterone Acetate SE
Side effect: hepatotoxicity, liver failure
Synthetic antiandrogen for prostate cancer
181
Mx salicyclate OD
IV Sodium bicarbonate (urinary alkalinisation) is the mainstay of treatment
Haemodialysis if severe
182
Mx of CO poisoning
100% O2 non rebreather for 6 hrs
183
Itchy, burning rash affecting forearms, face, neck, and upper chest in a V-shaped pattern, soon after starting a new medication
Photosensitive
STan TAN
Sulphonylureas
Thiazides
Tetracyclines (e.g. doxycycline, lymecycline) and quinolones
Amiodarone
NSAIDs
184
Med causing facial puffiness
Dexamethasone (Decadron)
Water retention: facial puffiness, ankle swelling
185
Which Abx are CI in renal impairment
Tetracyclines – risk of accumulation; avoid unless essential
Nitrofurantoin – avoid if eGFR <45 (ineffective and toxic risk)
186
Co prescription with Cyclophosphamide
mesna (sodium 2-mercaptoethane sulfonate
187
Mx of OD of LMWH
Protamine Sulphate
188
Folinic acid use in OD
Used to counteract methotrexate or trimethoprim toxicity.
189
SE of typical antipsychotics
Haloperidol, chlorpromazine
Hyperprolactinaemia: amenorrhoea, galactorrhoea, reduced libido, erectile dysfunction
Extrapyramidal side effects (EPSEs): parkinsonism, dystonias, akathisia, tardive dyskinesia
Antimuscarinic effect
190
SE of clozapine
Agranulocytosis: requires regular FBC monitoring
Myocarditis: ECG required prior to starting
Hypersalivation: may affect up to 1/3 of patients, treat with hyoscine butylbromide
191
1st Line anticipatory N+V in patients with obstructive bowel disorder
Hyoscine butylbromide.
192
Drug-induced Agranulocytosis
Causes include the 5 C’s of agranuloCytosis
Carbamazepine
Carbimazole
Co-trimoxazole
Clozapine
Cytotoxics (MTX)
193
Mx of lithium OD
Mild to moderate toxicity (alert, mild tremor, stable renal function):
→ IV 0.9% sodium chloride to enhance renal clearance.
Severe toxicity (confusion, seizures, renal failure + lithium >4 mmol/L, or just >5):
→ Haemodialysis.
194
MSRA
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