Polypharmacy

Question 1

What are the common side effects of furosemide?

Answer 1

• Mild GI disturbances - diarrhoea
• Postural hypotension
• Electrolyte disturbances - hypokalaemia, hyponatraemia
• Hyperesensitivity reactions (e.g. rash, photosensitivity, pruritus)
• Need to monitor renal function

Question 2

What are the less common side effects of furosemide?

Answer 2

• pancreatitis
• hepatic encephalopathy
• temporary increase in serum-cholesterol and triglyceride concentration
• hyperglycaemia (less common than with thiazides)
• acute urinary retention
• metabolic alkalosis
• blood disorders (including bone-marrow depression, thrombocytopenia, and leucopenia)
  hyperuricaemia
• visual disturbances
• tinnitus
• deafness (usually with high parenteral doses and rapid administration, and in renal impairment)

Question 3

What medications could be associated with renal function deterioration?

Answer 3

• Aspirin
• Ramipril
• Gabapentin
• Furosemide

Question 4

How is it best to prescribe new medications to a patient?

Answer 4

Ideally try to add in one medication at a time as opposed to adding multiple together. That way, if a SE happens, it will be easy to identify the causative drug.

Question 5

When should metformin be stopped?

Answer 5

There is an increased risk of lactic acidosis if metformin is given in renal impairment. NICE recommend that medication be stopped if there is a sudden deterioration in renal function, and avoid if eGFR less than 30mL/minute/1.732.

Question 6

What do you need to do when increasing rampipril and bisoprolol doses?

Answer 6

• Ramipril: check BP and renal function tests 10-14 days after increase
• Bisoprolol: check BP and HR after increase
• Patients should also report any weight gain of >2kg so any increased fluid can be dealt with before causing CV problems