Final Pharmacy Exam > Week 5 > Flashcards

Week 5 Flashcards

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1
Q

Which of the following is not an indication for carbemazepine

trigeminal neuralgia
focal seizures
diabetic neuropathy
propyhlaxis of bipolar
acute alcohol withdrawal
myoclonic seizures

A

myoclonic seizures as using carbemazepine in non focal seizures can exacerbate symptoms :)

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2
Q

name the different indications for carbemazepine

A

trigeminal neuralgia
focal seizures
diabetic neuropathy
prophylaxis of bipolar
acute alcohol withdrawal

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3
Q

which of the following ethnicities should be tested for the hla-b-1502 allele (multiple)

caucasian
greek
affro-carribean
han-chinese
thai

A

han- chinese and thai

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4
Q

why do we need to test han chinese and thai patients for the hla-b-1502 allele

A

greater risk of sjs so best to be avoided

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5
Q

what is important around the branding of carbemazepine

A

same brands should be stuck to due to different oral preparations having different bioavailability’s.

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6
Q

what is the level of carbemazepine that is reccomended 2 weeks after initiation

A

4-12mg/L

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7
Q

what is the pnuemonic to remember the side effects of carbemazepine

A

HAND BAG

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8
Q

List the side effects of carbemazepine using the HANDBAG Pnuemonic remember a fat person carries it

A

Hyponatraemia
Ataxia
Nystagmus
Drowsy
Blurred vision
Arrythmia
Gastrointestinal side effects
Weight gain

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9
Q

What does the H in handbag for carbamazepine stand for

A

Hyponatraemia

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10
Q

What does the A in handbag for carbamazepine stand for

A

Ataxia

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11
Q

What does the N in handbag for carbamazepine stand for

A

Nystagmus

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12
Q

What does the D in handbag for carbamazepine stand for

A

Drowsy

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13
Q

What does the B in handbag for carbamazepine stand for

A

Blurred Vision

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14
Q

What does the A in handbag for carbamazepine stand for

A

Arrythmia

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15
Q

What does the G in handbag for carbamazepine stand for

A

Gastro-intestinal side effects

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16
Q

What type of person carries the HAND BAG with Carbamazepine

A

A fat person due to the weight gain

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17
Q

Which of the following is not a contraindication of carbamazepine

Acute Porpyria
History of Bone Marrow Depression
Conduction abnormallities
Cardiac disease

A

Cardiac disease

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18
Q

what are the contra-indications of carbamazepine AHA

A

Acute Porpyria
History of Bone Marrow Depression
AV conduction abnormallitiees

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19
Q

what is carbamazepine associated with the risk of

A

Epilepsy Hypersensivity syndrome that will present usually within the first two months of treatment

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20
Q

should vitamin d supplementation be given to each patient on carbamazepine?

A

No not ALL patients but patients who

are immobile
dont get enough calcium in diet
dont get enough sun exposure

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21
Q

When to withdraw carbemazepine

A

Acute Liver Disease
Severe Leukopenia (Low WBC)
Symptoms of Hypersensitivty

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22
Q

What symptoms are associated with epilepetic hypersensitivity syndrome

A

Fever
Rash
Ulcers
Bruising
Bleeding

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23
Q

If someone experiences sensitivity with carbemazepines what other drugs may they experience issues with (O-P3)

A

oxcarbazepine
phenytoin
primidone
phenobarbital

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24
Q

What do we need to monitor in carbemazepine (think broad)

A

FBC
Renal Func
LFTS

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25
How does Carbemazepine affect the CYP3A4
Potent inducer so will interact with any drug that affects CYP3A4 this is why oral hormonal contraception unfortunatly isn't enough
26
What are the main three interactions with carbemazepine
Lithium Alcohol Doacs
27
What are the areas around statins that I need to understand
When to give What monitoring What patient counselling Conception Contraception Pregnancy Interactions Intensity and CVD prevention and treatment
28
What is the definition of a HIGH intensity STATIN
A statin that reduces LDL by more than 40%
29
What are the different HIGH intensity Statin
Atorvastatin Rosuvastatin Simvastatin 80mg
30
What do we give a patient with a 10 year risk of CVD >= 10% for primary prevention
HIGH intensity statin - Atorvastatin (usually atorvastatin 20) - Rosuvastatin - Simvastatin 80mg
31
What is the recommended statin in secondary prevention of CVD
Atorvastatin
32
In what non cardiac condition should statins be offered in
type 1 diabetes
33
What timeframe should we check someones lipid profile after starting a statin
3 months after
34
What should the reduction in non HDL be after starting a statin
>40%
35
What is ideal HDL range
>1mmol/L
36
Wht is ideal triglyceride range
<1.8mmol/L
37
what is ideal LDL range for high risk patients
<2mmol/L
38
what ideal LDL range for healthy patients
<3mmol/L
39
what is the ideal range of TC for high risk patients
<4mmol/L
40
what is the ideal range of TC for healthy adults
<5mmol/L
41
at what level would we consider making a diagnosis of hyperlipidaemia
>=6mmol/L
42
What is TC
Total Cholesterol
43
easy way to remember the cholesterol ranges?
1 2 3 4 5 6
44
what lipid range is >1 mmol/L
high density
45
what lipid range is <1.8mmol
triglycerides
46
what lipid range is <2mmol/L
LDL high risk
47
what lipid range is <3mmol/L
LDL healthy
48
what lipid range is <4mmol/L
TC at risk
49
what lipid range is <5mmol/L
TC healthy
50
what lipid range is >= 6mmol/L
when you make the hyperlipidaemia diagnosis
51
in the primary and secondary prevention of cardiovascular disease what should not be used
fibrates
52
what are some examples of fibrates
fenofibrate bezafibrate
53
what might be a second line option to a statin
ezetimibe
54
what might be a third line option in place of a statin and ezetimibe
after dual therapy then go to specialist to use a fibrate
55
in what scenario would you add a fibrate to a statin
if the patient has a high amount of triglyceride
56
what is nicotinic acid good at reducing
trigylceride LDL cholesterol concentration
57
IF using a statin and a fibrate together what does it increase the risk of
side effects such as rhabdomyolysis
58
What do we need to monitor in hypercholesterolaemia
Monitor liver function and creatinine kinase
59
what drug should we never use together with a statin to help manage hypercholesterolaemia
gemfibrozil
60
How do statins work? *MOA*
Inhibit HMG CoA reductaze which is involved in cholesterol synthesis so slows and inhibits cholesterol production
61
STATINS are more effective than the other lipid regulating drugs at lowering what type of cholesterol
LDL
62
what is better at reducing triglycerides? statins ezetimibe fibrates
fibrates
63
which statins are safe in pregnancy and breastfeeding
none are safe >:C
64
what is the main advice to give with statins
like out for unexplained muscle pain, tenderness or weakness
65
how early do we have to discontinue statins if we are trying to conceive
3 months
66
what two statins dont have to be taken at night
rosuvastatin atorvastatin
67
what is the dose for primary prevention of atorvastatin
20mg
68
what is the dose for secondary prevention of atorvastatin
80mg
69
which high intensity statin has a higher chance of rhabdo
simvastatin 80mg
70
what is the max dose of simvastatin with amlodipine
20mg
71
what is the max dose of atorvastatin with ciclosporin
10mg
72
what is the max dose of rosuvastatin with clopidogrel
20mg
73
what is the max dose of simvastatin with fibrate
10
74
what is the max dose of rosuvastatin with clopidogrel
20mg
75
what is the max dose of simvastatin with amlodipine
20mg
76
what is the max dose of simvastatin with amiodarone
20mg
77
what is the max dose of simvastatin with rate limiting CCB
20mg
78
what is the max dose of simvastin with ranolazine
20mg
79
What interactions are associated with a 10mg dose for statins
simvastatin + fibrate atorvastatin + ciclosporin
80
what do we need to monitor with statins
creatine kinase lfts hba1c
81
when do we monitor with statins
3 months 12 months
82
what is creatine kinase and statins associated with
leg cramps
83
what happens if at 3 months a patient has had their lfts checked and we notice that the liver enzymes are above a certain level? what is the level and what is the plan
>3 is the level if it is higher than this then we need to discontinue
84
what are the main interactions of statins
amiodarone colchicine nicotinic acid and fibrates carbemazepine clarithromycin and erythromycin grapefruit juice ketoconazole/ miconazole amlodipine
85
what drugs can cause an increased chance of rhabdomyolysis with a statin
amiodarone colchicine nicotinic acid fibrates amlodipine
86
what drug can increase the chance of hepatotoxicity with a statin
carbamazepine
87
what antibiotic can increase exposure to statins
clarithromycin erythromycin
88
what antifungal can increase exposure to a statin
ketoconazole miconazole
89
what drink can increase exposure to simvastatin
grapefruit
90
what are three examples of low intensity statins
pravastatin 10-40mg fluvastatin 20-40 simvastatin 10
91
what statin that even at a higher dose dose not roam into the realm of a medium intensity statin
fluvastatin
92
what statin at different doses has all three intensities
simvastatin
93
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