High Risk Drugs

1. Non - Dihydropyridines CCBs 2. Macrolides 3. Cimetidine 4. Ciprofloxacin

What 4 drugs increase the concentration of Theophylline?

1. Loop and Thiazides Diuretics 2. Beta 2 agonists 3. Amino or Theophylline 4. Gentamicin

What 4 drugs increase the risk of Hypokalaemia when given with Corticosteroids?

1. Ciclosporin 2. Tacrolimus 3. Vancomycin 4. NSAIDs

What 4 drugs increase the risk of nephrotoxicity when given with Gentamicin?

1. Full blood count 2. Renal function 3. Liver function 4. TPMT

What 4 things need to be monitored for Azathioprine?

1. ACEis and ARBs 2. Loop and Thiazides Diuretics 3. K+ sparing Diuretics 4. Metronidazole 5. NSAIDs

What 5 drug classes increase the risk of Lithium toxicity?

1. K+ sparing Diuretics (Spironolactone and Amiloride) 2. Heparin 3. Trimethoprim 4. NSAIDs 5. Immunosuppressants (Tacrolimus and Ciclosporin)

What 5 drug classes increase the risk of hyperkalaemia when given with ACEis and ARBs?

1. Carbamazepine 2. Phenobarbital 3. Phenytoin 4. Rifampicin 5. St Johns wort

What 5 drugs decrease the concentration of Ciclosporin?

1. Carbamazepine 2. Primidione 3. Phenobarbital 4. Phenytoin 5. Ritonavir

What 5 drugs decrease the concentration of Theophylline?

1. Warfarin 2. Dabigatran 3. Digoxin 4. Flecainide 5. Phenytoin

What 5 drugs does Amiodarone increase the concentration of?

1. Antipsychotics 2. Corticosteroids 3. Warfarin 4. Hormones 5. Simvastatin

What 5 drugs does Carbamazepine reduce the concentration of?

1. Macrolides 2. Azole antifungals 3. Grapefruit 4. Calcium channel blockers 5. Tacrolimus

What 5 drugs increase the concentration of Ciclosporin?

1. Amiodarone 2. Azole antifungals 3. Macrolides 4. Cimetidine 5. Fluoxetine

What 5 drugs increase the concentration of Phenytoin?

1. ACEis or ARBs 2. K+ sparing Diuretics 3. Potassium supplements 4. Heparin 5. Trimethoprim

What 5 drugs increase the risk of hyperkalaemia when given with Ciclosporin?

1. Thyroid function 2. Liver function 3. Potassium levels 4. Chest x - ray 5. ECG (if used IV)

What 5 things need to be monitored for Amiodarone?

1. Serum concentration 2. Renal function 3. FBCs 4. Thyroid function 5. ECG 6. Weight

What 6 things need to be monitored for Lithium?

1. Serum concentration 2. ECG 3. Blood pressure 4. Liver function 5. Full blood count 6. Folate 7. Vitamin D

What 7 things need to be monitored for Phenytoin?

1. Full blood count 2. Renal function (U&Es) 3. Liver function 4. Glucose 5. Lipids 6. Blood pressure 7. Weight 8. ECG

What 8 things need to be monitored for Antipsychotics?

1. Full blood count 2. Liver function 3. Potassium (Increased) and Magnesium (Decreased) 4. Lipids 5. Renal function 6. Blood pressure 7. Skin condition 8. Physical examination

What 8 things need to be monitored for Ciclosporin?

They increase it

How do ACEis and ARBs affect the concentration of Lithium?

Increase bleeding risk

How do Corticosteroids affect Warfarin?

Reduce excretion (and increase toxicity)

How do NSAIDs affect the Lithium and Methotrexate?

Increase risk of haematological toxicity

How does Azathioprine affect Allopurinol?

Increase risk of clotting

How does Azathioprine affect Warfarin?

It decreases magnesium

How does Ciclosporin increase the risk of Digoxin toxicity?

Hepatic metabolism

How is Carbamazepine eliminated?

Renal excretion

How is Digoxin eliminated from the body?

Renal excretion

How is Gentamicin eliminated from the body?

Hepatic metabolism

How is Phenytoin eliminated from the body?

Hepatic metabolism

How is Theophylline eliminated from the body?

1. Beta blockers 2. Non - Dihydropyridine CCBs

What 2 drug classes have an increased risk of myocardial depression when given with Amiodarone?

1. Vancomycin 2. Loop Diuretics

What 2 drugs increase the risk of ototoxicity when given with Gentamicin?

1. Antipsychotics 2. SSRIs 3. Tricyclic antidepressants

What 3 drug classes decrease the seizure threshold of Phenytoin?

1. Ciclosporin 2. Calcium channel blockers 3. Macrolides

What 3 drug classes increase the concentration of Digoxin?

1. Beta 2 agonists 2. Corticosteroids 3. Diuretics

What 3 drug classes increase the risk of Hypokalaemia when given with Theophylline?

1. Penicillins 2. NSAIDs 3. Proton pump inhibitors

What 3 drug classes increase the risk of toxicity when given alongside Methotrexate?

1. Phenytoin 2. Rifabutin 3. St Johns Wort

What 3 drugs decrease the concentration of Carbamazepine?

1. Warfarin 2. Hormones 3. Corticosteroids

What 3 drugs does Phenytoin decrease the concentration of?

1. Heart failure 2. Hepatic impairment 3. Viral infections

What 3 medical conditions can increase the serum concentration of Theophylline?

1. Blood pressure 2. Renal function 3. Serum electrolytes

What 3 things need to be monitored for ACEis or ARBs?

1. Full blood count 2. Renal function 3. Liver function

What 3 things need to be monitored for Carbamazepine?

1. Electrolytes (Potassium, Magnesium, Calcium) 2. Renal function 3. Heart rate

What 3 things need to be monitored for Digoxin?

1. Renal function 2. Auditory function 3. Vestibular function

What 3 things need to be monitored for Gentamicin?

1. Full blood count 2. Renal function 3. Liver function

What 3 things need to be monitored for Methotrexate?

1. Blood pressure 2. Renal function 3. Liver function

What 3 things need to be monitored for NSAIDs?

1. SSRIs 2. Fluoroquinolones 3. Tricyclics antidepressants 4. Typical antipsychotic

What 4 drug classes have an increased risk of ventricular arrhythmias when taken with Amiodarone?

1. Macrolides (Clarithromycin, Erythromycin) 2. SSRIs (Citalopram, Escitalopram) 3. Methadone 4. Anti arrhythmics (Amiodarone, Sotalol)

What 4 drug classes increase the risk of QT prolongation when taken with Antipsychotics?

1. Antihistamines 2. Anxiolytics 3. Tricyclic antidepressants 4. Opioids analgesics

What 4 drug classes increase the risk of sedation when taken with Antipsychotics?

1. Carbamazepine 2. Phenobarbital 3. Phenytoin 4. Rifamycins

What 4 drugs decrease the concentration of Corticosteroids?

1. Rifamycins 2. St Johns wort 3. Theophylline 4. Ciclosporin

What 4 drugs decrease the concentration of Phenytoin?

1. Steroids 2. SSRIs 3. Warfarin 4. Venlafaxine

What 4 drugs have an increased bleeding risk when given with NSAIDs?

1. Cimetidine 2. Clarithromycin 3. Fluoxetine 4. Erythromycin

What 4 drugs increase the concentration of Carbamazepine?

1. Blood pressure 2. Lipids 3. Potassium 4. Weight and Height 5. Bone mineral density 6. Glucose 7. Ocular 8. Adrenal suppression

What 8 things need to be monitored for Corticosteroids?

1. Blood pressure 2. ECG (Cardiomyopathy risk) 3. Glucose 4. Renal function 5. Liver function 6. Electrolytes (High K+) 7. Haematological parameters 8. Neurological parameters 9. Coagulation parameters

What 9 things need to be monitored for Tacrolimus?

1. Report any signs of bleeding or infection 2. Avoid live immunisation due to risk of infection

What are the 2 counselling points for Azathioprine?

1. Report any warning signs 2. Drink adequate amounts of fluids

What are the 2 counselling points for Gentamicin?

1. Report if any warning signs occurs 2. Ensure brand familiarity (Cat 1)

What are the 2 counselling points for Phenytoin?

1. Potassium 2. Plasma concentration

What are the 2 things that need to be monitored for Theophylline?

1. Hypersensitivity (Malaise, Fever, Rash) 2. Myleosuppression (Bruising or bleeding)

What are the 2 warning signs of Azathioprine?

1. Take first dose at bedtime 2. Drink adequate but not excessive volumes of fluid 3. Stop medication during sick days

What are the 3 counselling points for ACEis or ARBs?

1. Avoid sunlight and use wide spectrum sunscreen 2. Avoid driving at night (due to dazzling) 3. Interactions or effects may occur months after stopping Tx

What are the 3 counselling points for Amiodarone?

1. Avoid sunlight and use wide spectrum sunscreen 2. Drive or operate machinery with caution due to sedation 3. Avoid abrupt withdrawal due to relapse risk

What are the 3 counselling points for Antipsychotics?

1. Report any signs of toxicity 2. Inform patient to inform GP if they start/stop smoking 3. Ensure brand familiarity

What are the 3 counselling points for Theophylline?

1. EPS symptoms (Dystonia, Akthisia, Rigidity) 2. Labile blood pressure (Hypertension/Postural hypotension) 3. QT prolongation (Palpitations, Tachycardia)

What are the 3 warning signs of Antipyschotics?

1. Postural hypotension (Dizziness, Blurred vision) 2. Liver toxicity (Jaundice or elevated enzymes) 3. AKI (N&V, Dehydration, Anuria)

What are the 3 warnings signs of ACEis or ARBs?

1. Report if any warning signs occur 2. Use the lowest effective dose for the shortest period 3. Consider gastrointestinal protection 4. Advise to take with or after food

What are the 4 counselling points for NSAIDs?

1. Paradoxical bronchospasm (Cough, Tight Chest) 2. Adrenal suppression (Weight loss, Muscular weakness) 3. Immunosuppression (Thrush, Fever, Sore throat) 4. Psychiatric reactions (Suicide, Insomnia, Nightmare)

What are the 4 warning signs for Corticosteroids?

1. Blood disorders (Leucopenia, Thrombocytopenia) 2. Skin disorders (Toxic epidermal necrolysis) 3. Hepatic disorders (Hepatitis) 4. Anti-epileptic Hypersensitivity Syndrome (Rash, Fever)

What are the 4 warning signs of Carbamazepine?

1. Cardiac (Arrhythmias, Heart block) 2. Neurological (Psychosis, Dizziness, Lethargy) 3. Gastrointestinal (Anorexia, N&V, Diarrhoea) 4. Visual (Blurred or Yellow vision)

What are the 4 warning signs of Digoxin?

1. GI toxicity (Stomatitis) 2. Liver toxicity (Jaundice, Dark urine, Abdominal pain) 3. Blood disorders (Sore throat, Bruising, Ulcers, Fever) 4. Pulmonary toxicity (Dyspnoea, Cough)

What are the 4 warning signs of Methotrexate?

1. Agitation 2. Haematemesis 3. Tachycardia 4. Hyperglycaemia

What are the 4 warning signs of Theophylline toxicity?

1. Iron deficiency anaemia (Fatigue, Pale skin, SOB) 2. GI complications (Black stools, Persistent dyspepsia) 3. Renal impairment (Swollen ankles, Anuria) 4. Worsening of asthma

What are the 4 warnings signs of NSAIDs?

1. Encourage BP checks 2. Avoid live immunisations 3. Ensure brand familiarity 4. Avoid sunlight and use wide spectrum SPF 5. Avoid a high potassium and grapefruit diet

What are the 5 counselling points for Ciclosporin?

1. Report adrenal or immune suppression 2. Give patient a steroid card 3. Avoid abrupt withdrawal 4. Avoid close contact with infectious people 5. Avoid live immunisations

What are the 5 counselling points for Corticosteroids?

1. Nystagmus 2. Diplopia 3. Slurred speech 4. Hyperglycaemia 5. Ataxia

What are the 5 signs of Phenytoin toxicity?

1. Skin disorders (Toxic epidermal necrolysis) 2. Blood disorders (Bleeding, Bruising, Fever, Sore throat) 3. Suicidal thoughts 4. Low Vitamin D levels (Rickets, Osteomalacia) 5. Toxicity

What are the 5 warning signs of Phenytoin?

1. Report any warning signs 2. Ensure brand familiarity 3. Maintain constant salt and water intake (Low Na+ = Toxicity) 4. Avoid alcohol and caffeine (Cause dehydration) 5. Driving and drowsiness risk 6. Avoid abrupt withdrawal

What are the 6 counselling points for Lithium?

1. Report any warning signs immediately 2. Must be taken once weekly 3. Take folic acid on a different day to Methotrexate 4. Recommend effective contraception 5. Avoid OTC NSAIDs or Aspirin (Risk of Nephrotoxicity) 6. Encourage the annual flu vaccine

What are the 6 counselling points for Methotrexate?

1. Report any warning signs 2. Avoid sunlight and use wide spectrum SPF 3. Ensure brand familiarity 4. Advise patient it may affect performance of skilled tasks 5. Avoid live immunisations 6. Avoid a high potassium and grapefruit diet

What are the 6 counselling points for Tacrolimus?

1. Neurotoxicity 2. Blood disorders 3. Liver toxicity 4. Nephrotoxicity 5. Hypertension 6. Gingival hyperplasia

What are the 6 warning signs for Ciclosporin?

1. Hypo or Hyper Thyroidism 2. Visual disorders (Corneal microdeposits or Optic neuropathy) 3. Pulmonary toxicity (SOB or cough) 4. Liver disease (Jaundice) 5. Neurological toxicity (Neuropathy or Tremor) 6. Phototoxic skin reactions (Grey skin or Erythema)

What are the 6 warning signs of Amiodarone?

1. QT prolongation (Palpitations) 2. Visual disturbances (Blurred vision) 3. CNS disturbances (Confusion, Drowsiness) 4. Hypothyroidism (Fatigue) 5. Renal dysfunction (Polyuria, Polydipsia) 6. Intracranial hypertension (Headaches, Visual disturbances)

What are the 6 warning signs of Lithium?

1. Neurotoxicity (Tremor, Headaches) 2. Nephrotoxicity (Elevated creatinine) 3. Eye disorders (Blurred vision or Photophobia) 4. Skin disorders (Toxic epidermal necrolysis) 5. Blood disorders (Fever, Sore throat, Ulcers) 6. Hyperglycaemia (Increased thirst or urination) 7. CVD disorders (Arrhythmias, Hypertension) 8. Liver toxicity (Jaundice, N&V, Dark urine)

What are the 8 warning signs of Tacrolimus?

1. Report any warning signs immediately 2. Ensure brand familiarity (Cat 1) 3. Counsel patient on seizure risk and driving

What are the counselling points for Carbamazepine?

Hearing loss or impairment

What are the warning signs of Gentamicin?

Fluoroquinolones

What drug class increases the risk of convulsions when given with NSAIDs?

Statins

What drug class increases the risk of myopathy and must be avoided with Ciclosporin?

St. John's wort

What drug decreases the concentration of Digoxin?

Simvastatin

What drug has an increased risk of myopathy when given with Amiodarone?

Metoclopramide

What drug increases the risk of EPS side effects when given with Antipsychotics?

4 to 12 mg/L

What is the therapeutic range for Carbamazepine?

5 to 10 mg/L (or 3 to 5 mg/L if endocarditis)

What is the therapeutic range for Gentamicin?

10 to 15 mg/L (15 to 20 mg/L for endocarditits)

What is the therapeutic range for Vancomycin?

0.8 to 2 mcg/L

What is the therapeutic range of Digoxin?

0.4 to 1 mmol/L

What is the therapeutic range of Lithium?

10 to 20 mg/L (or 40 to 80 mmol/L)

What is the therapeutic range of Phenytoin?

10 to 20 mg/L (or 55 to 110 mmol/L)

What is therapeutic range of Theophylline?

It is taken at night so bloods can be done the following morning.

When is Lithium taken and why?

1. Phenobarbital 2. St John's wort 3. Rifampicin 4. Phenytoin

Which 4 drugs decrease the plasma concentration of Tacrolimus?

1. Macrolides 2. Grapefruit 3. Azole antifungals 4. Calcium channel blockers 5. Omeprazole

Which 5 drug classes increase the plasma concentration of Tacrolimus?

1. Potassium supplements 2. K+ sparing diuretics 3. ACEis and ARBs 4. Trimethoprim 5. Heparin 6. Ciclosporin

Which 6 drugs increase the risk of Hyperkalaemia when given with Tacrolimus?