High Risk Drugs

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What is the oral dose of Amiodarone? (1)
200mg TDS for 1 week, 200mg BD for 1 week then 200mg OD or minimum needed for arrhythmia
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Describe amiodarones mechanism of action (1)
Class III anti-arrhythmic that prolongxs phase 3 or cardiac action potential by blocking K+ channels and slowing repolarization.
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C/I of Amiodarone? (6)
Severe conduction disease unless pacemaker fitted), sinus node disease, iodine sensitivity, sino-atrial heart block (except cardiac arrest), sinus bradycardia, thyroid dysfunction
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Cautions of Amiodarone? (5)
Elderly, hypokalemia, severe bradycardia, heart failure, acute porphyrias
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Side effects of Amiodarone (11)
Bradycardaia, Hyper/pothyroidism, jaundice, slate grey skin, phototoxicity, corneal microdeposits, raised ALT
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How do you counsel patients on amiodarone corneal deposits (1)
Does not normally affect vision but can cause night glare; which will effect driving.
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Why does amiodarone cause corneal deposits and hepatomegaly? (1)
Amiodarone is a lipophilic drug which is metabolised in the liver and excreted through the bile salts. It therefore accumulates in tissues and can lead to toxicity.
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Describe amiodarone's place in management of arrhytmia (3)
Used as pharmacological cardioversion in pts with evidence of structural heart disease. To reduce risk of Post-op AF.Used as LT maintence in pts with LV impariment or CHF
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What is the half life of amiodarone? (1)
~ 50 days
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What are the baseline tests needed for amiodarone? (5)
TFTs, LFTs, ECG,Potassium and CXR
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List some important amiodarone drug Ix
DO NOT TAKE GRAPEFRUIT JUICE, Warfarin (dose reduction), Phenytoin (dose reduction), Simvastatin max 20mg, beta blockers, digoxin (half dose), drugs that prolong QT
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STELL? (5)
S - Skin (Grey Slate) T- Thyroid (Thyrotoxicosis hypo/hyper) E -Eyes (Microdeposits) L-Liver (LFTs) L-Lungs (pulmonary toxicity)
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What is the oral dose of Digoxin? (1)
CHF: 62.5 - 125 micrograms AF: 125-250 micrograms
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What is digoxin's mechanism of action? (1)
Digoxin binds to a membrane sodium potassium ATPase inhibiting action and increasing intracellular calcium.
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C/I of Digoxin (4)
Heart Block, 2nd degree AV block, SVT or VF
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Cautions? (7)
Hypokalemia, Hypomagnesia, Hypoclacemia, Hypoxia, Recent MI,
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Can digoxin be used in preg/bfeed? (1)
Yes. Is present in breast milk but amount is too small to be harmful.
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Dose from IV to oral? (1)
Increase dose by 20-33%
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When to take TDM of digoxin? (2)
(Trough) 1 hour pre, (Peak) 6 hours post
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Digoxin monitoring?
Keep K+ >4mmol/L, HR above 60bpm, monitor Ca2+ and Mg2+
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At what level dose toxicity occur?
1.5-3microgram/L
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Signs of digoxin toxicity? (6)
nausea, vertigo, and vomiting are prominent. Chronic may present as fatigue, malaise and visual disturbances
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Other cards in this set

Card 2

Front

Describe amiodarones mechanism of action (1)

Back

Class III anti-arrhythmic that prolongxs phase 3 or cardiac action potential by blocking K+ channels and slowing repolarization.

Card 3

Front

C/I of Amiodarone? (6)

Back

Preview of the front of card 3

Card 4

Front

Cautions of Amiodarone? (5)

Back

Preview of the front of card 4

Card 5

Front

Side effects of Amiodarone (11)

Back

Preview of the front of card 5
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