Prescribing in Special Populations Flashcards
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Read the first 7 Prescribing in Special Populations flashcards as text
A patient with Child-Pugh C cirrhosis requires regular analgesia for chronic pain. Which analgesic is safest at a reduced dose?
Answer: Paracetamol at a reduced dose (max 2 g/day)
Paracetamol at reduced doses (maximum 2 g/day) is safer than NSAIDs, which risk GI bleeding and hepatorenal syndrome, or opioids, which accumulate in liver failure.
A morbidly obese patient (BMI 48, actual body weight 145 kg) requires vancomycin dosing. Which weight should be used to calculate the initial dose?
Answer: Adjusted body weight
Adjusted body weight is used for vancomycin dosing in obese patients to avoid under-dosing with IBW or over-dosing with full ABW.
A patient with severe hepatic impairment (Child-Pugh C) develops a DVT. Which anticoagulant is most appropriate?
Answer: Low molecular weight heparin
LMWH is preferred in severe hepatic impairment because direct oral anticoagulants undergo significant hepatic metabolism and are generally contraindicated in this setting.
An immunocompromised patient receiving high-dose corticosteroids requires vaccinations. Which type of vaccine is contraindicated?
Answer: Live attenuated vaccines
Live attenuated vaccines are contraindicated in immunocompromised patients as the weakened organism may cause disseminated infection in the absence of adequate immune defences.
A patient with end-stage renal disease on haemodialysis is prescribed an antibiotic. How does dialysis most importantly affect drug dosing?
Answer: Dialysis can remove some drugs, requiring supplemental doses after sessions
Dialysis can significantly remove certain drugs from the circulation, and supplemental doses after dialysis sessions may be required to maintain therapeutic levels.
A 68-year-old woman with type 2 diabetes and CKD stage 3b (eGFR 32) on lisinopril develops hyperkalaemia with K+ 6.2 mmol/L. What is the most appropriate immediate action?
Answer: Stop lisinopril immediately and manage the hyperkalaemia
ACE inhibitors can cause dangerous hyperkalaemia in CKD; with K+ 6.2 mmol/L, lisinopril must be stopped immediately to prevent life-threatening cardiac arrhythmias.
A patient with hypothyroidism requiring high-dose warfarin is started on levothyroxine replacement. What change to warfarin therapy is anticipated?
Answer: The warfarin dose will likely need to decrease
Levothyroxine increases catabolism of vitamin K-dependent clotting factors, enhancing warfarin's anticoagulant effect and requiring a dose reduction to avoid over-anticoagulation.