pharmacology Miscellany
Every year, I make a note on my phone of dozens of little packets of medical information I have learned, re-learned, re-visited, or had cause to teach others. And every year I have to demonstrate for my appraisal some teaching and learning. So - when I have time (and it isn't very often these days - I am much better at not doing work-related stuff in my own time!) I combine the lot into infographics, which I hope are a fun and digestible format.
This time, I'm doing something different, and extra.... when I build "snippets" infographics like this new one, I have to do a lot of background reading:
It occurred to me that if I were to include the text in a blog post (as well as in the image) I might be able to increase the accessibility of these resources for any visually-impaired readers, but also give instant access to matching background reading for anyone whose curiosity is piqued, to create an easy way to bump up the educational value. So here we are!
The Pharmacology Miscellany content is all available in this blog, or you can download the PDF (which has a second page with clickable links) from my main Downloads page (see menu) or the FOAMedInfographics page.
Please let me know what you think, by email (my email address is on home page), or on Twitter - @DrLindaDykes
Metoclopramide can cause methaemoglobinaemia in adults, not just babies. | This 270-subject study in a Turkish ED is fascinating – one wonders how many of these we are missing (but presumably it very rarely matters clinically) - https://turkjemergmed.com/abstract/263 and link to full text from there. |
There’s a dose-dependent risk of AF with omega-3-acid ethyl ester medication - stop them if patient develops AF. However these are not the same as natural fish oil (triglyceride) omega-3 dietary supplements. | And an explanation of why natural fish-oil Omega-3 supplements are different: https://omegaquant.com/what-are-omega-3-ethyl-esters/#:~:text=To%20start%2C%20here%20is%20one,synthesized%20from%20the%20triglyceride%20form. |
Moderate steroid doses of 60mg prednisolone for 5/7 (followed by a 5/7 taper) are non-inferior to traditional very high-dose steroids in idiopathic sudden sensorineural hearing loss | To read about the research on steroid dose choice: https://www.jwatch.org/na56977/2024/01/16/steroid-dosing-idiopathic-sudden-sensorineural-hearing For an older but cracking overview of the topic: https://www.ncbi.nlm.nih.gov/books/NBK565860/ |
The fluoroquinolone side effects tale of woe continues: not only can they cause neurocognitive side effects centrally (e.g. confusion, depression and even encephalopathy causing psychosis) but also peripheral neuropathies, serotonin syndrome & many more! | |
In acute attacks of gout, colchicine can be carried on for six days at 500 micrograms BD (better tolerated taken BD), and some say that avoiding dairy produce whilst taking it reduces diarrhoea. Meanwhile, for gout prophylaxis, Febuxostat can be used if allopurinol is ineffective or not tolerated, but it does carry a black box warning for CV risks: avoid in patients with IHD or CCF. | |
Candesartan can be used off-licence for migraine prophylaxis. It’s taken BD, starting at 2mg BD and creeping up to 8mg BD with dose increase steps of 2mg /2 weeks. | |
Aspirin (for CV indications) does now get continued in patients with upper GI bleeds, according to the latest UK guidelines | |
Loop diuretics can cause thiamine deficiency (although it probably isn't common) | |
Ranolazine can cause hyponatraemia | |
It's an old classic, and much less likely to happen in these days of electronic prescribing that kindly alerts you if you try to prescribe an muppet combination of medications, but don’t mix trimethoprim (or co-trimoxazole!) and methotrexate. | |
Similarly, tramadol increases the anticoagulant effect of warfarin (and reduces the seizure threshold - beware patients who epilepsy taking soemone else's tramadol for toothache!) | https://bnf.nice.org.uk/interactions/tramadol/ - tramadol has a large selection of drug interactions! |
Immune Checkpoint Inhibitors carry a risk of pneumonitis, especially in lung cancer treatment. Typically, patients may develop fever, a (dry) cough, SOB and chest pain many months into treatment: don’t assume it’s a chest infection or C19! ICIs can do all sorts of other autoimmune mischief, too | Fabulous Canadian resource: https://www.cancercareontario.ca/sites/ccocancercare/files/guidelines/full/ImmuneCheckpointInhibitor.pdf And an overview with an EM perspective from the EMJ (open access) - https://emj.bmj.com/content/36/6/369 |
Leflunamide - an immunosuppressant used in rheumatology - has a very long-lasting active metabolite. A washout procedure (using colestyramine or activated charcoal) is required if severe side effects occur, before conception (otherwise the advice is to wait for two years before pregnancy - with washout it's 3 months), or if switching DMARDs. | (that's a download) and also https://medsafe.govt.nz/profs/PUArticles/LeflunomideJune2011.htm |
Carbocysteine (loved in some parts of the UK, loathed in others) dose is meant to be titrated down when the patient is well - and stopped if it doesn’t help. There’s also a once-daily option - NACSYS®️ - to reduce tablet burden. | |
Did you know you shouldn't use laxido with starch-based drink thickeners? | |
Ketamine nebs at 0.75mg/kg are as effective as 0.3mg/kg IV for pain relief in a 150-patient double blinded RCT. It does need breath-activated nebs, though! |
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