Therapeutic and safe prescribing

Last Updated on by FRCEM Intermediate

  • Common CYP450 inducers (CRP: Carbamazepine, Phenytoin, Phenobarbital, Refiampicin)- Drugs used with any of these will be metabolized and their therapeutic efficacy will be reduced.
  • CYP450 inhibitors (SICKFACES.com) : Sodium valproate, IHN, Clarithromycin, Ketoconazole, Fluconazole, Alcohol Binge, Amiodarone, Ciprofloxacin, Erythromycin , Sulfonamides, Chloramphenicol, Omeprazole , and Metronidazole)- Drugs used with these will not be metabolized adequately and their therapeutic efficacy will be increased
  • QT Prolongations
    • anti-Arrhythmic drug,
    • anti-Biotics (macrolides, quinolones),
    • anti-psychotics (droperidol),
    • Anti-Emetics (ondansetron ) .
    • Majority of the CYP450 inhibitors group are nearly the same as those prolong QTC.
  • Antimicrobial Stewardship
    • An organizational Approach
    • To promote and monitor Judicious use of antimicrobials
    • To preserve its future effectiveness
    • Read : Antimicrobial stewardship
  • Anticoagulation and NOAC’s
    • Warfarin Inhibits Vitamin K dependent Factors 2,7,9,10. Reversal with Vitamin K, and Prothrombin Complex Concentrate/Octaplex (FFP)
    • Dabigatran: Direct Thrombin Inhibitor. Reversal with Idarucizumab
    • Edoxaban: Factor Xa Inhibitor. Reversal with Andexanet alfa
  • Drugs with Narrow Therapeutic Index: Phenytoin, Lithium, Theophylline,Warfarin, Gentamicin
  • Common Antidotes
    • Cocaine: Benzodiazepine
    • Opioid: Naloxone
    • Organophosphorus: Atropine/Pralidoxime
    • Iron: Deferoxamine
    • Meth-Hemoglobinemia: Methylene Blue
    • Paracetamol: N-Acetyl Methionine
    • TCA: 8.4% NaHCO3
    • Beta-Blockers: Glucagon
  • Drugs Precipitating Glaucoma: Anticholinergics, Steroids, Sympathomimetics (All Asthma drugs)
  • Drugs Precipitating Myasthenic Crisis (ABCDE)
    • Anti-arrhythmic: Beta Blockers, Ca+2 Channel Blockers, Quinidine, Lidocaine,
    • Anti-biotics: Gentamicin, Macrolides, Quinolones, Tetracyclines,
    • Anti-psychotics: Phenothiazines & Lithium,
    • Diphenylhydantoin (Phenytoin)
    • Endocrines: Levothyroxine, ACTH

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