Workshop 2: Adverse Drug Reactions

Navigating eBNF, eMC, Medicines Complete and NHSD Q&As: Quiz 2

Use the eBNF, eMC, Medicines Complete and NHS D Q&A’s to answer the following questions. How do the sources compare? 1 What are Aurorix tablets? Are they Aurorix is a tradename used overseas therefore available in the UK and if so in Martindale will probably have the answer. what strength and what are they Search of Martindale reveals Aurorix is available called? in a number of countries. Made by Roche, contains Moclobemide. Available in the UK but called Manerix. 2 I used to pick up benzhexol tablets eBNF: main name is Trihexyphenidyl. from my Chemist but I have now (Benzhexol was the old name, in an attempt to been given something called get an international standard between names trihexyphenidyl. Is this a mistake? the trihex version has been adopted by the UK). 3 Can you find a report of an This is a question about drug and food interaction between warfarin and interacting therefore possible useful sources will avocado? be the BNF and Martindale but Stockley’s Interactions would be the best place to look. Stockley: Avocado has been reported to drop people’s INR when taking warfarin. The eMC does not have a SPC for warfarin, the BNF does not list an interaction. 4 I am having a cataract removed NHS D Q&A N27 Is it necessary to stop next week, should I stop or keep Clopidogrel, dipyridamole or low dose aspirin taking my aspirin? prior to minor surgery – full referenced answer. Don’t stop. 5 What is Red Chicken? Martindale: Red Chicken is a street name for diamorphine or heroin. 6 What can happen if you eat This is a question about drug and food walnuts and bananas while interacting therefore possible useful sources will drinking alcohol? be the BNF and Martindale but Stockley’s Interactions would be the best place to look. Stockley lists interactions between alcohol and food. Foods rich in serotonin such as bananas and walnuts can lead to diarrhoea and headaches if eaten while drinking alcohol. 7 I am eight weeks pregnant but I Fully referenced NHS D Q&A – answer is yes. have terrible hayfever. I usually take Flixonase , can I still use it? 8 Does Henry VIII have anything in Martindale: Kangaroo is listed as a street name common with a Kangaroo? for cocaine. A look at the extensive list of street names will also reveal Henry VIII. Entering Henry VIII gives 310 hits, therefore too general. Entering “Henry VIII” ie enclosed in quote marks gives one link for cocaine. 9 Do adrenaline or dipivefrine eye Martindale: Enter adrenaline in search box – 515 drops affect soft contact lenses? hits, too many. Enter dipivefrine 5 records. First record, the dipivefrine drug monograph does not seem to include any info. However under drug profile it lists it as a prodrug of adrenaline

Medicine Call Handling Drop in Sessions August 2006 Version 1 and also includes a link. Follow link to adrenaline, there is a section on the effect on contact lenses. Adrenaline drops has been reported to stain soft lenses, dipivefrine has not. The eMC dipivefrine drops = Propine. SPC makes no mention of effect on contact lenses. 10 When does Dr Feelgood look like More streetnames? Use Martindale. an elephant? Entering Dr Feelgood – 412 hits, too many Entering “Dr Feelgood” ie enclosed in quotes gives one link to diamorphine (or heroin). Entering elephant – 3 hits, diamorphine, ketamine, and phencyclidine. Elephant is also a street name for diamorphine. 11 I really like grapefruit juice but the Plendil = felodipine. Can be found in eBNF or leaflet that comes with my Martindale, eMC. Interactions section in eBNF Plendil tablets says I shouldn’t indicate it is a significant interaction but does drink it. Is this true? What can I not advise course of do? action. Fully referenced NHS D Q&A number 5. Can patients taking calcium channel blockers drink Grapefruit juice? Grapefruit juice is known to interfere with felodipine and they should not be taken together. Suggest refer to GP/UKMi. 12 Does False Unicorn have a False Unicorn = Herbal remedy scientifically justified use? Typing in false unicorn into the MedsComplete What effects can be expected if search box yields many results in all sources. taken in large doses? Enclosing false unicorn in quotes gives results in Martindale and Herbal Remedies although False Unicorn is specifically mentioned in Herbal Remedies. The plant is a member of the Lily family. No scientific evidence to justify use. Large doses may cause nausea and vomiting but otherwise no reports of toxicity/side effects. 13 Find the dose of sildenafil for the BNFC: 2.5.1.2 Pulmonary Hypertension: treatment of pulmonary Neonate: Intially 250-500mcg/kg every 4-8 hypertension in newborns in the hours, adjust according to response; max BNF for Children. Can you find it in 2mg/kg every 4 hours. the Martindale, the BNF or eMC? Not listed in other sources. 14 On the side of the packet of my BNF/contents:/general reference/E numbers Rich Tea Biscuits it says they E223 = sodium metabisulphite contain E223. Martindale: “sodium metabisulphite”: sulfites are What is that? Can it be dangerous? used in the food, wine and pharmaceutical industryas antioxidants and preservatives. Some people are hypersensitive to sulfites, most reports relate to use within foods as opposed to medicines. 15 Can Alka Rapid Crystals be used eMC – SPC for Alka Rapid Crystals contain by an asthmatic? 500mg of aspirin. Aspirin can induce bronchospasm in some asthmatics and best avoided. 16 What goes into a Brompton Martindale: Cancer Pain: ”Brompton Cocktail” Cocktail? – mixture of diamorphine or morphine, and cocaine. Now obsolete. (The original mix contained cocaine, diamorphine, and gin/brandy)

Medicine Call Handling Drop in Sessions August 2006 Version 1