Hospital+Pharmacy+Preparation

= = = = =[|Online store info]Hospital Pharmacy Preparation: A Crash Course =

if there is anything left out (which i'm sure there is), then please 'edit this page' and add some extra info! :)

Enzyme Inhibitors/Inducers
//In case you wanted to review the MCBT lectures: [|Enzyme induction] and [|Inhibition]//. Also, an [|article] on Cytochrome P450 plus tables from the [|AMH]

This is not the full list, but includes most of the commonly encountered medications
 * **CYP Enzymes** || **Substrates** || **Inhibitors** || **Inducers** ||
 * **1A2** || amitriptyline, fluvoxamine, haloperidol, paracetamol, verapamil, R-warfarin || amiodarone, fluoroquinolones || tobacco, omeprazole ||
 * **2C9** || amitritpyline, celecoxib, diclofenac, fluvoxetine, phenytoin, S-warfarin || amiodarone, paroxetine, sertraline, fluvoxamine || not clinically significant ||
 * **2C19** || amitriptyline, citalopram, diazepam, phenytoin, R-warfarin || fluvoxamine, paroxetine, ketoconazole || carbamazepine, prednisone, rifampin ||
 * **2D6** || amitriptyline, beta-blockers, olanzapine, oxycodone/codeine, paroxetine || SSRIs, amiodarone, celecoxib, bupropion || not clinically significant ||
 * **2E1** || Paracetamol || disulfiram || ethanol, isoniazid ||
 * **3A4** || amiodarone, amitriptyline, statin, macrolides, anticonvulsants, diazepam, antifungals, calcium channel blockers, sertraline, R-warfarin || antifungals, calcium channel blockers, antiretrovirals, macrolides, amiodarone, grapefruit juice || anticonvulsants, St. John's Wort, rifampin, glucocorticoids ||

Hepatic/Renal Function
Statins, gemfibrozil Amiodarone Pioglitazone, rosiglitazone Anticonvulsants (carbamazepine, valproic acid) Anti-arthritic agents (methotrexate, diclofenac, meloxicam, leflunomide) Anti-retroviral agents (ritonavir)
 * Drugs that require hepatic monitoring** //from [|here]//

//Generally dose adjustment is needed when the creatinine clearance is below 60 mL/min. Adjustments can be achieved by a reduction in dose, or an extension of the dosing interval, or both.//
 * Renal impairment** //from [|Prescribing in renal disease]// and [|AMH]

Antibiotics/antifungals: aminoglycosides (e.g. gentamicin), vancomycin, fluconazole, sulfamethoxazole Antivirals: famciclovir, aciclovir, valaciclovir, valganciclovir, ganciclovir Low molecular weight heparins (enoxaparin) Digoxin, sotalol, atenolol Potassium-sparing diuretics: (spironolactone) - can lead to hyperkalaemia Opioids: morphine, codeine, pethidine Psychotropics/anticonvulsants: amisulpride, gabapentin, lithium, levetiracetam, topiramate, vigabatrin Hypoglycaemic drugs: metformin (could lead to lactic acidosis), glibenclamide, glimepiride, insulin (can lead to increased hypoglycaemia) Drugs for gout: allopurinol, colchicine

Antibiotic spectrum
Refer to AP300 lectures: [|Principles of antimicrobial therapy] and [|Practice scenarios]. Also the spectrums of each antibiotic can be found in the [|AMH]

• **M** - microbiology guides therapy wherever possible • **I** - indications should be evidence-based • **N** - narrowest spectrum required • **D -** dosage appropriate to the site and type of infection • **M** - minimise duration of therapy • **E** - ensure monotherapy in most situations
 * The Antibiotic Creed** - **MINDME**

Reviewing a patient's medication list
This [|article] has some good points about medication lists and also common mistakes with abbreviations. [|Clinical Pharmacy Interventions] from the RAH presents what you should look for some commonly used medications. - [|Safety and Quality SA] have a few resources on reading Inpatient Charts