digoxin + furosemide interaction

in the bnf it says otassium canrenoate.

I cannot find anything that makes sense online to see why theres an interaction.
Can someone link me to the direct page or tell me the reason

Important to keep an eye on Potassium levels too! Don't wanna be causing an arrhythmia now

Yeah. Might also be a good idea to monitor cardiac output and tissue perfusion too, as the rate limiting effect of digoxin and the antihypertensive effect of furosemide may be an issue in some patients who may also be on other antihypertensives like ACE inhibitors and CCBs.

yeah man; crikey, you know your stuff!

How's revision and everything going m8?

Lol, don't worry - we just had to do a pharmaceutical care plan for an elderly patient who had several co-morbidities and as a result was on a wide spectrum of drugs, and 'presented at an A&E unit' with digoxin toxicity. Lots of renal stuff involved, so had to do a lot of reading up

Revision is not going as planned lol, we still have 2 weeks of lectures after we get back from Easter and then our first written exam (all MCQs), which covers lecture content from Jan-May is in mid May. Then we have OSCEs in the end of May (on one of the stations we're going to get a viva by a pharmacology lecturer on any of a list of 45 drugs relevant to cases this year, where they can ask us anything from molecular weight, to ADME, to clinical uses, dose ranges and trade names of the drug). Then have a calculations exam, which apparently is meant to be at pre-reg exam level (all MCQs, I hope!) and then the final exam (all SAQs ) in mid June, which will test everything from Sept-May.

Fun times.

How about you?

Looks like busy times ahead

We used to have all MCQ exams last year apart from the chemistry, physiochemical and pharmacy practice papers. This year we got four exams which has a little MCQ in first section, short answer questions then long answer questions at the end. Not sure how it will pan out tbh.

It's good they're getting you used to the pre-reg content now, would really help you! We haven't touched pre-reg content yet for 2nd year.

We get tested on our drug monographs in third year orally so not looking forward to that

I wish I started exam revision early but I couldn't because of all the coursework etc we got piled on us. Had a poster presentation day with my group where we formulated a new pharmaceutical drug and had to pick out of three API's based on their physiochemical/pharmacological data.

Had loads of PBL care plans to do too

I'm a medical student prepping for my IPL tutorial and this is along the same lines.

May I ask, the difference between increasing the dose interval and simply lowering the dose is what exactly? Patient comes in with a history of respiratory infection and is prescribed Piperacillin IV, his creatinine is re measured and shoots up, so we adjust his dose. He's also on anti - coagulant. The coagulants dose is lowered, but the Piperacillin interval increased. Is this because with a narrow therapeutic window intervals are preferred? It's not a compliance issue.

Increasing the dose interval allows the body to clear more of the drug from the plasma (metabolism / excretion), whereas reducing the dose simply reduces the total amount of drug that enters the plasma (from absorption). I suppose they're quite similar in that the net effect is that there is less of the drug in the plasma.

Not too sure about this one. Piperacillin (as with all penicillins, I think) is renally excreted, so it makes sense to either reduce the dose or increase its interval in AKI or CKD. I would presume that the plasma piperacillin concentration is too high, and so giving the next dose a few hours later may be better than reducing the dose but giving at the normal time - I suspect this would allow more of the drug to be cleared before the next dose is given.

To counter your final point, paracetamol has a very wide therapeutic window, but it in renal failure (eGFR < 30 ml/min) its dosage interval is increased (for an IV infusion at least) to 6 hours, instead of the usual 4-6 hours range. The same dose is given: paracetamol 1 g.

http://www.evidence.nhs.uk/formulary/bnf/current/4-central-nervous-system/47-analgesics/471-non-opioid-analgesics-and-compound-analgesic-preparations/paracetamol

Fair enough, and good point about paracetamol.

I did manage to come across the two alternative properties of antibiotics, which I assume is the answers. Some antibiotics, such as penicillins, are time-dependent, so longer in the system is more effective than bursts of increased concentration, unlike, say, quinolones.

Hadn't heard of this before today, but I guess this is the answer, although I had thought this would only apply to UTI's (better to leave it circulate in the urine, site of action, rather than administering lower doses more frequently), rather than what is the case here, respiratory.

Sounds like it's busy for you too!

For us though all of our exams (apart from OSCEs) have been MCQs, so it'll be a shocker to have an exam worth 50% of the exam section (so 35% of the whole year, as each module has a 70 : 30 split of exam : coursework) where it will be just SAQs.

Then next year it'll be SAQs in the Jan and May papers and then LAQs in June again

For us though only the 3rd and 4th years count for the final degree classification, weighting 50 : 50.

Do your 2nd year count at Reading?

I love care plans btw, very clinical and really makes me want to go for hospital in the end

To think how fast time has gone etc, seems like not too long ago we only just started out as freshers

Yeah 2nd year counts here, think it's worth 30% of my final degree.

What resources do you use btw, say for example when you look up different antibiotics, you got the different classes and of course they differ by the mechanism in which they act on, e.g. tetracycline on 30s ribosomes etc etc.......... like where do you get all the information from? surely not all of it is in the BNF and NICE, right?

I know right, can't believe we're almost half way through our degree!

Oh wow, that's a big chunk! So how is the rest weighted? 30% 3rd year and 40% 4th year?
For us it used to be 10% 2nd year, 30% 3rd year and 60% 4th year, but they changed the course structure just as my year joined, so now it's just 50% each in 3rd and 4th years.

For antibiotics specifically, Wikipedia. Not a good source, I know, but in terms of drugs and pharmacology, it's surprisingly accurate. Always make sure to check up the material with more reputable () sources. Wiki has this awesome table for antibiotics: http://en.wikipedia.org/wiki/List_of_antibiotics.

In terms of physiology, I tend to use YouTube videos like those by Armando Hasudungan (great teacher and artist!).

Yep! I think that's how it weighs out for us! Yeah you were saying before and even still I can't get over it being 50% in both years

Awesome, yeah I use wiki too sometimes (but I would never harvard/vancouver reference from wiki because they are strict about it looool ).

I like wiki as it's straight to the point haha, other places I look through sometimes just have so much unnecessary stuff (but if you have the time then it makes for an interesting read).

Yeah that guy is amazing at explaining physiology concepts. When I saw the drawings he does as he goes through the video, I was like woah . His video on haemostasis really helped me understand the clotting factors etc, tis' a hard topic to get round initially but once you understand it, it's easy!

Yeah, it's a lot of pressure on us, and 3rd year is apparently meant to be really difficult at Brighton. Last year, some 20 out of 150 had to re-sit their 3rd year, and about 10 or so were kicked off the course (they were already retaking their 3rd year)

Yeah, Wiki's good

Yeah, the first video I saw was him explaining gastric acid physiology in 1st year and I was in awe with his drawings and explanation, very nice. Love the way he explains everything logically. I shall definitely have a look at this clotting factor video - need to know the full cascade and where the NOACs, heparin and LMWHs act on the cascade

yeah, was learning about heparin yesterday when looking through some CV therapeutics lectures.

Very interesting MOA, same for the other AC's

Might even watch a random (but related) physiology video before I go sleep haha, always re-jogs my memory.