PHAM01 Commonly Rx Drugs
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PHAM01 Commonly Rx Drugs - Leaderboard
PHAM01 Commonly Rx Drugs - Details
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| 🇬🇧 | 🇬🇧 |
| Alendronic Acid: -Pathophysiology -Indicagtion -Interactions -Couselling -Side Effects | -Absorbed onto hydroxyappetite crystals in bone (slows rare of growth and dissolution)--> reduced bone turnover. - prophylaxis (long term/repeated streoid use)/ Long term established osteoporosis -Big molecule and chelatged with food and other drugs (struggles to be absorbed so little of drug is used by the body) -Take 30 mins before food, calcium and vitamin D after a different time to the drug, wiht a full glass of water sitting up right/ standing- gets to the stomach as quickly as possible to reduce risk of ulceration of oseophagus -Osteonercorsis of jaw (dentist review), Oseophageal reactions (oesoghagitis, uclers & strictures), Osteonecrosis of the external auditory canal. |
| Alfacalcidol: -Renal -Colcalciferol -Red Flag -Monitoring | -CKD stagfe 4 & 5 (hydroxylated derivative) -Stage 1,2 & 3 CKD, or if vitamin D deficiency and normal renal fucntion -Nausea & vomiting (hyperkaelmia) -Plasma calcium levels (OD/BD weekly) whenever nausea/ vomiting occur |
| Alfuzosin: -Drug class -BPH -Interactions | -Alpha blocker (tamsulosin, prazosin) -Relaxes smooth muscle- increasse in urinary flow (urinary rentention) - Antihypertensives (dose reduction)- Decrease in blood pressure |
| Allopurinol: -Indication -Dose -Side effects -Interactions | -Long term Gout (Xanthine-oxidase inhibitor) -100-300mg daily (2-3 weeks after attack has settled)- initial management (Nsaids/ Colchicine)- renal dose in renal impairment -Rash (stop (mild) reintroduce- reaccurnace (Immediately stop)- Allergy -Interacts with axiothioprine (metabolised by xanthine-oxidase)- toxcitiy of axiothiopurine. |
| Febuxostat: -Indication -Side effects | -alternative treatgment to chronic hyperuriceamia in gout -Hypersensitity (SJS)- rare (first month)- MORE LIKELY if rash wit allopurinol |
| Amiodarone: -Indication -Initiation -dose -side effects | -Treatment of arrthymias -under specilist: long half life (Losing dose)-- to get to steady state, stop (can still have sid effects and have interactions with other drugs) -200mg TDS For one week then reduced to 200 BD for 1 week and then maintenence 200 OD -Corneal microdeposits (reverisble)- NEED TO have an annual eye checkup -phototoxic reactions (skin is sensitive to the light)-skin discolouration- shield skin from light during during and several months after -hypo/hyper thyroidism (monitor TFTs) -SOB (suspect pneumonitis) -Hepatotoxcitie- raised transaminases (LFTs) |
| Amitripylline: -Class -Side effects -Overdose -Indications | -Tricyclic antidepressant -Antimuscarinic (sedation, dry mouth, blurred vission)- rare glaucoma- angle closure -Constipation & Urinary retention -Overdose (narrow dose window)- toxcitiy cardiovascular effects -Antidepressant- not recomended -Migrain prophylasix- not licnesed -Neuropathic pain (specialist)- still quiried (unlicnesed) |
| Amlodipine: -Class -indication -Pathopsiology -CCB -Interactions -rate limiting CCB | -Dihydropyrimidine CCB -hypertension & propjhylaxis of angina -it relaxes smooth muscle & dilates coronary and peripheral artieries which reduces blood pressure -main difference: dihydro has more influence on the vessles and less on the myocardium -Grapefruit juice; PLASMA CONC: felodipine, nifedipine and verapamil -Ankle swelling in higher amlodipine doses (dont go over 4mg) -amlodipine- increase expo to statins- adjust dose -verapamil & diltiazem (negative inotopic effect- supresses heart function) avoided in heart failure -interactions with B-BLOCKER (verapimil) |
| Amoxicillin: -Class -Allergies | -broad spectrum antibiotic -always check allergy status (rash and anaphylasis) -atopic (asthma/ excema/hayfever)- hight risk of naphylasis -one penecillin allergy -allergy/ sensitivity penecillins (most likely have a reaction to cephakosporins) |
| Apixaban: -Class -Side effects -Monitoring -Factors affecting dose | - Anticoagulant (DOAC) - Increased bleeding risk - No regular INR monitoring required -Must monitor: general compliance- short half life (if stopped for a few days, they are no longer anticoagulated), any problematic signs/symptoms, age, weight & renal function (CrCl) - Dosing depends on renal function (must use Creatinine clereance & not eGFR) -Dose is reduced if 2 of the following 3 apply: (serum creatinine >133micromol/litre, age>80, body weight <60kg) |
| Aripiprazole: -Class -Side effects -Interactions -Dispencing -Monitoring | -Antipsychotic (secondary) -Cardiovascular (BP) -Thromboembolism -QT prolongation -Neuroleptic Malignant Syndrome -weight gain -diabetes -Increased VTE risk -Shouldnt be given to people with dementia related conditons (cause strokes & increase motality) -Metabolised by CYP450 -depo and acute injeciton dose (confirm correct dispenced) 7.5 mg (acute)/ 400mg (depot) -monitor blood concentration with sings of toxciity/given with medication which may increase concentration |
| Aspirin: -Analgesic -Indication -Dose -CVD -GI bleed risk | -Not now used as an analgesic- high bleed risk -Secondary prevention of cardiovascular events -Usually 75mg OD -If they are hypertensive- is a risk facotr for CVD -If they have angina/MI/stroke/PVD- they have established CVD --> would give aspirin 75mg daily -If they are at a high risk of GI bleed --> can add a maintenance dose of PPI |
| Atenolol: -Pathopsyiology -Indications -Avoided -Side effects | -B- blocker, act in the heart, peripheral vaculature, bronchi, pancreus & liver -Hypertension (not 1/2/3rd line), angina, post MI, Arrhythmias, Heart failure -In patients with a history of asthma & bronchospasm -respiratory disease, fatigue (reduction of pulse & rate), Coldness of extramities -Cross BBB- sleep distubances & nightmares |
| Azathioprine: -Class -Uses -Side effects -TPMT | -Immmunosupressant- DMARD -Used in IBS, autoimmune conditions, transplant patients -Can cause bone marrow supression, neutropenia -TPMT enzyme metabolises azathiopurine -Need to determine if they are fast/intermediate/slow TPMT metaboliser of azathioprine -In TPMT deficiency (reduced activity)- more likely to have neutropenia + azathioprine toxicity |
| Azithromycin: -Class -Indication -Side Effects -Interations -Dispencing | -Macrolide (antibiotic) -Twice Weekly prophylaxis of COPD -Greater risk to those with a predisposition to QT interval prolongation -Gastrointestinal disorders -Reversible hearing loss ( long course) -Inhibitor of CYP450 -Look Alike, Sound Alike (Azathioprine // Azithromycin) |
| Candesartan: -Class -Difference betwene ACEI & ARB -Indication | -ARB -Unlike ACEI they dont inhibit the breakdown of bradykinin- unlikley to cause a dry cough - All licensed for hypertension |
| Citalopram: -Class (other examples) -How they differ from TCA (tricyclic antidepressants) -Side effects -Dose -Couselling | -SSRI selecitve serotonin reuptake inhibitor (Escitalopram, fluoxetine & sertraline)- effective when prescribed other medications -Less sedative and fewer antimuscarinic & CV side effects than TCAs -GI side effects -QT interval prolongation (citalopram & escitalopram)- dose dependent (ECG measurements with those with cardiac disease & electrolyte disturbances- corrected before starting treamtent. -40mg for adults -20mg for patients older than 65 -20mg for those with hepatic impairment -Discuss exspectations with patient (2-4 weeks to start to feel effect) -Available support -Not Addictive but slow withdrawal |
| Clarithromycin: -Class -Interactions | -Macrolide -Increases the exposure of statins -Macrolides have significant interactions with statins- can cause renal failure -Has lots of significant interactions due to QT prolongation and CYP3A4 inhibition |
| Clindamycin: -Class -Indication -Excreted -Antibiotic-associated colitis -Diarrhoea | -lincomycin antibiotics -Active against gram positive cocci (streptococci & penicillin-resistant staphylococci) & anaerorobes (bacteroids fragilis) -Bile & Urine -Can be fatal (Suspected/confirmed C.diff infectio- discontinue the antibiotic if appropriate & seek specalist advice if antiobitc cannot be stopped & expiriencing severe diarrhoea) - Can progress to highly severe |
| Clopidogrel: -Class -Indication -Interactions | -Antiplatelet -Secondary prevention of CVD -Usually given 2nd line (aspirin first) except when secondary prevention of stroke/TIA -Also used in duel antiplatelet therpay post MI/ACS -Interacts with omeprazole/esomeprazole -Clopidogrel is a prodrug & omeprazole/esoomeprazole prevents the conversion of clopidogrel to its active formm -Trials suggest this may reduce its antiplatelet effect & increase risk of cardiovascular events |
| Clozapine: -Class -Indication -Dose -Side Effects -Interactions | -Antipsychotic (2nd gen) -Used in schizophrenia in patients unresponsive to or intolerant of conventional antipsychotic drugs -Dose adjustments may be necessary if smoking stopped or started during treamtent (Tobacco is a CYP450 inducer- speeds up metabolism)- increased theophylline toxcitiy (copd) -Missed 48 hrs (condition can detiorate) need to re-titrate dose -Agranulocytosis (specalist monitoring services) -Intestinal obstruction -Constipation -Avoid concomitant use of clozapine with drugs which cause agranulosytosis & constipation |
| Codeine Phosphate: -Class -Prodrug -Side effects -Risks -8/500 co-codamol | -Weak opiate -Codeine is a prodrug- tkaing any enzyme inhibitors can make them side side effects without any analgesic effect -Constipation, drowsiness, sedation (all enhanced in elderly) -Risk of tolerance & dependence -it is a sub-therapeutic dose- codeine doesnt have its full analgesic effect but will have all of its side effects & can increase risk of tolerance/ dependence |
| Co-amoxiclav: -Side effects (increased risk/ how to reduce risk) -Monitoring | -Cholestatic Jaundice (during or shortly after its use) -More common in men & over 65 -Usually jaundice is self limiting -minimum length treatment -LFTs (raised ALP & Bilirubin) |
| Diclofenac: -Class -Side effects | -NSAID -GI bleeding risk, renal toxicity, inc risk of cardiovascular events -Cardiovascular risk is inc with COX-2 inhibitors- MHRA guidance mentions that CV risk of diclofenac is similar to that of COX-2 inhibitors. -This doesn’t apply to topical (gel/cream) |
| Digoxin: -Class -Dose -Indication -Side effects -Risks -Monitoing | -Cardiac glycoside -Dependent on age/lean body weight & renal function -Used in heart failure & arrhythmias -Anorexia, nausea, vomiting, diarrhoea, ab pain, headaches & confusion -Hypokaelamia (predisposes to toxicity), higher toxicity risk in renal impairment -Sampling for serum levels should be taken at least 6 hrs after the last dose (therapeutic range 0.5-1microgram/L) -Heart rate, BP, ECG & K+ |
| Domperidone: -Class -Pathophysiology -Problems | -Anti-emetic -Acts at the chemoreceptor trigger zone – used for relief of nausea & vomiting -Doesn’t cross BBB readily- alternative to metoclopramide (which does cross BBB- causes sedation + dystonic reactions) -Known to increase risk of arrhythmias or sudden cardiac death- risk is higher in older people over 60 yrs + those who receive daily oral doses of above 30 mg -Reduce treatment length + dose in older people -Domperidone should be avoided in patients who are taking concomitant medication known to cause QT prolongation (such as ketoconazole and erythromycin). |
| Doxycycline: -Risks -Indication -Dosing | -Tetracycline -Easily chelates to other metabolites in stomach acid -Photosensitivity -Respiratory tract infections in penicillin allergic patients or those who havnt repsonded -Stat dose first day 200mg then 100mg daily -Should not be used in children under 12 |
| Enalapril: -Class -Side effects -Renal -Hyperkalemia -Monitoring -Preganancy | -ACE inhibitor -Angioedema (swelling), may be accompanied by a rash -Can happen at start/during treatment -Patients that happemn to have had ACEI induced angioedema shouldnt be given this class of drug again (high risk of recurrence) -ACEI induced angioedma is due to excessive accumlation of bradykinin -Renal Impairment First-Dose hypotension (especially with concomittant diuretics) could take before bed -Hyperkaelamia -Persisent dry cough -Can cause renal toxcity be reno-protective -Will exspcet a small decline in renal function/eGFR when starting ACEI -There shouldnt be a massive decline- if there is it means it is contra-indicated -If they have bilateral renal artery stenosis (narrowed renal arterires-usally caused by atherosclerosis), ACEI reduce/abolish glomerular filtration-likley to cause renal failure -If they have CVD & known atherosclerosis or suspected/known renovascular disease- try to avoid ACEI in these patients |
| Enalapril- Part 2 | -Concomittant treatment with NSAIDs increased the risk of renal damage -Angiotension II causes constriction of efferent arteriole (where blood flow comes out of the kidneys)-causes increased intraglomerular pressure → inc filtration + inc permeability (more proteinuria) -Giving ACEi/ARB→ reduced angiotensin II→ efferent arteriole is dilated→ reduced intraglomerular pressure + proteinuria, and eGFR falls slightly – this reduction in pressure is reno-protective (in diabetes and CKD) -BUT if there is reduced blood flow coming in afferent arteriole (blood coming into kidneys) and using ACEi allows the efferent arteriole to be dilated→ intraglomerular pressure drops significantly→ eGFR drops significantly- become nephrotoxic -Blood flow in afferent arteriole may be reduced by: drugs/vasoconstrictors (e.g. NSAIDs), dehydration, diarrhoea, vomiting, renal artery stenosis, sepsis. -Hyperkalaemia -Inc risk of hyperkalaemia – avoid giving it with potassium sparing diuretics (e.g. spironolactone), K supplements and any other drugs that increase K levels (e.g. trimethoprim) -If potassium levels are above 6.5- becomes medical emergency- could cause acute cardiac event -Monitoring Renal function + electrolytes should be checked before starting, any dose changes (within 7-10 days) and during treatment may need to inc monitoring if there are any issues -Contra-indicated in pregnancy- effect babies BP & renal func (skull defects & oligohydramnois (too little amniotic fluid) |
| Erythromycin: -Class (others in class) -Indication -Side effects -Enzyme Inhibitor -Interactions | -Macrolide antibiotic (Azithromycin & clarithromycin) -Alternative in peneicillin allergic patients -Nausea, vomiting & diarrhoea -Important drug interactions (theophylline- avoid conmitant use with simvastain- increased myopathy risk) -Carbamazepine (macrolides can raise plasma carbamzepine levels) -Drugs that prolong QT interval (Antiarrhythmics, antipsychotics & TCAs) Methadone -Drugs that cause hypokaelamia (diuretics, corticosteroids & SAB2A)- hypokaelamia is a risk factor for QT interval prolongation -Statins- increased risk of myopathy (cyp450 & cyp3a4 inhibiiton)- if clarithromycin/ erythromycin is taken with atorvastatin (avoid concurrent use with antiotibs-moderately metabolized/ simvastatin (Severely metabolised-if antibiotic cant be stopped-stop treatment with simvbastatin during course) -Theophylline- erythromycin increased plasma concentration and theophylline can reduced absorption of oral erythromycin -Warfarin- unpredictable- effects of warfarin may be increased by macrolides -CCBs-amlodipine cap does of simvastatin at 20mg- increased risk of hypotension -Antidiabetic drugs & Insulin- clarithromycin & antidiabetic drugs (SU/Isulin)- Severe risk of hypoglyceamia |
| Etoricoxib: -Class -Concerns/Risks -General prescribing points -Renal -MHRA Guidance | -COX-2 Inhibitors -There are general GI & Renal concerns & increased risk of CV events -Use safest NSAID with lowest effective dose for shortest amount of time -Naproxen (1,000 mg daily or less) and low-dose ibuprofen (1,200 mg daily or less) have the most favourable cardiovascular safety profiles of all NSAIDs -Discuss any risks and how to mitigate them (e.g. prescribe PPI if necessary) -Drugs that inc risk of AKI are a double whammy (NSAID + ACEi) or triple whammy (NSAID + ACEi + diuretic) -NSAIDs can cause renal failure -Risk factors: existing renal impairment, elderly, people with diseases or taking drugs that predisposes them to renal failure -MHRA warning about Etoricoxib and its CV risks which increase with dose & duration- lowest effective daily dose should be used -Etoricoxib should not be Rx to those with BP presistently above 140/90 mmHg & inadequately controlled - BP needs to be controlled (as it increases CV risk)- before treatment |
| Ferrous Sulphate: -Indication -Hb Concentration -Side effects -Storage -Interactions | -Iron deficiency anaemia -Hb should rise (by 2g/100ml) & get back to normal range after 3-4 weeks, and should continue for a further 3 months to replenish iron stores -Gi irritation is common- can cause nausea/vomiting particularly if taken on empty stomach -Constipation- especially in elderly -Dark stools -Needs to be stored safely- it is a cuase of accidently overdose in children -Can affect absorption of other meds if taken at the same time |
| Finasteride: -Indication -Safety point (MHRA) -Excretion (Risk) | Benign prostate hyperplasia, alopecia in men (reduction in prostate size, with improvment in urinary flow rate) -Can cause depression & suicidal thoughts- should be discontinued if become present- and inform healthcare professional if they develop depression -Teratogenic (esxcreted in semen- use of a condom if sexual partner is pregnant or likely to become pregnant) -Women shouldnt handle crushed or broken tablets -Males- gynocomastia (report signs of changes: lumps, pain or nipple discharge) |
| Furosemide: -Class -Pathophysiology -Renal -Monitoring -STOPP Criteria (In older people) -Hypokaelamia -Prostate | -Loop diuretic -By interacting with ascending limb of the loop of henle, it inc excretion of sodium (can cause hyponatraemia- presents with confusion) + water -Rapid onset of action (IV 5 mins, orally 1-2 hours) -Duration of action= 4-6 hours – as they will be urinating a lot, can be problematic if they want to go out→ COUNSEL them on this -Inc risk of renal impairment→ they reduce blood volume- reduces blood flow to the kidneys- reduces eGFR → need to monitor renal function + electrolyte abnormalities -Need to monitor renal function, electrolytes and blood pressure (as blood vol is reduced- causes reduction in BP) regularly -If indication unclear, it needs to be reviewed (as it may be inappropriate): -It is NOT 1st line for hypertension (safer alternatives available) -For hypertension with concurrent urinary incontinence- may exacerbate incontinence For ankle oedema, but there’s no evidence of HF, liver failure, nephrotic syndrome or renal failure- safer alternatives available -Hypokaelamia (Loop diuretics cause- dangerous in patients with CVD- or if on cariac glycosides- digoxin- toxcitiy |
| Furosemide-Part2 | If they are prone to this (and in HF patients)- give potassium sparing diuretics with loop diuretics (to avoid hypokalaemia + the need for K supplements). Prostate If they have enlarged prostate and take loop diuretics- can’t pass urine as freely- can cause urinary retention (painful) Less likely if small doses or less potent diuretic used Need to determine that they have adequate urinary output before initiating treatment |
| Gabapentin: -Indications -Initiation -Safety points | -Range of indications: anti-epileptic, Neuropathic pain -Needs to be titrated gradually -Severe respiratory depression even without concomitant opiod medicines -CNS depressants & elderly might have a higher risk of experiencing sevre repiratory depression & dose adjustments may be necessary in these patients -Schedule 3 (except from Safe custody requirements) -Abuse risk (alcohol interaction & CNS depressants- opioids) |
| Methotrexate: -Class -Indication -Patient -Dose -Toxicitites & Monitioring -Excretion -NSAIDs -Folic acid | -DMARD - Rheumatoid arthritis, IBD, etc -Taken once a week (take it same day every week at around same time) - Blood toxicity- regular blood test monitoring is needed- shouldn’t dispense it if we don’t know when last monitoring was done or what the results were (need a follow-up monitoring) – Liver toxicity- monitor LFTs – Pulmonary toxicity- check if they have SOB (red flag) – Monitoring should be done every 1–2 weeks initially until stable, then should be monitored every 2–3 months -renally excreted- regularly monitor renal function – Caution with interacting drugs that may reduce renal excretion of methotrexate (e.g. NSAIDs, diuretics, ACEi) -DON’T sell NSAIDs to methotrexate patient- they reduce renal blood flow- reduces renal excretion of methotrexate - They have anti-folate activity- need folic acid to reduce toxicity – Folic acid is given once a week- take it a few days apart from the methotrexate |
| Metoclopramide: -Class -Side effects -Warnings/Risks -Licensing -Dose | -Anti-emetic -Can induce dystonic reactions involving facial and skeletal muscle spasms and oculogyric crises (spasms within eye muscles) – Risk of neurological effects such as short-term extrapyramidal disorders and tardive dyskinesia – These risks outweigh the benefits in long-term or high-dose treatment – So minimise dose + duration of treatment -Usual dose is 10 mg up to 3 times daily, max daily dose is 500 micrograms/kg |
| Metronidazole: -Indication -Pathophysiology -Alcohol | -Anti-microbial with high activity against Anaerobic bacteria -Has high activity against anaerobic bacteria -When taken with alcohol: flushing, feeling sick, vomiting, headache, dizzy & palpitations (avoid alcohol during course & for 48 hours afterwards) |
| Nitrofurantoin: -Indication -Renal | -1st line in UTI – Avoid if eGFR is less than 45ml/min/1.73m2 – This is because it is secreted into urinary tract- it needs to be secreted in a sufficient concentration to be effective |
| Prednisolone: -Class -Indication -Side effects -Risk -Withdrawal | -Corticosteroids -COPD exacerbations, IBD -Short-term: insomnia, mood disturbances, GI disturbances – Long-term: same as short-term and… osteoporosis, adrenal suppression, cushingoid state, diabetes, ocular effects (cataracts/glaucoma), skin changes (e.g. thinning, bruising), GI ulceration, growth retardation, hypokalaemia, fluid retention -If on long courses/high doses- may be immunocompromised– at risk of infection -Must be tapered down gradually if: • >3 weeks any dose • >40mg prednisolone (or equivalent) for more than 1 week • Multiple recent repeated courses • Short course within a year of stopping a long course • Been given repeat doses in the evening – If stopped abruptly- can cause adrenal suppression |
| Quinine Sulphate: -Indication -Patient counselling -Side effects -Prescribing -Interactions -Overdose | -Not routine treatment for nocturnal leg cramps- only give if necessary (weigh out risk/benefit) - If there is no benefit after at least 4 weeks- stop using it – DO NOT exceed the recommended dose -Tinnitus, impaired hearing, headache, nausea, disturbed vision, confusion, flushing, and abdominal pain – (rare) Thrombocytopenia- thought to be a hypersensitivity reaction Need to report any signs of thrombocytopenia: unexplained petechiae rash (pinpoint, round spots), bruising, or bleeding. -It should not be prescribed to those who have had previous side effects with quinine in drinks -It should not be prescribed to those who have had previous side effects with quinine in drinks -Significant interactions with digoxin and warfarin -Significant toxicity in overdose- can result in death or permanent visual loss |
| Tramadol: -Class -Risk -Seizures -Interactions | -Moderate opiate -Can cause tolerance + dependence -Avoid in patients with a history of epilepsy or those susceptible to seizures -tramadol lowers the seizure threshold - Used with caution with medication that can lower the seizure threshold (e.g. SSRIs, TCAs) – Has serotonergic activity- can cause serotonin syndrome if given with some antidepressants (SSRIs) |
| Trimethoprim: -Class -Pregnancy -Interactions -Blood disorder | -Anti-folate, antibiotic -Teratogenic in pregnancy (especially in 1st trimester) – ACEi + Trimethoprim = increased risk of hyperkalaemia – Methotrexate + Trimethoprim (both anti-folates) = increased risk of haematological toxicity -Can cause blood disorders- seek immediate medical attention if symptoms such as fever, sore throat, rash, mouth ulcers, purpura, bruising or bleeding develop |
| Warfarin: -Class -Interactions -Monitoring -Vitamin K | -Anticoagulant – Has many interactions with drugs and food – Examples: cranberry juice, pomegranate juice, alcohol, foods high in vit K, amiodarone, fluoroquinolones, metronidazole, phenytoin, omeprazole, carbamazepine, etc. – Requires regular INR monitoring – INR target for warfarin patients is usually between 2-3 – Interacts with vitamin K- vit K counteracts effects of warfarin + lowers INR (can be used if INR is too high) |