02/03 Flashcards
Risk factors for osteoporosis ?
Occurs most commonly in postmenopausal women, men over 50, long-term steroids. Risk factors: increasing age vitamin D deficiency low calcium intake lack of physical activity low BMI 18.5 kg/m² cigarette smoking excess alcohol intake parental history of hip fractures early menopause previous fracture at a site characteristic of osteoporotic fractures reumatoid arthritis and diabetes
How should you counsel patients to take alendronic acid tab ?
Tab taken with plenty of water while sitting or standing, on an empty stomach at least 30 min before breakfast ( or other meds) patient should stand or sit upright for at least 30 min after administration
What counselling in terms of s/e should you provide to your patients ?
Atypical femoral fractures: report any thigh, hip or groin pain during treatment.
Osteonecrosis of the jaw: maintain good, oral hygiene, receive routine dental checkups, and report any symptoms
Osteonecrosis of the external auditory canal: report any ear pain, discharge from ear or an ear infection during treatment
Oesophageal reactions: stop taking and seek med help ASAP if dysphagia, new or worsening heartburn, pain on swallowing or retrosternal pain
- What is the max amount of salt per day ?
2. Sugar ?
- 6g
2. 30g of free sugars
Febuxostat MHRA warnings ?
Stevens-Johnson syndrome and acute anaphylactic shock with febuxostat
increased risk of cardiovascular death and all-cause mortality in clinical trial in patients with a history of major cardiovascular disease; avoid treatment with febuxostat in patients with pre-existing major cardiovascular disease (e.g. myocardial infarction, stroke, or unstable angina), unless no other therapy options are appropriate
Pre-treatment screening with febuxostat ?
Monitor liver function tests before treatment as indicated.
What are the pro kinetic drugs used in nausea/vomiting in palliative care ?
metoclopramide domperidone
How should nausea and vomiting be treated in palliative care ?
prokinetic antiemetic: 1st line
Nausea and vomiting with opioid therapy: haloperidol or metoclopramide hydrochloride
Why drugs with antimuscarinics effects should not be used alongside prokinetic drugs ?
Drugs with antimuscarinic effects antagonise prokinetic drugs for example cyclizine, hyoscine
Palliative care patient has vomiting due to metabolic causes such as hypercalcaemia or renal failure, which antiemetic to give ?
haloperidol
When is cyclizine used in palliative care ?
nausea and vomiting due to mechanical bowel obstruction, raised intracranial pressure, and motion sickness.
Palliative care: patient has pruritus caused by obstructive jaundice, emollients have been tried but no effect, what can you recommend ?
colestyramine
Palliative care patient has raised intracranial pressure, what can be given ?
dexamethasone, before 6pm to ensure no insomnia
How should restlessness and confusion be treated in palliative care ?
haloperidol or levomepromazine
If patient returns CD2, 3 or CD4 ( part 1), is denaturing required ?
Yes, no witness but make a note of returned CD 2 destruction in a returned CD book
What blood test results would prompt you to suspect familial hypercholesterolaemia ?
total cholesterol level greater than 7.5 mmol/L and/or
A personal or family history of premature coronary heart disease (CHD, an event before 60 years in an index person or first-degree relative [parents, siblings, children]).
What diagnostic tests should be done if it is suspected patient has familial hypercholesterolaemia?
Take two measurements of low-density lipoprotein (LDL) cholesterol concentration.
first-line therapy in all patients with familial hypercholesterolaemia ?
A high-intensity statin, defined as the dose at which a reduction in LDL-cholesterol of greater than 40% is achieved.
Patients with primary heterozygous familial hypercholesterolaemia who have contra-indications to, or are intolerant of statins, can be considered for treatment with ezetimibe as monotherapy
Name high intensity statins ( dose at which reduction in LDL-cholesterol of greater than 40% is achieved ) ?
Atorvastatin 20, 40, 80 mg
Rosuvastatin 10, 20, 40
Simvastatin 80
When should malaria prophylaxis be started for chloroquine and proguanil hydrochloride ?
1 week before travel
when should malaria prophylaxis be started for mefloquine ?
2-3 weeks before travel
when should malaria prophylaxis be started for atovaquone with proguanil hydrochloride or doxycycline ?
1-2 days before travel
Malaria prophylaxis should be continued for 4 weeks after leaving, except for atovaquone with proguanil hydrochloride, how long for these drugs ?
1 week after leaving
What is the treatment for acute migraine attacks ?
Monotherapy, with either aspirin, ibuprofen, or a 5HT1-receptor agonist (‘triptan’) is recommended as first-line
How should sumatriptan be taken for migraines ?
In patients who experience aura with their migraine, it is recommended that 5HT1-receptor agonists are taken at the start of the headache and not at the start of the aura (unless the aura and headache start at the same time). Treatment with a 5HT1-receptor agonist can be repeated after 2 hours with the same or different drug if there has been an inadequate response to the initial dose.
What NSAIDs can be used to treat acute migraine attacks ?
naproxen [unlicensed indication], tolfenamic acid, and diclofenac potassium
What drugs are first line in preventative treatment of migraines ?
1st line propranalol
Unsuitable then metoprolol, atenolol (unlicensed), nadolol, timolol. Bisoprolol may be considered in patients already taking it for cardiac reasons.
BB unsuitable then topiramate.
What is supply criteria for sumatriptan ? OTC
Migraine must be diagnosed by a doctor or pharmacist
Established pattern of migraine (a history of five or more migraine attacks occuring over a period of at least one year)
Simple analgesics tried and ineffective.
Which patient groups should not be supplied with OTC sumatriptan ?
- under 18 or over 65
- pregnancy breastfeeding
- Heart disease risk factors (contraindicated in patients who have three or more risk factors i.e. diabetes, high cholesterol levels, smoking/use of NRT).
Which drug usage would prevent you from supplying sumatriptan OTC ?
Ergotamines (methysergide) MAOIs Triptans TCAs SSRIs/SNRIs
If first migraine attack occurs over 50 or has four or more attacks per month or headaches lasting more than 24 h, can you supply OTC sumatriptan ?
NO
IF patient experience which symptoms should they discontinue sumatriptan use ?
heat, heaviness, pressure or tightness (including throat and chest) occur.
How should maloff protect ( atovaquone 250mg with proguanil hydrochloride 100mg) be taken ?
One tab daily, one to two days prior to entering a malaria-endemic area, continued during period of stay, and for seven days after leaving the area
Which interaction drugs would require you to refer a patient who request maloff protect ?
Etoposide Rifampicin or rifabutin Metoclopramide Warfarin or other oral anticoagulants Tetracycline Indinavir, efavirenz, zidovudine or boosted protease inhibitors
Which medical conditions must be referred when requesting maloff protect ?
Patients with a history of depression, or seizures
Patients with tuberculosis
Which other patient groups should be referred when requesting maloff protect ?
If needing quantities to cover longer than 12 weeks travel
Patients under 18 years
Patients who weigh less than 40kg
What are the counselling points for maloff protect ?
Take at the same time each day
Take with food or a milky drink (to ensure maximum absorption)
If vomiting happens within 1 hour of taking dose, take another
Dizziness has been reported
What is a normal BP reading ?
TOP number: systolic: between 90 and 120
Bottom number: diastolic: between 60 and 80
Which drugs should not be stopped before surgery ?
antiepileptics, antiparkinsonian drugs, antipsychotics, anxiolytics, bronchodilators, cardiovascular drugs, glaucoma drugs, immunosuppressants, drugs of dependence, and thyroid or antithyroid drugs.
Which drugs should be stopped before surgery ?
COC: stop 4 weeks before
HRT: stop 4-6 weeks before, start when mobile
MAOIs gradually withdraw 2 weeks before
Lithium should be stopped 24 hours before major surgery
Potassium-sparing diuretics may need to be withheld on the morning of surgery because hyperkalaemia may develop
Ace - 24 hours before
Warfarin 5 days before elective surgery
Day before surgery: once daily long-acting insulin analogues, which should be given at a dose reduced by 20 %.
Gradual withdrawal of systemic corticosteroids should be considered in those whose disease is unlikely to relapse and have …?
- received more than 40 mg prednisolone (or equivalent) daily for more than 1 week;
- been given repeat doses in the evening;
- received more than 3 weeks’ treatment;
- recently received repeated courses (particularly if taken for longer than 3 weeks);
- taken a short course within 1 year of stopping long-term therapy;
- other possible causes of adrenal suppression.
Which clinical conditions would prevent use of ulipristal EC ?
severe liver impairment and in patients with severe asthma who are on oral glucocorticoid is not recommended.
Which clinical conditions would prevent use of levonorgestrel EC ?
severe liver dysfunction, patients at risk of ectopic pregnancy or who have suffered inflammation of the fallopian tubes, Chrohns disease
Which medications use would prevent you to supply ulipristal EC ?
carbamazepine, efavirenz, fosphenytoine, griseofulvin, nevirapine, oxcarbazepine, phenobarbital, phenytoin, primidone, rifabutin, rifampicin, St. John’s wort/Hypericum perforatum, long term use of ritonavir.
Patients who have taken CYP3A4 enzyme inducing medicines in the last 4 weeks and would like levonorgestrel what should you suggest ?
offered referral for a copper intrauterine device to be fitted within 5 days of unprotected sex/ failure of a contraceptive method. If this is not an option the woman should take double the usual dose of levonorgestrel
Levonorgestrel can also increase toxicity of ciclopsorin.
What is breast-feeding advice regarding ulirpristal and levonorgestrel ?
Ulipristal: do not breastfeed for 7 days
Levonorgestrel: tablet immediately after feeding and avoids nursing at least 8 hours following Levonelle
Patient has taken EC of ulipristal and asks you can she return to taking her normal contraceptive pill ?
If ulipristal is used, progestogen-containing drugs should not be restarted for 5 days afterwards. Patients should therefore be advised to use a reliable barrier method until their next period.
Patient has taken EC of levonorgestrel and asks your advice about resuming normal contraceptives ?
Patients can continue with their regular contraceptives following the use of levonorgestrel
What does Total parenteral nutrition mean ? ( TPN)
administration of nutritionally complete solution via central venous catheter
What AMBP/HMBP reading indicates stage 1 and stage 2 hypertension ?
stage 1 : 135/85 mmHg or higher.
stage 2 : 150/95 mmHg or higher.
