2015 Paper Flashcards
medication contraindicated in renal artery stenosis
ACEi
they affect dilation of arteries…
How might macrolides interact with some antipyschoyics?
Macrolides inhibit CYP
Clarithromycin not recommended with quetiapine
For significant results
p=
less than or equal to
0.05
If diuretics are given twice a day what times are appropriate?
No later than 4pm
so 8am and 2pm is suitable for BD
Pt counselling for mirtazepine
report signs of infection (fever, stomatitis, sore throat)
- risk of blood dyscrasia
Indication for mesna
Reduce haemorragic cycstitis (s/e of anticancer agents)
Medication causing haemorragic cycstitis?
Cyclophosphamaide
Which Vitamin aids the absorption of calcium
D
Can you crush finasteride?
Women of child baring potential should not handle crushed or broken tablets
Anti obesity drugs are indicated when….
BMI over 30
In whom at least 3 months of of managed care involving supervised diet, exercise and behaviour modification fails to achieve realistic reduction in weight
OR
BMI over 28 and other risk factors (T2DM, hypertension, hypercholesterolaemia)
Maximum treatment duration for orlistat
12 months
Risk of beta blockers in diabetes ?
Loss of warning of hypoglycaemia
Being dazzled by headlights is a side-effect of
Amiodarone
GI bleed causes stools to look….
Tarry in consistency
Causes of nausea due to medication etc that should be corrected and not treated with antiemetics
DKA
Digioxin and antiepileptic overdose
Main adverse effects of antihistamines
Antimuscurinic side effects and drowsiness
Mode of action of phenothiazine antiemetics (eg. …………)
Dopaminergic antagonists at chemoreceptors trigger zone
E.g. Prochloperazine and chlorpromazine
Problematic sideeffect of phenothiazines
Systemic reactions especially in children
Mode of action of metoclopramide
DA anatag acting on the GI
What antiemetic can be used in Parkinsons diease?
What is contraindicated ?
Dimperidone – it doesn’t cross the BBB
NOT metoclopramide
Mode of action of domperidone
Da anatag - at the chemo trigger zone. Less
Metoclopramide use is cautioned due to …. Up to what age?
EPS
-19
Granisetron and ondansetron act on what? When are they used (2)
5HT Antagonist
Post op and cytotoxic
Dexamethasone is used to treat nausea due to
Chemotherapy
Aprepitant action ….
is used to treat….
Neurokinin receptor antagonist
Nausea due to cisplatins
What antiemetic can be used in pregnancy ?
None - but sometimes short term Promethazineo
Also supplementation with thiamine thiamine to prevent wernickes
Risk factors for post op nausea and vom
Female
Non smoker
History of post op or motion sickness
Opioids
Three drug classes in BNF recommended for post op nausea and vom
5HT antagonists (ondansetron)
Phenothiazines
Antihistamines
Most effective drug at preventing motion sickness
Hyoscine hydrobromide
Promethazine is useful for sedative effect
(Metoclopramide, domperidone, 5HT anatag and phenothiazines - except promethazine - are ineffective)
Uses of beta histine
Vertigo, tinnitus, hearing loss associated with Ménière’s disease
Treatment for cradle cap
Olive or coconut oil or simple emollient
counselling for bisphosphonates 3
Report thigh, hip or groin pain.
Regular dental check ups.
Swallow whole with a full glass of water 30 mins before breakfast and other oral meds. Remain upright for 30mins.
How long until full effect of NSAIDs is achieved for
Pain
Inflammation
1 week for pain
3 weeks for inflammation
Less GI side effects when NSAIDs are selective for …..
Cox 2
Anti-inflammatory effects of ibuprofen are weaker therefore it is not suitable for…
Conditions where inflammation is prominent such as gout
First line NSAID is
Naproxen - lower incidence of side effects ( but more than ibuprofen)
Can methotrexate be given with ibuprofen ?
No- interaction with NSAIDS. Reduced excretion of methotrexate.
Can NSAIDs be given with Li
No. Interaction. Lithium excretion reduced by NSAIDs
Can NSAIDs be given with SSRIs?
No - increased bleeding risk
What anti diabetic drugs can’t be used with NSAIDs
Sulfonyureas
Medications that interact with trimethoprim 3
Phenytoin
Methotrexate
Some antimalarials
Drug licensed for premature ejaculation and its mode of action
Dapoxetine - short acting SSRI.
Two drugs that are excreted unchanged into the bile and therefore can accumulate in hepatic impairment
Rifampicin
Fusidic acid
Hypo proteineamia in hepatic disease is associated with reduced protein binding which can cause toxicity with highly protein bound drugs such as (2)
Prednisolone and phenytoin
Medication that percipitate hepatic encephalopathy
Sedative drugs
Opioid analgesics
Diuretics that cause hyperkalaemia
Drugs that cause constipation X
Oedema and ascities in hepatic disease can be exacerbated by drugs that cause fluid retention such as 2
NSAIDs and corticosteroids
drug for urinary incontinance that is not antimuscurinic
merabegron
drugs that are contraindicated with imidazoles (miconazole) include
statins
Imidazoles inhibit CYP
can clobetasone butyrate or clobetasone propionate be bought over the counter?
clobetasone butyrate 0.05% (eumovate)
maximum OTC dose of hydrocortisone cream
1%
Guidance for OTC hydrocortisone preparations for haemorrhoids
Only for over 18s
Can be used in pregnancy and breastfeeding
No more than 7 days
Not for new suffers who should be referred
what is premarin for?
how long should premarin be left on for?
coucelling for this?
scabies
8-12 hours. If hands are washed in this time it should be reapplied
what is a once only application for athletes foot?
direction
Lamisil once (terbinifine 1%) Wash off 24 hours after application
The initial and maximum dose of what statin depends on ethnicity
Rosuvastatin (start 5-10mg max 40mg)
Patients of asian origin (start at 5, max 20mg)
