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1
Q

Steroids - what are they and what do they do?

A

Tablet taken once a day long-term to reduce inflammation in the body

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2
Q

Steroids - minor risks

A

Weight gain
Acne
Mood change
Proximal myopathy
Skin thinning

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3
Q

Steroids - major side effects and ways to reduce these

A

Gastritis/peptic ulcers: take tablets with or soon after a meal, PPI, avoid NSAIDs

Osteoporosis: Vitamin D and calcium supplementation, keep active

Hypertension: regular BP check-up, diet/exercise/smoking cessation/alcohol etc

Diabetes: attend your check ups, diabetic symptoms to be aware of (polydipsia, polyuria), mindful of diet etc

Immunosuppression: be aware of infection risk, wash hands etc

Addisonian crisis: most important last - don’t stop suddenly!

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4
Q

Lifestyle modifications

A

Weight loss
Physical activity
Diet - reduce salt/fats
Smoking cessation
Reduce alcohol intake
Stress reduction
Adhere to treatments/targets

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5
Q

Warfarin - contraindications

A

Pregnancy
Significant risk of bleeding
Active bleeding

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6
Q

Warfarin - mechanism of action

A

Thins blood to treat/prevent blood clots
Blocks Vitamin K which is used by the body to make proteins that cause blood to clot

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7
Q

Warfarin - treatment course

A

Once daily tablet, usually taken in the evening
Different durations - 3-6 months, lifelong
Dose change takes 2-3 days to take effect

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8
Q

Warfarin - monitoring

A

Start at 5mg
INR on days 3/4/5
Refer to warfarin dosing charts
Then regular INR checks

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9
Q

Warfarin - side effects

A

Bleeding - when to seek advice: head injury, prolonged epistaxis, unusual headache, blood in urine/vomit/stool, unexplained/severe bruising

Diarrhoea
Rash
Hair loss
Nausea
Interactions: avoid liver, spinach, cranberry juice, alcohol binges, NSAIDs/aspirin

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10
Q

DOAC - contraindications

A

Significant renal impairment
Risk of or active bleeding
Not licensed for metallic heart valves

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11
Q

DOAC - mechanism of action

A

Thins blood to treat/prevent blood clots
Blocks a protein required for blood clotting

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12
Q

DOAC - treatment course

A

Once/twice daily tablet/capsule
Take with full glass of water sitting up
Duration: 3-6 months or lifelong

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13
Q

DOAC - monitoring

A

None regular
Annual U&Es (and before)

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14
Q

DOAC - side effects

A

Bleeding
GI disturbance
Irreversible

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15
Q

Levothyroxine - contraindications

A

None

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16
Q

Levothyroxine - mechanism of action

A

Synthetic version of thyroxine
Given cause thyroid not producing enough so to bring thyroid activity back to normal

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17
Q

Levothyroxine - treatment course

A

Once daily tablet before breakfast, taken long-term
Dose takes 4-6 weeks to take effect

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18
Q

Levothyroxine - monitoring

A

TSH every 2-3 months until stable, then annually

19
Q

Levothyroxine - side effects

A

Rare
Hyperthyroidism if over-prescribed
Hypothyroidism if under-prescribed

20
Q

Statin - contraindication

A

Pregnancy

21
Q

Statin - mechanism of action

A

Stop liver making cholesterol (why this is important)

22
Q

Statin - treatment course

A

Once daily tablet usually in the evening, taken long-term (decreases risk over many years)

23
Q

Statin - monitoring

A

Review lipids in 4 weeks then every 6-12 months
LFTs before, at 3 months and 12 months (monitor ALT)

24
Q

Statin - side effects

A

Muscle pains
Headache
Itching
Nausea, vomiting
Diarrhoea
Abdominal pain
Rhabdomyolysis (unexplained muscle pain - tell doctor)
Some interact with grapefruit juice

25
Q

Metformin - contraindications

A

Significant renal impairment
Ketoacidosis
Low BMI

26
Q

Metformin - mechanism of action

A

Increases response to insulin (cells take up more glucose)
Also reduces amount of glucose produced by the liver

27
Q

Metformin - treatment course

A

Once/twice/three times daily tablet within meals, taken long-term

28
Q

Metformin - monitoring

A

U&Es before and annually
HbA1c every 3-6 months until stable, then 6-monthly at diabetic check ups

29
Q

Metformin - side effects

A

Nausea
Diarrhoea
Abdominal pain
Weight loss
Lactic acidosis (don’t take on day or 2 days following GA/contrast)

30
Q

Iron tablets - contraindications

A

None

31
Q

Iron tablets - mechanism of action

A

Replace body’s iron supply, mineral needed to make RBCs

32
Q

Iron tablets - treatment course

A

Tablet or syrup taken 1-3 times daily (as much as able)
Works best taken without food however can irritate stomach
Takes 3-4 weeks for Hb to normalise then further 3 months to improve stores

33
Q

Iron tablets - monitoring

A

Hb at 3-4 weeks

34
Q

Iron tablets - side effects

A

GI irritation
Black stools
Metallic taste

35
Q

SSRI - contraindications

A

Suicidal risk
Mania

36
Q

SSRI - mechanism of action

A

Alter balance of chemicals in brain called neurotransmitters. Imbalance thought to lead to depression.

37
Q

SSRI - treatment course

A

Once daily tablet, 4-8 weeks to take effect
May slowly reduce tablet after 6 months of feeling better

38
Q

SSRI - monitoring

A

None

39
Q

SSRI - side effects

A

GI irritation
Appetite and weight change (up or down)
Headache
Drowsiness (take at night)
Anxiety for 2 weeks
Withdrawal
Increases suicide risk in younger patients

40
Q

Methotrexate - contraindications

A

Pregnancy
Breastfeeding
Hepatic impairment
Active infection
Immunodeficiency

41
Q

Methotrexate - mechanism of action

A

Reduces inflammation and suppresses immune system
Early use improves outcome and symptoms

42
Q

Methotrexate - treatment course

A

Once weekly tablet, long-term - same day. Dose builds up slowly, takes 3-12 weeks to work.
Folic acid on alternate day

43
Q

Methotrexate - monitoring

A

FBC, U&Es, LFTs
- Before
- Then every 2 weeks until stable
- Then every 2-3 months

44
Q

Methotrexate - side effects

A

Alopecia
Headaches
GI disturbance - no NSAIDs/aspirin
Myelosuppression - doctor if unexplained bleeding/bruising, infective symptoms and get annual flu jab
Liver and lung toxicity

Counselling (1 decks)

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