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Prescribing > BNF treatment summaries > Flashcards

BNF treatment summaries Flashcards

1
Q

first line drug options for MILD Alzheimers (give 3). What type of drug are they?

A

donepezil
galantamine
rivastigmine

(acetylcholinesterase inhibitors)

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2
Q

first line drug for SEVERE Alzheimer’s?

A

memantine hydrochloride

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3
Q

drug class used to treat wet AMD?

A

intravitreal anti-VEGF

aflibercept

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4
Q

name three aminoglycoside Abx

A

gentamycin
neomycin
streptomycin

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5
Q

2 drug options for acute alcohol withdrawal

A

chlordiazepoxide
diazepam

(both benzos)

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6
Q

first line for delirium tremens

A

oral lorazepam

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7
Q

2 drugs for pharma Rx of alcohol dependence

A

acamprosate

naltrexone

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8
Q

drug for wernicke’s

A

IV pabrinex

thiamine

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9
Q

3 drugs for iron def anaemia

A 
ferrous fumarate (200mg)
ferrous sulfate (300mg)
ferrous gluconate  (300mg)
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10
Q

name 3 antispasmodics for IBS

A

peppermint oil
mebeverine
buscopan (hyoscine butylbromide)

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11
Q

what class of drug is hyoscine butylbromide?

A

antimuscarinic

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12
Q

first line for ADHD

A

methylphenidate

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13
Q

second line for ADHD

A

atomoxetine

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14
Q

long acting alternative of sildenafil

A

tadalafil

“taadaa”

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15
Q

second line for ED

A

intracavernosal/intraurethral/topical ALPROSTADIL

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16
Q

first line for gonorrohoea

A

azithromycin stat + im ceftriaxone

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17
Q

PID Rx

A

doxycycline + metronidazole + im ceftriaxone

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18
Q

what do you give with isoniazid in TB treatment

A

pyridoxine hydrochloride to prevent isoniazid-induced neuropathy

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19
Q

name 3 macrolides

A

azithromycin
clarithromycin
erythromycin

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20
Q

abortive Rx for migraine

A

sumitriptan

or just aspirin/ibuprofen/paracetamol

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21
Q

first line preventive drug for migraine

A

propanolol

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22
Q

second line preventive drug for migraine

A

topiramate (if beta blockers dont work)

sometimes amitriptyline

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23
Q

pts undergoing PCI should receive what drugs?

A

eptifibatide and unfractionated heparin

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24
Q

migraine treatment summary?

A

abortive - NSAIDs, sumitriptan

preventive - propanolol, topiramate, amtriptyline

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25
Q

name a glycprotein IIb/IIIa inhibitor?

A

eptifibatide

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26
Q

in pts who cant get PCI within 90 minutes, what should they be given?

A

thrombolysis (streptokinase, alteplase)

and unfractionated heparin / or fondaparinux

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27
Q

in which pts are diltiazem / veraparmil contraindicated?

A

in those with LV dysfunction

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28
Q

state 5 long term drugs after STEMI

A 
aspirin and clopidogrel 
beta blocker (metoprolol)
ACE inhibitor
nitrates 
statins
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29
Q

adult can’t talk in sentences, peak flow 33-50% of predicted, RR >25, HR >110. what kind of asthma attack is this?

A

severe

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30
Q

define some parameters of a life threatening asthma attack in an adult

A 
silent chest
<33% pefr
<92% sats 
cyanosis 
normal paco2
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31
Q

when use nebulised ipratropium bromide in asthma attack?

A

poor initial response to salbutamol or

severe/lifethreatening

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32
Q

if severe asthma attack, with not a good response to inhaled bronchodilators, what do you use?

A

IV mg sulfate
IV salbutamol

sometimes IV aminophylline

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33
Q

dont forget what in asthma attack

A

oral prednisolone

if not - IV hydrocortisone

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34
Q

how soon should pts GP practice be informed of asthma attack following discharge

A

within 24hrs

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35
Q

a woman has a womb. what HRT do you give?

A

progesterone and oestrogen

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36
Q

a woman doesn’t have a womb. what HRT do you give?

A

oestrogen-only

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37
Q

what’s the period free HRT?

A

tibolone

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38
Q

what kind of HRT DOESNT increase stroke/IHD risk?

A

transdermal (gel/patch)

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39
Q

what are the options for HRT delivery?

A

transdermal
oral
implant

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40
Q

two advantages of HRT (disease wise)

A

less risk of osteoporosis and colorectal ca

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41
Q

combined HRT increases risk of what

A

breast cancer

stroke/VTE if oral

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42
Q

oestrogen-only HRT increases risk of what

A

endometrial ca

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43
Q

how do antibiotics work?

A

bac-static (stop growing, decrease toxin prod)

bac-cidal (kill)

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44
Q

name the 5Cs that cause c-diff

A 
Ciprofloxacin
Clindamycin
Cephalosporins
Co-amoxiclav
Carbapenems
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45
Q

why do abx cause c-diff?

A

all other bac in gut killed exc c diff - crazy

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46
Q

what is in co-amoxiclav?

A

amoxicillin and clavulanic acid (a beta lactamase inhibitor)

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47
Q

what kind of antibiotic are vancomycin and teicoplanin?

A

glycopeptides

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48
Q

what abx can be used for MRSA?

A

vancomycin

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49
Q

what is tazocin made up of?

A

piperacillin and tazobactam (beta lactamase inhibitor)

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50
Q

give example of a quinolone

A

ciprofloxacin

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51
Q

does ciprofloxacin cause c diff?

A

yes

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52
Q

does clindamycin cause c diff?

A

yes

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53
Q

do cephalosporins cause c diff?

A

yes

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54
Q

does co-amoxiclav cause c diff?

A

yes

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55
Q

do carbapenems cause c diff?

A

yes

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56
Q

what are the first line drugs for focal seizures?

A

carbamazepine and lamotrigine

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57
Q

what is the first line for generalised tonic clonic seizures?

A

sodium valproate

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58
Q

first line for generalised tonic clonic seizures in females of childbearing potential?

A

lamotrigine instead of valproate

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59
Q

only in what circumstances can valproate be used in females of childbearing potential?

A

when conditions of the Pregnancy Prevention Programme are met and alternative treatments are ineffective or not tolerated.

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60
Q

what is the alternative to valproate for pre-meopausal females?

A

lamotrigine

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61
Q

what is first line for absence seizures ?

A

ethosuximide

or valproate

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62
Q

is carbamazepine recommended for absence or myoclonic seizures?

A

no.

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63
Q

what antiepileptic ISNT recommended for myoclonic and absence seizures?

A

carbmazepine

64
Q

what is the first line for myoclonic seziures?

A

valproate

65
Q

what should people watch out for on carbamazepine?

A

signs of blood liver or skin disorders

e.g. fever, rash, mouth ulcers, bruising, bleeding

(acute liver disease, leucopenia, Steve jonhson)

–> seek immediate medical attention

66
Q

apart from epilepsy, what else can carbamazepine be used to treat?

A

trigeminal neuralgia

67
Q

two SEs of lamotrigine (clue: you get them in carbamazepine too)?

A

bone marrow failure, steven johnson

hypersensitivity thing

68
Q

pts on antiepileptics should be informed that they can increase suicidal thoughts.

A

yes. report any emergence of these or depression .

69
Q 
phenytoin SEs:
P= P450 inducer
H = Hirsutism
E = Enlarged gums
N = Nystagmus
Y = Yellow-browning of the skin
T = Teratogenic
O = Osteomalacia
I = Interferes with folate metabolism, leads to anaemia
N = Neuropathies: vertigo, ataxia, headaches
A

eek

70
Q

name some unpleasant SEs of valproate

A 
aggression
deafness
menstrual disturbance 
hair loss (regrowth of curly!)
weight gain
71
Q

what fatal thing can valproate cause

A

fatal liver failure

also pancreatitis

72
Q

what bloods often need monitoring on antiepileptics

A

FBC and LFT

73
Q

what blood needs checking 6monthly on valproate

A

LFT

74
Q

describe the stepwise treatment of chronic asthma

A
  1. ICS preventer
  2. SABA reliever
  3. add on LRTA or LABA
  4. high dose ICS
    OR add muscarinic antagonist (tioptropium) or theophylline mr OR asthma specialist
  5. oral prednisolone or Mab
75
Q

what asthma medication can cause bad dreamz

A

montelukast

76
Q

name a monocloncal antibody drug used for severe persistent allergic athma

A

omalizumab

77
Q

n/b ian thingy says ICS preventer first but i think nice guidelines say SABA reliever first

A

right, thanks :)

78
Q

if a 3yr olds asthma isnt controlled on low dose ICE and montelukast, what should you do?

A

refer to asthma specialist

79
Q

pts should be maintained at lowest possible dose of ICS. true or false?

A

true. consider decreasing maintence therapy when been controlled for at least three months (obvs review regularly during)

80
Q

give an example of a combination of an ICS and LABA in a single inhaler,

A

beclometasone with formoterol

budesonide w formoterol

81
Q

what is sodium cromoglicate

A

mast cell stabiliser used sometimes in asthma prophylaxis

82
Q

name a short acting muscarinic

A

ipratropium bromide

83
Q

name a long acting muscarinic

A

tioptropium bromide

84
Q

what is the initial management for COPD?

A

SABA (salbutamol)
or
SAMA (ipratropium)

85
Q

what is the next step in COPD management after not controlled w salbutamol/ipratropium

A

LABA
or
LAMA (tiotropium)

86
Q

if tiooptropium is started in a COPD pt who wasnt controlled on ipratropium inhaler, do you discontinue the ipratropium?

A

yes

87
Q

if LABA started in COPD pt who wasnt controlled on salbutamol inhaler, do you discontinue the salbutamol?

A

no. can continue salbutamol throughout all stages of COPD.

88
Q

if COPD not controlled w SABA/SAMA or LABA/LAMA, what’s next?

A

add ICS

89
Q

when are mucolytics used in COPD?

A

chronic productive cough, getting relief from mucolytics

90
Q

if all other treatment optimised and still having loads of exacerbations, what prophylactic abx might be considered

A

azithromycin

91
Q

first and second line treament for UTI in pregnant women?

A

1: nitrofurantoin
2: amoxicillin

(dont use trimethoprim in preg)

92
Q

people with raging pyelonephritis sensitivity not known:

A

IV cefuroxime

if not that unwell - oral cefalexin

(also suitable in preggers)

93
Q

abx for 7 days if uti in who

A

preggers, men, catheter

94
Q

once bm falls below 14 in dka treatment, what should be given by IV infusion

A

glucose 10% at 125ml/hr

95
Q

drug treatment for pts w life long premature ejaculation

A

dapoxetine

short acting SSRI, use on nights when required ;

96
Q

name two monoamine oxidase-B inhibitors for parkinsons

A

rasagiline

selegiline

97
Q

In early stages of Parkinson’s disease, patients whose motor symptoms decrease their quality of life should be offered what?

A

co-careldopa
or
co-beneldopa

98
Q

what is co-careldopa?

A

levodopa and carbidopa

99
Q

what actually is carbidopa?

A 
decarboxylase inhibitor
(given alongside Levodopa)
100
Q

what is co-beneldopa?

A

levodopa ad benserazide

101
Q

what is levodopa + benserazide?

A

co-beneldopa

102
Q

Parkinson’s disease patients whose motor symptoms do not affect their quality of life, could be prescribed a choice of…?

A

levodopa
dopamine agonists
MAO-B inhibitors

103
Q

Parksinons patient is having hypersexuality and compulsive gambling. What drug is this likely linked to?

A

dopamine agonists

104
Q

excessive sleepiness, hallucinations, and impulse control disorders are all SEs of what

A

dopamine agonists

105
Q

What are the three main side effects of levodopa therapy?

A

dyskinesia
on/off freezing
wearing off / motor fluctuations

106
Q

What is being ‘on’ and ‘off’ in parkinson’s?

A

on = symptoms controlled
off = symptoms come back (L-dopa not working properly/worn off)
FREEZING CAN HAPPEN DURING ON OR OFF PERIODS

107
Q

What are pramipexole and ropinirole?

A

dopamine agonists

108
Q

What are selegiline and rasagiline?

A

MAO-B inhibitors

109
Q

name some features of impulse control disorders on dopaminergic therapy in parkinsons

A

compulsive gambling
hypersexuality
binge eating
obsessive shopping

110
Q

combined hormonal contraception can decrease risk of which cancers

A

endometrial, ovarian, colorectal

111
Q

combined hormonal contraception increases risk of which cancer (slightly)

A

breast

112
Q

what is category 3 of UK MEC? (medical eligibility criteria)

A

a condition where risks of contraception outweigh benefits

113
Q

what is category 4 UK MEC?

A

a condition which represents unacceptable health risk if method is used

114
Q

as well as COCP, how else can u get combined hormonal contraceptives?

A

transdermal patches
vaginal rings

traditionally 21 days then 7 days break

115
Q

what is a monophasic vs multiphasic COCP?

A

monophasic = fixed amount of oestrogen + progestogen in each tablet

multiphasic = varying

116
Q

what is tricycling of COCP?

A

9 weeks of continuous use then 4-7 day hormone free interval

can also just have continuous use - no safety difference

117
Q

how do progestogen only contraceptives work mainly?

A

thickening cervical mucus to prevent sperm penetration

some inhibit ovulation too

118
Q

should you use Depo-provera for more than two years?

A

hmmm probably not. evaluate benefits against risks.

119
Q

is Depo-Provera good for women w osteoporosis risk?

A

no. consider something else.

120
Q

how long does Nexplanon implant last for ?

A

up to 3 yrs

121
Q

does contraceptive effect reverse quickly on removal of implant?

A

yes - rapid

unlike depo-provera - takes longer to get fertility back

122
Q

Depo-Provera is a progestogen only injection (medroxyprogesterone acetate). Name another brand.

A

SAYANA PRESS

Noristerat is injection that lasts 8wks

123
Q

what do Mirena, Jaydess and Levosert release into uterus?

A

levonorgestrel

124
Q

which IUS is licensed for menorrhagia

A

Levosert

125
Q

does fertility return rapidly after you get coil out?

A

yes

126
Q

how does the IUS prevent contraception?

A

thickens cervical mucus

prevents womb lining prolif (so helps menorrhagia)

sometimes inhibits ovulation

127
Q

name some UK MEC category 4s for COCP

A 
breastfeeding <6wks
smokers aged >35yrs
BMI >40
HTN >160
VTE 
DM w complications
IHD
migraines with aura
severe cirrhosis
128
Q

name some UK MEC category 3s for COCP

A 
BMI >35
HTN >140 
on CYP inducers
Hx breast ca 
mild cirrhosis 
migraine without aura
129
Q

theresa has BMI of 36 , mild liver cirrhosis and migraine without aura. she wants the COCP. what UKMEC category is she in?

A

3

130
Q

yvonne has a BMI of 41, DM w nephropathy, and Hx of DVT. she wants the COCP. what UK MEC category is she in?

A

4

131
Q

name some oestrogenic SEs

A

breast tenderness
nausea
headaches
vaginal discharge

132
Q

name some progestogenic SEs of pill

A

acne
mood swings/low mood
breakthrough bleeding

133
Q

the oestrogen in the COCP is what

A

ethinylestradiol

134
Q

marvelon pill is a monophasic COCP with what in

A

ethinylestradiol 30mcg and desogestrel 150mcg

135
Q

if you miss a pill you can take it how many hrs after the last one?

A

can take pill up to 72hrs after the last one

136
Q

janet missed a pill and didnt take the next one >72hrs later. how long should she use condoms for

A

7 days

assess need for emergency contraception

137
Q

what can POP do to your periods?

A

amenorrhoea / irregular bleeding

138
Q

how soon after starting is POP effective?

A

48hrs

139
Q

how long do u need to use condoms after implant insertion?

A

7 days

140
Q

what is main side effect of implant?

A

irregular bleeding

141
Q

how long does Depo-Provera last?

A

12 wks

142
Q

how long does Noristerat injection last?

A

8wks

143
Q

which is the contraceptive method where there can be a delay back to fertility?

A

injection

144
Q

which is the only contraceptive method which has been shown to potentially cause weight gain?

A

injection

145
Q

what can injection do to your bone density?

A

reduce

not recommended for those at risk of osteoporosis

146
Q

can mirena be used as endometrial protection with oestrogen only HRT in women w wombs?

A

yes

147
Q

are injection and IUS affected by liver enzyme inducers?

A

no

148
Q

name some emergency contraceptions

A

copper coil
Levonellle (72hrs)
EllaOne (120hrs)

149
Q

Levonelle morning after pill is levonorgestrel. what is EllaOne?

A

ulipristal acetate

150
Q

how long can u leave Jaydess coil in for?

A

3yrs

151
Q

spermicide not recommended for use with condoms. what barriers methods can you use a spermicide with?

A

diaphragm and caps

152
Q

oil based lubricants decrease efficacy of latex condoms - true or false?

A

true

153
Q

name two contraceptive methods not affected by liver enzyme inducers

A

IUS

and injection

154
Q

is implant affected by liver enzymes inducers?

A

yes

155
Q

name some liver enzyme inducer that you need to watch out for w contraception

A 
carbamazepine, phenytoin
rifampicin 
topiramate
st john's wort
some antiretrovirals 
(injection often better for pts w HIV)

Prescribing (5 decks)

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