[COM] Communicating information Flashcards
Before giving bisphosphonates
Hypocalcemia/vitamin D deficiency
Method of taking oral bisphosphonates to avoid oesophageal reaction
Should be swallowed with plenty of water while sitting or standing on an empty stomach at least 30 minutes before breakfast (or another oral medication); the patient should stand or sit upright for at least 30 minutes after taking
When should statins be taken and why?
Most cholesterol metabolism occurs overnight, so conventionally statins are taken at night.
What should you tell a patient taking statins if they need to be started on clarithromycin?
Statins should be stopped while taking clarithromycin (a CYP3A4 inhibitor) as they increase toxicity and associated side effects.
What should the GP do when a patient is started on olanzapine therapy?
An ECG in 1 week’s time
Olanzapine therapy can result in a prolonged QTc interval particularly if the patient has cardiovascular risk factors or personal history of cardiovascular disease (including smoking). This can potentially lead to dysrhythmias and therefore may change his treatment.
What monitoring should be done in patients on olanzapine?
Glucose
Lipids
Most important advice to give when starting ciprofloxacin
Seek medical advice if ankle or calf pain develops
Risk of tendonitis and tendon rupture with quinolone antibiotics
The antibiotic should be discontinued immediately if tendonitis develops. The risk is highest in patients over the age of 60 and in those taking corticosteroids.
Most important advice to give when patient taking clozapine
The patient should seek urgent medical assistance if constipation develops
This is due to the potentially fatal risk of intestinal obstruction, faecal impaction and paralytic ileus.
Most important advice to give when GTN spray started
The first and second dose can be taken at 5-minute intervals and if the pain does not ease after the second dose call an ambulance
Glyceryl trinitrate should be sprayed underneath the tongue, not on the tongue.
Glyceryl trinitrate can cause a migraine, however, this is less important advice than when to call an ambulance.
What advice should be given when aciclovir is started
Aciclovir can make skin more sensitive to the sun - wear sunblock and sun-protective clothing when appropriate.
First choice laxative in pregnancy
Bulk-forming e.g. Ispaghula husk (after increasing dietary fibre and fluid intake)
Can ibuprofen be used in pregnancy?
Ibuprofen is contraindicated in the third trimester of pregnancy as it can precipitate the closure of the fetal ductus arteriosus and cause other complications in labour.
How does a disulfiram-like reaction present?
Intensive nausea and vomiting
What side effect of systemic corticosteroids (other than acute adrenal insufficiency) should patients be warned about?
psychiatric disturbances, which can include suicidal ideation and psychotic reactions.
It is important to inform the patient and their family of this so that they recognise the signs early and can seek urgent medical advice.
What counts as effective contraception e.g. while taking isotretinoin?
Effective contraception is defined as one highly effective, user-independent method such as an intra-uterine device, or two complimentary but user-dependent methods, such as the combined oral contraceptive pill and condom use.
Why should lymecycline be stopped when a patient is started on isotretinoin?
Isotretinoin increases the risk of benign intracranial hypertension when given alongside tetracyclines, therefore tetracyclines must be stopped before starting isotretinoin.
What should patients avoid when taking MAOi medications e.g. phenelzine?
Alcohol
Tyramine-containing foods
Rifampicin contraception advice
The combined oral contraceptive pill is not appropriate and she should switch to another means of contraception
Women should change to a form that is not affected by the drug, such as an intra-uterine device or a parenteral progestogen.
Potent CYP450 enzyme inducer
Why should clozapine not be stopped suddenly?
Risk of rebound psychosis
Main risk of gliclazide?
HYPOGLYCAEMIA
patienst should be told to carry a source of sugar with them at all times
Will need to be stopped on the day of any surgery due to risk of hypoglycaemia
Patient started on warfarin. Advice about alcohol intake?
Binge drinking alcohol should be avoided is correct advice as consuming large amounts of alcohol can inhibit the metabolism of warfarin leading to an increased INR and subsequently increased risk of bleeding. In addition, binge drinking increases the risk of falls and other trauma.
What colour are 1mg warfarin tablets?
Brown
