Common treatments

Question 1

Migraine treatment

Answer 1

prophylaxis-
1. Propanolol if not then try other BB
1. FROVATRIPTAN CAN BE GIVEN INSTEAD OF OR IN ADDITION TO STANDARD PROPHYLACTIC TREATMENT IN FEMALES WITH PERIMENSTRUAL MIGRAINE (Give 2 days before until 3 days after menstruation starts!)
2a. Topiramate or sodium valproate for those >55 non childbearing
2b. Amitriptyline
3. Candesartan

should be tried for at least 3 months at the maximum tolerated dose, before deciding whether or not it is effective. A good response to treatment is defined as a 50% reduction in the severity and frequency of migraine attacks.

Treatment-
1a. Triptans (Sumatriptan is the first line) - restrict to 2 days per week. can take 2 doses- wait minimum of 2 hours. max doses for oral vs intranasal differ. Take at the start of a headache not the start of aura.
1b. NSAIDS (naproxen, tolfenamic acid or diclofenac. Ibuprofen not mentioned. Mefenamic acid if menstrual migraine).
1c. Paracetamol.
1d. Single dose metoclopramide or prochlorperazine single dose.
2. COMBINATION SUMATRIPTAN + NAPROXEN.

Question 2

Cluster headache treatment

Answer 2

prophylaxis
1. calcium channel blockers- verapamil hydrochloride
1. prednisolone short term
2. combination of pred and verapamil

treatment
1. 15L 100% oxygen for 10-20 minutes to abort attack OR triptans - sumatriptan SUBCUT again is the first line.
2. If unsuitable do nasal spray. or zolmitriptan nasal spray.
3.

Question 3

Tension headache treatment

Answer 3

paracetamol

Question 4

Stroke treatment - thrombolysis dose. Antiplatelet. Statin. And PPI dose.

Answer 4

ASPIRIN: 300 mg OD FOR 14 days started 24 hours AFTER thrombolysis or as soon as possible within 24 hours of symptom onset in patients not receiving thrombolysis. For TIA give it in combination with clopidogrel in patients with a low risk of bleeding Initially 300 mg for 1 DOSE within 24 hours of onset of symptoms, THEN 75 mg OD FOR 21 DAYS.
PPI - if histroy of dyspepsia with aspirin or if using DAPT!

Alteplase or tenecteplase

Clopidogrel 75mg OD

Atorvastatin 80mg OD

Question 5

Alzheimers medication dose

Answer 5

MILD-MODERATE= Donepezil 5mg
MODERATE alternative= MEMANTINE 5mg
SEVERE drug of choice = MEMANTINE 5mg

Question 6

GCA dose (look up Corticosteroids, inflammatory disorders)

Answer 6

Relapse is common if therapy is stopped prematurely. Many patients require treatment for at least 2 years and in some patients it may be necessary to continue long-term low-dose corticosteroid treatment.= 7.5-10mg OD and gradually reduce.

Eyes- rule of thumb at least 60mg prednisolone PO OD

methylprednisolone IS NOT ON BNF. NICE advises prednisolone 60-100mg OD for 3 days but BNF says prednisolone 40-60mg with the specfier 60mg used if visual symptoms occur.

Question 7

Amarosis fugax/TIA medication duration and dose.

Answer 7

Stroke - 300mg OD Aspirin for 14 days
TIA/amarosis fugax- 1 dose of 300mg OD aspirin followed up with 22 days of DAPT at 75mg not 300mg (smaller stroke less high drug needed)

Question 8

Optic neuritis medication and dose

Answer 8

if severe methylprednisolone 1g IV OD 3-5 DAYS
or
Methylpred 500mg PO OD for 5 days

Question 9

Orbital cellulitis dose

Answer 9

coamoxiclav-
PO 500/125 mg QDS (every 8 hours) for 7 days then review
IV 1.2g QDS (every 8 hours)

Alternative in penicillin allergy: clarithromycin with metronidazole.

Question 10

Meningitis medications and dose

Answer 10

If meningococcal disease (meningitis with non-blanching rash or meningococcal septicaemia) is suspected, benzylpenicillin sodium 1.2 g for 1 dose should be given before transfer to hospital, so long as this does not delay the transfer.
Cefotaxime 2 g for 1 dose may be an alternative in penicillin allergy BUT IF IMMEDIATE HYPERSENSITIVITY USE chloramphenicol.

In the hospital, consider adjunctive with dexamethasone (particularly if pneumococcal suspected in adults), starting before or with the first dose of antibacterial, but no later than 12 hours after starting antibacterial FOR ALL BUT LISTERIA AND MENINGOCOCCAL MENINGITIS.

In the hospital, if aetiology unknown:

Adult and child 3 months–59 years, cefotaxime (or ceftriaxone)

Adult aged 60 years and over cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin)

+ add vancomycin if prolonged or multiple use of other antibacterials in the last 3 months, if travelled in the last 3 months, to areas outside the UK with highly penicillin- and cephalosporin-resistant pneumococci.
Duration of treatment is at least 10 days.

Meningitis caused by Listeria
Amoxicillin 2 g every 4 hours IV (or ampicillin) + gentamicin
Duration of treatment is 21 days.
Consider stopping gentamicin after 7 days.

If history of immediate hypersensitivity reaction to penicillin, co-trimoxazole. Duration of treatment 21 days.

Question 11

Encephalitis medications and dose

Answer 11

note there is no encephalitis BNF page.

ACICLOVIR IV 10 mg/kg every 8 hours for at least 14 days (at least 21 days if also immunocompromised)—confirm cerebrospinal fluid negative for herpes simplex virus before stopping treatment.

Question 12

Status epilepticus medication and doses

Answer 12

midaz
loraz 4mg x2

Question 13

Trigeminal neuralgia medication and doses

Answer 13

note there is no BNF page for this. NICE says

carbamezapine 100 mg OD/BD Max 1.6g
Prescribing by brand is only needed for epilepsy.

Question 14

Conjunctivitis medication and dose

Answer 14

chloramphenicol drops

Most cases of acute bacterial conjunctivitis are self-limiting and resolve within 5–7 days without treatment

Question 15

Sinusitis medication and dose

Answer 15

BNF - nose for rhinitis and nose infections, antibacterial therapy for sinusitis

sinusitis typically refers to the acute infective problem
Rhinitis usually refers to the allergic or non-allergic (polyp) problem.

sinusitis is usually viral
If >10 days or has symptoms of bacterial (purulent discharge, high neutrophils), is systemically unwell, immunocompromised, coinciding pneumonia then backup prescription to be taken if they worsen at any time or symptoms do not improve within 7 days- of phenoxymethypenicillin 500mg QDS for 5 days.

rhinitis
1. topical nasal corticosteroids OR oral antihistamines. MOMETASONE 100 micrograms OD.
2. topical antihistamines (good for breakthrough but not as effective as topical nasal steroids)
3. oral steroids if severe
3. Nasal ipratropium bromide may be added to allergic rhinitis treatment when watery rhinorrhoea persists despite treatment with topical nasal corticosteroids and antihistamines; it does not affect other nasal symptoms.

nasal polyps: steroids
seasonal rhinitis can be treated 2 weekly prophylactically.

Question 16

Epistaxis medication and dose

Answer 16

Naseptin® QDS 10 days (chlorhexidine and neomycin (aminoglycoside-gram negative))
Mupirocin nasal oitment BD-TDS 5-7 days.

note- vancomycin is not classified as an aminoglycoside. Instead, vancomycin is a glycopeptide antibiotic used to treat Gram-positive infections, while aminoglycosides are usually used to treat Gram-negative infections.

The commonest cause of nasal vestibulitis is staph aureus infections (gram +)- hence, theoretically vancomycin would be a better choice than aminoglycosides (which do gram negative more than positive- neomycin is an aminoglycoside) but is efective for both gram positive and negative and is easily administered hence why it is chosen.

Question 17

Oral thrush medication and dose

Answer 17

1. Miconazole (24 mg/mL) oral gel 2.5 mL QDS 14 days. gel should not be swallowed immediately but kept in the mouth as long as possible. Dental prostheses should be removed at night and brushed with the gel.
2. Nystatin suspension oromucosal administration 1mL 100,000 units QDS 7 days or 48hr after lesions have resolved.

Question 18

Acute asthma attack medication and dose

Answer 18

Moderate - treat at home. salbutamol in a pressurised metered-dose inhaler and spacer

Severe or life threatening- treat in hospital. salbutamol 5mg no max via an oxygen driven nebuliser –> continuous if poor response. Nebulised ipratropium bromide 500 micrograms every 4-6hr (max 2mg) combined with nebulised salbutamol.

Prednisolone 40-50mg PO OD 5 days.
Continue inhaled corticosteroid.
If PO cant be taken given hydrocortisone.

Magnesium sulfate by intravenous infusion or aminophylline should only be used after consultation with senior medical staff. IV aminophylline is not likely to produce any additional bronchodilation unless life threatening asthma.

OXYGEN IF <94%

Question 19

Acute COPD exaccerbation medication and dose

Answer 19

BNF under respiratory infections antibacterial therapy

Non infective= prednisolone 30mg OD 5 days
Infective= PO Amoxicillin, clarithromycin, or doxycycline 5 days. If severely unwell IV amoxicillin, clarithromycin, co-amoxiclav, co-trimoxazole or tazocin.

For patients with persistent hypercapnic ventilatory failure, use non-invasive ventilation (NIV) if patients experience exacerbations despite the optimisation of medical treatment.

Question 20

CAP medication and dose

Answer 20

Low-moderate severity = Amoxicillin 500mg TDS 5 days. Increased to 1g TDS.

If atypical pathogens suspected: amoxicillin with clarithromycin or erythromycin (in pregnancy).

High severity= Co-amoxclav WITH clarithromycin OR oral erthromycin (in pregnancy).

Question 21

HAP medication and dose

Answer 21

non-severe = PO co-amox 500/125mg TDS 5 days then review.

severe or high resistance risk = IV
tazocin, ceftazidime, ceftriaxone, cefuroxime, or meropenem.

Question 22

Bronchitis medication and dose

Answer 22

doxy 200mg on first day then 100mg OD 4 days (5 day total course) https://www.nice.org.uk/guidance/ng120/resources/visual-summary-pdf-6664861405

Question 23

Otitis externa medication and dose

Answer 23

ciprofloxacin and steroids?

Question 24

Otitis media medication and dose

Answer 24

PO amoxicillin 500 mg TDS for 5–7 days. (BNF ONLY HAS CHILDREN’S DOSE) or if allergic clarithromycin or erythromycin if pregnant.

worsening symptoms despite 2-3 days of antibacterials = PO co-amoxiclav

Question 25

PE medication and dose

Answer 25

Thrombolytic treatment may be appropriate for selected patients with a symptomatic iliofemoral DVT or a PE with haemodynamic instability (massive PE (characterised by big PE with right heart strain (RBBB, raised troponin, increased right pressure) + haemodynamic instability).

Pharmacological treatment options for confirmed PE include:
Fondaparinux
LMWH
LMWH followed by an oral anticoagulant (dabigatran or edoxaban).
Oral anticoagulant treatment (warfarin, apixaban, or rivaroxaban).
UFH

DOACs (Apixaban, Rivaroxaban, Edoxaban, Dabigatran): First-line for most patients.

LMWH or Fondaparinux: Preferred in pregnancy, CAT (cancer-associated thrombosis- DOACS can be used but LMWH is still commonly used for its established efficacy), or severe renal impairment <15 eGFR.

Warfarin: Used in special cases like mechanical valves.

NOTE THERE IS NO ONE TREATMENT CHOICE FOR PE, BUT FOR DVT THERE IS. People with confirmed proximal DVT should be offered apixaban or rivaroxaban first line, and if these are not suitable: Low molecular weight heparin (LMWH) for at least 5 days followed by dabigatran or edoxaban, or. LMWH concurrently with a vitamin K antagonists for at least 5 days.

Question 26

STEMI medication and dose

Answer 26

> 11.0 mmol/litre glucose should receive insulin

PCI with radial access (UFH) or femoral access (bivalirudin)
Fibrinolysis (+fonduparinex)

Aspirin and prasugrel PRIOR TO PCI

Whereas DAPT AFTER FIBRINOLYSIS (almost akin to stroke, where aspirin is given 24hr after thrombolysis once a repeat CT is done to exclude haemorrhage) except this time it is immediately after fibronylsos not 24hr later.

Question 27

NSTEMI medication and dose

Answer 27

> 11.0 mmol/litre glucose should receive insulin

NO FIBRINOLYSIS - Fibrinolytic therapy (e.g., with alteplase, tenecteplase) carries a significant risk of major bleeding, including intracranial hemorrhage. Since the artery is only partially blocked in NSTEMI, using fibrinolytics poses an unnecessary bleeding risk without offering substantial benefit in opening the vessel.

In NSTEMI, the goal is more focused on stabilizing the plaque and preventing further clot formation, which is better achieved with antiplatelet and anticoagulant therapies (fonduparinex) rather than fibrinolysis.

PCI if unstable immediately
PCI within 72hr if grace >3%
if not then fonduparinex + DAPT.

Question 28

Angina medication and dose

Answer 28

GTN sublingual spray - 400 microgram per 1 dose

1st BB- atenolol 100mg OD or 50mg BD, bisoprolol 5mg OD, metoprolol or propranolol

2nd rate-limiting CCB= verapamil or diltiazem
can have long-acting nitrate with GTN

Statin- atorvastatin 20mg OD

Aspirin- 75mg OD

Question 29

HTN medication and dose ≥55

Answer 29

stage 1 (clinic 140/90) only treat under 80s if CVD established, diabetes, end organ damage, renal disease, or an estimated 10-year risk of CVD of ≥10%. If none present consider life style, re-review in 3-6 months and if no change –> anti-hypertensives. Consider treating if >80 years old if BP is 150/90.

stage 2 (clinic 160/100) HTN always treat

severe HTN (180mmHg or diastolic 120mmHg SAME DAY SPECIALIST REFERRAL)

Any HTN with eye, wee, heart microvascular effects or new confusion need immediate referral.

1st CCB - amlodipine 5mg OD
Thiazide-like diuretic or ACEI/ARB
Thiazide-like diuretic or ACEI/ARB
Spironalactone OR alpha or beta blocker (4.5 K+)

Question 30

HTN medication and dose <55

Answer 30

stage 1 (clinic 140/90) only treat under 80s if CVD established, diabetes, end organ damage, renal disease, or an estimated 10-year risk of CVD of ≥10%. If none present consider life style, re-review in 3-6 months and if no change –> anti-hypertensives.
stage 2 (clinic 160/100) HTN always treat
severe HTN (180mmHg or diastolic 120mmHg SAME DAY SPECIALIST REFERRAL)
Any HTN with eye, wee, heart microvascular effects or new confusion need immediate referral.

ACEI or ARB
Thiazide-like diuretic or CCB
Thiazide-like diuretic or CCB
Spironolactone or alpha or beta blocker (4.5 K+)

Question 31

Acute heart failure medication and dose

Answer 31

So first ask yourself what is acute heart failure? It isn’t really a diagnosis you can treat. You are treating the consequences of it i.e., pulmonary oedema, peripheral oedema, increased after-load leading to AKI

So in most cases the treatment for this is furosemide.
Furosemide IV- works within 30 minutes maximal effect and diuresis is complete within 6 hours so that, if necessary, they can be given twice in one day without interfering with sleep.

Diuresis is dose related.
Note eGFR must be greater than 30mL.

Stop beta-blockers (cause you are often combating hypotension and bradycardia)

Question 32

Chronic heart failure first line medication and dose

Answer 32

reduced ejection fracture you worry more. therefore you have drugs that reduce mortality
- ACEI (1st)= perindopril, ramipril, captopril, enalapril, lisinopril
- BB (1st)= bisoprolol, carvedilol, or nebivolol
- MRAs (spiro or eplerenone)

Persistent symptoms of heart failure, especially breathlessness without signs of significant fluid retention, are more likely to indicate the need for an MRA rather than an increase in diuretics. Whereas symptomatic acute relief of breathlessness and oedema are an indication to use furosemide.

Question 33

H pylori medication and dose

Answer 33

Oral first line for 7 days:
A PPI BD- esomeprazole 20mg BD
+ amoxicillin 1g PO, and either clarithromycin 500mg BD or metronidazole 400mg BD

Question 34

Gastric ulcer medicaiton and dose

Answer 34

In patients who have tested positive for H. pylori and have no history of NSAID use, Helicobacter pylori infection should be eradicated.

If the ulcer is associated with NSAID use, a proton pump inhibitor or histamine2-receptor antagonist (H2-receptor antagonist) should be used for 8 weeks, followed by Helicobacter pylori infection eradication treatment if the patient has tested positive for H. pylori.

Full dose therapy (standard dose)

Question 35

GORD medication and dose

Answer 35

‘Proven GORD’ refers to endoscopically-determined reflux disease, which may be due to:
Oesophagitis, when oesophageal inflammation and mucosal erosions are seen.
Endoscopy-negative reflux disease (or non-erosive reflux disease), when a person has symptoms of GORD but endoscopy is normal.

–> Offering a full-dose PPI for 4 weeks for proven GORD, to aid healing.

–> Offering a full-dose PPI for 8 weeks for proven severe oesophagitis, to aid healing.

Offer one of the following strategies to manage uninvestigated dyspepsia symptoms, depending on clinical judgement:

–> Prescribe a full-dose PPI for 4 weeks or

–> Test for Helicobacter pylori infection if the person’s status is not known or uncertain.

If symptoms persist or recur following initial management:
–> Switch to the alternative strategy (for example, offer a full-dose PPI for 4 weeks if the person has been tested for H. pylori infection, and vice versa).

Question 36

Constipation medication and dose

Answer 36

Constipation vs IBS

Constipation
Fruits high in fibre and sorbitol, and fruit juices high in sorbitol (berries), can help prevent and treat constipation.
–> small hard stools- bulk-forming laxatives (as long as adequate intake)

Short-duration constipation
In the management of short-duration constipation (where dietary measures are ineffective) treatment should be started with a bulk-forming laxative, ensuring adequate fluid intake. If stools remain hard, add or switch to an osmotic laxative. If stools are soft but difficult to pass or the person complains of inadequate emptying, a stimulant laxative should be added.

Faecal impaction
The treatment of faecal impaction depends on the stool consistency. In patients with hard stools, a high dose of an oral macrogol (such as macrogol 3350 with potassium chloride, sodium bicarbonate and sodium chloride) may be considered. In those with soft stools, or with hard stools after a few days treatment with a macrogol, an oral stimulant laxative should be started or added to the previous treatment. If the response to oral laxatives is inadequate, for soft stools consider rectal administration of bisacodyl, and for hard stools rectal administration of glycerol alone, or glycerol plus bisacodyl. Alternatively, an enema of docusate sodium or sodium citrate may be tried.

Chronic constipation
In the management of chronic constipation, treatment should be started with a bulk-forming laxative, whilst ensuring good hydration. If stools remain hard, add or change to an osmotic laxative such as a macrogol. Lactulose is an alternative if macrogols are not effective, or not tolerated. If the response is inadequate, a stimulant laxative can be added. The dose of laxative should be adjusted gradually to produce one or two soft, formed stools per day.

If at least two laxatives (from different classes) have been tried at the highest tolerated recommended doses for at least 6 months, the use of prucalopride (in women only) should be considered. If treatment with prucalopride is not effective after 4 weeks, the patient should be re-examined and the benefit of continuing treatment reconsidered.

A laxative (excluding lactulose as it may cause bloating) can be used to treat constipation. Patients who have not responded to laxatives from the different classes and who have had constipation for at least 12 months, can be treated with linaclotide. Loperamide hydrochloride is the first-line choice of anti-motility drug for relief of diarrhoea. Patients with IBS should be advised how on to adjust their dose of laxative or anti-motility drug according to stool consistency, with the aim of achieving a soft, well-formed stool.

Question 37

Diarrhoea non infectious medication and dose

Answer 37

Acute diarrhoea is that which lasts less than 14 days, but symptoms usually improve within 2–4 days.

ORS mainstay to prevent acute diarrhoea. - disodium hydrogen citrate with glucose, potassium chloride and sodium chloride; potassium chloride with sodium chloride; potassium chloride with rice powder, sodium chloride and sodium citrate.
if cant drink- IV fluids in hospital.

loperamide (initially 4mg then 2mg for UP TO 5 DAYS, max dose 16mg) is the standard treatment when rapid control of symptoms is required i.e., for mild-to-moderate travellers’ diarrhoea where toilet amenities are limited or unavailable BUT should be avoided in bloody or suspected inflammatory diarrhoea (febrile patients) AND in cases of significant abdominal PAIN (which also suggests inflammatory diarrhoea).

Ciprofloxacin - occasionally used for prophylaxis against travellers’ diarrhoea, but routine use is not recommended.

Question 38

Stomach cramps medication and dose

Answer 38

Antispasmodics can be divided into two main classifications:
1) antimuscarinics and
2) smooth muscle relaxants.

Antimuscarinics (anticholinergics) work by reducing intestinal motility and addressing smooth muscle spasm.

Tertiary amines (like atropine sulfate and dicycloverine hydrochloride 10mg TDS) are better absorbed but have more potential for CNS side effects.

Quaternary ammonium compounds (like hyoscine butylbromide 20mg QDS and propantheline bromide) are less absorbed and have fewer CNS side effects but may also have less systemic effect.

Dicycloverine hydrochloride has less antimuscarinic action systemically than atropine and also has direct smooth muscle relaxing effects, so it may provide a balance between effectiveness and fewer CNS side effects.

Hyoscine butylbromide is a popular choice for gastrointestinal spasm despite its poor absorption because it has minimal CNS side effects and works locally within the GI tract.

Smooth muscle relaxants (like alverine citrate 60mg TDS, mebeverine hydrochloride 200mg BD, and peppermint oil) act directly on the smooth muscle and may be helpful in Irritable Bowel Syndrome (IBS) to relieve pain or spasm.

Question 39

Diverticulitis medication and dose

Answer 39

Diverticulosis:
- bulk-forming laxatives
- paracetamol
- antispasmodics
- No NSAIDs or OPIOIDS- increase perforation risk

Diverticulitis:
Uncomplicated and complicated
Complicated include abscess, perforation or peritonitis, fistula, intestinal obstruction, haemorrhage or sepsis.

Suspected or confirmed uncomplicated acute diverticulitis
Oral first line: Co-amoxiclav

Suspected or confirmed complicated acute diverticulitis
Intravenous first line: Co-amoxiclav, or cefuroxime with metronidazole, or AGM= amoxicillin with gentamicin and metronidazole.

Question 40

Acute crohns flare medicaiton and dose

Answer 40

A corticosteroid (prednisolone 20-40MG or methylprednisolone or IV hydrocortisone 100–500 mg QDS) in patients with a first presentation or a single inflammatory exacerbation in a 12-month period.

Add-on treatment if there are two or more inflammatory exacerbations in 12 months or the corticosteroid dose cannot be reduced.

Azathioprine or mercaptopurine can be added to a corticosteroid or budesonide to induce remission.

In patients who cannot tolerate azathioprine or mercaptopurine or in whom thiopurine methyltransferase (TPMT) activity is deficient, methotrexate can be added to a corticosteroid.

Under specialist care, certain tumour necrosis factor alpha inhibitors may be used for the treatment of severe, active Crohn’s disease, and for moderate to severely active disease, other biologics (such as certain anti-lymphocyte monoclonal antibodies or interleukin inhibitors), or certain Janus kinase inhibitors may be used.

Loperamide hydrochloride or codeine phosphate can be used to manage diarrhoea associated with Crohn’s disease in those who DO NOT have colitis (REMEMBER THESE DRUGS CANNOT BE USED IN INFLAMMATION OR INFECTION). Colestyramine is licensed for the relief of diarrhoea associated with Crohn’s disease

Question 41

Acute UC medication and dose

Answer 41

Mild-moderate = enemas or suppositories topical aminosalicylates - It is recommended that mesalazine is prescribed by brand (with oral if extensive or if first-line therapy has failed. And then with oral steroids if that fails)

Moderate-severe- biologics

Severe- IV corticosteroids (methyl or hydrocortisone) due to life-threatening nature. If no improvement in 72hr ciclosporin or surgery.

In patients who experience an initial response to steroids followed by deterioration, stool cultures should be taken to exclude the presence of pathogens; cytomegalovirus activation should be considered.

Question 42

Chronic crohns medication and dose

Question 43

Chronic UC medication and dose

Question 44

viral Hepatitis medication and dose

Answer 44

Treatment for viral hepatitis should be initiated by a specialist. The management of uncomplicated acute viral hepatitis usually involves symptomatic supportive care. Early treatment of acute hepatitis C may reduce the risk of chronic infection and progression of liver disease. Hepatitis B and hepatitis C viruses are major causes of chronic hepatitis.

Active or passive immunisation against hepatitis A and B infections is available.

https://bnf.nice.org.uk/treatment-summaries/hepatitis/

Question 45

Alcoholic hepatitis medication and dose

Answer 45

under alcohol dependence - https://bnf.nice.org.uk/treatment-summaries/alcohol-dependence/

discriminant function of 32 or more can be given corticosteroids but only after any active infection or gastro-intestinal bleeding is treated, any renal impairment is controlled, and following discussion of the potential benefits and risks of treatment.

Corticosteroid treatment has been shown to improve survival in the short term (1 month) but not over a longer term (3 months to 1 year). It has also been shown to increase the risk of serious infections within the first 3 months of starting treatment.

Question 46

delirium tremens treatment

Answer 46

Tremers and delirium (agitation, confusion, paranoia, and visual and auditory hallucinations) in an alcoholic

oral lorazepam is first line and if declined parentral lorazepam or haloperidol (unlicensed) https://bnf.nice.org.uk/treatment-summaries/alcohol-dependence/

Question 47

Acute decompensated cirrhosis medication and dose

Answer 47

BNF DOESN’T HAVE A PAGE.
So treatment here is kind of similar approach to acute heart failure. You are not treating that, that is just a overarching name for an illness in these patients (which u need to diagnose and sort) that has tipped them over the edge. The illnesses are either
HE
jaundice
variceal bleeding
ascites
hepatorenal syndrome

So the cause of decompensating for liver disease is usually either

GI bleed
constipation
drug toxicity
alcohol
infections

treatment depends on the way they have decompensated…

HE- lactulose 25 mL every 12 h until at least two soft bowel motions are produced per day… don’t restrict protein intake.
jaundice- treat the cause of illness to enable liver to function and metabolise bilirubin again.
variceal bleeding- cipro prophylactically, specailist terlipressin, endoscopy, propanolol afterwards
ascites- tap, prophylactic cipro or ceftriaxone treatment SBP, and drain and albumin units.
hepatorenal syndrome- terlipressin and albumin or transplant.

Question 48

Biliary colic medication and dose

Answer 48

gallstones- https://bnf.nice.org.uk/treatment-summaries/gallstones/

PO or topical (rectal) paracetamol, NSAID for mild-to-moderate pain

IM diclofenac 75 mg OD MAX 2 DAYS for severe pain or, if not suitable, an IM opioid (such as morphine or pethidine hydrochloride- 25–100 mg)- This may be used alone or in combination with diclofenac if appropriate.

Question 49

Ascending cholnangitis medication adn dose

Answer 49

BNF doesn’t say but as ascending cholangitis is sepsis you give sepsis antibitoics.

HOWEVER FOR UNCOMPLICATED BILIARY INFECTIONS https://bnf.nice.org.uk/treatment-summaries/gastro-intestinal-system-infections-antibacterial-therapy/ …..
1. Biliary tract infection recommends
–> Ciprofloxacin or gentamicin or a cephalosporin

Question 50

Renal colic medication and dose

Answer 50

https://bnf.nice.org.uk/treatment-summaries/renal-and-ureteric-stones/

NSAIDS maybe diclofenac 75mg OD ?

If NSAIDs are contraindicated or not sufficiently controlling the pain, consider intravenous paracetamol.

alpha-adrenoceptor blockers for patients with distal ureteric stones less than 10mm in diameter

potassium citrate [unlicensed] in patients with recurrent stones composed of at least 50% calcium oxalate.

Thiazides [unlicensed] may be given if patients also have hypercalciuria after restricting their sodium intake to no more than 6g a day.

Question 51

Pyelonephritis medication and dose

Answer 51

Oral first line:
–> Cefalexin, or ciprofloxacin. If sensitivity known: co-amoxiclav, or trimethoprim.

IV first line (if severely unwell or unable to take oral treatment).
–> Amikacin, ceftriaxone, cefuroxime, ciprofloxacin, or gentamicin. Co-amoxiclav may be used if given in combination or sensitivity known.

Question 52

UTI medication and dose female male and pregnant and catheter

Answer 52

Female - back-up prescription to be used after 48hr if no improvement.
Trimethoprim 200 mg BD 3 days or Nitrofurantoin 100 mg BD 3 days

Pregnant- Immediate prescription
Nitrofurantoin 100 mg BD 7 days except from 37 weeks onwards, in which case use amoxicillin 500mg TDS 7 days.
Asymptomatic bacteriuria:
Amoxicillin, cefalexin, or nitrofurantoin.

Male 7 days- immediate prescription
Trimethoprim 200mg BD 7 days
Nitrofurantoin 100 mg BD 7 days

Catheter- immediate prescription and removing/changing catheter if it has been in place for > 7 days.
Oral first line (if no upper UTI symptoms):
Amoxicillin (only if culture susceptible), nitrofurantoin, or trimethoprim (if low risk of resistance).
Oral first line (upper UTI symptoms):
Cefalexin, ciprofloxacin, co-amoxiclav (if culture susceptible), or trimethoprim (if culture susceptible).

Reassess patients if symptoms worsen at any time, or do not start to improve within 48 hours of starting treatment.

Culture- all pregnant, all men, catheter? only women if >65 or haematuria

Question 53

ectopic pregnancy medication and dose

Answer 53

bnf obstetrics: https://bnf.nice.org.uk/treatment-summaries/obstetrics/

1. watchful waiting
2. medical - methotrexate
3. surgical - salpingectomy or -otomy

Question 54

Miscarriage management

Answer 54

bnf obstetrics: https://bnf.nice.org.uk/treatment-summaries/obstetrics/

https://www.nice.org.uk/guidance/ng126/chapter/Recommendations#management-of-miscarriage

Threatened - expectant for 7-14 days. If this is 2nd pregnancy you may consider cervical clerage or progesterone pessaries from 16 weeks onwards.

Missed- same as miscarriage
200 mg oral mifepristone and
48 hours later, 800 micrograms misoprostol (vaginal, oral or sublingual) unless the gestational sac has already been passed.

Incomplete - a single dose of misoprostol 600 micrograms (vaginal, oral or sublingual). Do not offer mifepristone as a treatment for incomplete miscarriage. [2012, amended 2023]

FOR REASONING WHY SEE BELOW*
Mechanisms of Action:
Misoprostol: This is a prostaglandin analogue that induces uterine contractions by softening and dilating the cervix, which leads to the expulsion of the pregnancy tissue. It is used for both medical abortions and miscarriages by stimulating uterine contractions to evacuate the uterine contents.

Mifepristone: This is an anti-progestin that blocks the hormone progesterone, which is essential for maintaining pregnancy. It works by softening the cervix and priming the uterus to respond to misoprostol. Mifepristone also destabilizes the uterine lining, making it more susceptible to the action of misoprostol.

Mifepristone is not needed in cases of incomplete miscarriage as the pregnancy is no longer viable and the goal is simply to evacuate the uterus. In missed miscarriage there is suggestion that the foetus is still attached somewhat and of course it is still attached and alive in abortion so is needed before misoprostol.

Question 55

abortion medication and dose

Answer 55

bnf obstetrics: https://bnf.nice.org.uk/treatment-summaries/obstetrics/

https://www.nice.org.uk/guidance/ng140/resources/patient-decision-aid-pdf-6906582255 - great decision aid

1. medical abortion up to 24 weeks
   1a. early abortion (9 weeks)
   anti-progesterone mifepristone 200mg PO. Followed by 800 micograms misoprostol (vaginally, PO, sublingually) 24-48 hours later.

1b. later medical abortion. Similar principle but misoprostol is given every 3-4 hours until the pregnancy is expelled.

Surgical from 14 weeks onwards.

before 10 weeks can do it at home.

Question 56

Vomitting medication and dose

Answer 56

WHOLE BODY
1. Granisetron, ondansetron, and palonosetron, (5HT3) post-operative, cytotoxics, or chemical nausea.
Ondansetron (chemo) = 8 mg (5 days max)
Ondansetron (post op) = 4mg IM or IV

2. Antihistamines (e.g. cinnarizine, cyclizine, promethazine hydrochloride, promethazine teoclate) for many underlying conditions including labyrinth disorders.
   Cyclizine 50mg TDS (IM IV PO)

BRAIN
1. Haloperidol and levomepromazine = nausea and vomiting in palliative care.
PO or S/C Haloperidol 0.5–1.5 mg OD every 2hrs (MAX 10mg)

2. Dexamethasone for chemotherapy-induced and raised ICP.

STOMACH
1. Metaclopramide for emesis associated with gastro-intestinal and biliary disease.
PO IV IM 10mg TDS
2. Domperidone doesn’t cross BBB and is less likely to cause central effects.

Question 57

Dysmenorrhea medication adn dose

Answer 57

Painful periods advice NOT ON BNF but you will find it under summaries- analgesics: dysmenorrhea https://bnf.nice.org.uk/treatment-summaries/analgesics/
Managed the same as pain anywhere else in the body unless the patient wants contraception at the same time. This is because there are less side effects giving them only pain relief compared to starting them on a contraceptive (of which COCP is first line)

so 1. NSAIDS or paracetamol
–> Mefenamic acid

2. 3-6 month trial of MONOPHASIC (all pills have the same amount of oestrogen and progestin) COC with 30-35 ethinlyestradiol and norethisterone, norgestimate or levorgestrel.
   Progesterone methods may also be considered. - TO FIND THIS DRUG SEARCH ETHINYLESTRADIOL WITH NORETHISTERONE
   ?prescribe by brand but i don’t think you need to
   https://bnf.nice.org.uk/drugs/ethinylestradiol-with-norethisterone/#directions-for-administration

GO OVER THIS PAGE IT IS REALLY GOOD!

Question 58

what oestrogen do we use in combined pills classically and why?

Answer 58

EE over E
aka Ethinylestradiol over estradiol
synthetic over natural.
EE has an ethinyl group at C17α in its molecule, making it more resistant to metabolism and improving bioavailability when taken orally which makes it have more effect on parts of the body, like the liver and uterus. It also decreases luteinizing hormone to reduce endometrial vascularisation and decreases gonadotrophic hormone to prevent ovulation. E doesnt do this so there is more risk of bleeding disturbance and irregularity.
However, EE can increase the risk of blood clots and other rare adverse effects.

Question 59

menorrhagia medication and dose

Answer 59

https://bnf.nice.org.uk/treatment-summaries/heavy-menstrual-bleeding/ - heavy menstrual bleeding

fibroid <3cm, unknown cause, suspected adenomyosis - Levonogestrel IUS, TXA NSAID 2nd line.

fibroids >3cm or distorted cavity - referral and TXA, NSAID, COCP, IUS first line.

A non-hormonal treatment is recommended in patients actively trying to conceive.

Question 60

Osteoarthritis medication and dose

Answer 60

topical NSAID (particularly for knee involvement) is first-line treatment. If the topical NSAID is ineffective or unsuitable, consider an oral NSAID.

https://bnf.nice.org.uk/treatment-summaries/non-steroidal-anti-inflammatory-drugs/

ibuprofen has topical versions
Apply up to 3 times a day, ibuprofen 5% gel to be administered. 14 day review?max?
1% diclofenic sodium gel - 3-4x day review after 14 days. (volterol?)

LOOK AT HOW THIS IS PRESCRIBED

Question 61

Gout medication and dose, when are signs of toxicity apparent and why max dose for acute management but not prophylaxis?

Answer 61

Acute- colchicine, high dose NSAID or oral corticosteroid (+/- PPI).

if unsuitable IM corticosteroid.
colchicine - 500 micrograms PO BD-QDS - do not repeat course w/i 3 days even if another flare occurs (this is due to toxcitiy risk!) TOTAL DOSE PER COURSE SHOULD NOT EXCEED 6MG, so if you were taking it TDS for 4 days you would reach this.

Preventative- allopurinol (levels from 100-900mg daily in doses of no more than 300mg AFTER food) or febuxostat 2-4 weeks after flare has settled with colchicine prophylaxis 500micrograms BD (for all)- there is no max dose here and that is because it reaches a lower plasma concentration consistently vs high dose used in acute phases (up to 2mg a day) which can lead to toxicity and overdose.

Onset - 6-8hr to reach peak concentration, so toxicity signs make take 6-8hr to come to fruition. if breast feeding wait 6-8hr after dosing.

Colchicine has a narrow therapeutic range and its use is limited by the development of toxicity at higher doses. However, unlike NSAIDs, it does not induce fluid retention; moreover, it can be co-administered with anticoagulants

Question 62

Rheumatoid arthritis short-term medication and dose

Answer 62

Monotherapy with a conventional disease-modifying antirheumatic drug (DMARD) (oral methotrexate, leflunomide, or sulfasalazine) should be given as first-line treatment. Conventional DMARDs have a slow onset of action and can take 2–3 months to take effect.

Consider short-term bridging treatment with a corticosteroid (by oral, intramuscular, or intra-articular administration) when starting treatment with a new conventional DMARD to provide rapid symptomatic control, while waiting for the new DMARD to take effect.

Short-term use of an oral non-steroidal anti-inflammatory drug (NSAID) or a selective cyclo-oxygenase-2 inhibitor should be considered for additional control of pain and stiffness associated with rheumatoid arthritis. Patients should be offered a proton pump inhibitor to minimise associated gastrointestinal adverse effects.

Question 63

Chronic rheumatoid arthritis medication and dose

Answer 63

Conventional DMARD
Then 2 conventional DMARD combination
Then, it is COMBINED WITH ADDITIONAL TNF alpha inhibitors, other biologic DMARDs, or targeted synthetic DMARDs if there is an inadequate response to combination conventionals.

WHY?
When initiating a biological or targeted DMARD, patients often continue with their conventional DMARDs (especially methotrexate) unless contraindicated or poorly tolerated. Methotrexate is often used in combination with biologics to reduce the risk of antibody formation against the biologic drug, which can improve the drug’s efficacy and reduce side effects.

Question 64

Septic arthritis medication and dose and where under the BNF does it come under?

Answer 64

https://bnf.nice.org.uk/treatment-summaries/musculoskeletal-system-infections-antibacterial-therapy/ = musculoskeletal system infections

Flucloxacillin
Suggested duration of treatment 4–6 weeks (longer if infection complicated).

If penicillin-allergic, clindamycin
Suggested duration of treatment 4–6 weeks (longer if infection complicated).

If MRSA use vancomycin or teicoplanin
Suggested duration of treatment 4–6 weeks (longer if infection complicated).

If gonococcal arthritis or Gram-negative infection suspected, cefotaxime (or ceftriaxone 2g IV OD)
Suggested duration of treatment 4–6 weeks (longer if infection complicated; treat gonococcal infection for 2 weeks).

Question 65

Sepsis medication and dose and where to find on BNF

Answer 65

blood infections antibacterial therapy

community acquired- tazocin (piperacillin has pseudomonal cover) 4.5g IV

If MRSA ADD vancomycin or teicoplanin

If anaerobic infection suspected, add metronidazole to ceftriaxone or cefotaxime.

If hospital acquired use beta lactam antibacterial (i.e., tazobactam, clavulanic acid, cilastatin) with antipseudomonal coverage i.e.,
Tazocin
ticarcillin + clavulanic acid
ceftazidime
imipenem with cilastatin
meropenem

if MRSA add vanc or teic
if anaerobic add metro to a broad spec cephalosporin as before

Septicaemia related to vascular catheter
Vancomycin (or teicoplanin)
If Gram-negative sepsis suspected, especially in the immunocompromised, add a broad-spectrum antipseudomonal beta-lactam.
Consider removing vascular catheter, particularly if infection caused by Staphylococcus aureus, pseudomonas, or Candida species.

Question 66

Warfarin reversal medication and dose

Answer 66

inr <5 not bleeding - hold dose 48hr then recheck restart at a dose 1mg lower

inr 5-8 not bleeding - nothing - hold dose 48hr then recheck, restart at a dose 1mg lower when inr <5

inr 5-8 bleeding - iv vit k 1-3mg

inr ≥8 bleeding - iv vit k 1-3mg, repeat if needed after 24hr, restart when inr <5

inr ≥8 not bleeding - oral vit k 1-5mg, repeat if needed after 24hr, restart warfarin when inr <5

major bleeding - PCC, 5mg vit k,

Question 67

Pre-eclampsia medicationS and doseS and where to find this. What is pre-eclampsia.

Answer 67

**So pre-eclampsia is hypertension with multiple organ involvement and damage. Essentially the symptoms you’d see in a non pregnant person with ragingly high BP not just your classic hypertension (which is what SEEM to have in pregnancy). The reason for this is are more susceptible is because they have increased blood volume and stroke volume (hence cardiac output). Since we know that Blood Pressure (BP) = Cardiac Output (CO) x Systemic Vascular Resistance (SVR) and in pregnancy patients are in maximum state of vasodilation there is huge potential for BP to rise. And also the reason their vessels are dilated is because so much blood is diverted to the placenta, so their other organs are only just about surviving in normal pregnancy, therefore when the body does go into a state of vasoconstriction the mothers organs are disproportionally affected. Leading to BRAIN, LIVER and KIDNEY damage.*

risk factor why?= 1 of the following: CKD, DM, autoimmune conditions, HTN, HTN in previous pregnancy. All these conditions blood vessels are already damaged or not delivering as much to the organs as a normal persons. 2 of the following= first pregnancy, >40 years, BMI >35, multiple pregnancies, family history. All these are risk factors not 100%s for the blood vessels not to work as well due to inflammation/fibrosis/genetic predisposition/new change for the body, OR due to more inflammatory markers being produced by the babies*

bnf htn summary https://bnf.nice.org.uk/treatment-summaries/hypertension/#hypertension-in-pregnancy

Treatment =
1. Aspirin 75–150 mg OD prophylactically from 12 weeks

2. Labetalol 100 mg BD –> nifedipine –> methyldopa 250 mg BD/TDS
   If on methyldopa change within 2 days of birth. Breastfeeding enalapril maleate is first line. In females of black African or African-Caribbean family origin consider nifedipine or amlodipine first line.
3. Seizure prophylaxis for severe HTN, pre-eclampsia or expected to deliver within 24hr (high risk period not because you have to deliver within 24hr of giving it, although delivery is the only treatment for eclampsia. Maternal administration of magnesium sulfate for longer than 5–7 days in pregnancy has been associated with hypocalcaemia, hypermagnesaemia, and skeletal side-effects in neonates)= IV magnesium sulfate. 4 g for 1 dose, to be given over 5–15 minutes, followed by (by continuous intravenous infusion) 1 gram/hour for 24 hours.
4. corticosteroids if early birth expected in 7 days and less than 35 weeks?

Question 68

Bone protection medication adn dose

Answer 68

1st= PO Alendronic acid 10mg OD, risedronate sodium or Ibandronic acid (reduce the occurrence of vertebral, non-vertebral and hip fractures).

2nd= IV zoledronic acid 5 mg once yearly as a single dose or s/c denosumab (RANKL inhibitor that also inhibits osteoclasts) zolendronic acid is 2nd line becasue among the bisphosphonates it has a higher incidence of ONJ. denosumab is 2nd line becasue its effects are quickly reversed after discontinuation, which increases the risk of fractures especially multiple vertebral fractures.
Zolendronic acid- 60 mg every 6 months.
strontium, or (raloxifene for women only= SERM- 2nd line because it’s less effective in reducing fractures at non-vertebral sites esp hip and both ralox and strontium have side effects: CVD, VTE and MI. Strontium can also aggravate menopausal symptoms) (teriparatide for men only) are alternative option for women and men who are intolerant of ORAL bisphosphonates.

In postmenopausal women with at least one severe or two moderate low-trauma vertebral fractures, teriparatide (s/c 20 micrograms daily for maximum duration of treatment 24 months) or romosozumab (s/c 210 mg once a month for 12 months, administered as two consecutive 105 mg injections at different injection sites) are recommended over oral bisphosphonates.

Younger postmenopausal women with menopausal symptoms who are at high risk of fractures= HRT or tibolone.

**Teriparatide MOA: parathyroid hormone analogue that stimulates new bone formation by acting on osteoblasts (bone-building cells). It’s typically reserved for severe osteoporosis because it builds new bone, making it highly effective in patients at very high risk of fractures. Again not first line for everyone even though they work because they’re such faff (S/C for 2 years! and not well adhered to) **

**Romosozumab MOA: a sclerostin inhibitor that both increases bone formation and decreases bone resorption used in patients at high risk of fractures, particularly those who’ve already had a fragility fracture and need urgent treatment to prevent more fractures. Again not first line for everyone even though they work because they’re such faff (S/C for 2 years! and not well adhered to) ****

NOTE DOSES ARE DIFFERENT FOR MEN VS WOMEN!

Question 69

Irregular broad rhythm tachycardia medication adn dose

Question 70

regular broad tachycardia medication adn dose

Question 71

regular narrow tachycardia medication and dose

Question 72

irregular narrow tachycardia medication adn dose

Question 73

non shockable rhythm medication and dose

Question 74

shockable rhythmn medication and dose

Question 75

paracemtaol reversal medication and dose

Answer 75

nac 12 or 21hr regime

Question 76

opioid reversal medication and dose

Answer 76

naloxone

Question 77

depression medication and dose

Answer 77

new episode depression: SSRIs
citalopram 20 mg OD (MAX 40MG)
escitalopram 10mg OD (MAX 20MG)
sertraline 50mg OD (MAX 200MG)
fluoxetine 20mg (MAX 60MG)
paroxetine 20mg (MAX 50MG)

Other antidepressant options include serotonin and noradrenaline reuptake inhibitors (SNRIs) such as duloxetine and venlafaxine, or an antidepressant based on the patient’s previous treatment history such as a tricyclic antidepressant (TCA). Note that TCAs are associated with the greatest risk in overdose, although lofepramine has the best safety profile.

Chronic depressive symptoms who havent sought treatment SSRI, SNRI or TCA.

Safety: SSRIs are safer, especially for initial treatment, because they have fewer serious side effects and are safer in overdose.
Side Effects: SNRIs and TCAs often have more intense side effects, like increased blood pressure (SNRIs) or anticholinergic effects (TCAs), making SSRIs a better first option for most patients.
Efficacy in Chronic Depression: SNRIs and TCAs may be more effective when depression is chronic, severe, or resistant to SSRIs, as they target multiple neurotransmitters (serotonin and norepinephrine), which may be more helpful in long-standing or complex cases.

Question 78

bradycardia medication and dose

Question 79

hyperkalaemia medication and dose

Question 80

hypercholestremia

Question 81

T2DM

Question 82

eczema management infected.

Answer 82

non systemic symptoms dont treat with antibiotics just give steroids and emollients

systemic symptoms give oral steroids and emollients

if you decide to treat for non systemic symptoms give fusidic acid- A topical antibiotic that can be used to treat infected eczema. It’s usually applied to a small area of infected eczema (less than 5 cm2) that isn’t responding to other treatments.

Question 83

smoking cessation first line drugs and which is contrainidcated in depression/epilepsy/psychiatric illness . Which is contraindicated in

Answer 83

Varenicline, or a combination of long-acting NRT (transdermal patch) and short-acting NRT (lozenges, gum, sublingual tablets, inhalator, nasal spray and oral spray), are the most effective treatment options and thus the preferred choices. If these options are not appropriate, bupropion hydrochloride or single therapy NRT should be considered instead. Note: varenicline is currently unavailable in the UK—for further guidance, see MHRA alert: Champix (varenicline) 0.5mg and 1mg tablets - Supply Disruption (available at: https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=103160).

TRICK QUESTION KIND OF BOTH
1. vareniciline is CI/caution with neuropsychiatric disorders (depression pscyhosis and sseizures)
2. Bupropion also has increased risk of seizures hence why it is CONTRAINDICATED in Acute alcohol withdrawal; CNS tumour; history of seizures; acute benzodiazepine withdrawal; bipolar disorder (due to causing mania, its like a serotonin drug); eating disorders (appetite reduction); severe hepatic cirrhosis

Question 84

psoriasis management

Answer 84

face and flexors- weak steroid 2 weeks
trunk and limbs- vit d and steroid od, vit d BD, vit d and steroid BD
scalp- steroid potent 4 weeks
Narrowband ultraviolet B (UVB) phototherapy can be offered to patients with plaque or guttate psoriasis in whom topical treatment has failed to achieve control.

Question 85

galactorrhea

Answer 85

cabergoline over bromocriptine

Question 86

DVT treatment

Answer 86

NOTE THERE IS NO ONE TREATMENT CHOICE FOR PE, BUT FOR DVT THERE IS. People with confirmed proximal DVT should be offered apixaban or rivaroxaban first line, and if these are not suitable: Low molecular weight heparin (LMWH) for at least 5 days followed by dabigatran or edoxaban, or. LMWH concurrently with a vitamin K antagonists for at least 5 days.

Question 87

vancomycin and neomycin or gentamicin uses and why.

Answer 87

vancomycin is not classified as an aminoglycoside. Instead, vancomycin is a glycopeptide antibiotic used to treat Gram-positive infections, while aminoglycosides are usually used to treat Gram-negative infections.

vanco - c diff (gram positive),
neomycin - otitis externa (pseudomonas),

Question 88

allergic conjuncitivits

Answer 88

1st rule out red flags for acute situations that need ophthalmology review (Serious conditions such as:
Acute glaucoma.
Episcleritis and scleritis.
Keratitis.
Iritis/uveitis.
Corneal ulcer, abrasion, or foreign body.
Preseptal or preorbital cellulitis.)

then distinguish from dry eye. KEY DIFFERENCE - THERE WILL ALWAYS BE INTENSE ITCHING WITH ALLERGIC CONJUNCITIVITS. DRY EYE WILL NOT BE ITCHY. Why you need to know this is because one of the treatments for allergic conjuncitivitis- anti-histamines cause antimuscarinic side effects includign dry eyes.

NUMBER 1 TREATMENT - NON PHARMACOLOGICAL.
*Wash hair before bed to reduce allergen exposure.
*Avoidance of eye rubbing.
*Apply cold compresses to the eyes (for 5–10 minutes once or twice daily)
*Apply ocular surface lubricants such as saline solution or artificial tears

NUMBER 2 PHARMACOLOGICAL
Preparations that have mast cell stabilizing properties include:
Sodium cromoglicate — licenced for use in allergic conjunctivitis and seasonal keratoconjunctivitis in adults and children, apply eye drops 4 times daily.
Lodoxamide — licenced for use in allergic conjunctivitis in adults and children over 4 years, apply eye drops 4 times daily.

Preparations that have antihistaminergic properties (contraindicated in acute glaucoma as it causes pupil dilation) include:
Antazoline — note: the only available preparation also contains xylometazoline. Licenced for use in seasonal allergic conjunctivitis in adults and children over 12 years, apply twice to three times daily; maximum duration of treatment 7 days.

Question 89

hameorrhaoid treatment

Answer 89

https://bnf.nice.org.uk/treatment-summaries/haemorrhoids/

external - visible painful and cause itching
internal - not visible not painful and cause bleeding

hygeine - Warm sitz baths
drugs - none more effective than the other - don’t actually reduce swelling protrusion or bleeding.. corticosteroids + LA. LA shouldn’t be used for more than 3 days as causes sensitisation of the skin and in rare cases - increased itching. steroids no longer than 7 days - thinning skin, and don’t use if fungal infection, ulcers, etc. as increase risk of infection.

preparation examples -
1. lidocaine hydrochloride,
2. benzyl benzoate with bismuth oxide, bismuth subgallate, hydrocortisone acetate, peru balsam and zinc oxide ,
3. cinchocaine with hydrocortisone,
4. cinchocaine with prednisolone.