Common treatments Flashcards
Migraine treatment
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. REMEMBER IN YOUR MED REVIEW YOU DIDN’T ASK ABOUT REDUCTION IN FREQUENCY. REMEMBER IN THE GIRLS REVIEW, YOU SAID THERE WAS ONLY 2 DRUGS - BUT REALLY THERE IS AMITRIPYTLLINE AND CANDESARTAN SHE COULD HAVE TRIED!
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. CONTRAINDICATED IN HTN AND IN THIS CASE YOU MUST USE ONE OF THE BELOW.
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.
Cluster headache treatment
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.
Tension headache treatment
paracetamol
Stroke treatment - thrombolysis dose. Antiplatelet. Statin. And PPI dose.
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
Alzheimers medication dose
MILD-MODERATE= Donepezil 5mg
MODERATE alternative= MEMANTINE 5mg
SEVERE drug of choice = MEMANTINE 5mg
GCA dose (look up Corticosteroids, inflammatory disorders)
60mg OD 3 DAYS. Can this be managed in GP? Or do you have to advise hospital appointment. If new symptoms - hospital, if known GCA- call rheumatology help line and then GP probably can prescribed 60mg OD.
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.
Amarosis fugax/TIA medication duration and dose.
Stroke - 300mg OD Aspirin for 21 days
TIA/amarosis fugax- 1 dose of 300mg OD aspirin + clopidogrel followed up with 21 days of DAPT at 75mg not 300mg (smaller stroke less high drug needed) then 75mg aspirin after this
Optic neuritis medication and dose
if severe methylprednisolone 1g IV OD 3-5 DAYS
or
Methylpred 500mg PO OD for 5 days
Orbital cellulitis dose
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.
Meningitis medications and dose
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 (i.e., not in GP!) 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.
Encephalitis medications and dose
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.
Status epilepticus medication and doses
midaz
loraz 4mg x2
Trigeminal neuralgia medication and doses
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.
Side locked.
Conjunctivitis medication and dose
chloramphenicol drops
Most cases of acute bacterial conjunctivitis are self-limiting and resolve within 5–7 days without treatment
Sinusitis medication and dose
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.
REMEMBER THOUGH YOU DON’T GIVE STEROIDS TO POST NASAL DRIP/RHINITIS THAT IS ASSOCIATED WITH A COLD AS THIS WILL NATURALLY REGRESS WITH THE COLD.
nasal polyps: steroids
seasonal rhinitis can be treated 2 weekly prophylactically.
Epistaxis medication and dose
SCREEN FOR HNC - Recurrent epistaxis, non healing ulcer, lump, unilateral polyp, supraclavicular or cervical lymphadenopathy, headache, vision change, >3 weeks symptoms. Smoking, alcohol, poor dentition, radiation history.
SCREEN FOR CVST - complication of sinusitis.
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.
Oral thrush medication and dose
- 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. (CANT BE USED IN PREGNANCY) BUT BEFORE YOU PRESCRIBE IT CONSIDER IF THEY’RE ON ANY DRUGS THAT IT WILL INTERACT WITH IE WARFARIN, AND IN THIS INSTANCE USE NYSTATIN!
- Nystatin suspension oromucosal administration 1mL 100,000 units QDS 7 days or 48hr after lesions have resolved.
Acute asthma attack medication and dose
This has changed. ALL WALES GUIDELINES. Reliance on SABA has reduced and patients are being put on ICS-LABA combo.
Moderate - treat at home. salbutamol or ICS-LABA combo (hopefully Symbicort Turbohaler 200/6) up to 12/day MAX. If using MDI use spacer. If dry inhalation obviously not.
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- BNF SAYS “In all cases of acute asthma, patients should be prescribed an adequate dose of oral prednisolone”
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%
NOTE IF NOT GOING TO HOPSITAL ALL PATIENTS NEED A FOLLOW UP IN 48 HOURS
Acute COPD exaccerbation medication and dose
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.
CAP medication and dose
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).
HAP medication and dose
non-severe = PO co-amox 500/125mg TDS 5 days then review.
severe or high resistance risk = IV
tazocin, ceftazidime, ceftriaxone, cefuroxime, or meropenem.
Bronchitis medication and dose
most causes of bronchitis are viral and do not neeed treatment. Only use them if systemically very unwell or at higher risk of complications as acute bronchitis is usually a self-limiting illness and the cough usually lasts about 3-4 weeks. Antibiotics only shorten cough duration by 1/2 day on average even if bacterial.
> 18 years = 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
12-17 years= amoxicillin (preferred in young women who are pregnant): 500 mg three times a day for 5 days.
Offer immediate antibiotic prescription or a back-up antibiotic prescription for a person at higher risk of complications, for example:
1. A pre-existing comorbid condition such as heart, lung, kidney, liver, or neuromuscular disease, immunosuppression, or cystic fibrosis.
Older than 65 years of age with 2 or more of the following, or older than 80 years with 1 or more of the following:
1. Hospital admission in the previous year.
2. diabetes
3. History of congestive heart failure.
4. Current use of oral corticosteroids.
Otitis externa medication and dose
ciprofloxacin and steroids or Gentamicin 0.3% drops (Genticin®)
with steroid.
Tips: warm drops before inserting into ear, lie on unaffected ear for 3-5 minutes. This increases likelihood of it working and reduces dizziness.
Otitis media medication and dose
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
TIP WITH ANY ANTIBITOIC TREATMENT YOU GENERALLY CHANGE IT IF AFTER 48HR IT HAS NOT HAD EFFECT (This incl. for otitis externa, UTI etc) so it is a good idea to book a f.u if not in hospital
PE medication and dose
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.
STEMI medication and dose
> 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.
NSTEMI medication and dose
> 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.
Angina medication and dose
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
HTN medication and dose ≥55
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+)
HTN medication and dose <55
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+)
Acute heart failure medication and dose
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. Following oral administration, the onset of the diuretic effect is about 1 and 1.5 hours 9, and the peak effect is reached within the first 2 hours. The duration of effect following oral administration is about 4-6 hours but may last up to 8 hours.
Diuresis is dose related.
Note eGFR must be greater than 30mL.
Stop beta-blockers (cause you are often combating hypotension and bradycardia)
Chronic heart failure first line medication and dose
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.
H pylori medication and dose
Oral first line for 7 days:
A PPI BD- esomeprazole 20mg BD
+ amoxicillin 1g PO, and either clarithromycin 500mg BD or metronidazole 400mg BD
Gastric ulcer medicaiton and dose
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)
GORD medication and dose
‘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).
Constipation medication and dose
Constipation vs IBS
Short term - bulk forming laxatives as long as adequate fluid intake. If hard- osmotic (or stool softner) i.e., laxido, macrogol, lactulose. If soft but difficult to pass or the person complains of inadequate emptying, a stimulant- sodium picosulphate or bisocodyl.
Faecal impaction- depends on consistency. If hard stools- oral macrogol (such as macrogol 3350 with potassium chloride, sodium bicarbonate and sodium chloride). If soft stools, or with hard stools after a few days treatment with a macrogol, add bisocodyl or sodium picosulphate (stimulant).
Alternatively, an enema of docusate sodium or sodium citrate may be tried.
Chronic- bulk-forming laxative. Again same as short term constipation- hard: softner/osmotic. Soft: stimulant. Lactulose is an alternative if macrogols are not effective, or not tolerated.
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) TRIAL FOR 4 weeks and only continued if effective.
In IBS - a laxative excluding lactulose as it may cause bloating. If no response to 2 classes of laxatives trila linaclotide (reduces visceral sensation). Loperamide hydrochloride for 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.
IN KIDS: <1 years lactulose. >1? year you can start to use laxido. can be used long term. and glycerol suppositories are CKS first line.
Diarrhoea non infectious medication and dose
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.
Stomach cramps medication and dose
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.
Diverticulitis medication and dose
Diverticulosis:
- bulk-forming laxatives
- paracetamol
- antispasmodics - mebeverine, alverine citrate, hyoscine butylbromide.
- 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.
Acute crohns flare medicaiton and dose
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
Acute UC medication and dose
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.
Chronic crohns medication and dose
Chronic UC medication and dose
viral Hepatitis medication and dose
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/
Alcoholic hepatitis medication and dose
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.
delirium tremens treatment
symptoms start at 6-12 hours: tremor, sweating, tachycardia, anxiety (think alcohol wears off if u dont keep driking and hangovers in teh morning like 12 hours later)
peak incidence of seizures at 36 hours
peak incidence of delirium tremens is at 48-72 hours: coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia
Tremers and delirium (agitation, confusion, paranoia, and visual and auditory hallucinations) in an alcoholic. 24-48hr = seizures peak
oral lorazepam is first line and if declined parentral lorazepam or haloperidol (unlicensed) https://bnf.nice.org.uk/treatment-summaries/alcohol-dependence/
Acute decompensated cirrhosis medication and dose
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.
Biliary colic medication and dose
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.
Ascending cholnangitis medication adn dose
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
Renal colic medication and dose
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.
Pyelonephritis medication and dose
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.
UTI medication and dose female male and pregnant and catheter
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, women >65, recurrent UTI, hospitalised recently, recent AB, abnormal urinary system, immunocompromised
Septic arthritis medication and dose and where under the BNF does it come under?
same as osteomyelitis
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).
Warfarin reversal medication and dose
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,
vit k takes 6hr to work. pcc works immediately
Why this? and what is terbutaline?
terbutaline = saba
opioid induced constipation treatment ?
upsi rules. How long until a pill is counted as ‘missed’?Why is this option correct ?
24hr late
what needs to be present to give drug treatment for HTN in those <80 years?
TARGET ORGAN DAMAGE, CVD, KIDNEY, DIABETES or QRISK 10% +
How to find HRT on BNF?
If you type up oestrogen it will come up with conjugated oestrogens with medroxyprogesterone. Using this you then select ‘other drugs in class’ on the ‘navigate to section’ bit.
Once you click here it will come up with a whole list. The 2 most common prescribed ones that you want to look at are
1. Estradiol 1mg (or 2mg) +
norethisterone sequential or continuous
- Estradiol + dydrogesterone
1/10mg (or 2/10mg) sequential
Brand names- elleste duet or evorel.
in sequential treatment progesterone should be given for 10 / 28 days.
remember hrt oestrogen is natural (estradiol), whereas contraceptive oestrogen is synthetic.
shingles treatment?
Oral antiviral treatment should be offered to patients with shingles who are immunocompromised, have non-truncal involvement (e.g. neck, limbs, perineum), or to those with moderate to severe pain or rash. Consider oral antiviral treatment for patients aged over 50 years to reduce the risk of post-herpetic neuralgia. Treatment with the antiviral should be started within 72 hours of the onset of rash. Immunocompromised patients with severe or widespread infection, or severely immunocompromised patients, or patients with shingles in the ophthalmic distribution of the trigeminal nerve, should be admitted to hospital or specialist advice should be sought.
vaginal fungal infection pregnancy tx.
clotrimazole pessary but like uti u have to treat it for longer (7 days as opposed to 1 singular pessary!)
