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.
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.
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.
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.
- 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). 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. Given to everyone with PEFR <50%.
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%
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
> 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.
Do not offer an antibiotic to treat an acute cough unless people are systemically very unwell or at higher risk of complications. Inform the person that:
Acute bronchitis is usually a self-limiting illness and the cough usually lasts about three to four weeks. Antibiotics only shorten cough duration by 1/2 day on average even if bacterial (which most are)
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
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
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.
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
Septic arthritis medication and dose and where under the BNF does it come under?
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 = laba
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.
