Communicating Information

Question 1

Ramipril

In pregnancy

Answer 1

• Stop and change to Labetalol (unless asthma)

- Teratogenic in first trimester

Question 2

Tamoxifen

Info to communicate (4)

Answer 2

• increases risk of endometrial cancer
• Tamoxifen increase anticoagulant effects of warfarin
• SE: hot flushes, not determined by time of dose
• Increases risk of VTE so look out for leg swelling, pain or redness and need urgent medical attention

Question 3

Gliclazide

Info to communicate (4)

Answer 3

Associated with hypoglycaemia:

• Do not miss meals
• Never double up missed doses
• Taken in morning with breakfast
• If > 160 mg then divide daily dose but still with meals

Question 4

Metformin

Answer 4

• Increased risk of lactis acidosis

Question 5

Methotrexate

Info to communicate (6)

Answer 5

• Regular WCC (FBC) monitoring required (1-2 weekly)
• ONLY ever taken weekly
• Infection risks are higher
• Folate antagonists (e.g. Trimethoprim) should never be used
• Folic acid limits toxicity to bone marrow
• Teratogenic - men and women use contraception whilst on and 6 months after

Question 6

Warfarin

Info to communicate (4)

Answer 6

• Major adverse effect = bleeding
• Alcohol affects metabolism of warfarin (acute and chronic have opposite impacts). So moderate drinking spread out across the week
• Most conditions aim for INR 2.5 but can be higher (recurrent VTE, mechanical valves)
• Initially weekly blood tests but once stable, they are monthly

Question 7

Ramipril

Info to communicate (5)

Answer 7

• Risk of hyperkalaemia
• Risk of renal failure
• Common SE = cough (release of bradykinin, dose dependent)
• Caution taken in elderly who are unwell (D+V) as increases risk of AKI
• Monitor renal function and potassium following initiation (1-2 weeks after)

Question 8

Prednisolone

Info to communicate (5)

Answer 8

• Long-term therapy increases risk of DM
• Steroids increase risk of osteoporosis,, give bisphosphonates (alendronic acid) in elderly/long courses
• Increased risk of gastric irritation so co-prescribe a PPI or H2 antagonists (ranitidine) in at risk patients
• Do not stop suddenly, risk of Addisonian crisis
• ## Risk of hypertension, monitored regularly

Question 9

Citalopram

Info to communicate (5)

Answer 9

• Can take up to 6 weeks to see improvement
• Photosensitivity
• If suicidal thoughts, seek help immediately
• Serotonin syndrome: agitation, temperatures, hallucinations, attend hospital immediately!
• Can cause dry mouth

Question 10

Insulin
Basal bolus regime
Info to communicate (5)

Answer 10

• Hypoglycaemia should be treated with carb or glucose tablets/infusion
• HbA1c is over 3-month period, should target 48 mmol/mol or less
• When unwell, increase insulin due to hyperglycaemia. However, if reduced oral intake then decrease insulin.
• Poor glycaemia control increases risk of microvascular and macrovascular complications
• Lipodystrophy can be caused by failure to rotate injection sites

Question 11

Bisphosphonates: Alendronic acid

Info to communicate (6)

Answer 11

• Reduce risk of fractures but most odds ratios exceed 0.5
• Given once weekly!
• Calcium salts reduce it’s absorption so do not take on same day
• Food should be avoided 2 hrs after taking as reduces absorption
• Take on an empty stomach with full glass of water and sit upright for 30 minutes
• SE: oesophagitis

Question 12

HRT and breast cancer risk (5)

Contraception

Answer 12

• Risk of breast Ca is higher for combined HRT, particularly continuous
• Risk is lower after stopping but risk persists for 10+ yrs after stopping compared with women who never used HRT
• Vaginal preparations do not increase risk
• No evidence that HRT protects against CVS disease or cognitive decline
• Risk of breast cancer is related to duration of use and not the age of person
• HRT is no an effective contraception
• HRT reduces postmenopausal bone density changes when on Tx