Communicating information

Question 1

BP medication before/during pregnancy?

Answer 1

ramipril is teratogenic, particularly in the first trimester

start on labetalol before conception (1st line)

Question 2

if starting someone on tamoxifen for breast CA?

Answer 2

↑ risk endometrial CA
↑ efficacy of warfarin (↑ INR)
hot flushes
↑ VTE risk

Question 3

starting someone on gliclazide?

Answer 3

↑ risk hypos

advise to not miss meals

Question 4

starting on methotrexate?

Answer 4

1-2 weekly monitoring of fbc for neutropenia is required
ONLY ONCE WEEKLY
↑ infection risk
never prescribe with trimethoprim (or Co-trimoxazole)
give folic acid to limit BM toxicity

Question 5

starting on warfarin?

Answer 5

warn risk of bleeding
acute alcohol inhibits enzymes and ↑ warfarin/INR
chronic alcohol induces enzymes and ↓ warfarin/INR
white (0.5 mg), brown (1 mg), blue (3 mg) and pink (5 mg)

Question 6

when starting ACEi?

Answer 6

↑K+ risk
cough
beware D+V (AKI)
renal failure risk
need to monitor U+E for 1-2 weeks

Question 7

starting long term steroids

Answer 7

↑ DM risk
↑ HT risk
↑ OP risk (>3 months, bisphosphonates)
↑ ulcer risk (PPI/ranitidine - H2)
never stop abruptly (Addisonian crisis)

Question 8

starting on an SSRI?

Answer 8

can take <6 weeks for Sx improvement
can feel suicidal/worse initially
hospital if agitation, hallucinations, fever (serotonin syndrome)

citalopram - photosensitivity
citalopram - excess salivation

Question 9

if unwell with T1DM?

Answer 9

↑ blood sugar when ill so ↑ insulin (DKA risk)

BUT if eating less bc ill then reduce insulin (hypo risk)

Question 10

how to take bisphosphonates?

Answer 10

• alendronic acid is a once weekly preparation
• Ca+ salts (adcal) ↓the absorption of bisphosphonates (not be taken at the same time)
• food should be avoided 2 hours after taking alendronic acid (↓ absorption
• THE TABLET NEEDS TO BE SWALLOWED WITH A FULL GLASS OF WATER AND REMAIN UPRIGHT FOR 30 MIN AFTERWARDS (THE TABLET NEEDS TO BE SWALLOWED WITH A FULL GLASS OF WATER AND REMAIN UPRIGHT FOR 30 MIN AFTERWARDS (less gastric S/E)