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3a conditions Tx > Drugs > Flashcards

Drugs Flashcards

1
Q

Parkinson’s (4 classes)

A
  1. Levodopa
  2. Ropinerole, Carbergoline, Bromocriptine
    (D agonists)
  3. Selegiline (MOA-B inhibitors)
  4. Entacapone, Tolcapone (COMTi)
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2
Q

Bell’s Palsy (2)

A
  1. Prednisolone within 72hrs
  2. Artificial tears
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3
Q

Trichomonas

A
  1. Oral Metronidazole 5-7 days
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4
Q

Scarlet Fever (2)

A
  1. IV Penicillin
  2. Azythromycin if allergic
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5
Q

Treatment for Syphilis (1)

A
  1. Benzathine Penicillin
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6
Q

TIA and Stroke (3)

A
  1. Aspirin 300mg

2nd Prevention:

  1. Clopidogrel 75mg
  2. Control RFs - statins, DM drugs and HTN drugs
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7
Q

Antiemetic suitable for Parkinson’s Disease (1)

A
  1. Domperidone (histamines worsen it)
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8
Q

Wernicke’s Encephalopathy (1)

A
  1. Pabrinex - Vit B n C
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9
Q

Hyperemesis Gravidarum (2)

A
  1. Oral Cyclizine / Promethazine (Antihistamines)
  2. Ondansteron or Metoclopramide (5HTs)

slight risk of cleft palate in 1st tri

IF SEVERE DEHYDRATION
3. Fluids + Electrolytes + Pabrinex - replace Vit B and C if wernickes

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10
Q

Viral Induced Wheeze (2)

A
  1. SABA
  2. ICS +/- LTRA (Monteleukast)
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11
Q

Post-Partum Thyroiditis (2)

A

Hyper thyroid stage managed with:
1. Propanolol

(not overactive thyroid so not carbimazole, this is purely symptomatic Tx)

Hypothyroid stage:
2. Thyroxine

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12
Q

PPH

A

(After ABCDE, Fluid resus, Mechanical palpation of uterus etc..)

  1. IV Oxytocin
  2. Ergometrine (CI HTN)
  3. Carboprost (CI Asthma)
  4. Misoprostol

Basically you’re trying to get the uterus to contract heavily to occlude/tamponade bleeding

Surgery from there on

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13
Q

Brain Abscess (3)

A
  1. Cefotaxime (IV 3rd Gen Cephalosporin)
    AND
  2. Metronidazole (covers fungal? i think….)
  3. Dexamethasone - Raised ICP Mx
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14
Q

Thread Worm (1)

A
  1. Mebendazole (and hygiene measures, FOR WHOLE HOUSEHOLD)
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15
Q

Whooping Cough (1)

A
  1. Macrolide - Clarithromycin or Azithromycin

14 day course

MUST BE WITHIN 21 DAYS OF Sx ONSET

Admit kids under 6 months, notifiable disease, 48hr school exclusion after ABx, Household PPx

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16
Q

Eclampsia (Seizures)

A
  1. MgSO4 for 24hrs post seizure or delivery
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17
Q

Pre-Eclampsia

A
  1. Labetalol (Nifedipine if Asthmatic)

Delivery of baby is definitive Tx

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18
Q

Adenomyosis (1)

A
  1. GnRH agonists (leuprolide)

Plus a hysterectomy eventually

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19
Q

Atrophic Vaginitis (2)

A
  1. Moisturisers and emollients
  2. Topical Oestrogen Cream
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20
Q

Medical Termination of Ectopic Pregnancy (1)

A
  1. Methotrexate
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21
Q

Endometrial Cancer in frail elderly women

A
  1. Progestogen therapy (basically bc surgery is CI)
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22
Q

Endometrial Hyperplasia (1)

A
  1. High dose progestogens or IUS
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23
Q

Endometriosis (3)

A
  1. NSAIDS +/- Paracetamol
  2. COCP
  3. GnRH analogues - induce pseudo-menopause

Drugs aint super useful tbh but could reduce symptoms

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24
Q

HMB

(3 for if contraception needed, 1 for if not, 1 for rapid stopping of HMB)

A

Requires Contraception:
1. IUS

  1. COCP
  2. Long acting Progestogens

Does NOT require contraception:
4. Mefenamic Acid 500mg or Tranexamic Acid

Rapid termination of HMB
5. Norethisterone

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25
Q

Medical termination/support of a miscarriage(1)

A
  1. Misoprostol
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26
Q

PID (4)

A
  1. Oral Ofloxacin
    AND
  2. IM Ceftriaxone
    AND
  3. Oral Doxycycline
    AND
  4. Oral Metronidazole

Basically, blast it with broad specs

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27
Q

PCOS (6)

A

General:
1. COCP - could help induce regular bleeds

Hirsutism:
COCP benefits this

  1. Eflornithine
  2. Spironolactone under specialists

Infertility:
4. Clomifene - Specialists and is debated

  1. Metformin
  2. Gonadotrophins
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28
Q

PMS (2)

A

Moderate:
1. 3rd gen COCP

Severe
2. SSRIs

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29
Q

Termination of Normal Pregnancy (1)

A

<9 wks:
1. Mifepristone (anti-progesterone) + prostaglandins to stimulate contractions

after which its surgery

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30
Q

Which psych drug class increases risk of gi bleed if taken with NSAIDS (thus requiring PPI co-prescription)

A

SSRIs

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31
Q

Urge Incontinence (2)

A

after bladder retraining,

  1. Antimuscarinics - Oxybutynin, tolterodine or darifenacin
  2. Mirabegron (B3-agonist, avoid if frail)
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32
Q

Only antiemetic suitable for Parkinson’s disease

A
  1. Domperidone (doesn’t cross BBB)

Other anti-histamines like cyclizine or prochlorperazine may worsen PD

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33
Q

Stress Incontinence (1)

A

after pelvic floor exercises:

  1. Duloxetine (SnRI)

*(increase ser and nor conc in pudenal nerve = increased sphincter stimulation - better sphincter)

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34
Q

Fibroids (6)

A

To manage Menorrhagia:

  1. IUS (LNG-IUS) - (only for small ones)
  2. NSAIDS - Mefenamic acid
  3. Tranexamic acid
  4. COCP
  5. Oral Progesterone / injectable

To Shrink Fibroids:
6. GnRH agonists - shrink by inducing pseudo-menopause since fibroids are E2 sensitive

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35
Q

Vaginal Candidiasis (Thrush) (3)

A
  1. Oral Fluconazole
  2. Clotrimazole intravaginal pessary
  3. Topical imidazole for vulvar Sx

oral Tx CI in Pregnancy

FOR RECCURENT:
fluconazole on a weird regimine - dont bother basically

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36
Q

Acute Dystonia (Oculogyric crisis / Torticollis) (1)

A
  1. Procyclidine
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37
Q

Tardive Dyskinesia (1)

A
  1. Tetrabenazine
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38
Q

Side Effects of Typical Antipsychotics (11)

Again, just to have as notes, not necessarily to learn by wrote, but you need to know each individually well as psych questions are pretty pharm specific

A
  1. Parkinsonism
  2. Acute Dystonia
  3. Tardive Dyskinesia
  4. Akathisia
  5. Antimuscarinic: dry mouth etc
  6. Weight gain, sedation
  7. Raised Prolactin
  8. Impaired Glucose metabolism
  9. Reduced Seizure Threshold
  10. Neuroleptic Malignant Syndrome
  11. Haloperidol is a QTc drug
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39
Q

Tardive Dyskinesia (1)

A
  1. Tetrabenazine
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40
Q

Suppression of Lactation (1)

A
  1. Cabergoline

(Dopamine Receptor Agonist and Dopamine inhibits Prolactin release)

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41
Q

Chickenpox EXPOSURE in pregnancy

A

If in doubt over mums immuno status, varicella ABs need checking

if </= to 20wks:
1. VZIG given

if >20 wks:
2. Antivirals - oral acyclovir 7 to 14 days post exposure

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42
Q

Puerperal Pyrexia/Endometritis (2)

A
  1. Clindamycin

AND

  1. Gentamicin
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43
Q

Contracted chickenpox in Pregnancy (1)

A

Seek specialist help

  1. Oral Acyclovir if >20wks within 24hrs of rash

if less than 20 wks, use is cautionary as potential risks to baby

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44
Q

Chorioamnionitis (1)

A

Prompt delviery and:

  1. IV broad spec ABxs
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45
Q

Epilepsy drugs in Pregnancy

A

Benefits of controlling epilepsy > risks to foetus

  1. Folic acid 5mg (which is higher dose) as higher risk of NTDs
  2. Valproate: risk of NTDs
  3. Carbamazepine: least teratogenic of older antiepileptics
  4. Phenytoin: cleft palate and needs vit k in last month to prevent newborn clotting disorders
  5. Lamotrigine: lower risk seemingly
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46
Q

Indications for high dose Folic Acid (5mg vs 400mcg) (3)

A
  1. Partner with NTD or previous NTD baby or strong FHx
  2. Antiepileptic drug use, has DM, Coeliac or Thalassaemia
  3. BMI > 30

*Still take till 12th week

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47
Q

Gestational DM (2)

A

If <7mmol/L at diagnosis then start trial of diet and exercise for 2 weeks, if failed then:

  1. SHORT ACTING Insulin
    then
  2. Metformin if still not controlled

If already >7mmol/L at diagnosis
1. Start the Insulin straight away

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48
Q

Mx of pre-existing DM in pregnancy (3)

A
  1. Stop hypoglycaemic agents except Metformin
  2. Start Insulin (Short acting)
  3. FOlic acid 5mg till wk 12

tight glycaemic control needed

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49
Q

Group B Streptococcus infection - Pregnancy (1 drug, 4 indications)

A
  1. BenPen (BenzylPenecillin)

Intrapartum Antibiotic Prophylaxis (IAP) should be offered to women who:

  • Detected GBS in this pregnancy
  • Previous GBS pregnancy
  • All Preterm labours / PROMs
  • Pyrexia in labour of >38 degrees
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50
Q

Foetus born to Hep B +ve mother (2)

A
  1. Vaccination
  2. Hep B IVIG
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51
Q

Outline SSRI Withdrawal Syndrome (5)

A
  1. GI disturbance - diarrhoea
  2. Headaches/electric shock feelings
  3. Paraesthesia
  4. Sweating
  5. Restlessness and mood changes
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52
Q

HIV in Pregnancy (2)

A
  1. ART for mum throughout regardless of prior usage
  2. Zidovudine infusion 4 hrs pre C-section

Neonate:
2. Zidovudine
1. Triple ART therapy for 4-6 wks
DONT BREASTFEED

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53
Q

Induction of Labour (IoL) (2)

A

surgical membrane sweep +/-

  1. Vaginal Prostaglandin E2
  2. Maternal oxytocin infusion

other methods are surgical and therefore not in these flashcards - check textbook chapter on passmed

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54
Q

Uterine Hyperstimulation (1)

A

If possible remove vaginal prostaglandins and offer tocolysis with:

  1. Terbutaline
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55
Q

Intrahepatic Cholestasis of Pregnancy (2)

A

induce labour at 37-38 wks

  1. Ursodeoxycholic acid
  2. Vit K supplements
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56
Q

Anaemia in pregnancy (1 with 3 thresholds)

A
  1. Ferrous Sulfate

treat if if:
1st trimester - hb < 110
2nd/3rd trimester - hb < 105
Post-partum - hb < 100

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57
Q

Jaundice in Pregnancy (1)

A
  1. Ursodeoxycholic acid for Sx relief
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58
Q

Cord Prolapse (1)

A

Mainly surgical, this card is to remind you that you can use tocolytics to reduce contractions and reduce risk of it prolapsing acutely again

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59
Q

VTE in Pregnancy

A
  1. 4 or more RFs means LMWH PPx

AVOID DOACS

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60
Q

Acute Stress Disorder (1)

A

following Trauma-focused CBT
1. Benzodiazepines

(only prescribe short term for acute agitation and sleep disturbance)

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61
Q

Alcohol Withdrawal (2)

A
  1. Long acting Benzodiazepines - Chlordiazepoxide or Diazepam
  2. Carbamazepine also effective
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62
Q

Key Side-effects of Typical Antipsychotics (10 - less to memorize, more to read through and remind yourself)

A
  1. Parkinsonism - (such that they are CI in Parkinson’s and dimentia)
  2. Acute Dystonia/dystonic reaction - (torticolis, oculogyric crisis)
  3. Akathisia
  4. Tardive Dyskinesia (chewing jaw, choreoid movements)
  5. Increase CVA and VTE risk
  6. Antimuscarinic SEs: dry mouth, blurred vision, urinary retention, constipation
  7. Sedation and weight gain
  8. Neuroleptic Malignant Syndrome: pyrexia, muscle stiffness
  9. Reduced seizure threshold
  10. Impaired glucose tolerance
  11. Raised Prolactin
  12. QT interval lengthening -haloperidol
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63
Q

Key SE of Clozapine (1)

A
  1. Agranulocytosis - dropped white cells and subsequent easy infection and immunosuppression

requires monitoring and is affected by smoking cessation or increase

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64
Q

The atypical antipsychotic with the best SE profile?

A

Aripiprazole

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65
Q

MoA of Benzodiazepines

A

Increase Frequency of chloride channel opening on GABA receptors (opens them more often - Frenzos - Frequency)

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66
Q

Otitis Media (1)

A
  1. Amoxicillin

In practice nothing is given its conservative and self limiting - NNT is like 35 or something and GPs dont give this but this is the medschool answers for SBAs

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67
Q

SEs of MOA-B inhibitors (4)

A
  1. Hypertensive Crisis
  2. Nausea
  3. Insomnia
  4. Dyspnoea
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68
Q

Class of antibiotics safe at any stage of pregnancy (1)

A
  1. Cephalosporins

eg: NOT
Nitrofurantoin (avoid in 3rd tri -haem anaemia and G6PD def)

Sulphonamides (3rd tri - kernicterus)
Tetracyclines (teeth staining and skeletal issues)
Trimethoprim (folate antagonist - NTDs)

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69
Q

Medication used in Sickle Cell to manage complications (2)

A
  1. Prophylactic Penicillin
  2. Hydroxycarbamide - prevent crisis
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70
Q

Med given to reverse DOAC/NOAC anticoagulation (1)

A
  1. Beriplex
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71
Q

Med given to reverse heparin effects (1)

A
  1. Protamine
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72
Q

Paracetamol Overdose (1)

A

N-acetylcysteine (NAC or acetadote) - replenishes glutathione stores

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73
Q

Common SEs of Dopamine Agonists - Ropinirole (3)

A
  1. Disinhibition/Compulsive behaviour
  2. Nausea
  3. Daytime drowsiness
74
Q

Common Levodopa SEs (4)

A
  1. Nausea
  2. Loss of Appetite
  3. Discolouration of Urine
  4. Drug induced parkinsonism and on/off/wearing off effect
75
Q

MoA of Barbiturates

A

Increase Duration (barbiDURATes) of Chloride channels on GABA receptors - hold em open longer

76
Q

Anti-craving medication for alcoholics (1)

A
  1. Acamprosate
77
Q

Alternative to Methadone for Opiate withdrawal regimes

A
  1. Buprenorphine
78
Q

Bipolar Disorder (3)

A

Stabilise with:
1. Lithium - requires monitoring

Treat mania with:
- removing antidepressant then
2. Antipsychotics - Olanzapine or Haloperidol

Treat Depression with
- Talking therapies then
3. Fluoxetine

79
Q

Drug that makes you feel sick on drinking alcohol (to prevent relapse)

A
  1. Disulfiram
80
Q

Depression (1)

A

SSRIs

Sertraline used in history of CVS disease

passmed doesnt deal with this in great detail, on placement ive seen patients on mirtazapine too for its appetite and sleep benefits and i think SnRIs could also be used but yeah, check for yourselves

81
Q

Generalised Anxiety Disorder and Panic Disorders (2)

A
  1. SSRI - Sertraline
    then
  2. SnRI if not working - Duloxetine or Venlafaxine

alongside education, CBT etc..

My GP tutor said anxiety really needs that CBT and that its harder to treat than Depression with drugs

82
Q

Insomnia (1)

A

Drugs only indicated if daytime function significantly impaired and lifestyle / sleep hydeine is being addressed too

  1. Z-Drugs (Hypnotics) - Zopiclone, Zolpidem, Zaleplon

Use as little as possible for as short as possible

83
Q

When do you monitor Lithium dosages?

A

12 hrs post dose then weekly until stable

once stable, every 3 months unless a change is made

TFTs and U/Es checked every 6 months

Lithium toxicity:
- N&V
- Tremor
- Nephrotoxicity - polyuria
- Hypothyroid Sxs
- Weight gain
HYEPRCALCAEMIA - 2nd to hyperparathyroidism

84
Q

OCD (1)

85
Q

PTSD (2)

A
  1. SnRIs - Venlafaxine
  2. SSRIs - Sertraline

CBT and EMDR are the best though

86
Q

Schizophrenia (1)

A
  1. Oral Atypical Antipsychotics

Realistically this is super specialist and very complex, you trial lots of different antiPs and find what works. Passmed doesnt deal with second-line stuff here
oh yeah and + CBT

87
Q

Seasonal Affective Disorder (1)

88
Q

SSRI of choice in paediatrics

A

Fluoxetine

89
Q

What needs co-prescribing with an SSRI and NSAID combo?

A

Proton Pump Inhibitor

90
Q

Which SSRI can characteristically lengthen QTc interval?

A

Citalopram (and escitalopram)

91
Q

3 drugs that may increase risk of serotonin syndrome if prescribed alongside SSRIs (3)

A
  1. Triptans
  2. TCAs - amitriptyline
  3. MOA-Bis
92
Q

How long after resolution of depressive symptoms should SSRIs be continued for?

93
Q

Acute Epiglottitis (1)

A

After intubation and O2
1. IV ABxs

94
Q

Paediatric Exacerbation of Asthma / acute attack (3)

A
  1. b-2-agonist 1 puff every 30-60 secs up to 10 (Salbutamol)
  2. Steroids

Obviously ABCDE and Admission if severe

I also saw on Paeds use of MgSO4 in really really bad exacerbations so:
3. MgSO4

95
Q

Routine Management of Asthma in 5 - 16 y/os

A

Stepwise algorithm

  1. SABA
  2. SABA + low dose ICS
  3. SABA + low dose ICS + LTRA
  4. SABA + low dose ICS + LABA (notice the LRTA is stopped here)
  5. SABA + MART (combo of LABA and ICS i believe)
  6. SABA + moderate dose ICS MART (or separate LABA and moderate ICS dose)
  7. SABA + one of the following:
    - Paeds High dose ICS
    - Theophylline
    - Specialists involvement

Basically, think of the SABA as an emergency reliever, its there to puff on when you get bad. The ICS/LRTA/LABA/MART are all then additions to prevent getting bad in the first place, almost maintenance prophylaxis meds

96
Q

Routine Management of Asthma in <5 y/os

A

Stepwise algorithm

  1. SABA
  2. SABA + 8wk trial of MODERATE dose ICS and reassess symptoms:
    - If no resolution - consider different Dx
    - If recurred within 4wks of no ICS - low dose ICS
    - If recurred outside 4wks of stopping ICS - Repeat trial
  3. SABA + paeds low dose ICS + LTRA
  4. Stop the LTRA and refer to paeds asthma specialist
97
Q

ADHD (3)

A

drug therapy as last resort:
1. Methylphenidate - 6wk trial - monitor weight and height as reduces appetite

  1. Lisdexamfetamine 2nd line
  2. Dexamfetamine if lisdexamfetamine is not tolerated but was useful

all cardiotoxic potentially so do ECG before starting

98
Q

Autism Spectrum Disorder

A

nothing disease altering, but Sx control with

  1. SSRIs - depression
  2. Antipsychotics - Aggression
  3. Methylphenidate: ADHD
99
Q

Cerebral Palsy (4)

A

For Spasticity:
1. Diazepam

  1. Intrathecal Baclofen
  2. Botox
  3. Anticonvulsants and analgesia as required
100
Q

Chickenpox (2)

A
  1. Calamine lotion
  2. VZIG if immunocompromised and exposed peripartum
101
Q

Constipation in Paediatrics (3)

A
  1. Movicol (Polyethylene glycol 3350 + Electrolytes) for impaction
  2. Add Stimulant if not effective in 2wks
  3. Lactulose is an osmotic one and is used as a substitute if movicol isn’t tolerated

In infants:
breastfed - constipation rare so look for causative Dx
Bottle-fed - give extra water between feeds

102
Q

Cows Milk Allergy (2)

A
  1. eHF - Extra hydrolysed Formula is first-line replacement
  2. AAF - Amino Acid Formula if no response to eHF or if severe CMA
103
Q

Croup (3)

A
  1. Single dose oral Dexamethasone (0.15mg/kg) regardless of severity (Prednisolone is alternative )

Emergency:
2. High-flow O2

  1. Nebulised Adrenaline
104
Q

Cyanotic Heart Disease in Newborn (thinking TGA) (1)

A
  1. Prostaglandin E1 - alprostadil

maintains ductus arteriosus for surgery

105
Q

Patent Ductus Arteriosus (2)

A
  1. Indomethacin - an NSAID - closes PDA

if needed to be preserved - eg. TGA
2. Prostaglandin E1 - Alprostadil

(INDOmethacin ENDS the pda, PRostaglandins PRESERVE it)

106
Q

Cystic Fibrosis (3)

A

(Physio, avoiding other CF patients, high calorie diet, MDT approach) PLUS:

  1. Vit K supplements
  2. Pancreatic enzyme supplements
  3. Lumacaftor/Ivacaftor - potentiator or CFTR transporter
107
Q

Eczema in Kids (3)

A
  1. Simple emollients
  2. Topical steroids (low dose, applied 30 mins after emollient)
  3. In severe - maybe ciclosporin
108
Q

Paediatric GORD (2)

A

Lots of prior lifestyle and education interventions, THEN:

  1. Trial GAVISCON
  2. PPI if unexplained feeding difficulties, distressed behaviour or faltering growth
109
Q

Migraines in Children (3)

A
  1. Ibuprofen > Paracetamol
  2. Triptans used in >12 yrs
  3. Propranolol for migraine PPx
110
Q

ITP in children (3)

A

usually no treatment

if severely low platelets:
1. Corticosteroids

  1. IVIGs
  2. Platelet Transfusion
111
Q

Infantile Spasms (West syndrome) (2)

A

poor prognosis

  1. Vigabatrin
  2. ACTH is also used
112
Q

Kawasaki Disease (2)

A
  1. High-dose Aspirin
  2. IVIG

(F/U with echocardiogram for coronary artery aneurysm)

(one of the only paeds indications of aspirin I believe due to normal risk of Reye’s syndrome)

113
Q

Meningitis in children (4)

A
  1. Antibiotics:
  • <3 months - IV Amoxicillin + IV Cefotaxime
  • > 3 months - IV Cefotaxime (or Ceftriaxone)
  1. Steroids:
  • Dexamethasone
  • < 3 months NICE say don’t give
  • > 3 months and lots of WBC in LP +/- purulent CSF etc
  1. Fluids:
    - Treat shock

(Prophylaxis for contacts with 4. Ciprofloxacin)

114
Q

Chlamydia (1) (plus alternative for pregnancy)

A
  1. Doxycycline 7 days BD 100mg

In Pregnancy
2. Azithromycin

115
Q

Bacterial Vaginosis (1)

A
  1. Oral Metronidazole
116
Q

Gonorrhoea (1)

A
  1. IM Ceftriaxone

add sensitivities according to micro - often Ciprofloxacin

117
Q

Trichomonas Vaginalis (1)

A
  1. Oral Metronidazole
118
Q

Neonatal Hypoglycaemia (1)

A

if feeding encourage more

if really low or not feeding:
1. Fluids w/ 10% dextrose

119
Q

Neonatal Sepsis (1)

A

First-line
1. Benzylpenecillin + Gentamicin
(CRP is taken frequently to monitor progression)

then close monitoring and supportive therapy, avoiding hypoglycaemia, electrolyte and fluid imbalance and acidosis

120
Q

Nocturnal Enuresis (1)

A
  1. Desmopressin

(following failure of advice, reward systems, enuresis alarms - in that order)

121
Q

Pneumonia in Children (3)

A
  1. Amoxicillin
  2. Macrolides added if no response
  3. Co-Amoxiclav if influenza is associated
122
Q

PARDS (2)

A
  1. Surfactant via endotracheal tube + assist ventilation
  2. Should have had corticosteroids in-utero to mature lungs
123
Q

Rickets (rare) (1)

A
  1. Oral Vit D
124
Q

Seborrhoeic Dermatitis in Children (2)

A

mild-moderate:
1. Baby Shampoo and oils

Severe:
2. Topical 1% hydrocortisone cream

125
Q

UTIs in children (2)

A

<3 months urgent refer to paeds

> 3 months with upper UTI - admit then:

  1. Cephalosporin (or Co-amoxiclav) 7-10 days

> 3 months with lower UTI - home treatment with:

  1. Oral Trimethoprim

(or nitrofurantoin, cephalosporin or amoxicillin)

126
Q

Acute Confusional State/Delirium (COTE) (2)

A
  1. Haloperidol or
  2. olanzapine

(CI in Parkinson’s)

127
Q

Alzheimer’s

A
  1. Acetylcholinesterase Inhibitors - Donepezil, Galantamine, Rivastigmine
  2. Memantine (NMDA receptor antagonist)

“DONE a PUZZLE by the RIVer containing MANatees”
(donepezil, rivastigmine, memantine)

128
Q

List 7 classes of drug that cause postural hypotension and thus falls in the elderly? (7)

A
  1. Nitrates
  2. Diuretics
  3. Anticholinergic meds
  4. Antidepressants
  5. BBs and AlphaBs
  6. L-Dopa
  7. ACEi and CCBs

(notice many are blood pressure meds, fall prevention is often focussed on DE-prescribing as often elderly are being over medicated)

129
Q

List 7 drug classes associated with falls in the elderly (not through postural hypotension)

A
  1. Benzos
  2. Antipsychotics
  3. Opiates
  4. Anticonvulsants
  5. Codeine
  6. Digoxin
  7. Sedatives

Notice most are Psych/neuro meds

130
Q

Lewy Body Dementia

A
  1. Ach Esterase Inhibitors - Donepezil, Rivastigmine
  2. Memantine

(same as alzheimer’s)

131
Q

Chemotherapy-related nausea (1)

A
  1. 5HT3 Antagonists - Ondansetron, Palonosetron
132
Q

Absence Seizures (3)

A

Firs line:
1. Ethosuximide

2nd Line
2. Male: Sodium Valproate
3. Female: Lamotrigine or Levetiracetam

Carbamazepine may make them worse

133
Q

Focal Seizures (3)

A

1st Line
1. Lamotrigine or Levetiracetam

2nd Line
2. Carbamazepine

134
Q

Myoclonic Seizures (2)

A
  1. Male: Sodium Valproate
  2. Female: Levetiracetam
135
Q

Tonic or Atonic Seizures (2)

A
  1. Males: Sodium Valproate
  2. Females: Lamotrigine
136
Q

Generalised Tonic-Clonic Seizures

A
  1. Males: Sodium Valproate
  2. Females: Lamotrigine or Levetiracetam
137
Q

Status Epilepticus (3)

A

ABCDE + check glucose then:

  1. IV Benzodiazepines - Diazepam (pre-hospital) or lorazepam (hospital)
  2. Phenytoin if ongoing

If no response within 45 minutes
3. General Anaesthesia

138
Q

Encephalitis (1)

A
  1. IV Acyclovir
139
Q

Essential Tremor (2)

A

First-line
1. Propranolol

2nd line
2. Primidone sometimes used

140
Q

Guillain-Barre Syndrome

A

NEVER GIVE STEROIDS

  1. IVIGs if needed
141
Q

Herpes Simplex Encephalitis (1)

A
  1. IV Acyclovir
142
Q

Idiopathic Intracranial Hypertension (2)

A

after weight loss advice

  1. Diuretics - Acetazolamide
  2. Topiramate - helps also with weight loss
143
Q

Lambert-Eaton Syndrome (2)

A

Treat underlying SCC of lung

  1. Immunosuppression - Prednisolone
  2. IVIGs/Plasmapheresis
144
Q

Intracranial Venous Thrombosis (1)

A
  1. Anticoagulation - LMWH
145
Q

Medication Overuse Headache

A

You can abruptly stop Simple analgesia and Triptans

Wean off Opioids gradually

146
Q

Migraine Acute Management (Adults) (2)

A
  1. Triptans + NSAIDs
  2. Metoclopramide - D2 receptor antagonist if above doesn’t work
147
Q

Migraine Prophylaxis (Adults) (4)

A

(2 or more attacks/ month)

Women of childbearing age:
1. Propranolol

Everyone else:
2. Topiramate

Women with predictable menstruation migraines:
3. Frovatriptan/Zolmitriptan as mini prophylaxis

  1. Mefenamic acid can also be used
148
Q

Migraine in Pregnancy

A
  1. Paracetamol
  2. NSAIDs 2nd line in 1st/2nd trimester

AVOID aspirin and opiates

149
Q

Migraine with COCP

A

Migraine with aura is an absolute UKMEC4 contraindication of COCP use

150
Q

Motor Neurone Disease / ALS (1)

151
Q

Multiple Sclerosis Acute Relapse (1)

A
  1. Steroids - IV Methylprednisolone
152
Q

Multiple Sclerosis Disease Modifying Drugs (5)

A

Reducing relapse risk:
1. Natalizumab - Antagonises receptor on leukocytes

  1. Ocrelizumab - anti-CD20 drug
  2. Fingolimod
  3. Beta-Interferon
  4. Glatiramer Acetate - acts as immune decoy
153
Q

Drugs used to manage MS complications (5)

A

Fatigue:
1. Amantadine

Spasticity:
2. Baclofen + Gabapentin

  1. Diazepam

Oscillopsia:
4. Gabapentin

Bladder Dysfunction
5. Anticholinergics

154
Q

Myasthenia Gravis (3)

A

1st line:
1. Pyridostigmine - (Long-acting Ach Esterase Inhibitor)

  1. Prednisolone - Immunosuppression
  2. Azathioprine, cyclosporine etc - immunosuppression

(+thymectomy)

155
Q

Myasthenic Crisis (2)

A
  1. Plasmapheresis
  2. IVIGs
156
Q

Narcolepsy (1)

A
  1. Modafinil - daytime stimulants
157
Q

Neuroleptic Malignant Syndrome (2)

A

Stop the Antipsychotic, admit and IV Fluids then:

  1. Dantrolene - sometimes used
  2. Bromocriptine - (Dopamine agonist) sometimes used
158
Q

Neuropathic Pain (5)

A
  1. Amitriptyline 10mg (neuropathic dose),
  2. Duloxetine,
  3. Gabapentin,

4.Pregabalin

Generally monotherapy

  1. Tramadol for exacerbations
159
Q

Paroxysmal Hemicrania (1)

A
  1. Indomethacin
160
Q

Raised ICP (1)

161
Q

Restless Legs Syndrome (4)

A
  1. Treat Iron deficieny - Ferrous Sulphate
    THEN:

first line:
2. Dopamine Agonists - Ropinirole, Pramipexole

  1. Benzodiazepines
  2. Gabapentin
162
Q

Ischaemic Stroke (2)

A

Depends on type and position but generally

  1. Thrombectomy within 6hrs + thrombolysis (Alteplase) in 4.5 hrs
  2. Aspirin 300mg if Haemorrhagic ruled out
163
Q

Prophylaxis of ischaemic stroke (2)

A
  1. Clopidogrel
  2. Aspirin +/- Dipyridamole if Clop not tolerated
164
Q

Tension Headache (Adults) (2)

A

Acute:
1. Aspirin, Paracetamol or NSAIDs

Prophylaxis:
2. low-dose Amitriptyline

165
Q

Trigeminal Neuralgia (1)

A
  1. Carbamazepine
166
Q

Tardive Dyskinesia (1)

A
  1. Tetrabenazine
167
Q

Impetigo (4)

A

SO, ABxs are NOT always indicated:

IF
A) Limited Localised Disease:
1. Hydrogen Peroxide 1% Cream

B) Lesions near eye or peroxide not suitable
2. TOPICAL Fusidic acid (ABx cream)

C) Extensive Disease or Immunosuppressed
3. Oral Flucloxacillin - fighting the Staph Aureus

(4. Erythromycin/clarithromycin if pen allergic)

+ School exclusion till lesions have dried out

168
Q

Mechanism of Action of Acamprosate (1)

A
  1. GABA2 agonist (and weak NMDA agonist) increasing GABA activity which interferes with the anticipatory phase of drinking (reduces cravings)
169
Q

Mechanism of Action of Disulfiram (1)

A
  1. Causes build-up of Acetaldehyde on consumption of alcohol causing unpleasant flushing, headaches and anxiety
170
Q

Mechanism of Naltrexone (1)

A
  1. Acts as opioid antagonist to reduce the initial pleasure of the “first sip” - anti alcoholism drug
171
Q

Drug used to reduce pleasure of the “first-sip” of alcohol (1)

A
  1. Naltrexone
172
Q

Drug used in Depression for its side effects of improving sleep and appetite (1)

A
  1. Mirtazepine
173
Q

1st Line anti-psychotic for acute delirium (1)

A
  1. Haloperidol 0.5mg PO
174
Q

List 4 medications that interact with Methylphenidate (4)

A
  1. Isocarboxazid - (MAO-Bi causes hypertensive crisis)
  2. Linezolid - (ABx increases risk of high BP)
  3. Risperidone - (Atypical Antipsych - causes dyskinesia risk)
  4. Carbamazepine - may decrease levels of methylphenidate
175
Q

Emergency contraception PILL suitable for up to 5 days post-UPSI (1)

A
  1. Ulipristal Acetate- EllaOne

Remember by Ella”120” - 120 hrs = 5 days
Also requires 5 days after taking before starting hormonal contraception again as that may interfere with EllaOne efficacy

176
Q

Emergency contraception PILL suitable for up to 3 days post-UPSI (1)

A
  1. Levonorgestrel (Levonelle) - 72hrs after

can start contraception straight away after i believe

177
Q

Most effective emergency contraception (1)

A
  1. Copper coil

120hrs/5days after UPSI

178
Q

Med used in Pre-Eclampsia if mother has asthma (1)

A
  1. Nifedipine

use labetalol if she doesn’t 1st line

178
Q

Med used in Pre-Eclampsia if mother has asthma (1)

A
  1. Nifedipine

use labetalol if she doesn’t 1st line

179
Q

Initial management of Corda Equina prior to surgery (1)

A
  1. Dexamethasone 16mg

Basically “High-Dose Dex” reduces compression as it reduces oedema around the tumour site/cauda equina site - this is followed by surgical decompression but is the immediate way of reducing harm

180
Q

Meds used 1st line in Heart Failure (2)

A
  1. ACEi
    AND
  2. Beta-Blockers

These reduce actual morbidity and mortality,
you would also likely need a loop diuretic like Furosemide to manage oedema and a CCB to deal with HTN etc etc but those tow drugs are disease modifying

181
Q

Medications used in Gout (2 chronic to lower uric acid, 1 in acute attacks)

A
  1. Allopurinol

second line
2. Febuxostat

ACUTE
3. Colchicine

3a conditions Tx (2 decks)

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