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Drugs Flashcards

1
Q

Metformin counselling (3)

A

Slow titration
Sick day rules
Side effects - GI

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2
Q

ACEI counselling (4)

A

First dose at night
U+E’s within 1-2 weeks
Sick day rules
SE: Cough

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3
Q

Statins counselling (3)

A

LFT’s baseline and then rpt LFT and cholesterol at 3months

Take at night
SE: Can cause muscle cramps and tummy issues

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4
Q

SSRI counselling (4)

A

4 weeks to work
- Can initially worsen mood and suicide risk

SE: Nausea, headache, sexual dysfunction

Don’t stop suddently

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5
Q

Levothyroxine counselling (3)

A

Take on empty stomach 30mins before food

Check TSH at 6 weeks post dose changes

SE: Palpitations, weight loss, anxiety if dose too high

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6
Q

Name 3 medications where sick day rules should be explained to patients

A

Metformin
ACEI
Diuretics
NSAIDS

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7
Q

What sick day rules should patients be counselled on?

A

Risk of AKI if dehydrated

Stop if vomiting or diarrhoea lasting 48 hours, restart when E+D normally for 24-248hours

If reduced urine output seek medical advice

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8
Q

What are the renal considerations for metformin?

A

<45 = Max 1g
<30 = STOP

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9
Q

What are the renal considerations for ACEI?

A

eGFR < 30 = Use with caution

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10
Q

What are the renal considerations for DOACs generally?

A

Reduce dose if eGFR <30

Stop if eGFR <15

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11
Q

What are the renal considerations for NSAIDS generally?

A

Avoid if eGFR <30

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12
Q

Name 5 drugs which need caution in the elderly due to high anticholinergic burden?

A

Amitryptiline
Oxybutynin (OAB)
Tolterodine (OAB)
Solifenacin (OAB)
Chlorphenamine
Propmethazine
Cyclizine
Prochlorperazine
Quetiapine

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13
Q

Acne topical management options?
(how frequnetly should they be applied?)

A

Adapalene with topical benzoyl peroxide _OD/BD

topical tretinoin with topical clindamycin - OD

topical benzoyl peroxide with topical clindamycin - OD/BD

Trial at least 12 weeks then trial alternative

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14
Q

Acne which COCP to use?

A

Co-cyprindiol (Dianette)

  • Licenced for this
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15
Q

Drug management of RA flare in primary care (IF new diagnosis/ not under specialist team) whilst awaiting specialist team

A

1st) NSAID (naproxen)

2) 4 week reducing course steroid - ONLY IF TOLD BY SPECIALIST

Prednisolone 20 mg daily for 7 days, then 15 mg daily for 7 days, then 10 mg daily for 7 days, then 5 mg daily for 7 days, then stop.

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16
Q

SSRI
a) A condition not to use in
b) Which one in children?
c) Start in primary care for children?

A

a) Bipolar

b) Fluoxetine

c) No, NICE says by CAMHS only

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17
Q

Apixaban counselling (5)

A

Dose: 5mg BD (reduce to 2.5mg if frail, under 60kg, CrCl 15-30)

  • Check any bleeding
  • Check other drugs (NSAIDS, SSRI, aspirin etc)

SE - bleeding, spontaneous, easy bruising, cuts/ shaving etc - seek medical help if doesn’t stop

Review in 1 month to assess for new bleeding
- Then FBC, renal and liver bloods annually

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18
Q

Bisphosphanate counselling (3)

A

How - Once per week, empty stomach, with big glass water
Stay upright for 30mins after

SE: GI
Safetynet: New hip or jaw pain

Dental check up and mention to dentist

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19
Q

Starting colchcine for gout - what common mediction should be temporarily held?

What are most common side effect?

A

Statins - hold

SE: GI side effects, nausea and diarrhoea

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20
Q

Tetracyclines counselling? (2)

A

Pregnancy and contraception (avoid)
Avoid sun (suncream)

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21
Q

Aspirin in pregnancy? Reasons to give and when to do in primary care?

A

Secondary care - give in primary care if won’t be seen by 12 weeks

To prevent pre-eclampsia, indications include diabetes, previous IUGR/ miscarriage, still birth, pre-eclampsia, hypertension or two of 1st pregnancy, over 40, BMI over 35, IVF etc

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22
Q

Folic acid in pregnancy - reasons for high dose?

A

Take until first trimester done/ three months

Previous NTD
Epilepsy medicines
Diabetes
BMI over 30

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23
Q

Sildenafil counselling (3)

A

CI - Angina, nitrates, low BP, active peptic ulcer etc

How: 30-60mins before sex, no more than once per day

SE: Flushing, headache, dizzyness

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24
Q

Hypertension in pregnancy? Key mx

A

<20 weeks - Chronic HTN
- Switch others antihypert to Labetolol or nifedipine - if <111/70 stop
If >140/90 - Start new labetalol whilst a/w tx

> 20 weeks - Refer straight in
- 140/90 - Assess matt triage
- 160/90 - Would need stay in hosp

Start aspirin from 12 weeks if not able to be done in secondary care

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25
COPD = Pharmacological management?
1)SABA Alone 2) Add LAMA (spiriva) OR - ICS/ LAMA if eosionophils/ >2 exacerbations/ 1 hospital in last 12m 3) LABA/ LAMA (Anoro elipta) combo Or if b) Triple therapy (Trelergy/ trimbow) 4) If not already there, triple therapy Refer for LTOT, home nebs etc.
26
LTOT indications in COPD? (5)
Sats <92% FEV1 <30% Polycythemia (Raised RBCs) Cyanosis Perioheral oedema Raised JVP
27
Desmopressin counselling for enuresis?
Usually over 7 (can be used 5-7), can be used short term control if needed Counsel: SE very rare but don't have much fluid and hour before and overnight (fluid overload risk) Review at 3 months
28
Hyperemesis medication options?
Usually resolves by 16-20 weeks Cyclizine Promethazine Prochlorperazine (stematil) Xonvea - new medication specifically licenced for hyperemesis - one or two per day 2nd line (no longer than 5 days each) - metoclopramide, domperidone or ondansatron (not first trimester) 3rd line - EPAU for oral steroids
29
Gonorrhoea - confirmed - 1st line mx?
If antibiotic sensativity unknown - ceftriaxone 1 g intramuscular (IM) OR if known Ciprofloxacin 500mg single dose oral
30
Chlamydia - confirmed 1st line mx?
Doxycycline 100mg BD for 7 days OR Azithromycin 1g orally on D1 followed by 500mg on D2 and D3
31
Genital warts - mx?
If declining GUM: 30% warts disappear within 6 months - Imiquod cream
32
Trichomonas - mx?
oral metronidazole 400–500 mg twice a day for 7 days OR Metronidazole 2g as a single dose
33
Bacterial vaginosis - mx?
Metronidazole 400 mg twice a day for 5 to 7 days OR Intravaginal metronidazole gel 0.75% once a day for 5 days OR Metronidazole 2g single dose (not if pregnant) (Encourage probiotics, loose underwear, avoid scented)
34
Management of recurrent bacterial vaginosis in GP?
Prolonged course of metronidazole (Consider removing IUD)
35
Thrush management in pregnancy?
Clotrimazole pessary - up to 7 nights in a row Avoid vaginal douche, tight fiting
36
Non-pregnant with thrush - first line?
Oral fluconazole 150mg
37
Recurrent candidia (definie and manage)
4 or more per year Swab and confirm Induction - D1, D4, D7 - fluconazole oral Maintaince- Once weekly for 6 months
38
Balanitis in men - first line management?
Hydrocortisone 1% OD for 14 days + either topical anti bac (mupirocin 2%) or topical antifungal depending on likely cause
39
Balanitis in babies - management?
Nappy free time, keep it dry Topical hydrocortisone and antifungal for 14 days (Safetynet RE possible)
40
Management steps of paediatric GORD?
Reassure (90% settle by age 1) 1) Smaller more frequent feeds 2) Trial thickener (carobel) 1-2 weeks 3) infant gaviscon 1-2weeks 4) PPI for 4 weeks (over 1m old) Consider CMPA (rash, blood in stools) or refer to paeds
41
On medicines like lamotrigiene - what contraception to consider?
IUS always first line COCP - enzyme inducer so would make lamotrigene less effective, don't use POP/ depo can be used Implant - less data on effectiveness for contraception
42
Allergic rhinitis - management (5)
1st: Intranasal steroid/ antihistamine or oral antihistamine 2nd - Combination above (up to 2 weeks to work fully) - Add decongestant - Add montelukast if asthma Consider if severe brief, 5-10 days of oral prednisolone (Masks, allergen avoidance etc)
43
Opiates in palliative care. Pain not controlled, how much to increase dose?
Up to 1/3 of dose at a time
44
Opiates in palliative care - which laxative and anti-emetic to add in?
Stimulant (senna) Metoclopramide (Oral 10mg QDS) - can easily be converted to syringe driver
45
N+V in palliative care - drug mx options? (4)
Oral or subcut: Levomepromazine - First line generally Metoclopramide (10mg QDS) or Haloperidol - Obstruction/ asicitis/ Cyclizine - Movement related/ mechanical obstruction (if all ineffective consider dexamethasone trial - especially raised ICP)
46
Mx of cough in palliative care? (3)
Humidifying air/ simple linctus 2) Codiene 3) Morphine - Consider nebs or musculoytic
47
Mx dyspnoea in pallative care (3)
Nebs Opiates Benzos (depending on cause)
48
Mx secretions in pallative care? (2)
Hyoscine (oral) Glycoperonium (s/c)
49
For N+V at the end of life - which antiemetic is first line in most indications and when would you not use it?
Levopromazine 1st line - Can be sedative so careful if not wanting lots of sedation Also caution in parkinsons
50
Pain relief with signifciant renal failure - best opitates? (2)
Oxycodone Fentanyl
51
Dapaglifozin counselling (3)
10mg OD - Risk gangrene and amputation (checking legs for ulcers/ change in skin) - Risk DKA (vomitng, unwell, low threshold to get checked out) - Thrush
52
Gout - acute attack - when to follow up (bloods/ start allopurinol?)
4 weeks (2-4 weeks to start allopurinol and 4-6 weeks to rpt uric acid) Don't forget to cover with colchicine
53
New tamsulosin - how to counsel (3)
Works in a few days OD - in morning SE- Dizzy, ejaculation problems
54
Name 3 drugs that can give parkinsonain features?
Antipyschotics prochlorperazine, metoclopramide,
55
Criteria for weight loss drugs?
Saxenda/ wegovy - BMI over 35 or some over 30 with co-morbidity - Specialist only Tirepatide (Mounjaro) s/c - Can be prescribed in GP if BMI over 35 + 1 weight comorbidity - Need 5% weight loss in 6 months Orlistat if BMI over 28 + RF or over 30 - Can be GP - Stop at 12 weeks if 5% weight not been lost ALL should be used alongside diet and exercise
56
Private shared care request for hormone therapies in gender dysphoria - what key principles?
No shared care with non-NHS organisations, we would be responsible and so not safe to do script No hormone checking or levels monitored by GP's Absolute no for under 18's to do hormones
57
Name a steroid for each rung of ladder?
Mild- Hydrocortisone Mod- Eumovate Potent- Betnovate Super potent- Dermovate
58
Syphillis - presentation (3) and mx?
Syx- Single painless sore, lympahdenopathy > rash and flu syx Mx- IM benzypenicillin
59
BASH position on doxy-PEP for STI's?
Not endorsed - Mainly due to resistance and concerns about infections that then can't be treated
60
How do you manage seborrhoeic dermatitis?
Stress/ diet etc Ketoconazole shampoo 2% for 4 weeks then 1-2 weekly for maintainance - Add potent steroid if severe inflammation - Add salycilic acid for scale Manage not cure, long term condition
61
COPD - how many exacerbations per year before doing FRAX?
3-4 steroids per year - Check FRAX/ consider steroid card
62
Mx - Cyclical breast pain with periods?
Fitting bra's Lifestyle advice NSAIDS If severe and above not working refer to specialist after 3m
63
Management PMS?
Conservative - Lifestyle, weight, diet etc Medical: - SImple analgesia - COCP - SSRI (off-licence)
64
Name 3 long term effects of benzo?
Cognitivie decline Balance/ falls Worsening anxiety or depression
65
Name the three most common GP drugs which increase bleed risk (excluding DOAC/ antiplatlet etc)?
SSRI's NSAIDS Steroids
66
COCP and POP - time to provide contraception?
POP- 2 days COCP - 7 days

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