EXAM FEEDBACK NOTES Flashcards
Which 2 anti-epileptics are safest in pregnancy?
Lamotrigine and levetiracetam are safer than other antiepileptic drugs in pregnancy because they are not linked with an increased risk of birth abnormalities compared with the general population, according to the recent MHRA review.
Hydroxychloroquine and Chloroquine Monitoring
Monitor for chloroquine and hydroxychloroquine retinopathy:
- Annual monitoring is recommended in all patients who have taken hydroxychloroquine for longer than 5 years.
- All patients should have an ophthalmological examination before initiating treatment and repeated at least every 12 months.
Hydroxychloroquine, chloroquine: increased risk of cardiovascular events when used with macrolide antibiotics; a reminder of psychiatric reactions (February 2022)
- Co-administration of azithromycin with hydroxychloroquine in patients with rheumatoid arthritis was associated with an increased risk of cardiovascular events (including angina or chest pain and heart failure) and mortality.
HEADLICE NICE CKS TREATMENT
- 1ST LINE
1st Line - wet combing or dimeticone 4% solution (HEDRIN) 1st line for:
- pregnant or breastfeeding women
- young children aged 6 months to 2 years
- people with asthma or eczema.
Hedrin® (dimeticone) 4% solution is licensed from 6 months of age.
Vamousse® is recommended from 2 years of age.
Lyclear® (Permethrin) and Derbac M® (Malathion) are licensed from 6 months. Resistance has developed to permethrin, in addition to this the administration of Lyclear® cream rinse means there is insufficient contact time, so it would be ineffective.
Therefore, Derbac M® is the only insecticide recommended in the UK now but resistance has developed.
TOPIRAMATE - MHRA ADVICE
Topiramate is not associated with bone marrow suppression and does not have the warning about blood, liver or skin disorders.
MHRA/CHM advice: Antiepileptics: risk of suicidal thoughts and behaviour (August 2008)
- The MHRA has recommended that patients and their carers should be advised to seek medical advice if any mood changes, distressing thoughts, or feelings about suicide or self-harming develop, and that the patient should be referred for appropriate treatment if necessary.
Patients should also be advised not to stop or switch antiepileptic treatment and to seek advice from a healthcare professional if concerned.
Combined oral contraceptives (COCs) are contraindicated in patients who have migraine with aura.
Progesterone only contraceptives are more appropriate e.g. desogesterel
CHRONIC GOUT TREATMENT
Allopurinol and febuxostat are used for the treatment of chronic gout and should not be initiated during an acute attack.
Allopurinol (Xanthine oxidase inhibitor) - Initially 100 mg daily, for maintenance adjust the dose to be taken preferably after food.
Common SE: Rash (discontinue therapy)
Interaction with azathioprine/mercaptopurine + allopurinol (dose adjustment required)
ACUTE GOUT ATTACK TREATMENT
1ST LINE TREATMENT -
NSAIDs e.g Naproxen + PPI
(Aspirin is not indicated in gout)
NSAID CONTRAINDICATIONS:
- Active gastrointestinal bleeding/ulceration
- Severe heart failure
GIVE -
ORAL COLCHICINE:
DOSE: 500 micrograms 2–4 times a day until symptoms relieved, maximum 6 mg per course, do not repeat the course within 3 days.
Choice of first-line agent depends on patient preference, renal function and co-morbidities.
Do not stop allopurinol or febuxostat during an acute attack of gout if the person is already established on these drugs.
Theophylline monitoring requirements (BNF)
Plasma-theophylline concentration is measured 5 days after starting oral treatment and at least 3 days after any dose adjustment. A blood sample should usually be taken 4-6 hours after an oral dose of a modified release preparation.
Constipation in children under 12yrs
Children under the age of 12 should be referred to their GP.
Children under 12 should be treated first-line with macrogol in combination with a balanced diet, fluids and behavioural interventions.
Stimulant laxatives are second line treatments. The laxatives listed are not available to purchase over the counter for this age group.
VET PRESCRIPTION
Pharmacists can either keep all documents that show all the required information or make a record in their private prescription book, records must be kept for at least 5 years. This record must include the batch number. The label should include the owners name and address and the prescription should include the telephone number of the prescriber. The declaration ‘prescribed for the treatment of an animal or herd under my care’ is only required for schedule 2 and 3 CDs. Diazepam is a schedule 4 CD
ISOTRETINOIN SUPPLY UNDER PPP
Prescriptions are limited to max 30 days’ supply
Prescription validity - only 7 days
SSRIs are better tolerated and are safer in overdose than other classes of antidepressants
Considered first-line for treating depression.
In patients with unstable angina or who have had a recent myocardial infarction, sertraline has been shown to be safe.
SODIUM VALPROATE
PHARMACISTS are asked to take the following IMPORTANT ACTIONS:
- PROVIDE a Valproate Patient Card every time you dispense a valproate medicine to ALL female patients. Please also note that the outer boxes of valproate are being changed in order to include a removable patient card, to be detached and given to the female patient at the time of dispensation.
- When dispensing any valproate preparation to female children, adolescents, women of childbearing potential, or pregnant women CHECK that their prescriber has discussed the risks of exposure in pregnancy with them and they are aware of these and subsequently they are taking EFFECTIVE CONTRACEPTION unless already pregnant. If the prescriber HAS NOT DISCUSSED the risks with the patient or the patient is not taking effective contraception, tell them to CONTACT their GP or specialist for an urgent follow-up appointment.
- Advise the patients NOT TO STOP valproate medication and to immediately contact their GP or specialist in case of suspected pregnancy.
- Ask if they have received the Valproate Patient Guide and provide a copy if they have not received this or no longer have it in their possession.
- Dispense valproate in the ORIGINAL PACKAGE with the outer warning and avoid repacking. In the situations where this cannot be avoided, always provide a copy of the package leaflet, and patient card, and add a warning sticker to the outer box
MONTELUKAST MHRA WARNING
Montelukast (Singulair®): reminder of the risk of neuropsychiatric reactions (September 2019)
Healthcare professionals are advised to be alert for neuropsychiatric reactions, including speech impairment and obsessive-compulsive symptoms, in adults, adolescents, and children taking montelukast.
Montelukast is usually given in the evening and the 5 mg tablets are chewable.
SE - Nightmares
Naproxen + Indapamide
Naproxen increases the risk of acute renal failure when given with indapamide.
Both indapamide and naproxen can increase the risk of hyponatreamia
