General questions Flashcards
Who is at the highest risk of osteoporosis?
- postmenopausal women
- men over 50
- patients taking long-term oral corticosteroids
What is first and second line for osteoporosis?
1st line: oral bisphosphonates (alendronic acid, risedronate sodium)
2nd line: parenteral bisphosphonate (zolendronic acid) / denosumab
What drug is reserved for postmenopausal women with severe osteoporosis at very high risk of fractures?
Teriparatide
What are common side-effects of bisphosphonates?
constipation; gastrointestinal discomfort; headache; malaise; myalgia; nausea; oesophageal ulcer (discontinue); oesophagitis (discontinue)
Give examples of alpha-blockers?
alfuzosin
doxazosin
tamsulosin
indoramin
What drugs can cause urinary retention?
opioids
antimuscarinics
sympathomimetics
TCAs
How can we treat benign prostatic hyperplasia?
finasteride OR dutasteride
PLUS alpha-blockers
When is codeine contraindicated?
Acute ulcerative colitis
Known ultra-rapid codeine metabolisers (CYP2D6)
List common side-effects of opioids
constipation
dry mouth
dizziness
headaches
urinary retention
arrythmias/palpitations
nausea and vomiting
Which NSAIDs have highest risk of CV events?
COX-2 selective inhibitors (celecoxib, etoricoxib, parecoxib)
Diclofenac 150mg daily
Ibuprofen 2.4g daily
List common signs/symptoms of serotonin syndrome?
- neuromuscular - e.g. tremors, seizures, rigidity
- autonomic dysfunction - e.g. tachycardia, hyperthermia, shivering, excessive sweating
- altered mental state - confusion, agression
What interactions are common with MAOIs?
tyramine rich foods and foods containing dopa (e.g. broad bean pods)
Which calcium channel blockers can be used in heart failure?
amlodipine (avoid all others)
State the common side-effects of CCB
flushing, peripheral oedema, headaches, nausea, palpitations
What are the exceptions to legal category of chloramphenicol?
eyedrops 0.5% (max 10ml) or ointment 1% (max 4g) can be sold for bacterial conjunctivitis.
For 5 day use, in anyone above 2 years old
What are the exceptions to legal category of tamsulosin 400mcg capsules?
Can be sold to the public for the treatment of functional symptoms of benign prostatic hyperplasia in men aged 45–75 years to be taken for up to 6 weeks before clinical assessment by a doctor
What vitamin supplementation do vegans needs?
Vitamin B12
Vitamin D
Which nutrient is low in alcoholics?
Thiamine (vitamin B1)
Which nutrient needs to be provided alongside isoniazid?
Pyridoxine (vitamin B6) - prevents peripheral neuropathy
What medication are used for the treatment of active TB (initial phase)
Rifampicin
Isoniazid (+ B6)
Pyrazinamide
Ethambutol
combination is used for 2 months
Which NSAIDs have highest risk of GI effects?
ketolorax
ketoprofen
piroxicam
what are symptoms of lactic acidosis
muscle cramps, abdominal pain, hypothermia, dyspnoea
When do children get vaccines during their first year of life?
8 weeks old
12 weeks old
16 weeks old
When do children get vaccinated against MMR?
First dose at 1 years old
Second dose at 3 years and 4 months old (before pre-school)
When can the seasonal influenza vaccination be given?
Between october and january
who is eligible for the annual seasonal influenza vaccine?
Anyone 65 years and older
Pregnant women (inactivated version)
List all the live vaccines that are currently used.
BCG - TB vaccine
Rotavirus (Rotarix)
Live attenuated influenza vaccine (fluenz tetra)
Oral typhoid vaccine
Yellow fever
Varicella
Shingles vaccine (Zostavax)
MMR
MMR vaccine and pregnancy
Exclude pregnancy before immunisation. Avoid pregnancy for at least 1 month after vaccination (same after varicella-zoster vaccine)
What pre-treatment screening needs to be done before administering the BCG vaccine?
none for children under 6.
skin test for hypersensitivity to tuberculoprotein for everyone over 6 (mantoux test)
What type of laxative is lactulose and macrogol?
Osmotic
List examples of stimulant laxatives?
Senna
Sodium picosulfate
bisacodyl
docusate (also acts as a faecal softener)
What are the contraindications to pseudoephedrine?
-severe or uncontrolled hypertension
-diabetes
-Closed angle glaucoma
-Severe acute or chronic kidney disease/renal failure
-Concurrent use of MAOIs
MHRA/CHM advice high doses of loperamide
Can cause serious cardiac adverse effects: QT prolongation, torsades de pointes and cardiac arrest.
Can be treated with naloxone
What are the renal impairment requirments for bisphosphonates (alendronic acid, risedronate)
Alendronic acid: avoid if CrCl <35ml/min
Risedronate: avoid if CrCl <30ml/min
Which electrolyte imbalanace needs to be corrected before using bisphosphonates?
Hypocalceamia
Contraindicated if low calcium levels.
How long should the CD registered be retained?
2 years from date of last entry
Which anti-emetics are contraindicated in PD? And which to avoid if patient taking apomorphine?
metoclopramide, haloperidol, prochlorperazine (anthing that antagonises dopamine).
If patient is taking apomorphine, avoid ondansetron as risk of QT interval prolongation.
Explain MHRA alert around the use of domperidone
No longer indicated for the relief N&V in children aged under 12 years or those weighing less than 35 kg.
Max 1 week use at lowest effective dose
What is sevelamer and what is it indicated for?
Phosphate binder (other drugs in same class: calcium acetate
Used for hyperphosphatemia in patients with CKD or on dialysis.
What are the first line for neuropathic pain?
amitriptyline
pregabalin
gabapentin
nortriptyline [unlicensed]; tramadol can only be used when all the first lines failed.
First line for trigeminal neuralgia?
Carbamazepine
What is the treatment for acute attacks of gout?
colchicine, or high dose of
NSAIDs or short course of oral corticosteroids
What is allopurinol and febuxostat used for?
Both used for prophylaxis of gout.
Also for prophylaxis of hyperuriceamia associated with chemotherapy.
They inhibit uric acid formation.
What cautions are associated with allopurinol?
Fluid intake should be 2-3L/ day
MHRA alert with colchicine?
Risk of serious and fatal toxicity in overdose - colchicine has narrow therapuetic window.
Early signs of toxicity include abdominal pain, diarrhoea, N&V.
Features after 1 to 7 days - arrythmias, renal impariment, hepatic impairment, respiratory distress
What are the LAMAs licensed for COPD?
Tiotropium
Glycopyrronium
Aclidinium
umeclidinium
Which LAMA is not once daily dosing?
Aclindinium (twice daily dosing)
What are common side effects of antimuscarinics (anticholinergic)
constipation; cough; dizziness; dry mouth; headache; nausea
Senna can change the urine to what colour?
Yellow or red-brown
What happens to urine colour with Parkinsons meds such as levodopa?
Makes the urine appear darker
Which medication can change urine colour to pink (harmless)?
Nefopam
What medication can discolour the urine reddish-brown?
entacapone
rifampicin
rifabutin (red-orange)
rifaximin
What is naloxegol licensed for?
treatment of opioid-induced constipation
Overuse/abuse of laxatives may lead to which electrolyte disturbance?
hypokalaemia
Which stimulant laxatives are used exclusively in terminally ill patients?
co-danthramer
co-danthursate
Which two laxatives are licensed for the treatment of opioid-induced constipation?
naloxegol
methylnaltrexine bromide
What to do with ferrous sulphate if once daily dosing is not tolerated?
Alternate day administration is possible.
List 10 drugs which have a high ACB burden
amitriptyline
atropine
chlorphenamine (piriton)
chlorpromazine
clozapine
diphenhydramine (benadryl, nytol, sleepeaze)
hyoscine hydrobromide (Kwells, joy-rides)
Imipramine
oxybutynin
procyclidine
solifenacin
tolterodine
Administration directions of bisphosphonates?
Swallow tablet whole
Take with plenty of water whilst stting or standing upright
Take 30 mins before breakfast or other meds
Stand or sit upright for 30 mins after administration
What sorts of symptoms should patient report whilst on bisphosphonate treatment?
Any thigh, hip or groin pain
Any ear pain, discharge from the ear or an ear infection
dysphagia, new or worsening heart burn, pain on swallowing or retrosternal pain
What are the most common side-effects associated with high cholinergic burden?
no see - blurred vision
no spit - dry mouth
no pee - urinary retention
no shit - constipation
What are the symptoms of anti-epileptic hypersensitivity syndrome?
Fever, rash, and swollen lymph nodes (lymphadenopathy).
It can appear 2 - 8 weeks after initiating therapy
Which type of studies are the most reliable (name top 2)?
systematic reviews
Followed by meta-analysis
Explain the guidance around the emergency supply of CDs (i) at the request of a prescriber and (ii) at the request of the patient
All CDs schedule 1, 2 or 3 (except phenobarbital for epilespy) cannot be supplied at the request of anyone.
Phenobarbital can be supplied at the request of a UK doctor only (not EEA or Swiss). Phenobarbital can only be supplied as emergency supply to patients of UK-registered prescribers.
Max quantity of CD 4,5 and phenobarbital at the request of a patient = 5 days worth. For any other POM, no more than 30 days can be supplied (except if insulin, ointment, cream, inhaler, oral contraceptive - a full treatment cycle should be supplied)
What are the 6 legally required information that needs to appear on a dispensed product?
- Name of patient
- Name and address of the supplying pharmacy
- Date of dispensing
- Name of the medicine
- Directions for use
- BNF precautionary labels (NOT KOOSAROC or use this on the skin only)
What advice needs to be given to patients with impetigo regarding spreading the infection?
Avoid school/work until all the lesions have dried and crusted over
OR until 48 hours after commencing treatment (hydrogen peroxide cream or antibiotics)
What is the OTC licensing for mebendazole?
Can be sold OTC for threadworm infections for adults (except pregnant or breastfeeding women) and children above 2 years old.
If a patient is taking which medication would you not supply mebendazole?
Cimetidine - interaction which increases concenration of mebendazole
What is the general advice when supplying mebendazole
Treat all members of the family (unless unsuitable) even if asymptomatic.
If reinfection occurs, second dose may be needed after 2 weeks.
What are the contraindications to the hyoscine hydrobromide?
Prostatic enlargement causing bladder outflow obstruction, severe ulcerative colitis, glaucoma and myasthenia gravis, urinary retention
What is the youngest age that can be treated OTC for travel sickness?
Age 3+
Can supply Joy ride which is licensed for children aged over 3.
Nothing OTC for under 3.
What is MHRA alert associated with hyoscine hydrobromide
Risk of severe anticholinergic side-effects with transdermal use.
More common in children.
Symptoms can persist for 24 hours or longer even after removal of patch.
What is the OTC licensing for amorolfine 5% nail lacquer?
Can only be sold to anyone aged 18 or over
Should be used between 6-9months
Maximum only 2 nails affected
Can only be used if mild fungal nail infection starts on the distal or lateral edge of nail.
Not for pregnant, diabetic or immunocompromised patients.
What spray can be used for protection against mosquito bites?
DEET 50% spray - can be used by pregnant/breastfeeding women and children over 2 months.
When considering malaria prophylaxis, which drugs should be avoided in patients with epilepsy?
mefloquine
chloroquine
Which treatment can be provided to pregnant women who are travelling to a malarious areas?
1st line: chloroquine (however there is issues with resistance). It is also safe in breastfeeding.
2nd line: mefloquine (can be given during second or third trimester). It is also safe in breastfeeding.
3rd line: doxycycline SHOULD BE AVOIDED IN PREGNANCY, can be used as long as the course is completed before 15 weeks of pregnancy [unlicensed]. Not safe in breastfeeding.
A patient who is travelling to a malarious area wants to purchase tablets for malaria prophylaxis.
They do take sertraline for depression but they have no other health conditions.
Which medication should be avoided?
Mefloquine - associated with potentially serious neuropsychiatric reactions
Which interactions can occur with potassium citrate for cystitis?
Hyperkalaemia with the concurrent use of following:
potassium sparing diuretics, ACEi/ARBs, aliskiren, ciclosporin and tacrolimus
Explain the use of folic acid for pregnancy and conception?
What doses and durations are used?
Average person should use 400mcg OD to be taken before conception and till week 12 of pregnancy.
Patients at high risk of neural tube defects/diabetics should use 5mg OD before conception and till week 12 of pregnancy.
Patients with sickle-cell disease should take 5mg OD before conception and throughout entire pregnancy.
What is the dosing for colchicine for acute gout flare up? What is the maximum dose per course?
500 micrograms 2–4 times a day until symptoms relieved
Total dose per course should not exceed 6 mg.
Do not repeat course within 3 days.
How long should you wait to do a urea 13 breathtest or stool antigen test for H.Pylori after taking:
(i) PPI
(ii) antibiotics
2 weeks after PPI
4 weeks after antibiotics
Risk of false negative
What are some risks associated with long term use of PPIs
Hypomagneseamia (more common after 1 yr of treatment but can occur after 3 months)
Increased risk of fractures and osteoporosis
Increased risk of C.diff infections (and other GI infections)
Reduce absorption of vitamin B12 (cobalamin)
What are some contraindications to the sale of viagra?
Previous MI or stroke in past 6 months
Unstable angina
Uncontrolled high BP/low BP
Patient taking alpha-blockers (-zosin) or tamsulosin
Patients taking nitratres or nicorandil
What colour does nitrofurantoin change urine to?
Yellow-brown
How do faecal softeners and osmotic laxatives differ in MOA?
osmotic laxatives draw water to the large bowel
faecal softeners increase penetration of the water into the poo by decreasing surface tension
What are the four licensed cannabis-based products and what schedule are they?
Dronabinol and nabilone - schedule 2
Sativex - schedule 4
Epidyolex - schedule 5
Which medicines need to be entered into the CD register?
How long should the CD register be retained?
All schedule 1 and 2
Sativex (schedule 4)
Should be retained for 2 years from date of last entry
Which schedule of controlled drugs require denaturing?
When is an authorised witness required for CD destruction?
All CDs schedule 2, 3 and 4 part 1.
Only schedule 2 expired/unwanted stock requires an authorised witness for destruction.
Which schedule 3 drugs require safe custody?
buprenorphine and temazepam
Which CDs require a standardised form to be used and which do not?
Private prescriptions require the use of a standardised form (and prescriber identification number - this is not the same as their GMC number)
Vet CD scripts do not need to be on standardised forms.
