GPHC Qns Flashcards
Paracetamol Doses For Children
- Comes in 120mg/5ml or 250mg/5ml
- Taken QDS
- Starts the same as Ibuprofen with 3-5 months, however the next bracket goes to 2y old
- Ages go up in 2s after 2y old
- Doses go up by 2.5ml every interval like ibuprofen and so important to remember the strengths
- Can take 250mg / 5ml liquid from 6y old
3m - 5m - 2.5ml
6m - 23m - 5ml
2y-3y - 7.5ml
4y-5y - 10ml
6y-7y - 5ml
8y-9y - 7.5ml
10y-12y - 10ml
Ibuprofen Doses For Children
- Comes in 100mg/5ml or 200mg/5ml
- Taken TDS
- Can take 200mg / 5ml liquid when reach 7 years old
- Starts at 3 -5m like paracetamol
- Ages go up in 3s
- Doses go up by 2.5ml every interval like paracetamol so important to remember strengths
3m, 4m,5m = 2.5ml
6m - 11m = 2.5ml TDS/QDS
1y,2y,3y = 5ml
4y,5y,6y = 7.5ml
7y,8y,9y = 10ml (200mg) or 5ml of higher strength liquid
10y,11y,12y = 7.5ml of higher strength liquid
What route should you give Vincristine and what route is contraindicated?
AVOID INTRATHECAL
You should give intravenously
What is the treatment for human and animal bites?
Oral
1) Co-amoxiclav
2) Pen allergic = Doxycycline with Metronidazole
IV
1) Co-amoxiclav
2) Pen allergic = Cefuroxime or Ceftriaxone with Metronidazole
What is the treatment for Cellulitis?
Mild - Moderate Normal Presentation:
1) Flucloxacillin
2) Pen allergic = Clarithromycin, Erythromycin (preg), Doxycycline.
Near Eyes or Nose:
1) Co-amoxiclav
2) Clarithromycin with Metronidazole
Severe Presentation:
1) Co-amoxiclav , Clindamycin, Cefuroxime, Ceftriaxone.
2) If MRSA add Vancomycin, Teicoplanin, or Linezolid (ONLY IF PREVIOUS TWO CANNOT BE USED)
What is the interaction between Simvastatin and Metronidazole?
SICKFACES.COM
Metronidazole is an enzyme inhibitor therefore less is metabolised.
Increased risk of myopathy and rhabdomyolysis.
Do not need to stop metronidazole.
Contraindicated = Itraconazole, Ketoconazole, Fluconazole, Posaconazole, Voriconazole, Erythromycin, Clarithromycin, Telithromycin
What is the usual dose for lansoprazole, what is it used for, and what is its cautionary label?
15 - 30mg OD
Gastric and Duodenal Ulcer (prophylaxis + treatment), Dyspepsia, Oesophagitis, GORD.
1) Take 30 to 60 minutes before food
2) Do not take indigestion remedies 2 hours before or after you take this medicine
What are the warnings for PPIs?
MHRA : Proton pump inhibitors (PPIs): very low risk of subacute cutaneous lupus erythematosus
1) Osteoporosis and risk of fractures
(Especially in elderly and after 1 year of use).
(IF AT RISK HAVE CALCIUM AND VIT-D)
2) Increase the risk of C.diff infection
3) Masks the signs of gastric cancer
4) Reduces the absorption of B12.
5) Hypomagnesemia -
(Measure before and during treatment especially w/ digoxin)
What is supposed to be on a label legally? (6)
1) Name of the patient
2) Name and address of the supplying pharmacy
3) Date of dispensing
4) Name of the medicine
5) Directions for use of the medicine
6) Precautions relating to the use of the medicine - e.g. for external use only
Keep out of sight and reach of children is NOT A LEGAL REQUIREMENT ON A LABEL
What are the drug interactions with contraceptives?
1) Enzyme INDUCING Drugs - CRAPGPS
(e.g. carbamazepine, eslicarbazepine acetate, efavirenz, nevirapine, oxcarbazepine, phenytoin, phenobarbital, primidone, rifabutin, rifampicin, ritonavir, St John’s wort, and topiramate)
2) Lamotrigine - Increase lamotrigine dose and use extra protection if using CHC
(Reduced efficacy of CHC and Reduced efficacy of Lamotrigine
3) St Johns Wart - CONTRAINDICATED
- Copper IUD, Progestogen-only IUD (levonorgestrel), or a Progestogen-only injectable contraceptive w/ condom (such as medroxyprogesterone acetate or nonhistone) is RECOMMENDED if using enzyme inducing drugs.
- For Emergency Contraception, a Copper IUD preferred however increasing the dose of levonorgestrel can be used
What treatment would you give for post-operative analgesia?
1) Paracetamol
Everyone before and after surgery
2) Ibuprofen
Immediate postoperative pain (pain during the first 24 hours after surgery)
NOT FOR HIP FRACTURE
3) Opioids
4) Ketamine
(others diclofenac, ketoprofen, ketorolac trometamol)
Which contraceptives are suitable in breastfeeding?
Emergency:
1) Copper IUD
2) Levonorgestrel (21 days after birth)
3) Ulipristal Acetate (21 days after birth)
Regular:
1) Progesterone only (21 days after birth)
Avoid Combined Hormonal Contraceptives and Oestrogens.
What is OTC Tranexamic Acid used for, what is its minimum age of licencing and what is the dose?
Menorrhagia (Heavy Periods)
18+
1 g 3 times a day for up to 4 days
Don’t give in Epilepsy, Current VTE, or Previous VTE, Irregular Periods, or using Contraceptives.
What is the NICE guidelines Asthma treatment for Children < 5 years? (4)
NO DIAGNOSTIC TEST (Treat based on symptoms and clinical judgement)
Treatment:
1) SABA alone
Maintanence therapy trial started if:
- Symptoms 3x a week
- Night waking
- Use of SABA 3x a week
(Maintenance Therapy Trial = 8 week trial of paediatric MODERATE dose ICS)
(If after the trial, symptoms reoccur MORE THAN 4 weeks of stopping, REDO THE TRIAL)
If after the trial, symptoms reoccur within 4 weeks of stopping initiate:
2) Paediatric LOW dose ICS as first line maintenance therapy.
If uncontrolled (same symptoms as above)
3) Add Montelukast Chewable Tablets - 4mg, Continue with paediatric low dose ICS
If uncontrolled (same symptoms as above)
4) STOP Montelukast and REFER
What is the NICE guidelines Asthma treatment for Children aged 5 - 16 years? (7)
Diagnosis:
1) Spirometry
(Forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio less than 70%)
2) Fractional exhaled nitric oxide (FeNO)
(35 ppb or more)
3) Peak flow variability
(Variability over 20%)
Treatment:
1) SABA alone
Maintenance therapy started if:
- Symptoms 3x a week
- Night waking
- Use of SABA 3x a week
2) Paediatric LOW dose of an ICS
If uncontrolled (same symptoms as above)
3) 4-8 week trial of Montelukast (LTRA) or Zafirlukast (12y+)
(6y - 14y = 5mg Chewable)(15y+ = 10mg Oral)
If uncontrolled (same symptoms as above)
4) Stop LTRA and Add LABA - Continue with paediatric low dose ICS
If uncontrolled (same symptoms as above)
5) Change ICS and LABA maintenance therapy to a MART regimen with a paediatric low maintenance ICS dose.
If uncontrolled (same symptoms as above)
6) Increase ICS dose to paediatric moderate dose either in MART or changing to a fixed dose regimen
If uncontrolled (same symptoms as above)
7) Increase ICS dose to a paediatric high dose ONLY AS A FIXED DOSE REGIMEN
OR
TRIAL THEOPHYLLINE w/ Paediatric moderate dose ICS and LABA (can be MART)
What is the NICE guidelines Asthma treatment for Adults? (7)
Diagnosis:
1) Spirometry
(Forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio less than 70%)
2) Fractional exhaled nitric oxide (FeNO)
(40 ppb or more)
3) Peak flow variability
(Variability over 20%)
Treatment:
1) SABA alone
Maintenance therapy started if:
- Symptoms 3x a week
- Night waking
- Use of SABA 3x a week
2) Add LOW dose of an ICS and 4-8 week trial of LTRA (Montelukast or Zafirlukast)
If uncontrolled (same symptoms as above)
3) Add LABA and CONSIDER stopping LTRA if no response
If uncontrolled (same symptoms as above)
5) Change ICS and LABA maintenance therapy to a MART regimen with a low maintenance ICS dose. (with or without LTRA)
If uncontrolled (same symptoms as above)
6) Increase ICS dose to moderate dose either in MART or changing to a fixed dose regimen w/ or without LTRA
If uncontrolled (same symptoms as above)
7) Increase ICS dose to a high dose ONLY AS A FIXED DOSE REGIMEN w/ or without LTRA
OR
TRIAL THEOPHYLLINE w/ moderate dose ICS and LABA (can be MART)
What is the BTS/SIGN guidelines Asthma treatment for Children < 5 years? (4)
1) SABA alone if infrequent short lived wheeze
2) Add VERY LOW dose ICS or LTRA
3) VERY LOW dose ICS and LTRA
4) Increase ICS to LOW DOSE
5) Refer
What is the BTS/SIGN guidelines Asthma treatment for Children aged 5 - 11 years? (7)
1) SABA alone if infrequent short lived wheeze
2) Add VERY LOW dose ICS
3) VERY LOW dose ICS and LABA or LTRA
4) Increase ICS dose to LOW dose with LABA and LTRA
If no response to LABA discontinue
5) Refer
What is the BTS/SIGN guidelines Asthma treatment for > 12 years? (7)
1) SABA alone if infrequent short lived wheeze
2) Add low dose ICS
3) Add LABA to low dose ICS as a combination inhaler
4)
a) Stop LABA if not working and Increase ICS to medium dose
b) Continue LABA and increase ICS dose to medium dose
c) Continue LABA and ICS and trial Theophylline, LAMA, or LTRA
5)
a) Trial high dose ICS
b) Add 4th drug e.g. LTRA, LAMA or Theophylline
REFER
6)
a) Daily steroid tablet
b) High dose ICS
c) Consider other treatments to minimise steroid use
REFER
What are the stages of quitting smoking?
1) Pre-contemplation
2) Contemplation
3) Preparation
4) Action
5) Maintenance
6) Relapse
What are the symptoms of imbalanced electrolytes (K+, Na+, Ca2+,Mg2+)?
Look at picture
Facts about Methadone / Buprenorphine
Look at picture
Missed dose on 2 consecutive days, send to prescribers due to lost tolerance.
More facts about Methadone / Buprenorphine
Look at picture
Missed dose on 2 consecutive days, send to prescriber due to lost tolerance.
What is this and what is the treatment?
Oral Thrush
Miconazole oral gel ( 4 months +)
Refer if difficulty or pain swallowing.
Refer if not improved after 1 week of treatment.
Continue for 7 days after all symptoms have cleared.
Continue for 10 days if using antifungals for nail infections
What is this and what is the treatment?
Ringworm
Scalp (tinea capitis), Body (tinea corporis), Groin (tinea cruris), Hand (tinea manuum), Foot (tinea pedis, athlete’s foot),
Nail (tinea unguium).
Clotrimazole cream
Refer if:
1) Ringworm has not improved after using antifungal medicine recommended by a pharmacist
2) You have ringworm on your scalp – you’ll usually need prescription antifungal tablets and shampoo
3) You have a weakened immune system – for example, from chemotherapy, steroids or diabetes
What is this and what is the treatment?
Warts and Verucas
Salicilllic acid - 2+
Bazuka - 2+
Surrounding area needs to be covered in petroleum jelly.
Could take 3 months to heal
AVOID IN DIABETES
What is this and what is the treatment?
Molluscum Contagiosum
Self limiting in 18 months
