Literally Everything Flashcards
Name the Category 1 Anti-epileptics
Primidone
Phenytoin
Phenobarbital
Carbamazepine
What are the common causes of a chronic cough?
Asthma Pneumonia Bronchitis COPD TB Lung Cancer ACEi
Customer comes in to the pharmacy and request Day Nurse to help with his cold. He’s never had it before but heard it was good from a friend.
Current Medication:
- Bisoprolol 5mg OD
Do not give!
Day Nurse contains pseudoephedrine.
Bisoprolol is a beta blocker.
Increased risk of hypertension.
Recommended for the treatment atrial flutter with structural heart defects or after heart surgery
Amiodarone
or
Sotalol
Which Beta Blockers tend to cause less Bradycardia?
Caliprolol
Acebutolol
Pindolol
Oxprenolol
What is Simeticone and what is it used for?
An anti-foaming agent used to prevent flatulence
- hiccup relief in palliative care
- licenced for infantile colic/wind pain
What is sotalol?
a non-Cardioselective BB, with Class III antiarrhythmic activity.
Which is more effective in the treatment of sustained ventricular tachycardia:
lidocaine or sotalol
Sotalol
How do Beta Blockers work as anti-arrythmics?
By attenuating the effects of the sympathetic system on automaticity and conductivity within the heart
What is Exocrine Pancreatic Insufficiency?
reduced secretion of pancreatoc enzymes into the duodenum.
Manifests as:
- maldigestion and malnutrition
(low circulating micronutrients, fat-soluble vitamins and lipoprotiens)
- Diarrhoea, abdominal cramps etc
Why do we not abruptly stop antiepilects?
Abrupt withdrawal can cause severe rebound seizures
particularly with barbiturates
barbiturate withdrawal may take several months
Enzyme Inducers
Carbemazepine Rifampicin Alcohol Phenytoin Griseofulvin Phenobarbital St Johns Wort` (Barbiturates, Smoking, Primidone, Topiramate, Ritonavir, Rifabutin)
CSM Warning for Pancreatin
The use of high strength preparations has been associated with the development of large bowel strictures (fibrosing colonopathy) in children with cystic fibrosis aged between 2 - 13 yrs
What is Digoxin?
A cardiac glycoside
Digoxin Indications
Atrial Fibrillation
Tachycardia
Heart Failure
How does Digoxin work?
as a positive inotrope
–> Increases the force of myocardial contraction and reduces conductivity within the AV node
Side Effects of:
Digoxin
Nausea Vomiting Diarrhoea Dizziness Blurred Vision
Desired Serum Concentration of:
Lithium
0.4 - 1 mmol/L
> 1.5 mmol/L may be toxic and fatal
Recommended for the treatment atrial flutter without structural heart defects or after heart surgery
D.C. shock or Cardiac pacing.
Drug treatment not necessary
Main counselling point to a 28 year old woman prescribed Basiliximab
woman of child bearing potential should use adequate contraception to prevent pregnancy, and continue to use it for an additional 4 months after the last dose of Basiliximub.
They should also not breast feed for 4 months after the last dose.
Lithium counselling points
Maintain adequate fluid intake
Avoid dietary changes which reduce or increase sodium intake.
Which Beta Blockers are water soluble?
celiprolol
Atenolol
Nadolol
Sotalol
less likely to enter the blood brain barrier, therefore less likely to cause sleep disturbances and nightmares
How are water soluble Beta blockers excreted?
Via the kidneys
dose reduction is often needed in renal impairment
Names some bisphosphonates
Alendranate | Risadronate
Bisphosphonates indication
Secondary prevention of osteoparatic fractures in susceptible post-menopausal women.
Raloxifene indication
For those who can not take bisphosphonates or who have suffered a fragility fracture despite treatment for a year and have a decline in bone marrow density (below pre-treatment level)
What is Teriparatide?
Parathyroid hormone fragment, used in osteoporosis.
for woman >65, who can’t take bisphosphonates (or for who bisphosphonates have failed) and have:
- extremely low bone marrow density
or
- low bone marrow density, suffered more than 2 fractures, BMI < 19 and premature menopause
Prevalence of G6PD deficiency?
Africans
Asians
South Europeans
Define MCV
and state normal range
The average volume of a red blood cell.
Normal: 80 - 100fl
Possible causes of a high MCV
Methotrexate toxicity
Folic acid deficiency
Normal white blood cell count
4 - 11 x10^9 /f
Causes of abnormal white blood cell count
High WBC could indicate::
- infection
- person is on steriods
Low WBC could indicate:
- Methotrexate harming bone marrow
Normal Platelet Count
150 - 400 x10^9/L
Possible cause of abnormal platelet count
Low platelet count could indicate:
- Methotrexate harming bone marrow
Normal Lymphocyte Count
1.5 - 4.0 x10^9/L
What is:
Bendroflumethiazide
its indication and side effects
Moderately potent Thiazide Diuretic
Indicated in Mild-Moderate Heart failure and Hypertension
Side Effects:
GI disturbance | postural HTN | Hypokalemia | Hyponatremia | Gout | Hypercalcemia
Time of on set and duration of action of
Bendroflumethiazide
Acts within 1-2hrs
Lasts 12 - 24 hrs
Define:
Hypercalcaemia
Excess calcium
> 3.5 mmol/L
Can cause renal damage and cardiac arrest
Causes Hypercalcaemia
Malignancy with bone marrow Thyrotoxicosis Hyperparathyroidism Thiazides Lithium Tamoxifen
What may a raised ALT/AST indicate
Liver inflammation
Define high Serum Urea, and what it could indicate
> 10 mmol/L
Could indicate renal failure, dehydration, high dietary protein intake, hypercatabolic state or haemorrhage.
Note: further tests are required to give more accurate assessments
If renally impaired, all drugs with significant renal excretion needs to be assessed
Normal Urea range
2.5 - 8 mmol/L
varies with age
Normal Creatinine range
60 - 125 micromol/L
varies with age
What are the parameters of Renal function in terms of creatinine clearance?
Normal > 90 ml/min/1.73m^2
Mild 60 - 90 ml/min/1.73m^2
Moderate 30 - 59 ml/min/1.73m^2
Severe 15 - 29 ml/min/1.73m^2
Established Renal Failure < 15 ml/min/1.73m^2
Why should we eradicate Helicobacter Pylori?
To reduce recurrence of gastric and duodenal ulcers and the risk of re-bleeding
For zolmitriptan orodispesible 2.5 mg tablets why is:
“Repeat the dose after 2 hours, if you experience no relief from the first dose” Inappropriate advise?
Because if a patient does not respond to the first dose it is unlikely that a second dose will benefit the same attack
HLA-B ISO2 allele is tested in which patients before starting on which medication, for what reason?
Tested in Han Chinese of Thai patients
Before starting on Carbamazipine or Eslicarbazepine
Due to risk of Steven Johnson Syndrome if test is positive.
What is Steven Johnson Syndrome?
is a rare, serious disorder of your skin and mucous membranes. It’s usually a reaction to a medication or an infection. Often, it begins with flu-like symptoms, followed by a painful red or purplish rash that spreads and blisters
Carbemazipine monitoring requirements?
Optimum response with a plasma concentration:
4 - 12 mg/L
(20 - 50 micromol/L)
measured after 1 - 2 weeks
Blood Counts
LFTs
Renal Tests
Treatment of Febrile Convulsions
Brief Convulsions - No specific treatment
Paracetamol to reduce fever and prevent further convulsions
Prolonged Convulsions ( > 5 minutes)
as for convulsive status epilepticus
IV Lorazepam
Treatment of non-convulsive status epilepticus
Urgency depends on severity of the patients condition
If:
- incomplete loss of awareness:
Usual oral antiepileptic therapy should be continued or restarted - Failure to respond or complete lack of awareness:
IV Lorazepam
Patient has convulsive status epilepticus. What would you give first: IV: Diazepam or Lorazepam
Lorazepam
diazepam is effective but comes at a high risk of thrombophlebitis
What regulations apply to Selegeline?
Driving regulations apply as it is converted to amfetamine
Treatment of Status Epilepticus
- Position patient to avoid injury
- Give O2
- Maintain BP
- Correct any hypoglycemia
(Give thiamine if alcohol abuse is suspected)
> 5 minutes
Give IV lorazepam
(Repeat once after 10 minutes if seizures reoccur or if fail)
> 25 minutes
Phenytoin or phenbarbital
> 45 minutes
Anesthesia w/ thiopental, midazolam or propofol
when is Acetazolamide used in epilepsy?
when the epilepsy is associated with menstruation
What is Clobazam and what is it used for?
A benzodiazepine.
used as adjunctive therapy in generalised tonic-clonic and refractory focal seizures.
Zonisamide Indications
Focal seizures with or without secondary generalisation in adults with newly diagnosed epilepsy
Valporic Acid Indications
Acute mania associated with bipolar disorder
Sodium Valporate indications
Tonic Clonic seizures particularity in primary generalised epilepsy
focal seizures
Generalised absence seizures
Sodium Valporate monitoring
LFTs and FBCs
Topiramate Indications
Alone or as adjunctive treatment in generalised tonic-clonic seizures or focal seizures with or without secondary generalisation
Prophylaxis of migraine
Rufinamide Indications
Adjunctive treatment of seizures in Lennox-Gastaut
At risk groups for Flu Vaccine
> 65 years Pregnant Diabetic Heart Disease Lung Disease Kidney Disease Neurological Disease Weakened Immune System
Referral Criteria for:
Cold and Flu
if patient: has COPD is Asthmatic is Immunocompromised has chronic kidney and heart disease
Difference between Cold and Flu
Cold
- gradual onset over 1 - 2 days lasting 7 - 14 days
(cough can persist for 2 weeks)
Flu
- Rapid onset of symptoms in hours - peak in winter
Fever | muscle/joint pain | Chills and Sweats
FEV1/FVC ratio <0.7
Indicates airflow obstruction
If FEV1:
< 30%
very severe COPD
if FEV1:
30 - 49%
indicates severe COPD
if FEV1:
50 - 80%
indicates moderate COPD
if FEV1:
> 90%
Indicates mild COPD
What is Desmopressin and when is it used?
A Vasopressin Analogue
used in the treatment of pituitary (Cranial) diabetes insipidus
and the differential diagnosis of diabetes insipidus
Which is more potent?
Vasopressin or Desmopressin
Demopressin
Which has a longer duration of action?
Vasopressin or Desmopressin
Desmopressin
Which causes vasoconstriction?
Vasopressin or Desmopressin
Vasopressin
How is the Flu treated?
- Rest, keep warm, drink plenty of fluids
- Take Paracetamol to lower fever
- Take Ibuprofen to relieve aches
N|B: Antibiotics are NOT required - Flu is viral not bacterial
- Antivirals to reduce symptoms/shorten duration
When should antivirals for the Flu be started? and what are they?
Should be started within 2 days of flu symptoms for high risk groups
Tamiflu (Oseltamivir) BD 5 days
Relenza (Zanamivir) 2 puffs BD 5 days
Seretide Evohaler
Whats in it?
Whos it for?
MDI of Fluticasone + Salmeterol
ICS + LABA
licenced for use in Asthma only
Seretide Accuhaler
Whats in it?
Whos it for?
DPI of Fluticasone + Salmeterol
ICS + LABA
Seretide 100 & Seretide 250 licenced for asthma only
Seretide 500 is for both asthma and COPD
Sybicort Turbohaler
Whats in it?
Whos it for?
DPI of Budesonide and Formoterol
ICS + LABA
100/6 licenced for asthma only
200/6 and 400/2 licenced for both asthma and COPD
Fostair 100/6
Whats in it?
Whos it for?
MDI
Beclometasone + Formoterol
for asthma and COPD
SIde Effects of Inhaled Steriods and how to prevent them
- Hoarse voice
Use a spacer - Oral Thrush (candidiasis)
Rinse/gargle mouth with water after use - Reflex cough
Inhale slowly/Use spacer
What interacts with steriods?
Antieplictis
- Carbemazipine | Phenobarbital | Phenytoin
Antifungals
- Ampholericin | Ciclosporin
Antivirals
- Ritonavir
Vaccines
SABA and LAMA interactions and side effects
increased risk of hypokalemia with:
- Theophyline
- Steroids
- Diuretics
S/E:
hypokalemia | Tachycardia | Tremors | Anxiety
Rescue Medication
Oral antibiotics Amoxicillin 500 mg - 1 g TDS or Clarythromycin 500 mg QDS or Doxycycline 200 mg on day 1 then 100 mg OD
AND
Oral Prednisolone 30 mg/day for 7 - 14 days
Signs of well controlled asthma and COPD
no day/night symptoms
no limitation on activity
no exacerbation
no need for rescue medication
Difference between asthma and COPD
Asthma Symptoms worse at night There's usually a trigger Good bronchodilator response Wheezing on expiration Starts in children/infants
COPD > 35 Smoker / Ex-smoker SOB persistent and progressive Poor bronchodilator response
CSM Warning for Terfenadine
An antihistamine
Rare hazardous arrhythmias are associated with terfenadine particularly associated with increased blood concentration
Therefore:
- Do not use more than the recommended dose
- Avoid in significant hepatic impairment/hyperkalaemia
- Avoid use with drugs that prolong QT interval/inhibit terfenadine metabolism
Antihistamines
uses
For allergies
Reduce rhinorrhea and sneezing
(less useful for nasal congestion)
Good for urticaria
Side Effects for Antihistamines
Dizziness | Drowsiness | Palpitations | Arrythmias | Hypotension | EPS | Hypersensitivity
Antihistamine Cautions
Old antihistamines: Prostatic hypertrophy | Urinary Retention | Glaucoma | Pyloroduodenal obstructions
New antihistamines: Hepatic Impairment | Epilepsy | Children and the elderly
Leukotriene Receptor Antagonists
Warning
Montelukast | Zafirlukast
Churg Strauss Syndrome has been associated with LRA use
In many cases reaction followed reduction/withdrawal of therapy.
Be alert to vasculitic rash, worsening pulmosary symptoms or cardiac complications
Corticosteriods and Asthma
Very effective
Recommended for prophylaxis of asthma when patient is using SABA > 3x/week and has disturbed sleep > 1 week
Regular use < risk of exacerbations
Alleviation of symptoms 3 - 7 days
ORAL steroids are for acute asthma attacks
Corticosteriods and COPD
May reduce exacerbations in COPD but no improvement in lung function
Which is more effective in asthma?
Beclometasone
Budesonide
or
Fluticasone
TRICK QUESTION
They are equally effective
Codeine and Coughing
for DRY cough
Will cause drowsiness and constipation. Limited use due to its additive nature
SHOULD NOT BE RECOMMENDED to patients
NOT TO BE SOLD TO < 18 years or breast feeding mothers
Cause of clostridium difficile infection
Can be the result of antibiotic therapy.
Particularly with:
- Ampicillin
- Amoxicillin
- Co-amoxiclav
- 2nd and 3rd Generation Cephalosporins
- Clindomycin
- Quinolones
Clostridium Difficile Treatment =
Metronidazole
Vancomycin
or
Fidaxomicin
Antimuscarinic Side Effects
Constipation
Transient Bradycardia
(followed by tachycardia, palpitations and arrhythmias)
Reduced bronchial secretions
Urinary urgency and retention
Dilation of pupils with loss of accommodation
Photophobia
Dry mouth
Flushing/Dryness of skin
Colestyramine interacts with..
Coumarins
BLACK DOT
what the heck is Colestyramine used for, how is it taken and what are its effects?
Diarrhoea and Pruitus
4g OD
Its not absorbed in the GI tract. Binds to bile acids forming an insoluble complex in the intestine
However it interferes with the absorption of fat soluble vitamins (A, D, K ) and folic acid
Supplements may be needed
Other drugs taken 1hr before or 4 - 6 hrs after
Ursodeoxycholic acid counselling point
Take at bed time or in divided doses (depending on weight)
Take WITH or AFTER food
May cause nausea, vomiting, diarrhoea
Avoid excess cholesterol and calories
Antacids decrease absorption so leave a 2 hour gap between
Name some thiazide diuretics
Bendroflumethiazide Chlortalidone Indapamide Metolazone Ximpamide
Duration of action
Thiazide Diuretics
12 - 24 hours
Ursodeoxycholic acid indication and side effects
Acts on the gall bladder to dissolve gall stones
Limitedd to use in patients where other techniques are ineffective
Which beta blocker is safe for use in pregnancy?
Labetolol
Name some Aminosalicylates
Mesalazine (must be prescribed by brand)
Sulfasalazine
Balsalazide
Counselling points for Aminosalicylates
Report any unexplained bruising or bleeding, sore throat, fever or malaise (blood disorders)
Colours Urine ORANGE
Stains contact lenses
Mesalazine (must be prescribed by brand)
Sulfasalazine
Balsalazide
Which PPI can be used in Pregnancy
omeprazole
Misoprstol indication/dose
Benign Ulcers/NSAID associated ulcer
200mg QDS
for >18 years
Best for the elderly of frail where NSAIDs can’t be stopped
Can cause spontaneous abortion in pregnant women
Can cause severe diarrhoea - STOP
Rivastigmine
indication and dose
Mild - moderate dementia (Alzheimers and Parkinsons)
Initially 1.5 mg BD increase every 2 weeks according to response and tolerence to 3- 6 mg BD
if treatment interrupted for more than several days, retitrate from 1.5 mg BD)
High Compression bandages
Used for the management of gross varices, post thrombotic venous insufficiency, venous leg ulcers and gross oedema in average sized limbs
Their use calls for expert knowledge inappropriate application can be hazardous
(cause necrosis leading to amputation )
Doppler testing required before treatment with compression bandages
Treatment of sinusitis
pain killer and decongestants
Phenytoin counselling points
- For the prevention of epileptic seizures NOT cure
- Take WITH or AFTER food
- Do not stop taking unless instructed by your doctor
- If you get a fever or rash or mouth ulcer unexplained bruising or bleeding seek medical help
- Can’t drive until seizure free for 1 year
How to take Alginantes
take AFTER FOOD and all medication
Less effective when taken lying down, therefore H2 antagonists may be more effective for night time symptoms
Tell me about Cardiac glycosides
Digoxin | Digitoxin
Used for heart failure | Supraventricular Arrythmias
S/E: nausea | vomiting | Diarrhoea | Dizziness | Blurred/Yellow Vision | Rash
Has a long half life
Renal function important for dosing
Special Care taken with the elderly
Beware of DIGITALIS TOXICITY
True or False
Buprenorphine is only licenced as and adjunct in the treatment of opioid dependence?
FALSE
Also licensed for premeditation
Intra-operative analgesia
Moderate - Severe pain
Centrally acting anti-hypertensives
Clonidine | Methyldopa | Monoxidine
Licenced for mild to moderate hypertention when thiazides, beta blocker, ACEi and CCBs are not appropriate or have failed to control BP
How can we reduce the risk of dependence on Benzodiazepines?
- use short course treatment (2 - 4 weeks only)
- Only used for severe and disabling conditions or for patients in extreme distress
what type of dependence is it for a patient on daily diazepam?
physical and psychological
True or false
Subcutaneous diamorphine is preferred to IM morphine in palliative care
TRUE
diamorphine is more soluble than morphine and can be given in a smaller volume
