Literally Everything part 2 Flashcards
True of False
Fentanyl patches should only be used in opioid tolerant patient
TRUE
Not suitable for acute pain or in patients whose analgesic requirements are changing rapidly
Risk of fatal respiratory depression in opioid naive patients
True or False
Buprenorphine is only licensed as an adjunct in the treatment of opioid dependence
False
Licensed for pre-medication | intraoperative analgesia | and moderate to severe pain
ACEi and diabetes
May have a specific role in the management of diabetic nephropathy
Therefore ACEi are particularly indicated for hypertension in Type 1 diabetes with nephropathy
You receive a bottle of Methadose 10 mg/ml. The prescription reads 20 ml Methadone daily.
Using a conical measure you pour out 20 mls of Methadose.
Why is this wrong?
Methadose is a concentrate and contains 10 mg/ml of methadone
Therefore needs to be diluted with Methadose diluent before dispensing
Amitriptyline for post herpic neuralgia counselling points
Take at night
Side effects: Drowsiness | Dry mouth | Blurred vision | Constipation | urinary retention | sweating
Don’t stop taking as side effects decrease after some time
Alcohol increases sedative effect
Not licensed so not mentioned in the PIL
If it doesn’t relieve pain in 1 week see GP
70 year old man
Aciclovir 800 mg tabs
1 tablet 5 times a day for 7 days
Has a very painful rash.
Name the condition
Post herpetic neuralgia
Peripheral nerve damage following acute herpes zoster infection => shingles
Care for a feverish child
Encourage fluid Only give food if they want it Watch out for: - dry mouth - no tears - sunken eyes (Signs of dehydration)
Check on child at night from time to time
Avoid too many clothes
Keep them out of school
What is a fever in children <5?
Temperature 38*C or above
Piperazine
Indication
Used to treat threadworms
Does not kill the worms directly, paralyses and dislodges them to be passed out in the stools
In order to ensure complete removal come contain senna
For 3 months +
Avoid in pregnancy
Children should take OM. Adults ON.
Mebendazole
Treatment of threadworms
Stops the worms from absorbing glucose therefore kills the worms.
For 2 years +
Avoid in pregnancy
Single tablet/5 ml spoonful
Repeated after 14 days
Side effects: abdominal pain | diarrhoea | rash
Threadworms treatment counselling points
Recommend for all family members as it is highly contagious.
Dose repeated after 14 days to ensure any eggs that have matured since first dose are eradicated
Personal prevention for Tapeworm
Wear close fitting underwear at night and change them every morning in the bath/shower
Wear cotton gloves at night to avoid collecting the eggs when scratching
Have a bath/shower every morning and wash around the anus to remove any eggs laid by the worm at night
Don’t bite or suck on nails
Don’t share towels
Wash between the nails in the morning and after using the toilet
Environmental prevention of threadworms
Eggs are highly contagious and can survive several weeks outside the body
Therefore vacuum regularly | wet dust | wash toys | change and wash clothes daily | change and wash bed linen and towels
Normal sodium levels
142 mm/L
Normal potassium levels
4.5 mm/L
Normal HCO3- levels
26 mm/L
Normal chloride levels
103 mm/L
Normal calcium levels
2.5 mm/L
Valproate and lamotrigine
INTERACTION
Valproate increases plasma concentration of lamotrigine
Treatment options for IBS
No cure Increase dietary fibre Whole meal bread/cereal Antispasmodics Antimuscarinics Muscle Relaxants
Bismuth subscalicylate
Anti-diarrhoeal agents
Slower acting than loperamide but still effective at reducing the incidence of diarrhoea
Not be given to children < 12 –> risk of Reye’s syndrome
30 ml every 30 - 60 minutes if required, up to a max of 8 doses in 24 hours
Few s/e but can cause black stools
4 examples of when a patients insulin requirements may increase
During infections | stress | accidental or surgical trauma | during puberty
Sulphonylureas can cause hypersensitivity reactions. When would such a reaction typically happen?
In the first 6 - 8 weeks of therapy
Intermediate insulin
onset
peak
Doa
Onset 1 - 2 hours
Peak 4 - 12 hours
DOA 16 - 42 hours
Sinusitis
Often accompany a cold
Pain behind the eyes
- particularly when bending
Nasal congestion and catarrh
Sore eyes and tenderness
Paracetamol dose child
4 - 5
240 mg
Every 4 - 6 hrs
Max 4 doses/day
Beta blockers toxicity
Symptoms: Lightheadedness, dizziness, bradycardia, hypotension
Treatment:
Adequate ventilation
Iv atropine( for bradycardia), if unresponsive inj glucagon in 5% glucose, if glucagon not available then iv isoprenalin
Cardiac pacemaker might be used to increase heart rate
Benzodiazepine toxicity
Symptoms: drowsiness, ataxia, dysarthria, nystagmus, occasionally respiratory depression and coma
Treatment:
Activated Charcoal (within 1 hour if patient awake and airway protected)
Flumazenil (particularly in patients with respiratory disorders)
Alcohol intoxication
Symptoms:
Ataxia, dysarthria, nystagmus, drowsiness, acidosis, hypotension and coma
Rx:
Aspiration of vomit is hazard, measures to reduce its risk
Supportive management, Maintain clear airway
Glucose given if hypoglycaemia
Activated charcoal repeated doses are used for overdosage of which drugs
Carbamazepine Dapsone Phenobarbital Quinine Theophylline
Charcoal should not be used for poisoning of which drugs
Petroleum distillates Corrosive substances Alcohol Malathion Cyanides Metal salts ( e.g lithium and iron)
Hemodialysis is required for toxicity of which drugs
Severely poisoned with any drug Ethylene glycol Lithium Methanol Phenobarbital Salicylates (alkalinisation of urine is also done) Sodium valproate
Paracetamol dose for a child
6 -7
240 - 250 mg
Every 4 - 6 hrs
Max 4 doses/day
Paracetamol dose for a neonate
28 - 32 weeks (corrected gestational age)
20mg/kg for 1 dose then 10 - 15 mg/kg every 8 - 12 hours prn
Max 30 mg/kg/day in divided doses
Note: Oral is unlicensed in < 2 months
Symptoms of Iron Poisoning
nausea Vomiting Abdominal pain Diarrohoea Haematemesis Rectal bleeding Hypotention Hepatocellular necrosis
LATER – severe acidosis
Coma, shock, metabolic acidosis
Digoxin Monitoring Requirements
Serum electrolytes (esp. Potassium)
as the possibility of digitalis toxicity is made worse by hypokalaemia
and RENAL FUNCTION
Warfarin Monitoring requirements
INR and Renal Function
Warfarin Counselling points
Take at the same time each day
Avoid major dietary changes (esp. involving salads and vegetables as it can affect the anticoagulant effect.)
Report any signs of bleeding or spontaneous bruising
Referral Criteria for Constipation
< 2 years
Pregnant
Tried treatment with no success after 5 -7 days
Large amount of blood in stools
Sudden changes in bowel habits with no obvious cause
Frail or elderly
Repeated use of laxatives
Management/suppression of Nausea and vomiting with cytotoxic drugs
Acute (N&V within 24 hrs)
- 5HT receptor antagonist may be of benefit + dexamethasone for someone with high risk emetics
Delayed (N&V > 24 hrs after)
- dexamethasone given by mouth either alone or with metoclopramide
Anticipatory (N&V prior to subsequent doses)
- Lorazepam helpful for amnesiac/sedative and anxiolytic effects
Treatment of Highly active relapsing remitting multiple sclerosis not recommended for patients with known risk of CV event she and why?
Fingolimod
- Known to cause transient bradycardia and heart block after first dose
Not recommended in certain patient groups who are high risk for cv event unless anticipated benefits outweigh the potential risk
Require cardiologist advice
Common side effects exhibited by most cytotoxic drugs
Oral mucositis Tumour lysis syndrome Hyperuricaemia Bone marrow suppression Alopecia Thromboembolism Nausea and vomiting
Remember these do not occur at the time of administration but days or weeks later
Management/ suppression of Oral Mucositis with cytotoxic drugs
REMEMBER PREVENTION IS MORE EFFECTIVE THAN TREATMENT
Good oral hygiene
- keep mouth clean and moist helps prevent mucositis
For 6 month +
- brushing teeth with a small soft brush and fluoride toothpaste 2 - 3 times a day
For < 6 months
- Oral sponge moistened with water or diluted anti-microbial solution (chlorohexidine)
Mucositis can be very painful and may require opioid analgesia
Treatment of cytotoxic induced urothedial toxicity
Mesna
Given by mouth but also IV
Injection can be given orally by placing contents of the ampule into a flavoured drink. Orange juice or cola
- can be stored in the fridge for up to 24 hrs in a sealed container
Signs of urothelial toxicity?
Haemorrhage cystitis
- blood in the urine
- bladder pain
- Irritative bladder symptoms
Results from damage to the bladders epithelium and blood vessels
Tacrolimus and grapefruit juice
INTERACTION
grapefruit juice is reported to increase the blood level of tacrolimus and should be avoided
Monitoring and tests for patients on Tacrolimus?
Initial post transplant/on a routine basis:
BP | ECG | Neurological | Visual status | Fasting blood glucose | Potassium | LFTs | renal | Haematology parameters | coagulation values | plasma protein
After initial dosing:
FBC regularly, doses adjusted accordingly
Trough concentration should be monitored closely especially during bouts of diarrhoea
How should oral Tacrolimus capsules be taken?
- Administration in 2 divided doses (morning and evening)
- Taken immediately following removal from the blister
- Swallow whole with water
- On an empty stomach 1hr before food or 2 - 3 hrs after food
- Can also be given via nasogastric tubing emptying capsule in water
What is the active ingredient in:
BurnEze
Benzocaine
Antibacterial considered safe for treatment of UTI in pregnancy
Penicillins
Cephalosporins
Nitrofurantoin –> Avoid at term
Which patients are more likely to be allergic to penicillins?
Patients with a history of atopic allergy
- asthma | eczema | hay fever
N|B: individuals with a history of anaphylaxis, urticaria, or rash immediately after penicillin administration are at risk of immediate hypersensitivity to a penicillin and these individuals should not receive a penicillin
Jaundice Symptoms
Yellowing of skin Yellowing of whites of eyes Itchy skin Pale stools Dark urine odor heavy stools
What is the chance a penicillin allergic patient also also being allergic to cefotaxime
0.5 - 6.5%
What antibiotic is likely to cause a patient with undiagnosed glandular fever to develop a maculopapular rach?
Amoxicillin/Ampicillin
Broad spectrum penicillins should not therefore be used for the blind treatment of sore throats
Treatment for suspected bacterial meningitis
Benzylpenicillin sodium
IV/IM
If penicillin allergic
- Cefotaxime
If also cephalosporin allergic
- Chloramphenicol
Antibacterials to avoid during pregnancy
Sulfadiazine
Quinolones
- ciprofloxacin
Is gentamicin orally active?
No
None of the aminoglycosides are absorbed from the gut
Although there is a risk of absorption in inflammatory bowel disease and liver failure
Therefore must be given by injection for systemic infections
When should a child with otitis media be treated with antibiotics?
In children without systemic features after 72 hrs if no improvement
Earlier if there is deterioration
- if patient is systemically unwell
- if at high risk of serious complications, those on immunosuppressants/cystic fibrosis
- if mastoiditis present
- if under 2 yrs and bilateral
Which 2 side effects are most frequently associated with the use of aminoglycosides and are dose related?
Ototoxicity (ear)
and Nephrotoxicity
occur mostly in elderly patients and in renal failure
Oral Tacrolimus prescription requirements
Must be prescribed by brand ONLY
switching is associated with reports of toxicity and graft rejection
A patient is given tacrolimus oral capsules for prophylaxis of graft rejection.
The patient wants to know how long they will be taking this medication for?
No limit to the duration of oral therapy can be given.
This would need to be a discussion between the patient and specialist should the request to cease medication be made
Treatment of non-complicated lower UTI in women
Nitrofurantoin MR 100 mg BD for 3 days
Alternative:
- Amoxicillin/ampicillin or oral cephalosporin for 7 days but a short course 3 days is usually adequate
If a patient has had a reaction to one penicillin should they be prescribed another?
No.
If allergic to one, they will be allergic to all because hypersensitivity is related to the basic penicillin structure
What is the advantage of giving co-amoxiclav rather than amoxicillin alone?
co-amoxiclav consists of amoxicillin and clavulanic acid.
Clavulanic acid is a beta-lactamase inhibitor, by itself it has no significant activity but by inactivating beta-lactamases it makes the combination active against beta-lactamase producing bacteria that are resistant to amoxicillin.
Usually reserved for infections likely or known to be caused by amoxicillin resistant beta lactamases producing strains
Treatment cascade for Diabetic patients with metformin intolerance
1 - sulfonylurea
hbA1c > 6.5%
2 - +DPP-4 inhibitor or thiazolidinedione
hbA1C > 7.5%
3 - Start insulin
hbA1C > 7.5%
4 Increase insulin dose and intensify regimen overtime
consider pioglitazone if:
- thiazolidinedion previously had marked glucose lowing effect
- Blood glucose control inadequate with high dose insulin
Alendronic acid counselling points
Should be swallowed whole with plenty of water while sitting or standing
Patient should remain sitting or standing for 30 minutes after taking the tablet
Take on an empty stromach 30 minutes before breakfast or any other medicine
Once weekly dosing (on the same day each week)
If they develop dysphagia, new or worsening heart burn, pain on swallowing STOP TAKING
If patient develops gastroenteritis whilst taking desmopressin,
Should they continue taking the medication?
No
Stop until fluid balance is normal
Diabetes stepwise treatment
- Lifestlye interventions -
if HbA1C >6.5% or individually agreed target
1- metformin (active dose titration
HbA1C >6.5
2 + Sulfonylurea (OD if adherence problem
HbA1C > 7.5%
3 + Insulin (Active dose titration) Particularly if the person is markedly hyperglycaemic
HbA1C > 7.5 %
4 Increase insulin dose and intensify regimen overtime
consider pioglitazone if:
- thiazolidinedion previously had marked glucose lowing effect
- Blood glucose control inadequate with high dose insulin
When is a sulfonyurea first line in diabetes?
if metformin is not tolerated or is contraindicated
if a rapid therapeutic response is required because of hyperglycemic symptoms
patient is NOT overweight
Possession of a schedule 1 CD…
Requires a home office licence.
However pharmacists can handle sch 1 CD such as cannabis in:
- possession for the purpose of destruction
- Possession for handing to the police (remember to maintain confidentiality. however is the quantity is so large that the drug could not possibly be used purely personally, it may be in public interest to identify the source)
Also remember that the patient has to give permission for the drug to be removed and destroyed.
If the patient refuses the pharmacist may call the police and under no circumstances can it be handed back to the patient
Name the ways in which a person/an organisation lawfully possess CDs
- Home office licence
enables the possession and supply of CDs in accordance with the terms of the licence (museums) - Home office group authority
enables possession and supply of CDs in accordance with the terms of group authority (paramedics operate under this) - Depending on the class of the drug
- On prescription
Why can pharmacists, doctors and dentists possess, supply and procure CDs schedule 2, 3, 4, and 5
The 2001 regulations under a general authority
Name some Schedule 4 (CD Benz POM or CD Anab POM)
Schedule 4 CD Benz POM
- Diazepam | Zopiclone | Sativex (a cannabinoid oral mucosal mouth spray)
Schedule 4 Anab POM
- anabolic and androgenic steriods and growth hormones
Name some Schedule 3 CDs
CD No Register POMs include
- Minor stimulant and other drugs
Buprenorphine | Temazepam | Tramadol | Midazolam | Phenobarbital
less likely to be misused and less harmful if misused than those in Sch 2
Name some Schedule 2 CDs
Pharmacists have a general authority to posses and supply and obtain
- Opiates
diamorphine | morphine | Methadone | oxycodone | pethidine - Major stimulants (amfetamines)
Quinalbarbitone and ketamine
Name some Schedule 1 CDs
CD Lic POM
Most sch 1 drugs have NO THERAPEUTIC USE
Licence required for their:
- Production
- Possession
- Supply
Include: Hallucinogenic drugs (LSD), ecstasy type substances, raw opium and cannabis
Roles and Responsibilities of the accountable officer
- Oversight of the monitoring and auditing of the management, prescribing and use of CDs
- Ensuring that systems are in place for recording concerns and incidents involving CDs and the operating of these systems
- Attending local intelligence Network meetings
- Submission of occurrence reports which describe the details of any concerns the organisation has had regarding the management of CDs
- Appointing an authorised witness for the destruction of CDs
Who is the enforcement body for CD offences?
The home office via the police
patient presents and request treatment for her son who is 8 years old.
He has had the flu for a couple of days and is now complaining of very painful spots in his mouth.
He is taking Carbimazole 10 mg OD but he’s been on it for quite a while and the mother doesn’t think it has anything to do with it.
what do you think?
Likely to be caused by the Carbimazole
inform the patient to contact the Dr immediately
After how many doses should the aminoglycoside serum concentration be measured?
Assuming normal renal function measure after 3 - 4 doses of a multiple daily dosing regimen and after a dose change.
Patients with renal impairment may require earlier and more frequent measurement
How long should a patient receive aminoglycosides for?
7
Which groups of diuretics should not ideally be given with aminoglycosides?
What if unavoidable?
Loop diuretics
–> as they are potentially ototoxic
e.g. Furosemide
administration of the aminoglycosides and the diuretics should be separated by as long period as possible
Antimalarials poisoning
SYMPTOMS:
Arrhythmias and convulsions
Overdosage of quinine, chloroquine and hydroxychloroquine is extremely hazardous
Seek urgent advice from NPIS
Calcium channel blocker toxicity
Symptoms:
NV, dizziness, agitation, confusion, acidosis and hyperglycaemia
Rx:
Activated charcoal
Calcium chloride or calcium gluconate (if severe)
Atropine (for bradycardia)
Very severe cases, insulina and glucose infusion
When should blood samples be taken for patients on a multiple daily dosing regimen of an aminogycoside?
1hr after IM or IV (peak)
and just before next dose (trough)
What is the recommended treatment for gastro-enteritis?
Nothing
Usually self limiting
Which side effect of isoniazid can be prevented by giving pyridoxine 10mg/day?
Peripheral neuropathy
More likely if there are pre-existing risk factors e.g. Diabetes | alcohol dependence | chronic renal failure | malnutrition | HIV
Signs to look out for whilst on long term use of trimethoprim and why?
Signs of blood disorders - seek immediate medical attention if develop:
Fever
Sore throat
Rash
Mouth ulcers
Purpura (spontaneous bleeding into the skin)
Unexplained bruising or bleeding
What antibiotic is not given to children under 12 and why?
Tetracyclines
It deposits in growing bone and teeth by binding to calcium causes stating and occasionally dental hypoplasia
Symptoms of Tuberculosis
Fatigue Malaise Fever Weight loss/anorexia Failure to thrive Pyrex is of unknown origin Chronic productive cough lasting more than 3 week some. May or may not contain blood Worsening shortness of breath
Patient has been prescribed the following:
- Isoniazide
- Ethambutol
- Pyrazonamide
- Rifampicin
What infection is it for? And what phase of treatment are they in? And what is the duration of treatment?
For concurrent use of 4 drugs is the INITIAL PHASE and is designed to reduce the bacterial population as rapidly as possible and prevent the emergence of drug resistant bacteria.
Treatment lasts 2 months
What antibacterial prophylaxis is recommended for a patient who has sustained a bomb blast injury where a flying piece of metal has penetrated through and out of their leg causing a fracture?
Co-amoxiclav or cefuroxime or metronidazole
Stat dose of gentamicin during the initial operation (repeated if septic during subsequent operations)
Continue IV until wound closure OR until no planned return to theatre
Complete a 6 week course of oral co-amoxiclav after conversation from IV antibiotics
Which patients MUST have their serum aminoglycoside concentration measured?
Should be done for all patients
MUST be done for
- neonates
- elderly
- the obese
- those with cystic fibrosis
Or if high doses are being given
Or I find there is renal impairment
Symptoms of hepatic disorders patients and careers need to be advised to look out for when they are taking isoniazid
Persistent nausea, vomiting, fever, malaise, jaundice
Unexplained deterioration during treatment
Patient counselling for iron tablets
- you are likely to be on these for a while. They don
Not provide and immediate fix but you should start to feel better and have more energy over the coming weeks - when your iron level is back to normal you will need to continue therapy for about 3 months to replenish your iron stores
- it might cause diarrhoea or constipation therefore increasing your fluid and fibre and exercise my help
- your stools are likely to turn black but this is normal
- best to take after food
Should iron tablets be taken before or after food?
After
Although best absorbed on an empty stomach they may be taken after food to reduce GI effects
4 patient groups who require prophylactic iron to prevent iron deficiency anaemia?
Pregnant women After sub/total gastroectomy Haemodialysis patients Low birth weight infants Menorrhagia Poor diet Malabsorption
Why would the pharmacist be concerned if a patient who had tendinitis last month presented with a prescription for ciprofloxacin?
Ciprofloxacin is a quinolone
Tendon da ache - including rupture - has been reported rarely in patients receiving quinolones.
May occurs within 48hrs of starting treatment
Cases have also been reported several months after stopping quinolones
Situations when systemic therapy is recommended for skin and nail infections
If topical therapy fails
If many areas are affected
If the are of infection is difficult to treat such as the nail and scalp
Safe system requirements for cytotoxic medicines
Cytotoxic drugs should be given a part of a wider pathway of care co-ordinated by a multiple disciplinary team
Cytotoxic drug should be prescribe drugs dispensed Andy administered only in the context of a written protocol or treatment plan
Injectable cytotoxic drugs should only be dispensed if they are prepared for administration
Oral cytotoxic drugs should be dispensed with clear directions for use
Why must pregnancy be excluded in women of child bearing age prior to starting treatment with lenalidomide?
Relatesded to thalidomide therefore there is a risk of teratogenesis
Every prescription MUST be accompanied by a completed Prescription Authoristaion Form
Pregnancy to be excluded before, effective contraception for 1 month before, for the duration of the treatment and for 1 month after.
The same applies to men, if their partner isn’t pregnant or not using effective contraception
Which medicine for malignant disease have had the side effects of keratitis and ulcerative keratitis reported due to their usage?
Cetuximab
Erlotinib
Gefitinib
Panitumumab
Metronidazole counselling points
- Do not drink alcohol while taking this medicine and for 2 days after
- space doses every throughout the day
- keep taking until the course is finished unless you are told to stop
- swallow whole, do not break or chew
- take with a full glass of water
- no additional precautions required when combined oral contraceptives is used
A 3 year old is prescribed
Nirofurantoin suspension 75 mg at night
What USB the indication?
UTI Prophylaxis
Probably following hospital administration for a serious UTI
State the indication for the following prescription:
- Metronidazole 500 mg BD for 5 days
Bacterial Vaginosis
Rifampin
Inducer or inhibitor?
inducer
Should fluconazole be prescribed in pregnancy?
Manufacturer advices to avoid
- multiple congenital abnormalities reported with long term high doses
A stat dose of fluconazole for thrush is therefore unlikely to cause any harm, however other preparations acre available and known to be safe
But if a woman has taken a dose of fluconazole before discovering she was pregnant you could reassure her that it would be unlikely to have an effect
What’s is Disulfram?
Used as Ann adjunct in the treatment of alcohol dependence(under expert supervision)
Gives rise to an extremely unpleasant systemic reaction after the injection of even a small amount of alcohol because it causes the accumulation of acetaldehyde in the body
Symptoms include:
Flushing of the face | throbbing headache | palpitations | tachycardia | nausea | vomiting
When is metronidazole given?
As an alternative to penicillin where the patient is allergic or the infection isn’t due to beta lactase producing anaerobes
Metronidazole and breastfeeding
The BNF states the significant amounts of metronidazole enter the breast milk,
Manufacturer advices to avoid large single doses, may give milk a bitter taste
Should not be given unless essential and avoid high dose short course treatment
Counselling points for Sporanox oral liquid
Sporanox is itraconazole
- do not take with food
- swish around the mouth and swallow, do not rinse mouth afterward
- space doses evenly throughout the days
- keep taking this medicine until the course is finished unless you are told to stop
- take this medicine when your stomach is empty. This means a hour before foo or two hours after food
- Patients should be told how to recognise signs of liver disorder and advise to seek prompt medical attention
(anorexia | nausea | vomiting | fatigue | abdominal pain | dark urine)
Rifampicin and contraception advice for patients
Whilst on Rifampicin long-term, the combined oral contraceptive pill will be less effective therefore an additional barrier method will need to be adopted to prevent any unwanted pregnancies.
An IUD is always recommended or progesterone only contraceptives
Since enzyme activity does not return to normal for several weeks after stopping an enzyme inducing drug, appropriate contraceptive measure are required for 4 weeks after stopping
Patches and Vaginal Rings are NOT RECOMMENDED
What are the symptoms of vaginal candidiasis?
- vulval itching
- vulval soreness and irritation
- pain/discomfort during urination
- discomfort during coitus
- vaginal discharge
( not always present, the discharge is usually odourless, can be thin and watery or think and white like cottage cheese )
Bomb blast victims must receive which accelerated vaccination course if they sustain injuries where the skin has been cut?
And when should they be tested to check their response to the vaccine?
Hepatitis B
At 3 months to determine hepB status
What are Gentamicins upper and lower limits for peak and trough serum concentrations for an adult patient with endocarditis?
Peak: 3 - 5 mg/L (1 hr post dose)
Trough: < 1 mg/L (pre-dose)
6 year old treated for primary nocturnal enuresis with Desmopressin 200 mg at bed time.
Why should the child avoid excessive drinking
Risk of hyponatraemic convulsions
Fluid overload warning - including during swimming
Symptoms of penicillin hypersensitivity
Rashes | Anaphylaxis | Death
Allergic reactions to penicillins occur in 1 a 10% of exposed individuals
Anaphylaxis in less than 0.05%
Make sure to check allergy status with every patient that gets an antibiotic prescription
What is the recommended dose of cefaclor for a 6 month old child with a severe infection?
40 mg/kg in 3 divided doses - max 1 g/day
Or 125 mg TDS
Uncomplicated genital chlamydia treatment
Doxycycline for 1 week
Single dose of azythromycin
When should antiviral treatment be initiated in Herpes zoster infections (shingles)?
Within 72 hrs of the onset of the rash and usually continues for 7 - 10 days as it can reduce the severity and duration of pain, reduce complications and reduce viral shedding
