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Pre-reg Exam > Low weight topics. > Flashcards

Low weight topics. Flashcards

1
Q

What is the treatment for arthritis?

A

DMARDs+ temporary corticosteroid

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2
Q

Which medicines are DMARDs?

A

Sulfasalazine (blood disorders)
Penicillamine (blood disorders)
Gold (blood disorders)
Hydrocychloroquine/ chloroquine (ocular toxicity)

Drugs affecting immune response:
methotrexate, azathioprine, ciclosporin, leflunamide

cytokine modulators:
Infliximab, etanacept (blood disorders, TB- treat first)

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3
Q

How is acute gout managed?

A

NSAIDs: diclofenac and naproxen first line (NOT ibuprofen/aspirin)
2nd line: colchicine (if NSAIDs contraindicated e.g in HF)

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4
Q

How is gout managed long term?

A

Allopurinol (take with food)
Febuxostat (causes serious hypersensitivity reactions like SJS)

DO NOT them during an attack, wait 1-2 weeks first.
Continue NSAID/ colchicine for 1 month after hyperuricemia corrected if starting on allopurinol as they may precipitate an attack.

However, if attack occurs while on them, continue as normal and treat attack.

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5
Q

What is myasthenia gravis?

A

Skeletal muscle weakness

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6
Q

What are some key side effects of quinine?

A

QT prolongation, convulsions, arrhythmias.

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7
Q

What drug options are there for spasticity (skeletal muscle relaxants)?

A

Baclofen- avoid abrupt withdrawal. Care with intrathecal use, you need a test dose + resuscitation available.

Others: dantroline, tizanidine, cannabis, diazepam.

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8
Q

When do the analgesic and inflammatory effects of NSAIDs take effect?

A

analgesic effect within 1 week

inflammatory effect within 3 weeks

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9
Q

Which NSAID is the drug of choice for inflammation?

A

Naproxen

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10
Q

Which medical conditions may be worsened by use of NSAIDs?

A

Asthma- bronchospasms.
HF- fluid retention- contraindicated.
Hypertension

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11
Q

Which NSAID has restricted use due to increased GI side effects and serious skin reactions?

A

Piroxicam - max 20mg OD

Prescribe with concomitant GI protective agent.

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12
Q

Which NSAIDs are lowest and highest risk of GI toxicity?

A

Lowest: COX-2 inhibitors (e.g celecoxib), ibuprofen

Highest risk: Ketoprofen, proxicam

Give with PPI if >45 or if NSAID is for arthritis and take with food to minimise this.

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13
Q

Which NSAIDS are at highest and lowest risk of cardiovascular events?

Which cardiovascular events?

A

Highest risk- high dose ibuprofen 2.4g OD, COX-2 inhibitors, diclofenac.

Lowest risk: low dose ibuprofen and naproxen

Increased risk of thrombotic events (MI and stroke)

NOTE: NSAIDS are contraindicated in HF.

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14
Q

Can NSAIDs be used in pregnancy?

What happens?

A

No- especially third trimester.

Delays labour
Causes pulmonary hypertension in newborn
Premature closure of foetal ductus arteriosus.

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15
Q

What are some side effects of NSAIDs?

A 
Bleeds (especially GI)
Fluid + sodium retention- oedema 
Asthma exacerbation
Nephrotoxicity
Cardiovascular events
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16
Q

Which medicine when used with NSAIDs can cause convulsions?

A

Quinolones- e.g cipro.

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17
Q

NSAIDs can reduce excretion and hence cause toxicity of which high risk drugs?

A

Methotrexate and lithium.

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18
Q

Which medicine can cause reversible female infertility?

A

NSAIDs

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19
Q

When should eye drops be discarded?

A

After 28 days if at home
After 1-2 weeks if in hospital
Single use only if outpatient/ surgery.

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20
Q

Which medicines can stain contact lenses orange?

A

Rifampicin and sulfasalazine.

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21
Q

If using more than one eye drop how long should a patient wait between applications?

A

5 minutes

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22
Q

What is glaucoma?
How is it managed?
Do the medicines have any side effects?

A

Raised intraocular pressure

1st line: beta blocker drops e.g timolol (C/I in asthma)
or
prostaglandin drops e.g latanoprost (can cause long eyelashes and darker iris colour/ dark flecks in the eye)

2nd line: sympathomimetic drops e.g brimonidine
carbonic anhydrase inhibitors e.g dorzolamide . Acetazolamide can be given systemically but it can cause blood and skin reactions- STOP.

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23
Q

What do you know about systemic chloramphenicol?

A

Serious haematological side effects.

AVOID in pregnancy- grey baby syndrome

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24
Q

What is closed angle glaucoma?

A

A medical emergency!

Cloudy eye, N+V headache, intense eye pain, rainbow coloured rings around lights.

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25
How can otitis external be managed?
Topical preparations such as neomycin and clioquinol can be used- 7 days. Acetic acid 2% (ear calm) can also help. NOTE: aluminium is an astringent and also helps as an anti- inflammatory.
26
How can otitis media be managed?
Usually self limiting. | Can give oral amoxicillin if no improvement after 72 hours.
27
What is in naseptin and bactroban?
naseptin- neomycin | bactroban- mupirocin (for MRSA)
28
What is the MHRA associated with emollients?
Fire risk with paraffin- based skin emollients. | Clothing/ bedding easily ignited by naked flames, do not smoke.
29
What can Benzyl alcohol cause in neonates?
Fatal toxicity syndrome
30
When can topical corticosteroids be used? When are they contraindicated?
Used in inflammatory skin conditions: eczema, dermatitis. Contraindicated in: acne, rosacea, skin infections (exacerbates them) NOTE: apply maximum BD
31
Which are the mild, moderate, potent, very potent steroids?
Very potent: clobetasol (dermovate) Potent: Betamethasone 0.1% (betnovate) hydrocortisone butyrate mometasone (elocon) Moderate: clobetasone (eumovate) betamethasone 0.025% (betnovate- RD) Mild: hydrocortisone <2.5%
32
What medicines are used for eczema and psoriasis?
``` emolients topical steroids coal tar ( long contact overnight) dithranol (short contact 5-60 minutes) Tacrolimus (Protopic) ``` Psoriasis: UVB therapy, system methotrexate, cyclosporin, acitretin.
33
What MHRA alerts are associated with brimonidine? | What is it for?
For rosacea Risk of systemic cardiovascular effects Risk of exacerbation of rosacea
34
What medicines can be used for acne?
1st line: adapaline (retinoid) +/- bezoyl peroxide azelaic acid topical- clindamycin ``` Oral- oxytetracycline, lymecycline, trimethoprim co cyprindiol (women only) ```
35
What are the PPP terms for isotretinoin supply?
Negative pregnancy test on script Prescription valid only 7 days Max 30 days supply Cant give as emergency supply without negative pregnancy test.
36
What are side effects of tretinoins?
Teratogenic - contraception during and 1 month after stopping. Hyperlipidemia - contraindicated Pancreatitis- STOP ASAP Hepatotoxicity psychiatric disorders- STOP Photosensitivity- Avoid UV light and use high factor sunscreen. NOTE: avoid waxing, laser etc during + 6 months after treatment.
37
Which contraceptives are not effective with tretinoin use?
Progestogen only
38
What is the MHRA advice associated with tretinoins?
Erectile dysfunction and decreased libido
39
What are lower limb infections spreading around a wound likely to be?
Cellulitis
40
How should impetigo be managed?
Bacterial: Fusidic acid (5 days) If extensive: Oral flucloxicillin or Clarithromycin (7 days) If MRSA: mupirocin.
41
How should scabies be managed?
1st line: permethrin 8-12 hours 2nd line: malathion 24 hours Apply to whole body Treat all members of household simultaneously Second application within a week of the first Itch can last after treatment- use crotamiton. (topical steroids and antihistamines also help) Ivermectin used for Norwegian scabies.
42
How is headlice managed?
** Only treat if live lice 1st line: wet combing or Dimeticone (Hedrin) Isopropyl myristate (full marks) Malathion (Derbac M) Risk of burns if hair exposed to flames Contact time 8-12 hours Two applications a week apart. Wet combing- 4 times over 2 weeks. No lice on 3 consecutive questions. NOTE: Permethrin (lyclear) is not recommended as 10 mins contact time is not enough to be effective.
43
Which immunisations are needed at birth for at risk neonates?
BCG (TB) and hep B
44
Which immunisations are needed at 2 months (8 weeks)?
6PMR 6in1- diphtheria, tetanus, pertussis, hep B, polio, haemophillus Pneunococcal Meningitis B Rotavirus (oral)
45
Which immunisations are needed at 3 months (12 weeks)?
6R 6in1- diphtheria, tetanus, pertussis, hep B, polio, haemophillus (dose 2) Rotavirus (dose 2)
46
Which immunisations are needed at 4 months (16 weeks)?
6PM 6in1- diphtheria, tetanus, pertussis, hep B, polio, haemophillus (dose 2) ``` Pneumococcal (dose 2) Meningitis B (2nd dose) ```
47
Which immunisations are needed at 1 years (12- 13 months)?
Harry Makes Mummy Pretty Mad ``` Haemophillus + Meningitis C (combined) Meningitis C (booster) MMR Pneumococcal (booster) Meningitis B (booster) ```
48
Which immunisations are needed between 2-8 years old?
Flu vaccine each year from September (nasal spray recommended)
49
Which immunisations are needed between 3 years and 4 months (40 months) - 5 years old?
MMR (dose 2) DTPP (6 in 1 without Hs)- diphtheria, tetanus, polio, pertussis (booster)
50
Which immunisations are needed between 11-14 years old (12- 13 in England)?
HPV
51
Which immunisations are needed between 13- 15 years old?
Meningitis ACWY DTP- diphtheria tetanus polio (booster)
52
Which immunisations are needed at 65 years old?
Pneumococcal Flu vaccine each year from September
53
Which immunisations are needed at 70 years old?
Varicella zoster (shingles)
54
In which allergy can you not give the flu jab?
egg allergy
55
When should live vaccines be avoided?
Immunocompromised patients
56
What is the paracetamol dose for post immunisation fever?
2 months+ weighing over 4kg: 60mg (2.5ml) asap 60mg repeated 4-6 hours later if needed. Max 2 doses in 24 hours (4 doses if >4 months)
57
What is the ibuprofen dose for post immunisation fever?
3 months+ weighing over 5kg: 50mg(2.5ml) asap 50mg repeated after 6 hours if needed. Max 2 doses (100mg) in 24 hours.
58
What is the difference between vaccines and immunoglobulins?
Vaccines stimulate the immune system to produce antibodies (pre-exposure prophylaxis) Immunoglobulins contain antibodies already and are given post exposure to the infection.
59
Which vaccination affects the Mantoux test for TB?
MMR Wait 4 weeks post MMR before doing the test.
60
Which vaccine leaves a scar which is fine and means that the vaccine has worked?
BCG (TB)
61
When should infants have all live vaccines postponed until 6 months old?
Exposure to TNF-a- inhibitors in utero from the mother. | Examples: monoclonal antibodies.
62
Which vaccine should be offered to pregnant women and when?
Pertussis (whooping cough) | At 16-32 weeks gestation.
63
Via which parenteral route are vaccines given?
IM or deep subcut. NOT IV.
64
What may the MMR vaccine cause?
Post- vaccination aseptic meningitis. Complete recovery normally follows. idiopathic thrombocytopenia purport. Usually within 6 weeks f dose. NOTE: not linked to autism or bowel disease.
65
Which drug is used for reversal of neuromuscular blockade of anaesthetics?
Anticholinesterases: | Neostigmine
66
What are antimuscarinics used for in surgery?
Atropine, glycopurronium | To reduce secretions in intubation.
67
What should be given with inhalation anaesthetics?
Oxygen minimum 25% at all times to prevent hypoxia.
68
Which drugs should NOT be stopped before surgery?
``` Antiepileptics antiparkinsons antipsychotics bronchodilators Cardiovascular meds (except K+ sparing diuretics) Corticosteroids Immunosuppressants thyroid and anti-thyroid meds ```
69
Which drugs should be stopped before surgery and when?
``` Combined oral contraceptives- 4 weeks HRT- 4-6 weeks before MAOIs- taper down 2 weeks before TCAs (cause hypotension) Lithium - 24 hours before K+ sparing diuretics ACE/ARBs/ diuretics- day of surgery AKI risk Antiplatelets Warfarin- 5 days before INR <1.5 Insulin- start VRII ```
70
Which poisons have a delayed toxicity effect?
paracetamol, iron, aspirin, TCAs
71
At what systolic BP is there a risk of irreversible brain damage?
<70mmHg
72
When can activated charcoal NOT be used for poison reversal?
iron, lithium, cyanides, alcohol.
73
What do you know about alcohol toxicity?
causes hypoglycaemia Reverse with: gastric lavage (stomach pump)
74
What does aspirin toxicity cause and how is it reversed?
Tinnitus, deafness, sweating Activated charcoal and if plasma conc >700mg/L, haemodialysis.
75
What does opioid toxicity cause and how is it reversed?
Pinpoint pupils, coma, respiratory depression Naloxone
76
What does paracetamol toxicity cause and how is it reversed?
N+V, liver necrosis, renal necrosis Activated charcoal, acetylcisteine if 4-15 hours post and plasma conc on or above the treatment line.
77
What is the dosing of acetylcisteine?
>40kg patients only 3 infusions over 21 hours- dose based on weight chart. 1st: drug + 200ml 5% glucose over 1 hour 2nd: drug + 500ml 5% glucose over 4 hours 3rd: drug + 1L 5% glucose over 16 hours
78
What does TCA toxicity cause and how is it reversed?
dilated pupils, acidosis, coma, respiratory depression, delirium, arrhythmias Activated charcoal, treat acidosis.
79
What does benzodiazepine toxicity cause and how is it reversed?
drowsy, ataxia, nystagmus, respiratory depression flumazenil, activated charcoal
80
What does beta blocker toxicity cause and how is it reversed?
bradycardia, hypotension Treat bradycardia and cariogenic shock: atropine, isoprenaline, glucagon
81
What does iron toxicity cause and how is it reversed?
N+V, haematemesis, rectal bleeding Desferrioxamine
82
What does lithium toxicity cause and how is it reversed?
N+V diarrhoea, coma Haemodialysis, stomach pump, bowel irrigation
83
What does stimulant (amphetamines, cocaine, ecstasy) toxicity cause and how is it reversed?
dilated pupils, arrhythmia diazepam for restlessness/ seizures
84
What does theophylline toxicity cause and how is it reversed?
severe vomitting, arrhythmia, seizures, severe hypokalaemia Activated charcoal, ondansetron, K+ supplements
85
How is cyanide toxicity reversed?
dicobalt (toxic) sodium nitrite + sodium thiosulfate hydroxocobalamin (cyanosis only)
86
What does anaesthetic toxicity cause and how is it reversed?
Light headedness, paraesthesia (pins and needles), blurred vision, numbness, tremors, convulsions Intralipid 20% (cardiovascular stability)

Pre-reg Exam (15 decks)

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