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Low weighted and MISC chapter > Low Weighted > Flashcards

Low Weighted Flashcards

1
Q

What is a local anaesthetic

A

Local - lidocaine or bupivacaine (longest duration of action)

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2
Q

General IV- ( Propofol,thiopental,Etomidate, ketamine)

A

Propofol - rapid recovery, low hangover effect
Thiopental - rapid onset, fat soluble so longer hangover effect
Etomidate - rapid recovery, no hanging effect
Ketamine - less hypotension, slow recovery, Hugh psychoactive side effects

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3
Q

General Anaesthesia- inhalation

A

Volatile liquids - isoflurane,desflurane,sevoflurane and nitrous oxide

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4
Q

Vaccines (active immunity)- live attenuated

A

Measles,mumps,rubella

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5
Q

Vaccines (active immunity)-inactivated

A

Meningococcal

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6
Q

Vaccines (active immunity)-inactivated toxins

A

Tetanus and diphtheria

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7
Q

Viral vectors

A

COVID 19- Astra zeneca

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8
Q

Nuclei acid

A

COVID 19 PFIZER AND MODERNA

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9
Q

Live vaccines should not

A

Be given during pregnancy

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10
Q

Vaccine intervals

A
  • Different inactivated vaccines can be given at any interval to each other
  • same inactivated vaccines need a minimum of 4 week interval
  • minimum 4 week interval between varicella zoster and MMR (Can be given on the same day)
  • Minimum 4 week interval between yellow fever and MMR - can’t be given on the same day
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11
Q

1 Year

A

Measles,Mumps, rubella (MMR)
Haemophilias influenza B+ meningococcal C
Meningococcal B , pneumococcal

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12
Q

3 years and 4 months

A

Measles,mumps and rubella
Diphtheria,tetanus,pertussis,poliomyelitis

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13
Q

11-14 years

A

Human papilloma virus
(2nd dose 6-24 months after 1st dose)

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14
Q

Pregnant females

A

Diphtheria,tetanus,pertussis+poliomyelitis (1 dose from the 16th week) influenza vaccine

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15
Q

Scabies - look like what???

A

-Red spots with silvery interlinking lines - usually in webbing of fingers/toes
- apply malathion or permethrin twice - 1 week apart
- apply to whole body including scalp,neck,face and ears
- treat ALL famil members
- avoid physical contact with other family members

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16
Q
A

Scabies

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17
Q
A

Scabies

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18
Q

Where are you most likely to get scabies?

A

folds of skin between fingers and toes
wrists
underarm area
waist
groin
bottom

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19
Q

Headlice

A
  • live moving lice with white eggs distributed
  • Wet combing - combing for 30 mins at 4 day intervals till no lice is found for 3 sessions (min 2 weeks)
  • dimeticone - apply for 8 hours to dry naturally - repeated after 7 days
  • malathion - apply 12 hours to dry naturally - repeated after 7 days (avoid in severe eczema or asthma due to alcohol contents)
  • benzoyl bento ate and permethrin - not recommended
    MHRA - SOME PREPS FLAMMABLE
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20
Q
A

HEADLICE/NITS

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21
Q

ECZEMA- what is used in mild to mod and mod to severe - topically?? What is used in refractory severe?? Systemic?)

A

Dry,flaky, skin - small red spots
Min types of irritant, allergic contact and atopic
Emollients- either to apply or as a bath or shower emollients
- topical corticosteroids - can be used (mild steroid for face or genitals
- anti histamines - not in atopic dermatitis
Mild - mod= pimecrolimus
Mod-sev - tacrolimus
- severe refractory eczema - systemic medication: cyclosporine, mycophenolate mofetil, moAbs

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22
Q
A

Eczema

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23
Q
A

Eczema

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24
Q
A

Eczema

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25
Q
A

Eczema

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26
Q

Psoriasis

A

Skin thickening and silvery white scaling,raised and larger patches and plaques. Systemic,immune -mediated inflammatory skin disease - can be in the joints too

-emollients
-topical corticosteroids
-coal tar preparations
- vitamin D - topical Analogues

Where topical treatment has failed
- phototherapy - UVA/UVB through trained professional
- systemic treatment - methotrexate,cyclosporine or acitretin (2nd line)

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27
Q
A

Psoriasis

28
Q

Topical corticosteroids

A

Mild - hydrocortisone
Moderate - closet as one
Potent - betamethasone
Very potent - clobetasol

Prolonged use= skin thinning
Apply thinly
Do not apply to broken skin

29
Q

ACNE - MHRA warning?? ISO warning??

A

MHRA - rare erectile dysfunction and decreased libido - treatment for under 18 needs to be approved by two prescribers
PPP- Pregnancy prevention program for isotretanon because of its tetrogenic nature
- contraception taken 1 month before and till 1 month after
- each prescription limited to 30 days
Risk of neuropsychiatric reactions - seek medical attention in mood changes
- avoid UV light, laser skin treatment, Derma ration and epilation

30
Q

Less severe and first line treatment

A
  • adaplene
  • benzoyl peroxide
    Clindamycin
  • Lyme/doxycycline
  • erythromycin
31
Q

Scalp and hair conditions

A

Dandruff (seborrheic dermatitis)
- treat with anti microbial - pyrithione zinc, selenium, tar extracts
- more persistent or severe dandruff - ketoconazole shampoo
-psoriasis of the scalp - coal tar and salicylic acid

Hirsutism - hormonal or due to drugs
- weight loss can reduce this in women
- can treat with laser therapy, eflornithine or co-cyprindiol
A;opecia
- finasteride and minoxidil

32
Q
A

Angioedema - anaphylaxis

33
Q
A

Angioedema -

34
Q
A

Acne

35
Q
A

Atopic eczema

36
Q

Chilblains

A

Chilblains often get better on their own without treatment.

Things you can do to help your symptoms

A soothing lotion, such as calamine or witch hazel, can help relieve itching. A pharmacist can give you advice about the right product for you.

you have chilblains and your skin has not got any better after 2 to 3 weeks
there is pus coming out of your skin
your temperature is very high or you feel hot or shivery
you keep getting chilblains
your chilblains are severe
you have diabetes and have chilblains – foot problems can be more serious if you have diabetes

37
Q

Chilblains

A
38
Q
A

Seborrhoea dermatits

39
Q
A

Seborrhoea dermatits

40
Q

MHRA warning

A

Epimax Ointment and Epimax Paraffin-Free Ointment can harm the eyes if used on the face. Do not prescribe these ointments for use on the face. Tell patients to wash their hands and avoid touching their eyes after using these products.

41
Q

Nasal Rhinitis and congestion

A

Rhinitis - sprays and drops
- sodium chloride, antihistamines,corticosteroids,ipratropium and xylometazoline
- not to be used for prolonged periods of time ( 7 days)
- can be used in pregnancy - low systemic absorption

Nasal polyps - review by ent specialist - use nasal corticosteroid

Nasal staphylococci-
Naseptin (contains peanuts) or mupirocin

  • naseptin has changed its formulation -removing Arachis oil (peanut oil). However, both the original formulation containing Arachis oil and the revised formulation without Arachis oil will be in circulation in the supply chain until November 2025.
42
Q

Glaucoma

A

Most common form - open angle glaucoma
- due to restricted drainage of the aqueous humour through trabecular mesh work leading to ocular hypertension

Treated with topical prostaglandin analogues (latanoprost,tafluprost, tavoprost, bimaprost)
- if initial prostaglandin analogues hasn’t worked, try different one
- if doesn’t work, topical beta blocker : betoxolol,levobutunolol or time lol
If that doesn’t work carbonic anhydride inhibitors - brinzolamide or dorzolamide
Brimonidine and piclocarpine can also be used

43
Q

Prostaglandin Analogues

A

Latanoprost. Tafluprost, tavoprost or bimaprost

Dry eyes
Ocular discomfort
Change to eye colour
Hyperpigmentation of periocular skin
Darkening, thickening and lengthening of eye lashes

44
Q

Rheumatoid arthritis

A

Chronic systemic inflammatory disease affecting joint synovial membrane

45
Q

RA pain and stiffness

A

Worsens wire rest, inactivity and heat in joints
Symptoms - nodules,swelling, tenderness, malaise, fatigue, fever and weight loss

Non drug therapy - physiotherapist, exercise, relaxation and stress management

46
Q

DMaRDs - Drug therapy RA

A

FISRT LINE - Methotrexate,leflunomide or sulfasalazine(hydroxychloroquine in mild)
SECOND LINE - MoAbs - adalimumab,infliximab,toclizumab,baricitinib
- Bridge with corticosteroids when rapid suppression is needed

NSAIDs can be used in pain relief - withdraw when response to DMARDS is enough

47
Q

Methotrexate

A
  • Taken ONCE weekly
  • prescription and label should clearly show the dose and frequency
  • methotrexate is commonly co- prescribed with folic acid, not to be taken on the same day as each other
  • patient should be advised to immediately report any signs of blood disorder, liver toxicity and respiratory effects
48
Q

Methotrexate side effects

A

Blood disorders: Sore throat, bruising and mouth ulcers
Liver tocity - nausea,vomiting, abdominal discomfort, dark urine, jaundice, itchy skin

Pulmonary toxicity - SOB and coughing

Gastrointestinal toxicity - stomatitis and diarrhoea

49
Q

Methotrexate toxicity antidote

A

FOLINIC ACID
Calcium folinate

50
Q

Methotrexate monitoring and screening

A

Full blood count, renal function test, liver function test:
- every 1-2 weeks until stable
- every 2-3 months thereafter

Screen out pregnancy prior to treatment:
- antifolate - harmful to foetus growth
- use effective contraception during treatment and for at least 6 months after for both men and women

51
Q

MTX interactions

A
  • nephrotoxic drugs: mtx reduced renal function
  • NSAID = nooooo
    Antifolates: trimethoprim and phenytoin
  • hepatotoxic drugs: Rfiampicin, antfungals etc
    Omeprazole and esomeprazole:
  • reduced clearance = increases toxicity
52
Q

Hyperuricaemia and gout

A

Raised Uric acid concentration in the blood - hyperurucaemia and the deposition of irate crystals in the joints and other tissues

Can be caused by -
- diet (high salt intake)
-medication
-bendroflumethazide
- chemotherapy drugs

53
Q

Treatment of acute gout

A

Started treatment as soon as possible
- treat with colchicine or high doses of an NSAID and PPI (Excluding aspirin)
- colchicine 500 mcg 2-4 times max 3 days - do not repeat course within 3 days

NSAIDs induced fluid retention (interaction with diuretic)

Alternative -
- short course of oral corticosteroid
- IM injection of corticosteroid or canakinumab

54
Q

Treatment of chronic gout

A
  • offered in frequent acute attacks of gout (2 or more in a year)
  • uric acid may be reduced with xanthine - oxidase inhibitors

First line- allopurinol
Second line - febuxostat - caution with febuxostat patients with history of cardiovascular disease

If acute attack happened during treatment - continue chronic treatment as well as treating the attack separately

55
Q

Allopurinol

A

When starting,flare- prophylaxis with colchicine/ NSAID is recommended
Common side effect- rash - discontinue if mild but restart carefully but discontinue immediately if recurrence

Interaction - allopurinol +azithropine/meracartopurine
Reduce dose of aza/merc

56
Q

Nocturnal Leg cramps

A

Quinine sulfate - may reduce the frequency of nocturnal leg cramps

Potential toxicity - quinine is not routinely recommended - use if cramps regularly disrupt sleep and are very painful or other treatment hasn’t worked

Trial for 4 weeks - if there is benefit - continue

Stop treatment every 3 months and assess need for further treatment

57
Q

Pain and inflammation

A

NSAID: analgesic and anti inflammatory - use in pain related to inflammation ( eg.rheumatoid arthritis,back pain and soft tissue disorders)

Contraindicated in asthmatic patients

58
Q

High risk

A

GI = Piroxicam, ketoprofen,ketorolac

CVD - COX-2 Selective inhibitors, ibuprofen 2.4 g, diclofenac

59
Q

Medium risk

A

GI- Idometacin,diclofenac,naproxen

60
Q

LOW

A

GI-Ibuprofen

CVD - Naproxen, ibuprofen 1.2g

61
Q

Lowest

A

GI = cox 2 selective inhibitors

62
Q

Cox -2 - selective inhibitors

A

Celecoxib, etoricoxib

63
Q

Pain and inflammation - NSAIDS

A
  • NSAID + low dose aspirin = increase GI bleed risk (use only if needed)
  • NSAIDS and alcohol - increase GI bleed risk
  • Use stomach protection PPI
  • Hypersensitivity reactions - cross sensitivity with aspirin too
  • avoid in renal impairment - risk of fluid retention and further impairment
  • avoid in pregnancy - caution in breastfeeding
64
Q

Interactions - NSAIDS

A

MTX/LITHIUM- Reduces clearance
Ciprofloxacin = increases risk of seizure
Blood thinners = increases risk of bleeding
Drugs which causes hyperkalaemia - hyperkalaemia
Drugs which cause renal failure - acute kidney injury

65
Q

FOETAL GROWTH

A

CAUTION WITH NSAID FROM 20TH WEEK

66
Q

PHOTOSENSITIVITY

A

METHOTREXATE

Low weighted and MISC chapter (5 decks)

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