M+M Drugs/ Examinations Flashcards
Name 5 general side effects of antipyschotics?
Weight gain, dizziness, drowsiness, headaches, stomach upset, memory problems, fatigue, motor (parkinsonain etc)
What are the two very serious side effects of antipyschotics?
Agranulocytosis - fever, rash, sore throat
Neuroleptic malignant syndrome- Hyperthermia, tachycardia, hypotension, seizures
SSRI’s - How/ how often do you take?
Tablet OD
SSRI - Length of tx
Stop 6 months after better but taper off
SSRI - Time to working
4-6 weeks
SSRI - SE’s to counsel (5)
2 weeks (GI disturbance and increased anxiety)
Low sex drive
Dry mouth
Drowsiness
SSRI - Tests and monitoring (1)
Review in 2 weeks
SSRI -
Contraindications (2)
Suicide risk
Past psych illness
Heart conditions (long-QT)
SSRI - Supplementary advice (2)
www.mind.org.uk
Don’t stop abruptly
Methotrexate - How to take (3)
Once weekly tablet
(Injection also available)
- Folic acid on other day
Methotrexate - Length of treatment
Long term
Methotrexate - Time to working
1 to 3 months
Methotrexate - Tests (details and frequency) - (4)
FBC, U+E’s, LFT’s
Baseline
@2weeks til stable
2-3 monthly
Methotrexate - Side effects (3)
Alopecia
Headaches
GI Disturbance
Methotrexate - Complications (3)
Pulmonary toxicity - SOB
Liver toxicity - Warn about alcohol
Myelosuppresion- Warn about infections (if you do get an infection then stop AB’s)
Methotrexate - Contraindications (3)
Immune deficiency
Pregnant/ breast feeding
Hepatic impairment
Methotrexate - Supplementary (3)
No NSAIDS, aspirin
Get flu jab annual
Arthritisresearch.org.uk
Lithium - How to take? (2)
Tablet, capsule or syrup
OD or BD
Lithium - Length of treatment
Long term
Lithium - Time to working
1-2 weeks
Lithium - Tests at baseline (4)
FBC, U+E, TFT’s, ECG
Lithium - Monitoring (3)
Check after 5 days
Then every week till stable for 4 wks
Then every 3 months
Lithium - Side effects (4)
GI (abdo pain/ nausea)
Metallic taste
Fine tremor
Water symptoms (thirst, polyuria, oedema)
(plus lithium toxicity)
Lithium - Complications to warn about (3)
Lithium toxicity (GI symptoms, ataxia, drowsiness)
Renal toxicity
Hypothyroidism
Lithium - Contraindications (4)
Pregnancy/ breastfeeding
Problems with heart
Problems with kidneys
Problems with thyroid
Lithium - Supplementary (1)
www.bipolaruk.org.uk
Atypical anti-psychotics - Mechanism for patients
Schizophrenia causes over-activity of chemicals which transmit messages in the brain
Medication helps block some of these messages
Atypical anti-psychotics - How to take
Tablet OD or depot injection (weekly)
Atypical anti-psychotics - Length of treatment
Quite a while, we want you to be stable and keep you there
Atypical anti-psychotics - Time to working
Immediately but may not feel full effects for a few days to weeks
Atypical anti-psychotics - tests
Occasional LFT’s
Atypical anti-psychotics - Important side effects (3)
Weight gain
Movement problems
Drowsiness
Atypical anti-psychotics - complications (2)
Neuroleptic malignant syndrome (fever and stiff muscles)
Agranulocytosis (sore throat, rash, infection)
Atypical anti-psychotics - contraindications (2)
Liver failure
Pregnancy (caution- risk benefit)
Levodopa - Mechanism for patients
Works to replace dopamine in your brain
As bits of your brain have stopped making it in PD
Levodopa - How to take
Tablet 3-4x daily with food
Levodopa - Length of treatment
For as long as keeps working, after 5 years most see end dose deterioration
Levodopa - Time to working
Immediately but a few days to a few weeks to see full effects
Levodopa - Tests
None
Levodopa - Important SE’s (3)
Psychosis and mania
N+V
Movements you can’t stop (dyskinesias)
Levodopa - Complications (1)
End dose deterioration and on off effects
Levodopa - Supplementary info
www.parkinsons.org.uk
Bisphosphonates - Mechanism
Stops your body breaking bone down and helps it to build bone back up
Bisphosphonates - Supplementary advice
Exercise, stopping smoking and eating a good diet are all just as important
Bisphosphonates - How to take (4)
Either weekly tablet or smaller dose daily
With full glass of water
At least 30 mins before food and stay upright for at least 30 mins
Bisphosphonates - Length of treatment
Long term
Bisphosphonates - Baseline tests (1)
Dental checkup (risk of osteonecrosis of jaw)
Bisphosphonates - Important SE’s (3)
Headache
Heartburn, bloating or indigestion
GI upset (diarrhoea)
Bisphosphonates - Complications (1)
Osteonecrosis of jaw
Bisphosphonates - Contraindications (3)
Pregnancy
Dysphagia
Stomach ulcers
Diazepam - Contraindications (3)
Respiratory depression
Neuromuscular weakness
Pulmonary insufficiency
Pyschosis
Diazepam - Indications (5)
Muscle spasms Anxiety Agitation Insomnia Panic attacks Alcohol withdrawal
Diazepam - How to take?
Oral tablet TDS
Or IM injection
Diazepam - Time to working?
Immediate
Diazepam - Tests?
None
Diazepam - Important SE’s (3)
Drowsiness
Confusion
Lightheadedness
Diazepam - Complications (2)
Muscular weakness (SOB) Dependence
Steroids - What are they?
Steroids naturally occur in your body and help your dampen down your immune system. When we give you steroid tablets we’re just giving you more of what your body already has to help it fight your immune system.
Note they are not the same as the steroids body builders use
Steroids - How long to take for and chance of side effects?
Short course <2weeks = Unlikely SE’s
Long course >2weeks = Possible SE’s
Steroids - Side effects (9)
1- Weight gain (via appetite increase) 2- Increased risk of infection (look out for it) 3- Increase risk diabetes 4- Increase blood pressure 5- Hair thinning 6- Skin thinning, bruising, poor healing, stretch marks 7- Mood and behaviour changes 8- Stomach ulcers (give with PPI) 9- Osteoporosis
Steroids - How to stop
Don’t stop suddenly if been taking for more than 3 weeks
Steroids - Symptoms of withdrawal (3)
Weak and tired
Nausea and vomiting
Abdo pain and diarrhoea
Name the 9 steps of a parkison examination
1) General inspection - Walking aids etc
2) Gait - Stooped, shuffling, festinating, reduced arm swing
- Pull test
FACE
3) Glabellar tap
4) Speech
5) Poverty of expression
ARMS
6) Tremor exam (rest, action should improve) - distract
7) Akinesia (thumb to fingers, play piano)
8) Tone and rigidity
FUNCTION
9) Write, handle coins
Name the framework of an Ank Spond examination
(Normal spine plus plantar fascitis, Achilles tendonitis, shoulder and hip for peripheral arthritis)
What are the components of spine exam? (6) - Specific detail for Feel and Special tests
General inspection
Gait
Look
Feel (paraspinal muscles, vertebral bodies, SI joints)
Move
Special tests (Back against wall - AS, schobers, straight leg raise, femoral nerve stretch)
What are the components of an opthalmoscope examination? (9)
1- General inspect (glasses, scars, discharge, swelling, redness) 2- Lighting comment 3- Red reflex 4- Warn closeness 5- Disc (nasal, CCC) 6- Quadrants 7- Look into light (Macula) 8- Repeat other eye 9- Summary (neuro exam, testing VA, fields, movements, reflexes)
Name fundoscopy examination findings in diabetic eye disease (4)?
Dot and blot haemorrhages
Cotton wool spots
Hard exudates
Microaneuryms
Name fundoscopy examination findings in Glaucoma? (1)
Large cup
Name fundoscopy examination findings in Papilloedema? (1)
Lost contour of disc
Name fundoscopy examination findings in Central Retinal Venous Oclusion? (2)
Haemorrhage and exudates
Name fundoscopy examination findings in Central Retinal Artery Oclusion? (1)
Cherry red spot
Name fundoscopy examination findings in AMD? (1)
Drusen deposits
What should be check in an examination of CNII?
3 Acuity (Snellen, colour, near) 3 Reflexes (D/C, RAPD, accomodation) 3 Fields (Gross, finger test, blind spot) 1 Opthalmoscopy
What should be tested for CN3/4/6?
Draw H with red pin
Accomodation
What is seen in a R trochlear nerve palsy?
On left gaze the right eye will be too far up (as superior oblique failed)
What is seen in a L occulomotor nerve palsy?
L eye points down and out, can’t adduct L eye
What is the function the inferior oblique muscle?
Elevates eye and turns laterally
What is the function of the superior oblique muscle?
Depresses eye and turns eye laterally
What components of the trigeminal nerve should be tested?(5)
Fine sensation (3 branches) Offer pinpick sensation Muscles of mastication Offer jaw jerk reflex Offer corneal reflex
What are the components of a test of CN8?
Whisper test
Rinne’s
Weber’s
Romberg
In a hand examination which nerve is being tested with wrist and finger extension?
Radial nerve
In a hand examination in little finger abduction?
Ulnar nerve
In a hand examination thumb abduction?
Median nerve
What are the components of a hip exam? Specific any that are specific to hip in more detail?
1) Intro - Pain/ hip replacement
2) Inspection (include footwear)
3) Gait
4) Look (include Trendelenburg and leg length)
5) Feel (temp, trochanter)
6) Move (flex, extend, rotate I/E, ab/aduct)
7) Special (Thomas’)
What are the components of a knee exam?
Intro Gen inspection Gait Look Feel Move Special (ACL/ PCL/ MCL/ LCL/ McMurray)
Give two CI to Carbamazepine (pharma)?
Warfarin
COCP
What things should be assessed on the feel component of a hand exam? (6)
Temperature Thenar/ hypothenar Duputrens Sensation Anatomical snuffbox Wrists and all joints
Name the special tests for a shoulder examination? (6)
Supraspinatus Teres minor/ infraspinatus Subscapularis Instability Scarf test Hawkings test (impingement)
What power tests should be done in a hand exam? - Include functional (6)
Wrist and finger extension (radial) Abduct little finger (ulnar) Abduct thumb (median) Power grip Ok sign pincer
Pick up coin (function)
What should ALWAYS be counselled on in a drug explanation station?
Allergies
What is the apparent leg length, where is it measure from?
Measured from xiphisternum or medial malleolus
What does a discrepancy in the apparent leg length suggest?
Spinal or pelvic deformity (for example scoliosis)
What does a discrepancy in the true leg length suggest?
Shortening of the limb (deformity or fracture)
What is the true leg length, where is it measure from?
ASIS to medial malleolus
Name 4 differentials for elbow pain?
Olecranon bursitis > Localised swelling over olecranon
Lateral epicondlyitis (Tennis)
Medial epicondylitis (Golfers)
Cubital tunnel syndrome (Ulnar nerve entrapment)
What are the components of an elbow exam? Give at least one sub-component of each (5)
Intro (include pain)
Look (include carrying angle)
Feel (include olecranon, temprature, biceps tendon)
Move (flex, extend, pronate, supinate)
Special tests (hands pronated)
- LE: Wrists up (extend) whilst palpating LE - Tennis
- ME: Wrists down (flex) whilst palpating ME - Golf
What are the steps of a cerebellar exam (and specific sub components)? (6)
Inspection
Gait - ataxic, tightrope walking
Romberg - Sensory ataxia (not cerebellar)
Face- Nystagmus, saccades, speech (+lengthy)
Arms - Tone, finger nose, arms up and cerebellar rebound, dydiadochokinesia
Legs - Coordination
Full neuro exam and exclude Parkinson’s etc.
What investigations would you do for suspected CES?
LL Neuro Spinal exam (disc prolapse) Abdominal exam (bladder) PR exam (sphincter tone)
Where to motor neurons deccusate?
Medulla
Where do the dorsal columns deccusate?
Brainstem
What information is carried by the dorsal columns?
Fine touch and proprioception
What information is carried by the spinothalamic tracts?
Pain and temperature
Where do the spinothalamic tracts deccusate?
Level of exit
What are the components of a balance examination?
General inspection Gait - including heel/toe Rombergs and unterbergers test Cerebellar exam (DANISH) Proprioception and lower limb sensation Offer dix-hallpike
What are the components of a tremor exam?
General inspection (rest tremor) Gait (Parkinsonian or Ataxic) Tremor (action, intention) Distract to exagerate Hyperthyroid (quick feel of neck)