Medications Flashcards
What are some long term risks of chronic steroid use (oral)?
Osteoporosis (1)
Osteonecrosis of the hip (1)
Myopathy (1)
Diabetes / Glucose intolerance (1)
Altered fat distribution /cushingoid appearance (1)
Loss of libido (1)
Adrenal suppression (1)
Dyslipidaemia (1)
Hypertension (1)
Cardiovascular events/ischaemic heart disease (1)
Increased risk of opportunistic infections (1)
Skin changes for example atrophy/telangiectasia/easy bruising/acne/alopecia (1)
Cataracts/Glaucoma (1)
Mood disturbances for example psychosis or depression (1)
Peptic ulcer disease (1)
Symptoms or signs of mild serotonergic toxidrome? and management
Tremor
Mild tachycardia
Inducible clonus
Hyper-reflexia in the lower limbs
Mild serotenergic toxidrome, doesn’t require anything in specific.
1. obviously cease the medication/s of concern
2. supportive therapies
For someone taking these medications
Citalopram for their depression
Tramadol prescribed for their lower back pain and
OTC St Johns Wart
What is the biggest risk?
These can cause reduced serotonin uptake specifically and therefore lead to serotonergic toxidrome.
Other drugs can decrease 5HT metabolism: e.g MOAs
Some drugs increase serotonin release: All opioids including tapentadol AND tramadol, various stimulants including phentermine, amphetamines
Some drugs are 5HT receptor agonists like Lithium
Any combination of these “classes” can lead to serotonergic toxidrome.
What are contraindications to the combined oral contraceptive pill?
(13)
Any VTE (current or past)
Immobilisation due to surgery
Thrombogenic mutations
HCC or liver tumour
Liver disease or cirrhosis
CURRENT breast cancer
IHD
Stroke or TIA
HTN sBP>160 or dBP> 110
Migraine WITH Aura in the last 5 years
Smoking 15+ /day AND aged > 35
Post partum first 6 weeks IF breastfeeding
Post partum first 3 weeks with VTE risk factors
Dose of an COPC in an appropriate patient
ethinylestradiol 30 + levonorgestrel 150 orally, daily. (Levlen ED)
How do you start a COPC versus POP
COPC
effective immediately if started on days 1-5 of cycle
will take 7 days to work at other times
POP
effective immediately if started on days 1-5 of cycle
Otherwise takes 48 hours (3 consecutive pills) to work.
What to do with a missed Progesterone only pill?
<24 hours, Take pill when remembered, then take next pill at scheduled time. Advise won’t be effective until 3 pills taken
if > 24 hours ie. more than one missed pill. Take the most recent missed pill, then take the next one when normally scheduled. Discard/don’t take the other missed pill/s. Won’t be effective for 48 hours (3 consecutive pills).
Consider emergency contraception if sexual intercourse occurred after the first missed pill. i.e 24 hours after the last pill was taken.
Forms of emergency contraception with dosing?
levonorgestrel 1.5 mg orally, as a single dose taken as soon as possible and within 96 hours (4 days) of unprotected sexual intercourse
ulipristal 30 mg orally, as a single dose taken as soon as possible and within 120 hours (5 days) of unprotected sexual intercourse
Copper IUD within 5 days.
what is quickstart method to starting oral contraception?
I means when you’re starting a patient on a oral contraception not on Day 1-5.
Needs 3 (POP) or 7 (COPC) to work, so use barrier contraception in that time.
If sexually active, since early pregnancy is not excluded, does need a pregnancy test in 4 weeks time. (or 3 weeks after starting if no further episodes of unprotected sex occurred in the first week of use)
List three types of medications that can cause a chronic cough?
ACEi (can take a year to clear)
NSAIDs (increase in LKT due to COX blockade)
Beta blockers (non selective types: propranolol and sotalol)
Side effects of PDE5i?
facial flushing
headache
dyspepsia
nasal congestion
dizziness
postural hypotension if on antihyperensive
What main effects should you watch for with prescription of montelukast?
Neuropsychiatric effects.
hallucinations, insomnia, irritability, dream abnormalities
primarily suicidal ideation
General common side effects of mirtazapine?
Increased appetite
Weight gain
drowsiness/sedation in the first few weeks
What are some side effects of lithium?
hypothyroidism
HYPERparathyroidism
Weight gain
can reduce concentrating abilities of kidneys - but doesn’t lead to impairment
no risk of teratogensis, but anti-psychotics preferred in pregnancy
Symptoms of lithium toxicity, not simply side effects.
gastrointestinal effects—nausea, vomiting, diarrhoea
CNS effects—tremor, hyperreflexia, ataxia
Cardiovascular effects—QT-interval prolongation is uncommon, but can occur in severe poisoning; arrhythmias are rare.