Medicine Flashcards
What is the 2nd line medication to treat IBS after antispasmodics/loperamide?
TCAs e.g. AMT for analgesic effect
When to do stool microscopy for diarrhoea (child)?
after 7 days
What eGFR to use metformin
a) with caution
b) STOP altogether
a) 45
b)30 - STOP
For GAD - how long to continue medication (SSRI) for?
For Panic disorder - how long?
Depression - how long?
12 months once established - due to risk of relapse
6 months
6 months
what is buproprion used for? how does it help? contraindications?
for smoking cessation
reduce craving
not in eating disorders, bipolar, pregnancy, hx of seizures
what is disulfiram used for?how does it help? contraindications?
promotes abstinence from alcohol - makes you feel like shit if you drink alcohol (cause severe rxn)
inhibit acetyldehyde dehydrogenase
not in cardiac failure, coronary artery disease, history of cerebrovascular accident (CVA), hypertension, psychosis and suicide risk.
what is acamprosate used for? how does it help? contraindications?
reduces craving, a weak antagonist of NMDA receptors
not in renal iimpairment, severe hepatic impairment
Features of suspected malignancy in a lump?
malignancy in a lump include
size more than 5 cm
increasing in size and deep to the fascia
pain
What are the 1st and 2nd line medications for GAD?
- SSRI
- another SSRI/ Venlafaxine (SNRI)
- pregabalin
What are the 1st, 2nd, 3rd line tx for GAD?
What are the 1st and 2nd line medications for panic disorder?
GAD:
1. SSRI
2. another SSRI/SNRI
3. pregabalin
Panic disorder
1. SSRI
2. TCA - imipramine, clomipramine
how to treat h pylori
PPI + amox + clari or metronidazole
if pen allergic
PPI + clari + metronidazole
in management of angina, what medication should not be prescribed together with a BB?
verapamil - risk of complete heart block
Also don’t Rx verapamil in HF
Mx of angina: first 4 steps
What other preventative meds to add?
BB or CCB based on person/comorbidities
then monotherapy up to maximum dose
add the other med
add other meds e.g. long acting nitrate etc.
then consider Pci/cabg
add statin & aspirin for preventative
Mx of heart failure (HFREF)
ACEi+BB
Aldosterone antagonist e.g. spironolactone/eplerenone
+?SGLT2i
3rd line: initiated by specialist
features of WPW syndrome on ECG?
Wave - Delta wave
PR - short
Wide - QRS
(narrow complex tachy)
Where might you expect ST changes for a posterior MI? and what sort of ST changes?
anterolateral leads (V1-3)
ST depression
what BP med is contraindicated in mod-severe aortic stenosis?
ACEi
for management of a pt w HTN and diabetes, which meds should not be used in combination? why?
Thiazide & BB
The routine use of beta-blockers in uncomplicated hypertension should be avoided, particularly when given in combination with thiazides, as they may cause insulin resistance, impair insulin secretion and alter the autonomic response to hypoglycaemia.
Poorly controlled HTN - already taking max dose ACEi and CCB. Next step? (step 3 in HTN algorithm)
Add thiazide-like diuretic e.g. indapamide.
What to Rx to treat gut oedema for pt with HF?
bumetanide - better bioavail than furosemide
Post splenectomy, what prophylactic abx to use?
Pen V 1st line for at least 2 yrs
What does the anaemic picture look like for pt with haemoglobinopathy?
anaemia is normocytic with a low or normal ferritin level
Important adverse effect of taking carbimazole?
agranulocytosis - fever, sore throat, mouth ulcers
what cancers are likely to spread to bone?
breast, thyroid, bowel, kidney, prostate and myeloma
A 68-year-old man is treated for a proven urinary tract infection. He has an enlarged prostate on examination.
According to the National Institute for Health and Care Excellence (NICE) guidelines, which is the MINIMUM wait, if any, before his prostate-specific antigen (PSA) should be measured?
6 weeks
A 61-year-old patient presents with dysuria, urinary urgency and frequency with perineal pain radiating to the rectum and tip of the penis. Urine dipstick test is positive for nitrites and leucocytes.
acute bacterial prostatitis
BP control in CKD: ACR<30 - what antihypertensive to Rx?
if ACR>30?
follow normal HTN guidelines
if ACR>30, ACEi/ARB first
What is the target Hba1c for T1DM patients?
48
Parameters for impaired glucose tolerance - fasting & 2hr?
6.1-7
7.8-11.1
Urine ACR result to diagnose microalbumiuria?
> 3
What value is fasting glucose for a diagnosis of prediabetes?
6.1-6.9
loop diuretic e.g. bumetanide, furosemide - effect on potassium
drop
ramipril - effect on potassium
increase
thiazide-like diuretic - effect on potassium
drop
spironolactone - effect on potassium
increase
Simon Broome criteria for FH - TC & LDL-C?
TC >7.5
LDL-C>4.9
What are DAST-A and CRAFFT tools used for?
substance misuse in adolescents
Which schedule of drugs are CDs?
List out Schedules 1-5 and what drugs are in each category
CDs = schedule 2,3
1: cannabis, LSD. no medicinal value
2: diamorphine, morphine, cocaine, pethidine, amphetamine
3: midazolam, temazepam, barbiturates, pregabalin, gabapentin, buprenorphine
4:
1. benzos (except midaz/temaz), zopiclone, zolpidem
2. hcg, somatotropin, androgenic/anabolic steroids
5: oramorph, codeine
ABX for severe campylobacter?
clarithromycin
Tx & duration for severe oesophagitis on endoscopy?
8/52 of standard dose PPI
if no help then HIGH dose PPI or switch to another PPI standard/high dose
indications for FIT testing & age categories
> 40, abdo pain + weight loss
<50, rectal bleed + abdo pain/weight loss
50, rectal bleed/abdo pain/weight loss
60 anaemia, with or without iron deficiency
1st, 2nd, 3rd line tx for C diff
vancomycin
fidoxamicin
iv vancomycin + metronidazole
How to monitor haemachromatosis Mx/venepuncture (what to measure & target)
aim
ferritin <50
transferrin sat <50%
Ferritin, iron, transferrin sat, TIBC, transferrin for:
IDA
haemachromatosis?
IDA: low ferritin, iron, transferrin sat; raised TIBC, raised transferrin
haemachromatosis: raised ferritin, iron, transferrin sat; low TIBC, transferrin
Tx of acute asthma exacerbation - prednisolone dosage for children
<2 y/o - 10mg
2-5 y/o - 20mg
>5 y/o - 30-40mg
Tx for Lyme disease?
Doxycycline 200mg, 21 days
Sun protection when taking doxy
amoxicillin, doxycycline for 21 days or azithromycin for 17 days.
how often to check TSH in thyroid disease - initially and once stable?
6 weeks initially
3 months once stable
what is the threshold for normal FIT? (when to refer)
> 10 mcg/hb g
what is the definition of young carers?
< age 18
urate level for gout dx?
> 360
if <360 during a flare, repeat in 2 weeks once flare settled
when to do ambulatory BP if found to have high clinic BP?
ambulatory blood pressure assessment if clinic readings are between 140/90 mmHg and 180/120 mmHg prior to commencing antihypertensive treatment.
Define osteopenia & osteoporosis in terms of Dexa scan results
> -1 is normal
Osteopenia: T -1.5 to -2.5
Osteoporosis: T <-2.5
How much of her initial body weight should she have lost to in order to continue treatment with orlistat?
5% in 3 months
More lenient if T2DM
warfarin - mx of high inr
inr 5-8, no bleed
inr 5-8, minor bleed
inor >8, no bleed
inr >8, minor bleed
major bleed
withhold warfarin, reduce maintenance dose
1-3mg iv vit K, stop warfarin, restart when inr <5
1-5mg po vit P IV version, stop warfarin, restart when inr <5, repeat in 24hr if still too high
1-3mg IV vit K, stop warfarin, restart when inr <5, repeat in 24hr if still too high
5mg IV vit K, stop warfarin, prothrombin complex or ffp
guidelines for starting orlistat
bmi >=28 + associated RF
bmi >=30
EoLC: convert 24hr dose po morphine to sc diamorphine
divide by 3
EoLC: convert 24hr po morphine to po oxycodone
divide by 1.5-2
EoLC: convert po codeine/tramadol to po morphine
divide by 10
EoLC: sc oxycodone to sc diamorphine
divide by 1.5
abx for chronic prostatitis (sx <6 months) and for how long?
trimethoprim or
doxycycline
4-6 weeks
Male STI treatment?
if epididymo-orchitis?
intramuscular ceftriaxone 1g as a single dose, plus doxycycline 100 mg orally twice daily for 10–14 day
epididymo-orchitis: ofloxacin 200 mg orally twice daily for 14 days, or levofloxacin 500 mg orally once daily for 10
Tx for prostatitis
ofloxacin or ciprofloxacin for 14 days
what factors make up the MELD score for liver cirrhosis?
bilirubin
albumin
PT
encephalopathy
ascites
what are the criteria in Glasgow 7 point checklist for malignant melanoma?
major:
change in size
irregular shape
irregular colour
minor:
>7mm diameter
oozing
inflammation
change in sensation
What timescale to NOT use PPI/abx before c-urea breath test for h pylori?
Urea breath test - no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI) in past 2 weeks
Which is the SINGLE MOST likely vitamin deficiency associated with coeliac disease?
Vit D
minimum length of abx treatment for non CF bronchiectasis?
7 days
(7-14)
List SE of amiodarone
corneal deposits, optic neuropathy
slate grey
thyroid dysfunction
pulmonary deposits
liver fibrosis
increase QT interval, brady cardia
skin rash - phytotoxic
peripheral neuropathy
effects may be delayed
define uncontrolled asthma
any exacerbation needing po steroid
waking up in night >1/week
frequent reg sx e.g. needing reliever inhaler >3 days/week
how much to allow eGFR to drop by when starting ACEi?
eGFR can drop by 25% from baseline
or Cr can increase by up to 30%
what are the criteria in ORBIT score?
Older age >75
Reduced Hb (can score 2)
Bleeding (2)
Insufficient renal fx
Treatment w antiplatelet
3 = medium
4-7 = high
AAA screening & what to do for each category
<3 - normal
3-4.4 - annual scan
4.5-5.4 - 3 monthly scan
>5.5 - refer within 2/52
Tx for OCD
mild/mod/severe
what scale to use?
scale: YBOCS
mild:
CBT (ERT)
mod:
SSRI
TCA - clomipramine
severe:
refer sec care to assess
hypothyroidism, goitre and anti-TPO, dx?
hashimoto’s thyroiditis
treatment for impetigo?
hydrogen peroxide
then if top abx:
fusidic acid
mupirocin if resistance to fusidic
