Medicines 1

Question 1

What are the key things to remember for hydrocortisone cream (dose, usage, length of treatment etc)?

Answer 1

Applied thinly 1-2 times a day for child or adult for a maximum of 1 week

Avoid prolonged use, shouldn’t be sold for face, broken skin, ano genital region

Has topical anti inflammatory activity

Question 2

What key but rare side effect should you be aware of with mirabegron?

Answer 2

Mirabegron - risk of severe hypertensive crisis

Monitor blood pressure before starting treatment and regularly during treatment, especially in people with pre-existing hypertension.

Question 3

What medication is contraindicated in severe peripheral arterial disease.

Answer 3

All beta-blockers are contraindicated in severe peripheral arterial disease. However, abrupt withdrawal of any beta-blockers could exacerbate isehaemic heart disease. Slow the reduction in dose and then stop should be advised.

Question 4

How can you remember dosing for paracetamol for paediatrics

Answer 4

“Half-Dose, Full-Dose” Rule
This rule uses a “half then full” dose approach based on the age group:

Under 1 year: Half of 120 mg

1–3 months: 30 mg
3–6 months: 60 mg
6 months to 1 year: 60–120 mg

1 to 6 years: Full 120 mg

1–2 years: 120 mg
2–4 years: 180 mg (1.5 times 120 mg)
4–6 years: 240 mg (double 120 mg)

6 to 12 years: Full 250 mg

6–8 years: 250 mg
8–10 years: 375 mg (1.5 times 250 mg)
10–12 years: 500 mg (double 250 mg)
12+ years: 500 mg (adult dose)

Question 5

What are the different types of insulin (remember the way of remembering them)

Answer 5

A good way to remember insulin types by their duration is to use a mnemonic that categorizes them by how fast they act: “Rapid Short Long, NPH Tags Along”. Here’s how it breaks down:

Rapid-Acting Insulins (Think of “logs” floating down a rapid river)

Insulins with “-log” in their name are rapid-acting.
Examples: Lispro (Humalog), Aspart (Novolog), Glulisine (Apidra)
Short-Acting Insulin (Think of “Regular” - it’s the regular, traditional insulin)
“Girls And Lads”

Each word stands for a different rapid-acting insulin:

G = Glulisine (Apidra)
A = Aspart (Novolog)
L = Lispro (Humalog)
The idea is that “Girls And Lads” are quick and full of energy, just like rapid-acting insulins, which act fast to reduce blood sugar.

These are typically Regular insulin.
Examples: Humulin R, Novolin R
Intermediate-Acting Insulin (NPH) (“NPH Tags Along”)

NPH insulin (Neutral Protamine Hagedorn) is the main intermediate-acting insulin.
Examples: Humulin N, Novolin N
Long-Acting Insulins (Think of “long” names for long-acting)

“Don’t Delay Long Glucose” (DDLG)

Breakdown of the Acronym:
D = Detemir (Levemir)
D = Degludec (Tresiba)
L = Lantus (Glargine) – also remember Toujeo, another form of Glargine
G = Glargine (this also covers Lantus and Toujeo, which are glargine-based insulins)

Question 6

`Which antidiabetic medication is notorious for causing hypos

Answer 6

See BNF introductory information to chapter 6, section 3.1 for infor­ mation on diabetes - type 1 diabetes. Hypoglycaemia in diabetes mellirus can be caused by the administration of insulin or sulpho­ nylurea. This can be compounded by impairment of the counter­ regulatory response to hypoglycaemia due to secretion of glucagon

Question 7

What is the effect of dipeptidyl peptidase-4 inhibitors effect on glucose levels and weight
name some examples too

Answer 7

Dipeptidyl peptidase-4 inhibitors (DDP-4) cause little or no weight gain, exhibit relatively litrle risk of hypoglycaemia and have relatively modest glucose-lowering activity.
saxagliptin, linagliptin, alogliptin, and vildagliptin

Question 8

What medication can cause Thrombocytopenia

Answer 8

See BNF, chapter 2, section 3.2 - introduction on heparins. Clinically important heparin-induced thrombocytopenia is immune-mediated and can be complicated by thrombosis. Sigus of heparin-induced thrombucytopenia include a 3 0 % reduction of platelet count, throm­ bosis, or skin allergy.

Question 9

What are some cautions associated with phenytoin?

Answer 9

Cautions, further information
MHRA advises consider vitamin D supplementation in patients who are immobilised for long periods or who have inadequate sun exposure or dietary intake of calcium.

Intramuscular phenytoin should not be used (absorption is slow and erratic).

HLA allele
Limited evidence suggests that the presence of HLA-B*1502 allele, particularly in individuals of Han Chinese or Thai origin, may be associated with an increased risk of Stevens-Johnson syndrome. Consider use if potential benefit outweighs risk.

Seizure exacerbation
Phenytoin may exacerbate seizures in patients with absence or myoclonic seizures (including juvenile myoclonic epilepsy), and myoclonic-atonic seizures.

Question 10

What is the normal target range for phenytoin?

Answer 10

The usual total plasma-phenytoin concentration for optimum response is 10–20 mg/litre (or 40–80 micromol/ litre)

Question 11

what is the equivalence beteen phenytoin formulations?

Answer 11

Phenytoinsodiummolecularequivalets are not necessarily biolog­ically equivalent. 100 mg of phenytoin sodium is approximately equivalent in therapeutic effect to 92 mg phenytoin base.

Question 12

What medications can cause Gout?

Answer 12

Thiazide diuretics: Also known as water pills, these are commonly used to treat high blood pressure.
Aspirin: Even low doses can increase the risk of gout.
Niacin: Used to treat cholesterol problems.
Pyrazinamide: Used to treat tuberculosis.
Cyclosporine and tacrolimus: Used to manage the body’s immune response.
Levodopa: Commonly used to treat Parkinson disease.
Beta-blockers and ACE inhibitors: Other drugs used to treat high blood pressure.

Question 13

how long after/before a dose should Gentamicin levels be taken?

Answer 13

TDM based on pharmacokinetics (conventional or extended) is based on serum concentrations measured at peak (30 min after completion of the IV injection or infusion ; Cmax or Cpeak ) and at trough (Cmin or Ctrough) before next dose

Question 14

Which Beta blockers can cross the BBB and cause nightmares?

Answer 14

Propranolol and metoprolol are beta blockers that can cross the blood-brain barrier (BBB) and cause nightmares

Question 15

What is the target HBA1C ?

Answer 15

For adults whose type 2 diabetes is managed either by lifestyle and diet, or lifestyle and diet combined with a single drug not associated with hypoglycaemia, support them to aim for an HbA1c level of 48 mmol/mol (6.5%). For adults on a drug associated with hypoglycaemia, support them to aim for an HbA1c level of 53 mmol/mol (7.0%). [2015]

In adults with type 2 diabetes, if HbA1c levels are not adequately controlled by a single drug and rise to 58 mmol/mol (7.5%) or higher:

reinforce advice about diet, lifestyle and adherence to drug treatment and

support the person to aim for an HbA1c level of 53 mmol/mol (7.0%) and

intensify drug treatment.

Question 16

What is a disulfiam like reaction and what medications cause it?

Answer 16

A disulfiram-like reaction is an adverse reaction that occurs when certain drugs are consumed with alcohol. This reaction is caused by a buildup of acetaldehyde, a toxic metabolite of alcohol, in the blood.

Cephalosporins, such as cefoperazone, cefamandole, and moxalactam
Metronidazole
Bactrim
Tinidazole
Ceftriaxone

For example, patients should avoid alcohol for 48 hours after taking metronidazole, and 72 hours after taking tinidazole.

Question 17

What medications can cause gingival hyperplasia and what causes it?

Answer 17

Medications that can cause gingival hyperplasia, also known as drug-induced gingival overgrowth, include:
Phenytoin: An anticonvulsant used to treat seizures and convulsions

Cyclosporine: An immunosuppressant used to prevent organ rejection after transplant

Calcium channel blockers: A class of cardiovascular drugs used to treat hypertension, chest pain, and irregular heartbeats. Examples include nifedipine, amlodipine, diltiazem, felodipine, and verapamil

Question 18

What are the doses of atorvastatin for primary and secondary prevention?

Answer 18

80mg atorvastatin is a secondary prevention dose, whilst primary prevention is atorvastatin 20mg.

Question 19

WHat is the maximum dose of SSRIs such as citalopram, escitalopram, sertraline, fluoxetine and paroxetine in over 65s

Answer 19

The maximum dose for citalopram in elderly patients older than 65 years is 20mg
escitalopram: 10mg
Sertraline: max dose isn’t affected by age (200mg daily)
Fluoxetine: Usual maximum dose is 40 mg per day but doses up to 60 mg per day can be used.
Paroxetine: maximum 40 mg per day.

Question 20

WHat are the target lithium levels

Answer 20

Samples should be taken 12 hours after the dose to achieve a serum-lithium concentration of 0.4–1 mmol/litre (lower end of the range for maintenance therapy and elderly patients).

A target serum-lithium concentration of 0.8–1 mmol/litre is recommended for acute episodes of mania, and for patients who have previously relapsed or have sub-syndromal symptoms.

Question 21

What is acarbose and how should it be taken?

Answer 21

Acarbose is the only medicine that belongs to a drug class called alpha glucosidase inhibitors.

This medication works by slowing down the digestion of starchy foods like potatoes, pasta and rice from the gut. This means that blood sugar levels rise more slowly after meals.

Acarbose is a tablet which you swallow. It should be taken with a meal. Chew the tablet with your first mouthful of food or swallow it whole with water immediately before the meal.

Question 22

How long are Fentanyl/buprenoprhine/Rotigotine (parkinsons) patches worn for before changing.

Answer 22

Fentanyl (Fencino, matrifen, Durogesic) = 72 hours

Buprenorphine = usually 7 days
- Butec: Duration: 7-day patch
- BuTrans: Duration: 7-day patch
- Reletrans: Duration: 7-day patch
- Transtec:Duration: 4-day or 96-hour patch (some may use it every 3 days)

Rotigotine = 24 hours

Question 23

When should SGLT2 inhibitors be stopped?

Answer 23

Severe hepatic impairment — manufacturer advises to avoid canagliflozin, empagliflozin, and ertugliflozin.

Increasing age — avoid empagliflozin if aged over 85 years, as risk of volume depletion.

Active foot disease (such as skin ulceration, osteomyelitis, or gangrene) — possible increased risk of lower limb amputation (mainly toes) with canagliflozin. Advise to stop treatment if signs of a foot complication develop, such as skin ulceration, discolouration, infection, or new pain/tenderness, and seek urgent medical assessment.
stop treatment if signs of a foot complication such as skin ulceration, discolouration, infection, or new pain/tenderness, and seek urgent medical assessment.

Diabetic ketoacidosis (DKA) — serious and potentially life-threatening cases of DKA have been reported in people taking SGLT-2 inhibitors. Advise to stop treatment immediately and seek medical advice if any clinical features of DKA develop.

Moderate-to-severe renal impairment — in general avoid initiation if estimated glomerular filtration rate (eGFR) is less than 60 mL/min/1.73 m2; avoid continuation if eGFR is less than 45 mL/min/1.73 m2.
Note: dapagliflozin is licensed for use in chronic kidney disease, but should not be initiated in people with eGFR less than 15mL/min/1.73 m2. The glucose-lowering efficacy of dapagliflozin is reduced when eGFR is less than 45 mL/min/1.73m2.

Question 24

What medications in particular should you look out for signs of agranulocytosis? (advised to report symptoms like fever, sore throat, or general malaise promptly)

Answer 24

Clozapine: Commonly used for treatment-resistant schizophrenia

Carbimazole/Methimazole: This anti-thyroid medication

Methotrexate

Sulfasalazine: Primarily used in treating inflammatory bowel disease and rheumatoid arthritis

Antiepileptic drugs (e.g., Carbamazepine, Phenytoin)

Question 25

What angle should insulin be injected at and how long for?

Answer 25

90 degrees and for approximately 5-10 seconds

Question 26

What are the main uses of metronidazole?

Answer 26

Treatment of anaerobic bacteria
Antibiotic-associated colitis caused by c.difficile – gram positive anaerobe
Oral infections or aspiration pneumonia = gram negative anaerobes in mouth
Surgical and gynaecological infections – gram negative anaerobes from colon
Protozoal infections

Question 27

What is the MOA of metronidazole?

Answer 27

Mechanism of action

Enters the bacterial cell wall via passive diffusion. In anaerobic bacteria reduction of metronidazole generates a nitroso free radical. This binds to DNA reducing synthesis and causing DNA degradation and cell death
Aerobic bacteria can’t reduce metronidazole so it is not effective

Question 28

What medications does metronidazole interact with?

Answer 28

Drugs:

Alcohol – disulfiram-like reaction when metronidazole given with alcohol
Cimetidine – metabolism of metronidazole inhibited by cimetidine (increased plasma concentration)
Coumarins – metronidazole enhances anticoagulant effect of coumarins
Disulfiram – psychotic reaction reported when metronidazole given with disulfiram
Lithium – metronidazole increases risk of lithium toxicity
Phenobarbital – metabolism of metronidazole accelerated by phenobarbital (reduced effect)
Phenytoin – metronidazole possibly inhibits metabolism of phenytoin (increased plasma concentration)

Question 29

What is the nature of the interaction between trimethoprim and methotrexate?

Answer 29

Increased risk of haematological side effects

Question 30

WHat are the cautions and contraindications with trimethoprim?

Answer 30

Cautions and contraindications; conditions

Contraindicated in first trimester of pregnancy – increased risk of fetal abnormalities like heart defects
Caution in folate deficiency who are more susceptible to adverse haematological effects
Caution in renal impairment – reduce dose
Neonates, elderly, HIV – susceptible to SE = caution
Contraindicated in blood dyscrasias – disease state of the blood