Medicines 1 Flashcards
What are the key things to remember for hydrocortisone cream (dose, usage, length of treatment etc)?
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
What key but rare side effect should you be aware of with mirabegron?
Mirabegron - risk of severe hypertensive crisis
Monitor blood pressure before starting treatment and regularly during treatment, especially in people with pre-existing hypertension.
What medication is contraindicated in severe peripheral arterial disease.
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.
How can you remember dosing for paracetamol for paediatrics
“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)
What are the different types of insulin (remember the way of remembering them)
A good way to remember insulin types by their duration is to use a mnemonic that categorizes them by how fast they act: 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)
`Which antidiabetic medication is notorious for causing hypos
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
What is the effect of dipeptidyl peptidase-4 inhibitors effect on glucose levels and weight
name some examples too
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
What medication can cause Thrombocytopenia
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.
What are some cautions associated with phenytoin?
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.
What is the normal target range for phenytoin?
The usual total plasma-phenytoin concentration for optimum response is 10–20 mg/litre (or 40–80 micromol/ litre)
what is the equivalence beteen phenytoin formulations?
Phenytoinsodiummolecularequivalets are not necessarily biologically equivalent. 100 mg of phenytoin sodium is approximately equivalent in therapeutic effect to 92 mg phenytoin base.
What medications can cause Gout?
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.
how long after/before a dose should Gentamicin levels be taken?
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
Which Beta blockers can cross the BBB and cause nightmares?
Propranolol and metoprolol are beta blockers that can cross the blood-brain barrier (BBB) and cause nightmares
What is the target HBA1C ?
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.
What is a disulfiam like reaction and what medications cause it?
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.
What medications can cause gingival hyperplasia and what causes it?
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
What are the doses of atorvastatin for primary and secondary prevention?
80mg atorvastatin is a secondary prevention dose, whilst primary prevention is atorvastatin 20mg.
WHat is the maximum dose of SSRIs such as citalopram, escitalopram, sertraline, fluoxetine and paroxetine in over 65s
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.
WHat are the target lithium levels
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.
What is acarbose and how should it be taken?
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.
How long are Fentanyl/buprenoprhine/Rotigotine (parkinsons) patches worn for before changing.
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
When should SGLT2 inhibitors be stopped?
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.
What medications in particular should you look out for signs of agranulocytosis? (advised to report symptoms like fever, sore throat, or general malaise promptly)
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)
What angle should insulin be injected at and how long for?
90 degrees and for approximately 5-10 seconds
What are the main uses of metronidazole?
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
What is the MOA of metronidazole?
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
What medications does metronidazole interact with?
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)
What is the nature of the interaction between trimethoprim and methotrexate?
Increased risk of haematological side effects
WHat are the cautions and contraindications with trimethoprim?
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
