Medicines 11

Question 1

Which calcium channel blockers should be avoided in heart failure and why?

Answer 1

Calcium channel blockers, with the exception of amlodipine, should be avoided in heart failure as they can further depress cardiac function and exacerbate symptoms

Verapamil may precipitate heart failure

Question 2

What is the CCB nimonidipine used for?

Answer 2

Its use is confined to prevention and treatment of vascular spasm following aneurysmal subarachnoid haemorrhage.

Question 3

What is the treatment for a DKA?

Answer 3

Diabetic ketoacidosis (DKA) is treated with a combination of fluids, electrolytes, and insulin

Question 4

How long is a yellow fever vaccination certificate valid for?

Answer 4

Certificate VALID FOR LIFE

Question 5

What is the first line treatment for depression in under 18s

Answer 5

Fluoxetine is the preferred antidepressant for treating moderate and severe depression in children and young people.

Question 6

What should you do if a patient is on the following medication?
Naproxen
Methotrexate
Folic acid

Answer 6

advise the patient of the interaction but that they are safe as long as they are both taken regularly and that regular blood tests are carried out.
Counsel the patient to report any signs of methotrexate toxicity immediately

Question 7

Which type of diabetes requires more regular monitoring through a blood glucose monitoring device ?

Answer 7

Type 1 diabetes is much more important to monitor as patients dependent on exogenous insulin.
Devices Used:
• Blood glucose meters (finger-prick testing)
• Continuous glucose monitoring (CGM) systems, e.g., FreeStyle Libre, Dexcom, Medtronic.

Type 2 diabetes
HBa1C is usually adequate every 3-6 months
Do not routinely offer self-monitoring of blood glucose in adults with type 2 diabetes unless they are on insulin, at risk of or experiencing hypoglycaemia, taking oral medications that increase hypoglycaemia risk (e.g., when driving), or are pregnant/planning pregnancy (NICE guideline, 2015; amended 2022).

Question 8

In which situations would an epileptic be able to apply to be able to drive again before a year of being seizure free.

Answer 8

If you had a seizure because your doctor changed or reduced your anti-epilepsy medicine, you can reapply when:

• the seizure was more than 6 months ago
• you’ve been back on your previous medication for 6 months
• you haven’t had another seizure in that time

You’ve had your first-ever seizure while awake and lost consciousness
- you haven’t had a seizure for 6 months
- DVLA’s medical advisers decide there isn’t a high risk you’ll have another seizure

You’ve had seizures while asleep and awake
You may still qualify for a licence if the only seizures you’ve had in the past 3 years have been while you were asleep.

Question 9

What are the rules around sale and supply of EHC?

Answer 9

Levonorgestrel (Levonelle®):
Licensed for use within 72 hours (3 days) of unprotected intercourse.
Available over-the-counter (OTC) for individuals aged 16 and over after a consultation with a pharmacist.
Ulipristal Acetate (ellaOne®):
Licensed for use within 120 hours (5 days) of unprotected intercourse.
Also available OTC for individuals aged 16 and over, following a pharmacist consultation.

Pharmacists or doctors can provide EHC in advance (e.g., if a patient is going on holiday or anticipates difficulty accessing a pharmacy in the future). This can help ensure timely use if needed.

Question 10

Which foods interact with MAOIs to cause hypertensive crisis?

Isocarboxazid
Phenelzine
Selegiline

Answer 10

Potentially life-threatening hypertensive crisis can develop in those taking MAOIs who eat tyramine-rich food (such as mature cheese, salami, pickled herring, Bovril®, Oxo®, Marmite® or any similar meat or yeast extract or fermented soya bean extract, and some beers, lagers or wines) or foods containing dopa (such as broad bean pods). Avoid tyramine-rich or dopa-rich food or drinks with, or for 2 to 3 weeks after stopping, the MAOI

An early warning symptom may be a throbbing headache. Patients should be advised to eat only fresh foods and avoid food that is suspected of being stale or ‘going off’. This is especially important with meat, fish, poultry or offal; game should be avoided. The danger of interaction persists for up to 2 weeks after treatment with MAOIs is discontinued. Patients should also avoid alcoholic drinks or de-alcoholised (low alcohol) drinks.

Question 11

What are the four pillars of heart failure

Answer 11

ACE inhibitors/ARBs/ARNIs: To manage neurohormonal dysfunction.
Beta-blockers: To control heart rate and reduce strain on the heart.
Mineralocorticoid receptor antagonists (MRAs): For reducing fluid retention and improving survival.
SGLT2 inhibitors: A recent addition that significantly reduces heart failure-related hospitalizations.
Diuretics are commonly used to manage symptoms but do not improve mortality. Monitoring and titration are key.

Question 12

Which medicines require a license from the home office to supply /prescribe treatment for addiction

Answer 12

A licence issued by the Home Secretary under the Misuse of Drugs (Supply to Addicts) Regulations 1997 is required to prescribe:
diamorphine,
cocaine, or
dipipanone for the treatment of addiction.

However, practitioners can prescribe other controlled drugs for addiction treatment, such as methadone and buprenorphine, without needing this licence.

Question 13

What is the first line treatment options for treatment of impetigo?

Answer 13

Hydrogen peroxide
2nd: fusidic acid

1st line oral treatment: Flucloxacillin

Question 14

what is the first line antibiotic for most animal bites?

Answer 14

co-amoxiclav

Question 15

what are the steps of the pain ladder?

Answer 15

For adults and children aged over 16 years, a stepwise strategy for managing mild-to-moderate pain is recommended:
Step 1 — paracetamol should be used.
Step 2 — paracetamol should be substituted with ibuprofen or, if ibuprofen is unsuitable, a weak opioid (such as codeine).
Step 3 — paracetamol should be added to ibuprofen or the weak opioid.
Step 4 — paracetamol should be continued and ibuprofen replaced with an alternative NSAID.
Step 5 — a weak opioid should be started in addition to paracetamol and/or a NSAID.

Question 16

What is the first line treatment for trigeminal neuralgia

Answer 16

Carbamazepine

Question 17

whats the difference between a TIA and an acute stroke

Answer 17

A TIA causes temporary neurological symptoms that resolve within 24 hours and leaves no permanent brain damage. In contrast, an acute stroke causes symptoms lasting more than 24 hours, often resulting in permanent brain damage. Imaging in a TIA shows no infarction, while an acute stroke typically shows evidence of infarction or haemorrhage.

Question 18

What is Naldemedine and what does it treat?

Answer 18

Naldemedine is a peripherally acting opioid receptor antagonist. It therefore decreases the constipating effects of opioids without altering their central analgesic effects.

Opioid-induced constipation [previous treatment with a laxative]

Question 19

What is the treatment for opioid induced constipation as per BNF

Answer 19

In patients with opioid-induced constipation, an osmotic laxative (or docusate sodium to soften the stools) and a stimulant laxative is recommended. Bulk-forming laxatives should be avoided.

Naloxegol is recommended for the treatment of opioid-induced constipation when response to other laxatives is inadequate.

Methylnaltrexone bromide is licensed for the treatment of opioid-induced constipation when response to other laxatives is inadequate.

Question 20

What is the iron content in the following irons: fumarate, gluconate, sulfate, sulfate dried

Answer 20

ferrous fumarate 200 mg 65 mg
ferrous gluconate 300 mg 35 mg
ferrous sulfate 300 mg 60 mg
ferrous sulfate, dried 200 mg 65 mg

Question 21

What is latanoprost used to treat and what are some key counselling points regarding it?

Answer 21

Raised intra-ocular pressure in open-angle glaucoma,
Ocular hypertension - Once daily

Changes in eye colour
Before initiating treatment, patients should be warned of a possible change in eye colour as an increase in the brown pigment in the iris can occur

Question 22

What is the potency of the topical steroids?

Answer 22

Mild
Hydrocortisone

Moderate
Alclometasone dipropionate
Clobetasone butyrate
Hydrocortisone butyrate

Potent
Beclometasone dipropionate
Betamethasone
Fludroxycortide
Fluocinolone acetonide
Fluocinonide
Fluticasone
Mometasone furoate

Very potent
Clobetasol propionate

Question 23

what are the general rules for use of topical steroids in children?

Answer 23

A mild corticosteroid such as hydrocortisone 0.5% or 1% is useful for treating nappy rash and hydrocortisone 1% for atopic eczema in childhood. A moderately potent or potent corticosteroid may be appropriate for severe atopic eczema on the limbs, for 1–2 weeks only, switching to a less potent preparation as the condition improves. In an acute flare-up of atopic eczema, it may be appropriate to use more potent formulations of topical corticosteroids for a short period to regain control of the condition. A very potent corticosteroid should be initiated under the supervision of a specialist

Question 24

What is febuxostat used to treat? what line treatment is it and what are the alerts to be aware of with the medication?

Answer 24

febuxostat - Treatment of chronic hyperuricaemia in gout

can be considered 1st line treatment or allopurinol also 1st line.
Allopurinol more common and does not share same safety alerts

MHRA alert 1: serious reports of hypersensitivity reactions, including Stevens-Johnson syndrome and acute anaphylactic shock with febuxostat.

MHRA alert 2: use febuxostat with caution in patients with pre-existing major cardiovascular disease (e.g. myocardial infarction, stroke, or unstable angina), especially those with high urate crystal and tophi burden or those initiating urate-lowering therapy

Question 25

What are some of the key side effects to note with Amiodarone ?
and what are the MHRA alerts to note with amiodarone?

Answer 25

Side-effects can occur at any time during treatment with, or in the months after stopping amiodarone.

Corneal microdeposits Patients taking amiodarone may develop corneal microdeposits (reversible on withdrawal of treatment). However, if vision is impaired or if optic neuritis or optic neuropathy occur, amiodarone must be stopped to prevent blindness and expert advice sought.

Thyroid function Amiodarone contains iodine and can cause disorders of thyroid function; both hypothyroidism and hyperthyroidism can occur. Hypothyroidism can be treated with replacement therapy without withdrawing amiodarone if it is essential; careful supervision is required.

Hepatotoxicity Amiodarone is also associated with hepatotoxicity and treatment should be discontinued if severe liver function abnormalities or clinical signs of liver disease develop.

Pulmonary toxicity If new or progressive shortness of breath or cough develops in patients taking amiodarone (or recently stopped), pulmonary toxicity should always be suspected. Pulmonary toxicity is usually reversible following early withdrawal of amiodarone.

Phototoxicity
Because of the possibility of phototoxic reactions, patients should be advised to shield the skin from light during treatment and for several months after discontinuing amiodarone; a wide-spectrum sunscreen to protect against both long-wave ultraviolet and visible light should be used.

MHRA alerts:
MHRA/CHM advice: Sofosbuvir with daclatasvir; sofosbuvir and ledipasvir (May 2015); simeprevir with sofosbuvir (August 2015): risk of severe bradycardia and heart block when taken with amiodarone
Avoid concomitant use unless other antiarrhythmics cannot be given.

MHRA/CHM advice: Amiodarone (Cordarone X®): reminder of risks of treatment and need for patient monitoring and supervision (March 2022)
Monitoring of patient parametersFor amiodarone hydrochloride
Liver function tests required before treatment and then every 6 months.

Serum potassium concentration should be measured before treatment.

Chest x-ray required before treatment.

In adults
Thyroid function tests should be performed before treatment, then at 6-monthly intervals, and for several months after stopping treatment

Question 26

What are the monitoring requirements with amiodarone?

Answer 26

Monitoring of patient parameters
For amiodarone hydrochloride
Liver function tests required before treatment and then every 6 months.

Serum potassium concentration should be measured before treatment.

Chest x-ray required before treatment.

In adults
Thyroid function tests should be performed before treatment, then at 6-monthly intervals, and for several months after stopping treatment (particularly in the elderly). Thyroid stimulating hormone levels should be measured if thyroid dysfunction is suspected. Consult specialist if thyroid function is abnormal.

If concomitant use of amiodarone with sofosbuvir and daclatasvir, simeprevir and sofosbuvir, or sofosbuvir and ledipasvir cannot be avoided because other anti-arrhythmics are not tolerated or contraindicated, patients should be closely monitored, particularly during the first weeks of treatment. Patients at high risk of bradycardia should be monitored continuously for 48 hours in an appropriate clinical setting after starting concomitant treatment. Patients who have stopped amiodarone within the last few months and need to start sofosbuvir and daclatasvir, simeprevir and sofosbuvir, or sofosbuvir and ledipasvir should be monitored.