Medicines 11 Flashcards
Which calcium channel blockers should be avoided in heart failure and why?
Amlodipine’s smooth on the heart,
While others may tear it apart.
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
What is the CCB nimonidipine used for?
Its use is confined to prevention and treatment of vascular spasm following aneurysmal subarachnoid haemorrhage.
What is the treatment for a DKA?
Diabetic ketoacidosis (DKA) is treated with a combination of fluids, electrolytes, and insulin
- IV Fluids – First Priority
🔹 Replace volume to correct dehydration. - IV Insulin – Next Step
🔹 Start after fluids; helps reduce blood glucose and ketone production.
🔹 Continue long-acting insulin if patient normally takes it. - Potassium Replacement
🔹 Monitor serum K⁺ closely.
🔹 Replace if needed – insulin drives K⁺ into cells → risk of hypokalaemia. - Glucose Administration
🔹 Once blood glucose drops to ~14 mmol/L, add glucose to prevent hypoglycaemia.
📝 Key Clinical Tip:
Treat potassium before insulin if hypokalaemia is present!
How long is a yellow fever vaccination certificate valid for?
Certificate VALID FOR LIFE
What is the first line treatment for depression in under 18s
Fluoxetine is the preferred antidepressant for treating moderate and severe depression in children and young people.
What should you do if a patient is on the following medication?
Naproxen
Methotrexate
Folic acid
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
Which type of diabetes requires more regular monitoring through a blood glucose monitoring device ?
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).
In which situations would an epileptic be able to apply to be able to drive again before a year of being seizure free.
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.
What are the rules around sale and supply of EHC?
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.
Which foods interact with MAOIs to cause hypertensive crisis? and how long a time frame should there be between consumption?
MAOIs:
Isocarboxazid
Phenelzine
Selegiline
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.
What are the four pillars of heart failure
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.
Which medicines require a license from the home office to supply /prescribe treatment for addiction
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.
Remember Difficult Controlled Drugs (DCD) require a home office license
However, practitioners can prescribe other controlled drugs for addiction treatment, such as methadone and buprenorphine, without needing this licence.
What is the first line treatment options for treatment of impetigo?
Localised Non Bullous Impetigo:
Hydrogen peroxide
2nd: fusidic acid
Wide spread non Bullous impetigo can be treated orally or topically
Bullous impetigo or non Bullous but systemically unwell - oral antibiotics
1st line oral treatment: Flucloxacillin
what is the first line antibiotic for most animal bites?
co-amoxiclav
what are the steps of the pain ladder?
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.
What is the first line treatment for trigeminal neuralgia
Carbamazepine
whats the difference between a TIA and an acute stroke
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.
What is Naldemedine and what does it treat?
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]
What is the treatment for opioid induced constipation as per BNF
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.
What is the iron content in the following irons: fumarate, gluconate, sulfate, sulfate dried
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
What is latanoprost used to treat and what are some key counselling points regarding it?
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
What is the potency of the topical steroids?
Mild
Hydrocortisone
Moderate
Alclometasone dipropionate
Clobetasone butyrate
Hydrocortisone butyrate
Potent
Beclometasone dipropionate
Betamethasone
Fludroxycortide
Fluocinolone acetonide
Fluocinonide
Fluticasone
Mometasone furoate
Very potent
Clobetasol propionate
Remember the BMFs are potent - any beginning with those letters have to be potent topically
what are the general rules for use of topical steroids in children?
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
What is febuxostat used to treat? what line treatment is it and what are the alerts to be aware of with the medication?
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
