Medicines 12

Question 1

Which medications cause first dose hypotension

Answer 1

• ACE inhibitors
• Alpha blockers - Doxazosin, tamsulosin, alfuzosin

Question 2

What are some key medications that have antimuscarinic affect

Answer 2

cyclizine
solifenacin
baclofen
clomipramine
haloperidol
hyoscine
oxybutynin
tiotropium
trospium
amitriptyline
chlorphenamine
clozapine
olanzapine

many more ……

Question 3

Whats the acronym to remember the symptoms of heart failure?

Answer 3

FACES

F – Fatigue: Reduced energy due to poor blood circulation.
A – Activity limitation: Difficulty performing physical activities because of shortness of breath and weakness.
C – Congestion:
Pulmonary congestion: Causing shortness of breath, orthopnea, and PND.
Systemic congestion: Leading to peripheral edema, ascites, and JVD.
E – Edema: Swelling in the legs, ankles, feet, and sometimes abdomen.
S – Shortness of breath: Especially during activity, lying down, or at night

Question 4

What does the word haemorrhage mean?

Answer 4

Haemorrhage refers to bleeding, specifically the loss of blood from blood vessels due to injury, rupture, or disease. It can occur internally (within the body) or externally (through a wound or body orifice).

Question 5

Why is creatinine kinase important to monitor in statin therapy?

Answer 5

Creatinine kinase (CK) is useful in statin therapy because it helps monitor for muscle-related side effects, specifically statin-induced myopathy or rhabdomyolysis, which are potential adverse effects of statin use.

Question 6

When does liver damage occur following paracetamol overdose?

Answer 6

Liver damage is maximal 3-4 days after paracetamol overdose

Question 7

Aside from diabetes what can metformin be used to treat?

Answer 7

Polycystic ovary syndrome

Question 8

What are the long term side effects assoicated with PPIs

Answer 8

1. Clostridium difficile infection.
2. Increased risk of bone fractures.
3. Acute interstitial nephritis (AIN).
4. Increased mortality in older patients.
5. Community acquired pneumonia.
6. Hypomagnesaemia.
7. Vitamin B12 deficiency.
8. Rebound acid hypersecretion syndrome.

Question 9

What medication for diabetes is contraindicated in heart failure

Answer 9

Pioglitazone

Question 10

When is thyroid function monitored in hypothyroidism in pregnancy ?

Answer 10

Maternal thyroid function will be assessed at diagnosis, at antenatal, second and third trimesters and after delivery

Question 11

What is the dose of carbimazole in treatment for hyperthyroidism in an adult? (hint 2 regimes)

Answer 11

Hyperthyroidism
15–40 mg daily continue until the patient becomes euthyroid, usually after 4 to 8 weeks, higher doses should be prescribed under specialist supervision only, then reduced to 5–15 mg daily, reduce dose gradually, therapy usually given for 12 to 18 months.

Hyperthyroidism (blocking-replacement regimen) in combination with levothyroxine
for carbimazole
40–60 mg daily, therapy usually given for 18 months.

Question 12

What are the symptoms of hypothyroidism ?

Answer 12

NHS : tiredness
being sensitive to cold
weight gain
constipation
depression
slow movements and thoughts
muscle aches and weakness
muscle cramps
dry and scaly skin
brittle hair and nails
loss of libido (sex drive)
pain, numbness and a tingling sensation in the hand and fingers (carpal tunnel syndrome)
irregular periods or heavy periods

Question 13

What are the symptoms of hyperthyroidism

Answer 13

NHS :
nervousness, anxiety and irritability
hyperactivity – you may find it hard to stay still and have a lot of nervous energy
mood swings
difficulty sleeping
feeling tired all the time
sensitivity to heat
muscle weakness
diarrhoea
needing to pee more often than usual
persistent thirst
itchiness
loss of interest in sex

Question 14

What are the Differences Between Hypothyroidism and Hyperthyroidism?

Answer 14

Hypothyroidism causes symptoms like slowed metabolism, tiredness, and weight gain. Having an underactive thyroid can decrease or slow down your bodily functions.

With hyperthyroidism, you may find yourself with more energy, as opposed to less. You may experience weight loss as opposed to weight gain. And you may feel anxious as opposed to depressed.

The most common difference between the two diseases relates to hormone levels. Hypothyroidism leads to a decrease in hormones. Hyperthyroidism leads to an increase in hormone production.

Question 15

What is a key counselling precaution with finasteride?

Answer 15

Finasteride is excreted in the semen and so use of a condom is advised if the partner is pregnant or likely to become pregnant. Finasteride may potentially affect the male genital organ development in the foetus

Question 16

What are the main side effects of inhaled corticosteroids?

Answer 16

Adrenal suppression, reduced bone mineral density, bruising, cataract, and glaucoma.
Growth suppression — may occur in children on high doses of inhaled corticosteroids, but final adult height does not seem to be affected.
Adrenal crisis, coma, and death — very rarely in children.
Oral candidiasis – thrush infection, hoarse voice
May increase risk of pneumonia in COPD
osteoporosis

Question 17

What should be done if oral thrush occurs form inhaled corticosteroid treatment.

Answer 17

An anti-fungal oral suspension or oral gel can be used to treat oral candidiasis without discontinuing corticosteroid therapy

Question 18

What are some key cautions or contraindications with inhaled corticosteroids?

Answer 18

Avoid in pulmonary TB
Caution in diabetes
High doses esp. fluticasone use with caution in history of pneumonia and children
Drugs: No significant interactions with inhaled

Question 19

How does carbocisteine work?

Answer 19

Reduction of sputum viscosity

Mechanism of action
Carbocisteine affects the nature and amount of mucus glycoprotein that is secreted by the respiratory tract by maintaining normal glycoprotein secretion and reducing goblet cell hyperplasia. Carbocisteine has also been shown to have a wide range of anti-inflammatory and antioxidant activities.

Question 20

What are the main side effects of carbocistiene?

Answer 20

Gastrointestinal bleeding
Erythema multiforme – hypersensitivity reaction – skin eruption - rash
Stevens-Johnson syndrome - skin condition painful sores

Question 21

What are the key cautions and contraindications with carbocistiene
and key medication interactions.

Answer 21

Cautions and contraindications; conditions

Contraindicated in active peptic ulceration
Caution in history of peptic ulceration – may disrupt gastric mucosal barrier
Avoid in first trimester of pregnancy

Drugs: None, however bare in mind medications that distrub GI may also have add on effect with carbo

Question 22

What are some key counselling points with carbocistiene?

Answer 22

Inform patients that if they develop any swelling around their face and mouth, difficulty breathing, skin rash, or develop black stools, they should stop taking Carbocisteine and contact their GP immediately.

Question 23

What are the cautions and contraindications of pseudoephedrine?

Answer 23

Diabetes
Heart disease, ischaemic heart disease
Hypertension
Hyperthyroidism
Raised intraocular pressure in children
Susceptibility to angle-closure glaucoma
May suppress lactation in breastfeeding
Caution in severe hepatic impairment
Caution in mild to moderate renal impairment
Avoid in severe renal impairment
Contra-indicated in patients taking monoamine oxidase inhibitors within the previous 2 weeks.

Question 24

What are key rules around sale of pseudophedrine ?

Answer 24

Children under 6 years should not be given over-the-counter cough and cold medicines containing pseudoephedrine. - 6 also earliest age in BNFc

720mg is max quantity can be sold to public
180mg max of ephedrine