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Y3 GP > Medicines > Flashcards

Medicines Flashcards

1
Q

What are three common side effects of Metformin?

A

GI upset
Diarrhoea
Lactic acidosis

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2
Q

What are two conditions that can cause a high ESR in elderly patients?

A

GCA/PMR

Multiple Myeloma

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3
Q

What type of lymphoma is more painful after alcohol intake?

A

Hodgkin’s lymphoma

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4
Q

What are a woman’s options for post-coital contraception?

A

Contraceptive pillA woman’s options for post-coital contraception include the emergency contraceptive pill (levonorgestrel or ulipristal acetate) taken within 3 days (levonorgestrel/levonelle)

5 days (ulipristal acetate/ellaone) after unprotected sexual intercourse.

Alternatively, a copper intrauterine device (Cu-IUD) can be inserted by a healthcare professional up to 5 days after unprotected sex to prevent pregnancy.

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5
Q

What are a male or female patient’s options for sterilisation?

A

Male patients have the option of vasectomy, a surgical procedure involving the cutting or blocking of the vas deferens to prevent the release of sperm during ejaculation. Female patients can undergo tubal ligation, a surgical procedure involving the blocking, cutting, or sealing of the fallopian tubes to prevent eggs from reaching the uterus for fertilisation.

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6
Q

How might your advice about contraception change if a patient has heavy/painful periods?

A

For patients with heavy or painful periods, contraceptive options that contain progestogens, such as progestogen-only pills, hormonal intrauterine devices (IUDs), or contraceptive implants, may be preferred as they can help alleviate menstrual symptoms. Additionally, non-hormonal methods like the copper intrauterine device (Cu-IUD) may be suitable for contraception without exacerbating heavy bleeding or pain

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7
Q

Are there any forms of contraception that you would avoid in a patient who wants to use contraception for a
short period before starting a family?

A

In a patient who desires contraception for a short period before starting a family, long-acting reversible contraceptive (LARC) methods such as hormonal or copper intrauterine devices (IUDs) and contraceptive implants should be approached with caution. While highly effective and reversible, they may not be suitable for short-term contraception due to the potential for longer-term effects on fertility restoration and potential costs associated with insertion and removal. Short-term contraceptive methods like barrier methods or oral contraceptive pills may be more appropriate for such individuals.

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8
Q

What forms of contraception help with heavy periods?

A

Levonorgestrel IUD (Mirena)
COCP is second line
POP or injectable

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9
Q

What forms of contraception might make periods heavier?

A

Copper coil- can make them longer and more painful
Some POP like the implant and pill (can be amenorrhoea too tho)
Emergency contraception (short term impacts on the cycle)

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10
Q

What is the Jaydess contraceptive?

A

Jaydesss for younger, thinner people not planning on having a baby- easier to get in than the mirena.

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11
Q

What shouldn’t you use in patients with migraines?

A

Migraine with aura- shouldn’t use the COCP, vaginal ring or the contraceptive patch

Safer is progesterone only contraceptive

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12
Q

What long-term contraception can you use?

A

Implant
IUS (hormone coil)
IUD (copper coil)
Injections (progesterone only)

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13
Q

How long does the implant last?

A

3 years
You can have it put back in in the same place
Generally done in GP, can be done in sexual health clinics
More common in younger people

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14
Q

How often do progesterone only injections need to be administered?

A

Every 3 months

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15
Q

What are some side effects of the implant?

A

Irregular bleeding- main reason it is removed in the end. Not necessarily heavy.
Skin changes, weight gain, loss of libido, acne.

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16
Q

What are advantages of the copper coil?

A

Women that are really sensitive to hormones can use a copper coil.
Always try and fit the 10 year coil.

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17
Q

What do you have to make sure before you insert a coil?

A

You have to be very certain there is no chance of pregnancy

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18
Q

How can the copper coil be used as emergency contraception?

A

Copper coil can be used as contraception in the first 5 days.

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19
Q

Advantages and disadvantages of deprovera

A

Deprovera injection- does rely on someone booking an appointment every 12 weeks.
6 months women have stopped having their periods.
Risk factor
Delay of fertility

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20
Q

What contraception has been found to actually cause weight gain?

A

Deprovera
Directly causes weight gain.

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21
Q

What guidance can you use to help you choose a contraception?

A

UKMEC- tells you which categories patients fit into, where benefits outweigh risks etc.

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22
Q

What percentage of vasectomies fail?

A

Less than 1%

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23
Q

What percentages of tubal ligation fail?

A

1.85% fail

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24
Q

When are you most likely to be pregnant after a vasectomy?

A

If you have unprotected sex within 3 months after the procedure due to motile sperm in the vas deferens.

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25
Q

How is a vasectomy carried out?

A

Under local anaesthetic
Scrotum can become bruised
Considered permanent- can be very difficult to reverse

26
Q

What happens after a vasectomy to ensure there is no sperm?

A

Two semen tests are carried out after to ensure there is no semen

27
Q

Does a vasectomy affect sex?

A

No same sex drive, can still get an erection, semen will have no sperm in it.

28
Q

What is the procedure of tubal ligation?

A

Tubal ligation- more invasive, women have to be under general anaesthetic

29
Q

What is the difference between the two different types of emergency contraception?

A

There are 2 main types of emergency pill used in the UK:

levonorgestrel (brands include Levonelle) which you need to take within 3 days (72 hours) after sex
ulipristal acetate (brands include ellaOne) which you need to take within 5 days (120 hours) after sex

If ellaone is taken 24 hours after sex, it is 2.5x more effective than levonel.

30
Q

When do you start COCP after levonel?

A

After giving levonel- emergency contraception you can start the COCP

You need

31
Q

When do you start COCP after ellaone?

A

Wait 5 days after ellaone- to start the COCP

32
Q

What are the rules for starting the COCP?

A

Starting on day 1 to 5 of your menstrual cycle
If you start taking the pill in the first 5 days of your cycle (day 1 is the first day of your period), you will be protected from pregnancy straight away.

Starting after day 5 of your menstrual cycle
If you start taking the pill more than 5 days after the start of your period, you will not be protected from pregnancy straight away.

You’ll need to use another type of contraception, such as condoms, until you’ve taken the pill for 7 days.

33
Q

What happens if you give COCP after 6 days?

A

Day 6 onwards- needs to use extra contraception for 2 days

34
Q

What are the symptoms of migraines with aura?

A

Flashes of light, blind spots, tingling of the face and hands

35
Q

What are the absolute contraindications to progesterone-only pills?

A

Severe renal insufficiency
Acute renal failure

36
Q

What length of prescription do you give if a patient is going abroad?

A

Only 3 months if they are going abroad

37
Q

What length of prescription do you give if they are being started on the pill?

A

3 months

38
Q

What advice can you give someone having a vasectomy?

A

They can change their mind up until the day of the surgery.

39
Q

What are recognised side-effects of statins?

A
  • Asthenia
  • Headache
  • Flatulance
40
Q

What are the main P450 inhibitors?

A

O DEVICES

Omeprazole
Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol
Sulphonamides

41
Q

What is the recommended therapeutic concentration of Digoxin?

A

1-2 micrograms/l

42
Q

What are the most common symptoms of digoxin toxicity?

A

Nausea, vomiting, diarrhoea, hallucinations, visual disturbance and drowsiness.

43
Q

What drugs have a narrow therapeutic index?

A
  • Phenytoin
  • Lithium
  • Warfarin
  • Theophylline
44
Q

Can warfarin be administered IV?

A

No must be oral.

45
Q

How often does INR have to be checked for patients with mechanical heart valves?

A

Every 2-4 weeks

46
Q

What are indications for warfarin therapy?

A

Treatment of DVT/PEPrevention of stroke in patients with AF

Prevention of recurrent TIA/stroke in those patients who have already suffered stroke

Prevention of VTE after insertion of a prosthetic heart valve

Warfarin is not used for the prevention of DVT/PE in surgical patients. The drug of choice in this case would be a Low Molecular Weight Heparin (LMWH) such as enoxaparin or tinzaparin used at the licensed prophylactic dose.

47
Q

What is the INR?

A

International normalised ratio
A measurement of the extrinsic coagulation pathway
Increased in the presence of chronic liver disease (liver is responsible for the production of coagulation factors)

48
Q

Explain the steps in the WHO analgesic ladder

A
  1. Paracetamol
  2. NSAID and PPI
  3. Add codeine/co-codamol (weak opioids)
  4. Stop codeine/co-codamol & trial tramadol (weak opioid)
  5. Reassess the patient
  6. Stop tramadol and start morphine
  7. Refer to pain managmeent specialists
49
Q

What are some common side effects of Amoxicillin?

A

Diarrhoea and nausea

50
Q

According to the STOPP criteria, which specific condition warrants discontinuation of proton pump inhibitors (PPIs) when used beyond the recommended duration?

A

History of Clostridium difficile infection
Prolonged PPI use can increase the risk of recurrent Clostridium difficile infections

51
Q

A 75-year-old patient with a history of atrial fibrillation (AF) is not on anticoagulation therapy. According to the START criteria, what is the recommended action, and why?

A

Initiate anticoagulation therapy
To reduce the risk of stroke associated with atrial fibrillation

52
Q

Under the STOPP criteria, why should digoxin not be prescribed at doses >125 micrograms/day for older adults with heart failure?

A

Increased risk of toxicity due to reduced renal clearance in older adults

53
Q

What is the START recommendation for an 82-year-old woman with osteoporosis and a previous fragility fracture who is not currently receiving any bone-protective treatment?

A

Initiate bisphosphonates (alendronate)
To reduce the risk of subsequent fractures

54
Q

A 70-year-old male with chronic obstructive pulmonary disease (COPD) is currently on long-term oral corticosteroid therapy. According to the START criteria, what additional therapy should be considered?

A

Initiate bisphosphonates (alendronate)
To prevent corticosteroid-induced osteoporosis

55
Q

Under the STOPP criteria, what is the rationale for avoiding non-steroidal anti-inflammatory drugs (NSAIDs) in a patient with chronic renal disease stage 3 or higher?

A

NSAIDs can further impair renal function and exacerbate chronic kidney disease

56
Q

In a patient with diabetes and a history of myocardial infarction (MI), the START criteria recommend the use of which class of medication if not already prescribed?

A

Initiate an ACEi or ARB
To reduce the risk of cardiovascular events and improve survival post-MI

57
Q

According to the STOPP criteria, why should selective serotonin reuptake inhibitors (SSRIs) be used cautiously in older adults with a history of hyponatraemia?

A

SSRIs can exacerbate hyponatraemia due to their potential to induce the syndrome of inapproriate antidiuretic hormone secretion (SIADH)

58
Q

What are the main benefits of using the STOPP/START tool?

A
  • Reduces polypharmacy and the risk of adverse drug events
  • Ensures appropriate medication use tailored to the patient’s clinical needs
  • Facilitates a structured medication review process
59
Q

What type of drug is EllaOne (Ulipristal acetate)

A

Progesterone receptor modulator
Works by delaying ovulation

60
Q

What are missed pill rules for the COCP?

A

Missed pill rules:

If pills are missed in week 1: use emergency contraception if she had UPSI in pill free interval for 1 week

If pills are missed in week 2: no need for emergency contraception

If pills are missed in week 3: Take the last pill that was missed, finish the current pack and start the next pack immediately after.

61
Q

What is a side-effect of Amlodipine?

A

Gum hypertrophy

62
Q

What should be avoided in a patient taking Ciprofloxacin?

A

Warfarin
Quinolone antibiotics enhance the effects of Warfarin

Y3 GP (13 decks)

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