Medicines 15 Flashcards
When Alendronic acid and a calcium/vitamin D supplement are co prescribed together what is a key counselling point to give the patient?
Avoid taking alendronic acid and the calci/vit D supplement at the same time .
Ideally atleast 4 hours between doses.
What counselling points are required with sildenafil?
Counselling
Drug will not produce an erection without sexual stimulation.
Should take about an hour before sexual activity to allow absorption
If erection doesn’t go after 2 hours seek medical help.
Report any eyesight changes
Do not take more than one dose in 24 hours
Must get same brand each time
Can be taken before or after food but after food will delay its onset
Do not drink grapefruit with this
What are some side effects of sildenafil?
Flushing
Headache
Dizziness, nausea
Nasal congestion
Hypotension
Tachycardia
Palpitations
Vascular events: myocardial infarction, stroke
Visual disorders – colour distortion due to inhibition of PDE6 in the retina may occur – urgent
what are the cautions and contraindications with sildenafil?
Avoid in those in whom vasodilation is dangerous:
Avoid in stroke or acute coronary syndrome or cardiovascular disease
Avoid or lower dose in severe hepatic or renal impairment – best to avoid in severe hepatic impairment
Contraindicated in hereditary degenerative retinal disorders
When used for erectile dysfunction: avoid if systolic blood pressure below 90 mmHg (no information available); patients in whom vasodilation or sexual activity are inadvisable; recent unstable angina
When used for pulmonary arterial hypertension: avoid in sickle-cell anaemia
Caution in active peptic ulceration and bleeding disorders
WHat medications does sildenafil interact with
When used for Erectile dysfunction
Manufacturer advises a starting dose of 25 mg with concurrent use of moderate and potent inhibitors of CYP3A4.
Many of the following are CYP3A4 inhibitors - SICK FACES.AC.AG.COM
Alpha-blockers – enhanced hypotensive effect when sildenafil given with alpha-blockers (avoid alpha-blockers for 4 hours after sildenafil)—when patient is stable on the alpha blocker initiate sildenafil at the lowest possible dose
Amlodipine – enhanced hypotensive effect
Cimetidine – concentration of sildenafil increased by cimetidine—consider reducing dose of sildenafil for erectile dysfunction
Clarithromycin, erythromycin, telithromycin – concentration of sildenafil increased—consider reducing initial dose of sildenafil for erectile dysfunction or reduce sildenafil dose frequency to once daily for pulmonary hypertension
Grapefruit juice – concentration of sildenafil increased.
Ketoconazole – concentration of sildenafil increased by ketoconazole—reduce initial dose of sildenafil for erectile dysfunction and avoid concomitant use of sildenafil for pulmonary hypertension
Nicorandil, nitrated – sildenafil significantly enhances hypotensive – avoid
Antivirals – avoid – increased risk of ventricular arrhythmias and increased concentration of sildenafil
Amiodarone, diltiazem, fluconazole – plasma concentration of sildenafil and side effects increased by these.
What are the symptoms of measles?
Cold-like symptoms
The first symptoms of measles include:
a high temperature
a runny or blocked nose
sneezing
a cough
red, sore, watery eyes
GREYISH WHITE SPOTS IN THE MOUTH
RED/BROWN BLOTCHY RASH
What vaccines are offered during pregnancy?
whooping cough vaccine – from 16 weeks
ADACEL or Boostrix IPV
RSV vaccine – from 28 weeks
Respiratory syncytial virus
When is folic acid required for each strength (5mg and 400mcg) in pregnancy?
Women at higher risk (e.g., diabetes, obesity, epilepsy, or family history of neural tube defects) are advised to take a higher dose of folic acid (5 mg daily) starting pre-conception and continuing until the 12th week of pregnancy.
400 micrograms daily for women with no additional risk factors, pre-conception until week 12.
What are the main indications of hydroxychloroquine?
Active rheumatoid arthritis
Dermatological conditions caused or aggravated by sunlight
What are some common side effects of hydroxychloroquine?
As per common side effecst in BNF
visual disturbances
mood altered
When would patients seek immediate medical attention when taking metformin
Manufacturer advises that patients and their carers should be informed of the risk of lactic acidosis and told to seek immediate medical attention if symptoms such as dyspnoea, muscle cramps, abdominal pain, hypothermia, or asthenia occur.
Which antimalarial can be given to someone with epilepsy?
Atovaquone-Proguanil (e.g., Malarone®)
Generally considered safe for people with epilepsy.
Does not lower the seizure threshold or interact significantly with common AEDs.
What are the NICE guidelines for blood glucose monitoring in type 1 diabetics?
Fasting (before meals):
4–7 mmol/L
2 hours after meals (postprandial):
5–9 mmol/L
SAME IN CHILDREN
Blood glucose should not fall below 4 mmol/L.
FOUR TO THE FLOOR
in terms of biochemical tests what is the usual indicator of hyperthyroidism?
TSH is typically suppressed in hyperthyroidism.
This occurs because the pituitary gland senses high levels of thyroid hormones (T3 and T4) and reduces TSH secretion as a negative feedback mechanism.
What is the counselling around the GTN spray?
Use 1 or 2 sprays under your tongue. If you’re still in pain after 5 minutes you can have a second dose of 1 or 2 sprays under your tongue.
Call 999 if you’ve taken 2 doses of GTN and you’re still in pain 5 minutes after your 2nd dose
aim the spray under the tongue and close your mouth immediately afterwards
learn how to use the spray before an angina attack as you may need to use it in a hurry or in
the dark
sit down before using the spray and for a few minutes afterwards
the most common side effects are headache and facial flushing
