Medicines 17

Question 1

What is Cauda equina syndrome and what are the symptoms?

Answer 1

Cauda equina syndrome (CES) is a medical emergency that occurs when the nerves at the bottom of the spinal cord are compressed. This compression can be caused by a herniated disk, tumor, infection, or trauma.
Symptoms
Back pain
Weakness in the legs
Numbness in the legs
Bladder dysfunction
Bowel dysfunction
Sexual dysfunction
Loss of sensation in the genitals
Loss of sensation when urinating or defecating

Question 2

For children using a steroid inhaler or nasal spray what annual monitoring should be done?

Answer 2

The height and weight of children receiving prolonged treatment with inhaled corticosteroids should be
monitored annually.

Question 3

What is the guidance for treating anaphylaxis in the community (ages aswell)

Answer 3

By intramuscular injection
CHILD UP TO 6 MONTHS 100–150 micrograms (0.1–0.15 mL), repeated after 5 minutes if necessary
CHILD 6 MONTHS–5 YEARS 150 micrograms (0.15 mL), repeated after 5 minutes if necessary
CHILD 6–11 YEARS 300 micrograms (0.3 mL), repeated after 5 minutes if necessary
CHILD 12–17 YEARS 500 micrograms (0.5 mL), repeated after 5 minutes if necessary; 300 micrograms (0.3 mL) should be given if child is small or prepubertal
ADULT 500 micrograms (0.5 mL), repeated after 5 minutes if necessary
If life-threatening features persist, further doses of intramuscular adrenaline/epinephrine can be given every 5 minutes until specialist critical care available.

High-flow oxygen should be given as soon as available.

Question 4

What is the guidance regarding a diabetic hypo in practice?

Answer 4

Hypoglycaemia Management – Revision Notes
Child ≤5 Years
By Mouth: 5 g glucose
Options:
20 mL Lift®
1.5 glucose tablets
½ tube glucose 40% gel
1 tsp sugar in water
Repeat after 15 min if needed.
By Buccal: 5 g (½ tube glucose 40% gel), repeat after 15 min if needed.
Child 5–11 Years
By Mouth: 10 g glucose
Options:
40 mL Lift®
3 glucose tablets
1 tube glucose 40% gel
2 tsp sugar in water
Repeat after 15 min if needed.
By Buccal: 10 g (1 tube glucose 40% gel), repeat after 15 min if needed.
Child 12–17 Years
By Mouth: 15 g glucose
Options:
60 mL Lift®
4 glucose tablets
1.5 tubes glucose 40% gel
3 tsp sugar in water
Repeat after 15 min if needed.
By Buccal: 15 g (1.5 tubes glucose 40% gel), repeat after 15 min if needed.
Adult
By Mouth: 15–20 g glucose
Options:
60–80 mL Lift®
4–5 glucose tablets
1.5–2 tubes glucose 40% gel
150–200 mL pure fruit juice
3–4 tsp sugar in water
Repeat after 15 min if needed.
By Buccal: 15–20 g (1.5–2 tubes glucose 40% gel), repeat after 15 min if needed.
Unresponsive or Oral Route Not Possible
Glucagon Injection (GlucaGen®)

IM Injection:
Child ≤8 years or ≤25 kg: 500 micrograms (0.5 mL)
Child ≥9 years or >25 kg: 1 mg (1 mL)
Adult: 1 mg (1 mL)
If no response after 10 min, proceed to IV glucose.
IV Glucose Infusion

10% Glucose (500 mg/kg)
Child: 5 mL/kg
Adult: 150–200 mL over 15 min
20% Glucose
Adult: 75–100 mL over 15 min

Question 5

When does a missed dose of the pill no longer provide effective protection?

Answer 5

A missed pill is one that is 24 or more hours late. If a woman misses only one pill, she should take an active pill as
soon as she remembers and then resume normal pill-taking. No additional precautions are necessary.

Question 6

What are the rules regarding distruction of controlled drugs tablets and aerosols?

Answer 6

Aerosol formulations should be expelled into water and the resulting liquid disposed of in an appropriately-
sized CD denaturing kit.
It is advisable to grind or crush solid dose formulations before adding them to a CD denaturing kit to ensure
that whole tablets or capsules are not retrievable.

Question 7

What key prescribing infromation is there with glyceryl trinitrate tablets?

Answer 7

Glyceryl trinitrate tablets are available in strengths of 500- and 600-micrograms—tablets should be supplied in glass containers of not more than 100 tablets, closed with a foil-lined cap, and containing no cotton wool wadding; they should be discarded after 8 weeks in use.

Question 8

Which beta blockers are more likely to cause nightmares and why?

Answer 8

Water soluble – atenolol, sotalol, nadolol – less likely to enter the brain, therefore less likely to cause sleep
disturbance and nightmares

Lipid soluble – labetalol, oxprenolol, propranolol, timolol - MORE LIKELY TO CAUSE NIGHTMARES

Question 9

What can spironolactone and furosemide cause if taken together?

Answer 9

(Hyponatraemia) - Both spironolactone and furosemide reduce sodium and this can be potentiated together

Question 10

What happens if fluconazole and domperidone are taken together?

Answer 10

(QT interval prolongation) – Domperidone increases the risk of QT-prolongation when given with fluconazole.
Manufacturer advises avoid

Question 11

What does a black triangle next to a medication mean?

Answer 11

The medicine has a black triangle meaning limited
experience with the medication. In this case, all ADRs should be reported

Question 12

What are the symtoms of hyponatraemia?

Answer 12

Mild (Na+ 130–135 mmol/L):

Nausea
Fatigue
Headache
Moderate (Na+ 125–129 mmol/L):

Confusion
Dizziness
Vomiting
Muscle weakness
Severe (Na+ <125 mmol/L):

Altered mental status
Seizures
Coma
Respiratory distress
Onset:

Acute: Rapid symptoms (seizures, coma).
Chronic: Milder symptoms (fatigue, cognitive impairment).

Question 13

How would you advise someone with measles?

Answer 13

Measles a virus so no antibiotics

Ask for an urgent GP appointment

Question 14

What is 1st and 2nd line treatment for meningitis according to BNF treatment summaries section?

Answer 14

1st line: Benzylpenicillin sodium injection (600 mg, 1.2 g) or Ceftriaxone injection (250 mg, 1 g, 2 g).

2nd line Chloramphenicol

Benzylpenicillin sodium injection (600 mg, 1.2 g)
By intravenous injection (or by intramuscular injection if venous access not available)
CHILD 1 MONTH–11 MONTHS 300 mg
CHILD 1–9 YEARS 600 mg
CHILD 10–17 YEARS 1.2 g
ADULT 1.2 g
or

Ceftriaxone injection (250 mg, 1 g, 2 g)
By deep intramuscular injection
CHILD 1 MONTH 250 mg
CHILD 2–11 MONTHS 500 mg
CHILD 1–4 YEARS 1 g
CHILD 5–8 YEARS 1.5 g
CHILD 9–11 YEARS 2 g
By intravenous injection or by deep intramuscular injection
CHILD 12–17 YEARS 2 g
ADULT 2 g

Question 15

What is the lipid target following a stroke?

Answer 15

evidence of atherosclerosis should aim to reduce fasting LDL-cholesterol below 1.8 mmol/L (equivalent to a non-HDL-cholesterol below 2.5 mmol/L in a non-fasting sample)

Question 16

As per the national stroke guideline what is the go to secondary prevention antiplatelet therapy?

Answer 16

For long-term prevention of vascular events in people with ischaemic stroke or TIA without paroxysmal or permanent atrial fibrillation:

clopidogrel 75 mg daily should be the standard antithrombotic treatment;
aspirin 75 mg daily should be used for those who are unable to tolerate clopidogrel

The combination of aspirin and clopidogrel is not recommended for long-term prevention of vascular events unless there is another indication e.g. acute coronary syndrome, recent coronary stent. [2023]

Question 17

What is the difference between mineralcorticoid and glucocorticoid?

Answer 17

1. Glucocorticoid Activity:
   Glucocorticoids (e.g., cortisol) are mainly involved in managing energy, inflammation, and stress.
   Key functions include:
   Increasing blood sugar levels by helping the body break down proteins and fats for energy (important during stress).
   Reducing inflammation by suppressing the immune system (helpful in treating allergies and autoimmune conditions).
   Controlling how the body handles stress.
   Think of glucocorticoids as the hormones that help your body fight stress and inflammation.
2. Mineralocorticoid Activity:
   Mineralocorticoids (e.g., aldosterone) are mainly involved in regulating salt and water balance in the body.
   Key functions include:
   Helping the kidneys retain sodium (salt) and water.
   Promoting the excretion of potassium.
   Maintaining blood pressure and fluid balance.
   Think of mineralocorticoids as the hormones that act like a fluid and salt manager to keep your blood pressure stable.

Summary:
Glucocorticoids: Manage energy, stress, and inflammation. (Example: Cortisol)
Mineralocorticoids: Regulate salt, water, and blood pressure. (Example: Aldosterone)

Question 18

How do glucocorticoids affect blood sugars ?

Answer 18

Cause hyperglycaemia

Question 19

When would you reduce dose of steroids gradually and when can you stop abruptly?

Answer 19

Stop Abruptly:

Short courses (<3 weeks).
Gradual Withdrawal Needed:

> 40 mg prednisolone/day for >1 week.
3 weeks of treatment.
Repeated evening doses (risk of adrenal suppression).
Recent repeated courses (e.g., asthma exacerbations).
History of long-term therapy (months/years).
Other adrenal suppression risks: excessive alcohol, stress (infection, trauma, surgery).

Question 20

what antiemetics are contraindicated in parkinsons disease and which antiemetics are recommended?

Answer 20

Avoid dopamine-blocking antiemetics like metoclopramide, prochlorperazine, and haloperidol in Parkinson’s disease.
Use domperidone or ondansetron as safer alternatives

Question 21

what are the COPD guidelines as per NICE CKS?

Answer 21

SABA or SAMA (as needed): Use for symptom relief through all stages.
If Symptoms Persist or Exacerbations Occur:

Assess for asthmatic features or steroid responsiveness:
No Asthmatic Features:
Offer LABA + LAMA (e.g., Spiolto, Duaklir, Anoro Ellipta). Stop SAMA if switching to long-acting therapy.
Asthmatic Features:
Consider LABA + ICS (e.g., Fobumix, Luforbec).
If Still Limited by Symptoms or Frequent Exacerbations (≥2 moderate or 1 severe in a year):

Offer Triple Therapy (LAMA + LABA + ICS)

Question 22

What is a key side effect to note with spironolactone?

Answer 22

gynaecomastia
breast neoplasm benign; breast pain

Question 23

What are some key side effects with finasteride?

Answer 23

Side effects

Impotence
Reduced libido = temporary
Breast tenderness and enlargement (gynaecomastia)
Hair growth
Breast cancer in men

Question 24

How does finasteride work in simple terms?

Answer 24

Reduce the size of the prostate gland and improve urinary flow

Question 25

What key counselling points are there with finasteride?

Answer 25

Take one tablet each day
Your symptoms may start to improve within a few weeks, although it can take up to six months for you to notice the full benefit.
Consider reducing or stopping the amount of caffeine you drink (commonly found in tea, coffee and cola) and alcohol. These can make your symptoms worse, so drinking less of these things may benefit you.
Must use a condom during sexual activity