Medicines 18 Flashcards
Which of the SSRIs cause QT prolongation?
All of them to some extent however most significant is CITALOPRAM
BNF only lists citalopram and escitalopram in Appendix 1
WHat is the advice around missed tablets with the pill (desogestorel)?
Contraceptive protection may be reduced if more than 36 hours have elapsed between two tablets. If the user is less than 12 hours late in taking any tablet, the missed tablet should be taken as soon as it is remembered and the next tablet should be taken at the usual time. If she is more than 12 hours late, she should use an additional method of contraception for the next 7 days. If tablets were missed in the first week after initiation of Cerazette and intercourse took place in the week before the tablets were missed, the possibility of a pregnancy should be considered.
WHat are the two main inhaler techniques?
MDIs – You need to breathe in slow and steady and, at the same time, press the canister on the inhaler once. Continue to breathe in slowly over 3 to 5 seconds, until your lungs feel full.
DPIs – If you use a dry powder inhaler, you need to breathe in quickly and deeply until your lungs feel full. This makes sure the medicine is completely inhaled.
What are the CORE symptoms of depression?
The core symptoms of depression as outlined in diagnostic criteria like DSM-5 or ICD-10 are:
Persistent Low Mood:
Feeling sad, hopeless, or empty most of the day, nearly every day.
Loss of Interest or Pleasure (Anhedonia):
A marked reduction in interest or enjoyment in activities that were previously enjoyable.
Fatigue or Low Energy:
Feeling tired or lacking energy, even without significant physical exertion.
Extra: outlined in NICE guidelines
During the last month, have you often been bothered by feeling down, depressed, or hopeless?
During the last month, have you often been bothered by having little interest or pleasure in doing things?
WHat are the different steps in the cycle of change?
Precontemplation:
The person is not yet considering change and may be unaware that their behavior is problematic.
Example: “I don’t see a problem with what I’m doing.”
Contemplation:
The person becomes aware of the problem and starts thinking about making a change but is ambivalent.
Example: “I know I should change, but I’m not sure how or if I’m ready.”
Preparation:
The person decides to take action and begins planning steps to change.
Example: “I’ll start next week and get support to help me.”
Action:
Active steps are taken to modify behavior.
Example: Joining a program, quitting smoking, or starting a healthier routine.
Maintenance:
The person works to sustain the changes and prevent relapse.
Example: Continuing the new behavior and reinforcing positive habits.
Relapse (Optional Stage):
The person may return to old behaviors but can re-enter the cycle at any stage.
Example: “I slipped up, but I’ll try again.”
What are the common doses seen for amoxicillin in children
Child 1–11 months
125 mg 3 times a day for 5 days, increased if necessary up to 30 mg/kg 3 times a day.
Child 1–4 years
250 mg 3 times a day for 5 days, increased if necessary up to 30 mg/kg 3 times a day.
Child 5–11 years
500 mg 3 times a day for 5 days, increased if necessary up to 30 mg/kg 3 times a day (max. per dose 1 g).
Child 12–17 years
500 mg 3 times a day for 5 days, increased if necessary up to 1 g 3 times a day.
What is a common side effect when starting nicorandil
and what other SE should you be aware of with nicorandil?
headache (more common on initiation, usually transitory)
Nicorandil can cause serious skin, mucosal, and eye ulceration; including gastrointestinal ulcers, which may progress to perforation, haemorrhage, fistula or abscess. Stop treatment if ulceration occurs and consider an alternative.
Why should beta blockers not be given with diltiazem or verapamil?
beta-blockers should not be given with verapamil or diltiazem (non-dihydropyridine calcium channel blockers) because of the risk of severe bradycardia, heart block, or profound hypotension.
What are some complications of shingles?
Complications can include:
postherpetic neuralgia
eye problems - refer for shingles near eye
Ramsay Hunt syndrome
the rash becoming infected with bacteria
white patches (a loss of pigment) or scarring in the area of the rash
inflammation of the lungs (pneumonia), liver (hepatitis), brain (encephalitis), spinal cord (transverse myelitis), or protective membranes that surround the brain and spinal cord (meningitis) – these complications are rare.
When are naloxone and naltrexone used?
Naloxone
Use: Emergency treatment of opioid overdose to reverse life-threatening respiratory depression.
Use:
Opioid dependence: To maintain abstinence by blocking the effects of opioids.
Alcohol dependence: To reduce cravings and relapse risk.
What is a common side effect/contraindication with ethambutol
side effects: nerve disorders; visual impairment
contraindications: Optic neuritis; poor vision
Ocular toxicity is more common where excessive dosage is used or if the patient’s renal function is impaired. Early discontinuation of the drug is almost always followed by recovery of eyesight.
What colour can the following drugs change the colour of urine?
triamterene
senna
co-danthromer
Sulfasalazine
Nitrofurantoin
Doxyrubicin
triamterene - Blue in some lights
Senna - yellow
co-danthromer - Red
Sulfasalazine - yellow/orange
Nitrofurantoin - dark yellow or brown
Doxyrubicin - pink or red for up to 48 hours after treatment. Harmless SE
Above what INR do you usually give phytomenadione?
INR above 8
or ANY INR with major/minor bleeding
What is the specific antedote for methotrexate toxicity?
Calcium folinate (Folinic Acid)
Which vitamins are fat soluble?
ADEK & beta-carotene
how does smoking effect theophylline levels
Smoking decreases theophylline levels
What is the criteria required to supply sumatriptan OTC?
Supply criteria for a patient aged 18-65:
I) Migraine must be diagnosed by a doctor or pharmacist
2) Established pattern of migraine (a history of five or more migraine attacks
occurring over a period of at least one year)
3) Simple analgesics tried and ineffective.
Concurrent administration of monoamine oxidase inhibitors and sumatriptan is contraindicated. Imigran is not licensed for use in patients who are pregnant or breastfeeding.
What is the general dosing for anaphylaxis ?
For Child 1 month—5 years ( <15kg): 150 mcg
For Child 6-11 years (>30kg): 300mcg
For Child 12 years old and over: 500 mcg
WHat key opthalmic side effetcs are there with oral steroids?
MHRA alert: Corticosteroids: rare risk of central serous chorioretinopathy with local as well as systemic administration
Patients are advised to report blurred vision
How long before surgery should the combined oral contraception be stopped?
4 weeks
This is to reduce the risk of venous thromboembolism (VTE), as CHC increases the risk of blood clots, and surgery further exacerbates this risk.
When is letrozole used for breast cancer
Not indicated for premenopausal women
Used in post menopausal women
What is a key caution/ side effect of Letrozole treatment?
Susceptibility to osteoporosis
bone pain
Monitoring requirements:
Osteoporosis
Assess bone mineral density before treatment and at regular intervals.
What age would be the minimum age for someone to consent to treatment
A person under 16 can consent to treatment if they are deemed “Gillick competent.”
It would rarely be appropriate or safe for a child less than
13 years of age to consent to treatment without a parent’s involvement. When it comes to sexual health, those under 13 are not legally able to consent to any sexual activity
Would it be appropriate to supply a diabetic patient with treatment for corns/calluses or Varuccas ?
No, refer and give lifestyle advice.
Rationale: Diabetic patients presenting with a foot problem should be referred to the GP for further examination at the earliest opportunity due to the risk of developing limb or life-threatening conditions. GPs would then assess the risk and refer to the foot protection service if needed or to acute services if there is a very high risk.
- OTC treatment for corns contain salicylic acid — these products are not suitable for patients who are diabetic or have blood circulatory disorders due to this risk of infection from the erosion of the skin.
- Lifestyle advice may include: to wear wide, comfortable shoes with a low heel
and to moisurise the feet.
What is the order of Risk of GI bleeds with NSAIDs
GI risk: (high) Piroxicam, Ketoprofen, Ketorolac —> (intermediate) Indometacin,
Diclofenac, Naproxen —>(low) Ibuprofen 1.2g/day
—> (lowest) COX-2 selective
inhibitors (“coxibs”)
