Medicines 2 Flashcards

Question

What vitamin can be used to prevent Isoniazid induced peripheral neuropathy

Answer 1

Isoniazid induced peripheral neuropathy can be prevented and treated with pyridoxine (vitamin b6). It is usually given to all patients prophylactically at the start of treatment.

Answer 2

Folic acid (Vitamin B9) Folic acid 400mcg is recommended up to 12 weeks of pregnancy to prevent neural tube defects. Sometimes folic acid 5mg is recommended for example in a woman receiving antiepileptic medication.

Answer 3

Ascorbic acid. Scurvy is rare now. It is due to vitamin C deficiency. It is prevented and treated with vitamin C.

Answer 4

Treatment for 4 month and repeat bloods to see if folate levels have corrected.

Answer 5

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a genetic condition that primarily affects red blood cells and increases vulnerability to certain medications, foods, infections, and other triggers that can cause hemolytic anemia (destruction of red blood cells). The deficiency occurs due to mutations in the G6PD gene, which is located on the X chromosome. Because of this, certain populations and groups are more at risk. Populations at Higher Risk of G6PD Deficiency: Geographic and Ethnic Groups: African and African American Descent: G6PD deficiency is relatively common in people of African descent, particularly among males. About 10–15% of African American males in the United States have the condition. Mediterranean Populations: Higher prevalence in people from Mediterranean countries, especially those of Greek, Italian, and Turkish descent. Middle Eastern Populations: More common among people from the Arabian Peninsula, Iran, and Iraq. South Asian Populations: Individuals from countries such as India and Pakistan are also at increased risk. Southeast Asian Populations: More frequent in people from regions like the Philippines, Malaysia, Indonesia, and Thailand. Gender: Male: Since the G6PD gene is located on the X chromosome, males (who have one X and one Y chromosome) are more frequently affected. If they inherit a defective G6PD gene, they are likely to have the deficiency. Female Carriers: Females have two X chromosomes, so they are less likely to be fully affected unless they inherit two copies of the mutated gene. However, females with one defective gene can be carriers, and some may show mild symptoms if they have partial enzyme deficiency. Females are at lower risk than males, and the ethnicities most at risk are Asian, African, and South European.

Answer 6

A lack of vitamin D can lead to bone deformities such as rickets in children, and bone pain caused by a condition called osteomalacia in adults.

Answer 7

Chloroquine due to its anti-inflammatory and immunomodulatory effects. Originally developed as an antimalarial drug, chloroquine is classified as a disease-modifying antirheumatic drug (DMARD)

Answer 8

Conventional Synthetic DMARDs (csDMARDs) These are traditional DMARDs that have been used for decades to manage RA and similar conditions. They work by broadly suppressing the immune system. Methotrexate: The most commonly used csDMARD, it inhibits the enzyme dihydrofolate reductase, reducing inflammation. Sulfasalazine: This anti-inflammatory drug is thought to work by suppressing the immune response. Leflunomide: It inhibits pyrimidine synthesis, which reduces immune cell proliferation. Hydroxychloroquine and Chloroquine: Originally antimalarials, they modulate immune response, reducing inflammation in autoimmune diseases. Biologic DMARDs (bDMARDs) Biologic DMARDs are derived from living organisms and target specific immune molecules or cells involved in inflammation. They are usually used when csDMARDs are ineffective. Types include: TNF inhibitors: Block tumor necrosis factor (TNF), a key molecule in inflammation (e.g., adalimumab, infliximab, etanercept). IL-6 inhibitors: Target interleukin-6 (IL-6), another inflammatory cytokine (e.g., tocilizumab). B-cell inhibitors: Target B cells involved in autoimmune responses (e.g., rituximab). T-cell costimulation inhibitors: Block the activation of T cells (e.g., abatacept). Biological DMARDs include abatacept, sarilumab and tocilizumab. Biological DMARDs are more target specific.

Answer 9

Eye Color Changes: Latanoprost may gradually increase the brown pigmentation in the iris, leading to a permanent change in eye color, particularly in patients with mixed-color irises (e.g., blue-brown, green-brown). This effect is usually gradual and may not be reversible. Eyelash and Eyelid Changes: It can cause eyelashes to grow longer, thicker, and darker, and may also lead to changes in eyelid skin pigmentation. Application Technique: Instruct patients to apply only one drop to the affected eye(s) once daily in the evening, as more frequent use can reduce its effectiveness. They should avoid touching the dropper tip to the eye or any surface to prevent contamination. Remove Contact Lenses: Latanoprost contains benzalkonium chloride, which can be absorbed by contact lenses. Patients should remove lenses before application and wait at least 15 minutes before reinserting them. Transient Blurring: Vision may be temporarily blurred after application, so patients should wait until vision is clear before driving or operating machinery. Storage: Before opening, keep the bottle in the refrigerator. Once opened, it can be stored at room temperature for up to six weeks. unless Xalatan

Answer 10

Typical symptoms and signs of glaucoma include: eye pain, often severe, and associated with headache, nausea, and vomiting caused by the pain. A red eye. Impaired visual acuity and lights are seen surrounded by halos. Semi-dilated and fixed pupil. Classically, the pupil becomes fixed in a vertically oval shape. A tender, hard eye (palpate very gently). When measured by an optometrist or ophthalmologist, the intraocular pressure (IOP) is typically very high.

Answer 11

Topical Treatments For mild to moderate psoriasis, topical treatments are often the first line of therapy. These are applied directly to the skin to help reduce inflammation, scaling, and plaque formation. Corticosteroids: Commonly used to reduce inflammation and itching (e.g., hydrocortisone, betamethasone). Vitamin D Analogues: Slow skin cell growth and can help reduce plaques (e.g., calcipotriene, calcitriol). Retinoids: Derived from vitamin A, they reduce skin cell turnover and inflammation (e.g., tazarotene). Calcineurin Inhibitors: Effective for sensitive areas, such as the face and folds of skin (e.g., tacrolimus, pimecrolimus). Coal Tar: Slows skin cell growth and reduces scaling, itching, and inflammation. Salicylic Acid: A keratolytic that helps remove scales, often used in combination with other therapies. 2. Phototherapy (Light Therapy) Phototherapy is used for moderate to severe psoriasis, especially when topical treatments are ineffective. UVB Phototherapy: Exposure to ultraviolet B (UVB) light slows the rapid skin cell turnover in psoriasis. PUVA (Psoralen and UVA): Combines a drug called psoralen with UVA light. It’s typically used for severe cases. Excimer Laser: Targets specific areas with a focused beam of UVB light, often used for smaller, localized lesions. 3. Systemic Treatments (Oral or Injectable Medications) These are used for moderate to severe psoriasis or for cases that have not responded to topical treatments or phototherapy. Systemic treatments affect the whole body, so they come with a greater risk of side effects. Methotrexate: Affects immune cell activity, helping reduce inflammation and cell turnover. Cyclosporine: Suppresses the immune system, quickly reducing symptoms, but is usually for short-term use. Oral Retinoids: Such as acitretin, help reduce skin cell production. Apremilast: A phosphodiesterase-4 (PDE4) inhibitor that reduces inflammation by affecting specific immune pathways. 4. Biologic Therapies Biologics are a newer class of systemic drugs that target specific parts of the immune system. These are usually injected or infused and are used for moderate to severe cases, particularly when other treatments have failed. TNF-alpha Inhibitors: Target tumor necrosis factor-alpha, a cytokine involved in inflammation (e.g., adalimumab, etanercept, infliximab). IL-12 and IL-23 Inhibitors: Target interleukin-12 and interleukin-23, which contribute to the inflammation process (e.g., ustekinumab). IL-17 Inhibitors: Target interleukin-17, which is involved in the immune response (e.g., secukinumab, ixekizumab). IL-23 Inhibitors: Block the action of interleukin-23 to reduce inflammation (e.g., guselkumab, tildrakizumab).

Answer 12

Midazolam: Common Choice: Midazolam is widely preferred because it has a rapid onset and a short duration of action, making it ideal for procedures where quick recovery from sedation is needed. Uses: Provides sedation, anxiolysis, and amnesia, which helps to relax patients before surgery. Administration: Can be given orally, intramuscularly, or intravenously. Lorazepam: Intermediate Duration: Lorazepam has a longer duration than midazolam but is still used preoperatively for patients who need a longer-lasting sedative effect. Uses: Provides anxiolysis and amnesia. Administration: Usually given orally or intravenously. Diazepam: Longer-Lasting Effects: Diazepam has a longer half-life, so it’s used less commonly for short procedures but can be effective in patients who require longer-lasting anxiolytic effects. Administration: Typically given orally or intravenously. Alprazolam: Short-Term Sedation: Although less common in surgical settings, alprazolam may be used preoperatively for its anxiolytic effects. Administration: Generally given orally.

Answer 13

Further notes on benzodiazepines and their interactions with other drugs: Clozapine – serious adverse events reported with concomitant use of benzodiazepines and clozapine Anti-Parkinson’s – benzodiazepines possibly antagonise effects of co-beneldopa and co-careldopa Olanzapine – increased risk of hypotension, bradycardia and respiratory depression when parenteral benzodiazepines given with intramuscular olanzapine Antihypertensive – enhanced hypotensive effects Antidepressants – increased sedative effects