Medicines 21 Flashcards
What is the supply criteria for selling tamsulosin OTC?
Supply criteria: Age 45-75 years old
Symptoms of benign prostatic hyperplasia (BPH) (e.g., difficulty urinating, weak stream, urgency, frequency).
symptoms been present >3 months
Which of the tetracyclines are most likely to cause photosensitivity reactions and which are not?
- Doxycline (very/common)
- Oxytetracycline (very/common)
-Lymecycline (very/common) - Democlocyline (very/common)
Photosensitivity more common than with other
tetracyclines - Minocycline rare
When should a referral be made with suspected thrush?
- Abnormal vaginal bleeding or a blood-stained discharge
- Aged under 16 or over 60 years
- Foul smelling vaginal discharge
- Lower abdominal pain or dysuria
- More than two infections of candidal vaginitis in the last six months
- Pregnancy or suspected pregnancy
- Previous history of a sexually transmitted disease or exposure to partner with
sexually transmitted disease - Vulval or vaginal ulcers, blisters or sores
Please note - thrush is not self-limiting and therefore option A is not appropriate.
Thrush is not life threatenin hence o tion B would be unsuitable.
What is the treatment for tuberculosis?
The recommended regimen is Rifampicin, Ethambutol, Isoniazid and
Pyrazinamide for 2 months; followed by continuation phase: Rifampicin and
Isoniazid for 4 months.
The isoniazid should always be taken with vitamin b6
(pyridoxine) to reduce the risk if isoniazid induced neuropathy.
Treatment should be started without waiting for culture results if clinical features are consistent with
Tuberculosis.
What monitoring is required with hydroxychloroquine?
Baseline eye check before treatment?
Annual eye checks after 5 years of treatment.
Annual monitoring (including fundus autofluorescence and spectral domain optical coherence tomography) is recommended in all patients who have taken hydroxychloroquine for longer than 5 years.
Annual monitoring may be started before 5 years of treatment if additional risk factors for retinotoxicity exist, such as concomitant tamoxifen therapy, impaired renal function (eGFR less than 60 mL/minute/1.73 m2), or high-dose therapy (more than 5 mg/kg/day of hydroxychloroquine sulfate.
What are the target predose trough levels with vancomycin?
Target Pre-Dose (‘Trough’) Concentrations:
🔹 10–20 mg/L (Depends on infection site & pathogen susceptibility)
🔹 15–20 mg/L (For pathogens with MIC ≥1 mg/L)
WHat is the recommended treatment for headlice?
First-Line Treatment: Physical Removal & Wet Combing
✅ Wet combing with a fine-toothed lice comb (bug-busting method)
Use on wet, conditioner-coated hair
Repeat every 3–4 days for at least 2 weeks
2️⃣ First-Line Pharmacological Treatment: Dimeticone (Physical Insecticides)
✅ Dimeticone 4% lotion or spray (Hedrin®)
Apply to dry hair, leave for 8 hours (overnight), then wash off
Repeat after 7 days
3️⃣ Alternative Pharmacological Treatments
Treatment Considerations
🔹 Resistant infestations → Try an alternative treatment if initial therapy fails
🔹 Pregnant & breastfeeding women → Prefer wet combing or dimeticone
🔹 Children under 6 months → Avoid chemical treatments; use wet combing
🔹 Household contacts → Only treat if live lice are found
How does selelgiline affect sinimet tablets?
When selegiline is added to a levodopa regimen it is possible to reduce the levodopa dosage by an average of 10 -30%. Reduction of the levodopa dose should be gradual in steps of 10% every 3 to 4 days.
The SPC also states ‘Since fluoxetine has a very long elimination half-life, at least 5 weeks should be allowed after stopping fluoxetine and before starting selegiline.’
What are the different various MHRA alerts associated with topirimate?
📌 💊 Antiepileptics & Suicide Risk (Aug 2008)
🔹 Increased risk of suicidal thoughts & behavior
🔹 Monitor mood & mental health in patients
📌 🔄 Switching Between Antiepileptic Brands (Nov 2017)
🔹 Topirimate - category 2
📌 ⚠️ Topiramate & Neurodevelopmental Risks (Jul 2022)
🔹 Study links prenatal exposure to increased risk of:
Autism spectrum disorder
Intellectual disability
Neurodevelopmental disorders
🔹 Counsel females of childbearing potential on pregnancy risks
📌 🚨 Topiramate – Pregnancy Prevention Programme (Jun 2024)
🔹 Contraindicated in pregnancy for migraine
🔹 Use for epilepsy only if no alternative
🔹 Significant risks:
Congenital malformations
Low birth weight
Intellectual disability, ASD, ADHD
🔹 Prescriber Responsibilities:
Identify & counsel all females of childbearing potential
Provide Patient Guide & complete Risk Awareness Form annually
🔹 Pharmacist Responsibilities:
Dispense whole packs with warning labels
Provide Patient Card & check contraception use
Infants (Under 1 Year)
📌 1–2 months
🔹 30–60 mg every 8 hours
📌 3–5 months
🔹 60 mg every 4–6 hours
📌 6–23 months
🔹 120 mg every 4–6 hours
Toddlers & Young Children
📌 2–3 years
🔹 180 mg every 4–6 hours
📌 4–5 years
🔹 240 mg every 4–6 hours
📌 6–7 years
🔹 240–250 mg every 4–6 hours
Older Children
📌 8–9 years
🔹 360–375 mg every 4–6 hours
📌 10–11 years
🔹 480–500 mg every 4–6 hours
📌 12–15 years
🔹 480–750 mg every 4–6 hours
Adolescents & Adults
📌 16–17 years
🔹 500 mg – 1 g every 4–6 hours
When do theophylline levels have to be monitored?
Theophylline monitoring requirements (BNF) - Plasma-theophylline concentration is measured 5 days after starting oral treatment and at least 3 days after any dose adjustment. A blood sample should usually be taken 4-6 hours after an oral dose of a modified release preparation.
What side effect does combining Prednisolone, salbutamol, salmeterol and theophylline cause?
Prednisolone, salbutamol, salmeterol and theophylline given together can increase the risk of hypokalaemia. Theophylline side-effects, further information (BNF) - Potentially serious hypokalaemia may result from beta2-agonis therapy. Particular caution is required in severe asthma, because this effect may be potentiated by concomitant treatment with theophylline and its derivatives, corticosteroids, and diuretics, and by hypoxia. Plasm-potassium concentration should therefore be monitored in severe asthma
What are the symptoms of rosacea and the treatment?
🔹 Flushing & Redness – Nose, cheeks, forehead, chin, neck, chest (comes & goes)
🔹 Skin Sensitivity – Burning/stinging with water or skincare products
🔹 Bumps & Pustules – Small pink/red bumps, sometimes with yellowish fluid
🔹 Dry & Swollen Skin – Especially around the eyes
🔹 Yellow-Orange Patches – May develop over time
🔹 Eye Involvement – Sore eyelids, crusts on lashes (Blepharitis)
🔹 Thickened Skin – Mostly on the nose (advanced cases)
🔹 Topical options:
Azelaic acid
Ivermectin
Metronidazole
🔹 Oral options (6–12 weeks, repeated intermittently):
Oxytetracycline or Tetracycline
Erythromycin (if tetracyclines unsuitable)
Doxycycline (unlicensed) if tetracyclines are inappropriate (e.g. renal impairment)
Low-dose modified-release doxycycline – Licensed for rosacea
Which contaceptive are contraindicated in migraine?
Combined oral contraceptives (COCs) are contraindicated in patients who have migraine with aura. Progesterone only contraceptives are more appropriate
How would you treat a child with constipation?
NHS: If you think your child may be constipated, take them to a GP.
Children under 12 should be treated first line with macrogol in combination with a balanced diet, fluids and behavioural interventions. Stimulant laxatives are second line treatments.
