Medicines 24 Flashcards
What do ketones in the urnine mean in some one with diabetes?
If ketones are high and you have diabetes, it may indicate diabetic ketoacidosis (DKA), which is a medical emergency.
When is aspirin able to be used in children?
It can be used as an exception in Kawasaki
disease; however, it is contraindicated if had previous hypersensitivity, and is unlicensed in under 16 year
olds.
Which bacteria is the biggest cause of UTIs?
UTIs are predominantly caused by bacteria from the gastrointestinal tract entering the urinary tract, with
escherichia coli being the most common cause.
What are the main key contraindications with the combine oral contraceptive?
🚫 Cardiovascular & Clotting Risk
VTE history (DVT/PE) or thrombophilia
Stroke, TIA, or MI history
Hypertension (≥160/100 mmHg)
Migraine with aura
Major surgery with immobilisation
🚫 Cancer & Liver Disease
Current/past breast cancer
Severe liver disease/cirrhosis
🚫 Other Key Risks
Age ≥35 & smoker
BMI ≥35 kg/m²
Diabetes with complications
Unexplained vaginal bleeding
how do PPIs affect methotrexate ?
PPI’s may increase the likelihood of limited MTX clearance increasing the
chances of MTX toxicity
What amount of vitamin D should a baby be given if needed?
Babies from birth to 1 year of age who are being breastfed should be given a daily supplement of 8.5-10 mcg of vitamin D.
When is the MMR vaccine administered?
MMR vaccine is administered at 1 year and again at 3 years 4 months.
What is the treatment of opioid induced constipation?
🔹 Laxatives (First-Line)
Stimulant: Senna, Bisacodyl → Stimulate bowel movements
Osmotic: Macrogol, Lactulose → Retain water in stools
🚨 Avoid bulk-forming laxatives (e.g., ispaghula husk)
🔹 PAMORAs (If Laxatives Fail)
Naloxegol (oral) – First-line
Methylnaltrexone (SC) – For severe cases
Naldemedine (oral) – Alternative option
🔹 Other Agents
Lubiprostone – ↑ Intestinal fluid secretion
Prucalopride – 5-HT4 agonist, enhances gut motility (severe cases)
What are the counselling points around of Lactulose?
Will make stool softer and easier to pass
Must drink plenty of water – 6-8 glasses a day
If regularly passing more than 2-3 soft stools per day he dose should be reduced or stopped
Can take up to 48 hours to have an effect
Eating a healthy diet, drinking plenty of water and getting regular gentle exercise can all help prevent constipation.
15ml (3x5ml spoons) twice daily
What drugs does lactulose interact with?
Warfarin – Lactulose may enhance anticoagulant effects of warfarin
What are the key side effects with Lactulose?
Flatulence
Abdominal cramps
Nausea – can be reduced by giving with water, fruit juice or meals
diarrhoea
What can prolonged use of stimulant laxatives cause?
Prolonged use can cause diarrhoea and hypokalaemia
What are the common side effects listed in the BNf for tamsulosin?
Common or very common
Dizziness; sexual dysfunction
Which VTE prophylaxis should be given if the patient does not want animal containing products
Low molecular weight heparin is the agent of choice for VTE prophylaxis, but enoxaparin is derived from
porcine intestinal mucosa. Fondaparinux is a synthetic product and is licensed for VTE prophylaxis so can be
used as an alternative.
What are the symptoms of digoxin toxicity?
Typical early symptoms of digoxin toxicity are nausea and vomiting with confusion, which can be
exacerbated by hypokalaemia that can result from diarrhoea. A characteristic symptom is visual
disturbances with yellow vision.
If a patient has cellulitis but is allergic to penicillin what is the first line treatment?
Clarithromycin is first line for patients being treated for cellulitis who are allergic to penicillin. Flucloxacillin
would be first line if the patient was not allergic to penicillin.
What are the signs of Lithium toxicity as per BNF
Patients and carers should be advised to report signs and symptoms of lithium toxicity, hypothyroidism, renal dysfunction (including polyuria and polydipsia), and benign intracranial hypertension (persistent headache and visual disturbance); medical attention should be sought if any of these occur. Patients and carers should also be counselled on the signs of relapse.
Maintain adequate fluid intake and avoid dietary changes which reduce or increase sodium intake. Patients and carers should be made aware of the risk of dehydration due to factors such as excessive alcohol intake, hot climates, and vomiting or diarrhoea. Medical attention should be sought if dehydration occurs.
Which medications require an alert card or treatment booklet?
What are some examples of target organ damage in hypertension?
Damage to organs such as the heart, brain, kidneys and eyes. Examples are left ventricular hypertrophy, chronic kidney disease, hypertensive retinopathy or increased urine albumin:creatinine ratio.
Which statins cause nightmares?
atorvastatin and simvastatin
Look to change to to more water soluble statins like rosuvastatin and pravastatin.
Over what level of total cholesterol do you suspect hyperlipidaemia ?
TC is above 7.5 mmol/L
What symptoms do you often see with familial hyperlipidameia
Xanthomas – Fatty deposits in tendons, especially the Achilles tendon and extensor tendons of the hands.
Xanthelasma – Yellowish cholesterol deposits around the eyelids.
Corneal Arcus – A grayish-white ring around the cornea, occurring prematurely in younger individuals.
