Medicines 25 Flashcards
Which chemotherapy agents are the most and least emetogenic?
- Mildly emetogenic treatment—fluorouracil, etoposide, methotrexate, the vinca
alkaloids, and abdominal radiotherapy. - Moderately emetogenic treatment—the taxanes, doxorubicin hydrochloride,
intermediate and low doses of cyclophosphamide, mitoxantrone, and high doses of
methotrexate. - Highly emetogenic treatment—cisplatin, dacarbazine, and high doses of
cyclophosphamide.
Additional information: there will be at least one question related to
chemotherapy druqs in the exam.
Which test can be used in suspected cushings syndrome?
Overnight dexamethasone suppression test is indicated for
diagnosing Cushing’s syndrome.
Normally, when the pituitary gland makes less
adrenocorticotropic hormone (ACTH), the adrenal glands make less cortisol.
Dexamethasone, which is like cortisol, lowers the amount of ACTH released by
the pituitary gland. This in turn lowers the amount of cortisol released by the
adrenal glands. Patient with Cushing’s syndrome have a very high cortisol levels
even after a dose of dexamethasone.
Which test is used to rule out coeliac disease?
Rationale: First-line test to rule out Coeliac disease involves serum
immunoglobulin (lg)A tissue transglutaminase antibody (tTGA) and total lgA test.
Patient with coeliac disease often present with
persistent, unexplained gastrointestinal symptoms, such as acid reflux, diarrhoea,
steatorrhoea, weight loss, abdominal pain, reduced appetite, bloating, and
constioation.
Which test can be used in suspected DVT?
Rationale: For people who are suspected to have DVT offer a D-dimer test (if
ultrasound scan cannot be carried out within 4 hours).
Additional information: Usual presentation of DVT - unilateral localised pain
(this is usually throbbing in nature) that occurs when walking or bearing weight,
and calf swelling (or more rarely, swelling of the entire leg). Tenderness. Skin
changes, which include oedema, redness, and warmth.
In suspected DVT, the two-level DVT Wells score can be used to assess the
probability of DVT.
What can the hydrogen test be used to detect?
Lactose Intolerance – Identifies the inability to digest lactose (milk sugar) due to lactase enzyme deficiency.
Fructose Malabsorption – Detects difficulty in absorbing fructose, which can lead to bloating, diarrhea, and discomfort.
What factors can increase the risk of scurvy?
Factors that increase chances of developing scurvy include:
No fresh fruits or vegetables in the diet for > 3 months
Poor Dietary intake in general — possible causes include chemotherapy, eating
disorders
Smoking — reduces the amount of vitamin C that is absorbed by the body
How would Phenytoin look on a drug kinetics graph
Phenytoin has a narrow therapeutic index and has non-linear kinetics.
This can result in difficulties in dose adjustment and interpretation of levels. A
small change in dosing can result in a large change in blood levels
Why is digoxin useful in AF ?
Positive inotrope → Increases the force of contraction by inhibiting the Na⁺/K⁺ ATPase pump, leading to increased intracellular calcium.
Negative chronotrope → Slows heart rate by increasing vagal (parasympathetic) tone, making it useful for atrial fibrillation (AF) with rapid ventricular response.
Used in:
Atrial fibrillation (to control ventricular rate)
Heart failure with reduced ejection fraction (HFrEF), particularly in symptomatic patients despite optimal therapy
What are the general different vaccines required throughout a lifespan
Rationale: Pneumococcal polysaccharide vaccine. - 65 years
Key vaccination summary below:
- 8 weeks : 6-in-l vaccine, Rotavirus vaccine, MenB
- 12 weeks: 6-in-l vaccine (2nd dose), Pneumococcal (PCV) vaccine, Rotavirus
vaccine (2nd dose) - 16 weeks: 6-in-l vaccine (3rd dose), MenB (2nd dose)
- 1 year: Hib/MenC (1st dose), MMR (1st dose), Pneumococcal (PCV) vaccine
(2nd dose), MenB (3rd dose) - 3 years and 4 months: MMR (2nd dose), 4-in-l pre-school booster
- 11-14 years - HPV vaccine is offered
- 65 years: Pneumococcal (PPV) vaccine, Flu vaccine (and every year after)
- 70 years: Shingles vaccine
*6-in-l: Diphtheria, hepatitis B, Hib (Haemophilus influenzae type b), polio,
tetanus
whooping cough (pertussis)
When should you stop methyldopa given for gestational hypertension in pregnancy?
Methyldopa taken during pregnancy should ideally be stopped within
2 days of birth as it may increase the risk of depression.
What uncommon side effect can occur with calrithromycin regarding the heart?
QT interval prolongation;
Which medications would cause statins to be held for a week when initiated
MACROLIDES - clarithro
Erythro
Which medication can be given for UTIs in pregnancy?
First choice is nitrofurantion 100 mg modified-release twice daily for 7 days (avoid in third trimester).
Second choice is either cefalexin 500 mg twice a day for 7 days OR amoxicillin 500 mg 3 times a day for 7 days.
Why is rivaroxaban over 15mg recommended with food?
the bioavailability can be reduced by up to 40% otherwise
Why should alcohol be cautioned/avoided in AF
Alcohol can cause/worsen AF
Alcohol can increase likelihood of doing silly things - falling over, bumping head
Alcohol increases everyones bleed risk physiologically
How does amiodarone affect the skin?
It can cause BLUE-GRAY discolouration - look like smurf
It can cause photosensitivity, which is more common - wear suncream for treatment and months following
How many months does amiodorone stay in the system following reaching loading doses?
3 to 10 months
What should patients go home on following an NSTEMI
Patients should go home in “SAABs”
Statin,
Aspirin,
ACE inhibitor
Beta blocker
second/dual antiplatelet therapy
What are the guidelines for heart failure?
BMJ guidelines:For heart failure with reduced ejection fraction (HFrEF), the “four pillars” of treatment include:
ACE inhibitors/ARBs/ARNIs: To manage neurohormonal dysfunction.
Beta-blockers: To control heart rate and reduce strain on the heart.
Mineralocorticoid receptor antagonists (MRAs): For reducing fluid retention and improving survival.
SGLT2 inhibitors: A recent addition that significantly reduces heart failure-related hospitalizations.
Diuretics are commonly used to manage symptoms but do not improve mortality. Monitoring and titration are key.
Why are ACEi and ARBs kidney protective in CKD or diabetes?
Reduces Intraglomerular Pressure
In diabetes and CKD, the renin-angiotensin-aldosterone system (RAAS) is often overactive, leading to high glomerular pressure.
ACE inhibitors dilate the efferent arteriole (the vessel exiting the glomerulus), reducing glomerular filtration pressure and slowing the progression of kidney damage.
Reduces Proteinuria
High glomerular pressure leads to protein leakage (albuminuria), which worsens kidney damage.
ACE inhibitors reduce proteinuria, protecting the glomeruli from further injury.
Lowers Blood Pressure
Hypertension is a major cause of CKD progression. By lowering systemic blood pressure, ACE inhibitors reduce kidney stress and slow CKD progression.
How do ACE inhibitor and ARBs interact with Lithium?
can increase lithium concentration, increasing the risk
of toxicity – this is the most concerning issue that should be acted upon first.
What does it mean if the trough levels of gentamycin come back high or the peak levels come back high in terms of dosing
The trough level came back high, which means the interval between the doses
should be increased. If the peak level was high, the dose should be decreased.
What are the MHRA alerts regarding nitrofurantoin?
🔴 Pulmonary Risks
Watch for acute lung reactions in the first week of treatment.
Monitor long-term users (especially elderly/children) for new or worsening respiratory symptoms.
Stop treatment immediately if pulmonary symptoms develop.
Use caution in patients with lung disease as symptoms may be masked.
🟠 Hepatic Risks
Be vigilant for liver dysfunction, especially in long-term use.
Periodically monitor liver function tests for signs of hepatitis or injury.
Use caution in patients with liver disease as symptoms may be masked.
What are the selective and non selective beta blockers?
These primarily block β₁ receptors (heart):
✅ Examples:
Atenolol
Bisoprolol
Esmolol
Metoprolol
Nebivolol
Non-Selective Beta-Blockers
These block both β₁ (heart) and β₂ (lungs, blood vessels, etc.):
✅ Examples:
Propranolol
Nadolol
Timolol
Carvedilol (also blocks α₁ receptors)
Labetalol (also blocks α₁ receptors)
What is the target HBA1C for someone diagnosed with Type 2 Diabetes?
✅ For adults managing diabetes with:
Diet & lifestyle alone OR with a single drug not causing hypoglycaemia → Target: 48 mmol/mol (6.5%)
A drug that may cause hypoglycaemia (e.g., sulfonylureas, insulin) → Target: 53 mmol/mol (7.0%)
⚠️ If HbA1c reaches 58 mmol/mol (7.5%) while on treatment:
1️⃣ Reinforce diet, lifestyle & medication adherence
2️⃣ Set a new target: 53 mmol/mol (7.0%)
3️⃣ Intensify drug treatment to improve control
