Medicines 26 Flashcards
What is the guidance regarding HBa1C in 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
What are the hypertension (blood pressure) guidelines with CKD?
✅ If ACR < 70 mg/mmol → Below 140/90 mmHg (Ideal: 120–139/<90 mmHg)
✅ If ACR ≥ 70 mg/mmol → Below 130/80 mmHg (Ideal: 120–129/<80 mmHg)
✅ Aged ≥ 80 years (Type 1 Diabetes, any ACR) → Below 150/90 mmHg
With ACR the higher the number the worse the kidney function and the more protein is being found in the urine
What are the key things to remember with methotrexate?
✅ Dosing & Administration:
Prescribe & dispense only one strength (usually 2.5 mg) to avoid errors.
Take once weekly on a set day (written on the prescription).
Can be taken before or after food.
✅ Folic Acid:
Must be co-prescribed to reduce GI, mucosal, and liver toxicity.
Take either once weekly (day after methotrexate) or daily except methotrexate day.
❌ Never take on the same day as methotrexate (reduces efficacy).
✅ Missed Dose:
Take within 1–2 days if remembered.
If more than 2 days late, skip and continue next week.
⚠️ Side Effects & Toxicities:
Bone marrow suppression (risk of infection, anemia, bleeding).
GI toxicity (nausea, vomiting, ulcers).
Liver toxicity (monitor LFTs).
Pulmonary toxicity (cough, breathlessness, pneumonitis).
✅ Handling Precautions:
Wash hands after touching tablets.
Regular monitoring is essential!
which of the calcium channel blockers cause ankle swelling?
🔹 Dihydropyridines (More Likely to Cause Swelling)
✅ Common culprits:
Amlodipine
Nifedipine
Felodipine
Lercanidipine
🔹 Non-Dihydropyridines (Less Likely to Cause Swelling)
Verapamil
Diltiazem
How long should a spacer last?
12 months
Within what timescale should intravenous antibacterials be reviewed for good antimicrobrial stewardship?
48 hours
Which score should be calculated to predict the risk of major bleeding for patients on
anticoagulation for atrial fibrillation?
CHA 2 DS 2 –VASc is a tool used to predict the risk of stroke in patients with
atrial fibrillation.
ORBIT and HAS-BLED are both tools used to predict the risk of major
bleeding with anticoagulation in AF, however ORBIT is the preferred tool recommended by NICE guidelines.
What is the usual treatment duration of metoclopramide?
As per the 2014 MHRA alert, metoclopramide should only be prescribed for
short-term use (up to 5 days). This is due to the risk of neurological adverse effects such as
tardive dyskinesia.
What side effect can risperidone cause in women?
⚠️ Milky nipple discharge can be a sign of hyperprolactinaemia.
⚠️ Risperidone (antipsychotic) can increase prolactin levels, leading to this symptom.
What are the low to high intensity statins?
📌 Low-Intensity Statins (Reduce LDL by <30%)
Simvastatin 10 mg
Pravastatin 10–20 mg
Fluvastatin 20–40 mg
📌 Medium-Intensity Statins (Reduce LDL by 30–50%)
Atorvastatin 10 mg
Simvastatin 20–40 mg
Pravastatin 40 mg
Rosuvastatin 5 mg
Fluvastatin 80 mg
📌 High-Intensity Statins (Reduce LDL by >50%)
Atorvastatin 20–80 mg
Rosuvastatin 10–40 mg
Simvastatin 80 mg (Not routinely recommended due to risk of muscle toxicity)
What is the risk associated with NSAIDs and ACEi’s, ARBs, diuretics
NSAID, ACE inhibitor and diuretic; this combination
of medications increases the risk of AKI, so we are most concerned about the risk of
nephrotoxicity.
When is an eye test required with hydroxychloroquine
Hydroxychloroquine carries a risk of retinopathy. Annual ophthalmological
monitoring is recommended in patients who have taken hydroxychloroquine for over 5 years,
although note that this may be started earlier when there are risk factors for retinopathy.
Why must tacrolimus be prescribed by brand when given orally?
Oral tacrolimus must be prescribed and dispensed by brand name, as switching
between brands has been linked to cases of toxicity and graft rejection.
What are the different potencies of the following topical steroids?
Mometasone
Hydrocortisone
Fluocinonide
Betamethasone
Clobetasol propionate
Hydrocortisone butyrate
Beclometasone
Fluocinolone
Fluticasone
Clobetasone
Alclometasone
Fludroxycortide
Topical Steroid Potency Classification
🔹 Mild: Hydrocortisone
🔹 Moderate:
Alclometasone
Clobetasone
Hydrocortisone butyrate
🔹 Potent:
Beclometasone
Betamethasone
Fludroxycortide
Fluocinolone
Fluocinonide
Fluticasone
Mometasone
🔹 Very Potent: Clobetasol propionate
Which steroid creams can be bought OTC?
Clobetasone cream (Eumovate) is available OTC and is licensed for children
over 12 years old.
hydrocortisone 1% cream is also available OTC but the
minimum licensing age is 10 years old.
What drug is entacapone and what colour can it turn the urine?
Entacapone is a COMT inhibitor.
can cause urine to be coloured reddish-brown.
Name some dopamine recepto agonists and what formulations they come in
- Ergot-Derived Dopamine Agonists
✔ Bromocriptine → Oral (Tablets, Capsules)
✔ Cabergoline → Oral (Tablets)
✔ Pergolide (withdrawn in some countries) - Non-Ergot Dopamine Agonists (Preferred due to fewer side effects)
✔ Pramipexole → Oral (Tablets, Prolonged-Release Tablets)
✔ Ropinirole → Oral (Tablets, Prolonged-Release Tablets)
✔ Rotigotine → Transdermal Patch
✔ Apomorphine → Subcutaneous Injection, Infusion
💡 Uses: Parkinson’s disease, restless legs syndrome, hyperprolactinaemia.
⚠ Side Effects: Nausea, hypotension, impulse control disorders (e.g., gambling, hypersexuality).
What is the brand name of acetylcysteine and what are its indications?
To the eye - Tear deficiency, Impaired or abnormal mucus production
Paracetamol overdose
NACYS effervescent tablets - Reduction of sputum viscosity
What is the mainstay treatment for Seborrheic dermatitis on the face and body ?
Offer ketoconazole 2% cream (once or twice a day) or another imidazole cream (clotrimazole or miconazole) for up to 4 weeks. An antifungal shampoo such as ketoconazole 2% can be used as body wash.
Consider offering a short course (up to 2 weeks) of a mild topical corticosteroid (depending on the affected areas) such as hydrocortisone 1% for flares to help settle inflammation.
For children and adolescents:
Offer an imidazole cream (clotrimazole [2–3 times per day] or miconazole [twice daily]) for up to 4 weeks — ketoconazole cream is not licensed for use in children.
Consider offering a mild to strong topical corticosteroid (depending on the affected areas) such as hydrocortisone 1% for flares to help settle inflammation.
What test should be done for H.Pylori and when should a retest be done following treatment?
Retesting should be performed at least 4 weeks (ideally 8 weeks) after treatment.
The urea (13C) breath test should be used for retesting
What is xerostomia ?
DRY MOUTH
What is the guidance around GTN spray use in an angina attack?
Use 1-2 sprays under the tongue, repeat after five minute intervals if required. If chest pain persists five minutes after second dose, call 999
What is the advice regarding sick day’ rules for type I diabetes mellitus?
While you are unwell it is VERY likely you will need to take
more insulin
* Even if you are vomiting you must NEVER stop taking your
insulin
* Monitor your urine or blood for ketones every 2 hours
* Monitor blood sugar levels once every 2 hours
* Drink at least ½ cup (100mls) of water every hour, but you can also
drink any other sugar free drinks
* Please do not fast. Try to eat some food which contains
carbohydrates e.g. yoghurt, toast, ice cream and cereal
* If you are worried about other symptoms not related to your
diabetes, please seek medical advice from NHS 111 in the first
instance
* You will need face to face medical attention if you are
continuously vomiting for more than 4-6hrs or if your ketone
levels in blood or urine are not reducing despite following sick
day rules.
Which deficiency is common with metformin treatment?
Vitamin B12 deficiency
What are the monitoring requirements are there with methotrexate?
have full blood count and renal and liver function tests repeated every 1–2 weeks until therapy stabilised, thereafter patients should be monitored every 2–3 months.
