Medicines 27 Flashcards
What does Emla cream contain?
lidocaine and prilocaine.
Which antibiotic treatments are preferred for Cellulitis?
Prescribe flucloxacillin 500 to 1000 mg four times daily for 5–7 days.
If this is unsuitable, or the person has a penicillin allergy, prescribe either:
Clarithromycin 500 mg twice daily for 5–7 days.
Doxycycline 200 mg on the first day then 100 mg once daily, for a total of 5–7 days.
Erythromycin (in pregnancy) 500 mg four times daily for 5–7 days.
What is the difference in appearance and treatment between bullous and non-bullous impetigo?
non-bullous impetigo doesn’t have blisters, while bullous impetigo does
For non-bullous:
🩹 First-line treatment: Hydrogen peroxide 1% cream – apply 2–3 times daily for 5 days.
🔄 If unsuitable: Fusidic acid 2% – apply 3 times daily for 5 days.
🚫 If resistance suspected/confirmed: Mupirocin 2% – apply 3 times daily for 5 days.
For Bullous:
💊 First-line: Flucloxacillin 500 mg 4× daily for 5 days.
🚫 Penicillin allergy (non-pregnant): Clarithromycin 250 mg 2× daily for 5 days (500 mg for severe infections).
🤰 Penicillin allergy (pregnant): Erythromycin 250–500 mg 4× daily for 5 days.
🦠 If MRSA suspected/confirmed: Consult a local microbiologist.
What are some key points regarding IV iron ?
Patients should be monitored for signs of hypersensitivity for at least 30mins after every dose of intravenous iron
Patients with asthma are at an increased risk of hypersensitivity reactions associated with intravenous iron therapy
intravenous desferrioxamine can be given to manage iron overdose
intravenous iron can cause a serious hypersensitivity reaction
Avoid in first trimester.
when is the pneumococcal vaccine given?
65 years
What is the target concentration of phenytoin?
Trough plasma concentration for optimum response: neonate–3 months, 6–15 mg/litre (25–60 micromol/ litre); child 3 months–18 years, 10–20 mg/litre (40–80 micromol/litre).
What is the effect from combined administration of phenytoin and the COC pill
Microgynon 30 might not be effective when taken with phenytoin
What are the symptoms of phenytoin overdose?
Symptoms of phenytoin toxicity include nystagmus, diplopia, slurred speech, ataxia, confusion, and hyperglycaemia.
What is the different monitoring required with sulfasalazine?
Renal function should be monitored before starting an oral aminosalicylate, at 3 months of treatment, and then annually during treatment.
Monitoring requirementsFor sulfasalazine
Monitoring of patient parametersFor sulfasalazine
Blood disorders
Close monitoring of full blood counts (including differential white cell count and platelet count) is necessary initially, and at monthly intervals during the first 3 months.
Renal function
Although the manufacturer recommends renal function tests in rheumatic diseases, evidence of practical value is unsatisfactory.
Liver function
Liver function tests should be performed at monthly intervals for first 3 months.
What medication should be avoided with starch based thickeners?
Addition of a polyethylene glycol (PEG)-based laxative to a liquid that has been thickened with a starch-based thickener
may counteract the thickening action, placing patients with dysphagia at a greater risk of aspiration.
macrogol 3350 with potassium chloride, sodium bicarbonate and sodium chloride
What is the choice of anticoagulation in pregnancy?
LMWH like enoxaparin or Dalteparin
-it does not cross the placenta
Sometimes unfractionated heparins
Whate are some key side effects of Low molecular weight heparins?
Bleeding
Injection site reactions
Heparin-induced thrombocytopenia – usually after 5-10 days
Hyperkalaemia
Skin necrosis
What cautions/contraindications are there with low molecular weight heparins?
Use with caution in patients at increased risk of bleeding, including those with clotting disorders, severe uncontrolled hypertension, recent surgery or trauma
Avoid during invasive procedures
Renal impairment = use a lower dose or use unrationed heparin
Avoid in severe hypertension
Caution in elderly
Caution in low body weight – increased risk of bleeding
What are the main uses of LMWHs?
Venous thromboembolism – LMWH 1st choice for VTE prophylaxis for inpatients and for initial treatment of
Deep vein thrombosis and pulmonary embolism
Acute coronary syndrome – LMWH part of 1st line therapy to improve revascularisation and prevent intracoronary thrombus progression
What are the long term risks associated with PPIs?
higher risk of fracture
increased risk of certain infections (including pneumonia and C. difficile)
nutritional deficiencies (including magnesium, iron, and vitamin B12)
What is the maximum monthly recommended use of triptans and why?
MOH can occur with 15 or more days per month use of simple analgesics (such as aspirin, ibuprofen and paracetamol) or 10 or more days use per month of triptans or combination analgesics.
What are some key side effects of loop diuretics
Dehydration
Hypotension
Dizziness
Low electrolyte state: hyponatraemia, hypocalcaemia, hypokalaemia, metabolic alkalosis
At high doses: hearing loss and tinnitus
What monitoring and counselling points are relevant with Furosemide?
Monitoring:
Improvement in patients symptoms
Increased urine output – indicates diuretic effect
Monitor sodium, potassium and renal function
Counselling:
Take dose in the morning to avoid sleep disturbances
Look out for signs of dehydration
Diabetics – careful may affect your glucose levels
What are the reactions of the following medications:
Lithium
Digoxin
Aminoglycosides
Phenytoin
Theophylline
Amiodarone
Sotalol
Beta 2 agonists
Lithium – levels of lithium increased due to reduced secretion
Digoxin – toxicity may increase due to hypokalaemia
Aminoglycosides – can increase risk of ototoxicity and nephrotoxicity
Phenytoin – effects of furosemide antagonised by phenytoin
Theophylline – increased risk of hypokalaemia
Amiodarone – hypokalaemia increases toxicity of amiodarone
Sotalol – hypokalaemia caused by loop diuretics increase risk of ventricular arrhythmias
Beta 2 agonists – increased risk of hypokalaemia with high doses
Name some thiazide and thiazide like diuretics
Thiazides
Bendroflumethiazide
Thiazide- like
Indapamide
Chlortalidone
What are some side effects of thiazides ?
Side effects
Hyponatraemia
Hypokalaemia
Cardiac arrhythmias
May increase glucose concentrations – unmask type 2 diabetes
May increase LDL- cholesterol and triglycerides
Impotence in men - inability to get erection or orgasm
What are the cautions/contraindications of Thiazides
Avoid in hypokalaemia and hyponatraemia
Reduce uric acid excretion – may precipate gout
Diabetes – can increase glucose concentration
Elderly – lower doses and adjust according to renal function
Not effective in renal disease
What are the monitoring requirements and counselling points required with thiazides?
Monitoring:
Potassium levels
Monitor electrolyte concentrations before therapy and 2-4 weeks into therapy
Counselling:
No effect of increasing dose from 2.5mg to 5mg and increases SE
Take first dose in morning to avoid sleep disturbance
May cause impotence in men
Avoid ibuprofen – can interfere with the way it works.
What are the effects of thiazide diuretics with the following medications:
NSAIDs
loop diuretics
Digoxin
Lithium
Sotalol
Corticosteroids
NSAIDs – effectiveness of thiazides reduced by NSAIDs (aspirin 75mg is OK)
Best avoid with loop diuretics – increased hypokalaemia (if combo given MONITOR K+ LEVELS)
Digoxin – can increase toxicity due to hypokalaemia
Lithium – reduce excretion of lithium – toxicity
Sotalol – hypokalaemia increases risk of ventricular arrhythmias
Corticosteroids – increase hypokalaemia
What is the effect on statins with the following medication,
cyp inhibitors: amiodarone, diltiazem, verapamil, itraconazole, macrolides
Fusidic acid
Amlodipine
Bezafibrate
Carbamazepine
Coumarins – warfarin
Grapefruit
cyp inhibitors: amiodarone, diltiazem, verapamil, itraconazole, macrolides
reduce metabolism of statin – increased risk of myopathy
reduce dose of statin to max. 20mg or stop until interacting drug course is finished
Fusidic acid – risk of myopathy – avoid – restart statin dose 7 days after last dose of fusidic acid
Amlodipine – risk of myopathy – max. 20mg statin
Bezafibrate – increased risk of myopathy – max. 10mg statin
Carbamazepine – reduces concentration of simvastatin – increase statin dose
Coumarins – warfarin – increases anticoagulant effect
Grapefruit – increases plasma concentration of simvastatin
