Medicines 28 Flashcards
How are hepatitis A,B & C spread?
Hep A: Faecal oral route, consuming contaminated food or water or close contact with contaminated person
Hep B: spread through blood, semen and other bodily fluids. Common transmission, unprotected sex, sharing needles, Mother to baby during birth
Hep C: Blood to blood contact, thorugh sharing needles, medical equipment or less commonly through sexual contact
What is japanese encephalitis?
A disease that affects the brain spread through mosquito bites
How long a time frame has to be left between administration of the MMR and yellow fever vaccines?
Public Health England advises MMR and yellow fever vaccines should not be administered on the same day; there should be a 4-week minimum interval between the vaccines. When protection is rapidly required, the vaccines can be given at any interval; an additional dose of MMR should be considered and re-vaccination with the yellow fever vaccine can also be considered in those at on-going risk.
What are the different immunisation schedules over the years:
SUmmarise:Neonates at risk only Bacillus Calmette-Guérin vaccine (around 4 weeks). Check severe combined immunodeficiency (SCID) screening outcome before giving, see Bacillus Calmette-Guérin vaccine.
hepatitis B vaccine (at birth, 4 weeks, and 1 year, see Hepatitis B vaccine).
8 weeks diphtheria with tetanus, pertussis, hepatitis B, poliomyelitis and haemophilus influenzae type b vaccine (Infanrix hexa® or Vaxelis®). First dose.
meningococcal group B vaccine (rDNA, component, adsorbed) (Bexsero®). First dose.
rotavirus vaccine (Rotarix®). Check SCID screening outcome before giving. First dose.
12 weeks diphtheria with tetanus, pertussis, hepatitis B, poliomyelitis and haemophilus influenzae type b vaccine (Infanrix hexa® or Vaxelis®). Second dose.
pneumococcal polysaccharide conjugate vaccine (adsorbed) (Prevenar 13® or Vaxneuvance®). Single dose.
rotavirus vaccine (Rotarix®). Check SCID screening outcome before giving. Second dose.
16 weeks diphtheria with tetanus, pertussis, hepatitis B, poliomyelitis and haemophilus influenzae type b vaccine (Infanrix hexa® or Vaxelis®). Third dose.
meningococcal group B vaccine (rDNA, component, adsorbed) (Bexsero®). Second dose.
1 year (on or after first birthday) measles, mumps and rubella vaccine (MMR VaxPRO® or Priorix®). First dose.
meningococcal group B vaccine (rDNA, component, adsorbed) (Bexsero®). Single booster dose.
pneumococcal polysaccharide conjugate vaccine (adsorbed) (Prevenar 13® or Vaxneuvance®). Single booster dose.
haemophilus influenzae type b with meningococcal group C vaccine (Menitorix®). Single booster dose.
2–3 years on 31st August 2024, primary school-aged children from reception to year 6, and secondary school-aged children in years 7–11 influenza vaccine (live). Each year from September. Note: live attenuated influenza nasal spray is recommended (Fluenz®); if contra-indicated or unsuitable, see Influenza vaccine.
3 years and 4 months, or soon after diphtheria with tetanus, pertussis and poliomyelitis vaccine (Boostrix-IPV® or Repevax®). Single booster dose.
measles, mumps and rubella vaccine (MMR VaxPRO® or Priorix®). Second dose.
11–14 years. HPV vaccine will be offered to individuals aged 12–13 years in England and Wales, those aged 12–14 years in Northern Ireland, and those aged 11–13 years in Scotland. human papillomavirus vaccine (Gardasil®9). 1 dose schedule. For individuals with immunosuppression or HIV infection, see Human papillomavirus vaccine.
13–15 years meningococcal groups A with C and W135 and Y vaccine (MenQuadfi®). Single dose.
13–18 years diphtheria with tetanus and poliomyelitis vaccine (Revaxis®). Single booster dose. Note: Can be given at the same time as the dose of meningococcal groups A with C and W135 and Y vaccine at 13–15 years of age.
Females of child-bearing age susceptible to rubella measles, mumps and rubella vaccine. Females of child-bearing age who have not received 2 doses of a rubella-containing vaccine or who do not have a positive antibody test for rubella should be offered rubella immunisation (using the MMR vaccine)—exclude pregnancy before immunisation, and avoid pregnancy for one month after vaccination.
Pregnant females Acellular pertussis-containing vaccine administered as diphtheria with tetanus and pertussis vaccine (Adacel®). 1 dose from the 16th week of pregnancy, usually around the time of the fetal anomaly scan (week 20).
influenza vaccine (inactivated). Single dose administered from September, regardless of the stage of pregnancy. For vaccine choice, see Influenza vaccine.
Routine immunisations during adult life
For routine immunisations in pregnancy, see Routine immunisation schedule.
When to immunise Vaccine given and dose schedule (for details of dose, see under individual vaccines)
Under 25 years, first time entrants to further or higher education meningococcal groups A with C and W135 and Y vaccine (Nimenrix®, MenQuadfi®, or Menveo®). Single dose. Note: Should be offered to those aged under 25 years entering further or higher education who have not received the meningococcal groups A with C and W135 and Y vaccine over the age of 10 years.
During adult life, if not previously immunised or 5 dose course is incomplete diphtheria with tetanus and poliomyelitis vaccine.
From 65 years influenza vaccine (inactivated). Each year from October. For vaccine choice, see Influenza vaccine.
65 years pneumococcal polysaccharide vaccine.
Individuals aged 65 years and 70–79 years herpes-zoster vaccine. For guidance on immunisation and choice of vaccine, see Varicella-zoster vaccines.
What are the side effects of nitrates ?
Flushing
Throbbing headaches
Light-headedness
Hypotension
Tolerance – sustained use
To maintain drug effectiveness in such patients – reduce blood-nitrate concentrations to low levels for 4 – 8 hours each day
Transdermal patches left off for 8-12 hours (overnight) in each 24 hours
Isosorbide mononitrate immediate release: no more than twice daily
Isosorbide dinitrate M/R tablets: no more than once daily
Isosorbide dinitrate M/R tablets/immediate release isosorbide mononitrate tablets second dose given after about 8 hours rather than 12 hours (to allow for nitrate free period)
Do not need nitrate therapy overnight – keep this as nitrate free period
What is the dosing with nitrates?
Stable angina: GTN sublingual spray – spray and wait 5 mins spray again wait 5 mins spray again wait 5 mins then spray if no relief call 999.
ISM – immediate release 2-3 times daily tablets for prevention
ISM – modified release/ transdermal patches – once daily
What are the main uses of ACE inhibitors and how does it work in the different indications?
1st line – hypertension (2nd line for Afro-Caribbean)
1st line – heart failure
Ischaemic heart disease (angina)
Diabetic nephropathy and CKD with proteinuria
Block action of ACE to prevent conversion of ATI to ATII. ATII is a vasoconstrictor and stimulates aldosterone secretion = so blocking reduces peripheral vascular resistance (afterload), and lower BP.
CKD: reduces intraglomerular pressure and slows progression of CKD.
Heart failure: Reducing aldosterone secretion promotes sodium and water excretion which reduces venous return (preload).
What is flurouracil used for and what is its brand name?
Cancer or Superficial malignant and pre-malignant skin lesions
Effudix cream - to apply topically
What specific side effects are noted in the BNF with cyclophosphamide
Alkylating drugs, Cyclophosphamide is used mainly in combination with other agents for treating a wide range of malignancies, including some leukaemias, lymphomas, and solid tumours. It is given by mouth or intravenously; it is inactive until metabolised by the liver.
Haemorrhagic cystitis
A urinary metabolite of cyclophosphamide, acrolein, can cause haemorrhagic cystitis; this is a rare but serious complication that may be prevented by increasing fluid intake for 24–48 hours after intravenous injection. Mesna can also help prevent cystitis when high-dose therapy (e.g. more than 2 g intravenously) is used or when the patient is considered to be at high risk of cystitis (e.g. because of pelvic irradiation).
Secondary malignancy
As with all cytotoxic therapy, treatment with cyclophosphamide is associated with an increased incidence of secondary malignancies.
What is trastuzumab and what are two key side effects with its use as per BNF?
MAB used to treat Breast or gastric cancer
Heart failure Consider discontinuing treatment in cases of left ventricular dysfunction.
Interstitial lung disease and pneumonitis Interstitial lung disease and pneumonitis, including fatal events, have been reported; if confirmed treatment should be discontinued.
What happens if Vinca alkaloids are administered intrathecally
Neurotoxicity
What kind of drug is methotrexate?
an Antimetabolite, dihydrofolate reductase inhibitor, DMARD
With low risk acute emesis with cytotoxic medications what pre treatment can be used?
What about high risk?
For patients at low risk of emesis, pretreatment with dexamethasone or lorazepam may be used.
For patients at high risk of emesis, a 5HT3-receptor antagonist (ondansetron), usually given by mouth in combination with dexamethasone and the neurokinin receptor antagonist aprepitant is effective.
What is given for hyperuricaemia in Cytotoxic therapy?
Hyperuricaemia, which may be present in high-grade lymphoma and leukaemia, can be markedly worsened by chemotherapy and is associated with acute renal failure.
Allopurinol should be started 24 hours before treating such tumours and patients should be adequately hydrated.
The dose of mercaptopurine or azathioprine should be reduced if allopurinol needs to be given concomitantly.
Febuxostat may also be used and should be started 2 days before cytotoxic therapy is initiated.
what antiepileptic drugs can be given once a day at bedtime?
LP3
- lamotrigine
- perampanel
- phenobarbital
- phenytoin
What specific MHRA alert is relevant for all antiepileptics
all antiepileptic drugs are associated with a small increased risk of suicidal thoughts and behaviour
What is a myoclonic seizure?
Myo - meaning muscle
Clonic - “Klonos” meaning rapid jerking movements
Seizure - Uncontrolled electrical disturbance in the brain
a Conscious seizure that causes sudden, brief involuntary muscle jerks
When should bisphosphonates be reviewed?
evaluating the continued need for a bisphosphonate at 5 years (3
years for IV zoledronate)
What is Denosumab?
Denosumab is a monoclonal antibody used to treat conditions related to bone loss and osteoporosis
Osteoporosis Treatment:
Prolia® (60 mg every 6 months)
Used in postmenopausal women and men at high risk of fractures.
Bone Loss Prevention:
In patients receiving hormone therapy for breast cancer (women) or prostate cancer (men).
Cancer-Related Bone Conditions
What are the key side effects to note with Denosumab?
Common Side Effects
Hypocalcaemia (monitor calcium levels, especially in CKD patients).
Infections (e.g., skin infections, cellulitis).
Osteonecrosis of the jaw (ONJ) – rare but serious, especially in cancer patients.
Atypical femoral fractures with long-term use.
Key Counselling Points
✔ Ensure adequate calcium and vitamin D intake.
✔ Watch for symptoms of low calcium (muscle cramps, tingling, fatigue).
✔ Maintain good oral hygiene and have regular dental check-ups (to prevent ONJ).
✔ Report any persistent thigh or groin pain (signs of atypical fractures).
List the symptoms of type 1 diabetes
4Ts
Thirsty – Excessive thirst (polydipsia) due to dehydration from frequent urination.
Tired – Feeling unusually tired or fatigued as the body cannot use glucose for energy.
Toilet (frequent urination) – Frequent urination (polyuria) because the kidneys are working overtime to get rid of excess glucose.
Thinner – Unexplained weight loss, even though the person might be eating more due to increased hunger (polyphagia).
What is the guidance for stable angina
🟢 Sublingual GTN – for attacks & pre-exertion use.
1st-Line:
✅ Beta-Blocker (Atenolol, Bisoprolol, Metoprolol, Propranolol)
🔹 Alternative if Contraindicated:
✔ Rate-Limiting CCB (Verapamil, Diltiazem) – Avoid in HF.
✔ Dihydropyridine CCB (Amlodipine) – For Prinzmetal’s angina.
2nd-Line (If Symptoms Persist on Monotherapy):
✅ Beta-Blocker + Dihydropyridine CCB (e.g., Amlodipine)
❌ Avoid Beta-Blocker + Verapamil/Diltiazem (Bradycardia risk).
🔹 If Combination Not Suitable – Add ONE of:
✔ Long-Acting Nitrate (Isosorbide Mononitrate)
✔ Ivabradine (HR >70 bpm, sinus rhythm)
✔ Nicorandil (K+ channel activator)
✔ Ranolazine (Safe in low BP)
3rd-Line (If Two-Drug Therapy Fails):
🔹 Refer for PCI or CABG.
What is the target Lithium concentration 12 hours after dose for acute mania?
Add what the normal maintenance concentration is too
✅ Acute Mania / High-Risk Patients: 0.8–1.0 mmol/L (For relapse prevention & sub-syndromal
✅ Maintenance & Elderly: 0.4–1.0 mmol/L (Lower end preferred).
WHat is the first line and second line therapy for ADHD and what other useful info should be remembered?
📌 First-Line Treatment:
✅ Methylphenidate OR Lisdexamfetamine (Trial for 6 weeks).
🔄 If ineffective, switch to the alternative first-line drug.
📌 Second-Line Treatment:
✅ Dexamfetamine (Unlicensed) → If beneficial response to lisdexamfetamine but intolerant of duration.
✅ Atomoxetine (Non-Stimulant) → If both first-line drugs fail or are intolerant.
📌 Additional Options (Specialist Advice Needed):
✔ Guanfacine (Unlicensed) → For co-existing aggression, rages, or irritability.
✔ Atypical Antipsychotics → If aggressive symptoms persist.
✔ Other unlicensed options (Bupropion, Modafinil, TCAs, Venlafaxine) → Not recommended unless specialist advice given.
📌 Formulations & Administration:
✔ Modified-Release preferred → Better adherence, convenience, reduced misuse.
✔ Immediate-Release → Used for dose titration or flexible dosing.
✔ Combination of MR + IR can extend duration of effect.
📌 Referral to Tertiary ADHD Service If:
🚨 Unresponsive to stimulants (MPH, LDX) and atomoxetine.
🚨 Considering Guanfacine or Atypical Antipsychotics.
📌 Monitoring & Side Effects:
✔ Effectiveness, side effects, sleep changes, stimulant misuse.
✔ Atomoxetine → Sexual dysfunction risk.
✔ Stimulants → Tics (Consider dose reduction, stopping, or switch to non-stimulant).
✔ Seizures → Review treatment & stop if contributing.
✔ Guanfacine → Risk of hypotension/fainting (Reduce dose or switch if needed).
Which medications can cause Gambling addiction
📌 Dopamine Agonists (Most Common Cause)
✅ Parkinson’s Disease & Restless Legs Syndrome treatments:
Pramipexole
Ropinirole
Rotigotine
Apomorphine
Cabergoline (Rarely used due to fibrosis risk)
✅ Levodopa (L-DOPA) can cause gambling addiction and other impulse control disorders, though less commonly than dopamine agonists (e.g., pramipexole, ropinirole).
📌 Other Medications
✅ Antipsychotics (Dopamine Partial Agonists):
Aripiprazole (Most reported case of impulse control issues)
✅ Antidepressants:
Bupropion (Dopamine & Noradrenaline Reuptake Inhibitor – may increase risk in susceptible patients)
