Medicines 29 Flashcards
How do citalopram and clarithromycin interact
Increased risk of QT prolongation
What is the treatment of gestational diabetes?
📌 Fasting Plasma Glucose <7 mmol/L at Diagnosis:
✅ Initial Treatment: Diet & exercise alone for 1-2 weeks.
🔄 If Targets Not Met: Add Metformin.
🔄 If Metformin is Ineffective or Contraindicated: Add Insulin.
📌 Fasting Plasma Glucose ≥7 mmol/L at Diagnosis:
✅ Immediate Treatment: Insulin (with or without Metformin) + Diet & Exercise.
📌 Fasting Plasma Glucose 6–6.9 mmol/L with Complications (e.g., Macrosomia, Hydramnios):
✅ Consider Immediate Insulin Treatment (with or without Metformin).
📌 Postpartum:
✅ Discontinue all hypoglycaemic treatments immediately after delivery.
How do the gliptins work?
↑ Insulin, ↓ Glucagon (via incretin system)
What does CD INV POM mean and what schedule does it refer to?
CD INV POM refers to Schedule 5 Controlled Drugs.
Schedule 5 (CD INV POM) – Key Points
✅ CD (Controlled Drug): Low-strength preparations of controlled drugs.
✅ INV (Investigational Drug): Can be used in clinical trials.
✅ POM (Prescription-Only Medicine): Requires a prescription for supply.
📌 CD (Controlled Drug):
Legally controlled substances due to potential for abuse/misuse.
Includes Schedule 1–5 drugs (e.g., morphine, diazepam).
Special prescription, storage, and dispensing requirements apply.
📌 INV (Investigational Drug):
Unlicensed medication used in clinical trials.
Requires strict regulation and monitoring.
📌 POM (Prescription-Only Medicine):
Only available with a valid prescription.
Includes antibiotics, antidepressants, strong painkillers.
Cannot be sold over the counter.
Which antiemetics can be used in pregnancy?
Prescribe oral cyclizine or promethazine (antihistamines), prochlorperazine or chlorpromazine (phenothiazines), or the combination drug doxylamine/pyridoxine (Xonvea®) first-line
What tests are uses to assess heart failure?
NT-pro-BNP Testing & Referral:
> 2000 ng/L → Urgent specialist referral & echocardiography (within 2 weeks).
400–2000 ng/L → Routine referral & echocardiography (within 6 weeks).
<400 ng/L → HF unlikely; consider specialist discussion if suspicion remains.
Key Points:
ESC threshold for normal: <125 pg/mL.
NT-pro-BNP does not distinguish HF subtypes.
Always arrange a 12-lead ECG.
• Cardiac Troponins: Helps differentiate heart failure from acute coronary syndromes.
- Electrocardiogram (ECG)
• Identifies arrhythmias, previous myocardial infarction, or left ventricular hypertrophy. - Chest X-ray
• Checks for pulmonary congestion, cardiomegaly, and pleural effusion. - Echocardiography (Echo)
• The most important imaging test for heart failure. It assesses:
• Ejection fraction (EF): Differentiates between heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF).
• Valve function, chamber size, and wall motion abnormalities. - Cardiac MRI
• Used if more detailed imaging is needed, particularly for identifying underlying causes like cardiomyopathy or myocarditis. - Stress Testing (e.g., Exercise Tolerance Test, Dobutamine Stress Echo)
• Evaluates the heart’s function under stress and helps assess ischemic heart disease. - Coronary Angiography
• Used if coronary artery disease is suspected as the cause of heart failure.
What is the CURB-65 score?
The CURB-65 score is a clinical tool used to assess the severity of community-acquired pneumonia (CAP) and guide decisions on hospital admission and treatment.
CURB-65 Criteria (Each factor scores 1 point)
C – Confusion (new disorientation, AMT score ≤8/10)
U – Urea >7 mmol/L
R – Respiratory rate ≥30/min
B – Blood pressure (SBP <90 mmHg or DBP ≤60 mmHg)
65 – Age ≥65 years
What is the guidance for opioid induced constipation?
An osmotic laxative (or docusate sodium to soften the stools) and a
stimulant laxative is recommended for opioid-induced constipation. Bulk-
forming laxatives should be avoided
Which statin is least likely to interact with clarithromycin and why ?
Rosuvastatin does not interact with
Clarithromycin as Rosuvastatin is only minimally
metabolised by CYP3A4, it is mediated by the
2C9 enzyme
How do steroids affect glucose levels?
Steroids can increase blood sugar
levels in people who have diabetes.
It can also increase blood sugar
levels in people who do not have
diabetes. This can happen because:
* the liver produces more sugar
during steroid treatment
* steroids make it harder for sugar
to move out of the blood
* your body may become resistant
to insulin while you are taking
steroids.
Therefore, an increase in insulin
requirement may be required
Which of the anti-epileptic medications would require two specialists to independently consider and document that there is no other effective or tolerated treatment?
Soidum Valproate
What are the 4Cs?
associated with Clostridioides difficile (C. difficile) infections and the development of antimicrobial resistance
Clindamycin
Cephalosporins (e.g., ceftriaxone, cefuroxime)
Co-amoxiclav (Amoxicillin + Clavulanic acid)
Ciprofloxacin (and other quinolones)
What risk factors are there for C.Diff infections?
- Long duration of antibiotics
- Multiple antibacterial use/courses
- PPI use
- Over 65 years
- Prolonged hospitalisation
- Previous exposure to C.Diff
What are the symptoms of bacterial vaginosis?
fishy odor, grey/white discharge, thin/watery discharge. It is NOT
an STI.
What blood levels of digoxin would suggest digoxin toxicity?
Levels less than 1.5 nanograms/mL in the absence of hypokalaemia indicate that
digoxin toxicity is unlikely.
* Levels greater than 3.0 nanograms/mL indicate that digoxin toxicity is likely.
* With levels between 1.5 nanograms/mL and 3.0 nanograms/mL, digoxin toxicity
should be considered a possibility.
What are some warning symptoms of digoxin toxicity?
- Cardiac e.g. arrhythmias, heart block
- Neurological e.g. weakness, lethargy, dizziness,
headache, mental confusion, psychosis - GI e.g. anorexia, nausea, vomiting, diarrhoea,
abdominal pain - Visual e.g. blurred and/or yellow vision
What is the treatment for hyperkalameia?
Calcium Chloride/Gluconate
Mechanism: Stabilises cardiac membranes, reducing the risk of life-threatening arrhythmias caused by high potassium levels.
Does not lower potassium, but protects the heart.
IV Injection Soluble Insulin + Glucose
Mechanism: Insulin shifts potassium into cells, lowering serum potassium levels. Glucose is given to prevent hypoglycaemia.
Salbutamol (Nebulised or IV Injection)
Mechanism: Beta-2 agonist action shifts potassium into cells.
Nebulised salbutamol is often used alongside insulin/glucose for a synergistic effect.
Sodium Bicarbonate Infusion
Mechanism: Used in metabolic acidosis-related hyperkalaemia to correct acidosis, which in turn helps shift potassium into cells.
Less commonly used unless acidosis is present.
What is the treatment for infected bites as per NICE guidance?
Oral 1st line
Co-Amoxiclav
* Alt in penicillin allergy: Doxycycline + Metronidazole
IV 1st line
* Co-Amoxiclav
* Alt in penicillin allergy:
Cefuroxime OR Ceftriaxone + Metronidazole
If someone is unable to tolerate clopidogrel or aspirin what is the next line treatment?
Dipyridamole MR 200mg
what is the treatment for vitamin B12 deficiency?
- Pernicious Anemia or Malabsorption
💉 First-line: Hydroxocobalamin 1 mg IM three times a week for 2 weeks (6 doses total).
🔁 Maintenance: Hydroxocobalamin 1 mg IM every 2–3 months for life. - Dietary Deficiency (e.g., Vegan Diet)
💊 First-line: Oral cyanocobalamin 50–150 mcg daily.
💉 Alternative (if IM preferred): Hydroxocobalamin 1 mg IM every 2–3 months. - Neurological Symptoms Present (e.g., Peripheral Neuropathy)
💉 First-line: Hydroxocobalamin 1 mg IM on alternate days for 2 weeks.
🔁 Maintenance: Continue 1 mg IM every 2 months for life.
Which vitamin should be avoided in pregnancy?
Vitamin A
fish liver oil as it is high in vitamin A
What are the general reasons for the following vitamins ?
Vitamin A (Retinol)
Vitamin C (Ascorbic Acid)
Vitamin D (Calciferol)
Vitamin E (Tocopherol)
Vitamin K (Phytomenadione)
Vitamin B1 (Thiamine)
Vitamin B2 (Riboflavin)
Vitamin B3 (Niacin) Used for healthy eyes and skin
Vitamin B6 (Pyridoxine)
Vitamin B7 (Biotin)
Vitamin B12 (Cobalamin)
Vitamin A (Retinol) Teratogenic, patients can be on PPP
Vitamin C (Ascorbic Acid) Deficiency can cause scurvy and gingival bleeding
Vitamin D (Calciferol) Deficiency can cause rickets and Osteomalacia
Vitamin E (Tocopherol) Cannot be taken with Warfarin (due to bleeding risk)
Vitamin K (Phytomenadione) Given to new born babies to prevent haemorrhage
Vitamin B1 (Thiamine) Used in Wernicke’s Encephalopathy
Vitamin B2 (Riboflavin) Used for healthy eyes and skin
Vitamin B3 (Niacin) Used for healthy eyes and skin
Vitamin B6 (Pyridoxine) Co-administered with Isoniazid to prevent neuropathy side
effects
Vitamin B7 (Biotin) For hair and nail growth and strength
Vitamin B12 (Cobalamin) Treated megaloblastic anaemia
Which oral analgesia is recommended for haemorrhoids?
- Opioids should be avoided as it can cause constipation as a common
- Simple analgesia e.g. Paracetamol is the most suitable pain relief.
side effect (which can cause/worsen haemorrhoids). - NSAIDs should also be avoided where there is rectal bleeding as it
can worsen the condition.
For individuals taking St Johns Wort & contraception what is the best contraception to go on ?
(depot medroxyprogesterone acetate (DMPA)) or
intrauterine methods
What are the three types of strokes?
🧠 Types of Stroke Flashcard
1️⃣ Transient Ischemic Attack (TIA) / Minor Ischemic Stroke
✅ Cause: Temporary blockage of a cerebral artery (clot/embolus)
📌 Symptoms: Stroke-like symptoms resolve within 24 hours
🩺 Diagnosis: Clinical + MRI/CT scan
💊 Management:
Aspirin 300 mg (immediately), then Clopidogrel 75 mg daily
Carotid Doppler (for stenosis)
Secondary prevention (BP, statins, lifestyle)
2️⃣ Ischemic Stroke (85%)
✅ Cause: Permanent artery blockage (Thrombosis or Embolism)
📌 Symptoms: Sudden weakness, facial droop, speech difficulty
🩺 Diagnosis: CT/MRI (confirms infarct)
💊 Management:
Thrombolysis (Alteplase) if within 4.5 hours
Thrombectomy if large vessel occlusion
Aspirin 300 mg for 2 weeks, then Clopidogrel 75 mg
Long-term: BP control, statins, anticoagulation (if AF present)
3️⃣ Intracerebral Hemorrhage (15%)
✅ Cause: Ruptured brain vessel (💥 often due to hypertension)
📌 Symptoms:
Sudden severe headache, vomiting, loss of consciousness
Neurological symptoms worsen over time (vs ischemic stroke)
🩺 Diagnosis: CT scan (shows bleed)
💊 Management:
Reverse anticoagulation (e.g., Vit K + prothrombin complex)
Lower BP (IV labetalol/nicardipine, target SBP <140 mmHg)
Surgery (for large hematomas)
