Medicines 3 Flashcards
What are the doses for Emergency treatment of acute anaphylaxis
0.5 mg (500 micrograms) of adrenaline in a 1:1,000 concentration.
Over 12 years: 0.5 mg (500 micrograms) IM
6 to 12 years: 0.3 mg (300 micrograms) IM
6 months to 6 years: 0.15 mg (150 micrograms) IM
Under 6 months: 0.01 mg/kg (10 micrograms/kg) IM
Important Points
Adrenaline should always be given intramuscularly for anaphylaxis, not intravenously, except in critical care or under specific guidance.
The 1:1,000 concentration (1 mg/mL) is used for IM administration.
Doses can be repeated every 5 minutes if there is no improvement, and ongoing monitoring is essential.
What are the first line antibiotics for COPD exacerbations?
First-line antibiotics in COPD exacerbation include tetracyclines, amoxicillin and macrolides. These are broad-spectrum antibiotics.
When is montelukast prescribed and what are some key counselling points/ length of treatment?
When is montelukast usually more helpful?
Montelukast is prescribed at step 2 or step 3 of the All Wales Adult Asthma Management guidelines when inhalers are not fully controlling the symptoms.
It should be a trial of montelukast for 6 weeks as there is risk of neuropsychiatric reactions
Such reactions include new or worsening changes in mood, sleep, or behaviour (e.g. nightmares, aggression, anxiety, depression, or thoughts of self-injury)
Montelukast is usually more helpful in those with symptoms worsened by exercise.
What is key information regarding theophylline?
The rate of absorption from modified-release preparations can vary between brands. If a prescription for a modified-release oral theophylline preparation does not specify a brand name, the pharmacist should contact the prescriber and agree the brand to be dispensed. Additionally, it is essential that a patient discharged from hospital should be maintained on the brand on which that patient was stabilised as an in-patient.
Plasma-theophylline concentration is increased in heart failure and hepatic impairment, and is decreased in smokers, therefore these should be considered when prescribing the initial infusion.
Smoking induces the metabolism of theophylline, decreasing plasma theophylline concentration. In patients who stop smoking, a reduction in the oral theophylline/aminophylline dose of up to 25 to 33% might be needed starting the day after smoking is stopped and during the first week.
What dose adjustments does atorvastatin have with other medications?
Dose adjustments due to interactions for atorvastatin
Manufacturer advises if concurrent use of ciclosporin is unavoidable, max. dose cannot exceed 10 mg daily.
Manufacturer advises max. dose 40 mg daily when combined with anion-exchange resin for heterozygous familial hypercholesterolaemia.
Manufacturer advises max. dose 20 mg daily with concurrent use of elbasvir with grazoprevir.
Manufacturer advises max. dose 20 mg daily with concurrent use of letermovir without ciclosporin.
Manufacturer advises max. dose 20 mg daily with concurrent use of sofosbuvir with velpatasvir and voxilaprevir.
What dose adjustments are there for simvastatin?
Manufacturer advises max. 10 mg daily with concurrent use of bezafibrate or ciprofibrate.
Manufacturer advises max. 20 mg daily with concurrent use of amiodarone, amlodipine, or ranolazine.
Manufacturer advises reduce dose with concurrent use of some moderate inhibitors of CYP3A4 (max. 20 mg daily with verapamil and diltiazem).
Manufacturer advises max. 40 mg daily with concurrent use of lomitapide or ticagrelor.
Manufacturer advises max. 20 mg daily with concurrent use of elbasvir with grazoprevir.
Manufacturer advises usual max. 20 mg daily with concurrent use of bempedoic acid or bempedoic acid with ezetimibe; max. dose 40 mg daily in patients with severe hypercholesterolaemia and at high risk of cardiovascular complications.
What dietary advice is required with warfarin?
Vitamin K-Rich Foods: High and inconsistent levels of vitamin K can reduce warfarin’s effectiveness.
Cranberry juice is also known to interact with warfarin and enhance its anticoagulant effect and therefore it should be avoided.
Patients should limit their alcohol intake to a maximum of one or two drinks a day and never binge drink. If there are major changes in alcohol consumption (e.g. the patient stops drinking, or starts drinking more) the INR can be affected.
WHat type of juice does amlodipine interact with?
Grapefruit juice - Grapefruit juice very slightly increases the exposure to Amlodipine
If patients struggle to swallow rivaroxaban what can they crush and mix the tablets with?
The MHRA has received a small number of reports suggesting a lack of efficacy (thromboembolic events) in patients taking 15 mg or 20 mg rivaroxaban tablets on an empty stomach. Healthcare professionals are advised to remind patients to take rivaroxaban 15 mg or 20 mg tablets with food. In those who have difficulty swallowing, these tablets can be crushed and mixed with water or apple puree immediately before, and followed by food immediately after, ingestion.
What counselling point is given with perindopril?
Take 30-60 minutes before food
Perindopril is best absorbed on an empty stomach
What are some key counselling points to give with amiodorone?
Sensitivity to light, the sensitivity can last for several months after stopping amiodorone - use plenty of suncream.
Report any symptoms of breathlessness, persistent cough, jaundice, restlessness, weight loss, tiredness or weight gain.
Avoid drinking grapefruit juice as it can increase risk of side effects
You will be started on a high dose, for one week only. Your dose will then be reduced over the following two weeks to a maintenance dose.
What are some key points regarding cholestyramine (indication, counselling points, cautions)
Interference with the absorption of fat-soluble vitamins (supplements of vitamins A, D, K, and folic acid may be required when treatment is prolonged).
Manufacturer advises the contents of each sachet should be mixed with at least 150 mL of water or other suitable liquid such as fruit juice, skimmed milk, thin soups, and pulpy fruits with a high moisture content.
As a precautionary measure, where concurrent drug therapy exists then such drugs should be administered at least one hour before or 4-6 hours after Questran Light.
What are ectopic beats and what is the treatment for them?
Ectopic beats
Ectopic beats are extra heartbeats that occur outside the heart’s regular rhythm. They’re often described as feeling like a fluttering, skipped beat, or extra thump in the chest.
If ectopic beats are spontaneous and the patient has a normal heart, treatment is rarely required and reassurance to the patient will often suffice. If they are particularly troublesome, beta-blockers are sometimes effective and may be safer than other suppressant drugs.
What are the different blood pressure readings/targets for different conditions (gestational hypertension, severe hypertension, normal hypertension, hypertension in the elderly, hypertension in diabetics, normal BP, patients with established CD)
Gestational hypertension - 135/85
severe hypertension - 180/120
normal BP - 120/80
Hypertension - 140/90
Stage 2 hypertension - 160/100
Patients over 80 yrs - 150/90
Patients with established cardiovascular disease - 135/85
Chronic kidney disease
Diabetes -
In the ALL wales management of asthma what is the first line treatment and why
Symbicort inhaler 200/6 when required - Formoterol has been shown to work almost as quickly as salbutamol. It has also got a PRN license which the other MART inhalers are trying to get. Give steroid from the off as evidence suggests deaths are caused by those who should be using steroids but arent.
