Medicines 32

Question 1

What is the advised treatment for acid reflux in pregnancy?

Answer 1

First-line treatment:

Antacids (aluminium + magnesium combinations) and alginates on an ‘as required’ basis after lifestyle changes.
Calcium-containing products:

Suitable for short-term or occasional use only.
Products to avoid in pregnancy:

Those containing sodium bicarbonate or magnesium trisilicate.
Formulation advice:

Liquid forms are faster acting and more effective than tablets.
Medication timing advice:

Avoid antacids within 2 hours of taking iron or folate supplements due to reduced absorption.

Question 2

How does deet affect suncream ?

Answer 2

DEET dilutes sunscreen so apply SPF 30-50 sunscreen first followed by insect
repellent with a DEET concentration >20%

Question 3

What are the symptoms of mumps?

Answer 3

Mumps is a contagious viral infection that causes painful swelling in the salivary glands under the ears. This swelling is called parotitis and gives the face a “hamster face” appearance.
Other symptoms include fever, headache, tiredness, and loss of appetite.

Early symptoms Fever, Headache, Muscle aches, Tiredness, and Loss of appetite.

Common symptoms
Painful swelling of the parotid glands under the ears
Puffy cheeks
Tender, swollen jaw
Difficulty swallowing

Question 4

Which emergency contraception is required if a patient is over 70kg and within 72 hours

Answer 4

70kg so ulipristal or 3g levonorgestrel is recommended

Question 5

Which high risk drug should change to salt in the diet be cautioned

Answer 5

Lithium
Maintain adequate fluid intake and avoid dietary changes which reduce or increase sodium intake.

Question 6

How should you deal with ankle swelling with amlodipine ? can lercanidipine be used ?

Answer 6

within the DHP group, it is thought that those which are more lipophilic, thus stay at the site of action for longer (such as lercanidipine and lacidipine), may be associated with a lower incidence of ankle oedema
ankle oedema incidence appears to be dose related

Gather the current BP in order to assess the appropriate action

Non-pharmacological interventions - these interventions include elevation of legs when in a prone position, or graduated compression stockings, may be an option in some patients with mild oedema
little evidence to suggest these methods may be effective in reducing oedema
Dosage adjustments - however note that the relationship with ankle oedema and CCB use may not occur in an exact dose-proportional relationship (1)
as dose related side effect - reduction of dose may lead to resolution/improvement
Switching to an alternative CCB
switching between classes e.g DHP to non DHP CCB; or within the same class e.g. a third generation DHP, such a lercanidipine, with a lower reported incidence of ankle oedema may also be an option
Adding an ACEi or ARB
evidence that adding an ACEi to a CCB reduces the incidence of ankle oedema. The mechanism by which this occurs is not currently known (4)
mechanisms by which ARBs reduce incidence of CCB induced ankle oedema remains unknown, but are likely to be similar to that involved when an ACEi is added to CCB therapy
Adding a nitrate
due to their venodilating action, may be offer some useful effects in treating CCB induced ankle oedema, but their use are limited by the practical considerations of having a stop-start regimen so tolerance does not develop (4)
Discontinuation of CCB