Medicines 32 Flashcards
What is the advised treatment for acid reflux in pregnancy?
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.
How does deet affect suncream ?
DEET dilutes sunscreen so apply SPF 30-50 sunscreen first followed by insect
repellent with a DEET concentration >20%
What are the symptoms of mumps?
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
Which emergency contraception is required if a patient is over 70kg and within 72 hours
70kg so ulipristal or 3g levonorgestrel is recommended
Which high risk drug should change to salt in the diet be cautioned
Lithium
Maintain adequate fluid intake and avoid dietary changes which reduce or increase sodium intake.
How should you deal with ankle swelling with amlodipine ? can lercanidipine be used ?
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
A doctor prescribes IV potassium chloride 40mmol to be given stat. What do you do?
IV potassium should never be given as a bolus due to cardiac arrest risk.
I would recommend diluting in 1L of saline over ≥4 hours with cardiac monitoring.
Why does mirtazipine cause sedation at lower doses?
🔹 Histamine (H1) Blockade – At 7.5–15 mg, strong H1 receptor blockade causes sedation & drowsiness.
🔹 Noradrenaline & Serotonin Effects – At 30–45 mg, increased noradrenaline & serotonin activity reduces sedation and promotes alertness.
➡️ Lower doses = More sedation
➡️ Higher doses = Less sedation
Why is duloxetine used to manage pain but venlafaxine isnt?
Stronger Noradrenaline Effect
Both duloxetine and venlafaxine are serotonin-noradrenaline reuptake inhibitors (SNRIs).
However, duloxetine inhibits noradrenaline reuptake at all doses, while venlafaxine mainly affects serotonin at lower doses and only significantly increases noradrenaline at higher doses.
Noradrenaline modulation is key for neuropathic pain relief.
Which Specific Allergy should you avoid use of Cyanocobalamin in ?
an allergy to cobalt
What are key points to remember with ciclosporin use?
Brands
Counselling points
✅ To avoid inadvertent switching between brands
✅ Different brands may have variable bioavailability
✅ If switching is necessary, monitor closely for changes in:
Blood-ciclosporin concentration
Serum creatinine
Blood pressure
Transplant function (for transplant indications)
🔹 Sandimmun® capsules and oral solution are available directly from Novartis for patients who cannot be switched to a different oral preparation.
Administration advice: Patients should be counselled on the correct use of different formulations
Avoid excessive UV exposure, including sunlight
In psoriasis & atopic dermatitis, avoid UVB therapy or PUVA
What MHRA alert is there for statins from 2023?
✅ Very rare cases of new-onset or worsening myasthenia gravis or ocular myasthenia linked to statins.
✅ Most cases improved after stopping statins, but some symptoms persisted or recurred on rechallenge.
✅ Symptoms appeared within days to 3 months of starting statins.
🔍 Advice for Healthcare Professionals:
🔹 Refer suspected cases to a neurologist—discontinue statin if risks outweigh benefits.
📝 Patient & Carer Advice:
🔸 Inform doctor before starting statins if you have a history of myasthenia gravis.
🔸 Continue statin unless advised to stop.
🔸 Report symptoms:
Muscle weakness (worse after activity)
Double vision, drooping eyelids
Difficulty swallowing, shortness of breath
🔸 Seek urgent medical help for severe breathing/swallowing problems.
Which Calcium channel blockers should be avoided in heart failure?
Calcium channel blockers, with the exception of amlodipine, should be avoided in heart failure as they can fur‐
ther depress cardiac function and exacerbate symptoms. With the exception of amlodipine, they can also in‐
crease mortality after myocardial infarction in patients with left ventricular dysfunction and pulmonary
congestion.
When should you Admit to Hospital or Seek Immediate Specialist Advice for Shingles
🔴 Serious complications suspected:
🧠 Meningitis, encephalitis, or myelitis
👁️ Ophthalmic involvement (shingles in the trigeminal nerve):
⚠️ Hutchinson’s sign (rash on nose tip/side/root)
😣 Eye pain, photophobia, visual impairment
👀 Reduced corneal sensitivity or unexplained red eye
👴 Head & neck involvement, especially in elderly people
❗ Severe or atypical presentation:
🔥 Haemorrhagic/necrotic lesions
🔄 Multisegmental involvement
🌍 Generalized herpes zoster
🩸 Mucosal involvement
🦠 Aberrant vesicles/satellite lesions
What key side effects are there with Methotrexate?
⚠️ Patient Advice: When to Seek Medical Attention 🚨
📌 Blood Disorders 🩸
👉 Report immediately if you experience:
Sore throat
Bruising
Mouth ulcers
📌 Liver Toxicity 🏥
👉 Watch for signs like:
Nausea & vomiting 🤢
Abdominal discomfort 🤕
Dark urine 🚽
📌 Respiratory Effects 🫁
👉 Seek help if you have:
Shortness of breath
Cough or fever 🌡️
🔹 Special caution in rheumatoid arthritis – risk of pulmonary toxicity (pneumonitis).
📌 Gastrointestinal Toxicity 🚫
👉 Stop treatment & report if you have:
Stomatitis (mouth/lip inflammation) 👄
Diarrhoea 💩
⚠️ Early detection is key – seek medical advice if you notice any of these symptoms! 🚑
What are the colours of Warfarin tablets?
1mg – brown tablet.
3mg – blue tablet.
5mg – pink tablet.
Which inhalers have the worst carbon footprint?
Dry powder inhalers (DPIs) and soft mist inhalers (SMIs) have a lower carbon footprint than pressurised metered
dose inhalers (pMDIs). This is because they do not contain propellants that produce powerful greenhouse
gases.
Which antiepileptic drugs should involve pre-treatment screening
testing the for HLA-B*1502 allele?
Pre-treatment screening for the HLA-B*1502 allele is recommended before starting carbamazepine and phenytoin in patients of Asian descent due to the increased risk of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).
✅ Drugs requiring HLA-B*1502 testing:
Carbamazepine
Oxcarbazepine (sometimes recommended)
Phenytoin (in certain populations)
Fosphenytoin (prodrug of phenytoin)
🚨 Key Point: If a patient tests positive for HLA-B*1502, avoid these drugs due to the high risk of severe skin reactions.
Via what route is the yellow fever vaccine given?
Sub Cut
WHat are the time frames for UTI treatment in:
non pregnant women
men
pregnant women
Non-pregnant women with an uncomplicated lower urinary tract infection (UTI) are prescribed a 3-day course of antibiotics, and men and
pregnant women with an uncomplicated lower UTI are prescribed a 7-day course of antibiotics
What is Oxybutynin and when should it be potentially stopped in the elderly?
🧓 Oxybutynin – STOPP Criteria for Inappropriate Prescribing
🔴 Potentially inappropriate use of oxybutynin in the elderly:
If used to treat extrapyramidal side effects of antipsychotics (🚨 risk of antimuscarinic toxicity).
In patients with:
Delirium or dementia (⚠️ worsens cognitive impairment).
Angle-closure glaucoma (❌ contraindicated; risk of acute exacerbation).
Chronic prostatism (🚽 risk of urinary retention).
If two or more antimuscarinic drugs are prescribed at the same time (⚠️ increased toxicity risk).
💊 Oxybutynin is an antimuscarinic used for overactive bladder but should be used cautiously in older adults due to high risk of cognitive impairment and falls.
What would be a reason that haloperidol is changed from tablets to Depot injections ?
The most likely reason for switching from haloperidol tablets to a depot injection is to improve medication adherence.
💉 Depot injections are long-acting formulations given at regular intervals (e.g., every 2–4 weeks), which:
✔️ Ensure consistent drug levels in the body.
✔️ Reduce the risk of non-adherence (common in conditions like schizophrenia).
✔️ Lower the chances of relapse due to missed doses.
If a breastfeeding lady is presenting with back pain & no red flag symptoms what is the most appropriate treatment?
🤱 Ibuprofen & Breastfeeding
✔️ Safe to take or use on skin while breastfeeding
✔️ Only tiny amounts pass into breast milk
✔️ Unlikely to cause side effects in baby
🔹 Managing Back Pain 🔹
✅ Do:
✔️ Stay active & continue daily activities
✔️ Take ibuprofen (paracetamol alone not recommended)
✔️ Use ice pack (wrapped in a towel) for swelling
✔️ Use heat pack for stiffness & muscle spasms
✔️ Try stretches & exercises for back pain
❌ Don’t:
🚫 Avoid staying in bed for long periods
Avoid oral ibuprofen in pregnancy.
What is the order of treatment for blood pressure in pregnancy?
✅ First-line: Labetalol (oral) to maintain BP <135/85 mmHg
🚫 If unsuitable: Nifedipine MR (🔹 unlicensed)
🚫 If both unsuitable: Methyldopa (🔹 unlicensed)
What do the different Side effect classifications represent in the BNF
Common
Uncommon
Rare etc
Very common (≥1 in 10 people) – Happens in at least 10% of patients.
Common (≥1 in 100 to <1 in 10) – Affects between 1% and 10% of patients.
Uncommon (≥1 in 1,000 to <1 in 100) – Affects 0.1% to 1% of patients.
Rare (≥1 in 10,000 to <1 in 1,000) – Happens in 0.01% to 0.1% of patients.
Very rare (<1 in 10,000) – Happens in fewer than 0.01% of patients.
What is a common cause of pruritus (itching) in chronic kidney disease (CKD)?
hyperphosphataemia
Excess phosphate leads to calcium-phosphate deposits in the skin and stimulates inflammatory mediators, causing itching.
