Medicines 33 Flashcards
if someone gets severe pain, tenderness, erythema, or swelling in the genital
or perineal area, accompanied by fever or malaise - What is the advice ?
📢 Patients should seek IMMEDIATE medical attention if they experience:
✅ Severe pain, tenderness, redness (erythema), or swelling in the genital or perineal area
✅ Accompanied by fever or feeling unwell (malaise)
⚠️ Possible Causes:
Urogenital infection
Perineal abscess
May precede necrotising fasciitis (a life-threatening soft tissue infection)
⏳ Early recognition is crucial—seek urgent help! A&E
how long will a pack of 24 Gina (estradiol hemihydrate 10 micrograms) vaginal tablets last?
Initial dose: One vaginal tablet daily for two weeks = 14 days
Maintenance dose: One vaginal tablet twice a week = 10 tablets left so 5 weeks = 35 days
14 days + 35 days = 49 days
How should you handle patient returned controlled drugs?
📜 Handling Returned Schedule 2 CDs
✅ Do NOT enter returned Schedule 2 controlled drugs (CDs) into the CD register
✅ Do NOT require an authorised witness for disposal
⚠️ However:
Good practice to document returns separately
Destruction should be carried out in the presence of another member of staff
Use a denaturing kit before disposal
With initiation or changing dose of ACE/ARBs when should monitoring be done.
🔬 Renal Function & Electrolytes:
✅ Check 1–2 weeks after starting treatment
✅ Check 1–2 weeks after each dose increase
✅ Annually thereafter, unless clinical concerns require more frequent monitoring
📉 Blood Pressure:
✅ Check 4 weeks after each dose titration
⚠️ Higher Risk Patients (e.g., PVD, diabetes, renal impairment, elderly)
🔍 Consider checking renal function & electrolytes within 1 week
Summarise the different MHRA alerts for Fluoroquinolones
🛑 Important Safety Information for Fluoroquinolones
⚡ Convulsions Risk
NSAIDs + quinolones → Increased seizure risk.
Applies to both adults and children, even without seizure history.
🦵 Tendon Damage & Rupture
Can occur within 48 hours of treatment or even months later.
Higher risk in:
Age 60+
History of tendon disorders from quinolones
Corticosteroid use → Avoid co-prescription.
If tendinitis develops, stop quinolone immediately.
💔 Aortic Aneurysm & Dissection Risk (MHRA 2018)
Use only if benefits outweigh risks in patients with:
Family history of aneurysms
Marfan syndrome, vascular Ehlers-Danlos syndrome
Takayasu arteritis, atherosclerosis, hypertension
Symptoms to watch for: Sudden severe abdominal, chest, or back pain → Seek urgent medical attention.
🫀 Heart Valve Regurgitation Risk (MHRA 2020)
Avoid in high-risk patients (e.g., congenital valve disease, connective tissue disorders).
Monitor for:
New palpitations
Shortness of breath (especially when lying flat)
Swelling in ankles, feet, or abdomen
🧠 Neuromuscular & Psychiatric Side Effects (MHRA 2019, 2023)
Potentially irreversible nerve & muscle damage → Peripheral neuropathy, muscle pain, weakness.
Psychiatric effects (even after first dose):
Depression, psychosis, suicidal thoughts (even in those with no prior history).
Worsening of existing psychiatric symptoms.
Stop fluoroquinolone immediately if these symptoms appear.
🚫 Updated Restrictions (MHRA 2024)
Fluoroquinolones are now restricted to cases where:
First-line antibiotics failed.
First-line antibiotics caused significant side effects.
First-line antibiotics are contraindicated.
They should NOT be used for mild or non-severe infections (e.g., acute bronchitis, uncomplicated cystitis).
what is the general guidance for secondary prevention?
Secondary Prevention Treatment after STEMI/NSTEMI
Initiation: All patients should receive secondary prevention treatment post-STEMI and NSTEMI. Clinical judgment is needed for unstable angina.
Core Medications:
ACE Inhibitor (or ARB if intolerant) – Start once the patient is stable; continue indefinitely.
Beta-Blocker – Start when stable. Continue indefinitely if reduced LVEF. Consider stopping after 12 months if LVEF is normal, based on patient discussion.
Dual Antiplatelet Therapy (DAPT) –
Aspirin (indefinite use) + a second antiplatelet (e.g., clopidogrel, ticagrelor, or prasugrel) for up to 12 months unless contraindicated.
Alternative: Clopidogrel monotherapy for aspirin hypersensitivity.
Anticoagulation (e.g., Rivaroxaban) can be used alongside aspirin or DAPT for high-risk patients with elevated cardiac biomarkers.
Statin – High-intensity statin therapy recommended for all with clinical cardiovascular disease.
Special Considerations:
Patients requiring long-term anticoagulation (e.g., for atrial fibrillation) need an individualized approach to balancing thrombotic vs. bleeding risks.
Alternatives for Beta-Blockers: Diltiazem or verapamil in patients without pulmonary congestion or reduced LVEF.
What is the recommended duration for continuing antidepressant treatment following remission in patients with depression and generalized anxiety disorder, and how should treatment be managed if there is partial response or lack of efficacy?
- Initial Review and Treatment Response
Review Frequency:
Every 1–2 weeks at the start of treatment.
Minimum Treatment Duration Before Assessing Efficacy:
At least 4 weeks (6 weeks in elderly) before considering a switch due to lack of efficacy.
If partial response, continue for another 2–4 weeks (elderly may take longer to respond).
- Maintenance Treatment After Remission
Depression: Continue antidepressants at the same dose for at least 6 months (12 months in elderly).
Generalized Anxiety Disorder (GAD): At least 12 months due to high relapse risk.
How long should someone be supplied for of atovaquone/progaunil when going away
1-2 days before, duration of holiday and 7 days after. Also available OTC
what antidiabetic drug classes are associated with weight gain? (RPS)
Insulin 💉 – Promotes glucose uptake and storage, leading to weight gain.
Sulfonylureas (e.g., gliclazide, glimepiride) 💊 – Increase insulin secretion, which can cause weight gain.
Thiazolidinediones (TZDs) (e.g., pioglitazone) 🍞 – Increase fat storage and fluid retention, contributing to weight gain.
Which antidiabetics are associated with weight loss
SGLT2 Inhibitors (e.g., dapagliflozin, empagliflozin) 🚽 – Promote glucose excretion in urine, leading to weight loss.
GLP-1 Receptor Agonists (e.g., liraglutide, semaglutide) 🍽️ – Reduce appetite and slow gastric emptying.
What is Varenicline?
Varenicline is a selective nicotine-receptor partial agonist. It reduces the severity of
cravings and withdrawal symptoms, while simultaneously reducing the rewarding
effects of nicotine
How many salbutamol inhalers can a school buy from a pharmacy in a 12-month period?
There is no limit
The number that can be obtained by individual schools is not specified in legislation.
Schools can purchase salbutamol inhalers and/or AAIs from pharmacies provided it is for small quantities, on an occasional basis and not for
profit.
Pharmacists should exercise their professional judgement when responding to requests from schools. Factors to consider include:
School size and number of sites it is comprised of
Number of children known to be affected
Past experiences e.g. of children not having access to an AAI or inhaler
What is the elderly and STOPP criteria in amiodorone?
🚫 STOPP Criteria: Helps identify potentially inappropriate prescriptions in older adults.
⚠️ Antiarrhythmic Therapy Warning:
Not recommended as first-line for supraventricular tachyarrhythmias.
Why? ❌ Higher risk of side effects than beta-blockers, digoxin, verapamil, or diltiazem.
🔍 Always consider safer alternatives! ✅
What are the MHRA alerts regarding Nitrofurantoin?
🔹 MHRA/CHM Safety Update (April 2023)
Reminder of the risks of pulmonary and hepatic adverse reactions
🚨 Pulmonary Risks
❗ Fatal case reported after a 10-day course of nitrofurantoin for UTI.
💨 Healthcare professionals should:
Monitor for acute pulmonary reactions within the first week of treatment.
Closely observe long-term users, especially elderly patients, for new or worsening respiratory symptoms.
Stop treatment immediately if pulmonary symptoms develop.
Be cautious when prescribing to patients with pre-existing lung disease, as this may mask symptoms.
🫁 Hepatic Risks
🩺 Monitor for liver dysfunction, particularly in long-term therapy.
Regularly check liver function tests for hepatitis or liver injury.
Use caution in patients with hepatic disease, as symptoms may be masked.
Educate patients and carers to seek immediate medical advice if symptoms of pulmonary or liver damage occur.
🚸 Same recommendations apply to children receiving nitrofurantoin.
💡 Key Takeaway:
✅ Be vigilant for early signs of lung or liver toxicity.
✅ Stop immediately if symptoms develop.
✅ Educate patients on warning signs.
You said:
what are the symptoms to look out for
ChatGPT said:
🚨 Symptoms to Watch for with Nitrofurantoin 🚨
🫁 Pulmonary (Lung) Adverse Reactions
🔴 Acute reactions (within the first week of treatment):
Shortness of breath (dyspnoea) 😤
Persistent cough (non-productive) 🤧
Chest pain 💔
Fever & chills ❄️🔥
Fatigue or malaise 😓
🔴 Chronic reactions (long-term use):
Progressive breathlessness over weeks/months
Chronic cough
Lung fibrosis (in severe cases)
🫀 Hepatic (Liver) Adverse Reactions
🔴 Signs of liver dysfunction:
Yellowing of skin/eyes (jaundice) 🟡
Dark urine ☕
Persistent nausea & vomiting 🤢
Loss of appetite 🍽️🚫
Unexplained fatigue 😴
Abdominal pain (especially upper right side) ⚠️
A 27-year-old man with migraine-related nausea and vomiting requests prochlorperazine maleate (Buccastem) 3mg OTC. What is the maximum duration of treatment?
✅ Answer: 2 days
💊 Key Points:
Dose: 1–2 tablets twice daily
Buccal administration: Place under the upper lip until dissolved. Do not chew or swallow.
Max duration: 2 days ⏳
If symptoms persist, seek medical advice.
What are the specific reversal agents for dabigatran, apixaban, and rivaroxaban?
Dabigatran → Praxbind (idarucizumab)
Apixaban & Rivaroxaban → Ondexxya (andexanet alfa)
Which pharmacological option is preferred for venous thromboembolism (VTE) prophylaxis in renally impaired patients?
Unfractionated heparin is the preferred choice as it is primarily cleared by the liver, meaning no dose adjustments are required in renal impairment.
Which drinks should be avoided with fexofenadine (as per NHS)
🍊 Avoid: Grapefruit juice, Apple juice, Orange juice 🚫
⚠️ Reason: These juices may increase the risk of side effects by affecting fexofenadine absorption.
What approved smoking cessation treatments are there?
Approved smoking cessation treatments include nicotine replacement therapy (NRT),
varenicline,
bupropion
A patient presents to the pharmacy with a prescription for Naftidrofuryl oxalate 100mg TDS. What is the likely indication?
✅ Answer: Peripheral arterial disease (PAD) / Intermittent claudication
listed in BNF as: Peripheral vascular disease &
Cerebral vascular disease
💡 Learning Point:
🔹 Naftidrofuryl oxalate is a vasodilator used to improve walking distance in patients with intermittent claudication due to peripheral arterial disease (PAD).
🔹 It works by improving oxygen supply to tissues and reducing lactic acid build-up in muscles.
🔹 Lifestyle changes such as smoking cessation, exercise, and diet are also key in managing PAD.
What is ranolazine used for?
✅ Answer: Chronic stable angina (as an add-on therapy when other anti-anginal drugs are insufficient)
💡 Learning Points:
🔹 Ranolazine is an anti-anginal medication that works by inhibiting late sodium currents in myocardial cells, reducing myocardial oxygen demand.
🔹 It does not significantly affect heart rate or blood pressure, making it useful for patients who cannot tolerate beta-blockers or calcium channel blockers.
🔹 Common side effects: Dizziness, constipation, nausea, and QT prolongation (monitor ECG in high-risk patients).
🔹 Avoid in: Severe renal or hepatic impairment and use with caution in QT-prolonging drugs.
What medication is first-line for preventing further episodes of chest pain in stable angina?
✅ Answer: Beta-blockers or calcium channel blockers (CCBs)
💡 Learning Points:
🔹 First-line options:
Beta-blockers (e.g., bisoprolol, atenolol) – preferred if no contraindications.
Calcium channel blockers (CCBs) (e.g., amlodipine, diltiazem) – alternative if beta-blockers are unsuitable or in combination therapy if symptoms persist.
🔹 If monotherapy is ineffective, a combination of a beta-blocker and a non-rate-limiting CCB (e.g., amlodipine) can be used.
🔹 Second-line options:
Long-acting nitrates (e.g., isosorbide mononitrate)
Nicorandil
Ivabradine
Ranolazine
🔹 All patients should also receive:
Aspirin (or clopidogrel if contraindicated)
A statin
Sublingual GTN for acute angina attacks
Which aldosterone antagonist is the most suitable for a heart failure patient with LVEF 30% following a non-ST elevation myocardial infarction (NSTEMI)?
✅ Answer: Eplerenone
💡 Learning Points:
🔹 Eplerenone is specifically indicated for heart failure with reduced ejection fraction (HFrEF) post-MI to improve survival and reduce hospitalisation.
🔹 Why not spironolactone?
Spironolactone is preferred in chronic HFrEF, but eplerenone is first-line post-MI due to a lower risk of gynecomastia and endocrine side effects.
what is the interaction between neprilysin inhibitors and ACE inhibitors?
🚨 Major Risk: Increased Bradykinin → Severe Angioedema
🔹 Neprilysin inhibitors (e.g., sacubitril in sacubitril/valsartan) block neprilysin, an enzyme that degrades bradykinin.
🔹 ACE inhibitors (e.g., ramipril, lisinopril) also increase bradykinin by inhibiting its breakdown.
🔹 Combined use leads to excessive bradykinin accumulation, increasing the risk of life-threatening angioedema (swelling of face, lips, throat).
❌ Clinical Implication:
🔺 Neprilysin inhibitors and ACE inhibitors should NEVER be used together.
🔺 A washout period of at least 36 hours is required when switching from an ACE inhibitor to sacubitril/valsartan to reduce angioedema risk.
