Medicines 34 Flashcards
Which antidiabetic medications increase the risk of falls ?
the ones that have strong hypoglycaemic effect
Insulin:
Insulin use is a significant risk factor for falls in older adults with diabetes, potentially due to the risk of hypoglycemia.
Sulfonylureas:
These oral medications also increase the risk of hypoglycemia, which can lead to falls.
Which antidiabetic medication is associated with Lactic Acidosis?
METFORMIN
Which thyroid medication should be brand specific?
Liothyronine
Patients switched to a different brand should be monitored (particularly if pregnant or if heart disease present) as brands without a UK licence may not be bioequivalent. Pregnant women or those with heart disease should undergo an early review of thyroid status, and other patients should have thyroid function assessed if experiencing a significant change in symptoms. If liothyronine is continued long-term, thyroid function tests should be repeated 1–2 months after any change in brand. (BNF)
Which type of dementia are acetylcholinesterase inhibitors NOT recommended in?
FRONTOTEMPORAL DEMENTIA
As per the RPS what are the ranges for monitoring with Lithium?
General range: 0.4–1.0 mmol/L
Lower range (0.4–0.6 mmol/L): May be used for:
Older patients
Long-term maintenance therapy for bipolar disorder
Patients treated for depression
Middle range (0.6–0.8 mmol/L): Recommended for first-time treatment of acute mania.
Higher range (0.8–1.0 mmol/L): May be considered for harder-to-treat cases of bipolar disorder or acute mania.
Key Notes:
Lithium levels need regular monitoring to ensure they remain within the target range and avoid toxicity.
Toxicity risk increases with levels above 1.2 mmol/L.
Regular monitoring should include checking renal and thyroid function
Which antiepileptic medication is contraindicated if someone has the HLA-B*1502 allele?
Carbamazepine
strongly associated with an increased risk of severe skin reactions, such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), in individuals of Asian ancestry when taking carbamazepine (CBZ)
Emergency status epilepticus management when facilities for resuscitation are not immediately available to the patient
buccal midazolam [unlicensed] or rectal diazepam. If intravenous access and resuscitation facilities are immediately available, intravenous lorazepam should be given.
What are the MHRA alerts regarding clozapine?
📌 Risk of Intestinal Obstruction & Paralytic Ileus (MHRA, 2017)
Clozapine can impair intestinal peristalsis, leading to faecal impaction, paralytic ileus, and intestinal obstruction (potentially fatal).
Patient Advice: Seek immediate medical attention if constipation develops before taking the next dose.
📌 Monitoring Blood Concentrations for Toxicity (MHRA, 2020)
Clozapine toxicity risk increases in specific clinical situations. Monitor blood concentration if:
✅ Patient stops smoking or switches to e-cigarettes 🚬➡️❌
✅ Drug interactions may raise clozapine levels 💊⬆️
✅ Pneumonia or serious infection occurs 🤒
✅ Suspected reduced metabolism 🚫🧪
✅ Signs of toxicity appear 🚨
🩸 Blood monitoring for toxicity is in addition to agranulocytosis screening.
Which antipyschotics are most associated with the following side effects:
- Extrapyramidal Symptoms
- Hyperprolactinaemia
- Sexual dysfunction
- QT prolongation risk
- Hypotension
Diabetes risk
Weight gain
Neuroleptic Malignant Syndrome (NMS)
📌 Extrapyramidal Symptoms (EPS) 🏃♂️⚡
More common with first-generation antipsychotics (e.g., haloperidol, fluphenazine).
Less common with second-generation antipsychotics (e.g., clozapine, quetiapine, aripiprazole).
Types:
Parkinsonism 🏛️ (bradykinesia, tremor)
Dystonia 💀 (muscle spasms, especially in young males)
Akathisia 🚶♂️ (restlessness, mistaken for agitation)
Tardive dyskinesia 😛 (involuntary facial movements, irreversible in some)
📌 Hyperprolactinaemia 🍼
High risk: risperidone, amisulpride, sulpiride
Low risk: aripiprazole, quetiapine, clozapine
Symptoms: menstrual irregularities, sexual dysfunction, osteoporosis
📌 Sexual Dysfunction ❤️❌
High risk: risperidone, haloperidol, olanzapine
Low risk: aripiprazole, quetiapine
📌 Cardiovascular Effects ❤️⚡
QT prolongation risk: high (pimozide), low (aripiprazole, olanzapine, risperidone)
Hypotension: Common, especially with clozapine & quetiapine (slow titration recommended).
📌 Metabolic Effects 🍔⚠️
Diabetes risk: Highest with second-generation APs; lowest with amisulpride & aripiprazole.
Weight gain: 🚨 High risk: clozapine, olanzapine Low risk: haloperidol, aripiprazole
📌 Neuroleptic Malignant Syndrome (NMS) 🥵⚠️
Symptoms: hyperthermia, rigidity, autonomic instability
Treatment: Stop antipsychotic immediately, consider bromocriptine & dantrolene
🩺 Regular monitoring & dose adjustments are key!
How many weeks should antidepressant treatment be continued before considering an alternative?
✅ 4 weeks (6 weeks in elderly patients)
Key Points:
Assess efficacy after 4 weeks.
If no improvement, consider switching or adjusting dose.
Full therapeutic effects may take 6–8 weeks.
Which viral infection is a known risk factor for the development of cervical cancer?
✅ Human papillomavirus (HPV)
Which drugs should not be commenced in someone with absent TPMT (thiopurine methyltransferase) activity?
🚫 Thiopurine drugs:
Azathioprine
Mercaptopurine
Thioguanine
TPMT metabolizes thiopurines; absent TPMT activity → risk of severe myelosuppression (bone marrow toxicity).
How long after stopping methotrexate should men and women wait before trying to conceive?
Women: ⏳ At least 3 months after stopping methotrexate before conceiving.
Men: ⏳ At least 3 months after stopping methotrexate before fathering a child.
WHat is the difference in advice between bone marrow supression with methotrexate vs carbimazole?
📌 Methotrexate + sore throat = A&E (risk of pancytopenia, life-threatening infections).
📌 Carbimazole + sore throat = GP (same day) (unless severe, then A&E).
Why is Methotrexate a Medical Emergency?
Methotrexate can cause pancytopenia (low RBCs, WBCs, platelets), which is more severe than agranulocytosis alone.
This leads to high infection risk and bleeding risk.
Patients on methotrexate with suspected blood dyscrasias need an urgent full blood count (FBC) immediately—A&E ensures quick testing and intervention.
Why GP for Carbimazole?
Carbimazole primarily affects neutrophils, but not usually platelets or RBCs.
If the patient feels well, a same-day GP appointment is reasonable.
If they appear very unwell (high fever, worsening infection signs, difficulty breathing, or confusion) → A&E referral instead.
What is the first line treatment for nocturnal enuresis?
Desmopressin
What is the recommended duration of treatment with leuprorelin for endometriosis according to the BNF?
11.25 MG EVERY 3 MONTHS FOR
MAXIMUM DURATION OF 6 MONTHS (NOT TO BE REPEATED),
TO BE STARTED DURING FIRST 5 DAYS OF MENSTRUAL
CYCLE.
What is the initial empirical treatment for acute prostatitis in men aged under 35 years according to the BNF?
ORAL FIRST LINE: CIPROFLOXACIN, OR
OFLOXACIN. ALTERNATIVE FIRST LINE (IF UNABLE TO TAKE FLUOROQUINOLONES): TRIMETHOPRIM.
Which weak diuretic can cause urine discoloration, and what color does it turn the urine?
Triamterene – can cause blue or blue-green urine discoloration. This is harmless but may be alarming to patients.
indications: Oedema,
Potassium conservation with thiazide and loop diuretics
What are the first-line, second-line, and specialist treatment options for a first episode of mild, moderate, or severe Clostridioides difficile infection?
✅ First-line:
Vancomycin 125 mg orally four times a day for 10 days - VANCOMYCIN TAKEN ORALLY FOR C.DIFF INFECTIONS
✅ Second-line (if vancomycin is ineffective):
Fidaxomicin 200 mg orally twice a day for 10 days
✅ If first- and second-line antibiotics are ineffective (specialist advice required):
Vancomycin up to 500 mg orally four times a day for 10 days
± Metronidazole 500 mg IV three times a day for 10 days
What is the antifungal treatment of choice for aspergillosis?
✅ Voriconazole is the first-line treatment for aspergillosis.
What is the first-line antibiotic treatment for an acute exacerbation of COPD?
✅ Oral antibiotic (e.g., macrolide, doxycycline, or amoxicillin) is the first-line treatment.
What is the first-line antibiotic treatment for cellulitis in adults?
✅ Flucloxacillin 500–1000 mg four times daily for 5–7 days
Alternatives if unsuitable or allergic to penicillin:
Clarithromycin 500 mg twice daily for 5–7 days
Doxycycline 200 mg on day 1, then 100 mg once daily (total 5–7 days)
Erythromycin (in pregnancy) 500 mg four times daily for 5–7 days
What is the recommended antibiotic treatment for periorbital cellulitis in adults?
✅ First-line: Co-amoxiclav 500/125 mg three times daily for 7 days (consider specialist advice).
If penicillin allergy:
Clarithromycin 500 mg twice daily for 7 days
PLUS
Metronidazole 400 mg three times daily for 7 days
What are the potential side effects of Linezolid?
⚠️ Possible side effects include:
Blood disorders: Reduced blood count (anaemia), bruising, bleeding.
Gastrointestinal: Sore mouth/mouth ulcers, nausea, diarrhoea, Clostridium difficile (pseudomembranous colitis).
Skin: Rashes.
Neurological: Headaches, dizziness, insomnia.
Vision changes: Blurred vision, changes in sharpness or colour (avoid driving/machinery if affected).
Serious risks: Serotonin syndrome (risk with other serotonergic drugs).
