Medicines 35 Flashcards
Which antibiotics should be avoided with sodium valproate?
Carbapenems (e.g., Meropenem, Imipenem, Ertapenem) – Decreases valproate levels, leading to loss of seizure control.
Rifampicin – Induces liver enzymes, reducing valproate levels and seizure control.
THINK ENZYME INDUCERS AND INHIBITORS
Fluoroquinolone’s lower the seizure threshold
Which drugs interact with vitamin D in the following categories?
🧪 Drugs that increase vitamin D metabolism (may require higher doses of vitamin D)
⚠️ Drugs that may reduce vitamin D absorption (may require higher doses of vitamin D).
💊 Drugs requiring caution with vitamin D:
🧪 Drugs that increase vitamin D metabolism (may require higher doses of vitamin D):
Antiepileptics (carbamazepine, phenytoin, barbiturates)
Corticosteroids
Ketoconazole, miconazole, clotrimazole
⚠️ Drugs that may reduce vitamin D absorption (may require higher doses of vitamin D):
Ion exchange resins (colestyramine)
Laxatives (paraffin oil)
Orlistat → Take vitamin D at least 2 hours after orlistat; monitor vitamin D levels.
💊 Drugs requiring caution with vitamin D:
Cardiac glycosides (e.g., digoxin) → Hypercalcaemia from excessive vitamin D can increase digoxin toxicity → Close monitoring needed.
Thiazide diuretics (bendroflumethiazide, indapamide, metolazone) → May increase calcium levels → Risk of hypercalcaemia.
Why use Vitamin D2 instead of Vitamin D3?
Vitamin D2 is Suitable for individuals who cannot take Vitamin D3 due to cultural, dietary, or religious reasons.
Vitamin D3 (cholecalciferol) is often animal-sourced or contains gelatine in some preparations.
Vitamin D2 (ergocalciferol) is plant-derived and a viable alternative.
Which form of vitamin D is used in PATIENTS
WITH SEVERE CHRONIC KIDNEY DISEASE, OR HAVE END STAGE RENAL FAILURE (ESRF)?
Alfacalcidol
🔹 Severe CKD impairs the kidneys’ ability to convert vitamin D into its active form (calcitriol).
🔹 Standard vitamin D supplements (cholecalciferol or ergocalciferol) require renal conversion, which is reduced in CKD.
🔹 Alfacalcidol or calcitriol bypass the kidneys and provide the active form directly.
What is the optimal way to enhance iron absorption from the gastrointestinal tract?
Take with Vitamin C
Ascorbic acid (Vitamin C) enhances iron absorption by converting ferric (Fe³⁺) iron to ferrous (Fe²⁺), which is more easily absorbed.
or an empty stomach
What is the primary function of folic acid in the body?
Red blood cell production
What is Beriberi and what is it caused by?
Beriberi is a disease caused by a deficiency of thiamine (vitamin B1), which can lead to various symptoms including fatigue, weakness, and nerve damage, and in severe cases, heart failure or muscle paralysis
WHich factors does Warfarin inhibit?
WARFARIN INHIBITS FACTORS II, VII, IX AND X.
How do bile acid sequesterants work?
Bile acid sequestrants are medications, such as cholestyramine, colestipol, and colesevelam, that bind to bile acids in the intestines, preventing their reabsorption and promoting cholesterol breakdown in the liver to lower LDL (“bad”) cholesterol levels
How does Entacapone effect urine?
The medicine may colour your urine (red, brown, or orange)
Via what route is the yellow fever vaccine administered?
Sub cut
SC
What is the treatment for community acquired pneumonia (NICE guidelines)?
💊 First Choice Oral Antibiotic:
✅ Amoxicillin 500 mg three times a day for 5 days (📖 check BNF for higher doses).
💊 Alternative Choices (Penicillin Allergy or Atypical Pathogens Suspected):
🔹 Doxycycline 200 mg on day 1, then 100 mg once daily for 4 more days (📅 total 5 days).
🔹 Clarithromycin 500 mg twice daily for 5 days.
🔹 Erythromycin (🤰 during pregnancy) 500 mg four times daily for 5 days.
⚖️ Moderate Severity (CRB-65 Score 1 or 2, managed in the community):
✔️ Amoxicillin 500 mg three times daily for 5 days ➕ (if atypical pathogens suspected)
➡️ Clarithromycin 500 mg twice daily for 5 days OR
➡️ Erythromycin (🤰 during pregnancy) 500 mg four times daily for 5 days.
👦 Young People (12–17 years) with Non-Severe Symptoms:
✅ First choice: Amoxicillin 500 mg three times daily for 5 days.
🔹 Alternative Choices (Penicillin Allergy or Atypical Pathogens Suspected):
Clarithromycin 250–500 mg twice daily for 5 days.
Erythromycin (🤰 during pregnancy) 250–500 mg four times daily for 5 days.
Doxycycline 200 mg on day 1, then 100 mg once daily for 4 more days (📅 total 5 days).
Which cardiovascular medication can worsen diabetes ?
Diuretics, thiazide and loop diuretics
Indapamide meant to have less affect on diabetes
Beta blockers can mask the symptoms of diabetes
What is the main liver enzyme to monitor with statins ?
Alanine Aminotransferase (ALT)
Those with serum transaminases that are raised, but less than 3 times the upper limit of the reference range, should not be routinely excluded from statin therapy. Those with serum transaminases of more than 3 times the upper limit of the reference range should discontinue statin therapy
If digoxin toxicity occurs what is the correct advice?
Advise the patient to stop taking digoxin and refer for medical review urgently. The BNF monograph recommends that if toxicity occurs, digoxin should be withdrawn as serious manifestations can occur requiring urgent specialist management. A digoxin plasma concentration within the therapeutic range does not exclude digoxin toxicity.
Which medication can be used in acute gout with history of MI?
Colchicine
What is the treatment and treatment length for folate deficiency?
Prescribing oral folic acid 5 mg daily. In most people, treatment will be required for 4 months.
What is Pityriasis versicolor (also called tinea versicolor)
a superficial fungal skin infection caused by the yeast Malassezia.
Key Features 🦠
✅ Discoloured patches on the skin (can be lighter or darker than surrounding skin)
✅ Commonly affects the chest, back, shoulders, and neck
✅ May be itchy or scaly, but often asymptomatic
✅ More noticeable after sun exposure (affected areas don’t tan)
✅ More common in warm, humid climates 🌴
When can withdrawal of antiepileptic drugs (AEDs) be considered in a seizure-free patient?
AED withdrawal may be considered after at least 2 years of being seizure-free.
Risk assessment for seizure recurrence should be performed, preferably by an epilepsy specialist.
Withdrawal should be gradual (typically over at least 3 months).
One drug at a time should be withdrawn in patients on multiple AEDs.
Barbiturates & benzodiazepines require a longer tapering period to prevent severe withdrawal seizures.
If seizures recur, revert to the last effective dose and seek specialist advice.
What is Misoprostol used for?
🔹 Prevention and treatment of gastric ulcers – particularly in patients taking long-term NSAIDs.
🔹 Medical abortion – used in combination with mifepristone.
🔹 Induction of labour – helps ripen the cervix and stimulate contractions.
what is the Difference Between Hyoscine Butylbromide & Hydrobromide
📌 Hyoscine Butylbromide (Buscopan)
✅ Used for: GI spasms, IBS, renal colic 🏥
✅ Mechanism: Relaxes smooth muscles 💪
✅ CNS Effects: ❌ Does not cross the blood-brain barrier
✅ Side Effects: Dry mouth, blurred vision, constipation 🚽
✅ Route: Tablets 💊 or injection 💉
📌 Hyoscine HYDRObromide
✅ Used for: Motion sickness, nausea & vomiting 🚢🤢
✅ Mechanism: Blocks vomiting signals in the brain 🧠
✅ CNS Effects: ✅ Crosses the blood-brain barrier → drowsiness 😴
✅ Side Effects: Drowsiness, dry mouth, dizziness 🌪️
✅ Route: Tablets 💊, patches 🩹, injection 💉
Remember HYDRObromide for BOAT
⚡ Key Difference:
Butylbromide = No CNS effects ❌🧠 → Gut spasms
Hydrobromide = CNS effects ✅🧠 → Motion sickness & nausea
What is used to treat hyperkalaemia and hypokalaemia?
🩺 Patiromer Calcium – Used for hyperkalaemia ⚡🩸
🍌 Potassium Chloride – Used for hypokalaemia 💪
Which antidiabetic medications are associated with weight loss (NICE guidance)
✅ SGLT2 Inhibitors 🚽🔻
🔹 Examples: Canagliflozin, Dapagliflozin, Empagliflozin, Ertugliflozin
🔹 Effects: Lowers blood glucose, promotes weight loss, and may improve cardiovascular outcomes ❤️
⚠️ Risk: Diabetic ketoacidosis
✅ GLP-1 Receptor Agonists 💉🍽️
🔹 Examples: Dulaglutide, Exenatide, Liraglutide, Lixisenatide, Semaglutide
🔹 Effects: Promotes weight loss & may improve cardiovascular outcomes
🔹 Use: Reserved for combination therapy when other treatments fail
✅ Dual GIP & GLP-1 Receptor Agonists 🔥📉
🔹 Example: Tirzepatide
🔹 Effects: Promotes weight loss & can be used as an alternative to GLP-1 agonists
What is the interaction between ciprofloxacin and NSAIDs
The interaction between ciprofloxacin (a fluoroquinolone antibiotic) and NSAIDs (nonsteroidal anti-inflammatory drugs) is primarily related to an increased risk of seizures.
How does enteral feeding affect phenytoin levels, and how should it be managed?
🔹 Effect: Enteral feeding reduces phenytoin absorption, leading to lower levels and poor seizure control.
🔹 Cause: Phenytoin binds to proteins in the feed, decreasing its bioavailability.
🔹 Management:
⏳ Stop feeding for 2 hours before & after phenytoin doses.
🩸 Monitor phenytoin levels closely to maintain seizure control.
