Medicines 37 Flashcards
What is spina bifida and how is it prevented?
Spina bifida is a neural tube defect where the spine and spinal cord fail to develop properly during early pregnancy, leading to a gap in the spinal column. This can cause nerve damage and physical disabilities ranging from mild to severe.
Prevention
The primary way to reduce the risk of spina bifida is by ensuring adequate folic acid (vitamin B9) intake before and during early pregnancy:
✅ Folic acid supplementation:
400 micrograms daily for women planning pregnancy and during the first 12 weeks of pregnancy.
5 mg daily for high-risk women (e.g., previous neural tube defect pregnancy, diabetes, or taking antiepileptic drugs).
What does the acronym MDRD?
MDRD stands for “Modification of Diet in Renal Disease.”
It refers to the MDRD equation, which is used to estimate the glomerular filtration rate (eGFR) and assess kidney function. This formula takes into account serum creatinine, age, gender, and race to estimate kidney function in patients with chronic kidney disease (CKD).
What are the side effects of glucocorticoids and mineral corticoids?
🔹 Mineralocorticoid Side Effects:
⬆ Hypertension
💧 Sodium & Water Retention
⬇ Potassium & Calcium Loss
📌 Most marked with: Fludrocortisone
📌 Significant with: Hydrocortisone, corticotropin, tetracosactide
📌 Negligible with: Betamethasone, dexamethasone
📌 Slight with: Methylprednisolone, prednisolone, triamcinolone
🔹 Glucocorticoid Side Effects:
🍬 Diabetes
🦴 Osteoporosis & Fractures (hip, vertebrae)
⚠ Avascular necrosis of femoral head
💪 Muscle wasting (proximal myopathy)
⚡ Psychiatric reactions
🩸 Weak link to peptic ulceration & perforation
What is considered as the first line treatment for nocturnal enuresis?
Enuresis alarms are generally considered a first-line treatment for bedwetting
❌ Do not use an enuresis alarm if:
🚫 The child/parents do not want to use one.
💧 Bedwetting is less than 1–2 times per week.
😓 Parents struggle emotionally with the burden of bedwetting.
😠 Parents express anger, negativity, or blame toward the child.
👶 The child is under 7 years old and cannot use an alarm.
What are the symptoms of Thrush?
✅ White, cottage cheese-like vaginal discharge (usually odorless)
✅ Itching & irritation around the vulva and vagina
✅ Soreness & stinging during sex or when urinating
🔹 Common triggers: Antibiotics, pregnancy, diabetes, weak immune system
How do combined oral contraceptives (COCs) affect migraines?
COCs can:
⛔ Trigger or worsen migraines — especially during the pill-free interval when oestrogen levels drop.
⚠️ Increase the risk of stroke in people who have migraine with aura (especially if over 35 or a smoker).
out of ropinorole and levodopa cause more impulse control disorders
Impulse control disorders (compulsive gambling, hypersexuality, binge eating, or obsessive shopping) can develop in a person with Parkinson’s disease who is on any dopaminergic therapy at any stage in the disease. Levodopa is also associated with impulse control disorders, however the answer reference given states: ‘Conversely, excessive sleepiness, hallucinations, and impulse control disorders are more likely to occur with dopamine-receptor agonists than with levodopa.’ Thus ropinirole is the best answer.
What schedule is midazolam?
🔐 Schedule 3 (CD No Reg Required) — Safe custody applies
Midazolam ✅
Temazepam ✅
Both require CD prescription requirements & safe custody.
📦 Schedule 4 Part I (CD Anab) — Minimal control
Diazepam
Lorazepam
Clonazepam
Nitrazepam
Oxazepam
No safe custody, no register entry, and CD Rx writing requirements do not apply (but still POMs).
What causes oral herpes?
Oral herpes is known as herpes labialis.
Which antihistamines are contraindicated with glaucoma?
First-generation (sedating) antihistamines are generally contraindicated or used with caution in patients with narrow-angle (angle-closure) glaucoma because they have anticholinergic effects that can increase intraocular pressure (IOP).
🚫 Examples (first-generation antihistamines):
Chlorphenamine
Promethazine
Diphenhydramine
Hydroxyzine
Cyclizine
What is the treatment for addisons disease? (NICE)
💊 1. Glucocorticoid Replacement
✅ Hydrocortisone
Adults: 15–25 mg daily in divided doses.
Example: 10 mg on waking, 5 mg at noon, 5 mg early evening.
Alternatively: 15 mg AM, 10 mg PM (less preferred).
Children: 8–10 mg/m²/day (3–4 divided doses).
Dosing should match circadian rhythm (or wake/sleep cycle in shift workers).
Alternative: Prednisolone (if specialist prescribes it).
🧂 Mineralocorticoid Replacement
✅ Drug: Fludrocortisone
Adults: 50–200 micrograms daily.
Children: Higher requirement + may need salt supplements.
May need dose increase in hot climates due to salt loss via sweat.
⚙️ Androgen Replacement (Specialist only)
✅ Optional: DHEA (unlicensed)
Prescribed only if persistent fatigue or symptoms despite optimal therapy.
Managed by endocrinology.
Which medication class stimulates insulin secretion by pancreatic beta cells
Sulphonylureas
Which GLP-1 receptor agonists are licensed for weight loss?
Liraglutide (brand name Saxenda)
Semaglutide (brand name Wegovy)
Also Tirzapetide but is GIP aswell as GLP-1
What are the recommended antibiotics for Hospital Acquired Pneumonia, both non severe and severe
💊 First-Line Oral Antibiotic (Non-Severe, Low Resistance Risk):
Co-amoxiclav
📌 500/125 mg TDS for 5 days, then review.
💊 Oral Alternatives (Penicillin Allergy or Co-amoxiclav Unsuitable):
(Based on microbiological advice + resistance data)
Doxycycline
📌 200 mg stat, then 100 mg OD for 4 days
Cefalexin ⚠️ (Caution in penicillin allergy)
📌 500 mg BD–TDS (up to 1–1.5 g TDS–QDS)
Co-trimoxazole ⚠️ (Off-label)
📌 960 mg BD
Levofloxacin ⚠️ (Off-label, only if IV switch)
📌 500 mg OD or BD
🔔 MHRA 2024 Warning:
Fluoroquinolones (e.g. levofloxacin) carry risks of long-term disabling side effects → use only if other options inappropriate.
💉 First-Line IV Antibiotics (Severe or High Resistance Risk):
Piperacillin with tazobactam
📌 4.5 g TDS–QDS
Ceftazidime
📌 2 g TDS
Ceftriaxone
📌 2 g OD
Cefuroxime
📌 750 mg TDS–QDS, up to 1.5 g QDS
Meropenem
📌 0.5–1 g TDS
Ceftazidime + Avibactam
📌 2/0.5 g TDS
Levofloxacin ⚠️ (Only if others unsuitable)
📌 500 mg OD or BD (higher dose if severe)
How long is a trimester during pregnancy ?
12-14 weeks
Which antibiotic is preferred for C diff reoccurrence (within 12 weeks)
Fidaxomicin PO
Rationale:
Recurrent CDI (within 12 weeks of a previous episode)
According to NICE and local guidelines, fidaxomicin is preferred over vancomycin for recurrent CDI as it has a lower recurrence rate due to its narrower spectrum and preservation of gut microbiota.
Which antibiotics are contraindicated in myasthenia gravis
❌ Antibiotics Contraindicated or Caution in Myasthenia Gravis (Risk of Neuromuscular Blockade)
Avoid or use with caution due to potential worsening of muscle weakness or respiratory failure:
- Aminoglycosides
Examples: Gentamicin, Amikacin, Tobramycin
Notes: High risk — may cause severe neuromuscular blockade; avoid unless essential.
- Fluoroquinolones
Examples: Ciprofloxacin, Levofloxacin, Moxifloxacin
Notes: MHRA warning – can exacerbate myasthenia gravis; avoid if possible.
- Macrolides
Examples: Erythromycin, Clarithromycin, Azithromycin
Notes: Can worsen symptoms — use with caution.
- Tetracyclines
Examples: Doxycycline, Tetracycline
Notes: May impair neuromuscular transmission — use with caution.
- Polymyxins
Examples: Colistin, Polymyxin B
Notes: High risk of neuromuscular blockade.
- Penicillamine (not an antibiotic but relevant)
Notes: Known to induce or worsen myasthenia gravis — avoid.
What is key to remember about amphotericin B
Anaphylaxis can occur with any intravenous amphotericin B product and a test dose is advisable before the first infusion in a new course; the patient should be carefully observed for at least 30 minutes after the test dose.
which antifungals are contraindicated in heart failure due to a risk of worsening symptoms
Itraconazole has negative inotropic effects, which means it reduces the strength of heart muscle contractions.
This can exacerbate congestive heart failure (CHF), particularly at higher doses (e.g. 200 mg twice daily).
MHRA warning: Avoid itraconazole in patients with ventricular dysfunction or history of heart failure, unless the benefit outweighs the risk.
What would the blood tests show for hyperthyroidism and hypothyroidism
Hyperthyroidism
TSH: Low
Free T4: High
Free T3: High
Hypothyroidism
TSH: High (Primary) or Low (Secondary)
Free T4: Low
Free T3: Low or Normal
What are the typical symptoms of cystitis?
🔥😣 Pain, burning, or stinging when peeing
🚽⏰ Needing to pee more often and urgently than usual
🌫️💧 Pee that’s dark, cloudy, or strong-smelling
🤕⬇️ Pain low down in the tummy (lower abdominal pain)
What is the treatment for day time sleepiness in Parkinsons Disease?
💊 Adjust Parkinson’s medication under specialist guidance
🚫 Rule out reversible causes (e.g., other drugs, physical conditions)
🌞😴 If persistent, consider MODAFANIL for excessive daytime sleepiness
🔄 Review modafinil treatment at least every 12 months
🚗 Patients should not drive, must inform the DVLA, and consider occupational risks
Where is pain associated with the following conditions?
Appendicitis
Diverticulitis
Gastric ulcer
Irritable bowel syndrome
Renal colic
🩻 Appendicitis – Central abdominal pain that moves to the right lower quadrant (RLQ)
📉 Diverticulitis & IBS – Pain typically in the left lower quadrant (LLQ)
💥 Renal colic – Severe pain in the loin/flank, may radiate to groin
🔥 Peptic ulcer – Epigastric pain, may worsen on an empty stomach and improve with food
When should HRT be stopped?
✅ A: Stop HRT if any of the following occur:
🔴 Cardiovascular / Respiratory
Sudden severe chest pain (even if not radiating)
Sudden breathlessness or coughing blood
Unexplained calf pain/swelling (DVT risk)
🟡 Gastrointestinal
Severe abdominal pain
🧠 Neurological
Unusual, severe or worsening headache
Sudden vision/hearing disturbances
Dysphasia, fainting, collapse
First seizure or stroke-like symptoms (e.g., one-sided weakness)
🧪 Liver
Signs of hepatitis, jaundice, or liver enlargement
🩺 Blood Pressure
Sustained BP >160/95 mmHg
🦵 Post-surgical or trauma
Prolonged immobility after surgery or leg injury
🚫 New contraindications
Discovery of a risk factor that contraindicates HRT
