Medicines 39 Flashcards
What should be followed for the spillage and disposal of cytotoxic drugs and related waste materials, according to the BNF?
📌 BNF Guidance:
“Use local procedures for dealing with spillages and safe disposal of waste material, including:
syringes
containers
absorbent material.”
📚 Source: BNF – Cytotoxic drugs
✅ Key Point:
Spillages of cytotoxic drugs must be handled according to your organisation’s local policies — not a national standard.
WHat schedule is pethidine ?
Pethidine is a Schedule 2 CD.
What oral side effect is commonly associated with chlorhexidine mouthwash, and how does it differ from tetracycline-induced staining?
Chlorhexidine:
Frequently causes brown staining of teeth.
Staining can be readily removed by polishing.
Tetracyclines:
Can cause permanent staining and dental hypoplasia in children under 12.
Staining occurs due to deposition in growing teeth and bones.
Unlikely to stain adult teeth.
How long should patients avoid donating blood during and after isotretinoin treatment?
Patients must not donate blood during isotretinoin therapy and for 4 weeks (1 month) after stopping.
This is to prevent risk to a pregnant transfusion recipient, as isotretinoin is teratogenic (can harm a foetus).
What is the first-line treatment for long-term control of gout, and which patients may prefer it?
Allopurinol is indicated in the prophylaxis of gout and is a first-line choice. For long-term control of gout, the formation of uric acid from purines may be reduced with the xanthine-oxidase inhibitors, allopurinol or febuxostat. Either option may be offered as first-line treatment, taking into account the patient’s preference and co-morbidities. However, NICE recommends alloprurinol in patients who have major cardiovascular disease.
Can you continue breastfeeding if you or your baby have thrush? How is it treated?
Yes, you can continue breastfeeding while being treated for thrush.
👶 For the baby:
Treated with an antifungal gel or liquid (safe for infants)
Wash hands carefully after treatment
🤱 For the mother:
Use antifungal cream on and around nipples after feeds
Wash hands thoroughly after application
Oral antifungal tablets may be needed in some cases
📅 Recovery:
Symptoms usually improve in 2–3 days
Full recovery may take longer
How long do conventional DMARDs take to start working?
Answer: Conventional DMARDs (e.g. methotrexate, sulfasalazine) have a slow onset of action — they typically take 2 to 3 months to show clinical benefit.
What is the first-line treatment for constipation in breastfeeding women?
✅ Answer: A bulk-forming laxative is the first-line treatment for constipation in breastfeeding women.
It is safe to use during breastfeeding and is available OTC (over the counter).
❓ What insulin strengths are considered high strength?
✅ Answer: Insulin preparations greater than 100 units/mL are classified as high-strength insulins.
❓ What are the common risk factors for developing gout?
✅ Answer:
🍖 High intake of meat and seafood
🍷 Alcohol consumption (≥10g/day)
💊 Diuretics use
⚖️ Obesity
💓 Hypertension, coronary heart disease, heart failure
🍬 Diabetes mellitus
🩺 Chronic kidney disease
📈 High triglycerides
🚹 Male gender
WHat is a key side effect to rememeber with baclofen?
baclofen can cause hallucinations, particularly in high doses or with abrupt withdrawal.
What is the treatment guidelines for acute migraine?
💊 First-Line Options (Monotherapy):
NSAIDs: Aspirin, Ibuprofen
Triptans (5HT1 agonists): e.g. Sumatriptan
Paracetamol: if other options unsuitable
📍Important Notes:
Take as early as possible in the headache phase.
Don’t take triptans during aura (unless aura + headache start together).
Subcutaneous sumatriptan or nasal zolmitriptan for early vomiting or severe attacks.
🌀 Antiemetics (optional add-on):
Metoclopramide or Prochlorperazine (can also relieve headache)
Domperidone as an alternative
(Metoclopramide: avoid regular use due to extrapyramidal risk)
💥 Combo Therapy:
Sumatriptan + Naproxen for inadequate monotherapy response.
🧬 If triptans fail (≥2):
Try Rimegepant.
What is the recommended treatment guidelines for migraine prophylaxis?
💊 First-Line:
Propranolol hydrochloride (Other beta-blockers: Metoprolol, Bisoprolol [unlicensed], etc.)
💊 Alternatives:
Topiramate (not for pregnancy unless PPP is met)
Amitriptyline (or other TCA if not tolerated)
Candesartan [unlicensed]
Sodium Valproate (age & gender restrictions – PPP rules apply)
Flunarizine, Pizotifen [limited evidence; specialist]
⏱️ Trial Duration:
At least 3 months at max tolerated dose.
Review at 6–12 months, consider tapering if effective.
💉 Advanced/Specialist:
CGRP Inhibitors (oral): Atogepant, Rimegepant (≥3 treatments failed)
CGRP Inhibitors (parenteral): Episodic or chronic migraine
Botulinum toxin A: For chronic migraine after 3 failed prophylactics & medication-overuse addressed.
What is the treatment for menstrual migraines?
📅 Timing:
Start 2 days before menstruation until 3 days after.
💊 Short-Term Prophylaxis:
Frovatriptan [unlicensed] – preferred
Alternatives: Zolmitriptan or Naratriptan [unlicensed]
⚠️ Key Advice:
Must have regular menstrual cycles.
Warn of medication-overuse headache risk if using triptans throughout the cycle.
What are the signs and symptoms of threadworm (Enterobius vermicularis) infection, particularly in children?
Visible worms: Small, white, thread-like worms in stool or around the anus (especially at night).
Itching: Intense itching around the anus or vagina, especially at night.
Sleep disturbances: Irritability and waking during the night.
Less common symptoms:
Weight loss
Bedwetting
Skin irritation around the anus
📌 Note: Worms usually emerge at night, making symptoms worse during sleep.
Do all statins interact with grapefruit juice according to the BNF?
Atorvastatin: Grapefruit juice increases exposure – caution advised.
Simvastatin: Grapefruit juice increases exposure – avoid.
Rosuvastatin: No interaction listed in the BNF.
pravastatin does not interact with grapefruit juice
✅ Not all statins have a significant interaction with grapefruit juice.
In a woman presenting with a unilateral headache and associated sickness, what condition is highly suggested and why?
Migraine is highly suggested because unilateral headache with associated nausea or vomiting is characteristic of migraine, particularly in women.
What causes glandular fever?
Infectious mononucleosis (glandular fever) is an infection most commonly caused by Epstein-Barr virus (EBV) (80–90% of cases).
What antibiotic causes a rash in glandular fever
The patient’s symptoms suggest she may have glandular fever and the GP should investigate this further. Patients with glandular fever may experience a rash when given amoxicillin.
YOU’VE EXPERIENCED IT
What is Agoraphobia
Agoraphobia is where a person becomes afraid of places or situations from which escape might be difficult.
What drug is licensed for the use in treating cellulitis but is not in the NICE guidelines?
clindamycin
What colour can co-danthramer change urine to?
Co-danthramer may colour urine pink
WHat is the treatment for a fungal infection on the scalp (NICE)?
“Systemic therapy is necessary for scalp infection”
1st line: oral griseofulvin (licensed) or oral terbinafine (off-label)
What is a fungal scalp infection known as?
tinea capitis
What is the treatment for Pityriasis versicolor?
Pityriasis versicolor, sometimes called tinea versicolor, is a common condition that causes small patches of skin to become scaly and discoloured (hypo/hyperpigmented). They usually occur on the trunk and back and upper arms. Pityriasis versicolor is caused by a type of yeast called Malassezia and is treated by ketoconazole shampoo.
