Medicines 43 Flashcards
What is haemorrhagic cystitis and how can it be prevented with cytotoxic medication?
Haemorrhagic cystitis is a condition where the bladder lining becomes inflamed and bleeds, leading to blood in the urine (haematuria)
Haemorrhagic cystitis = Urothelial toxicity
Caused by acrolein, a toxic metabolite of:
💊 Cyclophosphamide
💊 Ifosfamide
Prevented by mesna, which binds acrolein in the urinary tract
🔠 Mnemonic 1: “CYA, IF you don’t take MESNA!”
CYA = Cyclophosphamide
IF = Ifosfamide
MESNA = Saves your bladder from Acrolein
🧠 Translation: If you’re on Cyclophosphamide or Ifosfamide and you don’t take Mesna, you’ll be saying CYA to your bladder!
Which Beta Blockers are only ONCE daily dosing?
The BANCers
bisoprolol fumarate, atenolol, nadolol, celiprolol hydrochloride
Which Beta Blockers are licensed for Heart Failure?
“CaNeBis 🍁 helps HF”
Carvedilol, Nebivolol, Bisoprolol
Bisoprolol fumarate and carvedilol: Reduce mortality in any grade of stable heart failure.
Nebivolol: Licensed for stable mild to moderate heart failure in patients over 70 years
What is the role of propranolol in the pre-operative preparation for thyroidectomy in thyrotoxicosis?
Reverses clinical symptoms of thyrotoxicosis (e.g. palpitations, tremor) within 4 days
Does not alter thyroid hormone levels (routine tests remain elevated)
Reduces vascularity of the thyroid gland, making surgery easier
Used as part of pre-operative preparation
What are the key treatment steps for asthma in adults according to NICE (2017) and BTS/SIGN (2019)?
(Include inhaler types, stepwise approach, and key differences)
🧍 Adults =
NICE: ≥17 yrs | BTS/SIGN: >12 yrs
💨 Step 1 – Reliever
SABA (e.g. salbutamol) PRN
1 inhaler/month? 🚩 Poor control
🛡️ Step 2 – Preventer
Low-dose ICS
Start if: 3+ SABA/week, night symptoms, or recent attack
BTS/SIGN: Take ICS twice daily, brand-specific preferred
➕ Step 3 – Initial Add-on
NICE: Add LTRA (e.g. montelukast), review in 4–8 weeks
BTS/SIGN: Add LABA (e.g. salmeterol), use combo inhaler or MART (ICS + fast-acting LABA like formoterol)
⚙️ Step 4 – Additional Controllers
ICS + LABA (± LTRA)
Consider MART if still uncontrolled
Increase ICS to moderate dose if needed
🚨 Step 5 – Uncontrolled on Moderate ICS + LABA
Options:
↑ ICS to high-dose (fixed + SABA)
Add: LAMA (tiotropium), theophylline, or refer to 🩺 asthma specialist
📌 Extra Tips:
MART = Maintenance And Reliever Therapy
Always review control & step up/down as needed
Use a spacer with high-dose ICS via pMDI
What is the NEW UPDATED NICE 2024 asthma guidance?
Offer a low-dose ICS/formoterol combination inhaler to be used as needed for symptom relief.
This is known as AIR therapy (Anti-Inflammatory Reliever).
In November 2024, only certain budesonide/formoterol dry powder inhalers were licensed for this purpose.
Using other ICS/formoterol inhalers for this indication is considered off-label.
Prescribers should consult NICE or SIGN guidance on off-label prescribing and product SPCs (summary of product characteristics).
🚨 If Patient Is Highly Symptomatic or Has Severe Exacerbation
Initiate:
Low-dose MART (Maintenance and Reliever Therapy) with an ICS/formoterol inhaler regularly, not just as needed.
Treat acute symptoms immediately (e.g., with a short course of oral corticosteroids, if needed).
Once symptoms are under control, consider stepping down to as-needed AIR therapy if appropriate.
What MHRA alert is there for Ciclosporin?
MHRA/CHM advice: ciclosporin must be prescribed and dispensed by brand name (December 2009)
With systemic use:
Patients should be stabilised on a particular brand of oral ciclosporin because switching between formulations without close monitoring may lead to clinically important changes in blood-ciclosporin concentration.
What are the pneumonics to remember the following for Cyclosporin:
Indications
Side effects
Monitoring
Drug Interactions
MOA
📌 1. Indications: “RA-PAD-K”
Mnemonic: “RAPID Attack Kills Immunity”
R – Rheumatoid Arthritis
A – Atopic Dermatitis
P – Psoriasis (severe)
I – Immunosuppression (post-transplant)
D – Dry eye (ophthalmic use)
K – Kidney (Nephrotic Syndrome)
📌 2. Side Effects: “5 H’s & N”
Mnemonic: “Hairy, Hyper, Huge Gums, Hectic Kidneys & Nerves”
H – Hirsutism (excess hair growth)
H – Hyperlipidemia
H – Hypertension
H – Hyperglycemia
H – Hyperuricemia
N – Nephrotoxicity + Neurotoxicity (tremor, headache)
📌 3. Monitoring: “LIFT Me Up”
Mnemonic: “LIFT Me Up” (to avoid side effects)
L – LFTs (Liver function tests)
I – Infections (watch for signs due to immunosuppression)
F – FBC (for leukopenia, anemia)
T – Trough levels (narrow therapeutic range)
M – Magnesium (may decrease)
U – Urea & Creatinine (renal monitoring)
📌 4. Drug Interactions: “MAC + Grapefruit”
Mnemonic: “MAC Grapes Spoil Cyclosporin”
M – Macrolides (e.g. erythromycin → ↑ levels)
A – Azole antifungals (e.g. ketoconazole → ↑ levels)
C – Calcium channel blockers (e.g. verapamil → ↑ toxicity)
Grapefruit juice – inhibits CYP3A4 → ↑ ciclosporin levels
📌 5. Mechanism: “T Blocker”
Mnemonic: “CycLoSTOPs T-cells”
Cyclosporin inhibits calcineurin, which → blocks IL-2 production → suppresses T-lymphocyte activation
➡️ Key role: prevents immune response
What is Cyclosporin used for ?
Cyclosporin (also spelled cyclosporine) is an immunosuppressant medication used primarily to suppress the immune system. Here are its main uses:
🔹 Transplant Medicine
Preventing organ rejection in patients who have received:
Kidney transplants
Liver transplants
Heart transplants
It reduces the activity of T-lymphocytes to prevent the immune system from attacking the transplanted organ.
🔹 Autoimmune Conditions
Used when the immune system attacks the body’s own tissues. Common indications include:
🟢 Rheumatoid arthritis
For severe active cases that don’t respond to other treatments like methotrexate.
🟢 Psoriasis
Especially in severe, recalcitrant plaque psoriasis not controlled with topical treatments or phototherapy.
🟢 Atopic dermatitis
Short-term treatment of severe cases unresponsive to topical therapies.
🟢 Nephrotic syndrome
For steroid-dependent or frequently relapsing forms.
🔹 Ophthalmic Use
Ciclosporin eye drops (e.g., Ikervis®) are used for:
Severe dry eye disease
Keratoconjunctivitis sicca
By reducing inflammation in the lacrimal (tear) glands.
What Drugs are in the calcineurin inhibitor class
Cyclosporin, Tacrolimus, Pimecrolimus
Aside from Asthma what can Terbutaline be used to treat?
➡️ Uncomplicated premature labour
➡️ Between 22–37 weeks gestation
➡️ Given under specialist supervision in hospital
🎯 Purpose:
Relaxes uterine muscle 🧘♀️
Delays labour ⏳ by 24–48 hrs
Allows time for:
Corticosteroids to mature fetal lungs 💨🫁
Transfer to neonatal unit 🏥👶
🧠 Mnemonic:
“Terbutaline Temporarily Turns off Tightening” 🔄🤰
What is the treatment for Menopausal atrophic vaginitis?
Menopausal atrophic vaginitis may respond to a short course of a topical vaginal oestrogen preparation used for a few weeks and repeated if necessary.
What is the treatment for Trichomoniasis ? NICE
For men and women (not pregnant or breastfeeding):
Prescribe oral metronidazole 400–500 mg twice a day for 7 days.
Alternatively, prescribe metronidazole 2 g as a single oral dose.
What are the main differences between the COC and progesterone only Contraceptives
🌟 Combined Hormonal Contraceptives (CHC)
📋 Forms:
Tablets (COC)
Transdermal patches (CTP)
Vaginal rings (CVR)
🎯 Key Points:
Highly user-dependent → perfect use = <1% failure
Do not use after 50 years
Benefits:
↓ Ovarian, endometrial, colorectal cancer
Regular bleeding, less period pain
Helps PCOS, acne, PMS, bone density
Risks exist → check FSRH guideline
💊 COC Types:
Monophasic (same hormone dose) – first line
Multiphasic (varying hormone levels)
💡 Mnemonic for Benefits:
“CYCLE-PAM”
Cancer ↓ (ovarian, endometrial, colorectal)
Youthful skin (acne improvement)
Cycle control (regular periods)
Less bleeding/pain (menorrhagia, dysmenorrhoea)
Endometriosis relief
PCOS symptom management
Acne
Menopause symptom ↓
🧠 Regimens:
Traditional: 21 days + 7-day break
Tailored (unlicensed):
Shortened break: 21 + 4
Tricycling: 9 weeks + break
Continuous: No break
🔔 Note: Withdrawal bleeding ≠ true menstruation or pregnancy indicator
🩺 Monitoring & Surgery:
Annual review: check BP, BMI, interactions
Stop CHC 4 weeks pre-surgery
Resume 2 weeks post-mobility
If can’t stop → consider thromboprophylaxis
🌼 Progestogen-Only Contraceptives (POC)
📋 Forms:
Oral tablets (levonorgestrel, desogestrel, drospirenone)
Injections (medroxyprogesterone, norethisterone enantate)
Implant (etonogestrel)
Intrauterine device (IUD with levonorgestrel)
🎯 Key Points:
Work via:
Cervical mucus thickening
Endometrial changes
Tubal motility
Ovulation suppression (some types)
💡 Mnemonic for Mechanism:
“MOCE”
Mucus thickening
Ovulation blocked
Cycle implantation hindered
Endometrial alteration
💉 Injectables:
Depo (DMPA): every 13 weeks, may reduce bone density (review every 2 yrs)
Norethisterone enantate: short term (e.g. post-vasectomy)
📍 Implant:
3 years of protection
Failure rate ~0.05%
🔄 IUD:
Duration: 3–10 yrs
No ovulation suppression in most
Also used for dysmenorrhoea, endometriosis
How can i remember the 3 different categories in epilepsy?
🔴 Category 1 – Stick to the Same Brand (🛑 High Risk – Always SAME manufacturer)
CP3
Phenytoin
Carbamazepine
Phenobarbital
Primidone
💡 Visual Aid:
Imagine a RED prescription label stamped:
“STRICTLY SAME BRAND!”.
🟠 Category 2 – Use Clinical Judgment (⚠️ Medium Risk – Be Cautious)
remember the main 3 in this category are: VLT…Valproate, Lamotrigine, Topiramate
🟢 Category 3 – Brand Consistency Usually Not Needed (✅ Low Risk – Brand doesn’t matter much)
“Let’s Learn To Game Properly Every Vacation Break”
Levetiracetam
Lacosamide
Tiagabine
Gabapentin
Pregabalin
Ethosuximide
Vigabatrin
Brivaracetam
What is Topiramate ?
Topiramate is a medication that treats epilepsy and it can also prevent migraine headaches
It requires a Pregnancy Prevention Programme for women before starting
GLP-1 doses
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