Medicines 44 Flashcards
What is the first line treatment for Diverticlutis in hospital ?
Amoxicillin 1g (IV) TDS
PLUS
Metronidazole 500mg (IV) TDS or 400mg (PO) TDS
PLUS
Once Daily Gentamicin (Max. 5 days treatment, switch to alternative if on-going treatment necessary).
What is Lokelma - Sodium Zirconium Cyclosilicate
✅ Lokelma is a potassium binder used to treat hyperkalaemia (high potassium levels in the blood). ⚡🩸
🧪 How does it work?
Lokelma is a non-absorbed powder that works in the gut.
It exchanges sodium and hydrogen ions for potassium ions in the intestine ➔ traps potassium ➔ removes it naturally through the stool 🚽.
What is menopause
Menopause is the time when menstruation ceases permanently due to the loss of ovarian follicular activity. It occurs with the final menstrual period and is usually diagnosed clinically after 12 months of amenorrhoea
What is Perimenopause?
Perimenopause, also called the ‘menopausal transition’ or ‘climacteric’, is the period before the menopause when the endocrinological, biological, and clinical features of approaching menopause start. It is characterized by irregular cycles of ovulation and menstruation and ends 12 months after the last menstrual period
When is Sequential HRT used and when is Continuous combined used and what do they mean.
For perimenopausal women, sequential combined regimens are required where a monthly bleed continues. Whereas postmenopausal women, can use continuous combined regimens, associated with no monthly bleed.
🔄 Sequential (Cyclic) HRT
✅ What is it?
Oestrogen is given continuously every day 🌸
Progestogen is added for part of the cycle — usually 10–14 days per month 📅
🔁 Continuous Combined HRT
✅ What is it?
Oestrogen and progestogen are given together every day — no break 🚀
How often must someone with the Merena coil for HRT and contraception have it changed
EVERY 5 YEARS
What is Oestrogel?
✅ Oestrogel® = a transdermal gel containing estradiol (oestrogen) 🌸
✅ Applied to the skin ➔ absorbed into bloodstream — bypasses liver 🏃♀️.
📋 How to apply:
Apply to clean, dry, intact skin ➡️ arms, shoulders, or inner thighs 🦵💪
Allow gel to dry completely before dressing 👗.
❌ DO NOT apply on or near:
Breasts 🚫
Vulval area 🚫
Avoid contact with other people’s skin (especially men) right after application 🤝🚫.
No mixing with creams, lotions, or skin products 🧴🚫.
Do not wash the area for at least 1 hour after applying 🚿⏳.
What is both the initial management and long term management for Ischaemic stroke?
⚡ INITIAL MANAGEMENT
Thrombolysis:
➔ Give Alteplase or Tenecteplase within 4.5 hours if no intracranial haemorrhage (confirmed by imaging).
➔ Must be administered by experienced staff in a specialist stroke centre.
After Thrombolysis:
➔ Start antiplatelet (e.g., aspirin) after 24 hours (if no bleeding).
No Thrombolysis but disabling stroke:
➔ Start aspirin ASAP within 24 hours ➔ Continue for 2 weeks, then switch to long-term antithrombotic.
Other Important Points:
➔ Use a PPI if GI bleed risk.
➔ If aspirin allergy ➔ Use clopidogrel.
➔ No routine anticoagulants unless DVT/PE present or mechanical heart valve (special cases only).
➔ Warfarin not given in acute phase.
➔ Treat hypertension only if hypertensive emergency.
🛡️ LONG-TERM MANAGEMENT
Antiplatelet:
➔ Clopidogrel monotherapy preferred.
➔ If clopidogrel not suitable ➔ use aspirin.
Anticoagulation:
➔ Only if atrial fibrillation or other embolic risks.
➔ Timing based on stroke severity.
Statins:
➔ Start high-intensity statin (e.g., atorvastatin) ASAP, even if cholesterol normal.
Blood Pressure Management:
➔ Avoid beta-blockers unless another clear indication.
Lifestyle Modifications:
➔ Healthy diet, exercise, smoking cessation, alcohol moderation.
What is the Treatment for Acute Coronary Syndrome - both NSTEMI and STEMI
⚡ INITIAL MANAGEMENT
Pain Relief:
➔ GTN (sublingual/buccal) 💊 early.
➔ IV opioids (e.g., morphine) 💉 if needed.
Antiplatelet:
➔ Aspirin loading dose ASAP 🚑.
➔ Document if given before hospital 📝.
Oxygen:
➔ Only if O2 sat low (<94%) 🌬️❗.
Blood Sugar:
➔ Monitor glucose 🩸.
➔ If >11 mmol/L ➔ start insulin infusion 💉.
❤️ STEMI MANAGEMENT
Goal: Restore blood flow fast! 🏃♂️🫀
Primary PCI preferred if:
➔ Within 12 hrs of symptoms ⏳.
➔ PCI within 120 mins 🕑 vs fibrinolysis.
Medications:
➔ Aspirin + second antiplatelet (prasugrel, ticagrelor, clopidogrel) 💊💥.
➔ Heparin if radial access 💉.
➔ Bivalirudin if femoral access (unlicensed) 🚨.
➔ Antithrombin agent during fibrinolysis 🛡️.
💔 NSTEMI / UNSTABLE ANGINA MANAGEMENT
Strategy: Risk-based ➔ Revascularisation 🏥 or conservative 🛌.
Medications:
➔ Aspirin + second antiplatelet combo 💊💊.
➔ Fondaparinux unless immediate angiography 🔬.
➔ Heparin if renal impairment 🩺 or for PCI 🛠️.
🛡️ SECONDARY PREVENTION AFTER ACS
Lifestyle Changes:
➔ Cardiac rehab 🏋️♀️, diet 🥗, exercise 🏃♂️, stop smoking 🚭, reduce alcohol 🍷.
Medications:
➔ ACE inhibitor 🌡️ (or ARB if intolerant).
➔ Beta-blocker ❤️ (continue long-term if reduced LVEF).
➔ Dual antiplatelet therapy (DAPT) for 12 months ⏲️.
➔ High-intensity statin 🛢️.
Special cases:
➔ If aspirin allergy ➔ use clopidogrel 🧪.
➔ Can use rivaroxaban + aspirin ± clopidogrel if biomarkers ↑ 🔥.
➔ Tailor antithrombotic therapy if ongoing anticoagulation ⚖️.
What is the full treatment for STEMI?
Goal: Restore blood flow ASAP to save heart muscle 🫀⏳
🚑 Initial Management
Pain relief ➔ Give glyceryl trinitrate (GTN) 💨 (sublingual or buccal).
Morphine if pain severe 💉.
Aspirin loading dose immediately 🥄.
Monitor oxygen saturations — only give oxygen if hypoxic (SpO2 < 94%) 🌬️.
Monitor blood glucose → If >11.0 mmol/L, start insulin infusion 💉.
🛠️ Reperfusion Therapy
Primary PCI (Percutaneous Coronary Intervention) preferred 🛠️:
✅ If within 12 hours of symptoms AND
✅ If can be performed within 120 minutes compared to fibrinolysis.
Fibrinolysis (thrombolysis) offered if PCI not available soon 🧪.
💊 Antiplatelet and Anticoagulant Treatment
Aspirin + second antiplatelet (one of):
➔ Prasugrel (preferred if PCI unless high bleeding risk)
➔ Ticagrelor
➔ Clopidogrel (if others unsuitable)
Heparin (unfractionated) if PCI via radial access ✋.
Bivalirudin [unlicensed] if PCI via femoral access 🦵.
Glycoprotein IIb/IIIa inhibitors if indicated during PCI 🧬.
If fibrinolysis, give antithrombin agent at same time ⚡.
🧠 Secondary Prevention (Post-STEMI)
Dual antiplatelet therapy (Aspirin + second agent) for up to 12 months.
ACE inhibitor started once haemodynamically stable 🏥.
Beta-blocker started and continued long-term (especially if low LVEF) ❤️🩹.
Statin (high-intensity like Atorvastatin) immediately 🧈.
Lifestyle changes: healthy diet, exercise, smoking/alcohol advice 🏃♂️🍎🚭.
What is the full Treatment for NSTEMI (NICE)
Goal: Prevent further cardiac events and progression 🚧.
🚑 Initial Management
Pain relief ➔ GTN + morphine if needed 💨💉.
Aspirin loading dose immediately 🥄.
Monitor oxygen saturations — only give oxygen if needed 🌬️.
Monitor blood glucose — Insulin if >11.0 mmol/L 💉.
🔎 Risk Stratification
Assess risk of future cardiac events to decide management:
High risk ➔ Early coronary angiography + PCI if needed 🏥.
Lower risk ➔ Conservative medical management 🛡️.
💊 Antiplatelet and Anticoagulant Treatment
Aspirin + second antiplatelet (one of):
➔ Ticagrelor (often preferred)
➔ Clopidogrel
➔ Prasugrel (if angiography + PCI planned)
Antithrombin therapy: ➔ Fondaparinux (unless immediate angiography planned) 💉. ➔ Unfractionated heparin in significant renal impairment.
If PCI needed ➔ Give heparin in the catheter lab.
🧠 Secondary Prevention (Post-NSTEMI)
Dual antiplatelet therapy (Aspirin + second agent) for up to 12 months.
ACE inhibitor started when stable 🏥.
Beta-blocker started and continued long-term (especially if low LVEF) ❤️🩹.
Statin (high-intensity like Atorvastatin) immediately 🧈.
Lifestyle changes: healthy diet, exercise, smoking/alcohol advice 🏃♂️🍏🚭.
What blood glucose levels and HBA1C should you suspect Diabetes? (NICE)
HbA1c of 48 mmol/mol (6.5%) or more.
Fasting plasma glucose level of 7.0 mmol/L or more.
Random plasma glucose of 11.1 mmol/L or more in the presence of symptoms or signs of diabetes.
What is Bumetanide?
A loop Diuretic
What colour do the following medications turn urine? (BNF)
triamterene
levodopa
rifampicin
Co danthrusate
Co danthramer
Nitrofurantoin
Entacapone
Phenindione
idebenone
Sulfasalazine
(Ferrous sulphate, ferrous
gluconate, ferrous
fumerate - brown)
Senna
Nefopam
metronidazole
triamterene (blue under some lights)
levodopa (dark reddish)
rifampicin (red).
Co danthrusate - (urine orange) This medicine may colour your urine. This is harmless
Co danthramer - (urine red) - This medicine may colour your urine. This is harmless
Nitrofurantoin - urine may be coloured yellow or brown
Entacapone - colour urine reddish-brown
Phenindione - may turn urine pink or orange
idebenone may cause red-brown discolouration of the urine
Sulfasalazine - yellow discolouration of body fluid
Ferrous sulphate, ferrous
gluconate, ferrous
fumerate - brown
Senna - Yellow or red-brown
Nefopam - Pink
metronidazole - Dark yellow – Brown (darkens urine)
What common antimicrobrials interact with fexofenadine?
fexofenadine with erythromycin or ketoconazole has been found to result in 2-3 times increase
in the plasma concentrations of fexofenadine, though this was not accompanied by any effects on the QT interval or
any increase in adverse events compared to monotherapy
How can you reduce GI upset with IRON
Take iron tablets on an empty stomach. If possible, take your iron tablets first thing in
the morning when your stomach is empty and don’t eat until an hour afterwards. If not
possible then take one hour before and two hours after food. However, iron tablets can
upset your stomach, causing either constipation or diarrhoea, indigestion or stomach pain.
If you experience these side effects, try taking your iron tablets with or after meals. You
can also try taking them every other day. If this doesn’t help, your doctor or pharmacist can
suggest a different iron preparation that you may find easier to take.
What is the difference between legality requirements with Temazepam and Midazolam
(BNF) Safe custody requirements dont apply to midazolam - it doesnt need to be kept in the CD cabinet!
How often should routine cervical screening be offered to women and at what age?
How often should routine breast screening be offered to women and at what age?
Cervical - Routine screening is offered every three years for those aged 25 to 49 and every five years for those aged 50 to 64
Breast - Breast screening is offered every three years to women aged 50 to 70, and it may be offered earlier to women at higher risk
How often is screening for bowel cancer done and at what age?
men and women aged 60-74 are sent a home testing kit every two years - NHS
