Medicines 7

Question 1

Which steroids have equal minerlcorticoid and glucocorticoid activity

Answer 1

hydrocortisone

Question 2

In men what is the treatment for osteoporosis?

Answer 2

only alendronate (once-daily tablets) and risedronate (once-weekly tablets) are licensed for use in men. Both are first line options

Question 3

What type of type 2 diabetic medication is kinder to the kidneys?

Answer 3

SGLT2 inhibitors - reduce the risk of kidney disease progression

GLP-1 receptor agonists, reduce the risk of kidney disease progression.

DPP4 inhibitors
Usually well tolerated
Linagliptin is safest with renal impairment - none of the other gliptins are (require dose reductions)

Question 4

What are the symptoms of cushings syndrome

Answer 4

Cushing’s syndrome is a rare condition that occurs when the body produces too much cortisol

Weight gain
Weight gain, especially in the face and trunk, and a build-up of fat on the shoulders and back of the neck, known as a “buffalo hump”

Round face
A red, puffy, rounded face, also known as “moon face”

Thin skin
Thin skin that bruises easily and heals slowly, with purple or pink stretch marks

Other symptoms
Increased thirst, increased urination, high blood pressure, mood changes, anxiety, irritability, depression, and irregular menstrual periods

Question 5

What is addisons disease and list some symptoms

Answer 5

Addison’s disease, also known as primary adrenal insufficiency, is a rare disorder that occurs when the adrenal glands are damaged and can’t produce enough of the hormones cortisol and aldosterone

Fatigue
Muscle weakness
Low mood
Loss of appetite and unintentional weight loss
Increased thirst
Dizziness
Fainting
Cramps
Exhaustion
Darkened skin, lips, or gums

Question 6

Aside from bone marrow supression what other key risks are there to note with carbimazole (over active thyroid)?

Answer 6

teratogenic, Pancreatitis

MHRA/CHM advice: Carbimazole: increased risk of congenital malformations; strengthened advice on contraception (February 2019)
Carbimazole is associated with an increased risk of congenital malformations when used during pregnancy, especially in the first trimester and at high doses (daily dose of 15 mg or more).

Women of childbearing potential should use effective contraception during treatment with carbimazole. It should only be considered in pregnancy after a thorough benefit-risk assessment, and at the lowest effective dose without additional administration of thyroid hormones—close maternal, fetal, and neonatal monitoring is recommended.

MHRA/CHM advice: Carbimazole: risk of acute pancreatitis (February 2019)
Cases of acute pancreatitis have been reported during treatment with carbimazole. It should be stopped immediately and permanently if acute pancreatitis occurs.

Carbimazole should not be used in patients with a history of acute pancreatitis associated with previous treatment—re-exposure may result in life-threatening acute pancreatitis with a decreased time to onset.

Question 7

What does HbA1C stand for?

Answer 7

Glycosylated hemoglobin

Question 8

What are the diabetes guidelines for HBA1C targets?

Answer 8

Question 9

What needs to be screened for with regards to complications in adults with type 2 diabetes and what is less important?

Answer 9

Question 10

what are the mineralcorticoid side effects

Answer 10

hypertension
sodium retention
water retention
potassium loss
calcium loss
Mineralocorticoid side effects are most marked with fludrocortisone, but are significant with hydrocortisone, corticotropin, and tetracosactide

Question 11

Which vitamin deficiency is longterm metformin treatment known to cause ?

Answer 11

Reduced intestinal absorbance of vitamin B12

Question 12

dexamethasone related hyperglycaemia and why is this prevalent with covid-19

Answer 12

Dexamethasone-related hyperglycemia is a common side effect of this corticosteroid due to its impact on glucose metabolism

SARS-CoV-2 can damage pancreatic beta cells, impairing insulin secretion

Question 13

What time should isosorbide mononitrate be taken at

Answer 13

Take at 8am and 2pm to allow a nitrate free period

Question 14

What are the symptoms of liver dysfunction

Answer 14

Jaundice, yellowing of skin, yellowing of eyes, dark stools, liver pain

Question 15

What drugs are included in Schedule 4 class 1 controlled drugs

Answer 15

Schedule 4 includes in Part I drugs that are subject to minimal control, such as benzodiazepines (except temazepam and midazolam, which are in Schedule 3), non-benzodiazepine hypnotics (zaleplon, zolpidem tartrate, and zopiclone) and Sativex®
Records in registers do not need to be kept (except in the case of Sativex®).

Question 16

Which schedule 4 controlled drugs are in class 2

Answer 16

Part II includes androgenic and anabolic steroids, clenbuterol, chorionic gonadotrophin (HCG), non-human chorionic gonadotrophin, somatotropin, somatrem, and somatropin. Controlled drug prescription requirements do not apply and Schedule 4 Controlled Drugs are not subject to safe custody requirements.

Question 17

What are the different indications of pregablin?

Answer 17

• Peripheral and central neuropathic pain
• Adjunctive therapy for focal seizures with or without secondary generalisation
• Generalised anxiety disorder

Question 18

What is the first line SSRI in children (Child 5–17 years)

Answer 18

the SSRI fluoxetine is the first-line treatment in children.

The use of fluoxetine in children aged 5 to 11 years should be cautiously considered as effectiveness in this age group is not established.

In children who present with severe depression and recurrent depressive episodes who do not respond to or cannot tolerate fluoxetine, citalopram [unlicensed indication] or sertraline [unlicensed indication] can be used as an alternative under specialist supervision.

Paroxetine, venlafaxine and tricyclic antidepressants should not be used for the treatment of depression in children and young people.

Question 19

What is used to treat neuropathic pain?

Answer 19

Neuropathic pain is generally managed with a tricyclic antidepressant or with certain antiepileptic drugs. Amitriptyline hydrochloride and pregabalin are effective treatments for neuropathic pain.

Amitriptyline is licensed for use of neuropathic pain in children over 2 years.

Nortriptyline [unlicensed indication] may be better tolerated than amitriptyline hydrochloride.

Gabapentin is also effective for the treatment of neuropathic pain.

Capsaicin is licensed for neuropathic pain (but the intense burning sensation during initial treatment may limit use)

Question 20

Name some tricyclic antidepressants

Answer 20

Tricyclic antidepressants: Amitriptyline, Clomipramine, imipramine, doxepin

Question 21

What are the main uses for amitriptyline

Answer 21

Main uses

Moderate to severe depression
Unlicensed use for neuropathic pain and migraine prophylaxis

Question 22

What side effects are experienced with amitriptyline?

Answer 22

Side effects

Block antimuscarinic receptors:

Dry mouth
Constipation
Urinary retention
Blurred vision
Drowsiness
Block H1 and α1 receptors:

Sedation
Hypotension
Cardiac effects:

Arrhythmias
ECG changes = prolongation of QT and QRS intervals
Brain:

Convulsions
Hallucinations
Mania
Blockade of dopamine receptors:

Breast changes
Sexual dysfunction
Extrapyramidal symptoms: tremor, dyskinesia

Question 23

What key counselling points are there with amitriptyline ?

Answer 23

Depression – start with 50mg and increase in increments of 25 when required
Neuropathic pain – start with 10mg at night
Side effect
Symptoms will improve over a few weeks
May need psychological therapy – long-term benefits
Carry on treatment for at least 6 months after you feel better to stop depression from returning
Do not stop suddenly – causes flu-like withdrawal symptoms and sleepiness
Reduce dose slowly over 4 weeks to stop

Question 24

Which tricyclic antidepressant is infrequently associated with hepatic toxicity?

Answer 24

Lofepramine has a lower incidence of side-effects and is less dangerous in overdosage but is infrequently associated with hepatic toxicity.

Question 25

What are the general groups of tricyclic antidepressants?

Answer 25

Tricyclic and related antidepressant drugs can be roughly divided into those with additional sedative properties and those that are less sedating. Agitated and anxious patients tend to respond best to the sedative compounds, whereas withdrawn and apathetic patients will often obtain most benefit from the less sedating ones. Those with sedative properties include amitriptyline hydrochloride, clomipramine hydrochloride, dosulepin hydrochloride, doxepin, mianserin hydrochloride, trazodone hydrochloride, and trimipramine. Those with less sedative properties include imipramine hydrochloride, lofepramine, and nortriptyline.