Medicines management

Question 1

What tool can be used for medication reviews?

Answer 1

the STOPP START tool

Question 2

What is important to think about in medications fo elderly people?

Answer 2

the anticholinergic burden

Question 3

What is 1st, 2nd and 3rd line analgesia for mild- moderate pain?

Answer 3

1st- paracetamol 1g QDS
2nd- ibuprofen 400mg TDS (titrate up to 2.4g daily)
3rd- paracetamol and ibuprofen

Question 4

What is 4th line analgesia for mild- moderate pain?

Answer 4

paracetamol + naproxen or diclofenac (IE stronger NSAID)

Question 5

What is 5th line for mild- moderate pain (IE not releived by paracetamol + stronger NSAID)

Answer 5

Weak opioid such as codeine in addition to paracetamol and/ or an NSAID

Question 6

When should NSAIDs be used cautiously?

Answer 6

• In unstable asthma
• In those at increased risk of GI side effects (older, those with previous GORD/ ulcer disease)
• High dose ibuprofen and diclofenac should be avoided in those with established ischaemic heart disease, PAD, cerebrovascular disease

Question 7

What should be co prescribed with NSAIDs?

Answer 7

PPIs

Question 8

Name 3 drugs used to treat neuropathic pain?

Answer 8

amitriptyline
duloxetine
gabapentin
pregabalin

Question 9

Can you use combinations of neuropathic pain drugs

Answer 9

no- one at a time, specialists can step up treatment if all 4 fail to provide relief

Question 10

What website/ guideline is used to asses eligibility for contraceptions

Answer 10

UKMEC

Question 11

Give 4 contraindications of the COCP

Answer 11

• > 35 and smoke >15 a day
• breast feeding
• multiple CVD risk factors
• thrombosis or Fhx thombosis younger than 45
• very overweight
• hypertensive
• migraines with aura
• PMH or significant FHx breast cancer, brca1 or 2
• acute liver or gall bladder disease
• long periods of immobility

Question 12

What methods of contraception are safe in those with active or past breast cancer?

Answer 12

copper coil
condoms
abstinence
natural cycle apps

Question 13

When should copper and progesterone coils be used with caution/ not at all?

Answer 13

• cervical cancer
• current breast cancer (copper is safe)
• chlamydia infection (dont initiate)
• postparum sepsis
• organ transplant failure
• Long QT syndrome (dont initiate, can continue)

Question 14

What are the missed pill rules if you miss one pill (COCP)

Answer 14

• take missed pill, even if means taking 2 in one day
• take rest of pack as normal
• no extra contraception needed

Question 15

What are missed pill rules if you miss 2 or more pills (COCP)

Answer 15

• take last missed pill now even if means taking two in one day
• Take rest of back as normal
• If pills are missed in first week, get emergency contraception if UPSI in last 2 weeks
• If in second week, thats fine
• If in 3rd week, the next pack should be started without a break, there is no need for emergency contraception

Question 16

What are rules if you miss >7 pills?

Answer 16

start again as if starting for first time- IE start new pack on first day or next menstrual period

Question 17

What are missed pill rules for POP? (3)

Answer 17

• take missed pill as soon as remembers, even if means taking 2 in one day
• If the pill is >3 hrs late (or 12 hrs for some brands), other contraceptives are needed for the next 48hrs
• Consider emergency contraception if there was UPSI 2-3 days prior to missed pills or intercourse since missed pills

Question 18

is there a break between POP packs

Answer 18

No, take continuously, older brands need to be taken at same time every day

Question 19

When should metformin be avoided?

Answer 19

When eGGR is less than 30

Question 20

Which hypoglycaemic drugs should not be given to obese pts and why

Answer 20

Sulphonylureas (gliclazide) or poiglitazone as both can cause weight gain

Question 21

Which hypoglycaemic drugs should be avoided in pancreatitis (2)

Answer 21

Gliptins, glp1 analogues

Question 22

When should sglt2 inhibitors (glifozins) be avoided?

Answer 22

Frequent UTI 
Gfr less than 60 (don’t give if less than 45)
Ketoacidosis 
Pregnancy 
Also need to warn them about DKA risk

Question 23

Other than obesity, when should a poiglitazone be avoided?

Answer 23

Hepatic, renal or heart failure (causes volume overload)