Medicines management Flashcards
What tool can be used for medication reviews?
the STOPP START tool
What is important to think about in medications fo elderly people?
the anticholinergic burden
What is 1st, 2nd and 3rd line analgesia for mild- moderate pain?
1st- paracetamol 1g QDS
2nd- ibuprofen 400mg TDS (titrate up to 2.4g daily)
3rd- paracetamol and ibuprofen
What is 4th line analgesia for mild- moderate pain?
paracetamol + naproxen or diclofenac (IE stronger NSAID)
What is 5th line for mild- moderate pain (IE not releived by paracetamol + stronger NSAID)
Weak opioid such as codeine in addition to paracetamol and/ or an NSAID
When should NSAIDs be used cautiously?
- 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
What should be co prescribed with NSAIDs?
PPIs
Name 3 drugs used to treat neuropathic pain?
amitriptyline
duloxetine
gabapentin
pregabalin
Can you use combinations of neuropathic pain drugs
no- one at a time, specialists can step up treatment if all 4 fail to provide relief
What website/ guideline is used to asses eligibility for contraceptions
UKMEC
Give 4 contraindications of the COCP
- > 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
What methods of contraception are safe in those with active or past breast cancer?
copper coil
condoms
abstinence
natural cycle apps
When should copper and progesterone coils be used with caution/ not at all?
- cervical cancer
- current breast cancer (copper is safe)
- chlamydia infection (dont initiate)
- postparum sepsis
- organ transplant failure
- Long QT syndrome (dont initiate, can continue)
What are the missed pill rules if you miss one pill (COCP)
- take missed pill, even if means taking 2 in one day
- take rest of pack as normal
- no extra contraception needed
What are missed pill rules if you miss 2 or more pills (COCP)
- 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
What are rules if you miss >7 pills?
start again as if starting for first time- IE start new pack on first day or next menstrual period
What are missed pill rules for POP? (3)
- 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
is there a break between POP packs
No, take continuously, older brands need to be taken at same time every day
When should metformin be avoided?
When eGGR is less than 30
Which hypoglycaemic drugs should not be given to obese pts and why
Sulphonylureas (gliclazide) or poiglitazone as both can cause weight gain
Which hypoglycaemic drugs should be avoided in pancreatitis (2)
Gliptins, glp1 analogues
When should sglt2 inhibitors (glifozins) be avoided?
Frequent UTI Gfr less than 60 (don’t give if less than 45) Ketoacidosis Pregnancy Also need to warn them about DKA risk
Other than obesity, when should a poiglitazone be avoided?
Hepatic, renal or heart failure (causes volume overload)
