Miscellaneous Flashcards
A patient presents at the pharmacy complaining of mild diarrhoea, elevated temperature and some other flu-like symptoms. On further questioning they tell you that they returned from Bolivia three months ago. What do you do/ what product do you recommend for this patient?
Refer to GP ASAP, don’t recommend a product.
Bolivia is in South America and this area has Malaria. Patient could be displaying Malaria symptoms- refer in case.
What are the target levels of gentamicin in treating endocarditis?
Post-dose one hour PEAK serum concentration: 3-5 mg/L
Pre-dose TROUGH serum concentration: less than 1mg/L
A patient presents a prescription for Clobazam tablets, with no extra endorsements. What is the issue?
Clobazam is an SLS item. This means it can be prescribed for certain conditions only as listed in the drug tariff it can only be prescribed for epilepsy.
You should ask the patient what the indication is and return the prescription to the prescriber for endorsement of SLS if it is for epilepsy.
Which epilepsy drugs should prescribers ensure the same brand is maintained?
Phenytoin Carbamazepine Phenobarbital Primidone (all the P's!)
What is Atropine used as a reversal agent for?
Overdose of beta blockers!
What should be recommended for strained muscles?
RICE- Rest, Ice, Compression, Elevation
Ibuprofen good as its anti-inflammatory
Remember must be over 16 years old to buy ibuprofen, nurofen, paracetamol etc
A patient comes in to your pharmacy requesting an emergency supply as he is on holiday, he is on Zopiclone, simvastatin and Tramadol. What do you do?
I can give him a max 5 day supply of his Zopiclone as this is a Schedule 4 (Part I) CD.
I can give him max 30 days supply of his Simvastatin as this is a POM.
Tramadol is a schedule 3 CD therefore cannot be given as an emergency supply, only CD that can in Phenobarbital for epilepsy.
What age does one have to be to buy Curanail?
18 years and over
What is the active ingredient in Curanail 5% nail lacquer?
amorolfine
When should people requesting Curanail 5% nail lacquer be referred?
Should only be sold OTC for treatment of MILD cases of fungal nail infection
For treatment of 2 NAILS MAX- any more and refer!
Patients with underlying conditions, which predispose for fungal nail infection (impaired circulation, diabetes mellitus, immunosuppression)
A patient on warfarin presents with an INR of 5.0, their usual range is 2.0- 3.0. They have recently started taking St Johns Wort for a mild depressive episode. What is going on here?
St Johns Wort= CYP450 enzyme INHIBITOR.
Warfarin = metabolised by CYP450.
Metabolism is decreased, warfarin levels rise, thins blood even more and INR increased.
What parkinsons drug is known to cause a sudden onsets of drowsiness, so people should be careful driving?
Pramiprexole
What vitamin should pregnant women avoid?
Vitamin A
Do not eat liver or liver products, such as pâté, because these are very high in vitamin A.
Pregnant women should take Folic acid and Vitamin D supplements. When? Dose?
Folic acid 400mcg for first trimester (12 weeks)
Vitamin D 10mcg- whole of pregnancy and breastfeeding.
In an anaphylactic reaction, how would you expect the pulse to be?
Weak!
also may lose conciousness, confusion, dizziness
When is “prescribed for an animal under my care” needed on Vet prescriptions?
For CD’s!!
Prescribed under the veterinary cascade is needed for all other prescriptions
Is the strength of medication needed when entering in the POM book?
Only when MORE than one strength is available. Think in exam- is this the only strength
Use By date vs Expiry date?
Use by= end of previous month
Expiry= end of current month
A patient has an INR of 8.5 but is not experiencing any bleeding. What should be done?
Hospital admission needed: stop warfarin and give phytomenidione 5mg daily.
What 3 drugs need to be handled with care?
Finasteride
Methotrexate
Vincristine injection
What is first line for preventing post-menopausal osteoporosis?
Bisphosphonates- alendronic acid, risedronate
Bisphosphonates = used for both preventing and treating post menopausal osteoporosis.
Other options (2nd line):
HRT
Calcitriol
Which NSAID has the most favourable thrombotic safety profile?
Naproxen
What is strontium?
Bone formation stimulant Used in osteoporosis Contra-indicated: Current/ previous VTE Temporary/ prolonged immobilisation Uncontrolled HTN
What vaccination produces small fluid-filled spots at the injection site?
BCG
What can phenytoin cause you to become deficient in?
Folate
Which antidepressant is recommended first line in children?
Fluoxetine
What antibiotics are used to treat C. diff?
Metronidazole or Vancomycin
Usually prescribe a 10-14 day course of these
What is tonsillitis most commonly caused by?
Mostly Viral e.g. adenovirus, rhinovirus
Also by Streptocococcus bacteria
Non-blanching rash = ?
Meningitis
refer to hospital ASAP
Means it does not disappear with a glass
Tacrolimus, an immunosuppressant, has been prescribed with fluconazole. What do you need to do?
Interaction!
Tacrolimus is metabolised by CYP450
Fluconazole is an enzyme inhibitor
Therefore need to reduce the dose of tacrolimus, increased levels could lead to nephrotoxicity- monitor renal function
What happens to MCV and Hb in:
Iron deficient anaemia
B12 deficient anaemia
Folate deficient anaemia
Iron deficient: BOTH MCV and Hb LOW
B12 deficient: MCV HIGH, Hb LOW
Folate deficient: MCV HIGH, Hb LOW
For iron deficient- give ferrous sulphate
B12 deficient- give hydroxycabalamin
Folate deficient- give Folic acid
A patient with asthma requests to buy Feminax Ultra (Naproxen 250mg) OTC. What do you do?
Naproxen= NSAID
NSAIDs cautioned in asthma due to risk of bronchospasm.
Should ask patient if they have used NSAIDs before- if yes and was okay- sell but indicate need to have blue inhaler to hand just in case. If previous bronchospasm- probably would not sell.
Check they are over 15- licensed age to buy
What are bacterial throat infections caused by?
Group A beta-haemolytic streptococcus
(Streptococcus pyogenes)
“Strep throat”
What virus is glandular fever caused by?
Epstein Barr virus
What do strefen lozenges contain?
Flubiprofen 8.75mg
NSAID used for sore throats
can only be used in over 12y
max 5 lozenges in 24 hr, fo max 3 days
A 17 year old comes into your pharmacy asking for Galcodeine linctus for an unproductive, dry cough that they have had for the last month now. What do you do?
Do not sell
Codeine linctus is not allowed to be used in under 18’s according to MHRA advice- risks outweigh benefits.
Also the cough has been present for 3 weeks- referral symptom!
A patient has been using Nexium OTC for some time now, with no symptom improvement. You decide to refer, how long will they have been trying Nexium for?
Over 2 weeks
Nexium= Esomeprazole.
If symptoms do not improve after 2 weeks on a PPI then refer.
What are the side effects of omeprazole?
WhaHeadache Diarrhoea Constipation Abdominal pain N&V Flatulence Remember its all the GI SEs!
What PPI’s can be bought OTC?
Omeprazole 10mg: (Zanprol) P (TT OD)
Esomeprazole 20mg (Nexium) GSL
Pantoprazole 20mg (Pantoloc) P
Rabeprazole 10mg P
Omeprazole increases the concentrations of C_______ and T_______
Voriconazole increases the conc of O_______
Omeprazole decreases absorption and therefore activity of K______ and I________
Omeprazole increases [Cilostazol] for peripheral vascular disease and [Tacrolimus] used after transplants.
Voriconazole increases the conc of Omeprazole
Omeprazole decreases the absorption of Ketoconazole and Itraconazole due to it decreasing intragastric activity (as do all PPIs)
Calcium, magnesium and alluminium containing antacids can interact with which drugs?
These antacids chelate with the following to form insoluble complexes and therefore reduce their absorption: Tetracyclines Quinolones Imidazoles (Ketoconazole) Phenytoin Penicillamine Bisphosphonates
SO avoid taking antacids at the same time as these drugs!
Which dyspepsia medications are cautioned in patients with heart disease?
Antacids containing sodium (effects fluid balance)
Alginates (as usually sodium alginate)
Which metal ion in antacids can cause Contipation? Which can cause diarrhoea?
Constipation- Calcium and Aluminium
Diarrhoea- Magnesium
What PPI has a marked interaction with Clopidogrel?
Antiplatelet effect definitely reduced by omeprazole and esomeprazole.
Possibly, but not so much by lansoprazole, pantoprazole and rabeprazole. Pantoprazole safest PPI to use or switch to a H2 antagonist.
Once Ispaghula husk sachets have been made up, what should be done?
Drink it as soon as effervescence subsides! Otherwise the drink ‘Sets’ and becomes undrinkable
What is the issue with prolonged use of lactulose in children?
Development of dental caries (teeth breakdown)
What should patients avoid taking at the same time as bisacodyl (a stimulant laxative- Dulcolax)?
Antacids and MILK
Bisocodyl are enteric coated, these can break down the coating and lead to dyspepsia and gastric irritation
Which laxatives work fastest? Which have intermediate? Which take longest?
Stimulants quickest- 6-12 hours (Glycerol suppositories 30 mins), but can cause diarrhoea and abdo pain.
Lactulose and bulk forming take 48-72 hours for effects to be seen, bulk forming slightly faster.
Softeners are the slowest- take 3 days or more
What is the safest laxative to use in pregnancy?
Fibre supplementation and BULK- forming laxatives safest. Ispaguhula husk first line.
Stimulants and macrogols (osmotic) are safe but stimulants may cause diarrhoea and abdominal pains.
Why should caffeine drinks be avoided in constipation?
Caffeine can act as a diuretic and make constipation worse.
Diuretics can cause constipation as they act to get rid of excess fluid- they can cause dehydration and therefore constipation.
What medications do we need to be wary of when recommending travel sickness treatments. Hint these products contain Hyoscine and antihistamines such as cinnarizine, promethazine and meclozine
These drugs have ANTI-CHOLINERGIC side-effects: be careful of other drugs that have these due to the additive effects e.g.
Tricyclic Antidepressants (e.g. Amitriptyline)
Butyrophenones e.g. Haloperidol
Phenothiazines e.g. Chlorpromazine
Anti-travel sickness medications can cause drowsiness. What must you ask people requesting these?
Whether this will be a problem- i.e. are they going to be driving?
Contain things like promethazine which is very sedating
What is gastroenteritis caused by?
Virus- the Rotavirus (especially in children)
Also campylobacter in adults- bacteria- most common cause of food poisoning in the UK
Which anti-emetics should be avoided in Parkinsons disease? what is the drug of choice?
AVOID dopamine antagonists that cross the BBB as these will worsen Parkinsons-
Metoclopromide
Prochlorperazine
These will interact with alcohol because they cross the BBB.
Anti-emetic of choice- Domperidone (10-20mg TDS) as this is a dopamine antagonist that does not cross the BBB
What anti-sickness medication is available OTC? what are the brand names of these?
Prochlorperazine- Buccastem M (indicated for migraine related N and V)
Bismuth- pepto bismol- settles stomach
If Nausea and Vomitting have been present for over __ hours, Motilium cannot be recommended OTC.
What age is Motilium licensed in?
Motilium contains Domperidone
Licensed OTC for Nausea and Vomitting if less than 48 hours duration!
Licensed for use in over 16 years
When should vomitting in children be referred?
In neonates- up to 1 month old- Refer
Under 1 year old lasting over 24 hours
Projectile vomitting in under 3 months
Failure to respond to OTC
What is the best thing to recommended for a sore throat in pregnant women?
CANNOT have strepsils as these have a high alcohol content- manufacturer advises avoid
Can have soothers
Or simple linctus
What are the 3 most common bacterial organisms implicated in cystitis?
E Coli (Over 80% cases)
Staphylococcus
Proteus
What is pyelonephritis?
A complication of cystitis- where bacteria moves from bladder up ureter into Kidney. Symptoms- fever, chills, flank pain
Patient requires a 7 day course of ciprofloxacin 500mg BD.
Refer if a patients cystitis symptoms have lasted over 5-7 days as they may have developed pyelonephritis.
How many days does cystitis need to be present for to warrant referral?
What age groups with cystitis should we refer?
Present for over 7 days - as could have developed into pylonephritits (travelled up to kidney).
Children under 16 years- refer as could indicate urethral abnormality getting it this young
Women over 70 years- more susceptible to complications
What symptoms present with cystitis would warrant referral?
Vaginal discharge- could indicate vaginal infection (vaginitis)
Heamaturia
Associated fever/ flank pain- could indicate pyelonephritis (moved up to kidney- Upper UTI)
What does DYS mean I.e. Dysphagia Dysmennorhea Dyspepsia Dysuria
PAINFUL:
Swallowing
Periods
Digestion
Urination
Potassium Citrate containing products can be given to patients with cystitis. Who should these be avoided in (Hint: what medications?)
Anyone on: Potassium-sparing diuretics; Spironolactone Eplerenone Amiloride
ACE inhibitors
Risk of hyperkaleamia!
Sodium Citrate containing products can be given to patients with cystitis. Who should these be avoided in?
Patients with hypertension (as salt increases BP)
Patients with heart disease
Renal impairment
Pregnant women- these should be referred anyway
What is the OTC dose and counselling for use of Azithromycin (Clamelle) for treatment of confirmed asymptomatic chlamydia?
2 x 500mg tablets (1g) as a STAT dose
Should be taken at least 2 hours after any food or any drink other than water (Ideally take before bed).
Partner should also take this (don’t need +ve test).
Licensed for over 16 years
Common side effects: GI upset, nausea, vomitting, abdo discomfort, visual disturbance, dizziness, headache, flatulence
What is classed as ‘Recurrent’ cystitis or Thrush?
Cystitis: 2 episodes in the last 6 months or 3 episodes in the last 12 months Thrush: 2 episodes in 6 months 4 episodes in 12 months These patients should be referred
Which antihistamine, licensed for motion sickness (but don’t see it used very often) may be abused?
Cyclizine
It crosses the BBB and can cause hallucinatory effects
What are the side effects of EHC?
Headache Nausea Dizziness Stomach pain Mentrual pain
Nausea is the most common
Promethazine containing products can be taken for motion sickness. What condition is promethazine cautioned in?
Glaucoma
What is the organism causing the majority of thrush cases?
Candida Albicans
What two more serious conditions can vaginal thrush present similarly to?
Bacterial Vaginosis- linked to pelvic inflammatory disease, most common cause of discharge, requires antibiotics (Metronidazole)
Trichomoniasis- C. trachomatis- protozoal infection: can cause infertility
Dominant feature of thrush= Vulval itching, discharge
What ages should be referred with thrush?
Under 16’s (as not common in this age group)
Over 60’s (less common after menopause because of hormonal changes?)
After how many days of treatment should thrush cases be referred?
after 7 days if symptoms persist
Can men be treated for thrush?
Yes- If a woman has thrush it is advised that her partner is also treated using the clotrimazole cream on his penis.
What are the treatment options OTC for thrush?
Clotrimazole cream 2% w/w for external
10% w/w for internal
(note these are stronger than the creams used for e.g. athletes foot and jock itch where 1% is used)
Fluconazole oral 150mg STAT
Can pregnant women be treated for thrush OTC? what about diabetics? What about 18 year old girls? What about a man requesting thrush cream?
Pregnant women- refer (as OTC products not licensed and can be difficult to treat)
Diabetics- Refer as thrush could indicate poor glyceamic control
18 year old girl you can treat (must refer under 16’s)
Man requesting cream is fine as partner may have it and men can use the clotrimazole cream on their penis or take a fluconazole STAT dose.
What strength is the Canesten pessary used for thrush?
500mg of clotrimazole
Should be inserted at night so that it doesn’t fall out in the day
When should you refer a patient seeking insomnia medication?
Chronic insomnia (lasts longer than 3 weeks)
If its an adverse effect to medication
Children under 16 years
Prostatic Hypertrophy
Closed angle glaucoma
This is because antihistamines recommended for insomnia can exacerbate the symptoms of these.
What conditions can antihistamines exacerbate the symptoms of?
Closed angle glaucoma- as they can cause pupil dilation
Prostatic hypertrophy- as antihistamines can increase urine frequency
What drugs are available OTC for insomnia? What classification are these?
Diphenhydramine (NYTOL)
Promethazine (SOMINEX, PHENERGAN)
These are both sedating antihistamines
All P meds
What drugs could cause a patient to have insomnia?
Fluoxetine- this is mildly stimulating MAOI's: e.g. Phenelzine, Tranylcypromine, Rasageline, Selegiline Corticosteroids Phenytoin Theophylline (FACT-P)
What are the side effects of antihistamines, especially the doses of ones used in insomnia?
Anticholinergic side effects: Dry mouth Constipation Blurred vision TINNITUS
What interactions can Nytol and Sominex have?
Sleep meds containing diphenhydramine and promethazine antihistamines:
TCA’s: antimuscarinic and sedative effects are potentially enhanced by co-administration of antihistamines.
Also MAOI’s in previous 2 weeks (long half life so stays in the body)
What are the interactions of antihistamines?
TCA’s: antimuscarinic and sedative effects are potentially enhanced by co-administration of antihistamines.
Also MAOI’s in previous 2 weeks (long half life so stays in the body)
Co-administration of antifungal imidazoles (eg, ketoconazole, itraconazole) and macrolide antibiotics (eg, erythromycin, clarithromycin) is to be avoided: these drugs raise the plasma concentration of second-generation antihistamines (loratadine, ceterizine- newer, non sedating)
What are the first generation and second generation antihistamines??
First generation:
Older, sedating ones
Diphenhydramine
Promethazine
Second generation: newer less sedating
Loratidine, Ceterizine
OTC sleep medication should not be used long term. When is a it recommended that they see their doctor?
If they are still struggling after 2 weeks of using OTC meds.
Over 3 weeks of no sleep is classed as chronic insomnia.
What is the difference between Nits and Lice?
Lice are the actual living things
Nits are the empty egg shell that stick to hair
Presence of Nits does not necessarily mean lice infestation. A live lice needs to be seen for OTC treatment to commence.
Insecticides and Dimeticone are available OTC to treat head lice. Can you name some insecticides? What is the difference?
Insecticides: Permethrin (LYCLEAR), Malathion (DERBAC M). This kills both lice and eggs off.
Apply for 10 minutes. Most people cured after single application- but can be re-applied after 7 days if needed.
Dimeticone (HEDRIN) traps and suffocates lice but may not kill eggs. Apply for 8 hours and definitely re-apply after 7 days, as it is less effective than Lyclear.
Which product (LYCLEAR OR HEDRIN) is preferred in headline treatment?
Lyclear (Permethrin)
Only needs to be applied for 10 mins (8 hours for hedrin- dimeticone).
Usually effective in one dose (Hedrin have to repeat in 7 days)
Safe in asthmatics
But Hedrin- can use in pregnancy
What is the licensing (age, pregnancy) for Lyclear (permethrin) and Hedrin (Dimeticone)?
Both for over 6 months old
Hedrin possibly safer in pregnancy
Lyclear definitely safe in asthma
Which headlice treatment is preferred in asthma?
Lyclear
Hedrin is not safe in asthma. Is is alcohol based. Contains dimeticone
How should rivaroxiban be taken?
With food
Food massively affects it’s absorption
A patient on a statin is started on fusidic acid tablets for a staphylococcal skin infection. What do you recommend?
Fusidic acid increases the concentration of statins significantly, increasing the risk of myopathy and rhabdomylosis. It is recommended that the statin is withheld during treatment and for 7 days after the last dose of fusidic acid due to the long half life.
A doctor wants to start a macrolide in a patient with pneumonia. The patient is also taking atorvastatin 80mg. What do you advise?
Withold the statin through the 7 day treatment course, as the macrolide (e.g. erythromycin, clarithromycin) will interact and increase statin levels, increasing risk of myopathy and rhabdomylosis.
What does one cycle of CPR involve?
30 chest compressions followed by 2 rescue breaths.
How do you respond to a choking child?
Give up to 5 back blows followed by 5 abdominal thrusts. If this does not work then call 999.
What drugs are used in the management of hypotension?
Noradrenaline/ norepinephrine (vasoconstrictor)
Phenylephrine
Dopamine (Sympathomimetic ionotrope that increases cardiac output)
What may turn your stools black?
Iron containing products- e.g. ferrous sulphate
Pepto Bismol
What are patients on Hydroxychloroquine (used for Rhumatoid arthritis and lupus erythematosus) advised to report?
Any problems with vision e.g. blurred as it can cause Ocular Toxicity and this is screened for.
Which painkiller has a risk of overdosing an infant if used in breast-feeding women due to a maternal variation in capacity to metabolise?
Codeine
How can desmopressin (a hormone, used for urinary incontinence) effect electrolytes?
Can cause Hyponatreamia
What is nystagmus?
Involuntary movement of eyelids
stimulants may cause this
What diuretics for treating oedema would be less appropriate in someone with CKD?
Potassium sparing diuretics, e.g. Amiloride and Triamterene.
This is because there is a high risk of hyperkalaemia in renal impairment.
What electrolyte disturbance do ACE inhibitors cause?
HYPERKALEAMIA!
If a pregnant woman is going abroad to an area renowned for malaria, what preventative measures are there for her?
Proguanil can be given in the usual doses during pregnancy as benefit of prophylaxis in malaria outweighs risk. I.e. not 100% safe in pregnancy but not contra-indicated as would be safer to give than risk her getting malaria. Ensure the mother has adequate folate supplements!
Tetracyclines should NOT be given to patients under the age of?
12 years old
Doxycycline is a tetracycline!
What is Desferrioxamine mesilate (Deferoxamine) used for?
Deferoxamine is a chelating agent, used to remove excess iron from the body
What has long term use of Tetracycline antibiotics (e.g. Doxycycline, Oxytetracycline, Tetracycline, Minocycline) Been associated with?
Tetracyclines have been associated with discoloration of growing bones and teeth.
Minocycline: Pigmentation of various body sites including skin, nails, bone, mouth and eyes
What does the black upside down triangle mean in the BNF?
New to the market or used for a new indication
Highlights need to report any ADRs
Generally stays with the drug for 5 years
What is first line treatment for women with threadworm that are pregnant?
strict hygiene measures for six weeks (e.g. cut finger nails and launder bedding and towels on a daily basis).
Not enough safety info on Mebendazole (antielmintics), manufacturer states avoid, however if hygeine measures don’t work, could consider it.
Which antisecretory and mucosal protectant drugs is a potent uterine stimulant?
Misoprostol
What bacteria cause impetigo?
Staphylococcus aureus or Streptococcus pyogenes
What two vitamins are lacking in megoblastic aneamias, and therefore what are there treatments?
Folate - Treat with folic acid 5mg daily for 4 months
Vitamin B12- treat with Hydroxocobalamin- given by IM injection
Most megoblastic aneamias result from a lack of either one of these. Establish the cause asap, if not possible can treat with both.
What does aminophylline (used in asthma) do to Lithium?
It increases Lithiums excretion
Daktocort cream and ointment vary slightly in their storage instructions. What are these?
Daktocort cream: store in a fridge (2-8 degrees)
Daktocort ointment: store below 25 degrees (kept at room temp)
Once Oramorph® concentrated 20 mg/mL solution has been opened, what is the expiry date?
4 months
Co-amoxiclav oral suspension (reconstituted)- how long is the expiry?
7 days
Systane eyedrops are lubricant eye drop containing propylene glycol, used for relief of burning/ irritation from dry eyes. What is their expiry?
Discard any remaining solution 6 months after first opening
If a doctor requests Rifaximin (antibiotic for travellers’ diarrhoea) as an emergency supply, whats the number of days you will provide?
3 days (as it is a 3 day course) An orally administered antibiotic could be given in the smallest quantity that will provide a full course of treatment
What class of antibiotics are commonly used in treatment of acne?
The tetracyclines
Doxycycline, Lymecycline, Minocycline, Oxtetracycline, Tetracycline
What B vitamin is Thiamine?
B1
What B vitamin is hydroxycabalmin (used in anaemia)
B12
What B vitamin is Pyridoxine?
Vitamin B6
Note: pyridoxine is used in isoniazid induced neuropathy- isoniazid is one of the drugs used in TB (part of RIPE) so often used in TB patients. Don’t get confused with Pyrazinamide (bactericidal drug used in TB treatment, the P in RIPE)
This antipsychotic drug is cautioned in aggressive patients as even low doses may aggravate symptoms of aggression
Sulpiride
What are the trigger factors for GORD?
Drugs which cause lower oesophageal sphincter relaxation (e.g. calcium channel blockers and theophylline)
smoking
alcohol
obesity.
What drugs seen in epilepsy can induce their own metabolism?
Phenobarbitone will induce the metabolism of itself
As will carbamazepine
Counselling points for GTN tablets?
If the patient experiences chest pain, they should take a tablet immediately by putting it under the tongue
The tablets should preferably be taken sitting down
The tablets should not be transferred to another container
Facial flushing may occur after taking the tablets
What is Melaena?
Black tarry stools
Would be a red flag symptom
Patients on etrapenem (carbapenem antibiotic) may experience this side effect
What is Hyperaesthesia?
Excessive skin sensitivity to non-painful stimuli
Caused by medication such as Nilotinib (chemo drug)
What is the medical term for excessive sweating?
Hyperhidrosis
Which laxative is cautioned in diabetics?
Lactulose (due to its sugar content- lactose, galactose, epilactose)
What kind of laxative is Methylcellulose?
Bulk forming laxative that also acts as a faecal softener.
which laxative can be used to prevent risk of hepatic encephalopathy?
Lactulose
What is ecchymosis?
Bruising
SE of warfarin
Azathrioprine is a drug that requires reporting of blood disorder symptoms, what is this drug?
An immunosuppressant
Used in chrons, RA, transplant rejection, severe eczema
Need to look out for bone marrow suppression symptoms of bruising, bleeding or infection
What is Hypertrichosis?
an increase in hair growth
What effect can lactulose have on warfarin?
Can enhance the anticoagulant effects
A patient taking ergotamine for treatment of her migraines. She says to you shes lost feeling in her fingers since starting it. What could this mean?
Numbness or tingling of the extremities in patients taking ergotamine may be a result of peripheral vasospasm.
Which of the NOAC’s interacts with the rate limiting CCB Verapamil?
DABIGATRAN
Verapamil may increase the plasma concentration of dabigatran
Dose reduction of Dabigatran therefore required
What CCB can cause gum hyperplasia (enlargement of gums)?
Nifedipine
Which insulin can be used as an alternative to the classic soluble insulin in the cases of diabetic emergencies?
Insulin Aspart
What is bradycardia and what is tachycardia?
Bradycardia= slow heart rate, below normal resting rate Tachycardia= fast heart rate, above normal resting rate
What is misoprostol used for?
Used for gastric ulcers caused by NSAIDS
Also used to terminate pregnancy (aborting agent) as it is a potent uterine stimulant
Simvastatin taken with the Fibrate drugs can cause increased risk of Rhabdomyolisis. Which fibrate is absolutely contra-indicated with Simvastatin?
Gemfibrozil- do not use with a statin
Bezafibrate- max dose of simvastatin= 10mg
How should GTN tablets be dispensed for patients?
Dispense in the manufacturers original pack and endorse accordingly.
This is because the drug is hygroscopic (will absorb moisture from the air) and the manufacturers original packaging consists of a amber glass bottle with screw caps lined with aluminium foil. Do not remove from this- only dispense OP’s, cannot be broken down. Do not put any cotton wool or wadding in bottle! Only foil as a cushioning material.
If it is absolutely necessary to break it down: dispense in amber glass containers with screw caps lined with aluminium foil, filled with aluminium foil as a cushioning material.
The tablets have an 8 week expiry after pack is opened.
How long is the expiry date once GTN tablets are opened?
8 weeks.
As GTN tablets are hygroscopic and will absorb moisture, therefore after 8 weeks they are not to be used.
How should NICORANDIL (potassium channel opener used in Myocardial ischaemia) be dispensed?
Keep in original package in order to protect from moisture- it is hygroscopic!
Special blister pack with a sieve desiccant to absorb moisture- do not remove from this.
Nicorandil is a medication that needs to be stored in its original blister pack to avoid moisture. After opening, how many days expiry does it have?
Each blister strip should be used within 30 days of opening.
Does a woman aged 50 presenting a prescription for HRT have to pay?
Yes
Only hormonal preparations for contraceptive purposes are exempt from this charge, if she was over 60 however she would not have to pay!
What is chloroform water actually used for when added to formulations?
It is an anti-bacterial
Very unpleasant stuff- no bacteria will grow
Why is Colestyramine contra-indicated in complete biliary obstruction?
Because its mechanism is to bind to bile acids and prevent their re-absorption to promote conversion of cholesterol into bile acids and therefore clear LDL cholesterol (used in Hyperlipidaemias). So it would not be effective if the bile ducts were blocked.
First line for hypertension in pregnancy?
Labetolol
Then methyldopa or nifedipine (unlicensed) can be used second line
How often is bowel cancer screening?
every 2 years
What is the difference between:
Hyoscine butylbromide
AND
Hyoscine hydrobromide
Butylbromide = less sedating (buscopan: IBS)
Hydrobromide = more sedating (travel sickness/EOL: quells/ampules)
What do you think this patient is being treated for, Rx:
- insulin (novorapid)
- dextrose
- salbutamol 5mg Nebules QDS
Hyperkalaemia
