Miscellaneous info Flashcards
What is given in Acute coronary syndrome (MI, unstable angina)?
- Aspirin dispersible tablets 300mg PLUS:
- GTN spray 1-2 puffs repeated as required
- OR GTN tablets 0.3mg-1mg, repeat as required
what is the adrenaline dose for ages 5 years and below?
0.15ml (150mcg), repeated every 5 mins if necessary
what is the adrenaline dose for ages 6-11 years?
0.3ml (300mcg), repeated every 5 mins if necessary
what is the adrenaline dose for ages 12-17?
- 5ml (500mcg), repeated every 5 mins if necessary, .
- 0.3ml if child is small or prepubertal
what is the adrenaline dose for an adult?
0.5ml (500mcg), repeated every 5 mins if necessary
other an adrenaline, what else can be given for prophylaxis?
- high flow O2 and IV fluid asap.
- IM/IV chlorphenamine
- IV hydrocortisone (for more severe patients).
what abx is given for pneumococcal disease?
dose?
Benzylpenicillin IV or IM if venous access is not available.
single dose should be given before urgent transfer to hospital.
what are the doses to treat pneumococcal disease?
neonate: 300mg child 1-11 months: 300mg child 1-9 years: 600mg child 10-17 years: 1.2g adult: 1.2g
what abx is given for pneumococcal disease for those with a penicillin allergy? dose?
Cefotaxime IV (IM if venous affect is not available)
- neonate: 50mg/kg
- child 1 month- 11 years: 50mg/kg (Max of 1g)
- Age 12 - adult: 1g
What does the GFR range of 90ml/min and over indicate?
Normal
What does the GFR range of 60-89ml/min indicate?
Mild reduction
Relative to Normal range in young adults
What does the GFR range of 45-59ml/min indicate?
Mild to Moderate reduction
What does the GFR range of 30-44ml/min indicate?
Moderate-severe reduction
What does the GFR range of 15-29ml/min indicate?
Severe reduction
What does the GFR range of under 15ml/min indicate?
Kidney failure
Who do we administer the quadrivalent flu vaccine to?
Under 65 years of age
Who do we administer the trivalent flu vaccine to?
Over 65 years of age
What is the live flu vaccine? Who is it usually given to? When is this CI?
Nasal flu vaccine given nasally.
Usually given to children (around age 2-9)
Do not give to patients with uncontrolled asthma or immunocompromised: give inactivated injection instead
What is trigeminal neuralgia? What is the 1st line treatment?
- Sudden, severe facial pain.
- Describedas a sharp shooting pain or like having an electric shock in the jaw, teeth or gums.
Treatment: Carbamazepine
what are the cautions for inhaled antimuscarinics?
susceptibility to angle closure glaucoma
paradoxical bronchospasm
bladder outflow
prostatatic hyperplasia
which inhaled antomuscarinic has the warning of the risk of acute angle closure glaucoma?
neb ipratropium bromide
especially when given with neb salbutamol and possibly with other beta2 agonist.
protect the patient’s eyes from neb drugs or drug powder.
what is bambuterol the pro drug of?
terbutaline
what is antiepiletic hypersensitivity syndrome? which drugs cause this?
- CP3 (carbamzaepine, phenytoin, phenobartial, primidone)
- lacosamide, lamotrigine
- oxcarbazepine
- rufinamide
symptoms start between 1 and 8 weeks of exposure
- fever, rash and lymphadenopathy most common.
- STOP DRUG IMMEDIATELY IF THIS HAPPENS
what are the CI of opioids?
- acute respiratory depression
- comatose patients
- head injury
- raised intracranial pressure
What points should be included when reporting biological adverse effects?
Brand name
Batch number
Biologics are subject to Black triangle status
What makes an oral liquid preparation sugar free?
DOES not contain glucose, fructose or sucrose.
CONTAINS: hydrogenated glucose syrup, mannitol, maltitol, sorbitol or xylitol
What excipients should be avoided in neonates in injections and why?
Benzyl alcohol: fatal toxic syndrome in preteen neonates
Polyoxyl caster oils: associated with severe anaphylactoid reaction.
when travelling abroad, which medicines do not subject to import/export licensing? what do they need to carry instead?
sch 4 part 2 (CD anab) for self admin
sch 5 CD.
advised to carry a cover letter signed by the prescriber or drug worker.
when travelling abroad, which medicines are subject to having a personal export/import license?
sch 2, 3 or 4 part 1 CD
sch 4 part 2 CD if they are carrying more than a 3 months supply or intending to travel for more than 3 calendar months.
what is the application process for obtaining a export/import license for travelling?
supported with a covering letter signed by their prescriber or drug worker which confirms:
- patient’s name and address
- travel itinerary
- the names of the prescribed CD, doses and total amounts to be carried.
processing time: at least 10 days
what does the black triangle symbol indicate?
how long products have this symbol for?
what should be reported?
identifies newly licensed medicines that require additional monitoring by the EMA.
- product usually has the black triangle for 5 years, can be extended if needed.
- all suspected reactions, including those considered not to be serious should be reported via the yellow cars scheme.
what does NRLS mean?
national reporting and learning system.
-adverse reactions where harm occurs can be reported here.
list the drugs capable of causing oral ulceration
ACEi gold nicorandil NSAIDS pancreatin penicillamine proguanil
list the drugs associated with lichenoid eurptions
ACEi NSAIDS methyldopa chloroquine oral antidiabetics thiazide diuretics gold
what is the equivalent subcut dose of diamorphine compared to oral morphine?
1/3
in pallative care, what is taken for anorexia?
prednisolone or dexamethasone
in pallative care, what is taken for bowel coli and excessive respiratory secretions?
subcut injection of hyoscine HBr
hysocine butylBr or
glycopyrronium
given every 4 hours prn
in pallative care, what is taken for capillary bleeding
tranexamic acid orally.
usually discontinued 1 week after the bleeding has stopped.
alternatives:
guaze soaked n tranexamic acid or adrenaline appied to the area.
in pallative care, what is taken for constipation?
lactulose and senna
co-danthramer
methylnalrexone Br: for when the above have been tried and not helping.
in pallative care, what is taken for convulsions?
prophylactic phenytoin or carbamezepine
- or diazepam rectally or phenobarbital infusion
- midazolam by subcut infusion
in pallative care, what is taken for dry month?
good oral hygiene
chew SF gum
suck on ice cubes or pineapple pieces
artificial saliva
dry month associated with oral thrush: treat with nystatin or miconazole
in pallative care, what is taken for dysphagia?
dexamethasone
in pallative care, what is taken for dyspnoea?
breathlessness at rest may be relieved by oral morphine in carefully titrated dose.
diazepam can be given for dyspnoea with anxiety
dexamethasone can be given if there is bronchospasm or partial obstruction.
in pallative care, what is taken for GI pain?
the pain of bowel coli may be reduced by loperamide.
hyoscine HBr s/l tablets (Kwells)
stomach disention pain due to pressure: antacid + antiflatulance + prokinetic (domperidone) before meals.
in pallative care, what is taken for hiccups?
- antacids + antiflatulance preps
- if this fails add metoclopramide PO or S/C or I/M
- if this also fails: baclofen, nifedipine or chlopromazine can be tried.
in pallative care, what is taken for insomnia?
temazepam
in pallative care, what is taken for intractable cough?
moist inhalations or regular admin of oral morphine.
AVOID methadone because it has a long duration of action and can accumulate.
in pallative care, what is taken for muscle spasm?
diazepam or baclofen
in pallative care, what is taken for pruritius?
colestryamine
in pallative care, what is taken for raised intracranial pressure?
high dose of corticosteriods e.g. dexamethasone.
dose given before 6pm to reduce the risk of insomnia.
what drugs are compatible with diamorphine?
-cyclizine- can precipitate at concs above 10mg/ml or when NaCl 0.9% is present.
- dexamethasone
- haloperidol- likely to precipitate after 24 hrs at concs above 2mg/ml
- hyoscine
- levomepromazine
- midazolam
- metclopramide
What is the NRT chewing gum dose for those that smoke less than 20 cigarettes per day?
2mg
What is the NRT chewing gum dose for those that smoke more than 20 cigarettes per day?
4mg
what vaccine is given to to those what work with primates?
hep A vaccine
what lab test is associated with Crigler-Najjar syndrome?
Bilirubin build up
what is given to control bleeding due to incomplete miscarriage or abortion via IM admin?
Oxytocin
what is a common side effect of Montelukast newly started?
hyperkinesia
what antimalarial is not recommended for the treatment of falciparum malaria?
chloroquine
what is duration of admin of malarone?
start 1-2 days before travel, during travel and then 7 days after travel.
what antiepiletic drug causes kidney stones?
topirimate
what are the CIs of nitrates?
- hypotensive conditions
- raised intracranial pressure due to cerebral haemorrage and head trauma.
- toxic pulmonary oedema
what are the further info points on tolerance and nitrates?
- reduction of blood-nitrate concs to low levels for 4-12 hours OD maintains effectiveness.
- transdermal patches should be left off for 8-12 hrs (overnight) in each 24 hours.
- for the case of M/R ISBDN (and conventional formulations of ISBMN): the 2nd dose of BD doses should be given 8 hrs rather than after 12 hrs.
- conventional forms of ISBMN should not be usually given BD unless small doses are given.
when is tibolone given for osteoporosis?
restricted to younger post menopausal women with menopausal symptoms who are at high risk of fractures.
taken continuously
what is the therapy of hyperthyroidism in pregnancy?
1st trimester: PU (carbimazole has a risk of congential malformations)
2nd trimester: Carbimazole (PU is hepatotoxic to the mother and foetus in the 2nd trimester)
when patients start feeling better for their 1st episode of depression while taking their antidepressants, can they stop treatment
continue taking for a further 6 months (12 months in elderly), then gradually taper off medicines.
when patients start feeling better for their 2nd episode of depression or high risk of relapse while taking their antidepressants, can they stop treatment
take meds for at least 2 years, then taper off gradually.
when is a patient likely to notice the effects of antidepressants?
until 2 weeks
when is an antidepressant deemed as not effective?
taken for 4 weeks with no difference, (6 weeks in elderly)
can be switched to another drug
what opioids should be avoided in renal impairment?
dihydrocodeine
pethidine
codeine- use with caution in mild to moderate renal impairment.
what opiods are safest in renal impairment?
fentanyl and alfentanyl- metabolised into non toxic metabolites
- buprenorphine- excreted in the bile
- oxycodone= max inital dose pf 2.5mg every 6 hours (avoid if eGFR is less than 10ml/min)
what is given for N+V caused by chemicals (drugs, toxins etc)?
halperidol
what is given for N+V caused by chemo?
ondansteron
what is given for N+V caused by gastro issues?
metoclopramide
what is given for N+V caused by raised intracranial pressure, motion sickness, bowel construction?
cyclizine
what is given for N+V in parkinson’s disease?
domperidone
What are the common SEs of valproate?
Abdo pain Agitation Alopecia Anaemia Hepatic disorders Abnormal behaviour Confusion Low Na+ Irregular Menstrual cycle Thrombocytopenia Weight gain Nystagmus
When would stop valproate treatment immediately?
Hepatic dysfunction signs and symptoms (stop if prothrombin time is high)
Pancreatitis
What are the monitoring requirements of valproate?
Liver function before therapy and during the 1st 6 months
FBC
What is the MHRA product recall class 1?
Requires immediate recall because the product poses a serious or life threatening risk to health.
What is the MHRA product recall class 2?
Specifies a recall within 48 hours because. The defect could harm the patient but its not life threatening.
What is the MHRA product recall class 3?
Requires action to be taken within 5 days because the defect is likely to harm the patient and is being carried out for reasons other than patient safety.
What is the MHRA product recall class 4?
Advises caution to be exercised when using the product but indicates the product poses no threat to patient safety.
