Notebook Flashcards
1
Q
Clozapine traffic light system
A
Result of last blood test:
Red- needs to be reviewed by Dr
Amber- depends on Dr’s judgement
Green- can take
2
Q
Missing clozapine doses
A
Patients who have missed clozapine doses for more than 48 hours will need to have the medicine re-titrated. They cannot continue taking their usual maintenance dose. If they miss more than three days of clozapine their blood testing frequency may need to change.
3
Q
TRS
A
Treatment resistant schizophrenia (had 1 or 2 other antipsychotics and experienced EPSEs)
4
Q
Carbamazepine-clozapine
A
Increase the risk of myelosuppression when given with clozapine
5
Q
Clozapine- smoking
A
Smoking decreases dose
6
Q
Clozapine- caffeine
A
Caffeine increases the dose
7
Q
Essential services
A
Dispensing medicines (required to keep copy of all supply)
Dispensing appliances e.g. cathetar, incontinence and stoma appliances
Repeat dispensing
Disposal of unwanted medicines
Clinical governance
Public health (promotion of healthy lifestyles)
Signposting
Support for self care
8
Q
Drug Tariff
A
What is paid to community pharmacies for the NHS services provided
9
Q
How many public health campaigns are community pharmacies required to take part in?
A
6
10
Q
Authorising witness for destruction of CDs
A
Not a requirement to have authorising witness for patient-returned CDs. Record still needs to be made in the register.
For expired pharmacy stock, it is a legal requirement to have a witness for obsolete, expired and unwanted Schedule 1 and 2 CDs.
11
Q
Advanced services
A
Community pharmacy consultation service MURs (decommissioned at end of 03/21) NMS Flu vaccination service Appliance use reviews Stoma appliance customisation Hepatitis C testing service
12
Q
Enhanced services
A
Smoking cessation
Provision of hormonal contraception
Supervised methadone consumption
Needle exchange service
13
Q
NMS categories
A
Asthma/COPD
Diabetes (type 2)
Antiplatelets/anticoagulants
Hypertension
14
Q
Stages of NMS
A
1) Patient engagement (Day 1)
2) Intervention (Day 7-14)
3) Follow-up (Day 21-28)
15
Q
Categories eligible for flu vaccine
A
Aged 65+
Have certain health conditions
Pregnant
In long-stay residential care
Receive carer’s allowance/main carer for an older or disabled person at risk
Lives with someone who is at high risk of coronavirus
Front line health workers and social care workers
16
Q
What is the sodium content of Gaviscon Advance suspension?
A
2.3 mmol of sodium per 5ml
17
Q
Which pain relief meds are not on the Dentists Formulary?
A
Codeine
Co-codamol
18
Q
Maximum codeine sale
A
32
19
Q
Highest codeine strength P med
A
12.8mg
20
Q
Max ibuprofen sale
A
96 (3 boxes)
21
Q
Topical decongestants
A
Oxymetazoline
Xylometazoline
Ephedrine
22
Q
Oral decongestants
A
Phenylephrine
Pseudoephedrine
23
Q
Duration of use of topical decongestants
A
Do not use for longer than 7 days- rebound congestion
24
Q
Patients to avoid decongestants in
A
High BP
Diabetes
Hyperthyroidism
Heart disease
25
Cough suppressants for dry coughs
Codeine
Pholcodeine
Dextromethorphan
26
Expectorants for productive coughs
```
Guaifenesin
Squill
Ipecacuanha
Sodium citrate
Ammonium chloride
```
27
Soothing agents for dry, tickly coughs
Glycerin
Honey
Simple linctus
28
Codeine age
12 years and over- associated with risk of respiratory side effects
29
Potassium citrate/sodium citrate for cystitis
Use for max 2 days before seeing GP
Sodium citrate- caution in heart disease, hypertension or renal impairment
30
Symptoms of cystitis (inflammation of the bladder)
Wanting to urinate more frequently and urgently
Pain/burning while peeing
Dark/cloudy/strong-smelling urine
31
Symptoms of thrush (Candida)
Pain during urination
Soreness around outer vaginal area
Thick, cottage-cheese like vaginal discharge
32
Treatment of thrush
Antifungals- clotrimazole, fluconazole
Max OTC age 60
If patient is diabetic- refer (sign of uncontrolled diabetes)
33
Treatment of period pain
NSAIDs (due to the increase in prostaglandins)
34
When is it best to do pregnancy testing?
HCG levels are the highest in the morning so it is best to do them in the morning
35
Teething gel containing salicylates
Not recommended in under 16- Reyes syndrome
36
Head lice treatment
Non-insecticides: cyclomethicone or dimethicone (so can be used in pregnancy and breast-feeding)
Insecticides: malathion or permethrin (alternate to prevent resistance)
37
Meningitis
Inflammation of the lining of the brain and spinal cord
| Bacterial meningitis is more dangerous than viral and can cause septicaemia.
38
Define constipation
Fewer than 3 bowel movements per week
39
How long do laxatives take to work?
Stimulant laxatives: 6-12 hours [Glycerin suppositories work in about 15-30 minutes. They are mildly irritant so should be moistened with water before insertion]
Bulk forming: 1-2 days
Osmotic: 2-3 days
40
Haemorrhoids (piles)
Swollen veins in the back passage (internal) or around the anus (external) that can be painful, itchy and can bleed
Docusate is licensed for the prevention and treatment of piles
41
Preferred group of laxatives in IBS
Bulk forming
42
Symptoms of meningitis
```
Fever
Vomiting
Severe headache
Stiff neck
Dislike of bright lights
Very sleepy
Confusion
Non-blanching rash
```
43
Treating dandruff
Shampoos containing selenium sulphide (mild), salicylic acid, coal tar or zinc pyrithione
Ketoconazole can treat and prevent dandrugg and seborrhoeic dermatitis
44
Psoriasis
Red inflamed skin with silvery scales
Usually localised to knees and elbows
Treat with coal tar and salicylic acid
45
Sale of Dovonex
Contains calcipotriol (Vitamin D analogue)
Can be sold for 18 years and over
Max 12 weeks treatment for Dr-diagnosed psoriasis, then must see Dr for ongoing treatment
46
Treatment for male pattern baldness and certain types of hair loss
Minodixil (2%/5%)
Needs 4 months continued use
Max age for use 65 years
47
OTC treatments for acne
```
Salicylic acid
Benzoyl peroxide (Bleaches skin + increases sensitivity to light)
```
48
Cold sores
Caused by herpes simplex type 1 virus
| Treat with aciclovir cream
49
Warts
Mostly on the hands (if on the feet then veruccas)
Caused by HPV
Salicylic acid and lactic acid e.g. Bazuka, Salactol
Can take months-years to work
No OTC products to be used on the face or in the anal/genital areas
50
OTC hydrocortisone
```
Over the age of 10
Can't be used by pregnant/breast-feeding women
Not for the face or anal/genital area
Apply thinly
Max 7 days use
```
51
OTC clobetasone butyrate
Over the age of 12
52
Permethrin for scabies
Apply 5% preparation over whole body including face, neck, scalp and ears then wash off after 8–12 hours. If hands are washed with soap within 8 hours of application, they should be treated again with cream.
53
Scabies on treatment
Malathion: left on for 24 hours
Permethrin: left on for 8-12 hours
Repeat after a week
Treat whole family
Refer pregnant women and children under 2
54
Corns and calluses (caused by ill-fitting shoes)
Corns: in between the toes- where it's moist
Calluses: on the ball or heel of the foot
55
Onychomycosis (fungal nail infections)
Amorolfine hydrochloride 5% nail lacquer
18 years and over
Not suitable for pregnant or breastfeeding
56
Athletes foot
Imidazole antifungals: miconazole, clotrimazole
Non-imidazole antifungal: terbinafine
If the foot is inflamed- treat with hydrocortisone and antifungal till the rash is cleared, and continue for further 2 weeks.
57
Tamsulosin for BPH age restrictions
45-75
58
Bacterial and viral conjunctivitis
Conjunctivitis usually causes a pink or red, gritty feeling in the eye and may cause the eyelids to stick together in the morning.
Often starts in one eye, usually spreading to the other.
Bacterial conjunctivitis normally causes a yellow or green sticky discharge
Viral conjunctivitis normally causes a watery discharge
59
Allergic conjunctivitis
Allergic conjunctivitis usually causes pink or red itchy eyes. The eyes are normally watery and other allergy symptoms such as sneezing and a runny nose may be present.
Sodium cromoglicate can be used in over 2 years of age
60
Chloramphenicol for bacterial conjunctivitis
Over the age of 2. Not suitable for pregnant or breastfeeding women.
Eye drops: every 2 hours for the first 48 hours, then every 4 hours
Continue treatment for 48 hours after the eye appears normal
Max licensed duration: 5 days
Cannot be given if they have had laser eye surgery less than 6 months ago
61
Caution with naphazoline and xylometazoline
Work by shrinking blood vessels- check if they have HTN, diabetes, overactive thyroid or raised cholesterol
62
Arachis oil can be used for ear wax
Check peanut allergy
63
Miconazole oral gel age
4 months and over
64
Brown staining of teeth
Chlorhexidine
65
Antibiotics that cause intrinsic staining
Tetracyclines (4th month in utero to 12 years) so contraindicated in under 12 years and during pregnancy and breastfeeding.
66
Osteonecrosis of the jaw
Greater risk for those taking IV bisphosphonates for cancer than oral for osteoporosis or Paget's disease
67
Which drugs can cause gingival hyperplasia (overgrowth)?
Phenytoin
Ciclosporin
Nifedipine (and other CCBs)
68
What drugs can cause xerostomia (dry mouth)?
```
Excessive diuretic use
Antihistamines
Antimuscarinics
Alpha blockers
Baclofen
TCAs
SSRIs
```
69
Increased saliva production
Clozapine
| Neostigmine
70
Hypoalbuminaemia
Can occur in severe liver disease
| Reduced protein binding= increased toxicity of highly protein bound drugs e.g. phenytoin and prednisolone
71
Dexamethasone for nerve compression pain
Anti-inflammatory properties
| Reduces oedema around tumours
72
When is CrCl used?
DOACs and renally excreted drugs
| Not for periods of rapidly changing renal function and AKI
73
What is the eGFR for Stage 1 CKD?
≥90
74
What is the eGFR for Stage 2 CKD?
60-89
75
What is the eGFR for Stage 3a CKD?
45-59
76
What is the eGFR for Stage 3b CKD?
30-44
77
What is the eGFR for Stage 4 CKD?
15-29
78
What is the eGFR for Stage 5 CKD?
<15
79
What is the INR target range for valvular AF?
3-4
80
What is the INR target range for non-valvular AF?
2-3
81
CHADVASC and HASBLED
Women already have a score of 1 in CHADVASC
| Score of 2 in both
82
Which DOACs can be crushed?
Apixaban
Rivaroxaban
Edoxaban
83
CrCl>95
Should not take edoxaban as it would be cleared too quickly
84
What are the weight limitations for DOACs?
<50kg
| >120kg
85
Treating PE/DVT with apixaban
10mg BD for 7 days, then 5mg BD thereafter
86
Off label use of metformin
PCOS
87
Off-label vs unlicensed
Off label: Medicine being used in a way that is different to that described in the licence.
E.g. used for a disease that is not in the license, used for an age group outside the licensed range, using medicine at a higher dose than stated
Unlicensed: Medicine may have MA in other countries, but not the UK so has to be imported. May also need to be made up to be taken as unlicensed preparation. Some medicines have no license at all.
88
Keeping private Rx
2 years
89
Keeping Vet Rx
5 years
90
Legal requirement for vet CDs
Valid for 28 days
Include a declaration that these items are “prescribed for the treatment of an animal or herd under his care”
Maximum of 28 days treatment should be prescribed unless situations of long term ongoing medication (e.g. treatment of epilepsy in dogs)
Standardised form is not required
91
Schedule 1,2,3,4 Rxs are valid for how long
28 days
92
Schedule 5 Rxs are valid for how long
6 months
93
Record keeping of POM-V supplies
Name of medicine
Date of receipt or supply
Batch number
Quantity
Name and address of the supplier or recipient
If there is a written prescription, record the name and address of the prescriber and keep a copy of the prescription.
94
Additional details that must be added to Vet Prescriptions
Name and telephone number of the prescriber
Qualification of the prescriber
Name and address of the owner of the animal (and where the animal is kept, if different)
Identification and species of the animal(s)
Withdrawal period (if relevant)
Any necessary warnings
If necessary, a declaration that it is “for administration under the cascade” (see below)
If the prescription is repeatable, the number of times it can be repeated.
95
EEA doctors
Cant prescribe unlicensed meds and CD schedules 1, 2 and 3
| Also can't supply phenobarbital as emergency supply
96
RP record
Should be treated as CD register so put * for amendments
Writing reason for absence is good practice, not legally required
Must record when and by whom changes were made
97
In the absence of the responsible
pharmacist, pharmacy staff, as outlined in the
pharmacy procedures...
* CANNOT supply GSL medicines against a prescription unless there is a second pharmacist present
* CANNOT sell P medicines unless there is a second pharmacist present
* CANNOT hand out pre-bagged and checked medicines to patients or delivery drivers unless there is a second pharmacist present
* CANNOT sell or supply any medicines, including GSL medicines, if the responsible pharmacist is absent for more than two hours unless another responsible pharmacist is appointed.
98
Schedule 3 CDs
Temazepam, gabapentin, pregabalin and tramadol are all Schedule 3 Controlled Drugs. Emergency supplies of these medicines are not allowed and so they cannot be supplied.
99
Schedule 4 CDs
Medicines such as benzodiazepines (apart from temazepam, which is Schedule 3), zopiclone, and zolpidem are Schedule 4 Controlled Drugs. Up to five days’ treatment may be supplied, if it is clinically appropriate and after an assessment.
100
Schedule 5 CDs
Medicines such as dihydrocodeine and codeine containing products (including co-codamol 30mg/500mg) are Schedule 5 Controlled Drugs. Up to five days’ treatment may be supplied if it is clinically appropriate and after an assessment.
101
Labelling of emergency supply
Must state 'For emergency supply'
102
CD requirements: total quantity in words and figures
Schedule 2 and 3
103
CD repeats permitted
Schedule 4 and 5
104
When is the UK prescriber address required for CDs?
Schedule 2 and 3
105
Sativex
```
Licensed medicine containing cannabis
Schedule 4 Part 1
Doesn't need to be locked away
To be kept in the fridge
Do not need to keep record of stock in and out
Not required for safe custody
```
106
Dentists prescribing
Can prescribe anything in the BNF privately and as an emergency but must following Dentists formulary in normal instances
107
Community Practitioner Nurse
Cannot prescribe phenobarbital- not on their formulary
108
Private scripts for CDs
Must be on standardised prescription form (FP10CD)
109
Methadone for addiction
Can be prescribed by Independent Pharmacy Prescribers- but not other meds for addiction e.g. diamorphine, dipiprenone and cocaine
110
CD requirements
Must be recorded if proof of identity was requested
111
Patient returns of CDs
Are not added to the CD register
112
Signed orders for salbutamol/adrenaline auto-injectors
Needs to be supplied from the Head Teacher including:
1) Name of the school
2) Purpose of the product
3) Total quantity required
The signed order is kept for 2 years. Good practice to put in the POM register.
Only one brand of AAIs should be supplied.
113
Audit cycle
1) Identify problem/issue
2) Set criteria + standards
3) Observe practice/ data collection
4) Compare performance with criteria and standards
5) Implementing change
114
Cough symptom differentiation
TB: night sweats, fever, weight loss
HF: shortness of breath
Pneumonia: non-productive initially but progresses to productive
Chronic Bronchitis: closely associated with Hx of smoking
Cystic fibrosis: recurrent infections, wheeze [Picked up with heel-prick test in babies]
Laryngotracheobronchitis (croup): usually presents at night
Pertussis (whooping cough): cold-like symptoms before whooping cough
115
Right lower quadrant pain
Appendicitis
| Refer to hospital
116
Right upper quandrant pain
Peptic ulcer- just off the midline
| Liver is also in this region so it could be gall stones
117
Left lower quadrant pain
Likely to be IBS- around the small intestine area
118
Signs of measles
Small blueish-white spots lined with a red ring along the palate in the mouth
119
Febrile neutropenia
Tazocin + Ciprofloxacin
Temp ≥ 38°C or signs of sepsis
+
Neutrophil count <0.5x10^9/L
120
Pirinase (fluticasone nasal spray)
POM>4 years
| P>18 years
121
Clobetasone cream
P>12 years
122
Tranexamic acid
Not suitable for those with irregular periods
123
Sumatriptan 50mg OTC
<65 years
124
Naproxen 250mg OTC
15-50 years
125
Max licensed duration of prochlorperazine
2 days
126
Max licensed duration of co-codamol (8/500)
3 days
127
Max licensed duration of Naproxen 250mg
3 days
128
Max licensed duration of omeprazole
14 days
129
Ibuprofen-bendroflumethiazide
Reduced diuretic and anti-hypertensive effect
130
Rennies-ciprofloxacin
Reduced plasma concs (space doses as far apart as possible)
131
Sodium citrate-lithium
Reduced lithium concentrations
132
Maloff Protect
Combinaton of atovaquone and proguanil hydrochloride
Can take antacids with aluminium with 2hr gap
Avoid supply if on metoclopramide, rifampicin or tetracycline as decreases their concentration.
133
Which drugs have reduced absorption due to antacids?
```
Warfarin
Tetracyclines
Digoxin
Rifampicin
Iron (2hr gap)
Chlorpromazine
Ciprofloxacin + norfloxacin
```
134
Fexofenadine
Now GSL
Over the age of 12
One tablet OD
135
BMI
<18.5 underweight
18.5-25 normal
25-30 overweight
>30 obese
136
Pernicious anaemia (B12 deficiency)
Hydroxocobalamin (retained longer than cyanocobalamin) for up to 3 months
137
Megaloblastic anaemia (due to poor nutrition, pregnancy or antiepileptics)
Folic acid for 4 months
138
SSRIs
Initially risk of suicidal thoughts
Hyponatraemia
Risk of serotonin syndrome
139
Recommendation for physical activity per week
150 mins of moderate intensity
| Weight loss target of 10-15%
140
Mechanism of action of biguanides
Reduces gluconeogenesis of glucose in the liver
| Increases the intestinal absorption of glucose and increases the glucose uptake and utilisation in the cells
141
Advantages of using metformin
Doesn't cause weight gain
| Doesn't cause hypoglycaemia (as it does not stimulate insulin secretion)
142
Most common adverse effect of metformin
Diarrhoea
143
HbA1c for treatment with metformin/diet + lifestyle alone
48mmol/l
144
Sulfonylureas (glibenclamide, gliclazide, glimepiride, glipizide, tolbutamide)
May cause hypoglycaemia (more likely with long-acting sulfonylureas such as glibenclamide).
Associated with modest weight gain, probably due to increased plasma-insulin concentrations.
145
Acarbose
has a poorer anti-hyperglycaemic effect than many other antidiabetic drugs, including the sulfonylureas, metformin hydrochloride, and pioglitazone.
146
The meglitinides, nateglinide and repaglinide
have a rapid onset of action and short duration of activity. These drugs can be used flexibly around mealtimes and adjusted to fit around individual eating habits which may be beneficial for some patients, but generally are a less preferred option than the sulfonylureas.
147
The thiazolidinedione (pioglitazone)
Pioglitazone should not be used in patients with heart failure or a history of heart failure.
Incidence of heart failure is increased when pioglitazone is combined with insulin especially in patients with predisposing factors e.g. previous myocardial infarction.
Pioglitazone should not be used in patients with active bladder cancer or a past history of bladder cancer, or in those who have uninvestigated macroscopic haematuria. Pioglitazone should be used with caution in elderly patients as the risk of bladder cancer increases with age.
148
Sitagliptin dose reduction
Manufacturer advises reduce dose to 50 mg once daily if eGFR 30–45 mL/minute/1.73 m2.
Manufacturer advises reduce dose to 25 mg once daily if eGFR less than 30 mL/minute/1.73 m2.
149
The dipeptidylpeptidase-4 inhibitors (gliptins), alogliptin, linagliptin, sitagliptin, saxagliptin, and vildagliptin
do not appear to be associated with weight gain and have less incidence of hypoglycaemia than the sulfonylureas.
150
Mechanism of DPP4-inhibitors
increase incretin levels (GLP-1 and GIP), which inhibit glucagon release, which in turn increases insulin secretion, decreases gastric emptying, and decreases blood glucose levels.
151
The sodium glucose co-transporter 2 inhibitors (canagliflozin, dapagliflozin, and empagliflozin)
may be suitable for some patients when first-line options are not appropriate.
Canagliflozin and empagliflozin can be beneficial in patients with type 2 diabetes and established cardiovascular disease.
Sodium glucose co-transporter 2 inhibitors are associated with a risk of diabetic ketoacidosis.
152
SGLT2 inhibitors mode of action
Sodium-glucose co-transporter-2 inhibitors work by inhibiting SGLT2 in the PCT, to prevent reabsorption of glucose and facilitate its excretion in urine. As glucose is excreted, its plasma levels fall leading to an improvement in all glycemic parameters.
153
GLP1 agonists
The glucagon-like peptide-1 receptor agonists, dulaglutide, exenatide, liraglutide and lixisenatide, should be reserved for combination therapy when other treatment options have failed.
154
Liraglutide
Proven cardiovascular benefit and should be considered in patients with type 2 diabetes and established cardiovascular disease.
155
HbA1c target for adults prescribed a single drug associated with hypoglycaemia (such as a sulphonylurea), or two or more antidiabetic drugs in combination
Aim for an HbA1c concentration of 53 mmol/mol
156
'Poorly controlled' diabetes
Rise of HbA1c to 58 mmol/mol (7.5%) or higher)
Drug treatment should be intensified, alongside reinforcement of advice regarding diet, lifestyle, and adherence to drug treatment.
157
STEMI
Complete blockage of the artery
158
NSTEMI
Partial blockage of the artery
159
AF ECG
Absence of the P wave
160
What medicines would you typically see for a patient who has undergone a renal transplant?
```
Mycophenolate
Tacrolimus
Prednisolone
Cimetidine
Atorvastatin
Aspirin
```
161
Carbapenems
Avoid if severe penicillin allergy
Seizure risk at high doses or in renal failure
Interaction: valproate (diminishes valproate levels)
162
Generations of cephalosporins
1st- Cefalexin, cefradine
2nd- Cefuroxime
3rd- Cetriaxone, ceftazidime
163
Tetracyclines
```
Avoid in pregnancy and in children
Avoid milk/dairy with tetracycline/oxytetracycline
Avoid antacids (iron and zinc preparations) may reduce the absorption as it chelates
```
164
Macrolides
QT interval prolongation
Erythromycin is useful as prokinetic
Common enzyme inhibitor- interacts with warfarin, carbamazepine, etc.
165
Clindamycin
A lincosamide
High risk of C.difficile- can cause colitis so be wary of diarrhoea (streaked with bright red blood)
166
Trimethoprim
Can affect the folate pathway- risk of severe bone marrow suppression with methotrexate
Can cause hyperkalaemia and hyponatraemia
167
Trimethoprim-warfarin
Increases the anticoagulant effect of warfarin
168
Trimethoprim- phenytoin
Increases the concentration of phenytoin
169
Aminoglycosides
Dosing based on weight and renal function
| Risk of nephrotoxicity and ototoxicity
170
Glycopeptides e.g. teicoplanin, vancomycin
Dosing based on weight and renal function
| Mainly gram positive/MRSA infections
171
Quinolones
```
Caution in under 12s
QT prolongation
May induce convulsions- esp with NSAIDs
Enzyme inhibitors- interactions!!
Risk of tendon damage
Iron, zinc, antacids and calcium reduce absorption
```
172
Nitrofurantoin eGFR
Avoid <45
173
TB treatment
INITIAL (12 months)
Rifampicin, Isoniazid, Pyrazinamide, Ethambutol
CONTINUATION (4 months)
Rifampicin, Isoniazid
174
Rifampicin
Strong enzyme inducer- interacts with COC, ciclosporin, rivaroxaban
Discolouration to teeth, urine, sweat, phlegm, discolours contact lenses
Monitor renal, hepatic and FBC
175
When to take rifampicin
On an empty stomach (1hr before food/2hrs after)
176
Ethambutol
Reversible ocular toxicity
177
When to take isoniazid
On an empty stomach (1hr before food/2hrs after)
178
Monitoring isoniazid
Renal + hepatic bloods
179
What bacterium can cause the infective exacerbation of COPD?
Streptococcus pneumoniae
180
Azoles e.g. fluconazole, itraconazoles
Prophylaxis + treatment of fungal infections
181
Imidazoles e.g. clotrimazole, miconazole, ketoconazole
Local treatment of vaginal thrush and dermatophytes
182
Shingles treatment
Aciclovir 800mg five times a day for 7 days
183
Threadworm treatment
<2 years refer to GP
| Repeat treatment 2 weeks after
184
Amphotericin B
Not interchangeable preparations- must be brand specified
Used for severe systemic fungal infections
Can cause nephrotoxicity
185
Vancomycin
Loading dose: 25-30mg/kg irrespective of renal function
Trough conc: 10-20mg/L
Risk of red man syndrome with vancomycin- slow IV infusion- do not exceed 10mg/min
Oral vancomycin isn't systemically absorbed- used for C diff
186
Bridging with DOACs
Not needed due to their fast onset of action
187
Childbearing age to consider for valproate
12-49
188
Indications for sodium valproate
Epilepsy
Bipolar disorder
(Off-license) Migraines
189
Fentanyl patches
Contraindicated in opioid-naive patients
Avoid head exposure- causes fentanyl to be released quicker
Use for longer than 3 months results in dependence
190
Monitoring for lithium
Assess renal, cardiac, and thyroid function before treatment initiation.
An ECG is recommended in patients with cardiovascular disease or risk factors for it. Body-weight or BMI, serum electrolytes, and a full blood count should also be measured before treatment initiation.
Monitor body-weight or BMI, serum electrolytes, eGFR, and thyroid function every 6 months during treatment, and more often if there is evidence of impaired renal or thyroid function, or raised calcium levels.
Lithium levels should be measured 3 monthly for the first 12 months, then 6 monthly. Unless the patient is deemed high risk. If dose changes are made, measure 1 week after.
191
Lithium counselling advice
Carry Purple book
Avoid dietary changes that affect sodium intake (low sodium= increased conc)
Seek medical attention if diarrhoea or vomiting- leads to sodium depletion that increases plasma lithium concentration
Avoid OTC NSAIDs
192
Lithium drug interactions
The plasma concentration of lithium is increased by ACE inhibitors, angiotenin II receptor antagonists, diuretics and NSAIDs resulting in increased plasma levels and toxicity
Interacts with amiodarone- both prolong QT interval
193
Lithium causes hypothyroidism
Prevents the secretion of thyroid hormones
194
Lithium-naproxen
Naproxen increases lithium levels
195
Target lithium concentrations
Maintenance: 0.4-1mmol/l
Elderly: lower end of the range
Acute episode of mania: 0.8-1mmol/l
196
Pre-renal causes of AKI
Hypovolaemia
Reduced cardiac output
Drugs that reduce blood pressure and circulating volume e.g. ACEs, ARBs, loop diuretics, NSAIDs
197
Renal causes of AKI
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Toxins and drugs (antibiotics, contrast media, chemo)
Vascular- thrombosis
Glomerular
Tubular
Interstitial
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198
Post-renal causes of AKI
Obstruction- renal stones, blocked cathetar
199
If patient with history of stroke is on citalopram (prolongs QT)
Switch to sertraline
200
Venlafaxine
can increase BP
201
First line for gout
NSAIDs (excluding aspirin)/colchicine (can be given if on anticoags)
202
Long term gout therapy
Xanthine-oxidase inhibitors: allopurinol or febuxostat.
Allopurinol is recommended as first-line urate-lowering therapy where renal function allows. Febuxostat can be used as an alternative when allopurinol is contra-indicated or not tolerated.
203
Thiazide and thiazide-like diuretics e.g. indapamide, bendroflumethiazide
Can cause hyperglycaemia and can antagonise oral antidiabetic meds
Can exacerbate gout
Can cause hypokalaemia- dangerous in severe CV disease and in patients who are taking cardiac glycosides (hypokalaemia= digoxin toxicity; in patients with hepatic impairment hypokalaemia may precipitate encephalopathy)
204
ACE inhibitors in pregnancy
Teratogenic risk- avoid
205
Mineralocorticoid
Used for hypotension- sodium and water retention, potassium loss
High mineralocorticoid and low glucocorticoid effect- fludrocortisone
206
Glucocorticoid
Used for diabetes, osteoporosis, peptic ulceration, muscle wasting, psychiatric reactions (sleep or mood disturbances)
High glucocorticoid effect- betamethasone, dexamethasone
207
NICE recommendation for smoking cessation
Use of long acting (patches) for constant nicotine and supplement with short acting form (lozenges, nasal spray or gum)
208
Vareniciline
Reduces seizure threshold
209
Bupropion
Increased risk of serotonin syndrome
210
> 10 cigarettes daily
High strength patch daily for 6-8 weeks, then medium strength for 2 weeks, then low strength for final 2 weeks
211
<10 cigarettes daily
Medium strength patch for 6-8 weeks, then low strength for 2-4 weeks
212
Theophylline
Can cause hypokalaemia- monitor if using concomitant salbutamol
Concentration increased in heart failure, liver impairment and viral infections
Decreased by smoking and alcohol consumption
213
Side effect of SGLT-2 inhibitors
Gangrene- would result in amputation
