Pass Medicine Flashcards
What factors may exacerbate psoriasis?
- trauma
- alcohol
- drugs : BB, lithium, antimalarials, NSAIDs and ACE-i, infliximab
- WD of systemic steroids
A 64-year-old man is diagnosed as being hypertensive. He is known to suffer from chronic heart failure secondary to alcoholic cardiomyopathy (NYHA class I). Which one of the following medications is contraindicated?
- lisinopril
- indapamide
- verapamil
- bisoprolol
V
The following medications may exacerbate heart failure:
- thiazolidinediones: pioglitazone is contraindicated as it causes fluid retention
- verapamil: negative inotropic effect
- NSAIDs/glucocorticoids: should be used with caution as they cause fluid retention.
low-dose aspirin is an exception - many patients will have coexistent cardiovascular disease and the benefits of taking aspirin easily outweigh the risks
4. class I antiarrhythmics : flecainide (negative inotropic and proarrhythmic effect)
Can a pt continue warfarin in pregnancy?
No! CI
most are swtiched to LMWH for whole of pregnancy
Which of the following should be avoided in pt with chronic heart failure ?
- ibuprofen
- PCM
- oral codeine
- tramadol
ibuprofen
- NSAIDs may cause fluid retention in heart failure
(low-dose aspirin is an exception)
what drugs are harmful in pregnancy?
Antibiotics
- tetracyclines
- aminoglycosides
- sulphonamides and trimethoprim
- quinolones: the BNF advises to avoid due to arthropathy in some animal studies
Other drugs - ACE inhibitors, angiotensin II receptor antagonists - statins - warfarin - sulfonylureas - retinoids (including topical) cytotoxic agents
The majority of antiepileptics including valproate, carbamazepine and phenytoin are known to be potentially harmful. The decision to stop such treatments however is difficult as uncontrolled epilepsy is also a risk
which drugs should be used with caution in patients with asthma?
NSAIDs
BB
adenosine:
-
What Abx for Rx of exacerbations of chronic bronchitis?
Amoxicillin
Tetracycline
Clarithromycin
Abx for lower UTI
Trimethoprim
(nitrofurantoin)
Alternative : amox or cephalosporin
Abx for acute pyelonephritis
Broad spectrum cephalosporin (e.g. cefotaxime) or quinolone (e.g. cipro)
Abx for acute prostatitis
Quinolone (e.g. cipro) or trimethoprim
Abx uncomplicated community-acquired pneumonia
Amoxicillin (doxy or clarithromycin in penicillin allergic, add fluclox if staphylococci suspected e.g. in influenza)
Abx for pneumonia possible caused by atypical pathogens
Clarithromycin
Abx HAP
Within 5 days of admission: co-amox or cefuroxime
More than 5 days after admission: tazocin OR a broad spectrum cephalosporin (e.g. ceftazidime) OR a quinolone (e.g. cipro)
What pts are classified as needing a statin for secondary prevention of CV events?
& what dose
Known ischaemic heart disease OR
Cerebrovascular disease OR
Peripheral arterial disease
ATORVASTATIN 80MG OD
What pts are classified as needing a statin for primary prevention of CV events?
& what dose?
QRISK >/= 10%
OR
most T1DM
OR
CKD if eGFR <60
20 MG ATORVASTATIN (consider titrating up if non-HDL has not fallen by >= 40%)
What drug to treat cellulitis?
Fluclox
or if allergic, clarithromycin, erythromycin
Treatment of c/diff
oral Metronidazole 10-14 days
vanc
What is the WHO analgesic ladder?
Step 1: Non-opioid analgesics
- paracetamol
- non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin
Step 2 : Mild opioid analgesics
- codeine
- dihydrocodeine
Step 3 :Strong opioid
- analgesics
- morphine
Should you prescribe an anti-inflammatory to a pt already taking aspirin?
As the patient is already taking aspirin it is best to avoid anti-inflammatories. Prescribing an anti-inflammatory to a patient taking aspirin both negates the anti-platelet effect and increases the risk of gastrointestinal bleeding.
Rx for urgency incontinence
- Oxybutynin hydrochloride/
- Tolterodine tartrate/
- Darifenacin
(#1 CI in frail, older women)
start at lowest dose
Mirabegron if (the above) anticholinergics are CI
Rx for SVT
vasovagal manouvres
6mg adenosine (if no asthma)
if this fails
give 12 mg?
Classification of asthma attack
Moderate: PEFR 50-75% best or predicted Speech normal RR < 25 / min Pulse < 110 bpm
Severe: PEFR 33 - 50% best or predicted Can't complete sentences RR > 25/min Pulse > 110 bpm
Life-threatening: PEFR < 33% best or predicted Oxygen sats < 92% Silent chest, cyanosis or feeble respiratory effort Bradycardia, dysrhythmia or hypotension Exhaustion, confusion or coma
Rx severe asthma attack
high-flow oxygen
inhaled short-acting beta2 agonist (salbutamol)
steroid:
- either oral prednisolone or IV hydrocortisone
Ipratropium bromide is useful if the response to the above treatment is poor but it is not a first-line drug.
What time of day should you give the first dose of an antihypertensive?
at night
to avoid first-dose postural hypotension
Rx angina, already on GTN spray
BB, (if CI: CCB)
aspirin and statin (all pts with any form of CVD should take these)
Rx suspected meningitis in ED
cefotaxime + amoxicillin
Emergency contraception
Levonorgestrel (within 72hrs - 3 days)
Ulipristal acetate (120hrs - 5 days)
what patients should hartmans not be used in?
those with hyperkalaemia - it contains potassium
Give some endocrine SEs of glucocorticoids and some MSK ones
endo:
- increased appetite/wt gain, hirtuism, hyperlipid
MSK:
- osteoporosis, proximal myopathy, AVN FH
When should you add a 2nd drug to a T2DM pt taking metformin?
can titrate up & encourage lifestyle changes to aim for HbA1c of 48 mmol/mol, but should only add a second drug if the HbA1c rises to 58 mmol/mol (7.5%)
what is the level classified as hypoxiaemic in spo2 terms
<94%
Drug causes of SIADH & what does SIADH do to electrolytes?
sulfonylureas (glimepiride and glipizide) SSRIs, tricyclics carbamazepine vincristine cyclophosphamide
HYPONATRAEMIA
mineralcorticoid SEs
& example
- fluid retention
- hypertension
Fludrocortison
Hydrocortisone
How to prevent contrast-induced nephropathy?
- adequate hydration
- IV 0.9% NaCl
When does BNF suggest gradual WD of systemic corticosteroids?
if patients have:
- received more than 40mg prednisolone daily for more than one week
- received more than 3 weeks treatment
- recently received repeated courses
what should all patients with CVD be taking?
a statin
& aspirin (or clopidogrel if stroke or have PAD)
What are some important thing to communicate to pt regarding alendronic acid?
- 30 mins before breakfast
- osteonecrosis of the jaw –> routine dentist
- oesophageal reactions: stop taking & seek medical attention if heartburn or pain on swallowing develops
what is hypoglycaemic awareness & what drug can reduce it?
ability to experience / percieve the symptoms of hypoglycaemia
beta blockers
Impetigo Rx
Topical fusidic acid
Oral flucloxacillin or erythromycin if widespread
Cellulitis Rx (if near the eyes or nose)
Co-amoxiclav (clarithromycin, + metronidazole if penicillin-allergic)
Erysipelas Abx
Flucloxacillin (clarithro, erythro or doxy if penicillin allergic)
Animal or human bite Abx
Co-amox (doxy + metronidazole if penicillin allergic)
Mastitis during breast-feeding Abx
Flucloxacillin
Abx throat infections
Phenoxymethylpenicillin (erythromycin alone if penicillin allergic)
Abx sinusitis
Amoxicillin or doxycycline or erythromycin
Abx Otitis media
Amoxicillin (E if pen-allergic)
Abx Otitis externa
Fluclox (E if pen-allergic)
[a combined topical Abx and corticosteroid is generally used for mild/moderate cases of otitis externa]
Abx periapical or peridontal abscess
amox
Gingivitis: acute necrotising ulcerative Abx
Metronidazole
Gonorrhoea Abx
IM ceftriaxone + oral azithromycin
Chlamydia Abx
Doxycycline or azithromycin
PID Rx
Oral ofloxacin + oral metronidazole
OR
IM ceftriaxone + oral doxycycline + oral metronidazole
Syphilis Rx
Benzathine benzylpenicillin
OR
Doxycycline or erythromycin
BV Rx
PO or topical metronidazole
OR
topical clindamycin
Rx campylobacter enteritis
Clarithromycin
Rx Salmonella (non-typhoid)
Ciprofloxacin
Rx Shigellosis
Ciprofloxacin
