Planning management Flashcards by Lewis Liversedge

Management of acne vulgaris

1) Single topical therapy (BPO, topical retinoids)

2) Topical combination therapy (BPO + topical antibiotic or topical retinoid

3) Oral antibiotics (tetracycline, lymecycline, oxytetracycline, doxycycline)
COCP can be an alternative for women

4) oral isotretinoin

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Typical antipsychotics: important side effects

EPSEs: Parkinsonism, acute dystonia, akathisia, tardive dyskinesia

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Specific risk of antipsychotics in the elderly

Increased risk of VTE and stroke

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Common side effects of both typical and atypical antipsychotics

Anti-muscarinic: dry mouth, blurred vision, urinary retention, constipation
Sedation
Weight gain
Raised prolactin (less likely in atypical antipsychotics)
Impaired glucose tolerance
Neuroleptic malignant syndrome: pyrexia, muscle stiffness
Reduced seizure thresholds

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Antipsychotics: monitoring bloods

FBC, UEs, LFTs at start of therapy and annually

Lipids, weight at start of therapy, 3 months, annually

Fasted blood glucose, prolactin at start of therapy at 6 months, annually

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Other monitoring: antipsychotics

Just remember cardio stuff
BP
ECG
Cardiovascular risk assessment (annually)

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Benzodiazepines act on which channels

Enhance GABA by increasing the frequency of chloride channels

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What length of time should benzodiazepines be prescribed for

2-4 weeks

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If patients are withdrawn too quickly from BZPs, what may occur:

BZP withdrawal syndrome
Insomnia
irritability
anxiety
tremor
loss of appetite
perceptual disturbances

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2 non -drug contraindications of BREAST FEEDING

Galactosaemia
Viral infections

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Antibiotic contraindications during breast feeding (not necessarily pregnancy)

Ciprofloxacin, tetracycline, chloramphenicol, sulphonamides

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Psychiatric drugs which are contraindicated in breast feeding

Lithium
Benzodiazpines

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Other drugs which are contraindicated in breast feeding

Aspirin
Carbimazole
Methotrexate
Methotrexate
Sulfonylureas
Cytotoxic drugs
Amiodarone

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UKMEC 4 contraindications of COCP

> 35 years-old and more than 15 cigarettes/ day
Migraine with aura
History of VTE or ischaemic heart disease
Breast feeding < 6 weeks PP
Uncontrolled hyppertension
Current breast cancer
POSITIVE ANTI-PHOSPHOLIPID ANTIBODIES

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UKMEC 3 contraindications

> 35 <15 cigarettes/day
BMI > 35
Family history of thromboembolic disease
Controlled hypertension
Immobility: wheel chair use
Carrier of known gene mutations (BRCA1/ BRCA2
Current gall bladder disease

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Tx. FAECAL impaction in children

MOVICOL paediatric Plain
2) MOVICAL PLUS STIMULANT (if no response in 2 weeks)
3) Substitute a stimulant laxative singly or in combination w/ osmotic laxative such as lactulose if Movicol not tolerated

Maintenance therapy is a similar regime

COCP MoA

Inhibits ovulation

PoP MoA

Thickens cervical mucus
Desogestrel inhibits ovulation and thickens cervical mucus

Depot (medroxyprogesterone acetate) MoA

Inhibits ovulation and thickens cervical mucus

Implant MoA:

Inhibits ovulation and thickens cervical mucus

Copper coil MoA

Decreases sperm motility and survival -> inhibits IMPLANTATION

IUS (mirena coil) MoA

Prevents endometrial proliferation and thickens cervical mucus

All children with croup should receive:

DEXAMETHASONE (0.15mg/kg)

GAD tx.

1) Education and active monitoring
2) Self help
3) CBT +/- drug treatment

Drug treatment for GAD

First line is SERTRALINE if ineffective offer an alternative SSRI/SNRI If neither can be tolerated consider PREGABALIN

UKMEC4 for Nexplanon:

Current breast cancer

When can IUS and IUD be relied upon respectively:

IUS after 7 days (uses hormones) IUD immediately as more of a physical blockade

Lithium adverse effects: (LITHIVM

Leucocytosis Inspipidus (diabetes) Tremor/teratogenicity Hypothyroidism Increased weight V - vomitting Miscellaneous - ECG changes T wave flattening/inversion, acne, hyper calcaemia

Adverse effects of RETINOIDS (isotretinoin)

Teratogenicity Dry skin, eyes, lips/mouth Low MOOD Raised triglycerides Photosensitivity Hair thinning Nose bleeds Intracranial hypertension

Rosacea mx.

Predominant flushing/erythema -> Brimonidine gel as required Mild/moderate: topical IVERMECTIN alt. topical metronidazole or topical azaelic acid Moderate to severe papules and pustules TOPICAL IVERMECTIN w/ oral DOXYCYCLINE

SSRI most useful in pts. w/ previous MI

SERTRALINE

SSRI side effects

GI symptoms = most common side effect Increased of GI bleeding -> PPI should be offered if pt. also taking an NSAID

SSRI which prolongs the QT interval

CITALOPRAM 40 mg is maximum daily dose for adults 20 mg for elderly (plus 65 years) 20 mg for hepatic impairment

Should SSRIs be given with WARFARIN/HEPARIN

NO, instead use MIRTAZAPINE

Other interactions of SSRIs

Triptans (serotonin syndrome) MAOIs (serotonin syndrome)

Tricyclic antidepressants adverse effects

Drowsiness Dry mouth Blurred vision Constipation Urinary retention Lengthening of QT interval

Mx URGE incontinence

1) Bladder retraining (6weeks) 2) Anti-muscarinics (OXYBUTYNIN, Tolteridone, Darifenancin 3) Mirabegron may be used if there is concern about anticholinergic side effects in frail elderly patients

Mx. STRESS INCONTINENCE

1) Pelvic floor muscle training 2) surgical procedures - retropubic mid-urethral tape procedures 3) Duloxetine if women DECLINE surgical intervention