Planning management Flashcards
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
Typical antipsychotics: important side effects
EPSEs: Parkinsonism, acute dystonia, akathisia, tardive dyskinesia
Specific risk of antipsychotics in the elderly
Increased risk of VTE and stroke
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
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
Other monitoring: antipsychotics
Just remember cardio stuff
BP
ECG
Cardiovascular risk assessment (annually)
Benzodiazepines act on which channels
Enhance GABA by increasing the frequency of chloride channels
What length of time should benzodiazepines be prescribed for
2-4 weeks
If patients are withdrawn too quickly from BZPs, what may occur:
BZP withdrawal syndrome
Insomnia
irritability
anxiety
tremor
loss of appetite
perceptual disturbances
2 non -drug contraindications of BREAST FEEDING
Galactosaemia
Viral infections
Antibiotic contraindications during breast feeding (not necessarily pregnancy)
Ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
Psychiatric drugs which are contraindicated in breast feeding
Lithium
Benzodiazpines
Other drugs which are contraindicated in breast feeding
Aspirin
Carbimazole
Methotrexate
Methotrexate
Sulfonylureas
Cytotoxic drugs
Amiodarone
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
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
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
