Prescribing Flashcards
When can you give oestrogen only HRT and when can you give combined
No uterus = oestrogen only
Uterus = combined
Because of risk of endometrial hyperplasia/cancer on oestrogen only
Rules on periods and HRT
<50 patients have to have been period free for 24 months to qualify for continuous therapy - if not cyclical
>50 12 months for continuous
3 Alternative to hormone replacement therapy
1) Clonidine - Alpha blocker. Prevents vasomotor symptoms
2) Fluoxetine - SSRI
3) Venlafaxine - SNRI
8 Contraindications of HRT
Undiagnosed abnormal bleeding Endometrial cancer/hyperplasia Breast cancer hx Raised BP Hx of VTE Liver disease Cardiovascular disease Pregnancy
Example of oral oestrogen only medication
Estradiol - Estelle solo
example of transdermal oestrogen only
Estradiol - Evorel
Example of progesterone IUD
Levonorgestrol - Mirena
Example of oral combined
Estelle duet
Example of transdermal combined contraceptive
Evorel sequi = cyclical
Evorel conti = continuous
Side effects of progesterone
Mood swings weight gain acne fluid retention bloating
side effects of oestrogen
nausea/vom
breast tenderness
headaches
cramps
Reason for choosing transdermal over oral
Lower risk of headache, CVD, VTE
What drugs should be used to managed CKD caused by DM or hypertension
ACE-I
ARB
What drugs should be stopped in AKI/renal impairment
diuretics
NSAIDs
Rifampicin
ACE-I/ARB - may have been prescribed in CKD
ciclosporin
Lithium - may need dose reduction. Don’t completely stop. Same for digoxin
Opioids - morphine and codeine avoid. Swap codeine for oxycodone where possible.
Calcium channel blocker to be used in hypertension
Amlodipine (or nifedipine but don’t)
Ca blocker to use in unstable angina
Don’t use one!
Ca blocker to use in stable angina
Any. Amlodipine is safest choice.
Cardio selective Ca blockers
non-dihydropyradines - verapamil and diltiazem
Vascular selective Ca Blockers
dihydropyradine - amlodipine nifedipine
What Ca blockers are CI with B blockers
non-dihydropyradines - verapamil and diltiazem
Indications for Verapamil
Arrhythmias
SVT
CI of Ca blockers
Avoid non-d in HF and in AV conduction delay/heart block.
Avoid non-d along side a b blocker
Avoid in unstable angina and aortic stenosis
SSRI to prescribe in cardiac disease
Sertraline
Treatment for lactational mastitis
Flucloxacillin
Monitoring for patients on digoxin
digoxin levels (toxic) Potassium levels because digoxin raises potassium
Drugs that cause constipation
Opioids Anti-cholenergic drugs Iron supplements Anti-emetics Bisphosphonates Ondansetron
1st 2nd and 3rd line mx of constipation
Bulk forming - ishaghula husk
Osmotic - lactulose or macrocell
Stimulant - senna
CI for laxatives
Bowel obstruction
Faecal impaction
Antibiotics to prescribe in COPD exacerbation
Doxycycline
Amoxicillin
Clari
1) Drug to give in COPD exacerbations when patients who aren’t getting better. + Dose
2) Another supportive measure that can be done in unwell patients
1) Aminophylline 5mg/kg max
2) NIV
1) First 3 drugs of management of asthma exacerbation
2) 2 specialist drug which may be given
1) Steroids (pred 40-50mg daily or IV hydrocortisone 100mg). Nebulised salbutamol 2.5mg. Nebulised ipratropium 500mcg
2) Mg 1.2-2g IV. Aminophylline
1) Rules on maintenance fluid prescribing in stroke patients - why?
2) How much, water, K+, Na+, Cl- needed per day.
3) How much glucose needing in stable patient
1) No glucose in first 24 hours due to risk of cerebral oedema
2) 25-30ml/kg of water. 1mmol/kg of electrolytes
3) 50-100g/day of glucose
1) How much glucose in a 5% dextrose bag 1L
2) How much K+ in 1L 0.3% and 0.15%
1) 50g
2) 40mmol and 20mmol
What rate do you prescribe fluids for:
1) Resus
2) Dehydration
3) Maintenance
1) < 15 min
2) 4-6 hours
3) 8-12 hours
1) When do you prescribe resuscitations fluids
2) What fluid, volume and rate?
3) When to escalate
1) BP < 90. HR > 90. CRT > 2
2) 500mL saline. < 15 min. (250 in frail)
3) after 2L
Fluids to prescribe in hypoglycaemia
20% glucose in 100mLs
Progesterone only pills:
1) What counts as a missed pill
2) How to manage a missed pill
3) When might they need emergency contraception
1) traditional pill >3hrs from due. Desogestrol >12 hrs
2) Take the pill asap, might involve taking 2 pills at once. Use condoms for next 48 hours
3) Unprotected sex within the 48 hours they will require emergency contraception
COCP:
1) What counts as a missed pill
2) When is emergency contraception required
1) 24 hours late (48 hours from last pill)
2) 1 missed pill, just take it and you’re fine.
3) If 2 missed pills within the first 7 days of a pack
Management of gout.
If allergic to first line
Naproxen
Colchicine
Management of strep throat
If allergic to first line
Phenoxymethylpenicillin
Clarithromycin
1) First line emergency contraception option
2) Medical option
3) If the person if taking enzyme inducing drugs - what should be done
1) Copper coil
2) 1.5mg levonorgestrol.
3) Ideally copper coil. If not increase levo dose to 3mg
How to manage a patient on statins with raised LFTs
Raised = 3 times the upper limit in this case
stop statin for 1 month. See if LFTs come down, then restart at a lower dose.