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phase2a medicine > prescribing > Flashcards

prescribing Flashcards

information from the prescribing questions

1
Q

FP10D

A

yellow and issued by dentists

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2
Q

FP10MDA

A

blue

e.g. methadone

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3
Q

what should an FP10 include?

A 
prescriber's signature
prescriber's address
date
patient details 
information about product supplied
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4
Q

prescription charge

A

£8.60 (1st April 2017)

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5
Q

routes of administration

name 5

A 
oral (po)
intravenous (iv)
rectal (pr)
subcutaneous (sc)
intramuscular (im)
intra-nasal (in)
topical (top)
sublingual (sl)
inhaled (inh)
nebulised (neb)
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6
Q

vaccines given at 8 weeks

A

5 in 1: diphtheria, tetanus, whooping cough, polio, Hib
pneumococcal
rotavirus
meningitis B

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7
Q

administration routes of paracetamol

A

orally, per-rectum, intravenous

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8
Q

how do NSAIDs work?

A

inhibit cycle-oxygenase which catalyses the synthesis of prostaglandins and thromboxane from arachidonic acid
COX-1 is present in normal cells
COX-2 is induced by inflammatory cells

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9
Q

contraindications for NSAIDs

name 3

A

active or recurrent GI bleeding, active or recurrent GI ulceration, GI bleeding or ulceration related to NSAID use, severe heart failure, allergy to aspirin, renal failure, dehydration

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10
Q

use NSAIDs ‘with caution’ in patients with…

name 4

A

allergic disorders, cardiac impairment, cerebrovascular disease, coagulation defects, connective tissue disorders, Crohn’s disease, elderly, heart failure, ischaemic heart disease, peripheral arterial disease, risk factors for cardiovascular events, ulcerative colitis, uncontrolled hypertension

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11
Q

aspirin (and other NSAIDs) in asthmatics:

A

may cause bronchospasm (8-20%)

patients with chronic rhinitis or a history of nasal polyps are at greater risk

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12
Q

how do NSAIDs cause renal dysfunction?

A

they inhibit the biosynthesis of prostaglandins which maintain renal medullary blood flow

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13
Q

which patients are at risk of renal dysfunction caused by NSAIDs?

A 
neonates
elderly
patients with heart disease
patients with liver disease
patients with renal disease
patients with a reduced circulating blood volume
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14
Q

acute interstitial nephritis

A

a less common cause of renal impairment that becomes apparent after many months of NSAID use

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15
Q

how is metformin excreted?

A

it is cleared by active tubular secretion and is excreted unchanged in the urine

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16
Q

what is the elimination half life of a drug?

A

the time required for the serum concentration of the drug to reduce by 50%

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17
Q

what is there a risk of for patients on metformin given IV contrast?

A

lactic acidosis (mortality of 30-50%)

if more than 100ml of contrast is used, metformin should be withheld for 48hrs beforehand

if serum creatinine is normal the month before, <100ml of contrast may be given

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18
Q

which drugs require dose adjustment in renal impairment?

A

drugs that are excreted unchanged in the urine

esp. those with a narrow therapeutic index

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19
Q

ramipril

A

angiotensin converting enzyme inhibitor

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20
Q

what does ACE do?

A

it converts angiotensin I to Angiotensin II (a vasoconstrictor which also stimulates the release of aldosterone)

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21
Q

what do ACE inhibitors cause?

A

vasodilation and potassium retention

inhibition of salt and water retention

22
Q

when should renal function be checked for patients on ACEi?

A

before starting the drug, and 2-4 weeks after any increase in dose

check periodically during treatment, especially if there is renal impairment (patient is at risk of hyperkalaemia)

23
Q

how many patients get an ACE inhibitor cough?

A

10-30%

it is more common in women

24
Q

why does an ACE inhibitor cough occur?

A

accumulation of kinins in the lungs

25
Q

why are afro-carribean patients rarely given ACEi?

A

they commonly have low renin essential hypertension, where the RAAS is not contributing much to their hypertension

26
Q

options for contraception

name 4

A

contraceptive pill, contraceptive patch, vaginal ring, contraceptive injection, contraceptive implant, intra-uterine device, intra-uterine system, condoms, female condoms, contraceptive cap, contraceptive diaphragm

27
Q

the combined oral contraceptive pill

A

contains oestrogen and progesterone

suppresses ovulation by interfering with the gonadotrophin release by the pituitary via negative feedback on the hypothalamus –> prevents LH surge which triggers ovulation

cause the endometrium to become thinner which prevents implantation

cervical mucous becomes thicker –> more difficult for sperm to reach egg

28
Q

loperamide

A

opioid receptor agonist
reduces GI tract motility
allows more water to be absorbed from faecal matter

29
Q

what is folic acid needed for?

A

synthesis of thymidylate and purine nucleotides (therefore, it is needed for DNA synthesis)

30
Q

what is the action of methotrexate?

A

methotrexate is a reversible competitive inhibitor of dihydrofolate reductase (DHFR) - it prevents nucleic acid synthesis and causes cell death

31
Q

folic acid for patients on methotrexate

A

5mg once weekly on a different day to the methotrexate

32
Q

monitoring of patients on methotrexate

A

FBC, renal and liver function tests before starting treatment and repeated every 1-2 weeks until therapy stabilised

after this point, monitor patients every 2-3 months

33
Q

doxazasin

A

alpha-1-adrenergic receptor antagonist

antihypertensive

34
Q

tamsulosin

A

subtype-selective alpha-1-A and alpha-1-D adrenoreceptor antagonist

35
Q

intraoperative floppy iris syndrome (IFIS)

A

observed during cataract surgery in patients on alpha blockers - patient should let their surgeon know before the operation that they are taking them

36
Q

alpha blockers side effects

A

postural hypotension - try taking them at night to reduce problems

retrograde ejaculation in 30% men

37
Q

cyclosporin

A

T-lymphocyte suppressor of Th1 cells

inhibits production of interleukin-2 and other cytokines activated by lymphocytes

38
Q

therapeutic index

A

the range of doses at which a medication is effective without unacceptable adverse events

39
Q

drugs with a narrow therapeutic index

name 5

A

cyclosporin, gentamicin, vancomycin, warfarin, lithium, digoxin, theophylline, methotrexate, phenytoin, insulin

40
Q

how to monitor drugs

A 
plasma concentrations (phenytoin)
clinical effects (anti-hypertensives)
blood tests (warfarin and INR)
41
Q

how to take alendronic acid

A

take the tablet whole with plenty of water while sitting or standing
take on an empty stomach at least 30 minutes before breakfast
stay upright for at least 30 minutes after taking the tablet

42
Q

when to stop taking aldenronic acid and seek medical attention

A

symptoms of oesophageal irritation such as dysphagia, heartburn, pain on swallowing, or retrosternal pain

43
Q

letrozole

A

used in post-menopausal women with oestrogen receptor positive breast cancer

long-term use can contribute to osteoporosis (give alendronic acid and AdCal (vitamin D))

44
Q

action of alendronic acid

A

oral bisphosphonate

inhibits osteoclast mediated bone resorption

45
Q

St John’s Wort

A

herbal medicine used to treat the symptoms of mild and moderate depression

46
Q

St John’s Wort interactions

name 3

A

SSRIs, oral contraceptive pill, warfarin, cyclosporin, HIV medication, digoxin, statins

47
Q

first line medication for moderate depression

A

selective serotonin reuptake inhibitor

48
Q

prophylaxis

A

treatment given or an action taken to prevent disease

49
Q

clenil modulate

A

used for prophylaxis of asthma

50
Q

salbutamol

A

used to treat acute symptoms of asthma during exercise

51
Q

spacer

A

an add-on device used to increase the ease of administering aerosolised medication from a metered dose inhaler

phase2a medicine (53 decks)

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