Prescribing section Flashcards
What is the treatment for unstable angina?
300mg aspirin loading dose (then 75mg OD) unless significant risk of bleeding
What is the treatment for acute asthma?
Salbutamol inhaler if moderate (100micrograms/dose) 2-10 puffs every 10-20 mins; or salbutamol nebuliser 5mg every 20-30 mins as required. Systemic steroid course: prednisolone 40mg OD PO for 5 days
If severe or life threatening: 5mg Salbutamol neb (every 20-30mins) + 500 micrograms Ipratropium bromide every 4-6 hours.
same steroid as above but can give IV hydrocortisone if necessary
Oxygen if required!
+/- magnesium sulphate or aminophylline if needed
What is the treatment for dyspepsia?
PPI (omeprazole 20mg OD PO) and diet and lifestyle changes, unless pregnant.
If pregnant: start with diet and lifestyle changes, then start with antacids such as gaviscon or then H2 antagonists such as famotidine
What medication is used for thromboprophylaxis?
LMWH or heparin as long as not bigger risk of bleeding
e.g. enoxaparin 20-40mg
What is the treatment for low severity community acquired pneumonia? (CAP) (CURB65 = 0)
Empirical oral antibiotics (Oral amoxicillin 500mg TDS for 5 days) or clarithromycin or doxycycline if allergic to penicillin
What is the treatment for moderate severity CAP (CURB65 1-2)?
Dual empirical oral/IV antibiotics. Amoxicillin + clarithromycin
Penicillin allergic: Doxycycline 200mg on day one, then 100mg each day after or erythromycin if pregnant
What is the treatment for high severity CAP (CURB65 3+)
Dual combo:
IV co-amoxiclav
+
Oral Clarithromycin
Penicillin allergic: Cefuroxime + clarithromycin
What is the treatment for HAP?
Oral co-amoxiclav
Doxycycline 200mg on day 1 and then 100mg in the days afterif pen allergic (if symptoms are mild/mod with low risk of resistance)
If severe/high risk of resistance: Piperacillin/tazobactam IV
+
if suspected or confirmed MRSA: vancomycin
What is the definition of HAP?
Acquired 48hrs after admission
What is the treatment for bacterial meningitis?
Supportive treatment (sepsis 6)
Ceftriaxone
Dexamethasone
+ amoxicillin (or Bactrim if pen allergic) for Listeria if immunocompromised/elderly/pregnant
What is the treatment for cellulitis?
Flucloxacillin oral/IV or clarithromycin if mild
If severe but not near eyes, nose or lower extremity: IV fluclox / IV clari
If severe + near eyes, nose or lower extremity,: oral/IV Co-amoxiclav or clarithromycin+metronidazole
What is the treatment for pyelonephritis?
men/non-pregnant = co-amoxiclav or cefalexin for 7-10 days
Complicated/pregnant = cefalexin if oral, cefuroxime if IV
What is the treatment for infective endocarditis?
Start broad while awaiting sensitivities: amoxicillin +/- gentamicin (or if pen allergic/MRSA suspected, start vanc + gent)
What is the treatment for mild-mod pain?
Oral paracetamol 1g QDS PRN
NSAIDs if not C/I
Co-codamol (8mg codeine in)
What is the treatment for severe pain?
Morphine
Oxycodone if renally impaired
How do you prescribe maintenance fluids?
25-30 ml/kg/day of water and
approximately 1 mmol/kg/day of potassium, sodium and chloride and
approximately 50-100 g/day of glucose to limit starvation ketosis
e.g. for 70kg man: 2L water, 70mmol of potassium, sodium and chloride, 50-100g glucose. 1 salty + 2 sweet,
1L dextrose saline + 40mmol potassium added (given over 8hrs), 1L dextrose saline + 20mmol potassium added (given over 4 hrs), 500ml dextrose saline + 20mmol potassium added (given over 4 hrs)
What is the treatment for short course constipation?
- Bulk forming laxatives : e.g. Fybogel
- Osmotic: e.g. Laxido
- Stimulant: Senna
What is the treatment for opioid induced constipation?
Osmotic and stimulant (not bulk forming)
What is the treatment for faecal impaction?
- Macrogol
- Senna after 3 days of macrogol
- Enemas (e.g. phosphate enema)
What is the treatment for anaphylaxis? (adult)
500 micrograms adrenaline in a 1 in 1000 IM injection. Repeat in 5 mins if no improvement
What is the treatment for anaphylaxis (child 6-11 years)
300 micrograms adrenaline in a 1 in 1000 IM injection. Repeat in 5 mins if no improvement
What is the treatment for anaphylaxis (child 0-5 years)
150 micrograms adrenaline in a 1 in 1000 IM injection. Repeat in 5 mins if no improvement
What is the treatment for mild-mod allergy
Antihistamines:
Cetirizine hydrochloride (non-drowsy)
Promethazine/ chlormethazine (sedating)
What is the treatment for pneumonia in children?
Amoxicillin with/or macrolide (clarithromycin)
What is the treatment for croup?
Oral dexamethasone
+/-
Oxygen
Nebulised budesonide
Nebulised adrenalin
Intubation and ventilation
What is the treatment for epiglottitis?
IV ceftriaxone
Oral dexamethasone
What is the treatment for GORD in children?
Gavsicon mixed with feeds
Thickened feeds
Omeprazole if needed
Which antiviral is used to treat Herpes simplex virus and varicellar zoster virus paediatric encephalitis?
Aciclovir (empirical treatment
Which antiviral is used to treat cytomegalovirus paediatric encephalitis?
Ganciclovir
What antibiotics for meningitis in under 3 month old children?
Cefotaxime + amoxicillin (to cover listeria)
What antibiotics for meningitis in over 3 month old children?
Ceftriaxone
What are the complete contraindications to the COCP?
are pregnant
are a smoker and over 35 years old
are over 35 years old and stopped smoking less than one year ago
have a BMI of greater than 35kg/m2
suffer from migraine with aura
are breastfeeding up to 6 weeks post-partum
have cardiovascular and venous thromboembolism risk factors
have a family history of breast cancer
What things score 3/4 on the UKMEC for COCP (risks outweigh benefits)
Obesity, multiple CVD risk factors, high blood pressure, immobility, family history of VTE, diabetic complications,
Contraindications to combined HRT:
Current, past, or suspected breast cancer
Known or suspected oestrogen-sensitive cancer
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia
Previous idiopathic or current venous thromboembolism (deep vein thrombosis or pulmonary embolism), unless the woman is already on anticoagulant treatment
Active or recent arterial thromboembolic disease (for example angina or myocardial infarction)
Untreated hypertension
Active liver disease with abnormal liver function tests
Porphyria cutanea tarda
Pregnancy
Dubin-Johnson and Rotor syndromes (or monitor closely)
What is the first line medical treatment of overactive bladder?
Oxybutynin (anticholinergic)
Mirabegron (non-anticholinergic)
What are the contraindications to anticholinergic medications?
myasthenia gravis.
hyperthyroidism.
glaucoma.
enlarged prostate.
hypertension (high blood pressure)
urinary tract blockage.
increased heart rate (tachycardia)
heart failure.
severe dry mouth
hiatal hernia
severe constipation
liver disease
Down syndrome
What is the normal dose for statins, for people whose Q-risk is above 10%?
Atorvastatin 20mg ON
What are the 4 A’s of secondary prevention after CVS event?
Antiplatelet medication (aspirin, clopidogrel and ticagrelor)
Atorvastatin 80mg
Atenalol/Bisoprolol
ACEi
How long are patients given dual antiplatelet therapy after an MI?
Aspirin 75mg lifelong
Clopidogrel/ticagrelor (12 months)
What is the management of stable angina?
GTN spray
Betablocker and/or calcium channel blocker (diltiazem and verapamil are both contraindicated in heart failure as they reduce the ejection fraction)
What medication is used in thrombolysis (when PCI is not available within 2 hrs)?
Alteplase
What is the management of pericarditis?
NSAID
Colchicine (taken longer term)
What is the management of chronic heart failure?
ACEi
Beta blockers
Furosemide
Spironolactone if ACEi and Betablockers not controlling symptoms
What is the treatment algorithm for rate control in AF?
- Beta blocker
- Calcium channel blocker (not diltiazem or verapamil in heart failure)
- Digoxin (risk of toxicity)
What is the treatment algorithm for anticoagulation in AF?
- DOAC (e.g. apixaban)
- Warfarin if DOAC contraindicated
What is the treatment algorithm for SVT?
- Vagal maneouvres
- Adenosine
- Verapamil or beta blocker
- DCCV
If DCCV shocks are unable to correct a patient with SVT, what medication is used?
Amiodarone IV
What medication infusion is used in the acute management of torsades de pointes?
Magnesium infusion (even if their magnesium is fine)
What is the treatment algorithm for patients at risk of asystole?
IV Atropine (first line)
Inotropes (e.g. isoprenaline or adrenaline) (second line)
What medication is used to control hyperthyroidism?
Carbimazole
+/- Levothyroxine titration (block and replace)
+/- beta blockers for symptomatic relief
Radioactive iodine is part of the treatment for hyperthyroidism
What is the treatment for thyroid storm?
Oral High dose anti-thyroid drug (e.g. propyluracil/carbimazole/etc.)
+
IV hydrocortisone
+
Propranolol
+ oral iodine/potassium iodide
What is the treatment for hypothyroidism
levothyroxine
What medications can be used in hyperaldosteronism?
Aldosterone antagonists:
Eplerenone
Spironolactone
What medications are used in the management of adrenal insufficiency?
Hydrocortisone (used to replace cortisol)
Fludrocortisone (used to replace aldosterone)
What is the treatment algorithm in an adrenal crisis?
IV/IM hydrocortisone
IV fluids
Correct any hypoglycaemia
What is the dose of insulin infusion for someone in DKA?
Fixed rate insulin infusion (Actrapid iat 0.1 units/kg/hr
What is the treatment algorithm for Type 2 diabetes (assuming lifestyle changes have been tried)?
First line: metformin (+SGLT-2 inhibitor such as dapagliflozin if patient has existing CVS disease or HF)
Second line: Add one of the following:
Sulfonylurea (gliclazide)/ pioglitazone/ DPP-4 inhibitor such as linagliptin/ SGLT-2 inhibitor such as dapagliflozin
Third line: metformin + 2 of second line drugs
Fourth line: insulin therapy
What medications can be considered in acromegaly where surgery is not suitable?
Somatostatin analogues (octreotide) to block GH release
Dopamine agonists (e.g. bromocriptine) to block GH release
Pegvisomant (GH receptor antagonist) - given by s/c injection
What medication is used to manage SIADH?
Vasopressin receptor antagonists (e.g. tolvaptan) - specialist use only!
What medication is used in managing diabetes insipidus?
Desmopressin (synthetic ADH)
What medications are used in phaeochromocytoma?
Alpha blockers (e.g. doxazosin)
Beta blockers (only when established on alpha blockers)
What medication is used in prophylaxis of bleeding in stable oesophageal varices?
Non-selective beta blockers (e.g. propranolol)
What medications are used in bleeding oesophageal varices?
Vasopressin analogues (terlipressin or somatostatin) to cause vasoconstriction
Also, propylactic broad-spectrum antibiotics
What medications are used in ascites?
Aldosterone antagonists (e.g. spironolactone)
What antibiotics are used to SBP?
IV Tazocin (after ascitic tap)
What medications are used in hepatic encephalopathy?
Lactulose
+/- rifaximin/metronidazole (antibiotic)
What medications are used for alcohol withdrawal?
Chlordiazepoxide and Pabrinex
What medications can be used to cure Hep C?
Direct acting antiviral medications (e.g. sofosbuvir and daclatasvir)
What medication is used to manage autoimmune hepatitis?
High-dose steroids (e.g. prednisolone)
or azathioiprine
What medication is used to treat wilson’s disease?
Copper chelation: penilliamine or trientine
What medication is used to treat primary biliary cholangitis?
Ursodeoxycholic acid (protects cholangiocytes)
Colestyroamine (for symptoms of pruritis)
What is the treatment algorithm for mild to moderate ulcerative colitis?
First line: Oral/rectal mesalazine (aminosalicylate)
Second line: Corticosteroids (prednisolone
What is the treatment for acute severe ulcerative colitis?
IV hydrocortisone
or IV ciclosporin
or IV infliximab
What are the medications that can be used for maintaining remission in ulcerative colitis>?
Mesalazine
or Azathioprine
or Mercaptopurine
What medications should be used in the initial management of COPD?
SABA
SAMA (e.g ipratropium bromide)
What medications should be used in asthmatic/steroid-responsive COPD?
LABA
steroid inhaler
What medications should be used in non asthmatic/steroid-responsive COPD?
LABA
LAMA
What is the treatment for PE?
Apixaban (first line)
LMWH treatment dose (second line)
IF massive PE with haemodynamic compromise –> continuous infusion of unfractionated heparin and thrombolysis with alteplase
What medications can be used in idiopathic pulmonary hypertension?
Calcium channel blockers
IV prostaglandins
Endothelin receptor antagonist
Sildenafil
What medication is used in moderate-severe sarcoidosis?
Long term oral steroids with bisphosphonate and PPI protection (first line)
Methotrexate is second line
What drug is used to treat benzodiazepine overdose?
Activated charcoal (if within 1 hr of digesting0
Flumazenil (under specialist use only)
What antibiotic is used to treat chlamydia?
Doxycycline
BUT if pregnant - need to use azithromycin or erythromycin
What is the first-line medication to treat ADHD
Methylphenidate hydrochloride
What antiplatelet medication should be used in a STEMI if the patient is about to go for PCI?
Prasugrel
What medication is recommended in T2DM to reduce risk of diabetic nephropathy when albumin:creatinine ratio is raised?
ACEi such as ramipril or ARB
When sensitivities are unknown, which antibiotic should be given for gonorrhoea?
IM ceftriaxone 1g as a single dose
What medication should be used in iron salt overdose (e.g. ferrous sulphate overdose)?
Desferrioxamine mesilate
What is the treatment algorithm for acute diverticulitis (uncomplicated as well as complicated)?
Uncomplicated: Oral Abx
Co-amoxiclav
or
(Penicillin allergy): trimethoprim with metronidazole
Complicated: IV Abx
Co-amoxiclav, or cefuroxime with metronidazole, or amoxicillin with gentamicin and metronidazole
or
(penicillin allergy): ciprofloxacin with metronidazole
What medication should be used to treat oral thrush in someone with HIV?
Fluconazole oral
What medication should be used in urge incontinence?
Oxybutynin
What medication should be used in stress incontinence?
Duloxetine
Which thiazide diuretic should be added to ACEi/ARB + CCB for third line treatment of hypertension?
Indapamide
What medication is used to reduce frequency of Raynaud’s attacks?
Nifedipine
When prescribing anything for children, what should you make sure you look at on the BNF?
BNFC!!
What medication should be used to treat epiglottitis?
Cefotaxime
What medication should be used for pain relief for ankylosing spondylitis?
NSAIDS
Which macrolide is contraindicated in pregnancy?
Clarithromycin.
Use erythromycin if pregnant
How frequently can a salbutamol nebuliser be repeated in acute asthma?>
Every 20-30mins as required
What is most important when giving medication to a patient who is vomiting?
To not give it orally! Give IV if possible
What medication is used to treat delirium tremens?
Lorazepam
What medication is used to treat alcohol withdrawal?
Chlordiazepoxide
(+Pabrinex)
What mucolytic drug is used first line in Cystic fibrosis?
Dornase-alfa
What medication is used in breast cancer that is oestrogen receptor positive (premenopausal women)?
Tamoxifen
What is the second line treatment for COPD with asthmatic features?
LABA with ICS: e.g. formoterol with budesonide
Which PPIs interact with clopidogrel?
Omeprazole and esomeprazole
What medication can be used to help treat ascites?
Spironolactone
