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Prescribing section Flashcards

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1
Q

What is the treatment for unstable angina?

A

300mg aspirin loading dose (then 75mg OD) unless significant risk of bleeding

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2
Q

What is the treatment for acute asthma?

A

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

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3
Q

What is the treatment for dyspepsia?

A

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

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4
Q

What medication is used for thromboprophylaxis?

A

LMWH or heparin as long as not bigger risk of bleeding
e.g. enoxaparin 20-40mg

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5
Q

What is the treatment for low severity community acquired pneumonia? (CAP) (CURB65 = 0)

A

Empirical oral antibiotics (Oral amoxicillin 500mg TDS for 5 days) or clarithromycin or doxycycline if allergic to penicillin

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6
Q

What is the treatment for moderate severity CAP (CURB65 1-2)?

A

Dual empirical oral/IV antibiotics. Amoxicillin + clarithromycin

Penicillin allergic: Doxycycline 200mg on day one, then 100mg each day after or erythromycin if pregnant

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7
Q

What is the treatment for high severity CAP (CURB65 3+)

A

Dual combo:
IV co-amoxiclav
+
Oral Clarithromycin

Penicillin allergic: Cefuroxime + clarithromycin

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8
Q

What is the treatment for HAP?

A

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

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9
Q

What is the definition of HAP?

A

Acquired 48hrs after admission

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10
Q

What is the treatment for bacterial meningitis?

A

Supportive treatment (sepsis 6)
Ceftriaxone
Dexamethasone

+ amoxicillin (or Bactrim if pen allergic) for Listeria if immunocompromised/elderly/pregnant

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11
Q

What is the treatment for cellulitis?

A

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

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12
Q

What is the treatment for pyelonephritis?

A

men/non-pregnant = co-amoxiclav or cefalexin for 7-10 days
Complicated/pregnant = cefalexin if oral, cefuroxime if IV

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13
Q

What is the treatment for infective endocarditis?

A

Start broad while awaiting sensitivities: amoxicillin +/- gentamicin (or if pen allergic/MRSA suspected, start vanc + gent)

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14
Q

What is the treatment for mild-mod pain?

A

Oral paracetamol 1g QDS PRN
NSAIDs if not C/I
Co-codamol (8mg codeine in)

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15
Q

What is the treatment for severe pain?

A

Morphine
Oxycodone if renally impaired

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16
Q

How do you prescribe maintenance fluids?

A

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)

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17
Q

What is the treatment for short course constipation?

A
  1. Bulk forming laxatives : e.g. Fybogel
  2. Osmotic: e.g. Laxido
  3. Stimulant: Senna
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18
Q

What is the treatment for opioid induced constipation?

A

Osmotic and stimulant (not bulk forming)

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19
Q

What is the treatment for faecal impaction?

A
  1. Macrogol
  2. Senna after 3 days of macrogol
  3. Enemas (e.g. phosphate enema)
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20
Q

What is the treatment for anaphylaxis? (adult)

A

500 micrograms adrenaline in a 1 in 1000 IM injection. Repeat in 5 mins if no improvement

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21
Q

What is the treatment for anaphylaxis (child 6-11 years)

A

300 micrograms adrenaline in a 1 in 1000 IM injection. Repeat in 5 mins if no improvement

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22
Q

What is the treatment for anaphylaxis (child 0-5 years)

A

150 micrograms adrenaline in a 1 in 1000 IM injection. Repeat in 5 mins if no improvement

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23
Q

What is the treatment for mild-mod allergy

A

Antihistamines:
Cetirizine hydrochloride (non-drowsy)
Promethazine/ chlormethazine (sedating)

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24
Q

What is the treatment for pneumonia in children?

A

Amoxicillin with/or macrolide (clarithromycin)

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25
What is the treatment for croup?
Oral dexamethasone +/- Oxygen Nebulised budesonide Nebulised adrenalin Intubation and ventilation
26
What is the treatment for epiglottitis?
IV ceftriaxone Oral dexamethasone
27
What is the treatment for GORD in children?
Gavsicon mixed with feeds Thickened feeds Omeprazole if needed
28
Which antiviral is used to treat Herpes simplex virus and varicellar zoster virus paediatric encephalitis?
Aciclovir (empirical treatment
29
Which antiviral is used to treat cytomegalovirus paediatric encephalitis?
Ganciclovir
30
What antibiotics for meningitis in under 3 month old children?
Cefotaxime + amoxicillin (to cover listeria)
31
What antibiotics for meningitis in over 3 month old children?
Ceftriaxone
32
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
33
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,
34
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)
35
What is the first line medical treatment of overactive bladder?
Oxybutynin (anticholinergic) Mirabegron (non-anticholinergic)
36
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
37
What is the normal dose for statins, for people whose Q-risk is above 10%?
Atorvastatin 20mg ON
38
What are the 4 A's of secondary prevention after CVS event?
Antiplatelet medication (aspirin, clopidogrel and ticagrelor) Atorvastatin 80mg Atenalol/Bisoprolol ACEi
39
How long are patients given dual antiplatelet therapy after an MI?
Aspirin 75mg lifelong Clopidogrel/ticagrelor (12 months)
40
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)
41
What medication is used in thrombolysis (when PCI is not available within 2 hrs)?
Alteplase
42
What is the management of pericarditis?
NSAID Colchicine (taken longer term)
43
What is the management of chronic heart failure?
ACEi Beta blockers Furosemide Spironolactone if ACEi and Betablockers not controlling symptoms
44
What is the treatment algorithm for rate control in AF?
1. Beta blocker 2. Calcium channel blocker (not diltiazem or verapamil in heart failure) 3. Digoxin (risk of toxicity)
45
What is the treatment algorithm for anticoagulation in AF?
1. DOAC (e.g. apixaban) 2. Warfarin if DOAC contraindicated
46
What is the treatment algorithm for SVT?
1. Vagal maneouvres 2. Adenosine 3. Verapamil or beta blocker 4. DCCV
47
If DCCV shocks are unable to correct a patient with SVT, what medication is used?
Amiodarone IV
48
What medication infusion is used in the acute management of torsades de pointes?
Magnesium infusion (even if their magnesium is fine)
49
What is the treatment algorithm for patients at risk of asystole?
IV Atropine (first line) Inotropes (e.g. isoprenaline or adrenaline) (second line)
50
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
51
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
52
What is the treatment for hypothyroidism
levothyroxine
53
What medications can be used in hyperaldosteronism?
Aldosterone antagonists: Eplerenone Spironolactone
54
What medications are used in the management of adrenal insufficiency?
Hydrocortisone (used to replace cortisol) Fludrocortisone (used to replace aldosterone)
55
What is the treatment algorithm in an adrenal crisis?
IV/IM hydrocortisone IV fluids Correct any hypoglycaemia
56
What is the dose of insulin infusion for someone in DKA?
Fixed rate insulin infusion (Actrapid iat 0.1 units/kg/hr
57
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
58
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
59
What medication is used to manage SIADH?
Vasopressin receptor antagonists (e.g. tolvaptan) - specialist use only!
60
What medication is used in managing diabetes insipidus?
Desmopressin (synthetic ADH)
61
What medications are used in phaeochromocytoma?
Alpha blockers (e.g. doxazosin) Beta blockers (only when established on alpha blockers)
62
What medication is used in prophylaxis of bleeding in stable oesophageal varices?
Non-selective beta blockers (e.g. propranolol)
63
What medications are used in bleeding oesophageal varices?
Vasopressin analogues (terlipressin or somatostatin) to cause vasoconstriction Also, propylactic broad-spectrum antibiotics
64
What medications are used in ascites?
Aldosterone antagonists (e.g. spironolactone)
65
What antibiotics are used to SBP?
IV Tazocin (after ascitic tap)
66
What medications are used in hepatic encephalopathy?
Lactulose +/- rifaximin/metronidazole (antibiotic)
67
What medications are used for alcohol withdrawal?
Chlordiazepoxide and Pabrinex
68
What medications can be used to cure Hep C?
Direct acting antiviral medications (e.g. sofosbuvir and daclatasvir)
69
What medication is used to manage autoimmune hepatitis?
High-dose steroids (e.g. prednisolone) or azathioiprine
70
What medication is used to treat wilson's disease?
Copper chelation: penilliamine or trientine
71
What medication is used to treat primary biliary cholangitis?
Ursodeoxycholic acid (protects cholangiocytes) Colestyroamine (for symptoms of pruritis)
72
What is the treatment algorithm for mild to moderate ulcerative colitis?
First line: Oral/rectal mesalazine (aminosalicylate) Second line: Corticosteroids (prednisolone
73
What is the treatment for acute severe ulcerative colitis?
IV hydrocortisone or IV ciclosporin or IV infliximab
74
What are the medications that can be used for maintaining remission in ulcerative colitis>?
Mesalazine or Azathioprine or Mercaptopurine
75
What medications should be used in the initial management of COPD?
SABA SAMA (e.g ipratropium bromide)
76
What medications should be used in asthmatic/steroid-responsive COPD?
LABA steroid inhaler
77
What medications should be used in non asthmatic/steroid-responsive COPD?
LABA LAMA
78
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
79
What medications can be used in idiopathic pulmonary hypertension?
Calcium channel blockers IV prostaglandins Endothelin receptor antagonist Sildenafil
80
What medication is used in moderate-severe sarcoidosis?
Long term oral steroids with bisphosphonate and PPI protection (first line) Methotrexate is second line
81
What drug is used to treat benzodiazepine overdose?
Activated charcoal (if within 1 hr of digesting0 Flumazenil (under specialist use only)
82
What antibiotic is used to treat chlamydia?
Doxycycline BUT if pregnant - need to use azithromycin or erythromycin
83
What is the first-line medication to treat ADHD
Methylphenidate hydrochloride
84
What antiplatelet medication should be used in a STEMI if the patient is about to go for PCI?
Prasugrel
85
What medication is recommended in T2DM to reduce risk of diabetic nephropathy when albumin:creatinine ratio is raised?
ACEi such as ramipril or ARB
86
When sensitivities are unknown, which antibiotic should be given for gonorrhoea?
IM ceftriaxone 1g as a single dose
87
What medication should be used in iron salt overdose (e.g. ferrous sulphate overdose)?
Desferrioxamine mesilate
88
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
89
What medication should be used to treat oral thrush in someone with HIV?
Fluconazole oral
90
What medication should be used in urge incontinence?
Oxybutynin
91
What medication should be used in stress incontinence?
Duloxetine
92
Which thiazide diuretic should be added to ACEi/ARB + CCB for third line treatment of hypertension?
Indapamide
93
What medication is used to reduce frequency of Raynaud's attacks?
Nifedipine
94
When prescribing anything for children, what should you make sure you look at on the BNF?
BNFC!!
95
What medication should be used to treat epiglottitis?
Cefotaxime
96
What medication should be used for pain relief for ankylosing spondylitis?
NSAIDS
97
Which macrolide is contraindicated in pregnancy?
Clarithromycin. Use erythromycin if pregnant
98
How frequently can a salbutamol nebuliser be repeated in acute asthma?>
Every 20-30mins as required
99
What is most important when giving medication to a patient who is vomiting?
To not give it orally! Give IV if possible
100
What medication is used to treat delirium tremens?
Lorazepam
101
What medication is used to treat alcohol withdrawal?
Chlordiazepoxide (+Pabrinex)
102
What mucolytic drug is used first line in Cystic fibrosis?
Dornase-alfa
103
What medication is used in breast cancer that is oestrogen receptor positive (premenopausal women)?
Tamoxifen
104
What is the second line treatment for COPD with asthmatic features?
LABA with ICS: e.g. formoterol with budesonide
105
Which PPIs interact with clopidogrel?
Omeprazole and esomeprazole
106
What medication can be used to help treat ascites?
Spironolactone
107

PSA revision (4 decks)

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