SCA online - drug prescribing

Question 1

HRT in breast cancer counselling

Answer 1

HRT increases risk of breast Ca..
- in over 60s
- use longer than 5yrs
- Combined increases risk more than oestrogen only

Other risks:
VTE
CHD
Stroke
Obesity - this is the greatest factor, lost weight is better than avoiding HRT

Question 2

Recurrent UTI: after sex

Answer 2

Treat current UTI with Abx

Mx/
Lifestyle - Stay hydrated, urinate before and after sex, clean properly before and after sex, wipe from front to back.
Med - Stat antibiotic after sex
Follow up

Question 3

Recurrent UTI: Age related

Answer 3

Recurrent UTI in post menopausal women can be due changes within the urinary tract because of lower oestrogen levels.

Mx/
Treat current infection
Lifestyle - fluids, clean front to back, clean and urinate before and after sex.
Abx prophylaxis - either stat dose after sex, or low daily dose
Vaginal oestrogen (if no contraindication)
FU and refer if need

Question 4

Weight management

Answer 4

Lifestyle
- diet - reduce portions, more vegetables, high fibre
- exercise - >150min/ week
- Behavioural therapy - weight management programs, CBT

Med
- Orlistat - SE loose stools. Need to lose 5% BW within 3 months to continue prescribing.
- GLP-1 analogues (liraglutide, semaglutide) - BMI >30 or BMI >27 with co morbidities (HTN, T2DM etc) - weight loss clinic prescription

Surgery (refer to bariatric team)
- bariatric surgery

Question 5

AKI

Answer 5

Kidneys act as a filter, cleaning the blood and removing waste from urine. AKI is when the kidneys are not working as well as they should be.

Common causes
Pre - dehydration, D&V
Renal - drugs, nephritis, infection
Post - prostate, ca

Question 6

Anticoagulation in AF

Answer 6

CHADsVAS vs ORBIT (anaemia, Hx bleeding)

DOAC > Warfarin generally - use warfarin if CKD, prosthetic heart valves.

Avoid anticoagulation in <65 and no other risk factors

DOAC Counselling
- safety net - report any signs of bleeding/ bruising
- take DOAC with food and water
- carry anticoag card/ bracelet

Question 7

Chronic migraine

Answer 7

Acute
- triptans, NSAIDs, paracetamol, anti emetic

Prophylaxis
- B blocker (propranolol)
- Amitriptyline
- Topiramate (precaution young women)
- Behavioural therapies, acupuncture

CGRP inhibitors (monoclonal antibody medications)
- subcut injections
- need neurologist/ headache clinic to prescribe

Rule out medication overuse headaches before prescribing prophylaxis

Question 8

Chronic Pain

Answer 8

Long term pain condition - no further damage to tissue. Being on multiple pain medications can have serious health effects.

Mx/
Explain chronic pain
Mobilise more
Exercise therapy, physiotherapy, refer pain clinic
Discuss reducing pain meds inc opioids, gabapentinoids

Question 9

Addiction (Diazepam)

Answer 9

Big three Qs for addiction.
- Physical dependence/ withdrawal symptoms - anxiety, sweating, insomnia
- Psychological dependence - can not function without taking
- Tolerance- needing increasing doses to have the same effect

Risks of Diazepam/
MH - Cognitive impairment, depression, emotional blunting.
Phys - falls, respiratory depression
Soc - poor relationships, neglect

Mx/
- Drugs/ Alcohol team - gradual withdrawal under supervision
- SSRI/ mental health medication?
- CBT

Question 10

New Heart failure

Answer 10

Symptomatic - furosemide

Mx/
1st
- ACEi + BB
- Consider Antiplatelet (If ischaemic heart disease) + Statin (QRISK)
- Manage co morbidities - T2DM, HTN, obesity, smoking)
- Screen for depression
- Heart failure rehabilitation (when stable)
- Annual flu, one off pneumococcal vaccine
- Regular FU

2nd - Spironolactone

3rd - Empagliflozin - cardiology initiated