Section 4: Providing information Flashcards

1
Q

How long do SSRIs take to work?

A

SSRIs can take up to 6 weeks before patients see an improvement, may worsen depression before alleviating it

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2
Q

What are some side effects of SSRIs?

A

The most common is a dry mouth. May also lead to serotonin syndrome (if on multiple SSRIs, ecstasy) ~ agitation, pyrexia, hallucinations

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3
Q

What are the side effects/ risks of ACE inhibitors?

A

Increased risk of hyperkalemia

Teratogenic, switch for labetalol in pregnancy

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4
Q

What is important advice to give patients starting on clozapine?

A

If the patient experiences a sore throat or feels unwell, they should seek medical attention (risk of agranulocytosis - only try if 2 others antipsychotics have failed)

Note: regular monitoring is required (but not most important!)

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5
Q

What must be checked before starting azathioprine?

A

Check TPMT activity/ levels. If absent, azathioprine is contraindicated.

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6
Q

What drugs cause agranulocytosis?

A

Carbimazole, clozapine, carbamazepine + azathioprine

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7
Q

What anti-microbials are safe in pregnancy?

A

Penicillin and cephalosporins

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8
Q

When do you avoid trimethoprim and nitrofurantoin in pregnancy?

A

Avoid trimethoprim in 1T (try tri in 3T)

Avoid nitrofurantoin in 3T

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9
Q

What do you avoid when taking metronidazole?

A

Alcohol. Combination can cause profuse vomiting.

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10
Q

How long before major surgery do you stop the COCP?

A

4 weeks before major surgery were long period of immobility predicted

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11
Q

If a patient misses 1 pill and is 4h late for her 2nd pill at the start of the pack, what advice would you give her?

A

Ensure she takes both pills now (only considered late if >24h after) and carry on as normal. No need for emergency contraception. Carry on with the normal 7 day pill break.

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12
Q

What is important to tell patients taking MTX?

A

Avoid conception while taking it and for 6 months after (both men and women)

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13
Q

A patient on ramipril for hypertension is planning pregnancy. What do you do with her antihypertensive Tx?

A

Stop ramipril - it can be teratogenic. Replace with labetalol before conception.

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14
Q

What is an important side effect of tamoxifen to warn patients about?

A

Tamoxifen increases the risk of VTE. Look out for signs of DVT e.g. leg swelling, pain, readness.

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15
Q

What cancer does tamoxifen lead to increased risk of?

A

Endometrial cancer. May also be implicated in increased cervical cancer risk e.g. polyps.

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16
Q

How often does INR need to be monitored in patients on warfarin?

A

Initially, weekly blood tests until dose is stabilised. After this, perform tests monthly.

17
Q

What is important to co-prescribe in elderly patients on long-term steroid therapy e.g. polymyalgia rheumatica?

A

An H2 antagonist (ranitidine) or PPI (omeprazole) to reduce gastric irritation. Consider bisphosphonate to reduce risk of osteoporosis.

18
Q

How would you advise a patient starting on bisphosphonates?

A

On an empty stomach (>30 min bef breakfast), take the tablet with a full glass of water and remain upright for 30 min afterward. Avoid calcium supplements and food for 30-60min, which will reduce absorption.

19
Q

What drugs should be avoided in combination with iron or calcium?

A

Levothyroxine and bisphosphonates, as the metal ions bind the drugs in the GI tract, reducing absorption

20
Q

What advice to give with carbimazole?

A

Report symptoms of infection, bleeding - risk of agranulocytosis
Women to be on effective contraception - risk of teratogenicity