Medications

Question 1

Name one example of a mild topical corticosteroid (be specific)

Answer 1

Hydrocortisone 0.5%-1%
DERMAID

Question 2

Name one example of a moderate topical corticosteroid (be specific)

Answer 2

Methylprednisolone aceponate 0.1%
ADVANTAN

OR

Betamethasone valerate 0.02-0.05%
ANTROQUORIL, CELESTONE-M

OR

Triamcinolone acetonide 0.02-0.05%
TRICORTONE, ARISTOCORT

Question 3

Name one example of a potent topical corticosteroid (be specific)

Answer 3

Betamethasone diproprionate 0.05%
ELUPHRAT, DIPROSONE

OR

Betamethasone valerate 0.05-0.1%
BETNOVATE

OR

Mometasone furoate 0.1%
ELOCON, NOVASONE

Question 4

Name one example of a very potent topical corticosteroid (be specific)

Answer 4

Betamethasone diproprionate 0.05% in optimised vehicle
ELEUPHRAT OV, DIPROSONE OV

OR

Clobetasone proprionate 0.05%
CLOBEX

Question 5

Give some examples of potential side effects of topical steroids

Answer 5

• Skin atrophy
• Systemic adverse effects
• Stretch marks in armpits or groin area
• Enlarged or broken capillaries (Telangiectasia)
• Easy bruising of the skin
• Localised increased hair thickness and length
• Acne like changes
• Colour change in skin
• Periorificial dermatitis
• Steroid rosacea
• Pustular psoriasis
• Rare: glaucoma, cushing, growth retardation (unlikely from topical use)
• Red skin syndrome (rare reaction from inappropriate steroid use)

Question 6

For topical corticosteroids, what formulation is best when?

Answer 6

Ointments for dry, scaling rashes (occlusive effect) or mucocutaneous lesions

Creams for wet/oozing lesions

Lotions for hairy areas

Question 7

Renin-angiotensin system inhibitor AEs

Answer 7

Hypotension (more common in elderly)

Hyperkalaemia (increases with renal impairment)

AKI (caution when dehydrated)

Drug interactions (NSAIDs, diuretics, SGLT2i)

Cough

Allergy (angioedema)

Question 8

What medications may need to be withheld in CKD when unwell?

Answer 8

SADMANS
- sulfonylureas (reduced clearance -> ↑ AEs)
- ACEi
- diuretics
- metformin (reduced clearance -> ↑ AEs)
- ARBs
- NSAIDs
- SGLT2i

Question 9

Signs of lithium toxicity

Answer 9

N&V + diarrhoea
tremor, hyper-reflexia, ataxia, dysarthria
prolonged QT, hypotension

Question 10

Signs of serotonin toxicity

Answer 10

hyper-reflexia, clonus, shivering, tremor, hypertonia, rigidity
hyperthermia, sweating, flushing, mydriasis, tachycardia
agitation, anxiety, confusion, altered consciousness

Question 11

AEs of SSRIs, SNRIs and TCAs

Answer 11

SSRIs - headache, GI upset, sexual dysfunction, hyponatraemia, transient suicidality in young people

SNRIs - as above + HTN

TCAs - anticholinergic Sx (dry mouth, tremor) + cardiac (hypotension, tachycardia, prolonged QT)

Question 12

Common AEs of anti-psychotics

Answer 12

weight gain, dyslipidaemia, hyperglycaemia, hypertension
+ EPSEs eg. dystonia, Parkinsonism, tardive dyskinesia

Question 13

Life threatening AE of anti-psychotic

Answer 13

Neuroleptic malignant syndrome
1. EPSEs = lead-pipe rigidity, bradykinesia/akinesia, dystonia, dysphagia, tremor
2. Hyperthermia
3. Autonomic Sx = tachycardia, HTN, labile BP, sweating, tachypnoea
4. CNS Sx = drowsiness, confusion, coma

Question 14

Patient instructions for administering their thyroid hormone replacement

Answer 14

Take on an empty stomach with water, 30-60mins before food

Do not take with calcium or iron supplements

Ensure medication is stored correctly (ie. in the fridge if required)

Question 15

4 medications for long-term management of ischaemic heart disease

Answer 15

1. Aspirin
2. Statin
3. B-blocker (non-dihydropyridine CCB if BB CI)
4. ACEi

Question 16

Triple therapy for HFrEF

Answer 16

1. ACEi > ARB
2. B-blocker (HF specific - carvedilol, bisoprolol, nebivolol or metoprolol XL)
3. Mineralocorticoid receptor antagonist (spironolactone)

+ SGLT2i if criteria met