Section 4: Providing information

Question 1

How long do SSRIs take to work?

Answer 1

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

Question 2

What are some side effects of SSRIs?

Answer 2

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

Question 3

What are the side effects/ risks of ACE inhibitors?

Answer 3

Increased risk of hyperkalemia

Teratogenic, switch for labetalol in pregnancy

Question 4

What is important advice to give patients starting on clozapine?

Answer 4

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!)

Question 5

What must be checked before starting azathioprine?

Answer 5

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

Question 6

What drugs cause agranulocytosis?

Answer 6

Carbimazole, clozapine, carbamazepine + azathioprine

Question 7

What anti-microbials are safe in pregnancy?

Answer 7

Penicillin and cephalosporins

Question 8

When do you avoid trimethoprim and nitrofurantoin in pregnancy?

Answer 8

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

Avoid nitrofurantoin in 3T

Question 9

What do you avoid when taking metronidazole?

Answer 9

Alcohol. Combination can cause profuse vomiting.

Question 10

How long before major surgery do you stop the COCP?

Answer 10

4 weeks before major surgery were long period of immobility predicted

Question 11

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?

Answer 11

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.

Question 12

What is important to tell patients taking MTX?

Answer 12

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

Question 13

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

Answer 13

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

Question 14

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

Answer 14

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

Question 15

What cancer does tamoxifen lead to increased risk of?

Answer 15

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

Question 16

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

Answer 16

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

Question 17

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

Answer 17

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

Question 18

How would you advise a patient starting on bisphosphonates?

Answer 18

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.

Question 19

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

Answer 19

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

Question 20

What advice to give with carbimazole?

Answer 20

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