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A - Pre-reg Exam COPY > Low weight topics. > Flashcards

Low weight topics. Flashcards

1
Q

What is the treatment for arthritis?

A

DMARDs+ temporary corticosteroid

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2
Q

Which medicines are DMARDs?

A

Sulfasalazine (blood disorders)
Penicillamine (blood disorders)
Gold (blood disorders)
Hydrocychloroquine/ chloroquine (ocular toxicity)

Drugs affecting immune response:
methotrexate, azathioprine, ciclosporin, leflunamide

cytokine modulators:
Infliximab, etanacept (blood disorders, TB- treat first)

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3
Q

How is acute gout managed?

A

NSAIDs: diclofenac and naproxen first line (NOT ibuprofen/aspirin)
2nd line: colchicine (if NSAIDs contraindicated e.g in HF)

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4
Q

How is gout managed long term?

A

Allopurinol (take with food)
Febuxostat (causes serious hypersensitivity reactions like SJS)

DO NOT them during an attack, wait 1-2 weeks first.
Continue NSAID/ colchicine for 1 month after hyperuricemia corrected if starting on allopurinol as they may precipitate an attack.

However, if attack occurs while on them, continue as normal and treat attack.

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5
Q

What is myasthenia gravis?

A

Skeletal muscle weakness

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6
Q

What are some key side effects of quinine?

A

QT prolongation, convulsions, arrhythmias.

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7
Q

What drug options are there for spasticity (skeletal muscle relaxants)?

A

Baclofen- avoid abrupt withdrawal. Care with intrathecal use, you need a test dose + resuscitation available.

Others: dantroline, tizanidine, cannabis, diazepam.

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8
Q

When do the analgesic and inflammatory effects of NSAIDs take effect?

A

analgesic effect within 1 week

inflammatory effect within 3 weeks

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9
Q

Which NSAID is the drug of choice for inflammation?

A

Naproxen

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10
Q

Which medical conditions may be worsened by use of NSAIDs?

A

Asthma- bronchospasms.
HF- fluid retention- contraindicated.
Hypertension

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11
Q

Which NSAID has restricted use due to increased GI side effects and serious skin reactions?

A

Piroxicam - max 20mg OD

Prescribe with concomitant GI protective agent.

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12
Q

Which NSAIDs are lowest and highest risk of GI toxicity?

A

Lowest: COX-2 inhibitors (e.g celecoxib), ibuprofen

Highest risk: Ketoprofen, proxicam

Give with PPI if >45 or if NSAID is for arthritis and take with food to minimise this.

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13
Q

Which NSAIDS are at highest and lowest risk of cardiovascular events?

Which cardiovascular events?

A

Highest risk- high dose ibuprofen 2.4g OD, COX-2 inhibitors, diclofenac.

Lowest risk: low dose ibuprofen and naproxen

Increased risk of thrombotic events (MI and stroke)

NOTE: NSAIDS are contraindicated in HF.

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14
Q

Can NSAIDs be used in pregnancy?

What happens?

A

No- especially third trimester.

Delays labour
Causes pulmonary hypertension in newborn
Premature closure of foetal ductus arteriosus.

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15
Q

What are some side effects of NSAIDs?

A 
Bleeds (especially GI)
Fluid + sodium retention- oedema 
Asthma exacerbation
Nephrotoxicity
Cardiovascular events
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16
Q

Which medicine when used with NSAIDs can cause convulsions?

A

Quinolones- e.g cipro.

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17
Q

NSAIDs can reduce excretion and hence cause toxicity of which high risk drugs?

A

Methotrexate and lithium.

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18
Q

Which medicine can cause reversible female infertility?

A

NSAIDs

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19
Q

When should eye drops be discarded?

A

After 28 days if at home
After 1-2 weeks if in hospital
Single use only if outpatient/ surgery.

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20
Q

Which medicines can stain contact lenses orange?

A

Rifampicin and sulfasalazine.

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21
Q

If using more than one eye drop how long should a patient wait between applications?

A

5 minutes

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22
Q

What is glaucoma?
How is it managed?
Do the medicines have any side effects?

A

Raised intraocular pressure

1st line: beta blocker drops e.g timolol (C/I in asthma)
or
prostaglandin drops e.g latanoprost (can cause long eyelashes and darker iris colour/ dark flecks in the eye)

2nd line: sympathomimetic drops e.g brimonidine
carbonic anhydrase inhibitors e.g dorzolamide . Acetazolamide can be given systemically but it can cause blood and skin reactions- STOP.

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23
Q

What do you know about systemic chloramphenicol?

A

Serious haematological side effects.

AVOID in pregnancy- grey baby syndrome

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24
Q

What is closed angle glaucoma?

A

A medical emergency!

Cloudy eye, N+V headache, intense eye pain, rainbow coloured rings around lights.

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25
Q

How can otitis external be managed?

A

Topical preparations such as neomycin and clioquinol can be used- 7 days.
Acetic acid 2% (ear calm) can also help.

NOTE: aluminium is an astringent and also helps as an anti- inflammatory.

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26
Q

How can otitis media be managed?

A

Usually self limiting.

Can give oral amoxicillin if no improvement after 72 hours.

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27
Q

What is in naseptin and bactroban?

A

naseptin- neomycin

bactroban- mupirocin (for MRSA)

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28
Q

What is the MHRA associated with emollients?

A

Fire risk with paraffin- based skin emollients.

Clothing/ bedding easily ignited by naked flames, do not smoke.

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29
Q

What can Benzyl alcohol cause in neonates?

A

Fatal toxicity syndrome

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30
Q

When can topical corticosteroids be used? When are they contraindicated?

A

Used in inflammatory skin conditions: eczema, dermatitis.

Contraindicated in: acne, rosacea, skin infections (exacerbates them)

NOTE: apply maximum BD

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31
Q

Which are the mild, moderate, potent, very potent steroids?

A

Very potent:
clobetasol (dermovate)

Potent:
Betamethasone 0.1% (betnovate)
hydrocortisone butyrate
mometasone (elocon)

Moderate:
clobetasone (eumovate)
betamethasone 0.025% (betnovate- RD)

Mild:
hydrocortisone <2.5%

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32
Q

What medicines are used for eczema and psoriasis?

A 
emolients
topical steroids
coal tar ( long contact overnight)
dithranol (short contact 5-60 minutes)
Tacrolimus (Protopic)

Psoriasis: UVB therapy, system methotrexate, cyclosporin, acitretin.

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33
Q

What MHRA alerts are associated with brimonidine?

What is it for?

A

For rosacea

Risk of systemic cardiovascular effects
Risk of exacerbation of rosacea

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34
Q

What medicines can be used for acne?

A

1st line: adapaline (retinoid) +/- bezoyl peroxide
azelaic acid
topical- clindamycin

Oral- oxytetracycline, lymecycline, trimethoprim
co cyprindiol (women only)
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35
Q

What are the PPP terms for isotretinoin supply?

A

Negative pregnancy test on script
Prescription valid only 7 days
Max 30 days supply
Cant give as emergency supply without negative pregnancy test.

36
Q

What are side effects of tretinoins?

A

Teratogenic - contraception during and 1 month after stopping.
Hyperlipidemia - contraindicated
Pancreatitis- STOP ASAP
Hepatotoxicity
psychiatric disorders- STOP
Photosensitivity- Avoid UV light and use high factor sunscreen.

NOTE: avoid waxing, laser etc during + 6 months after treatment.

37
Q

Which contraceptives are not effective with tretinoin use?

A

Progestogen only

38
Q

What is the MHRA advice associated with tretinoins?

A

Erectile dysfunction and decreased libido

39
Q

What are lower limb infections spreading around a wound likely to be?

A

Cellulitis

40
Q

How should impetigo be managed?

A

Bacterial:
Fusidic acid (5 days)
If extensive: Oral flucloxicillin or Clarithromycin (7 days)

If MRSA: mupirocin.

41
Q

How should scabies be managed?

A

1st line: permethrin 8-12 hours
2nd line: malathion 24 hours

Apply to whole body
Treat all members of household simultaneously
Second application within a week of the first
Itch can last after treatment- use crotamiton. (topical steroids and antihistamines also help)
Ivermectin used for Norwegian scabies.

42
Q

How is headlice managed?

A

** Only treat if live lice
1st line: wet combing or Dimeticone (Hedrin)
Isopropyl myristate (full marks)
Malathion (Derbac M)

Risk of burns if hair exposed to flames
Contact time 8-12 hours
Two applications a week apart.
Wet combing- 4 times over 2 weeks. No lice on 3 consecutive questions.

NOTE: Permethrin (lyclear) is not recommended as 10 mins contact time is not enough to be effective.

43
Q

Which immunisations are needed at birth for at risk neonates?

A

BCG (TB) and hep B

44
Q

Which immunisations are needed at 2 months (8 weeks)?

A

6PMR

6in1- diphtheria, tetanus, pertussis, hep B, polio, haemophillus

Pneunococcal
Meningitis B
Rotavirus (oral)

45
Q

Which immunisations are needed at 3 months (12 weeks)?

A

6R

6in1- diphtheria, tetanus, pertussis, hep B, polio, haemophillus (dose 2)

Rotavirus (dose 2)

46
Q

Which immunisations are needed at 4 months (16 weeks)?

A

6PM

6in1- diphtheria, tetanus, pertussis, hep B, polio, haemophillus (dose 2)

Pneumococcal (dose 2)
Meningitis B (2nd dose)
47
Q

Which immunisations are needed at 1 years (12- 13 months)?

A

Harry Makes Mummy Pretty Mad

Haemophillus + Meningitis C (combined)
Meningitis C (booster)
MMR 
Pneumococcal (booster)
Meningitis B (booster)
48
Q

Which immunisations are needed between 2-8 years old?

A

Flu vaccine each year from September (nasal spray recommended)

49
Q

Which immunisations are needed between 3 years and 4 months (40 months) - 5 years old?

A

MMR (dose 2)

DTPP (6 in 1 without Hs)- diphtheria, tetanus, polio, pertussis (booster)

50
Q

Which immunisations are needed between 11-14 years old (12- 13 in England)?

A

HPV

51
Q

Which immunisations are needed between 13- 15 years old?

A

Meningitis ACWY

DTP- diphtheria tetanus polio (booster)

52
Q

Which immunisations are needed at 65 years old?

A

Pneumococcal

Flu vaccine each year from September

53
Q

Which immunisations are needed at 70 years old?

A

Varicella zoster (shingles)

54
Q

In which allergy can you not give the flu jab?

A

egg allergy

55
Q

When should live vaccines be avoided?

A

Immunocompromised patients

56
Q

What is the paracetamol dose for post immunisation fever?

A

2 months+ weighing over 4kg:

60mg (2.5ml) asap
60mg repeated 4-6 hours later if needed.

Max 2 doses in 24 hours (4 doses if >4 months)

57
Q

What is the ibuprofen dose for post immunisation fever?

A

3 months+ weighing over 5kg:

50mg(2.5ml) asap
50mg repeated after 6 hours if needed.

Max 2 doses (100mg) in 24 hours.

58
Q

What is the difference between vaccines and immunoglobulins?

A

Vaccines stimulate the immune system to produce antibodies (pre-exposure prophylaxis)

Immunoglobulins contain antibodies already and are given post exposure to the infection.

59
Q

Which vaccination affects the Mantoux test for TB?

A

MMR

Wait 4 weeks post MMR before doing the test.

60
Q

Which vaccine leaves a scar which is fine and means that the vaccine has worked?

A

BCG (TB)

61
Q

When should infants have all live vaccines postponed until 6 months old?

A

Exposure to TNF-a- inhibitors in utero from the mother.

Examples: monoclonal antibodies.

62
Q

Which vaccine should be offered to pregnant women and when?

A

Pertussis (whooping cough)

At 16-32 weeks gestation.

63
Q

Via which parenteral route are vaccines given?

A

IM or deep subcut.

NOT IV.

64
Q

What may the MMR vaccine cause?

A

Post- vaccination aseptic meningitis. Complete recovery normally follows.

idiopathic thrombocytopenia purport. Usually within 6 weeks f dose.

NOTE: not linked to autism or bowel disease.

65
Q

Which drug is used for reversal of neuromuscular blockade of anaesthetics?

A

Anticholinesterases:

Neostigmine

66
Q

What are antimuscarinics used for in surgery?

A

Atropine, glycopurronium

To reduce secretions in intubation.

67
Q

What should be given with inhalation anaesthetics?

A

Oxygen minimum 25% at all times to prevent hypoxia.

68
Q

Which drugs should NOT be stopped before surgery?

A 
Antiepileptics
antiparkinsons
antipsychotics
bronchodilators
Cardiovascular meds (except K+ sparing diuretics)
Corticosteroids
Immunosuppressants
thyroid and anti-thyroid meds
69
Q

Which drugs should be stopped before surgery and when?

A 
Combined oral contraceptives- 4 weeks 
HRT- 4-6 weeks before
MAOIs- taper down 2 weeks before
TCAs (cause hypotension)
Lithium - 24 hours before
K+ sparing diuretics
ACE/ARBs/ diuretics- day of surgery AKI risk
Antiplatelets
Warfarin- 5 days before INR <1.5
Insulin- start VRII
70
Q

Which poisons have a delayed toxicity effect?

A

paracetamol, iron, aspirin, TCAs

71
Q

At what systolic BP is there a risk of irreversible brain damage?

A

<70mmHg

72
Q

When can activated charcoal NOT be used for poison reversal?

A

iron, lithium, cyanides, alcohol.

73
Q

What do you know about alcohol toxicity?

A

causes hypoglycaemia

Reverse with: gastric lavage (stomach pump)

74
Q

What does aspirin toxicity cause and how is it reversed?

A

Tinnitus, deafness, sweating

Activated charcoal and if plasma conc >700mg/L, haemodialysis.

75
Q

What does opioid toxicity cause and how is it reversed?

A

Pinpoint pupils, coma, respiratory depression

Naloxone

76
Q

What does paracetamol toxicity cause and how is it reversed?

A

N+V, liver necrosis, renal necrosis

Activated charcoal,
acetylcisteine if 4-15 hours post and plasma conc on or above the treatment line.

77
Q

What is the dosing of acetylcisteine?

A

> 40kg patients only
3 infusions over 21 hours- dose based on weight chart.

1st: drug + 200ml 5% glucose over 1 hour
2nd: drug + 500ml 5% glucose over 4 hours
3rd: drug + 1L 5% glucose over 16 hours

78
Q

What does TCA toxicity cause and how is it reversed?

A

dilated pupils, acidosis, coma, respiratory depression, delirium, arrhythmias

Activated charcoal, treat acidosis.

79
Q

What does benzodiazepine toxicity cause and how is it reversed?

A

drowsy, ataxia, nystagmus, respiratory depression

flumazenil, activated charcoal

80
Q

What does beta blocker toxicity cause and how is it reversed?

A

bradycardia, hypotension

Treat bradycardia and cariogenic shock: atropine, isoprenaline, glucagon

81
Q

What does iron toxicity cause and how is it reversed?

A

N+V, haematemesis, rectal bleeding

Desferrioxamine

82
Q

What does lithium toxicity cause and how is it reversed?

A

N+V diarrhoea, coma

Haemodialysis, stomach pump, bowel irrigation

83
Q

What does stimulant (amphetamines, cocaine, ecstasy) toxicity cause and how is it reversed?

A

dilated pupils, arrhythmia

diazepam for restlessness/ seizures

84
Q

What does theophylline toxicity cause and how is it reversed?

A

severe vomitting, arrhythmia, seizures, severe hypokalaemia

Activated charcoal, ondansetron, K+ supplements

85
Q

How is cyanide toxicity reversed?

A

dicobalt (toxic)
sodium nitrite + sodium thiosulfate
hydroxocobalamin (cyanosis only)

86
Q

What does anaesthetic toxicity cause and how is it reversed?

A

Light headedness, paraesthesia (pins and needles), blurred vision, numbness, tremors, convulsions

Intralipid 20% (cardiovascular stability)

A - Pre-reg Exam COPY (15 decks)

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