All

Question 1

Steroids - what are they and what do they do?

Answer 1

Tablet taken once a day long-term to reduce inflammation in the body

Question 2

Steroids - minor risks

Answer 2

Weight gain
Acne
Mood change
Proximal myopathy
Skin thinning

Question 3

Steroids - major side effects and ways to reduce these

Answer 3

Gastritis/peptic ulcers: take tablets with or soon after a meal, PPI, avoid NSAIDs

Osteoporosis: Vitamin D and calcium supplementation, keep active

Hypertension: regular BP check-up, diet/exercise/smoking cessation/alcohol etc

Diabetes: attend your check ups, diabetic symptoms to be aware of (polydipsia, polyuria), mindful of diet etc

Immunosuppression: be aware of infection risk, wash hands etc

Addisonian crisis: most important last - don’t stop suddenly!

Question 4

Lifestyle modifications

Answer 4

Weight loss
Physical activity
Diet - reduce salt/fats
Smoking cessation
Reduce alcohol intake
Stress reduction
Adhere to treatments/targets

Question 5

Warfarin - contraindications

Answer 5

Pregnancy
Significant risk of bleeding
Active bleeding

Question 6

Warfarin - mechanism of action

Answer 6

Thins blood to treat/prevent blood clots
Blocks Vitamin K which is used by the body to make proteins that cause blood to clot

Question 7

Warfarin - treatment course

Answer 7

Once daily tablet, usually taken in the evening
Different durations - 3-6 months, lifelong
Dose change takes 2-3 days to take effect

Question 8

Warfarin - monitoring

Answer 8

Start at 5mg
INR on days 3/4/5
Refer to warfarin dosing charts
Then regular INR checks

Question 9

Warfarin - side effects

Answer 9

Bleeding - when to seek advice: head injury, prolonged epistaxis, unusual headache, blood in urine/vomit/stool, unexplained/severe bruising

Diarrhoea
Rash
Hair loss
Nausea
Interactions: avoid liver, spinach, cranberry juice, alcohol binges, NSAIDs/aspirin

Question 10

DOAC - contraindications

Answer 10

Significant renal impairment
Risk of or active bleeding
Not licensed for metallic heart valves

Question 11

DOAC - mechanism of action

Answer 11

Thins blood to treat/prevent blood clots
Blocks a protein required for blood clotting

Question 12

DOAC - treatment course

Answer 12

Once/twice daily tablet/capsule
Take with full glass of water sitting up
Duration: 3-6 months or lifelong

Question 13

DOAC - monitoring

Answer 13

None regular
Annual U&Es (and before)

Question 14

DOAC - side effects

Answer 14

Bleeding
GI disturbance
Irreversible

Question 15

Levothyroxine - contraindications

Answer 15

None

Question 16

Levothyroxine - mechanism of action

Answer 16

Synthetic version of thyroxine
Given cause thyroid not producing enough so to bring thyroid activity back to normal

Question 17

Levothyroxine - treatment course

Answer 17

Once daily tablet before breakfast, taken long-term
Dose takes 4-6 weeks to take effect

Question 18

Levothyroxine - monitoring

Answer 18

TSH every 2-3 months until stable, then annually

Question 19

Levothyroxine - side effects

Answer 19

Rare
Hyperthyroidism if over-prescribed
Hypothyroidism if under-prescribed

Question 20

Statin - contraindication

Answer 20

Pregnancy

Question 21

Statin - mechanism of action

Answer 21

Stop liver making cholesterol (why this is important)

Question 22

Statin - treatment course

Answer 22

Once daily tablet usually in the evening, taken long-term (decreases risk over many years)

Question 23

Statin - monitoring

Answer 23

Review lipids in 4 weeks then every 6-12 months
LFTs before, at 3 months and 12 months (monitor ALT)

Question 24

Statin - side effects

Answer 24

Muscle pains
Headache
Itching
Nausea, vomiting
Diarrhoea
Abdominal pain
Rhabdomyolysis (unexplained muscle pain - tell doctor)
Some interact with grapefruit juice

Question 25

Metformin - contraindications

Answer 25

Significant renal impairment Ketoacidosis Low BMI

Question 26

Metformin - mechanism of action

Answer 26

Increases response to insulin (cells take up more glucose) Also reduces amount of glucose produced by the liver

Question 27

Metformin - treatment course

Answer 27

Once/twice/three times daily tablet within meals, taken long-term

Question 28

Metformin - monitoring

Answer 28

U&Es before and annually HbA1c every 3-6 months until stable, then 6-monthly at diabetic check ups

Question 29

Metformin - side effects

Answer 29

Nausea Diarrhoea Abdominal pain Weight loss Lactic acidosis (don't take on day or 2 days following GA/contrast)

Question 30

Iron tablets - contraindications

Answer 30

None

Question 31

Iron tablets - mechanism of action

Answer 31

Replace body's iron supply, mineral needed to make RBCs

Question 32

Iron tablets - treatment course

Answer 32

Tablet or syrup taken 1-3 times daily (as much as able) Works best taken without food however can irritate stomach Takes 3-4 weeks for Hb to normalise then further 3 months to improve stores

Question 33

Iron tablets - monitoring

Answer 33

Hb at 3-4 weeks

Question 34

Iron tablets - side effects

Answer 34

GI irritation Black stools Metallic taste

Question 35

SSRI - contraindications

Answer 35

Suicidal risk Mania

Question 36

SSRI - mechanism of action

Answer 36

Alter balance of chemicals in brain called neurotransmitters. Imbalance thought to lead to depression.

Question 37

SSRI - treatment course

Answer 37

Once daily tablet, 4-8 weeks to take effect May slowly reduce tablet after 6 months of feeling better

Question 38

SSRI - monitoring

Answer 38

None

Question 39

SSRI - side effects

Answer 39

GI irritation Appetite and weight change (up or down) Headache Drowsiness (take at night) Anxiety for 2 weeks Withdrawal Increases suicide risk in younger patients

Question 40

Methotrexate - contraindications

Answer 40

Pregnancy Breastfeeding Hepatic impairment Active infection Immunodeficiency

Question 41

Methotrexate - mechanism of action

Answer 41

Reduces inflammation and suppresses immune system Early use improves outcome and symptoms

Question 42

Methotrexate - treatment course

Answer 42

Once weekly tablet, long-term - same day. Dose builds up slowly, takes 3-12 weeks to work. Folic acid on alternate day

Question 43

Methotrexate - monitoring

Answer 43

FBC, U&Es, LFTs - Before - Then every 2 weeks until stable - Then every 2-3 months

Question 44

Methotrexate - side effects

Answer 44

Alopecia Headaches GI disturbance - no NSAIDs/aspirin Myelosuppression - doctor if unexplained bleeding/bruising, infective symptoms and get annual flu jab Liver and lung toxicity