Key Medicines 53 Flashcards
(23 cards)
What is the treatment for anxiety
Generalised Anxiety Disorder (GAD): SSRIs (e.g., sertraline, escitalopram) are first-line; SNRIs (e.g., venlafaxine) may be alternatives. CBT should also be considered.
Acute panic attacks: Benzodiazepines (e.g., diazepam, lorazepam) may be used short-term only due to the risk of dependence.
Beta-blockers (e.g., propranolol) help manage physical symptoms like palpitations but do not address psychological symptoms.
Why are chlorohenamine and hydrocortisone sometimes used in anaphylaxis ?
Chlorphenamine and hydrocortisone are given as adjuncts in the management of anaphylaxis to help manage symptoms and reduce the risk of delayed or biphasic reactions — but they are not first-line treatments.
Here’s why they are used:
⸻
✅ Chlorphenamine (an antihistamine)
• Mechanism: Blocks H1 histamine receptors.
• Purpose: Helps relieve cutaneous symptoms such as:
• Urticaria (hives)
• Pruritus (itching)
• Flushing
• Limitations:
• It does not reverse airway obstruction or hypotension.
• Works slowly (can take 30–60 minutes), so it is not suitable for treating life-threatening symptoms.
⸻
✅ Hydrocortisone (a corticosteroid)
• Mechanism: Reduces inflammation and suppresses the immune response.
• Purpose:
• May help prevent or reduce severity of biphasic reactions (recurrence of symptoms after initial resolution).
• Can help settle prolonged inflammation, especially airway swelling.
• Limitations:
• Slow onset (hours), so it plays no role in acute symptom relief.
• Evidence for its effectiveness in preventing biphasic reactions is limited but still commonly used in practice
What is the management of osteoarthritis
First-line: Paracetamol and topical NSAIDs (if affecting a single joint, e.g., knee, hand).
Second-line: Oral NSAIDs (with PPI), intra-articular steroid injections for flares.
Avoid opioids where possible; tramadol may be used short-term if pain is severe.
What drugs cause hyperprolactanamia and what is the solution
Common causes: Antipsychotics (risperidone, haloperidol) and metoclopramide.
Symptoms: Galactorrhoea, amenorrhea, erectile dysfunction.
Management: Consider switching to aripiprazole or using dopamine agonists (cabergoline, bromocriptine) in resistant cases.
What are the MHRA alerts for the gabapentanoids
Gabapentin - Respiratory depression
MHRA/CHM advice: Gabapentin (Neurontin®): risk of severe respiratory
depression (October 2017)
Pregabalin - Respiratory depression + others
MHRA/CHM advice: Pregabalin (Lyrica®): reports of severe respiratory
depression (February 2021)
MHRA/CHM advice: Pregabalin (Lyrica®): findings of safety study on risks
during pregnancy (April 2022)
MHRA/CHM advice: Pregabalin (Lyrica®) and risk of abuse and dependence:
new scheduling requirements from 1 April (April 2019)
What is the cross sensitivity of ACE inhibitors allergy (angiodema) with ARBs
ACE inhibitors may cause angioedema (bradykinin-mediated, not immune-related); ARBs may be an alternative, but cross-reactivity risk exists (~10%)
What is the treatment for status elliptacus
Initial Management: Secure the airway, provide oxygen, and monitor cardiac and respiratory function.
First-line Treatment: Buccal midazolam or rectal diazepam; IV lorazepam if IV access is available. Repeat second dose if seizures persist for 5–10 minutes.
Second-line: If seizures continue after two benzodiazepine doses, administer IV levetiracetam, IV phenytoin, or IV sodium valproate. Consider general anesthesia if unresponsive.
Folic Acid doses for different indications:
Pregnancy
Megaloblastic Anaemia (due to folate deficiency)
Methotrexate Use
🧬 Pregnancy and Pre-conception
Standard pregnancy (low-risk):
400 micrograms (mcg) once daily
→ Start before conception until 12 weeks gestation
High-risk pregnancy (e.g. family/personal history of NTDs, diabetes, obesity, antiepileptic drugs, thalassaemia trait):
5 mg once daily
→ Start before conception until 12 weeks gestation
🧫 Megaloblastic Anaemia (due to folate deficiency)
Initial treatment:
5 mg once daily
→ May be increased to 15 mg daily in severe cases
→ Continue for ~4 months, or until deficiency is corrected
Maintenance (if ongoing risk):
5 mg once daily or intermittently, depending on cause
💉 Methotrexate Use (Folate Supplementation)
To reduce methotrexate toxicity (e.g. in RA, psoriasis):
5 mg once weekly (on a different day to methotrexate)
→ Sometimes given as 5 mg 6 days a week, excluding methotrexate day
What is the treatment of acute angle closure glaucoma?
Management of Acute Angle-Closure Glaucoma
Symptoms: Sudden eye pain, blurred vision, headache, nausea, and a fixed mid-dilated pupil.
Treatment: IV acetazolamide + topical beta-blocker (timolol) + pilocarpine eye drops.
Urgent ophthalmology referral is required to prevent permanent vision loss.
Which common drugs cause photosensitivity (not exhaustive list)
Common culprits: Tetracyclines (doxycycline), amiodarone, Retinoids fluoroquinolones, sulfonamides.
Advise patients to use high SPF sunscreen (SPF 50+), avoid direct sun exposure, and wear protective clothing.
How do you manage iron overload in patients on long term transfusions
Iron overload can occur in patients receiving chronic blood transfusions (e.g., thalassemia, sickle cell disease).
Treatment involves iron chelation therapy (e.g., deferasirox, deferiprone, desferrioxamine).
Monitor ferritin levels and liver iron concentration regularly.
What is the electrolyte disturbance in tumour lysis syndrome?
hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia.
Management: IV hydration, allopurinol or rasburicase for uric acid reduction, and calcium correction if symptomatic.
What can sudden withdrawal of parkinsons medications cause?
Sudden withdrawal of Parkinson’s drugs can lead to neuroleptic malignant syndrome (NMS).
What causes malignant hyperthermia and what is the treatment?
Triggered by volatile anaesthetics (halothane) or suxamethonium.
Symptoms: Hypercapnia, muscle rigidity, tachycardia, high fever.
Treatment: IV dantrolene, active cooling, hyperventilation.
Which beta blockers are preferred in diabetes?
Cardioselective beta-blockers (bisoprolol) are preferred in diabetic patients.
Monitor blood glucose levels more closely in patients on beta-blockers.
What is Troponin ideal fro and what is BNP best fro diagnosing?
Troponin is the gold-standard biomarker for myocardial infarction — repeat after 3 hours if initial is normal.
Troponin released when cardiac muscle is damaged
BNP or NT-proBNP supports diagnosis of heart failure — high levels suggest volume overload.
BNP released when ventricles are stretched
CRP and procalcitonin help differentiate bacterial vs viral infection — procalcitonin rises more in bacterial causes.
Which common antibiotics have the counselling point “Take with or after food”
Source: Public Health Wales
Nitrofurantoin
Metronidazole
Erythromycin doesnt have to be but: Take with food to reduce nausea
Co-Trim - Not Cautionary label but: Take with food to reduce nausea
What are the cautionary labels for Quinolones ?
Do not take milk, indigestion remedies, or medicines containing iron or zinc, 2 hours before or after you take this medicine
Label 9
Space the doses evenly throughout the day. Keep taking this medicine until the course is finished, unless you are told to stop
Label 25
Swallow this medicine whole. Do not chew or crush
General counselling point: Take with or without food but do not take
with dairy products (e.g.milk, yoghurt) or mineral-fortified fruitjuice.
What is the MHRA alert with PPIs?
Proton Pump Inhibitors (PPIs): Very Low Risk of Subacute Cutaneous Lupus Erythematosus (SCLE)
📌 Key Points:
PPIs (e.g. omeprazole, lansoprazole, pantoprazole, etc.) have been associated with a very low risk of causing SCLE, an autoimmune skin condition.
SCLE is characterised by:
Red, scaly patches or ring-like lesions, especially on sun-exposed areas (arms, chest, neck).
Lesions may resemble psoriasis or eczema.
May occur weeks or months after starting a PPI.
PPIs may trigger SCLE in both patients with and without a history of lupus.
What are the MHRA alerts with Warfarin?
⚠️ MHRA Safety Alerts: Warfarin & Vitamin K Antagonists
🧬 1. Hepatitis C Treatment Interactions (Jan 2017)
🧪 Direct-acting antivirals for hepatitis C can alter liver function, affecting warfarin’s effect.
📉📈 Monitor INR closely during co-treatment to avoid under/over-anticoagulation.
🦠 2. COVID-19 and INR Monitoring (Oct 2020)
🤒 Illness, incl. COVID-19, may increase warfarin sensitivity ➜ dose may need reducing.
🔍 Continue INR monitoring in infected/unwell patients to avoid bleeding risk.
💊 Be cautious of drug interactions (e.g. with antibacterials/antivirals).
🔄 If switching to a DOAC ➜ stop warfarin first to prevent over-anticoagulation.
📢 Advise patients to contact their GP if:
They have COVID-19 symptoms
Are unwell, losing appetite, or vomiting
Start new meds/supplements
Change diet/alcohol/smoking habits
Can’t attend blood tests
🩸 3. Calciphylaxis Risk (July 2016)
🦵 Rare cases of painful skin rash (calciphylaxis) linked to warfarin.
🔎 More common in patients with end-stage renal disease, but can occur without.
🚨 If suspected ➜ refer urgently, consider stopping warfarin.
💊 4. Tramadol Interaction Warning (June 2024)
⚠️ Combining tramadol + warfarin can dangerously raise INR ➜ bleeding risk.
🧠 Fatal intracranial bleed reported in one case.
👩⚕️ Adjust warfarin dose or monitor INR more closely when co-prescribing.
👥 Counsel patients:
🩸 Report bleeding signs urgently
📞 Always inform HCP before starting/stopping meds
💬 Seek advice before self-medicating
What do the NHS and British Heart foundation recommend as healthy cholesterol levels? (controversial in my opinion)
Total cholesterol- Below 5mmol/L
HDL (good cholesterol)- Above 1.0mmol/L for men or above 1.2mmol/L for women
Non-HDL (bad cholesterol) - Below 4mmol/L
British Heart Foundation:
non-HDL cholesterol, 4mmol/L or below
HDL cholesterol, 1mmol/L or above for men (who were assigned male at birth), and 1.2mmol/L or above for women (who were assigned female at birth)
LDL cholesterol, 3mmol/L or below
total cholesterol, 5mmol/L or below
fasting triglycerides, 1.7mmol/L or below
non-fasting triglycerides, 2.3mmol/L or below.
What is Extravasation
Leakage of IV drugs/fluids into surrounding tissue ➜ can cause tissue necrosis if not managed promptly.
⚠️ High-Risk Factors:
Drugs: Cytotoxics, acidic/alkaline, high osmolarity, alcohol/PEG excipients
Patients: Elderly, very young, sedated, anticoagulated
🛡️ Prevention:
Use central line for high-risk drugs
Rotate cannula sites regularly
Follow manufacturer guidelines
Consider GTN patch to improve vein patency
Ask patients to report pain/burning immediately
🚨 Management:
Stop infusion immediately
Do NOT remove cannula – attempt aspiration first
Give steroids (e.g. hydrocortisone) for inflammation
Use antihistamines/analgesics for symptoms
Specialist advice needed for further management
🧊 Treatment Approaches:
Localise & Neutralise:
Cold compresses, antidotes, e.g. dexrazoxane (for anthracyclines)
Spread & Dilute:
Warm compresses, saline infiltration, hyaluronidase (not for vesicants unless indicated), limb elevation
