Learning Points from doing Q’s

Question 1

Ganciclovir contraindications?

And other general information - indications, caution, interactions etc

Answer 1

Used for local tmt of HSV - eye gel only. (POM)

Also tmt and suppression of CMV in immunosuppressed.

CONTRAINDICATED - abnormally low Hb, abnormally low neuts, abnormally low platelets.

CAUTION (IV use)
Potential carcinogen and teratogen, ensure adequate hydration.

INTERACTIONS - myelosuppressive and nephrotoxic drugs.

SIDE EFFECTS - (IV)
Abdo pain, abnormal thinking, convulsions, ear pain, eye pain, GI ADRs, hepatic dysfunction, renal impairment, pancytopenia, arrhythmias.

(Eye) burning sensation, tingling.

CONCEPTION AND CONTRACEPTION -
Ensure effective contraception during tmt and barrier contraception for men during and for at least 90 days after stopping.

Pregnancy and BF - avoid. TERATOGENIC risk

Renal impairment - reduce dose if eGFR less than 70ml/min.

Monitoring - FBC closely.

Handling and storage - ganciclovir is toxic and need protection for handling and administration.

Question 2

Safest laxative in pregnant women?

Answer 2

Lactulose

Question 3

Status epilepticus at home tmt ?

Answer 3

Buccal midazolam (unlicensed use in 18+)

Question 4

Legal restriction to collect prescription?

Answer 4

There isn’t one.

Up to pharmacists professional judgement.

Question 5

1st line for faecal impaction and hard stools?

Answer 5

Macrgols

Question 6

Are standard NHS FP10 scripts repeatable?

Answer 6

No - must have Repeat Authorisation form to do this.

Then have Repeat dispensing scripts for each time to be dispensed with specified intervals. First one must be done within 6 months unless CD 4 then should be 28 days.

After first dispensing there is no time limit on when the rest of the repeats can be dispensed and there is no limit for the number of repeats.

CD 4&5 are repeatable.

CD 2-3 must be on instalment prescription for repeat dispensing.

Question 7

What can you do with a repeat dispensing script if the number of repeats is not specified?

Answer 7

Repeat ONCE only (2x in total)

Unless for oral contraceptive - this can be repeated 5x (6x in total)

The repeats can be dispensed from different pharmacies. Mark on prescription Pharmacy address and date of dispensing.

NB. Prisons do not use FP10’s and so can’t have repeat dispensing unless very unlikely event that FP10 is authorised for use.

Question 8

Name the B vitamins?

Answer 8

B1 = THIAMINE

B6 = PYRIDOXINE

B9 = FOLIC ACID

B12 = COBALAMIN

Question 9

Name the B vitamins?

Answer 9

B1 = THIAMINE

B6 = PYRIDOXINE

B9 = FOLIC ACID

B12 = COBALAMIN

Question 10

What is ergotism and which drugs can cause it?

Answer 10

Ergotism is poisoning produced by eating food affected by ergot or by using ergotamine.

Headache, vomiting, diarrhoea, and gangrene of fingers and toes.

Ergot-derived meds can increase risk if taken with ergotamine - cabergoline/pergolide/bromocriptine

Question 11

Lithium interactions - drugs that can increase lithium concentrations?

Answer 11

Metronidazole can reduce clearance of lithium.

NSAIDs/Coxibs - monitor lithium levels more frequently if NSAID started or stopped

ACE inhibitors - ramipril/lisinopril etc

ARBS - candesartan/losartan etc..

Diuretics - thiazides most likely to increase levels. Reduce lithium dose and re-stabilise with frequent monitoring. Loops less likely to increase level.

Drugs affecting electrolyte balance eg steroids

Tetracyclines

Question 12

Drugs that decrease lithium levels?

Answer 12

Increased lithium renal clearance -

Xanthines (theophylline/caffeine)

Sodium bicarbonate cont. products

Diuretics (osmotic)

Urea

Calcitonin

Question 13

Interactions with lithium increasing risk of neurotoxicity?

Answer 13

Antipsychotics - confusion, disorientation, tremor, EPSE’s

Methyldopa

Triptan derivatives or serotonergic AD’s - May precipitate serotonin syndrome

CCBs - neurotoxicity such as ataxia, somnolence, confusion. Li concs may be increased.

Carbamazepine - dizziness, somnolence, confusion, ataxia.

Question 14

Other lithium interactions?

Answer 14

QT prolongation risk - Apsy’s, methadone, macrolides, amiodarone etc

Reducing epileptic threshold - SSRI’s, TCA’s, Apsy’s, anaesthetics, theophylline etc..

Question 15

What is serotonin syndrome?

Answer 15

Potentially life-threatening ADR. Excess serotonin - needs hospitalisation.

Mental status change (agitation, confusion, eventually coma)

Neuromuscular abnormalities (myoclonus, tremor, akathisia, rigidity)

Autonomic hyperactivity
(Tachycardia, shivering, hyperthermia)

GI symptoms (diarrhoea)

Question 16

Contraindications for lithium?

Answer 16

Cardiac disease

Cardiac insufficiency

Severe renal impairment

Untreated hypothyroidism

Breastfeeding

Patients with low sodium levels (dehydrated/low sodium diet)

Addison’s disease - (primary adrenal insufficiency)

Brugada syndrome - a ventricular arrhythmia

Question 17

Warts and verrucas are caused by which virus?

Answer 17

HPV

Question 18

Cold sores vs genital herpes? What viruses?

Answer 18

HSV 1 - cold sores

HSV 2 - genital herpes

Question 19

Lubiprostone - prescribing and dispensing information?

Answer 19

Dispense capsules in original container - discard any capsules remaining 4 weeks after opening.

Question 20

How should movicol be kept after reconstitution?

Answer 20

Keep in fridge and discard if unused after 6 hours.