Medicines 40 Flashcards
(25 cards)
What dietary or medicinal precautions should be taken with ciprofloxacin?
Avoid milk, indigestion remedies, or medicines containing iron or zinc for 2 hours before and after taking ciprofloxacin, as they can reduce its absorption.
What is important to know about phenytoin’s pharmacokinetics?
Phenytoin is ~90% plasma protein bound and metabolized in the liver.
At low concentrations, it follows first-order kinetics (elimination proportional to concentration).
At therapeutic levels, metabolism becomes saturated, leading to zero-order kinetics — small dose increases can cause large rises in free phenytoin levels.
What are the signs of lithium intoxication?
Blurred vision
Resting tremor
Muscular weakness
Confusion, ataxia, coarse tremor, drowsiness, and in severe cases: seizures, coma, and renal failure.
Remember:
Mnemonic: “LiTHIUM”
Each letter helps you remember a key symptom:
L – Lethargy / Light-headedness
T – Tremor (coarse, resting)
H – Hyperreflexia / Hypotonia (muscle weakness)
I – Impaired vision (blurred vision)
U – Unsteady gait (ataxia)
M – Mental changes (confusion, drowsiness, coma)
Specifically, What blood monitoring is required when initiating and continuing clozapine therapy, and what are the criteria for discontinuation due to neutropenia?
🔍 Before starting:
✔️ WCC & differential must be normal
📅 Monitoring schedule:
🔸 Weekly for first 18 weeks
🔸 Then every 2 weeks
🔸 After 1 year stable: every 4 weeks
🔸 Continue for 4 weeks after stopping
🛑 Discontinue & refer to haematologist if:
⚠️ WCC < 3000/mm³
⚠️ Neutrophils < 1500/mm³
What is Vigabatrin and …
What are the key safety concerns with vigabatrin and how should patients be monitored?
Vigabatrin is an antiepileptic (anticonvulsant) medicine used primarily for:
Infantile spasms (West syndrome) – particularly in children under 2 years old
Refractory focal seizures (partial seizures) – only when other treatments have failed or aren’t suitable
🧨 Seizure Exacerbation:
Vigabatrin may worsen:
❌ Absence seizures
❌ Myoclonic seizures (e.g., juvenile myoclonic epilepsy)
❌ Tonic/atonic seizures
❌ Dravet & Lennox-Gastaut syndromes
❌ Myoclonic-atonic seizures
👁️ Visual Field Defects:
Risk may appear from 1 month to several years after starting
Often irreversible, may worsen even after stopping
⚠️ Test visual fields:
🔍 Before starting
🔁 Every 6 months during treatment
🗣️ Warn patients & carers to report new visual symptoms
📞 Urgent ophthalmology referral if symptoms appear
💊 Consider gradual withdrawal if issues arise
What important visual side effect is associated with linezolid, and what advice should be given to patients?
🔸 Linezolid can cause severe optic neuropathy.
🔸 Patients should be advised to report any changes in eyesight, such as:
Changes in visual acuity
Changes in colour vision
Blurred vision
Any visual field defects
🔸 Prompt evaluation and referral to an ophthalmologist is recommended if symptoms occur.
🔸 If linezolid is taken for more than 28 days, regular visual monitoring is advised.
What is Aztreonam?
A monobactam antibiotic
Active against aerobic Gram-negative bacteria (including Pseudomonas aeruginosa)
No activity against Gram-positive bacteria or anaerobes
What can vitamin K be used for in babies?
injection at birth to prevent serious bleeding, including intracranial bleeding.
What is Oxytocin?
A hormone and medication
Produced naturally by the pituitary gland
Synthetic form used in medical settings
🔑 Key Uses of Oxytocin:
Induction of labour:
Stimulates uterine contractions to initiate or accelerate labour
Administered via IV infusion in controlled doses
Postpartum haemorrhage prevention:
Administered after delivery to reduce bleeding by promoting uterine contraction
What is the treatment for spacsticity symptoms in MS?
💊 First-Line Treatment:
Baclofen is often recommended first-line for spasticity management.
Consider comorbidities, drug interactions, contraindications, and patient preference when choosing treatment.
💊 Second-Line Option:
Gabapentin (off-label use as of Aug 2022) can be used if baclofen is not tolerated or ineffective.
What is the treatment for relapse in MS?
💊 First-line Treatment:
Oral methylprednisolone 500 mg once daily for 5 days
(Start as early as possible, within 14 days of symptom onset)
⚠️ Do NOT:
Use lower doses
Provide steroids in advance for self-use
💡 Key Points:
Not all relapses need steroids (e.g., mild relapse)
Discuss risks and benefits:
Reduces relapse duration (~13 days)
May reduce severity
Potential side effects: mood changes, agitation, confusion, hyperglycaemia
What is key to remember about timolol eye drops ?
💊 Drug Class:
Beta-blocker (topical ophthalmic)
📌 Systemic Absorption:
Systemically absorbed despite topical use
Can cause systemic beta-blocker effects (e.g. ↓ HR, ↓ BP, bronchospasm)
🫀 Cardiovascular Risks:
Use caution in:
Coronary heart disease
Prinzmetal’s angina
Cardiac failure
First-degree heart block
May cause bradycardia, hypotension, heart failure exacerbation
Monitor pulse rate and watch for signs of heart failure
🧊 Vascular Concerns:
Use with caution in severe peripheral circulatory disorders (e.g. Raynaud’s)
🫁 Respiratory Risks:
Contraindicated in asthma ❌ (risk of bronchospasm, including fatal cases)
Use with caution in mild/moderate COPD only if benefits outweigh risks
🍬 Endocrine Considerations:
May mask signs of hypoglycaemia
(Caution in diabetes, especially labile or insulin-dependent)
May also mask signs of hyperthyroidism
👁️ Ocular Side Effects:
Can cause dry eyes
Caution in patients with corneal disease
💡 Tip to Reduce Systemic Absorption:
Nasolacrimal occlusion or closing eyelids for 1–2 minutes post-instillation
(Reduces systemic uptake)
WHat do each of the following terms mean:
Akathisia
Dystonia
Myoclonic Jerks
Tardive Dyskinesia
Hirsutism
Tinnitus
Hyperhidrosis
Hypertrichosis
Tenesmus
Hypertriglyceridemia
Tympanosclerosis
🧠 Akathisia
A movement disorder characterized by an intense feeling of inner restlessness and a need to be constantly moving. Commonly caused by antipsychotic medications.
🧠 Dystonia
Involuntary muscle contractions that cause repetitive movements or abnormal postures, such as twisted neck or eye rolling. Can be acute or chronic.
⚡ Myoclonic Jerks
Sudden, brief, involuntary muscle twitches or jerks. Can affect any group of muscles and are seen in conditions like epilepsy or after certain medications.
🤐 Tardive Dyskinesia
A late-onset side effect of long-term antipsychotic use, involving involuntary, repetitive movements like lip smacking, tongue thrusting, or grimacing.
🧔 Hirsutism
Excess hair growth in women in areas where men typically grow hair (e.g., face, chest). Often linked to hormonal imbalance like in PCOS.
👂 Tinnitus
The perception of sound (e.g., ringing, buzzing) in the ears or head without an external source. Can be caused by ear damage, infections, or medications.
💦 Hyperhidrosis
Abnormally excessive sweating not related to heat or exercise. Can affect hands, feet, armpits, or whole body.
🧔 Hypertrichosis
Excessive hair growth over the entire body or in unusual areas. Unlike hirsutism, it’s not limited to male-pattern areas and can affect both sexes.
💩 Tenesmus
The feeling of needing to pass stools, even if the bowels are already empty. Often painful and associated with conditions like IBD or infections.
💉 Hypertriglyceridemia
A condition where triglyceride levels in the blood are abnormally high. Increases risk of heart disease and pancreatitis.
👂 Tympanosclerosis
A condition where the eardrum (tympanic membrane) becomes thickened and scarred, often due to chronic ear infections. May cause hearing loss.
What four things is Duloxetine indicated for ?
- Major Depressive Disorder
By mouth — Adult - Generalised Anxiety Disorder
- Diabetic Peripheral Neuropathy (Painful Neuropathy)
- Moderate to severe stress urinary incontinence
Name some SNRIs
duloxetine
venlafaxine
Name some Noradrenaline and specific serotonergic antidepressants (NASSAs)
Mirtazipine (only relevant one)
Name some Tricyclic antidepressants (TCAs)
amitriptyline, clomipramine, dosulepin, imipramine, lofepramine and nortriptyline.
Why are TCAs cautioned in glaucoma?
TCAs (tricyclic antidepressants) have antimuscarinic (anticholinergic) effects — they block muscarinic acetylcholine receptors. This leads to side effects like:
Dry mouth
Blurred vision
Constipation
Urinary retention
And importantly… increased intraocular pressure
What is pizotifen and what is it used for ?
Pizotifen is a serotonin antagonist used primarily for the prevention of migraines and cluster headaches.
Prevention of vascular headache,
Prevention of classical migraine,
Prevention of common migraine,
Prevention of cluster headache
Prophylaxis of migraine
What are the indications of Sodium Valproate?
- Epilepsy (first-line for many seizure types)
Generalised seizures (e.g. tonic-clonic)
Absence seizures
Myoclonic seizures
Atonic seizures
Focal (partial) seizures — sometimes used when other treatments fail
- Bipolar disorder
Used for acute manic episodes and for prophylaxis of mood swings - Migraine prophylaxis (unlicensed use in the UK)
What are the indications of fusidic acid?
Staphylococcal skin infections
Apply 3–4 times a day (usually for 7 days)
Non-bullous impetigo
(in patients who are not systemically unwell or at high risk of complications)
Apply 3 times a day for 5–7 days
Secondary bacterial infection of eczema
(for localised infections only)
Apply 3 times a day for 5–7 days
👁️ Topical (to the eye):
Staphylococcal eye infections
Apply twice daily
💊 Oral (tablets or suspension):
Staphylococcal infections due to susceptible organisms
Penicillin-resistant staphylococcal infections (including osteomyelitis)
Staphylococcal endocarditis (in combination with other antibacterials)
What is the treatment for Acne ?
🎯 First-Line Treatment:
All severities:
▫️ Adapalene + Benzoyl Peroxide
▫️ Tretinoin + Clindamycin
Mild–Moderate:
▫️ Benzoyl Peroxide + Clindamycin
Moderate–Severe:
▫️ Adapalene + Benzoyl Peroxide + Oral Lymecycline or Doxycycline
▫️ Azelaic Acid + Oral Lymecycline or Doxycycline
Alternatives if unsuitable:
▫️ Oral Trimethoprim (unlicensed) or Macrolide (e.g. Erythromycin)
▫️ Topical Benzoyl Peroxide (monotherapy)
Special Cases:
Females with PCOS:
▫️ Add Co-cyprindiol (Ethinylestradiol + Cyproterone)
▫️ Review after 6 months
Severe Acne (e.g. nodulocystic):
▫️ Oral Isotretinoin via specialist
▫️ Ensure Pregnancy Prevention Programme in place if needed
▫️ Consider mental health referral pre-treatment
▫️ Oral Prednisolone for isotretinoin-induced flares
What are the risks of tetracyclines in pregnancy & breastfeeding?
Pregnancy:
Avoid due to risk of fetal bone/teeth development issues (hypoplasia, staining).
Can affect bone growth and cause tooth discoloration.
Breastfeeding:
Avoid due to potential risk of tooth discoloration and bone issues in infants.
Safer alternatives recommended.
How does co-careldopa and co-beneldopa affect the urine
can discolor the urine, often turning it red, brown, or black.
