Medicines 45 Flashcards
(25 cards)
Why is it important to test TPMT levels before starting thiopurine treatment?
🧬 Drug:
Thiopurines (e.g., azathioprine)
🔎 Metabolism:
Metabolised by Thiopurine Methyltransferase (TPMT) enzyme.
⚠️ Problem:
TPMT Deficiency → ❗ Reduced breakdown of thiopurines → 🔥 Toxic accumulation → Severe side effects.
🧪 Clinical Action:
Test TPMT levels before starting treatment. 🩺
🛡️ If Deficient:
Consider:
⚖️ Dose adjustment
🔄 Alternative treatment to avoid toxicity.
📚 Summary:
Low TPMT = Higher risk of thiopurine toxicity → Always screen first! ✅
When can Orlistat be sold over the counter (OTC)?
🏪 OTC Sale Criteria:
Medication: Orlistat
Condition: Can be sold over the counter to individuals who meet both:
BMI ≥ 28 kg/m² ⚖️
Following a reduced-calorie, lower-fat diet 🍽️🥑
🧠 Key Reminder:
Always advise dietary modification alongside Orlistat use for effective weight loss.
Not suitable for individuals with normal or underweight BMI. ❌
When should a GLP-1 receptor agonist be considered in type 2 diabetes treatment?
🔄 When to Switch to a GLP-1 Receptor Agonist:
If triple therapy is:
❌ Ineffective
❌ Not tolerated
❌ Contraindicated
✅ Consider a GLP-1 receptor agonist for people with:
BMI ≥ 35 kg/m² ⚖️ (adjust for black, Asian, and minority ethnic groups) plus specific psychological or medical conditions related to obesity
OR
BMI < 35 kg/m² and either:
Insulin therapy would cause occupational problems 🛠️
Weight loss would benefit obesity-related comorbidities ❤️
📝 Important Note:
Continue GLP-1 therapy only if after 6 months:
HbA1c drops by ≥ 11 mmol/mol 📉
Weight loss of ≥ 3% of initial body weight ⚡
What are the effects of hypokalaemia?
“K+ CAN FLY LOW”
K+ – Potassium low
C – Cardiac arrhythmia
A – Abdominal symptoms (constipation, nausea)
N – Neurological (confusion, fatigue)
F – Flattened T waves
L – Low energy
Y – Your heart may skip a beat (arrhythmia)
L – Leg cramps
O – Out of breath (respiratory issues)
W – Weak muscles
What is the timeframe recommended between different eye drops or gels
It is recommended to wait at least 5 minutes between using different eye drops or
eye gels. This is because the first eye drop or gel can wash away the second eye
drop or gel if instilled in the eye too quickly.
Waiting 5 minutes allows the first eye drop or gel to be absorbed into the eye before
the second eye drop or gel is instilled.
What are the guidelines/ recommended treatment for dry eye?
👁️ Mild Dry Eye:
👓 Hypromellose – most frequently used
Requires frequent instillation initially (e.g. hourly), then ↓ frequency
🔁 Alternatives:
🧴 Carbomers and Polyvinyl alcohol – longer retention = reduced frequency (4× daily)
⚠️ Carbomers may blur vision more than hypromellose
💡 Preservative-free formulations are preferred in frequent/chronic use
👁️🗨️ Moderate to Severe Dry Eye:
Use after 6–8 week trial of mild treatments
Options:
💧 Sodium hyaluronate
🧴 Hydroxypropyl guar
🧴 Carmellose sodium
🌙 Eye Ointments (e.g., Liquid paraffin + White soft paraffin):
Good for recurrent corneal epithelial erosion
Best used before bed (can cause blurred vision)
❌ Avoid during contact lens wear
What is a key advantage of DOACs over Warfarin
✅ Key Advantages of DOACs:
🧪 No routine INR monitoring needed – unlike warfarin, which requires regular blood tests.
🍽️ Fewer food interactions – no need to avoid vitamin K-rich foods (like leafy greens).
💊 Predictable dosing – fixed daily doses, no frequent adjustments.
⏱️ Faster onset of action – typically within hours vs. days for warfarin.
⚖️ Lower risk of intracranial bleeding – especially in patients with atrial fibrillation.
📉 Shorter half-life – quicker offset if the drug needs to be stopped (useful pre-surgery).
✅ Lower Risk:
🧠 Intracranial bleeding (less than with warfarin)
➖ Similar Risk:
🔴 Overall major bleeding (similar or slightly lower than warfarin)
⚠️ Higher Risk:
🩸 GI bleeding – esp. with rivaroxaban & dabigatran, particularly in older adults
When should a child swith from formula milk to cows milk?
➡️ At 12 months of age ✅
❌ Before 12 months:
A baby’s digestive system is not mature enough to process the nutrients in cow’s milk properly.
Formula milk or breast milk should be used instead during this period.
✅ After 12 months:
Switch to full-fat cow’s milk 🥛 — provides essential fats for brain development.
What are symptoms of Phenytoin overdose?
Symptoms of phenytoin
overdose typically include nystagmus (uncontrolled eye movements), ataxia (loss of coordination), confusion, and diplopia (double vision).
“Drunken CHANDi”
🔹 Breakdown (CHANDi):
• C – Confusion
• H – Hyperglycaemia
• A – Ataxia - loss of control of bodily moments
• N – Nystagmus - rapid uncontrollable eye movements
• D – Diplopia - double vision
• i – Impaired speech (Slurred speech)
What does Ciclosporin do?
CYCLO = Ciclosporin
C = Calcineurin inhibitor (mechanism)
Y = Your immune system is suppressed (used in transplant to prevent rejection)
C = Chronic inflammatory diseases (e.g. severe eczema, psoriasis, RA)
L = Lowers T-cell activity
O = Organ transplant protection
💡 Quick Summary:
🔒 Ciclosporin suppresses the immune system by inhibiting calcineurin, preventing T-cell activation.
🧬 Used for: organ transplant, autoimmune diseases, severe eczema or psoriasis.
WHat are some reasons to refer a fungal nail infection?
Involvement of more than one or two nails
→ Especially if multiple nails are infected or the infection is spreading quickly.
Nail matrix is affected
→ Signs include distortion of nail shape or thickening near the nail base.
Severe nail involvement or extensive infection
→ E.g. nails are crumbling, detaching, or very thickened.
Diabetic patients
→ Higher risk of complications, such as foot ulcers or secondary infections.
Immunocompromised individuals
→ Includes patients on chemotherapy, long-term steroids, or with HIV.
Failure of OTC treatment or recurrence
→ If topical treatment hasn’t worked or infection keeps returning.
What are the symptoms of Bone marrow Suppression?
sore throat, mouth ulcers, bruising, fever, malaise, or non-specific illness develops.
NOT DIARRHOEA
What is hyperemesis gravidarum
Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting in pregnancy that goes beyond typical morning sickness. It can lead to significant dehydration, weight loss, and electrolyte imbalances, often requiring medical treatment or hospitalization.
What are some benefits of the combined oral contraceptive?
CHCs offer several health benefits beyond contraception, including:
🧬 Reduced risk of endometrial cancer
💢 Reduced dysmenorrhea (painful periods)
💆♀️ Improvement in acne
🩸 Better management of menstrual-related symptoms
What are the conditions in which sodium valproate is first line? as per BNF
D MALT
Dravet Syndrome
Myoclonic seizures
Atonic seizures
Lennox-Gastraut
Tonic-Clonic
When is lamotrigine and levetiracetam first line
Focal seizures
Why is Labetalol used in hypertensive emergencies (e.g., BP 200/140 mmHg with papilloedema and retinal haemorrhage)?
Labetalol is used because:
⚡ It provides rapid BP reduction
💉 Administered IV for immediate effect
🔄 It’s a combined alpha- & beta-blocker, allowing controlled titration
✅ Recommended by NICE for hypertensive emergencies due to its efficacy & safety
What makes Levomepromazine effective for managing nausea and vomiting, particularly in palliative care?
Levomepromazine is a broad-spectrum anti-emetic working at multiple receptor sites, including dopamine type 2 (D2) antagonist, H1, 5HT-2 receptors and serotonergic sites. This makes it useful in situations such as palliative care as it can cover many aetiologies of nausea and vomiting and works secondarily as a sedative.
Levomepromazine can cause a prolonged QT interval so you should be cautious prescribing this alongside other medications that can affect the QT interval such as citalopram, fluconazole and sotalol.
What are the key MHRA restrictions and cautions for metoclopramide use?
🧠 Risk Identified:
Neurological AEs: Extrapyramidal disorders, tardive dyskinesia
Risks > Benefits in long-term or high-dose use
🔒 Restrictions (Adults ≥18 yrs):
ONLY for short-term use (max 5 days)
Usual dose: 10 mg up to 3× daily
Use for:
Post-op nausea & vomiting
Radiotherapy-induced N&V
Delayed chemo-induced N&V
Acute migraine (to aid analgesic absorption)
Symptomatic N&V
💉 Administration Guidance:
IV = Slow bolus over ≥3 mins
Oral = Use graduated syringe for liquids
🚫 Contraindications:
3–4 days post-GI surgery
Epilepsy
GI: Bleed, obstruction, perforation
Phaeochromocytoma
When is ondansetron particularly useful as an antiemetic?
🌀 Ondansetron is especially useful in:
Postoperative nausea and vomiting (PONV) — commonly used as part of enhanced recovery programmes (ERPs)
Chemotherapy-induced nausea and vomiting (CINV) — both acute and delayed phases
Radiotherapy-induced nausea and vomiting
🧬 Why it’s effective:
It blocks 5-HT3 receptors on GI macrophages
Prevents inflammatory cell infiltration during GI surgery
➡️ Helps restore gut motility and reduce postoperative ileus
Which antiemetic is best in renal impairment
Ondansetron is a suitable antiemetic for patients with renal impairment. It is effective
for controlling nausea and vomiting and does not require dose adjustment in patients
with reduced creatinine clearance.
WHat are some common side effects with thiazide diuretics?
Alkalosis hypochloraemic; constipation; diarrhoea; dizziness; electrolyte imbalance; erectile dysfunction; fatigue; headache; hyperglycaemia; hyperuricaemia; nausea; postural hypotension; skin reactions; vomiting
Which sulphonylurea is best in renal impairment?
For all sulfonylureas
Sulfonylureas should be used with care in those with mild to moderate renal impairment, because of the hazard of hypoglycaemia. Care is required to use the lowest dose that adequately controls blood glucose.
Avoid where possible in severe renal impairment.
Renal impairmentFor gliclazide
If necessary, gliclazide which is principally metabolised in the liver, can be used in renal impairment but careful monitoring of blood-glucose concentration is essential.
Which SGLT-2 is best in renal impairment?
✅ Dapagliflozin
Licensed for chronic kidney disease (CKD) even in patients without diabetes
Can be continued at eGFR ≥ 15 mL/min/1.73m²
Shown in the DAPA-CKD trial to significantly reduce progression of CKD and mortality
✅ Empagliflozin
Licensed for CKD and heart failure
Can be initiated in CKD if eGFR ≥ 20 mL/min/1.73m²
Proven renal protection in EMPA-KIDNEY trial
