Medicines 47 Flashcards
(25 cards)
What are the folic acid recommendations for women before and during pregnancy based on risk of neural tube defects (NTDs) or other congenital malformations?
🔹 High-Risk Women — Advise folic acid 5 mg daily pre-conception and continue for at least the first 12 weeks of pregnancy if they:
Have or their partner/family has a history of NTDs or congenital malformations
Had a previous pregnancy affected by NTD or congenital defect
Have diabetes mellitus
Have a haematological condition (e.g., sickle cell anaemia, thalassaemia)
→ Note: Women with sickle cell disease, thalassaemia, or thalassaemia trait should continue 5 mg daily throughout pregnancy
Take medicines affecting folate metabolism (e.g., anti-epileptics, HIV medications)
🔹 All Other Women — Recommend 400 micrograms (µg) daily, starting before conception and continuing for at least 12 weeks into pregnancy.
🔹 BMI ≥ 25 kg/m² or increased pre-eclampsia risk — 400 µg is sufficient unless other high-risk factors are present.
Which antidiabetic medication can cause increased respiratory tract infections?
Sitagliptin - common side effect - include upper respiratory infection, stuffy or runny nose and sore throat
What conditions can cause theophylline levels to increase?
The plasma-theophylline concentration is increased in heart failure, hepatic impairment, and in viral infections.
How should NSAIDs be used in people with heart failure or cardiovascular disease?
🔴 Severe Heart Failure
Avoid all NSAIDs
🟠 Mild to Moderate Heart Failure
Avoid: COX-2 inhibitors, diclofenac, high-dose ibuprofen (≥2400 mg/day)
Cautious Use: Standard NSAIDs (not diclofenac or high-dose ibuprofen) may be used with close monitoring
First-Line Options:
Ibuprofen ≤1200 mg/day
Naproxen ≤1000 mg/day
⚠️ Ischaemic Heart Disease, Cerebrovascular Disease, or Peripheral Arterial Disease
First-Line Options:
Ibuprofen ≤1200 mg/day
Naproxen ≤1000 mg/day
Contraindicated: COX-2 inhibitors, diclofenac, high-dose ibuprofen
How do you remember the components of the 6 in 1 vaccine
Hips, Tits, Dripping Pussy = Hard Willy (nah im cooked)
H — Hepatitis B
T — Tetanus
D — Diphtheria
P — Polio
H — Hib (Haemophilus influenzae type b)
W — Whooping Cough (Pertussis)
Which drugs can exaccerbate psoriasis and how can you remember it ?
Drugs can provoke/exacerbate psoriasis include lithium, chloroquine, hydroxychloroquine, beta blockers, NSAIDS, ACEI
A – ACE inhibitors
B – Beta-blockers
L – Lithium
A – Antimalarials (Chloroquine, Hydroxychloroquine)
N – NSAIDs
C – Chloroquine
H – Hydroxychloroquine
What is megaloblastic anaemia ?
A type of anaemia where red blood cells are larger than normal (macrocytic) and don’t mature properly due to impaired DNA synthesis.
📌 Main Causes
Vitamin B12 deficiency (e.g. pernicious anaemia, poor diet, malabsorption)
Folic acid deficiency (e.g. poor diet, alcoholism, pregnancy, certain drugs like methotrexate)
🔍 Key Features
Fatigue, weakness
Pale skin
Shortness of breath
Glossitis (smooth, sore tongue)
Neurological symptoms (only in B12 deficiency): tingling, numbness, balance issues
💊 Treatment
Vitamin B12 injections (e.g. hydroxocobalamin IM)
Oral folic acid (only if B12 deficiency is ruled out)
⚠️ Important: Never give folic acid alone if B12 deficiency is present — it can worsen neurological symptoms.
What are the symptoms of rubella ?
The main symptom of rubella is a spotty rash that starts on the face or behind the ears and spreads to the neck and body.
The rash takes 2 to 3 weeks to appear after getting rubella.
You might also have lumps (swollen glands) in your neck or behind your ears.
Rubella can also cause:
aching fingers, wrists or knees
a high temperature
coughs
sneezing and a runny nose
headaches
a sore throat
sore, red eyes
What is Guillain-Barré Syndrome, and how is it linked to Campylobacter infection?
Definition: GBS is a rare autoimmune disorder where the immune system attacks peripheral nerves.
Cause/Trigger: Often follows Campylobacter infection (~1 in 1000 cases).
Onset: Appears 1–3 weeks post-infection.
Symptoms:
Progressive global limb weakness (proximal and distal)
Cranial nerve involvement
Potential respiratory failure
Course: Rapid progression; most recover fully, but some may have permanent disability or die.
🧪 Key Concept: Autoimmune peripheral neuropathy following GI infection (Campylobacter is the most common trigger in the UK).
How should urinary stress incontinence be managed according to NICE guidance?
Trial: Minimum 3 months, supervised
Trainer: Continence adviser, women’s health physio, or specialist nurse
Exercise target: At least 8 contractions, 3x/day
if doesnt work consider surgery
if surgery not appropriate try duloxetine
What is treatment in Urgency urinary incontinence?
Use if bladder training fails and frequency is a key symptom
First-line options:
IR oxybutynin (avoid in frail elderly)
IR tolterodine
Darifenacin
Consider total anticholinergic load and comorbidities (e.g. dementia)
What is stress incontinence vs urine incontinence?
Stress incontinence occurs when urine leaks during physical activity or when the bladder is under pressure (e.g., coughing, laughing, exercising), often due to weakened pelvic floor muscles. Urgency incontinence, on the other hand, is characterized by a sudden, strong urge to urinate that is difficult to control, and may involve involuntary leakage
What is Calcitriol
Vitamin D analogue that can be used to treat psoriasis
Why is naloxone included in combination with buprenorphine for opioid dependence treatment?
Buprenorphine is a partial opioid agonist used for opioid dependence.
Naloxone is an opioid antagonist included to prevent misuse.
When taken sublingually (as prescribed), naloxone has minimal effect due to poor bioavailability.
If injected (parenteral misuse), naloxone becomes active and can precipitate withdrawal, discouraging misuse.
What is the MHRA alert relating to the implant
Implant migration - neurovascular injury and implants migrating to the vasculature (including the pulmonary artery).
Monitoring for Tacrolimus vs ciclosporin
Ciclosporin: 🩺 Before Treatment:
Measure serum creatinine at least twice
Full dermatological and physical exam
Check blood pressure
Baseline renal and liver function
Check blood lipids before and after 1 month
🧪 During Treatment:
Serum creatinine:
Every 2 weeks for 3 months
Then monthly
For RA: After initial phase, every 4–8 weeks
Blood pressure: Monitor regularly, discontinue if uncontrolled
Serum potassium & magnesium: Monitor due to risk of hyperkalaemia
Liver function tests: Especially if on NSAIDs
Lymphadenopathy: Investigate if persistent in atopic dermatitis
Renal biopsy: Annually if used long-term in nephrotic syndrome
Tacrolimus: 🩺 Therapeutic Drug Monitoring:
Monitor whole blood trough levels
Adjust based on response or during diarrhoea
Higher doses may be needed in Black African/African-Caribbean patients
🧪 During Treatment:
Blood pressure
ECG: Watch for signs of cardiomyopathy
Renal & liver function
Fasting blood glucose: Risk of diabetes
Neurological status: Check vision, look for signs of PRES
Electrolytes, including magnesium
Haematological & coagulation parameters
Plasma protein
Which drugs should be avoided in acute porphorias
Basically any high risk meds or epilepsy medications
How long is iron usually supplemented for ?
3 months
Amphoteracin B IV monitoring?
Monitor for hypersensitivity every 30 mins like with iron
WHat drugs cause Hypokalaemia
ABCDEI
Amiophylline/theophyline
Beta agonists/ salbutamol
Corticosteroids
Diuretics - loop & thiazide
Erythromycin & clarithromycin
I Insulin
What drugs cause Hyperkalaemia
Thanks B
Trimethoprim
heparin
Ace/Arb
Nsaids
K+ Sparing
Beta-blockers
What is the guidance for CAP?
🟢 Low Severity CAP
(CRB65 = 0 or CURB65 = 0–1)
💊 First-line (Oral):
Amoxicillin: 500 mg TDS for 5 days (can increase dose per BNF)
💊 Alternatives (if penicillin allergy or atypical pathogen suspected):
Doxycycline: 200 mg day 1, then 100 mg OD x 4 days (5-day total)
Clarithromycin: 500 mg BD for 5 days
Erythromycin (Pregnancy): 500 mg QDS for 5 days
🟡 Moderate Severity CAP
(CRB65 = 1–2 or CURB65 = 2)
💊 First-line (Oral):
Amoxicillin: 500 mg TDS for 5 days
Plus (if atypical pathogens suspected):
Clarithromycin: 500 mg BD for 5 days
OR (Pregnancy):
Erythromycin: 500 mg QDS for 5 days
💊 Alternatives (Penicillin allergy):
Doxycycline: 200 mg day 1, then 100 mg OD x 4 days (5-day total)
Clarithromycin: 500 mg BD for 5 days
🔴 High Severity CAP
(CRB65 = 3–4 or CURB65 = 3–5)
💉 First-line:
Co-amoxiclav:
Oral: 500/125 mg TDS
IV: 1.2 g TDS
PLUS:
Clarithromycin: 500 mg BD orally or IV
OR (Pregnancy):
Erythromycin: 500 mg QDS orally
All for 5 days
Carbamazepine therapeutic range
4-12 mg/L
What is the antibacterial for leg ulcers?
🟢 Non-severely unwell patients
💊 First-line (oral):
Flucloxacillin
💊 Alternatives (penicillin allergy or flucloxacillin unsuitable):
Doxycycline
Clarithromycin
Erythromycin (in pregnancy)
💊 Second-line (oral, guided by microbiology):
Co-amoxiclav
Alternative in penicillin allergy:
Co-trimoxazole (unlicensed)
🔴 Severely unwell patients
💉 First-line (oral or IV):
(guided by microbiology if available)
IV flucloxacillin ± IV gentamicin and/or IV metronidazole
OR IV co-amoxiclav ± IV gentamicin
💉 Alternative (penicillin allergy):
IV co-trimoxazole (unlicensed) ± IV gentamicin and/or IV metronidazole
💉 Second-line (oral or IV; guided by microbiology/specialist):
IV piperacillin/tazobactam
OR IV ceftriaxone ± IV metronidazole
🧫 If MRSA infection suspected or confirmed
(Add to standard treatment)
💉 IV or Oral options:
IV vancomycin
IV teicoplanin
