Medicines 48 Flashcards
(23 cards)
What is megaloblastic anaemia and its treatment?
🔴 1. Megaloblastic Anaemia
Causes:
Vitamin B12 deficiency (e.g. pernicious anaemia, post-gastrectomy, nitrous oxide, congenital disorders)
Folate deficiency (e.g. poor diet, pregnancy, drugs like antiepileptics)
Key Points:
✅ Always identify if B12 or folate is deficient before starting treatment (except in emergencies).
❗ Never give folic acid alone in undiagnosed megaloblastic anaemia → may worsen B12-related neuropathy.
💉 Hydroxocobalamin is preferred for vitamin B12 deficiency: IM injection initially, then every 3 months for life.
📅 Folic acid: 4 months of daily treatment usually sufficient.
🚫 Avoid multivitamins with B12 or folic acid unless needed.
What is iron deficiency anameia and its treatment?
⚫ 2. Iron-Deficiency Anaemia
Causes:
Blood loss (menorrhagia, GI bleeding), malabsorption (coeliac, IBD), increased demand (pregnancy)
Key Points:
✅ Confirm iron deficiency before treating.
💊 Oral iron (ferrous salts): once daily is effective with fewer side effects.
🔄 Monitor Hb response over 4 weeks, continue 3 months after normalisation.
💉 IV iron (e.g. iron sucrose, ferric carboxymaltose): use if oral fails or not tolerated, or in renal dialysis.
What is sickle cell anaemia and its treatment?
🟡 3. Sickle-Cell Anaemia
Cause:
Genetic disorder causing abnormal haemoglobin (HbS)
Key Points:
🩸 Can cause painful sickle-cell crises → treat with fluids, analgesia, infection control.
💉 Vaccinations & lifelong penicillin prophylaxis important for infection prevention.
🌿 Folic acid needed due to increased red cell turnover.
💊 Hydroxycarbamide reduces frequency of crises and complications.
What is G6PD deficiency and the advice?
.
🟢 4. G6PD Deficiency
Cause:
Genetic enzyme deficiency, common in certain ethnic groups.
Key Points:
🔥 Risk of acute haemolytic anaemia triggered by drugs, infections, or fava beans (favism).
🧪 Be cautious with high-risk drugs (e.g. dapsone, nitrofurantoin, co-trimoxazole, fluoroquinolones).
⚠️ Risk is dose-dependent and varies between individuals.
🚫 Avoid mothballs (naphthalene) and certain drugs unless absolutely necessary.
What are the non ergot derived derived dopamine agonists
Ropinirole
Pramipexole
Rotigotine
Apormorphine
What are the Ergot derived dopamine agonists?
BCP
Bromocriptine
Cabergoline
Pregolide
What is the treatment for an anal fissure?
✅ Acute Anal Fissure (< 6 weeks)
Initial goals:
Soften stools to reduce strain and allow healing.
First-line treatments:
Bulk-forming laxative
→ e.g. Ispaghula husk
Osmotic laxative (if needed)
→ e.g. Lactulose
Pain relief:
Topical anaesthetic (e.g. lidocaine ointment)
Simple oral analgesia (e.g. paracetamol or ibuprofen)
If not improving:
➡️ Refer to hospital specialist.
✅ Chronic Anal Fissure (≥ 6 weeks)
Medical treatment options:
Topical glyceryl trinitrate (GTN) ointment
0.4% or 0.2% (unlicensed)
Modest healing benefit vs. placebo
Common side effect: Headache (~20–30%)
Topical diltiazem 2% or topical nifedipine 0.2–0.5% (unlicensed)
Similar effectiveness to GTN
Fewer side effects than GTN
Oral diltiazem or nifedipine (unlicensed)
Possible alternative if topical treatment not suitable
More systemic side effects → topical preferred
does renal or liver impairment affect lamotrogine ?
Hepatic impairment
Hepatic impairmentFor lamotrigine
Manufacturer advises caution in moderate to severe impairment.
Dose adjustments
Manufacturer advises dose reduction of approx. 50% in moderate impairment, and approx. 75% in severe impairment; adjust according to response.
Renal impairment
Renal impairmentFor lamotrigine
Caution in renal failure; metabolite may accumulate.
Dose adjustments
Consider reducing maintenance dose in significant impairment.
(BNF)
What is the treatment for neuropathic pain?
🔹 First-line treatments
Amitriptyline (TCA)
Pregabalin (antiepileptic)
→ Can be used in combination if monotherapy fails at max tolerated dose
Nortriptyline (unlicensed)
→ Better tolerated than amitriptyline
Gabapentin
→ Also effective
🔹 Alternative/Add-on Options
Tramadol
→ Short-term use if others ineffective
→ Can be used while awaiting specialist review
Morphine or oxycodone
→ Specialist initiation only
🔹 Topical options (localised pain or oral meds not tolerated)
Lidocaine 5% medicated plasters
Capsaicin:
0.075% cream → Postherpetic neuralgia
8% patch → Peripheral neuropathic pain (specialist only)
🔹 Other treatments
Corticosteroids → In compression neuropathy (to reduce swelling)
Neuromodulation → e.g. Spinal cord stimulation (specialist only)
Multidisciplinary care → Physio + psychological support often needed
What is the guidance for chronic facial pain?
✅ Chronic Facial Pain
Includes:
Persistent idiopathic facial pain (aka atypical facial pain)
Temporomandibular dysfunction
Management:
Tricyclic antidepressants (unlicensed)
Specialist referral essential
Psychological support often needed
Monitor long-term treatment for efficacy and side-effects
Which antipsychotics have the highest risk of sexual dysfunction
The HORs
Highest risk: haloperidol, olanzapine, risperidone
What is convulsive status epilepticus?
A seizure lasting 5 minutes or longer, or recurrent seizures without recovery in between.
Which 2 antibiotics can cause cholestatic jaundice
Flucox
Co-amox
Which abx need to be taken on an empty stomach. Hour before or 2 hours after food
Amazing Pharmacists forget ordering after food
Azithromycin caps
Phenoxymethylpenicllin
Flucloxacillin
Oxytetracycline
Ampicillin
Fosfomycin
Which electrolytes disturbances does trimethoprim cause
Hyperkalemia
Hyponatraemia
What are the MHRA alerts with Denosumab
Atypical femoral fractures (≥2.5 yrs use) → new thigh/hip/groin pain → consider stopping.
ONJ risk → dental exam if risk factors; avoid invasive dental work; maintain oral hygiene.
Hypocalcaemia → check Ca²⁺ before/after doses (esp. renal impairment); monitor symptoms (e.g. cramps, tingling).
Ear ON → rare; report ear pain/infection.
Rebound hypercalcaemia → up to 9 months post-stop (esp. in giant cell tumour).
↑ New malignancies (Xgeva®) vs zoledronate – monitor.
Multiple vertebral fractures post-discontinuation (Prolia®) → do not stop without specialist review.
Avoid in <18 yrs → risk of severe hypercalcaemia & AKI.
What is the patient advice with denosumab as per BNF?
Report new thigh/hip/groin pain → may signal atypical femoral fracture.
Oral hygiene essential → attend dental check-ups; report jaw symptoms (pain, loose teeth, swelling).
Report symptoms of hypocalcaemia → e.g. muscle cramps, tingling, spasms.
Patient reminder card → give to all patients (ONJ risk).
Missed dose (Prolia®) → give within 1 month of scheduled date.
How often is Denosumab given?
You have Prolia every 6 months.
You usually have Xgeva every 4 weeks. If you have giant cell tumour of the bone you have an extra dose 1 week and 2 weeks after the first dose.
What is the guidance for asthma in pregnancy
✅ Monitoring & Support
Offer asthma reviews in early pregnancy and postpartum.
Reassure that asthma medication is safe and important to prevent harm to mother and baby.
🚭 Smoking
Strongly advise against smoking and offer support to quit.
💊 Medications to Continue
Safe to continue as normal:
SABA and LABA (short/long-acting beta2 agonists)
ICS (inhaled corticosteroids)
Oral theophyllines
💥 During Exacerbations
Oral corticosteroids should be used if needed – benefits outweigh risks.
➕ Other Add-ons
If already on LTRA (e.g. montelukast) or LAMA, continue them if needed for control.
What is the Updated Asthma guidance for under 5s
🟢 Step 1: Initial Trial
Trial low-dose ICS (twice daily for 8–12 weeks) + SABA if:
Interval symptoms (esp. with atopy), or
Severe acute wheeze (e.g. hospitalised or ≥2 steroid courses).
🔵 Step 2: After the Trial
If no improvement:
✅ Check inhaler use & adherence
✅ Check for triggers (e.g. smoke, damp)
✅ Reconsider diagnosis
➡️ Refer to specialist if still uncontrolled
If improved:
🛑 Stop ICS + SABA
🔁 Review in 3 months
🟡 Step 3: If Symptoms Return
If symptoms recur or acute attack occurs:
🔄 Restart regular ICS (low → moderate dose as needed)
🗓️ Reassess & consider stopping again within 12 months
🔴 Step 4: If Still Uncontrolled
➕ Add LTRA for 8–12 weeks
⚠️ Monitor for neuropsychiatric side effects (e.g. with montelukast)
❌ Stop if ineffective
⛔ If LTRA fails: refer to specialist
What is the Asthma guidance for 5-11 year olds?
🟢 Start:
💊 Low-dose ICS + 💨 SABA as needed
🟡 If uncontrolled:
🔁 Try low-dose MART (⚠️ off-label; child must manage regimen)
⬆️ Step up to moderate-dose MART if needed
🔴 If MART not suitable:
➕ Add LTRA (🕒 trial 8–12 weeks)
🔄 Or switch to low-dose ICS/LABA + SABA
⬆️ Step up to moderate-dose ICS/LABA if still uncontrolled
⚠️ Refer to specialist if symptoms persist on
🔸 Moderate-dose MART or
🔸 Moderate-dose ICS/LABA (with or without LTRA)
What is the Updated asthma guidance for over 12s
Guidance aged over 12
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🟢 Initial Treatment
Offer as-needed low-dose ICS/formoterol (AIR therapy) for mild asthma
⚠️ Only specific budesonide/formoterol dry powder inhalers are licensed (others = off-label)
🔸 If Highly Symptomatic or Severe at Presentation
Start with low-dose MART + treat acute symptoms (e.g. oral steroids)
Consider stepping down to as-needed AIR later if well-controlled
🔁 Stepwise Escalation
Low-dose MART
👉 Offer if asthma not controlled on as-needed ICS/formoterol
Moderate-dose MART
👉 If not controlled on low-dose MART
If still uncontrolled despite good adherence:
🔬 Check FeNO & eosinophils:
If high → refer to specialist
If normal → trial LTRA or LAMA for 8–12 weeks:
✅ If controlled → continue
➕ If partial response → add trial of the other
❌ If no response → stop and try the alternative
⚠️ Monitor for neuropsychiatric effects (esp. with montelukast)
🚨 Referral
Refer to specialist if asthma remains uncontrolled after:
Moderate-dose MART
Trials of both LTRA and LAMA
