Medicines 49

Question 1

What is the treatment for mild to moderate ulcerative colitis?

Answer 1

🔹 Mild-to-Moderate UC
Proctitis:

1st line: Topical aminosalicylate

Add oral aminosalicylate or steroid if no response

Proctosigmoiditis / Left-sided colitis:

1st line: Topical + high-dose oral aminosalicylate

Add topical/oral steroid if no response

Extensive colitis:

1st line: Topical + high-dose oral aminosalicylate

If needed: Add oral steroid

Question 2

What is the treatment for moderate to severe Ulcerative colitis

or severe acute ulcerative colitis

Answer 2

🔸 Moderate-to-Severe UC
Managed under specialist care

Use:

Biologics (e.g. TNF-α inhibitors, anti-integrins)

JAK inhibitors, S1P modulators

🔺 Acute Severe UC (Medical Emergency)
Admit to hospital

IV corticosteroids (hydrocortisone or methylprednisolone)

If not tolerated: IV ciclosporin or infliximab

Surgery if no response in 72h or worsening symptoms

Exclude infections (e.g. CMV) if deterioration after initial response

Question 3

What is Crohn’s Disease – Acute & Maintenance Treatment

Answer 3

Acute (Induction):

1st-line: Corticosteroids (prednisolone, methylprednisolone, IV hydrocortisone)

Alt. (mild/moderate ileal/right-sided): Budesonide or aminosalicylates (less effective, fewer side effects)

Add-on if ≥2 flares/year or steroid-dependent: Azathioprine or mercaptopurine (unlicensed); methotrexate if thiopurines unsuitable

Specialist use: TNF-α inhibitors, other biologics, or JAK inhibitors (moderate–severe)

Maintenance:

Monotherapy: Azathioprine/mercaptopurine (unlicensed) if used for induction or poor prognosis

Methotrexate: Only if used for induction or thiopurine intolerance

Steroids/budesonide: Not for maintenance

Post-surgery (ileocolonic): Azathioprine ± 3 months metronidazole

Not recommended post-op: Mercaptopurine, biologics, budesonide, aminosalicylates

Question 4

What is the symptomatic treatment for Diarrhoea in chrons disease?

Answer 4

Loperamide or codeine: for non-colitic diarrhoea

Colestyramine: for bile acid-related diarrhoea

Use with caution depending on site/severity

Question 5

What is the treatment for fistulating chrohns disease

Answer 5

Metronidazole/ciprofloxacin (max 3 months for metronidazole)

Azathioprine or mercaptopurine to control inflammation

Infliximab if no response to conventional therapy – ensure drainage of sepsis first

Surgery (drainage, fistulotomy, seton insertion) often needed

Maintain treatment ≥1 year

Question 6

Which medications cause intracranial hypertension?

Answer 6

CLACT

Cyclosporine
Lithium
(A) High-dose vitamin A supplements
Corticosteroid withdrawal
Tetracyclines

Question 7

Medications that cause Hypernatraemia

Answer 7

1. Loop Diuretics
   Furosemide, Bumetanide, Torsemide
   ⮕ Cause more water than sodium loss → relative sodium excess
2. Osmotic Diuretics
   Mannitol
   ⮕ Pull water into urine, leading to dehydration
3. Sodium-containing drugs or infusions
   Hypertonic saline, sodium bicarbonate, effervescent tablets
   ⮕ Direct sodium loading
4. Mineralocorticoids
   Fludrocortisone
   ⮕ Promotes sodium retention
5. Lithium
   ⮕ Can cause nephrogenic diabetes insipidus → water loss and hypernatremia

Question 8

Medications that cause Hyponatramia

Answer 8

Mechanism: Water retention or sodium loss. Often due to SIADH (Syndrome of Inappropriate ADH Secretion).

1. Diuretics
   Thiazide diuretics (e.g., bendroflumethiazide, indapamide)
   ⮕ Promote sodium loss, especially in elderly
2. Antidepressants
   SSRIs (e.g., sertraline, fluoxetine)
   TCAs (e.g., amitriptyline)
   ⮕ Can induce SIADH
3. Antipsychotics
   Risperidone, haloperidol
   ⮕ Associated with SIADH
4. Antiepileptics
   Carbamazepine, oxcarbazepine, valproate
   ⮕ Increase ADH effect or secretion
5. Chemotherapy agents
   Cyclophosphamide, vincristine
   ⮕ Stimulate ADH release
6. Desmopressin (DDAVP)
   ⮕ Mimics ADH → water retention
7. NSAIDs
   ⮕ Potentiate ADH action by reducing renal prostaglandins

Question 9

What is a Hordoleum

Answer 9

A stye, also known as a hordeolum, is a common, painful, localized infection of an eyelid gland, usually caused by bacteria

Question 10

What is a notifiable disease and how would you recognise it?

Answer 10

A notifiable disease is an illness that, by law, must be reported to public health authorities when it is diagnosed. This helps track and control the spread of infections that could harm individuals or the public.

🔍 How to recognise a notifiable disease:
You don’t need to memorise all of them, but you should be aware that notifiable diseases are often serious, contagious, or pose a public health risk. Examples include:

Measles

Mumps

Tuberculosis (TB)

COVID-19

Meningitis

Food poisoning (certain types)

🩺 How would you know it’s notifiable?
Check the patient’s symptoms and diagnosis – if it’s a known serious infectious disease, check if it’s on the notifiable list.

Look it up – the UK Health Security Agency (UKHSA) and BNF list notifiable diseases.

If you’re unsure – ask the local Health Protection Team (HPT) or follow your workplace’s protocol.

Question 11

What is the effect on blood glucose that ACE inhibitiors have?

Answer 11

ACE inhibitors (like ramipril, lisinopril, enalapril) are generally associated with improving insulin sensitivity, so they can help reduce blood sugar levels slightly or have a neutral effect.

Question 12

Whats the difference between Pityriasis versicolor and vitiligo?

Answer 12

Question 13

What is Mefenemic acid

Answer 13

Mefenamic acid is a non-steroidal anti-inflammatory drug (NSAID) used to treat mild to moderate pain, especially period pain (dysmenorrhoea) and menorrhagia (heavy menstrual bleeding).

⚠️ Cautions
Avoid in patients with peptic ulcer, GI bleeding, or inflammatory bowel disease

Use with caution in patients with:

Asthma

Kidney or liver impairment

Cardiovascular disease

Question 14

What are the different anaesthesias used in children?

Answer 14

💉 Intravenous Anaesthetics
1. Propofol

✅ Most commonly used IV anaesthetic

💨 Rapid onset and recovery; minimal hangover

⚠️ Not commonly used in neonates

🛌 Also used for sedation during procedures

2. Thiopental Sodium (Barbiturate)

🎯 Induction only (no analgesic properties)

⏱️ Rapid onset & awakening (redistribution)

🧠 Sedation may last up to 24h; cumulative effect with repeated doses

⚠️ Respiratory & cardiovascular depression

3. Etomidate

💨 Rapid recovery, minimal hangover

⚠️ Causes extraneous muscle movements

➕ Less hypotension than propofol/thiopental

👌 Movements reduced with opioid or benzodiazepine premedication

4. Ketamine

💪 Maintains BP (less hypotension)

🧒 Used in children needing repeat anaesthesia (e.g. burns dressings)

🐢 Slower recovery

⚠️ Psychotic effects (hallucinations, nightmares)

👌 Use with benzodiazepines (e.g. diazepam) to reduce side effects

🌬️ Inhalational Anaesthetics
Includes gases and volatile liquids

💨 Delivered via calibrated vaporisers

💧 Carrier gases: air, oxygen, or nitrous oxide-oxygen mixtures

⚠️ Oxygen concentration should always be ≥25%, usually ≥30% when using nitrous oxide

🧯 Requires special equipment for storage/admin

Question 15

How is gestational diabetes managed based on fasting plasma glucose levels?

Answer 15

< 7 mmol/L at diagnosis:
→ Start with diet & exercise.
→ If targets not met in 1–2 weeks → Add metformin.
→ Insulin if metformin not tolerated or ineffective.

≥ 7 mmol/L at diagnosis:
→ Start insulin immediately, with or without metformin, alongside diet & exercise.

6.0–6.9 mmol/L with complications (e.g. macrosomia or hydramnios):
→ Consider immediate insulin, with or without metformin.

After delivery:
→ Stop hypoglycaemic treatment immediately.

Question 16

What are primary, secondary and tertiary prevention

Answer 16

🛡️ Primary Prevention
Prevent the disease before it starts
👉 e.g. Vaccines, healthy lifestyle advice

🔍 Secondary Prevention
Catch the disease early to stop it getting worse
👉 e.g. Screening tests, early treatment

🩺 Tertiary Prevention
Manage the disease to prevent complications
👉 e.g. Rehab, long-term medication, complication control

Question 17

Does vitamin D cause hypo or hypercalcaemia?

Answer 17

excess vitamin D can cause hypercalcemia

Question 18

How do you treat Warfarin overdose and in what ranges

Answer 18

🔴 INR > 8 with minor bleeding
Stop warfarin

Give vitamin K (phytomenadione) IV slowly

Repeat in 24h if INR remains high

Restart warfarin when INR < 5

⚠️ INR > 8 with no bleeding
Stop warfarin

Give oral vitamin K (IV prep used orally – off-label)

Repeat in 24h if INR remains high

Restart warfarin when INR < 5

🔴 INR 5–8 with minor bleeding
Stop warfarin

Give vitamin K IV slowly

Restart warfarin when INR < 5

⚠️ INR 5–8 with no bleeding
Withhold 1–2 doses

Reduce maintenance dose

Question 19

What can cause raised ALP

Answer 19

🦴 B - Bone Disorders
Paget’s disease

Bone metastases

Healing fractures

Osteomalacia / Rickets

Hyperparathyroidism

🧪 L - Liver Causes
Cholestasis (e.g. gallstones, biliary obstruction)

Primary biliary cholangitis

Primary sclerosing cholangitis

Liver metastases

Hepatitis (mildly raised)

🦠 I - Infiltrative Conditions
Sarcoidosis

Amyloidosis

Tumours infiltrating liver or bone

🍼 P - Physiological / Pregnancy
Normal in 3rd trimester (placental ALP)

Children/teens (due to bone growth)

Question 20

How do you treat tumour lysis syndrome?

Answer 20

Prevention involves aggressive hydration and the use of medications to lower uric acid levels (allopurinol or rasburicase).

Question 21

How should an acute gout flare be managed?

Answer 21

🕒 Treat early – as soon as possible after symptom onset.

🔹 First-line options (choose based on comorbidities/preferences):

NSAID (e.g. naproxen, max dose) + consider PPI for gastric protection.

Colchicine.

Oral corticosteroid (e.g. prednisolone 30–35 mg OD for 3–5 days) (off-label use).

💉 If oral treatments not tolerated/ineffective:

Consider IM or intra-articular corticosteroid injection (off-label).

🧊 Adjunctive advice:

Ice packs for pain relief.

Rest, elevate, and cool the joint.

Paracetamol for additional pain relief if needed.

🚫 Avoid aspirin – it may worsen gout.

🧠 Education points:

Explain signs, causes, progression of gout, and need for long-term urate-lowering therapy (ULT).

Discuss risk factors (e.g. obesity, CKD, hypertension, certain meds).

Share support resources (e.g. forums, charities).

📌 Ongoing advice:

Continue ULT (e.g. allopurinol or febuxostat) during flare.

Seek review if no improvement after 1–2 days or symptoms worsen.

🚫 Do not offer IL-1 inhibitors unless NSAIDs, colchicine, and corticosteroids are all unsuitable—refer to rheumatology first.

Question 22

Which analgesics can be used in breastfeeding? (according to the SPS)

Answer 22

💊 Analgesics & NSAIDs in Breastfeeding – Safety Summary Flashcard
🔴 Avoid Completely:

Codeine → ❌ Do not use (MHRA: Risk of serious side effects in infant such as sedation or respiratory depression due to metabolism to morphine)

🟡 Use With Caution (Short-term only, monitor infant):

Dihydrocodeine → ✅ Cautious use okay short-term

⚠ Limited data, may pass into milk in small amounts

Safe in practice but not fully evidenced

Tramadol → ✅ Cautious use okay short-term

Monitor baby for drowsiness, poor feeding, or breathing issues

🟢 Preferred Options:

Paracetamol → ✅ Safe during breastfeeding

Low levels in milk, well tolerated

Ibuprofen & Diclofenac → ✅ Preferred NSAIDs

Short half-lives, extensive safe use in breastfeeding

🔴 NSAIDs to Avoid:

Mefenamic acid → ❌ Avoid

Associated with haemolytic anaemia and other adverse effects

Question 23

What are the rules around supply of GnRH analogues

Answer 23

❌ What’s Banned?

Private prescriptions for puberty blockers (GnRH analogues)

For the treatment of gender dysphoria/incongruence

In under-18s

Effective: 1 January 2025

Also banned: Dispensing private prescriptions from the EEA/Switzerland for under-18s, dated on or after 3 June 2024

✅ Exceptions

Ongoing treatment allowed if:

The prescription was issued in the UK

Patient is already receiving treatment (NHS or private)

📚 Background

Based on the Cass Review: Found insufficient evidence of safety or effectiveness of puberty blockers in this context

Question 25

What HBA1C ranges are classified as prediabetic and diabetic?

Answer 25

42–47% - prediabetic > 48% - diabetic