Medicines 50 Flashcards
(25 cards)
What are the indications, dosing, and safety considerations for Zopiclone?
🟡 Indication:
Short-term insomnia (up to 4 weeks)
Adults: 7.5 mg at bedtime
Elderly/chronic pulmonary insufficiency: Start with 3.75 mg at bedtime; may increase to 7.5 mg if necessary
⚠️ Contraindications:
Respiratory failure
Severe sleep apnoea
Myasthenia gravis
Marked neuromuscular respiratory weakness
History of complex sleep-related behaviours with hypnotics
⚠️ Cautions:
Avoid prolonged use (risk of tolerance & withdrawal)
Elderly (↑ risk of sedation, falls)
Depression or psychiatric illness
Drug/alcohol abuse history
Hepatic impairment (reduce dose)
Renal impairment (start with 3.75 mg)
👶 Pregnancy & Breastfeeding:
Not recommended in pregnancy – risk of neonatal withdrawal, hypotonia, hypothermia, respiratory depression
Avoid in breastfeeding – present in milk
❗ Common Side Effects:
Dry mouth
Bitter taste
Drowsiness
Uncommon/Rare:
Confusion, hallucinations, falls
Behavioural disturbances
Memory/concentration issues
Respiratory depression
🚗 Patient Advice:
May impair driving and skilled tasks next day
Avoid alcohol (enhances sedative effects)
How do Zopiclone and Zolpidem compare in use, effects, and safety?
🧠 Similarities
Both are non-benzodiazepine hypnotics (“Z-drugs”)
Used for short-term treatment of insomnia (max 4 weeks)
Enhance GABA activity for sedative effect
Risk of dependence, tolerance, withdrawal
Side effects: Drowsiness, dizziness, confusion, memory disturbances, taste disturbance (zopiclone)
🟦 Zopiclone
Standard dose: 7.5 mg at bedtime
(3.75 mg for elderly or in hepatic/renal impairment)
Half-life: ~5–6 hours ⏱ (longer)
Common side effect: Bitter/metallic taste, dry mouth
Daytime sedation: More likely (caution with driving next day 🚗)
Pregnancy/Breastfeeding: Avoid – risks of neonatal depression & withdrawal
🟩 Zolpidem
Standard dose: 10 mg at bedtime
(5 mg for elderly/hepatic impairment)
Half-life: ~2–3 hours ⏱ (shorter)
Less hangover effect than zopiclone
More likely to cause sleepwalking or complex sleep behaviours
Pregnancy/Breastfeeding: Also not recommended
⚖️ Clinical Tips
Zopiclone = longer duration, more next-day sedation
Zolpidem = shorter duration, less morning drowsiness, but higher risk of sleep-related behaviours
How should metformin be used in patients with CKD stage 3 (eGFR 30–45 mL/min)?
Metformin is not contraindicated in CKD stage 3 (eGFR 30–45 mL/min), but dose reduction and monitoring are essential.
Start with 500 mg once daily to reduce the risk of lactic acidosis.
Monitor renal function regularly — deterioration may require dose adjustment or discontinuation.
Avoid metformin only if eGFR drops below 30 mL/min or other contraindications arise.
Can e-cigarettes be reported to the yellow card scheme?
e-cigarettes, including their refills (e-liquids), can be reported through the Yellow Card scheme. The Yellow Card scheme, managed by the Medicines and Healthcare products Regulatory Agency (MHRA), allows anyone to report suspected side effects or safety concerns related to medicines, vaccines, medical devices, blood products, and, importantly, e-cigarettes
How should lidocaine plasters be used for post herpetic neuralgia?
🎯 Indication:
Localised pain relief in post-herpetic neuralgia
📎 How it works:
Delivers topical anaesthetic
Slow absorption through the skin
Undergoes first-pass metabolism in the liver
⏱️ Usage Instructions:
Apply for 12 hours per day
Remove after 12 hours to prevent systemic toxicity
⚠️ Caution:
Do NOT leave on overnight
Overuse may cause systemic side effects
What are the contraindications for sildenafil
❌ Contraindications:
Recent AMI (within 6 months)
Recent stroke (within 6 months)
Unstable angina
Severe cardiac failure
Optic neuropathy
⚠️ Caution:
Sexual activity may be inadvisable in these patients
Refer to GP before issuing, even if prescribed previously
🔁 Reason:
Ensure patient is safe to resume sexual activity
Underlying cardiovascular risk must be assessed
Aside from treatment of malaria what is an indication for Quinine?
Nocturnal leg cramps
What is the dose of metronidazole in treatment of BV
Metronidazole is use for Bacterial vaginosis (notably Gardnerella vaginalis infection) at a dose of 400-500mg twice daily for 5-7 days, alternatively 2g for
1 dose.
What is the treatment for tinea Versicolor ?
Ketoconazole 2% shampoo (once a day for 5 days) or selenium sulphide shampoo (once a day for 7 days)
What is the most common cause of primary hyperparathyroidism, and what is an important consideration in secondary care?
Cause: Most commonly due to a benign adenoma of a parathyroid gland.
Secondary care step: Measure vitamin D levels.
If low or insufficient → Offer vitamin D supplementation before or during further management.
When should SGLT2 inhibitors be offered to adults with type 2 diabetes?
✅ Cardiovascular Benefit
Offer an SGLT2 inhibitor with proven CV benefit if the patient has:
Chronic heart failure or
Established atherosclerotic cardiovascular disease
Offer:
With metformin as part of first-line treatment
As first-line if metformin is contraindicated/not tolerated
At any stage if HF or ASCVD develops later, based on current regimen and preferences
✅ Chronic Kidney Disease (CKD)
Offer an SGLT2 inhibitor licensed for CKD if:
Patient is on maximum tolerated ACEi or ARB
ACR > 30 mg/mmol
Meets eGFR and licensing criteria for the specific SGLT2 inhibitor
How should infection in otitis externa be managed, and what are the risks of prolonged treatment?
✅ Treatment Plan:
Use topical anti-infective (with or without corticosteroid)
Minimum duration: 1 week
Maximum duration: up to 2 weeks if symptoms persist
⚠️ Risks of Prolonged Use:
Alters ear canal flora
Increases risk of fungal infection
May cause hypersensitivity reactions
🦠 If fungal infection suspected:
Use topical antifungal such as:
Clotrimazole 1% solution - can be supplied OTC
Acetic acid 2% spray (unlicensed)
Flumetasone pivalate with clioquinol
💧 Astringent option:
Aluminium acetate ear drops (can reduce moisture/inflammation)
When can a pharmacy professional disclose confidential information without patient consent?
✅ Disclosure is only justified if:
It is required by law, or
It is in the public interest, and
It meets data protection legislation
👮♂️ If requested by police:
The officer does not have automatic access
The pharmacy professional must confirm:
A legitimate legal power is being used
There is a clear and valid reason for the request
📌 Always record the request and justification for disclosure.
How is acute osteomyelitis and septic arthritis managed, particularly in patients with diabetes mellitus?
✅ Osteomyelitis (acute, below the ankle in diabetics)
First-line: Flucloxacillin
+ Fusidic acid or rifampicin for first 2 weeks
Duration: 6 weeks
If penicillin-allergic: Clindamycin
+ Fusidic acid or rifampicin for first 2 weeks
If MRSA suspected: Vancomycin (or Teicoplanin)
+ Fusidic acid or rifampicin for first 2 weeks
Specialist referral if chronic infection or prosthetic involvement
✅ Septic Arthritis (below the ankle in diabetics)
First-line: Flucloxacillin
Duration: 4–6 weeks (longer if complicated)
If penicillin-allergic: Clindamycin
If MRSA suspected: Vancomycin (or Teicoplanin)
If gonococcal/Gram-negative suspected: Cefotaxime or Ceftriaxone
Treat gonococcal arthritis for at least 2 weeks
Specialist referral if prosthetic joint present
Key Point:
High-dose flucloxacillin is first-line for deep-seated Staphylococcus aureus bone infections.
What are the key points of bowel cancer screening in the UK?
✅ Eligibility:
Offered every 2 years to individuals aged 54–74 (soon to include ages 50–74).
Aged 75+: Eligible on request.
📦 Screening method:
FIT kit (Faecal Immunochemical Test) sent automatically by post.
🔍 Purpose:
Detect early signs of bowel cancer, which becomes more common with increasing age.
How often should cervical screening be done in women?
Al women and people with a cervix between the ages of 25 and 64 should go for regular cervical screening.
Screening is dependent on age:
Under 25 will be invited for a test up to 6 months before they turn 25
25- to 49-year-olds are invited every 3 years
50- to 64-year-olds are invited every 5 years
65 or older are invited only if a recent test was abnormal
Trans men and non-binary people with a cervix are eligible for cervical screening.
How often are mammograms done ?
Breast cancer is the most common type of cancer in women in the UK. Breast screening uses mammography radiography to detect smal changes in the
breast before other symptoms or signs of breast cancer develop.
Invitations for routine mammography screening are sent out to women aged 50-70 years (from the age of 50 years up to their 71st birthday) in England,
Northern Ireland, Scotland, and Wales.
Screen is usually conducted every 3 years.
What is the guidance for tetanus vaccination and booster doses?
✅ Routine immunisation: Given in childhood as part of the UK schedule.
💉 Primary course: Followed by 2 booster doses.
✈️ Travel advice:
Travellers should be up-to-date with tetanus vaccination.
If last booster was >10 years ago and travelling to areas with limited medical access, give a booster, even if they’ve had 5 doses previously.
🔁 Booster frequency: Every 10 years to maintain protection.
How is severe hypercalcaemia managed and what treatments are used?
Initial step: Correct dehydration with IV 0.9% sodium chloride.
Stop aggravating drugs: Discontinue thiazides, vitamin D, and restrict dietary calcium.
If persists:
Bisphosphonates (e.g., pamidronate disodium): Inhibit bone resorption; considered most effective.
Corticosteroids: Only useful in cases due to sarcoidosis or vitamin D toxicity (slow onset).
Calcitonin (salmon): Used in malignancy-related hypercalcaemia; less effective if bisphosphonates fail.
How is hypercalciuria managed, particularly when no underlying cause is found?
Investigate and treat any identifiable underlying cause.
If idiopathic (no cause found):
Increase fluid intake to reduce stone formation.
Prescribe bendroflumethiazide to reduce calcium excretion.
Moderate calcium intake may help, but severe restriction is not beneficial and may be harmful.
How does smoking affect theophylline?
Smoking induces hepatic cytochrome P450 enzymes, particularly CYP1A2, which metabolises theophylline. This means:
🚬 Effect of Smoking on Theophylline:
Increased clearance of theophylline (faster metabolism)
Reduced plasma concentration
Shortened half-life
Higher dose may be required to achieve therapeutic effect
⚠️ Clinical Implication:
If the patient stops smoking, the enzyme induction reverses, leading to slower metabolism of theophylline → risk of toxicity unless the dose is adjusted.
Monitoring of theophylline levels is essential, especially during changes in smoking habits.
What is microcytic anaemia
Microcytic anaemia is a type of anaemia where the red blood cells (RBCs) are smaller than normal (microcytic) and usually have reduced haemoglobin content (hypochromic), making them pale in colour.
🩸 Key Features:
Low mean corpuscular volume (MCV): < 80 fL
Low haemoglobin concentration
Pale, small red blood cells on a blood film
🔍 Common Causes (TICS mnemonic):
Thalassaemia
Iron deficiency anaemia (most common)
Chronic disease (sometimes)
Sideroblastic anaemia
What is akathisia
Akathisia is a type of movement disorder that causes an intense feeling of inner restlessness and an uncontrollable urge to move. People often describe it as a feeling of being unable to sit still.
Which opioids can increase the risk of seretonin syndrome?
⚠️ Which opioids carry serotonin risk?
Only opioids with serotonergic activity increase this risk — primarily:
Tramadol
Pethidine (meperidine)
Fentanyl
Methadone
Dextromethorphan (a cough suppressant with similar effects)
✅ Co-codamol (codeine + paracetamol):
Low risk of serotonin syndrome
Codeine is metabolised to morphine, which has minimal serotonergic activity
Generally considered safe with SSRIs at normal doses
Caution still advised if used long-term or at high doses
