Medicines 52 Flashcards
(19 cards)
What is the first line antihypertensive in someone with a history of angiodema
Usually an ACEi / ARB would be used as first-line treatment in a
patient under 55, however given the history of angioedema a CCB
such as amlodipine would be used. A thiazide-like diuretic such as
indapamide is another suitable option.
* ACEi treatment is contraindicated in patients with history of
angioedema (hereditary, idiopathic or prior ACEi therapy) as per
BNF.
* ARB should be used with caution in patients with a history of
angioedema (as per BNF).
When is budesonide offered in Crohns?
Consider budesonide for a first presentation or a single inflammatory
exacerbation in a 12-month period for people if conventional
glucocorticosteroids are contraindicated, or if the person declines or cannot
tolerate them. Explain that budesonide is less effective than a conventional
glucocorticosteroid, but may have fewer side effects.
WHen are tamoxifen, anastrazole and letrozole used as adjuvant treatment in breast cancer?
Tamoxifen - ASCO guidelines published June 2014 recommend extended adjuvant endocrine therapy for women with early breast cancer either with tamoxifen alone or using sequential treatment with tamoxifen and aromatase inhibitors. All
premenopausal women should receive at least 5 years of tamoxifen 20 mg once a day. Treatment beyond 5 years can be with either tamoxifen or an aromatase
inhibitor dependent on menopausal status.
- Letrozole – suitable for postmenopausal women only
- Anastrozole - suitable for postmenopausal women only
What is the treatment for opioid induced constipation?
According to the BNF: ‘In patients with opioid-induced
constipation, an osmotic laxative (or docusate sodium to soften the
stools) and a stimulant laxative is recommended.
How often should a spacer be cleaned according to asthma uk?
Once a month
How do spacers affect systemic absorbtion?
Systemic side effects can be reduced by using a spacer
spacers increase the proportion of the drug delivered to the
airways and reduce the amount of drug deposited in the oropharynx
(thereby reducing local adverse effects and reducing the amount of systemic
absorption)
WHich tetracyclines can be taken with milk?
✅ Tetracyclines that CAN be taken with milk:
These are less affected by calcium, so milk has minimal or no clinically significant effect on their absorption:
Doxycycline – Slight reduction in absorption, still acceptable with milk.
Minocycline – Absorption not significantly affected by food or milk.
Lymecycline - fine with milk & other foods
❌ Tetracyclines that should NOT be taken with milk:
These form insoluble complexes with calcium, leading to significantly reduced absorption:
Tetracycline
Oxytetracycline
Demeclocycline
What are the rules around monitoring for sick day rules?
An increase in monitoring frequency may be needed, such as at least every 3–4 hours including through the night and advice to record the results.
Insulin doses may need to be adjusted, depending on the results.
To continue to self-monitor blood glucose levels carefully when feeling better, until they are back to baseline.
Seek urgent medical advice if blood glucose levels remain uncontrolled.
Consider the need for blood or urinary ketone monitoring.
This should be checked regularly, for example at least every 3–4 hours including through the night, and record the results.
If the urine ketone level is greater than 2+, or blood ketone level is greater than 3 mmol/L, the person should seek immediate medical advice. See the section on When to suspect hyperglycaemic emergencies (DKA and HHS) for more information.
What is 1st line treatment in more severe depression?
An SSRI or SNRI drug such as venlafaxine is a suitable choice according to
NICE recommendations for treatment of more severe depression. Note that
SSRIs (fluoxetine, sertraline, citalopram, etc) are usually chosen rather than
an SNRI such as venlafaxine as first-line treatment, but NICE guidance does
support the use of SNRIs such as venlafaxine.
What is the MOA of gliclazide
Stimulates insulin secretion from B cells in pancreas
What is the MHRA alert regarding MR formulations of opioids
Prolonged-release opioids: Removal of indication for relief of post-operative pain
The indication for the treatment of post-operative pain has been removed from the licences of all prolonged release opioids due to the increased risk of persistent post-operative opioid use (PPOU) and opioid-induced ventilatory impairment (OIVI).
Scarlet fever abx
Offer a 10-day course of phenoxymethylpenicillin (penicillin V) first-line.
Second-line options for people with penicillin allergy are:
Birth to 6 months — clarithromycin for 10 days.
Non-pregnant adults and children aged 6 months to 17 years — azithromycin for 5 days, or clarithromycin for 10 days.
Pregnant or postpartum (within 28 days of childbirth) — erythromycin for 10 days.
If someone came into the pharmacy and had unprotected sex < 48 hrs ago but was under 16 which contraceptive is favourable
You could refer her to another pharmacy that provides levonorgestrel on a PGD, but this requires the PGD allowing supply of levonorgestrel to children under 16 and is also not convenient to the patient, as they may have to travel far (can they travel?) and requires them to go through the questions again with another pharmacist – this may put them off getting EHC.
- EllaOne can be sold to children under the age of 16. As there are no
contraindications, and it is within the 120-hour window since unprotected
sex, EllaOne is the most appropriate option.
Name some effects of antimuscarinics:
Tachycardia
palpitations and arrhythmias; difficulty with micturition - urinary retention; constipation.
Cant shit cant spit cant see cant pee
can overuse of inuslin cause DKA ?
This is the correct answer as it is actually insulin non-
adherence/omission that can precipitate DKA. Overusing insulin would lead
to hypoglycaemia.
what are the symptoms of cauda equina?
Symptoms of cauda equina syndrome:
* Severe low back pain.
* Motor weakness, sensory loss, or pain in one or commonly
both legs.
* Saddle anaesthesia (unable to feel anything in the body areas
that sit on a saddle)
* Bladder dysfunction (such as urinary retention or
incontinence)
* Bowel incontinence.
How long should prescribed antifungals be applied to the body for? (NICE)
Terbinafine
Clotrimazole
miconazole
Econazole
The following application regimens are recommended for the treatment of fungal infection of the body and groin:
Terbinafine 1% cream (children above 12 years of age)
Apply thinly to the affected area once or twice a day for up to 1–2 weeks.
Clotrimazole 1% cream
Apply to the affected area 2–3 times a day and continue for at least 4 weeks. A strip of cream about half a centimetre long is enough to treat an area about the size of the hand.
Miconazole 2% cream
Apply to the affected area twice a day continuing for 10 days after all skin lesions are healed.
Econazole 1% cream
Apply to the affected area twice a day and continue until all skin lesions are healed.
