Miscellaneous Flashcards

Question

NSAIDs

Answer 1

Non-selective: Aspirin, naproxen, ibuprofen, diclofenac Selective: celecoxib GI: piroxicam, ketoprofen, and ketorolac trometamol are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk

Answer 2

Stevens-Johnson Syndrome Affects skin, mucous membranes, genitals and eyes The syndrome often begins with flu-like symptoms, followed by a red or purple rash that spreads and forms blisters. The affected skin eventually dies and peels off. Facial swelling and swollen lips covered in crusty sores are common features of Stevens-Johnson syndrome. The mucous membranes inside your mouth, throat, eyes and genital tract may also become blistered and ulcerated. ``` Drug causes: allopurinol carbamazepine lamotrigine nevirapine the "oxicam" class of anti-inflammatory drugs (including meloxicam and piroxicam) phenobarbital phenytoin sulfamethocazole and other sulfa antibiotics sertraline sulfasalazine ``` TEN is a severe form of SJS

Answer 3

Antihypertensives- rebound hypertension- tachycardia Anticoagulants Antidepressants- MAOI Benzodiazepines Steroids- adrenal glands reduce production of cortisol when taking steroids and if abrupt withdrawal then low level of cortisol in body=weakness, nausea, vomiting, diarrhoea, and abdominal pain Opioids- withdrawal symptoms: restlessness, anxiety, diarrhea, and generalized pain Seizure medication- withdrawal: agitation, confusion, and disorientation Thyroid medications- rapid heartbeat, fever, fainting, and if left untreated, coma

Answer 4

Venlafaxine associated with withdrawal so not suitable for non-adherent patients SSRIs for mild depression (citalopram)- first-line, safer in overdose, better tolerated Cannot start MOAI straight after stopping SSRI as increased risk of serotonin syndrome SSRI V TCA- TCA higher adverse effects, toxic in overdose, SSRI less sedating, fewer antimuscarinic effects and fewer cardiotoxic effects MAOI dangerous interaction with some food and drugs- require specialist Review use every 1/2 weeks at start Continue for 4 weeks before trying alternative In remission continue for 6 months SSRI associated with hyponatremia Associated with suicidal thoughts TCA given once daily at night (long half-life) TCA not suitable for children or elderly MAOI best in phobic, depressed, atypical, hypochondriacal, hysterical MAOI- Other antidepressants should not be started for 2 weeks after treatment with MAOIs has been stopped (3 weeks if starting clomipramine or imipramine). Conversely, an MAOI should not be started until: at least 2 weeks after a previous MAOI has been stopped (then started at a reduced dose) at least 7–14 days after a tricyclic or related antidepressant (3 weeks in the case of clomipramine or imipramine) has been stopped at least a week after an SSRI or related antidepressant (at least 5 weeks in the case of fluoxetine) has been stopped

Answer 5

important to take other medicines at least 1 hour before or 4–6 hours after taking this new medicine = colestyramine management of high triglycerides = Ezetimibe can be used to manage high triglycerides when a statin alone is not sufficient Patient taking amiodarone =atorvastatin. (max 20mg) Statins are the first-line option for reducing cardiac risk in patients with high cholesterol. Note the interaction between amiodarone and simvastatin in the BNF (patients should still be monitored for myopathy if atorvastatin has been started

Answer 6

Supplement for calcium in renal impairment- alfacalcidol- Vitamin D aids the absorption of calcium. Note this patient has renal disease so will need the activated form of vitamin D3 Total gastrectomy- A total gastrectomy is complete removal of the stomach and these patients need supplementation with vitamin B12 Vitamin to avoid during pregnancy- Vit A (retinol) (isotretinoin) (PPP) Wernickes encephalopathy- Pabrinex is a vitamin B complex that is used in the initial management of Wernicke’s encephalopathy. This should be changed to oral thiamine when clinically appropriate

Answer 7

HIV patients cannot receive live vaccines due to their weak immune system. So Fluenz Tetra (influenza vaccine) is not appropriate Tetanus vaccine required for patients with wounds. Tetanus-prone wounds include compound fractures, certain animal bites and scratches, puncture-type injuries acquired in a contaminated environment (these are likely to contain tetanus spores), wounds or burns with systemic sepsis, and wounds containing foreign bodies—this list is not exhaustive. High-risk tetanus-prone wounds include any tetanus-prone wounds or burns that either show extensive devitalised tissue or require surgical intervention that is delayed more than 6 hours, or wounds that are heavily contaminated with material likely to contain tetanus spores (such as soil or manure).

Answer 8

``` Low intensity (20–30% LDL-C reduction): • fluvastatin 20–40 mg daily • pravastatin 10–40 mg daily • simvastatin 10 mg daily Medium intensity (31–40% LDL-C reduction): • atorvastatin 10 mg daily • fluvastatin 80 mg daily • rosuvastatin 5 mg daily • simvastatin 20–40 mg daily High intensity (more than 40% LDL-C reduction) • atorvastatin 20–80 mg daily • rosuvastatin 10–40 mg daily • simvastatin 80 mg daily. ```

Answer 9

Age, allergies, weight, immune status, renal function, hepatic function, pregnancy/ breastfeeding, other conditions, previous antibiotic treatment, other medications, routes of administration

Answer 10

glibenclamide, gliclazide, glimepiride, glipizide, tolbutamide

Answer 11

pioglitazone

Answer 12

alogliptin, linagliptin, saxagliptin, vildagliptin, sitagliptin

Answer 13

exenatide, exenatide LAR liraglutide, lixisenatide,dulaglutide, semaglutide

Answer 14

dapagliflozin, canagliflozin, empagliflozin, ertugliflozin

Answer 15

Symptoms: shortness of breath (dyspnoea and orthopnoea), fatigue, ankle swelling, nocturnal cough, sputum frothy and tinged red Diagnosis: additional 3rd and 4th heart sounds, elevated JVP, ECG echo, BNP/NT-proBNP Reduced ejection fraction: ACEi (monitor renal function and electrolytes, low dose at bedtime, titrate slowly), loop diuretic (furosemide), beta -blocker, MRA Specialist treatment: ivabradine, valsartan, hydralazine, digoxin

Answer 16

Symptoms: fever, vomiting/nausea, lethargy, irritability/unsettled behaviour, ill appearance, refusing food/drink, headache, muscle ache/joint pain, respiratory symptoms/signs or breathing difficulty. Less common non-specific symptoms/signs include: chills/shivering, diarrhoea, abdominal pain/distension, sore throat/coryza or other ear, nose, and throat symptoms/signs. More specific symptoms/signs include: non-blanching rash (petechial rash, purpuric), stiff neck, capillary refill time of more than 2 seconds, cold hands and feet, unusual skin colour, shock and hypotension, leg pain, back rigidity, bulging fontanelle, photophobia, kernig's sign (person unable to fully extend at the knee when hip is flexed), brudzinski's sign (person’s knees and hips flex when neck is flexed), unconsciousness or toxic/moribund state, paresis, focal neurological deficit including cranial nerve involvement and abnormal pupils, seizures. Diagnosis: lumbar puncture for CSF Management: neonates: Ampicillin 50 mg/kg or amoxicillin 25 mg/kg and cefotaxime 50 mg/kg or ceftazidime 50 mg/kg. Adults: Cefotaxime 2 g three times daily or ceftriaxone 2–4 g once daily

Miscellaneous Flashcards

(41 cards)