Oral Assessment Pt 2 Flashcards
(86 cards)
1
Q
What is the cefalexin dose for UTI prophylaxis in adults and children?
A
Adult: 250mg PO N
Child: 12.5mg/kg PO N (max 250mg)
2
Q
What is the cefalexin dose for UTI treatment in adults and children?
A
Adult: 500mg PO 12 BD for 5 days for women, 7 in men
Child: 12.5mg/kg (500mg max) every 6 hours for 3 days
3
Q
What are some lifestyle points for cefalexin (or antibiotics in general)?
basic inf control
A
Responsibility to try prevent spread of infection
* wash hand, coughing manners, not sharing utensils or waterbottles or cups, stay home where possible
Also keep your immunisations up to date (tet, diphtheria, whooping)
4
Q
What class of drug is doxycycline?
A
Tetracycline Ab
5
Q
How does Doxycycline work?
Bacterio -cidal or -static
A
Inhibits bacterial protein synth by reversibly binding to 30S subunit of the ribosome; bacteriostatic
Effect in acne vulgaris and rosacea also involves mechanisms other than antimicrobial activity
6
Q
What are the indications of Doxycyline?
A
- Acne
- Rosacea
- Infections caused by M. Pneumoniae
- CAP
- Exacerbations of chronic bronchitis
- Acute bacterial sinusitis
- Chlamydial and other non-gonococcal genital tract infs
- Malaria prophylaxis
- Malaria Tx (with quinine)
- Chronic prostatitis
7
Q
Standard dose of Doxy (adult and child)
A
Adult: 100mg PO, OD or BD
Child: 2mg/kg (max 200mg) BD on day 1, then 2mg/kg OD (max 100mg) - round to nearest 25mg)
In serious inf: dose can be increased to 4mg/kg (max 200mg d) in 1 or 2 doses
8
Q
What is the dose of Doxycycline in Acne?
A
50mg OD for at least 6 weeks, if needed inc to 100mg OD (after the 6 weeks at least)
Child >8yo also
9
Q
What is the dose of Doxycycline in Rosacea?
A
ADULT ONLY: 50mg OD
10
Q
What is the dose of Doxycycline in Malaria prophylaxis?
Extra Counselling
A
Start 2 days before entering malarial area, and continue 4 weeks after endemic area
Adult: 100mg OD
Child >8yo: 2mg/kg (max 100mg) OD
Prevent bites: use repellents & protective clothing. Seek medical help if febrile illness (fever) occurs within 12 months of exposure.
11
Q
What is the dose of Doxycycline in Malaria treatment?
A
Uncomplicated
Adult: 100mg every 12 hours for 7 days with quinine 600mg
Child: 2mg/kg 12 hourly for 7 days with quinine
12
Q
Counselling points for Doxycycline?
CALS
A
- (B) Take with food or milk to reduce stomach upset
- (4a) Do not take with antacids, iron, Ca or Zn supplements within 2 hours of taking Doxy - interfere with absorption
- (8) Avoid excessive sun exposure as this medicine will make you more sensitive to the sun (wear sunscreen, protective clothing)
13
Q
Counselling points for Doxy other than CALs
A
- Take with a full glass of water and sit upright for at least 30 minutes after taking your dose - can get stuck in the oesophagus and cause epigastric burning / oesophageal ulcers
- Ensure to complete course even if you feel better (malaria proph and tx, inf)
- Try to reduce alcohol consumption - can reduce doxy plasma levels
14
Q
Common ADEs of Doxycycline
A
- N, V, D,
- epigastric burning,
- tooth discolouration and enamel dysplasia,
- photosensitivity
Inf:
* fungal overgrowth
15
Q
Monitoring points for Doxycycline
A
- Efficacy of treatment (esp in acne, rosacea and infections - resolution of symptoms)
- LFTs (long term use or impairment or other hepatotoxic drugs) - cause hepatitis, hepatotoxicity
- Complete blood count - dyscrasias
- Renal Function (long term therapy) - unlikely to cause effects due to mainly being hepatically cleared but for sake of completness
16
Q
Doxycycline in children.
What are the concerns and what is a more acceptable age range?
A
Tooth discolouration and enamel dysplasia
* Can be permanent if given in latter pregnancy (post 18-weeks - mineralisation of child’s teeth), infancy and childhood <8yo
* more common in long-term use or repeated short-term courses.
Reduced bone growth
* causes stable calcium complex in any bone forming tissue
* decrease in fibula growth seen in prem infants given oral tetra
Use in >8yo, otherwise less than 21 days
17
Q
What drug class is Isotretinoin?
A
Retinoid
18
Q
How does Isotretinoin work?
A
Modulates cell proliferation and differentiation. Reduces sebum excretion, Cutibacterium acnes numbers, inflammation and cyst formation
19
Q
Indications of Isotretinoin
A
- Cystic Acne, severe
Also excepted:
* Keratinisation disorders (specialist advice)
* Rosacea (papulopustular), severe or refractory
20
Q
What is the dose of Isotretinoin in Acne?
A
Initially 0.5mg/kg in 1 or 2 doses. After 4 weeks, dose may be adjusted to response and tolerance; max 1mg/kg daily in 1 or 2 doses (may be poorly tolerated)
Lower doses may be used in some circumstances
21
Q
How do you reduce risk of relapse in Acne with Isotretinoin when stopping?
A
Specialist may continue the isotretinoin for a few months after the lesions are resolved
22
Q
What is the dose of Isotretinoin in Rosacea?
A
Usual initial dose – 0.25-0.3mg/kg daily in 1 or 2 doses, then adjust dose to response and tolerance; max 1mg/kg d. Use lowest effective dose, may be as low as 10mg 3 times a week
Specialists may continue treatment (eg 4-8 weeks) after inflammatory lesions are well controlled
23
Q
What are the counselling points for Isotretinoin?
Basics / CALs
A
- Best taken with food
- Makes you quite sensitive to the sun you will burn easy. Wear sunscreen always, protect skin from sunlight with protective clothing and staying in the shade where possible
- May cause refractory acne flare – usually in first few weeks of Tx. Mostly mild and will improve with continued Tx (severe = urgent derm rv –> dose reduction + oral corticos may be req)
- Can cause a fair bit of dryness, particularly in the skin, lips and eyes - good, hydrating lip balms, moisturisers and lubricating eyedrops are recommended
24
Q
What is an extra precaution for women when using Isotretinoin?
A
Women must be using contraception before, during and 1 month after taking. Causes severe birth defects (any pregnancies will most likely have to be terminated)
25
What else should you avoid when using Isotretinoin?
| Appart from sun
* Vitamin A supplements
* Waxing, dermabrasion, and laser hair removal must be avoided during and 6 months after stopping - scarring and irritation risk
* Topical anti-acne preparations - increase risk of local irritation
* Don't donate blood during or 8 weeks after stopping treatment
26
What are points of referral for a patient taking Isotretinoin?
* Nausea, Headache or visual changes (poor night vision or blurring)
* If dryness is unmanageable or contacts are too uncomfortable
* Experiencing a change in mood
27
Common ADEs of Isotretinoin?
* Acne flares (first few weeks)
* Dryness of skin and mucous membranes
* Eye disorders
* Raised creatinine kinase levels
* Dyslipidaemia
* Altered blood glucose levels
* Photosensitivity
## Footnote
Also, R: Neutropenia, anaemia, decreased bone mineral density esp with long-term use
28
Monitoring for Isotretinoin?
* LFTs and lipids at baseline, 1 month and clinically as required
* Full blood count (neutropenia, anaemia)
*Blood glucose (esp in diabetes)
* Cholesterol (dyslipidaemia)
* Renal function (raised Creatinine kinase levels)
* Bone mineral density (esp in long-term)
29
What drug class is Famciclovir?
Antiviral – Guanine analogue
30
How does Famciclovir work?
Inhibit viral DNA polymerase and DNA synthesis after phosphorylation by viral and cellular enzymes
31
Indications of Famciclovir
Treatment and prevention of herpes simplex infections
Shingles
32
What is the dose of Famciclovir for Genital Herpes Treatment?
| Initial infection and recurrent (immunocompetent)
Initial infection:
250mg PO tds for 5-10d
Recurrent:
125mg bd for 5d
OR
500mg first dose, then 250mg 12 hourly for 3 more doses (48 hours total)
OR
1g bd for 1 day
33
What is the dose of Famciclovir for Genital Herpes Prevention?
| Immunocompetent
250mg BD
34
What is the dose of Famciclovir for Cold Sores Treatment?
1.5g as a single dose
35
What is the dose of Famciclovir for Shingles Treatment?
500mg TDS for 7 days (10 if immunocompromised)
Start dosing ASAP, within 72 hours of infection onset. Can consider after the 72 hours if high risk of severe shingnles or complications (eg immuno-suppressed, progressive clinical state)
36
What are the counselling points for Famciclovir?
| Basics
* Can make you feel dizzy or confused, don't drive or operate machinery if affected
* For reccurent herpes simplex infections, carry a course of tablets on you so that you can start them as soon as you notice
37
Shingles Counselling Famciclovir
* OTC pain relief
* Can sometimes get prescription pain relief (opioids)
* Can also use capsicacin cream to help with nerve pain (or lidocaine gel)
* Keep the area clean - bathe in saline and cover with a wound dressing
* Apply cool, wet compress, ice pack to help reduce pain and itch
* Don't scratch --> bacterial infection and scars
* Loose-fitting cotton clothes to avoid irritating the rash
* Sleep and rest
* Healthy diet
* Someone who has not had the chicken pox vaccine can catch chicken pox from someone who had shingles (fluid from shingles blisters)
38
Common ADEs of Famciclovir?
* H, V, D
* Confusion esp in elderly, dizzy, rash
* Jaundice and hallucinations
39
Monitoring of Famciclovir?
* Renal function and famciclovir conc (esp in impair) - dose adjustments are needed in impairment
* Symptom of resolution e.g. lesion healing, pain reducing
* LFTs if pre-existing liver disease or long-term use
40
What drug class is Esomeprazole?
Proton-Pump Inhibitor
41
How does Esomeprazole work?
Bind to the hydrogen/ potassium ATPase enzyme system (proton pump), inhibiting both stimulated and basal acid secretion
42
Indications of Esomeprazole
* GORD
* H. Pylori eradication, as part of an effective regimen
* Tx and prevention of NSAID-induced gastric ulcer
* Short-term treatment of upper GI Sx associated with NSAIDs
* Prevention of peptic ulcer rebleeding
43
What is the dose of Esomeprazole in GORD?
Init (oral/IV): 20mg OD for 4-8 weeks. If response is inadequate, inc dose to 40mg d for a further 4 weeks
Maint: reduce to min req
Change from IV to Oral ASAP
44
What is the dose of Esomeprazole in H. Pylori?
Oral/IV, 20mg BD, with clarithro 500mg BD and amox 1g BD (metronidazole if pen allergy) for 14 days
45
What is the dose of Esomeprazole in Treatment and Prevention of NSAID-associated gastric ulcer?
Treatment: 20mg OD PO/IV for 4-8 weeks
Prevention: 20mg PO OD for 4 weeks (while using NSAID)
46
What are the counselling points for Esomeprazole?
| Basics / CALs
* Generally well tolerated
* Tabs: Swallow whole - can disperse in water, then drink within 30 minutes
* Grans: Mix 1 sachet with 15mL of water and allow to thicken for a few mins, stir again and drink within 30mins
Reassess ongoing PPI use regularly with your physician, if Sx are well controlled (after at least 4-8 weeks of Tx) consider;
* stopping (unless severe oesophagitis or complicated disease) or,
* intermittent use when Sx develop
* step down to lowest effective dose
47
Referral Points for Esomeprazole
* Tell your doctor if you develop Sx such as black stools or vomit that looks like coffee grounds
48
Common ADEs of Esomeprazole?
* H, N, V, D, abdominal pain, constipation, flatulence
49
Monitoring for Esomeprazole?
* B12
* Renal fxn
* BMD
* iron
* Mg, Ca, K+ (esp w long-term)
* Reflux Sx – see if can stop or reduce or prn
* Ixn w other meds; warf, MTX, escital, tacro, clopidog, mycophen
50
What drug class is Budesonide?
Inhaled Corticosteroid
51
How does Budesonide (inhaled) work?
Reduce airway inflammation and bronchial hyper-reactivity
52
Indications of inhaled Budesonide
* Maintenance treatment of asthma and COPD (COPD add on Tx where inadequately controlled by LABA)
* Croup
* Eosinophilic oesophagitis (spec advice)
53
What is the standard adult dose of inhaled Budesonide for Asthma?
| solo
DPI: 100-400mcg bd, max 2000mcg d (spec refer for >800mcg)
Possible for OD dosing up to 400mcg d
Nebs: 0.5-1mg BD
54
What is the dose of inhaled Budesonide in asthma for children?
100-200mcg bd,
up to 800mcg d in severe persistent asthma (spec refer for >800mcg or <5y >400mcg)
55
What is the dose of budesonide in COPD?
DPI: 400mcg BD
| Adjunct therapy
56
What is the dose of Budesonide/Fomoterol for asthma maintenance?
| Adult and Child
Adult, pMDI/DPI 100/6–400/12 micrograms twice daily.
Child >6 years, pMDI/DPI 100/6–200/12 micrograms twice daily.
57
What is the dose of Budesonide/Fomoterol in asthma maintenance and symptom relief (SMART therapy)?
| pMDI, DPI
pMDI, 100/3mcg
4 inhal d in 1 or 2 doses (max 4 bd) regularly for prevention
Sx: 2 inh prn; rpt every few mins prn up to max 12 inh at any one time or 24 inh d including reg doses
DPI 100/6 or 200/6mcg
2 inh d in 1 or 2 doses (max 2 inh bd) regularly for prevention
Sx: 1 inh prn; rpt every few mins prn to max 6 inh at any one time, or 12 inh d incl reg doses
58
What are the counselling points for inhaled Budesonide?
| Basics
* Rinse mouth out after use to avoid oral thrush
* Shake rapihalers well before use
* Tell your doctor ASAP if you need this med in higher doses or more frequently than prescribed
* Asthma – R/v w/in 2-3d if >6 inh via DPI or >12inh via pMDI are req in 24 hours for Sx relief
* with extremely high doses, don't stop suddenly as there is risk of adrenal suppression - consider need of additional corticos during periods of stress
59
Common ADEs of inhaled Budesonide?
| how can you reduce systemic ADEs
* dysphonia, oropharyngeal candidiasis, bruising, facial skin irritation (nebs)
Systemic ADEs:
- Depends on systemic absorption. dep on dosage, duration of Tx + delivery
- Red. by; use spacer, rinse mouth w water (garg + spit after ea dose)
* Imp growth – only small impact on final height; poorly controlled asthma may also reduce growth. Effect on other organ growth (brain + lung) not well defined
60
Monitoring of inhaled Budesonide?
* Bone density – risk of osteop + fracture unknown – consider screening w long-term high-dose
* Glaucoma, cataract – risk may be inc
* Pneumonia – COPD
* Skin thinning + bruising – inc risk w higher dose and elderly
61
What drug class is Insulin Glargine?
MOA?
Insulin
Replace or supplement endogenous insulin
Increase or restore ability to metabolise glucose by enhancing cellular glucose uptake; inhibit endogenous glucose output and lipolysis
Insulin glargine is a long-acting insulin, designed to mimic the basal insulin level – the insulin that is usually avail during the day when not eating
62
Indications of Insulin Glargine
* Diabetes mellitus; Type 1, Type 2 or gesta-tional diabetes
63
What is the dose of Insulin Glargine?
Doses and regimen are dependent on individual treatment endpoints and are adjusted according to blood glucose monitoring
Dosed by Units rather mg or g
(max of 80U per single injection)
SC usually given in abdomen (less commonly butt, upper arm or thigh) - rotate injection site but in the same general area to prevent damage to fat and tissues below skin
64
What are the counselling points for Insulin Glargine?
| Basics
* Drinking alcohol decreases your blood glucose and mask warning signs of hypoglycaemia – avoid binge, always eat something when you are drinking
* The Optisulin brand (100 Units/mL) starts working in 1-2 hours (Toujeo brand (300 Units/mL) 1-6 hours)
* Make sure that you, your family and friends know how to recognise and treat hypogly. – ask your diabetes educator if unsure
* Check blood glucose before driving, on long trips check at least every 2 hours
* The two strengths are NOT interchangeable
* Don’t mix 2 insulins together, inject each separately
65
Common ADEs of Insulin Glargine?
* Hypoglycaemia, weight gain, allergic reaction, local reaction including erythema, lipodystrophy, amyloidosis
66
How is hypoglycaemia caused and what are the signs and symptoms?
* Excessive dosage, delayed or insufficient food, inc physical activity
* Sx: sweating, hunger, faintness, palpitations, tremor, lip tingling, H, visual disturb, confusion, altered mood
67
Monitoring of Insulin Glargine?
* Blood glucose levels
* weight gain
* Signs and symptoms of hypoglycaemia
68
What drug class is Yaz and what is the active ingredients?
| How many active/inactive pills are there?
Hormonal combined oral contraceptive
Drospirenone 3mg / Ethinylestradiol 20mcg
| 24 active and 4 inactive
69
How does Combined oral contraceptives work work?
All COCs contain an estrogen and progestogen. They inhibit ovulation, reduce receptivity of endometrium to implantation and thicken cervical mucus to form a barrier to sperm.
70
Indications of Yaz (drospirenone 3mg / ethinylestradiol 20mcg)
* Contraception
* Moderate Acne
* Premenstrual Dysphoric Disorder (PMDD)
Also Menstrual disorders, endometriosis, premenstrual syndrome
71
How do you take COCs
Yaz (drospirenone 3mg / ethinylestradiol 20mcg)
Brenda-35 (cyproterone 2mg / ethinylestradiol 35mcg)
1 tablet at the same time each day
If no preceding contra:
Immediate contraception – start active pill within first 5 days of your period starting. If you start at any other point in cycle, take active pills for 7 (additional contraception during this time)
Changing from progestogen-only pill:
Start day after stopping old pill (use additional contraceptives if you haven’t taken active pills for 7 days)
72
When do you commence taking COCs after having an emergency contraceptive pill?
After taking levenorgestrel or ulipristal EC: start taking active pills within 12 hours after taking levenorgestrel; wait at least 5 days before taking the active pills after taking ulipristal
73
What are the counselling points for COCs?
| Basics
What to expect:
* While taking inactive pills, a withdrawal bleed (similar to your period) should start
* Sometimes this may not occur
* Continue taking the pills as normal but consider the possibility of pregnancy if the pill has not been taken correctly or if 2 consecutive withdrawal bleeds in a row are missed
* Irregular bleeding or spotting is common at first but usually settles down after 2-3 months
When less effective:
* Some meds may reduce efficacy (tirzepatide, St John’s Wort, modafinil)
* V, severe diarrhoea, forgetting to take active pill
74
What is classified as a missed pill and what should you do?
| COCs
* V within 2 hours of taking – take another ASAP
* <24 hours late – take asap then next at the usual time
* >24 hours or experience V or severe D for more than 24 hours: late = take asap then correct time (can mean taking 2 at same time). THEN continue daily and use another contraceptive until you have taken actives for 7 days in a row. Seek EC if unprotected sex during this time
75
Common ADEs of COCs?
* Breakthrough bleeding
* N, V
* breast enlargement
* mood changes
* reduced libido
* inc BP and fluid retention
Tolerance to ADEs may develop during first 3 months
76
Monitoring of COCs?
* Signs and Sx of VTEs (increased risk with cyproterone)
* breakthrough bleeding
* adherence and correct taking
77
What is Microlut?
How does it work?
Progestogen only oral contraceptive
levonorgestrel 30mcg
Thickens cervical mucous to impede the passage of sperm and change the endometrium, reducing the potential for implantation. Acts on the hypothalamus and supress pituitary LH surge and may inhibit ovulation
78
Indications of Microlut (levenorgestrel 30mcg)
* Contraception
(preferred during BF – estrogens prevent lactation)
Also sometimes menstrual disorders, endometriosis
79
How do you take Microlut?
1 x 30mcg tab od std
When to start:
If no preceding pill: for immediate contraception, start taking pills within FIRST 5 days of period starting. If any other time in cycle, use other contraceptive methods for at least 48 hours
Preceding pill: when you start taking the new pill, also continue taking active COC for first 7 days
80
What are the counselling points for Microlut (levonorgestrel 30mcg)?
| Basics
* Important to take pill at std (no more than 3 hours late) – important to choose a time that will work for you
* Pill is taken continuously, no inactive (sugar) pills or break like other pills
* Changes in bleeding pattern can include spotting, irregular or prolonged bleeding or periods stopping
81
What counts as a missed pill for Microlut and what should you do?
If you are more than 3 hours late, or have persistent vomiting or severe diarrhoea = pill not as effective:
* if late, take pill as soon as you remember, then take the next at the correct time (can mean taking 2 at same time or same day), STILL take daily BUT use another contraceptive for 48 hours (use emergency contraception if you have unprotected sex during this time)
82
What drug class is Nirmatrelvir and Ritonavir?
Antiviral aka Paxlovid
83
How does Nirmatrelvir and Ritonavir work?
Nirmatrelvir inhibits main protease of severe acute respiratory syndrome CoV-2, preventing viral replication; ritonavir inc N levels by inhibiting its metabolism
84
What is the dose of Nirmatrelvir and Ritonavir?
Start Tx within 5 days of symptom onset
Adult: Nirmatrelvir 300mg and ritonavir 100mg every 12 hours for 5 days
85
What are the counselling points for Nirmatrelvir and Ritonavir?
| Basics
* Start taking within 5 days of onset of infection
* Swallow whole do not crush or chew
* Check contraception (effective contraception during Tx for at least 7 days after course is complete – Rit can red efficacy of COCs and combined hormonal vag ring. Should also use barrier method during Tx and continuing until one menstrual cycle has passed)
86
Common ADEs of Nirmatrelvir and Ritonavir?
* C: taste disturbance, D
* I or R: myalgia, HTN, hypersensitivity rxn (anaphylax)
