OTHER Flashcards
(69 cards)
1
Q
AMIODARONE
what are the adverse effects of amiodarone?
A
- hypothyroidism + hyperthyroidism
- corneal deposits
- pulmonary fibrosis/pneumonitis
- liver fibrosis/hepatitis
- peripheral neuropathy
- photosensitivity
- slate grey appearance
- thrombophlebitis
- bradycardia
- long QT interval
2
Q
AMIODARONE
what are the important drug interactions?
A
- decreases metabolism of warfarin = increased INR
- increases digoxin levels
3
Q
DRUG MONITORING
how and when should statins be monitored?
A
LFTs
- at baseline, 3 months and 12 months
4
Q
DRUG MONITORING
how and when should ACE inhibitors be monitored?
A
U&Es
- prior to treatment
- after increasing dose
- at least annually
5
Q
DRUG MONITORING
how and when should amiodarone be monitored?
A
- TFTs, LFTs, U&Es and CXR prior to treatment
- TFTs + LFTs every 6 months
6
Q
DRUG MONITORING
how and when should methotrexate be monitored?
A
FBC, LFT and U&Es
- before starting treatment
- repeated weekly until dose is stabilised
- monitored every 2-3 months
7
Q
DRUG MONITORING
how and when should azathioprine be monitored?
A
- FBC, LFT before treatment
- FBC weekly for first 4 weeks
- FBC + LFTs every 3 months
8
Q
DRUG MONITORING
how and when should lithium be monitored?
A
TFT and U&Es prior to treatment
lithium levels weekly until stabilised
lithium levels every 3 months
TFT, U&Es every 6 months
9
Q
DRUG MONITORING
how and when should sodium valproate be monitored?
A
LFT, FBC before treatment
LFT periodically during first 6 months
10
Q
DRUG MONITORING
how and when should glitazones be monitored?
A
LFT before treatment
LFT regularly during treatment
11
Q
ADVERSE DRUG REACTIONS
which drugs can cause impaired glucose tolerance?
A
- thiazides
- steroids
- tacrolimus
- ciclosporin
others
- interferon-alpha
- nicotinic acid
- antipsychotics
12
Q
ADVERSE DRUG REACTIONS
which drugs can cause thrombocytopaenia?
A
- quinine
- abciximab
- NSAIDS
- loop diuretics (furosemide)
- antibiotics (penicillin, sulphonamides, rifampicin)
- carbamazepine
- sodium valproate
- heparin
13
Q
ADVERSE DRUG REACTIONS
which drugs can cause urinary retention?
A
- TCAs (amitriptyline)
- anticholinergics (anti-psychotics, antihistamines)
- opioids
- NSAIDS
- disopyramide
14
Q
ADVERSE DRUG REACTIONS
which drugs can cause lung fibrosis?
A
- amiodarone
- cytotoxic agents
- methotrexate
- sulfasalazine
- nitrofurantoin
- dopamine receptor agonists (bromocriptine, cabergoline, pergolide)
15
Q
ADVERSE DRUG REACTIONS
which drugs can cause cataracts?
A
steroids
16
Q
ADVERSE DRUG REACTIONS
which drugs can cause optic neuritis?
A
ethambutol
amiodarone
metronidazole
17
Q
ADVERSE DRUG REACTIONS
which drugs can cause retinopathy?
A
chloroquine
quinine
18
Q
ADVERSE DRUG REACTIONS
which drugs can cause photosensitivity?
A
- thiazides
- tetracyclines, sulphonamides, ciprofloxacin
- amiodarone
- NSAIDs
- psoralens
- sulphonylureas
19
Q
SIDE EFFECTS OF COMMON DRUGS
what are the side effects of ACE inhibitors?
A
- cough
- hyperkalaemia
20
Q
SIDE EFFECTS OF COMMON DRUGS
what are the side effects of thiazide diuretics?
A
- gout
- hypokalaemia
- hyponatraemia
- impaired glucose tolerance
21
Q
SIDE EFFECTS OF COMMON DRUGS
what are the side effects of CCBs?
A
- headache
- flushing
- ankle oedema
22
Q
SIDE EFFECTS OF COMMON DRUGS
what are the side effects of beta blockers?
A
- bronchospasm (especially in asthmatics)
- fatigue
- cold peripheries
23
Q
SIDE EFFECTS OF COMMON DRUGS
what are the side effects of doxazosin?
A
- postural hypotension
24
Q
SIDE EFFECTS OF COMMON DRUGS
what are the side effects of amoxicillin?
A
- rash with glandular fever (infectious mononucleosis)
25
SIDE EFFECTS OF COMMON DRUGS
what are the side effects of co-amoxiclav?
cholestasis
26
SIDE EFFECTS OF COMMON DRUGS
what are the side effects of flucloxacillin?
cholestasis (usually develops several weeks after use)
27
SIDE EFFECTS OF COMMON DRUGS
what are the side effects of erythromycin?
GI upset
prolongs QT interval
28
SIDE EFFECTS OF COMMON DRUGS
what are the side effects of ciprofloxacin?
lowers seizure threshold
tendonitis
29
SIDE EFFECTS OF COMMON DRUGS
what are the side effects of metronidazole?
reaction following alcohol ingestion
30
SIDE EFFECTS OF COMMON DRUGS
what are the side effects of doxycycline?
photosensitivity
31
SIDE EFFECTS OF COMMON DRUGS
what are the side effects of trimethoprim?
rashes (including photosensitivity)
pruritus
suppression of haematopoesis
32
SIDE EFFECTS OF COMMON DRUGS
what are the side effects of metformin?
GI side effects
lactic acidosis
33
SIDE EFFECTS OF COMMON DRUGS
what are the side effects of sulfonylureas?
- hypoglycaemia
- increased appetite + weight gain
- SIADH
- liver dysfunction (cholestatic)
34
SIDE EFFECTS OF COMMON DRUGS
what are the side effects of glitazones?
- weight gain
- fluid retention
- liver dysfunction
- fractures
35
SIDE EFFECTS OF COMMON DRUGS
what are the side effects of gliptins?
pancreatitis
36
PRESCRIBING IN RENAL FAILURE
which drugs should you avoid?
antibiotics - nitrofurantoin, tetracycline
NSAIDs
lithium
metformin
37
PRESCRIBING IN RENAL FAILURE
which drugs are more likely to accumulate and require dose adjustment?
- most antibiotics (penicillin, cephalosporins, vancomycin, gentamicin, streptomycin)
- digoxin
- atenolol
- methotrexate
- sulphonylureas
- furosemide
- opioids
38
PRESCRIBING IN RENAL FAILURE
which drugs are relatively safe in renal disease + can sometimes use normal dose?
antibiotics (erythromycin, rifampicin)
diazepam
warfarin
39
THERAPEUTIC DRUG MONITORING
when should you take lithium levels?
12 hrs post lithium dose
40
THERAPEUTIC DRUG MONITORING
when should you take ciclosporin levels?
trough levels immediately before dose
41
THERAPEUTIC DRUG MONITORING
when should you take digoxin levels?
at least 6 hrs post-dose
42
TRAVEL HEALTH ADVICE
what types of travel increase the risk of some diseases?
- travelling in rural areas
- backpacking
- staying in hostels or camping
- long trips
- pre-existing conditions
43
TRAVEL HEALTH ADVICE
which travel vaccines are provided on the NHS?
- polio (given as combined diptheria/tetanus/polio)
- typhoid
- hepatitis A
- cholera (not generally given)
44
HOSPITAL ACQUIRED INFECTIONS
what are the common pathogens?
- methicillin-sensitive s.aureus (MSSA)
- methicillin-resistants-aureus (MRSA)
- s.aureus
- c.difficile
- e.coli
- pseudomonas
45
HOSPITAL ACQUIRED INFECTIONS
what are the risk factors?
- indwelling catheters
- vascular access devices
- genetics
- immunity
- co-morbidities (malnutrition, alcoholism, immunocompromise)
46
HOSPITAL ACQUIRED INFECTIONS
what is the management of a HAP?
- 1st line = co-amoxiclav
- 2nd line = tazocin, cephalosporins or meropenem
- if MRSA = vancomycin or teicoplanin
47
HOSPITAL ACQUIRED INFECTIONS
what are the common types of infection?
- HAPs (onset >48hrs after admission)
- UTIs
- surgical site infections
48
HOSPITAL ACQUIRED INFECTIONS
what is the management of a catheter associated UTI?
- lower UTI = trimethoprim or nitrofurantoin for 7 days
- upper UTI = cefalexin
49
HOSPITAL ACQUIRED INFECTIONS
what is the management of indwelling line sepsis?
- vancomycin +/- broad-spectrum beta lactam (tazocin, ceftazidime or meropenem)
if MRSA = vancomycin
if anaerobic = metronidazole
50
HOSPITAL ACQUIRED INFECTIONS
how can they be prevented?
- hand hygiene
- PPE
- safe disposal of sharps
- aseptic non-touch techniques
- correct waste disposal
- equipment decontamination
- regular cleaning
51
FIT NOTES
when are they required?
if you cannot work for more than 7 days, including weekends and bank holidays.
52
FIT NOTES
who can provide FIT notes?
- doctors
- nurses
- pharmacists at GP surgeries, hospitals and clinics
- physiotherapists
- occupational therapists
53
FIT NOTES
what can the fit note tell the employer?
- person is unfit for work
- person may be able to return with certain adjustments
54
DRIVING ADVICE
what are the rules for driving for epilepsy/seizures?
1ST UPROVOKED/ISOLATED SEIZURE
- 6 months off (if no mass on scan + no definite epilepsy)
ESTABLISHED EPILEPSY
- if seizure free for 12 months = can drive
- if no seizures for 5 yrs (with/without meds) = licence until 70 restored
- if meds withdrawn = should not drive for 6 months
55
DRIVING ADVICE
what are the rules for driving for syncope?
- simple faint = no restriction
- single episode, explained + treated = 4 weeks off
- single episode, unexplained = 6 months off
- >2 episodes = 12 months off
56
DRIVING ADVICE
what are the rules for driving for stroke/TIA?
1 month off driving + may not need to inform DVLA
if multiple TIAs over short period = 3 months off + inform DVLA
57
DRIVING ADVICE
what are the rules for driving for craniotomy?
1 year off driving
58
DRIVING ADVICE
what are the rules for driving for narcolepsy/cataplexy?
cease driving on diagnosis
can restart once satisfactory control of symptoms
59
DRIVING ADVICE
what are the rules for driving for conditions such as MS and MND?
need to inform DVLA and complete PK1 form
60
DRIVING ADVICE
what are the rules for driving HGVs for patients with diabetes?
following standards must be met
- no severe hypoglycaemic episodes in last year
- full hypoglycaemic awareness
- must show adequate control of blood glucose by regular blood glucose monitoring (>twice daily
- understand risks of driving with hypoglycaemia
61
DRIVING ADVICE
what are the rules for driving for diabetes?
if on insulin
- have hypoglycaemic awareness
- no more than 1 hypo requiring assistance in last year
- no relevant visual impairment
if on tablets
- if tablets can induce hypos, no more than 1 hypo requiring assistance in last year
if diet controlled
- no requirement to inform DVLA
62
DRIVING ADVICE
what are the rules for driving for acute coronary syndromes?
4 weeks off driving
63
SCREENING
what is abdominal aortic aneurysm screening?
single abdominal USS for males aged 65
64
SCREENING
what are the outcomes for abdominal aortic aneurysm screening?
<3cm = normal (no further action
3-4.4cm = small aneurysm (rescan every 12m)
4.5-5.4cm = medium aneurysm (rescan every 3m)
>5.5cm = refer within 2w to vascular surgery
65
SCREENING
which abdominal aortic aneurysms are at low risk of rupture?
- asymptomatic
- <5.5cm diameter
- abdominal USS surveillence
66
SCREENING
which abdominal aortic aneurysms are at high risk of rupture?
- symptomatic
- >5.5cm diameter
- rapidly enlarging (>1cm/yr)
67
SCREENING
when is cervical cancer screening done?
- 25-49 yrs = every 3 years
- 50-64 yrs = every 5 years
cannot be offered to women over 64
68
SCREENING
when is breast cancer screening done?
- 50-70yrs = every 3 years
after 70 women can request mammogram
69
SCREENING
when is bowel cancer screening done?
all men and women 60-74yrs = FIT test every 2 years
anyone over 74 can request a test
