Chapter 5 Qs: Communicating Information

Question 1

Q5.1. Ramipril and pregnancy

Answer 1

Ramipril teratogenic, especially in first trimester – advised to convert to labetalol before conception. BP doesn’t fall until 2nd trimester.

Question 2

Q5.2. Tamoxifen: general knowledge

for communicating information (4)

Answer 2

• Tamoxifen increases risk of endometrial cancer
• Increases warfarin efficacy so susceptible to high INR
• Timing will not reduce risk of hot flushes (common S/E).
• Tamoxifen increases risk of VTE so swollen leg may suggest DVT needing urgent medical attention.

Question 3

Q5.3. Giclazide/metformin: general knowledge

for communicating information (4)

Answer 3

• Gliclazide (a sulphonylurea) increases risk of hypoglycaemia so don’t miss meals.
• Gliclazide taken in morning with breakfast.
• Metformin (a biguanide) doesn’t usually cause hypoglycaemia as it works by increasing insulin sensitivity, while gliclazide increases insulin production.
• Risk of lactic acidosis is with metformin.

Question 4

Q5.4. Methotrexate: general knowledge

for communicating information (5)

Answer 4

• With methotrexate, regular WBC monitoring needed as risk of neutropenia.
• Only ever take once-weekly unless for oncological conditions.
• Higher risk of infection.
• Never use trimethoprim + co-trimoxazole (both also folate antagonists) with methotrexate.
• Folic acid given alongside methotrexate to limit toxicity to BM.

Question 5

Q5.5. Warfarin: general knowledge

for communicating information (4)

Answer 5

• Warfarin carries significant risk of bleeding – reduced by regular INR monitoring.
• Alcohol affects metabolism of warfarin – acute intoxication inhibits enzymes, chronic alcohol excess induces enzymes.
• Warfarin tablets colour coded – white = 0.5mg, brown = 1mg, blue = 3mg, pink = 5mg.
• For most conditions (AF, DVT + PE), INR 2.5 is the aim. For recurrent VTE or those with mechanical prosthetic valves, INR 3.5 is the aim.

Question 6

Q5.6. ACEi: general knowledge

for Communicating information (5)

Answer 6

• ACE-i increase risk of hyperkalaemia
• Cough a common S/E due to release of bradykinin (often dose-dependent)->trial ARB
• be cautious if become unwell on ACE-i as they increase risk of AKI
• ACEi and diuretics can cause renal failure
• It is important to monitor renal function (and K+) following initiation of ACE-i, especially if CKD – do 1-2 weeks following initiation.

Question 7

Q5.7. Steroids: general knowledge

for Communicating information (4)

Answer 7

• Long-term steroids increase risk of diabetes mellitus (so monitor BMs regularly)
• Long-term steroids increase risk of osteoporosis (so add bisphosphonate e.g. alendroic acid)
• Long-term steroids increase risk of gastric irritation + gastric/duodenal irritation (give H2 antagonists e.g. ranitidine, or PPIs e.g. omeprazole).
• Never stop abruptly due to risk of Addisonian crisis.

Question 8

Q5.8. SSRIs: general knowledge

for Communicating information (5)

Answer 8

• SSRIs can take up to 6 weeks before symptoms improve.
• Citalopram increases photosensitivity (take sunlight precaution).
• If on anti-depressants, can still be suicidal so seek help immediately – small proportion feel worse immediately after starting.
• Serotonin syndrome (agitation, temperatures, hallucinations) is life-threatening – need hospital admission.
• SSRIs can cause dry mouth.

Question 9

Q5.9. DM management: general knowledge

for Communicating information (5)

Answer 9

• Depending on consciousness, hypoglycaemia treated with carbohydrate or glucose tablets/infusions.
• HbA1c gives average glucose control over 3-months – target = 48mmol/mol or less.
• When unwell, blood glucose increases so higher basal doses required – otherwise risk of DKA, but if eating less, may cause hypoglycaemia.
• Poor glycaemic control significantly increases risk of micro + macrovascular complications.
• Failure to rotate injection sites can lead to lipodystrophy.

Question 10

Q5.9. Bisphosphonates: general knowledge

for Communicating information (5)

Answer 10

• Bisphosphonates reduce risk of #.
• Alendroic acid is once weekly preparation.
• Calcium salts (Adcal D3) reduce absorption of bisphosphonates so don’t take at same time.
• Avoid food 2 hours after taking alendroic acid as it reduces its absorption.
• Alendroic acid tablet needs to be swallowed with full glass of water + remain upright for 30minutes after – this minimises gastric S/Es.