1
Q
What is a local anaesthetic
A
Local - lidocaine or bupivacaine (longest duration of action)
2
Q
General IV- ( Propofol,thiopental,Etomidate, ketamine)
A
Propofol - rapid recovery, low hangover effect
Thiopental - rapid onset, fat soluble so longer hangover effect
Etomidate - rapid recovery, no hanging effect
Ketamine - less hypotension, slow recovery, Hugh psychoactive side effects
3
Q
General Anaesthesia- inhalation
A
Volatile liquids - isoflurane,desflurane,sevoflurane and nitrous oxide
4
Q
Vaccines (active immunity)- live attenuated
A
Measles,mumps,rubella
5
Q
Vaccines (active immunity)-inactivated
A
Meningococcal
6
Q
Vaccines (active immunity)-inactivated toxins
A
Tetanus and diphtheria
7
Q
Viral vectors
A
COVID 19- Astra zeneca
8
Q
Nuclei acid
A
COVID 19 PFIZER AND MODERNA
9
Q
Live vaccines should not
A
Be given during pregnancy
10
Q
Vaccine intervals
A
- Different inactivated vaccines can be given at any interval to each other
- same inactivated vaccines need a minimum of 4 week interval
- minimum 4 week interval between varicella zoster and MMR (Can be given on the same day)
- Minimum 4 week interval between yellow fever and MMR - can’t be given on the same day
11
Q
1 Year
A
Measles,Mumps, rubella (MMR)
Haemophilias influenza B+ meningococcal C
Meningococcal B , pneumococcal
12
Q
3 years and 4 months
A
Measles,mumps and rubella
Diphtheria,tetanus,pertussis,poliomyelitis
13
Q
11-14 years
A
Human papilloma virus
(2nd dose 6-24 months after 1st dose)
14
Q
Pregnant females
A
Diphtheria,tetanus,pertussis+poliomyelitis (1 dose from the 16th week) influenza vaccine
15
Q
Scabies - look like what???
A
-Red spots with silvery interlinking lines - usually in webbing of fingers/toes
- apply malathion or permethrin twice - 1 week apart
- apply to whole body including scalp,neck,face and ears
- treat ALL famil members
- avoid physical contact with other family members
16
Q
A
Scabies
17
Q
A
Scabies
18
Q
Where are you most likely to get scabies?
A
folds of skin between fingers and toes
wrists
underarm area
waist
groin
bottom
19
Q
Headlice
A
- live moving lice with white eggs distributed
- Wet combing - combing for 30 mins at 4 day intervals till no lice is found for 3 sessions (min 2 weeks)
- dimeticone - apply for 8 hours to dry naturally - repeated after 7 days
- malathion - apply 12 hours to dry naturally - repeated after 7 days (avoid in severe eczema or asthma due to alcohol contents)
- benzoyl bento ate and permethrin - not recommended
MHRA - SOME PREPS FLAMMABLE
20
Q
A
HEADLICE/NITS
21
Q
ECZEMA- what is used in mild to mod and mod to severe - topically?? What is used in refractory severe?? Systemic?)
A
Dry,flaky, skin - small red spots
Min types of irritant, allergic contact and atopic
Emollients- either to apply or as a bath or shower emollients
- topical corticosteroids - can be used (mild steroid for face or genitals
- anti histamines - not in atopic dermatitis
Mild - mod= pimecrolimus
Mod-sev - tacrolimus
- severe refractory eczema - systemic medication: cyclosporine, mycophenolate mofetil, moAbs
22
Q
A
Eczema
23
Q
A
Eczema
24
Q
A
Eczema
25
Eczema
26
Psoriasis
Skin thickening and silvery white scaling,raised and larger patches and plaques. Systemic,immune -mediated inflammatory skin disease - can be in the joints too
-emollients
-topical corticosteroids
-coal tar preparations
- vitamin D - topical Analogues
Where topical treatment has failed
- phototherapy - UVA/UVB through trained professional
- systemic treatment - methotrexate,cyclosporine or acitretin (2nd line)
27
Psoriasis
28
Topical corticosteroids
Mild - hydrocortisone
Moderate - closet as one
Potent - betamethasone
Very potent - clobetasol
Prolonged use= skin thinning
Apply thinly
Do not apply to broken skin
29
ACNE - MHRA warning?? ISO warning??
MHRA - rare erectile dysfunction and decreased libido - treatment for under 18 needs to be approved by two prescribers
PPP- Pregnancy prevention program for isotretanon because of its tetrogenic nature
- contraception taken 1 month before and till 1 month after
- each prescription limited to 30 days
Risk of neuropsychiatric reactions - seek medical attention in mood changes
- avoid UV light, laser skin treatment, Derma ration and epilation
30
Less severe and first line treatment
- adaplene
- benzoyl peroxide
Clindamycin
- Lyme/doxycycline
- erythromycin
31
Scalp and hair conditions
Dandruff (seborrheic dermatitis)
- treat with anti microbial - pyrithione zinc, selenium, tar extracts
- more persistent or severe dandruff - ketoconazole shampoo
-psoriasis of the scalp - coal tar and salicylic acid
Hirsutism - hormonal or due to drugs
- weight loss can reduce this in women
- can treat with laser therapy, eflornithine or co-cyprindiol
A;opecia
- finasteride and minoxidil
32
Angioedema - anaphylaxis
33
Angioedema -
34
Acne
35
Atopic eczema
36
Chilblains
Chilblains often get better on their own without treatment.
Things you can do to help your symptoms
A soothing lotion, such as calamine or witch hazel, can help relieve itching. A pharmacist can give you advice about the right product for you.
you have chilblains and your skin has not got any better after 2 to 3 weeks
there is pus coming out of your skin
your temperature is very high or you feel hot or shivery
you keep getting chilblains
your chilblains are severe
you have diabetes and have chilblains – foot problems can be more serious if you have diabetes
37
Chilblains
38
Seborrhoea dermatits
39
Seborrhoea dermatits
40
MHRA warning
Epimax Ointment and Epimax Paraffin-Free Ointment can harm the eyes if used on the face. Do not prescribe these ointments for use on the face. Tell patients to wash their hands and avoid touching their eyes after using these products.
41
Nasal Rhinitis and congestion
Rhinitis - sprays and drops
- sodium chloride, antihistamines,corticosteroids,ipratropium and xylometazoline
- not to be used for prolonged periods of time ( 7 days)
- can be used in pregnancy - low systemic absorption
Nasal polyps - review by ent specialist - use nasal corticosteroid
Nasal staphylococci-
Naseptin (contains peanuts) or mupirocin
- naseptin has changed its formulation -removing Arachis oil (peanut oil). However, both the original formulation containing Arachis oil and the revised formulation without Arachis oil will be in circulation in the supply chain until November 2025.
42
Glaucoma
Most common form - open angle glaucoma
- due to restricted drainage of the aqueous humour through trabecular mesh work leading to ocular hypertension
Treated with topical prostaglandin analogues (latanoprost,tafluprost, tavoprost, bimaprost)
- if initial prostaglandin analogues hasn’t worked, try different one
- if doesn’t work, topical beta blocker : betoxolol,levobutunolol or time lol
If that doesn’t work carbonic anhydride inhibitors - brinzolamide or dorzolamide
Brimonidine and piclocarpine can also be used
43
Prostaglandin Analogues
Latanoprost. Tafluprost, tavoprost or bimaprost
Dry eyes
Ocular discomfort
Change to eye colour
Hyperpigmentation of periocular skin
Darkening, thickening and lengthening of eye lashes
44
Rheumatoid arthritis
Chronic systemic inflammatory disease affecting joint synovial membrane
45
RA pain and stiffness
Worsens wire rest, inactivity and heat in joints
Symptoms - nodules,swelling, tenderness, malaise, fatigue, fever and weight loss
Non drug therapy - physiotherapist, exercise, relaxation and stress management
46
DMaRDs - Drug therapy RA
FISRT LINE - Methotrexate,leflunomide or sulfasalazine(hydroxychloroquine in mild)
SECOND LINE - MoAbs - adalimumab,infliximab,toclizumab,baricitinib
- Bridge with corticosteroids when rapid suppression is needed
NSAIDs can be used in pain relief - withdraw when response to DMARDS is enough
47
Methotrexate
- Taken ONCE weekly
- prescription and label should clearly show the dose and frequency
- methotrexate is commonly co- prescribed with folic acid, not to be taken on the same day as each other
- patient should be advised to immediately report any signs of blood disorder, liver toxicity and respiratory effects
48
Methotrexate side effects
Blood disorders: Sore throat, bruising and mouth ulcers
Liver tocity - nausea,vomiting, abdominal discomfort, dark urine, jaundice, itchy skin
Pulmonary toxicity - SOB and coughing
Gastrointestinal toxicity - stomatitis and diarrhoea
49
Methotrexate toxicity antidote
FOLINIC ACID
Calcium folinate
50
Methotrexate monitoring and screening
Full blood count, renal function test, liver function test:
- every 1-2 weeks until stable
- every 2-3 months thereafter
Screen out pregnancy prior to treatment:
- antifolate - harmful to foetus growth
- use effective contraception during treatment and for at least 6 months after for both men and women
51
MTX interactions
- nephrotoxic drugs: mtx reduced renal function
- NSAID = nooooo
Antifolates: trimethoprim and phenytoin
- hepatotoxic drugs: Rfiampicin, antfungals etc
Omeprazole and esomeprazole:
- reduced clearance = increases toxicity
52
Hyperuricaemia and gout
Raised Uric acid concentration in the blood - hyperurucaemia and the deposition of irate crystals in the joints and other tissues
Can be caused by -
- diet (high salt intake)
-medication
-bendroflumethazide
- chemotherapy drugs
53
Treatment of acute gout
Started treatment as soon as possible
- treat with colchicine or high doses of an NSAID and PPI (Excluding aspirin)
- colchicine 500 mcg 2-4 times max 3 days - do not repeat course within 3 days
NSAIDs induced fluid retention (interaction with diuretic)
Alternative -
- short course of oral corticosteroid
- IM injection of corticosteroid or canakinumab
54
Treatment of chronic gout
- offered in frequent acute attacks of gout (2 or more in a year)
- uric acid may be reduced with xanthine - oxidase inhibitors
First line- allopurinol
Second line - febuxostat - caution with febuxostat patients with history of cardiovascular disease
If acute attack happened during treatment - continue chronic treatment as well as treating the attack separately
55
Allopurinol
When starting,flare- prophylaxis with colchicine/ NSAID is recommended
Common side effect- rash - discontinue if mild but restart carefully but discontinue immediately if recurrence
Interaction - allopurinol +azithropine/meracartopurine
Reduce dose of aza/merc
56
Nocturnal Leg cramps
Quinine sulfate - may reduce the frequency of nocturnal leg cramps
Potential toxicity - quinine is not routinely recommended - use if cramps regularly disrupt sleep and are very painful or other treatment hasn’t worked
Trial for 4 weeks - if there is benefit - continue
Stop treatment every 3 months and assess need for further treatment
57
Pain and inflammation
NSAID: analgesic and anti inflammatory - use in pain related to inflammation ( eg.rheumatoid arthritis,back pain and soft tissue disorders)
Contraindicated in asthmatic patients
58
High risk
GI = Piroxicam, ketoprofen,ketorolac
CVD - COX-2 Selective inhibitors, ibuprofen 2.4 g, diclofenac
59
Medium risk
GI- Idometacin,diclofenac,naproxen
60
LOW
GI-Ibuprofen
CVD - Naproxen, ibuprofen 1.2g
61
Lowest
GI = cox 2 selective inhibitors
62
Cox -2 - selective inhibitors
Celecoxib, etoricoxib
63
Pain and inflammation - NSAIDS
- NSAID + low dose aspirin = increase GI bleed risk (use only if needed)
- NSAIDS and alcohol - increase GI bleed risk
- Use stomach protection PPI
- Hypersensitivity reactions - cross sensitivity with aspirin too
- avoid in renal impairment - risk of fluid retention and further impairment
- avoid in pregnancy - caution in breastfeeding
64
Interactions - NSAIDS
MTX/LITHIUM- Reduces clearance
Ciprofloxacin = increases risk of seizure
Blood thinners = increases risk of bleeding
Drugs which causes hyperkalaemia - hyperkalaemia
Drugs which cause renal failure - acute kidney injury
65
FOETAL GROWTH
CAUTION WITH NSAID FROM 20TH WEEK
66
PHOTOSENSITIVITY
METHOTREXATE
Low weighted and MISC chapter
flashcards
Decks in class (4)
# Cards
