Miscellaneous

Question 1

Side effect of Methyphenidate for ADHD?

Answer 1

Methylphenidate is first line in children and should initially be given on a six-week trial basis. It is a CNS stimulant which primarily acts as a dopamine/norepinephrine reuptake inhibitor.

Side-effects include abdominal pain, nausea and dyspepsia.

In children, weight and height should be monitored every 6 months - known to cause stunted growth. This is due to its appetite suppressing effect which may lead to inadequate calorie intake and subsequently slow down growth.

Cardiotoxic. Perform a baseline ECG before starting treatment

Question 2

Pharmacological treatment for ADHD in children, 1st 2nd and 3rd line treatment?

Answer 2

Methylphenidate is first line in children. If there is inadequate response, switch to lisdexamfetamine.
Dexamfetamine should be started in those who have benefited from lisdexamfetamine, but who can’t tolerate its side effects.

Question 3

Peak incidence of delirium tremens following alcohol withdrawal?

Answer 3

72 hours.

Delirium tremens, a severe form of alcohol withdrawal syndrome, usually occurs 48 to 96 hours after the last drink, with peak incidence around 72 hours. This condition is characterised by acute confusion, hallucinations, and extreme agitation. It can be life-threatening and requires immediate medical attention.

Question 4

Timing of alcohol withdrawal symptoms?

Answer 4

Symptoms start at 6-12 hours: tremor, sweating, tachycardia, anxiety.

Peak incidence of seizures at 36 hours

Question 5

Alcohol withdrawal management?

Answer 5

First-line: long-acting benzodiazepines: Chlordiazepoxide or Diazepam.

Lorazepam is often preferred in patients with liver cirrhosis. Lorazepam is metabolised through glucuronidation, which is less affected by liver function. Even in patients with significant liver impairment, glucuronidation tends to remain intact, making lorazepam a safer choice.

Chlordiazepoxide on the other hand, undergoes hepatic oxidation via the cytochrome P450 system which is significantly impaired in cirrhosis.

This can lead to prolonged drug accumulation and an increased risk of toxicity including sedation and hepatic encephalopathy.

Carbamazepine also effective in treatment of alcohol withdrawal

Question 6

Nicotine replacement therapy side effects?

Answer 6

Nicotine replacement therapy
adverse effects include nausea & vomiting, headaches and flu-like symptoms.

NICE recommend offering a combination of nicotine patches and another form of NRT (such as gum, inhalator, lozenge or nasal spray) to people who show a high level of dependence on nicotine or who have found single forms of NRT inadequate in the past.

Question 7

When to start varenicline?
Common side effects?
Duration of treatment?

Answer 7

Varenicline: a nicotinic receptor partial agonist.

• Should be started 1 week before the patients target date to stop.
• Recommended course of treatment is 12 weeks (but patients should be monitored regularly and treatment only continued if not smoking).

Nausea is the most common adverse effect. Other common problems include headache, insomnia, abnormal dreams.

Should be used with caution in patients with a history of depression or self-harm. There are ongoing studies looking at the risk of suicidal behaviour in patients taking varenicline.

Contraindicated in pregnancy and breastfeeding.

Question 8

When to start Bupropion?

Answer 8

A norepinephrine-dopamine reuptake inhibitor and nicotinic antagonist.

Unlike many antidepressants it has a minimal effect on serotonin.

• Should be started 1 to 2 weeks before the patient’s target date to stop.
• Small risk of seizures (1 in 1,000)
• Contraindicated in epilepsy, pregnancy and breast feeding. Having an eating disorder is a relative contraindication.

Question 9

First line for smoking cessation in pregnant women?

Answer 9

First-line interventions in pregnancy should be cognitive behaviour therapy, motivational interviewing or structured self-help and support from NHS Stop Smoking Services.

Evidence of NRT in pregnancy is mixed but it is often used if the above measures failure. There is no evidence that it affects the child’s birthweight. Pregnant women should remove the patches before going to bed.

Varenicline and bupropion are contraindicated in pregnancy.

Question 10

Alcohol limit for men and women?

Answer 10

Men and women should drink no more than 14 units of alcohol per week.

If you do drink as much as 14 units per week it is best to spread this evenly over 3 days or more.

Pregnant women should not drink.

Question 11

Simple formula to measure units of alcohol?

Answer 11

Volume in Litres x ABV

1 Unit = 10ml of pure alcohol

Question 12

British National Formulary (BNF), you notice the following symbol beside the drug name: POM

Answer 12

This symbol means ‘prescription-only medicine’.

Question 13

Most frequently occurring metabolic effect of laxative overuse?

Answer 13

Hypokalaemia.

Question 14

What does the following symbol (upside down triangle) denote when it appears adjacent to a drug name

Answer 14

Preparations for which there is limited experience of use

Question 15

Tapering gabapentin?

Answer 15

Gabapentin is recommended to be reduced in increments – here in 300 mg increment reductions each one to two weeks. Opiates can be reduced by 10% per one to two weeks.

Question 16

Role of Caldicott Guardian?

Answer 16

The Caldicott guardian is the senior person responsible for protecting confidential patient information and ensuring appropriate information sharing and handling of identifiable patient information.

Question 17

How long is validity of prescription for controlled drugs?

Answer 17

Prescriptions for Controlled Drugs are valid for 28 days from the date of issue. Prescriptions for all other items are valid for 6 months (or 12 months for repeatable prescriptions).

The following CD Schedule 3 requirements also apply:

• The prescription must clearly state the form (e.g. tablets, capsules), strength and dose.
• The dose must be as specific as possible; ‘Take One as directed’ is acceptable, however, ‘Take as directed’ is not .
• The quantity prescribed must be written in words and figures.
• The total quantity supplied should not exceed 30 days, unless in exceptional circumstances as with all other controlled drugs.

Question 18

What is patient specific direction?

Answer 18

A patient specific direction is an instruction to supply or administer medication to a named patient.

This must be signed for by a prescriber after assessment and allows health care assistants to administer prescription-only medications.

As an example, a healthcare assistant with appropriate training can administer vitamin B12 injections but the dose and frequency must be written by a prescriber.

Question 19

Maximum size of paracetamol that can be bought from pharmacist?

Answer 19

Pharmacists can sell packs of 32 paracetamol tablets.

Retail shops can only sell pack sizes of 16 paracetamol tablets.