What drug is used to treat ADHD (1st line med Rx)?
What else is it used for?
Side effect
Class
Methylphenidate
Treatment of: ADHD and narcolepsy
Side effects: stunted growth (important for children as restricts growth potential; perhaps due to methylphenidate reducing effect on appetite), insomnia, weight loss, anxiety, nausea and vomiting, cardiotoxicity – baseline ECG
Class: CNS stimulant -> blocks dopamine and norepinephrine reuptake by neurones (more available at the synapses)
1st line medical treatment for head lice/Pediculus Capitis
apart from wet combing, 1st line drug
- malathion (liquid to wash off with soap and water) - insecticide
Adrenaline doses in anaphylaxis:
- <6months - 6 years
- 6 - 12 years
- adult and child >12 years
<6 months - 6 years
150 micrograms (0.15ml 1 in 1,000)
6-12 years
300 micrograms (0.3ml 1 in 1,000)
Adult and child > 12 years
500 micrograms (0.5ml 1 in 1,000)
Drugs abbreviations. What do they mean?
- a.c.
- b.d.
- a. c. = ante cibum (before food)
- b. d. = bis die (twice daily)
Drugs abbreviations. What do they mean?
- o.d.
- o.m.
- o. d. = omni die (every day)
- o. m. = omni mane (every morning)
Drug abbreviations. What do they mean?
- o.n.
- p.c.
- o. n. = omni nocte (every night)
- p. c. = post cibum (after food)
Drug abbreviations. What do they mean?
- p.r.n.
- q.d.s
- p. r. n. = pro re nata (when required)
- q. d. s. = quater die sumendum (to be taken four times daily)
1st line (medication) management of Eczema
- classes and names of the drugs
- Emollient – e.g hydromol, Aveeno, soft white paraffin, dermol, E45 (don’t tend to use aqueous cream as causes stinging), zerobase, ultrabase (many options)
- Topical Steroid – start with a mild or moderate potency steroid (not on face) e.g hydrocortisone 1% (mild) or clobetasone butyrate (eumovate) (moderate potency)
Medication and advice in a child with chickenpox
- Topical calamine lotion to relieve the itch
- Paracetamol for temperature control if needed (avoid NSAID in chicken-pox)
- Anti-histamine (Chlorphenamine) for itch – please note this is an unlicensed use in children under 1
- Infection control advice – chicken pox is contagious 1-2 days before the rash appears and until all the blisters have formed scabs (which usually takes between 5-10days) – should stay away from nursery / other immunocompromised individuals.
- Give mum advice as she is pregnant – if mum is not known to have had chickenpox before she will need an urgent blood test to see if she is immune and then ongoing treatment depending on the result
Threadworms/ pinworms infection
Presentation
Transmission route
What may support diagnosis?
Medication used
Presentation: itchiness in the perianal area, seeing ‘white stuff’ in the faeces or around the anus; vulvar symptoms are possible in girls
Transmission: swallowing the eggs
Dx support: Sellotape application to peri-anal area -> send off to lab for microscopy
Medication: Mebendazole (antihelmintic) single doe for a child and family + hygiene advice
*repeat dose if needed
What antibiotic would you use as a 1st line for Mycoplasma pneumoniae infection in children?
Erythromycin
Are SSRIs safe in the pregnancy?
Yes. They are not teratogenic
Can we use NSAIDs in chicken pox?
Ibuprofen should be avoided in chicken pox as there is an associated risk between use of NSAIDs and the development of necrotising fasciitis
1st line meds used for chronic constipation in paediatrics
*what may be required beforehand?
Stool softener laxatives e.g. Movicol or Lactulose
may require glycerine suppositories to help soften the rectal stool initially.
Diclofenac
- class
- trade name
- medical uses
- MoA
- when it is not recommended to be taken
Diclofenac
Class: NSAIDs
Trade name: Voltaren (oral or topical)
Uses: to treat pain (including dysmenorrhoea) , inflammatory disorders
MoA: inhibits COX-1 and COX2 -> decreases the production of prostaglandin
Not recommended: 3rd trimester of pregnancy, active stomach and peptic ulcer, IBDs
Medical treatment for Von Willebrand disease
- Tranexamic acid -> anti-fibrinolytic
- Desmopressin -> release von Willebrand from endothelium
- factor VIII concentrate
Therapies for Clostridium Difficle infection
- first-line therapy is oral metronidazole for 10-14 days
- if severe or not responding to metronidazole then oral vancomycin may be used
- for life-threatening infections a combination of oral vancomycin and intravenous metronidazole should be used
Contraindications for use of b-blockers
- uncontrolled heart failure
- asthma
- sick sinus syndrome
- concurrent verapamil use: may precipitate severe bradycardia
Which anaesthetic agent is used for the introduction of anaesthesia?
Sodium thiopentone
- Extremely rapid onset of action making it the agent of choice for rapid sequence of induction
- Marked myocardial depression may occur
- Metabolites build up quickly
- Unsuitable for maintenance infusion
- Little analgesic effects
Which anaesthetic agent has anti-emetic properties?
Propofol
- Rapid onset of anaesthesia
- Pain on IV injection
- Rapidly metabolised with little accumulation of metabolites
- Proven antiemetic properties
- Moderate myocardial depression
- Widely used especially for maintaining sedation on ITU, total IV anaesthesia and for daycase surgery
Ketamine
- what is it used for
- properties
- features and side effects
- May be used for induction of anaesthesia
- Has moderate to strong analgesic properties
- Produces little myocardial depression making it a suitable agent for anaesthesia in those who are haemodynamically unstable
- May induce state of dissociative anaesthesia resulting in nightmares
Etomidate, why to use, why not to use - features
- Has favorable cardiac safety profile with very little haemodynamic instability
- No analgesic properties
- Unsuitable for maintaining sedation as prolonged (and even brief) use may result in adrenal suppression
- Post operative vomiting is common
