Step up management of acne
Step-up management of acne:
- single topical therapy (topical retinoids, benzoyl peroxide)
- topical combination therapy (topical antibiotic, benzoyl peroxide, topical retinoid)
- oral antibiotics: e.g. Oxytetracycline, doxycycline. Improvement may not be seen for 3-4 months
- oral isotretinoin: only under specialist supervision
What drugs can exacerbate psoriasis?
Plaque psoriasis. Numerous drugs are known to exacerbate psoriasis including:
- Lithium
- Beta-blockers
- NSAIDs
- ACEi
- TNF-alpha inhibitors
- Anti-malarials
Pharmacological options (x3) to manage mild-moderate Alzheimer
Acetylcholinesterase inhibitors (so less ACh is broken down → more available at the synapse): donepezil, galantamine and rivastigmine
Mechanism of action of statins
Statins inhibit the action of HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis
Who should receive statin as primary prevention?
- name of the drug
- dose
Primary prevention groups:
- 10 - year CVS risk > or = 10%
- most type I diabetics
- CKD if eGFR <60
Give Atorvastatin 20 mg
(if non-HDL have not fallen by = or >40% then consider Atorvastatin 80mg)
Who should receive statin as secondary prevention?
- name of the drug
- dose
Secondary prevention group:
- established CVS disease
- established IHD
- peripheral vascular disease
Atorvastatin 80 mg
What medication may cause ototoxicity?
Drug ototoxicity:
- aminoglycosides (e.g. Gentamicin)
- furosemide
- aspirin
- cytotoxic agents
What’s the management of Scabies?
Permethrin 5% (1st line) -> # function of neurones in scabies mites lice
Malathion 0.5% (2nd line) -> pesticide
Treatment for Haemophilus influenza pneumonia (patient with COPD)
Haemophilus influenzae is the most common cause of infective exacerbations of COPD.
Treatment: a course of amoxicillin or tetracycline or clarithromycin together with prednisolone.
What’s the drug used for malaria prophylaxis?
What’s its common contraindication due to side effects?
Mefloquine (Lariam)
Contraindication: a history of anxiety, depression or other psychiatric disorders
It has neuro-psychiatric effects
Sulfonylureas
- example of drug
- MoA
- common side effects (common ones)
- is it OK to take them in pregnancy and breastfeeding?
Sulfonylurea
Example: Gliclazide
MoA: stimulate the release of insulin from pancreatic Beta cells (therefore used only if the patient has some functional beta cells) -> used in type II DM
* bind to an ATP-dependent K+(KATP) channel on the cell membrane of pancreatic beta cells
SE: weight gain, hypoglycaemic episodes
Pregnancy and breastfeeding: should be avoided
- What drug to give and how much (dose) in case of TIA?
- contraindications
Aspirin 300 mg immediately
Contraindications: a bleeding disorder, being on anticoagulants, patient is already taking the aspirin (continue taking aspirin at the dose is routinely taken until review by a specialist)
Common side effects of muscarinic M1 antagonists
Side effects:
- muscarinic M1 -> anticholinergic effects:
- dry mouth
- blurred vision
- constipation
- urinary retention
- impotence
- cognitive impairment
Common side effects of H1 antagonists
histaminergic H1 -> antihistamine effects:
- sedation
- weight gain
- drowsiness
- dry mouth, nose, and throat
- headache
1st line treatments (drugs) in HF when a patient’s renal function is normal
B-blocker (e.g. bisoprolol) & ACE inhibitor (e.g. Ramipril)
What 2nd line treatment for HF?
- second-line treatment is now either: an aldosterone antagonist, angiotensin II receptor blocker or a hydralazine in combination with a nitrate
What’s 3rd line treatment for HF (if symptoms persist on 1st an 2nd line)?
- if symptoms persist cardiac resynchronisation therapy or digoxin or ivabradine.
*The criteria for ivabradine include that the patient is already on suitable therapy (ACE-inhibitor, beta-blocker + aldosterone antagonist), has a heart rate > 75/min and a left ventricular fraction < 35%
What else should be considered in a patient with HF ? (beyond 1-3rd line treatment) e.g. symptomatic Rx
- diuretics should be given for fluid overload
- offer annual influenza vaccine
- offer one-off pneumococcal vaccine
*one-off - adults require a single dose of that vaccine (unless they have asplenia, #spleen or kidney -> then booster every 5 years)
B-blockers licensed to use in HF
Beta-blockers licensed to treat heart failure in the UK:
- bisoprolol
- carvedilol
- nebivolol
1st line Management in HYPERKALAEMIA
- calcium gluconate -> to reduce cardiac excitability and thus reduce the risk of arrhythmias
- insulin/dextrose infusion & nebulised salbutamol * -> this is to shift K+ into the cells
*do not use salbutamol if patient is tachycardiac
Which combination of two diuretics is contraindicated?
Amiloride + spironolactone
- both act in DCT
- both are potassium-sparing -> combination will result in life-threatening hyperkalaemia
Drug used for management of BPH?
- name
- mechanism of action
- side effects
- Name: Tamsulosin
- MoA: It is alpha1 (L1) blocker -> this will induce relaxation of SM in the neck of the bladder/ prostate -> less resistance to urine flow
- Side effects: dizziness, headache, sleepiness, nausea, blurry vision, and sexual problem, postural hypotension
What’s a primary treatment to reduce the excess of copper in Willson’s disease?
Penicillamine - metal chelating agent
