Chapter 5 Qs: Communicating Information Flashcards Preview

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Flashcards in Chapter 5 Qs: Communicating Information Deck (10):
1

Q5.1. Ramipril and pregnancy

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

2

Q5.2. Tamoxifen: general knowledge

for communicating information (4)

  • 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.

3

Q5.3. Giclazide/metformin: general knowledge

for communicating information (4)

  • 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.

4

Q5.4. Methotrexate: general knowledge

for communicating information (5)

  • 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.

5

Q5.5. Warfarin: general knowledge

for communicating information (4)

  • 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.

6

Q5.6. ACEi: general knowledge

for Communicating information (5)

  • 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.

7

Q5.7. Steroids: general knowledge

for Communicating information (4)

  • 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.

8

Q5.8. SSRIs: general knowledge

for Communicating information (5)

  • 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.

9

Q5.9. DM management: general knowledge

for Communicating information (5)

  • 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.

10

Q5.9. Bisphosphonates: general knowledge

for Communicating information (5)

  • 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.