Presentation on theme: "AKT Pharmacology Quiz Dr. V.Krishnamoorthy. Contraceptive Advice A.2 days of extra contraceptive precautions req B.7 days of extra contraceptive precautions."— Presentation transcript:
Contraceptive Advice A.2 days of extra contraceptive precautions req B.7 days of extra contraceptive precautions req C.14 days of extra contraceptive precautions req D.Emergency contraception req E.No extra contraceptive precautions req F.Omit pill free week
For each patient described, select the SINGLE MOST appropriate advice from the list above. Each option may be used once, more than once or not at all.
1. A 24 yr old woman is on the COC pill. She is on day 19 of the packet & rings to say she forgot her pill yesterday morning and had intercourse last night. She has taken her pill this morning. He last period was normal and she has taken all her other pills correctly.
2. A 36 year old woman is taking the POP. She is on day 14 of the packet & rings to say she forgot her pill yesterday & had intercourse last night. She has taken her pill this morning. Her last period was normal & she has taken all other pills accurately.
3. A 28 yr old woman had her first baby 8/52 ago. She is not breast feeding & wishes to restart contraception straightaway. She has not started her periods yet and receives her first injection of Medroxy progesterone acetate that day.
4. A 26 yr old woman is taking the COC pill. She forgot to start her new packet of pills 3 days ago & had intercourse last night. Her last period was normal and she had taken her previous pack of pills accurately.
5. A 24 yr old woman is taking the COC pill. She is on day 6 of the packet & is treated with a 7 day course of oral flucloxacillin for wound infection.
COCP Missed Pill : take missed pill asap, then next pill at usual time Extra contraception for 7 days if – vomiting/ severe diarrhoea missed pill > 12 hrs antibiotics ( 7 days after completing course ) Emergency contraception if – >/= 4 pills missed mid pack >/= 2 pills missed at start or end of pack
POP Missed pill –or delayed >3 hrs ( 12 hrs for Cerazette )- continue taking pill at usual time & use extra precautions for 2 days. If missed or delayed > 3 hrs & intercourse has occurred before 2 further tabs have been correctly taken – emergency contraception.
Which of the following drugs must never be used in subcutaneous infusions as they cause severe irritation at the site Midazolam Dexamethasone Diazepam Chlorpromazine Prochlorperazine Cyclizine Levomepromazine Hyoscine hydrobromide Hyoscine butylbromide
The answers are 3, 4, 5 Diazepam, prochlorperazine & chlorpromazine cause severe irritation at the site. NEVER use them in a subcutaneous infusion Cyclizine and levomepromazine may also cause local irritation sometimes but are used in a subcutaneous infusion
Antibiotic Treatment Flucloxacillin Penicillin V Co-amoxiclav Benzylpenicillin Amoxicillin Methicillin Penicillin and flucloxacillin None of these
Match the scenarios given below to the single most appropriate antibiotic treatment: each response may be used once, more than once or not at all. A hamster bit a plumber 24 hours ago. The bite is a small one on the back of her right hand and it looks inflamed. She is otherwise well. A one year old boy with headache, leg pains and preferring to be in a darkened room, has a stiff neck and a non blanching rash on his buttocks on examination.
A 19 yr male has a 10 day history of fatigue, a sore throat and a temperature. On examination he has cervical and occipital lymphadenopathy. A monospot blood test done 24 hours ago has just been received back and is positive. A 26 yr nursery care worker has a fever, malaise, a cough productive of purulent sputum and left sided pleuritic chest pain. On examination there are coarse crackles heard at the left side of the chest A 4 yr girl presented to surgery with a red patch on the cheek covered in a golden crust. The child is otherwise well.
Animal and human bites Co-amoxiclav alone (or doxycycline + metronidazole if penicillin-allergic) Cleanse wound thoroughly. For tetanus-prone wound, give human tetanus immunoglobulin (with a tetanus-containing vaccine if necessary, according to immunisation history and risk of infection)
Meningitis caused by meningococci Benzylpenicillin IM and transfer to hospital or cefotaxime Treat for at least 5 days; Glandular fever Do not give Amoxicillin – can cause a rash Symptomatic Rx only Community acquired pneumonia - - Amoxicillin
Impetigo Topical fusidic acid (or mupirocin if meticillin-resistant Staphylococcus aureus); oral flucloxacillin or erythromycin (1) if widespread (1) Topical treatment for 7 days usually adequate; max. duration of topical treatment 10 days; Erysipelas Phenoxymethylpenicillin (or erythromycin (1) if penicillin-allergic) (1) Treat for at least 7 days; add flucloxacillin to phenoxymethylpenicillin if staphylococcus suspected;
Cellulitis Benzylpenicillin + flucloxacillin (or erythromycin (1) alone if penicillin-allergic) (1) Substitute phenoxymethylpenicillin for benzylpenicillin if oral treatment appropriate
Side effects of diabetic drugs Options Metformin Sulphonylureas Glitazones For each of the side-effects below, select the most appropriate drug group from the list above. Each option can be used once, more than once or not at all. More than 2 options can also be used.
Reduced Vit B absorption Weight gain and liver dysfunction Lactic acidosis Hypoglycaemic episodes Syndrome of inappropriate ADH secretion
Simvastatin and Grapefruit juice - Grapefruit juice can increase the risk of rhabdomyolysis as a side effect of taking simvastatin Disulfiram and vodka – Disulfiram is used in the Rx of alcohol dependence
Warfarin and Cranberry juice – cranberry juice can raise the INR of patients on warfarin. NOTE : beware of high intake of tomatoes with warfarin – there is excess Vit K in tomatoes. Warfarin is a Vit K antagonist. So excess Vit K in tomatoes reverses the effect of warfarin
Hay fever A 20 yr old student suffers from hay fever. She is about to take her final exams & is worried that the meds may cause drowsiness. She is on Erythromycin for an ear infection. Which anti-histamine would be MOST suitable for treating her hay fever?
A – Promethazine B – Desloratidine C – Chlormethiazole D – Chlorpheniramine maleate E – Terfenadine
Desloratidine – long acting H1 antagonist poor CNS penetration no interaction with abx Cetrizine, desloratidine & fexofenadine are all used to treat hay fever with equal efficacy. However, Cetrizine & Fexofenadine interact with Erythromycin & other macrolides. Chlorpheniramine & Terfenadine cause drowsiness & interact with Erythromycin.
Heart Failure A 76 yr old man who seldom attends the Surgery is finally brought in by his wife with several weeks Hx of orthopnoea, PND & swollen ankles. O/E bibasal creps, HR110/min ECG- sinus rhythm. After treatment with ACEi & frusemide, he is still symptomatic & tachycardic. Which of the following is correct re further management?
A – He should be started on beta blocker. B – He should be referred for a bi-ventricular pacemaker. C – He should start Digoxin for rate control. D – His dose of diuretic should be increased. E – Spironolactone should be started.
Patients with heart failure should be referred for consideration of a cardioselective BB- Carvedilol. Diuretics are an adjunct for initial Rx of oedema. Mainstay of Rx is ACEi & BB. Digoxin & Spironolactone both have a place but not as 1 st / 2 nd line. Bi-ventricular pacing in severe heart failure.
Management of Chest pain A 55 yr old man has a 2 hour Hx of severe central chest pain radiating to his lt arm. He has no previous significant medical history. His BP is 150/85 mmHg, his chest is clear & his pulse is regular at 90/min. In addition to Aspirin, which is the SINGLE MOST appropriate drug for this patient. Select one option only.
A – Amiodarone B – Carvedilol C – Diamorphine D – Furosemide E – Ramipril
Post MI A 58 yr old woman attends 2 months after a MI. She has made a good recovery but has developed features of low mood & poor sleep pattern with early morning wakening. Which is the SINGLE MOST appropriate drug for this patient?
A – Amitryptiline B – Fluoxetine C – Lofepramine D – Mirtazepam E – Venlafaxine
Answer – Fluoxetine Sertraline is the most appropriate of SSRIs. TCA – Can cause conduction defects & arrythmias ( amitryptiline, nortryptiline, lofepramine, imipramine, dothiepine ) NARI – Venlafaxine has similar cardiac profile.