Stage 2 OSCE Prep

name some ACE inhibitors

ramipril, lisinopril, perindopril

ACE inhibitors are used for

HTN

HF

Ramipril starting dose

1.25mg to 2.5mg

ACE inhibitors side effects

persistent dry cough

dizziness

fatigue

angio-oedema

all ACEi should not be used during

pregnancy

ACEi sick day rules

Sickness, nausea or diarrhoea

Must stop medication, restart medication 48hrs after feel better or symptoms stop

what medications interact with ACEi particularly

NSAIDS

diuretics

lithium

ARBS

Angiotensin Receptor Blockers

ARBs examples

candesartan, olmesartan, valsartan

what are ARBs used for

HTN

HF when ACEi not tolerated

candesartan initial dose

8mg OD increased if necessary

ARB side effects

dizziness

hyperkalemia

hypotension

ARB counselling points

avoid OTC NSAIDS unless advised

not safe during pregnancy

beta blockers examples

atenolol bisoprolol propanolol

beta blockers uses

HTN

Angina

HF

Arrythmias

beta blockers side effects

fatigue

cold extremities

dizziness

beta blockers counselling points

bbs can worsen breathing problems especially if patient has asthma or COPD

Calcium channel blockers (CCB) examples

amlodipine, felodipine, nifedipine

CCB uses

HTN

Angina

Arrhythmias

CCB Side effects

peripheral oedema

headache

fatigue

CCB Counselling points

avoid grapefruit/ grapefruit juice

be cautious alongside bbs and ACEi as may cause hypotension

Not safe for use during pregnancy

furosemide use

oedema

resistant HTN

furosemide drug class

loop diuretic

furosemide side effects

frequent urination

dizziness

muscle cramps

furosemide counselling points

take consistently the same way every day

be cautious of interactions with

-other diuretics

-NSAIDs

-lithium

-digoxin

may not be safe during pregnancy

GTN Spray is also known as

Glyceryl trinitrate spray

GTN spray is used for

first sign of chest pain (angina)

or when you expect an activity to trigger chest pain

GTN common side effects

headache

dizziness

nausea

burning/ tingling sensation under the tongue

GTN instructions for use

sit down before using spray

spray under the tongue

close mouth after

spraying and wait for medication to work

don't swallow for a few secs

ring 999 if you have taken ..... doses of GTN

2 doses of GTN and you're still in pain 5 mins after second dose.

take last dose when waiting for ambulance to arrive

inform patient this could be the sign of a heart attack

h. pylori eradication therapy

ppi and antibiotics

e.g. lansoprazole + amoxicillin + clarithromycin or metronidazole

if patient is allergic to penicillin and needs h. pylori

ppi + clarithromycin + metronidazole

naproxen use

pain and inflammation

gout

naproxen counselling

-take with or after food

-swallow whole with water

-be cautious alongside anticoagulants, ACEi/ diuretics

-not recommended for pregnant women

-elderly people at higher risk of stomach bleeding + kidney problems

-may worsen asthma symptoms

inhaled laba example

salmeterol

formeterol

inhaled laba + ics inhaler examples

symbicort

fostair

laba + ics uses

asthma

COPD

-Maintenance medication not rescue inhaler

how do laba + ics work

LABA helps to relax the muscles around the airways to keep them open

ICS reduces inflammation to prevent symptoms

how to use an inhaler: counselling

-shake inhaler before use if required

-exhale fully to empty the lungs

-place mouthpiece around the lips and form a tight seal

inhale deeply and slowly while pressing the cannister to release the medication

Hold breath for 5-10 seconds

rinse the mouth with water to prevent oral thrush from ICS

common side effects of laba + ics

hoarseness or sore throat from ICS

Oral thrush

LAMA

Long acting muscarinic inhaler

LAMA inhaler example

tiotropium

aclidinium

common side effects of LAMA

dry mouth

hoarseness

oral thrush

can cause constipation in elderly

ICS examples

beclomethasone

fluticasone

common side effects of ics inhalers

oral thrush

hoarseness

sore throat/ cough

NOACs stand for

Novel Oral anticoagulants

DOACs stand for

Direct Oral anricoagulants

NOACs are also known as

DOACS

NOACS/ DOACS examples

apixaban

rivaroxaban

edoxaban

dabigatran

what are NOACs/ DOACs used for

to treat and prevent blood clots in conditions like Atrial Fibrillation, DVT, Pulmonary embolism, post surgery prophylaxsis

Common side effects of NOACS/ DOACS

Increased risk of bleeding

GI issues

Dyspepsia

increased risk of bleeding can lead to more

nosebleeds, gums, bruising + more serious- gi bleeding

what med is more likely to cause GI upset/ dyspepsia

dabigitran

bleeding precautions: advise the patient to

use soft bristle toothbrush/ electric razor to minimise bleeding risk

avoid activities with high injury risk

report any signs of bleeding/ unusual bruises

drug interactions with DOACS/ NOACS

other anticoagulants/ antiplatelet drugs (aspirin/ clopidogrel)

NSAIDs

Strong CYP3A4/ P-gp inhibitors e.g. ketoconazole/ clarithromycin which may affect NOAC levels

what is prednisolone

corticosteroid used to treat inflammatory/ autoimmune conditions like asthma, rheumatoid arthritis, lupus

common side effects of prednisolone

increased appetite

weight gain

fluid retention (oedema)

mood changes

insomnia

GI discomfort

long term use side effects of prednisolone

adrenal suppression

osteoporosis

muscle weakness

hyperglycaemia

cushingoid features (moon face, buffalo hump, weight around stomach)

how to take prednisolone

with food in the morning to mimic body's natural cortisol rhythm

what are PPIs

proton pump inhibitors

Name some examples of PPIs

omeprazole

esomeprazole

pantoprazole

lansaprazole

common side effects of PPIs

GI issues

headache

when and how to take PPI

take on an empty stomach

30-60 minutes before breakfast

for twice daily dosing. take second before dinner

swallow tablet whole

what are sodium alginate/ calcium carbonate/ magnesium carbonate (gaviscon) used for

GORD

heartburn

how does gaviscon work

forms a protective barrier on top of stomach contents, preventing acid reflux from entering the oesophagus

side effects of gaviscon

GI issues

when to take gaviscon

after meals

before bedtime

what does gaviscon interact with

tetracyclines + quinolones

thyroid medications

iron supplements

what is salbutamol and what is it used for

short acting beta agonist used to relieve symptoms of asthma + COPD

common side effects of salbutamol

tremors

tachycardia

headache

muscle cramps

what does salbutamol interact with

beta blockers

diuretics

name some statins

atorvastatin

simvastatin

what are statins used for

to lower cholesterol and triglyceride levels in the blood

common side effects of statins

muscle pain

GI issues

Headache

what are the symptoms of rhabdomyolysis

dark urine

severe muscle pain/ weakness

when to take statins

in evening

name a thiazide like diuretic

indapamide

what are thiazide like diuretics used for

HTN

Oedema associated with heart failure

how do thiazide like diuretics work

inhibit sodium-chloride symporter in distal convoluted tubule of kidney

promotes sodium + water excretion

common side effects of thiazide like diuretics

electrolyte imbalances

dehydration

GI issues

metabolic changes like hyperglycaemia/ hyperuricemia

counselling points for indapamide (+ thiazide-like diuretics)

take once daily in the morning to avoid nighttime urination

thiazide-like diuretics interactions

digoxin

lithium- can increase toxicity of both

NSAIDs- may reduce effectiveness

what is warfarin used for

Anticoagulant (blood thinner)

used for DVT, PE, AF

target INR ranges for DVT, PE, AF

2.0-3.0

target INR ranges for mechanical heart valves

2.5-3.5

frequency of monitoring when starting warfarin

every 1-2 days until stable

frequency of monitoring for stable patients on warfarin

every 2-4 weeks

how does warfarin dosing work

given a loading dose (5-10mg for 1-2 days) followed by a maintenance dose based on INR

Drugs that increase INR- RISK OF BLEEDING (and may interact with warfarin)

NSAIDS

Amiodarone

antiplatelets (aspirin/ clopidogrel)

antibioitcs

drugs that decrease INR- RISK OF CLOTS

(interact with warfarin)

carbamazepine

cholestyramine

warfarin is a vitamin K inhibitor. ensure patient's diet maintains a

consistent intake of vitamin-K foods rather than avoiding

side effects of warfarin

bleeding

when to take warfarin

same time daily, usually in evening

can warfarin be used during pregnancy

no use Low molecular weight heparin instead

SOCRATES stands for

Site

Onset

Character

Radiates

Associated symptoms

Time/duration

Exacerbating

Severity

Site-

where is the pain

Onset

what were you doing when the pain started- How and when

Character

what does the pain feel like, is it constant or does it come and go

Radiates

does the pain go anywhere else

Associated symptoms

Do you have any other symptoms?