Dr Zae

Studying pharmacy and medicine has taught me just how much each one needs the other. 👩🏻‍💻 #medEd

[Dr Zae @DailyPharmacist]

Recently saw a patient who’d been referred to A&E by a community pharmacist. They’d gone to the pharmacy for simple OTC medication.

Turns out they had an aggressive type of cancer that typically has low survival rates as it’s usually caught late. Very proud of that pharmacist ❤️

[Dr Zae @DailyPharmacist]

@Dr_Done_ At least GP has shortages. There are many surgical PAs where I'm doing F1. They are listed into theatres, referred to as “surgeon" in op notes and get clinic time. Meanwhile surgical trainees and junior doctors are fighting to get into theatre and F1s are stuck updating ward list

[Dr Zae @DailyPharmacist]

@DoctorPonglenis @toast36742904 It’s a mix of 2 medical specialties on one ward. Don’t want to be too specific but this Trust is a huge employer and advocate of PAs in both medicine and surgery. I feel like I’m working in the future of the NHS and it does not look good for junior doctor training.

[Dr Zae @DailyPharmacist]

@DoctorPonglenis @toast36742904 FY1 here. I was told by a consultant today that I am the “arms” of the 3 PAs on the ward because they can’t prescribe or request scans. They are treated the same as regs (except they do way more clinics than the regs). I am treated like their assistant. It is so demoralising.

[Dr Zae @DailyPharmacist]

ACUTE PULMONARY OEDEMA INITIAL MANAGEMENT 🫁

“Pour SOD”

• Pour away (stop) IV fluids
• Sit patient up
• Oxygen - if saturation <95%
• Diuretics - furosemide 40mg IV stat

💡 Other treatments in severe oedema include IV morphine, CPAP & inotropes

[Dr Zae @DailyPharmacist]

⚠️ Drugs that can exacerbate HEART FAILURE

• NSAIDS: sodium & fluid retention, decrease renal function

• VERAPAMIL: negative inotropic effect

• CORTICOSTEROIDS: sodium & fluid retention

• PIOGLITAZONE: fluid retention

• FLECAINIDE: negative inotrope & proarrhythmic

[Dr Zae @DailyPharmacist]

🫀STABLE ANGINA MANAGEMENT

3 KEY COMPONENTS:

1️⃣ Immediate symptom relief →
GTN spray

2️⃣ Long term symptom relief →
β-blocker
+/- Calcium channel blocker

3️⃣ Secondary prevention →
Aspirin
Atorvastatin
ACE inhibitor

[Dr Zae @DailyPharmacist]

CHRONIC HEART FAILURE🫀

First line drug treatment

⚠️ Start low & increase doses as tolerated:

ACEi eg. ramipril
B-blocker eg. bisoprolol

Give diuretic eg. furosemide for congestive symptoms & fluid retention

➕ Add aldosterone antagonist if symptoms still not controlled

[Dr Zae @DailyPharmacist]

METFORMIN

🍯 First line drug in type 2 diabetes management

↑ insulin sensitivity
↓ liver glucose production

Does not increase or decrease body weight

Does not cause hypoglycaemia

⚠️ Notable side effects:
Diarrhoea
Abdominal pain
Lactic acidosis

[Dr Zae @DailyPharmacist]

UTI IN PREGNANCY🤰🏻

⚠️ Risk of pyelonephritis, premature rupture of membranes & pre-term labour

💊 Give antibiotics for 7 days

Trimethoprim - avoid in FIRST trimester as this is a folate antagonist

Nitrofurantoin - avoid in THIRD trimester due to risk of neonatal haemolysis

[Dr Zae @DailyPharmacist]

PULMONARY EMBOLISM:

🫁 Thrombi embolise via right heart into pulmonary arteries

🗣 Symptoms:
Breathlessness
Chest pain
Cough/haemoptysis
Hypotension (if PE sufficient to compromise cardiac output)

⚠️ Signs:
Tachycardia
Tachypnoea
Hypoxia (PE less likely if PaO2 >10.7 pKa)

[Dr Zae @DailyPharmacist]

OSTEOPOROSIS PRESCRIBING:

Bisphosphonates (e.g. alendronic acid) interfere with osteoclast activity, stopping reabsorption of bone.

Key side effects to remember:

🧪 Reflux & oesophageal erosions
🦴 Atypical femoral fractures
👂🏻 Osteonecrosis of jaw & external auditory canal

[Dr Zae @DailyPharmacist]

SUSPECTED LUNG CANCER

⚠️ NICE recommend offering chest X-ray within 2 weeks to patients over 40 with:

• finger clubbing
• recurrent / persistent chest infections
• thrombocytosis
• chest signs of cancer
• unexplained symptoms e.g. cough, chest pain, dyspnoea, fatigue

[Dr Zae @DailyPharmacist]

MECHANICAL HEART VALVES

🫀 Used in aortic stenosis & mitral regurgitation

3 major complications to remember:

🔺Thrombus formation causing stroke - lifelong anticoagulation needed to prevent this
🔺Infective endocarditis
🔺Haemolysis causing anaemia

[Dr Zae @DailyPharmacist]

CORTICOSTEROID ADVERSE EFFECTS

💧 Mineralocorticoid effects:
Hypertension
Sodium & water retention
Potassium loss
Calcium loss

💪🏼 Glucocorticoid effects:
Diabetes
Osteoporosis
Muscle wasting

⚠️ May also cause psychiatric reactions & are linked to peptic ulcers

[Dr Zae @DailyPharmacist]

Why do people on corticosteroids need higher doses during surgery?

Surgery stresses the body and increases steroid requirement, but long-term steroid use suppresses normal adrenal production

IV hydrocortisone is used peri-operatively to meet extra need & prevent adrenal crisis

[Dr Zae @DailyPharmacist]

ORAL CANDIDIASIS: overgrowth of candida in the mouth

⚠️ Predisposing factors:
• Immunodeficiency
• Antibiotic use
• Diabetes
• Smoking
• Dentures

💊 Treatment options:
• Miconazole gel
• Nystatin liquid
• Fluconazole tablets - recurrent/severe episodes

[Dr Zae @DailyPharmacist]

OTITIS MEDIA: middle ear infection

👶🏼 Common in children

Most resolve without antibiotics in 3 days

Give immediate antibiotics in co-morbid, systemically unwell or immunocompromised pts

1st line: amoxicillin
Penicillin allergy: clarithromycin
Pregnancy + allergy: erythromycin

[Dr Zae @DailyPharmacist]

GYNAECOMASTIA - enlargement of glandular breast tissue in males

Caused by oestrogen/androgen imbalance

Multiple aetiologies, including drugs

💪🏼Anabolic steroids: ↑oestrogen
🧠Antipsychotics: ↑prolactin
💧Spironolactone: ↓testosterone
🫀Digoxin: stimulate oestrogen receptors

[Dr Zae @DailyPharmacist]

POTASSIUM INFUSIONS:

⚠️ Usual rate of potassium infusion should not exceed 10 mmol/hour
🫀 This is due to the risk of inducing arrhythmia & cardiac arrest
🩺 Faster rates should only be administered through a central line, under expert supervision and with cardiac monitoring