Thanks very much for putting together this thoughtful and comprehensive series. I have my exam tomorrow and now feel well prepared. It's especially helpful that you have discussed the most important sections of the BNF. Many thanks!!
** NB, whilst methotrexate use can cause skin reactions following sun exposure, Answer A in Case 8 relates more specifically to Amiodarone use. It is interesting to note that with amiodarone use, sunscreen should be worn EVEN on a cloudy day **
Dear Bryceleatherman7247, I have looked at the online BNF again as there can always be updates since this series was produced - however if you look in the side effects for clozapine, it first lists the side effects for "For all antipsychotic drugs" and you are correct hyperprolactinaemia is listed here, however this isn't for clozapine specifically. I have copied in a response to a previous similar question which I hope you will find useful: "For 'all' antipsychotics, hyperprolactinaemia is listed as a side effect, however in relation to clozapine specifically (and other second generation antipsychotics) - if you look in the "Psychoses and related disorders" treatment summary (screenshot provided on the next slide of the series) you can see hyperprolactinaemia is in fact stated to be rarely associated with clozapine as well aripiprazole, quetiapine and a few other second generation antipsychotics. I appreciate this was a tricky question and it would help if the information in the treatment summary was also reflected in the clozapine monograph - I hope this clarifies your query. Rest assured in the exam, given the time constraints, I would not think you would be expected to look beyond the side effects section in the monograph to find answers :)" Please do get back in touch if you need any further clarification. KR, MTB
Hey there! Thank you for your query. For 'all' antipsychotics, hyperprolactinaemia is listed as a side effect, however in relation to clozapine specifically (and other second generation antipsychotics) - if you look in the "Psychoses and related disorders" treatment summary (screenshot provided on the next slide) you can see hyperprolactinaemia is in fact stated to be rarely associated with clozapine as well aripiprazole, quetiapine and a few other second generation antipsychotics. I appreciate this was a tricky question and it would help if the information in the treatment summary was also reflected in the clozapine monograph - I hope this clarifies your query. Rest assured in the exam, given the time constraints, I would not think you would be expected to look beyond the side effects section in the monograph to find answers :) Good luck for the exam, KR, MTB
Hi, just a quick question about the last asthma question. We are taught for peak flow to take the three readings and then record the best, if you do this with the best being 390, then his PEFR is >75% his usual of 500ml. Therefore, shouldn't this be classed as a mild exacerbation? Why is it that the worst is used here? Thanks so much for all your videos!
Dear Mhairihunter, Thank you for your question, You are correct, you take the best of the 3 readings. The BNF treatment summary classifies moderate exacerbation as Peak flow > 50-75% best or predicted. The patient's peak flow is >75% of their best/predicted and therefore would fit into the moderate category as there is no mild classification in the BNF. We hope this helps, KR, MTB
Thanks for this! Brilliant video as always. Just with the fact that the rate of increase in Na in 24 hrs should not exceed >10mmol/L in 24hrs... if you are giving 1L of 0.9% NaCl to a patient in order to correct their hyponatraemia, wouldn't you be giving 154 mmol/L? and thus far exceed the limit? Please can you clarify the confusion
That sodium that you give will diffuse across all the fluid compartments. However giving 0.9% saline isn't always the correct thing to do - it depends on the cause of the hyponatraemia and how best to manage it.
Thanks very much for putting together this thoughtful and comprehensive series. I have my exam tomorrow and now feel well prepared. It's especially helpful that you have discussed the most important sections of the BNF. Many thanks!!
** NB, whilst methotrexate use can cause skin reactions following sun exposure, Answer A in Case 8 relates more specifically to Amiodarone use. It is interesting to note that with amiodarone use, sunscreen should be worn EVEN on a cloudy day **
For Clozapine, it actually lists hyperprolactinaemia as very common. Does that change the answer to D?
Dear Bryceleatherman7247, I have looked at the online BNF again as there can always be updates since this series was produced - however if you look in the side effects for clozapine, it first lists the side effects for "For all antipsychotic drugs" and you are correct hyperprolactinaemia is listed here, however this isn't for clozapine specifically.
I have copied in a response to a previous similar question which I hope you will find useful:
"For 'all' antipsychotics, hyperprolactinaemia is listed as a side effect, however in relation to clozapine specifically (and other second generation antipsychotics) - if you look in the "Psychoses and related disorders" treatment summary (screenshot provided on the next slide of the series) you can see hyperprolactinaemia is in fact stated to be rarely associated with clozapine as well aripiprazole, quetiapine and a few other second generation antipsychotics. I appreciate this was a tricky question and it would help if the information in the treatment summary was also reflected in the clozapine monograph - I hope this clarifies your query.
Rest assured in the exam, given the time constraints, I would not think you would be expected to look beyond the side effects section in the monograph to find answers :)"
Please do get back in touch if you need any further clarification.
KR,
MTB
for the last question hyperprolactinaemia comes up as a common side effect on bnf?
2nd last question i mean
Hey there!
Thank you for your query.
For 'all' antipsychotics, hyperprolactinaemia is listed as a side effect, however in relation to clozapine specifically (and other second generation antipsychotics) - if you look in the "Psychoses and related disorders" treatment summary (screenshot provided on the next slide) you can see hyperprolactinaemia is in fact stated to be rarely associated with clozapine as well aripiprazole, quetiapine and a few other second generation antipsychotics. I appreciate this was a tricky question and it would help if the information in the treatment summary was also reflected in the clozapine monograph - I hope this clarifies your query.
Rest assured in the exam, given the time constraints, I would not think you would be expected to look beyond the side effects section in the monograph to find answers :)
Good luck for the exam,
KR,
MTB
Hi, just a quick question about the last asthma question. We are taught for peak flow to take the three readings and then record the best, if you do this with the best being 390, then his PEFR is >75% his usual of 500ml. Therefore, shouldn't this be classed as a mild exacerbation? Why is it that the worst is used here?
Thanks so much for all your videos!
Dear Mhairihunter,
Thank you for your question,
You are correct, you take the best of the 3 readings.
The BNF treatment summary classifies moderate exacerbation as Peak flow > 50-75% best or predicted. The patient's peak flow is >75% of their best/predicted and therefore would fit into the moderate category as there is no mild classification in the BNF.
We hope this helps,
KR, MTB
Thanks for this! Brilliant video as always. Just with the fact that the rate of increase in Na in 24 hrs should not exceed >10mmol/L in 24hrs... if you are giving 1L of 0.9% NaCl to a patient in order to correct their hyponatraemia, wouldn't you be giving 154 mmol/L? and thus far exceed the limit? Please can you clarify the confusion
That sodium that you give will diffuse across all the fluid compartments. However giving 0.9% saline isn't always the correct thing to do - it depends on the cause of the hyponatraemia and how best to manage it.