Psychiatric & Endocrine
Depression, panic disorder, anxiety
Escitalopram 10-20mg once daily
GI (e.g. nausea, vomiting), Antimuscarinic (fewer than TCAs), cardiotoxic in overdose (less than TCA)
Not if < 18y (except fluoxetine).
Moderate-severe depression associated with psychomotor/physiological
changes (e.g. sleep/apetite disturbance), nocturnal enuresis in
children. E.g. Imipramine
Cardiac (arryhythmiax, heart block), antimuscarinic (dy mouth, blurred vision, constipation, urinary retention), overdose
Hypnotic, short term relief of severe anxiety, panic disorders. Longer acting e.g. diazepam, shorter acting e.g. lorazepam.
Mouth: 2mg tds
Dependence, drowsiness, confusion, ataxia, amnesia, muscle weakness
Resp depression, sleep apnoea, sev hepatic impairment
Ultra-fast (use w meals): Humalog, novarapid
Soluble (30m before meals): Humilin S, Actrapid
Intermediate acting: Humilin I or Insulatard
Long acting: Ultratard
Long acting analogue: Lanctus/inslin glargine
Premixed: Novomix 30
If overweight start with metformin (side effect: slimming), if
underweight start with sulfonylurea (side effect: weight gain).
Biguanides: metformin (the only one!)
↑Insulin sensitivity (also a treatment for PCOS)
GI (anorexia, nausea...), lactic acidosis
liver/renal impairment (lactic acidosis), recent MI, XR contrast, general anaesthesia, pregnancy, breast feeding
GI, liver function (→cholestasis).
Liver/renal impirment, breast-feeding, pregnancy, ketoacidosis
Starting the pill:
Enquire: Sexually active, partner, consenting relationship (if underaged), last period (?risk of pregnancy), smoking
failures, SEs, how to take pill reliably, what to do if miss pill,
extra protection w abx. “Do u have any questions or concerns”, arrange
Missing the pill:
CoC: If <12h
late protection maintained. If >12h take as soon as possible but use
barrier for 7d (if that 7d runs in to pill-free, than continue next
packet w/o break). Vomiting within 2h of taking pill: advice for missed
PoC: Take as soon as possible and resume normal schedule. If >3h late use backup.
Progesterone only: Levorgestrel 1.5mg as soon as possible
IUD: Cu coil up to 5d after
Methods of Contraception
Combined Oral Contraceptive (CoC)
(E and P): prevent ovulation, thicken cervical mucus, dec receptivity.
Effective, reversible, convenient, relief of menstrual probs/less ovarian/endometrial Ca, protect against PID.
Headaches, ↑BP, breakthrough bleeding, weight gain, breast tenderness, acne, mood swings, no protection for STDs.
TED, MI/stroke, br Ca, cervical Ca, liver Ca.
CVS: hx or FH of thrombosis, clotting disorders, IHD, valvular hrt disease, AF, sickle cell anaemia
Migraine w aura or sev migraine
Hepatic: abn LFTs, jaundice of pregnancy
Other: hormone dependent carcinoma, pregnancy, undiagnosed vaginal bleeding
DM, ↑BP, smoking, age>35, obesity
↑dose if broad spectrum abx, enzyme inducers (eg. carbamezepine, phenytoin, rifampicin).
Progesterone Only Pill (PoP)
reversible, convenient, avoid CVS effects of estrogen, used if
contraindication to CoC, can use during breast feeding.
Amenorrhoea/breakthrough bleeding, needs to be taken same time daily, including ovarian cysts and possible br Ca.
long acting progesterone prevents ovulation, thicken mucus, decreases uterine receptivity.
Effective, convenient, br feeding. ⊖Cannot be stopped, menstrual irregularities common, wt gain common.
A progesterone rod Similar to injectables, but long duration. ⊖Similar to injectables.
Cu wire. Left in 5y years. Induces inflammatory response in uterus.
Effective (immediately after fitting), reversible, convenient.
Bleeding between periods, menorrhagia first few cycles, uterine
perforation (first 20d, ectopic pregnancy (if failure, so low absolute
T shaped, 5y, reduces endometrial growth and prevents implantation.
Effective, convenient, reversible, reduces blood loss and dysmenorrhoea.
Menstrual irreg for first m's, prestegenic SEs, ovarian cyst.
Insertion before intercouse allows spontaneity, protect against STIs.
Protects against STDs.
Planning, lacks spontaneity, cooperation from both partners, can fail.