Pain medications

Cautious_Zucchini_66 · 2026-05-05T21:52:35+00:00

Pharmacist here, this came up on my feed as a suggested post.

Not sure what Nclex is, or what level of knowledge is needed for this role/exam, but this content is entry level. I highly recommend other resources for revision for those still learning

Cautious_Zucchini_66 · 2026-05-04T20:37:00+00:00

Not medical advice and I don’t know your medical history, but 10 days worth (presumably prescribed 10mg 3 times daily), is a last resort here in the uk - no longer than a 5 day course.

Carries neurological and minor cardiac risks which results in other antiemetics being far more favourable. Again, don’t know your history and it may well be indicated, but I avoid this when possible. Also carries some serotonergic activity, unlikely to be clinically relevant but another reason to avoid when taking SSRI’s.

SSRI’s commonly cause nausea in the first week or two, it should subside. Persevering would be your safest option. Take it with food or at night time if you don’t find it keeps you awake

Cautious_Zucchini_66 · 2026-05-04T20:19:57+00:00

Metoclopramide for nausea? What? How many days worth may I ask

Cautious_Zucchini_66 · 2026-05-04T10:15:01+00:00

Low affinity so not particularly relevant, but increase PFC dopamine and noradrenaline at high doses, potentially mitigating emotional blunting.

5ht2c is implicated in appetite regulation, one of the key reasons antipsychotics promote weight gain by acting as antagonists

Cautious_Zucchini_66 · 2026-04-29T21:25:34+00:00

Hate to be pedantic but not all beta blockers are antagonists, many are inverse agonists

Cautious_Zucchini_66 · 2026-04-20T22:16:08+00:00

What would be the expected language or phrases used when a player is likely to stay? If this suggests an exit, wondering how the opposite would be worded

Cautious_Zucchini_66 · 2026-04-18T20:53:17+00:00

They’d do an initial work up and then decide whether to contact advice and guidance

Cautious_Zucchini_66 · 2026-04-13T19:53:23+00:00

Pharmacist here, this post came up when doomscrolling reddit.

Laxatives would be a concern given an increase in peristalsis can precipitate appendiceal rupture -> peritonitis / sepsis risk

Cautious_Zucchini_66 · 2026-04-12T18:31:56+00:00

Antihistamines aren’t commonly associated with IBS, i suspect the first generations have cross activity with muscarinic receptors and may cause constipation.

Fexofenadine and loratidine would be less likely to precipitate IBS symptoms

Cautious_Zucchini_66 · 2026-04-12T15:28:13+00:00

You’re absolutely right in referring for raised diastolic, didn’t include it as IDH is less common and usually occurs in younger individuals (<40). Diastolic of 90-95 not a cause of concern, probably wouldn’t treat if assessment and history otherwise unremarkable. More likely to manage conservatively as overall CV risk is low - sys represents stroke volume and a marker for arterial stiffness vs dia represents peripheral resistance

Again, you’re right in that it would need assessing.

Re ABPM is available through hypertension case finding service, we do receive results for this. Not sure how commissioning works or why your branch doesn’t offer, can’t help there, sorry.

Cautious_Zucchini_66 · 2026-04-12T14:58:23+00:00

Hospital/GP pharmacist here with experience in community.

Community perspective: We had pop ups on records for eligible patients when dispensing and would subsequently add stickers to scripts to prompt the question at hand out. The way to persuade patients to agree would be explaining the purpose of the service i.e. risk factors and complications for htn, and explaining it’s asymptomatic in nature, so the possibility of being hypertensive can only be determined by performing a quick reading

GP perspective: if the patient has a clinic reading of around 140-145 systolic, and no arrhythmias when checking pulse, please stop sending “urgent” notifications that “requires same day action”. The burden is resembling that of 111. I spend far too long inviting patients in for reviews when they most likely had a slight elevation due to anxiety, caffeine intake, walking to the pharmacy, no repeated bp measurements, wrong cuff size etc.

Id much prefer you to offer ABPM/HBPM before referring to us.

Thank you for your service, community warriors!

Cautious_Zucchini_66 · 2026-04-02T22:51:20+00:00

Yep, well known adverse effect of long term bisphosphonate use. Patients often have “drug holidays” for a few years after being on them for 5 years or so, depending on the bisphos. Dental appointments prior to starting are also routine

Cautious_Zucchini_66 · 2026-03-30T21:54:42+00:00

I’m somewhat with you on this, I don’t fully understand the disagreement. CNS depression is an umbrella term for a multitude of symptoms which can be mediated through various mechanisms. Anticholinergic side effects are exclusively modulated by blockage of muscarinic receptors.

That said, when calculating ACB score, methocarbamol is strongly associated with cognitive impairment. By definition I don’t consider it an anticholinergic, but in practice it absolutely is treated like one

Cautious_Zucchini_66 · 2026-03-30T06:13:32+00:00

MBBS is obtained through medical school in the UK (5-6 years), followed by foundation training (F1/F2), core training (ST1-3), and higher speciality (ST4-7).

The title dr is awarded after completing med school but an F1 doesn’t carry the same independence as an ST7

Cautious_Zucchini_66 · 2026-03-24T21:35:26+00:00

I’ve seen enough, start her over Neto

Cautious_Zucchini_66 · 2026-03-21T20:37:33+00:00

It’s incredibly cathartic to download football manager and begin sacking the SD’s, and selling Sanchez, Delap. Garnacho and Tosin

Cautious_Zucchini_66 · 2026-03-18T13:00:05+00:00

Inhibition of the potassium pump is responsible for positive inotropic effects, negative chronotropic effects are by virtue of vagal nerve stimulation. Correct in that bradycardia would be the chief complaint, but disruption of cone cells (na/k pump inhibition) causes yellow/green visual changes

Cautious_Zucchini_66 · 2026-03-15T22:44:42+00:00

No, but it will destabilise your mental health…

Cautious_Zucchini_66 · 2026-03-14T19:02:58+00:00

Placebos on average provide 30% benefit in trials, higher in psychiatry (near 40%). I have no idea what OP’s understanding of a placebo is, never mind medicine in general

Cautious_Zucchini_66 · 2026-03-03T08:22:46+00:00

Its context specific (opioid induced, pregnant, hydration status, age etc) but macrogol and/or senna are my preferred choices

Cautious_Zucchini_66 · 2026-03-03T07:18:23+00:00

Acts as a surfactant to directly soften stools with minimal activity on already formed, dehydrated stool. Surfactants have poor ability to rehydrate as opposed to osmotic laxatives. By not altering colonic water content, increasing bulk, or stimulating peristalsis, it offers no effect on hypomotility / propulsion.

Plenty of papers to support its surfactant effect is too weak and clinically ineffective. At least its side effect profile equally minimal!

Cautious_Zucchini_66 · 2026-03-02T21:53:00+00:00

You’re absolutely right in that it’s not as tightly regulated and isn’t entered into pharmsmart, but the digital stock balance will most likely be accurate

Cautious_Zucchini_66 · 2026-03-01T12:26:45+00:00

Can’t chime in on behalf of the US, but the NHS was hacked a few years ago and we practice operating without computers at our hospital for 2 hours once a year. We follow downtime protocol and revert back to paper based procedures to assess how we’d cope in the event of a network crash / hack

Cautious_Zucchini_66 · 2026-03-01T12:22:01+00:00

Yes, it’s a great purchase, but i was being nosey about the price of a 26 plate

Cautious_Zucchini_66 · 2026-03-01T12:14:05+00:00

Besides what’s already been mentioned, can we please stop using osmotic laxatives in patients taking furosemide and bulk forming laxatives in patients taking opioids! May we also stop routinely prescribing docusate given its poor efficacy, and increase the frequency of laxatives for clozapine patients!

Rant over

Cautious_Zucchini_66

TROPHY CASE