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In this month's Round Up highlights include guidance regarding the use of antidrepressants in coronary heart disease; and the implications of a raised CK on statin treatment.
Multisystem inflammatory syndrome in children (MIS-C) – what is this condition? Is it similar to Kawasaki's disease? Is steroid treatment beneficial for children affected by MIS-C?: Multisystem inflammatory syndrome in children (MIS-C)
1) Which statement regarding MIS-C is false?
MIS-C is a presumed post-infectious complication of coronavirus disease 2019 (Covid-19)
MIS-C can cause coronary-artery aneurysms and sometimes a shock-like presentation
glucocorticoid therapy is not of proven benefit in MIS-C
Antibiotic treatment for acute diverticulitis – if a patient is managed in primary care and oral antibiotics are given then is cefalexin and metronidazole the first-choice antibiotic regime or is it co-amoxiclav alone?: Non surgical management (including suggested antibiotic regimes) of acute diverticulitis
2) Which statement regarding antibiotic treatment in acute diverticulitis is false?
irrespective of penicillin allergy, cefalexin and metronidazole is first choice oral therapy
use of trimethoprim and metronidazole is an alternative oral therapy option
co-amoxiclav is first choice oral therapy
Raised CK on statin treatment: Myalgia and myositis associated with statin treatment
3) Which statement regarding a raised CK on statin treatment is false?
the use of a fibrate with a statin increases the risk of statin related myopathy
myopathy is more likely to occur with water soluble statins such as pravastatin than lipophilic statins such as simvastatin
if CK this is significantly elevated (>5x upper limit of normal) or if myopathy is suspected, statin treatment should be stopped
Antidepressants if coronary heart disease – this subject is summarised on GPnotebook.: Depression and heart disease
4) Which statement regarding antidepressant treatment in coronary heart disease is false?
escitalopram is the SSRI of choice if a history of coronary heart disease
if CHD then tricyclic antidepressants are less preferred options and should generally be avoided
venlafaxine should be avoided if possible if coronary heart disease
Use of tamoxifen if no personal history of breast cancer – when is tamoxifen indicated in a woman with no personal history of breast cancer? For how long should the tamoxifen therapy be continued in this scenario?: Chemoprevention if no personal history of breast cancer
5) Which statement regarding the use of tamoxifen if no personal history of breast cancer is false?
tamoxifen should be offered for 5 years to premenopausal women at high risk of breast cancer unless they have a past history or may be at increased risk of thromboembolic disease or endometrial cancer
anastrozole should be offered for 5 years to postmenopausal women at high risk of breast cancer unless they have severe osteoporosis.
consider raloxifene for 5 years for women without a uterus if they have no history or increased risk of thromboembolic disease and do not wish to take tamoxifen
SGLT2 use versus use of sulphonylureas – a recent study has compared the all-cause mortality of these two diabetic therapies. The results of this study suggest that, compared with sulfonylureas, SGLT2 inhibitor use was associated with reduced risk of all-cause mortality among individuals using metformin for treatment of type 2 diabetes. But how did use of metformin affect the results of this study?: SGLT2 inhibitors in comparison to sulphonylureas (SUs) - comparison of all-cause mortality
6) Which statement regarding comparing SGLT2 inhibitors and sulphonylureas is false?
evidence suggests an increase in all-cause mortality risk if using sulphonylureas compared to SGLT2 inhibitors, when added to metformin therapy
analyses suggested that combined use of SGLT2 inhibitors and metformin was associated with reduced risk of all-cause mortality compared with SGLT2 inhibitors alone
evidence of difference in all-cause mortality was only evident in patients with coronary heart disease and type 2 diabetes