Category Archives: Credits 2019

Onset of action of antidepressants

For twenty-five years I’ve accepted without question the standard teaching that SSRIs take 2 – 3 weeks to kick in and often longer. Then, due to a family situation, I actually went and looked it up, and discovered that the … Continue reading

Posted in Credits 2019, Medication, Psychiatry | Leave a comment

Anticoagulation in people with a falls risk

I’ve been very wary of anticoagulating elderly frail people at risk of falls – it feels very antithetical to ‘First, do no harm’ – but it seems I might have been being overcautious. I looked this up as part of … Continue reading

Posted in Anticoagulants, Cardiovascular, Credits 2019, DENs, Medication | 3 Comments

Withdrawal of CANH in patients without capacity

The BMA guidance. General points: Where capacity is in doubt, the principles for establishing it are the usual ones, including the importance of doing everything possible to maximise capacity (looking at different ways of communicating and of allowing the person … Continue reading

Posted in Credits 2019, Medicolegal | Leave a comment

Intrauterine contraception (copper or progestagenic)

When to insert, and when precautions are needed Note the following general principles: IUC should not be inserted where there is a possibility of existing pregnancy (previous sex without a reliable method of contraception being used correctly for every episode … Continue reading

Posted in Contraception, Credits 2019 | Leave a comment

Aspirin + clopidogrel short-term after TIA/ischaemic stroke

I belatedly got round to reading a January BMJ that contained this article, an analysis of previous work on DAPT (dual antiplatelet therapy) after TIA/stroke. The recommendations are: After either a high-risk TIA or a minor ischaemic stroke, use both … Continue reading

Posted in Cardiovascular, Credits 2019, Medication | Leave a comment

Progestagen-only pill

Remember that enzyme inducers exert an effect on other medications for 28 days after their cessation. This means, among other things, that when starting an oral contraceptive within 28 days after finishing an EI it’s necessary to use other precautions … Continue reading

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Combined hormonal contraceptives

COC, patch, or vaginal ring. Random notes If a woman with a history of UPSIĀ  within the past three weeks needs contraception and her pregnancy test is negative, she can go ahead and start; however, she should check another pregnancy … Continue reading

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NNTs/ARRs for secondary prevention of cardiovascular events

The other day, I had one of those “Do I really need all these pills, Doctor?” questions that requires a grey-area conversation about risk reduction. Anyway, in medical terms the information needed is “What is the NNT for each of … Continue reading

Posted in Cardiovascular, Credits 2019, DENs | Leave a comment

Avascular necrosis of the femoral head

Pathogenesis of AVNFH isn’t known, but it occurs when the microcirculation of the femoral head is disrupted, leading to necrosis and eventual subchondral collapse of the femoral head (with consequent secondary arthritis). Incidence is around 1 in 50 000. It … Continue reading

Posted in Credits 2019, Don't miss, Joints, Orthopaedics | Leave a comment


Had to see someone yesterday about a lowish phosphate level, and, since I know nothing about hypophosphatemia, it was learning time. I found a couple of useful articles for quick reference – this one in the BMJ and this one … Continue reading

Posted in Credits 2019, DENs, Lab results | Leave a comment