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Nebulised salbutamol tachycardia — GPhC CRA MCQ

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HardRespiratory TherapeuticsNebulised salbutamol tachycardiaGPhC CRA

A 20-year-old taking isotretinoin for severe acne is prescribed doxycycline for suspected atypical pneumonia. Two days later she reports a new severe headache, pulsatile tinnitus and transient visual obscurations. What is the priority pharmacy intervention?

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Correct answer: C — Stop and urgently query the combination and arrange assessment for intracranial hypertension

Systemic retinoids and tetracyclines are each associated with benign intracranial hypertension, so the doxycycline SmPC says concurrent use should be avoided. Severe headache, pulsatile tinnitus and visual obscurations are concerning manifestations and require prompt assessment because permanent visual loss has occurred. Timing separation or dose reduction does not remove the pharmacodynamic risk. Antacids merely impair doxycycline absorption unpredictably, and substituting another tetracycline preserves the class hazard. The prescription should be queried and a non-tetracycline alternative selected by the prescriber.

Reference: Doxycycline 100 mg capsules SmPC. https://www.medicines.org.uk/emc/product/13082/smpc