17 December

Question 1

What is a condition in which macrogol should be used with caution and why?

Answer 1

Macrogol has a high sodium content so should be used with caution in heart failure

Question 2

What should you always do when making recommendations to the team?

Answer 2

You should always quote your evidence when making recommendations to the team (such as relevant obs or labs)

Question 3

What should you consider with bedbound patients?

Answer 3

Patients lose 1% muscle mass every day they spend in bed

Question 4

Describe the role of oral iron in HFrEF

Answer 4

Oral iron has little evidence in HFrEF so should not be used

Question 5

What must you keep in mind when monitoring the use of beta blockers in heart failure?

Answer 5

Beta blockers can increase BNP

Question 6

How long should you wait after an iron infusion before starting oral iron?

Answer 6

Don’t start oral iron for 5 days post iron infusion

Question 7

How do we approach iron supplementation in children?

Answer 7

We always want to use oral iron where possible in children

Question 8

What reference should you cite for iron infusions in patients with heart failure?

Answer 8

There is a SALHN protocol for iron infusions in HFrEF

Question 9

Which is preferred in HFrEF and why: iron carboxymaltose or iron polymaltose?

Answer 9

Iron carboxymaltose is preferred to polymaltose in HFrEF because it has less fluid and better evidence

Question 10

How should electrolytes be monitored for patients on furosemide?

Answer 10

For furosemide we monitor electrolytes every 1-2 weeks until stable, then every 6 months, and 1-2 weeks after every dose change

Question 11

What monitoring is required after an iron carboxymaltose infusion?

Answer 11

Monitor EUC 2 weeks post iron infusions as iron carboxymaltose can cause hypophosphataemia

Question 12

Describe the role of diltiazem in heart failure.

Answer 12

Diltiazem can worsen Heart failure

Question 13

What is the target haemoglobin in males with heart failure?

Answer 13

145

Question 14

What is the target haemoglobin in females with heart failure?

Answer 14

135

Question 15

What does STML stand for?

Answer 15

Short Term Memory Loss

Question 16

What is the active ingredient in Rulide?

Answer 16

Roxithromycin

Question 17

When should you request iron studies?

Answer 17

You only need iron studies if haemoglobin is low

Question 18

What should you consider about the timing of iron studies?

Answer 18

Don’t take iron studies in infectious patients as ferritin will be falsely elevated

Question 19

What is claudication?

Answer 19

Muscle pain due to a lack of oxygen that’s triggered by activity and relieved by rest

Question 20

How are premature babies monitored in hospital?

Answer 20

Prem babies stay in NICU until they are at term

Question 21

How is carvedilol dosed?

Answer 21

Carvedilol is used once daily for hypertension and twice daily for heart failure

Question 22

Do you need consent before giving iron infusions?

Answer 22

Yes

Question 23

Do you always need to hold SGLT2 inhibitors for surgery?

Answer 23

Only if the patient is fasting

Question 24

What should you always remember when reviewing iron deficiency anaemia?

Answer 24

You should check the lowest level from this admission

Question 25

When should you request lipid studies?

Answer 25

Only if it is implicated in one of the patient’s current issues

Question 25

When should you request lipid studies?

Answer 25

Only if it is implicated in one of the patient’s current issues

Question 26

When should you request HbA1c?

Answer 26

Only if it is implicated in one of the patient’s current issues

Question 27

What is the drug class of milrinone?

Answer 27

Phosphodiesterase 3 inhibitor

Question 28

What is the mechanism of action of milnirone?

Answer 28

Inotrope; increases force of myocardial contraction; systemic and pulmonary arterial vasodilator.

Question 29

What are two indications for milrinone?

Answer 29

Severe heart failure refractory to other treatment, for short-term use (48 hours) in intensive or coronary care units
Low cardiac output states, eg after cardiac surgery, particularly when associated with pulmonary hypertension