2.

Question 1

What effect on K+ has DKA?

What happens to K+ during treatment of DKA?

Answer 1

DKA causes hyperkalamia

When Insulin is given to treat DKA K+ drops

(so potassium requires regular hourly monitoring and potential replacement)

Question 2

Nephrotoxic meds

Answer 2

• ACE inhibitors
• NSAIDs
• radiological contrast
• gentamycin
• vancomycin
• tetracycline

Question 3

Causes of raised ALP

Answer 3

• Fractures
• Liver damage (posthepatic/obstructive)
• cancer
• Paget’s disease
• Osteomalacia
• Pregnancy
• Surgery
• Hyperarathyroidism

Question 4

What changes would you make to levothyroxine levels if TSH range (mlU/L) was <0.5?

Answer 4

if TSH range <0.5 then decrease the dose

Question 5

What changes would you make to levothyroxine levels if TSH range (mlU/L) was 0.5-5?

Answer 5

If TSH range 0.5-5 NIL action = keep the same dose

Question 6

What changes would you make to levothyroxine levels if TSH range (mlU/L) was >5 ?

Answer 6

If TSH >5 then increase levothyroxine dose

Question 7

What drugs may cause hepatitis? (3)

Answer 7

• paracetamol OD
• statins
• rifampicin

Question 8

Drugs causing cholestasis (5)

Answer 8

• Flucloxacillin
• Co-Amoxiclav
• Nitrofurantoin
• steroids
• sulphonylureas (e.g. Gliclazide)

Question 9

What does it mean when a drug has a narrow therapeutic index?

Answer 9

small difference in blood concentration of the drug between therapeutic and toxic effect

Question 10

Examples of drugs with narrow therapeutic index

Answer 10

• digoxin
• theophylline
• lithium
• phenytoin
• gentamycin, vancomycin, teicoplanin

Question 11

Futures of Digoxin toxicity

Answer 11

• confusion
• nausea
• visual halos
• arrhythmias

Question 12

Features of Lithium toxicity

• early
• intermediate
• late

Answer 12

• Early: tremor
• Intermediate: tiredness
• Late: arrhythmias, seizures, comas, renal failure, diabetes insipidus

Question 13

Features of Phenytoin toxicity

Answer 13

• gum hypertrophy
• ataxia
• nystagmus
• peripheral neuropathy
• teratogenicity

Question 14

What drugs can be both ototoxic and nephrotoxic? (2)

Answer 14

Gentamycin and Vancomycin

Question 15

If gentamicin levels are to high what shall we do?

Answer 15

Decrease frequency by 12 hours, do not change the required dose - follow graph

(with other drugs we usually decrease the dose)

Question 16

Normal range of gentamycin (mg/L)

Answer 16

In everything other than bacterial endocarditis

5-10 mg/L in 1 hour post dose (peak)

<2 mg/L just before next dose

Question 17

Range of Gentamicin in Infective Endocarditis (mg/L)

Answer 17

• Peak (1 hour after post dose): 3-5 mg/L
• Just before next dose: <1

Question 18

When to use paracetamol nomogram (treatment line graph)

Answer 18

at least 4 hours post-ingestion

(if plasma levels above treatment line - give N-Acetylcysteine treatment)

Question 19

Do we use paracetamol nomogram (treatment line) if staggered OD or unknown time of ingestion?

Answer 19

No - we do give N - Acetylcysteine treatment straight away (without use of nomogram)

Question 20

What’s target INR for most of the patient on Warfarin?

What are the exceptions?

Answer 20

• INR 2.5 - for most patients on Warfarin
• INR 3.5 - recurrent thromboembolism while on Warfarin
• INR above 2.5 (depends on individual factors) for valve replacement, patient’s risk factors etc.

* INR 1 - normal, when no Warfarin

Question 21

Patient on Warfarin with major bleed (hypotension or bleeding in eye/brain). What do you do?

Answer 21

• stop Warfarin
• give 5-10 mg IN Vit K
• give prothrombin complex

Question 22

No bleeding and INR:

• INR 5-8
• INR >8

Answer 22

No bleeding and:

• INR 5-8: omit dose of Warfarin for 2 days then reduce the dose
• INR >8: omit Warfarin + give 1-5mg Vitamin K PO

Question 23

Minor bleeding and:

• INR 5-8
• INR >8

Answer 23

Minor bleeding and:

• INR 5-8: omit Warfarin + give 1-5mg vitamin K IV
• INR >8: omit Warfarin + give 1-5mg vitamin K IV