4th 20

Question 1

Lithium toxicity early symptom

Answer 1

Restlessless

Question 2

Lithium toxicity symptoms

Answer 2

Restlessness
D&V
Agitation
Tremor
Muscle fasciculations

Question 3

When does lithium toxicity typically occur in patients on treatment?

Answer 3

Usually when they are ill or dehydrated

Question 4

SSRI overdose and serotonin syndrome eye symptom

Answer 4

Nystagmus

Question 5

Which drugs often cause hypokalaemia?

Answer 5

Loop diuretics e.g. furosemide

Question 6

Why do loop diuretics cause hypokalaemia?

Answer 6

They block the Na/K/Cl transporter, so K+ can’t be retreived, but keeps more water in the lumen -> urine

Question 7

ACEi example

Answer 7

Remipril

Enalapril

Question 8

ACEi can cause what change in potassium?

Answer 8

Excretion of K+ because inhibiting retention with aldosterone. SO causes hyperkalaemia.

Question 9

Theophylline is used for what?

Answer 9

Bronchodilation in COPD and refractory asthma

Question 10

When should you check theophylline levels after commencing treatment?

Answer 10

5 days

Question 11

Chronic heart failure with reduced ejection fraction treatment

Answer 11

ACEi
B blocker (unless contraindicated = bradycardia or asthma)

These drugs reduce morbidity and mortality

Can add spironolactone according to guidelines if these dont control it well enough

Question 12

Clarithromycin (macrolide) and statins interact to cause what?
What may be increased in the bloods?

Answer 12

Rhabdomyolysis, creatinine kinase

Question 13

Treatment of GORD

Answer 13

Omeprazole 20mg PO once daily

Question 14

Verapamil hydrochloride is a …

Answer 14

CCB

Question 15

CCB is used to…

Answer 15

Reduce blood pressure

Question 16

CCB alongside B blocker can cause…

Answer 16

Collapse due to cardiac side effects (hypotension and heart block!)
This combination can cause ECG changes

Question 17

Once TSH level is stable on levothyroxine, how often do you need to measure it?

Answer 17

Yearly

Question 18

Side effects of quinolones (antibiotic such as ciprofloxacin)

Answer 18

Diarrhoea
Constipation
LOADS others
E.g. rendon rupture

Question 19

1mg = how many mcg?

Answer 19

1000

Question 20

After starting lithium, when should you monitor lithium levels?

Answer 20

12 hours later and then weekly

Question 21

What should be performed before starting lithium?

Answer 21

ECG

Question 22

How often should thyroid, calcium and U&Es be checked on lithium?

Answer 22

Every 6 months

Question 23

Which test to monitor warfarin use?

Answer 23

INR

Question 24

INR target in AF

Answer 24

2-3

Question 25

Drug type that can exacerabate Parkinson’s symptoms

Answer 25

Dopamine antagonist

Question 26

What type of drug is metoclopramide?

Answer 26

Dopamine antagonist

Question 27

What type of drug is clozapine?

Answer 27

Dopamine antagonist for refractory schizophrenia

Question 28

Major risk factor of clozapine

Answer 28

Agranulocytosis

Question 29

Patient presenting over 24hr after overdose with jaundice, hepatic tenderness and a raised ALT (liver failure) which drug should be administered?

Answer 29

Acetylcysteine

Question 30

Herpes in T1 distribution, intensely painful =

Answer 30

Shingles

Question 31

Treatment for shingles

Answer 31

Aciclovir

Question 32

Management of secondary pneumothorax

Answer 32

Chest drain insertion

Question 33

Management of primary pneumothorax <2cm

Answer 33

Needle thoracentesis