A complex patient example (Tania W23)

Question 1

Why must folic acid be given with MTX?

Answer 1

Its a folate antagonist (anti-folate)

by blocking conversion of dihydrofolate

Question 2

SE of MTX

Answer 2

• mouth ulcers (stomatitis)

Question 3

What is the main sign of sepsis?

Answer 3

Confusion

others..?

Question 4

Which drug cannot be given with MTX because its also anti-folate?

Answer 4

Trimethoprim

Question 5

SE of trimethoprim

Answer 5

Pancytopenia (complete loss of blood cells (WBC/RBC/Platelets) - fatal)

Question 6

First line for UTI?

Answer 6

Nitrofurantoin

Question 7

Contraindications for Nitrofurantoin?

Answer 7

Must have good renal function (above eGFR 45) for it to work

Question 8

Why is ciproflox not used as much? What are the SE?

Answer 8

Risk of C.diff increases

Clears good gut flora also

Many interactions

Question 9

What is the potency of tramadol respective to morphin?

Answer 9

1/5 of morphines potency

Question 10

Describe the affects of TRAMADOL

Answer 10

• binds to mu-opiod receptos (work like SNRI)

- INC seretonin + NA in the brain (seretonin syndrom)

Question 11

What is the ceiling dose for tramadol?

Answer 11

600 mg (in post-op pain)

400 mg regular

Question 12

What is the max dose of morphine?

Answer 12

There is none…

Question 13

What should you be careful of when prescribing digoxin?

Answer 13

• renal impairment (will accumulate and cause toxicity)

- K levels (hypokalaemia common)

Question 14

Which score if used for severity of arthritis?

Answer 14

DAS-28 score

CRP and ERP levels measured (inflammatory markers)

Question 15

Which opioid can you give for pain management in renal impairment?

Answer 15

Fentanyl patch