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Pharmacy Pre-Registration > BNF > Flashcards

BNF Flashcards

1
Q

Half black-Half white box means

A

JFC says less suitable for prescribing

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2
Q

Black triangle means

A

limited experience of the use of this product and the MHRA requests that all suspected adverse reactions should be reported
Biosimilar
EMA says require additional monitoring

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3
Q

NHS with strike through

A

not prescribable under NHS

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4
Q

Very common side effect

A

> 1 in 10

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5
Q

Common side effect

A

1 in 10 - 1 in 100

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6
Q

Less common side effect

A

1 in 100 - 1 in 1000

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7
Q

Rare side effect

A

1 in 1000 to 1 in 10,000

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8
Q

Very rare side effect

A
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9
Q

Sugar-free means

A

No fructose, glucose, sucrose

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10
Q

Why do sugar-free marked products contain some sugars?

A

They do not cause dental caries

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11
Q

Unlicensed in the BNF Vs Unlicensed drugs

A

Unlicensed use in the BNF is off-label use

Unlicensed drugs are unapproved drugs in the country

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12
Q

CHM means

A

Commission on Human Medicines

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13
Q

MHRA means

A

Medicines and Healthcare products Regulatory Agency

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14
Q

Dose of Zopiclone

A

7.5mg at bedtime. 3.75mg in elderly or chronic pulmonary insufficiency

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15
Q

Appendix 1 of the BNF is

A

Interactions

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16
Q

Appendix 3 of the BNF is

A

Cautionary labels

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17
Q

Appendix 4 of the BNF is

A

IV additives

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18
Q

Appendix 5 of the BNF is

A

Wound dressings

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19
Q

After the appendices there are

A

Dental Formulary
Nurse Formulary
Manufacturers

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20
Q

Chlorhexadine solutions in neonates

A

Risk of burns

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21
Q

Dose of Atorvastatin

A

Primary Hypercholesterolaemia/Hyperlipidaemia or Familial Hypercholesterolaemia: 10mg
Primary Prevention CVD: 20mg
Secondary prevention CVD: 80mg (MAX)

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22
Q

Consequences of prescribing outside of marketing authorisation

A

Increases professional responsibility and liability

Must inform patient

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23
Q

Provide an oral syringe when

A

Dose prescribed is not a multiple of 5 (

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24
Q

Oral/Enteral syringes must

A

be labelled “Oral” or “Enteral” in large font size

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25
Q

Which excipients are shown in monograph

A

Aspartame, Gluten, Sulfites, Tartrazine, Arachis (peanut) oil, Sesame oil

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26
Q

Label is recommended to include

A

Keep out of sight and reach of children

Use this medicine only on your skin (when applicable)

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27
Q

Presence of Polyoxyl Castor oil in injections shown because

A

Associated with severe anaphylatic reactions

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28
Q

Presence of Propylene Glycol in oral/parenteral is shown because

A

Interacts with Disulfiram/Metronidazole

Adverse effects if elmination impaired - eg. renal failure in neonates/young/slow metabolisers

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29
Q

Freshly prepared must be made

A

No more than 24hours before its use

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30
Q

Recently prepared can be used for

A

4 weeks stored at 15-25deg

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31
Q

Water means

A

Freshly drawn drinkable from public supply

Freshly Boiled Cooled Purified

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32
Q

NICE against SMC in Scotland

A

SMC wins

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33
Q

Which drugs are irritant/potent and should be handled with caution

A

Corticosteroids, some Antimicrobials, Phenothiazines, Cytotoxics

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34
Q

Patients MUST be warned to

A

Keep all meds out of REACH of children

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35
Q

Child-resistant container unless

A

Original Pack inadvisable to break, Pt difficulty opening, requested, none available

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36
Q

Labelling MUST include

A

Patient Name, Name + Address of person dispensing, Date of dispensing, Name of medicine, Directions for use, Precautions

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37
Q

Label is recommended to include

A

Keep out of sight and reach of children

Use this medicine only on your skin (when applicable)

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38
Q

Can dispense prescriptions from

A

Doctors, Dentists from EEA and Switz except Sch 1,2,3 and unlicensed in UK.

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39
Q

Prescription requirements for EEA/Switz

A

Ink/indelible, dated, name patient, address prescriber, particulars, signed

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40
Q

PGD is

A

Patient Group Direction

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41
Q

NICE is

A

National Institute of Health and Care Excellence

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42
Q

t.i.d

A

three times daily

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43
Q

NICE against SMC in Scotland

A

SMC wins

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44
Q

Normal Prescription requirements

A

Name and address patient, signed in ink, address prescriber, particulars, date, DOB if

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45
Q

a.c

A

before food

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46
Q

b.d, o.d, t.d.s, q.d.s

A

twice, once, three, four times daily

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47
Q

o.m

A

every morning

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48
Q

o.n

A

every night

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49
Q

p.c

A

after food

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50
Q

p.r.n

A

when required

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51
Q

q.q.h

A

every four hours

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52
Q

stat means

A

immediately

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53
Q

t.i.d

A

three times daily

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54
Q

Caution 1

A

Warning: This medicine may make you sleepy

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55
Q

Caution 2

A

Warning: This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Do not drink alcohol

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56
Q

Caution 3

A

Warning: This medicine may make you sleepy. If this happens, do not drive or use tools or machines

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57
Q

Caution 4

A

Warning: Do not drink alcohol

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58
Q

Caution 5

A

Do not take indigestion remedies 2 hours before or after you take this medicine

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59
Q

Caution 6

A

Do not take indigestion remedies, or medicines containing iron or zinc, 2 hours before or after you take this medicine

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60
Q

Caution 7

A

Do not take milk, indigestion remedies, or medicines containing iron or zinc, 2 hours before or after you take this medicine

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61
Q

Caution 8

A

Warning: Do not stop taking this medicine unless your doctor tells you to stop

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62
Q

Caution 9

A

Space the doses evenly throughout the day. Keep taking this medicine until the course is finished, unless you are told to stop

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63
Q

Caution 10

A

Warning: Read the additional information given with this medicine

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64
Q

Caution 11

A

Protect your skin from sunlight—even on a bright but cloudy day. Do not use sunbeds

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65
Q

Caution 12

A

Do not take anything containing aspirin while taking this medicine

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66
Q

Caution 13

A

Dissolve or mix with water before taking

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67
Q

Caution 14

A

This medicine may colour your urine. This is harmless

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68
Q

Caution 15

A

Caution: flammable. Keep your body away from fire or flames after you have put on the medicine

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69
Q

Caution 16

A

Dissolve the tablet under your tongue—do not swallow. Store the tablets in this bottle with the cap tightly closed. Get a new supply 8 weeks after opening

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70
Q

Caution 17

A

Do not take more than . . . in 24 hours

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71
Q

Caution 18

A

Do not take more than . . . in 24 hours. Also, do not take more than . . . in any one week

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72
Q

Caution 32

A

Contains aspirin. Do not take anything else containing aspirin while taking this medicine

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73
Q

Caution 21

A

Take with or just after food, or a meal

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74
Q

Caution 22

A

Take 30 to 60 minutes before food

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75
Q

Caution 24

A

Suck or chew this medicine

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76
Q

Caution 26

A

Dissolve this medicine under your tongue

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77
Q

Caution 27

A

Take with a full glass of water

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78
Q

Caution 28

A

Spread thinly on the affected skin only

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79
Q

Caution 29

A

Do not take more than 2 at any one time. Do not take more than 8 in 24 hours

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80
Q

Caution 30

A

Contains paracetamol. Do not take anything else containing paracetamol while taking this medicine. Talk to a doctor at once if you take too much of this medicine, even if you feel well

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81
Q

Caution 32

A

Contains aspirin. Do not take anything else containing aspirin while taking this medicine

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82
Q

On a FP10D a Dentist can prescribe

A

Only those meds in Dental Practitioners Formulary

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83
Q

Ordering for surgery use and Private Rx the dentist can order

A

Anything in any quantity

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84
Q

T/F: Dentists must contact GP if they prescribed something

A

False

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85
Q

Computer-issued Rx must have

A
  1. Patients first and last name and initials, patient address, age of patients under 12 and over 60, age under 5 in years and months
  2. Dr’s name, address, ref no, PCT, ph no
  3. English. Dose and quantity numbers, frequency words. Warnings in words.
  4. Max no items/Rx. Rest space spoilt
  5. Hand alterations exceptional - signed. Contraceptives with ♀sign. CD signed.
  6. “Confidential” on other side. Duplicate labelled as such
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86
Q

Emergency supply by patient

A
  1. Interview to check need, previous use, dose
  2. Max 5 days for Phenobarb and Sch 1,2,3. 30 Days anything else unless Insulin/Ointment/cream/aerosol/contraceptive/AB
  3. POM entry date, name, quantity, form, strength, pt name, address, nature emergency
  4. Label: date, name, quantity, form, strength, pt name, pharmacy name, address, words “Emergency Supply”, words “Keep out of reach of children”
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87
Q

Emergency supply for prescriber

A
  1. Satisfactory reason
  2. Give Rx in 72 hours
  3. Directions of prescriber
  4. No 1, 2, 3 except Phenobarb for epilepsy
  5. POM entry date of supply, date on Rx, date recieved RX, name, quantity, form, strength, prescriber name, address, pt name, address
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88
Q

Schedule 1 includes

A

Lysergide etc which are not used medicinally. HO special license

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89
Q

Schedule 2 includes

A

Diamorphine, Morphine, Pethidine, Amfetamines, Sodium Oxybate, Cocaine

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90
Q

Schedule 2 need

A

Safe custody (not secobarbital), registers etc

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91
Q

Schedule 3 include

A

Barbiturates (not secobarbital), Buprenorphine, Midazolam, Temazepam, Tramadol

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92
Q

Schedule 3 need

A

2 years invoice, Registers, Safe custody (except phenobarb, midazolam, tramadol, pentazocine, mazindol, meprobamate, phentermine)

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93
Q

Schedule 4 (1) include

A

Include Benzos (not tramadol, midazolam), zaleplon, zolpidem, zopiclone

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94
Q

Schedule 4 (2) include

A

Androgenic and Anabolic steroids, Clenbuterol, Gonadotrophins, Somatropin

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95
Q

Schedule 4 need

A

No Rx requirements, no safe custody

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96
Q

Schedule 5 need

A

Retention 2 years

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97
Q

Prescription requirements for CDs are

A

Indelible, signed by hand, dated, prescribers address, pt name and address, form and strength, volume in ml or dose units/total in words and figures, dose

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98
Q

Pharmacist can amend Sch 2 or 3 scripts by

A

if total quantity in words/figures only or minor typographical errors

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99
Q

Pharmacist amendment must be

A

clearly attributable to pharmacist

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100
Q

Script validity of Schedule 2, 3, 3 is

A

28 days from issue date or date post-dated

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101
Q

Instalment scripts must specify

A

Amount of instalments, intervals to be observed

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102
Q

Regarding repeats for schedule 2 and 3

A

not allowed

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103
Q

Private prescriptions for schedule 2 and 3 must be

A

Written on designated form giving prescribers identification number unless in hospital

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104
Q

30 days treatment on Rx for

A

Schedule 2, 3 and 4 unless justified (add to notes)

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105
Q

Canabis extract used for

A

spasticity in multiple sclerosis

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106
Q

Supervised consumption when

A

starting (3 months), after relapse, major dose increase

Continued until prescriber confident on compliance

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107
Q

Which drugs are not subject to import export licensing

A

Sch 4 (2) and 5

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108
Q

Personal import export license for carrying

A

Sch 2, 3, 4 (1) if travelling for more than 3 months

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109
Q

To treat addiction of Cocaine, Diamorphine and Dipipanone

A

need a HO license

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110
Q

To treat pain with Cocaine, Diamorphine and Dipipanone

A

no license needed

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111
Q

What should be reported via the Yellow Card Scheme

A

All suspected SERIOUS/new drug adverse drug reactions to any therapeutic agents even if due to overdose, misuse, medication error or off-label and unlicensed meds.

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112
Q

Who can report on Yellow card scheme

A

Healthcare professional or patient/carer

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113
Q

What is the Drug Safety Research Unit

A

Identifies selected patients on new meds and collects data on clinical events

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114
Q

How long does a black triangle drug remain a black triangle drug

A

5 years

115
Q

Which ADR of black triangle drugs should be reported

A

ALL ADR

116
Q

Examples of serious ADR

A

Blood disorders, Anaphylaxis, Endocrine disturbance, Effect on fertility, Haemorrhage, Renal impairment, Jaundice, Opthalmic disorder, severe skin/CNS effects, reactions in pregnant women

117
Q

NRLS is

A

National reporting and learning system

When medication error

118
Q

Drug Safety Update is

A

a monthly newsletter from MHRA and CHM

119
Q

Oral ulceration side effect of

A

Cytotoxics (methotrexate), ACEI, gold, nicorandil, NSAIDs, Pancreatin, Penicillamine, Proguanil, Protease inhibitors
Aspirin (left in mouth), essential oils (rarely)

120
Q

Erythema Multiforme/Steven-Johnson syndrome side effect of

A

Antibacterials, Antiretrovirals, Sulfonamide derivatives, Anticonvulsants

121
Q

Lichenoid eruptions associated with

A

ACEI, NSAIDs, Methyldopa, Chloroquine, Oral Antidiabetics, Thiazide diuretics, gold

122
Q

Candidiasis side effect of

A

Antibacterials, immunosuppresants, corticosteroids

123
Q

What causes brown staining of teeth

A

Frequent use of Chlorhexadine mouthwash, spray or gel

remove by polishing

124
Q

Enamel (of teeth) stained black by

A

Iron

125
Q

Superficial staining of teeth by

A

Co-amoxiclav

126
Q

Intrinsic yellow-grey staining of teeth caused by

A

Tetracyclines

127
Q

Tetracycline contraindicated in

A

Pregnancy, Breast feeding,

128
Q

Flouride ingestion can cause

A

Dental fluorosis with mottling of enamel

Areas of hypoplasia/pitting

129
Q

Osteonecrosis of jaw by

A

Bisphosphonates therefore dental check up

130
Q

Gengival overgrowth by

A

Phenytoin, Ciclosporin, Nifidipine (CaCB)

131
Q

Xerostomia means

A

reduced flow

132
Q

Xerostomia (and dry mouth) caused by

A

Antimuscarinics (Anticholinergics), SSRI, TCAs, Alpha blockers, Antihistamines, Antipsychotics, Baclofen, Buprpion, Clonidine, 5HT1 agonists, opioids, tizanidine, diuretics (in excess)

133
Q

Pain in salivary glands caused by

A

Antihypertensives (Clonidine, Methyldopa) and vinca alkaloids

134
Q

Swelling of salivary glands caused by

A

iodides, antithyroid drugs, phenothiazines, sulfonamides

135
Q

Taste altered by

A

Amiodarone, Calcitonin, ACEI, Carbimazole, Clarithromycin, gold, Griseofulvin, Lithium salts, Metformin, Metronidazole, Penicillamine, Phenindione, Propafenone, Protease inhibitors, Terbinafine, Zopiclone

136
Q

Defective medicines reported to

A

Defective Medicines Report Centre

137
Q

Adverse drug reactions in children should be reported by

A

Yellow Card Scheme and British Paediatric Surveillance Unit’s Orange Card Scheme or NRLS

138
Q

Neonate and infant are

A

First month and First year

139
Q

If child dose greater than adult dose

A

Should not exceed adult dose

140
Q

Obese child

A

Use IBW

141
Q

Dose frequency consideration in children

A

Flexible so don’t have to wake at night

142
Q

Rifampacin and Fusidic acid excreted

A

Hepatically

143
Q

Phenytoin and Prednisolone

A

Highly protein bound

144
Q

Hypoalbuminaemia/proteinaemia causes

A

Increase in conc of drugs highly protein bound

145
Q

What happens with anticoagulants in liver disease

A

Clotting factors made in liver -> conc down -> increase prothombin time -> more sensitive to anticoagulants (phenindione/warfarin)

146
Q

Drugs that can precipitate hepatic encephalopathy

A

All sedative drugs, opioid analgesics, hypokalaemia causing diuretics, constipation causing drugs

147
Q

Oedema and Ascites exacerbated by

A

Drugs giving rise to fluid retention like NSAIDs and Corticosteroids

148
Q

Elderly person without raised serum creatinine

A

because of wasting muscle. Assume mild impairment

149
Q

Loading does is reduced in renal impairment T/F?

A

False

150
Q

Patients at extremes of weight and renail impairment

A

30 BMI use absolute GFR/Cr Cl (CG)

151
Q

Tetrogenesis (Malformations) occurs during

A

First trimester: 3 - 11 wks

152
Q

Growth, functional development and toxic effects on foetus

A

2nd and 3rd trimester

153
Q

Drugs unsafe in breast feeding

A

Fluvastatin, Phenobarbital, Bromocriptine

154
Q

Do not give oral treatment to palliative care when

A

Dysphagi, coma, nausea, vomiting

155
Q

What are the three classes of analgesics

A
  1. Non-Opioid (Para, NSAID)
  2. Opioid (Codeine, Morphine)
  3. Adjuvants (Anti-epileptics, Anti-depressants)
156
Q

Pain management in palliative care

A

Paracetamol -> NSAIDS -> Codeine -> Tramadol -> Morphine (Burprenorphine, Fentanyl, Hydromorphone, Oxycodone, Methadone)

157
Q

Psychological dependence with opioids not issue when

A

palliative care

158
Q

Pain in bone metastases

A

Bisphosphonates, radiotherapy, strontium

159
Q

Neuropathic pain management

A

TCA -> Antiepileptic (Pregabalin, Gabapentin)
Ketamine
Nerve compression pain: Corticosteroids (Dexamethasone)
Epidural

160
Q

Breakthrough pain dose amount

A

1/10 to 1/6th of original dose

161
Q

Review pain management if

A
162
Q

Which of the following Fentanyl formulation is licensed for breakthrough pain: Nasal, Buccal, Sublingual

A

all

163
Q

Opioids should be prescribed with

A

laxatives

164
Q

Patient can’t tolerate morphine but needs opioid

A

Oxycodone

165
Q

Oral:Parenteral dose morphine

A

2:1

166
Q

Transdermal morphine for

A

steady patients/long term

167
Q

Palliative Anorexia give

A

Prednisolone 15-30mg daily

Dexamethasone 2-4mg daily

168
Q

Palliative Bowel Colic or excessive respiratory secretions give

A

Hyoscine hydrobromide 0.4mg
Hyoscine Butylbromide 20mg
Glycopyrronium 0.2mg

169
Q

Palliative Capillary bleeding

A

Tranexamic acid by mouth

Or gauze soak Tranexamic or Adrenalin - onto site

170
Q

Palliative Bleeding with prolonged clotting in liver disease

A

Vitamin K

171
Q

Palliative constipation

A

Faecal softner with peristaltic stimulant (co-danthmer)
Lactulose
Methylnaltrexone

172
Q

Palliative convulsions

A

Prophylaxis: Phenytoin, Carbamazapine
Diazepam 10mg rectal, Phenobarbital 50-200mg bd
Midazolam IV

173
Q

Palliative dry mouth

A

Chewing SF gum, suck ice, suck pineapple, artificial saliva (Aquoral, Biotene Oralbalance, AS Saliva Orthana, Xerotin, Saliveze, Salivix)

174
Q

Palliative dysphagia

A

Dexamethasone 8mg daily

175
Q

Palliative Dyspnoea

A

Morphine 5mg qqh
Diazepam 5-10mg daily
Dexamethasone 4-8mg daily

176
Q

Fungating tumours

A

Antibacterial drugs

Metronidazole

177
Q

Palliative GI pain

A

Colic: Loperamide 2-4mg qd, Hysoscine hydrobromide (Kwells)
Distension: Antiflatulent (Simitecone), Domperidone 10mg td before meals

178
Q

Palliative Hiccup

A

Antacid, Antiflatulent, Metoclopramide 10mg every 6-8 hours, Baclofen 5mg bd, Nifedipine 10mg rd, chlorpromazine

179
Q

Palliative Insomnia

A

Benzodiapines, Temazepam before hypnotics

180
Q

Intractable cough

A

morphine 5mg qqh

NOT methadone

181
Q

Palliative Nausea and Vomiting

A

Treat cause then anti-emetic (Haloperidol 1.5mg/5-10mg od/bd, metocloperamide 10mg td) 4-5 days
Cyclizine 50mg td
Levomepromazine 6mg or 6.25mg at bedtime - 12.5-25mg bd with dexamethasone 8-16mg

182
Q

Palliative pruritis

A

Emollients

Obstructive Jaundice: Colestyramine

183
Q

Raised intracranial pressure

A

dexamenthasone 16mg for 4-5days -> 4-6mg

184
Q

Counselling with dexamethasone

A

Give before 6pm to avoid insomnia

185
Q

Palliative Restless and Confusion

A

Antipsychotic every 2 hour: Haloperidol 2mg oral/2.5mg SC or Levomepromazine 6mg oral/6.25mg SC

186
Q

Parenteral route when

A

Patient unable to take by mouth
Malignant bowel obstruction
Patient doesn’t want by mouth (occasionally)

187
Q

Midazolam in palliative care

A

Flumazenil available to reverse effects

Use high strength

188
Q

Side effect of Levopromazine

A

Sedation

189
Q

Cyclizine not given with

A

Diaorphine and others

190
Q

Metoclopramide causes

A

Skin reactions

191
Q

Ocreotide acts by

A

stimulating water, electrolyte absorption and inhbits water secretion in bowel - for vomiting due to bowel obstruction

192
Q

SC pain relief

A

Diamorphine cuz can give less

193
Q

T/F?: Injections can be mixed

A

False. Syringe drivers can be if compatible

194
Q

What is contraindicated in syringe drivers

A

Chlorpromazine, prochlorpromazine, Diazepam

Less: Levomepromazine, cyclizine

195
Q

What CAN be mixed with Diamorophine

A

Cyclizine (low dose), Dexamethasone, Haloperidol (24hrs), Hyoscine, Levomepromezine, metoclopremazine, midazolam

196
Q

Tablets in frail elderly cause

A

Mouth ulceration, oesophageal ulceration

197
Q

Old people sensitivity increased to

A

Opioid analgesics, benzodiazepines, antipsychotics, antiparkinsonian drugs
Antihypertensives, NSAIDs

198
Q

Renal clearance in elderly patients

A

reduces. Therefore VERY susceptible to nephrotoxic drugs

199
Q

Narrow TI drugs in elderly

A

After MI/CxInf go toxic

200
Q

Lipid soluble drugs in elderly

A

reduced because liver volume reduced

201
Q

Elderly person with constipation, which drugs causative

A

Antimuscarinics, Tranquilisers

202
Q

Elderly person with hypotension, which drugs causative

A

diuretics, psyschotropics. Causes falls

203
Q

Elderly people side effects hypnotics

A

drowsiness, unsteady gait, slurred speech, confusion

Benzodiazepines impair balance

204
Q

Elderly people on diuretics

A

NOT for long term for grav oedema (raise legs, stockings, increase movement)

205
Q

Elderly people side effects NSAIDs

A

serious bleeding

206
Q

Elderly people contraindication NSAIDS

A

Cardiac disease, renal impairment

207
Q

Paracetamol used first in elderly for

A

osteoarthritis, soft-tissue lesions, back pain, rheumatoid arthritis

208
Q

For osteoarthritis, soft-tissue lesions, back pain, rheumatoid arthritis give

A

Try weight reduction, warmth, exercise, walking stick (all except RA) -> para -> low dose NSAID -> max para + low dose NSAID -> para + max NSAID or Opioid
NEVER 2 NSAIDs

209
Q

Drugs causing ADR in elderly

A

antiparkisonians, antihypertensives, psychotropics, digoxin (125mcg or 62.5mcg if renal)

210
Q

Which drugs avoided in elderly

A

Bone marrow suppression causing (co-trimoxazole, mianserin) as blood disorders more common
Long acting antidiabetics, glibenclamide

211
Q

Elderly on Warfarin

A

lower maintenance dose

212
Q

Dosage in elderly

A

50% of normal adult

213
Q

Hypotension during dental appointment

A
  1. Lay flat
  2. Oxygen
  3. Transfer to hospital urgently
214
Q

Anaphylatic reactions can happen with

A

latex gloves, arachis (peanut) oil etc

215
Q

Symptoms of Anaphylaxis

A

Paresthesia, flushing, sweeling of face
Itching especially hands/feet
Bronchospasm/Laryngospasm - wheezing and difficulty
Rapid Weak pulse, BP fall, pale colour, cardiac arrest

216
Q

Management Anaphylaxis

A

Andrenaline 0.5mg IM

Oxygen

217
Q

Asthma attack in dentists

A

2 puffs short acting beta2 agonist (salbutamol) via spacer/bag if needed
Oxygen
with salbutamol5mg/terbutaline10mg nebuliser
If anaphylaxis: Adrenaline

218
Q

Cardiac emergency in dentists

A

GTN
If MI (severe/prolonged angina) sit in position comfortable
Oxygen
Aspirin 300mg (send note)

219
Q

MI symptoms

A 
Progressive onset of severe crushing pain across front chest, pain radiate toward shoulder/down arm/neck/jaw
Skin pale/clammy
Nausea vomiting
Weak pulse, BP down
Breathlessness
220
Q

Epileptic patients at dentist

A

continue treatment as normal

221
Q

Epileptic seizure symptoms

A

Loss consciousness. ridid, falls, cry, tonic
30 seconds jerking, tongue biting
Mouth frothing, urinary incontinence
After it - flaccid, unconscious, confusion

222
Q

Management epileptic seizure

A

Oxygen
After convulsion - coma position, check breathing
>5min - give Midazolam 10mg buccal

223
Q

Hypoglycaemia symptoms

A

trembling, sweating, pins/needles lips/tongue, hunger, palpitation, headache, double vision, concentration difficulty, slurred speech, confusion, behaviour change, convulsions, unconsciousness

224
Q

Management hypoglycaemia

A

Glucose 10-20g as sugar, Lucozade 55ml, coca cola 100ml, ribena blackcurrant 19ml (before dilution), 2 tsp sugar, 3 sugar lumps
Repeat 10-15mins
Glucagon 1mg IM

225
Q

Syncope symptoms

A

Feel faint, low BP, Pale/sweating, Yawn, slow pulse, nausea vomiting, dilated pupils, muscular twitching

226
Q

Management syncope

A

Lay flat, raise leg, loosen tight clothing, sweet tea/sugar in tea

227
Q

Very Anxious patient at dentists with cardiac issues

A

Temazepam

228
Q

Anticoagulant therapy at dentists

A

72 before INR assessed

Minor dental

229
Q

IM injections contraindicated in

A

Patients taking anticoagulants with high INR/haemostasis disorder and try to avoid in any anticoagulant

230
Q

Anticoagulant serious interactions

A

Aspirin, NSAIDs, Carbamazepine, imidazole, triazole antifungals (miconazole), Erthyromycin, Clarithromycin, Metronidazole
Broad-spectrum antibiotics: ampicillin/amoxicillin

231
Q

Need help identifying tablet/capsule

A

Front cover, Medicines information centre

232
Q

What are delayed acting poisons

A

Aspirin, ironm paracetamol, TCA, Co-phenotrope (diphenoxylate with atropine Lamotil), MR preps

233
Q

CO poisoning

A

oxygen max conc

234
Q

CNS depressants poisoning

A

Hypotension: raise foot bed + IV NaCl

vaso sympathomimetics

235
Q

Aspirin OD

A

Fluid depletion no hypotension. vomiting, sweating, hyperpnoea

236
Q

Amfetamines/Phencyclidine/Cocaine OD

A

Hypertension

237
Q

Cardiac conduction/arrhythmia from

A

TCA/Antipsychotic/Antihistamine OD

238
Q

Hypothermia from

A

Barbiturates/Phenothiazine/CNS stimulant/Antimuscanic OD

239
Q

Severe Hyperthermia side effect of

A

Serotonin Syndrome

240
Q

Treating OD side effect convulsion

A

Diazepam 10mg/Lorazepman 4mg

241
Q

Should not be given IM for convulsions

A

Benzodiazepines

242
Q

Give activated charcoal if the following are OD

A

Carbamazepine, Dapsone, Phenobarbital, Quinine, Theophylline

243
Q

Give activated charcoal with

A

Antiemetic

244
Q

Activated charcoal doesn’t work with

A

Iron, Lithium

245
Q

Aspirin OD

A

Activated Charcoal, Sodium Bicarboante (check plasma - hypokalaemia riks)
Severe: Haemodialysis

246
Q

Symptoms of Aspirin OD

A

Hyperventilation, Tinitus (ringing ears), deafness, vasodilation, sweating

247
Q

Symptoms Mefenemic Acid OD

A

Convulsions

248
Q

Symptoms Ibuprofen OD

A

Nausea, vomiting, epigastric pain, tinnitus (ringing ears)

249
Q

NSAID OD management

A

Activated charcoal

250
Q

Symptoms Paracetamol poisoning

A

Nausea, vomiting (24hrs), right subcostal pain/tenderness (means hepatic necrosis)
3-4 days symptoms LD: encephalopathy, haemorrhage, hypoglycaemia, cerebral oedema, death

251
Q

Paracetamol OD weight 140kg

A

Use 110kg for above 110

252
Q

Management Paracetamol OD

A

Acetylecysteine (up to 8 hrs) if above treat line or 8-24hrs after high OD
High OD: Activated charcoal

253
Q

Liver damage identified by

A

plasma-paracetamol conc after 4 hours

254
Q

Plasma-paracetamol conc for times

A

4-15 hours

255
Q

Enzyme inducers should be considered in paracetamol OD

A

No

256
Q

Acetylcysteine dosage

A

3 IV infusions over 21 hours

257
Q

Acetylcysteine caution in

A

Asthma, Anticoagulant

258
Q

Opioid OD characterised by

A

Respiratory depression, pin point pupils, coma

259
Q

Management Opioid OD

A

Nalaxone which reverses it with multiple doses (buprenorphine partial reverse)

260
Q

Opioid OD dose not appropriate for

A

Opioid induced respiratory depression and sedation in palliative care/chronic opioid use

261
Q

TCA OD symptoms

A

Dry mouth, coma, hypotension, hypothermia, hyerreflexia, convulsions, respiratory failure, cardiac problems, dilated pupils, urinary retension

262
Q

management TCA OD

A

IV Lorazepam/Diazepam
Activated charcoal
Sodium bicarbonate

263
Q

SSRI OD symptoms

A

nausea, vomiting, agitation, tremor, nystagamus, drowsiness, sinus tachycardia, convulsions

264
Q

What is serotonin syndrome

A

neurophsychiatric effects, neuromuscular hyperactivity, autonomic instability, hyperthermia, rhabdomylosis, renal failure, coagulopathies (blood can’t clot)

265
Q

management SSRI OD

A

Activated charcoal
Lorazepam, diazepam, midazolam
Contact NPIS for serotonin syndrome

266
Q

Antimalarial (quinine, chloroquine, hydroxychloroquine) OD symptoms

A

arrhythmia, convulson

Contact NPIS

267
Q

BB OD symptoms

A

lightheaded, dizzy, syncope (due to bradycardia/hypotension), heart failure exacerbation
Sotalol and Propanolol more

268
Q

Management BB OD

A

Atropine IV
unresponsive -> Glucagon + glucose
or Isoprenaline

269
Q

CaCB OD symptoms

A

nausea, vomiting, dizziness, agitation, confusion, coma, hyperglycaemia
Verapamil, Diltiazem: hypotension, arrythmia, heart block, asystole and cardiac depression

270
Q

management CaCB OD

A

Activated Charcoal (

271
Q

Benzodiazepine OD symptoms

A

drowsy, ataxia (balance), dysarthria (can’t speak), nystagmus (involuntary eye), respiratory depression, coma

272
Q

Management Benzodiazepine OD

A

Activated charcoal (

273
Q

Iron OD symptoms

A

nausea, vomiting, abdo pain, diarrhoea, blood in vomit, rectal bleeding, hypotension, hepatocellular necrosis
Severe: coma, shock, metabolic acidosis

274
Q

Management Iron OD

A

Desferroxiamine IV

Contact NPIS

275
Q

Lithium toxicity caused by

A

Dehydration, renal bad function, infection, diuretics, NSAIDs

276
Q

Symptoms of Lithium OD

A

delayed (12hours)
apathy, restleness -> vomiting, diarrhoea, ataxia, weakness, dysathria (speaking problem), muscle twitching, tremor
-> convulsion, coma, hypotension

277
Q

management lithium OD

A

haemodialysis, correct electrolytes, convulsion, renal problem
Severe: Gastric lavage

278
Q

Phenothiazine OD

A

Hypotension, hyperthermia, cardiac problems, dystonia (give procyclidine/diazepam), convulsions

279
Q

Second gen Antipsychotics OD

A

drowsy, convulsions, extrapyrimidal symptoms, hypotension, ECG problems
Activated charcoal

280
Q

Stimulant OD symptoms

A

Amfetamines: wakefulness, paranoia, hallucination, hypertension, convulsion, hyperthermia, coma
Cocaine: Agitation, dilated pupils, tachycardia, hypertension, hallucination, hyperthermia, hypertonia, hyperreflexia, cardiac problem
Ecstasy: delirium, coma, convulsions, hyperthermia, renal failure, rhabdomyolysis, coagulation, hypotension, haemorrhage

281
Q

Treatment stimulant OD

A

Amfetamines: tepid sponging, anticonvulsants, artificial respiration
Cocaine: IV diazepam
Ecstasy: Diazepam

282
Q

Theophylline OD symptoms

A

vomiting, agitation, restlessness, dilated pupuls, tachycardia, hypergylcaemia, blood vomit, convulsions, hypokalaemia

283
Q

management theophylline poisoning

A 
activated charcoal
ondansetron
IV potassium chloride
IV lorazepam/diazepam
BB unless asthma

Pharmacy Pre-Registration (5 decks)

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