Chapter 2 Qs Flashcards

1
Q

Q2.1 Give an example of 2 drugs that should be stopped in a pt with haemoptysis

A

Antiplatelets: Aspirin

Anticoagulants: LMWH

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2
Q

Q2.1 Give an example of 2 pescriptions that should be stopped in a hyperkalaemic patient

A

ACEi (ramipril)

IV fluid with added potassium

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3
Q

Q2.2 What affect do these drugs have on K+

  1. Bendroflumethiazide
  2. Lisinopril
A
  1. Bendroflumethiazide, thiazide diuretic, hypokalaemia
  2. Lisinopril, ACEi, hyperkalaemia
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4
Q

Q2.2 What is the mechanism of action of the following antiemetics:

  1. Metoclopramide:
  2. Domperidone:
  3. Cyclizine:
A
  1. Metoclopramide: dopamine antagonist, crosses BBB, exacerbated parkinsonian symproms
  2. Domperidone: dopamine antagonist Doesn’t cross BBB, safe in PD
  3. Cyclizine: antihistamine anti-emetic
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5
Q
A
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6
Q

Q2.3 Name one drug which results in a dry cough as a SE

A

ACE-I cause dry cough through accumulation of bradykinin via reduced degradation by ACE.

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7
Q

Q2.3 What affects do the following drugs have on electrolytes:

  1. Lisinopril
  2. Bendroflumethiazide
A
  1. Lisinopril, ACE-i cause hyperkalaemia via reduced aldosterone production, and reduced K+ excretion in kidneys (aldosterone antagonists do this too).
  2. Bendroflumethiazide, is a thiazide diuretic which causes hypokalaemia (loop diuretics do this too)
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8
Q

Q2.4. How do the following two drugs cause ‘stomach upset’:

  1. Ibuprofen
  2. Prednisolone
A
  1. Ibuprofen, NSAID, inhibits prostaglandin synthesis needed for gastric mucosal protection.
  2. Prednisolone, Oral steroids inhibit gastric epithelial renewal.

Both → indigestion/dyspepsia.

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9
Q

Q2.4. How do the following two drugs cause renal falure:

  1. Ibuprofen
  2. Ramipril
A
  1. Ibuprofen, NSAID inhibits prostaglandin synthesis → reduced renal artery diameter → reduced kidney perfusion + function.
  2. Ramipril, ACEi, reduces angiotensin II profuction req for preserving glomerular filtration when blood flow is reduced
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10
Q

Q2.5. Give an example of a drug type that should be stopped if patient is constipated

A

STOP opioids e.g. co-codamol, codeine

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11
Q

Q2.6 Common PMHx contra-indication for Ibuprofen

A

Asthma: NSAIDs (e.g. ibuprofen) cause bronchoconstriction, so avoid unless strictly necessary + under supervision (not at home).

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12
Q

Q2.6 Important to remember regarding PRN medications

A

For prescription to be valid, must write maximum PRN frequency – can’t just write “as required” on its own.

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13
Q

Q2.6 CI for trimethoprim in a pt with RA on methotrexate

A

Trimethoprim = folate antagonist, so CI with methotrexate (also folate antagonist) as risk of BM toxicity → pancytopenia + neutropenic sepsis.

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14
Q

Q2.6 Important to remember in a septic pt on methotrexate

A

If on methotrexate + septic, must stop it pending exclusion of neutropenic sepsis.

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15
Q

Q2.7 Important side effect on CCB

A

CCBs (e.g. amlodipine) cause ankle swelling. Do not use in HF.

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16
Q

Q2.7 How long after an ischaemic stroke should we wait to start LMWH?

A

Stop LMWH (e.g.enoxaparin) for 2 months (duration varies throughout UK) following an ischaemic stroke

17
Q

Q.2.8 How to check how to manage warfarin and INR on the BNF

A

Check BNF for this by typing in “warfarin INR”/Oral anticoagulants in search bar.

If patient has high warfarin (INR 5-8), withhold a few doses.

If patient on warfarin with INR >2 (i.e. therapeutic), then do not give prophylactic heparin as increases risk of bleeding unnecessarily.

18
Q

Q2.9 Important trivia re asthma

  1. Beta Blockers
  2. NSAIDS
  3. Apsirin (NSAID)
A
  1. Beta-blockers; strictly CI (can precipitate bronchospasm)
  2. NSAIDs; use with caution (can precipitate bronchospasm)
    • If asthmatic already on NSAID without problem, may continue.
  3. Aspirin, although an NSAID, very rarely worsens asthma – so commonly (but cautiously) used.
19
Q

Q2.9 What is the maximum dose of aspirin?

A

300mg

20
Q

Q2.9 What is Co-amoxiclav

A

= amoxicillin + clavulanic acid.

21
Q

Q2.10 Common CI to microgynon

A

Microgynon ED is COCP – CI in migraine with aura, as significantly increases risk of stroke.

22
Q

Q2.10 Max dose of Bisoprolol (&important drug to NOT co-prescribe)

A

20 mg per day

Do NOT use with verapamil

23
Q

Q2.10 Rout for Insulin?

A

All insulin is SC e.g. Novomix

except sliding scales using short-acting insulin (e.g. Actrapid or Novorapid) given by IV infusion.