Communicating Information

Question 1

What should be monitored after starting an ACEi?

Answer 1

Monitor renal function + Electrolytes following initiation - 1/2 weeks

Question 2

Give 3 things Tamoxifen increases the risk of

Answer 2

Increases risk of endometrial cancer

Increases efficacy of Warfarin, can lead to High INR readings

Increases risk of DVT/PE

Question 3

Metformin increases risk of what?

Answer 3

Lactic acidosis

Question 4

Gliclazide increases risk of what?

Answer 4

Hypoglycemia

Should be taken with meals and meals should not be missed

Question 5

What biochemical markers should be monitored in a patient taking methotrexate?

Answer 5

FBC - Neutropenia

LFTs - Liver cirrhosis

(1-2 weekly whilst initiating therapy, then 2-3 monthly)

Question 6

Patients taking methotrexate should report what immediately?

Answer 6

Signs/Symptoms of infection, especially sore throat.

Due to risk of severe infection/neutropenic sepsis

Question 7

What should be prescribed alongside methotrexate? When should it not be taken?

Answer 7

Folic acid

Should NOT be taken on the same day

Question 8

What is used to treat methotrexate toxicity?

Answer 8

Folinic acid

Question 9

What is the major adverse effect of Warfarin?

Answer 9

Increased risk of bleeding

Question 10

What affect does Alcohol have on Warfarin metabolism?

Answer 10

Acute intoxication - Inhibits Warfarin Metabolism

Chronic alcohol excess - Increases Warfarin Metabolism

(Drinking should be modes and spread out)

Question 11

When should patients taking Warfarin have blood tests?

Answer 11

Weekly when initiating

Monthly thereafter

Question 12

What effect to macrolides have on Warfarin?

Answer 12

Enzyme inhibitors - Increase effects of Warfarin

Question 13

What dietary change can alter Warfarin metabolism?

Answer 13

Increase in vitamin K - Increase INR

(Cranberry/Grapefruit/Pomegranate juice)

Question 14

Steroids (prednisolone) can increase the risk of what? (4)

Answer 14

Increase risk of hyperglycaemia and diabetes

Increase the risk of osteoporosis (consider bisphosphonate)

Increase risk of gastric irritation/ulceration (consider PPI)

Increased risk of hypertension (monitor BP)

Question 15

Why should long courses of Steroids (prednisolone) not be stopped abruptly?

Answer 15

Can cause Addisonian Crisis due to adrenal suppression

Taper dose if pt needs to come off steroids

Question 16

Give 3 potential side effects of Citalopram (SSRI)

Answer 16

Nausea

Dry mouth

Photosensitivity

Question 17

How should hypoglycaemia ideally be treated?

Answer 17

Oral glucose tablets

Question 18

How often is HbA1c measured in diabetics?

Answer 18

Every 3 months

Question 19

Failure to rotate insulin injection sites can cause what?

Answer 19

Lipodystrophy

Question 20

When and how should bisphosphonates (alendronic acid) be taken? (3)

Answer 20

30 minutes before food/other medication

Take with a full glass of water and stay upright for 30 mins after.

Take one dose daily in the morning

Question 21

Bisphosphonates commonly cause what?

Answer 21

Oesophageal irritation

Question 22

Bisphosphonates increase the risk of what? (3)

Answer 22

Atypical fracture (consider bisphosphonate holiday)

Osteonecrosis of the jaw (regular check ups/good dental hygiene)

Osteonecrosis of external auditory canal (report ear pain/discharge)

Question 23

What should not be taken at the same time as bisphosphonates? Why?

Answer 23

Calcium supplements.

As can reduce absorption

Question 24

Outline some key points regarding the risk of breast cancer in patients taking HRT (4)

Answer 24

Risk of breast cancer is related to the duration of use (not the age at which HRT is started)

Risk of breast cancer is higher in combined HRT (esp continuous) when compared to Oestrogen Only HRT

Risk of breast cancer decreases after stopping HRT

Vaginal only HRT does NOT increase risk of breast cancer