Communicating information

Question 1

Allopurinol - starting and ADR

Answer 1

Don’t start in an acute attack - wait 2 weeks after

Stop if rash

Interacts with theophilline

Question 2

Adverse effects of cyclosporin

Answer 2

nephrotoxicity
hepatotoxicity
fluid retention
hypertension
hyperkalaemia
hypertrichosis
gingival hyperplasia
tremor
impaired glucose tolerance
hyperlipidaemia
increased susceptibility to severe infection

Question 3

Digoxin monitoring

Answer 3

not routine - measure 8-12 hours of last dose if worried about toxicity

Question 4

Signs of digoxin toxicity

Answer 4

generally unwell, lethargy, nausea & vomiting, anorexia, confusion, yellow-green vision
arrhythmias (e.g. AV block, bradycardia)
gynaecomastia

Question 5

gentamicin ADR + contraindications

Answer 5

Nephrotoxic and ototoxic

CI in MG

Question 6

Gentamicin dosing

Answer 6

both peak (1 hour after administration) and trough levels (just before the next dose) are measured
if the trough (pre-dose) level is high the interval between the doses should be increased
if the peak (post-dose) level is high the dose should be decreased

Question 7

Adverse effects of heparin

Answer 7

Bleeding
thrombocytopenia
OP
K+ raised

Question 8

Heparin OD

Answer 8

Protamine sulphate

Question 9

Types of heparin

Answer 9

UFH (standard)

LMWH - enoxaparin, dalteparin,

Question 10

Comparison of UFH vs LMWH

Answer 10

UFH - we monitor APTT and it may be used in CKD - renal failure. Risk of heparin induced thrombocytopenia

LMWH - monitoring is anti Factor Xa - lower risk of HIT. main top line.

Question 11

Therapeutic range for lithium

Answer 11

0.4-1

Question 12

Signs of toxicity in lithium OD

Answer 12

Tremor - coarse (Fine is normal)
hyperreflexia
confusion
seiuzres
coma

Question 13

What can macrolides NOT be taken with?

Answer 13

Statisn

Question 14

Examples of macrolides

Answer 14

clarithromycin

azithromycin

Question 15

Adverse effects of macrolides

Answer 15

prolongation of the QT interval
gastrointestinal side-effects are common. Nausea is less common with clarithromycin than erythromycin
cholestatic jaundice: risk may be reduced if erythromycin stearate is used
P450 inhibitor (see below)
azithromycin is associated with hearing loss and tinnitus

Question 16

SE of metformin

Answer 16

lactic acidosis
GI upset
renal failure. Do not take if EGFR <30 or if creatinine is >150

Question 17

Paracetamol OD

Answer 17

NAC <1 hr

4 hrs treatment line - unless staggered then take

Question 18

OD benzodiazepine Mx

Answer 18

Flumazenil

Question 19

TCA OD

Answer 19

Mx IV bicarbonate

treat arrythmia

Question 20

Adverse effects of tamoxifen

Answer 20

Menstrual issues
Hot flushes
VTE
Endometrial cancer

Question 21

Lithium OD Mx

Answer 21

Saline

Question 22

PDE5 inhibitors example, CI, side effect

Answer 22

Sildenafil

CI
nitrates, recent stroke/MI

SE
blue vision 
nasal congestion
flushing
GI 
headache

Question 23

What is amiloride?

Answer 23

weak diuretic, usually given with thiazides or loop diuretics as an alternative to potassium supplementation (remember that thiazides and loop diuretics often cause hypokalaemia)

Question 24

Examples of aldosterone antagonists

Answer 24

Spiro

Question 25

Mx of ascites

Answer 25

Drain | Spiro

Question 26

When to avoid adenosine?

Answer 26

COPD/Asthma - give veraparamil

Question 27

Prescribing in epilepsy: avoid

Answer 27

``` Caution - enzyme inducers alcohol, cocaine, amphetamines ciprofloxacin, levofloxacin aminophylline, theophylline bupropion methylphenidate (used in ADHD) mefenamic acid ```

Question 28

What drugs may worsen HF?

Answer 28

Thiazolidediones - pioglitazone - fluid retention Verapamil NSAID/GC flecanaide

Question 29

Drugs to avoid in renal failure?

Answer 29

ABx - tetracycline + nitrofurantoin NSAID lithium metformin

Question 30

Drugs needing dose adjustment in CKD

Answer 30

``` most antibiotics including penicillins, cephalosporins, vancomycin, gentamicin, streptomycin digoxin, atenolol methotrexate sulphonylureas furosemide opioids ```

Question 31

Drugs to avoid in pregnancy

Answer 31

``` ABx Quinolone Tetracycline Aminoglycoside Sulphonamide and trimethoprim ace/arb Satin warfarin sulphonylurea ```