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Year 4 Prescribing > Concentrated Questions > Flashcards

Concentrated Questions Flashcards

1
Q

Daily req of water

A

20-30ml/kg/day

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2
Q

Daily req of Na/K/CL

A

1mmol / kg / day

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3
Q

Daily req of glucose I

A

50-100g/day

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4
Q

What is resusc fluids

A

NaCL

NO K!!!

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5
Q

How quick do you give resusc fluids

A

15 mins

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6
Q

Normal fluids given iver

A

8-12 hours

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7
Q

Typical maintenance

A

One salt two sugar with KCL in each sugar

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8
Q

If giving multiple bags of NaCl be aware of

A

Hyperchloraemia

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9
Q

How much fluid can you prescribe at once

A

No more than 1 day worth

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10
Q

Most fluid bags are how many litres

A

1 litre

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11
Q

How many bags of NaCl can you give in a day

A

1

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12
Q

How much resusc fluids for kids

A

20mls per kg in 15 mins

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13
Q

Maintenance fluids for kids

A

100ml /kg/ day first 10kg
50ml/kg/ day next 10kg
20ml/kg/day for weight over 20kg

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14
Q

Can’t give aspirin in kids due to

A

Reye’s syndrome

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15
Q

What do you need to consider with fluid prescribing post operative my

A

Renal impairment due to either contrast or hypo volaemia

Bleeding intra and post op

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16
Q

Stopping warfarin before surgery

A

5 days

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17
Q

Stopping noacs before surgery

A

48hoirs

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18
Q

When to stop clopidogrel before surgery

A

Hold morning of surgery

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19
Q

When do you stop aspirin before surgery

A

7 days before

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20
Q

Name 4 drugs you withhold preop to prevent renal impairment

A

ACEI (hold morning of)
Metformin (hold 48 hours pre and post op)
NSAIDS (limit use pre and post op)
Gentamicin (avoid)

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21
Q

All surgical pets are prescribed

A

VTE prophylaxis (dalteparin) - different doses for prophylaxis and treatment

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22
Q

When do you need to half the dose of paracetamol

A

<50kg or significant renal dysfunction

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23
Q

When do you avoid NSAIDS

A

Asthma
Renal impairment
GI ulcer or bleed

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24
Q

Morphine is excreted via

A

Kidneys use oxy in impairment

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25
Q

4 common side effects of morphine

A

Itch nausea constipation drowsiness

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26
Q

What form of pain relief is given in Pts with poor swallow

A

Patch

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27
Q

5 class of drugs which exhibit anticholinergic activity and hence increased risk of falls and impaired cognition

A 
Antidepressants 
Antipsychotics 
Antiemetics 
Antihistamines 
Benzos
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28
Q

What causes hupovokaemix hyponatraemia

A

D+V

Diuretics - loops and thiazides

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29
Q

What causes euvolaemic hyponatraemia

A

Hypothyroid
Addisons
SIADH - ppis ssris carbamazepine

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30
Q

What causes hupeevolaemic hyponatraemia

A

Liver failure
Renal failure
Heart failure

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31
Q

Drug causes of hyperkalaemia

A

ACEI
ARBS
Spironolactone / amiloride
Metformin NSAIDS gentamicin ( impair renal excretion)

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32
Q

Name 5 drugs which cause hyperglycaemia

A 
Olanzapine (2nd gen antipsychotixsh 
Pred 
Tacrolimis (calcineurin inh) 
Beta blockers 
Thiazides
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33
Q

4 drugs which cause hypoglycaemia

A

Insulin
Sulphonylureas (gliclazide)
Pioglitazone
SGLT2

(NOT Metformin)

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34
Q

What is the normal QT

A

Male <440

Female <470

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35
Q

If long QT and untreated can lead to

A

Torsades de pointed

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36
Q

Treat torsades

A

Cardio vert and mgso4

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37
Q

Name 7 causes of long QT

A

Antipsychotics (haloperidol/ olanzapine)
Antidepressants (citalopram and venlafaxine)
Antiemetics (ondansetron)
Beta blockers (sotalol)
Flecaimide
Amiodarone
Abx- ciprofloxacin and erythromycin

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38
Q

CANNOT CO PRESCRIBE AZATHIOPRINE WITH

A

allopurinol (risk of life threatening myelosuppressjon)

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39
Q

Where is warfarin broken down in the body

A

Liver

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40
Q

INR …..,, by p450 inhibitors

A

Increases

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41
Q

INR …… by p450 inducers

A

Decrease

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42
Q

Name p450 inhibitors

A 
Sodium valproate 
Isoniazid 
Cimetidine 
Ketokonazol
Fluconazole 
Alcohol (binge) 
Chloramphenicol 
Erythromycin 
Sulphonamides 
Ciprofloxacin 
Omeprazole 
Metronidazole
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43
Q

P450 inducers examples

A 
St John’s Wart 
Carbamazepine 
Rifampicin 
Alcohol (chronic) 
Phenytoin 
Griseofulvin (anti fungal) 
Phenobarbitone 
Sulphonylureas
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44
Q

When do you stop the statin if CK raised

A

If five times limit of normal or symptoms intolerable

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45
Q

When do you stop statins with abn LFTs

A

If three times limit of normal

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46
Q

What do you need to advise the other about warfarin other than bleeding risk and monitoring

A

Limit alcohol use

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47
Q

How often do you take bisphosphonates usually

A

Same day each week

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48
Q

How do you take bisphosphonates

A

Take on empty stomach and sit straight or stand for thirty minutes after it

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49
Q

What are the main risks of bisphosphonates (3)

A

Osteonecrosis of jaw
Atypical fractures
Upper GI effects

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50
Q

What decreases the absorption of bisphosphonates

A

Calcium salts
Food and drink
NSAIDS

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51
Q

How often do T1DM monitor insulin

A

4 times a day (before meals and befor bed)

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52
Q

Targwt hba1c

A

48

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53
Q

Target glucose levels before and after meals

A

4-7

5-9

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54
Q

What changes are made to insulin if unwell

A

BMs higher so higher nasal doses required

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55
Q

Pills decrease risk of

A

Endometrial and ovarian cancer

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56
Q

Pill increases risk of

A

Breast cancer

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57
Q

Tamoxifen increases risk of (3)

A

Endometrial and ovarian ca

VTE risk

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58
Q

Tamoxifen does what to warfarin

A

Increase efficacy

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59
Q

Common side effect of tamoxifen

A

Hot flushes

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60
Q

When do you stop Metformin

A

If egfr less than 30

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61
Q

When should sulphonylureas be give.

A

Morning

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62
Q

When should statins be given

A

Night

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63
Q

How long does it take for antidepressants to work in

A

6 weeks

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64
Q

Anti hypertensive in pregnancy

A

Labetolol

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65
Q

Common side effect of SSRI

A

Dry mouth

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66
Q

Symptoms of serotonin syndrome

A

Agitation
Pyrexia
Hallucinations

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67
Q

What three drugs cause agranulocytosis

A

Carbimazole
Carbamazepine
Clozapine

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68
Q

What must you check before starting azathioprine

A

TPMT activity

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69
Q

Methotrexate must be coprescribed with

A

Folic acid ( give on days not taking methotrexate)

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70
Q

UTI and pregnant give

A

Amoxicillin

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71
Q

What causes profuse vomiting when combined with metronidazole

72
Q

1:1000 means

A

1g in 1000mls

73
Q

1:10000 means

A

1g in 10000mls

74
Q

4 side effects of ACEI

A

Dry cough
Hyperkalaemia
Renal failure
Postural hypotension

75
Q

4 side effects of beta blockers

A

Erectile dysfunction
Bradycardia
Fatigue
Cold extremities

76
Q

3 side effects of ccbs

A

Ankle swelling
Headache
Flushing

77
Q

Side effects for diuretics

A

Hypokalaemia

78
Q

Two side effects of spironolactone

A

Hyperkalaemia

Gynaecomastia

79
Q

Where do you find the warfarin and bleeding guidance

A

Oral anti coags

80
Q

Phenytoin side effects

A

Gum hyperteophy

Hirsuitism

81
Q

3 side effects of carbamazepine

A

Rash
Hyponatraemia
Dry mouth

82
Q

Na valproate side effects 3

A

Teratogenic
Weight gain
Tremor

83
Q

Lamotrigine se 1

A

Rash (SJS)

84
Q

SSRI side effect 4

A

Sick
SIADH
Reduced libido
Insomnia

85
Q

TCAs

A

Anticholinergic (confusion agitation)

86
Q

3 maoi

A

Hypertension
Jaundice
Hyperthermia

87
Q

Insulin 3 se

A

Hypos
Lipohypeetrophy
Hypokalaemia

88
Q

Metformin 2 se

A

Lactic acidosis

Weight loss

89
Q

Sulphonylureas gliclazide 2

A

Hypos

Weight gain

90
Q

Three SE of pioglitazone

A

Hepatotoxic
Fractures
Bladder cancer

91
Q

Se of acarbose

A

Flatulence

92
Q

5 sulphasalazine

A 
Myelosuppression 
Hepatitis 
Oligospermia 
Rash 
Renal failure
93
Q

4 gold

A

GN
Myelosuppressjon
Erythroderma
Thrombocytopenia

94
Q

4 penicillamien

A

GN
Myasthenia
Lupus
Taste disturbance

95
Q

Chloroquine 2

A

Retinopathy

Tinnitus

96
Q

4 methotrexate

A

Hepatotoxicity
Pneumonitis
Myelosuppressjon
Mucositis

97
Q

2 anti tnf drug

A

Reactivation of TB

Infection

98
Q

Cyclophosphamide 1

A

Haemorrhaging cystitis

99
Q

Azathioprine 1

A

Myelosuppressjon

100
Q

Cyclophosphamide 5

A

Tremor nephritis

Hyper trichosis gum hyperplasia burning hands and feet

101
Q

Rifampicin 2

A

Red orange secretions

Hepatitis

102
Q

Isoniazid 2

A

Neuropathy

Hepatitis

103
Q

Pyrazinamide 1

104
Q

Ethambutol

A

Optic neuritis

E = eye

105
Q

Haloperidol 2

A

Dystonia

Qt prolongation

106
Q

Where can I find info on how to treat a dystonia

A

Dystonia and other reactions bnf

107
Q

Rispweidone olanzapine

A

Metabolic syndrome

108
Q

COCP 4

A

Clots oedema cervical and breast cancer pressure (hypertension)

109
Q

Depot contraception

A

Osteoporosis

Delayed fertility return

110
Q

9 se of steroids

A

Cushing’s diabetes thin skin psychosis osteoporosis hypokalaemia infections neutrophilia falls

111
Q

7 amiodarone

A 
Thyroiditis 
Pulmonary fibrosis 
Peripheral neuropathy 
Myopathy 
Slate grey skin 
Hepatitis 
Metallic taste
112
Q

2 adenosine

A

Sense of impending doom

Flushing

113
Q

Symptoms of lithium overdose

A

Tremor

Ataxia dysarthria coma convulsions N+D hypothyroidism nephrogenic DI

114
Q

Gentamicin is toxic to what

A

Ototoxic and nephrotoxicity

115
Q

C diff risk in

A 
Cephalosporin 
Co amoxiclav 
Clindamycin 
Ciprofloxacin (quinolones)
Clarithromycin (macrloides)
116
Q

Hyponatraemia main ones

A

SSRI diuretics

117
Q

Hyperkalaemia

A

Na bicarb

Fluids

118
Q

Hypokalaemia

A

Salbutamol
Insulin
Diuretics

119
Q

Hyperkalaemia

A 
Spironolactone 
ACEI 
NSAIDS 
Trimethoprim 
Cyclosporine 
Tacrolimus
120
Q

Hypocalcaemia

A

Loops
Bisphosphonates
Phenytoin

121
Q

Hypercalcaemia

122
Q

8 drugs that damage liver

A 
Paracetamol 
Statins 
Valproate 
Nitrofurantoin 
Methotrexate 
Antifungals 
Amiodarone 
RIP (TB)
123
Q

Monitor warfarin with

124
Q

Monitor vanc with

A

Trough (after 48 hours therapy or before 4th dose)

125
Q

2 ways to monitor valproate

126
Q

3 ways to monitor statins

A

Lipids
TFTs
UandE

127
Q

Monitor phenytoin

A

ECG and trough

128
Q

Three ways to monitor methotrexate

A

FBC UandE LFTs

129
Q

How to monitor gentamicin

A

Level 6-14 hours post dose and UandE

130
Q

How to monitor digoxin

A

UandE

Digoxin level 6 hours post dose

131
Q

How to monitor azathioprine

132
Q

How to monitor antifungals

133
Q

How to monitor antipsychotics

A

Prolactin
Weight
Lipids
Clozapine - WCCs (FBC)

134
Q

How to monitor amiodarone

A

TFTs
LFTs at baseline then 6myhs
CXR before
K baseline

135
Q

What do you monitor with ACEI

A

BP

UandE (creatinine urea K Na eGFR)

136
Q

How to treat hypo

A

75mls 20% glucose IV or IM glucagon but use IV if they have a cannula

137
Q

24 hour insulin requirement usually

A

0.3 units per kg per 24 hours

138
Q

How do you determine when to give the next dose of gent

A

Creatinine clearance

139
Q

Which drugs are in micro grams

A

Levothyroxine

Digoxin

140
Q

What do you give in Parkinson’s who develop and unsafe swallow

A

Rotigotine oatch

141
Q

Se of rotigotine oatch

A

Drowsiness

142
Q

What pain relief do you use in crcl <30

143
Q

What drugs cause extrapyramidal side effects and what disease should they not be used in

What can be used as an alternative

A

Metoclopramide
Haloperidol

Parkinson’s

Domperidone

144
Q

What is indapamide

145
Q

What’s the go to for severe severe pain

A

5mg IV morphine

146
Q

What should you not coprescribe acei with but is not in the BNF

147
Q

If high risk of a vte but needing to come off warfarin post op

A

Bridge with LMWH as can be more easily reversed

148
Q

When to stop Metformin

A

Stop in near sepsis or if creatinine clearance >150

149
Q

Why can diclofenac cause low consciousness

A

Increase in creatinine

150
Q

What’s the dose of calcium gluconate in hyperkalaemia

151
Q

What can calcium gluconate also be used to treat

A

Hypocalcaemia

152
Q

Great hypercalcaemia

153
Q

Acute flare of Crohns or Uc

A

IV hydrocortisone

154
Q

C diff once off infection.

A

Oral metronidazole

155
Q

C diff more than once

156
Q

Symptoms of an acute dystonic reaction

A

Painful eye and neck spasms

157
Q

How to treat acute dystonic reactions

A

Procyclidine hydrochloride 5mg/ml injection

158
Q

How to prescribe HRT to avoid withdrawal bleeding

A

Same dose continuously instead of two patches a week when each patch is on for 24 hours

159
Q

What drugs should you avoid in PVD due to peripheral vasoconstriction

A

Beta blockers

ACEI in severe disease

160
Q

Why should steroids not be stopped abruptly

A

Risk of adrenal suppression.

161
Q

Symptoms of scarlet fever

A 
Macular red rash 
Strawberry tongue 
Red throat 
Fever 
>38•c
162
Q

Treat scarlet fever with

A

Phenoxymethylpenicillin

163
Q

How do you take rivaroxaban

A

Taken with food

164
Q

Co amoxiclav commonly causes what

165
Q

When’s do you consider the rise in creatinine when starting and ACEI

166
Q

Monitoring of treatment in heart failure

A

Exercise tolerance

167
Q

What is the target for starting a statin

A

After 3 months of treatment a >40% reduction in LDL

168
Q

500mls of fluid over

169
Q

1 litre of fluid over

A

10-12 hours

170
Q

What are the main drugs that cause urinary retention

A 
Morphine (opiates) 
Anticholinergic a 
General anaesthetics 
Alpha agonists 
Benzos 
NSAIDS
CCBs 
Antihistamines 
Alcohol
171
Q

With abn LFTs when do yin stop statin (needs to be because of statin)

A

If >3x upper limit of normal

172
Q

Common drugs to cause diarrhoea

A

ACEI

Aledronic acid

173
Q

Name two drugs that can cause ankle oedema

A

Amlodipine

Naproxen

174
Q

First line in nerve pain in elderly

A

Paracetamol

175
Q

When do you take loperamide

A

After each loose stool

176
Q

Well known toxicity of cephalosporin

Year 4 Prescribing (28 decks)

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