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1
Q

What is the initial dosing regime of warfarin?

A

5mg initially

Monitor every 1-2 days

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2
Q

What interacts with warfarin OTC and what is the interaction?

A

Miconazole- enzyme inhibitor exacerbates bleeding

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3
Q

What is the antidote for warfarin

A

Phytomenadione (Vitamin K)

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4
Q

What is the appropriate length of treatment with warfarin for calf DVT?

A

6 weeks

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5
Q

What is the appropriate length of treatment for provoked VTE with warfarin?

A

3 months

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6
Q

What is the appropriate length of treatment for unprovoked DVT with warfarin?

A

3 months minimum

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7
Q

What to if a patient is experiencing a major bleed?

A

1) stop warfarin
2) IV phytomenadione
3) fresh frozen plasma

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8
Q

What to do with elective surgery?

A

Stop warfarin 5 days before

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9
Q

What to do in emergency surgery with a patient on warfarin?

A

Delay 6-12 hours
Or with
IV phytomenadione + dried prothrombin complex

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10
Q

How should patients be managed initially if they have an MI

A 
Morphine IV
Metoclopramide 
Oxygen
Nitrate
Aspirin
MMONA
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11
Q

How should patients be managed long term following an MI?

A 
Ace Inhibitor
Clopidogrel (1 year for NSTEMI, atleast 4 weeks in STEMI)
Statin
Aspirnin
B-Blocker
G-GTN
ACS BAG
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12
Q

What strength of adrenaline is administered in cardiac arrest and what can be given IV if a defibrilator is present?

A

1 in 1000

IV amiodarone

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13
Q

When should diuretics be taken and why?

A

Morning because if taken at night, it can cause sleep disturbances due to frequent urination

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14
Q

Where are loop diuretics indicated?

A

Odema
Heart Failure
Severe Hypertension

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15
Q

Where are thiazide diuretics indicated?

A

Odema

Hypertension

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16
Q

What side effects can occur with bendroflumethiazide?

A

Hypo of most electrolytes
Gout
Hyperglycaemia
Hypercalcaemia

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17
Q

What form of laxatives should not be for opioid-induced constipation?

A

Bulk forming laxatives

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18
Q

What form of laxatives should be for opioid-induced constipation?

A

Stimulant or Osmotic laxatives

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19
Q

What form of laxatives should be used for children?

A

1) Macrogol + Dietary Advice
2) Stimulant Laxatives
3) Lactulose

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20
Q

What is simeticone?

A

Simeticone is an anti-foaming agent incorporated in antacids too relieve flatulence.

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21
Q

What is used in palliative care for the treatment of hiccups?

A

Simeticone

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22
Q

Why are bismuth-containing antacids not adviced?

A

Absorbed bismuth can be neurotoxic, with the possibility of inducing encephalothapy.

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23
Q

What are the two tests which can be done to determine `the presence of H.pylori

A

1) C13 breath test

2) Stool antigen test

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24
Q

When should H.pylori testing not be conducted?

A

They should not be conducted in those taking an anti-secretory within the last 2 weeks or an antibiotic within the last 4 weeks of conducting the test

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25
Q

What are the treatment regimes for H.pylori?

A

PPI+ 2 Abx

PPI + (Clarithromycin/Amoxicillin/Metronidazole) + (Clarithromycin/Amoxicillin/Metronidazole)

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26
Q

What conditions have been linked with the use of PPIs?

A

Osteoporosis, Lupus and C.Difficile infections

27
Q

What is the definition of an arrhythmia?

A

Irregular heartbeats

28
Q

What is AF?

A

The most common form of arrhythmia with extremely rapid and uncontrolled electrical activity in the atria and variable conduction through the AV node.

29
Q

What is the first line drug treatment for AF?

A

Rate control
Beta Blockers - excluding sotalol
Verapamil
Diltiazem

30
Q

What is the second line drug treatment for AF?

A

Rate control
Beta Blockers - including sotalol
Flecainide
Amiodarone

31
Q

What TWO risks should patients who are suffering from AF be assessed on?

A

Risk of Stroke- CHADS2 VASC

HASBLED - Risk of bleeding

32
Q

What is the Vaughan Williams classification for anti-arrhythmic drugs?

A

Class 1 - Na+ channel blockers
Class 2 - \Beta blockers
Class 3 - Sotalol and Amiodarone
Class 4 - Ca2+ channel blockers

33
Q

What treatments are available for supraventricular tachycardia and which the preferred option?

A

Cardiac Glycosides
Adenosine
Verapamil
Adenosine is the preferred treatment

34
Q

What treatments are available for ventricular arrhythmias?

A

Lidocaine

Sotalol

35
Q

What treatments are available for both supraventricular and ventricular?

A

Amiodarone

Beta Blockers

36
Q

What is the dosing of digoxin?

A

Up to 125mcg - HF

125-250mcg - AF

37
Q

What are the SEs associated with digoxin?

A 
Nausea
Vomiting
Blurred Vision 
Yellow  Vision
Confusion 
Diarrhoea
Bradycardia
38
Q

What is the target concentration of digoxin in the plasma and what is the toxic range?

A

1-2mcg/L - Normal

1.5-3mcg/L - Toxic

39
Q

What are the risk factors of digoxin toxicity?

A

Hypomagnesia, Hypokalaemia, Hypercalcaemia, Hypoxia and Renal Impairment

40
Q

How can digoxin toxicity be treated?

A

Atropine or in very severe cases, Digoxin-Specific Antibody (Digumab) can be used

41
Q

What is Amiodarone?

A

Amiodarone is a drug that is used for rhythm control in AF and can also be used in supraventricular and ventricular arrhythmias.

42
Q

What is the dosing regime for amidoarone?

A

200mg TDS- Week 1
200mg BD- Week 2
200mg OD- Week 3 onwards

43
Q

What precipitates Torsades De Pointes?

A

Bradycardia (Beta Blockers, Hypokalaemia and QT interval prolongation)

44
Q

What is the treatment for Torsades De Pointes?

A

Magnesium Sulphate IV

45
Q

What monitoring is required for Amiodarone and how often should this be conducted?

A 
Thyroid
Serum Potassium
Lungs
Liver
Monitoring should be conducted every 6 months
46
Q

What is the target INR for patients on warfarin?

A

2.5 +/- 0.5

47
Q

What is the target INR for patients on warfarin for recurrent DVT

A

3.5 +/- 0.5

48
Q

What to do in the following situationsw:

1) INR > 5 + no bleeding
2) INR > 8 + no bleeding
3) INR > 5 + minor bleeding
4) INR > 5 + minor bleeding

A

1) Withdraw 1-2 doses
2) Omit warfarin + oral phytomenadione
3) Omit warfarin + IV phytomenadione
4) Omit warfarin + IV phytomenadione

49
Q

What are the advantages of NOACs in comparison to warfarin?

A

1) No INR needed
2) Low risk of bleeding
3) No monitoring required

50
Q

What is involved in the management of a stroke:

Short Term:

Long Term:

A

Short Term:
Alteplase
Aspirin or Clopidogrel 24-48 hours after thrombolysis

Long Term:
Statin started 48 hours irrespective to cholesterol level
Aspirin/Dipyridamole/Clopidogrel started
Aim to lower BP below <130/80 - Beta blockers are NOT recommended

51
Q

What is the target Hba1c for a women who has diabetes in pregnancy and what should be given for supplementation?

A

Target Hba1c for women who have pre-existing diabetes -> 48mmol/mol
Supplementation - Folic Acid 5mg

52
Q

What is the ideal antidiabetic drug in pregancy planning?

A

Isophane insulin

53
Q

What should be done in type 2 diabetic women post - birth?

A

They should continue metformin or resume the glibenclamide

54
Q

What are the signs and symptoms of DKA?

A

Sweet smelling breath, high blood ketones, severe hyperglycaemia, drowsiness, polyuria

55
Q

What is the treatment for DKA?

A

Soluble insulin, saline, K+ unless anuria, long acting insulin and add glucose once conc is <14mmol/L, and continue till pH is above 7.3

56
Q

How often should type 1 diabetics monitor their blood glucose?

A

It should be monitored no more than 2 hours before and every 2 hours for long journeys

57
Q

What should patients do when their blood glucose is :
<4mmol/L
5mmol/L

A

<4mmol/L - do not drive

5mmol/L - take a carbohydrate before driving

58
Q

For which drugs do patients need to record their blood glucose BD even if they are not driving?

A

Drugs that cause hypos, such as SUs, meglitinides and Insulin

59
Q

What should be done for patients who are experiencing a hypo while driving?

A

Find a safe place to park up, turn off the engine and eat and wait for 45 mins before blood sugar levels reach the norm

60
Q

What are the signs of lactic acidosis?

A 
The signs of lactic acidosis are: 
Dyspnoea
Hypothermia
Abdominal pain
Muscle cramps
Asthenia (weakness)
61
Q

What should be done to treat SU-induced hypoglycaemia?

A

Hospital admission

62
Q

When should pioglitazone be continued?

A

If there is >0.5% weight loss over 6 months

63
Q

What are the risk factors associated with osteoporosis?

A

Elderly, over 65, underweight, smoker and alcohol drinker, corticosteroid therapy and a family history

Errors (6 decks)

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