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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
What are the treatment regimes for H.pylori?
PPI+ 2 Abx | PPI + (Clarithromycin/Amoxicillin/Metronidazole) + (Clarithromycin/Amoxicillin/Metronidazole)
26
What conditions have been linked with the use of PPIs?
Osteoporosis, Lupus and C.Difficile infections
27
What is the definition of an arrhythmia?
Irregular heartbeats
28
What is AF?
The most common form of arrhythmia with extremely rapid and uncontrolled electrical activity in the atria and variable conduction through the AV node.
29
What is the first line drug treatment for AF?
Rate control Beta Blockers - excluding sotalol Verapamil Diltiazem
30
What is the second line drug treatment for AF?
Rate control Beta Blockers - including sotalol Flecainide Amiodarone
31
What TWO risks should patients who are suffering from AF be assessed on?
Risk of Stroke- CHADS2 VASC | HASBLED - Risk of bleeding
32
What is the Vaughan Williams classification for anti-arrhythmic drugs?
Class 1 - Na+ channel blockers Class 2 - \Beta blockers Class 3 - Sotalol and Amiodarone Class 4 - Ca2+ channel blockers
33
What treatments are available for supraventricular tachycardia and which the preferred option?
Cardiac Glycosides Adenosine Verapamil Adenosine is the preferred treatment
34
What treatments are available for ventricular arrhythmias?
Lidocaine | Sotalol
35
What treatments are available for both supraventricular and ventricular?
Amiodarone | Beta Blockers
36
What is the dosing of digoxin?
Up to 125mcg - HF | 125-250mcg - AF
37
What are the SEs associated with digoxin?
``` Nausea Vomiting Blurred Vision Yellow Vision Confusion Diarrhoea Bradycardia ```
38
What is the target concentration of digoxin in the plasma and what is the toxic range?
1-2mcg/L - Normal | 1.5-3mcg/L - Toxic
39
What are the risk factors of digoxin toxicity?
Hypomagnesia, Hypokalaemia, Hypercalcaemia, Hypoxia and Renal Impairment
40
How can digoxin toxicity be treated?
Atropine or in very severe cases, Digoxin-Specific Antibody (Digumab) can be used
41
What is Amiodarone?
Amiodarone is a drug that is used for rhythm control in AF and can also be used in supraventricular and ventricular arrhythmias.
42
What is the dosing regime for amidoarone?
200mg TDS- Week 1 200mg BD- Week 2 200mg OD- Week 3 onwards
43
What precipitates Torsades De Pointes?
Bradycardia (Beta Blockers, Hypokalaemia and QT interval prolongation)
44
What is the treatment for Torsades De Pointes?
Magnesium Sulphate IV
45
What monitoring is required for Amiodarone and how often should this be conducted?
``` Thyroid Serum Potassium Lungs Liver Monitoring should be conducted every 6 months ```
46
What is the target INR for patients on warfarin?
2.5 +/- 0.5
47
What is the target INR for patients on warfarin for recurrent DVT
3.5 +/- 0.5
48
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
1) Withdraw 1-2 doses 2) Omit warfarin + oral phytomenadione 3) Omit warfarin + IV phytomenadione 4) Omit warfarin + IV phytomenadione
49
What are the advantages of NOACs in comparison to warfarin?
1) No INR needed 2) Low risk of bleeding 3) No monitoring required
50
What is involved in the management of a stroke: Short Term: Long Term:
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
What is the target Hba1c for a women who has diabetes in pregnancy and what should be given for supplementation?
Target Hba1c for women who have pre-existing diabetes -> 48mmol/mol Supplementation - Folic Acid 5mg
52
What is the ideal antidiabetic drug in pregancy planning?
Isophane insulin
53
What should be done in type 2 diabetic women post - birth?
They should continue metformin or resume the glibenclamide
54
What are the signs and symptoms of DKA?
Sweet smelling breath, high blood ketones, severe hyperglycaemia, drowsiness, polyuria
55
What is the treatment for DKA?
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
How often should type 1 diabetics monitor their blood glucose?
It should be monitored no more than 2 hours before and every 2 hours for long journeys
57
What should patients do when their blood glucose is : <4mmol/L 5mmol/L
<4mmol/L - do not drive | 5mmol/L - take a carbohydrate before driving
58
For which drugs do patients need to record their blood glucose BD even if they are not driving?
Drugs that cause hypos, such as SUs, meglitinides and Insulin
59
What should be done for patients who are experiencing a hypo while driving?
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
What are the signs of lactic acidosis?
``` The signs of lactic acidosis are: Dyspnoea Hypothermia Abdominal pain Muscle cramps Asthenia (weakness) ```
61
What should be done to treat SU-induced hypoglycaemia?
Hospital admission
62
When should pioglitazone be continued?
If there is >0.5% weight loss over 6 months
63
What are the risk factors associated with osteoporosis?
Elderly, over 65, underweight, smoker and alcohol drinker, corticosteroid therapy and a family history

Errors (6 decks)

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