General

Question 1

How answer questions relating to paracetamol OD

Answer 1

Is chart on BNF for paracetamol levels

Question 2

How access table to convert opioids

Answer 2

Type in prescribing in palliative care

Question 3

How calculate PRN/breathrough analgesia

Answer 3

1/6th of 24 hour dose

Question 4

How manage a rise in glucose if T1DM using insulin and have to go on course of corticosteroids

Answer 4

Increase units by 10%

Question 5

Interpreting gentamicin nomogram

Answer 5

• where plot is, that section determines the further dosing rate (below q24 hour line= redose in 24 hour intervals)

Question 6

What do if on gentamicin nomogram, plot is on line between section

Answer 6

Use the longer interval above

Question 7

What do if on gentamicin nomogram, plot is above the 48 hour section

Answer 7

Stop gentamicin and redraw levels in a few hours

Question 8

What do if with gentamicin nomogram it is before 6 hours

Answer 8

Redraw later when can actually plot on graph

Question 9

When have to taper steroid doses

Answer 9

Over 40mg prednisolone for 1 week
Received over 3 weeks treatment of any dose
Received lots of repeated courses recently

Question 10

Oral to liquid morphine

Answer 10

Same

Question 11

How to find out what concentration a drug is available at

Answer 11

Look at medicinal form

Question 12

When it comes to gentamicin monitoring, what are peak and trough levels

Answer 12

Peak is taken within 1 hour of levels
Trough is taken just before next administration

Question 13

What is normal peak and trough ranges for gentamicin monitoring

Answer 13

Peak- 5-7
Trough- under 1

Question 14

What do if peak levels are too high for gentamicin monitoring

Answer 14

Reduce dose

Question 15

What do if trough levels are too high in gentamicin monitoring

Answer 15

Increase interval between doses

Question 16

What do if someone has a HbA1c of under 48 and on metformin

Answer 16

Do nothing

Question 17

Anti-emetic if QT prolongation

Answer 17

Cyclizine 50mg

Question 18

Person on morphine develops AKI what do

Answer 18

Switch to oxycodone

Question 19

Develop thyrotoxicosis on amiodarone what is immediate management

Answer 19

Stop

Question 20

When communicating information what need to consider if 2 answers are true

Answer 20

Medical history- is a side effect relevant to their condition

Question 21

When searching for ferrous sulphate in interactions what search for

Answer 21

Iron

Question 22

When doing data interpretation based off serum drug levels what need to consider

Answer 22

If on max dose?
What is their renal function and does BNF have dose adjustments for this?

Question 23

If theophylline/aminophylline monitoring question in community, what does it mean if they have been admitted with vomiting and confusion

Answer 23

Toxicity so withhold

Question 24

Side effect of pioglitazone relating to glucose

Answer 24

Is low

Question 25

When check ketones in T1DM when ill

Answer 25

If BM over 15

Question 26

Sick day rules for T1DM

Answer 26

If N&V means can not drink fluids then go to hospital straight away Continue normal isulin Take BM more often

Question 27

If have changed night-time insulin, what is best monitoring option

Answer 27

Pre breakfast glucose

Question 28

When may not stop aspirin during surgery

Answer 28

If patient has angina with recent stroke, MI or has coronary stent

Question 29

What may be done with DOAC perioperatively

Answer 29

Normally stopped 48 hours before but decision may be made to switch to UFH

Question 30

Which drugs need to be stopped pre surgery

Answer 30

DOAC- 48 hours before Warfarin- 5 days before Antiplatelets- 5 days before Lithium- 24 hours before COCP and HRT- 4 weeks before MAOi- potentially depends on anaesthesia being use Spironolactone- morning of op ACEi/ARB- 24 hours before NSAIDs- 1 week before

Question 31

If haemoptysis what drugs need to stop

Answer 31

Any antiplatelet or anticoagulant

Question 32

When are NSAIDs CI

Answer 32

Renal impairment LVF Clotting derangement GORD etc Asthma

Question 33

If ascites what fluid give

Answer 33

Human albumin solution

Question 34

Bolus give if HF

Answer 34

250ml NaCl

Question 35

Fluids to give if oligouric

Answer 35

NaCl 1L over 2-4 hours

Question 36

In adult weighing over 100kg, how long give maintenance fluids over

Answer 36

8 hours

Question 37

What do with methotrexate in active infection

Answer 37

Withold

Question 38

If acute stroke, what do with VTE prophylaxis

Answer 38

Do not give under any circumstances

Question 39

If oedema on CCB and been given furosemide what need to do

Answer 39

Stop furosemide

Question 40

Acute MI, what is best pain relief

Answer 40

GNT spray

Question 41

How monitor response to addisons tx

Answer 41

WEIGHT

Question 42

When looking at dose what 3 things need to tick off each time

Answer 42

Dose- think about weight Frequency- is it divided? Administration route

Question 43

What can do with insulin if not responding to DKA

Answer 43

Increase by 1 unit/ hour

Question 44

First line emollient for dermatitis like rash

Answer 44

Liquid paraffin ointment Topical As required

Question 45

Dermatitis rash on face, trialled emollient

Answer 45

Hydrocortisone 1% Avoid potent ones on face

Question 46

Extensive dermatitis rash on chest what use

Answer 46

Potent topical corticosteroid- betamethasone valerate 0.025%

Question 47

What do for emergency contraception if taking P450 inducer

Answer 47

Double dose

Question 48

Monitoring LMWH vs UFH

Answer 48

UFH- aPTT LMWH- factor Xa activity if renal impairment

Question 49

Post op how step down opioids

Answer 49

Works in reverse WHO pain ladder If well controlled on regular opioids and not using PRN then can either switch to only PRN or weak opioid

Question 50

P450 inducers

Answer 50

antiepileptics: phenytoin, carbamazepine barbiturates: phenobarbitone rifampicin St John's Wort chronic alcohol intake griseofulvin smoking

Question 51

P450 inhibitors

Answer 51

antibiotics: ciprofloxacin, erythromycin isoniazid cimetidine,omeprazole amiodarone allopurinol imidazoles: ketoconazole, fluconazole SSRIs: fluoxetine, sertraline ritonavir sodium valproate acute alcohol intake

Question 52

DKA fluids in kids: shock vs not shocked

Answer 52

Shock- 10ml/kg over 10 minutes Non- shock- 10ml/kg over 30 minutes

Question 53

How monitor response to antibiotics for pneumonia

Answer 53

RR