Important drug information

Question 1

Recommended times to take diuretics

Answer 1

In the morning + early afternoon to avoid nocturia

Question 2

When is it best to take the first dose of ACEi or ARBs?

Answer 2

Before bed to reduce hypotension

Question 3

Which anti-hypertensive should electrolytes and renal functioning be monitored for?

Answer 3

ACEi and ARBs - creatinine, eGFR and K+

Question 4

Who can prescribe amiodarone?

Answer 4

Senior staff (unless at a cardiac arrest when a bolus injection is given)

Question 5

What drink should patients on amiodarone avoid?

Answer 5

Grapefruit juice

Question 6

When should aspirin be taken?

Answer 6

After food to avoid gastric irritation

Question 7

Should aspirin be used for primary or secondary prevention of vascular events?

Answer 7

Secondary - the absolute risk of serious vascular events is low and benefits are outweighed by risk of serious bleeding

Question 8

Route of administration for heparin

Answer 8

Subcutaneous injection

Question 9

When is warfarin usually administered?

Answer 9

Around 6pm once daily for consistent effects on the INR taken the following morning

Question 10

What is the INR?

Answer 10

International normalised ratio - prothrombin time of someone on warfarin divided by that of a non-warfarin control - should be 2.0-3.0 in AF and VTE

Question 11

What should patients needing immediate anticoagulation start with?

Answer 11

Heparin (fast onset) + Warfarin

Question 12

What do warfarin patients carry with them?

Answer 12

Yellow book - acts as an alert to their warfarin therapy and is use to record doses, blood tests, treatment indication and duration

Question 13

When are statins usually administered?

Answer 13

Once daily in the evening, as they have greater effect when dietary intake is at its lowest

Question 14

Why should grapefruit juice be avoided with statins?

Answer 14

It inhibits cytochrome P450, so increases risks of adverse effects

Question 15

When prescribing a nebuliser what must you always indicate?

Answer 15

Whether the nebuliser should be driven by oxygen (asthma) or air (COPD)

Question 16

What is a reservoir mask?

Answer 16

Critical illness or sats <85%:

Bag that is continuously filled by incoming oxygen supply, containing at least 60-80% oxygen at a rate of 15L/min

Question 17

What is a venturi mask?

Answer 17

Patients in chronic Type 2 respiratory failure:
A blend of oxygen with air at a fixed ratio. The oxygen concentration (28%) + flow rate are indicated by the colour of the device

Question 18

What are nasal cannulae?

Answer 18

Patients who need oxygen but are not critically ill:

Deliver variable oxygen concentrations at 2-6L/min

Question 19

What should be indicated when prescribing O2?

Answer 19

Target O2 sats range:
94-98% in most patients
88-92% in Type 2 failure

Question 20

Why should only a small quantity of amitriptyline be supplied?

Answer 20

Reduce risk of overdose, especially in suicidal people

Question 21

How long should SSRIs be prescribed for after symptoms of depression have gone?

Answer 21

6 months or 2 years for recurrent depression

Question 22

Which benzodiazepine is used for which indication?

Answer 22

Seizures: IV diazepam or lorazepam
Alcohol withdrawal: diazepam (long-acting)
Sedation: midazolam (short-acting)
Insomnia + anxiety: temazepam

Question 23

Why should DA therapy not be stopped suddenly?

Answer 23

Deterioration in symptom control and may precipitate neuroleptic malignant syndrome (fever, muscular rigidity, altered mental state)

Question 24

What should be discussed with females taking anticonvulsants?

Answer 24

Contraception + pregnancy

Question 25

What are the driving rules for epilepsy?

Answer 25

Do not drive unless seizure free for 12 months or for 6 months after changing or stopping treatment

Question 26

What is the benefit of newer anti-convulsants?

Answer 26

Lamotigrine + Levetiracetam (Keppra) may be better tolerated (but no evidence they are more effective)

Question 27

What time of day should amitriptyline be taken and why?

Answer 27

Night time because it causes sleepiness (can get a hangover effect the next morning)

Question 28

Which cardiac drug can be used to treat anxiety?

Answer 28

Propanolol - up to 3x per day (but BP must be monitored)