Medicine

Question 1

What dies 8.4% sodium aqueous solution mean?

Answer 1

8.4g of sodium per 100ml

Question 2

What does 0.9% saline mean

Answer 2

0.9g of sodium in 100ml

Question 3

1. Write 1 prescription to lower potassium in hyperkalaemia.

2. Write a prescription to protect the heart in hyperkalaemia

Answer 3

1 .date, time… 10UNITS OF ACTRAPID IN 50ml 50% DEXTROSE, IV, OVER 15mins, sign+bleep
2. date, time… 20ml 10% CALCIUM GLUCONATE, IV, OVER 5mins, sign+bleep

Question 4

general principle of fluids

Answer 4

2 sweet, 1 salty.
1L of 0.9% NaCl with 20mmol KCl over 8hrs
1L of 0.9% NaCl with 20mmol KCl over 8hrs
1L of 5% dextrose with 20mmol KCl over 8hrs

Question 5

When to avoid dextrose

Answer 5

head injury e.g. stroke!!!

Question 6

name some low molecular weight heparins

Answer 6

Enoxaparin

Tinzaparin

Question 7

what to monitor with LMWH

Answer 7

platelets

potassium

Question 8

Max length of time before needing INR check?
what time of day is it usually taken?
what about change in dose?

Answer 8

• 12 weeks.
• In morning
• After 2 days

Question 9

What common drugs are used with caution with warfarin

Answer 9

NSAIDs (ibuprofen, aspirin a bit too)

Question 10

How to monitor the response to treatment of diuretics

Answer 10

weight loss

Question 11

How to monitor the response to treatment of ace inhibitors

Answer 11

Exercise tolerance

Question 12

How to monitor the response to treatment of antibiotics

Answer 12

CRP

Question 13

How to monitor the response to treatment of polymylagia rheumatica

Answer 13

ESR

Question 14

How to monitor the response to treatment of HIV meds

Answer 14

HIV RNA levels

Question 15

Digoxin monitoring

• levels taken when
• toxicity Ix
• risks of toxicity

Answer 15

Take 6 hours after last dose.
Toxicity if over 2üg/L
Hypokalaemia increases toxicity risk
Monitor U+E and renal function

If ?toxicity = U+E, digoxin levels and ECGS

Question 16

sick day insulin for T1 and T2 DM

Answer 16

T1DM = Increase quick acting by 10% if BM between 10-13mmol/L
Monitor ketones
T2DM = Increase insulin by 20% if BM between 10-15mmol/L

Question 17

Prescription of morphine for pain

Answer 17

10mg every 4 hours.

Question 18

Rescue opioids for breakthrough pain

Answer 18

1/6 to 1/10 of background dose.

Question 19

how much to increase morphine by

Answer 19

1/2 to 1/3

Question 20

Meaning of co-codamol 8/500

Answer 20

500g paracetamol

8g codeine

Question 21

max paracetamol dose for a day

Answer 21

4g

Question 22

How to increase levothyroxine

Answer 22

By 25micrograms a change

Question 23

ADR of carbimazole and monitoring

Answer 23

FBC as can cause neutropenia and agranulocytosis

Question 24

When to take lithium levels

Answer 24

trough = 12 hours after last dose. Can delay morning dose to take sample

Question 25

gentamicin monitoring

Answer 25

Peak concentration = sample 1hr after last dose. If this is high (over 10mg'L) REDUCE dose. Trough concentration = sample taken before administration of next dose. If high (over 2mg/L), INCREASE time between doses.

Question 26

Long term steroids and sick day rules

Answer 26

double dose of steroids when acutely unwell.

Question 27

Paracetamol OD. - dose which is toxic - use of NAC

Answer 27

- > 150mg/kg within 1 hour. - Use empirically if presenting after 8hrs of ingestion. - Can only use NAC after paracetamol levels after 4hrs of ingestion are known and compared to nomogram. - Give if staggered OD (longer than 1hr). BNF = Poisoning, emergency treatment

Question 28

BIPHASIC INSULIN REGIME. 1. HIGH BM before lunch/dinner? 2. HIGH BM before bed/breakfast 3. LOW BM before lunch/dinner? 4. LOW BM before bed/breakfast

Answer 28

1. Increase breakfast dose by 10% 2. Increase evening meal dose by 10% 3. Reduce breakfast dose by 10% 4. Reduce evening meal dose by 10%

Question 29

What reduction in what parameter do you want to see with statin use and what to do if it is wrong?

Answer 29

``` What to see a 40% REDUCTION in the NON-HDL cholesterol. If not achieved: 1. check adherence. 2. increase atorvastatin dose 3. consider ezetimibe ```

Question 30

Monitoring of LFT and creatinine kinase with statins

Answer 30

- LFTs - look at transaminases, if OVER 3X UPPER NORMAL LIMIT, stop! - CK - if OVER 5X UPPER NORMAL LIMIT, stop!

Question 31

Man got severe diarrhoea, what should he do with metformin meds?

Answer 31

If severe D+V, consider stopping metformin.

Question 32

Adrenaline: 1. 1 : 10,000 meaning? 2. 1 : 1000 meaning?

Answer 32

1. 100micrograms/ml --> 1 mg in 10 mL | 2. 500micrograms/0.5ml --> 1mg/ml

Question 33

BASAL BOLUS INSULIN: 1. What time of day will tell you whether their pre-lunch bolus is right? 2. What time of day will tell you whether their post-breakfast dose is right? 3. What time of day will tell you whether their evening meal dose is right?

Answer 33

1. Pre-evening meal BM 2. Pre-lunch 3. Bedtime

Question 34

Name 5 drugs which increase risk of hyperglycaemia

Answer 34

Steroids, anti-psychotics, tacrolismus, beta-blockers, thiazide diuetics.

Question 35

Name 6 drugs which increase risk of raised cholesterol

Answer 35

``` Systemic steroids Diuretics (thiazide and loop) Most antipsychotics Cyclosporine (and less frequently tacrolimus) Most HIV medications SGLT2 inhibitors (-flozins) ```

Question 36

Drugs to be used in caution in heart failiure

Answer 36

Pioglitazone Verapamil NSAIDs

Question 37

How many mmol of K in 0.15% and 0.3% KCl?

Answer 37

0. 15% = 20mmol/L | 0. 3% = 40mmol/L

Question 38

What to do with the patients insulin regime in DKA

Answer 38

Stop short acting Continue long acting Start a fixed rate IV insulin infusion.

Question 39

Mx for 1st case and 2nd case of c.diff

Answer 39

``` 1st = Metronidazole 2nd = Vancomycin ```

Question 40

Good drugs for post-op nausea

Answer 40

``` Cyclizine (no QT effects) Ondansetron Promethazine Prochlorperazine BNF treatment summaries = DROPERIDOL but should only be prescribed by specialist for PONV ```