MFE Flashcards
The pharmacist flags a patient in a local nursing home to you for polypharmacy review due to a number of high-risk medications.
The patient’s prescription includes amitriptyline, oxybutynin and tramadol. You decide to assess the patient for any side effects of these medications.
Which symptom would make you concerned that these medications were resulting in side effects?
A - Ankle swelling
B - Frequent urination
C - Blurred vision
D - Cough
E - Diarrhoea
C - Blurred vision
Which of the following medication pairs is an example of a polypharmacy prescribing cascade?
A - amlodipine and bisoprolol
B - spironolactone and sando K
C - digoxin and azithromycin
D - simvastatin and clarithromycin
E - aspirin and lansoprazole
E - aspirin and lansoprazole
AN 82-year-old patient with Parkinsons attends their routine review appointment. She had an elective knee replacement 3 months ago and has been less active. Their Parkinson’s motor symptoms are stable but on discussing non-motor symptoms she is only moving her bowels every 3 days, passing very large Type 4 Bristol Stool Scale stool. Prior to her knee replacement she moved her bowels every day usually and she would like to get back to this. She has a good fluid intake and a balanced diet. Her abdomen is soft and non-tender with normal bowel sounds. She is on levodopa 3 times a day, paracetamol 4 times a day and laxido one sachet ones a day.
What would be the pharmacological therapy of choice to optimise her bowels movements?
A - Change laxido to lactulose
B - Add Fybogel as required
C - Change laxido to docusate
D - Add senna tablets
E - Increase Laxido to twice a day
D - Add senna tablets
A 72-year-old retired nurse reports worsening back pain. The pain is described as “aching” and she point to her lumbar spine. The pain is present throughout the day, worse when moving and standing, and also causes difficulty sleeping. She has a past history of osteoarthritis, gastric ulcer (2020) and gastro-oesophageal reflux. Neurological examination is normal. Recent bloods show normal renal and liver function.
Medications are amitriptyline (20mg at night), omeprazole (20mg twice daily), and paracetamol (1g four times daily).
What prescription change would you advise?
A - Switch amitriptyline to pregabalin 25mg twice daily
B - Increase amitriptyline to 30mg at night
C - Start codeine 30mg four times daily
D - Start morphine sulphate modified release 5mg twice daily
E - Start naproxen 250mg twice daily
C - Start codeine 30mg four times daily
A 74-year-old man with multiple falls is assessed following a fall when getting out of bed. He is unhurt but is concerned about further falls. He reports he feels dizzy when he gets out of his chair.
Observations: HR 85bpm irregular, respiratory rate 14 breaths/min, oxygen saturations 98% on air, temperature 37.0. Lying his BP is 125/90, standing it is 115/80 (immediately), 100/78 (at 1minute), 112/80 (at 3minutes).
Past medical history: atrial fibrillation, benign prostatic hypertrophy, depression, essential hypertension, and myocardial infarction (2018)
Medications:
bendroflumethiazide (2.5mg once daily), bisoprolol (2.5mg once daily), edoxaban (60mg once daily), sertraline (100mg once daily), tamsulosin modified release (400mg once daily)
What prescription change would you advise?
A - Stop tamsulosin
B - Reduce bisoprolol
C - Stop bendroflumethiazide
D - Reduce sertraline
E - Stop edoxaban
C - Stop bendroflumethiazide
