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My Pham Notes > Mixed Qs > Flashcards

Mixed Qs Flashcards

1
Q

Furosemide & bumetanide (loops) interactions

Gentamicin + furosemide
Lithium + furosemide
NSAID + furosemide
Phenytoin + furosemide

A

Ototoxicity / nephrotoxicity
Lithium toxicity
HF
Diuretic effect reduced

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2
Q

Can Loops (furosemide or bumetanide) cause pancreatitis ?

A

Yes can also cause gout, diabetes, deafness, cramps

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3
Q

Which of the following eye drops cause brown pigmentation, blepharitis, dry mouth/ drowsiness? blepharoconjunctivitis?

Betaxolol
Brinzolamide
Latanoprost
Brimodine

A

Latanoprost- brown pigmentation
Betaxolol- blepharoconjunctivitis
Brinzolamide- blepharitis
Brimodine- dry mouth, drowsiness

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4
Q

Which antibiotics cause c diff?

A

Clindamycin
Cephalosporins
Broad spectrum penicillin
Fluoroquinolones
PPIs

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5
Q

With amiodarone every 6 months you should do what monitoring?

A

Thyroid
before start of treatment + 6 months + 12 months after stopping treatment
Liver function before start of treatment + 6 months

Chest X-ray before treatment
K before treatment

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6
Q

Does beclometasone inhaler need to be prescribed by brand ?

A

Yes such as Qvar/ clenil

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7
Q

Can inhaled corticosteroids be taken during pregnancy?

A

Yes as normal

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8
Q

When should a steroid card with beclometasone be provided ?

A

Prolonged high doses > 1000mcg

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9
Q

Interaction
nitrate + sildenafil

A

Severe HYPOtension or Myocardial infarction

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10
Q

Interaction with grapefruit ?

A

Clopidogrel
Felodipine
Amiodarone
Sertraline
Simvastatin
Amlodipine

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11
Q

Interaction ciprofloxacin + methotrexate

A

methotrexate toxicity

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12
Q

Interactions
Trimethoprim + ciclosporin

A

Nephrotoxicity

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13
Q

Many drugs should be given on the day of surgery even when the patient is nil by mouth. Which medications should you omit?

A

OMIT:.
NSAIDs
ACEi
AIIRAs
Diuretics
Antiplatelets /anticoagulants
Lithium
meds not essential in the short term. eg. vitamins, iron, laxatives,
osteoporosis treatment, liquid antacid medicines (eg gaviscon), HRT, anti- histamines,
herbal remedies or homeopathic medicines
Diabetic alt meds need to be prescribed

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14
Q

colchicine dosing for gout

A

500mcg 2-4 times a day until symptoms relieved
max 6mg /course
do not repeat course within 3 days

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15
Q

Lithium can cause hypo/hyperthyroidism, so do not confuse with lithium toxicity symptoms

A

lithium toxicity= vomiting diarrhea
visual disturbances
incontinence (polyurea)
fine tremor
confusion/drowsiness
hypernatremia
seizures
bradycardia
cardiac arrhythmias

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16
Q

Hydroxychloroquine used in malaria and RA

A

safety info- risk of CVD events
Retinopathy- monitoring required annually if been on medication for 5 years
QT prolongation

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17
Q

UPPER Respiratory tract infection
what do you to give Adults? pregnancy? children?

Lower RTI- Amoxycillin, doxycycline Clarithromycin

A

Adults- phenoxymethylpenicillin
allergic then clarithromycin

Pregnancy - Erythromycin

Children-phenoxymethylpenicillin
allergic then clarithromycin

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18
Q

How often should the safety and efficacy of pioglitazone be reviewed?

A

risk of bladder cancer, review every 3-6 months

patients should be advised to report promptly any hematuria, dysuria, urinary urgency during treatment

discontinue if jaundice occurs

HF= discontinue

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19
Q

Leflunomide used in RA

A

ESSENTIAL to be on contraception 2 years AFTER treatment for women and 3 months for men

Hepatotoxic!

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20
Q

Can you give hydrocortisone to be applied on ears or infected skin?

A

Hydrocortisone can be applied to the ears not the face.

It can be used in irritant dermatitis but not on infected or broken skin

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21
Q

Strength of adrenaline for different age groups

A

Adrenaline injection 1mg/ml
0-6m 100-150 mcg
6m 150 mcg
6 yrs 300mcg
12+ 500mcg

repeated after 5 minutes if necessary

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22
Q

If INR is above 8 regardless of bleeding or not

A

Then give repeated dose of Phytomenadione if INR still too high AFTER 24 hours

however, if INR is below 8, no repeat doses of Phytomenadione, just wait to restart once INR falls below 5

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23
Q

What is the wash out period for sertraline?

A

Sertraline - 2 week washout period
SSRI- 1 week wash out period

MAOIs require 2 weeks washout period
Moclobemide requires no washout period

Fluoxetine- 5 weeks
Imipramine, clomipramine- 3 weeks
TCAs- 1-2 weeks

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24
Q

Hypersalivation can be treated with hyoscine ____?

A

hyoscine hydrobromide provided the patient isn’t at risk from additive antimuscarinic side effects of hyoscine + clozapine

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25
Q

which sweeteners are sugar free?

A

ALL the ol’s
mannitol
sorbitol
xylitol

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26
Q

CD2
Methylphenidate (ADHD)
Specify brand
Concerta XL
Equasym XL
Medikinet XL

A

Stunt growth (children)
Weight loss, decrease appetite
HTN
Tic
Alopecia

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27
Q

Patient on cyclophosphamide and gets UTIs etc
why is Mesna prescribed?

A

Mesna used to treat cytotoxic induced urethral toxicity

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28
Q

Can Antimuscarinics be given in gastro-intestinal obstruction?

A

Antimuscarinics are contraindicated in gastro-intestinal obstruction, urinary retension, paralytic ileus, toxic megalon, urinary retention, significant bladder outflow obstuction

Darifenacin
Fesoterodine
Oxybutynin
Tamsulosin
Tolterodine
Trospium

29
Q

when to avoid Nitrofurantoin?
Trimethoprim?

A

Nitrofurantoin- avoid at term

Trimethoprim avoid at 1st trimester

30
Q

Interaction
Lithium + Furesomide

A

hypokalaemia

31
Q

Does Filgrastim (stimulates production of neutrophils) cause hyper or hypo uricemia?

A

HYPERuricemia

Avoid in pregnancy

32
Q

Topiramate (antiepileptic)

A

Vision disorders

33
Q

Patient on ACE inhibitor in
combination with NSAIDs

A

Patient on ACE inhibitor which in
combination with NSAIDs
increases risk of kidney injury.
DAMN

Diuretics
ACEi/ARBS/ aminoglycosides
Metformin
NSAIDs

34
Q

On metformin (one drug)

hypoglycaemic agent (sulfonylureas) or 2 and more drugs

A

< 48mmol

<53 mmol

35
Q

Which statins are taken anytime during the day?

A

Atorvastatin or Rosuvastatin

36
Q

interaction
Alcohol + atorvastatin

A

Hepatotoxicty

37
Q

How old do you have to be to take domperidone for N+V ?

A

domperidone 10mg TID
>12 years
>35kg
max 1 week
side effect- dry mouth

metoclopramide 10mg TID
>18
max 5 days
(IV dose should only be administered as slow bolus over 3 minutes)

38
Q

Tiaprofenic acid + cystitis?

A

Due to reports of severe cystitis, the CSM has recommended that tiaprofenic acid
should not be given to patients with urinary tract disorders. Topical NSAIDs can be
used to substitute or supplement paracetamol for knee or hand osteoarthritis. If
paracetamol and/or topical NSAIDs are ineffective, consider oral NSAIDs or weak
opioids

39
Q

How do you administer drugs likely to cause extravasation?

A

central line

40
Q

where is GTN patch placed in respect to cannula and why?

A

place distal to cannula to improve patency of the vessel in patient with small veins

41
Q

Evidence Hierarchy

A

Systematic reviews
Meta analysis
RCT
Cohort

42
Q

Interaction-
methotrexate + trimethoprim

A

Nephrotoxicity
Both antifolates, so reduction in folate means methotrexate side effects thus concurrent use of trimethoprim and methotrexate can also increase the risk of nephrotoxicity

43
Q

HTN: second line for anyone >55 or Afro caribbean is

A

1st line CCB
2nd line ACE/ARB

ARB preferred in Afro-carribean

44
Q

NSAID + prednisolone

A

GI complications

45
Q

Ferritin level range?

A

15-200

46
Q

WBC

A

4 -11

47
Q

Total cholesterol

A

< or equal to 5

48
Q

which drugs should be stopped when patient is sick?

A

D iuretic
A CE/ARB
M etformin
N SAID
S GLT2

49
Q

hypoglycaemic? <4 mmol/L

A

15-20 g of fast acting carbohydrate

3/4 heap tea spoons of sugar dissolved in water
4-7 glucose tablets

150-200ml pure fruit juice

50
Q

missed dose of lithium

A

more than 6 hours then skip missed dose and take usual dose at usual time

51
Q

Interaction
metronidazole + warfarin

A

increased risk of bleeding

52
Q

Mastitis in pregnancy

A

1st line
10-14 days
flucloxacillin
pen allergy = erythromycin

53
Q

LITHIUM monitoring

A

Lithium beet it!

BMI
Electrolytes
EGFR
Thyroids

6 months

54
Q

Methotrexate monitoring
Faryal makhdoom 3 kids

A

F BC
R enal
L iver

1-2 weeks intially
2-3 months once stable

55
Q

Amiodarone monitoring

A

c hest x ray
u potassium
L iver every 6 months
T hyroids every 6 months

56
Q

Statin monitoring

A

H bA1c
U and Es
L iver
T thyroid

Liver 3m and 12m

Ck above 5 -don’t start
Liver above 3 -stop

57
Q

Nystatin dose

A

1ml QDS a day AFTER food - 7 days
Continue for 48 hours after condition resolved

58
Q

Vidagliptin

A

Liver + pancreatitis counselling

59
Q

Risk factors for developing AKI

A

65+
eGFR<60
Heart failure
Liver disease
Diabetes
Hx of AKI
Oliguria
Sepsis
Dementia
Hypovalaemia
DAMN
Aminoglycosides
Iodine based contrast media within past week
Hx of urological obstruction
Deteriorating early warning scores

60
Q

Yellow fever vaccine

A

Do not give to immunosuppressed HIV infected individuals
Single dose
Live attenuated vaccine

61
Q

Tamoxifen OD

A

Reduces risk of breast cancer
Increases risk of endometrial cancer
Increases risk of DVT - swollen leg
Paroxetine reduces effectiveness of tamoxifen

Common side effect is hot flush

62
Q

Acyclovir

800 mg 5 times a day for 7 days

A

Varicella zoster (chickenpox)

Herpes zoster (shingles)

63
Q

MAOIs interactions

A

The following predispose patients to hypertensive crisis when
used with MAOI:
Tyramine rich foods
Ephedrine and pseudoephedrine
Levodopa
Stimulants g methylphenidate and amphetamine

The following predispose patients to serotonin syndrome
when used with MAOI:
Tramadol
Other antidepressants

The following predispose patients to CNS excitation or
depression when used with MAOI:
Tramadol
Pholcodine
Opioids

Avoid the above during MAOI treatment and for 14 days
after stopping the MAOI

64
Q

Migraine

A

Migraine treatment
Triptan

Migraine prophylaxis
P ropanolol
A mitriptyline
T opiramate (teratogenic)

65
Q

ductus arteriosus

A

Indometacin or ibuprofen can be used to close the ductus arteriosus

66
Q

Omeprazole fights with mESsI

A

W arfarin
M ethotrexate
E someprazole
C lopidogrel
c
I
Talopram

67
Q

Hypothyroidism

A

Levothyroxine

Liothyronine - emergency 🚨

68
Q

Methotrexate interaction
Faryal
Peng actually Needs to chill out

A

NSAIDs
Penicillins Amoxicillin 🚨
Trimethoprim
Omeprazole
Citalopram

69
Q

Increase dose of Morphine to max dose
Daily dose 100mg

A

Max 1/2
Min 1/3

100 * 0.5 = 50

50 + 100 = 150mg

My Pham Notes (22 decks)

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