More random past paper qs Flashcards
Paediatric paracetamol dosing (under 6)
120 mg/5 mL
2-12 months - 2.5 mL
12-24 months - 5 mL
2-4 years - 7.5 mL
4-6 years - 10 mL
Paediatric paracetamol dosing (over 6)
250 mg/5 mL
6-8 years - 5 mL
8-10 years - 7.5 mL
10-12 years - 10 mL
Paediatric ibuprofen dosing (for general pain/fever)
100 mg/5 mL
3-6 months - 2.5 mL 7-12 months - 2.5 mL up to FOUR times a day 1-3 years - 5 mL 4-6 years - 7.5 mL 6-9 years - 10 mL
Paediatric ibuprofen dosing (post-immunisation pyrexia)
For all children aged 3 and up:
2.5 mL of 100 mg/5 mL, followed by 2.5 mL 6 hours later if required
(If second dose doesn’t work, see GP)
Which administrative route should be avoided when using vinca alkaloids?
Intrathecal
should only be administered via IV
What can be given to treat cellulitis (first-line) if the infection is NOT on the face?
Flucloxacillin
Clarithromycin/doxycycline if pen allergic
Erythromycin if pregnant
What can be given to treat cellulitis (first-line) if the infection IS on the face (near eyes/nose)?
Co-amoxiclav
If unsuitable: clarithromycin with metronidazole
What cautionary label(s) are needed on lansoprazole?
Do not take indigestion remedies 2 hours before or after you take this medicine (2)
Take 30 to 60 minutes before food (22)
Swallow this medicine whole. Do not chew or crush (25) - for GR caps only
What is required on a dispensing label for it to be legal?
Patient name Drug name Instructions for administration Name and address of dispensary Date of dispensing Warning labels KOOSAROC
What drugs interact with emergency hormonal contraceptives?
CYP inducers can reduce their efficacy
Remember: BS CRAP GPS
Barbiturates St John's Wort Carbamazepine Rifampicin Alcohol (chronic) Phenytoin Griseofulvin Protease inhibitors Sulfonylureas/Smoking
Which beta-blockers are hydrophilic? What does this mean for their pharmacokinetics and side-effect profile?
Celiprolol
Atenolol
Nadolol
Sotalol
Renally excreted (doses should be adjusted in renal impairment) Less likely to cross the BBB, and therefore less likely to cause nightmares
How many days after UPSI is levonorgestrel (Levonelle) most effective?
3 days
How many days after UPSI is ulipristal (EllaOne) effective?
5 days
What are some symptoms of hand, foot and mouth disease?
Sore throat
Not wanting to eat
Fever
Followed by mouth ulcers and blisters/rashes on palms and soles of feet
How is hand, foot and mouth disease treated?
Plenty fluids and OTC paracetamol/ibuprofen
Viral infection so NO antibiotics
What are the monitoring requirements for lithium?
Before initiation:
Renal, cardiac and thyroid function
BMI, U&Es, FBC
ECG if pt has CVD/risk factors
Every 6 months:
BMI, U&Es, eGFR, FBC
(more often if evidence of impairment)
Cardiac function - regular
How soon after a lithium dose should levels be taken? What is the target range?
12 hours,
0.4 - 1 mmol/L
What should people taking lithium be aware of?
Look out for: Lithium toxicity Hypothyroidism Renal dysfunction Benign intracranial hypertension
May impair skilled tasks
Why shouldn’t thiazide diuretics and lithium be used together?
Thiazides can
→ increase risk of HYPOkalaemia
→ increase the plasma conc. of lithium
Are faxed Rxs valid?
No - not indelible ink
Pharmacist can use their discretion to mitigate risks and supply, unless CD Sch 2 or 3 (illegal to supply)
What is Zika virus?
A disease spread by mosquitos lasting 2-7 days; mild and not harmful (unless pregnant)
NOT a notifiable disease
What electrolyte balances can loop diuretics cause?
HYPO everything (K, Na, Mg, Ca)
What electrolyte balances can thiazide diuretics cause?
HYPOkalaemia
At higher doses, it can also disrupt:
Na+, uric acid, glucose and lipids
What electrolyte balances can thiazide-like diuretics cause?
HYPERcalacaemia
HYPO K, Na and Mg
What electrolyte imbalances can aldosterone antagonists cause?
HYPERkalaemia
HYPO Mg and Na
What are levels of renal function as determined by eGFR (mL/min/1.73 m²)?
>90 - high 60-89 - mild 45-59 - mild/moderate 30-44 - moderate/severe 15-29 - severe <15 - renal failure
Who can receive free NHS prescriptions?
Aged > 60 Aged < 16 Aged 17/18 and in full-time education On benefits/low income scheme Receiving war pension Medical exemption certificate Pre-paid certificate Pregnant (w/ a maternity exemption certificate)
Who can receive the flu jab for free?
Aged >50 High-risk due to comorbidities Pregnant Live with immunocompromised person(s) Care home residents Healthcare workers
What are some risk factors of osteoporosis?
Post-/ early menopause Long-term use of steroids Old age Low BMI Smoking/drinking Parental Hx of fractures Co-morbidities e.g. RA, diabetes
BMI ranges :/
<18.5 - underweight
18.5-24.6 - heathy 🤨
25-29.9 - overweight
30-39.9 - obese
What happens when naproxen is taken with sertraline?
Increased risk of bleeding
Increased likelihood of hypoNa
What happens when naproxen is taken with steroids?
Increased risk of GI bleeding - caution (avoid with [methyl]prednisolone)
When are bisphosphonates contraindicated?
Oesophageal abnormalities
Hypocalcaemia
Factors which delay emptying e.g. stricture
ClCr < 35 mL/min
When should bisphosphonate use be reviewed?
Every 5 years (3 years with zoledronate)
What are the major side effects of amiodarone?
P BITCH 🤭
Photosensitivity Breathing (pulmonary toxicity) Irregular HR (arrhythmia) Thyroid dysregulation Corneal microdeposits Hepatotoxicity
What interacts with amiodarone?
It’s a CYP inhibitor!
Warfarin - can increase INR so dose needs to be reduced by 1-2 thirds; monitor
Digoxin - can cause toxicity so dose needs to be halved; monitor
Also:
drugs that cause hypoK/QT prolongation
grapefruit juice
simvastatin
beta-blockers
Which statin does not need to be taken at night?
Atorvastatin, due to its longer half life
What is oxybutinin?
An antimuscarinic used for urinary frequency, urgency or incontinence
Which antidiabetics cause weight gain?
Remember: eating PISza makes you biggger
Pioglitazone
Insulin
Sulfonylureas (gli-)
Which antidiabetics cause weight loss?
Remember: Gotta Lose Some Gravity
GLP-1s (-glutide) SGLT2 inhibitors (-flozin)
Which antidiabetics have a high[er] risk of hypoglycaemia?
Insulin
Sulfonylureas (higher in older people)
What are some symptoms of hypoglycaemia?
Remember: Plasma SHugar Drops SPLAT
Palpitations Sweating Hunger Dizziness Shaky/trembling Pale skin Lips - tingly Anxiety Tiredness
Why are beta-blockers cautioned in diabetes?
They can mask symptoms of hypoglycaemia
Which antipsychotics are more likely to cause weight gain and glucose intolerance?
2nd generation (-pine, -one): quetiapine, clozapine, asenapine, olanzapine risperidone, paliperidone, aripiprazole
Which antipsychotics are more likely to cause EPSEs and hyperprolactinaemia?
1st generation (-zine, -ol) chlorpromazine, levomepromazine, prochlorperazine haloperidol, flupentixol
NOT promethazine (an antihistamine)!
How long should a record of a veterinary POM supply be kept for? What needs to be recorded?
5 years
Name of medicine Date of receipt/supply Batch no. Name and address of receiver/supplier [Also, keep copy of Rx]
What is cabergoline?
A dopamine receptor agonist, used to treat hyperprolactinaemia
What is donepezil?
An acetylcholinesterase inhibitor used in treatment of dementia
A patient who was recently initiated on phenytoin develops a rash. What should you do?
Withdraw; encourage them to seek medical attention
[Possible leucopenia - patients should be made aware of symptoms of blood/skin disorders (flu-like symptoms) and report ASAP]
Criteria for gradual withdrawal of steriods
> 40 mg OD for ≥ 1 week
Repeat evening doses
3 weeks of treatment
Recently repeated courses
Short course within 1 year of stopping long term Tx
Other possible causes of adrenal suppression
Which antiemetic is suitable for use in Parkinson’s?
Domperidone (doesn’t cross BBB, less EPSEs)
What are some MOA inhibitors?
Remember: Mr PITSR
Moclobemide Phenelzine Tranylcypromine Selegiline Rasagiline
What antibiotics can be taken with/after food?
Remember: Molly’s Nice Cheesy PIzza
Metronidazole
Nitrofurantoin
Clarithromycin
Pivmecillinam
What antibiotics should be taken on an empty stomach?
Remember: POFAT
Phenoxymethylpenicillin Oxytetracycline Flucloxacillin Azithromycin caps Tetracycline
What are some examples of aminoglycosides?
Remember: NTAGS
Neomycin Teicoplanin Amikacin Gentamicin Streptomycin
What is the target plasma concentrations for gentamicin and amikacin?
Peak:
5-10 mg/L (3-5 mg/L for endocarditis)
Trough
>2 mg/L (1 mg/L for endocarditis)
Which medicines are ototoxic?
Remember: My Great Cousin [is] Very Very Loud
Macrolides Gentamicin Cisplatin Vancomycin Vinca alkaloids Linezolid
What medicines can increase the concentration of lithium?
Remember: Lily And Stacey Need Managing
Loop diuretics ACEis Spironolactone NSAIDs Methotrexate
Which medicines can cause blood disorders?
Remember: Take Care, Sally-Mae
Tacrolimus
Co-trimoxazole
Sulfasalazine
Mesalazine
Which cephalosporins are 1st gen?
Remember: cefa-
Cefalexin
Cefadroxil
Cefradine
Which cephalosporins are 2nd gen?
Remember: 2 FOXes FOR tea
Cefuroxime
Cefaclor
Which cephalosporins are 3rd gen?
Remember: contains T except cefixime
Cetriaxone
Cetfotaxime
Ceftazidime
Cefixime
How long should a patient wait before drinking alcohol after a course of metronidazole?
48 hours
What two drug classes can increase the risk of side effects of quinolones?
NSAIDs - increase the risk of seizures
Steroids - increase the risk of tendon damage
Outline antibiotic treatment for UTIs.
Men:
nitrofurantoin OR trimethoprim, 7 days
Pregnant women:
nitrofurantoin, 7 days
waiting for culture? - cefalexin, 7 days
Non-pregnant women:
nitrofurantoin OR trimethoprim, 3 days
Avoid nitro if eGFR < 45
Can trimethoprim be taken in renal impairment?
Yes - dose needs to be halved after 3 days if eGFR = 15-30
Outline antibiotic treatment for human/animal bites.
1st line: co-amoxiclav
PA/CI’d: metronidazole AND doxycycline
3 days for prophyx
5 days for Tx
Outline treatment for acute otitis media.
1st line: amoxicillin
PA/CI’d: clarithromycin/erythromycin
2nd line: co-amox
Tx should last 5-7 days
Outline treatment for otitis externa.
1st line: acetic acid 2%, 7 days
OR topical neomycin, 7-14 days
Cellulitis? - flucloxacillin, 7 days
What is the maximum length of time parenteral aminoglycosides can be used for?
7 days
Outline treatment for C. difficile infection.
1st line: vancomycin
2nd line: fidaxomicin
3rd line: vanc +/- metronidazole
10 days
Trimethoprim interactions
ACEis, ARBs, NSAIDs, diuretics, ciclosporin - increased risk of hyperK
Aciclovir - nephrotoxicity
SSRIs, NSAIDs, carbamazepine, amitriptyline - increased risk of hypoNa
Methotrexate - risk of haematologic SEs e.g. bone marrow suppression
