NPS foundation term

Question 1

What is a common cause of COPD exacerbation?

Answer 1

Infection; viral URTI and bacterial LRTI. Non infective causes like air pollution and temperature changes can also exacerbate COPD acute

Question 2

What is the rationale for drug use in an acute exacerbation of COPD?

Answer 2

symptom relief and to treat exacerbation

Question 3

How should we treat an acute exacerbation of COPD? (general drugs)

Answer 3

Bronchodilator beta2 agonists and ipratropium bromide (anticholinergic)–> symptom reliefOral corticosteroids shorn recovery and reduce the severity of the acute exacerbationAntibiotic therapy

Question 4

What should we do immediately with an acute exacerbation of COPD?

Answer 4

Provide oxygen via venturi mask (observe in case the patient is a CO2 retainer)

Question 5

What is a multidisciplinary pulmonary rehabilitation program?

Answer 5

Graduated increments in exercise to train skeletal and accessory respiratory muscles. Increase exercise tolerance

Question 6

What medication should we use to treat an acute exacerbation of COPD? (list specific drugs and dose)

Answer 6

salbutamol 100 mg, ipratropium bromide 40mg, doxycycline 100 mg, prednisolone 25 mg, and nicotine if required

Question 7

What are some recommended non drug treatments for acute pulmonary oedema APO

Answer 7

1. restrict salt2. sit the patient upright3. high o2 flow therapy4. restrict fluid 5. CPAP

Question 8

What are some clinical symptoms of APO?

Answer 8

Dypsnoea, tachycardia, poor peripheral circulation, agitation, restlessness, lung crackles widespread, altered conscious state. due to intraalveolar fluid acculmulation and extreme SNS activation

Question 9

How would we treat APO (drugs?)

Answer 9

LMNOPL- Lasex Frusemide (IV) Once only 40mgM- morphine IV every 2 hrs 2.5mg (reduces preload)N- GTN sublingually PRN 600 microgramO- oxygenP- sit up position

Question 10

What do we worry about with APO, and how can we prevent it?

Answer 10

Venous thrombosis embolism–> VTE. VTE prophylaxis= enoxaparin.

Question 11

What can cause delirium in older patients?

Answer 11

UTI, infections, changes in electrolytes, benzodiazapines, digoxin toxicity, diuretics (can cause hyponatremia)

Question 12

What can we give a confused older patient (delirium)

Answer 12

Haloperidol PO 1mg

Question 13

What can cause hyponatremia?

Answer 13

SSRIs, diuretics (indapamide)

Question 14

What are the most effective LDL lowering agents? How much do they reduce LDL levels by? how many times do you take this drug?

Answer 14

Statins. They reduce LDL by 30-50%. Recommended once daily

Question 15

What drug would you take if you had elevated triglyceride levels but not LDL levels?

Answer 15

Fibrates. Fenofibrate, gemfibrizol

Question 16

What are some adverse effects of statins?

Answer 16

Myopathy + elevated liver enzymes

Question 17

When would combination therapy of statins and other lipid modifying drugs be indicated? what are the usual combinations?

Answer 17

When statin mono therapy does not achieve LDL lowering goals. Instead of increasing the dose (which may increase risk of myopathy), we can add ezetimide or fibrates

Question 18

What should be monitored subsequent to commencing statin therapy?

Answer 18

Serum lipids ever 4-6 weeks Adverse effectsLFTs for elevated transaminasesCK- should be measured before starting a statin

Question 19

if we had a patient with an NSAID induced gastric ulcer, but requires NSAID medication for pain relief, then what drug would we prescribe?

Answer 19

Misoprostol 400 mg. However, the best case scenario is getting them off NSAIDs and using another drug class like paracetamol for pain relief

Question 20

What are the drugs of first choice for NSAID induced ulcers?

Answer 20

Proton pump inhibitors.

Question 21

What might happen if you prescribe verapamil and digoxin together? (think additive effect)

Answer 21

Both depress the AV node and so may cause heart block

Question 22

How might diclofenac interfere with the effect of frusemide? What is diclofenac?

Answer 22

Diclofenac may decrease the efficacy of frusemide as NSAIDs cause sodium and water retention and compete for the organic acid secretory pathway of frusemide

Question 23

How might diclofenac cause renal impairment?

Answer 23

Prostaglandin inhibition may be associated with decreased renal perfusion and a decline in kidney function in patients with renal disease

Question 24

What Ace inhibitor is best used to treat HT and cardiac failure?

Answer 24

enalapril

Question 25

For a patient with renal impairment and heart failure, would it be necessary to administer another drug for potassium levels if on loop diuretics?

Answer 25

Potassium supplements are not usually needed in these circumstances. Potassium retention tends to occur in renal impairment and dietary potassium is usually sufficient to replace losses associated with small doses of frusemide. Also, ACE inhibitors used in heart failure are associated with potassium retention because of aldosterone inhibition.

Question 26

is verapamil indicated in cardiac failure? what other drug would you suggest?

Answer 26

Negative inotropes are best avoided in cardiac failure and may contribute to AV block in patients on digoxin. An ACE inhibitor would be a better choice given her heart failure.

Question 27

What happens to verapamil’s bioavailability in liver cirrhosis?

Answer 27

It increases bc its primary mode of metabolism is hepatic metabolism

Question 28

Triple whammy drugs? what do they cause?

Answer 28

Acute renal failure. Ace inhibitor, NSAID and diuretic

Question 29

how to prevent post operative nausea and vomiting preoperatively?

Answer 29

administer dexamethasone prior to anaesthetic

Question 30

how to treat post operative pain and vomiting?

Answer 30

morphine and paracetamol (to reduce opioid dose) and 5HT3 antagonists like ondanestron. Do not give oral form of medication because of vomiting

Question 31

why shouldn’t tramadol be used with pethidine?

Answer 31

risk of serotonin toxicity