Official Mocks Flashcards
What is the first line treatment/dose for pulmonary oedema secondary to heart failure?
Furosemide 10 mg/mL injection (INTRAVENOUS)
The correct dose is 20-50 mg IV as a once only dose. Doses below 20 mg score zero. Doses above 50 mg up to 100 mg would be effective but unnecessarily high (deduct 1 mark). The IM route would be less effective (deduct 1 mark)
Via which route should furosemide be given in acute pulmonary oedema?
Intravenous!!!
What is the first line prophylaxis regimen for patients undergoing an elective hip replacement?
Patients undergoing an elective hip replacement should be given thromboprophylaxis with either a low molecular weight heparin administered for 10 days followed by low-dose aspirin for a further 28 days, or a low molecular weight heparin administered for 28 days in combination with anti-embolism stockings until discharge, or rivaroxaban .
If these options are unsuitable, apixaban or dabigatran etexilate can be considered as alternatives. If pharmacological prophylaxis is contra-indicated, anti-embolism stockings can be used until discharge.
What dose of rivaroxaban is used for patients undergoing elective hip replacement?
10mg PO daily
What IV fluid should be given in a hypoglycaemic patient?
Glucose 10% is first line IV treatment of hypoglycaemia. If glucose 10% is not available, glucose 20% is a suitable alternative.
Infusions of 10% (100-200 mL) or 20% (50-100 mL) deliver between 10-20 g of glucose.
Infusion rates up to 20 minutes are optimal and score full marks.
Glucose 50% is hypertonic and so risks extravasation, and should not be used. Glucose 5% is too weak and so a large volume would be required and this would be impractical.
What volume of IV glucose 10% should be given in hypoglycaemic patients? Over what time?
100-200ml
NOTE: this provides 10-20g glucose
Can be given at a rate of 2 mins - 20 mins (no more than that!)
Found under ‘Medical Emergencies in the Community’ treatment summary
What is the dose of lymecycline in acne?
408mg PO daily
Has the advantage of once daily dosing and there is no need to take the tablets at specific times of day e.g. with meals.
What are the standard doses of tacrolimus?
Tacrolimus (Prograf®) capsules are available as 500 micrograms, 1 mg and 5 mg.
Initial doses post transplant are 200-300 micrograms/kg
Maintenance doses may commonly be in the range 1-2 mg PO 12-hrly.
What is wrong with the following prescription: tacrolimus (Prograf®) 1 g oral (PO) twice daily (12-hrly)?
Should be MILLIGRAMS
What electrolyte abnormality may be seen in heparin use?
Hyperkalaemia
Due to inhibition of aldosterone synthesis.
What electrolyte abnormalities may be caused by tacrolimus?
Hyperkalaemia
When should antiplatelet agents be stopped before surgery? Any exceptions?
Antiplatelet agents are usually stopped up to 7 days before surgery; the main exemption from this would be a patient who had received recent vascular stenting, in which case surgery is usually held off until the crucial antiplatelet period has finished as they are high risk for stent thrombosis if antiplatelet agents are stopped too early.
Why should allopurinol be stopped in an AKI?
Can accumulate
BNF advises a max daily dose of 100 mg (or less if more severe renal injury) until renal function improves.
In patients taking at least 25 micrograms of transdermal fentanyl per hour, how should you manage breakthrough pain?
Nasal fentanyl
The maximum initial dose is 50 micrograms into one nostril, repeated once if necessary after 10 minutes wit and a minimum of 4 hours between treatment of each pain episode.
Which antibiotic should be avoided in UTI treatment if eGFR is less than 45?
Nitrofurantoin
Which class of drugs is first line in acute alcohol withdrawal (to treat symptoms)?
Benzodiazepines e.g. chlordiazepoxide hydrochloride 20 mg PO 6-hrly
If a patient taking warfarin has an INR >1.5 on the day before surgery, what should be done?
Give phytomenadione (vitamin K) 1-5 mg PO, using the IV preparation.
What should you tell patients taking rivaroxaban doses of 15/20mg?
Should be taken WITH FOOD
In those who have difficulty swallowing, these tablets can be crushed and mixed with water or apple puree immediately before, and followed by food immediately after, ingestion.
Which type of contraceptive is required in patients taking topiramate e.g. for migraines?
NOTCOCP or POP (or any other that will be metabolised differently)
Patient should use an alternative form of contraception until 4 weeks after they stop taking the medication
What an be expected when starting lisinopril treatment?
A small rise in creatinine (<20%) is to be expected when starting an ACE inhibitor and does not require investigation or a change in prescription.
What are the most serious adverse effects of ciclosporin?
Nephrotoxicity
Hypertension
How should a transient rise in glucose when taking glucocorticoids be managed in an IDDM patient?
Increase in the usual insulin dose of 10%
Which drug is indicated in acute dystonic reactions?
Procyclidine hydrochloride (antimuscarnic drugs).
The correct initial dose is 5-10mg IM/IV. Parenteral administration is preferred over PO as there may be an unsafe swallow.
Which drug is recommended for all patients admitted to hospital with IECOPD?
Prednisolone 30 mg PO daily for 5 days i
If a man has received man has already received 2 L sodium chloride 0.9% in the last 24 h, what is the most appropriate NEXT bag to maintain his hydration while NBM?
Potassium chloride and glucose intravenous infusion
How much Na and Cl are in each bag of 0.9% sodium chloride?
154 mmol
NOTE: for an 80kg man, the daily requirement is 80mmol. This is the same for potassium.
How much potassium is given by: 1L sodium chloride 0.9%/potassium chloride 0.15% solution?
20mmol
Daily requirement for an 80kg man = 80mmol
What type of HRT will stop the patient from having a withdrawal bleed?
A product that releases the same dose continuously, rather than a sequential product, will avoid withdrawal bleeding.
What is an example of a continuous combined HRT preparation that can be given transdermally?
A product containing both oestrogen and progestogen is required.
Which drugs are contraindicated in peripheral vascular disease?
Beta blockers
B-Adrenoceptor blockers can cause peripheral vasoconstriction and worsen ischaemia in PVD.
ACE inhibitors are also cautioned in severe PVD (look for signs of critical ischaemia)
Which drugs are known to contribute to biventricular heart failure?
corticosteroids and calcium channel blocker
Which drugs can predispose to vaginal candidiasis (thrush)?
Amoxicillin
Clarithromycin
Prednisolone
What is the usual dosage of citalopram?
10-20mg PO daily
What antibiotic should be given in Scarlet fever?
phenoxymethypenicillin
If a child is tolerating an oral fluid challenge, give PO. If not, give IV.
Patient is normally on warfarin and starts taking clarithromycin. If their INR is within range, what should you do?
Keep them on the SAME dose, but recheck the INR in 48 hours.
After missing one pill (i.e. more than 24 hours late) anywhere in the pack or starting a new pack one day late, what should be done?
She should take the pills for her first and second day now, resume normal pill taking for the rest of the cycle, and take the subsequent 7-day pill-free break - she does not require additional contraceptive measures
What should be checked 1 week after epleronone is started?
Serum potassium.
Eplerenone is a potassium-sparing diuretic and therefore hyperkalaemia is a primary risk. Serum potassium should be monitored during initiation, especially in at-risk groups (elderly, chronic kidney disease, diabetes mellitus)
What is a common side effect of mirtazipine?
Sleep disturbances (including abnormal dreams)
What is a common electrolyte disturbance seen with thiazide-like diuretic use?
Hypokalaemia
What class of drugs is indapamide?
Thiazide-like diuretic
Why should simvastatin and gemfibrozil not be used together?
Gemfibrozil is known to interact with simvastatin and increases the risk of simvastatin-associated severe myopathy and rhabdomyolysis. Therefore, concomitant use should be avoided.
Gemfibrozil significantly increases simvastatin acid plasma concentrations, probably because of inhibition of simvastatin acid uptake by the hepatic sinusoidal xenobiotic uptake transporter OATP1B1. Gemfibrozil is also a potent mechanism-based inhibitor of CYP2C8.
What is the correct treatment of hypoglycaemia in an unconscious patient in hospital?
20 g glucose IV using a 20% solution
What is the most appropriate measure of the beneficial effects of beta blockers?
Heart rate
When should a statin be discontined?
When a statin is suspected to be the cause of myopathy and creatine kinase concentration is markedly elevated or or if muscular symptoms are severe
If a statin is discontined due to suspected myopathy, what is the next step?
If symptoms resolve, and creatine kinase levels return to normal, the statin should be reintroduced at a lower dose.
Before prescribing ondansetron, what should you check?
QTc interval
In high doses 5-HT3 antagonists can prolong the QT interval, so check if the patient is taking other drugs (e.g. quetiapine) that can also prolong the QT interval.
Next best would be cyclizine usually.
What are the possible doses for cyclizine?
cyclizine 50 mg/ mL injection
40 mg intravenous three times daily
30 mg intravenous once only
1mL intravenous once only
50 mg intravenous three times daily
Which antiemetic should be prescribed in patients at risk of extrapyramidal side effects and QT prolongation?
Cyclizine
What is the first line treatment for shingles?
Aciclovir
800 mg PO 5 times daily for 7 days
Use of the liquid is inconvenient and not required so loses 1 mark.
What are the possible fluids to give for resus?
Sodium chloride 0.9%
Ringer’s solution
Plasma-Lyte
Hartmann’s solution
If patients need IV fluid resuscitation, use crystalloids that contain sodium in the range 130-154 mmol/L, with a bolus of 500 mL over less than 15 minutes.
What is the starting dose of metformin?
500mg PO daily (for at least one week)
Start low to minimise side effects.
What side effect do both ciclosporin and eplerenone cause?
Hyperkalaemia
What is the maximum dose of citalopram in the elderly?
20mg
What is the dose of dexamethasone for croup?
0.15 mg/kg
For a 10kg child, this is 1.5mg.
What side effect do alendronic acid and prednisolone share?
GI disturbances e.g. dyspepsia.
NOTE: sympotms of GI irritation caused by alendronic acid are not improved by PPIs.
What side effect do alendronic acid and lansoprazole share?
Diarrhoea / Loose stools
Which drug classes commonly cause peripheral (ankle) oedema?
Calcium channel blocks e.g. amlodipine
NSAIDs e.g. naproxen
Which drugs commonly cause bradycardia?
Beta blockers
Digoxin
What is the treatment for vaginal candidal infection in pregnancy?
Clotrimazole pessary 100 mg PV daily for 7 days
Prolonged therapy is advised for candidal infection in pregnancy. Systemic therapy is not recommended during pregnancy.
What is the first line treatment for C.difficile infections?
vancomycin 125 mg PO 6-hrly
If a T1DM patient is admitted with DKA, how should their insulin be adjusted?
Short-acting SC insulin should be stopped, and long-acting insulin should be continued.
Patient requires fixed-rate IV insulin alongside fluid resuscitation.
What should you consider when prescribing analgesia to elderly patients?
If they might be vulnerable to the adverse effects of non-steroidal anti-inflammatory drugs (e.g. gastrotoxicity, renal impairment) and opioid analgesics (e.g. constipation, nausea, drowsiness).
This includes drugs such as gabapentin, which is known to cause drowsiness.
What advice should be given when prescribing loperamide hydrochloride?
Loperamide hydrochloride should be taken as an initial dose of 4 mg followed by 2 mg after each loose stool up to a maximum of 16 mg/24 h.
What is a common side effect of ciclosporin? What must be monitored?
Nephrotoxicity is a well-known adverse effect of ciclosporin therapy. Renal function measurements are required before starting ciclosporin. During treatment, monitor serum creatinine every 2 weeks for the first 3 months, then monthly.
What is a common side effect of liraglutide (GLP 1 analogue)?
Nausea and vomiting
What is the first line treatment of anti-psychotic-induced parkinsonism, particularly symptoms of tremors?
Procyclidine (anti-cholinergic drug)
At which blood pressure should the COCP be stopped?
> 160/95 mmHg
What must you check before starting a patient on azathioprine?
Measurement of thiopurine methyltransferase is required before dosing to ensure that patients who have low action of this enzyme required for metabolism are treated with an appropriate dose to reduce risk of toxicity.
What should patients be told when starting apixaban treatment?
to report any bruising or other signs of bleeding immediately
Whcih opioid is best for patients with renal impairment?
Oxycodone
Oxycodone is metabolised by the liver to inactive metabolites, making it an appropriate option where strong analgesia is required in the setting of renal impairment. Morphine is less appropriate in this context because, although it is also hepatically metabolised, one of its key metabolites, morphine 6-glucuronide, is active and indeed more potent than morphine. This metabolite is renally excreted and will therefore accumulate in renal impairment.
What should you give a patient on warfarin with an INR >10 and vomiting blood?
dried prothrombin complex 50 units/kg IV once only
If amiodarone is causing thyrotoxicosis, what is the most appropriate action?
Stop taking it (at least temporarily)
Thyroid function tests suggest development of thyrotoxicosis, which may be very refractory, and amiodarone hydrochloride should usually be withdrawn, at least temporarily, to achieve control.
ONE drug that is most appropriate to provide rapid relief of bronchospasm in IECOPD.
salbutamol 1 mg/ mL nebuliser liquid
2.5-5mg via a nebuliser
What might a relatively high sodium and urea indicate in a patient (e.g. post-stroke)?
That they might be somewhat fluid depleted
How quickly should maintenance fluids be given?
An appropriate infusion rate would be 500 mL over 4-6 h or 1 L over 8-12 h.
What are some important side effects of statins?
Important dose-related adverse effects are myalgia (although the risk of myopathy, myositis, and rhabdomyolysis associated with statin use is rare) and disturbed liver function. Other adverse effects include gastro-intestinal disturbances, sleep disturbance and headache.
Why drugs commonly cause dehydration?
DIURETICS
Bendroflumethiazide is a thiazide diuretic commonly prescribed for hypertension that can cause excessive sodium and water loss. Spironolactone is a potassium-sparing diuretic that is indicated for the treatment of resistant hypertension and heart failure and can also lead to significant dehydration.
Metformin in renal impairment?
Should be stopped as it accumulates (cannot be cleared), but does not CAUSES renal impairment
Which drugs can cause urinary retention
Morphine and other opioids (especially in the early post-operative period
Others:
* Anticholinergics (eg, antipsychotic drugs, antidepressant agents, anticholinergic respiratory agents, detrusor relaxants)
* General anaesthetics,
* Alpha-adrenoceptor agonists,
* Benzodiazepines (e.g. diazepam),
* Non-steroidal anti-inflammatory drugs (e.g. ibuprofen),
* Calcium-channel blockers,
* Antihistamines,
* Alcohol.
Drugs that can cause confustion?
- Morphine and metoclopramide
- Anticholinergics (eg, antipsychotic drugs, antidepressant agents, anticholinergic respiratory agents, detrusor relaxants),
- Antipsychotics,
- Antidepressants,
- Anticonvulsants.
- Less common causes (histamine H2 receptor antagonists, digoxin, beta-blockers, corticosteroids, non-steroidal anti-inflammatory agents and antibiotics.
IV insulin infusion for DKA?
fixed rate of 0.1 units/kg/h.
Which drugs often cause anaphylaxis?
ß-lactam antibiotics (e.g. penicillin, cephalosporins), aspirin and other NSAIDs, chemotherapy, vaccines, parenteral iron injections, and herbal preparations.
Some drugs cause anaphylactoid reactions by directly triggering mast cell degranulation (e.g. vancomycin, morphine, x-ray contrast among others).
How is the benefit of allopurinol measured?
Allopurino’s primary therapeutic effect is to reduce serum urate by inhibiting the activity of the enzyme xanthine oxidase) and this is a good surrogate measure of the benefits of therapy.
Renal adverse effects of lithium?
Lithium therapy can impair renal function and this should be monitored with intermittent renal function tests. Other important renal adverse effects are nephrotic syndrome and nephrogenic diabetes insipidus.
