Official mocks Flashcards
treatment for pulmonary oedema than requires immediate treatment
Loop diuretic:
- furosemide IV
DOSE = 20 -50 mg
(other optimal answer would be glyceryl trinitrate 50mL infusion
What is the first line IV treatment for hypoglycaemia?
Glucose 20%
- if not available, glucose 10% is a suitable alternative
Infusions of 10% (100-200mL) or 20% (50-100mL) deliver between 10-20g of glucose.
Infusion rates up to 20 minutes are optimal
Glucose 50% is hypertonic so risks extravasation
Glucose 5% is too weak & a large volume would be required
What are some suitable treatments for acne that has not responded to topical therapy?
Tetracycline 500 mg PO BD
Doxycycline 100mg PO OD (doesn’t have to be taken at certain times e.g. with food)
Which 3 of the following are most likely contributing to hyperkalaemia?
atorvostatin co-amox dalteparin sodium lactulose mycophenolate mofetil oxycodone PCM prochlorperazine ramipril tacrolimus
& which to be adjusted?
Dalteparin (and all heparins)
- via inhibition of aldosterone synthesis
Ramipril:
- via reducing aldosterone
Tacrolimus
- due to reduced potassium escretion
Adjust: ramipril first, then tacrolimus (with a serum conc) and finally dalteparin
Do you need to stop aspirin before surgery? if so how long before?
YES
one week prior to surgery
main exemption is if a pt has recieved 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
Which 2 should be withheld in an AKI until renal function recovers?
allopurinol 300mg
amitriplyline
bisoprolol
candesartan
ACE-i & ARBs (candesartan) are nephrotoxic so should be suspended
Allopurinol can accumulate in renal dysfunction & max dose should be 100 mg until renal function improves
Which 3 of these drugs are most likely to be causing confusion in an elderly man who has high urea and high Cr?
a. clopidogrel
b. atorvostatin
c. co-codamol
d. diazepam
e. doxycycline
f. prednisolone
Pt has developed AKI, can result in reduced clearance of medicines and an increase in adverse effects.
- so codeine and dizepam retention may be contributing
Glucocorticoids can also cause confusion particularly in the elderly
What 2 drugs are most likely to be causing hyponatraemia?
- aspirin
- bendroflumethiazide
- citalopram
- levothyroxin
bendroflumethiazide: well known cause of hypoN
SSRIs: recognised complication of SSRIs, via inappropriate ADH secretion
How often should levothyroxine sodium be taken?
daily
what is isaphula husk?
a bulk-forming laxative
what do laxatives do to potassium?
they cause hypOkalaemia
- cause loss of potassium in the stool
Pt with metastatic cancer, intermittent acute onset, severe pain in her back
DH: fentanyl 50 micrograms/h transdermal patch, one patch applied 72-hourly
PCM 1g PO 6-hrly
most appropriate management option at this stage?:
a. buprenorphine 10 microograms/h transdermal patch one patch applied 4-hourly PRN
b. fentanyl 50 micrograms/actuation nasal spray one spray to one nostril repeated once after 10 mins as required
c. morphine sulfate 10 mg PO 4-hrly as required
b. fentanyl 50 micrograms/actuation nasal spray one spray to one nostril repeated once after 10 minutes as required
- pts receiving at least 25 micrograms of transdermal fentanyl per hr can use nasal fentanyl for breakthrough pain
- max initial dose is 50 micrograms into one nostril, repeated once if necessary after 10 mins (with max of 2 sprays for each pain episode and a minimum of 4 hrs between each treatment of episode.
- F is absorbed rapidly from nasal mucosa so acts quickly
(morphine sulfate dose is too low in this scenario. additionally, its advised that the same drug be used for regular and breakthrough pain relief - nasal spray likely to provide faster relief)
79 yr old male with UTI
DH: folic acid 5mg PO daily, allergic to penicillin
which antibiotic
a. co-amox
b. nitrofurantoin m/r 100 mg PO 12-hourly for 3 days
c. nitrofurantoin m/r 100 mg PO 12-hourly or 7 days
d. trimethoprim 200 mg PO 12-hrly for 7 days
Trimethoprim 200mg PO 12-hourly for 7 days
( it blocks folate metabolism, and may therefore exacerbate pre-existing folate deficiency, but this doesn’t preclude its use for a short course of treatment. 7 day course is indicated in a male)
First line treatment in alcohol withdrawal?
Benzodiazepines
e.g. chlordizepoxide hydrochloride 20mg PO 6 hourly
Peri-operative anticoagulation for a patient who is on warfarin
Warfarin should be stopped 5 days before elective surgery
Phytomenadione (vitamin K1) by mouth (using the intravenous preparation orally [unlicensed use]) should be given the day before surgery if the INR is ≥1.5. If haemostasis is adequate, warfarin sodium can be resumed at the normal maintenance dose on the evening of surgery or the next day.
Patients stopping warfarin sodium prior to surgery who are considered to be at high risk of thromboembolism (e.g. those with a venous thromboembolic event within the last 3 months, atrial fibrillation with previous stroke or transient ischaemic attack, or mitral mechanical heart valve) may require interim therapy (‘bridging’) with a low molecular weight heparin (using treatment dose). The low molecular weight heparin should be stopped at least 24 hours before surgery; if the surgery carries a high risk of bleeding, the low molecular weight heparin should not be restarted until at least 48 hours after surgery.
What is the most important information you should tell a patient starting rivaroxaban?
- if he misses a dose he should take 2 tablets the next day
- rivaroxaban can cause dry mouth
- rivaroxaban should be taken with food
- st johns wort should be avoided when taking rivaroxaban
Should be taken with food to improve absorption
A 28yr old is started on topiramate 25mg PO daily for migraine, she is sexually active and taking desogestrel 75mcg PO daily
what advice to give her about contraception?
She should change to an alternative method of contraception until 4 weeks after she has ceased taking topiramate
- The efficacy of oral progestogen-only preparations is reduced by enzyme-inducing drugs such as topiramate, and an alternative C method, unaffected by the interacting drug, is recommended during teratment with an enzyme-inducing drug and for at least 4 weeks afterwards.
https: //bnf.nice.org.uk/treatment-summary/contraceptives-interactions.html
how many nanograms in a microgram?
1000
Which is the most likely adverse effect to be caused by beta-adrenoceptor blockers?
- ED
- hypoK
- rash
- sedation
- wt gain
= BB
Sexual dysfunction (including ED), is a recognised adverse effect of B-adrenoceptor blockers, frequency not known
Which of the following drugs is most likely to contribute to jaundice?
- aspirin
- bisoprolol
- co-amox
- metformin
- PCM
cholestatic J can commonly, or very commonly occur, either during or shortly after Rx with co-amoxiclav
risk of acute liver toxicity is 6 x greater with co-amoxiclav than with amoxicillin
cholestatic J is more common above the age of 65 and in men
Which prescription is most likely to interact with dabigatran etxilate to cause GI bleeding?
- amlodipine
- bisoprolol
- citalopram
- digoxin
- metformin
citalopram has been reported to increase the risk of bleeding events with dabigatran, esp GI haemorrhage, particularly in the over 65s
what do you do if someones creatinine rises by <20% when starting an ACE inhibitor?
continue it and repeat U&Es after 1 week
- small rise (<20%) is expected and dosen’t require Ix or change in prescription
whats the most appropriate option to monitor for beneficial effects of IV furosemide after 2 days of treatment?
Weight
RR isnt good as is confounded by too many other factors
What is best monitoring test for adverse effects of carbimazole within 2 weeks of starting treatment, (in a pt presenting with sore throat)
FBC
Neutropenia is a less common, but potentially serious, adverse effect of carbimazole
If peridopril erbumine is used for heart failure treatment, whats best way to monitor for beneficial effects of it over the first month?
- exercise tolerance
- HR
- pro brain natiuretic peptide
- serum creatinine
- troponin
exercise tolerance
Whats the most appropritae option to monitor for adverse effects of ciclosporin after 2 weeks of treatment?
- fasting lipid profile
- FBC
- HBA1c
- serum creatinine
- urinalysis
- serum creatinine
most serious adverse effects are nephrotoxicity and HTN (mediated by vasoconstrictive effects on renal arterioles)
- before initiation of Rx, baseline assessment of RF should be established and RF should be monitored every 2 weeks until results are stable.
- BP should also be monitored on a regular basis
[although leucopenia and thrombocytopenia may occur in pts treated with ciclosporin, RF is more important, esp in the first 2 weeks of Rx. FBC should be taken monthly until results are stable, then every 3 months]
Transient rise in blood glucose caused by corticosteroids in T1dM? what Mx?
an increase in the usual insulin dose of 10% would be an appropriate way to manage this
What is a normal fasting blood glucose? whats pre-diabetes? whats diabetes?
<5.6 mmol/L = normal
(5.6 to 6.9 mmol/L) is considered prediabetes.
If it’s 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes.
A man gets started on atorvostatin 20mg PO OD for hypercholesterolaemia 3 months ago.
His serum HDL remains 1.5 (>1.55), but his serum LDL cholesterol has decreased to 2.1 from 4.1
what do you do regarding his statin?
keep it the same
As after 3 months of treatment a >40% reduction in non-HDL cholesterol has occured
Someone’s started on gentamicin, the chart cant be read until 6hrs after first dose given. the conc you have is from 4 hrs post dose. what to do?
repeat the blood test 2 hrs later
other options include working out the pts creatinine clearance or discussing with micro
Pt with exacerbation of COPD, over past 3 days. What to prescribe her?
High-dose nebulised B2 agonist is first line
- Give as early as possible
Salbutamol or Terbutaline
[add ipratropium bromide (500mcg NEB) to B2 agonist treatment for pts in those with a poor initial response to B2 agonist therapy. Salbutamol alone should be tried first]
Pt needs 10 500 units of tinzaparin, what do you prescribe?
A dose of 11 000 /(or 10 000) units is practical for administration
If patient has had a stroke 7 days ago, and been E&D less and unwell for 2 days. Now can’t swallow.
Na+ 144
Random plasma glucose 7.2
What IV fluid to give?
If the patient is symptomatic: for Dx of DM
- fasting glucose greater than or equal to 7.0 mmol/l
- random glucose greater than or equal to 11.1 mmol/l (or after 75g oral glucose tolerance test)
So.. I think we assume this random one was actually a fasting one? Even though fasting is supposed to be 8hrs after last meal, and we can’t be sure of that.
But right answer = sodium chloride 0.9% / potassium chloride 0.3% 1000mL over 8-12 hours
!!!! Glucose-containing fluids have the potential to exacerbate cerebral injury - so don’t use (current glucose is elevated)
What to give for hypercholesterol in a pt with a 10-year risk of cardiovascular disease of 10% or more?
/ most type 1 TDM or CKD with eGFR <60
Atorvastatin
20mg OD
(if non-HDL has not fallen by >/= 40% then consider titrating up to 80mg)
Which 2 most likely to cause haematemesis? & why?
- amlodipine
- aspirin
- digoxin
- ibuprofen
- metformin
- ramipril
- senna
& which 2 most likely to be contributing to renal impairment?
- aspirin
- ibuprofen
Both inhibit COX and the production of prostaglandins that protect the gastric mucosa against acid-related erosion & ulceration
(also can cause damage through some other mechanisms too)
- rampiril & ibprofen
(digoxin will accumulate in renal imapriment, but won’t cause decreased renal function)
which most likely to cause dehydration?
- amiodarone
- amitriplyline
- atenolol
- bendroflumethiazide
- prazosin
- spironolactone
bendro: thiazide-like diuretic, can cause excessive sodium and water loss
spiro
What 3 drugs should be stopped due to results : hyperkalaemia, renal impairment, and iron deficiency anaemia?
and which 1 might be causing hypoglycaemia?
- amlodipine
- aspirin
- doxazosin
- ezetimibe
- metformin
- pioglitazone
- ramipril
- simvastatin
Ramipril –> likely to cause hyperK and renal impairment
Metformin is CI in pts with significant renal impairment or who are acutely unwell and tissue hypoxia is likely
Aspirin is likely cause of iron deficiency anaemia
b. pioglitazone:
a. What drug most likely to cause urinary rentention in the postoperative period?
b. what 2 are contributing to confusion?
- candesartan
- co-amox
- dalteparin
- metoclop
- morphine sulphaste
- PCM
a. morphine and other opiod analgesics can cause urinary retention, esp in the early postoperative period
b. metoclopramide hydrochloride & morphine
What are some drugs that commonly cause urinary retention?
- anticholinergics (e.g. antipsychotic drugs, antidepressant agents, anticholinergic resp agents, detrusor relaxants)
- opioids
- general anaesthetics
- alpha-adrenoceptor agonists (e.g. doxazosin)
- benzos
- NSAIDs
- CCBs
- antihistamines
- alcohol
What is strongly indicated in a pt with long history of alcohol abuse and disorientation who may have/ or is at risk of WE?
IV vitamin B
- even if pt presents with tablets of thiamine, doesn’t mean he hasn’t got critical deficit of vitamin B that might threaten his neuro function
T1DM with ketones + 2, and finger prick glucose of 28, (also hyperkalaemia), how to treat?
soluble insulin 50 units in NaCL 0.9% 50 mL by IV infusion at a rate of 0.1 units/kg/hr
(this is first line over calcium resonium [calcium polystyrene sulfonate])
Whats the folic acid dose for pregnany lady?
Depends on risk of conceiving a child with a NTD
- if low: 400 mcg daily before conception and until week 12 of pregnancy
- if high (e.g. FH of spina bifida) : 5 mg daily until week 12
Does alendronic acid:
a. stimulate the cells that form new bone?
b. reduce the incidence of further vertebral and non-vertebral fractures in pts with osteoporosis
b.
when is oestrogen combined with a progestogen for HRT?
& why?
for women with an intact uterus
to reduce the risk of endometrial carcinoma associated with unopposed oestrogen
If a solution is 0.1%, how do you express this as a weight per volume?
0.1g per 100mL
100mg per 100mL
1mg/mL
what age group does ototoxicity (and nephrotoxicity) occur most commonly in those taking aminoglycosides?
elderly
