Other mocks Flashcards
When in prochlorperazine contraindicated?
Parkinson’s
Can result in extra-pyramidal side effects
Which anti-emetic should be avoided after gastrectomy?
Metoclopramide (pro-kinetic)
What is the dose and route of ondansetron in post-operative nausea?
4mg (IV preferred if patient has cannula in situ, but can also be given IM)
What is the first line antidepressant in children?
Fluoxetine
The initial dose is 10mg once-daily orally, which can be administered as a single or divided dose.
It is the only antidepressant for which trials show that the risks are outweighed by the benefits. It has a long half-life which makes it useful in younger group of patients whose adherence to medication may be sub-optimal.
In a child with status epilepticus secondary to febrile seizures, which drugs can be given?
Diazepam (PR)
Midazolam (buccally)
Also: lorazepam (IV)
Which blood pressure medication should be used in pre-eclampsia?
Labetalol 20mg/hour IV
There is no fixed dose stated for labetalol as it is given as a continuous infusion, hence a rate instead is recommended which is titrated every 30 minutes according to clinical improvement.
Although labetalol can be taken orally, the patient is having nausea and a cannula has been inserted, making the intravenous route preferred.
Other options include nifedipine or methyldopa. As she does not have any major complications (haemodynamically unstable, coagulation abnormalities or HELLP syndrome), she can be managed conservatively for now i.e. without delivery of the foetus.
What is the first line treatment for otitis media in children?
Amoxicillin 500mg PO TDS
If penicillin allergy: clarithromycin
What is the first line management of constupation in children?
If no signs of faecal impaction, use regular maintenance laxatives.
Osmotic (stool softening) laxatives are the first-line drug prescribed in children with constipation. The macrogol ‘Movicol’ (Polyethylene glycol 3350 plus electrolytes) or Lactulose are recommended as first-line treatment.
Stimulant laxatives such as Senna and sodium picosulphate should be used as second-line and so would not be appropriate in this instance.
Duration: often 28 days
If a patient’s asthma is not well controlled on SABA + ICS, what is the next step?
Montelukast 10mg PO OD
What is the first line treatment for hypothyroidism?
25-50 micrograms per day (with titration for adults aged 65 or over and adults with a history of cardiovascular disease).
It should be taken in the morning on an empty stomach and before any other medication has been taken. The dose can be uptitrated every 4 weeks by 25-50mcg. The patient should be reviewed and have TSH levels every 3 months after initiation of levothyroxine therapy and adjust the dose according to symptoms and TFT results.
Which drug classes commonly cause QTc interval prolongation?
Typical (haloperidol), atypical (risperidone) antipsychotics and SSRIs (fluoxetine)
What is the maximum dose of haloperidol that can be given to patients with schizophrenia?
20mg daily
T1DM recovering after elective surgery. Was kept on long acting insulin and started on VRII. Once able to eat and drink, what should be done?
As the patient is able to eat and drink, she should restart her usual subcutaneous fastacting insulin with her next meal with the VRIl running for 30-60 minutes afterwards to ensure stable BMs.
First line treatment for ADHD
Methylphenidate hydrochloride 5mg PO OD
Lisdexamfetamine mesilate
When should you consider uptitrating fluoxetine?
The BNF says: Patients should be reviewed every 1-2 weeks at the start of antidepressant treatment. Treatment should be continued for at least 4 weeks (6 weeks in the elderly) before considering whether to switch antidepressant due to lack of efficacy. In cases of partial response, continue for a further 2-4 weeks (elderly patients may take longer to respond).
Over how many weeks should citalopram be tapered and gradually reduced (when wanting to stop it)?
4 weeks
Which electrolyte disturbances increase the likelihood of digoxin toxicity?
hypercalcaemia, hypokalaemia and hypomagnesaemia.
Patient on warfarin. Minor bleeding + INR >8. What should you do?
NICE recommends to stop warfarin and give 0.5-1 mg phytomenadione (vitamin K) by slow intravenous injection, or 5 mg by mouth
Is carbamazepine an enzyme inducer or inhibitor?
Carbamazepine is a PY450 enzyme inducer - this is the enzyme responsible for the metabolism of the combined oral contraceptive pills. Increased activity of said enzyme results in the combined oral contraceptive pill being metabolised quicker and therefore having a lower efficacy.
Other PY450 inducers include phenytoin, phenobarbital, felbamate, topiramate, oxcarbazepine and primidone.
What imaging should be done when amiodarone is started?
Chest X-ray
A potentially severe side effect of amiodarone use is pulmonary fibrosis. Existing lung damage should be ruled out prior to starting this drug
What is a commonly reported side effect of tamsulosin?
Postural hypotension
What test should be done to monitor for adverse effects of terbinafine?
It is recommended to measure liver function prior to and at 4-6 weeks after starting this drug as terbinafine is known to be hepatotoxic
When ulipristal acetete is being used to treat FIBROIDS, what should be monitored?
Ulipristal acetate is metabolised by the liver and as such liver function tests are recommended when it is being used long-term to treat fibroids.
This is not necessary if it is taken as a single dose for emergency contraception.
Aside from aspirin, what else should be given to patients with a STEMI to reduce the chance of recurrent atherothrombotic events?
Clopidogrel
Second line in gastric ulcers, aside from PPIs?
H2 antagonists e.g. ranitidine
What should be given to women with GBS in labour?
Benzylpenicillin 3g IV every 4 hours
Listed as ‘Intrapartum prophylaxis against group B streptococcal infection’
What is the dose of sodium valproate for seizure management?
Sodium valproate used for seizure management is prescribed at 20-30mg/kg daily. However, the maximum recommended dose is 2.5g daily
What is the maximum dose with allopurinol and how should it be given?
Up to 900mg of allopurinol can be prescribed in a day but must be done in divided doses. The maximum per dose is 300mg.
What should patients be warned about when starting co-careldopa?
Can lead to excessive daytime sleepiness
When should digoxin levels be measured?
6 hours after the last dose
What should be monitored in prolonged steroid treatment in children?
Height and weight
If a patient is taking digoxin for AF, what might suggest non-adherence?
Digoxin levels below therapeutic range
Tachycardia
