passmed q errors

Question 1

for STEMI immediate mx if allergy to aspirin give what

Answer 1

clopi 300mg once only
or
ticagrelor 180mg once only

Question 2

what is atorvastatin starting dose for primary prevention

Answer 2

20mg

Question 3

what blood test abnormality can tacrolimus cause

Answer 3

PANcytopaenia

Question 4

should co-codamol be stopped in an AKI

Answer 4

yes due to risks of adverse effects with renal excretion

Question 5

2 drugs that can cause fluid retention

Answer 5

CCBs
Corticosteroids - Systemic corticosteroids (prednisolone) commonly cause fluid retention via the stimulation of mineralocorticoid receptors, which lead to sodium and water retention

Question 6

can ondansetron cause constipation

Answer 6

yes by delayed colonic transit

Question 7

unprotected sex a few ago and this is her DHx: carbamazepine 300mg PO TDS, salbutamol 200 micrograms inhaler PRN, beclometasone dipropionate 200 micrograms inhaler BD, regular multivitamins

Answer 7

levonergestrel < 12h
-dose usually 1.5mg BUT she is on an enzyme inducer so need a higher dose = 3mg

BNF “When used orally as an emergency contraceptive, the effectiveness of levonorgestrel could be reduced in women taking enzyme-inducing drugs (and for up to 4 weeks after stopping); a copper intra-uterine device should preferably be used instead. If the copper intra-uterine device is undesirable or inappropriate, the dose of levonorgestrel should be increased to a total of 3 mg taken as a single dose; pregnancy should be excluded following use, and medical advice sought if pregnancy occurs.”

Question 8

what is cimetidine

Answer 8

CYP450 inhibitor

-slows down metabolism of drugs increasing their toxicity

Question 9

what is important to check when using trimethoprim or co-trimoxazole in pts with renal impairment

Answer 9

Trimethoprim in patients at risk of AKI –> potassium is the most important electrolyte to check

Question 10

with a statin at 3m when you check LFTs what is a sign that they should be stopped

Answer 10

if transaminases are raised MORE THAN 3X ULN –> STOP statin and repeat LFTs in 1 month
- if they are only slightly raised (less than 3xULN) then you don’t need to stop the statin, just recheck them in 1month

Question 11

For T1DM if his glucose is high before breakfast what should the change be to his evening insulin eg if it is 15 U in evening

Answer 11

Titrating insulin with glucose-
increase in 10% in previous dosage if pre-meal BM >7
-15 U increase to 16.5U but round this

Question 12

how to step down analgesia post op

Answer 12

use the reverse pain ladder 
strong opiod 
weak opiod 
NSAIDs
paracetamol

Question 13

what is the equivalent dose of morphine PO to dihydrocodeine PO

Answer 13

10mg morphine PO = 100mg dihydrocodeine PO

-there is a table in ‘prescribing for palliative care’

Question 14

anti emetic for post-op analgesia

Answer 14

ondansetron
cyclizine - CI in HF
prochlorperazine - CI in PD

Question 15

for hypo unconscious pt in hosp with cannulae

Answer 15

tx with IV Glucose 10% 150ml 15 minutes

Question 16

drugs CI in breastfeeding

Answer 16

fluoxetine
tetracycline
aspirin
lithium carbonate

Question 17

GBS + mothers - swab + - at risk of neonatal sepsis - have what drug prophylactically

Answer 17

Ben pen sodium 3g IV

Question 18

pt with diabetes + evidence fo nephropathy what drug ot start

Answer 18

lisinopril

Question 19

what to give for uTI if trimethoprim (eg not resistant or on folate antag) and nitro (low renal ftn eGFR<45) not suitable

Answer 19

fosfomycin

Question 20

abruptly stopping SSRis / antidepress leads to what

Answer 20

discountinuation symptoms

• restless
• irritable

Question 21

what does co-careldopa lead to that pts shld be warned about

Answer 21

excess daytime sleepiness

-warn pts about this risk + need to use caution whilst driving or operating machinery

Question 22

what should pts be told about haloperidol with regards to mvmnt disorders

Answer 22

Haloperidol is an anti-psychotic that is used to treat schizophrenia and other psychoses.
It is linked to extra-pyramidal effects such as AKATHISIA due to it being a dopamine D2 receptor antagonist. - Akathisia is a movement disorder associated with restlessness and inability to stay still.

Question 23

why should you tell pts to keep their diet stable with warfarin

Answer 23

warfarin is a vit k antagonist that promotes anticoagulation

-foods with lots of vit K eg GREEN LEAFY VEG + lIVER can interefere with how it works

Question 24

what is the amount of glucose in 1L 10% dextrose over 8h that will be given in 2h

Answer 24

so amount of glucose in 10% dextrose = 10mg in 100mL = 100mg in 1000mL
given over 8h
so over 2h
100mg / 4 = 25mg

Question 25

A 38-year-old patient suffers from hypomagnesaemia. She is prescribed a magnesium sulphate infusion of 10g once-daily for five days in a 0.9% sodium chloride solution. The concentration of magnesium sulphate should not exceed 20%.

What is the minimum volume of 0.9% sodium chloride required to safely make up the magnesium sulphate solution?

Answer 25

A concentration of 20% is 20kg in 100L = 20mg in 0.1mL = 200mg in 1mL. Since the patient requires 10g of magnesium sulphate, the minimum volume of 0.9% sodium chloride is: 10g ÷ 200mg/mL = 50mL.

Concentration ratios (20% in this case) are based on units of kilogram and litre as they belong to the International System of Units (SI units) which are used by convention.

Question 26

cholestatic jaundice with what drug

Answer 26

macrolide - you get incr ALP compared to ALT

NB. clindamycin can cause hepatic jaundice , with raised ALT and AST vs lower ALP

Question 27

atorvastatin 3m after starting what to measur

Answer 27

LFTs - measure before starting, measure at 3m and 12m afterwards as it is known to be hepatoxic

Question 28

straight after medical TOP with mifepristone what should you measure

Answer 28

BP - you can get severe hypotension

UPT - likely still + so do it at 3 weeks

Question 29

pt on Palliative care - they want to make his PO morphine into SC infusion - calculate how much , convert it and what should be the PRN dose of SC as well

Answer 29

The patient is currently on a total of 200mg morphine sulphate PO a day (75mg 12 hrly regular Morphine sulphate and 5 doses of 10mg/5mL of Oramorph® = 150mg + 5 x10mg = 200mg). To convert into subcutaneous infusion, the regular dose has to be half the daily amount of PO morphine sulphate (200/2 = 100mg) and the PRN dose one sixth the total amount given regularly (1/6 x 100 = 16.7mg)

Question 30

with DKA on fixed rate insulin infusion what are the targets with regards to what drops etc and by how much - ketones + glucose

Answer 30

Ketone reduction should be >0.5mM/h
Glucose reduction >3mM/h
-if these targets are not met then you should increase insulin rate by 1U/hour increments hourly until ketones fall at target rates