Past Exam Qu's

Question 1

What factors do we need to consider when loading warfarin?

Answer 1

Age- use lower loading dose in the elderly as target INR is achieved with a much lower maintenance dose

Ethnicity- Indo-Asians and Afro-Caribbeans require higher doses

Albumin- warfarin is 99% protein-bound therefore a decline in albumin results in lower dose requirements

Smoking

Indication

Question 2

What is the most common method for monitoring UFH therapy?

Answer 2

APTT (activated partial thromboplastin time)

A fixed therapeutic range for the aPTT of 1.5 to 2.5 times the control value has become widely accepted,

Question 3

What is the Haemoglobin reference range in females?

Answer 3

120 - 150

Question 4

What is the target levels for the TDM drug Phenobarbitone?
How long does it take to reach steady state?
How long is its half life?

Answer 4

10 - 40mg/L
3-4 weeks to reach steady state
long half life of 5 days

Question 5

What is the target levels for the TDM drug carbamazepine? When should levels be looked at?

Answer 5

4-10 mg/L

Take a trough at least 2 weeks after starting or dose change

Question 6

What is the target levels for the TDM drug Phenytoin? when should levels be looked at?

Answer 6

10-20mg/L

A trough level should be taken 2-4 weeks after starting

Question 7

Around 90% of potassium in our body is intracellular, 10% is in extracellular fluid. This 10% is what we are referring to when we say our target potassium range is 3.5- 5.3- the extracellular potassium concentration

Answer 7

This means that K+ biochemistry results are a poor reflection of total body potassium

Question 8

What are the signs of hyperkaleamia?

Answer 8

Weakness
Paralysis
Confusion
Parasthesia (tingling)
Vomitting
ECG changes (Resting membrane potential, shorter Action potentials)

Question 9

What is the treatment for hyperkalaemia?

Answer 9

Severe: K+ >6.5mmol/L/ any ECG changes
URGENT treatment with 10-20ml of Calcium Gluconate 10% by slow IV injection over 2 mins. This temporarily protects against myocardial excitability.

Then give an IV injection of SOLUBLE INSULIN (5-10 units) with glucose 50% to drive potassium into cells and reduce serum potassium concentration.

Nebulised/ Slow IV salbutamol may also be used- use with caution in those with Cardiovascular disease.

Any acidosis should be corrected with sodium bicarbonate infusion

Ion-exchange resins can be used to remove excess potassium in mild hyperkaleamia or moderate if there are no ECG changes

Question 10

Calcium gluconate 10% by IV injection over 2 mins is used for treatment of Hypocalceamia. Is this correct?

Answer 10

NO this is how we administer for hyperkaleamia

In hypocalceamia with use calcium gluconate infused over 30 mins

Question 11

What do we use calcitonin for?

Answer 11

HYPERCALCAEMIA

It is a hormone that acts to reduce blood calcium (Ca2+), opposing the effects of parathyroid hormone (PTH).

Question 12

What is digoxins half life?

Answer 12

around 40 hours

Question 13

What are the symptoms of macrocytic anaemia?

Answer 13

Glossitis
SOB
angular stomatitis
altered bowel habit
anorexia- weight loss
tachycardia
bilateral peripheral neuropathy

Question 14

According to the NICE classification of CKD, what level of renal impairment does a CrCl/ GFR of 48ml/min indicate?

Answer 14

Moderate

Question 15

What is the interaction between amiodarone and digoxin?

Answer 15

Amiodarone increases plasma levels of digoxin- so we need to HALVE the dose of digoxin

Question 16

Is there an interaction between Lithium and diclofenac?

Answer 16

YES there is an interaction between lithium and all NSAID’s:

excretion of lithium reduced by NSAIDs (increased risk of toxicity)

Question 17

Amiodarone has a long half-life; there is a potential for drug interactions to occur for several weeks (or even months) after treatment with it has been stopped

Answer 17

dizziness, vision problems, seeing halos around lights;
loss of coordination
feeling weak or tired
nausea, vomiting, constipation;
numbness or tingling;
tremors;
abnormal liver function tests and thyroid function tests
Slate grey skin

Question 18

What is the normal range for prothrombin time?

Answer 18

Prothrombin times is the average time range for blood to clot and is usually about 10 to 14 seconds

Question 19

What is the treatment guidelines for cellulitis? What if streptococcal infection is confirmed?
What is they are penicillin allergic?

Answer 19

Flucloxacillin

Strep confirmed: Benzylpenicillin/ Pen V

Penicillin allergic: clindamycin or clarithromycin or vancomycin

Question 20

What is a pharmacodynamic interaction?

Answer 20

The effects of one drug are changed by the presence of another drug at its site of action.

For example, 2 drugs competing for a particular receptor: Beta2 agonist such as salbutamol competing with a beta blocker such as propranolol.

Question 21

The root cause analysis process

Answer 21

Identify problem
define problem 
understand problem
identify root cause
corrective action
monitor systme

Question 22

How is Vancomycin administered?

Answer 22

As a slow IV infusion (NOT IV BOLUS OR IM INJECTION) at no more than 10mg/min, over at least 60 mins to avoid red man syndrome

Question 23

Do corticosteroids cause hypo or hyperkaleamia?

Answer 23

HYPOKALEAMIA

Question 24

Pseudomonas aeruginosa is a common Gram-negative bacteria causing infections such as hospital acquired pneumonia. What antibiotics are active against this?

Answer 24

aminoglycosides- gent, amikacin
quinolones- ciprofloxacin, moxifloxacin
cephlasporins- cetriaxones, ceftazadime
carbapenems- meropenem

Note: most penicillins DONT- we use amox and gent for HAP at work- amok added for gram positive cover

Question 25

Why can HbA1C reflect glucose levels over a period of 3 months?

Answer 25

Because red blood cells in the human body survive for 8-12 weeks before renewal, measuring glycated haemoglobin (or HbA1c) can be used to reflect average blood glucose levels over that duration, providing a useful longer-term gauge of blood glucose control.

Normal target: < 42 mmol/mol
Those with diabetes: < 48 mol/mol

Question 26

What are the target BM’s in adults with T2DM?

On waking?

Before meals?

After meals?

Answer 26

on waking: 5–7mmol/l

before meals at other times of the day:
4–7mmol/l

90 minutes after meals: 5–9mmol/l.