Past Paper Questions 2 Flashcards
500mg Metformin PO
When suspecting meningitis with a non-blanching rash, first step of management is always IM antibiotics in a community setting before urgently transferrig to hospital
which medication is most important to stop while the patient is taking clarithromycin
Colchicine
- clarithromycin is a macrolide which is an inhibitor
- therefore macrolides increase the exposure of colchicine
which 2 medication would contribute to the risk of a gastro-intestinal bleed
SSRI’s and ibuprofen
-> both individually increase the risk of bleeding
how to take folic acid with methotrexate
- Methotrexate Mondays
- Folate Fridays (avoid on days of methotrexate)
acute migraine management
First line:
- triptans
- NSAIDs
- paracetamol
Second line:
- metoclopramide or prochloperazine (IM/IV)
migraine prophylaxis management
First line
- propanolol
- topiramate (terarogenic)
- amitriptyline
Second line
- acupuncture
Third line
- frovatriptan
4th line
- candesartan
- erenumab (monoclonal antibodies)
which drugs to look out for if asthma
- beta blockers
- ibuprofen
- adenosine
which anticoagulant can be used to prevent stroke in AF
DOAC e.g. apixaban = if CHADS2-VASc >2
when is warfarin used instead of DOAC
- haemophilia
- metallic heart valve
- CKD
- DOAC ineffective
which antiepileptics appropriate for pregnancy
Lamotrigine and Levetiracetam
oral codeine to oral morphine
divide by 10
oral tramadol to oral morphine
divide by 10
oral morphine to oral oxycodone
divide by 1.5
oral morphine to subcut morphine
divide by 2
oral morphine to subcutaenous diamorphine
divide by 3
0.1% solution
= 1g in 100ml
therefore 1x 1000= 1000mg
= 10mg/ml
there 0.1g in 100ml
therefore 0.1 x 1000= 100mg
therefore 1mg/ml
drugs not good for psoriasis
Lithium
Propanolol
Anti-malarials
Imiquimod
management of paediatric convulsive seizures (inc febrile) lasting loger than 5 minutes in the community
Diazepam rectal solution or midazolam oromucosal solution
acute hypoglycaemia management
contraceptive injection name
Medroxyprogesterone acetate
150mg
IM
every 12 weeks (do not put three monthly)
management of B12 deficiency
Hydroxocobalamin
1mg
IM
Once Daily
Sam is a 70 year old who presents to A&E with shortness of breath. He recently moved to Southend after residing in London for 50 years. He was discharged from the hospital in London a few weeks ago due to diverticulitis. He mentions that there were a lot of changes to his medications. His knee pain has also been flaring up.
PMH: asthma, osteoarthritis, gout, hypertension, anxiety
Bloods and chest X-ray are unremarkable
DH:
Select the TWO medications that you should be cautious about co-prescribing due to the potential for hypersensitivity and/or haematological reactions (write the number in the blank eg: A and B)
A and B
Allopurinol and Enalapril
- increases risk of hypersensitivity reaction
A 76-year-old gentleman, Mr Perkins, was admitted to orthopaedic department, who sustained an intracapsular neck of femur fracture, after tripping over an uneven pavement. He is listed for hemiarthroplasty tomorrow morning.
He has past medical history of Asthma, Diabetes Mellitus, BPH and Idiopathic Parkinson’s disease,
He was made nil by mouth from midnight for the procedure.
Blood tests:
Hb 127 g/L,
WBC 6.6 x 109/L,
PLT 321 x 109/L,
normal U&Es
Obs: Respiratory Rate 17/min, BP 122/83mmHg, HR 90/min, T 36.8C, Conscious level: Alert
A: Select ONE Prescription that is most appropriate to be converted to an equivalent transdermal preparation while the patient is nil by mouth (write the number in the blank eg: A)
Madopar oral -> converted to Rotigone transdermal patch
if patient has diabetes and heart failure always co-prescribe emtformin with
SGLT-2 inhibitor e.g. Dapagliflozin
good painrelief for osteoarthritis before stronger painkillers started
Paracetamol and Diclofenac gel
monitoring methotrexate
- avoid in pregnancy
- can cause liver toxicity- liver function tests necessary
instructions for taking alendronic acid
take the medication upright on an empty stomach with a full glass of water 30 minutes before breakfast and remain upright for at least 30 minutes
A 3-year-old child with asthma requires a salbutamol nebuliser. The recommended dose is 0.15 mg/kg. The child weighs 15 kg. Salbutamol nebuliser solution is available at 5 mg/ml. Calculate the volume of salbutamol solution needed for one dose.
0.45ml
A 42-year-old patient with type 2 diabetes is prescribed insulin glargine. The endocrinologist recommends a dose of 0.2 units/kg/day. The patient weighs 90 kg. Insulin glargine comes in a concentration of 100 units/ml. Calculate the volume of insulin glargine the patient should inject once daily to the nearest 0.1ml.
0.2
A 25-year-old female with anaemia is prescribed oral iron supplements. The recommended dose for replacing iron deficiency is approximately 1.5g of elemental iron per week. Ferrous sulphate 200mg tablets contain 70 mg of elemental iron in each tablet. How many tablets should she take daily to achieve the recommended dose of elemental iron replacement?
3
A 38-year-old male with a history of severe depression is being managed with CBT and medication. He presents to his GP 6 weeks after starting a new medication with symptoms of dry mouth, blurred vision, constipation, and difficulty urinating. Which of the following is the most likely drug that he has been prescribed? (2Pt)
* Bupropion
* Sertraline
* Amitriptyline
* Propranolol
* Escitalopram
Amitriptyline
An 80-year-old woman was admitted to hospital with a UTI and delirium from her nursing home and is started on an antibiotic. Several days into the admission, she begins to develop fever, chills, cough, chest pain, and difficulty breathing. Radiographic imaging shows diffuse interstitial infiltrates.
On examination, she is anxious. Pulse is 120/min and Respiratory rate is 35/min . Auscultation reveals fine inspiratory crackles in middle and lower zones bilaterally.
The Consultant suspects the patient may have had a drug-reaction.
Select one medication that is most likely responsible for this patient’s presentation. (2Pt)
* Nitrofurantoin
* Ciprofloxacin
* Amoxicillin
* Trimethoprim/sulfamethoxazole
* Cephalexin
Nitrofurantoin
A 68-year-old female with a history of atrial fibrillation has been stably managed on Sotalol 80mg once daily for several years. She was recently diagnosed with rheumatoid arthritis and started on a new disease-modifying antirheumatic drug (DMARD). She presents to the clinic with symptoms of palpitations and light-headedness. An ECG reveals a significantly prolonged QT interval. Which of the following medications is most likely responsible for her prolonged QT interval? (2Pt)
* Hydroxychloroquine
* Methotrexate
* Sulfasalazine
* Leflunomide
* Azathioprine
Hydroxychloroquine
A 22-year-old male with a history of acute psychotic episodes is admitted to the psychiatric unit and started on medication for his symptoms. Two weeks later, he develops severe muscle rigidity, high fever, and altered mental status. His laboratory tests show an elevated creatine kinase level. He is diagnosed with neuroleptic malignant syndrome (NMS). Given his medication regimen, which of the following drugs is most likely responsible for the development of NMS?
- Clonazepam
- Pregabalin
- Sertraline
- Lamotrigine
- Haloperidol
Haloperidol
Nehal, a 32-year-old lady is diagnosed with epilepsy following multiple tonic-clonic seizures. Initially, she was prescribed lamotrigine and then levetiracetam, however had allergic reactions to both. She does not have any current plan to conceive but has a stable partner. After being reviewed by two neurologists, she has been started on sodium valproate and has given written consent that she will abide by the conditions of the pregnancy prevention programme. Before initiating sodium valproate, which of the following is most appropriate to perform? (2Pt)
* FBC and U&E
* FBC and LFT
* Urine Dipstick for Pregnancy
* FBC, LFT and Urine Dipstick for Pregnancy
* FBC, U&Es and Urine Dipstick for Pregnancy
FBC, LFT and Urine dipstick for pregnancy
Blood tests for RIPE protocol for TB
Full Blood Count (FBC), Liver Function Tests (LFTs), Visual Acuity Test, and Renal Function Tests
Sam is a 35-year-old male presented to his GP to follow up on his diabetes. He has type I diabetes and is compliant with a basal-bolus regime. He reports exercising at least 1 hour three times per week and eats a balanced diet and follows carb-counting strictly which he has done lifelong given his diabetes. Bloods and observations are as follows:
He is not keen to increase his total insulin dose. Select the one most appropriate adjunct to help improve his glycaemic control. (2Pt)
* Add Metformin
* Switch to mixed Insulin
* Encourage exercise and refer to a dietician
* Add Sitagliptin
* Add exenatide
add metformin
- others rely on being able to produce insulin
A 30-year-old lady with a history of schizophrenia, migraine and asthma attends her GP for routine blood tests. She feels well in herself however reports regular wheeze, worse at night.
DH: Salbutamol PRN, clozapine, citalopram, propranolol, paracetamol and ibuprofen.
Her GP is concerned about the following blood test results and refers her to the medical assessment unit for evaluation.
Select the one most appropriate course of action from the following options. (2Pt)
* Stop Clozapine
* Continue clozapine but stop citalopram and propranolol
* Stop clozapine, propranolol and ibuprofen
* Stop clozapine, propranolol, ibuprofen and paracetamol
* Stop clozapine, propranolol, ibuprofen and citalopram
Stop clozapine, propanolol and ibuprofen
- wheeze
HRT for : Uterus intact + LMP <12m
- oral sequential combined oestrogen and progesterone (Elleste-Duet 1mg or 2mg)
- patch sequential combined oestrogen and progesterone (Evorel Sequi)
HRT for : Uterus intact + LMP >12m
- Oral continuous combined oestrogen and progesterone (Elleste-Duet Conti)
- Kliovance
- Tibolone
HRT: Mx vasomotor sx in someone that cant take HRT
Clonidine
HRT for: post-hysterectomy
- oral or patch oestrogen (Elleste-Solo)
- Tibolone
