Planning Mx

Question 1

How long should oral iron replacement therapy be given?

Answer 1

Until the haemoglobin is in the normal range and then for a further 3 months to replenish stores

Question 2

What is an acceptable rise in creatinine and K+ after starting ACE inhibitors?

Answer 2

1. Up to 30% rise in creatinine (from baseline)
2. Rise in K+ up to 5.5mmol/L
   (decline in eGFR should be <25%)

Question 3

Monitoring for ACE inhibitors - what do you measure before starting and before increasing the patient’s dose?

Answer 3

Check U&E and renal function tests

Question 4

What do you prescribe with methotrexate and when should you take this drug?

Answer 4

Folic acid 5mg once WEEKLY should be co-prescribed, take 24h after methotrexate dose

Question 5

Methotrexate and pregnancy advice

Answer 5

Contraception for at least 3 months after stopping methotrexate (also advice this to men!)

Question 6

Monitoring of Lithium

Answer 6

1. Lithium levels (12h post-dose) - measure weekly after each dose change and until conc are stable (then measure every 3m)
2. Thyroid and renal function

Question 7

Duration of treatment in

1. UTI in men
2. UTI in women (uncomplicated)

Answer 7

1. 7 days

2. 3 days

Question 8

When do you stop taking warfarin before surgery? How would you Mx the patient if the INR is 1.5 or higher on the day before surgery?

Answer 8

5 days before

Give phytomenadione orally the day before.

Question 9

When do you stop taking antiplatelet (aspirin, clopidogrel, ticagrelor) drugs before surgery?

Answer 9

7 days

Question 10

What would you advise patients taking topiramate (and other enzyme inducing drugs) regarding their oral contraception?

NB both COCP and P4 only pills are affected

Answer 10

Change to an alternative method of contraception until 4 weeks after she has ceased taking the medication.

Question 11

Patient with strong hx of alcohol dependence - shows signs of tremor, sweatiness, agitation as well as confusion and poor memory

How would you manage?
A) Pabrinex
B) Lorazepam

Answer 11

Pabrinex!

In this case where the patient is presenting with symptoms of both withdrawal and possible Wernicke’s encephalopathy, must treat Wernicke’s first to avoid progressing into Korsakoff’s. Then treat the withdrawal after.

This still applies even if they have come in with prescription of thiamine and folic acid

Question 12

What is the first line treatment in patients with a severe flare of UC (>6 loose stools a day and systemically unwell)?

Answer 12

IV hydrocortisone