Practical Use of the BNF

Question 1

If searching for - pre-treatment screening, drug monitoring or patient and carer advice - search under the …

Answer 1

drug name

Question 2

Drug interactions on medicine complete

Answer 2

type in all the relevant drugs in the search bar (separated by a space), click enter, on left click interactions - will tell you the interactions and potentially evidence for this interaction

Question 3

A 52 year old man is on co-trimoxazole for pneumocystis jurovecci pneumonia but is unable to tolerate it due to diarrhoea. Which alternative drug treatment can be offered? (find on BNF)

Answer 3

Atovaquone is licensed for the treatment of mild to moderate pneumocystis infection in patients who cannot tolerate co-trimoxazole

Question 4

Thrombocytopenia is commonly attributed to amlodipine - T or F?

Answer 4

F - rare

Question 5

Searching for a specific term?use …

Answer 5

control F on relevant drug page

Question 6

68yo woman is admitted with uncontrolled pain and swallowing difficulty - taking oral morphine sulfate MR30mg BD only for bone pain related to metastatic carcinoma of the breast - what dose of fentanyl patch is most appropriate?

Answer 6

fentanyl ‘24’ patch every 72 hours due to 60mg daily (30mg bd = 60mg)

Question 7

Searching for dose conversions of opioids? go to where?

Answer 7

prescribing in palliative care section

Question 8

Searching for conversions and units?

Answer 8

search units or conversions - can also be used to calculate dose in the absence of measurements

Question 9

Searching for IV fluids?

Answer 9

BNF not perfect but gives some info on different fluid - search fluid and electrolytes and check NICE algorithms for IV Fluid Therapy

Question 10

Searching for blood products?

Answer 10

BNF is not great, blood components are not licensed medicines

Question 11

Blood product infusion rates

Answer 11

red cells over 60-120 minutes (no slower than over 4 hours)
platelets over 30-60 minutes
fresh frozen plasma (FFP) over 10-20 mL/kg/hour - volume of FFP in a unit is variable, mean FFP unit volume = 271 mls (rounded up to 275 mls for ease of formulation)

Question 12

Searching for dose equivalence or activity of corticosteroids?

Answer 12

Search glucocorticoid therapy/corticosteroids

For gradual withdrawal of corticosteroids search under each individual corticosteroid and click on treatment cessation

Question 13

Activity of corticosteroids:
Higher mineralocorticoid activity =
Higher glucocorticoid activity =
Very high glucocorticoid =

Answer 13

Higher mineralocorticoid activity = fludrocortisone, hydrocortisone
Higher glucocorticoid activity = prednisolone
Very high glucocorticoid = betamethasone, dexamethasone

Question 14

Very high glucocorticoid = … and …

Answer 14

betamethasone, dexamethasone

Question 15

Higher glucocorticoid activity = …

Answer 15

prednisolone

Question 16

Higher mineralocorticoid activity =

Answer 16

fludrocortisone, hydrocortisone

Question 17

Adverse effects of corticosteroids: Mineralocorticoid

Answer 17

hypertension
na and water retention
k+ loss

Question 18

Adverse effects of corticosteroids: Glucocorticoid

Answer 18

Hyperglycaemia (Diabetes)
Avascular necrosis of the femoral head
Osteoporosis
Proximal myopathy
Psychiatric reactions
Peptic ulceration and perforation

Question 19

Other adverse effects of corticosteroids (non-specific)

Answer 19

thin skin/easy bruising
adrenal suppression
immunosuppression
cushing’s syndrome

Question 20

Searching for HRT?

Answer 20

BNF not ideal but really useful for contraindications/cautions - search sex hormones or menopause

Question 21

HRT - go back to basics
… …. - oestrogen only
Uterus - no … (combined - oestrogen and progestogen)
Uterus with … (sequential combined)

Answer 21

HRT - go back to basics
No uterus - oestrogen only
Uterus - no periods (combined - oestrogen and progestogen)
Uterus with periods (sequential combined)