Prescribing

Question 1

HRT in a peri-menopausal woman

Answer 1

-ve Hysterectomy => oestrogen and progesterone e.g. Levonorgestrel 7mcg/ estradiol 50mcg 24hr via patch

+ve hysterectomy => estradiol 50mcg 24h transdermal patch

Question 2

What are the starting doses for statins?

Answer 2

Atorvastatin - 20mg Primary, 80 mg Secondary

Simvastatin - 40mg, increase to 80mg if severe

Question 3

Treatment for hypoglycaemia in a confused/drowsy pt

Answer 3

15g glucose IV i.e. 75 ml 20% glucose IV

Question 4

A patient is admitted 7 hours after an acute stroke, and appears slightly dehydrated but is haemodynamically stable. Write a prescription for an IV fluid that is most appropriate for this patient

Answer 4

1L 0.9% Saline + 0.3% KCl.

Glucose containing fluids can exacerbate cerebral injury

Question 5

What is the first line treatment of a DVT/ PE

Answer 5

DOAC. Rivaroxaban or Apixaban. If Cx (antiphospholipid syndrome) then LMWH

Question 6

How do you treat AF that has been present for >48h?

Answer 6

If AF has been present for >48h, anticoagulate with DOAC/ LMWH for at least 3W (and 4W after) before DC
cardioversion.

Question 7

What drug do you prescribe in a patient with hypertension and BPH?

Answer 7

Prazosin

Question 8

What do you prescribe for BPH

Answer 8

Doxazosin

Question 9

How do you treat hypoglycaemia with impaired consciousness?

Answer 9

20g Glucose IV => 100ml 20% Dextrose IV OR 200ml 10%

Alt. IM/SC glucagon

Question 10

What are target HbA1c levels for

a) patients on metformin
b) patients on metformin + gliclazide?

Answer 10

a) 48mmol/mol - consider intensifying Tx if HbA1C >58

b) 53 mmol/mol

Question 11

What is the average maintenance fluids and K+ required in an adult?

Answer 11

3L IV maintenance fluids per day

i. e. 8 hourly bags of 1L with 40-60mmol day
i. e. 20mmol in each 1L bag.

Question 12

What is the dosage of adrenaline used in cardiac arrest?

Answer 12

IV 1mg of 1:10000 adrenaline.

Question 13

What is 1st line Tx of T2 diabetes in patients with renal impairment?

Answer 13

If eGFR >45, metformin is first line.

If eGFR <30, 1st line is sulfonylurea e.g. gliclazide - note increased risk of hypoglycaemia.

Question 14

What is the 1st line fluid to prescribe in hypovolemic shock following initial bolus of 0.9% NaCl?

Answer 14

For hypovolaemic shock, burns and cardiopulmonary bypass, prescribe a colloid bolus to maintain intravascular pressure e.g. fluid challenge of 500ml gelofusine (gelatin) IV over 30 min.

Question 15

Patient taking ramipril for hypertension presents to GP with a cough. What will you do with this prescription?

Answer 15

Start on trial of angiotensin receptor blocker. eg candasartan losartan

Question 16

What is the correct dosage of enoxaparin to prescribe in VTE prophylaxis?

Answer 16

20mg in low risk, 40mg in high risk

Question 17

What is the 1st line treatment for hospital acquired bneumonia?

Answer 17

Co-amox 500/125 mg three times a day orally or 1.2 g three times a day IV5 for 5 days in total then review

Tazocin if severe. 4.5mg TDS

Question 18

What is an appropriate dose of Senna to prescribe for constipation?

Answer 18

7.5 mg - 15mg

Question 19

What do you check before starting a patient on ramipril?

Answer 19

U&Es and Renal function