Prescribing

Question 1

What is the drug treatment for Impetigo?

Answer 1

BNF recommends oral Flucloxacillin for widespread impetigo.

More isolated areas can be treated with topical Fusidic acid.

Question 2

Drug treatment for acute pulmonary oedema?

Answer 2

Furosemide, 40mg IV.

Example of examination: bibasal crepitations, heart sounds 1 + 2 + 3. JVP 6 - 7 cm, bipedal oedema noted.

Question 3

Drug treatment for patient with acute adrenal insufficiency due to withdrawal of prednisolone?

Answer 3

Dexamethasone 3.4mg IV

OR

Hydrocortisone 100mg IV

Question 4

Drug treatment to control secretions on patient with end of life care?

Answer 4

Glycopyrronium 200mcg S/C

Secretions can be troublesome and an anti-cholinergic agent like Glycopyrronium (especially given in the subcutaneous route in drowsy patients) can be very helpful. An alternative is hyoscine hydrobromide/butylbromide, which also helps with vomiting, however Glycopyrronium is often used first as it is more effective for respiratory secretions.

Question 5

Drug treatment for breathlessness on patient on end of life care?

Answer 5

Morphine 2.5 - 5mg S/C

Breathlessness can initially be treated with supplementary oxygen and sometimes with a fan in the room. However when this is not enough morphine can be used as well. The oral route is ideal in patients who can tolerate this. If patient is not tolerating orally, the subcutaneous can be considered.

Benzodiazepines are also useful for the treatment of breathlessness.

Question 6

Medication for prevention of pneumococcal infection in paediatric patient with sickle cell anaemia?

Answer 6

Phenoxymethylpenicillin, oral 250mg, twice a day.

Prophylactic penicillin is usually given to children at least until age 5 years and often after that as well to decrease risk of pneumoccocal infection due to functional asplenia.

Question 7

Drug treatment for 35y/o man with sharp central chest pain, worse on lying back and better on sitting forward. ECG shows widespread ST elevation.

Answer 7

Ibuprofen 600 - 800mg, Oral, 8 hourly (TDS)

Clinical symptoms of pericarditis. Cause of pericarditis is most often infective (viral or bacterial). Autoimmune diseases can also cause this presentation. The first line choice is usually ibuprofen but other NSAIDs are acceptable.

Question 8

First line drug treatment for rate control of AF?

Answer 8

The first line treatment for someone without evidence of HF is either a beta-blocker or calcium channel blocker.

Question 9

Drug treatment for chlamydia?

Answer 9

• Doxycycline 100mg twice daily for seven days.

However if pregnant, doxycycline is contraindicated in pregnancy, alternatives”

• Erythromycin 500mg twice daily for 14 days

OR

• Amoxicillin 500mg three times a day for seven days

Question 10

Most appropriate immediate drug for anaphylaxis?

Answer 10

Adrenaline 1:1,000 0.5mg (500 micrograms) IM

Question 11

Treatment of limited impetigo?

Answer 11

Treatment of limited impetigo affecting small areas of the skin is to use topical hydrogen peroxide 1% cream. If unsuitable (eg around eyes) offer topical antibacterial (fusidic acid).

Question 12

Medication for end of life agitation?

Answer 12

Agitation can be controlled by benzodiazepines like Midazolam. The subcutaneous route is usually preferred due to its controlled release of drug to the patients.

Note: Haloperidol or levomepromazine would not be appropriate in a patient with parkinsons.

Question 13

Drug treatment for clostridium difficile infection?

Answer 13

Oral metronidazole is often used as first ine therapy. The duration should be 10 to 14 days. Dose is 400mg TDS (500mg tds also acceptable).

Second line treatment is oral Vancomycin.

Question 14

First line antibiotic for low-severity community acquired pneumonia?

Answer 14

Amoxicillin, 500mg, Oral, 8-hourly (TDS), 5 days.

Question 15

Drug treatment for old man with urinary retention while he awaits surgery? (BPH)

Answer 15

Tamsulosin 400 micrograms, Oral, Daily.

Medical therapy may help with symptoms whilst surgical options are considered. Tamsulosin is an alpha blocker which causes smooth muscle relaxation.

Question 16

19y/o woman with anaemia, nine weeks pregnant. Drug treatment?

Answer 16

Ferrous sulphate, 200mg, Oral, 2 - 3 times daily.

Question 17

Immediate management for patient with eclampsia?

Answer 17

Magnesium sulphate 4g, in 0.9% soidum chloride, 5 - 15 minutes, IV.

Immediate treatment is with magnesium suplhate infusion and then to control the blood pressure. After the initial loading dose, a maintenance dose needs to be prescribed as well.

Question 18

Prescription for 2 nebulised medications for acute asthma?

Answer 18

Salbutamol 5mg
Ipratropium bromide 0.5mg
NEB

Question 19

Drug treatment for angina?

Answer 19

GTN Spray, 400mcg, Sublingual

Question 20

Antibiotic for 2 year old child with suspected meningitis?

Answer 20

Ceftriaxone, 80mg/kg, IV

OR

Cefotaxime 50mg/kg IV

Question 21

Drug treatment for life threatening community acquired pneumonia of patients from a nursing or residential home?

Answer 21

Co-Amoxiclav 1.2g IV

AND

Clarithromycin 500mg IV

Question 22

Drug treatment for infective conjunctivits.

Answer 22

Chloramphenicol drops 0.5%. 2-hourly. 1 drop per eye

First line treatment is usually chloramphenicol eye drops, it is important to be specific on the strength of the eye drops when prescribing. The frequency is usually advised as 2 hourly during waking house. The duration is usually discussed with the patients- the drops should be used until the infection is controlled and then for a further 48 hours after healing.

The duration can be variable but patient should come to see the GP if not resolved in one week.

Question 23

Drug treatment for prophylaxis of tuberculosis

Answer 23

Isoniazid, 300mg orally once a day. Duration?

When an active TB infection is found in an adult, all family members who have been in contact with that person usually are also treated with isoniazid regardless of their own skin test results.

Question 24

Most appropriate first line diuretic for patient with ascites due to liver cirrhosis? (no evidence of infection)

Answer 24

Spirinolactone, 100mg (starting dose), Oral, Daily.

Treatment includes fluid restriction, low salt diet and pharmacological treatment. Spirinolactone is the first line duiretic as it addresses the deranged renin-angiotensin-aldosterone balance. Starting doses of up to 100mg daily are often used.

Second line agents include furosemide.

Question 25

Treatment for uncomplicated UTI in women?

Answer 25

BNF recommends either Trimethoprim or Nitrofurantoin. The duration of treatment for uncomplicated UTI in women is 3 days.

Question 26

Drug treatment for Impetigo?

Answer 26

The treatment of limited impetigo, affecting small areas of the skin is to use Topical hydrogen peroxide 1% cream. If topical hydrogen peroxide 1% cream is unsuitable (eg if impetigo is around the eyes), offer a topical antibacterial (fusidic acid).

Topical 1% hydrogen peroxide is usually applied to the affected area two to three times a day for 5 days and fusidic acid 2% is applied for three times a day for a total of 5 days.

Question 27

What are the different types of laxatives and their examples?

Answer 27

Osmotic laxatives
- examples include lactulose, macrogols and rectal phosphates

Stimulant laxatives

• examples include senna, docusate, bisacodyl and glycerol
• co-danthramer should only be prescribed to palliative patients due to its carcinogenic potential

Bulk-forming laxatives
- examples include ispaghula husk and methylcellulose

Faecal softners

• include arachis oil enemas
• not commonly prescribed

Question 28

Management for shingles?

Answer 28

Aciclovir 800mg five times daily for 7 days

Question 29

What is the starting dose of metformin?

Answer 29

500mg PO daily for one week, taken with breakfast.

Start low to minimise side effects.

Then 500mg twice daily for one week, then 500mg three times daily.

Question 30

Drug management for acute dystonic reaction?

Answer 30

Procyclidine hydrochloride 5mg/ml.

5 - 10 mg IM/IV. Parenteral administration is preferred over oral as there may be unsafe swallow.

Question 31

First line IV treatment of hypoglycaemia?

Answer 31

Glucose 20% is first line IV treatment for hypoglycaemia. If glucose 20% is not available, glucose 10% is a suitable alternative.

Infusions of 10% (100 - 200ml) or 20% (50 - 100ml) deliver between 10 - 20g of glucose.

I put glucose 20% 100ml over 15 mins and got full marks. Cant find exactly.

Glucose 50% is hypertonic and risks extravasation.