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3B + Finals > Prescribing > Flashcards

Prescribing Flashcards

1
Q

When can you give oestrogen only HRT and when can you give combined

A

No uterus = oestrogen only
Uterus = combined
Because of risk of endometrial hyperplasia/cancer on oestrogen only

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2
Q

Rules on periods and HRT

A

<50 patients have to have been period free for 24 months to qualify for continuous therapy - if not cyclical
>50 12 months for continuous

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3
Q

3 Alternative to hormone replacement therapy

A

1) Clonidine - Alpha blocker. Prevents vasomotor symptoms
2) Fluoxetine - SSRI
3) Venlafaxine - SNRI

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4
Q

8 Contraindications of HRT

A 
Undiagnosed abnormal bleeding 
Endometrial cancer/hyperplasia 
Breast cancer hx 
Raised BP
Hx of VTE
Liver disease
Cardiovascular disease
Pregnancy
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5
Q

Example of oral oestrogen only medication

A

Estradiol - Estelle solo

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6
Q

example of transdermal oestrogen only

A

Estradiol - Evorel

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7
Q

Example of progesterone IUD

A

Levonorgestrol - Mirena

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8
Q

Example of oral combined

A

Estelle duet

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9
Q

Example of transdermal combined contraceptive

A

Evorel sequi = cyclical

Evorel conti = continuous

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10
Q

Side effects of progesterone

A 
Mood swings 
weight gain 
acne
fluid retention 
bloating
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11
Q

side effects of oestrogen

A

nausea/vom
breast tenderness
headaches
cramps

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12
Q

Reason for choosing transdermal over oral

A

Lower risk of headache, CVD, VTE

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13
Q

What drugs should be used to managed CKD caused by DM or hypertension

A

ACE-I

ARB

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14
Q

What drugs should be stopped in AKI/renal impairment

A

diuretics
NSAIDs
Rifampicin
ACE-I/ARB - may have been prescribed in CKD
ciclosporin
Lithium - may need dose reduction. Don’t completely stop. Same for digoxin
Opioids - morphine and codeine avoid. Swap codeine for oxycodone where possible.

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15
Q

Calcium channel blocker to be used in hypertension

A

Amlodipine (or nifedipine but don’t)

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16
Q

Ca blocker to use in unstable angina

A

Don’t use one!

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17
Q

Ca blocker to use in stable angina

A

Any. Amlodipine is safest choice.

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18
Q

Cardio selective Ca blockers

A

non-dihydropyradines - verapamil and diltiazem

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19
Q

Vascular selective Ca Blockers

A

dihydropyradine - amlodipine nifedipine

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20
Q

What Ca blockers are CI with B blockers

A

non-dihydropyradines - verapamil and diltiazem

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21
Q

Indications for Verapamil

A

Arrhythmias

SVT

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22
Q

CI of Ca blockers

A

Avoid non-d in HF and in AV conduction delay/heart block.
Avoid non-d along side a b blocker
Avoid in unstable angina and aortic stenosis

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23
Q

SSRI to prescribe in cardiac disease

A

Sertraline

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24
Q

Treatment for lactational mastitis

A

Flucloxacillin

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25
Q

Monitoring for patients on digoxin

A 
digoxin levels (toxic)
Potassium levels because digoxin raises potassium
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26
Q

Drugs that cause constipation

A 
Opioids 
Anti-cholenergic drugs 
Iron supplements
Anti-emetics
Bisphosphonates
Ondansetron
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27
Q

1st 2nd and 3rd line mx of constipation

A

Bulk forming - ishaghula husk
Osmotic - lactulose or macrocell
Stimulant - senna

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28
Q

CI for laxatives

A

Bowel obstruction

Faecal impaction

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29
Q

Antibiotics to prescribe in COPD exacerbation

A

Doxycycline
Amoxicillin
Clari

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30
Q

1) Drug to give in COPD exacerbations when patients who aren’t getting better. + Dose
2) Another supportive measure that can be done in unwell patients

A

1) Aminophylline 5mg/kg max

2) NIV

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31
Q

1) First 3 drugs of management of asthma exacerbation

2) 2 specialist drug which may be given

A

1) Steroids (pred 40-50mg daily or IV hydrocortisone 100mg). Nebulised salbutamol 2.5mg. Nebulised ipratropium 500mcg
2) Mg 1.2-2g IV. Aminophylline

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32
Q

1) Rules on maintenance fluid prescribing in stroke patients - why?
2) How much, water, K+, Na+, Cl- needed per day.
3) How much glucose needing in stable patient

A

1) No glucose in first 24 hours due to risk of cerebral oedema
2) 25-30ml/kg of water. 1mmol/kg of electrolytes
3) 50-100g/day of glucose

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33
Q

1) How much glucose in a 5% dextrose bag 1L

2) How much K+ in 1L 0.3% and 0.15%

A

1) 50g

2) 40mmol and 20mmol

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34
Q

What rate do you prescribe fluids for:

1) Resus
2) Dehydration
3) Maintenance

A

1) < 15 min
2) 4-6 hours
3) 8-12 hours

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35
Q

1) When do you prescribe resuscitations fluids
2) What fluid, volume and rate?
3) When to escalate

A

1) BP < 90. HR > 90. CRT > 2
2) 500mL saline. < 15 min. (250 in frail)
3) after 2L

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36
Q

Fluids to prescribe in hypoglycaemia

A

20% glucose in 100mLs

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37
Q

Progesterone only pills:

1) What counts as a missed pill
2) How to manage a missed pill
3) When might they need emergency contraception

A

1) traditional pill >3hrs from due. Desogestrol >12 hrs
2) Take the pill asap, might involve taking 2 pills at once. Use condoms for next 48 hours
3) Unprotected sex within the 48 hours they will require emergency contraception

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38
Q

COCP:

1) What counts as a missed pill
2) When is emergency contraception required

A

1) 24 hours late (48 hours from last pill)
2) 1 missed pill, just take it and you’re fine.
3) If 2 missed pills within the first 7 days of a pack

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39
Q

Management of gout.

If allergic to first line

A

Naproxen

Colchicine

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40
Q

Management of strep throat

If allergic to first line

A

Phenoxymethylpenicillin

Clarithromycin

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41
Q

1) First line emergency contraception option
2) Medical option
3) If the person if taking enzyme inducing drugs - what should be done

A

1) Copper coil
2) 1.5mg levonorgestrol.
3) Ideally copper coil. If not increase levo dose to 3mg

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42
Q

How to manage a patient on statins with raised LFTs

A

Raised = 3 times the upper limit in this case

stop statin for 1 month. See if LFTs come down, then restart at a lower dose.

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43
Q

Name 10 drugs that legthen the Qtc

A 
Antipsychotics 
Type 1a anti-arrhythmics 
Flacainide 
Amiodarone 
Anti-depressants 
Macrolides
Hydroxychloroquine
44
Q

1) What is the dose and volume of a VRII
2) What is considered a hypo on VRII
3) How is a hypo managed
4) When to manage a hyperglycaemic episode as DKA
5) Which diabetic drugs need to be stopped on VRII
6) When/how do you switch a patient back to their normal insulin regime

A

1) 50 units in 49.5mL (1U/mL)
2) < 4
3) Stop VRII for max 20 minutes. Give 20% glucose 100mL
4) When ketones >3
5) Oral hypoglycaemics. Fast acting insulins. Keep long acting insulins
6) At meal time. When they no longer have nausea or vomiting. Give food and dose of fast acting insulin. Turn VRII off after 30-60 minutes.

45
Q

How to calculate insulin regime in insulin naive patients

1) By weight
2) For twice daily injections
3) For basal bolus

A

1) 0.5U x weight. in elderly 0.3U x weight
2) 60% in morning injection 40% in afternoon
3) 50% - long acting - 25% morning 25% eve
50 % derided into 3 doses of rapid acting for 3 meals

46
Q

1) Indications for digoxin
2) mechanism of action
3) 4 side effects
4) contra-indications of digoxin
5) What to do with digoxin in renal failure
6) What can cause digoxin toxicity
7) symptoms of digoxin toxicity

A

1) AF. 3rd line mx of heart failure
2) increases intracellular Na, cells retain Ca and so have stronger contraction
3) bradycardia, visual disturbance, rash, dizziness
4) 2nd degree HB. Ventricular arrhythmias
5) Dose reduction
6) Renal impairment. Low K+, Low Mg, raised Ca. Thiazide and loop diuretics. Amiodarone
7) GI upset. Palpitations. Dyspnoea. Syncope

47
Q

Side effect of ace-i more common in afro-caribean people.

A

Angio-oedema

48
Q

indications for managing a PE with thrombolysis

A

Haemodynamically unstable
Cardiac arrest
Evidence of right heart strain

49
Q

Management of stable patients with PE

A

DOAC treatment dose

LMWH treatment dose

50
Q

Contraindication for DOACs and the alternative

A

Pregnancy - LMWH

51
Q

Cautions when prescribing LMWH

A

Renal impairment - low clearance so will accumulate - consider dose reduction

52
Q

Serious adverse effect of heparin

A

HIT
Antibodies to heparin cause platelets to start coagulation cascade.
Platelets all used up

53
Q

Severe adverse reaction of DOACs

A

severe cutaneous acute reaction

54
Q

Other side effects of DOACs

A

constipation

GI upset

55
Q

Caution when prescribing DOACs

A

Teratogenic - don’t give in pregnancy

56
Q

Antidote for heparin overdose

A

protamine

57
Q

1) Warfarin mechanism of action
2) 2 contraindication for warfarin use
3) effect of CYP450 enzymes on warfarin

A

1) vitamin K antagonist
2) liver disease. Pregnancy
3) Inducers increase warfarin breakdown - increased clotting risk. Inhibitors prevent warfarin breakdown - increased INR and bleeding risk

58
Q

How to manage the following:

1) INR 5-8 no bleeding
2) INR > 8 bleeding
3) INR 5-8 bleeding
4) INR > 8 no bleeding
5) Major bleeding

A

1) Stop warfarin for 2-3 days. Remeasure INR
2) IV phytomenadione 1-5mg. Stop warfarin.
3) IV phytomenadione 1-5mg. Stop warfarin
4) Oral phytomenadione 1-5mg. Stop warfarin
5) Dried prothrombin complex 50U/kg. + IV phytomenadione 5mg

59
Q

1) Drug used to manage focal seizures
2) Drug for most other seizures
3) Second line drug

A

1) Carbamazepine
2) Valproate
3) Carbamazepine or Lamotrigine

60
Q

Best anti-epileptic for pregnant and breast feeding women

A

Lamotrigine

61
Q

Side effects of Carbamazepine

A 
Oedema 
Hyponatraemia 
GI upset 
Leucopenia 
Thrombocytopenia
62
Q

Side effects of valproate

A 
increased weight 
raised LFTs
thrombocytopenia 
hair loss
oedema 
ataxia 
tremor
63
Q

Drugs that lower the seizure threshold

A

SSRIs
Tricyclics
Antipsychotics
Tramadol

64
Q

Patient presents with lymphadenopathy, fever and a rash. PMH: epilepsy

1) likely diagnosis
2) causes

A

1) Anti-epileptic hypersensitivity syndrome
2) Aromatic epileptic drugs
Phenytoin. Phenobarbitol. Carbamazepine

65
Q

Management of status epileptics

1) Outside of hospital
2) With IV access
3) After ? long

A

1) Buccal midazolam 10mg every 10 min
2) 4mg lorazepam
3) 25 min - ITU. Give phenytoin infusion. Then propafol if still no resolution.

66
Q

Side Effects of lithium

A 
L - Leukocytosis 
I - increased weight 
T - tremor 
H - hypothyroidism 
I - impaired renal function 
U - increased during output 
M - metalic taste
67
Q

Signs of lithium toxicity

A 
T - Tremor
O - oliguric AKI
X - Ataxia
I - increased reflexes 
C - convulsions
68
Q

Extra Pyramidal signs seen with anti-psychotics

A

Parkinsonism - bradykinesia, tremor, rigidity
Akethesia
Dystonia
tardive dyskinesia

69
Q

Patient recently started on respiradone presents with stiff neck muscles, and eyes rolled upwards.

1) Name of symptoms
2) Diagnosis
3) Management

A

1) Rigidity of neck and jaw muscles + oculogyric crisis
2) Acute dystonic reaction
3) Procyclidine

70
Q

1) Timing of neuroleptic malignant syndrome

2) Management

A

First 10 days of starting anti-psychotic

Bromocriptine

71
Q

Symptoms of neuroleptic malignant syndrome

A 
Confusion
Pyrexia 
increased HR
Fluctuating BP
Rigidity 
Derranged LFTs
Leukocytosis 
raised CK
72
Q

1) Cause of serotonin syndrome

2) Timing of symptoms presenting

A

1) Increased serotonin

2) Within minutes of taking SSRI

73
Q

Symptoms of Serotonin syndrome

A 
Headache 
agitation 
Hypomania 
Shivering 
Sweating 
Hyperthermia 
Hypertension 
Increased reflexes 
Myoclonus 
Tremor
74
Q

Peri-operative management of:

1) Sex hormones
2) Anti-platelets (aspirin)
3) Warfarin
4) ace-i and why

A

1) Combined hormones (HRT and contraception) should be stopped 4 weeks prior to elective surgery. Contraception can be restarted 2 weeks post of. HRT once fully mobilised (VTE risk)
2) Anti-platelets should be stopped 7 days prior to elective surgery
3) Warfarin stopped 5 days prior to surgery. Measure INR on the day/day before. Give phytymenodione 1-5mg if INR still >1.5
4) Need stopping prior to surgery (24 hrs) because of risk of peri-operative hypotension

75
Q

Emergency reversal drug for dabigantran

A

Idarucizumab

76
Q

Emergency reversal of apixaban or rivaroxiban

A

Andexant alpha

77
Q

Patient has pitting oedema up to thighs and bibasal crackles on auscultation.
Prescription and route, why?

A

IV furosemide

Pulmonary oedema requires faster acting loop diuretic (not oral)

78
Q

Mx of nausea in vomiting post op in a patient with schizophrenia

A

Cyclizine
Ondansetron would normally be first line but this patient is likely to be on an anti-psychotic which would further prolong the QTc.

79
Q

1) Best anti-emetic for nausea caused by hepatomegaly, reduced gut motility.
2) Serious side effect of this drug, and the worse effected age group.
3) Similar drug with fewer side effects
4) drugs that commonly cause nausea through reduced gut motility

A

1) Metoclopramide
2) Acute dystonia
3) Domperidone
4) Opioids

80
Q

1) Drugs used to manage nausea in palliative care

2) Side effect - when to avoid

A

1) Haloperidol

2) Extra-pyramidal signs. Avoid in Parkinson’s

81
Q

1) Best anti-emetic to use in patients with vertigo.
2) Mechanism of action
3) 2 side effects
4) 2 contraindications

A

1) Cyclizine
2) H1 receptor antagonist
3) anti-cholinergic. Anti-histaminic
4) Hepatic encephalopathy. Prostate hyperplasia

82
Q

1) Best anti-emetic to use in peri-operative nausea
2) Side effect
3) Second line anti-emetic in post surgical nausea

A

1) Ondansetron
2) Prolongation of QTc
3) cyclizine

83
Q

Drug licensed for management of N/V in migraines

A

Metochlopramide

84
Q

important side effects of amiodarone

A

Hyperthyroidism
bradycardia
AV block
Hepatitis

85
Q

Important contraindications of adenosine

A

Coronary ischemia
Heart failure
asthma and COPD

86
Q

1st and second line management of oral candida

A

1 - Nystatin

2 - Miconazole

3 - PO fluconazole when the above topical treatments don’t work

87
Q

Monitoring required before starting patient on COCP

A

BP

88
Q

Patient presents to A&E feeling unwell.
ABG shows Low C02. Low pH. Low Bicarb.
What drug is likely to have caused this

A

Metabolic acidosis

Metformin

89
Q

Monitoring to do for patients on ACE-I

A

Renal function

Esp K and Na

90
Q

1) 4 drugs for managing pseudonomal infection

2) Only oral option

A

1) Ceftazidime. Aminoglycosides. Gentamycin. Tobramycin. Ciprofloxacin
2) Ciprofloxacin

91
Q

Adverse effects of statins

A

Headache. GI upset. Myopathy/rhabdo. Increased liver enzymes, hepatitis

92
Q

When prescribing what drugs would you have to suspend statins? Why?

A

CYP450 inducers.

Amiodarone. Diltiazem. Itraconazole. Macrolides

93
Q

1) Side effects of glucocorticoids

2) Serious adverse effects

A 
1)Diabetes/glucose intolerance 
Osteoporosis 
Increased R of infection 
Fluid retention 
Hypokalaemia 
Mood changes
Muscle atrophy/breakdown
2) Peptic ulcers - warn about abdo pain. Addisonian crisis when stopped.
94
Q

Drugs that should be avoided with glucocorticoids

A

B agonists - increase hypokalaemia

NSAIDs increase R of peptic ulcers

95
Q

1) action of ACE-I
2) Side effects
3) CI/interactions

A

1) decreases angiotensin 2 and aldosterone through RAAS. Efferent arteriole dilation (protective in CKD). Reduced Na absorption and water through distal tubule
2) Low BP after first dose. Dry cough (switch to ARB). Angioedema
3) Pregnancy, AKI, Renal artery stenosis.
NSAIDs increase renal damage. Potassium elevating drugs

96
Q

1) Action of spiro
2) Side effects
3) CI

A

1) aldosterone antagonist in distal tubule. Na and water excretion. K retention
2) Hyperkalaemia. Titties.
3) Renal impairement (K+) Addisons (hypo-aldosteronism)

97
Q

1) Action of furosemide
2) side effects
3) CI

A

1) Blocks Na/K/Cl channel in loop. All electrolytes and water quickly excreted
2) Ototoxic - hearing loss, tinnitus. Worsens gout.
3) Avoid in hepatic encephalopathy.

98
Q

1) Action of thiazide

2) side effects

A

1) Blocks Na/Cl channel in distal tubule. Stops Na reabsorption, therefore water.
2) impotence, gout.

99
Q

Stepwise management of acne vulgarisms

A

1 - Benzoyl peroxide
2 - Add topic retinoid (adapalene)
3 - Topic retinoid + topic abx (clindamycin)
4 - Benzoyl peroxide + clindamycin
5 - Add oral abx, tetracyclines first eg doxy
6 - If above not working/CI/tolerated. Erythro or trimethoprim
7 - Oral isotrenin

100
Q

Adverse effect of isotrenin

A

dry skin/lips
photosensitivity
depression
steven - Johnson’s syndrome

101
Q

Important patient communication thing for isotrenin

A

Highly teratogenic

Female patients must be on contraception

102
Q

Mx of hirsutism due to hyperandrogegism

A

Co-cyprindiol

103
Q

Management of a patient with pmh of gout, during a current attack

A

Continue allopurinol if already taking. Short term mx with NSAID (if tolerated) or colchicine.

104
Q

When to advice a pt to call an during chest pain ambulance if prescribed GTN.

A

Chest pain > GTN > 5 min > next dose of GTN > 5 min > if pain not subsided - call ambulance.

105
Q

Management of DKA

A

0.1U/kg/hr fixed rate insulin - actrapid.

106
Q

Management of hyperglycaemia hyper osmotic state

A

0.05U/kg/hr fixed rate infusion - actrapid

3B + Finals (15 decks)

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