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PSA > Prescribing > Flashcards

Prescribing Flashcards

1
Q

hypotensive on examination, what drugs are contraindicated?

A

A blockers (eg. Doxasosin), B blockers, Calcium channel blockers (eg. Amlodopine), sedatives, tricyclics

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2
Q

Hypertensive on examination, what drugs are contraindicated?

A

Methylphenidate, NSAIDs, Oestrogens, Venlafaxine, Triptans

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3
Q

Low respiratory rate, what drug(s) to prescribe for likely cause(s)?

A

Naloxone to reverse opioids or Flumazenil to reverse benzos.

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4
Q

Bruising on examination, what drugs are contraindicated?

A

Anticoagulants (heparin, Warfarin, Apixaban, Antiplatelets (clopidogrel, ticagralor)

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5
Q

Confusion and sedation on examination, what drugs are contraindicated?

A

Central nervous system depressants eg Benzos

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6
Q

wheezing on examination, what drugs are contraindicated?

A

B blockers, NSAIDs

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7
Q

Low haemoglobin, what to prescribe to correct it?

A

Ferrous sulphate, Folic acid, Hydroxocobalamin

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8
Q

Low haemoglobin, What drugs are contraindicated?

A

NSAIDs, anticoagulants

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9
Q

Poor renal function, antibiotics to avoid?

A

Gentamicin, Ciprofloxacin, Cephalosporins (eg. Cephalexin, Cefuroxime, Ceftriaxone)

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10
Q

Poor renal function, drugs to avoid (not Abx)? (12)

A

Loop diuretics, Potassium sparing diuretics, NSAIDs, ACE inhibitors and ARBs, Digoxin, Lithium, Methotrexate, Opioids, Metformin, Gliclazide, Insulin, Allopurinol

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11
Q

Amiodarone has a common drug interaction with…?

A

Grapefruit, prelongs QT and causes arrhythmias

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12
Q

Warfarin has a common drug interaction with…(3 drugs other than vit K)?

A

Clarithromycin and Cranberry juice –> enhances anticoagulation, NSAIDs and Asprin –> bleeding risk due to gastric toxicity and antiplatelet

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13
Q

Verapamil has a common drug interaction with…?

A

Beta blockers

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14
Q

Aminoglycosides eg Gentamicin have a common drug interaction with…?

A

Loop diuretics eg Furosemide

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15
Q

Phenytoin has a common drug interaction with…?

A

Miconazole, causes phenytoin toxicity

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16
Q

Haloperidol has a common drug interaction with…?

A

Fluoxetine, haloperidol toxicity

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17
Q

Azathioprine has a common drug interaction with…?

A

Allopurinol, Azathioprine toxicity

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18
Q

Catecholamines (eg. dopamine, adrenaline) have a common drug interaction with…?

A

Monoamine oxidase inhibitors (eg. selegiline, isocarboxazid), hypertensive crisis

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19
Q

Ciclosporin has a common drug interaction with…?

A

St John’s Wort, loss of immunosuppression

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20
Q

COCP has a common drug interaction with…?

A

Rifampicin

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21
Q

Lithium has a common drug interaction with…?

A

Diuretics, Ace inhibitors, lithium toxicity

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22
Q

Methotrexate has a common drug interaction with…?

A

NSAIDs –> methotrexate toxicity causing neutropenia, deranged liver

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23
Q

Sildenafil has a common drug interaction with…?

A

Glyceryl trinitrate –> severe hypotension or MI

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24
Q

Salbutamol has a common drug interaction with…?

A

Atenolol, inhibits bronchodilator effect

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25
Q

Phenelzine (MAOIs) has a common drug interaction with…?

A

Tyramine (salami, yeast extract) –> life threatening hypertensive crisis

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26
Q

ACE inhibitors have a common drug interaction with…?

A

Potassium containing salt eg Lo-Salt, risk of hyperkalemia

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27
Q

Ciprofloxacin has a common drug interaction with…?

A

Ferrous sulfate, reduces absorption of quinolone abx

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28
Q

Citalopram

A
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29
Q

Ace Inhibitors have a common drug interaction with…(2)?

A

NSAIDs –> increase risk of renal impairment, and Diuretics –> hypotension due to volume depletion

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30
Q

Peptic ulcer in PMHx, what drugs are contraindicated?

A

Aspirin and NSAIDs

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31
Q

Chronic Kidney disease in PMHx, what drugs are contraindicated?

A

NSAIDs, ACE inhibitors, clearance of many drugs slowed eg Gentamicin, digoxin …

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32
Q

Chronic Heart Failure in PMHx, what drugs are contraindicated?

A

Calcium channel blockers, flecainide, tricyclics, NSAIDs, corticosteroids

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33
Q

Asthma in PMHx, what drugs are contraindicated?

A

B blockers, NSAIDs

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34
Q

Heart block in PMHx, what drugs are contraindicated?

A

B blockers, digoxin, verapamil

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35
Q

Parkinson’s disease in PMHx, what drugs are contraindicated?

A

Antipsychotics eg. Haloperidol

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36
Q

Common drug types that may require a reduce dose in the elderly? (8)

A

Aminoglycosides (eg Gentamicin), Anticholinergics, Anticoagulants, Antipsychotics, B Blockers, Hypoglycemics, Opioids, Sedative hypnotics.

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37
Q

Drugs with potential teratogenic effect? (13)

A

ACE inhib, ARBs, Carbimazole, isotretinoin, lithium, methotrexate, oral contraceptives, phenytoin, sodium valproate, statins, thalidomide, trimethoprim, warfarin

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38
Q

Signs of severe hypovolaemia?

A

Dizziness, weakness, fatigue, thirst
Low urine output
Increased HR, decreased BP, decreased JVP
signs of hepatic or cardiac ischemia

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39
Q

Maximum rate of IV infusion for potassium replacement?

A

10 mmol/hour ideally (max conc. 40mmol/L)

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40
Q

Daily requirement of potassium, sodium, or chloride?

A

1 mmol/kg/day

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41
Q

Daily requirement of glucose to limit starvation ketosis?

A

50-100g /day

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42
Q

Electrolytes lost in vomiting?

A

chloride, potassium, sodium, and bicarbonate

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43
Q

Electrolytes lost in diarrhoea?

A

sodium, potassium and magnesium

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44
Q

Daily requirement of water?

A

25-30mg/kg/day, (2L for 80kg person)

45
Q

Fluid resuscitation in hypovolemic shock, initial step?

A

500ml crystalloid solution containing sodium over <15 mins.

46
Q

Fluid resuscitation in hypovolemic shock, management after 1st fluid bolus…

A

reassess, further bolus of 250-500mls and reassess until 2000 mls given, then seek expert help

47
Q

How many grams of glucose in 100mls of “glucose 5%”?

A

5 grams

48
Q

(Types of) Drugs to stop before surgery? (7)

A

I LACK OP
Insulin, lithium, Anticoagulants, COCP and HRT, K sparing diuretics, Oral HypOglycemics (high metformin, gliclazide, -flozins) perindopril and other ACE inhibs and ARBs.

49
Q

Citalopram

A
50
Q

Levothyroxine dose change, when to check TFT?

A

6-8 weeks

51
Q

Levothyroxine, maintainable monitoring of TFT?

A

Annual

52
Q

Amioderone monitoring requirements?

A

TFT before and every 6 months after

53
Q

Digoxin monitoring requirements?

A

HR in hospital before treatment

54
Q

Gentamicin monitoring requirements?

A

Plasma conc, narrow therapeutic window

55
Q

Methotrexate monitoring requirements?

A

FBC before, 2 weeks for 2 months, monthly for 4 months, 3 monthly thereafter

56
Q

Vitamin D deficiency blood test, measure and monitor?

A

Plasma 25-hydroxyvitamin D, monitor plasma calcium

57
Q

Starting adalimumab, test to do?

A

Latent or active TB

58
Q

Blood test for indication of risk of bleeding?

A

Anti-factor Xa activity

59
Q

Lithium monitoring requirements?

A

measure serum lithium 12 hrs post dose, and every 3 months normally

60
Q

causes of high potassium (not drugs) (4)

A

Excessive dietary intake, metabolic acidosis, renal failure, rhabdomyolysis/burns/trauma

61
Q

How to protect the heart in Hyperkalaemia

A

10ml Calcium Gluconate 10% IV over 3-5 mins

62
Q

How to lower serum potasium?

A

5-10 units insulin (Actrapid) and 50ml glucose 50% over 5-15 mins
Salbutamol neb

63
Q

How to excrete excess potassium?

A

Calcium Resonium

64
Q

Contraindication to IM injection?

A

Pt is on warfarin

65
Q

Ideal blood glucose conc. before meals? (mmol/L)

A

4 - 7 mmol/L

66
Q

Ideal blood glucose conc. after meals? (mmol/L)

A

less than 9 mmol/L

67
Q

3 indications for Gentamicin

A

bacterial endocarditis, neutropenic sepsis, surgical prophylaxis

68
Q

When to measure serum gentamicin after once daily dose?

A

6-14 hours later

69
Q

Omeprazole dose for GORD?

A

20mg once daily

70
Q

Simvastatin dose for CVD prevention?

A

20-40mg once daily

71
Q

when to measure serum vancomycin?

A

After 36 - 72 hours / 3 - 6 doses

72
Q

How to manage hypokalaemia?

A

ready-to-use infusion of sodium chloride 0.9% and Potassium chloride 40mmol in 1L over 4 hours

73
Q

Rhabdomyolysis blood results?

A

Super high CK and Hyperkalaemia

74
Q

Co prescribing with what drug (2) drops max dose of statin to 20mg?

A

Diltiazem and Amlodopine

75
Q

Blood test to monitor clozapine?

A

FBC - WCC agranulocytosis

76
Q

Methotrexate monitoring blood tests?

A

FBC, U&Es, LFTs: baseline, weekly until stabilised, then every 2-3 months

77
Q

Drugs that cause urinary retention (8 types)

A

Anticholinergics, general Anaesthetics, Alpha blockers, B blockers, Benzos, Calcium channel blockers, NSAIDs, Antihistamines, Alcohol

78
Q

Drugs that may cause anaphylaxis (6)

A

B lactam abx (penicillin, cephalosporins), Aspirin and NSAIDs, chemotherapy, vaccines, parenteral iron injection, herbal remedies

79
Q

Indication to stop statin?

A

Transaminase over 3x upper limit

80
Q

How to change gentamicin prescription?

A

peak level –> change dose, trough level –> change frequency

81
Q

Normal dose range for warfarin

A

1mg - 15mg

82
Q

typical methotrexate prescription?

A

7.5 mg to 15mg weekly, (also often folate prescribed on different day)

83
Q

treatment of methotrexate overdose?

A

Folinic acid

84
Q

common interactions with methotrexate? (7)

A

Aspirin, Clozapine, Ciprofloxacin, NSAIDs, corticosteroids, Penicillin, Trimethoprim

85
Q

Gram negative diplococci STI

A

Gonorrhoea

86
Q

Hypoglycemia affecting consciousness, first line management?

A

Glucagon

87
Q

contraindication to glucagon in management of hypoglycaemia

A

Fasted pt, alcohol induced, On a sulfonylurea eg gliclazide, adrenal insufficiency, chronic hypoglycemia

88
Q

At what INR should you give vit K?

A

over 8 always, or over 5 if bleeding

89
Q

1st Antiemetic for pt who is at risk of extrapyramidal SE and QT prolongation?

A

Cyclizine

90
Q

Warfarin + CP450 enzyme inducer, INR?

A

decrease action of warfarin (metabolised faster), so INR decreases (time to clot is quicker)

91
Q

Warfarin + CP450 inhibitor, INR?

A

warfarin not broken down for longer –> increased action –> increased INR (more runny)

92
Q

Mnemonic for enzyme inducers?

A

NP + SC you can buy over the counter Nifampicin (+RIifampicin), Phenytoin. St john’s wart, Cigarette smoke, CHRONIC alcohol.

93
Q

Mneumonic for enzyme inhibitors?

A

FAAF OR IKEA + SC you are inhibited from buying OTC. eg. fluconazole, ACUTE alcohol, amioderone, fluoxitine, omeprazole, ritonavir, Isonaside, Ketoconazole, erythromycin, Allopurinol. SSRIs, Sodium valproate, Cimetidine, Ciprafloxacin.

94
Q

CP450 inducer drugs that break the rules?

A

Rifampicin, Carbamazepine

95
Q

Name an osmotic laxative

A

docusate sodium, Movicol

96
Q

Name a stimulant laxative

A

Senna

97
Q

Name a bulk-forming laxative

A

ispaghula husk

98
Q

Normal obs under 3 months?

A

HR: 110 -170 RR: 25-60 Systolic BP: 60-105

99
Q

Normal obs 3-6 months?

A

HR: 105-165 RR: 25-55 Systolic BP: 65-115

100
Q

Normal obs 6m to 5 years?

A

HR: 85-150 RR: 20-40 Systolic BP: 70-120

101
Q

Normal obs for 5-12 years?

A

HR: 70-135 RR: 16-34 Systolic BP: 80-130

102
Q

Severe Liver cirrhosis, drugs to stop?

A

NSAIDs, ACE inhibitors, statins

103
Q

drug induced cholestatic jaundice and hepatitis?

A

Flucloxacillin and co amox, Paracetamol, NSAIDs, Rifampicin, Methotrexate, Amioderone

104
Q

First line management of ascites in liver cirrhosis?

A

Spironolactone

105
Q

1st line management of overt hepatic encephalopathy

A

Lactulose 30-50ml TDS

106
Q

How to manage oedema due to calcium channel blockers?

A

Stop the drug, should resolve

107
Q

HB threshold for blood transfusion?

A

70 or less, 80 or less in ACS

108
Q

Management for eclampsia seizure?

A

Magnesium sulfate

109
Q

NSAIDs and ACE inhibitors sick day rule?

A

Stop if vomiting, diarrhoea, or signs of infection

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