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Prescribing > Prescribing > Flashcards

Prescribing Flashcards

1
Q

2 drugs that are prescribed weekly?

A

alendronate and methotrexate

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1
Q

2 medications taken at night?

A

statins and amitriptyline

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2
Q

Carbimazole is?

A

an anti thyroid drug

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3
Q

Carbamazepine is?

A

an anti-epileptic

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4
Q

Chlorphenamine is?

A

an antihistamine

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5
Q

Chlorpromazine is?

A

an antipsychotic

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6
Q

Approximately what percentage of patients who are allergic to penicillin are also allergic to cephalosporins?

A

0.5-6.5%

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7
Q

Can tazocin be given to someone with a penicillin allergy?

A

no it is piperacillin plus tazobactam so has penicillin in it

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8
Q

Can Timentin be given to someone with a penicillin allergy?

A

no it is ticarcillin with clavulanic acid so has penicillin in it

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9
Q

Can magnapen / co-fluampicil be given to someone with a penicillin allergy?

A

no it is a penicillin

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10
Q

Can Augmentin be given to someone with a penicillin allergy?

A

no its co-amoxiclav which is amoxicillin plus clauvanic acid

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11
Q

Drug for treating bacterial meningitis?

A

Ceftriaxone

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12
Q

List some stimulant laxatives?

A

Senna
Bisocodyl
Docusate

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13
Q

Examples of bulk forming laxatives?

A

Ispaghula husk
Methylcellulose
Sterculia

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14
Q

Examples of osmotic laxatives?

A

Lactulose
Macrogols (polyethylene glycols)
Phosphate and sodium citrate enemas

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15
Q

After initiating an antidepressant should review a patient in?

A

2 weeks (therefore provide 14 tablets)

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16
Q

First line drug and dose to terminate a SVT?

A

adenosine 6mg

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17
Q

1st line antibiotics for lower urinary tract infections?

A

nitrofurantoin and trimethoprim

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18
Q

H pylori eradication therapy?

A

PPI
1st line amoxicillin plus metronidazole
2nd line clarithromycin plus metronidazole

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19
Q

Paracetamol dosing?

A

0.5-1g 4x daily (max 4g in 24 hrs)

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20
Q

Ibuprofen dosing?

A

400 mg 3 x daily (max 1.2 g)

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21
Q

Who gets antibiotics in otitis media?

A

people who are systemically unwell
have otorrhoea (suggests ear drum perforation)
or aged less than 2 and bilateral
1st line = amoxicillin

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22
Q

UTI in pregnancy?

A

should generally avoid trimethoprim (especially in 1st trimester as teratogenic) and give nitrofurantoin instead
Dont give nitrofurantoin near term (more than 36 weeks)

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23
Q

2 asthma drugs that can rarely induce Churg Strauss syndrome?

A

Montelukast, Omalizumab

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24
Q

List some sedating antihistamines?

A

chlorphenamine (Piriton), cinnarizine, diphenhydramine, hydroxyzine and promethazine, Alimemazine

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25
Q

Preferred antiplatelet for secondary prevention of a stroke?

A

Clopidogrel

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26
Q

2 drugs that can worsen myasthenia gravis?

A

Gentamicin
Beta blockers

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27
Q

How long is tamoxifen usually used for following mastectomy?

A

5 yrs

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28
Q

Should statins be prescribed in pregnancy?

A

no

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29
Q

Adjustments on gentamicin dosing?

A

if the trough (pre-dose) level is high, interval between the doses should be increased
if the peak (post dose) level is high the dose should be decreased

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30
Q

Who with a paracetamol overdose gets n-acetylcysteine?

A
  • anyone who hits the line on treatment threshold curve after four hours
  • anyone who presents with an unclear/ staggered overdose (taken paracetamol over more than 1 hr)
  • anyone who presents within 8-24 hours who has taken more than 150mg/ kg
  • anyone who presents after 24 hours with AST/ ALT above normal, hepatic tenderness or clear jaundice
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31
Q

Can you prescribe topical retinoids in pregnancy?

A

both topical and oral retinoids are contraindicated in pregnancy

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32
Q

Hormone replacement therapy should be avoided in?

A

patients with ischaemic heart disease

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33
Q

Treatment of hypoglycaemia in an unconscious patient/ one who cannot swallow glucose?

A

10% glucose is first line
want to deliver 15-20g of glucose

therefore there’s 10g in 100ml, so in 150 ml there would be 15 g

give it over 15 minutes

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34
Q

What indicates effective treatment with furosemide in an acute situation?

A

weight reduction

35
Q

If someone is hyperglycaemic how much do you adjust insulin by?

A

increase by 10%

36
Q

Warfarin and INR guidelines day before surgery?

A

in those on warfarin if INR > 1.5 on the day before surgery, phytomenadione (vitamin K) is indicated

37
Q

Important thing to tell patients about taking rivaroxaban?

A

it must be taken with food

38
Q

Normal INR and INR target range for those on warfarin?

A

normal INR is < 1.1
target range for those on warfarin is 2-3

39
Q

In hospital what drug is generally first line for VTE prophylaxis?

A

low molecular weight heparin

some forms of this include enoxaparin (Lovenox) or dalteparin (fragmin)

fondaparinux which is similar to LMWH can be used as an alternative

40
Q

In what specialty are all patients considered high VTE risk?

A

orthopaedics
so if question asks about prophylaxis of patient undergoing ortho surgery consider them high risk when looking at BNF guidelines

41
Q

Prescribing of drugs for heart failure?

A

should consider ACEi and beta blockers in everyone with heart failure as this improves survival
may then consider adding aldosterone antagonist (e.g. epleronone or spironolactone)
only give digoxin (improves symptoms but not survival) if already on these 3

42
Q

2 things that should be measured before commencing the COCP?

A

BMI and blood pressure

43
Q

Why do we prescribe diclofenac less now?

A

diclofenac has been found to slightly increase risk of heart attack and stroke. Better to prescribe another NSAID, especially if the patient has hypertension

44
Q

2 drugs that can be given in acute pulmonary oedema?

A

furosemide and isosorbide dinitrate

45
Q

If someone with diabetes develops proteinuria?

A

prescribe an ACE inhibitor
(does not matter if they are not hypertensive you aer prescribing it to reduce the proteinuria)

46
Q

Describe how you should take a bisphosphonate?

A

Must take with a full glass of water and remaining upright for 30 minutes after administration.
Should be taken on an empty stomach and not within 2 hours of any milk or dairy products

(main reason for this is that bisphosphonates can cause oesophageal erosions and GI upset)

47
Q

Use of mood stabalisers in pregnancy?

A

There are no safe mood stabalisers
Valproate and carbamazepine are the most teratogenic as they cause neural tube defects and should be avoided
Lamotrigine is less bad than other anti-convulsants and appears safer as the evidence base increases
Lithium should be avoided if possible, associated with cardiac anomalies particularly Ebstein’s anomaly, could consider reintroduction immediately postpartum

48
Q

Use of antipsychotics in pregnancy?

A

2nd generation drugs olanzapine and quetiapine have the best evidence base
Overall antipsychotics appear to be safe
Women with repeated relapses should stay on their medication
There is an increased risk of GDM with 2nd generation drugs due to weight gain as a drug side effect

49
Q

Acetyl cysteine dosing is calculated using?

A

body weight

50
Q

Problems with giving phenytoin through enteral feeding/ NG tube?

A

Phenytoin suspension requires to be administered effectively with vigorous shaking to ensure the drug is well suspended before administration. The suspension must be flushed down the NG tube to ensure absorption is maximised. This can be hard to ensure done correctly and giving it IV may be a better option

51
Q

After a first infusion when are gentamicin levels taken?

A

8 hours

52
Q

If you suspect digoxin toxicity, levels should be taken?

A

at least 6 hours post dose

53
Q

Blood monitoring if on a statin?

A

LFTs and cholesterol

54
Q

Carbamazepine can cause?

A

hyponatraemia

55
Q

When writing micrograms you must?

A

write it fully in words

56
Q

When prescribing insulin units you must write?

A

full word units

57
Q

In Addisons disease and someone is unwell what should you do to steroid dose?

A

double it

58
Q

What drug can mask symptoms of hypoglycaemia and cause reduced hypoglycaemia awareness?

A

beta blockers

59
Q

Is warfarin safe in breastfeeding?

A

yes safe in breastfeeding but not in pregnancy

60
Q

Describe what needs to be included in HRT and what will cause a withdrawal bleeds vs no withdrawal bleed?

A

In HRT you need oestrogen to improve symptoms and progresterone for endometrial protection. If the woman wants to avoid a withdrawal bleed you give a product that has both continuously as opposed to sequentially

note:if they have had a hysterectomy then they do not need progesterone

61
Q

When taking the COCP a missed pill counts as?

A

> 24 hours since you should have taken it

62
Q

What class of drug is indapamide?

A

thiazide like diuretic

63
Q

What class of drug is bumetanide?

A

a loop diuretic

64
Q

If you are giving a drug for nausea in someone who is vomiting what is important to remember?

A

if someone is vomiting oral route is inappropriate!
make sure to prescribe IV/ IM/ SC
If they are likely to already have a cannula in it is better to prescribe IV

65
Q

Insulin treatment for DKA?

A

stop short acting insulin
continue long acting insulin
start fixed rate IV insulin infusion
when glucose drops below 14, you start an infusion of that too

66
Q

When are COMT inhibitors e.g. entacapone prescribed?

A

they are co-prescribed with ldopa in patients who are on ldopa who have developed dyskinesia or motor fluctuations despite optimal ldopa

67
Q

When someone is on methotrexate what are they usually also prescribed?

A

folic acid
there are different regimes for this but they usually take it on different days than they take their methotrexate

68
Q

Treatment pathway for status epilepticus?

A
  1. if the patient has IV access give IV lorazepam, if not buccal midazolam or rectal diazepam
  2. no response = repeat
  3. if no response after 2 benzodiazepine doses go to 2nd line treatment - IV levetiracetam, sodium valproate or phenytoin
  4. if no response can give phenobarbital or GA under expert supervision
69
Q

In DKA when do you start giving glucose as a fluid?

A

when glucose levels fall below 14 mmol/l

70
Q

Hyperphosphataemia can occur in CKD, what is the treatment?

A

if not on dialysis patients should be prescribed phosphate binders e.g. calcium carbonate

71
Q

What time of the day should steroids be given and why?

A

Steroids cause disrupted sleep and should ideally be taken in the morning

72
Q

Treatment of alzheimers disease?

A

in mild to moderate: first line is ache inhibitors e.g. donepezil, galantamine or rivastigmine
if these are not tolerated memantine is second line

In severe alzheimers disease memantine is first line

73
Q

What drug can be used for prevention of sickle cell crises?

A

Hydroxycarbamide (increases production of fetal haemoglobin)

74
Q

If someone is in fast AF and haemodynamically unstable?

A

they need prepared for DC cardioversion

cannot give a beta blocker if HD unstable

75
Q

What is the first line treatment for PE and DVT?

A

apixaban or rivaroxaban (obviously check for comorbidities or contraindications incase need a different drug)

76
Q

What is important to note about statin dosing and indication?

A

Dosing is different depending on indication
- primary hypercholesteraemia (usually 10mg)
- primary cardiac prevention in someone high risk (ie QRISK over 10) - 20mg
- secondary prevention (someone who has already had a MI) - 80mg

77
Q

Best thing to monitor to look for improving dehydration?

A

blood pressure

78
Q

Folic acid prescribing in pregnancy?

A

this is suggested in everyone to help prevent neural tube defects

Women should take 400 micrograms daily 3 months prior to conception and up to week 12

Those who are at higher risk of neural tube defects should take high dose 5mg folic acid, this includes:
- those with spina bifida/ family risk of spina bifida
-those who are folic acid deficient
- coeliac disease
-diabetes
-on AEDs
-sickle cell disease
-BMI > 30

79
Q

Main drug to prescribe for any EPS related to antispychotic?

A

procyclidine

80
Q

List some examples of cephalosporins?

A

ceftriaxone, cephalexin, cefazolin, ceftazidime

81
Q

What is the action of digoxin?

A

positive inotropic and negative chronotropic drug, meaning that it increases the force of the heartbeat and decreases the heart rate

(hence it can cause bradycardia)

82
Q

Under what in the BNF can you find treatment guidelines for electrolyte abnormalities plus the normal values of different fluids and how many mmol in different bags?

A

Fluid and electrolytes treatment summary

83
Q

1st line diuretic for ascites due to liver cirrhosis?

A

spironolactone

84
Q

What do you search in BNF to find information about overdose/ toxicology and antidotes?

A

poisoning

85
Q

What would show a heart failure treatment is working?

A

improved exercise tolerance

Prescribing (11 decks)

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