Prescribing Flashcards
1
Q
2 drugs that are prescribed weekly?
A
alendronate and methotrexate
1
Q
2 medications taken at night?
A
statins and amitriptyline
2
Q
Carbimazole is?
A
an anti thyroid drug
3
Q
Carbamazepine is?
A
an anti-epileptic
4
Q
Chlorphenamine is?
A
an antihistamine
5
Q
Chlorpromazine is?
A
an antipsychotic
6
Q
Approximately what percentage of patients who are allergic to penicillin are also allergic to cephalosporins?
A
0.5-6.5%
7
Q
Can tazocin be given to someone with a penicillin allergy?
A
no it is piperacillin plus tazobactam so has penicillin in it
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
9
Q
Can magnapen / co-fluampicil be given to someone with a penicillin allergy?
A
no it is a penicillin
10
Q
Can Augmentin be given to someone with a penicillin allergy?
A
no its co-amoxiclav which is amoxicillin plus clauvanic acid
11
Q
Drug for treating bacterial meningitis?
A
Ceftriaxone
12
Q
List some stimulant laxatives?
A
Senna
Bisocodyl
Docusate
13
Q
Examples of bulk forming laxatives?
A
Ispaghula husk
Methylcellulose
Sterculia
14
Q
Examples of osmotic laxatives?
A
Lactulose
Macrogols (polyethylene glycols)
Phosphate and sodium citrate enemas
15
Q
After initiating an antidepressant should review a patient in?
A
2 weeks (therefore provide 14 tablets)
16
Q
First line drug and dose to terminate a SVT?
A
adenosine 6mg
17
Q
1st line antibiotics for lower urinary tract infections?
A
nitrofurantoin and trimethoprim
18
Q
H pylori eradication therapy?
A
PPI
1st line amoxicillin plus metronidazole
2nd line clarithromycin plus metronidazole
19
Q
Paracetamol dosing?
A
0.5-1g 4x daily (max 4g in 24 hrs)
20
Q
Ibuprofen dosing?
A
400 mg 3 x daily (max 1.2 g)
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
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)
23
Q
2 asthma drugs that can rarely induce Churg Strauss syndrome?
A
Montelukast, Omalizumab
24
List some sedating antihistamines?
chlorphenamine (Piriton), cinnarizine, diphenhydramine, hydroxyzine and promethazine, Alimemazine
25
Preferred antiplatelet for secondary prevention of a stroke?
Clopidogrel
26
2 drugs that can worsen myasthenia gravis?
Gentamicin
Beta blockers
27
How long is tamoxifen usually used for following mastectomy?
5 yrs
28
Should statins be prescribed in pregnancy?
no
29
Adjustments on gentamicin dosing?
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
30
Who with a paracetamol overdose gets n-acetylcysteine?
- 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
31
Can you prescribe topical retinoids in pregnancy?
both topical and oral retinoids are contraindicated in pregnancy
32
Hormone replacement therapy should be avoided in?
patients with ischaemic heart disease
33
Treatment of hypoglycaemia in an unconscious patient/ one who cannot swallow glucose?
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
34
What indicates effective treatment with furosemide in an acute situation?
weight reduction
35
If someone is hyperglycaemic how much do you adjust insulin by?
increase by 10%
36
Warfarin and INR guidelines day before surgery?
in those on warfarin if INR > 1.5 on the day before surgery, phytomenadione (vitamin K) is indicated
37
Important thing to tell patients about taking rivaroxaban?
it must be taken with food
38
Normal INR and INR target range for those on warfarin?
normal INR is < 1.1
target range for those on warfarin is 2-3
39
In hospital what drug is generally first line for VTE prophylaxis?
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
In what specialty are all patients considered high VTE risk?
orthopaedics
so if question asks about prophylaxis of patient undergoing ortho surgery consider them high risk when looking at BNF guidelines
41
Prescribing of drugs for heart failure?
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
2 things that should be measured before commencing the COCP?
BMI and blood pressure
43
Why do we prescribe diclofenac less now?
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
2 drugs that can be given in acute pulmonary oedema?
furosemide and isosorbide dinitrate
45
If someone with diabetes develops proteinuria?
prescribe an ACE inhibitor
(does not matter if they are not hypertensive you aer prescribing it to reduce the proteinuria)
46
Describe how you should take a bisphosphonate?
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
Use of mood stabalisers in pregnancy?
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
Use of antipsychotics in pregnancy?
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
Acetyl cysteine dosing is calculated using?
body weight
50
Problems with giving phenytoin through enteral feeding/ NG tube?
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
After a first infusion when are gentamicin levels taken?
8 hours
52
If you suspect digoxin toxicity, levels should be taken?
at least 6 hours post dose
53
Blood monitoring if on a statin?
LFTs and cholesterol
54
Carbamazepine can cause?
hyponatraemia
55
When writing micrograms you must?
write it fully in words
56
When prescribing insulin units you must write?
full word units
57
In Addisons disease and someone is unwell what should you do to steroid dose?
double it
58
What drug can mask symptoms of hypoglycaemia and cause reduced hypoglycaemia awareness?
beta blockers
59
Is warfarin safe in breastfeeding?
yes safe in breastfeeding but not in pregnancy
60
Describe what needs to be included in HRT and what will cause a withdrawal bleeds vs no withdrawal bleed?
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
When taking the COCP a missed pill counts as?
> 24 hours since you should have taken it
62
What class of drug is indapamide?
thiazide like diuretic
63
What class of drug is bumetanide?
a loop diuretic
64
If you are giving a drug for nausea in someone who is vomiting what is important to remember?
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
Insulin treatment for DKA?
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
When are COMT inhibitors e.g. entacapone prescribed?
they are co-prescribed with ldopa in patients who are on ldopa who have developed dyskinesia or motor fluctuations despite optimal ldopa
67
When someone is on methotrexate what are they usually also prescribed?
folic acid
there are different regimes for this but they usually take it on different days than they take their methotrexate
68
Treatment pathway for status epilepticus?
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
In DKA when do you start giving glucose as a fluid?
when glucose levels fall below 14 mmol/l
70
Hyperphosphataemia can occur in CKD, what is the treatment?
if not on dialysis patients should be prescribed phosphate binders e.g. calcium carbonate
71
What time of the day should steroids be given and why?
Steroids cause disrupted sleep and should ideally be taken in the morning
72
Treatment of alzheimers disease?
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
What drug can be used for prevention of sickle cell crises?
Hydroxycarbamide (increases production of fetal haemoglobin)
74
If someone is in fast AF and haemodynamically unstable?
they need prepared for DC cardioversion
cannot give a beta blocker if HD unstable
75
What is the first line treatment for PE and DVT?
apixaban or rivaroxaban (obviously check for comorbidities or contraindications incase need a different drug)
76
What is important to note about statin dosing and indication?
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
Best thing to monitor to look for improving dehydration?
blood pressure
78
Folic acid prescribing in pregnancy?
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
Main drug to prescribe for any EPS related to antispychotic?
procyclidine
80
List some examples of cephalosporins?
ceftriaxone, cephalexin, cefazolin, ceftazidime
81
What is the action of digoxin?
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
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?
Fluid and electrolytes treatment summary
83
1st line diuretic for ascites due to liver cirrhosis?
spironolactone
84
What do you search in BNF to find information about overdose/ toxicology and antidotes?
poisoning
85
What would show a heart failure treatment is working?
improved exercise tolerance
