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Year Five - Prescribing Safety Assessment > Prescribing > Flashcards

Prescribing Flashcards

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1
Q

What are the three classes of calcium channel blockers?

A

Dihydropyridines

Verapamil

Dilitiazem

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2
Q

Name three examples of dihydropyridine calcium channel blockers

A

Nifedipine

Amlodipine

Felodipine

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3
Q

What are the three side effects of dihydropyridine calcium channel blockers?

A

Headache

Flushing

Ankle Swelling

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4
Q

Which drug class does verapamil interact with? What does this interaction result in?

A

Beta-Blockers

Heart Block

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5
Q

What are the five side effects of verapamil?

A

Bradycardia

Hypotension

Heart Failure

Flushing

Constipation

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6
Q

In which two circumstances should we be cautious about the administration of diltiazem?

A

Heart Failure Patients

Those Who Have Been Administered Beta-Blockers

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7
Q

What are the four side effects of diltiazem?

A

Bradycardia

Hypotension

Heart Failure

Ankle Swelling

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8
Q

What is the most appropriate management option when ACE inhibitors result in an eGFR reduction > 25%?

A

The ACE inhibitor dose should be reduced

There should be regular monitoring of renal function, and if this worsens the ACE inhibitors may need to be stopped

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9
Q

What is stage one hypertension?

A

It is defined as a clinic blood pressure between 140/90mmHg and 160/100mmHg

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10
Q

What are the three criteria for anti-hypertensive management of stage one hypertension?

A
  • Discuss anti-hypertensive drug therapy with patients aged <80 years who have ≥1 of the following: established cardiovascular disease, kidney disease or an estimated 10-year risk of cardiovascular disease of ≥10%
  • Consider anti-hypertensive drug therapy for patients aged ≥80 years who have a clinic blood pressure >150/90mmHg
  • Consider anti-hypertensive drug therapy for patients aged <60 years with an estimated 10-year risk of cardiovascular disease <10%.
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11
Q

What is stage two hypertension?

A

It is defined as a clinic blood pressure > 160/100mmHg

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12
Q

What is the criteria for anti-hypertensive management of stage two hypertension?

A

It is offered to all patients with stage two hypertension

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13
Q

What are the two first line management options of heart failure?

A

ACE Inhibitor

AND

Beta-Blocker

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14
Q

What ramipril dose, route and frequency is recommended in those who have had a recent myocardial infarction with evidence of heart failure?

A

Ramipril 2.5mg Twice Daily

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15
Q

Which dose, route and frequency of GTN is used to manage myocardial ischaemia and unstable angina?

A

Dose = 400-800mcg

Route = Sublingual

Frequency = Once

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16
Q

Which second anti-platelet agent is preferred in STEMI patients undergoing PCI?

A

Prasugrel

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17
Q

When treating STEMIs what is the dose of DOACs dependent upon?

A

It is dependent upon whether patients are going to receive PCI or not

PCI < 12 hours

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18
Q

What is the first line management option of SVT? What dose, route and frequency?

A

IV Adenosine 6mg Once Only

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19
Q

What is the first line primary prevention management option of cardiovascular events in those with hypercholesterolaemia? What dose, route and frequency?

A

Atorvastatin 20mg One Daily

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20
Q

What is the first line secondary prevention management option of cardiovascular events in those with hypercholesterolaemia? What dose, route and frequency? What classifies as cardiovascular disease?

A

Atorvastatin 80mg Once Daily

Stroke, Transient Ischaemic Attack, Ischaemic Heart Disease, Peripheral Arterial Disease

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21
Q

What % reduction in LDL cholesterol levels should be evident after 3 months of statin treatment?

A

> 40%

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22
Q

What effect do statins have on liver function tests?

A

Increased ALT Levels

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23
Q

How should the statin dose be adjusted when it results in ALT elevation - less than 3 times the upper limit of the reference range?

A

The statin should be continued at the same dose

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24
Q

How should the statin dose be adjusted when it results in ALT elevation - more than 3 times the upper limit of the reference range?

A

The statin should be discontinued

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25
How should the statin dose be adjusted when it results in CK elevation - less than 5 times the upper limit of the reference range?
The statin can be continued at a lower dose
26
How should the statin dose be adjusted when it results in CK elevation - more than 5 times the upper limit of the reference range?
The statin should be discontinued and clinical features should be monitored If symptoms resolve and statin treatment is still indicated based on their serum cholesterol levels, a statin could be started again at a lower dose
27
What is the definition of postural hypotension?
It is defined as a systolic drop of > 20mmHg and/or a diastolic drop of > 10mmHg
28
What is the first line management option of postural hypotension?
Fludrocortisone
29
What is the first line management option of pulmonary oedema?
IV Furosemide 20mg Once Only
30
What is the first line management option of chronic asthma in children under 5 years old?
Short Acting Beta2 Agonist (SABA)
31
What dose, route and frequency of salbutamol is initially trialled?
Inhaled Salbutamol 1-2 Puffs As Required
32
What is the second line management option of chronic asthma in children under 5 years old? How long should this be trialled for?
Inhaled Corticosteroids (ICS) 8 Weeks
33
What is the third line management option of chronic asthma in children under 5 years old?
Leukotriene Receptor Antagonist (LTRA)
34
What is the fourth line management option of chronic asthma in children under 5 years old?
Specialist Review
35
What is the first line management option of chronic asthma in children over 5 years old?
Short Acting Beta2 Agonist (SABA)
36
What is the second line management option of chronic asthma in children over 5 years old?
Inhaled Corticosteroid (ICS)
37
What is the third line management option of chronic asthma in children over 5 years old?
Leukotriene Receptor Antagonist (LTRA)
38
What is the fourth line management option of chronic asthma in children over 5 years old?
Long Acting Bronchodilator Inhalers (LABA)
39
What are the three classifications of acute asthma?
Moderate Severe Life Threatening
40
What are the four clinical features of moderate acute asthma?
PEFR > 50% Predicted Normal Speech Normal RR Normal HR
41
What are the five clinical features of severe acute asthma?
PEFR 33-50% Predicted Impaired Speech Respiratory Distress Features RR > 40 (1-5 yrs old), RR > 30 (> 5 yrs old) HR > 140 (1-5 yrs old), HR > 125 (> 5 yrs old)
42
What are the seven clinical features of life threatening acute asthma?
PEFR < 33% Saturations < 92% Poor Respiratory Effort Silent Chest Hypotension Cyanosis Confusion/Coma
43
How do we manage moderate acute asthma attacks?
Nebulised Salbutamol
44
What are the five management options for severe acute asthma attacks? List it in the stepwise order
Nebulisers With Salbutamol (2.5mg -5mg)/Ipratropium Bromide (500mcg) IV Hydrocortisone (100mg) IV Magnesium Sulphate (1.2mg - 2mg) IV Aminophylline Prednisolone (40-50mg Once Daily for Five Days)
45
What dose of oral prednisolone is advised in severe paediatric acute asthma attacks?
1 mg per kg of body weight once daily for 3 days
46
What is the first line management option of severe acute exacerbations of COPD? What dose, route and frequency?
Salbutamol 1mg/mL Nebuliser Liquid
47
What is the second line management option of severe acute exacerbations of COPD? What dose, route and frequency?
Ipraotropium Bromide 500mcg/Salbutamol 2.5mg/2.5mL Nebuliser Liquid
48
What is the first line management option of chronic COPD?
Short Acting Muscarinic Antagonist (SAMA) OR Short Acting Beta2 Agonist (SABA)
49
What is the second line management option of chronic COPD - if asthma/steroid responsive?
Long Acting Beta2 Agonist & Inhaled Corticosteroid (ICS)
50
List three examples of combined ICS & LABA inhalers
Formoterol & Budesonide Formoterol & Beclometasone Salmeterol & Fluticasone
51
What is the second line management option of chronic COPD - if not asthma/steroid responsive?
Long Acting Beta Agonist (LABA) & Long Acting Muscarinic Antagonist (LAMA)
52
What is the third line management option of chronic COPD?
Long Acting Beta2 Agonist (LABA) & Long Acting Muscarinic Antagonist (LAMA) & Inhaled Corticosteroid (ICS)
53
What is the most appropriate oxygen therapy in those with COPD and CO2 retention?
28% Venturi Mask 4L/min
54
When is non-invasive ventilation recommended to manage COPD exacerbations?
Respiratory Acidosis = pH 7.25 - 7.35
55
How do we monitor for adverse effects of oxygen therapy in COPD patients - due to the risk of hypercapnic respiratory failure?
Arterial Blood Gas
56
Which three drugs should be administered with caution in asthma and COPD patients?
Adenosine Beta-Blockers NSAIDs
57
What is the first line management option of community acquired pneumonia?
Amoxicillin
58
What are the three second line management options of community acquired pneumonia?
Clarithromycin Doxycyline Erythromycin
59
What are the five features of ascending cholangitis?
Fever Right Upper Quadrant Pain Jaundice Confusion Hypotension
60
What is the first line management option of ascites secondary to liver cirrhosis? What dose, route and frequency?
Spironolactone 100mg Once Daily
61
What is the first line management option of c.difficile infection - when they have had a previous c.difficile infection in the past 12 weeks?
Fidaxomicin
62
Which drug does omeprazole interact with - decreasing its efficacy? What can be administered instead?
Clopidogrel Lansoprazole
63
What are the four features of shingles?
Fever Headache Burning Pain Over Affected Dermatome Erythematous, Macular/Vesicular Rash Over Affected Dermatome
64
What is the first line management option of shingles?
Aciclovir 800mg 5 times daily for 7 days
65
What are the four features of scabies?
Pruritus Symmetrical Erythematous Papules Linear Burrows on Side of Fingers, Interdigital Webs & Flexor Aspect of Wrists Excoriation Marks
66
What is the first line management option of scabies? What dose, route and frequency?
Permethrin 5% Cream Dose = Apply To Whole Body Route = Topical Frequency = Once Weekly For Two Doses
67
What is the first line management option of cellulitis?
Flucloxacillin
68
What is the first line management option of cellulitis in pregnancy? What dose, route and frequency?
Erythromycin 500mg Four Times Daily For 5-7 Days
69
When is metformin used to manage type two diabetes?
It is the first line pharmacological management option
70
Whar are the three side effects of metformin?
Gastrointestinal Upset Vitamin B12 Malabsorption Lactic Acidosis
71
What are the two factors which make type two diabetics susceptible to lactic acidosis when administered metformin?
Liver disease Renal failure
72
How do we reduce the risk of gastrointestinal side effects associated with metformin?
The metformin dose should be started at a low dose and tritiated up slowly
73
What is the most appropriate management step when individuals develop unacceptable metformin side effects?
We switch to modified-release metformin
74
What are the six contraindications of metformin?
Chronic Kidney Disease, eGFR < 30ml/min Recent Myocardial Infarction Sepsis Acute Kidney Injury Alcohol Abuse Severe Dehydration
75
In which condition should metformin be stopped in? Explain
Myocardial Infarction Lactic acidosis risk
76
How should metformin be administered prior to surgery?
The afternoon dose on the day of surgery is usually withheld
77
When are sulfonylureas used to manage type two diabetics?
They are a second line pharmacological management option
78
Name three sulfonylureas used to manage type two diabetics
'ides' Glimepiride Gliclazide Glipizide
79
What are the six side effects associated with sulfonylureas?
Hypoglycaemic Episodes Weight Gain Hyponatraemia (SIADH) Hepatotoxicity Peripheral Neuropathy Bone Marrow Suppression
80
What are the four contraindications of sulfonylureas?
Pregnancy Breastfeeding Renal Failure Hepatic Failure
81
How should sulfonylureas be administered prior to surgery?
It should be withheld on the day of surgery
82
When are thiazolidinediones used to manage type two diabetes?
It is a second line pharmacological treatment option
83
Name a thiazolidinedione used to manage type two diabetes
Pioglitazone
84
What are the five side effects associated with thiazolidinediones?
Weight Gain Liver Impairment Fluid Retention Bone Fractures Urinary Bladder Cancer
85
What are the three contraindications of thiazolidinones?
Heart Failure Obesity Active/Previous History of Bladder Cancer
86
When are SGLT-2 inhibitors used to manage type two diabetes?
They are a second line pharmacological management option They should be introduced in all cases where individuals develop cardiovascular disease, have a high risk of cardiovascular disease (QRISK > 10%) or develop heart failure
87
Name three SGLT-2 inhibitors used to manage type two diabetes
'glifozin' Canagliflozin Dapagliflozin Empagliflozin
88
What are the six side effects associated with SGLT-2 inhibitors?
Weight Loss Urinary Tract Infection Thrush Fournier’s Gangrene Normoglycaemia Ketoacidosis Diabetic Foot Disease
89
What are the four features of Fournier's gangrene?
Fever Perineum Pain Perineum Swelling Perineum Erythema
90
What is an advantage of SLGT-2 inhibitor administration?
It reduces cardiovascular disease
91
When are DPP-4 inhibitors used to manage type two diabetes?
They are a second line pharmacological treatment option
92
Name three DPP-4 inhibitors used to manage type two diabetes
'gliptin' Saxagliptin Sitagliptin Vildagliptin
93
What are the two side effects associated with DPP-4 inhibitors?
Nausea & Vomiting Acute Pancreatitis
94
Why are DPP-4 inhibitors preferable to thiazolidinediones and sulfonylureas?
They dont cause weight gain
95
When are GLP-1 analogues used to manage type two diabetes?
They are a fourth line pharmacological treatment option
96
What two other hypoglycaemic drugs are GLP-1 analogues administered with?
Metformin Sulfonylureas
97
In which two circumstances, do we administer GLP-1 analogues?
In individuals with a BMI > 35kg/m2, who are of European descent and there are complications associated with their increased weight In individuals with a BMI < 35kg/m2, on which insulin is unacceptable due to occupational implications or weight loss would benefit their comorbidities
98
Name three GLP-1 analogues used to manage type two diabetes
'tide' Exenatide Liraglutide Lixisenatide
99
What are the three side effects of GLP-1 analogues?
Weight Loss Nausea & Vomiting Acute Pancreatitis
100
What is the administration route of GLP-1 analogues?
Subcutaneous injection
101
Which anti-diabetic drug is least likely to cause hypoglycaemia?
Metformin
102
When is insulin used to manage type two diabetes?
It It is a third line pharmacological management option, which should be co-administered with metformin
103
Name two rapid acting insulins
Insulin Aspart - Novorapid Insulin Lispro - Humalog
104
When patients present with a blood glucose > 15 what insulin should be administered? How many units?
Novorapid 4 Units
105
Name two short acting acting insulins
Actrapid Humalin S
106
Name two intermediate acting insulins
Isophane Inuslin Humulin I
107
Name three long acting insulins
Insulin Determir - Levemir Insulin Glargine - Lantus Tresiba
108
What insulin regime is used to manage type one diabetes?
Basal Bolus Regime This involves administration of a long acting insulin once/twice daily, with short acting insulin with meals
109
What are the three side effects of insulin?
Hypoglycaemia Weight gain Lipodystrophy
110
How should the dose of insulin be adjusted prior to surgery?
The insulin should be administered as normal the day before surgery, except for long acting insulins which should be reduced in dosage by 20%
111
What insulin regime should be administered in patients who are nil by mouth for extended periods?
Variable Rate This is when the insulin dose is altered depending on regular blood glucose levels
112
What insulin regime and dose should be administered in DKAs?
Fixed Rate - 0.1 units/kg/h It is advised that short acting insulin should be stopped, whilst long acting insulin is continued
113
What insulin regime and dose should be administered in HSS?
Fixed Rate - 0.05 units/kg/h
114
How should the insulin regime be adjusted when the evening glucose readings are elevated however the morning glucose readings are normal?
It is preferable to adjust the existing regimen, rather than to add in an additional insulin prescription We would increase the morning insulin dose by 10%
115
What is the first line management option of hypoglycaemia in an unconscious patient in hospital?
IV Glucose 20% 100mL
116
What is the first line management option of hypoglycaemia in an unconscious patient - in which IV access in unattainable?
IM Glucagon
117
What are the two monitoring requirements of type one diabetes?
HbA1c Home Glucose Readings
118
What is the HbA1c target in type two diabetic patients?
< 48mmol/mol (6.5%)
119
What fasting glucose level indicates a diagnosis of gestational diabetes?
> 5.6mmol
120
What OGTT level at 2 hours indicates a diagnosis of gestational diabetes?
> 7.8mmol
121
What are the management options of gestational diabetes in those with a fasting glucose < 7mmol?
It involves trial of diet, exercise and metformin
122
What is the management option of gestational diabetes in those with a fasting glucose > 7mmol?
Short Acting Insulin
123
What are the seven features of adrenal insufficiency?
Nausea & Vomiting Diarrhoea Constipation Hyperpigmentation Mood Changes Weight Loss Postural Hypotension
124
What are the two first line treatments of adrenal insufficiency?
Hydrocortisone Fludrocortisone
125
What is the first line management option of Addisonian crisis?
Loading Dose of IM/IV Hydrocortisone 100mg
126
How should Addison's disease medications be adjusted during periods of acute illness?
The hydrocortisone dose should be doubled, however the fludrocortisone dose can remain the same
127
What is the most appropriate management option when thyroid hormone levels are within the normal range - in those with hypothyroidism on levothyroxine?
The medication dose of levothyroxine should be maintained
128
When the levothyroxine dose should be increased, how should this be conducted?
It should be increased in increments of 25mg with TSH levels re-checked 4 weeks after the dose increase
129
What is the most appropriate management option when amiodarone administration results in hypothyroidism?
The amiodarone should be continued and levothyroxine should be initiated
130
What is the first line management option of hyperthyroidism?
Carbimazole
131
What is the most appropriate management option when amiodarone administration results in hyperthyroidism?
The amiodarone should be withheld
132
What is the first line management option of Cushing's syndrome? What dose, route and frequency?
Metyrapone 0.25g Once Daily
133
What are the four features of hypocalcaemia?
CATs go numb Convulsions Arrythmias Tetany Numbness
134
Which two examination signs indicate hypocalcaemia?
Trousseau's Sign Chvostek's Sign
135
What is the feature of hypocalcaemia on ECG scans?
Prolonged QT
136
What is the first line treatment of hypocalcaemia?
IV Calcium Gluconate 10% 10ml over 10 minutes
137
What are the four features of hyperkalaemia?
Diarrhoea Muscle Weakness Hyporeflexia Arrythmias
138
What are the five features of hyperkalaemia on ECG scans?
Tall Tented T Waves Absent P Waves Broad QRS Complexes Sinusodial Wave Pattern Ventricular Fibrillation
139
What is the first line treatment of hyperkalaemia?
IV Calcium Gluconate 10% 30ml over 10 minutes
140
Which three blood test results indicate primary hyperparathyroidism?
Increased PTH Levels Increased Calcium Levels Low Phosphate Levels
141
What is the first line management option of primary hyperparathyroidism?
Cinacalcet 10mg Twice Daily
142
What is the first line management option of venous thromboembolism?
Apixaban OR Rivaroxaban
143
How long should DOACs be administered in provoked venous thromboembolism?
3 Months
144
How long should DOACs be administered in unprovoked venous thromboembolism?
6 Months
145
When is lifelong administration of DOACs required?
When individuals experience recurrent venous thromboembolisms or if they have an unmodifiable risk factor
146
What is the first line prophylactic management option of venous thromboembolism?
Low Molecular Weight Heparin - e.g. dalteparin, enoxaparin or tinzaparin
147
What is the contraindication of low molecular weight heparin? What is an alternative?
Renal Failure Unfractioned Heparin
148
What blood test is used to monitor unfractioned heparin administration?
aPTT
149
What blood test is used to monitor low molecular weight heparin administration?
Anti-Factor Xa
150
How do we monitor NOACs administration?
It is monitored clinically
151
What blood test is used to monitor warfarin administration?
INR
152
What is a contraindication of aspirin? Why? What is the exception to this rule?
Children < 16 Years Old This is due to the risk of Reye's syndrome In Kawasaki disease, as the benefits are thought to outweigh the risks
153
What are the six features of Ménière's disease?
Aural Fullness Vertigo Tinnitus Nystagmus Sensorineural Hearing Loss Positive Romberg Test
154
What is the first line management option of acute Ménière's disease attacks?
Prochlorperazine
155
What is the first line prophylactic management option of Ménière's disease?
Betahistine
156
How do we monitor the effect of antibiotics when treating catheter associated urinary tract infections?
We review symptoms over the next 72 hours and ensure they are resolving It is important to note that dipstick urinalysis is nearly always positive due to long-term colonisation in patients with an indwelling catheter. Therefore, they are unlikely to be helpful in assessing efficacy of treatment
157
Which drug does trimethoprim interact with, increasing the risk of haemotological toxicity?
Methotrexate
158
What is the first line management option of urinary tract infections?
Nitrofuratoin
159
What is the first line management option of urinary tract infections in pregnant women who are in their first and second trimester?
Nitrofuratoin 50mg Four Times Daily For Seven Days
160
What is a contraindication of nitrofurantoin?
eGFR < 45mL/min/1.73 m2
161
What is the first line management option of benign prostatic hypertension?
Alpha Blocker - e.g tamsulosin
162
What is the first line management option of stress urinary incontinence?
Serotonin-Noradrenaline Reuptake Inhibitors (SNRI) - e.g. duloxetine
163
What is the first line management option of urge urinary incontinence?
Anticholinergics - e.g. oxybutynin, tolterodine, darifenacin
164
Which investigation is used to differentiate between cranial and nephrogenic diabetes insipidus?
Desmopressin Stimulation Test
165
What water deprivation test results indicate cranial diabetes insipidus? Explain this
In cranial diabetes insipidus, the patient lacks ADH. The kidneys are still capable or responding to ADH Therefore, initially the plasma osmolality remains low as it continues to be diluted by excessive water secretion in the kidneys Then when synthetic ADH is given, the kidneys respond by reabsorbing water and concentrating the urine, so the urine osmolality will be high
166
What water deprivation test results indicate nephrogenic diabetes insipidus? Explain this
In nephrogenic diabetes insipidus, the patient is unable to respond to ADH They are diluting their urine with the excessive water secretion from the kidneys Therefore, the urine osmolality will be low initially and remain low even after the synthetic ADH is given
167
What is the first line management option of cranial diabetes insipidus? What dose, route and frequency?
Desmopressin 100mcg Three Times Daily
168
What is the first line management option of nephrogenic diabetes insipidus?
Thiazide Diuretics
169
What is the first line management option for pain relief in renal stones?
NSAIDs
170
What is the second line management option for pain relief in renal stones - when NSAIDs are contraindicated?
IV Paracetamol
171
In those with renal impairment, what dose of gentamicin is recommended?
3mg/kg Check trough level would be acceptable then give further dose if < 1mg/kg
172
What are the seven clinical features of acute intermittent porphyria?
Vomiting Abdominal Pain Hallucinations Polyneuropathy Urine Discolouration Tachycardia Hypertension
173
What is the first line prophylactic management option of migraines? What dose, route and frequency?
Propanolol 40mg Twice Daily
174
What is the first line management option of tension headaches?
Paracetamol
175
What is the first line management option of meningitis in children within the community?
IM Benzypenicillin 1.2g
176
What is the first line management option of meningitis in children within the hospital?
IM Cefotaxime 1g
177
What is the key feature of myasthenia gravis?
Muscle Fatigability This is when muscles become progressively weaker during periods of activity and slowly improve after periods of rest
178
What are the four clinical features of myasthenia gravis?
Proximal Muscle Weakness Diplopia Ptosis Dysphagia
179
What is the first line management option of myasthenia gravis?
Pyridostigmine
180
What are the three features of essential tremor?
Bilateral Tremor Tremor Worse When Arms Outstretched Tremor Improved By Alcohol & Rest
181
What is the first line management option of essential tremor?
Propanolol
182
What is the first line management option of trigeminal neuralgia?
Carbamazepine
183
What is the first line management option of prolactinomas? What route, dose and frequency?
Cabergoline 500mcg Once Weekly
184
What is the first line management option of cerebral oedema, caused by brain tumours?
Dexamethasone
185
What are the three features of primary open-angle glaucoma?
Peripheral Vision Field Loss Decreased Visual Acuity Optic Disc Cupping
186
What is the first line management option of primary open-angle glaucoma? What dose, route and frequency?
Latanoprost 50mcg One Drop To Right Eye Daily
187
What are the four clinical features of allergic conjunctivitis?
Bilateral Conjunctival Erythema Bilateral Conjunctival Swelling Eyelid Swelling Itching
188
What is the first line management option of allergic conjunctivitis? What dose, route and frequency?
Topical Sodium Cromoglicate One Application Four Times Daily
189
What analgesic management is used in compartment syndrome? What dose, route and frequency?
IV Morphine 5mg 4 Hourly
190
What are the three features of Achilles tendon rupture?
Ankle/Calf Pain Popping Sound Inability To Walk
191
Which antibiotic prophylaxis is recommended to manage open fractures? What dose, route and frequency?
IV Co-Amoxiclav 1.2g Three Times Daily
192
Which drug should be administered when initiating allopurinol? Which other drug class should be considered if colchicine cannot be tolerated?
Colchicine NSAIDs
193
What are the four features of ankylosing spondylitis?
Lower Back Pain Back Stiffness Worse In Morning, Improves With Exercise Reduced Forward/Lateral Flexion Reduced Chest Expansion
194
What is the first line management option of ankylosing spondylitis? What dose, route and frequency?
Naproxen 500mg Once Daily
195
What are the four features of alcohol withdrawal?
Anxiety Sweating Tremor Tachycardia
196
What are the six features of delirium tremens?
Fever Confusion Delusions Hallucinations Tremor Tachycardia
197
What is the first line management option of delirium tremens?
Benzodiazepines - diazepam, chlordiazepoxide, lorazepam
198
What is the first line benzodiazepine in those with hepatic failure?
Lorazepam
199
What is a contraindication to IV benzodiazepine administration in delirium tremens?
It is contraindicated in those who are confused and disorientated
200
What is the first line management option of alcohol withdrawal - in those with reduced oral intake/disorientation who are at risk of Wenicke's encephalopathy?
IV Pabrinex 2 Pairs Three Times Daily
201
What are the three clinical features of hepatic encephalopathy?
Confusion Ascites Asterix
202
What is the first line management option of hepatic encephalopathy?
Lactulose
203
What is the target serum lithium levels in those administered lithium?
0.4 - 1 mmol/L
204
How should the lithium dose be adjusted when the serum levels are below the target range?
It is recommended to slightly increase the lithium dose and review the patient in 7 days
205
What is the feature of bacterial vaginosis on microscopy?
Clue Cells
206
What is the first line management option of bacterial vaginosis?
Metronidazole 2g Stat Dose
207
What is the feature of gonorrhoea on microscopy?
Gram-Negative Diplococci
208
What is the first line management option of gonorrhoea? What dose, route and frequency?
IM Ceftriaxone 1g Once Only
209
What folic acid dose should all pregnant woman take until the 12th week of pregnancy?
400mcg
210
What folic acid dose should all pregnant woman who are at higher risk of conceiving a child with a neural tube defect take until the 12th week of pregnancy?
5mg
211
What are the eight criteria which indicate a dose of 5mg folic acid during pregnancy?
Parents Affected By A Neural Tube Defect Previous Pregnancy Affected By A Neural Tube Defect Family History of A Neural Tube Defect Woman Is Taking Anti-Epileptic Drugs Woman Has Coeliac Disease Woman Has Diabetes Woman has Thalassaemia Trait Woman Has A BMI > 30
212
What is the first line management of vaginal candidiasis in pregnancy? What dose, route and frequency?
Clotrimazole Pessary 100mg Daily For 7 Days
213
What is the first line management of community acquired pneumonia in pregnancy?
Erythromycin
214
What is the definition of chronic hypertension in pregnancy?
It is defined as pre-existing hypertension or hypertension onset < 20 weeks gestation
215
What is the first line management option for chronic hypertension patients who fall pregnant?
Their pre-existing medications should be stopped and instead they should be offered a beta-blocker - such as labetalol
216
What is the second line management option for chronic hypertension patients who fall pregnant?
Their pre-existing medications should be stopped and instead they should be offered a calcium channel blocker - such as nifedipine
217
What is the third line management option for chronic hypertension patients who fall pregnant?
Their pre-existing medications should be stopped and instead they should be offered an alpha-blocker - such as methyldopa
218
What is the definition of pregnancy induced hypertension?
It is defined as hypertension onset > 20 weeks gestation
219
What is the definition of pre-eclampsia?
It is defined as pregnancy induced hypertension with evidence of proteinuria (>0.3g/24hours)
220
What is the definition of eclampsia?
It is defined as pre-eclampsia with the development of tonic-clonic seizures
221
What is the definition of HELLP syndrome?
HELLP Haemolysis Elevated Liver enzymes Low Platelets
222
What is the first line prophylactic management option of pre-eclampsia?
Aspirin 75-150mg from 12 weeks until birth
223
What is the first line management option of eclampsia? What route, dose and frequency?
IV Magnesium Sulphate 4g Once Only
224
What is the reversal agent of magnesium sulphate?
Calcium gluconate
225
What is the first line medical management option of ectopic pregnancies?
IM Methotrexate
226
When should cyclical HRT be administered to manage menopause?
This should be administered in women who have had a period within the last year
227
When should continuous HRT be administered to manage menopause?
This should be administered in women who have not had a period within the last year
228
When should both oestrogen and progesterone be used to manage menopause?
This should be administered in all women who still have a uterus
229
When should only oestrogen be used to manage menopause?
This should be administered in all women who no longer have a uterus
230
What are the five formulations of HRT?
Tablets Patches Gels Pessaries Rings
231
What HRT should be administered in women who have an intact uterus and have had a period within the last year?
They should be administered the oral sequential combined oestrogen and progestogen (Elleste-Duet 1mg/2mg OR Estradiol 1mg/2mg & Norethisterone Sequential OR Estradiol & Dydrogesterone 1/10mg Sequential) OR They should be administered the sequential combined oestrogen and progesterone patch (Evorel Sequi)
232
What HRT regime is recommended when individuals suffer from irregular bleeding?
Continuous
233
What HRT should be administered in women who have an intact uterus and have not had a period within the last year?
They should be administered oral combined continuous oestrogen and progesterone (Elleste-Duet Conti, Evorel Conti, Tibolone)
234
What HRT should be administered in women who have are post-hysterectomy?
They should be administered the oral oestrogen (estradiol, tibolone) OR They should be administered the patch oestrogen (Elleste-Solo)
235
How often should HRT transdermal patched be changed?
Once/Twice Weekly
236
What are the two first line prophylactic management options of postmenopausal osteoporosis?
Alendronic Acid Risedronate Sodium
237
What is the first line management option for menopausal vasomotor symptoms - in those who are unable to take HRT?
Clonidine
238
What is the first line management option for menopausal atrophic vaginitis?
A topical vaginal oestrogen either in the form of a pessary or ring
239
What are the six risks associated with HRT administration?
Breast Cancer Endometrial Cancer Ovarian Cancer Coronary Artery Disease Venous Thromboembolism Stroke
240
When can levonestregel be prescribed as emergency contraception?
It can be administered when individuals present < 72 hours following unprotected sexual intercourse
241
What are the three criteria for a double dose of levonestregel to be administered?
Weight > 70kg BMI > 26 Vomiting Within 3 Hours of First Dose
242
How soon after levongestregel administration can contraception be initiated?
It can be started straight away
243
When can ulipristal acetate be prescribed as emergency contraception?
It can be administered when individuals present < 120 hours following unprotected sexual intercourse
244
How soon after ulipristal acetate administration can contraception be initiated?
It can be started after 5 days
245
What is a contraindication of ulipristal acetate?
Asthma
246
What is the drug name of the combined oral contraceptive pill?
Ethinylestradiol With Levonorgestrel
247
How long does it take for the combined oral contraceptive pill to become effective?
7 Days
248
What are the three risks associated with the combined oral contraceptive pill?
Breast Cancer Cervical Cancer Venous Thromboembolism
249
What are the two benefits associated with the combined oral contraceptive pill?
Endometrial Cancer Ovarian Cancer
250
What advice should be given when individuals have missed one combined oral contraceptive pill anywhere in the pack or starting a new pack one day late?
They should take the missed pill and today's pill even though that means taking two pills in one day She should carry on taking the rest of the pack as normal The patient is still protected against pregnancy and therefore there is no need to use additional contraception
251
What is the drug name of the progesterone only pill?
Desogestrel
252
How long does it take for the progesterone only pill to become effective?
2 Days
253
What is the adverse side effect associated with desogestrel?
Irregular Bleeding
254
Which drug class reduces the efficacy of the progesterone only pill? What advice should be provided when administration is required?
Enzyme Inducing Drugs - e.g. topiramate, etc An alternative contraceptive method (IUD) is recommended during treatment and for at least 4 weeks afterwords
255
What is the first line management option for infertility - due to anovulatory cycles in the female partner? What dose, route and frequency?
Clomifene 50mg Once Daily For 5 Days
256
Which eight drugs are contraindicated in pregnancy?
ACE Inhibitors Angiotensin II Receptor Antagonists Anti-Epileptics Statins Sulfonylureas Retinoids Cytotoxic Agents Warfarin
257
Which drug is contraindicated when breastfeeding?
Aspirin
258
What is the first line management option of oestrogen receptor positive breast cancer? What route, dose and frequency?
Tamoxifen 20mg Once Daily
259
What are the six features of scarlet fever?
Fever > 38C Nausea & Vomiting Headache Sore Throat Macular Red Rash Strawberry Tongue
260
What is the first line management option of scarlet fever?
Phenoxymethylpenicillin 125mg Four Times Daily For Ten Days
261
What is the second line management option of scarlet fever?
Azithromycin
262
What are the seven features of acute otitis media?
Fever Otalgia Ear Discharge Hearing Loss Bulging Tympanic Membrane Opacification/Erythema of Tympanic Membrane Tympanic Membrane Perforation
263
What is the first line management option of acute otitis media?
Amoxicillin
264
What is the feature of impetigo?
Golden Crusted Skin Lesions In Mouth Region
265
What is the first line management option of impetigo?
Hydrogen Peroxide 1% Cream
266
What are the nine features of meningitis?
Fever Nausea & Vomiting Headache Neck Stiffness Photophobia Seizures Purpuric Rash Drowsiness Bulging Anterior Fontanelle
267
What is the first line management option of bacterial meningitis in the hospital setting in those < 3 months?
IV Cefotaxime & Amoxicillin
268
What is the first line management option of bacterial meningitis in the hospital setting in those > 3 months?
IV Ceftriaxone
269
What virus infection most commonly causes encephalitis?
Herpes Simplex Virus
270
What are the four clinical features of encephalitis?
Fever Vomiting Headache Seizures
271
What is the first line management option of encephalitis?
Aciclovir
272
What is the first line management option of absence seizures? What dose, route and frequency?
Ethosuximide 250mg Twice Daily
273
What are the three features of whooping cough?
Dry Cough, Worse At Night & After Feeding, May Result In Vomiting or Central Cyanosis Inspiratory Whoop Apnoea
274
What is the first line management option of whooping cough?
Macrolide Antibiotics - mycin
275
What is the first line prophylactic management option of pneumococcal infection in sickle cell patients?
Phenoxymethylpenicillin
276
What is the second line prophylactic management option of pneumococcal infection in sickle cell patients?
Erythromycin
277
What is the first line management option of GORD in children?
Alginic Acid
278
How should the gentamicin dose be adjusted in children, when the peak and trough concentrations are high?
The post-dose/peak concentration determines the dose - therefore should be reduced The pre-dose/trough concentration determines the interval - therefore should also be reduced
279
What are the three first line analgesia agents?
'Nonopioid Drugs' Paracetamol Ibuprofen Naproxen
280
What is the maximum IV paracetamol dose in those under 50kg?
15mg/kg
281
What drug class should always be administered in conjunction with ibuprofen?
Proton Pump Inhibitors
282
What are the three analgesia agents used to manage neuropathic pain?
Amitriptyline Pregabalin Gabapentin
283
What should be administered in those with neuropathic pain who are unable to consume tablets or who suffer from localised pain?
Lidocaine Patch
284
What are the three second line analgesia agents?
'Weak Opioid & Nonopioid Drugs' Codeine Co-Codamol Tramadol
285
What are the four third line analgesia agents?
'Strong Opioid & Nonopioid Drug' Morphine Diamorphine Buprenorphine Fentanyl
286
What is the first line analgesic agent for acute post-operative pain, after paracetamol and ibuprofen? What dose, route, frequency and rate?
IV Morphine 5mg Every Four Hours Rate = 1-2mg/minute
287
Which analgesic is contraindicated in those with a history of ischaemic heart disease?
Diclofenac
288
What anti-emetic is recommended in patients with vertigo, motion sickness or vestibular disorders?
Cyclizine
289
What anti-emetic is recommended in post-operative patients?
Ondansetron
290
What is a contraindication of ondansetron? What alternative anti-emetic should be administered for post-operative nausea?
Prolonged QT Cycylizine
291
Which three anti-emetics are recommended in palliative care patients?
Cyclizine Haloperidol Levopromazine
292
What anti-emetic is administered in those with acute chemotherapy induced nausea?
Ondansetron
293
What anti-emetic is administered in those with delayed chemotherapy induced nausea?
Metoclopramide
294
What anti-emetic is recommended in those with Parkinson's disease?
Domperidone
295
What anti-emetic is recommended in hypermedia gravidum?
Promethazine
296
List an osmotic laxative
Lactulose
297
List five stimulant laxatives
Bisacodyl Docusate Glycerol Senna Sodium Picosulfate
298
List two bulk-forming laxatives
Ispaghula Husk Methylcellulose
299
In paracetamol overdoses, when should activated charcoal be administered?
In those who present within 1 hour of the overdose
300
In paracetamol overdoses, what are the four criteria which indicate acetylcysteine administration?
The plasma paracetamol concentration is on or above a single treatment line joining points of 100mg/L at 4 hours and 15mg/L at 15 Horus There is a staggered overdose, or there is doubt over the time of paracetamol ingestion The patient presents within 8-24 hours of ingestion and overdose on more than 150mg/kg of paracetamol The patient presents > 24 hours of infection and experience jaundice, hepatic tenderness or an increased ALT level
301
What is the first line management option of iron overdoses? What dose, route and rate?
IV Desferrioxamine Mesilate 15mg/kg/hr
302
What is the first line management option of tricyclic antidepressant overdoses? What dose, route and rate?
IV Sodium Bicarbonate 50mmol
303
What dose of adrenaline should be administered during acute anaphylactic reactions in adults?
Adrenaline 500mcg IM (0.5mL of 1:1000)
304
How many EpiPens should patients be supplied?
Two
305
What dose, route and frequency of adrenaline should be administered during cardiac arrest?
Adrenaline 1mg IV/IM (10ml of 1:10000)
306
What haemoglobin level indicates blood transfusion management?
< 70g/L
307
What are the eight types of penicillin?
Amoxicillin Ampicillin Benzypenicillin Flucloxacillin Phenoxymethylpenicillin Co-Amoxiclav (Augmentin) Co-Flumpicil (Magnapen) Piperacillin With Tazobactam (Tazocin) Ticarcillin With Clavulanic Acid (Timentin)

Year Five - Prescribing Safety Assessment (8 decks)

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