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Year Five - Prescribing Safety Assessment > Prescribing > Flashcards

Prescribing Flashcards

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
Q

How should the statin dose be adjusted when it results in CK elevation - less than 5 times the upper limit of the reference range?

A

The statin can be continued at a lower dose

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26
Q

How should the statin dose be adjusted when it results in CK elevation - more than 5 times the upper limit of the reference range?

A

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

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27
Q

What is the definition of postural hypotension?

A

It is defined as a systolic drop of > 20mmHg and/or a diastolic drop of > 10mmHg

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28
Q

What is the first line management option of postural hypotension?

A

Fludrocortisone

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29
Q

What is the first line management option of pulmonary oedema?

A

IV Furosemide 20mg Once Only

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30
Q

What is the first line management option of chronic asthma in children under 5 years old?

A

Short Acting Beta2 Agonist (SABA)

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31
Q

What dose, route and frequency of salbutamol is initially trialled?

A

Inhaled Salbutamol 1-2 Puffs As Required

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32
Q

What is the second line management option of chronic asthma in children under 5 years old? How long should this be trialled for?

A

Inhaled Corticosteroids (ICS)

8 Weeks

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33
Q

What is the third line management option of chronic asthma in children under 5 years old?

A

Leukotriene Receptor Antagonist (LTRA)

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34
Q

What is the fourth line management option of chronic asthma in children under 5 years old?

A

Specialist Review

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35
Q

What is the first line management option of chronic asthma in children over 5 years old?

A

Short Acting Beta2 Agonist (SABA)

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36
Q

What is the second line management option of chronic asthma in children over 5 years old?

A

Inhaled Corticosteroid (ICS)

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37
Q

What is the third line management option of chronic asthma in children over 5 years old?

A

Leukotriene Receptor Antagonist (LTRA)

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38
Q

What is the fourth line management option of chronic asthma in children over 5 years old?

A

Long Acting Bronchodilator Inhalers (LABA)

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39
Q

What are the three classifications of acute asthma?

A

Moderate

Severe

Life Threatening

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40
Q

What are the four clinical features of moderate acute asthma?

A

PEFR > 50% Predicted

Normal Speech

Normal RR

Normal HR

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41
Q

What are the five clinical features of severe acute asthma?

A

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)

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42
Q

What are the seven clinical features of life threatening acute asthma?

A

PEFR < 33%

Saturations < 92%

Poor Respiratory Effort

Silent Chest

Hypotension

Cyanosis

Confusion/Coma

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43
Q

How do we manage moderate acute asthma attacks?

A

Nebulised Salbutamol

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44
Q

What are the five management options for severe acute asthma attacks? List it in the stepwise order

A

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)

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45
Q

What dose of oral prednisolone is advised in severe paediatric acute asthma attacks?

A

1 mg per kg of body weight once daily for 3 days

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46
Q

What is the first line management option of severe acute exacerbations of COPD? What dose, route and frequency?

A

Salbutamol 1mg/mL Nebuliser Liquid

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47
Q

What is the second line management option of severe acute exacerbations of COPD? What dose, route and frequency?

A

Ipraotropium Bromide 500mcg/Salbutamol 2.5mg/2.5mL Nebuliser Liquid

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48
Q

What is the first line management option of chronic COPD?

A

Short Acting Muscarinic Antagonist (SAMA)

OR

Short Acting Beta2 Agonist (SABA)

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49
Q

What is the second line management option of chronic COPD - if asthma/steroid responsive?

A

Long Acting Beta2 Agonist

&

Inhaled Corticosteroid (ICS)

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50
Q

List three examples of combined ICS & LABA inhalers

A

Formoterol & Budesonide

Formoterol & Beclometasone

Salmeterol & Fluticasone

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51
Q

What is the second line management option of chronic COPD - if not asthma/steroid responsive?

A

Long Acting Beta Agonist (LABA)

&

Long Acting Muscarinic Antagonist (LAMA)

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52
Q

What is the third line management option of chronic COPD?

A

Long Acting Beta2 Agonist (LABA)

&

Long Acting Muscarinic Antagonist (LAMA)

&

Inhaled Corticosteroid (ICS)

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53
Q

What is the most appropriate oxygen therapy in those with COPD and CO2 retention?

A

28% Venturi Mask 4L/min

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54
Q

When is non-invasive ventilation recommended to manage COPD exacerbations?

A

Respiratory Acidosis = pH 7.25 - 7.35

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55
Q

How do we monitor for adverse effects of oxygen therapy in COPD patients - due to the risk of hypercapnic respiratory failure?

A

Arterial Blood Gas

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56
Q

Which three drugs should be administered with caution in asthma and COPD patients?

A

Adenosine

Beta-Blockers

NSAIDs

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57
Q

What is the first line management option of community acquired pneumonia?

A

Amoxicillin

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58
Q

What are the three second line management options of community acquired pneumonia?

A

Clarithromycin

Doxycyline

Erythromycin

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59
Q

What are the five features of ascending cholangitis?

A

Fever

Right Upper Quadrant Pain

Jaundice

Confusion

Hypotension

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60
Q

What is the first line management option of ascites secondary to liver cirrhosis? What dose, route and frequency?

A

Spironolactone 100mg Once Daily

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61
Q

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?

A

Fidaxomicin

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62
Q

Which drug does omeprazole interact with - decreasing its efficacy? What can be administered instead?

A

Clopidogrel

Lansoprazole

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63
Q

What are the four features of shingles?

A

Fever

Headache

Burning Pain Over Affected Dermatome

Erythematous, Macular/Vesicular Rash Over Affected Dermatome

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64
Q

What is the first line management option of shingles?

A

Aciclovir 800mg 5 times daily for 7 days

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65
Q

What are the four features of scabies?

A

Pruritus

Symmetrical Erythematous Papules

Linear Burrows on Side of Fingers, Interdigital Webs & Flexor Aspect of Wrists

Excoriation Marks

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66
Q

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

A

Permethrin 5% Cream

Dose = Apply To Whole Body

Route = Topical

Frequency = Once Weekly For Two Doses

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67
Q

What is the first line management option of cellulitis?

A

Flucloxacillin

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68
Q

What is the first line management option of cellulitis in pregnancy? What dose, route and frequency?

A

Erythromycin 500mg Four Times Daily For 5-7 Days

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69
Q

When is metformin used to manage type two diabetes?

A

It is the first line pharmacological management option

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70
Q

Whar are the three side effects of metformin?

A

Gastrointestinal Upset

Vitamin B12 Malabsorption

Lactic Acidosis

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71
Q

What are the two factors which make type two diabetics susceptible to lactic acidosis when administered metformin?

A

Liver disease

Renal failure

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72
Q

How do we reduce the risk of gastrointestinal side effects associated with metformin?

A

The metformin dose should be started at a low dose and tritiated up slowly

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73
Q

What is the most appropriate management step when individuals develop unacceptable metformin side effects?

A

We switch to modified-release metformin

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74
Q

What are the six contraindications of metformin?

A

Chronic Kidney Disease, eGFR < 30ml/min

Recent Myocardial Infarction

Sepsis

Acute Kidney Injury

Alcohol Abuse

Severe Dehydration

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75
Q

In which condition should metformin be stopped in? Explain

A

Myocardial Infarction

Lactic acidosis risk

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76
Q

How should metformin be administered prior to surgery?

A

The afternoon dose on the day of surgery is usually withheld

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77
Q

When are sulfonylureas used to manage type two diabetics?

A

They are a second line pharmacological management option

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78
Q

Name three sulfonylureas used to manage type two diabetics

A

‘ides’

Glimepiride

Gliclazide

Glipizide

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79
Q

What are the six side effects associated with sulfonylureas?

A

Hypoglycaemic Episodes

Weight Gain

Hyponatraemia (SIADH)

Hepatotoxicity

Peripheral Neuropathy

Bone Marrow Suppression

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80
Q

What are the four contraindications of sulfonylureas?

A

Pregnancy

Breastfeeding

Renal Failure

Hepatic Failure

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81
Q

How should sulfonylureas be administered prior to surgery?

A

It should be withheld on the day of surgery

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82
Q

When are thiazolidinediones used to manage type two diabetes?

A

It is a second line pharmacological treatment option

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83
Q

Name a thiazolidinedione used to manage type two diabetes

A

Pioglitazone

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84
Q

What are the five side effects associated with thiazolidinediones?

A

Weight Gain

Liver Impairment

Fluid Retention

Bone Fractures

Urinary Bladder Cancer

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85
Q

What are the three contraindications of thiazolidinones?

A

Heart Failure

Obesity

Active/Previous History of Bladder Cancer

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86
Q

When are SGLT-2 inhibitors used to manage type two diabetes?

A

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

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87
Q

Name three SGLT-2 inhibitors used to manage type two diabetes

A

‘glifozin’

Canagliflozin

Dapagliflozin

Empagliflozin

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88
Q

What are the six side effects associated with SGLT-2 inhibitors?

A

Weight Loss

Urinary Tract Infection

Thrush

Fournier’s Gangrene

Normoglycaemia Ketoacidosis

Diabetic Foot Disease

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89
Q

What are the four features of Fournier’s gangrene?

A

Fever

Perineum Pain

Perineum Swelling

Perineum Erythema

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90
Q

What is an advantage of SLGT-2 inhibitor administration?

A

It reduces cardiovascular disease

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91
Q

When are DPP-4 inhibitors used to manage type two diabetes?

A

They are a second line pharmacological treatment option

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92
Q

Name three DPP-4 inhibitors used to manage type two diabetes

A

‘gliptin’

Saxagliptin

Sitagliptin

Vildagliptin

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93
Q

What are the two side effects associated with DPP-4 inhibitors?

A

Nausea & Vomiting

Acute Pancreatitis

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94
Q

Why are DPP-4 inhibitors preferable to thiazolidinediones and sulfonylureas?

A

They dont cause weight gain

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95
Q

When are GLP-1 analogues used to manage type two diabetes?

A

They are a fourth line pharmacological treatment option

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96
Q

What two other hypoglycaemic drugs are GLP-1 analogues administered with?

A

Metformin

Sulfonylureas

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97
Q

In which two circumstances, do we administer GLP-1 analogues?

A

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

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98
Q

Name three GLP-1 analogues used to manage type two diabetes

A

‘tide’

Exenatide

Liraglutide

Lixisenatide

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99
Q

What are the three side effects of GLP-1 analogues?

A

Weight Loss

Nausea & Vomiting

Acute Pancreatitis

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100
Q

What is the administration route of GLP-1 analogues?

A

Subcutaneous injection

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101
Q

Which anti-diabetic drug is least likely to cause hypoglycaemia?

A

Metformin

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102
Q

When is insulin used to manage type two diabetes?

A

It It is a third line pharmacological management option, which should be co-administered with metformin

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103
Q

Name two rapid acting insulins

A

Insulin Aspart - Novorapid

Insulin Lispro - Humalog

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104
Q

When patients present with a blood glucose > 15 what insulin should be administered? How many units?

A

Novorapid

4 Units

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105
Q

Name two short acting acting insulins

A

Actrapid

Humalin S

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106
Q

Name two intermediate acting insulins

A

Isophane Inuslin

Humulin I

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107
Q

Name three long acting insulins

A

Insulin Determir - Levemir

Insulin Glargine - Lantus

Tresiba

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108
Q

What insulin regime is used to manage type one diabetes?

A

Basal Bolus Regime

This involves administration of a long acting insulin once/twice daily, with short acting insulin with meals

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109
Q

What are the three side effects of insulin?

A

Hypoglycaemia

Weight gain

Lipodystrophy

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110
Q

How should the dose of insulin be adjusted prior to surgery?

A

The insulin should be administered as normal the day before surgery, except for long acting insulins which should be reduced in dosage by 20%

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111
Q

What insulin regime should be administered in patients who are nil by mouth for extended periods?

A

Variable Rate

This is when the insulin dose is altered depending on regular blood glucose levels

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112
Q

What insulin regime and dose should be administered in DKAs?

A

Fixed Rate - 0.1 units/kg/h

It is advised that short acting insulin should be stopped, whilst long acting insulin is continued

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113
Q

What insulin regime and dose should be administered in HSS?

A

Fixed Rate - 0.05 units/kg/h

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114
Q

How should the insulin regime be adjusted when the evening glucose readings are elevated however the morning glucose readings are normal?

A

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%

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115
Q

What is the first line management option of hypoglycaemia in an unconscious patient in hospital?

A

IV Glucose 20% 100mL

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116
Q

What is the first line management option of hypoglycaemia in an unconscious patient - in which IV access in unattainable?

A

IM Glucagon

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117
Q

What are the two monitoring requirements of type one diabetes?

A

HbA1c

Home Glucose Readings

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118
Q

What is the HbA1c target in type two diabetic patients?

A

< 48mmol/mol (6.5%)

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119
Q

What fasting glucose level indicates a diagnosis of gestational diabetes?

A

> 5.6mmol

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120
Q

What OGTT level at 2 hours indicates a diagnosis of gestational diabetes?

A

> 7.8mmol

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121
Q

What are the management options of gestational diabetes in those with a fasting glucose < 7mmol?

A

It involves trial of diet, exercise and metformin

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122
Q

What is the management option of gestational diabetes in those with a fasting glucose > 7mmol?

A

Short Acting Insulin

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123
Q

What are the seven features of adrenal insufficiency?

A

Nausea & Vomiting

Diarrhoea

Constipation

Hyperpigmentation

Mood Changes

Weight Loss

Postural Hypotension

124
Q

What are the two first line treatments of adrenal insufficiency?

A

Hydrocortisone

Fludrocortisone

125
Q

What is the first line management option of Addisonian crisis?

A

Loading Dose of IM/IV Hydrocortisone 100mg

126
Q

How should Addison’s disease medications be adjusted during periods of acute illness?

A

The hydrocortisone dose should be doubled, however the fludrocortisone dose can remain the same

127
Q

What is the most appropriate management option when thyroid hormone levels are within the normal range - in those with hypothyroidism on levothyroxine?

A

The medication dose of levothyroxine should be maintained

128
Q

When the levothyroxine dose should be increased, how should this be conducted?

A

It should be increased in increments of 25mg with TSH levels re-checked 4 weeks after the dose increase

129
Q

What is the most appropriate management option when amiodarone administration results in hypothyroidism?

A

The amiodarone should be continued and levothyroxine should be initiated

130
Q

What is the first line management option of hyperthyroidism?

A

Carbimazole

131
Q

What is the most appropriate management option when amiodarone administration results in hyperthyroidism?

A

The amiodarone should be withheld

132
Q

What is the first line management option of Cushing’s syndrome? What dose, route and frequency?

A

Metyrapone 0.25g Once Daily

133
Q

What are the four features of hypocalcaemia?

A

CATs go numb

Convulsions

Arrythmias

Tetany

Numbness

134
Q

Which two examination signs indicate hypocalcaemia?

A

Trousseau’s Sign

Chvostek’s Sign

135
Q

What is the feature of hypocalcaemia on ECG scans?

A

Prolonged QT

136
Q

What is the first line treatment of hypocalcaemia?

A

IV Calcium Gluconate 10% 10ml over 10 minutes

137
Q

What are the four features of hyperkalaemia?

A

Diarrhoea

Muscle Weakness

Hyporeflexia

Arrythmias

138
Q

What are the five features of hyperkalaemia on ECG scans?

A

Tall Tented T Waves

Absent P Waves

Broad QRS Complexes

Sinusodial Wave Pattern

Ventricular Fibrillation

139
Q

What is the first line treatment of hyperkalaemia?

A

IV Calcium Gluconate 10% 30ml over 10 minutes

140
Q

Which three blood test results indicate primary hyperparathyroidism?

A

Increased PTH Levels

Increased Calcium Levels

Low Phosphate Levels

141
Q

What is the first line management option of primary hyperparathyroidism?

A

Cinacalcet 10mg Twice Daily

142
Q

What is the first line management option of venous thromboembolism?

A

Apixaban

OR

Rivaroxaban

143
Q

How long should DOACs be administered in provoked venous thromboembolism?

144
Q

How long should DOACs be administered in unprovoked venous thromboembolism?

145
Q

When is lifelong administration of DOACs required?

A

When individuals experience recurrent venous thromboembolisms or if they have an unmodifiable risk factor

146
Q

What is the first line prophylactic management option of venous thromboembolism?

A

Low Molecular Weight Heparin - e.g. dalteparin, enoxaparin or tinzaparin

147
Q

What is the contraindication of low molecular weight heparin? What is an alternative?

A

Renal Failure

Unfractioned Heparin

148
Q

What blood test is used to monitor unfractioned heparin administration?

149
Q

What blood test is used to monitor low molecular weight heparin administration?

A

Anti-Factor Xa

150
Q

How do we monitor NOACs administration?

A

It is monitored clinically

151
Q

What blood test is used to monitor warfarin administration?

152
Q

What is a contraindication of aspirin? Why? What is the exception to this rule?

A

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
Q

What are the six features of Ménière’s disease?

A

Aural Fullness

Vertigo

Tinnitus

Nystagmus

Sensorineural Hearing Loss

Positive Romberg Test

154
Q

What is the first line management option of acute Ménière’s disease attacks?

A

Prochlorperazine

155
Q

What is the first line prophylactic management option of Ménière’s disease?

A

Betahistine

156
Q

How do we monitor the effect of antibiotics when treating catheter associated urinary tract infections?

A

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
Q

Which drug does trimethoprim interact with, increasing the risk of haemotological toxicity?

A

Methotrexate

158
Q

What is the first line management option of urinary tract infections?

A

Nitrofuratoin

159
Q

What is the first line management option of urinary tract infections in pregnant women who are in their first and second trimester?

A

Nitrofuratoin 50mg Four Times Daily For Seven Days

160
Q

What is a contraindication of nitrofurantoin?

A

eGFR < 45mL/min/1.73 m2

161
Q

What is the first line management option of benign prostatic hypertension?

A

Alpha Blocker - e.g tamsulosin

162
Q

What is the first line management option of stress urinary incontinence?

A

Serotonin-Noradrenaline Reuptake Inhibitors (SNRI) - e.g. duloxetine

163
Q

What is the first line management option of urge urinary incontinence?

A

Anticholinergics - e.g. oxybutynin, tolterodine, darifenacin

164
Q

Which investigation is used to differentiate between cranial and nephrogenic diabetes insipidus?

A

Desmopressin Stimulation Test

165
Q

What water deprivation test results indicate cranial diabetes insipidus? Explain this

A

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
Q

What water deprivation test results indicate nephrogenic diabetes insipidus? Explain this

A

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
Q

What is the first line management option of cranial diabetes insipidus? What dose, route and frequency?

A

Desmopressin 100mcg Three Times Daily

168
Q

What is the first line management option of nephrogenic diabetes insipidus?

A

Thiazide Diuretics

169
Q

What is the first line management option for pain relief in renal stones?

170
Q

What is the second line management option for pain relief in renal stones - when NSAIDs are contraindicated?

A

IV Paracetamol

171
Q

In those with renal impairment, what dose of gentamicin is recommended?

A

3mg/kg

Check trough level would be acceptable then give further dose if < 1mg/kg

172
Q

What are the seven clinical features of acute intermittent porphyria?

A

Vomiting

Abdominal Pain

Hallucinations

Polyneuropathy

Urine Discolouration

Tachycardia

Hypertension

173
Q

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

A

Propanolol 40mg Twice Daily

174
Q

What is the first line management option of tension headaches?

A

Paracetamol

175
Q

What is the first line management option of meningitis in children within the community?

A

IM Benzypenicillin 1.2g

176
Q

What is the first line management option of meningitis in children within the hospital?

A

IM Cefotaxime 1g

177
Q

What is the key feature of myasthenia gravis?

A

Muscle Fatigability

This is when muscles become progressively weaker during periods of activity and slowly improve after periods of rest

178
Q

What are the four clinical features of myasthenia gravis?

A

Proximal Muscle Weakness

Diplopia

Ptosis

Dysphagia

179
Q

What is the first line management option of myasthenia gravis?

A

Pyridostigmine

180
Q

What are the three features of essential tremor?

A

Bilateral Tremor

Tremor Worse When Arms Outstretched

Tremor Improved By Alcohol & Rest

181
Q

What is the first line management option of essential tremor?

A

Propanolol

182
Q

What is the first line management option of trigeminal neuralgia?

A

Carbamazepine

183
Q

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

A

Cabergoline 500mcg Once Weekly

184
Q

What is the first line management option of cerebral oedema, caused by brain tumours?

A

Dexamethasone

185
Q

What are the three features of primary open-angle glaucoma?

A

Peripheral Vision Field Loss

Decreased Visual Acuity

Optic Disc Cupping

186
Q

What is the first line management option of primary open-angle glaucoma? What dose, route and frequency?

A

Latanoprost 50mcg One Drop To Right Eye Daily

187
Q

What are the four clinical features of allergic conjunctivitis?

A

Bilateral Conjunctival Erythema

Bilateral Conjunctival Swelling

Eyelid Swelling

Itching

188
Q

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

A

Topical Sodium Cromoglicate One Application Four Times Daily

189
Q

What analgesic management is used in compartment syndrome? What dose, route and frequency?

A

IV Morphine 5mg 4 Hourly

190
Q

What are the three features of Achilles tendon rupture?

A

Ankle/Calf Pain

Popping Sound

Inability To Walk

191
Q

Which antibiotic prophylaxis is recommended to manage open fractures? What dose, route and frequency?

A

IV Co-Amoxiclav 1.2g Three Times Daily

192
Q

Which drug should be administered when initiating allopurinol? Which other drug class should be considered if colchicine cannot be tolerated?

A

Colchicine

NSAIDs

193
Q

What are the four features of ankylosing spondylitis?

A

Lower Back Pain

Back Stiffness Worse In Morning, Improves With Exercise

Reduced Forward/Lateral Flexion

Reduced Chest Expansion

194
Q

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

A

Naproxen 500mg Once Daily

195
Q

What are the four features of alcohol withdrawal?

A

Anxiety

Sweating

Tremor

Tachycardia

196
Q

What are the six features of delirium tremens?

A

Fever

Confusion

Delusions

Hallucinations

Tremor

Tachycardia

197
Q

What is the first line management option of delirium tremens?

A

Benzodiazepines - diazepam, chlordiazepoxide, lorazepam

198
Q

What is the first line benzodiazepine in those with hepatic failure?

199
Q

What is a contraindication to IV benzodiazepine administration in delirium tremens?

A

It is contraindicated in those who are confused and disorientated

200
Q

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?

A

IV Pabrinex 2 Pairs Three Times Daily

201
Q

What are the three clinical features of hepatic encephalopathy?

A

Confusion

Ascites

Asterix

202
Q

What is the first line management option of hepatic encephalopathy?

203
Q

What is the target serum lithium levels in those administered lithium?

A

0.4 - 1 mmol/L

204
Q

How should the lithium dose be adjusted when the serum levels are below the target range?

A

It is recommended to slightly increase the lithium dose and review the patient in 7 days

205
Q

What is the feature of bacterial vaginosis on microscopy?

A

Clue Cells

206
Q

What is the first line management option of bacterial vaginosis?

A

Metronidazole 2g Stat Dose

207
Q

What is the feature of gonorrhoea on microscopy?

A

Gram-Negative Diplococci

208
Q

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

A

IM Ceftriaxone 1g Once Only

209
Q

What folic acid dose should all pregnant woman take until the 12th week of pregnancy?

210
Q

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?

211
Q

What are the eight criteria which indicate a dose of 5mg folic acid during pregnancy?

A

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
Q

What is the first line management of vaginal candidiasis in pregnancy? What dose, route and frequency?

A

Clotrimazole Pessary 100mg Daily For 7 Days

213
Q

What is the first line management of community acquired pneumonia in pregnancy?

A

Erythromycin

214
Q

What is the definition of chronic hypertension in pregnancy?

A

It is defined as pre-existing hypertension or hypertension onset < 20 weeks gestation

215
Q

What is the first line management option for chronic hypertension patients who fall pregnant?

A

Their pre-existing medications should be stopped and instead they should be offered a beta-blocker - such as labetalol

216
Q

What is the second line management option for chronic hypertension patients who fall pregnant?

A

Their pre-existing medications should be stopped and instead they should be offered a calcium channel blocker - such as nifedipine

217
Q

What is the third line management option for chronic hypertension patients who fall pregnant?

A

Their pre-existing medications should be stopped and instead they should be offered an alpha-blocker - such as methyldopa

218
Q

What is the definition of pregnancy induced hypertension?

A

It is defined as hypertension onset > 20 weeks gestation

219
Q

What is the definition of pre-eclampsia?

A

It is defined as pregnancy induced hypertension with evidence of proteinuria (>0.3g/24hours)

220
Q

What is the definition of eclampsia?

A

It is defined as pre-eclampsia with the development of tonic-clonic seizures

221
Q

What is the definition of HELLP syndrome?

A

HELLP

Haemolysis

Elevated Liver enzymes

Low Platelets

222
Q

What is the first line prophylactic management option of pre-eclampsia?

A

Aspirin 75-150mg from 12 weeks until birth

223
Q

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

A

IV Magnesium Sulphate 4g Once Only

224
Q

What is the reversal agent of magnesium sulphate?

A

Calcium gluconate

225
Q

What is the first line medical management option of ectopic pregnancies?

A

IM Methotrexate

226
Q

When should cyclical HRT be administered to manage menopause?

A

This should be administered in women who have had a period within the last year

227
Q

When should continuous HRT be administered to manage menopause?

A

This should be administered in women who have not had a period within the last year

228
Q

When should both oestrogen and progesterone be used to manage menopause?

A

This should be administered in all women who still have a uterus

229
Q

When should only oestrogen be used to manage menopause?

A

This should be administered in all women who no longer have a uterus

230
Q

What are the five formulations of HRT?

A

Tablets

Patches

Gels

Pessaries

Rings

231
Q

What HRT should be administered in women who have an intact uterus and have had a period within the last year?

A

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
Q

What HRT regime is recommended when individuals suffer from irregular bleeding?

A

Continuous

233
Q

What HRT should be administered in women who have an intact uterus and have not had a period within the last year?

A

They should be administered oral combined continuous oestrogen and progesterone (Elleste-Duet Conti, Evorel Conti, Tibolone)

234
Q

What HRT should be administered in women who have are post-hysterectomy?

A

They should be administered the oral oestrogen (estradiol, tibolone)

OR

They should be administered the patch oestrogen (Elleste-Solo)

235
Q

How often should HRT transdermal patched be changed?

A

Once/Twice Weekly

236
Q

What are the two first line prophylactic management options of postmenopausal osteoporosis?

A

Alendronic Acid

Risedronate Sodium

237
Q

What is the first line management option for menopausal vasomotor symptoms - in those who are unable to take HRT?

238
Q

What is the first line management option for menopausal atrophic vaginitis?

A

A topical vaginal oestrogen either in the form of a pessary or ring

239
Q

What are the six risks associated with HRT administration?

A

Breast Cancer

Endometrial Cancer

Ovarian Cancer

Coronary Artery Disease

Venous Thromboembolism

Stroke

240
Q

When can levonestregel be prescribed as emergency contraception?

A

It can be administered when individuals present < 72 hours following unprotected sexual intercourse

241
Q

What are the three criteria for a double dose of levonestregel to be administered?

A

Weight > 70kg

BMI > 26

Vomiting Within 3 Hours of First Dose

242
Q

How soon after levongestregel administration can contraception be initiated?

A

It can be started straight away

243
Q

When can ulipristal acetate be prescribed as emergency contraception?

A

It can be administered when individuals present < 120 hours following unprotected sexual intercourse

244
Q

How soon after ulipristal acetate administration can contraception be initiated?

A

It can be started after 5 days

245
Q

What is a contraindication of ulipristal acetate?

246
Q

What is the drug name of the combined oral contraceptive pill?

A

Ethinylestradiol With Levonorgestrel

247
Q

How long does it take for the combined oral contraceptive pill to become effective?

248
Q

What are the three risks associated with the combined oral contraceptive pill?

A

Breast Cancer

Cervical Cancer

Venous Thromboembolism

249
Q

What are the two benefits associated with the combined oral contraceptive pill?

A

Endometrial Cancer

Ovarian Cancer

250
Q

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?

A

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
Q

What is the drug name of the progesterone only pill?

A

Desogestrel

252
Q

How long does it take for the progesterone only pill to become effective?

253
Q

What is the adverse side effect associated with desogestrel?

A

Irregular Bleeding

254
Q

Which drug class reduces the efficacy of the progesterone only pill? What advice should be provided when administration is required?

A

Enzyme Inducing Drugs - e.g. topiramate, etc

An alternative contraceptive method (IUD) is recommended during treatment and for at least 4 weeks afterwords

255
Q

What is the first line management option for infertility - due to anovulatory cycles in the female partner? What dose, route and frequency?

A

Clomifene 50mg Once Daily For 5 Days

256
Q

Which eight drugs are contraindicated in pregnancy?

A

ACE Inhibitors

Angiotensin II Receptor Antagonists

Anti-Epileptics

Statins

Sulfonylureas

Retinoids

Cytotoxic Agents

Warfarin

257
Q

Which drug is contraindicated when breastfeeding?

258
Q

What is the first line management option of oestrogen receptor positive breast cancer? What route, dose and frequency?

A

Tamoxifen 20mg Once Daily

259
Q

What are the six features of scarlet fever?

A

Fever > 38C

Nausea & Vomiting

Headache

Sore Throat

Macular Red Rash

Strawberry Tongue

260
Q

What is the first line management option of scarlet fever?

A

Phenoxymethylpenicillin 125mg Four Times Daily For Ten Days

261
Q

What is the second line management option of scarlet fever?

A

Azithromycin

262
Q

What are the seven features of acute otitis media?

A

Fever

Otalgia

Ear Discharge

Hearing Loss

Bulging Tympanic Membrane

Opacification/Erythema of Tympanic Membrane

Tympanic Membrane Perforation

263
Q

What is the first line management option of acute otitis media?

A

Amoxicillin

264
Q

What is the feature of impetigo?

A

Golden Crusted Skin Lesions In Mouth Region

265
Q

What is the first line management option of impetigo?

A

Hydrogen Peroxide 1% Cream

266
Q

What are the nine features of meningitis?

A

Fever

Nausea & Vomiting

Headache

Neck Stiffness

Photophobia

Seizures

Purpuric Rash

Drowsiness

Bulging Anterior Fontanelle

267
Q

What is the first line management option of bacterial meningitis in the hospital setting in those < 3 months?

A

IV Cefotaxime & Amoxicillin

268
Q

What is the first line management option of bacterial meningitis in the hospital setting in those > 3 months?

A

IV Ceftriaxone

269
Q

What virus infection most commonly causes encephalitis?

A

Herpes Simplex Virus

270
Q

What are the four clinical features of encephalitis?

A

Fever

Vomiting

Headache

Seizures

271
Q

What is the first line management option of encephalitis?

272
Q

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

A

Ethosuximide 250mg Twice Daily

273
Q

What are the three features of whooping cough?

A

Dry Cough, Worse At Night & After Feeding, May Result In Vomiting or Central Cyanosis

Inspiratory Whoop

Apnoea

274
Q

What is the first line management option of whooping cough?

A

Macrolide Antibiotics - mycin

275
Q

What is the first line prophylactic management option of pneumococcal infection in sickle cell patients?

A

Phenoxymethylpenicillin

276
Q

What is the second line prophylactic management option of pneumococcal infection in sickle cell patients?

A

Erythromycin

277
Q

What is the first line management option of GORD in children?

A

Alginic Acid

278
Q

How should the gentamicin dose be adjusted in children, when the peak and trough concentrations are high?

A

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
Q

What are the three first line analgesia agents?

A

‘Nonopioid Drugs’

Paracetamol

Ibuprofen

Naproxen

280
Q

What is the maximum IV paracetamol dose in those under 50kg?

281
Q

What drug class should always be administered in conjunction with ibuprofen?

A

Proton Pump Inhibitors

282
Q

What are the three analgesia agents used to manage neuropathic pain?

A

Amitriptyline

Pregabalin

Gabapentin

283
Q

What should be administered in those with neuropathic pain who are unable to consume tablets or who suffer from localised pain?

A

Lidocaine Patch

284
Q

What are the three second line analgesia agents?

A

‘Weak Opioid & Nonopioid Drugs’

Codeine

Co-Codamol

Tramadol

285
Q

What are the four third line analgesia agents?

A

‘Strong Opioid & Nonopioid Drug’

Morphine

Diamorphine

Buprenorphine

Fentanyl

286
Q

What is the first line analgesic agent for acute post-operative pain, after paracetamol and ibuprofen? What dose, route, frequency and rate?

A

IV Morphine 5mg Every Four Hours

Rate = 1-2mg/minute

287
Q

Which analgesic is contraindicated in those with a history of ischaemic heart disease?

A

Diclofenac

288
Q

What anti-emetic is recommended in patients with vertigo, motion sickness or vestibular disorders?

289
Q

What anti-emetic is recommended in post-operative patients?

A

Ondansetron

290
Q

What is a contraindication of ondansetron? What alternative anti-emetic should be administered for post-operative nausea?

A

Prolonged QT

Cycylizine

291
Q

Which three anti-emetics are recommended in palliative care patients?

A

Cyclizine

Haloperidol

Levopromazine

292
Q

What anti-emetic is administered in those with acute chemotherapy induced nausea?

A

Ondansetron

293
Q

What anti-emetic is administered in those with delayed chemotherapy induced nausea?

A

Metoclopramide

294
Q

What anti-emetic is recommended in those with Parkinson’s disease?

A

Domperidone

295
Q

What anti-emetic is recommended in hypermedia gravidum?

A

Promethazine

296
Q

List an osmotic laxative

297
Q

List five stimulant laxatives

A

Bisacodyl

Docusate

Glycerol

Senna

Sodium Picosulfate

298
Q

List two bulk-forming laxatives

A

Ispaghula Husk

Methylcellulose

299
Q

In paracetamol overdoses, when should activated charcoal be administered?

A

In those who present within 1 hour of the overdose

300
Q

In paracetamol overdoses, what are the four criteria which indicate acetylcysteine administration?

A

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
Q

What is the first line management option of iron overdoses? What dose, route and rate?

A

IV Desferrioxamine Mesilate 15mg/kg/hr

302
Q

What is the first line management option of tricyclic antidepressant overdoses? What dose, route and rate?

A

IV Sodium Bicarbonate 50mmol

303
Q

What dose of adrenaline should be administered during acute anaphylactic reactions in adults?

A

Adrenaline 500mcg IM (0.5mL of 1:1000)

304
Q

How many EpiPens should patients be supplied?

305
Q

What dose, route and frequency of adrenaline should be administered during cardiac arrest?

A

Adrenaline 1mg IV/IM (10ml of 1:10000)

306
Q

What haemoglobin level indicates blood transfusion management?

307
Q

What are the eight types of penicillin?

A

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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