Prescribing

Question 1

Give the drug management for chronic heart failure

Answer 1

1st line: ACE inhibitor and b-blocker (not foe preserved ejection fraction)
2nd line: aldosterone antagonist e.g spironolactone

Question 2

What is the first line drug that is used for management when PE is suspected?

Answer 2

DOAC!

Question 3

What drugs should be used for rate and rhythm control for atrial fibrillation

Answer 3

b blocker or VERAPAMIL.
If one drug doesnt work use both.
An/or with digoxin

Question 4

How should you manage a patient presenting with acute AF with haemodynamic instability?

Answer 4

Haemodynamic instability classes as: hypotension, HF, etc

They should be ELECTRICALLY CARDIOVERTED!

Question 5

How should patients presenting with acute AF be managed if they are haemodynamically stable

Answer 5

<48hrs = rate or rhythm control
(b-blockers, ca channel blockers, digoxin = rate)
(b-blocker, amiodaraone = rhythm)

> 48 hrs - rate control

Question 6

Which insulin and how much would you give for hyperkalaemia

Answer 6

10 units ACTRAPID in 100ml of 20% dextrose over 30 min IV

Question 7

In a patient on metformin with T2DM when should a second drug be added?

Answer 7

HbA1c of 58mmol/mmol

Question 8

Give the first-line management of T2DM

Answer 8

1. Metformin. If high risk CVD, first ESTABLISH metformin, then ADD SGLT-2 inhibitor
2. if metformin is not well tolerated give modified-release metformin
3. if contraindicated (metabolic acidosis, renal function)
   CVD - SGLT-2 monotherapy
   no CVD risk - DPP-4 inhibitor (gliptin)

Question 9

Give the most important side-effect to know about carbimazole

Answer 9

AGRANULOCYTOSIS

Question 10

In a woman who has had a hysterectomy or mirena in situ what type of HRT should

Answer 10

Oestrogen only:
Estradiol!
Elleste or evorel patch

Question 11

How is digoxin excreted?

Answer 11

Renally, therefore patients with renal impairment are at greater risk of toxicity

Question 12

Sodium valporate is normally toxic to which organ?

Answer 12

The Liver!
Liver function should be measured at baseline and regaularly throughout the course of treatment

Question 13

In a patient with a uterus who is peri-menopausal/ in their first year or 2 after menopause which HRT should be used

Answer 13

cyclical combined
Ellest duet or evorel sequi

Question 14

Give a combined OCP

Answer 14

Microgyon

Question 15

Give progesterone only

Answer 15

cerezette

Question 16

In a patient who is post-menopausal with a uterus give the HRT options

Answer 16

Continual
Premique low dose, eborel conti patch