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Medicine > Prescribing > Flashcards

Prescribing Flashcards

1
Q

How could you tell how fluid depleted a patient is?

A

Reduced UO - 500mL
Reduced UO + ^HR - 1L
Reduced UO + ^HR + shocked - 2L

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2
Q

How much fluid is required by an adult roughly?

A

3L a day (2L in elderly)

1L saline or 2L dextrose for electrolytes (1 salty 2 sweet)

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3
Q

What is the anti-emetic of choice?

A

Cyclizine (SE fluid retention)

Metoclopramide if HF

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4
Q

When should you avoid using metoclopramide?

A

Parkinson’s
Young women (risks dyskinesia)

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5
Q

What is the daily maximum dose of paracetamol?

A

4g

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6
Q

How would an ACEi and a thiazide diuretic affect serum potassium levels?

A

ACEi - hyperkalaemia
Thiazide - hypokalaemia

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7
Q

What specific analgesia should be avoided in asthmatics?

Why?

A

Ibuprofen

Risks bronchoconstriction

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8
Q

Why are BBs contraindicated in asthmatics?

A

Risks bronchospasm

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9
Q

Why shouldn’t patients with migraine with aura take COCP?

A

Risks stroke

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10
Q

For how long after an acute stroke is prophylactic enoxaparin contraindicated?

why?

A

2 months

Risk of haemorrhagic change (ischaemic areas with damaged blood vessels)

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11
Q

How is insulin usually given?

A

SC

sliding scales using short acting insulin are IV

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12
Q

Name 4 key causes of hyponatraemia

A

4 Ds

Dehydration
Drips
Drugs
Diabetes Insipidus

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13
Q

Broadly, which drugs might cause hyponatraemia?

A

Effervescent tablets or IV preps with high sodium content

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14
Q

What is the main cause of neutrophilia?

A

Bacterial infection

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15
Q

Name 3 main causes of neutropenia

A

Viral infection
Clozapine (antipsychotic)
Carbimazole (antithyroid)

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16
Q

Which RA drug might cause thrombocytopenia?

A

Penicillamine

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17
Q

Name 2 main causes of hypovolaemic hyponatraemia

A

Fluid loss
Diuretics

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18
Q

Name 3 causes of euvolaemic hyponatraemia

A

SIADH
Psychogenic polydipsia
Hypothyroidism

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19
Q

Name 2 main causes of hypervolaemic hypontraemia

A

HF
Renal failure

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20
Q

What 2 endocrine conditions are associated with hypokalaemia?

A

Cushing’s and Conn’s syndrome

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21
Q

How would you react to TFT’s with respect to levothyroxine doses?

A

<0.5 - decrease dose
0.5-5 - nothing
>5 - increase dose

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22
Q

What is Gentamicin normally used for?

A

Severe infections

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23
Q

What is a normal INR?

A

1.1

On warfarin - 2.5

Recurrent VTE on warfarin or metal replacement valves - 3.5

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24
Q

If there is a major bleed in a patient on warfarin, what should you do?

A

Stop warfarin
Give 5-10mg IV vit K
Give prothrombin complex

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25
Q

How would you manage over anticoagulation based on INR?

A

<6 - reduce warfarin
6-8 - omit warfarin for 2 days then reduce (you can stop it because it has such a long half life)

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26
Q

How may carbamazepine affect sodium levels?

A

May cause hyponatraemia

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27
Q

How should an Addison’s patient’s steroid regimen be altered during infection?

A

Increase steroid intake to provide adequate cortisol for stress response (‘sick day rules’)

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28
Q

What aspirin dose is offered to STEMI / NSTEMI patients?

A

300mg PO

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29
Q

What analgesia is offered to patients with STEMI / NSTEMI?

A

Morphine 5-10mg IV with metoclopramide 10mg IV

GTN spray/tablet

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30
Q

What anticoagulant therapy is offered to those with an NSTEMI?

A

Clopidogrel 300mg oral + LMWH

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31
Q

What BB is offered to those with a STEMI / NSTEMI?

A

atenolol 5mg

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32
Q

What is the 1st line Abx in skin infections?

A

flucloxacillin (staph!)

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33
Q

What precautions should be taken with ramipril in pregnancy?

A

Teratogenic in 1st trimester, convert to labetalol before conception

34
Q

What blood test is required with methotrexate?

A

Regular monitoring of WBCs given risk of neutropenia

35
Q

How should a patient eat around alendronic acid?

Why?

A

Food should be avoided 2 hours after taking alendronic acid as it reduces its absorption

36
Q

How often is alendronic acid taken?

A

once weekly

37
Q

How many grams of solute are in a 100mL 1% solution preparation

A

1g

38
Q

How many mg of solute are in a 1mL 1% solution preparation

A

10mg

39
Q

How many mg in a g?

A

1000

40
Q

How many mL in a L?

A

100

41
Q

What skin condition may propranolol exacerbate?

A

Psoriasis

42
Q

Why don’t you give propranolol to diabetics?

A

Mildly induces diabetes

Also, if their control isn’t good, you risk hypos. These symptoms may be dampened and they may not even know they’re having a hypo. This is very risky

43
Q

What might a reaction between co-amoxiclav and allopurinol present as?

A

Widespread rash

44
Q

What sort of diuretic is spironolactone?

What is its’ main use case?

A

Potassium-sparing

Ascites

45
Q

In hyperkalaemia, how would you reduce serum potassium?

A

10 units of Actrapid in 100mL of 20% Dextrose over 30 min IV

46
Q

What is required for baseline monitoring of vancomycin?

A

Serum creatinine

47
Q

What are the 2 classic side effects of vancomycin and gentamicin?

A

Nephrotoxicity
Ototoxicity

48
Q

How are statins monitored?

A

3 months - serum ALT and lipid profile

12 months - serum ALT

49
Q

What is the reference range for Lithium?

When are toxic effects likely to manifest?

A

0.4-0.8 mmol/L
toxic if > 1.5mmol/L

50
Q

How should FBC be monitored in Methotrexate therapy?

A

Monitoring of FBC at regular intervals is imperative, but once therapy has been stabilised, FBC can be monitored every 2-3 months

51
Q

What should be tested at baseline and regular intervals in those on olanzapine?

A

Fasting blood glucose

52
Q

What is the most important parameter to check when starting someone on the oral contraceptive pill?

A

BP

53
Q

Name 3 things which should be checked before commencing amiodarone therapy

A

CXR
LFT
K+

54
Q

What should be checked in a patient presenting with a sore throat who is on carbimazole?

A

Neutrophil count

55
Q

What 2 things should you check before commencing sodium valproate therapy?

A

LFTs
FBCs (no potential for bleed before starting and pre-op)

56
Q

What should be monitored regularly in patients taking clozapine?

A

FBC - risk of neutropenia

57
Q

What 3 categories of drugs are likely to interact

A

Narrow therapeutic window

Require careful titration of dose according to effect

Associated with cytochrome P450

58
Q

Name a side effect seen in broad spectrum Abx use

Name 2 examples of these antibiotics

A

C diff

Cephalosporins
Ciprofloxacin

59
Q

What respiratory SE is found with ACEi and BBs?

A

ACEi - dry cough
BB - wheeze in asthmatics

60
Q

Name 2 SE associated with heparins

A

Bleeding (if renal failure or <50kg)

HIT

61
Q

Why and how should heparin be prescribed alongside warfarin?

A

Ironically warfarin has a pro-coagulant effect initially as well as taking a few days to become an anti-coagulant; thus heparin should be prescribed alongside warfarin and continued until the INR exceeds 2

62
Q

Name 4 SE of aspirin

A

Bleed
Peptic ulcers / gastritis
Tinnitus (large doses)

63
Q

What ophthalmological SEs are associated with digoxin?

A

Blurred vision
Xanthopsia (disturbed yellow-green visual perception including ‘halo’ vision)

64
Q

Name early, intermediate, and late (5) SEs of lithium therapy

A

Early - tremor

Intermediate - tiredness

Late - arrhythmias, seizures, coma, renal failure, DI

65
Q

Name a SE of haloperidol

A

Dyskinesias

66
Q

Name the SE profile of dexamethasone and prednisolone

A

STEROIDS

Stomach ulcers
Thin skin
Edema
R and L heart failure
Osteoporosis
Infection
Diabetes
cushing’s Syndrome

67
Q

What SEs are associated with Ibuprofen?

A

NSAID

No urine (renal failure)
Systolic dysfunction (HF)
Asthma
Indigestion
Dyscrasia (clotting abnormality)

68
Q

Name 4 SEs of statins

A

Myalgia
Abdominal pain
Liver failure
Rhabdomyolysis

69
Q

Name 4 drugs with a narrow therapeutic window

A

Warfarin
Digoxin
Phenytoin
Theophylline

70
Q

Name 2 types of drugs which require careful dosage control

A

Anti-HTN
Anti-DM

71
Q

Name 6 drugs which are cytochrome P450 inducers

A

PC BRAS

Phenytoin
Carbamazepine
Barbiturates
Rifampicin
Alcohol (chronic)
Sulphonylureas

72
Q

Name 9 drugs which are cytochrome P450 inhibitors

what food is too?

A

AO DEVICES

Allopurinol
Omeprazole
Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol (acute intoxication)
Sulphonamides

Grapefruit juice

73
Q

When mixed with alcohol, drugs causing GI bleed include…

A

NSAIDs

74
Q

When mixed with alcohol, drugs causing lactic acidosis include…

A

Metformin

75
Q

When mixed with alcohol, drugs causing anticoagulation include…

A

Warfarin

76
Q

When mixed with alcohol, drugs causing HTN crisis include…

A

MAOIs

77
Q

When mixed with alcohol, drugs causing sweating, flushing, nausea, and vomiting include…

A

Metronidazole
Disulfiram

78
Q

When mixed with alcohol, drugs causing sedation include…

A

Barbiturates
Opioids
Benzodiazepines

79
Q

Why should methotrexate and trimethoprim not be co-prescribed?

A

Risk of neutropenia as both folate antagonists

80
Q

What kind of diuretic is amiloride with respect to electrolyte imbalance?

A

Potassium-sparing

Medicine (22 decks)

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