Prescribing

Question 1

How could you tell how fluid depleted a patient is?

Answer 1

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

Question 2

How much fluid is required by an adult roughly?

Answer 2

3L a day (2L in elderly)

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

Question 3

What is the anti-emetic of choice?

Answer 3

Cyclizine (SE fluid retention)

Metoclopramide if HF

Question 4

When should you avoid using metoclopramide?

Answer 4

Parkinson’s
Young women (risks dyskinesia)

Question 5

What is the daily maximum dose of paracetamol?

Answer 5

4g

Question 6

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

Answer 6

ACEi - hyperkalaemia
Thiazide - hypokalaemia

Question 7

What specific analgesia should be avoided in asthmatics?

Why?

Answer 7

Ibuprofen

Risks bronchoconstriction

Question 8

Why are BBs contraindicated in asthmatics?

Answer 8

Risks bronchospasm

Question 9

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

Answer 9

Risks stroke

Question 10

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

Answer 10

2 months

Question 11

How is insulin usually given?

Answer 11

SC

sliding scales using short acting insulin are IV

Question 12

Name 4 key causes of hyponatraemia

Answer 12

4 Ds

Dehydration
Drips
Drugs
Diabetes Insipidus

Question 13

Broadly, which drugs might cause hyponatraemia?

Answer 13

Effervescent tablets or IV preps with high sodium content

Question 14

What is the main cause o f neutrophilia?

Answer 14

Bacterial infection

Question 15

Name 3 main causes of neutropenia

Answer 15

Viral infection
Clozapine (antipsychotic)
Carbimazole (antithyroid)

Question 16

Which RA drug might cause thrombocytopenia?

Answer 16

Penicillamine

Question 17

Name 2 main causes of hypovolaemic hyponatraemia

Answer 17

Fluid loss
Diuretics

Question 18

Name 3 causes of euvolaemic hyponatraemia

Answer 18

SIADH
Psychogenic polydipsia
Hypothyroidism

Question 19

Name 2 main causes of hypervolaemic hypontraemia

Answer 19

HF
Renal failure

Question 20

What 2 endocrine conditions are associated with hypokalaemia?

Answer 20

Cushing’s and Conn’s syndrome

Question 21

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

Answer 21

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

Question 22

What is Gentamicin normally used for?

Answer 22

Severe infections

Question 23

What is a normal INR?

Answer 23

1.1

On warfarin - 2.5

Recurrent VTE on warfarin or metal replacement valves - 3.5

Question 24

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

Answer 24

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

Question 25

How would you manage over anticoagulation based on INR?

Answer 25

<6 - reduce warfarin
6-8 - omit warfarin for 2 days then reduce