prescribing

Question 1

fluid maintenance kids

Answer 1

100ml/kg/day for first 10kg
50ml/kg for second 10kg
20ml/kg for rest

Question 2

fluids: emergency resus?

Answer 2

NACL 0.9% 500ml over 10 mins

Question 3

fluids: emergency hypoglycemia

Answer 3

glucose 20% 100mls in 15 mins

Question 4

fluids: emergency hypokalaemia

Answer 4

NACL 0.9%/KCL 0.3% 1000ml in 4 hours

Question 5

which diabetes meds inhibit renal glucose reabsorption

Answer 5

SGLT2 inhibitors
-> gliflozins

Question 6

which diabetic drug class can cause bladder cancer and heart failure

Answer 6

thiazolidinediones

Question 7

which diabetic drug most commonly causes diarrhoea

Answer 7

biguanide (metformin)

Question 8

2nd line tx for a T2DM when metformin isnt working optimally if heart condition?

Answer 8

SGLT2

Question 9

drug choice for VTE prophylaxis in renal impairment

Answer 9

unfractionated heparin

if no renal impairment then use LMWH -> dalteparin or enoxaparin

Question 10

types of LMWH

Answer 10

dalteparin (fragmin), enoxaparin (clexane) and tinzaparin

Question 11

drug choice for treatment of VTE

Answer 11

apixaban or rivaroxaban

Question 12

monitoring of LMWH

Answer 12

anti-factor Xa

Question 13

monitoring for UFH

Answer 13

APTT

Question 14

monitoring for DOAC

Answer 14

clinically

Question 15

monitoring for warfarin

Answer 15

INR

Question 16

reversal for LMWH and UFH

Answer 16

protamine sulphate

Question 17

reversal for DOAC

Answer 17

andexanet alpha -> apix and rivarox

idarucizumab -> dabigitran

Question 18

reversal for warfarin

Answer 18

vit K
PCC

Question 19

signs and symptoms hypocalcaemia

Answer 19

CATs Go Numb
Convulsions
Arrythmias
Tetany
numbness

Trousseau’s and Chvostek’s sign

Question 20

why does blood transfusion cause hypocalciema

Answer 20

has citrate in it to preserve but this can chelate the calcium

Question 21

when to avoid nitrofurantoin in pregnancy?

Answer 21

when at term as causes neonatal haemolysis
-> use amoxicillin instead

Question 22

meningitis tx summary for GP

Answer 22

medical emergency in the community

Question 23

fluids to prescribe in hypercalcaemia

Answer 23

NACL 0.9% 1000ml 4 hrs

Question 24

maintenance fluids (no losses/replacement)

Answer 24

25-30ml/kg/day water
1mmol/kg/day electrolytes
50-100g glucose/day

aim 1000ml over 8-12 hours

Question 25

mainenance fluids with losses

Answer 25

minimum 30ml/kg/day water replace electrolytes aim 1000ml over 4-6 hours

Question 26

max rate of potassium infusion

Answer 26

10mmol/hr

Question 27

tx hyperkalaemia

Answer 27

calcium gluconate 10% 30ml over 10 mins

Question 28

when to give cyclical/sequential HRT

Answer 28

when still having periodswh

Question 29

when to give continuous HRT

Answer 29

when no periods for >12 months

Question 30

name of combined HRT in BNF

Answer 30

elleste-duet estradiaol with noresthisterone

Question 31

what does trough level mean in gentamicin dosing

Answer 31

the dose level after >14 hours after it was taken if <1 then it is safe to give another dose the chart is only used from 6-14hours which is when the gentamicin should be at its peak level

Question 32

metformin dose for surgery

Answer 32

if BD continue if TDS omit lunch dose

Question 33

sulfonylurea dose with surgery

Answer 33

omit on day

Question 34

SGLT2 inhibitor dose with surgery

Answer 34

omit the day before and day of surgery

Question 35

insulin dosing and surgery

Answer 35

reduce long acting insulin by 20% omit all other types

Question 36

acute tx of migraine no aura

Answer 36

aspirin or ibuprofen

Question 37

acute tx of migraine with aura

Answer 37

sumatriptan

Question 38

prevention migraine

Answer 38

propanolol

Question 39

drugs likely to cause oral thrush

Answer 39

ABX steroids immunosuppressants tx with nystatin drops

Question 40

which class of diabetic medication can cause euglycemic DKA

Answer 40

SGLT2 inhibitors -> flozins also assoc with fournier's gangrene

Question 41

3 drugs that can cause galactorrhoea

Answer 41

citalopram olanzapine metoclopramide

Question 42

important counselling points for isotretinoin

Answer 42

teratogenic -> 1 user independent form (coil) or 2 complementary user dependent forms (condom + pill) monitor LFT and lipids warn about neuropysch effects

Question 43

important counselling points for warfarin or DOAC

Answer 43

unexpected bleeiding ust be investigated lower threshold for IX following head injury vomitting blood, hit head, unable to stop bleeding = AE avoid binge drinking women shouldnt get pregnant

Question 44

side effect of tamsulosin

Answer 44

floppy iris syndrome - withhold around time of cataract surgery

Question 45

monitoring for steroids long term in kids

Answer 45

growth monitoring annually

Question 46

rise in creatinine when starting ACEi?

Answer 46

normal to get small rise <20% repeat U+E in 1 week

Question 47

most serious effects of ciclosporin

Answer 47

nephrotoxicity and HYT need to have baseline renal function and measure 2 weekly until stable BP and serum ciclosporin also regularly measured

Question 48

elevated glucose levels at lunch?

Answer 48

change insulin breakfast dose

Question 49

reduction in non-HDL needed to remain on same statin dose?

Answer 49

>40% reduction in non-HDL