Prescribing Flashcards
What to search in the BNF if:
a) you know what the treatment for the condition is?
b) you don’t know what the treatment for the condition is?
a) search under medication on the BNF
b) search under treatment summaries on the BNF
Effect of calcineurin inhibitors (e.g. tacrolimus) on K+?
Can cause hyperkalaemia due to reduced renal excretion.
How long prior to elective surgery should warfarin be stopped?
5 days
In patients taking warfarin, what should be given the day before elective surgery if the INR is ≥1.5?
Vitamin K (phytomenadione)
Mx of thyrotoxicosis due to amiodarone?
Withhold amiodarone at least temporarily to achieve control.
Mx of hypothyroidism due to amiodarone?
Levothyroxine therapy (can continue amiodarone)
Role of antivirals in shingles in people >50?
Reduces risk of post-herpetic neuralgia
Can naproxen cause ankle oedema?
Yes
Length of clotrimazole in pregnant women with vaginal candidiasis?
7 days
When should loperamide be taken?
After every loose stool
What monitoring is required during ciclosporin therapy?
Renal function
Mx of hyperthyroidism in patients taking amiodarone?
Withold amiodarone
Give 3 drugs which increase the risk of fractures
1) PPIs
2) Steroids
3) GnRH agonists e.g. buserelin, goserelin
Give some drugs that increase the risk of falls
- benzos
- antidepressants (TCAs and SNRIs)
- MOAIs
- most antipsychotics
- opiates
- most antihypertensives e.g. diuretics, beta blockers
What are 2 diabetic drugs that increase the risk of pancreatitis?
- GLP-1 mimetics (e.g. exenatide)
- DPP-4 inhibitors e.g. sitagliptin
What diabetic medication can cause euglycaemic ketoacidosis?
SGLT-2 inhibitors e.g. canagliflozin
Side effects of pioglitazone?
- oedema
- HF
- post-menopausal osteoporosis
- bladder cancer
Apixaban in pregnancy?
Contraindicated
Thiazides in pregnancy?
Contraindicated
How can thiazides affect glucose?
Can cause hyperglycaemia
Medical mx of orthostatic hypotension?
Trial of fludrocortisone 100mcg PO daily
Important safety information about amitriptyline and alcohol?
Alcohol enhances the effects of amitriptyline –> avoid driving/operating heavy machinery
When should ketones be checked in T1D?
When BMs >15
Why should T1 diabetics seek medical help if they are unable to drink fluids due to N&V?
Due to risk of DKA –> need IV access
Why is IV vancomycin not effective in C. diff?
Doesn’t reach the bowel
Why should calcium carbonate (and calcium containing foods) not be taken at the same time as iron?
Calcium decreases the absorption of iron
How can SGLT-2 inhibitors result in postural hypotension?
Due to hypovolaemia as a side effect
Who is at higher risk of tendon injury with quinolones (e.g. ciprofloxacin)?
- Age ≥60
- Pts on corticosteroids
- Renal impairment
What class of laxative is lactulose?
Osmotic
Impact of taking lithium and thiazides together?
Thiazides can cauyse lithium toxicity
What needs to be monitored in patients taking mineralocorticoid therapy?
U&Es
What should be measured just before treatment with UH or LMWH?
Platelets
Regular monitoring may be required if treatment >4 days
Key side effect of lactulose?
Bloating (avoid in IBS)
What are the 4 most common antibiotics that cause C. diff?
- Clindamycin
- Co-amoxiclav
- Cephalosporins e.g. cefalexin, ceftriaxone
- Ciprofloxacin
What 2 medications can be used in the mx of NMS?
- dantrolene
- bromocriptine
At what eGFR should you stop metformin?
<30
Lansoprazole vs omeprazole in pregnancy?
Omeprazole > lansoprazole
Lansoprazole is contraindicated
What do you need to prescribe in DKA once the blood glucose drops below 14?
Glucose 10% IV at a rate of 125mls/hour
e.g. 1000mls over 8 hours
What fluid should be used to treat mild hypernatraemia?
IV glucose 5% e.g. 1000ml over 6h
(if oral route not appropriate)
What rate should you aim to reduce sodium by in hypernatraemia?
No quicker than 10 mmol/day
Reduces risk of cerebral oedema
Give 3 medications that increase the risk of an acute episode of gout?
- Thiazide diuretics
- Loop diuretics
- Aspirin
How does aspirin increase the risk of gout?
Reduces the urinary excretion of uric acid
Why are beta blockers contraindicated in PAD?
They cause peripheral vasoconstriction and worsen ischaemia
Why can furosemide precipitate digoxin toxicity?
As furosemide can lead to hypokalaemia
Interaction between methotrexate and warfarin?
Trimethoprim increases the effects of warfarin –> risk of bleeding
Interaction between baclofen and glycopyrronium bromide when taken together?
Can enhance antimuscarinic effects
Recommended treatment for whooping cough (pertussis)?
Macrolides e.g. clarithromycin
What is 2nd line for lower UTI in pregnancy?
Cefalexin and amoxicillin
What medication can be used for prophylaxis of tension headaches?
Amitriptyline
Mx of Lyme disease?
Doxycycline
When is metronidazole gel best administered for BV?
At night (prevent leakage)
What time gap is recommended between taking levothyroxine & oral iron?
4 hours
Levothyroxine absorption is reduced by oral iron
What can be a useful marker to assess clinical response to abx therapy?
CRP
