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Prescribing (P4) > Prescribing > Flashcards

Prescribing Flashcards

1
Q

What drugs commonly induce Cytochrome P450 [PC BRAS]?

A 
Phenytoin
Carbamazepine
Barbiturates
Rifampicin
Alcohol (chronic use)
Sulphonylurea

[NB: acute alcohol inhibits CP450]

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2
Q

What are ‘sick day rules’ with regards to steroids?

A

When patients are ill they need to double their dose of steroids.

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3
Q

What drugs should be stopped before surgery?

[I LACK OP]

A 
Insulin
Lithium
Anticoagulants/Antiplatelets
COCP/HRT
K-sparing diuretics
Oral hypoglycaemics
Perindopril (+ other ACEi)
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4
Q

What is the risk of using erythromycin in a patient taking warfarin?

A

Erythromycin is an enzyme inhibitor and can cause a dangerous rise in INR

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5
Q

Do ACEi cause hypo or hyperkalaemia?

A

Hyperkalaemia

If a patient is already hyperkalaemic, ACEi should be stopped.

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6
Q

If a patient is allergic to penicillin, is co-amoxiclav safe?

A

No

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7
Q

What is the maximum dose of paracetamol?

A

4g/day

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8
Q

True or false, in a patient with haemoptysis you must not give aspirin, heparin or warfarin?

A

True. Any active bleeding is a contraindication for these drugs.

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9
Q

True or false, heparin is contraindicated in acute ischaemic stroke?

A

True, due to the risk of bleeding into the stroke.

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10
Q

Give two side effects of steroids

A

[STEROIDS]

Stomach ulcers
Thin skin
Edema
Right + Left Heart Failure
Osteoporosis
Infection 
Diabetes 
Syndromes (Cushings)
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11
Q

Give two contraindications for NSAIDs

A

[NSAID]

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

[NB: Aspirin is an exception as is permitted in asthma, HF and renal failure].

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12
Q

Give two side effects of antihypertensives

A

Hypotension
Bradycardia
Electrolyte disturbance

Dry cough (ACEi)
Peripheral oedema (CCB)
Renal failure (Diuretics)
Wheeze in asthma (BB)
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13
Q

How many pieces of identifying information must be included in a prescription or clerking for a new patient?

A

3

  • DOB
  • Name
  • Hospital number
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14
Q

True or false, co-amoxiclav and Tazocin contain penicillin?

A

True

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15
Q

How might you administer antiemetics if a patient is vomiting?

A

Non-oral route

IM / IV / SC

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16
Q

True of false, a patient that is NBM can still receive their oral medication

A

True

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17
Q

What is the maximum administration rate of IV potassium?

A

No more than 10mmol/hr

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18
Q

Under what two general scenarious are fluids given?

A

Replacement

Maintenance

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19
Q

What three things should you check prior to giving any fluids?

A

U&E (electrolyte levels)

Not fluid overloaded (JVP/oedema)

Not in urinary retention

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20
Q

Give a contraindication for compression stockings

A

Peripheral arterial disease (indicated by absent foot pulses). This may cause acute limb ischaemia.

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21
Q

If a patient is hypernatraemic or hypoglycaemic, what fluid replacement can you give?

A

5% Dextrose

[Don’t give 0.9% saline!]

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22
Q

What fluid replacement should you give a patient with ascites?

A

Human Albumin Solution [HAS] - maintains oncotic pressure.

[Don’t give saline 0.9%]

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23
Q

If a patient is shocked with BP <90, what fluid replacement should you give?

A

Gelofusine (colloid)

Higher osmotic content so stays intravascularly for longer.

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24
Q

If a patient is shocked from bleeding, what fluids do you give?

A

Ideally blood transfusion or a colloid if not available.

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25
Q

If a patient is hypotensive or tachycardic, how much fluid should you give?

A

Start with 500ml bolus (250ml if HF) and reassess.

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26
Q

What two things are most in-patients given to prevent clotting?

A

LMWH e.g. dalteparin

Compression stockings

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27
Q

True or false, metoclopramide is to be avoided with Parkinson’s patients?

A

True. It is a dopamine antagonist and may exacerbate symptoms.

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28
Q

Roughly how much fluid does an adult require per day?

A

Adults = 3L/day

Elderly = 2L/day

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29
Q

How much potassium does an adult require a day?

A

40 mmol

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30
Q

How is potassium administered?

A

5% dextrose or 0.9% saline + KCL can be given.

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31
Q

What analgesia would you give for Mild, Moderate and Severe pain?

A

Mild: Paracetamol/NSAID

Moderate: Codeine/Tramadol + Paracetamol

Severe: Morphine Sulphate + Co-codamol

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32
Q

Give a contraindication for Ibuprofen

A

Allergy to aspirin/NSAIDs
Active bleed
Asthma
Renal failure

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33
Q

Do Thiazide diuretics cause hypo or hyperkalaemia? Explain how.

A

Hypokalaemia

They increase potassium excretion as raised sodium concentration in the DCT activates aldosterone resorption of Na and excretion of K.

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34
Q

Which antiemetics should you not give in a patient with bowel obstruction?

A

Pro-kinetics

  • Metoclopramide
  • Domperidone

[Block D2 receptors]

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35
Q

What is the mechanism behind ACEi causing a dry cough in some patients?

A

Causes increase in bradykinins

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36
Q

Why do ACEi cause hyperkalaemia?

A

They reduce aldosterone production which thus reduces potassium excretion in the kidneys.

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37
Q

What kind of diuretics can cause hypokalaemia?

A

Thiazides

They increase Na concentration in DCT which triggers aldosterone receptors to reabsorb Na and excrete K

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38
Q

How does ibuprofen increase the risk of gastric inflammation and ulceration?

A

Ibuprofen inhibits prostaglandins making the Gastric mucosa more vulnerable.

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39
Q

Why do oral steroids increase the risk of GI ulceration?

A

Steroids inhibit gastric epithelial renewal, thus weakening the gastric mucosa.

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40
Q

How does ibuprofen affect the kidneys?

A

Inhibits prostaglandins

This causes renal artery stenosis

This reduces kidney perfusion

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41
Q

What kind of diuretic should be stopped in a patient with hypokalaemia?

A

Thiazides e.g. bendroflumethiazide

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42
Q

A patient with asthma requires mild analgesia. Which analgesic would you not give?

A

Ibuprofen

[Contraindicated in asthma as it can cause broncho constriction].

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43
Q

True or false, trimethoprim is safe to give patients taking methotrexate?

A

False.

Trimethoprim is a folate antagonist as is methotrexate. If you give both you risk bone marrow toxicity and neutropenic sepsis.

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44
Q

True or false, methotrexate is safe to continue in patients with sepsis?

A

False.

Methotrexate is a folate antagonist and may induce bone marrow failure and neutropenia makingsepsis far worse!

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45
Q

True or false, loop diuretics can cause hypokalaemia?

A

True.

[The only diuretics that don’t are potassium sparing diuretics]

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46
Q

What type of drug is amlodipine? What is a common side effect?

A

Calcium Channel Blocker

Peripheral oedema. Stop CCB if patient gets this.

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47
Q

How long after a stroke is it safe to give a patient an anticoagulant?

A

Around 2 months

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48
Q

What is the target range for INR?

A

2-3

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49
Q

True or false, it is safe to give both a beta blocker and verapamil (CCB)?

A

False.

Together they may cause bradycardia/asystole.

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50
Q

What is the dose of aspirin recommended for acute treatment of MI and for prophylaxis?

A

300mg (acute MI)

75mg/day (prophylaxis)

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51
Q

True or false, patients with migraine + aura should not be given COCP?

A

True

It can increase their risk of stroke.

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52
Q

What type of insulin is given IV?

A

Short-acting e.g. actrapid or novorapid.

Most insulin is given Subcut

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53
Q

True or false, beta blockers are contraindicated in asthmatics?

A

True

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54
Q

Why do you check WCC in a patient taking clozapine?

A

Clozapine [Antipsychotic] 2nd gen can cause agranulocytosis and neutropenia.

If this happens, stop the drug and refer to haematologust.

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55
Q

What is the normal range for potassium?

A

3.5 - 5.0 mmol/L

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56
Q

Give two causes of hyperkalaemia

A

[DREAD]

Drugs (K-sparing, ACEi)
Renal failure
Endocrine (Addisons)
Artefact (clotted sample)
DKA
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57
Q

Give two causes of hypokalaemia

A

[DIRE]

Drugs (loop/thiazides)

Inadequate intake/loss - diarrhoea/vomiting

Renal tubular acidosis

Endocrine (Cushings/Conn’s)

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58
Q

Give two causes of low neutrophils

A

Viral infection
Chemotherapy
Clozapine (antipsychotic)
Carbimazole (antithyroid)

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59
Q

Give two causes of high lymphocytes

A

Viral infection
Lymphoma
CLL

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60
Q

Give two causes of high neutrophils

A

Bacterial infection
Tissue damage
Steroids

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61
Q

Give two causes of microcytic, normocytic and macrocytic anaemia

A

Microcytic:

  • Iron deficiency
  • Thalassaemia
  • Sideroblastic

Normocytic:

  • Blood loss
  • Haemolytic
  • Renal failure

Macrocytic:

  • Alcohol
  • Vit B12/Folate deficiency
  • Liver disease
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62
Q

Give two causes of thrombocytopenia

A

[Low platelets]

Infection (viral)
Myeloma
Heparin
DIC
ITP
HUS
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63
Q

Give a cause of prerenal, renal and postrenal kidney injury

A

Prerenal:

  • Dehydration
  • Sepsis
  • Blood loss
  • Renal artery stenosis

Renal:

  • Drugs (NSAID, ACEi)
  • Radiology contrast
  • Inflammation
  • Rhabdomyolysis

Postrenal:

  • Kidney stones
  • Prostate cancer
  • BPH
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64
Q

True or false, most AKI is caused by a pre-renal issue?

A

True.

70% is prerenal
10% is renal
20% post-renal

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65
Q

Other than kidney injury, what else can cause a raised urea level?

A

Upper GI bleed.

The acid breaks down the blood producing urea.

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66
Q

What clotting factors are vitamin K dependent?

A

[1972]

10, 9, 7, 2

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67
Q

What clotting tests measure the vitamin K dependent clotting factors?

A

PT (Extrinsic = Warfarin)

INR

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68
Q

Give two causes of raised Alk phos

A

Post-hepatic obstruction

[+ALKPHOS]
Any fracture
Liver damage
Kancer
Pregnancy
Hyperparathyroidism
Osteomalacia
Surgery
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69
Q

At what TSH value would you decrease the levothyroxine dose or increase it?

A

TSH <0.5 = Decrease

TSH >5 = Increase

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70
Q

What is Gilbert’s syndrome?

A

A liver disorder where the liver does not process bilirubin. This results in high bilirubin levels and jaundice.

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71
Q

What would you expect with Bilirubin, AST/ALT, ALP levels with prehepatic, hepatic and posthepatic issues?

A

Prehepatic:
- Raised unconjugated bilirubin

Hepatic:

  • Raised conjugated + unconjugated bilirubin
  • Raised AST/ALT

Posthepatic:

  • Raised conjugated bilirubin
  • Raised ALP
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72
Q

What is the difference between primary and secondary hypothyroidism?

A

Primary:
Low T4 produced by thyroid.

Secondary:
Low TSH produced by pituitary causing low T4.

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73
Q

Name an antibiotic which is ototoxic

A

Gentamicin
Vancomycin

[They are also nephrotoxic. This is why serum levels are monitored]

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74
Q

What is the treatment for paracetamol overdose?

A

N-acetyl cysteine

[NAC]

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75
Q

What antioxidant in the liver is required for the breakdown of paracetamol?

A

Glutathione

This becomes depleted in an OD resulting in a toxic accumulation of metabolites.

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76
Q

At what level of INR would you reverse Warfarin using Vitamin K?

A

> 8 (no symptoms)

> 5 (if bleeding)

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77
Q

True or false, trimethoprim is contraindicated in pregnancy?

A

True. It is a folate antagonist. It can cause neural tube defects in pregnancy.

[Co-amoxiclav would be a safe alternative]

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78
Q

A patient with addisons is sick with the flu, what drug should be doubled in dose?

A

Steroids

[Sick day rules]

79
Q

Digoxin is not advised for patients with bradycardia, true or false?

A

True. It will slow the heart even more!

80
Q

Which diuretic is the main treatment for heart failure?

A

Furosemide (loop)

[Loop for lungs!]

81
Q

What is a suitable treatment for AF in a patient with asthma?

A

Digoxin or Diltiazem (CCB)

[Beta blockers are contraindicated in asthma]

82
Q

What is a suitable treatment for AF in a patient with peripheral oedema?

A

Digoxin or Beta blocker

[Amlodipine (CCB) may make the oedema worse].

83
Q

What is the first line treatment for neuropathic pain?

A

Tricyclic Antidepressant e.g. amitriptyline

84
Q

What is the acute management of STEMI?

A

ABCDE

15L O2 Non rebreather mask (unless COPD)

Apsirin 300mg

IV Morphine 10mg with Metoclopramide

GTN

PCI

Beta Blocker

85
Q

What drug do you give in addition to defibrilation?

A

Amiodarone 300mg IV

86
Q

What do you treat Narrow QRS tachycardia and Broad QRS tachycardia with?

A

Narrow = Adenosine (if regular). Amiodarone if irregular.

Broad = Amiodarone + beta blocker.

87
Q

What is the management of acute anaphylaxis?

A

ABCDE

15L non rebreather

Remove cause

Adrenaline 500 micrograms
(of 1:1000)

Chlorphenamine 10mg IV

Hydrocortisone
200mg IV

Asthma tx if wheeze

88
Q

What is the management of acute asthma attack?

A

ABCDE

100% O2 non rebreather mask

Salbutamol 5mg nebuliser

Hydrocortisone IV or prednisolone oral

Ipratropium

Theophyline (only if life threatening)

89
Q

What % level of O2 is a safe starting point in patients with COPD?

A

28%

90
Q

Give an indication for a chest drain in a secondary pneumothorax

A

> 2cm

Patient SOB

Patient >50 yo

[If not then aspirate]

91
Q

How do you distinguish between a tension pneumothorax and a typical pneumothorax?

A

Tracheal deviation or cardiac sequalae e.g. hypotensive due to decreased cardiac output suggest tension PT.

{pressure in pleura becomes +ve pushing on other structures. Therefore the trachea deviates away from the PT. This occurs as pleura acts like a one way valve growing in pressure but not releasing it]

In a standard PT the pleural pressure simply equals atmospheric and the lung collapses but it is not +ve pressure!

92
Q

What is the scoring system used to determine whether a patient with pneumonia needs to be treated in hospital?

A

[CURB65]

Confusion
Urea >7.5 mmol/L
Resp Rate >30/min
BP <90 (systolic)
65+ years old

2 or more = hospital tx with oral or IV abx.

3+ consider ITU

93
Q

What is the acute management for PE?

A

ABCDE

High flow O2

Morphine + Metoclopramide

LMWH e.g. tinzaparin (SC)

If low BP IV gelofusine + thrombolysis.

94
Q

What is the acute management of a GI bleed?

A

ABCDE + [8 Cs]

Cannulae (large bore) + Catheter (fluid monitoring)

Crystalloid/Colloid

Cross-match 6 units

Correct clotting abnormalities

Camera (Endoscopy)

Culprit drugs stop e.g. NSAIDs, Warfarin etc

Call surgeons if severe

95
Q

What is the drug treatment for suspected bacterial meningitis in the GP setting?

A

1.2g Benzylpenicillin

96
Q

What is the management of acute meningitis in the hospital setting?

A

ABCDE

High flow O2

IV fluids

Dexamethasone IV

LP (+/- CT head)

2g Cefotaxime IV

Consider ITU

97
Q

What is the acute management of seizures/status epilepticus?

A

ABCDE

Recovery position with O2

Lorazepam IV or diazepam IV or midazolam buccal

If still fitting after 2 mins repeat

Inform anaesthetics

Phenytoin infusion

Intubate + propofol

98
Q

What is the acute management of ischaemic stroke?

A

ABCDE

CT head to exclude haemorrhagic!

<4.5 hrs thrombolysis

Aspirin 300mg

Transfer to stroke unit

99
Q

How is DKA diagnosed?

A

Hyperglycemia (BM often >30mmol/L)

Keto (urine/blood levels)

Acidosis (low pH on ABG)

100
Q

What is the difference between DKA and HONK?

A

HONK is characterised by very high blood glucose (hyperosmolar!), renal impairment and absent ketones.

In DKA the ketones (blood/urine) are raised.

[Both are treated the same but HONK requires 50% the fluids].

101
Q

What is the treatment for DKA?

A

ABCDE

IV fluids: 1L over 1hr, then over 2, then 4 then 8.

Sliding scale insulin

Monitor BM, K and pH

102
Q

What is meant by sliding scale insulin?

A

Dose of insulin is varied depending on the carbohydrate intake at meals. This is used in the treatment of DKA.

103
Q

What are the diagnostic criteria for AKI?

A

1) Rise in serum creatinine >26 micromol/L above baseline over 48hrs.
2) Rise in serum creatinine >50% over baseline in L6 months.
3) Urine output <0.5 ml/kg/hr over 6 consecutive hours.

[Just 1 = +ve Dx]

104
Q

What is the management of AKI?

A

ABCDE

Cannula + catheter (fluid monitoring)

IV fluid 500ml stat, then 1L 4hrly

Search for cause

Monitor U&E and fluids

105
Q

What are the BP thresholds for treatment based on at home ambulatory measurements?

A

> 150/95

OR

> 135/85 + high risk CVD or organ damage.

[Ambulatory monitoring is preferred by NICE now due to white coat syndrome]

106
Q

What is the recommended treatment for chronic heart failure?

A

ACEi + Beta Blocker

Escalation
+ isosorbide mononitrate
+ spironolactone

107
Q

What is the first line antihypertensive for a black person or >55yo?

A

CCB

[Thiazide diuretic if not tolerated or they have oedema]

108
Q

What is the order of escalation for antihypertensive treatment for under 55 white patients?

A

ACEi/ARB

ACEi/ARB + CCB

ACEi/ARB + CCB + Thiazide diuretic

109
Q

What is the Chadsvasc for?

A

Risk of stroke in patients with AF

110
Q

Which criterion of Chadsvasc counts for 2 points?

A

Age >75

111
Q

According to chadsvasc which gender is more at risk of stroke?

A

Female (1 pt)

112
Q

What medication is given to patients with AF to prevent a stroke?

A

Aspirin 75mg daily

Warfarin (target INR 2.5)

113
Q

How is rate controlled in patients with AF?

A

Beta blocker or CCB
Amiodarone

[if Beta blockers and CCB contraindicated use Digoxin].

114
Q

Give an indication that a person’s chest pain is due to stable angina not ACS?

A

1) No sweating/vomiting
2) Resolves on rest within 15 minutes
3) Responds to GTN spray

115
Q

If troponin is raised what are your two ACS differentials?

A

STEMI or NSTEMI

[Do an ECG to differentiate]

116
Q

A patient with chest pain has an ECG which shows V1-4 ST depression, what two things could this be?

A

Anterior ischaemia

Posterior infarction

[Add V7-9 posteriorly to confirm]

117
Q

What is the long term tretment for stable angina (angina pectoris)?

A

GTN spray
Aspirin
Statin
Beta blocker / CCB

[For unstable angina consider PCI/CABG]

118
Q

What is the treatment ladder for asthma?

A

1) SABA
2) + Inhaled Steroid
3) + LABA
4) Leukotriene receptor antagonist / theophylline
5) + Daily steroid tablet [+ ref specialist care]

119
Q

How do you manage CV risk factors in patients with DM?

A

Aspirin 75mg/day
Statin
+/- ACEi (depends on renal function).

Annual review of albumin-creatinine ratio (ACR) (early indicator of diabetic nephropathy)

120
Q

Why is albumin-creatinine ratio (ACR) checked in patients with DM?

A

It is an indicator of diabetic nephropathy and CVD

121
Q

What is the first line treatment of Type 1 diabetes?

A

Insulin

122
Q

What is the treatment ladder for DM type 2?

A

1) Metformin
2) + Sulphonylurea (gliclazide)
3) + DPP-4 inhibitor (gliptin)
4) + Insulin

[c comes before p]
[DPP = gliPtin]

123
Q

In advanced Parkinson’s disease what is the 1st line treatment?

A

Co-beneldopa (or co-careldopa)

[Levodopa + peripheral Dopa decarboxylase inhibitor]

NB: In mild PD a dopamine agonist e.g Ropinirole or MAOi may be more appropriate as LDOPA has a finite period of benefit.

124
Q

At what point is someone diagnosed with epilepsy?

A

If they have 2+ seizures

125
Q

What is the 1st line treatment for generalised seizures?

A

Sodium Valproate or Lamotrigine

2nd: Carbamazepine

126
Q

What is the 1st line treatment for focal seizures?

A

Carbamazepine or Lamotrigine

2nd: Sodium Valproate

127
Q

True or false, sodium valproate should be avoided in pregnancy?

A

True. It is teratogenic

128
Q

What is a common side effect of lamotrigine and carbamazepine?

A

Rash

129
Q

Before starting a patient on Azathioprine, what should be checked?

A

Their Thioprine S-methyl Transferase (TPMT) enzyme levels.

10% of people are deficient in this resulting in a potentiated drug effect and possibly liver and marrow toxicity.

130
Q

How is rheumatoid arthritis treated acutely (flare ups) and chronically?

A

Acute:
IM methylprednisolone

Chronic:
Methotrexate + another DMARD e.g. sulfasalazine or hydroxychloroquine.

[If fail to respond then TNF alpha inhibitors e.g. infliximab]

131
Q

What is the 1st line treatment for Alzheimer’s disease?

A

Mild-Moderate = Acetylcholinesterase inhibitors:

  • Donepezil
  • Rivastigmine
  • Galantamine

Moderate-Severe = NMDA antagonist - Memantine

132
Q

When should you never give a patient a laxative?

A

If there is bowel obstruction!

133
Q

How are flare ups of crohn’s disease treated?

A

Mild: Prednisolone oral
Severe: Hydrocortisone IV

[Can be administered rectally also]

134
Q

For patients with insomnia, what drug would you prescribe as a first line?

A

Zopiclone orally

[Hypnotic]

135
Q

How do you treat non-infectious diarrhoea?

A

Loperamide or codeine (also helps with pain).

[NB: If cause of diarrhoea is infectious then you don’t want to prevent flushing out. Exclude with stool cultures]

136
Q

What are the 4 types of laxatives?

A

Softeners - Docusate
e.g. faecal impaction.

Osmotics - Lactulose

Bulking - Isphagula husk

Stimulants - Senna or Bisacodyl

[Stops Our Bottoms Sticking]

137
Q

What is a common side effect of Beta 2 agonist overuse?

A

Tremor

[Rather than increasing salbutamol inhaler, one can add beclomethasone inhaler]

138
Q

What is the 1st line antibiotic used to treat skin infections?

A

Flucloxacillin oral

[mild-moderate cases]

139
Q

What is the 1st line treatment for acute heart failure with pulmonary oedema?

A

Furosemide (loop diuretic)

[Loop for Lungs]

140
Q

True or false, bendroflumethiazide is the tretment of choice for heart failure?

A

False. It is a thiazide diuretic which are used for peripheral oedema.

Loop diuretics are used for HF/pulmonary oedema e.g. furosemide.

NB: remember thiazides can cause hypokalaemia.

141
Q

True or false, carbimazole can cause neutropenia?

A

True

142
Q

Which antihistamines are sedating?

A

Sedating:
Cyclizine
Promethazine

(Cycling makes you tired!)

Non-sedating:
Cetirizine
Fexofenadine
Loratidine

143
Q

What would you use to treat a patient with suspected vascular dementia?

A

Aspirin 75mg/day
Amlodipine

NB: If patient has sudden loss then it is not likely alzheimer’s and is more likely vascular

144
Q

What is the MMSE out of and how is it scored?

A

Max 30

24-30 = Normal
18-23 = Mild
0-17 = Severe

[Remember 24 and above is normal]

145
Q

What class of drug would you use to treat mild vs severe alzheimer’s?

A

Mild = Acetylcholinesterase inhibitors: Rivastigmine, Donepezil and Galantamine

Severe = NMDA antagonist: Memantine

146
Q

In an acute STEMI what is the best initial treatment for relieving pain?

A

GTN

[This is faster acting than morphine and may relieve the ischaemia].

147
Q

What is the 1st line treatment for PE?

A

LMWH e.g. Dalteparin

148
Q

True or false, ramipril should be avoided in pregnancy?

A

True. It is teratogenic.

[Beta blocker is the best option e.g. Labetalol]

149
Q

True or false, Tamoxifen increases the risk of VTE?

A

True.

150
Q

Which of gliclazides or gliptins carry the highest risk of hypoglycemia?

A

Sulphonylureas (Gliclazide)

Therefore, patients must not skip meals!

[Gliclazides increase insulin production. Metformin just increases sensitivity to existing insulin]

151
Q

When taking long-term methotrexate, how often should FBC be monitored?

A

Every 1-2 weeks to detect if there is any neutropenia.

[Methotrexate should only ever be taken once weekly]

152
Q

What is the maximum frequency of methotrexate?

A

Never more than once per week! It can cause neutropenia if taken more than this.

153
Q

How does alcohol affect warfarin?

A

Acute alcohol inhibits enzymes potentiating its effect.

Chronic alcohol use induces enzymes reducing warfarin’s effects.

154
Q

True or false, warfarin tablets are colour coded to indicate dose?

A

True.

White (0.5mg)
Brown (1mg)
Pink (5mg)

155
Q

What is the major adverse effect of warfarin?

A

Bleeding

156
Q

Why should you be worried if a patient on ACEi becomes unwell with diarrhoea and vomiting?

A

ACEi increase the risk of AKI and kidney injury.

Therefore, when sick the risk is even higher!

157
Q

What antihypertensive would you give in pregnancy e.g. pre-eclampsia?

A

Beta blocker e.g. labetalol

or Nifedipine (CCB)

[Thiazides, ACEi, ARB are not safe in pregnancy!]

158
Q

What is the first line antihypertensive in DM?

A

Still ACEi / ARB

159
Q

What is the 1st line choice of antihypertensive in CKD?

A

ACEi/ARB

160
Q

When would you use an ACEi over the age of 55 or in a black person?

A

Hx of HF

Hx of coronary heart disease

161
Q

When prescribing long term steroids (>3months), what also should you prescribe to protect their bone health?

A

Bisphosphonates

162
Q

Why are ACEi not routinely used as a first line in patients who are over 55 or black?

A

They are less sensitive to renin

163
Q

True or false, citalopram makes you more sensitive to sunlight?

A

True. Precautions must be taken when going out in the sun.

164
Q

A patient taking SSRIs has agitation, hallucinations and fluctuating temperatures. What does this suggest?

A

Serotonin syndrome

They need hospital treatment with cyproheptadine (periactin)

165
Q

When calculating doses, what does 1% solution mean?

A

1g in 100g

or

1g in 100ml

166
Q

Before administering vancomycin what must you check?

A

The patient’s renal function e.g serum creatinine levels.

Vancomycin clearance is reduced in patients with impaired renal function.

167
Q

What must you check before giving a patient statins?

A

Their liver function. Check their AST/ALT.

168
Q

True or false, methotrexate can be given to patients with abnormal liver function?

A

False.

169
Q

What is it important to check prior to administering antipsychotics?

A

Blood glucose

Hyperglycaemia and diabetes are known side-effects

170
Q

Before starting a patient on COCP what standard clinical test should you do?

A

Blood pressure

Need to assess CVD risk factors

171
Q

What imaging should be done prior to giving amiodarone?

A

Baseline CXR as amiodarone can cause pulmonary toxicity.

[Also need to check TSH/T4 levels, LFTs, FBC]

172
Q

What is the main side effect concern of carbimazole?

A

Neutropenia

[If patient reports sore throats it could be a sign if bone marrow suppression]

173
Q

Other than BP, what should be routinely monitored when a patient is taking ACEi?

A

U&E

ACEi can cause hyperkalaemia and electrolyte disturbance.

174
Q

What blood test should you check prior to giving digoxin?

A

Serum creatinine

It is renally excreted.

175
Q

True or false, sodium valproate is hepatotoxic?

A

True. You must check the patient’s liver function (ALT) first.

176
Q

True or false, FBC must be checked weekly for 18 weeks with clozapine?

A

True. Need to check for agranulocytosis / neutropenia.

177
Q

What % of NHS admissions are related to adverse drug reactions (ADRs)?

A

5%

178
Q

What is the difference between type A and type B drug reactions?

A

Type A are common and expected.

Type B are idiosyncratic and unpredictable.

179
Q

Give a known adverse drug reaction to gentamicin and vancomycin

A

Ototoxicity

Nephrotoxicity

180
Q

Which antibiotics typically cause C diff?

A

Any can. Typically broad spectrum e.g. cephalosporins or ciprofloxacin.

181
Q

Give two side effects of calcium channel blockers

A

Hypotension
Bradycardia
Peripheral oedema
Flushing

182
Q

True or false, warfarin has a pro-coagulant effect initially?

A

True. This is why bridging therapy is needed with heparin until INR exceeds 2

183
Q

True or false, aspirin in high doses can cause tinnitus?

A

True

184
Q

Give two side effects of amiodarone

A

Pulmonary fibrosis
Thyroid disease
Grey skin
Corneal deposits

185
Q

True of false, lithium can cause a tremor?

A

True

186
Q

What is the significance of a drug having a narrow therapeutic index?

A

It means that they are vulnerable to subtherapeutic or toxic effects if their bioavailability is even slightly altered e.g. warfarin, digoxin or phenytoin.

187
Q

What is the difference between pharmacodynamics and pharmacokinetics?

A

Pharmacodynamics = the body’s effect on drugs.

Pharmacokinetics = drugs movement through body

188
Q

True or false, beta blockers can cause cold extremities?

A

True

189
Q

True or false, amiloride can cause hyperkalaemia?

A

True. It is a potassium sparing diuretic

[NB: If a patient is taking ACEi and amiloride, be hypervigilant for hyperkalaemia]

190
Q

At what INR level do you treat with IV Vitamin K?

A

8+

[Can be given by mouth if there is no active bleeding]

191
Q

What is the first intervention for a patient in anaphylaxis

A

Secure the air way first!

[Head tilt-chin lift, nasopharyngeal adjunct or intubation. This is the priority before giving adrenaline].

192
Q

True or false, if a hypoglycaemic patient is conscious, you can treat them with 10-20 g glucose by mouth?

A

True

193
Q

How do gliclazides (sulphonylureas) work?

A

They stimulate the pancrease to produce more insulin

[Higher risk of hypos!]

Prescribing (P4) (1 decks)

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