Prescribing Flashcards
What drugs commonly induce Cytochrome P450 [PC BRAS]?
Phenytoin Carbamazepine Barbiturates Rifampicin Alcohol (chronic use) Sulphonylurea
[NB: acute alcohol inhibits CP450]
What are ‘sick day rules’ with regards to steroids?
When patients are ill they need to double their dose of steroids.
What drugs should be stopped before surgery?
[I LACK OP]
Insulin Lithium Anticoagulants/Antiplatelets COCP/HRT K-sparing diuretics Oral hypoglycaemics Perindopril (+ other ACEi)
What is the risk of using erythromycin in a patient taking warfarin?
Erythromycin is an enzyme inhibitor and can cause a dangerous rise in INR
Do ACEi cause hypo or hyperkalaemia?
Hyperkalaemia
If a patient is already hyperkalaemic, ACEi should be stopped.
If a patient is allergic to penicillin, is co-amoxiclav safe?
No
What is the maximum dose of paracetamol?
4g/day
True or false, in a patient with haemoptysis you must not give aspirin, heparin or warfarin?
True. Any active bleeding is a contraindication for these drugs.
True or false, heparin is contraindicated in acute ischaemic stroke?
True, due to the risk of bleeding into the stroke.
Give two side effects of steroids
[STEROIDS]
Stomach ulcers Thin skin Edema Right + Left Heart Failure Osteoporosis Infection Diabetes Syndromes (Cushings)
Give two contraindications for NSAIDs
[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].
Give two side effects of antihypertensives
Hypotension
Bradycardia
Electrolyte disturbance
Dry cough (ACEi) Peripheral oedema (CCB) Renal failure (Diuretics) Wheeze in asthma (BB)
How many pieces of identifying information must be included in a prescription or clerking for a new patient?
3
- DOB
- Name
- Hospital number
True or false, co-amoxiclav and Tazocin contain penicillin?
True
How might you administer antiemetics if a patient is vomiting?
Non-oral route
IM / IV / SC
True of false, a patient that is NBM can still receive their oral medication
True
What is the maximum administration rate of IV potassium?
No more than 10mmol/hr
Under what two general scenarious are fluids given?
Replacement
Maintenance
What three things should you check prior to giving any fluids?
U&E (electrolyte levels)
Not fluid overloaded (JVP/oedema)
Not in urinary retention
Give a contraindication for compression stockings
Peripheral arterial disease (indicated by absent foot pulses). This may cause acute limb ischaemia.
If a patient is hypernatraemic or hypoglycaemic, what fluid replacement can you give?
5% Dextrose
[Don’t give 0.9% saline!]
What fluid replacement should you give a patient with ascites?
Human Albumin Solution [HAS] - maintains oncotic pressure.
[Don’t give saline 0.9%]
If a patient is shocked with BP <90, what fluid replacement should you give?
Gelofusine (colloid)
Higher osmotic content so stays intravascularly for longer.
If a patient is shocked from bleeding, what fluids do you give?
Ideally blood transfusion or a colloid if not available.
If a patient is hypotensive or tachycardic, how much fluid should you give?
Start with 500ml bolus (250ml if HF) and reassess.
What two things are most in-patients given to prevent clotting?
LMWH e.g. dalteparin
Compression stockings
True or false, metoclopramide is to be avoided with Parkinson’s patients?
True. It is a dopamine antagonist and may exacerbate symptoms.
Roughly how much fluid does an adult require per day?
Adults = 3L/day
Elderly = 2L/day
How much potassium does an adult require a day?
40 mmol
How is potassium administered?
5% dextrose or 0.9% saline + KCL can be given.
What analgesia would you give for Mild, Moderate and Severe pain?
Mild: Paracetamol/NSAID
Moderate: Codeine/Tramadol + Paracetamol
Severe: Morphine Sulphate + Co-codamol
Give a contraindication for Ibuprofen
Allergy to aspirin/NSAIDs
Active bleed
Asthma
Renal failure
Do Thiazide diuretics cause hypo or hyperkalaemia? Explain how.
Hypokalaemia
They increase potassium excretion as raised sodium concentration in the DCT activates aldosterone resorption of Na and excretion of K.
Which antiemetics should you not give in a patient with bowel obstruction?
Pro-kinetics
- Metoclopramide
- Domperidone
[Block D2 receptors]
What is the mechanism behind ACEi causing a dry cough in some patients?
Causes increase in bradykinins
Why do ACEi cause hyperkalaemia?
They reduce aldosterone production which thus reduces potassium excretion in the kidneys.
What kind of diuretics can cause hypokalaemia?
Thiazides
They increase Na concentration in DCT which triggers aldosterone receptors to reabsorb Na and excrete K
How does ibuprofen increase the risk of gastric inflammation and ulceration?
Ibuprofen inhibits prostaglandins making the Gastric mucosa more vulnerable.
Why do oral steroids increase the risk of GI ulceration?
Steroids inhibit gastric epithelial renewal, thus weakening the gastric mucosa.
How does ibuprofen affect the kidneys?
Inhibits prostaglandins
This causes renal artery stenosis
This reduces kidney perfusion
What kind of diuretic should be stopped in a patient with hypokalaemia?
Thiazides e.g. bendroflumethiazide
A patient with asthma requires mild analgesia. Which analgesic would you not give?
Ibuprofen
[Contraindicated in asthma as it can cause broncho constriction].
True or false, trimethoprim is safe to give patients taking methotrexate?
False.
Trimethoprim is a folate antagonist as is methotrexate. If you give both you risk bone marrow toxicity and neutropenic sepsis.
True or false, methotrexate is safe to continue in patients with sepsis?
False.
Methotrexate is a folate antagonist and may induce bone marrow failure and neutropenia makingsepsis far worse!
True or false, loop diuretics can cause hypokalaemia?
True.
[The only diuretics that don’t are potassium sparing diuretics]
What type of drug is amlodipine? What is a common side effect?
Calcium Channel Blocker
Peripheral oedema. Stop CCB if patient gets this.
How long after a stroke is it safe to give a patient an anticoagulant?
Around 2 months
What is the target range for INR?
2-3
True or false, it is safe to give both a beta blocker and verapamil (CCB)?
False.
Together they may cause bradycardia/asystole.
What is the dose of aspirin recommended for acute treatment of MI and for prophylaxis?
300mg (acute MI)
75mg/day (prophylaxis)
True or false, patients with migraine + aura should not be given COCP?
True
It can increase their risk of stroke.
What type of insulin is given IV?
Short-acting e.g. actrapid or novorapid.
Most insulin is given Subcut
True or false, beta blockers are contraindicated in asthmatics?
True
Why do you check WCC in a patient taking clozapine?
Clozapine [Antipsychotic] 2nd gen can cause agranulocytosis and neutropenia.
If this happens, stop the drug and refer to haematologust.
What is the normal range for potassium?
3.5 - 5.0 mmol/L
Give two causes of hyperkalaemia
[DREAD]
Drugs (K-sparing, ACEi) Renal failure Endocrine (Addisons) Artefact (clotted sample) DKA
Give two causes of hypokalaemia
[DIRE]
Drugs (loop/thiazides)
Inadequate intake/loss - diarrhoea/vomiting
Renal tubular acidosis
Endocrine (Cushings/Conn’s)
Give two causes of low neutrophils
Viral infection
Chemotherapy
Clozapine (antipsychotic)
Carbimazole (antithyroid)
Give two causes of high lymphocytes
Viral infection
Lymphoma
CLL
Give two causes of high neutrophils
Bacterial infection
Tissue damage
Steroids
Give two causes of microcytic, normocytic and macrocytic anaemia
Microcytic:
- Iron deficiency
- Thalassaemia
- Sideroblastic
Normocytic:
- Blood loss
- Haemolytic
- Renal failure
Macrocytic:
- Alcohol
- Vit B12/Folate deficiency
- Liver disease
Give two causes of thrombocytopenia
[Low platelets]
Infection (viral) Myeloma Heparin DIC ITP HUS
Give a cause of prerenal, renal and postrenal kidney injury
Prerenal:
- Dehydration
- Sepsis
- Blood loss
- Renal artery stenosis
Renal:
- Drugs (NSAID, ACEi)
- Radiology contrast
- Inflammation
- Rhabdomyolysis
Postrenal:
- Kidney stones
- Prostate cancer
- BPH
True or false, most AKI is caused by a pre-renal issue?
True.
70% is prerenal
10% is renal
20% post-renal
Other than kidney injury, what else can cause a raised urea level?
Upper GI bleed.
The acid breaks down the blood producing urea.
What clotting factors are vitamin K dependent?
[1972]
10, 9, 7, 2
What clotting tests measure the vitamin K dependent clotting factors?
PT (Extrinsic = Warfarin)
INR
Give two causes of raised Alk phos
Post-hepatic obstruction
[+ALKPHOS] Any fracture Liver damage Kancer Pregnancy Hyperparathyroidism Osteomalacia Surgery
At what TSH value would you decrease the levothyroxine dose or increase it?
TSH <0.5 = Decrease
TSH >5 = Increase
What is Gilbert’s syndrome?
A liver disorder where the liver does not process bilirubin. This results in high bilirubin levels and jaundice.
What would you expect with Bilirubin, AST/ALT, ALP levels with prehepatic, hepatic and posthepatic issues?
Prehepatic:
- Raised unconjugated bilirubin
Hepatic:
- Raised conjugated + unconjugated bilirubin
- Raised AST/ALT
Posthepatic:
- Raised conjugated bilirubin
- Raised ALP
What is the difference between primary and secondary hypothyroidism?
Primary:
Low T4 produced by thyroid.
Secondary:
Low TSH produced by pituitary causing low T4.
Name an antibiotic which is ototoxic
Gentamicin
Vancomycin
[They are also nephrotoxic. This is why serum levels are monitored]
What is the treatment for paracetamol overdose?
N-acetyl cysteine
[NAC]
What antioxidant in the liver is required for the breakdown of paracetamol?
Glutathione
This becomes depleted in an OD resulting in a toxic accumulation of metabolites.
At what level of INR would you reverse Warfarin using Vitamin K?
> 8 (no symptoms)
> 5 (if bleeding)
True or false, trimethoprim is contraindicated in pregnancy?
True. It is a folate antagonist. It can cause neural tube defects in pregnancy.
[Co-amoxiclav would be a safe alternative]
A patient with addisons is sick with the flu, what drug should be doubled in dose?
Steroids
[Sick day rules]
Digoxin is not advised for patients with bradycardia, true or false?
True. It will slow the heart even more!
Which diuretic is the main treatment for heart failure?
Furosemide (loop)
[Loop for lungs!]
What is a suitable treatment for AF in a patient with asthma?
Digoxin or Diltiazem (CCB)
[Beta blockers are contraindicated in asthma]
What is a suitable treatment for AF in a patient with peripheral oedema?
Digoxin or Beta blocker
[Amlodipine (CCB) may make the oedema worse].
What is the first line treatment for neuropathic pain?
Tricyclic Antidepressant e.g. amitriptyline
What is the acute management of STEMI?
ABCDE
15L O2 Non rebreather mask (unless COPD)
Apsirin 300mg
IV Morphine 10mg with Metoclopramide
GTN
PCI
Beta Blocker
What drug do you give in addition to defibrilation?
Amiodarone 300mg IV
What do you treat Narrow QRS tachycardia and Broad QRS tachycardia with?
Narrow = Adenosine (if regular). Amiodarone if irregular.
Broad = Amiodarone + beta blocker.
What is the management of acute anaphylaxis?
ABCDE
15L non rebreather
Remove cause
Adrenaline 500 micrograms
(of 1:1000)
Chlorphenamine 10mg IV
Hydrocortisone
200mg IV
Asthma tx if wheeze
What is the management of acute asthma attack?
ABCDE
100% O2 non rebreather mask
Salbutamol 5mg nebuliser
Hydrocortisone IV or prednisolone oral
Ipratropium
Theophyline (only if life threatening)
What % level of O2 is a safe starting point in patients with COPD?
28%
Give an indication for a chest drain in a secondary pneumothorax
> 2cm
Patient SOB
Patient >50 yo
[If not then aspirate]
How do you distinguish between a tension pneumothorax and a typical pneumothorax?
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!
What is the scoring system used to determine whether a patient with pneumonia needs to be treated in hospital?
[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
What is the acute management for PE?
ABCDE
High flow O2
Morphine + Metoclopramide
LMWH e.g. tinzaparin (SC)
If low BP IV gelofusine + thrombolysis.
What is the acute management of a GI bleed?
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
What is the drug treatment for suspected bacterial meningitis in the GP setting?
1.2g Benzylpenicillin
What is the management of acute meningitis in the hospital setting?
ABCDE
High flow O2
IV fluids
Dexamethasone IV
LP (+/- CT head)
2g Cefotaxime IV
Consider ITU
What is the acute management of seizures/status epilepticus?
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
What is the acute management of ischaemic stroke?
ABCDE
CT head to exclude haemorrhagic!
<4.5 hrs thrombolysis
Aspirin 300mg
Transfer to stroke unit
How is DKA diagnosed?
Hyperglycemia (BM often >30mmol/L)
Keto (urine/blood levels)
Acidosis (low pH on ABG)
What is the difference between DKA and HONK?
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].
What is the treatment for DKA?
ABCDE
IV fluids: 1L over 1hr, then over 2, then 4 then 8.
Sliding scale insulin
Monitor BM, K and pH
What is meant by sliding scale insulin?
Dose of insulin is varied depending on the carbohydrate intake at meals. This is used in the treatment of DKA.
What are the diagnostic criteria for AKI?
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]
What is the management of AKI?
ABCDE
Cannula + catheter (fluid monitoring)
IV fluid 500ml stat, then 1L 4hrly
Search for cause
Monitor U&E and fluids
What are the BP thresholds for treatment based on at home ambulatory measurements?
> 150/95
OR
> 135/85 + high risk CVD or organ damage.
[Ambulatory monitoring is preferred by NICE now due to white coat syndrome]
What is the recommended treatment for chronic heart failure?
ACEi + Beta Blocker
Escalation
+ isosorbide mononitrate
+ spironolactone
What is the first line antihypertensive for a black person or >55yo?
CCB
[Thiazide diuretic if not tolerated or they have oedema]
What is the order of escalation for antihypertensive treatment for under 55 white patients?
ACEi/ARB
ACEi/ARB + CCB
ACEi/ARB + CCB + Thiazide diuretic
What is the Chadsvasc for?
Risk of stroke in patients with AF
Which criterion of Chadsvasc counts for 2 points?
Age >75
According to chadsvasc which gender is more at risk of stroke?
Female (1 pt)
What medication is given to patients with AF to prevent a stroke?
Aspirin 75mg daily
Warfarin (target INR 2.5)
How is rate controlled in patients with AF?
Beta blocker or CCB
Amiodarone
[if Beta blockers and CCB contraindicated use Digoxin].
Give an indication that a person’s chest pain is due to stable angina not ACS?
1) No sweating/vomiting
2) Resolves on rest within 15 minutes
3) Responds to GTN spray
If troponin is raised what are your two ACS differentials?
STEMI or NSTEMI
[Do an ECG to differentiate]
A patient with chest pain has an ECG which shows V1-4 ST depression, what two things could this be?
Anterior ischaemia
Posterior infarction
[Add V7-9 posteriorly to confirm]
What is the long term tretment for stable angina (angina pectoris)?
GTN spray
Aspirin
Statin
Beta blocker / CCB
[For unstable angina consider PCI/CABG]
What is the treatment ladder for asthma?
1) SABA
2) + Inhaled Steroid
3) + LABA
4) Leukotriene receptor antagonist / theophylline
5) + Daily steroid tablet [+ ref specialist care]
How do you manage CV risk factors in patients with DM?
Aspirin 75mg/day
Statin
+/- ACEi (depends on renal function).
Annual review of albumin-creatinine ratio (ACR) (early indicator of diabetic nephropathy)
Why is albumin-creatinine ratio (ACR) checked in patients with DM?
It is an indicator of diabetic nephropathy and CVD
What is the first line treatment of Type 1 diabetes?
Insulin
What is the treatment ladder for DM type 2?
1) Metformin
2) + Sulphonylurea (gliclazide)
3) + DPP-4 inhibitor (gliptin)
4) + Insulin
[c comes before p]
[DPP = gliPtin]
In advanced Parkinson’s disease what is the 1st line treatment?
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.
At what point is someone diagnosed with epilepsy?
If they have 2+ seizures
What is the 1st line treatment for generalised seizures?
Sodium Valproate or Lamotrigine
2nd: Carbamazepine
What is the 1st line treatment for focal seizures?
Carbamazepine or Lamotrigine
2nd: Sodium Valproate
True or false, sodium valproate should be avoided in pregnancy?
True. It is teratogenic
What is a common side effect of lamotrigine and carbamazepine?
Rash
Before starting a patient on Azathioprine, what should be checked?
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.
How is rheumatoid arthritis treated acutely (flare ups) and chronically?
Acute:
IM methylprednisolone
Chronic:
Methotrexate + another DMARD e.g. sulfasalazine or hydroxychloroquine.
[If fail to respond then TNF alpha inhibitors e.g. infliximab]
What is the 1st line treatment for Alzheimer’s disease?
Mild-Moderate = Acetylcholinesterase inhibitors:
- Donepezil
- Rivastigmine
- Galantamine
Moderate-Severe = NMDA antagonist - Memantine
When should you never give a patient a laxative?
If there is bowel obstruction!
How are flare ups of crohn’s disease treated?
Mild: Prednisolone oral
Severe: Hydrocortisone IV
[Can be administered rectally also]
For patients with insomnia, what drug would you prescribe as a first line?
Zopiclone orally
[Hypnotic]
How do you treat non-infectious diarrhoea?
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]
What are the 4 types of laxatives?
Softeners - Docusate
e.g. faecal impaction.
Osmotics - Lactulose
Bulking - Isphagula husk
Stimulants - Senna or Bisacodyl
[Stops Our Bottoms Sticking]
What is a common side effect of Beta 2 agonist overuse?
Tremor
[Rather than increasing salbutamol inhaler, one can add beclomethasone inhaler]
What is the 1st line antibiotic used to treat skin infections?
Flucloxacillin oral
[mild-moderate cases]
What is the 1st line treatment for acute heart failure with pulmonary oedema?
Furosemide (loop diuretic)
[Loop for Lungs]
True or false, bendroflumethiazide is the tretment of choice for heart failure?
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.
True or false, carbimazole can cause neutropenia?
True
Which antihistamines are sedating?
Sedating:
Cyclizine
Promethazine
(Cycling makes you tired!)
Non-sedating:
Cetirizine
Fexofenadine
Loratidine
What would you use to treat a patient with suspected vascular dementia?
Aspirin 75mg/day
Amlodipine
NB: If patient has sudden loss then it is not likely alzheimer’s and is more likely vascular
What is the MMSE out of and how is it scored?
Max 30
24-30 = Normal 18-23 = Mild 0-17 = Severe
[Remember 24 and above is normal]
What class of drug would you use to treat mild vs severe alzheimer’s?
Mild = Acetylcholinesterase inhibitors: Rivastigmine, Donepezil and Galantamine
Severe = NMDA antagonist: Memantine
In an acute STEMI what is the best initial treatment for relieving pain?
GTN
[This is faster acting than morphine and may relieve the ischaemia].
What is the 1st line treatment for PE?
LMWH e.g. Dalteparin
True or false, ramipril should be avoided in pregnancy?
True. It is teratogenic.
[Beta blocker is the best option e.g. Labetalol]
True or false, Tamoxifen increases the risk of VTE?
True.
Which of gliclazides or gliptins carry the highest risk of hypoglycemia?
Sulphonylureas (Gliclazide)
Therefore, patients must not skip meals!
[Gliclazides increase insulin production. Metformin just increases sensitivity to existing insulin]
When taking long-term methotrexate, how often should FBC be monitored?
Every 1-2 weeks to detect if there is any neutropenia.
[Methotrexate should only ever be taken once weekly]
What is the maximum frequency of methotrexate?
Never more than once per week! It can cause neutropenia if taken more than this.
How does alcohol affect warfarin?
Acute alcohol inhibits enzymes potentiating its effect.
Chronic alcohol use induces enzymes reducing warfarin’s effects.
True or false, warfarin tablets are colour coded to indicate dose?
True.
White (0.5mg)
Brown (1mg)
Pink (5mg)
What is the major adverse effect of warfarin?
Bleeding
Why should you be worried if a patient on ACEi becomes unwell with diarrhoea and vomiting?
ACEi increase the risk of AKI and kidney injury.
Therefore, when sick the risk is even higher!
What antihypertensive would you give in pregnancy e.g. pre-eclampsia?
Beta blocker e.g. labetalol
or Nifedipine (CCB)
[Thiazides, ACEi, ARB are not safe in pregnancy!]
What is the first line antihypertensive in DM?
Still ACEi / ARB
What is the 1st line choice of antihypertensive in CKD?
ACEi/ARB
When would you use an ACEi over the age of 55 or in a black person?
Hx of HF
Hx of coronary heart disease
When prescribing long term steroids (>3months), what also should you prescribe to protect their bone health?
Bisphosphonates
Why are ACEi not routinely used as a first line in patients who are over 55 or black?
They are less sensitive to renin
True or false, citalopram makes you more sensitive to sunlight?
True. Precautions must be taken when going out in the sun.
A patient taking SSRIs has agitation, hallucinations and fluctuating temperatures. What does this suggest?
Serotonin syndrome
They need hospital treatment with cyproheptadine (periactin)
When calculating doses, what does 1% solution mean?
1g in 100g
or
1g in 100ml
Before administering vancomycin what must you check?
The patient’s renal function e.g serum creatinine levels.
Vancomycin clearance is reduced in patients with impaired renal function.
What must you check before giving a patient statins?
Their liver function. Check their AST/ALT.
True or false, methotrexate can be given to patients with abnormal liver function?
False.
What is it important to check prior to administering antipsychotics?
Blood glucose
Hyperglycaemia and diabetes are known side-effects
Before starting a patient on COCP what standard clinical test should you do?
Blood pressure
Need to assess CVD risk factors
What imaging should be done prior to giving amiodarone?
Baseline CXR as amiodarone can cause pulmonary toxicity.
[Also need to check TSH/T4 levels, LFTs, FBC]
What is the main side effect concern of carbimazole?
Neutropenia
[If patient reports sore throats it could be a sign if bone marrow suppression]
Other than BP, what should be routinely monitored when a patient is taking ACEi?
U&E
ACEi can cause hyperkalaemia and electrolyte disturbance.
What blood test should you check prior to giving digoxin?
Serum creatinine
It is renally excreted.
True or false, sodium valproate is hepatotoxic?
True. You must check the patient’s liver function (ALT) first.
True or false, FBC must be checked weekly for 18 weeks with clozapine?
True. Need to check for agranulocytosis / neutropenia.
What % of NHS admissions are related to adverse drug reactions (ADRs)?
5%
What is the difference between type A and type B drug reactions?
Type A are common and expected.
Type B are idiosyncratic and unpredictable.
Give a known adverse drug reaction to gentamicin and vancomycin
Ototoxicity
Nephrotoxicity
Which antibiotics typically cause C diff?
Any can. Typically broad spectrum e.g. cephalosporins or ciprofloxacin.
Give two side effects of calcium channel blockers
Hypotension
Bradycardia
Peripheral oedema
Flushing
True or false, warfarin has a pro-coagulant effect initially?
True. This is why bridging therapy is needed with heparin until INR exceeds 2
True or false, aspirin in high doses can cause tinnitus?
True
Give two side effects of amiodarone
Pulmonary fibrosis
Thyroid disease
Grey skin
Corneal deposits
True of false, lithium can cause a tremor?
True
What is the significance of a drug having a narrow therapeutic index?
It means that they are vulnerable to subtherapeutic or toxic effects if their bioavailability is even slightly altered e.g. warfarin, digoxin or phenytoin.
What is the difference between pharmacodynamics and pharmacokinetics?
Pharmacodynamics = the body’s effect on drugs.
Pharmacokinetics = drugs movement through body
True or false, beta blockers can cause cold extremities?
True
True or false, amiloride can cause hyperkalaemia?
True. It is a potassium sparing diuretic
[NB: If a patient is taking ACEi and amiloride, be hypervigilant for hyperkalaemia]
At what INR level do you treat with IV Vitamin K?
8+
[Can be given by mouth if there is no active bleeding]
What is the first intervention for a patient in anaphylaxis
Secure the air way first!
[Head tilt-chin lift, nasopharyngeal adjunct or intubation. This is the priority before giving adrenaline].
True or false, if a hypoglycaemic patient is conscious, you can treat them with 10-20 g glucose by mouth?
True
How do gliclazides (sulphonylureas) work?
They stimulate the pancrease to produce more insulin
[Higher risk of hypos!]
