Prescribing + Pharmacology 25/5/20

Question 1

antihypertensive effects of ACEIs

Answer 1

1) . vascular resistance reduced
2) . ECF volume reduced (reduced sodium reabsorption & reduced aldosterone)
3) . Bradykinin elevated (lead to dry cough)

Question 2

ACEI side effects

Answer 2

• dry cough
• hypotension
• angioedema (face/tongue/throat)
• hyperkalaemia (do not use with K+sparing diuretics
• congenital malformation in pregnancy (give labetalol)

Question 3

ARB side effects

Answer 3

• hypotension
• hyperkalaemia
• congenital malformation in pregnancy (give labetalol)

Question 4

CCB (NON-DIHYDROPYRIDINES - eg. verapamil) CIs

Answer 4

• bradycardia
• heart failure (HFREF)
• Wolff-Parkinson-White/sick sinus/sino-atrial block

Question 5

CCB (DIHYDROPYRIDINES - eg. amlodipine) CIs

Answer 5

• significant aortic stenosis

- unstable angina

Question 6

SEs of CCBs

Answer 6

• bradycardia
• reflex tachycardia (nifedipine)
• hypotension (esp. verapamil)
• abdo discomfort
• flushing
• palpitations

Question 7

indications for CCBs

Answer 7

Dihydropyridines (eg. amlodipine = vascular targetting mostly)
- angina prophylaxis (amlodipine)
- antihypertensive
- Raynaud’s (nifedipine)
- post-SA haemorrhage prevention of vasospasms (nimodipine)
NON-dihydropyridines (eg. verapamil = cardiac targetting mostly)
- supraventricular arrhythmias
- angina
- antihypertensive

Question 8

where do osmotic diuretics (eg. mannitol) and carbonic anhydrases act?

Answer 8

proximal convoluted tubule

Question 9

where do loop diuretics (eg. furosemide) act?

Answer 9

Loop of Henle/thick ascending limb

Question 10

where do thiazide diuretics (eg. bendroflumethiazide) act?

Answer 10

distal convoluted tubule

Question 11

where do potassium-sparing diuretics (eg. spironolactone/amiloride) act?

Answer 11

collecting duct

• principal cells = amiloride
• intercalated cells = spironolactone

Question 12

total blood volume calcs for neonate, child and adult

Answer 12

neonate = 90ml/kg
child = 80ml/kg
adult = 70ml/kg

Question 13

osmolality vs osmolarity

Answer 13

osmolality = osmoles per kg solvent
osmolarity = osmoles per litre

Question 14

deficit calcs (paeds)

Answer 14

% deficit x 10 x weight = deficit fluids in ml/kg/day

Question 15

maintenance fluids (paeds) over 24hrs

Answer 15

first 10kg = 100ml/kg/day
next 10kg = 50ml/kg/day
thereafter = 20ml/kg/day

Question 16

checks for prescribing: weak/strong opioids
weak eg. codeine, tramadol
strong eg. morphine, diamorphine, oxycodone

Answer 16

• respiratory function
• head injury/raised ICP (can interfere with pupil reflex)
• renal function
• frailty
• acute abdomen
• driving?
• dependence?

Question 17

checks for prescribing: paracetamol

Answer 17

• liver function

- frailty/cachexia (<50kg = 500mg qds max dose)

Question 18

checks for prescribing: NSAIDs

Answer 18

• bleeding risk (coagulopathy, platelets)
• renal function
• asthma
• GI bleed risk
• meds (eg. warfarin, digoxin, steroids)

Question 19

PRN vs modified release opioids

Answer 19

general rule PRN should be max 1/6th dose of modified release 24hr dose

Question 20

alongside opioid prescribe…

Answer 20

• stimulant laxative (eg. senna/bisacodyl)

- anti-emetic (cyclizine/prochlorperazine)

Question 21

SEs of opioids

Answer 21

• constipation
• nausea
• sedation
• dry mouth
  less common:
• psychomimetic effects
• myoclonus
• respiratory depression