Prescribing Safety Assessment: Answers from Papers

Question 1

What drugs affect lithium excretion?

Answer 1

Diuretics (in particular thiazides), NSAIDs, ACEI. Loop are best diuretics if have to give.

Question 2

Main contraindications for stimulant laxatives?

Answer 2

Cramps (may be obstruction) or colitis

Question 3

When to take stimulant laxatives?

Answer 3

At night!

Question 4

When not to use osmotic or softener laxatives?

Answer 4

If already feel bloated then not osmotic, and if have soft stool then softener will not help!

Question 5

A group of patients that should not use cyclizine?

Answer 5

Those with heart failure as can worsen fluid overload; metoclopramide better in these patients

Question 6

Treating mild allergic reaction?

Answer 6

Give anti-histamine but no need for steroids or adrenaline

Question 7

Two diuretic types causing hypokalaemia?

Answer 7

Thiazide and loop

Question 8

Dosing interval for the first-line anti-emetics?

Answer 8

8 hourly! (Cyclizine and metoclopramide)

Question 9

Citalopram dosing for elderly?

Answer 9

Maximum dose for over 65 is 20mg!

Question 10

How long should you continue iron supplementation for?

Answer 10

Should give until Hb in normal range then for a further three months to replenish stores!

Question 11

Who gets blood transfusion in IDA?

Answer 11

Only those who are severely symptomatic and cannot wait for effects of iron supplements (or cannot tolerate), or those with Hb <70 (higher in IHD)

Question 12

A cause of leukocytosis with normal CRP?

Answer 12

Being on steroids

Question 13

Which patients should ACEI be avoided in?

Answer 13

Aortic stenosis (particularly if severe/symptomatic)

Question 14

Firstline antibiotic in otitis media in children?

Answer 14

Amoxicillin, with co-amox reserved for those with unresponsive or severe infection. Clarithro if penicillin allergic.

Question 15

Drugs to avoid in myasthenia gravis?

Answer 15

Those with anti-muscarinic i.e. anti-cholinergic burden as will exacerbate myasthenia

Question 16

First-line antibiotic in epiglottitis?

Answer 16

Cefotaxime

Question 17

What is the aim of LMWH in VTE?

Answer 17

Prevents the clot enlarging while the body breaks it down, rather than thrombolysing it

Question 18

When is thrombolysis indicated in DVT?

Answer 18

Never!

Question 19

Best drug for acute severe anxiety?

Answer 19

Benzos e.g. diazepam; any would have been acceptable

Question 20

Choosing drugs for managing anxiety?

Answer 20

Benzos in the young, haloperidol in the elderly (becaues of dystonic reactions)

Question 21

Key bloods to monitor in digoxin?

Answer 21

Serum creatinine (as will have increased risk of toxicity in renal dysfunction) and potassium (as hypokalaemia increases toxicity)

Question 22

Key blood at baseline in valproate?

Answer 22

ALT (hepatotoxic)

Question 23

Monitoring initially for clozapine?

Answer 23

First 18 weeks = weekly FBC

Question 24

Key thing to monitor for phenytoin infusion?

Answer 24

ECG as can cause arrhythmias. No point monitoring plasma phenytoin during infusion, but check it afterwards

Question 25

What would be useful to check for after two weeks of fluoxetine?

Answer 25

A rash (may warn of coming systemic reaction). Check for suicidal ideation, not for mood assessment.

Question 26

Adverse effects for oestrogen-containing oral contraceptives?

Answer 26

Headaches, weight gain, irritability

Question 27

Are B-blockers stopped pre-operatively?

Answer 27

No

Question 28

Which patients is enoxaparin dose-adjusted for?

Answer 28

EGFR <30 and weight under 50kg!

Question 29

How do heparins cause hyperkalaemia?

Answer 29

Inhibit aldosterone synthesis

Question 30

When are antiplatelets stopped for surgery?

Answer 30

Usually 7 days before (unless have recent vascular stenting, in which case hold off surgery until crucial antiplatelet period has finished)

Question 31

Allopurinol in renal dysfunction?

Answer 31

Can accumulate so limit dose in renal dysfunction

Question 32

How often should thyroxine be taken?

Answer 32

Daily!

Question 33

What EGFR would preclude nitrofurantoin?

Answer 33

<45

Question 34

Usual length of UTI treatment for men?

Answer 34

7 days

Question 35

First-line treatment for alcohol withdrawal?

Answer 35

Chlordiazepoxide

Question 36

Key instruction for taking rivaroxaban?

Answer 36

Take with food! (To improve absorption)

Question 37

Efficacy of oral progestogen-only preparations and enzyme inducers?

Answer 37

Question used topiramate. These drugs decrease the efficacy of the contraceptive so should switch to an alternative method until 4 weeks post-drug

Question 38

Is sedation a side effect of B-blockers?

Answer 38

No! Cause fatigue but not sedation

Question 39

Hepatic side effect of co-amox?

Answer 39

Can cause cholestatic jaundice, particularly in over 65s and men!

Question 40

What should you do if get small rise in creatinine after starting ACEI?

Answer 40

If small (<20%), this is to be expected, so does not require investigation or change in prescription

Question 41

Best way to monitor beneficial effects of furosemide for heart failure after two days?

Answer 41

Weight, not RR, as this is confounded by too many other factors

Question 42

Best way to monitor beneficial effects of perindropril for HF after one month?

Answer 42

Exercise tolerance

Question 43

Most serious side effects of ciclosporin (and therefore things to check at baseline)?

Answer 43

Causes hypertension and nephrotoxicity, so check BP and U&E at baseline then monitor every 2 weeks until stable

Question 44

Appropriate way to manage insulin dose if have transient hyperglycaemia?

Answer 44

Increase by 10%

Question 45

What determines successful statin treatment and therefore no need for dose adjustment?

Answer 45

If, after 3 months, non-HDL cholesterol has decreased by >40% then dose is fine

Question 46

Drugs causing urinary retention?

Answer 46

Anticholinergics, general anaesthetics, alpha-adrenoreceptor agonists, benzos, NSAIDs, CCBs, antihistamines, alcohol, opioids

Question 47

Drugs causing confusion?

Answer 47

Opiods, anticholinergics, antipsychotics, antidepressants, anticonvulsants, metoclopramide