Prescribing section

Question 1

Patient in oncology who is ongoing Ix for back pain. She has developed a painful rash to the right side of her face. PMHx - breast cancer. DH tamoxifen, paracetamol, dihydrocodeine and a reducing dose of oral dexamethasone.

Obs stable

What is the drug and dose most appropriate to treat the rash?

Answer 1

Aciclovir 800mg 5x daily for 7 days (shingles)

NB treatment is continued for 2 days after crusting of lesions in immunocompromised patients.

Question 2

A 56 year old man presents to ED with 3 day hx of vomiting. PMH - previous gastritis but otherwise well

O/E - normal temp, HR 115, BP 100/50, JVP not raised, RR 21/min, SpO2 97%. No other abnormalities on examination

Ix - Na 132, K 5.3, Cl 80, Bicarbonate 34, Urea 14, Creat 250

ECG sinus tachycardia

Prescribe one IV fluid that is most appropriate for this stage

Answer 2

Sodium chloride 0.9% (no K+ added!)
500ml in under 15 min (do 10 min!) or 1L in 30mins

The patient is shocked and dehydrated and has AKI. He has lost gastric fluid that has generated a hypochloraemic metabolic alkalosis which is best treated with saline.

Question 3

Starting dose of metformin

Answer 3

500mg OD PO

Question 4

Easiest DOAC to prescribe in AF/VTE prophylaxis

Answer 4

Rivaroxaban - can be given once daily

Question 5

Drugs you can prescribe for NEUROPATHIC pain

Answer 5

1. TCAs - amitryptilline
2. Anti-epileptic drugs
3. Gabapentin, pregabalin
4. Ketamine
5. Nerve compression - dexamethasone
6. Nerve blocks/regional anaesthesia

Question 6

How do you start oral morphine regime with palliative patients

Answer 6

1. Immediate release first
2. Once pain has stabilised, switch to modified release of the same dose (12hrly, or 24hrly)
3. Pain between doses can be managed by a rescue dose that is usually 1/6 of the regular dose

Question 7

Alternative to morphine in patients with renal failure

Answer 7

Oxycodone

Question 8

Equivalent doses of opioid analgesics
Morphine PO
Morphine IM SC IV
Diamorphine
Codeine PO

Answer 8

Morphine PO - 10mg
Morphine IM SC IV - 5mg
Diamorphine - 3mg
Codeine PO - 100mg

Question 9

Patient with hypoglycaemia with failing GCS - prescribe appropriate infusion to manage this (including infusion solution, volume and duration)

Answer 9

Glucose 20% 100ml 10min (my answer)

PSA answer: glucose 20% in volumes between 50-100ml given within 20min would provide sufficient glucose

Question 10

Drugs you can use orally to treat acne

Answer 10

Doxycycline
Lymecycline
Tetracycline

Question 11

Right after a cerebrovascular injury - which type of fluid is best prescribed and which one should be avoided?

Answer 11

Better to prescribe saline and avoid glucose - excessive glucose-containing fluids have the potential to exacerbate cerebral injury

Question 12

How much fluid per hour would be good to give a patient who is likely to have some fluid deficit as well as requiring maintenance fluids?

Answer 12

100ml/h

It would therefore be appropriate to give a bag for 8hourly or 10hourly!

Also do not forget to replace potassium!

Question 13

Dose of IM adrenaline to be given in an anaphylactic shock

Answer 13

0.5mL 1 in 1000 solution IM (500 micrograms)

Question 14

Dose of IV adrenaline to be given in a cardiac arrest

Answer 14

1mg of 1 in 10000 IV (can be given every 3-5 mins)