Prescription review

Question 1

Which antibiotic increases the effect of warfarin.

Answer 1

Erythromycin – acts on cytochrome P450 system as an enzyme inducer.

Question 2

Contraindications of steroids.

Tip: think side effects.

Answer 2

Stomach ulcers.
Thin skin.
oEdema.
Right and left heart failure.
Osteoarthritis.
Infections.
Diabetes.
cushing's Syndrome

Question 3

NSAIDs contraindications.

Answer 3

No urine (renal failure).
Systolic dysfunction.
Asthma.
Indigestion.
Dyscrasia (clotting issue)

Question 4

Three categories of antihypertensive side effects.

Answer 4

Hypotension.
Mechanical – bradycardia/electrolyte imbalance.
Specifics.

Question 5

Ramipril, lisinopril.

Side effects

Answer 5

ACEi.
Hyperkalaemia.
Dry cough.
Renal failure.

Question 6

Bisoprolol, labetalol.

Side effects

Answer 6

Beta-blockers.
Wheeze in asthmatics.
Worsened acute heart failure.
Hypotension.

Question 7

Amlodipine, diltiazem, verapamil.

Side effects

Answer 7

Calcium channel blockers.
Peripheral oedema.
Flushing.
Drowsiness.

Question 8

Furosemide

Side effects

Answer 8

Loop-diuretic.
Gout.
Diabetes exacerbation.
Hypokalaemia.

Question 9

Spironolactone.

Side effects

Answer 9

Potassium sparing diuretics.
Hyperkalaemia.
Gynaecomastia.

Question 10

Medication choice for nausea .

Answer 10

Regular antiemetic:
Cyclizine 50mg 8-hourly IV/IM/oral.
Unless in heart failure –> Metroclopramide 10mg IV/IM .

Question 11

Who should you not give metoclopramide to?

Answer 11

Dopamine antagonist.
Parkinson’s patients.
Young women (risk of dyskinesia).

Question 12

Prescribing pain relief when not currently in pain.

Answer 12

No regular medication.

As required paracetamol: 1g up to 6 hourly.

Question 13

Prescribing pain relief when in mild pain.

Answer 13

Regular paracetamol: 1g up to 6 hourly.

As required codeine: 30mg up to 6 hourly.

Question 14

Prescribing pain relief when in severe pain.

Answer 14

Regular co-codamol 30/500: 2 tablets 6 hourly.

As required morphine sulphate: 10mg up to 6 hourly

Question 15

First line treatment for neuropathic pain.

Answer 15

Amitriptyline – 10mg oral nightly. Or

Pregabalin – 75mg oral 12-hourly.

Question 16

Maximum amount of paracetamol in a day.

Answer 16

4g

Question 17

When do you not give 0.9% saline fluid and what do you give instead?

Answer 17

– When the patient is hypernatraemic or hypoglycaemic:
Give 5% dextrose instead.
– When the patient has ascites: give human-albumin solution.
– When systolic bp <90: give gellofusine (a colloid).
–When patient is shocked with bleeding: give transfusion.

Question 18

Levels of predicting fluid depletion.

Answer 18

Reduced urine output (<30ml/h) shows 500ml fluid depletion.
Reduced UO and tachycardia shows 1L depletion.
The above + shock shows 2L depletion.

Question 19

What fluid should be given in a hypotensive, tachycardic patient?

Answer 19

500ml 0.9% saline bolus.

Or 250ml in heart failure patients.

Question 20

What fluid should an oliguric patient be given?

Answer 20

1L 0.9% saline over 1-2 hours before reassessing.

Unless due to blockage/prostate enlargement.

Question 21

Oliguria vs anuria.

Answer 21

Oliguria – <30ml/h urine output. (<400-500ml/24h)

Anuria – no urine output.