PSA 1 Flashcards
Patient with asthma/COPD - what would you prescribe instead of adenosine?
Verapamil
Three drugs you would use with caution for asthma
NSAIDs, Beta-blockers and adenosine
Three drugs you would use with caution in IHD
NSAIDs
Oestrogens: e.g. combined oral contraceptive pill, hormone replacement therapy
Varenicline (nicotine replacement)
How would you rate control a patient with AF that has a past medical Hx of HF
Digoxin
Patient with AF and known Hx of asthma - what would you use to rate control the patient?
Verapamil
Digoxin - when would you measure serum levels?
Just before the next dose (technically 6h post-dose)
Diabetes drug CI in heart failure
Pioglitazone (thiazolidinediones) - causes fluid retention
What would prescribe to a pregnant women with thrush?
Clotrimazole pessary - 100mg PV daily for 7 days (longer course for pregnant women
What is the regime to follow regarding insulin prescription in a patient who has just presented with DKA?
STOP short-acting insulin; CONTINUE long-acting insulin. A fixed rate-insulin infusion should also be started alongside fluid resuscitation.
In the elderly - be careful in prescribing NSAIDs and opioids as they are particularly vulnerable to its adverse effects. What are the main SE to be concerned of?
Gastrotoxicity and renal impairment in NSAIDs.
Constipation, nausea and drowsiness in opioids.
What is the correct way of taking loperamide? (e.g. in a patient who is going travelling)
Loperamide should be taken after each loose stool.
Should be taken as an initial dose of 4mg followed by 2mg after each loose stool, up to a max of 16mg/24h
What is the most important information option to provide to a patient regarding effect of sertraline?
Beneficial effects may take up to 6 weeks to become apparent.
Ciclosporin - name a key side effect and monitoring regime
Nephrotoxicity is a well know SE of ciclosporin.
Renal function measurements are required before starting the drug. During Rx, monitor serum creat every 2 weeks for the first 3 months, then monthly.
What key measurement is required before starting a patient on azathioprine?
Thiopurine methytransferase -
if patient has a low dose of this enzyme they are treated with a tailored (lower?) dose in order to reduce toxicity (increased risk of myelosuppression)
What is the most appropriate analgesia for severe pain in the setting of renal impairment?
NB fentanyl causes fewer problems than morphine in renal disease but not good for acute pain if patch, as onset of action is too slow! (and less titratable)
Oxycodone - metabolised by the liver to inactive metabolities
(morphine is also hepatically metabolised, but one of its metabolities, morphine 6-glucoronide, is renally excreted and will therefore accumulate)
