PSA

Question 1

Drugs which are enzyme inducers?

**Increase enzyme activity = decrease drug concentration.

Answer 1

Phenytoin
Carbamazepine
Barbituates
Rifampicin
Alcohol (chronic excess)
Sulphonylureas

**PC BRAS

Question 2

Drugs which are enzyme inhibitors?

**Decrease enzyme activity = increase drug concentration.

Answer 2

Allopurinol
Omeprazole
Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol (acute intoxication)
Sulphonamides

**AO DEVICES

Question 3

Drugs to stop before surgery?

Answer 3

Insulin
Lithium
Anticoagulants/ antiplatelets
COCP/ HRT
K-sparing diuretics
Oral hypoglycaemic
Perindopril and other ACEi's

**I LACK OP

Question 4

How long before surgery should you stop the COCP/ HRT?

Answer 4

4 weeks before surgery.

Question 5

How long before surgery should you stop lithium?

Answer 5

The day before surgery.

Question 6

How long before surgery should you stop potassium sparing diuretics/ ACEi’s?

Answer 6

The day of surgery.

Question 7

What is an absolute contraindication to the prescription of gentamicin?

Answer 7

Myasthenia Gravis.

Question 8

Gentamicin dose should be calculated according to what?

Answer 8

Ideal body weight.

Question 9

How should you dose gentamicin if a patient weighs less than the stated ideal body weight?

Answer 9

Calculate the dose manually using 5-7mg/kg/day.

Question 10

Most common prescribing regimen used for gentamicin?

Answer 10

Once daily dosing.

Question 11

The dose interval of gentamicin on a once daily dosing regimen is determined by what?

Answer 11

The Hartford Nomogram.

Question 12

How are doses of gentamicin normally rounded?

Answer 12

To the nearest 40mg (as gentamicin comes in 40mg ampoules).

Question 13

Maximum dose of gentamicin?

Answer 13

560mg per day.

Question 14

When should gentamicin levels be checked?

Answer 14

6-12 hours after the dose.

Question 15

What should you do if a gentamicin level is not checked within the window?

Answer 15

Wait until blood levels are <1mg/L and then give the second dose.

**2nd dose cannot be given within 24 hours though.

Question 16

When might the multiple daily dosing regimen for gentamicin be used?

Answer 16

For IE, neonatal sepsis or paediatrics.

Question 17

What should be avoided in patients taking metronidazole?

Answer 17

Alcohol consumption

**Avoid during treatment and for 48 hours after metronidazole course completion.

Question 18

If a patient with infection has a low BP, what should you withhold?

Answer 18

Anti-hypertensives.

Question 19

How should metronidazole tablets be taken?

Answer 19

Should be swallowed whole during or after a meal with a glass of water.

Question 20

How is warfarin monitored?

Answer 20

INR.

Question 21

How is unfractionated heparin monitored?

Answer 21

APTT.

Question 22

How are DOACs monitored?

Answer 22

No regular monitoring.

Question 23

Reversal of warfarin?

Answer 23

Vitamin K ± PCC

Question 24

Reversal of dabigatran?

Answer 24

Idarucizumab.

Question 25

DOAC reversal?

Answer 25

None.

Question 26

Anticoagulants to avoid if a patient has poor renal function?

Answer 26

Dabigatran + Rivaroxaban.

Question 27

3 drugs that warfarin can interact with that are not enzyme inducers/ inhibitors?

Answer 27

``` COCP Theophylline Corticosteroids Tricyclics Pethidine Statins ```

Question 28

When should warfarin be stopped prior to surgery?

Answer 28

Stop 3-5 days prior to surgery + check INR is <1.5 before surgery.

Question 29

When should rivaroxaban + apixaban be stopped prior to surgery?

Answer 29

Stop 48 hours prior to surgery.

Question 30

When should clopidogrel + ticagrelor be stopped prior to surgery?

Answer 30

Stop 5 days prior to surgery.

Question 31

When should aspirin be stopped prior to surgery?

Answer 31

Continue it unless there is a high risk of bleeding associated with the surgery (neurosurgery/ prostatectomy).

Question 32

Management of a patient taking warfarin with major bleeding?

Answer 32

Stop warfarin Give urgent phytomenadione IV Give urgent PCC (factors II, VII, IX + X) **FPP can be used as an alternative if PCC not available

Question 33

Preferred anticoagulants in patients with creatinine clearance of <15?

Answer 33

LMWH then UFH OR LMWH then warfarin

Question 34

Anticoagulant preferred in patients who are haemodynamically unstable?

Answer 34

UFH

Question 35

What are the normal daily fluid requirements for patients?

Answer 35

25-30ml/kg/day of water. 1mmol/kg/day of Na+, K+ and Cl-. 50-100g/day glucose.

Question 36

How much glucose does 100ml 5% glucose contain?

Answer 36

5g (50g in 1L).

Question 37

What is the Holliday-Segar formula?

Answer 37

100ml/kg/day for the first 10kg of weight. 50ml/kg/day for the next 10kg of weight. 20ml/kg/day for any weight over 20kg.

Question 38

How do you calculate drip rate?

Answer 38

Drip rate = (Total volume of fluid (ml) / total time required for delivery (hours)) x drop factor (number of drops per ml). **Drip rate gives you the number of drops required per hour. In order to convert to drops per minute, divide by 60.

Question 39

How are the doses of insulin for a basal bolus regimen calculated?

Answer 39

0.5-0.75 units/kg/day 50% given as long acting basal insulin in am Other 50% is split into 3 doses and given as short acting insulin at breakfast, lunch and tea

Question 40

How are the doses of insulin for a twice daily biphasic regimen calculated?

Answer 40

0.5-0.75 units/ kg/ day. Split into 2 doses. 2/3 given in the am. 1/3 given in the pm.

Question 41

Insulin used for DKA?

Answer 41

Short acting | Normall Actrapid

Question 42

How is the short acting insulin used to treat DKA dosed?

Answer 42

0.1 unit/kg/ hour.

Question 43

Why shouldn't you give glucagon to diabetics who chronically misuse alcohol?

Answer 43

It is ineffective as these patients have depleted glycogen stores. **Use 100mL 20% glucose instead.

Question 44

Pioglitazone + Novomix 30 can cause what?

Answer 44

Pulmonary oedema

Question 45

What do tetracyclines cause in children?

Answer 45

Tooth discolouration + pitting of tooth enamel.

Question 46

What do you prescribe as fluid resuscitation for children?

Answer 46

20ml/kg of a glucose free crystalloid over <10 minutes.

Question 47

What do you prescribe as fluid resuscitation for neonates?

Answer 47

10-20ml/kg of a glucose free crystalloid over <10 minutes.

Question 48

What should the sodium content in fluids used for children be?

Answer 48

131 - 154mmol/L **This is basically NaCl or Hartmann's.

Question 49

4 drug classes that are proven to be safe in pregnancy?

Answer 49

Paracetamol Beta lactam antibiotics Steroids Bronchodilators

Question 50

Indications for high dose (5mg) folic acid in pregnancy?

Answer 50

``` Previous baby with spina bifida FHx spina bifida AEDs Coeliac disease Diabetes BMI >/= 30 SCD/ thalassemia ```

Question 51

When is a loading dose of IV aminophylline required prior to infusion?

Answer 51

If the patient is not taking oral theophylline.

Question 52

NSAIds + CCBs used in combination can precipitate what?

Answer 52

Heart failure.

Question 53

Opioids antidote?

Answer 53

Naloxone.

Question 54

Benzodiazepines antidote?

Answer 54

Flumezanil.

Question 55

SSRIs antidote?

Answer 55

None. | Treat acidosis with sodium bicarbonate.

Question 56

TCAs antidote?

Answer 56

Serum alkalisation.

Question 57

Paracetamol antidote?

Answer 57

NAC.

Question 58

Aspirin/ salicylate antidote?

Answer 58

Serum alkalisation.

Question 59

Digoxin antidote?

Answer 59

Digibind.

Question 60

Insulin/ beta blockers antidote?

Answer 60

Glucagon.

Question 61

Iron salts antidote?

Answer 61

Desferroxamine mesylate.

Question 62

Methanol/ ethylene glycol antidote?

Answer 62

Ethanol.

Question 63

Dabigatran antidote?

Answer 63

Prax bind.

Question 64

Who should be given high dose nicotine patches for NRT?

Answer 64

Those who smoke >/=10 a day.

Question 65

Who should be given medium dose nicotine patches for NRT?

Answer 65

Those who smoke <10 a day.

Question 66

When should a patient be given the higher dose of levonorgestrel as emergency contraception?

Answer 66

If BMI >26 or body weight >70kg.

Question 67

What type of hormonal contraception should you prescribe for a women with a uterus who has had a period in the last year?

Answer 67

Oral/ transdermal sequential combined HRT.

Question 68

What type of hormonal contraception should you prescribe for a woman with a uterus whose last period was >1 year ago OR who has been on HRT for a year?

Answer 68

Oral/ transdermal continuous combined HRT.

Question 69

What type of hormonal contraception should you prescribe for a woman who does not have a uterus?

Answer 69

Oral/ transdermal oestrogen.

Question 70

Types of oral sequential combined HRT?

Answer 70

Elleste Duet tablets | 1/2mg oestradiol + 1mg norethisterone.

Question 71

Types of transdermal sequential combined HRT?

Answer 71

Evorel sequi patches Elleste Duet Conti 50mcg oestradiol + 170mcg norethisterone.

Question 72

Types of oral continuous combined HRT?

Answer 72

Elleste Duet Conti | 2mg oestradiol + 1mg norethisterone.

Question 73

Types of transdermal continuous combined HRT?

Answer 73

Evorel conti patches | 50mcg oestradiol + 170mcg norethisterone.

Question 74

Types of oral unopposed oestrogen HRT?

Answer 74

Elleste solo | 1mg/2mg oestradiol

Question 75

Types of transdermal unopposed oestrogen HRT?

Answer 75

Evorel patch | 25/50/75/100mcg oestradiol.

Question 76

Indications for transdermal HRT therapy?

Answer 76

- Individual preference - Poor symptom control with oral HRT. - GI disorder affecting oral absorption. - Previous or FHx of VTE - BMI >30 - Variable blood pressure control - Migraine - Current use of hepatic inducing enzyme medication - Gall bladder disease

Question 77

What should you prescribe for post-menopausal osteoporosis?

Answer 77

Bisphosphonates + calcium and vitamin D supplement (e.g. Adcal D3).

Question 78

Breakthrough dose of morphine?

Answer 78

1/6th total daily dose of morphine

Question 79

What is preferred to morphine in palliative patients with mild-moderate renal impairment?

Answer 79

Oxycodone

Question 80

What is preferred to morphine in palliative patients with severe renal impairment?

Answer 80

Fentanyl/ Buprenorphine

Question 81

When increasing opioid dose, how much should the dose be increased by?

Answer 81

30-50%.

Question 82

Oral codeine to oral morphine?

Answer 82

Divide by 10

Question 83

Oral tramadol to oral morphine?

Answer 83

Divide by 10

Question 84

Oral morphine to oral oxycodone?

Answer 84

Divide by 1.5/2

Question 85

A 12mcg transdermal fentanyl patch equates to how much PO morphine daily?

Answer 85

30mg

Question 86

A 10mcg transdermal buprenorphine patch equates to how much PO morphine daily?

Answer 86

24mg

Question 87

PO morphine to SC morphine?

Answer 87

Divide by 2

Question 88

PO morphine to SC diamorphine?

Answer 88

Divide by 3

Question 89

PO oxycodone to SC diamorphine?

Answer 89

Divide by 1.5

Question 90

Number of tablets required = ?

Answer 90

Number of tablets = dose required/ dose in tablet.

Question 91

Infusion rate = ?

Answer 91

Total volume in mL/ Total time in hours

Question 92

Volume of liquid medication needed?

Answer 92

What you want x what it's in DIVIDED BY What you've got

Question 93

How much glucose in 100mL 5% glucose?

Answer 93

5g per 100mL