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Finals Revision > PSA > Flashcards

PSA Flashcards

1
Q

Can you give ACEis in pregnancy?

A

No, avoid where possible! Convert to labetalol before conception

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2
Q

How does Tamoxifen affect risk of VTE, endometrial cancer and Warfarin

A

Increases them all
Increased risk VTE and endometrial cancer
Increases efficacy of warfarin

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3
Q

Are lactic acidosis and hypoglycaemia more commonly associated with gliclazide than metformin?

A

Lactic acidosis = NO, it is more commonly associated with Metformin
Hypoglycaemia = YES, not commonly associated with Metformin

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4
Q

When should Gliclazide be taken?

A

In the morning with breakfast
If dose is >160mg take in 2 doses (both with meals)

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5
Q

How frequently is methotrexate given?

A

Once weekly! Give folic acid at least 24 hours after

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6
Q

Which 2 commonly used antibiotics should be avoided with methotrexate and why?

A

Trimethoprim and Co-Trimoxazole
They are folate antagonists and increase its affect!

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7
Q

Name the colours of warfarin tablets?

A

White = 0.5mg
Brown = 1mg
Blue = 3mg
Pink = 5mg

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8
Q

What INR should you aim for in warfarin treatment for AF, DVT or PE?

A

2.5

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9
Q

How does alcohol affect warfarin efficacy?

A

Acute intoxication causes increased affects of warfarin
Chronic excess causes reduced warfarin affects

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10
Q

Are diarrhoea and vomiting concerning in those taking ACEis?

A

Yes they can be, especially in the elderly - increased risk of AKI

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11
Q

When should you monitor renal function and K+ levels after starting ACEis?

A

1-2 weeks following initiation

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12
Q

You are prescribing steroids for >3 months to an elderly patient. What should you also prescribe?

A

Bisphosphonates. Also consider gastric protection

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13
Q

How long can SSRIs take to work?

A

Up to 6 weeks

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14
Q

Over how long a period does HbA1c give a view of glucose control?

A

3 months

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15
Q

What should you do to insulin dosage when a diabetic patient is ill?

A

Increase it - blood glucose levels will increase

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16
Q

Should you take AdCal with Aldendronic acid?

A

No, calcium salts reduced bisphosphonate absorption

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17
Q

How often should alendronic acid be taken?

A

Once weekly

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18
Q

Which type of HRT most increases breast cancer risk?

A

Combined HRT

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19
Q

How long does the increased risk of breast cancer persist after taking HRT?

A

10 years

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20
Q

What are the general rules for which fluid to give?

A

Give all patients NaCl 0.9% UNLESS:
- Hypernatraemic or Hypoglycaemic (give 5% dextrose)
- Has ascites (give Human Albumin Solution)
- Is shocked from bleeding (give blood products)

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21
Q

How much fluid should you give if the patient is tachycardic or hypotensive?

A

500ml bolus immediately
If known HF give 250ml!

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22
Q

How much fluid should you give if the patient is oliguric?

A

1L over 2-4 hours (providing oliguria is not due to urinary obstruction)

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23
Q

What type of drug should be given to prevent a clot enlarging in PE?

A

LMWH!

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24
Q

Which 2 drugs are the first line management of chronic Heart Failure?

A

ACEis and Beta Blockers

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25
Q

What medication should you give first to treat breathlessness in asthma attack?

A

Salbutamol

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26
Q

What medication should you give first to treat chest pain in MI?

A

GTN

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27
Q

What medications can treat breathlessness in acute AF?

A

CCBs or Beta blockers!

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28
Q

What is the treatment to LOWER potassium in hyperkalaemia?

A

Short acting insulin with glucose (Actrapid/Novorapid)
10 units of Actrapid/Novorpaid in 100ml of 20% dextrose over 30mins IV

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29
Q

Focal seizures are best treated with Carbamazepine or Lamotrigine. Under what circumstances would you prefer Lamotrigine?

A

Pregnancy or low sodium (Carbamazepine can cause SIADH)

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30
Q

How do you decide whether to use Metformin or Gliclazide?

A

Metformin = 1st line in overweight patients
Gliclazide = 1st line in normal/underweight patients or if the creatinine is >150

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31
Q

What are the 2 main side effects of Vancomycin and Gentamycin?

A

Nephrotoxicity and Ototoxicity

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32
Q

How often should liver function be measured when taking statins? When would LFTs mean statins are contraindicated

A

Before, at 3 months and at 12 months.
Statins are contraindicated if pre-treatment AST or ALT is raised more than 3 times normal!

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33
Q

Correct blood lithium concentrations are 0.4-0.8mmol/l. When are toxic effects likely to manifest?

A

Serum concentrations above 1.5mmol/l

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34
Q

How often should lithium levels be monitored?

A

Weekly then every 3 months once stable

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35
Q

What should you do if pre-treatment LFTs are abnormal when commencing Methotrexate?

A

NOT treat

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36
Q

What should you do if there is clinically significant drops in WCC or platelets when treating with methotrexate?

A

STOP treatment

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37
Q

Can you give amiodarone to patients with hypokalaemia?

A

Yes but with caution - increased risk of arrhythmias

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38
Q

What is a key side effect of carbimazole?

A

Bone marrow suppression and agranulocytosis - advise patients to report illness e.g. sore throat immediately

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39
Q

What should you always monitor with digoxin treatment?

A

Renal function - digoxin is excreted at the kidneys
Measure plasma digoxin levels if toxicity, non-compliance or inadequate doses are suspected

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40
Q

What is the crucial monitoring needed in clozapine? How long do you need to monitor for?

A

FBC - due to the risk of neutropenia and agranulocytosis
Monitor weekly for 18 weeks after starting! Then every 2 weeks for 1 year then monthly

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41
Q

What is a common ADR of broad spectrum Abx e.g. Cephalosporins or Ciprofloxacin?

A

C. difficile colitis

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42
Q

What are the common ADRs of ACEis?

A

Hypotension, electrolyte abnormalities, AKI and dry cough

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43
Q

What are the common ADRs of Beta Blockers?

A

Hypotension, bradycardia, wheeze in asthmatics, worsening of acute HF

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44
Q

What are the common ADRs of CCBs?

A

Hypotension, bradycardia, peripheral oedema and flushing

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45
Q

What are the common ADRs of Diuretics?

A

Hypotension, electrolyte abnormalities, AKI, gynaecomastia in spironolactone

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46
Q

What are the common ADRs of Heparins?

A

Haemorrhage (especially if renal failure or <50kg), heparin induced thrombocytopenia

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47
Q

What are the common ADRs of Warfarin?

A

Haemorrhage - initially warfarin is procoagulant so heparin should be prescribed alongside until INR >2

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48
Q

What are the common ADRs of Aspirin?

A

Haemorrhage, peptic ulcers, gastritis and tinnitus

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49
Q

What are the common ADRs of Digoxin?

A

Nausea, vomiting, diarrhoea, blurred vision, confusion, drowsiness and xanthopsia (disturbed yellow/green visual perception)

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50
Q

What affect do potassium levels have on digoxin?

A

Low potassium increases its effect, high potassium reduces its effect

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51
Q

What are the common ADRs of Amiodarone?

A

ILD (pulmonary fibrosis), hypo- and hyper-thyroidism, skin greying and corneal deposits

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52
Q

What are the common ADRs of Lithium?

A

Early - tremor
Intermediate - tiredness
Late - arrhythmias, seizures, coma, renal failure, DI

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53
Q

What are the common ADRs of Haloperidol?

A

Acute dystonic reaction and drowsiness

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54
Q

What are the common ADRs of Steroids?

A

Stomach ulcers, Thin skin, oEdema, Right and left heart failure, Osteoporosis, Infection, Diabetes, cushing’s Syndrome

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55
Q

What additional ADR may be seen with fludrocortisone (aside from STEROID acronym)?

A

Hypertension, sodium and water retention

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56
Q

What are the common ADRs of NSAIDs?

A

No urine (renal failure), Systolic dysfunction (heart failure), Asthma, Indigestion, Dyscrasia (clotting abnormalities)

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57
Q

What are the common ADRs of Statins?

A

Myalgia, Abdo pain, increased AST/ALT and rhabdomyolysis

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58
Q

Name the common enzyme inducers?

A

PC BRAS: Phenytoin, Carbamazepine, Barbiturates, Rifampicin, Alcohol (chronic), Sulphonylureas

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59
Q

Name the common enzyme inhibitors?

A

AO DEVICES: Allopurinol, Omeprazole, Disulfiram, Erythromycin, Valproate, Isoniazid, Ciprofloxacin, Ethanol (acute intoxication), Sulphonamides

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60
Q

Which drug should NEVER be prescribed alongside beta blockers?

A

Verapamil (especially IV) as can cause hypotension and asystole

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61
Q

What should you search on the BNF to check vitamin K requirements for warfarin over anticoagulation?

A

Phytomenadione

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62
Q

Is Metformin of a Sulphonylurea more likely to cause hypoglycaemia?

A

Suphonylurea
Metformin is more likely to cause lactic acidosis

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63
Q

What is the 1st line medical treatment for croup?

A

One off PO Dexamethasone (150mcg/kg)

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64
Q

Name 3 drugs commonly associated with dyspepsia?

A

Steroids, bisphosphonates and NSAIDs

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65
Q

Which diabetes drug should be avoided in metabolic acidosis patients?

A

Metformin - it can cause lactic acidosis

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66
Q

Name 2 bulk forming laxatives?

A

Isphaghula husk and Sterculia

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67
Q

Which diabetes drugs are most associated with hypoglycaemia?

A

Insulin and sulphonureas

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68
Q

Name 3 types of women who should be given the higher dose (5mg) folic acid in pregnancy?

A

Previous child with a NTD
On antiepileptics
Has DM

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69
Q

How can you monitor the therapeutic benefit of diuretics in fluid overload treatment?

A

Daily weights

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70
Q

When can activated charcoal be given in paracetamol overdose?

A

If the patient presents within 1 hour of OD

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71
Q

How can you treat cellulitis in a person with a penicillin allergy (i.e. can not have fluclox)?

A

Clarithromycin but if pregnant give erythromycin

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72
Q

Who is diclofenac contraindicated in?

A

Those with a history of IHD, PAD, CVD

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73
Q

Which drugs should be given in the secondary prevention of CVD?

A

ACEis, Beta blockers, dual antiplatelet therapy (aspirin and clopidogrel/ticagrelor) and a statin

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74
Q

Which investigations are required before starting amiodarone?

A

CXR, ECG, U&Es, TFTs, LFTs

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75
Q

What drug should you use as an alternative to PPIs in a patient on methotrexate?

A

Magnesium carbonate (PPIs increase the risk of toxicity)

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76
Q

What is a 10% solution equivalent to in g/ml?

A

10g/100ml

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77
Q

When should you refer a patient to same day secondary care with severe HTN (Systolic BP >180)?

A

If there is papilloedema or retinal haemorrhage on fundoscopy, signs of end organ damage (e.g. confusion, HF or AKI) or suspected phaeochromocytoma (e.g. postural hypotension, abdo pain or palpitations)

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78
Q

What is the first line management for confirmed PE in a haemodynamically stable patient?

A

Apixaban or Rivaroxaban

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79
Q

What is the first line management for confirmed PE in a haemodynamically unstable patient?

A

Unfractionated heparin and thrombolysis

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80
Q

What should patients do if they miss a dose of warfarin?

A

Carry on as normally prescribed (i.e. do NOT double dose)

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81
Q

How does binge drinking affect warfarin?

A

Increases the INR and increases risk of bleeding

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82
Q

What does a 0.025% solution mean in mg/mls?

A

25mg per 100mls or 0.25mg per 1 ml

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83
Q

How many micrograms are in a milligram?

A

1000

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84
Q

Name some notable side effects seen in anti-muscarinics e.g. Oxybutanin?

A

Dry mouth, blurred vision, constipation and cognitive impairment

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85
Q

What drug class is Diclofenac? What is a common side effect to be aware of?

A

NSAID
Dyspepsia, GI ulceration and bleeding

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86
Q

Which type of diuretics are known to increase the risk of gout? Give an example?

A

Thiazide like diuretics
E.g. Indapamide and Metolazone

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87
Q

What is a common use for Prochlorperazine? What is the most important side effect?

A

Tx of Nausea/vomiting and vestibular disorders
Can cause extra pyramidal side effects e.g. acute dystonia

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88
Q

What is an important side effect of statins? When should treatment be stopped?

A

Myalgia, myositis and myopathy
If symptoms are severe of if Creatinine Kinase >5

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89
Q

What formula can be sued to estimate a child’s weight in an emergency situation?

A

(Age+4)x2

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90
Q

How do we convert:
g -> mg -> micrograms -> nanograms

A

Times each by 1000

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91
Q

What concentration is a 1:1000 drug?

A

1g in 1000ml or 1mg per ml

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92
Q

What is the conversion when changing oral morphine to s/c?

A

Divide the dose by 2!

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93
Q

If you prescribe 1L of fluids to be given over 8 hours, how many mls are given per hour?

A

125ml

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94
Q

Can bisphosphonates be crushed?

A

NO - they will cause GI upset

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95
Q

Who is Diclofenac contraindicated in?

A

Those with ischaemic heart disease, peripheral arterial disease or cerebrovascular disease

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96
Q

Name 3 things that will reduce tetracycline antimicrobial absorption?

A

Calcium, antacids and iron

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97
Q

Name 1 thing that will reduce quinolone antimicrobial absorption?

A

Iron

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98
Q

Name 2 things that will reduce ciprofloxacin antimicrobial absorption?

A

Calcium and magnesium

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99
Q

What is the equivalence of digoxin elixir vs tablets?

A

50 micrograms of elixir is equivalent to 62.5 micrograms of tablet

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100
Q

Should SSRIs be taken at night?

A

NO! This can cause sleep disturbances

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101
Q

When should you take levotyroxine?

A

In the morning before breakfast

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102
Q

When should simvastatin be taken?

A

At night

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102
Q

How can vitamin C affect the absorption of iron salts?

A

It increases the speed of absorption

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103
Q

What is the initial treatment for acute and severe asthma attack?

A

Nebulised salbutamol with oxygen

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104
Q

True or false changing the preparation of lithium may require a dose change?

A

True

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104
Q

How often should TFTs be monitored for Thyroid dysfunction in a patient taking lithium?

A

Every 6 months

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105
Q

Is lithium safe for use in pregnancy?

A

No! Avoid where possible

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106
Q

What is the reversal agent for Benzodiazepine overdose

A

Flumazenil

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107
Q

How can we treat unruptured ectopic pregnancy with an adnexal mass <35 and a hCG <1500 with no foetal heat beat?

A

Oral methotrexate

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108
Q

What do we need to monitor with methotrexate therapy?

A

FBC, U&Es and LFTs

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109
Q

Mx of Meningitis in Children?

A

<3 months = IV Cefotaxime and Amoxicillin
>3 months = IV Ceftriaxone

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110
Q

What are the blood pressure targets?

A

<80:
Clinical <140/90, ABPM <135/85
>80
Clinical <150/90, ABPM <145/85

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111
Q

What should you ALWAYS monitor when treating with LMWH or unfractionated heparin for >4 days?

A

Platelet count

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112
Q

What is Acute Intermittent Porphyria?

A

Abdominal pain, hallucinations, polyneuropathy and urine discolouration seen by enzyme deficiency. Commonly caused by medications

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113
Q

When should you take Rivaroxaban?

A

With food

114
Q

How should you treat severe hypercalcaemia with a known malignancy?

A

IV Fluids and IV Bisphosphonates e.g. Zoledronic acid

115
Q

What should you monitor during the administration of phenytoin to check for side effects?

A

ECG and Blood Pressure

116
Q

Which food is known to interact with Felodipine?

A

Grapefruit

117
Q

How do Rifampicin and Atorvastatin interact?

A

Rifampicin increases Atorvastatin’s effect by up to 7 times

118
Q

How does grapefruit juice affect fexofenadine?

A

It will stop its uptake

119
Q

Can you take St John’s Wart alongside SSRIs?

A

NO! It can cause serotonin syndrome

120
Q

How do antacids affect ciprofloxacin?

A

Decrease its absorption. Cipro should be taken 2 hours before or 4 hours after antacids

121
Q

True or false, all anticoagulants interact with SSRIs?

A

TRUE - increased bleeding risk

122
Q

What is the maximum dose of Simvastatin a person can have when they are already taking Diltiazem or Amlodipine?

A

20mg per day

123
Q

Name 4 drugs that are known to cause haemolytic anaemia in those with G6PD deficiency?

A

Anti-malarials, Nitrofurantoin, Quinolones e.g. Ciprofloxacin and Sulphonamides e.g. Co-trimoxazole

124
Q

ACEis can cause angiooedema. Which populations are particularly affected by this?

A

Afro-Caribbean patients

125
Q

How much should you generally increase insulin doses by?

A

10%

126
Q

Ciclosporin is nephrotoxic, how often should you monitor renal function? What else should you monitor?

A

Before starting and every 2 weeks until the dose is stable.
Also monitor BP

127
Q

Above what % rise in creatinine should you be concerned when a patient is taking ACEis?

A

> 20%

128
Q

What is an important side effect of Flucloxacillin to mention?

A

It can cause jaundice

129
Q

What is an important side effect of propranolol to mention to male patients?

A

Erectile dysfunction

130
Q

Which antibiotic is known to stop POP contraceptives? How long should barrier protection be used for after stopping the drug?

A

Topiramate
4 weeks

131
Q

What should you do if a patient on Warfarin has an INR >1.5 the day before surgery?

A

Use PO Vitamin K (Phytomenadione)

132
Q

How should you dose pain medication for breakthrough pain?

A

1/6th of the 24 hour dose using the same drug where possible

133
Q

Which classes of drug should always be stopped in AKI?

A

ACEis and ARBs
Allopurinol should also be stopped

134
Q

Which medications must be stopped prior to surgery?

A

Antiplatelets and anticoagulants, lithium, COCP and HRT, potassium sparring diuretics and ACEis, oral hypoglycaemics and insulin

135
Q

What is the 1st line management for hypoglycaemia where glucogen gel can not be given?

A

Glucose 20% - 150mls over 5 mins

136
Q

What % of 1L of 0.9% NaCl and 1L of HAS will go into the intravascular compartment?

A

0.9% NaCl = 25%
HAS = 100%

137
Q

How can we treat fluid overload which causes pulmonary oedema?

A

Stop fluids, give IV furosemide, give sublingual or IV nitrates and use CPAP

138
Q

What is the most important thing to monitor with clozapine treatment? When should you monitor this?

A

WBC count. Weekly for the 1st 18 weeks, then fortnightly for the 1st year then monthly thereafter.

139
Q

What should you monitor with methotrexate treatment?

A

FBC, U&Es and LFTs weekly until stable and then every 2-3 months thereafter. Also do a CXR before initiating treatment

140
Q

When should you take plasma lithium concentrations?

A

Every 3 months for the first year, every 6 months there after.
Take 12 hours after the dose is given

141
Q

What volumes of fluid/electrolytes should patients be given for maintenance over 24 hours?

A

25-30ml/kg/day water
1mmol/kg/day of sodium, chloride and potassium
50-100 g/day of glucose

142
Q

What is the minimum urine output you should aim for in fluid replacement?

A

0.5ml/kg/hour

143
Q

How much water is lost due to insensible losses in an otherwise healthy individual?

A

500-800mls, increases greatly if the patient is pyrexic, tachypnoeic, sweating or in open surgery

144
Q

When can you use Human Albumin Solution (HAS)?

A

ONLY in those with severe sepsis

145
Q

Name 3 causes of distributive shock?

A

Sepsis, anaphylaxis and neurogenic shock

146
Q

Name 2 causes of hypovolaemic shock?

A

Haemorrhage or burns

147
Q

What are the 4 grades of shock?

A

I = 15% loss
II = 15-30% loss
III = 30-40% loss
IV = 40-50% loss

148
Q

Name 4 causes of cardiogenic shock?

A

Ischaemia, heart failure, arrhythmias and cardiomyopathy

149
Q

Name 2 causes of obstructive shock?

A

PE or cardiac tamponade

150
Q

Which class of drug is most likely to interact with opioids to cause respiratory depression?

A

Benzodiazepines

151
Q

What should you do with patients taking steroids who are ill?

A

Double the dose of steroids

152
Q

What should the target INR be for patients with a prosthetic heart valve?

A

2.5

153
Q

Why should you never prescribe a Beta-blocker and Verapamil?

A

It can cause hypotension, bradycardia and a first degree heart block

154
Q

What is the first and second line treatment for CAP?

A

Amoxicillin first line
Clarithromycin second line

155
Q

What are the treatment options for Chlamydia?

A

Azithromycin (single dose PO)
Doxycycline (7 days PO)

156
Q

What is the typical management plan for treating short term constipation?

A
  1. Give bulk forming laxatives (ispaghula husk)
  2. If stools remain hard add osmotic laxatives (e.g. lactulose)
  3. If stools are soft but hard to pass add stimulant laxatives (e.g. senna)
157
Q

How should you treat faecal impation?

A

If stools are hard give high dose macragol. If stools are soft or macragol is ineffective add oral stimulant laxative (e.g. senna)

158
Q

What parameter will confirm diabetic nephropathy? What drug should you give these patients?

A

Albumin:Creatinine >3mg/mmol
Treat with ACEi or ARB even if the BP is normal

159
Q

Name 3 conditions which require a loading dose regime when starting warfarin?

A

PE, DVT and Cardiac valve replacement

160
Q

When should you monitor INR after initiating or removing an interacting drug from a patient’s drug regime? How regularly should you monitor INR?

A

4-7 days after, measure twice weekly until the patient is stable

161
Q

When should you measure plasma-digoxin concentration?

A

If you suspect toxicity. Measure 6 hours after the dose was given (unless there are features of severe toxicity)

162
Q

Which electrolyte abnormality increases the risk of digoxin toxicity?

A

Hypokalaemia

163
Q

Apart from plasma-digoxin concentration, what else should you measure if you suspect digoxin toxicity?

A

U&Es, pules, blood pressure and cardiac rhythm

164
Q

How long after initiating lithium is it appropriate to measure the serum-lithium concentration?

A

After 4-7 days. Then measure weekly until stable

165
Q

Can you prescribe lithium as a generic name (rather than a branded product)

A

No! Prescribe the brand name as different brands have different bioavailabilities

166
Q

Apart form plasma concentrations what else should you measure in patients on lithium treatment?

A

Cardiac function with ECG, TFTs, U&Es, calcium and BMI every 6 months

167
Q

Name 3 signs of lithium toxicity?

A

Convulsions, hypotension, renal failure, electrolyte imbalances and coma

168
Q

How does hyponatraemia affect lithium concentrations?

A

It increases the concentrations

169
Q

Name 3 Sx of methotrexate toxicity?

A

lymphopenia, thrombocytopenia, pallor, nausea/vomiting, Gi bleeding, dysuria/anuria

170
Q

What is the treatment for bone marrow suppression secondary to methotrexate treatment?

A

Folinic acid rescue therapy

171
Q

Define hypokalaemia, name 4 symptoms?

A

Serum K+ <3.5mmol/l
Muscle weakness/cramps, fatigue, constipation and palpatations

172
Q

True or false, where possible you should use commercially pre-prepared potassium chloride in NaCl over making it up yourself?

A

True!

173
Q

What is the maximum concentration of potassium chloride that can be given via the peripheral route?

A

40mmol/l. If a concentration exceeds this it must be given centrally

174
Q

Define hyperkalaemia, name 4 symptoms?

A

K+ >5.3 mmol/l, severe if >6.5mmol/l
Sx = nausea, muscle weakness, ECG changes, VF

175
Q

What drugs can you give in hyperkalaemia?

A

Calcium gluconate to protect the myocardium (give alongside glucose if taking digoxin)
Reduce serum K+ with insulin and glucose or nebulised salbutamol

176
Q

What blood glucose concentrations should we aim for in diebetics?

A

4-7mmol/l before meals and <9mmol/l after meals

177
Q

When should you measure serum gentamicin concentrations in once daily regimes?

A

After the first dose but before the second dose is delivered - exact timings depend on local guidance

178
Q

Apart from serum levels, what should you always monitor with gentamicin treatment?

A

Renal function!

179
Q

Name 4 Sx of Gentamicin Toxicity?

A

Tinnitus/deafness, balance problems, nausea & vomiting, renal dysfunction, stomatitis, colitis and neutropenia

180
Q

When should you measure vancomycin concentrations?

A

Before the 3rd and 6th dose. Routine monitoring is not required when given PO (to treat C.diff)

181
Q

How fast should you administer vancomycin? What happens if you administer it too quickly?

A

Over at least 60 mins.
Too quickly can cause cardiac arrest, cardiogenic shock, anaphylaxis and red man syndrome (treat with chlorphenamine)

182
Q

Name 4 symptoms of vancomycin toxicity?

A

Blood disorders, fevers, nausea & vomiting, red man syndrome, renal dysfunction and SJS or Toxic epidermal necrolysis

183
Q

When should you measure serum gentamicin concentrations in trough and peak concentration?

A

One hour before the dose and one hour after the dose

184
Q

When should you perform full blood count in a patient on Carbimazole?

A

If there is clinical suspicion of infection

185
Q

How often should you measure TFTs in those on Carbimazole?

A

Every 6 weeks until TSH is within the reference range

186
Q

When treating BV with Metronidazole gel, when should it be administered?

A

At night

187
Q

Which patients will always require IV glucose instead of IM Glucagon in hypogylcaemia?

A

Those who have had a prolonged period of fasting, adrenal insufficiency, chronic hypoglycaemia or alcohol-induced hypoglycaemia or those taking a sulfonylurea

188
Q

Is constipation a concern in those taking Clozapine?

A

YES! Patients should seek immediate medical advice if constipation develops. There is a risk of intestinal obstruction, faecal impaction and paralytic ileus

189
Q

How can we treat cerebral oedema associated with brain metastases?

A

Oral dexamethasone

190
Q

What is the classic triad of Wernicke’s encephalopathy?

A

Mental state changes, ophthalmoplegia and gait dysfunction

191
Q

If GTN fails to control pain in ACS what should you do next?

A

Give IV morphine

192
Q

How would paracetamol dosing be affected if a patient is very light (weighs less than 50kg)?

A

Half the dose (500mg instead of 1g)

193
Q

True or false, combine HRT is safe in women with a PMH of VTE?

A

False! Combined and Oestrogen-only HRT both further increase the risk of VTE

194
Q

True or false, Beta blockers can cause bronchospasm in COPD?

A

True!

195
Q

What type of medication should you always start in elderly patient on long term steroids?

A

Bisphosphonates
Also consider PPI protection

196
Q

When is it best to use metoclopramide over cyclizine?

A

In cardiac cases. Cyclizine is generally first line but it can worsen fluids retention in cardiac cases

197
Q

How should you treat neuropathic pain?

A

Amitriptyline or pregabalin. Give duloxetine in painful neuropathy

198
Q

How do thiazide like diuretics typically affect potassium?

A

They cause hypokalaemia

199
Q

What advice should you give to a patient on oral steroids?

A

When they are sick they should double the dose of their steroids. If they are unable to take oral medications they should switch to IM hydrocortisone

200
Q

Describe the analgesic ladder?

A

Paracetamol
NSAID
Weak opioid e.g. codeine (more constipating) or tramadol (can cause hallucinations and agitation esp. in the elderly)
Strong opioid e.g. morphine

201
Q

How do you treat late onset HAP (acquired >5 days after admission)

A

3/7 IV Piperacillin with Tazobactam then consider changing to oral

202
Q

What are the contraindications to stimulant laxatives and osmotic laxatives respectively?

A

Stimulants are contraindicated with colitis or cramping
Osmotics are contraindicated with bloating

203
Q

What can we give as a 1 off dose to allow immediate relief of dyspepsia?

A

Magnesium carbonate

204
Q

How can we measure improvement in condition following pneumonia treatment?

A

O2 sats, ABG and resp rate

205
Q

Which type of rate control is known to cause facial flushing?

A

CCBs

206
Q

When do we use tamoxifen?

A

In the management of breast and prostate cancer

207
Q

Which types of diuretics can cause gout flare ups?

A

Thiazide like diuretics

208
Q

Should we alter Beta blocker or CCB doses before surgery?

A

No, avoid where possible.
If there is a drop in BP stop diuretics before altering Beta blockers or CCBs

209
Q

Name 3 drugs that reduce the excretion of lithium?

A

ACEis, NSAIDs and diuretics (furosemide is the safest if diuretics are needed)

210
Q

Name the causes of hyperkalaemia?

A

Drugs, Renal failure, Endocrine issues, Artefact (sample failure) and DKA

211
Q

Which type of NIV should you use in type 1 and type 2 respiratory failure respectively?

A

T1 = CPAP
T2 = BiPAP

212
Q

How can you manage exacerbation of COPD?

A

Salbutamol and ipratropium bromide along side Abx

213
Q

When should statins be taken?

A

At night

214
Q

Name a treatment of neutropenic sepsis?

A

Piperacillin with Tazobactam

215
Q

If you prescribe a salbutamol neb e.g. for asthma exacerbation, should you with hold PRN salbutamol inhaler?

A

YES

216
Q

A 88 year old patient has new onset AF (>48hrs) with asthma and peripheral oedema. How should you treat?

A

Digoxin
Bisoprolol is contraindicated due to asthma
Verapamil or Diltiazem can worsen peripheral oedema

217
Q

Those experiencing anaphylaxis, urticaria or rash immediately after administration of a penicillin are more likely to be allergic to what type of Abx?

A

Cephalosporins and other beta lactams (e.g. carbapenems

218
Q

After anaphylaxis how long should you observe the patient for?

A

6-12 hours

219
Q

People who have had severe anaphylaxis to which food product can not receive the influenza vaccine?

A

EGG

220
Q

Name 4 conditions associated with increased risk of drug allergy?

A

HIV, EBV, CMV and CF

221
Q

Name 2 classes of drugs which are known to aggravate urticaria?

A

NSAIDs and Opioids

222
Q

Which 2 drugs can be given alongside IM adrenaline to prevent reoccurrence of symptoms when adrenaline wears off?

A

IV Chlorphenamine and hydrocortisone
You may also choose to give IV or inhaled salbutamol

223
Q

Which two drugs should you prescribe for up to 3 days following a severe drug anaphylaxis?

A

Prednisolone and a non-sedating anti-histamine

224
Q

When should you take mast cell tryptase blood samples in suspected allergy?

A

As soon as possible after emergency treatment and 1-2 hours after symptom onset

225
Q

Is aspirin safe for breast feeding women?

A

No, it can cause Reye’s syndrome

226
Q

You are treating hypothyroidism with levothyroxine. What does it mean if T4 levels are within normal range but TSH is low?

A

You are over treating - reduce the dose

227
Q

Which drugs are known to cause SIADH?

A

Sulfonylureas, tricyclic antidepressants, SSRIs, carbamazepine, vincristine and cyclophosphamide

228
Q

Name 3 drugs that should be used with caution in established IHD?

A

NSAIDs, Oestrogens, Varenicline

229
Q

True or false, we can measure the effectiveness of Digoxin by measuring the ventricular rate?

A

True

230
Q

Name 4 drugs known to worsen seizure control in epileptics?

A

Ciprofloxacin, aminophylline, methylphenidate and mefenamic acid

231
Q

In a COPD patient with an exacerbation how much oxygen should you give if no ABG is available?

A

28% via a venturi mask

232
Q

Under what circumstances can you NOT use eGFR as an estimation of GFR (you must use creatinine clearance)?

A

Older adults, patients on toxic medicines, patients with extremes of muscle mass, patients on medicines with a narrow therapeutic index and patients on DOACs

233
Q

What are the target blood pressures in CKD patients?

A

<140/90 if Albumin:Creatinine is <70
<130/80 if Albumin:Creatinine is >70
If their Albumin:Creatinine is 30 or less they can follow normal HTN guidelines, if it is more than 30 prescribe and ACEi or ARB first line

234
Q

Name 2 circumstances in which ACEis and ARBs should be avoided?

A

In renovascular disease (e.g. renal artery stenosis) or any widespread vascular disease

235
Q

What is the maximum dose of Citalopram in those who are over 65?

A

20mg

236
Q

When treating iron deficiency anaemia with ferrous sulphate, how long should you treat?

A

Until Hb is normalised and then for 3 months after

237
Q

What is the initial Mx of T2DM?

A

Lifestyle modifications with diet and exercise

238
Q

How can excessive alcohol intake affect blood sugar levels in diabetics?

A

It can cause life threatening hypoglycaemia - patients should be warned about this

239
Q

Which type of drugs can be used to prevent expansion of a clot in suspected DVT?

A

LMW Heparins e.g. enoxaparin or dalteparin
Can be given as a one off dose whilst a diagnosis is confirmed

240
Q

Name some SEs of the COCP?

A

Mood changes, headaches, painful/heavy withdrawal bleeds and weight changes

241
Q

Name 3 withdrawal affects of benzos?

A

Tremor, anxiety and insomnia

242
Q

What can be used in the treatment of nausea/vomiting associated with migraine?

A

Prochlorperazine

243
Q

How should levothyroxine dose be adjusted in pregnancy?

A

Increase the dose

244
Q

What is the maximum dose of levothyroxine that should be used in the elderly?

A

50-200 micrograms

245
Q

How do you medically manage GORD in infants/children?

A

Initially treat with Alginic acid. If this is ineffective you can switch to omeprazole

246
Q

Can you use adenosine in those with Asthma and COPD? If no what should you use instead?

A

No, use verapamil

247
Q

Patients with asthma are more at risk of bronchospasm due to ibuprofen if they also have what?

A

Nasal polyps

248
Q

Which type of drug should you stop first in diabetics having hypos?

A

Sulfonylureas e.g. Glicazide

249
Q

True or false, Verapamil is safe in HF?

A

False! It’s contraindicated

250
Q

How should you dose pain relief for breakthrough pain?

A

1/6th of the dose of regular meds

251
Q

What should you prescribe in stable angina?

A

PRN GTN, statin, aspirin, ACEi if DM, CCB or Beta blocker (if ineffective combine or switch)

252
Q

How much Na+ and Cl- is found in 1L of NaCl 0.9%?

A

154 mmol of each

253
Q

Which type of HRT will avoid withdrawal bleeds?

A

Continuous release HRT
Examples include estradiol with levonorgestral and estradiol with norethisterone

254
Q

Can you give beta blockers in peripheral vascular disease?

A

No, they can cause vasoconstriction

255
Q

Can you give ACEi in peripheral vascular disease?

A

Yes if mild but they are contraindicated in critical ischaemia

256
Q

Name 2 classes of drugs known to exacerbate HF?

A

CCBs and steroids

257
Q

Name 3 types of drugs known to cause delirium?

A

Opioids, benzos and trazadone

258
Q

Which type of drug commonly predisposes patients to candida?

A

Steroids

259
Q

How do we mange scarlet fever?

A

Pen V for 10 days

260
Q

What should you do if you miss the first day of a new pack when taking the COCP?

A

Take 2 pills and carry on as normal - no need to use additional barrier contraception or emergency contaception

261
Q

How long should you use contraception for when taking methotrexate? Can you take NSAIDs?

A

Whilst taking the drug and for 6 months after
NSAIDs can be used but with caution

262
Q

How does mirtazipine affect sleep?

A

It causes sleep disturbances and abnormal dreams

263
Q

What is the most common electrolyte abnormality seen with thiazide like diuretics?

A

Hypokalaemia

264
Q

How should you treat an unconscious hypoglycaemic patient?

A

IV 20% glucose
IM can be used in an out of hospital setting

265
Q

Sx of adrenal crisis? How do you treat?

A

Hypotension, hyperkalaemia and hyponatraemia in the context of dizziness, abdo pain, nausea and vomiting with long term steroids use
Mx = hydrocortisone

266
Q

What is the ideal fluid bolus to give in resusitation?

A

500mls 0.9% sodium chloride over 15mins

267
Q

How does naproxen affect the ankles?

A

It can cause ankle oedema

268
Q

Insulin Mx of DKA?

A

Stop short S/C acting insulin, continue long acting S/C insulin and give a fixed rate of IV insulin alongside fluid resusitation

269
Q

What is the first choice management for shingles pain?

A

Simple analgesia e.g. paracetamol. If this fails give amitryptilline

270
Q

What is a good strong opioid to give in the context of renal impairment?

A

Oxycodone

271
Q

What should you do if amiodarone causes thyrotoxicosis?

A

Temporarily withold it

272
Q

Mx of headlice?

A

Dimeticone liquid/spray or Malathion liquid

273
Q

Sx and Mx of Meniere’s disease?

A

Vertigo, hearing loss, tinnitus and a feeling of fullness in the ear
Mx = Betahistine (reduce frequency of the attacks), Prochlorperazine (alleviate nausea and vomiting and vertigo)

274
Q

Which drug should be taken for B12 replacement?

A

Hydroxocolabamin

275
Q

Name a medication used to treat increased Intraocular Pressure?

A

Latanoprost

276
Q

Which diabetic drug is contraindicated if the patient has had bladder cancer?

A

Pioglitazone

277
Q

Which type of diabetes drugs can cause Fournier’s gangrene (necrotising fasciitis of the genitalia)?

A

SGLT2 inhibitors (-flozins)

278
Q

How often should you monitor lithium levels after a dose change?

A

Weekly until stable dose concentration, then every 3 months for the first year and for every 6 months there after

279
Q

How fast should you give an IV fluid bolus?

A

Less than 15 mins

280
Q

How can binge drinking affect the INR?

A

It can increase it and increase the risk of bleeding

281
Q

Patients on Labetalol must be advised to report any signs of liver dysfunction including no specific itch, why?

A

Labetalol can be associated with severe hepatocellular damage

282
Q

What should you do if you develop signs of infection or D&V whilst taking NSAIDs?

A

Stop treatment temporarily to reduce risk of kidney damage

283
Q

Can you give PPIs to those taking methotrexate? If not what is the alternative?

A

Yes but with caution
Use magnesium carbonate instead if possible

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