PSA Flashcards
Can you give ACEis in pregnancy?
No, avoid where possible! Convert to labetalol before conception
How does Tamoxifen affect risk of VTE, endometrial cancer and Warfarin
Increases them all
Increased risk VTE and endometrial cancer
Increases efficacy of warfarin
Are lactic acidosis and hypoglycaemia more commonly associated with gliclazide than metformin?
Lactic acidosis = NO, it is more commonly associated with Metformin
Hypoglycaemia = YES, not commonly associated with Metformin
When should Gliclazide be taken?
In the morning with breakfast
If dose is >160mg take in 2 doses (both with meals)
How frequently is methotrexate given?
Once weekly! Give folic acid at least 24 hours after
Which 2 commonly used antibiotics should be avoided with methotrexate and why?
Trimethoprim and Co-Trimoxazole
They are folate antagonists and increase its affect!
Name the colours of warfarin tablets?
White = 0.5mg
Brown = 1mg
Blue = 3mg
Pink = 5mg
What INR should you aim for in warfarin treatment for AF, DVT or PE?
2.5
How does alcohol affect warfarin efficacy?
Acute intoxication causes increased affects of warfarin
Chronic excess causes reduced warfarin affects
Are diarrhoea and vomiting concerning in those taking ACEis?
Yes they can be, especially in the elderly - increased risk of AKI
When should you monitor renal function and K+ levels after starting ACEis?
1-2 weeks following initiation
You are prescribing steroids for >3 months to an elderly patient. What should you also prescribe?
Bisphosphonates. Also consider gastric protection
How long can SSRIs take to work?
Up to 6 weeks
Over how long a period does HbA1c give a view of glucose control?
3 months
What should you do to insulin dosage when a diabetic patient is ill?
Increase it - blood glucose levels will increase
Should you take AdCal with Aldendronic acid?
No, calcium salts reduced bisphosphonate absorption
How often should alendronic acid be taken?
Once weekly
Which type of HRT most increases breast cancer risk?
Combined HRT
How long does the increased risk of breast cancer persist after taking HRT?
10 years
What are the general rules for which fluid to give?
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)
How much fluid should you give if the patient is tachycardic or hypotensive?
500ml bolus immediately
If known HF give 250ml!
How much fluid should you give if the patient is oliguric?
1L over 2-4 hours (providing oliguria is not due to urinary obstruction)
What type of drug should be given to prevent a clot enlarging in PE?
LMWH!
Which 2 drugs are the first line management of chronic Heart Failure?
ACEis and Beta Blockers
What medication should you give first to treat breathlessness in asthma attack?
Salbutamol
What medication should you give first to treat chest pain in MI?
GTN
What medications can treat breathlessness in acute AF?
CCBs or Beta blockers!
What is the treatment to LOWER potassium in hyperkalaemia?
Short acting insulin with glucose (Actrapid/Novorapid)
10 units of Actrapid/Novorpaid in 100ml of 20% dextrose over 30mins IV
Focal seizures are best treated with Carbamazepine or Lamotrigine. Under what circumstances would you prefer Lamotrigine?
Pregnancy or low sodium (Carbamazepine can cause SIADH)
How do you decide whether to use Metformin or Gliclazide?
Metformin = 1st line in overweight patients
Gliclazide = 1st line in normal/underweight patients or if the creatinine is >150
What are the 2 main side effects of Vancomycin and Gentamycin?
Nephrotoxicity and Ototoxicity
How often should liver function be measured when taking statins? When would LFTs mean statins are contraindicated
Before, at 3 months and at 12 months.
Statins are contraindicated if pre-treatment AST or ALT is raised more than 3 times normal!
Correct blood lithium concentrations are 0.4-0.8mmol/l. When are toxic effects likely to manifest?
Serum concentrations above 1.5mmol/l
How often should lithium levels be monitored?
Weekly then every 3 months once stable
What should you do if pre-treatment LFTs are abnormal when commencing Methotrexate?
NOT treat
What should you do if there is clinically significant drops in WCC or platelets when treating with methotrexate?
STOP treatment
Can you give amiodarone to patients with hypokalaemia?
Yes but with caution - increased risk of arrhythmias
What is a key side effect of carbimazole?
Bone marrow suppression and agranulocytosis - advise patients to report illness e.g. sore throat immediately
What should you always monitor with digoxin treatment?
Renal function - digoxin is excreted at the kidneys
Measure plasma digoxin levels if toxicity, non-compliance or inadequate doses are suspected
What is the crucial monitoring needed in clozapine? How long do you need to monitor for?
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
What is a common ADR of broad spectrum Abx e.g. Cephalosporins or Ciprofloxacin?
C. difficile colitis
What are the common ADRs of ACEis?
Hypotension, electrolyte abnormalities, AKI and dry cough
What are the common ADRs of Beta Blockers?
Hypotension, bradycardia, wheeze in asthmatics, worsening of acute HF
What are the common ADRs of CCBs?
Hypotension, bradycardia, peripheral oedema and flushing
What are the common ADRs of Diuretics?
Hypotension, electrolyte abnormalities, AKI, gynaecomastia in spironolactone
What are the common ADRs of Heparins?
Haemorrhage (especially if renal failure or <50kg), heparin induced thrombocytopenia
What are the common ADRs of Warfarin?
Haemorrhage - initially warfarin is procoagulant so heparin should be prescribed alongside until INR >2
What are the common ADRs of Aspirin?
Haemorrhage, peptic ulcers, gastritis and tinnitus
What are the common ADRs of Digoxin?
Nausea, vomiting, diarrhoea, blurred vision, confusion, drowsiness and xanthopsia (disturbed yellow/green visual perception)
What affect do potassium levels have on digoxin?
Low potassium increases its effect, high potassium reduces its effect
What are the common ADRs of Amiodarone?
ILD (pulmonary fibrosis), hypo- and hyper-thyroidism, skin greying and corneal deposits
What are the common ADRs of Lithium?
Early - tremor
Intermediate - tiredness
Late - arrhythmias, seizures, coma, renal failure, DI
What are the common ADRs of Haloperidol?
Acute dystonic reaction and drowsiness
What are the common ADRs of Steroids?
Stomach ulcers, Thin skin, oEdema, Right and left heart failure, Osteoporosis, Infection, Diabetes, cushing’s Syndrome
What additional ADR may be seen with fludrocortisone (aside from STEROID acronym)?
Hypertension, sodium and water retention
What are the common ADRs of NSAIDs?
No urine (renal failure), Systolic dysfunction (heart failure), Asthma, Indigestion, Dyscrasia (clotting abnormalities)
What are the common ADRs of Statins?
Myalgia, Abdo pain, increased AST/ALT and rhabdomyolysis
Name the common enzyme inducers?
PC BRAS: Phenytoin, Carbamazepine, Barbiturates, Rifampicin, Alcohol (chronic), Sulphonylureas
Name the common enzyme inhibitors?
AO DEVICES: Allopurinol, Omeprazole, Disulfiram, Erythromycin, Valproate, Isoniazid, Ciprofloxacin, Ethanol (acute intoxication), Sulphonamides
Which drug should NEVER be prescribed alongside beta blockers?
Verapamil (especially IV) as can cause hypotension and asystole
What should you search on the BNF to check vitamin K requirements for warfarin over anticoagulation?
Phytomenadione
Is Metformin of a Sulphonylurea more likely to cause hypoglycaemia?
Suphonylurea
Metformin is more likely to cause lactic acidosis
What is the 1st line medical treatment for croup?
One off PO Dexamethasone (150mcg/kg)
Name 3 drugs commonly associated with dyspepsia?
Steroids, bisphosphonates and NSAIDs
Which diabetes drug should be avoided in metabolic acidosis patients?
Metformin - it can cause lactic acidosis
Name 2 bulk forming laxatives?
Isphaghula husk and Sterculia
Which diabetes drugs are most associated with hypoglycaemia?
Insulin and sulphonureas
Name 3 types of women who should be given the higher dose (5mg) folic acid in pregnancy?
Previous child with a NTD
On antiepileptics
Has DM
How can you monitor the therapeutic benefit of diuretics in fluid overload treatment?
Daily weights
When can activated charcoal be given in paracetamol overdose?
If the patient presents within 1 hour of OD
How can you treat cellulitis in a person with a penicillin allergy (i.e. can not have fluclox)?
Clarithromycin but if pregnant give erythromycin
Who is diclofenac contraindicated in?
Those with a history of IHD, PAD, CVD
Which drugs should be given in the secondary prevention of CVD?
ACEis, Beta blockers, dual antiplatelet therapy (aspirin and clopidogrel/ticagrelor) and a statin
Which investigations are required before starting amiodarone?
CXR, ECG, U&Es, TFTs, LFTs
What drug should you use as an alternative to PPIs in a patient on methotrexate?
Magnesium carbonate (PPIs increase the risk of toxicity)
What is a 10% solution equivalent to in g/ml?
10g/100ml
When should you refer a patient to same day secondary care with severe HTN (Systolic BP >180)?
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)
What is the first line management for confirmed PE in a haemodynamically stable patient?
Apixaban or Rivaroxaban
What is the first line management for confirmed PE in a haemodynamically unstable patient?
Unfractionated heparin and thrombolysis
What should patients do if they miss a dose of warfarin?
Carry on as normally prescribed (i.e. do NOT double dose)
How does binge drinking affect warfarin?
Increases the INR and increases risk of bleeding
What does a 0.025% solution mean in mg/mls?
25mg per 100mls or 0.25mg per 1 ml
How many micrograms are in a milligram?
1000
Name some notable side effects seen in anti-muscarinics e.g. Oxybutanin?
Dry mouth, blurred vision, constipation and cognitive impairment
What drug class is Diclofenac? What is a common side effect to be aware of?
NSAID
Dyspepsia, GI ulceration and bleeding
Which type of diuretics are known to increase the risk of gout? Give an example?
Thiazide like diuretics
E.g. Indapamide and Metolazone
What is a common use for Prochlorperazine? What is the most important side effect?
Tx of Nausea/vomiting and vestibular disorders
Can cause extra pyramidal side effects e.g. acute dystonia
What is an important side effect of statins? When should treatment be stopped?
Myalgia, myositis and myopathy
If symptoms are severe of if Creatinine Kinase >5
What formula can be sued to estimate a child’s weight in an emergency situation?
(Age+4)x2
How do we convert:
g -> mg -> micrograms -> nanograms
Times each by 1000
What concentration is a 1:1000 drug?
1g in 1000ml or 1mg per ml
What is the conversion when changing oral morphine to s/c?
Divide the dose by 2!
If you prescribe 1L of fluids to be given over 8 hours, how many mls are given per hour?
125ml
Can bisphosphonates be crushed?
NO - they will cause GI upset
Who is Diclofenac contraindicated in?
Those with ischaemic heart disease, peripheral arterial disease or cerebrovascular disease
Name 3 things that will reduce tetracycline antimicrobial absorption?
Calcium, antacids and iron
Name 1 thing that will reduce quinolone antimicrobial absorption?
Iron
Name 2 things that will reduce ciprofloxacin antimicrobial absorption?
Calcium and magnesium
What is the equivalence of digoxin elixir vs tablets?
50 micrograms of elixir is equivalent to 62.5 micrograms of tablet
Should SSRIs be taken at night?
NO! This can cause sleep disturbances
When should you take levotyroxine?
In the morning before breakfast
When should simvastatin be taken?
At night
How can vitamin C affect the absorption of iron salts?
It increases the speed of absorption
What is the initial treatment for acute and severe asthma attack?
Nebulised salbutamol with oxygen
True or false changing the preparation of lithium may require a dose change?
True
How often should TFTs be monitored for Thyroid dysfunction in a patient taking lithium?
Every 6 months
Is lithium safe for use in pregnancy?
No! Avoid where possible
What is the reversal agent for Benzodiazepine overdose
Flumazenil
How can we treat unruptured ectopic pregnancy with an adnexal mass <35 and a hCG <1500 with no foetal heat beat?
Oral methotrexate
What do we need to monitor with methotrexate therapy?
FBC, U&Es and LFTs
Mx of Meningitis in Children?
<3 months = IV Cefotaxime and Amoxicillin
>3 months = IV Ceftriaxone
What are the blood pressure targets?
<80:
Clinical <140/90, ABPM <135/85
>80
Clinical <150/90, ABPM <145/85
What should you ALWAYS monitor when treating with LMWH or unfractionated heparin for >4 days?
Platelet count
What is Acute Intermittent Porphyria?
Abdominal pain, hallucinations, polyneuropathy and urine discolouration seen by enzyme deficiency. Commonly caused by medications
When should you take Rivaroxaban?
With food
How should you treat severe hypercalcaemia with a known malignancy?
IV Fluids and IV Bisphosphonates e.g. Zoledronic acid
What should you monitor during the administration of phenytoin to check for side effects?
ECG and Blood Pressure
Which food is known to interact with Felodipine?
Grapefruit
How do Rifampicin and Atorvastatin interact?
Rifampicin increases Atorvastatin’s effect by up to 7 times
How does grapefruit juice affect fexofenadine?
It will stop its uptake
Can you take St John’s Wart alongside SSRIs?
NO! It can cause serotonin syndrome
How do antacids affect ciprofloxacin?
Decrease its absorption. Cipro should be taken 2 hours before or 4 hours after antacids
True or false, all anticoagulants interact with SSRIs?
TRUE - increased bleeding risk
What is the maximum dose of Simvastatin a person can have when they are already taking Diltiazem or Amlodipine?
20mg per day
Name 4 drugs that are known to cause haemolytic anaemia in those with G6PD deficiency?
Anti-malarials, Nitrofurantoin, Quinolones e.g. Ciprofloxacin and Sulphonamides e.g. Co-trimoxazole
ACEis can cause angiooedema. Which populations are particularly affected by this?
Afro-Caribbean patients
How much should you generally increase insulin doses by?
10%
Ciclosporin is nephrotoxic, how often should you monitor renal function? What else should you monitor?
Before starting and every 2 weeks until the dose is stable.
Also monitor BP
Above what % rise in creatinine should you be concerned when a patient is taking ACEis?
> 20%
What is an important side effect of Flucloxacillin to mention?
It can cause jaundice
What is an important side effect of propranolol to mention to male patients?
Erectile dysfunction
Which antibiotic is known to stop POP contraceptives? How long should barrier protection be used for after stopping the drug?
Topiramate
4 weeks
What should you do if a patient on Warfarin has an INR >1.5 the day before surgery?
Use PO Vitamin K (Phytomenadione)
How should you dose pain medication for breakthrough pain?
1/6th of the 24 hour dose using the same drug where possible
Which classes of drug should always be stopped in AKI?
ACEis and ARBs
Allopurinol should also be stopped
Which medications must be stopped prior to surgery?
Antiplatelets and anticoagulants, lithium, COCP and HRT, potassium sparring diuretics and ACEis, oral hypoglycaemics and insulin
What is the 1st line management for hypoglycaemia where glucogen gel can not be given?
Glucose 20% - 150mls over 5 mins
What % of 1L of 0.9% NaCl and 1L of HAS will go into the intravascular compartment?
0.9% NaCl = 25%
HAS = 100%
How can we treat fluid overload which causes pulmonary oedema?
Stop fluids, give IV furosemide, give sublingual or IV nitrates and use CPAP
What is the most important thing to monitor with clozapine treatment? When should you monitor this?
WBC count. Weekly for the 1st 18 weeks, then fortnightly for the 1st year then monthly thereafter.
What should you monitor with methotrexate treatment?
FBC, U&Es and LFTs weekly until stable and then every 2-3 months thereafter. Also do a CXR before initiating treatment
When should you take plasma lithium concentrations?
Every 3 months for the first year, every 6 months there after.
Take 12 hours after the dose is given
What volumes of fluid/electrolytes should patients be given for maintenance over 24 hours?
25-30ml/kg/day water
1mmol/kg/day of sodium, chloride and potassium
50-100 g/day of glucose
What is the minimum urine output you should aim for in fluid replacement?
0.5ml/kg/hour
How much water is lost due to insensible losses in an otherwise healthy individual?
500-800mls, increases greatly if the patient is pyrexic, tachypnoeic, sweating or in open surgery
When can you use Human Albumin Solution (HAS)?
ONLY in those with severe sepsis
Name 3 causes of distributive shock?
Sepsis, anaphylaxis and neurogenic shock
Name 2 causes of hypovolaemic shock?
Haemorrhage or burns
What are the 4 grades of shock?
I = 15% loss
II = 15-30% loss
III = 30-40% loss
IV = 40-50% loss
Name 4 causes of cardiogenic shock?
Ischaemia, heart failure, arrhythmias and cardiomyopathy
Name 2 causes of obstructive shock?
PE or cardiac tamponade
Which class of drug is most likely to interact with opioids to cause respiratory depression?
Benzodiazepines
What should you do with patients taking steroids who are ill?
Double the dose of steroids
What should the target INR be for patients with a prosthetic heart valve?
2.5
Why should you never prescribe a Beta-blocker and Verapamil?
It can cause hypotension, bradycardia and a first degree heart block
What is the first and second line treatment for CAP?
Amoxicillin first line
Clarithromycin second line
What are the treatment options for Chlamydia?
Azithromycin (single dose PO)
Doxycycline (7 days PO)
What is the typical management plan for treating short term constipation?
- Give bulk forming laxatives (ispaghula husk)
- If stools remain hard add osmotic laxatives (e.g. lactulose)
- If stools are soft but hard to pass add stimulant laxatives (e.g. senna)
How should you treat faecal impation?
If stools are hard give high dose macragol. If stools are soft or macragol is ineffective add oral stimulant laxative (e.g. senna)
What parameter will confirm diabetic nephropathy? What drug should you give these patients?
Albumin:Creatinine >3mg/mmol
Treat with ACEi or ARB even if the BP is normal
Name 3 conditions which require a loading dose regime when starting warfarin?
PE, DVT and Cardiac valve replacement
When should you monitor INR after initiating or removing an interacting drug from a patient’s drug regime? How regularly should you monitor INR?
4-7 days after, measure twice weekly until the patient is stable
When should you measure plasma-digoxin concentration?
If you suspect toxicity. Measure 6 hours after the dose was given (unless there are features of severe toxicity)
Which electrolyte abnormality increases the risk of digoxin toxicity?
Hypokalaemia
Apart from plasma-digoxin concentration, what else should you measure if you suspect digoxin toxicity?
U&Es, pules, blood pressure and cardiac rhythm
How long after initiating lithium is it appropriate to measure the serum-lithium concentration?
After 4-7 days. Then measure weekly until stable
Can you prescribe lithium as a generic name (rather than a branded product)
No! Prescribe the brand name as different brands have different bioavailabilities
Apart form plasma concentrations what else should you measure in patients on lithium treatment?
Cardiac function with ECG, TFTs, U&Es, calcium and BMI every 6 months
Name 3 signs of lithium toxicity?
Convulsions, hypotension, renal failure, electrolyte imbalances and coma
How does hyponatraemia affect lithium concentrations?
It increases the concentrations
Name 3 Sx of methotrexate toxicity?
lymphopenia, thrombocytopenia, pallor, nausea/vomiting, Gi bleeding, dysuria/anuria
What is the treatment for bone marrow suppression secondary to methotrexate treatment?
Folinic acid rescue therapy
Define hypokalaemia, name 4 symptoms?
Serum K+ <3.5mmol/l
Muscle weakness/cramps, fatigue, constipation and palpatations
True or false, where possible you should use commercially pre-prepared potassium chloride in NaCl over making it up yourself?
True!
What is the maximum concentration of potassium chloride that can be given via the peripheral route?
40mmol/l. If a concentration exceeds this it must be given centrally
Define hyperkalaemia, name 4 symptoms?
K+ >5.3 mmol/l, severe if >6.5mmol/l
Sx = nausea, muscle weakness, ECG changes, VF
What drugs can you give in hyperkalaemia?
Calcium gluconate to protect the myocardium (give alongside glucose if taking digoxin)
Reduce serum K+ with insulin and glucose or nebulised salbutamol
What blood glucose concentrations should we aim for in diebetics?
4-7mmol/l before meals and <9mmol/l after meals
When should you measure serum gentamicin concentrations in once daily regimes?
After the first dose but before the second dose is delivered - exact timings depend on local guidance
Apart from serum levels, what should you always monitor with gentamicin treatment?
Renal function!
Name 4 Sx of Gentamicin Toxicity?
Tinnitus/deafness, balance problems, nausea & vomiting, renal dysfunction, stomatitis, colitis and neutropenia
When should you measure vancomycin concentrations?
Before the 3rd and 6th dose. Routine monitoring is not required when given PO (to treat C.diff)
How fast should you administer vancomycin? What happens if you administer it too quickly?
Over at least 60 mins.
Too quickly can cause cardiac arrest, cardiogenic shock, anaphylaxis and red man syndrome (treat with chlorphenamine)
Name 4 symptoms of vancomycin toxicity?
Blood disorders, fevers, nausea & vomiting, red man syndrome, renal dysfunction and SJS or Toxic epidermal necrolysis
When should you measure serum gentamicin concentrations in trough and peak concentration?
One hour before the dose and one hour after the dose
When should you perform full blood count in a patient on Carbimazole?
If there is clinical suspicion of infection
How often should you measure TFTs in those on Carbimazole?
Every 6 weeks until TSH is within the reference range
When treating BV with Metronidazole gel, when should it be administered?
At night
Which patients will always require IV glucose instead of IM Glucagon in hypogylcaemia?
Those who have had a prolonged period of fasting, adrenal insufficiency, chronic hypoglycaemia or alcohol-induced hypoglycaemia or those taking a sulfonylurea
Is constipation a concern in those taking Clozapine?
YES! Patients should seek immediate medical advice if constipation develops. There is a risk of intestinal obstruction, faecal impaction and paralytic ileus
How can we treat cerebral oedema associated with brain metastases?
Oral dexamethasone
What is the classic triad of Wernicke’s encephalopathy?
Mental state changes, ophthalmoplegia and gait dysfunction
If GTN fails to control pain in ACS what should you do next?
Give IV morphine
How would paracetamol dosing be affected if a patient is very light (weighs less than 50kg)?
Half the dose (500mg instead of 1g)
True or false, combine HRT is safe in women with a PMH of VTE?
False! Combined and Oestrogen-only HRT both further increase the risk of VTE
True or false, Beta blockers can cause bronchospasm in COPD?
True!
What type of medication should you always start in elderly patient on long term steroids?
Bisphosphonates
Also consider PPI protection
When is it best to use metoclopramide over cyclizine?
In cardiac cases. Cyclizine is generally first line but it can worsen fluids retention in cardiac cases
How should you treat neuropathic pain?
Amitriptyline or pregabalin. Give duloxetine in painful neuropathy
How do thiazide like diuretics typically affect potassium?
They cause hypokalaemia
What advice should you give to a patient on oral steroids?
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
Describe the analgesic ladder?
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
How do you treat late onset HAP (acquired >5 days after admission)
3/7 IV Piperacillin with Tazobactam then consider changing to oral
What are the contraindications to stimulant laxatives and osmotic laxatives respectively?
Stimulants are contraindicated with colitis or cramping
Osmotics are contraindicated with bloating
What can we give as a 1 off dose to allow immediate relief of dyspepsia?
Magnesium carbonate
How can we measure improvement in condition following pneumonia treatment?
O2 sats, ABG and resp rate
Which type of rate control is known to cause facial flushing?
CCBs
When do we use tamoxifen?
In the management of breast and prostate cancer
Which types of diuretics can cause gout flare ups?
Thiazide like diuretics
Should we alter Beta blocker or CCB doses before surgery?
No, avoid where possible.
If there is a drop in BP stop diuretics before altering Beta blockers or CCBs
Name 3 drugs that reduce the excretion of lithium?
ACEis, NSAIDs and diuretics (furosemide is the safest if diuretics are needed)
Name the causes of hyperkalaemia?
Drugs, Renal failure, Endocrine issues, Artefact (sample failure) and DKA
Which type of NIV should you use in type 1 and type 2 respiratory failure respectively?
T1 = CPAP
T2 = BiPAP
How can you manage exacerbation of COPD?
Salbutamol and ipratropium bromide along side Abx
When should statins be taken?
At night
Name a treatment of neutropenic sepsis?
Piperacillin with Tazobactam
If you prescribe a salbutamol neb e.g. for asthma exacerbation, should you with hold PRN salbutamol inhaler?
YES
A 88 year old patient has new onset AF (>48hrs) with asthma and peripheral oedema. How should you treat?
Digoxin
Bisoprolol is contraindicated due to asthma
Verapamil or Diltiazem can worsen peripheral oedema
Those experiencing anaphylaxis, urticaria or rash immediately after administration of a penicillin are more likely to be allergic to what type of Abx?
Cephalosporins and other beta lactams (e.g. carbapenems
After anaphylaxis how long should you observe the patient for?
6-12 hours
People who have had severe anaphylaxis to which food product can not receive the influenza vaccine?
EGG
Name 4 conditions associated with increased risk of drug allergy?
HIV, EBV, CMV and CF
Name 2 classes of drugs which are known to aggravate urticaria?
NSAIDs and Opioids
Which 2 drugs can be given alongside IM adrenaline to prevent reoccurrence of symptoms when adrenaline wears off?
IV Chlorphenamine and hydrocortisone
You may also choose to give IV or inhaled salbutamol
Which two drugs should you prescribe for up to 3 days following a severe drug anaphylaxis?
Prednisolone and a non-sedating anti-histamine
When should you take mast cell tryptase blood samples in suspected allergy?
As soon as possible after emergency treatment and 1-2 hours after symptom onset
Is aspirin safe for breast feeding women?
No, it can cause Reye’s syndrome
You are treating hypothyroidism with levothyroxine. What does it mean if T4 levels are within normal range but TSH is low?
You are over treating - reduce the dose
Which drugs are known to cause SIADH?
Sulfonylureas, tricyclic antidepressants, SSRIs, carbamazepine, vincristine and cyclophosphamide
Name 3 drugs that should be used with caution in established IHD?
NSAIDs, Oestrogens, Varenicline
True or false, we can measure the effectiveness of Digoxin by measuring the ventricular rate?
True
Name 4 drugs known to worsen seizure control in epileptics?
Ciprofloxacin, aminophylline, methylphenidate and mefenamic acid
In a COPD patient with an exacerbation how much oxygen should you give if no ABG is available?
28% via a venturi mask
Under what circumstances can you NOT use eGFR as an estimation of GFR (you must use creatinine clearance)?
Older adults, patients on toxic medicines, patients with extremes of muscle mass, patients on medicines with a narrow therapeutic index and patients on DOACs
What are the target blood pressures in CKD patients?
<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
Name 2 circumstances in which ACEis and ARBs should be avoided?
In renovascular disease (e.g. renal artery stenosis) or any widespread vascular disease
What is the maximum dose of Citalopram in those who are over 65?
20mg
When treating iron deficiency anaemia with ferrous sulphate, how long should you treat?
Until Hb is normalised and then for 3 months after
What is the initial Mx of T2DM?
Lifestyle modifications with diet and exercise
How can excessive alcohol intake affect blood sugar levels in diabetics?
It can cause life threatening hypoglycaemia - patients should be warned about this
Which type of drugs can be used to prevent expansion of a clot in suspected DVT?
LMW Heparins e.g. enoxaparin or dalteparin
Can be given as a one off dose whilst a diagnosis is confirmed
Name some SEs of the COCP?
Mood changes, headaches, painful/heavy withdrawal bleeds and weight changes
Name 3 withdrawal affects of benzos?
Tremor, anxiety and insomnia
What can be used in the treatment of nausea/vomiting associated with migraine?
Prochlorperazine
How should levothyroxine dose be adjusted in pregnancy?
Increase the dose
What is the maximum dose of levothyroxine that should be used in the elderly?
50-200 micrograms
How do you medically manage GORD in infants/children?
Initially treat with Alginic acid. If this is ineffective you can switch to omeprazole
Can you use adenosine in those with Asthma and COPD? If no what should you use instead?
No, use verapamil
Patients with asthma are more at risk of bronchospasm due to ibuprofen if they also have what?
Nasal polyps
Which type of drug should you stop first in diabetics having hypos?
Sulfonylureas e.g. Glicazide
True or false, Verapamil is safe in HF?
False! It’s contraindicated
How should you dose pain relief for breakthrough pain?
1/6th of the dose of regular meds
What should you prescribe in stable angina?
PRN GTN, statin, aspirin, ACEi if DM, CCB or Beta blocker (if ineffective combine or switch)
How much Na+ and Cl- is found in 1L of NaCl 0.9%?
154 mmol of each
Which type of HRT will avoid withdrawal bleeds?
Continuous release HRT
Examples include estradiol with levonorgestral and estradiol with norethisterone
Can you give beta blockers in peripheral vascular disease?
No, they can cause vasoconstriction
Can you give ACEi in peripheral vascular disease?
Yes if mild but they are contraindicated in critical ischaemia
Name 2 classes of drugs known to exacerbate HF?
CCBs and steroids
Name 3 types of drugs known to cause delirium?
Opioids, benzos and trazadone
Which type of drug commonly predisposes patients to candida?
Steroids
How do we mange scarlet fever?
Pen V for 10 days
What should you do if you miss the first day of a new pack when taking the COCP?
Take 2 pills and carry on as normal - no need to use additional barrier contraception or emergency contaception
How long should you use contraception for when taking methotrexate? Can you take NSAIDs?
Whilst taking the drug and for 6 months after
NSAIDs can be used but with caution
How does mirtazipine affect sleep?
It causes sleep disturbances and abnormal dreams
What is the most common electrolyte abnormality seen with thiazide like diuretics?
Hypokalaemia
How should you treat an unconscious hypoglycaemic patient?
IV 20% glucose
IM can be used in an out of hospital setting
Sx of adrenal crisis? How do you treat?
Hypotension, hyperkalaemia and hyponatraemia in the context of dizziness, abdo pain, nausea and vomiting with long term steroids use
Mx = hydrocortisone
What is the ideal fluid bolus to give in resusitation?
500mls 0.9% sodium chloride over 15mins
How does naproxen affect the ankles?
It can cause ankle oedema
Insulin Mx of DKA?
Stop short S/C acting insulin, continue long acting S/C insulin and give a fixed rate of IV insulin alongside fluid resusitation
What is the first choice management for shingles pain?
Simple analgesia e.g. paracetamol. If this fails give amitryptilline
What is a good strong opioid to give in the context of renal impairment?
Oxycodone
What should you do if amiodarone causes thyrotoxicosis?
Temporarily withold it
Mx of headlice?
Dimeticone liquid/spray or Malathion liquid
Sx and Mx of Meniere’s disease?
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)
Which drug should be taken for B12 replacement?
Hydroxocolabamin
Name a medication used to treat increased Intraocular Pressure?
Latanoprost
Which diabetic drug is contraindicated if the patient has had bladder cancer?
Pioglitazone
Which type of diabetes drugs can cause Fournier’s gangrene (necrotising fasciitis of the genitalia)?
SGLT2 inhibitors (-flozins)
How often should you monitor lithium levels after a dose change?
Weekly until stable dose concentration, then every 3 months for the first year and for every 6 months there after
How fast should you give an IV fluid bolus?
Less than 15 mins
How can binge drinking affect the INR?
It can increase it and increase the risk of bleeding
Patients on Labetalol must be advised to report any signs of liver dysfunction including no specific itch, why?
Labetalol can be associated with severe hepatocellular damage
What should you do if you develop signs of infection or D&V whilst taking NSAIDs?
Stop treatment temporarily to reduce risk of kidney damage
Can you give PPIs to those taking methotrexate? If not what is the alternative?
Yes but with caution
Use magnesium carbonate instead if possible
