PSA Flashcards
1
Q
What is a risk factor associated with osteonecrosis of the jaw in patients on bisphosphonates?
A
poor dental hygiene
2
Q
What are the adverse effects associated with bisphosphonates?
A
Oesophageal reactions e.g., oesophagitis, ulcers
Osteonecrosis of the jaw
Increased risk of atypical stress fractures
Hypocalcaemia
3
Q
How should bisphosphonates be administered?
A
30 minutes before breakfast, with water on an empty stomach
4
Q
Prior to bisphosphonate therapy, what should be corrected first?
A
Correct calcium and vitamin D
5
Q
Why is pioglitazone contraindicated in heart failure?
A
Causes fluid retention
6
Q
Why is verapamil contraindicated in heart failure?
A
Exerts a negative inotropic effect
7
Q
Why are NSAIDs not recommended in patients with heart failure?
A
Causes fluid retention
8
Q
Lifestyle + Metformin - HbA1c target?
A
48 mmol/mol
9
Q
HbA1c target for sulfonylurea
A
<53 mmol/mol
10
Q
When should oxygen be delivered in ACS management?
A
if oxygen saturations are <94%
11
Q
How is fondaparinux administered?
A
SC injection
12
Q
What is the preferred VTE prophylactic drug?
A
Low molecular weight heparin (LMWH) e.g., enoxaparin
13
Q
Which type of heparin is indicated as VTE prophylaxis in patients with CKD?
A
Unfractionated heparin (UFH)
14
Q
What are the common adverse effects associated with amlodipine?
A
Diarrhoea, peripheral oedema, headache,
15
Q
What parameter is used to assess whether the digoxin dose is effective?
A
Ventricular rate at rest
16
Q
When should the digoxin level be measured post administration?
A
at least 6 hours after the last dose
17
Q
Which drug is used as an alternative to adenosine, in patients with asthma?
A
Verapamil
18
Q
Which two investigations are recommended to assess for digoxin toxicity other than digoxin level?
A
ECG
Urea and electrolytes
19
Q
Which drugs are usually taken at night?
A
Statins and amitryptiline
20
Q
Which anti-emetic is indicated in patients that have a prolonged QT interval?
A
Cyclizine
21
Q
Which three anti-emetics are associated with QT prolongation?
A
Metoclopramide
Ondanestron
Haloperidol
22
Q
What is the first line drug for the management of shingles?
A
800 mg acyclovir oral five times daily for 7 days
23
Q
What is the first line pain management for postherpetic neuralgia?
A
Simple analgesia e.g., paracetamol
24
Q
What is the first line management for fluid resuscitation?
A
IV crystalloids 500 mL bolus over 15 minutes e.g., 0.9% sodium chloride
25
What effect does ciclosporin have on potassium?
Hyperkalaemia
26
What is the investigation performed prior to starting statins?
Serum AST/ALT
27
When should serum ALT be checked once starting statin therapy?
At 3 and 12 months
28
When should a statin be stopped in reference to serum transaminase level?
3 x UPPER normal limit of AST/ALT
29
What investigation should be performed prior to starting vancomycin?
Serum creatinine - renal function
30
What is the normal reference range for lithium?
0.4-0.8
31
How frequently should lithium levels be measured once stabilised?
Every 3 months
32
What investigations should be checked at baseline when starting methotrexate?
Baseline FBC and liver function tests
33
How frequently should FBC be measured in patients first starting methotrexate, until stabilisation?
Every 1-2 weeks
34
What investigations are performed at baseline in patients starting olanzapine?
Blood lipids, weight and fasting blood glucose
35
Which investigation is important to perform in patients starting hormonal contraception?
Blood pressure
36
Which electrolyte should be checked prior to starting amiodarone?
Potassium
37
What baseline investigations should be performed prior to starting amiodarone?
Baseline X-ray due to pulmonary toxicity
38
When is the 1-hour peak serum concentration for gentamicin?
3-5 mg/L
39
What investigation should be performed in regular intervals in patients on ACEi?
Urea and electrolytes
40
What investigation is performed prior to starting sodium valproate?
Liver function tests at baseline
41
How frequent should FBC be measured in patients on clozapine?
Weekly for the first 18 weeks due to agranulocytosis risk
42
What are the two main adverse effects associated with gentamicin and vancomycin?
Ototoxicity
Nephrotoxicity
43
What visual disturbance is associated with digoxin?
yellow/green visual perception distortion
44
What are the main adverse effects associated with aspirin?
Peptic ulcers, and gastritis
Tinnitus in large doses
45
What is the early adverse effect associated with lithium?
Tremor
46
What are the late adverse effects associated with lithium?
Renal failure
Diabetes insipidus
Seizures
47
What are the commonest enzyme inhibitors (AO DEVICES)?
Allopurinol
Omeprazole
Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol
Sulphonamides
'AODDEVICES'
48
What are the commonest enzyme inducers (PC BRAS)?
Phenytoin
Carbamazepine
Barbituates
Rifampicin
Alcohol
Sulphonylureas
49
What significant adverse drug reaction is associated with metformin?
Lactic acidosis
50
What adverse drug reaction is associated with monoamine oxidase inhibitors?
Hypertensive crisis
51
Which drug is contraindicated in patients taking methotrexate and why?
Trimethoprim - increased risk of bone marrow suppression, pancytopenia and neutropenic sepsis
52
What class of drug is amiloride?
Potassium-sparing diuretic
53
What effect does amiloride have on potassium?
Hyperkalaemia
54
What effect does erythromycin have on INR?
Increases INR - Cytochrome p450 inhibitor
55
What is the preferred ABx for severe HAP?
IV Tazocin
56
What is the main adverse effect associated with semaglutide?
Nausea
57
What investigations should be monitored for short-course prednisolone?
Blood pressure and urinary glucose
58
What investigation should be performed prior to starting arirpriazole?
Serum prolactin
59
What investigation is performed to assess for treatment response for statins?
Lipid profile
60
What parameter is assessed to monitor treatment response in patients with pneumonia?
Respiratory rate
61
What parameter is assessed to monitor treatment response in patients with acute exacerbation of asthma?
Oxygen saturations
62
What is measured to assess for the efficiency of furosemide in acute heart failure?
Weight change
63
Which drugs should be discontinued before surgery?
Antiplatelets (aspirin), anticoagulants (heparin), and the contraceptive pill, lithium
64
What should happen to short-acting insulin prior to surgery?
Converted to a sliding scale
65
What is the maximum daily dose of paracetamol?
4 g/day
66
What dose of alendronic acid is prescribed weekly?
70 mg
67
What is the daily dose of alendronic acid?
10 mg
68
What should happen to steroid dose pre-surgery?
Doubled
69
Which drugs can increase lithium toxicity?
Thiazide like diuretics and ACE inhibitors (reduce lithium renal excretion)
70
In patients on levothyroxine replacement therapy presenting with low TSH (below reference range), what should be done to the dose?
Reduce levothyroxine dose
71
What fluids should be prescribed to patients with hypokalaemia?
1 L potassium chloride over 4 hours (20 mmol) with 5% dextrose
72
Over how many hours is 1L of calcium/potassium replacement delivered?
4 hours
73
Over how many hours is typical maintenance fluids (e..g, 1 L of 0.9% sodium chloride delivered)?
8 hours
74
Why should the dose of phenytoin be increased by minimum increments?
Phenytoin has a narrow therapeutic index
75
Maximum daily dose of potassium?
1 mmol/kg/day
76
In patients with hyperkalaemia, which investigation should be performed?
ECG
77
What is the first line diabetic drug in patients with chronic kidney disease?
Gliclazide (sulphonylurea)
78
What type of analgesia is codeine?
Weak opioid
79
What is co-codamol?
Paracetamol and codeine
80
Which anti-emetic is indicated for central causes of nausea and vomiting?
cyclizine
81
What class of anti-emetic is ondanestron?
5HT3 antagonist
82
What is the first line drug for patients with congestive acute heart failure?
IV furosemide 80 mg STAT
83
Emergency fluid resuscitation fluids
0.9% sodium chloride 500 mL 10 minutes
84
Emergency hypoglycaemia fluids
Glucose 20% 100 mL 15 minutes
85
Emergency hypokalaemia fluids
Sodium chloride 0.9%/potassium chloride 0.3% 1 L over 4 hours
86
Emergency hypercalcaemia fluids
Sodium chloride 0.9% 1L over 4 hours
87
Over how many minutes should 20% glucose 100 mL be administered?
Over 15 minutes
88
What is the initial fluid equation for children?
10mL/kg 10 minutes
89
What effect does both omeprazole and alendronic acid have on stools?
Diarrhoea
90
When should loperamide be taken?
After each loose stool
91
Time duration for antidepressant effect to take place?
4-6 weeks
92
Frequency of methotrexate administration
Once a week
93
What is co-prescribed with methotrexate?
Folic acid
94
What is the benefit of co-prescription of folic acid with methotrexate?
Reduced methotrexate-induced mucositis and myleosuppression
95
What should be monitored during methotrexate treatment?
Monitor FBC, renal and liver function (reports of dyscrasias) and liver cirrhosis
96
How should clozapine be discontinued?
Gradual dose reduction over 1-2 weeks due to risk of rebound psychosis
97
Contraceptive advice for patients on isotretinoin?
2 complementary user-dependent forms of contraception
98
What should be monitored in children on steroids?
Height and weight, BP
99
Which class of antibiotics is contraindicated in patients on insulin?
Macrolides - increased risk of hypoglycaemic episodes
100
Why are macrolide antibiotics contraindicated in statins?
Cytochrome p450 inhibitors - reduced metabolism = increased myopathy and rhabdomyolysis
101
What adverse effect is commonly associated with ACE-inhibitors?
Dry cough due to increased bradykinin
102
What effect does ibuprofen have on kidney perfusion?
Reduces renal artery diameter and blood flow - decreases GFR
103
What is the maximum daily dose of paracetamol?
4 g
104
Which is the preferred first-line anti-emetic?
Cyclizine
105
How frequently should methotrexate be prescribed?
Weekly
106
What is the maximum dose of citalopram for patients aged >65?
20 mg
107
What is the haemoglobin cut-off for blood transfusion?
<70 g/L
108
What are the common adverse effects associated with phenytoin use?
Gum hyperplasia and dysarthria
109
In the event of ECG changes and hyperkalaemia, what is the first-line management?
10% calcium gluconate 30 mL, 10 minutes
110
Which drug is indicated for the rate control of fast AF, in the context of known asthma?
Digoxin
111
What is the reversible warfarin agent in patients with minor bleeding (INR 5-8)?
Slow injection of vitamin K
112
What is a common adverse effect associated with opioid-based medication - and should be counselled on?
Constipation - advice additional laxatives
113
Which laxative is contraindicated for opioid-induced constipation?
Bulk-forming laxatives
114
What anti-androgen adverse effect is associated with spioronolactone?
Gynaecomastia
115
What is the consequence of failing to rotate insulin injection sites?
Lipodystrophy
116
What effect does excessive alcohol consumption have on glucose levels in patients with diabetes?
Hypoglycaemia
117
Which is a common anxiolytic prescribed to pre-operative patients for anxiety?
2 mg diazepam oral (once-only medicine)
118
What investigation should be performed prior to prescribing sodium valproate?
Liver function tests
119
What investigation should be monitored during a phenytoin infusion?
ECG (and BP)
120
What adverse effect does the concomitant use of NSAIDs have with methotrexate use?
Increase thrombocytopenia risk
121
What adverse effect is associated with the concomitant use of methotrexate with trimethoprim?
Myelosuppression
122
Frequency of methotrexate administration?
Weekly
123
1st line drug for the management of an Addisonian crisis?
IV hydrocortisone
124
Metformin three times a day - surgery rule?
Omit lunchtime dose
125
Sulfonylurea - surgery dose rule?
Omit morning dose
126
Which anti-diabetic drug should immediately be discontinued on the day of surgery?
SGLT-2 inhibitors
127
What is the preferred antimicrobial agent for prophylaxis during the caeserean section?
Cefuroxime
128
Most common adverse effect associated with methotrexate (concerning)?
Leucopenia
129
In which form is the risk of ototoxicity highest in patients taking furosemide?
Intravenous
130
Which four drugs are associated with ototoxicity?
Gentamicin
Furosemide
Bumetanide
Vancomycin
131
What are the common precipitants of c-difficile diarrhoea?
Omeprazole (PPIs)
Low magnesium
Low sodium
Antibiotics e.g., co-amoxiclav, clindamycin, ciprofloxacin, cephalosporins
132
What is the antidote to opioid overdose?
Naloxone IM 400 micrograms
133
Dose units for levothyroxine?
Micrograms
134
Dose units for digoxin?
Micrograms
135
What effect does phenytoin have on the combined oral contraceptive pill?
Phenytoin is predicted to decrease the efficacy of Combined hormonal contraceptives
136
First-line drug for drug-induced Parkinsonism?
Procyclidine hydrochloride
137
Which drug is indicated for the management of neuroleptic malignant syndrome?
Dantrolene or bromocriptine
138
What effect do quinolones have on the QT interval?
QT-prolongation
139
Adverse effect associated with quinolones?
Risk of tendon rupture
Reduce seizure threshold
140
When should metformin be stopped (eGFR threshold)?
<30
141
How frequently should blood glucose be checked?
At least every 4 hours (>5 times/day)
142
When should a double dose of levonestregel be administered for vomiting patients?
If vomiting occurs within 3 hours
143
What is the main contraindication to ulipristal acetate?
Contraindicated in asthma
144
What is the reversible agent for benzodiazepines?
Flumazenil
145
Which drug is associated with floppy iris syndrome?
Tamsulosin
146
When should lithium be discontinued pre-surgery?
Day before surgery
147
For how long should COCP be discontinued for prior to surgery?
4 weeks before surgery
148
When should potassium-sparing diuretics and ACE inhibitors be discontinued for surgery prep?
4 weeks before surgery
149
How should the gentamicin dose be adjusted if the trough is >2?
Increase dose interval
150
How should the gentamicin dose be adjusted if the peak is >10?
Decrease the dose
151
On the day before surgery, what should be done to the long-acting insulin dose?
Dose reduction by 20%
152
Which drug is indicated in the management of giant-cell arteritis with visual changes?
Intravenous Methylprednisolone 0.5-1g IV daily for 3 days
153
What is the first-line management for ring-worm?
Clotrimazole 1% cream topical 1- application
154
What is the first-line anti-emetic for nausea and vomiting during pregnancy?
Promethazine
155
Which drugs are associated with a tremor?
Haloperidol, salbutamol, theophylline
156
What effect does nitrofurantoin have on respiratory function?
Hypersensitivity reaction in acute form
Pulmonary fibrosis (long-term)
157
Which antibiotic increases the risk of seizures in patients on sodium valproate?
Meropenem
158
