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1
Q

1st line statin for established CV disease

A

Atorvastatin

Can be taken in the morning unlike simvastatin

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2
Q

First line antihyptertensive in over 55 or Afro-Carribean.

Side effects

A

Amlodipine

SE = dizziness, flushing, hypotension, bradycardia, peripheral oedema

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3
Q

Quetiapine monitoring

A 
FBC, U&E, LFTs at start and annually
Lipids, weight at start, then annually 
FBG and prolactin at start, 6mo then annyally
BP baseline and frequently 
ECG at baseline
CV risk assessment annually
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4
Q

Carbimazole side effects

A

Neutropenia
Agranulocytosis
Warn about sore throats when treatment initiated and check FBC

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5
Q

Alendronate (bisphosphonate) advice

Things to look out for

When should you stop

A

• Take with lots of water sitting/standing on empty stomach > 30 mins before breakfast. Stay upright for 30 mins after.

  • Report atypical femoral #s (hip, thigh, groin pain), osteonecrosis of jaw (see dentist before starting + regular check ups)/auditory canal.
  • Stop and seek medical attention if dysphagia or worsening heartburn
  • Constipation is less important side effect
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6
Q

Empirical therapy for meningitis if >3mo

A

2g IV cefotaxime STAT

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7
Q

Starting opioid treatment

Caution in?

A

Offer patients regular oral release morphine, with 1/6 total dose for breakthrough pain.
Oral release is preferable to transdermal patches.
Laxatives should be prescribed for all starting strong opioids

Careful in CKD patients (use alfentanil, buprenorphine and fentanyl)

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8
Q

If trough levels are raised?

A

Increase interval between doses

Assumes peak dose is not too high (then need to reduce dose size)

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9
Q

If peak levels are raised?

A

Reduce dose drug

Assumes trough dose is not too high (then need to increase dose interval)

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10
Q

Steps of stable angina mangement

A
  1. PRN GTN spray
  2. Secondary prevention (aspirin, statin, CV risk factors)
  3. One anti-anginal depending on CIs (BB or CCI)

then

  1. Increase anti-anginal dose as tolerated
  2. Add second antianginal if not CI, or long acting nitrate or nicorandil
  3. If uncontrolled on two anti-anginals refer for revascularisation
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11
Q

Requirements for water in maintenance fluids?

A

25-30ml/kg/day

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12
Q

Requirements for sodium in maintenance fluids?

A

1mmol/kg/day

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13
Q

Requirements for potassium in maintenance fluids?

A

1mmol/kg/day

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14
Q

Requirements for chloride in maintenance fluids?

A

1mmol/kg/day

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15
Q

Requirements for glucose in maintenance fluids?

How much glucose in 1L 5% glucose

A

50-100g/day

5% = 5g glucose in 100ml, so need 1-2L 5% glucose per day

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16
Q

3 medications to be careful with in ischemic heart disease

A
  1. NSAIDs
  2. Oestrogens (COCP, HRT)
  3. Varenicline
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17
Q

3 drugs to worry about in asthmatics

A
  1. NSAIDs (risk increased if nasal polyps)
  2. BB
  3. Adenosine
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18
Q

Chronic HF Mx steps

A
  1. ACEi + BB (if not contraindiated)
  2. Increases doses as tolerated

If still inadequate add;

  • mild = ARB
  • mod/Afro-Carribean = Hydralazine and isosorbide mononitrate
  • severe = spironolactone

If symptoms persist, cardiac resynchronisation or digoxin can be considered

Give diuretics for fluid overload

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19
Q

Hypoglycemic signs

Which drug worsens awareness

A

Sympathetic signs (sweating, anxiety, confusion, aggression)

BB reduces awareness

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20
Q

When to give NAC in paracetamol overdose

A
  • There is a staggered overdose (doubt over time of ingestion, regardless of concn)
  • Plasma [paracetamol] on or above single treatment line
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21
Q

Test for dignoxin toxicity

A
  1. Digoxin level
  2. ECG
  3. U&Es
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22
Q

Teratogens

A
  1. Tetracyclines
  2. Aminoglycosides
  3. Sulphonaides
  4. Trimethoprim
  5. Quinolones
  6. ACEi
  7. Statins
  8. Warfarin
  9. Sulphonylureas
  10. Retinoids
  11. Cytotoxic agents
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23
Q

Treatment of CAP

A

Amoxicillin

Clarithromycin

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24
Q

Rapid acting insulins (before meals)

A 
Insulin lispro (Humalog)
Insulin aspart (NovoRapid)
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25
Q

Sodium valproate monitoring

A
  • LFTs (pre, first 6mo)

* FBC (only pre treatment)

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26
Q

Corticosteroids side effects

A
  • Endocrine (impaired glucose, increased appetite, hirstutism, hyperlipidaemia)
  • Cushing’s
  • Musk (osteoporosi, myopathy, AVN femoral head)
  • Immuno (reactivation of TB, increased suceptibility to infection)
  • Psych (imsomnia, mania, depression, psychosis)
  • GI (ulceration, pancreatitis)
  • Opthalmic (glaucoma, cataracts)
  • Intracranial HTN
  • Neutrophilia
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27
Q

Carbamezepine

A

SIADH (hypoNa)

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28
Q

Amiodarone monitoring

A
  • TFTs (pre and every 6mo)
  • LFTs (pre and every 6mo)
  • K+ (pre)
  • CXR (Pre)
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29
Q

Monitoring rate control AF with Digoxin

A
  • Ventricular rate (since it is rate control)

* Serum digoxin level at least 6h post-dose

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30
Q

Rifampacin - inducer or inhibitor

A

Inducer

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31
Q

How often methotrexate taken

A

Once per week

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32
Q

Drugs not to be taken while breastfeeding

A
  • Ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
  • Lithium, benzos
  • Aspirin
  • Carbimazole
  • Methotrexate
  • Sulfonylureas
  • Cytotoxic drusg
  • Amiodarone
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33
Q

What proportion of penicillin allergic patients also allergic to cephalosporin

A

0.5% - 6.5%

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34
Q

How many mmol of Na/Cl are there in one L of 0.9% saline?

A

154mmol

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35
Q

Osmotic laxative example

Contraindication

A

Lactulose

Bloating

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36
Q

Stimulant laxative example

Contraindication

A

Senna

Colitis/cramps

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37
Q

Oral codeine> Oral morphine

A

divide by 10

38
Q

Oral tramadol > oral morphine

A

Divide by 10

39
Q

Oral morphine > oral oxycodone

A

Divide by 2

40
Q

Oral morphine > SC morphine

A

Divide by 2

41
Q

Oral morphine > SC diamorphine

A

Divide by 3

42
Q

Metronidazole effect on warfarin

A

Increases antigoaulation effect of warfarin

Increases INR

43
Q

Emregency contraception

A

Levonorgestrel 1.5mg PO stat
Or
Ulipristal 30mg PO Stat

44
Q

Fluconazole - inhibitor or inducer

45
Q

Stable angina management

A
  1. PRN GTN
  2. Secondary prevention (aspirin, statin, CV risk factors)

If still experiencing symptoms

  1. BB or CCI
  2. then add other antianginal or long acting nitrate or nicronadil
  3. If uncontrolled on 2 antianginals refer for revascularisation
46
Q

psoriasis exacerbation

A
  • alcohol
  • beta blockers
  • lithium
  • antimalarials
  • NSAIDs
  • ACEi
  • Infliximab
47
Q

Avoid 5% glucose for fluids in which patients

A

Just had a stroke as risk of cerebral oedema

48
Q

Which drugs affect lithium excretion and increase risk of lithium toxicity

A

NSAIDs - should be avoided in patients taking lithium

49
Q

First line treatment for constipation in children

A 
Macrogols (osmotic) with escalating dose regime. 
Use stimulants (senna) or stool softeners (docusate) if macrogols not tolerated.
50
Q

Oral morphine > SC diamorphine

A

1/3 dose oral morphine = SC dose diamorphine

51
Q

What should you report on the yellow card scheme

A

Suspected ADR to all medicines (vaccines, immunglobulins, herbal medicines etc.) even if reaction is well recognised.

New medicines under additional medicines have ▼ symbol on package and should report all suspected ADRs for these

52
Q

When giving cyclizine SC for nausea, use 0.9% saline or water for dilution?

A

Use water as can precipitate in saline

53
Q

Convert stone to kg

A

1 stone = 6.35kg

54
Q

Selective COXib contraindications

A

History of vascular disease

55
Q

Oculogyric crisis

A

Procyclidine

56
Q

Transdermal patch

A

Estradiol with levonorgestrel

57
Q

Methotrexate

A

Effective contraception must be used for men and women during and for 3mo after treatment

58
Q

when to take loperamide

A

After each loose stool

59
Q

Monitoring adverse effects of COCP

A

Increase in BP

STop if >160/95

60
Q

Monitoring effectiveness of furosemide

A

Body weight

61
Q

Amiodarone ==> thyrotoxicosis management

A

Stop amiodarone as it may be very refractory. Withdraw, at least temporarily, to achieve control

62
Q

VTE in adults with phobia of injection

63
Q

First line treatment of hypoglycemia

A

Glucose 20% 75ml over 10mins

64
Q

Antiplatelets before surgery

A

Stop 7d before

65
Q

Allopurinol with renal problems

A

Max daily dose of 100mg or less until renal function improved

66
Q

Avoid nitrofurantoin if

67
Q

First line treatment in alcohol withdrawal

A

Chlordiazepoxide

68
Q

What to monitor if taking DOAC

A

Report any unexplained bruising bleeding

69
Q

Cholestatic jaundice antibiotic

A

Co-Amoxiclav

70
Q

Starting new ACEi - what to expect from Cr

A

Small rise in Cr expected when starting ACEi

71
Q

NSAIDs in kidney

A

NSAIDs reduce renal flow

72
Q

Addisonian patient sick day rules

A

Double dose steroids

73
Q

Cyclizine side effects

A

Antimuscarinic

74
Q

Ramipril in pregnancy

A

Teratogenic in first trimester > labetalol?

75
Q

Tamoxifen risks

A

Increases risk VTE

76
Q

Methotrexate risk

How often taken

A

Neutoropenia.

Take once per week

77
Q

Citalopram in the sun

A

Increases photosensitivity

78
Q

First line heart failure

A

ACEi plus BB

79
Q

1st line hyperkalaemia

A

5U Actrapid + 50ml 50% glucose over 5 mins

80
Q

2nd line hyperkalaemia

A

5mg nebulised salbutamol stat

81
Q

Metformin for overweight or underweight

A

Overweight

SUs put on weight

82
Q

Immediate relief of dyspepsia?

A

Magnesium carbonate

83
Q

Diabetes insipitus causes

84
Q

What to monitor in HRT or COCP

85
Q

Codydramol

A

Codeine and parcetamol

86
Q

If peak dose is high

A

Reduce dose

87
Q

If trough is high

A

Increase interval

88
Q

Heparins and potassium

A

Hyperkalaemia as decrease aldosterone synthesis

89
Q

Allopurinol in renal dysfunction

90
Q

Citalopram and sodium

A

Canc cause hypoNa

91
Q

Breakthrough pain morphine dose

92
Q

Stopping aspirin before surgery

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