PSA

Question 1

Enzyme Inducers

Answer 1

↑ Enzyme Activity, ↓ Drug Concentration
PC BRAS:
Phenytoin, Carbamazepine, Barbiturates, Rifampicin, Alcohol (chronic excess), Sulphonylureas

Question 2

Enzyme Inhibitors

Answer 2

↓ Enzyme Activity, ↑ Drug Concentration
AODEVICES:
Allopurinol, Omeprazole, Disulfiram, Erythromycin, Valproate, Isoniazid, Ciprofloxacin, Ethanol (acute intoxication), Sulphonamides

Question 3

Drugs to stop with surgery

Answer 3

COC/HRT: 4 weeks before
Lithium: 1 day before
Potassium-sparing diuretics/ACE-inhibitors: Day of surgery
Anticoagulants (warfarin/heparin including prophylactic dose); Antiplatelets (aspirin/clopidogrel/dipyridamole): Variable (normally 7 days occasionally continued during surgery)
-Oral hypoglycaemic drugs and insulin: Variable
-Metformin stopped because lactic acidosis.
-Other oral hypoglycaemics and insulin stopped becaause hypoglycaemia
-Sliding scale should be used

Question 4

Drugs to increase with surgery

Answer 4

Steroids: as the stress of surgery could cause an adrenal crisis

Question 5

Prophylactic heparin specific concern

Answer 5

Contraindicated in ischaemic stroke, due to bleeding risk

Question 6

Spironolactone SE

Answer 6

Hyperkalaemia,Gynaecomastia

Question 7

Amount of replacement fluids in HF

Answer 7

250ml NaCl

Question 8

Max speed for IV K+

Answer 8

10mmol/hr

Normally comes in 20mmol

Question 9

Fluid requirements per kg

Answer 9

25-30ml/kg of H20
1mmol/kg of Na/Cl/K
50-100g of glucose

Question 10

Good starting antiemetics

Answer 10

Cyclizine: oral/IV/IM 50mg 8hrly (watch fluid retention in cardiac pts)
Metoclopramide: 10mg 8hrly (avoid in parkinson’s and movement disorders, dopamine antagonist)

Question 11

Neuropathic pain first line

Answer 11

pregabalin, or amitriptyline

Question 12

Drug class contraindicated with CCBs

Answer 12

BBs

Question 13

Causes of low neutrophils

Answer 13

Clozapine, Carbimazole, Viral infection, Chemo/Radiotherapy

Question 14

Types of hyponatraemia

Answer 14

Hypovolaemic: Fluid loss, Diuretics
Euvolaemic: SIADH
Hypervolaemic: HF, renal failure

Question 15

Types of hypernatraemia

Answer 15

Dehydration, drips (too much NaCl), drugs, diabetes insipidus

Question 16

Types of hypokalaemia

Answer 16

Drugs (loop/thiazine diuretics)
Inadequate intake (d&v)
Renal tubular acidosis 
Endocrine (Cushing's/Conn's syndromes)

Question 17

Types of hyperkalaemia

Answer 17

Drugs (K+ sparing diuretics, ACEis. LMWH)
Renal failure 
Endocrine (addison's)
Artifact 
DKA

Question 18

Raised urea with normal creatinine meaning

Answer 18

Upper GI haemmorhage

or dehydration

Question 19

Liver enzymes raised

Answer 19

Hepatic: AST/ALT
Obstructive: ALP

Question 20

Drugs causing cholestasis

Answer 20

Flucloxacillin, co-amoxiclav, nitrofurantoin, steroids and sulphonylureas

Question 21

Using TSH to alter levothyroxine dose in hypothyroidism

Answer 21

<0.5 - reduce dose

>5 - increase dose

Question 22

Digoxin toxicity

Answer 22

confusion, nausea, visual halos, arrhythmias

Question 23

Lithium toxicity

Answer 23

Early: Tremor, fatigue
Late: arrhythmias, seizures, renal failure, coma

Question 24

Phenytoin toxicity

Answer 24

gum hypertrophy, ataxia, nystagmus, peripheral neuropathy, teratogenic

Question 25

Gentamicin/Vancomycin toxicity

Answer 25

ototoxicity and nephrotoxicity

Question 26

High INR management

Answer 26

<6 reduce dose
6-8 omit for 2 days then reduce dose 
>8 omit and give vit K
if bleeding and INR >5 then give vit K
if >1.5 day before surgery then give vit K

Question 27

Valproate SEs

Answer 27

Tremor, teratogenic, weight gain

Question 28

Types of laxatives

Answer 28

Softener: Docusate
Bulking: Isphagula husk
Stimulant: Senna, Bisocadyl
Osmotic: Lactulose, phosphate enema

Question 29

Antimuscarinc drugs and SEs

Answer 29

Can’t see, wee, spit or shit

Cyclizine, amitriptyline, ipratropium

Question 30

Haloperidol MoA

Answer 30

Dopamine antagonist so can’t be used in parkinson’s

Question 31

HTN in pregnancy

Answer 31

Labetalol

Do not use ACEis

Question 32

Gliclazine information

Answer 32

Beware of hypos, so don’t take at night and don’t miss meals

Question 33

Carbimazole vs Carbmazepine

Answer 33

carbimazole: antithyroid
carbmazepine: antiepileptic

Question 34

Types of insulin

Answer 34

Rapid: Insulin aspart (NovaRapid), insulin lispro (Humalog)
Short acting: Actrapid, Humulin S
Long acting: insulin determir (Levemir), insulin glargine (Lantus)

Question 35

1% means

Answer 35

1g in 100mL
10mg in 1mL
1g in 100g (weight/weight)

Question 36

Drug X: 20mg/2ml, how much NaCl added to get 1mg/ml

Answer 36

18ml

Question 37

Actrapid dose in Hyperkalaemia

Answer 37

10U in 100mL of 20% Dex, over 30Mins

Question 38

Metformin and kidneys

Answer 38

Don’t use of creatine >150

or eGFR is <30

Question 39

Alcohol interactions

Answer 39

NSAIDs: GI bleeding risk
Metformin: Lactic acidosis
Warfarin: Acute = more bleedy, chornic = less bleedy
MAOis: HTN crisis
Metronidazole/disulfiram: sweating, flushhing N+V
Opiods/benzos: sedation

Question 40

Types of ARB

Answer 40

Candesartan, Losartan, valsartan

Question 41

Adrenaline doses

Answer 41

Cardiac Arrest: 1mg, 1:10,000 (10mL)

Anaphylaxis: 0.5mg, 1:1,000 (0.5mL)

Question 42

Normal Urine Output

Answer 42

1000-2000mL per day

Oliguric if <500mL per day (<20mL per hr)

Question 43

statin dosage

Answer 43

Atorvastatin
20mg Primary Prevention
80mg secondary prevention

Question 44

IV Glucose in hypoglycaemia

Answer 44

20% Glucose 100mL over 15mins

10% Glucose 100mL over 15mins