PSA foundation book

Question 1

Reye’s sx

Answer 1

children & aspirin

Question 2

Oculogyric crisis

Answer 2

young females with metoclopramide

Question 3

warfarin is highly bound do albumin

Answer 3

sulfonamides which compete for binding sites cause displacement of warfarin

Question 4

rifampicin is a potent enzyme inducer

Answer 4

increases metabolism of COCP

Question 5

cytochrome P450 (liver- phase 1- oxidation, reduction and hydrolysis) inducers- tf breaks down other drugs

Answer 5

phenobarbitol
rifampicin
phenytoin
ethanol
carbamazepine

Question 6

cytochrome P450 (liver- phase 1- oxidation, reduction and hydrolysis) inhibitors

Answer 6

Disulfiram
chloramphernicol
corticosteroids
cimetidine
MAO-i
Erythromycin
Ciprofloxacin

Question 7

drugs to give earlier in the day as they are stimulants

Answer 7

steroids
SSRIs
aminophylline

Question 8

sleep advice

Answer 8

sleep hygiene (avoid caffeine, alcohol, nicotine, daytime naps, cerebral activity before sleep, encourage exercise, light snack 1-2hours before bed, ear plugs and eye shades)

Question 9

common oral hypnotics- only ST

Answer 9

diazepam
temazepam
zopiclone

Question 10

liver disease and prescribing

Answer 10

-can lead to raised levels of Wafarin, phenytoin and prednisone
hepatic encephalopathy can be made worse by sedative drugs and fluid overload with NSAIDs and corticosteroids
-avoid hepatotoxic drugs- only prescribed by specialist: methotrexate and isotretinoin.
-avoid IM injection- incr risk of bleeding
-paracetamol can be used but consider reduced dose

Question 11

renal disease and prescribing

Answer 11

-NSAID, gentamicin, lithium, Ace-i, IV contrast- give with caution

Question 12

pregnancy acceptable drugs

Answer 12

penicillin, cephalosporin, heparin, ranitidine, paracetamol, codeine

Question 13

pregnancy drugs to avoid

Answer 13

tetracycline, streptomycin, quinolone, wafarin, thiazide, Ace-i, lithium, NSAIDs, alcohol, retinoids, barbiturates, opioids, cytotoxic drugs and phenytoin.

Question 14

children- these drugs can only be prescribed by a specialist

Answer 14

tetracycline
aspirin
prochlorperazine
isoretinoin

Question 15

CI to sedatives

Answer 15

Resp depression

sleep apnoea

Question 16

Sedative SE

Answer 16

hangover
confusion
ataia
falls
aggression
withdrawal sx

Question 17

Steroid SE

Answer 17

GI ulceration
reactivate TB
Skin thinning and poor wound healing
Na and fluid retention
Hyperglaycaemia
Osteoporosis
HTN

Question 18

Steroid SE

Answer 18

GI ulceration
reactivate TB
Skin thinning and poor wound healing
Na and fluid retention
Hyperglaycaemia
Osteoporosis
HTN

Question 19

topical corticosteroids SE

Answer 19

thinning of the skin
worsening local infection, striae and telangiectasia, acne, depigmentation, hypertrichosis, cushion’s and risk of Addison’s

Question 20

c. difficile infection

Answer 20

can lead to pseudomembranous colitis

spores are resistant to stomach acid and alcohol gel

Question 21

c. difficile IX

Answer 21

PCR for toxin then immunoassay for the toxin

Question 22

LTOT criteria

Answer 22

• non smoker- O2<7.3 despite max rx. These values should be stable on two occasions >2weeks apart
• If 7.3-8 need one of cor pulmonale, polycythaemia, peripheral oedema or nocturnal hypoxia
• terminally ill