PSA Part 3

Question 1

What adverse effects need to be reported to the Yellow Card Scheme?

Answer 1

All serious allergic reactions should be reported

Diarrhoea, dyspepsia, nausea and urticaria rash would only need to be reported for new drugs which have the black triangle status

Question 2

If a women is already on an enzyme inducer drug, and needs contraception, what contraception is best for them?

Answer 2

Copper intra-uterine device

Women who are already established on enzyme inducers, such as anti-epileptics or antiretrovirals, should be advised of potential interactions with combined contraceptives and offered a reliable form of contraception, such as the copper intra-uterine device

Answer 3

The child is not in shock and appears to be 5% dehydrated, which correlates to clinical dehydration without any red flag features.

Calculating total fluid replacement

1. Calculate the fluid deficit:

Fluid deficit (mL) = % dehydration x weight (kg) x 10 
5% x 19 x 10 = 950 mL
2. Calculate the maintenance fluid requirement:

1000 mL/day for the first 10kg
450 mL/day for the next 9kg
Total = 1450 mL/day
3. Add the fluid deficit and maintenace fluid requirement:

950 + 1450 = 2400 mL/day
4. Calculate the rate (mL/hour):

2400 divided by 24 hours = 100mL/hour

Question 4

How do you calculate the 24 hour maintenance fluid requirements in children over the age of 1 month?

Answer 4

Body-weight 24-hour fluid requirement

Under 10 kg = 100 mL/kg

10–20 kg = 100 mL/kg for the first 10 kg + 50 mL/kg for each 1 kg body-weight over 10 kg

Over 20 kg = 100 mL/kg for the first 10 kg + 50 mL/kg for each 1 kg body-weight between 10–20 kg + 20 mL/kg for each 1 kg body-weight over 20 kg (max. 2 litres in females, 2.5 litres in males)

Question 5

How do you calculate fluid deficit in children?

Answer 5

Fluid deficit (mL) = % dehydration x weight (kg) x 10

Question 6

What drugs are commonly prescribed in micorgrams?

Answer 6

Digoxin

Levothyroxine

Pizotifen - migraine prophylaxis

Question 7

What is Lithium Toxicity exacerbated by? What are some drug examples that can affect renal elimination of lithium/electrolyte imbalances?

Answer 7

ACEi

NSAIDs

Diuretics

Sodium Containing Compounds

Question 8

Which electrolyte disturbances is MOST likely to exacerbate lithium toxicity?

Answer 8

Hyponatraemia

Question 9

What are 5 common drug causes of hepatotoxicity?

Answer 9

Anti-TB drugs

Amiodarone

Azathioprine

Antibiotics

Statins

Question 10

When should you not use LMWH?

Answer 10

After an acute stroke

Question 11

What group of patients is codeine contraindicated in?

Answer 11

Children less than 12 years of age, due to risk of toxicity

Question 12

What type of organ injury do antibiotics cause?

Answer 12

Cause drug-induced liver injury that is either cholestatic, hepatocellular, or mixed

Question 13

How do you measure the beneficial effects of a diuretic?

Answer 13

Urine output and weight

Question 14

What is normal urine output?

Answer 14

0.5-1.5ml/kg/hour

Question 15

40 mmol and 20 mmol of Potassium Chloride in fluids can also be shown as what percentage?

Answer 15

0. 3% is 40 mmol

0. 15% is 20 mmol

Question 16

What is the mnemonic for the principal pharmacological treatments for an infective exacerbation of COPD?

Answer 16

The principal pharmacological treatments for an infective exacerbation of COPD can be remembered using O-ABC (oxygen, antibiotics, bronchodilators, corticosteroids)

Question 17

What is torsades de pointes and how can you get it?

Answer 17

Torsades de Pointes is a specific type of ventricular tachycardia, or fast heart rhythm that begins in your heart ventricles

You can get it if you inherited Long QT syndrome or if you take certain medicines

Common causes for torsades de pointes include drug-induced QT prolongation and less often diarrhea, low serum magnesium, and low serum potassium or congenital long QT syndrome

Question 18

What should capillary blood glucose readings be in T1DM and T2DM before meals and after meals?

Answer 18

T1DM:

Before meals - 4-7 mmol/L
After meals - under 9 mmol/L

T2DM:

Before meals - 4-7 mmol/L
After meals - under 8.5 mmol/L

Question 19

Example of a short acting insulin preparation?

Answer 19

Soluble insulin, ActRapid

Question 20

Example of intermediate-acting insulin?

Answer 20

Isophane insulin, Insulatard

Often mixed insulin - so Biphasic insulin is a combination of short-acting and intermediate acting insulin

Question 21

Example of long-acting insulin?

Answer 21

Insulin Glargine, Lantus

Question 22

What is the insulin used for variable rate IV insulin infusions?

Answer 22

Short acting insulin

Question 23

Gentamicin is contraindicated in what condition?

Answer 23

Myasthenia Gravis

Question 24

Gentamicin - In once daily dose regimens, when should you measure serum-gentamicin concentrations to help avoid toxicity?

Answer 24

Before the second dose is administered

Question 25

Gentamicin - when should you change dose and interval?

Answer 25

High peak concentration - dose need to be reduced

High pre dose concentration - increase time interval between doses

If both are high when measuring, can increase interval and reduce dose at same time

Question 26

When preparing an infusion of amiodarone, what diluent do you use?

Answer 26

Glucose 5%

Amiodarone is incompatible with sodium chloride

Question 27

What are some drugs that can be prescribed by brand names?

Answer 27

Diltiazem Preparations

Antiepileptics

Lithium Salts

Theophylline preparations

Some immunosuppressant therapies - Tacrolimus

Question 28

What is the interaction between amlodipine and simvastatin?

Answer 28

Has the potential to increase exposure to simvastatin

Associated with increased risk of myopathy

Give 10-20mg of simvastatin, if patient is already on amlodipine

Question 29

What are some drugs that might cause confusion?

Answer 29

Anticholinergics

Antipsychotics

Antidepressants

Anticonvulsants

Less common causes - beta blockers, digoxin, H2 receptor antagonists, corticosteroids, NSAIDs, antibiotics

Question 30

What electrolyte and fluid disturbance can HRT cause?

Answer 30

Sodium and fluid retention

Leads to a rise in blood pressure

Should be stopped if BP - 160/95

Question 31

Which drug is generally advised to be used for regular and breakthrough pain relief in palliative care?

Answer 31

The same drug for both, not a different one for each

Question 32

If INR is >1.5 day before surgery, what do you give?

Answer 32

Phytomenadione

Question 33

There is a small rise in what, when you start an ACEi?

Answer 33

Serum creatinine - expected

Question 34

What are anti-emetics indicated for treatment of nausea in acute migraines?

Answer 34

Antiemetics specifically licenced for the treatment of nausea associated with migraines include:

Prochlorperazine 3-6mg buccal PRN - up to 1 dose daily, tablets should be placed high between the upper lip and gum and then left to dissolve

Metoclopramide 10mg PO PRN - up to 1 dose daily

Question 35

When should you take levothyroxine?

Answer 35

30-60 minutes before breakfast, caffeine and other medications