Question practice Flashcards
A 24-year-old woman with rheumatoid arthritis + asthma is seen in A&E for dysuria, urinary frequency and nausea.
Diagnosed with UTI. A pregnancy test is negative. She is taking co-codamol (8/500 2 tabs 6hrly), omeprazole and methotrexate 15mg weekly (next dose due tomorrow). She is started on Trimethoprim and additional analgesia of paracetamol, ibuprofen by a colleague who asks you to review the prescription before discharging her.
What 4 drugs should be stopped with/without alternative prescriptions?
Paracetamol - already taking max pcm dose in her co-codamol intake.
Methotrexate - stop MTX if ?neutropenic sepsis.
Trimethoprim is a folate antagonist. Contraindication to patients taking methotrexate (another folate
antagonist) due to the risk of bone marrow toxicity.
Ibuprofen - NSAIDs can exacerbate bronchoconstriction in asthmatics.
An 81-year-old patient is being treated for AF. PMH of HTN. He was initially started on warfarin and verapamil, but the ventricular rate remained above 100/min on maximum dose verapamil, so bisoprolol was added. The med reg also noticed peripheral oedema and started furosemide. The patient has a normal ejection fraction.
You have been asked to see him because HR is 52 b.p.m. and BP is 128/72mmHg; all other observations are normal but HIGH INR.
So current drugs are: Furosemide, warfarin, enalapril, verapamil, enoxaparin, bisoprolol.
Which 4 would you stop?
Furosemide - peripheral oedema drug induced not cardiac as normal EF so diuretic not useful.
Verapamil - CCB causing peripheral oedema.
Warfarin - lower INR
Enoxaparin - high INR has increased bleed risk and this drug will add to it.
A 61-year-old patient is admitted following one week of shortness of breath and wheeze. His medical history includes asthma, gout and HTN for which he started treatment a month ago. He is allergic to penicillin and does not smoke. His GP has given him ABx and analgesia believing his symptoms were due to a chest infection but this has not helped.
When you see him his respiratory rate is 32/min, 02 sat 91% (on air) and he is afebrile. He has a widespread expiratory wheeze and a new maculopapular rash over his legs.
Current meds: Allopurinol, amlodipine, aspirin, enalapriil, propranolol, co-amoxiclav, ibuprofen
Which 4 meds should be stopped
Ibuprofen - worsens asthma
Propranolol - CI in asthma
Aspirin - could also worsen asthma like NSAIDs
Co-amoxiclav - allergic to penicillin.
A 68-year-old patient with BPH is admitted with lethargy. He has not passed urine for 5 days and reports painful abdominal distension.
O/E: HR 115bpm, BP 132/88mmHg, RR 18/min, Sa02 99% (on air). Examination reveals a palpable bladder with over
litre of urine visible on bladder scan.
INVESTIGATIONS: hyperkalaemia!!
An ECG shows tall T-waves throughout and sinus tachycardia.
- Write a prescription for the FIRST DRUG to lower the patient’s potassium. (Please use the
‘once only’ section.)
Date. Time. ACTRAPID. 10 UNITS IN 50ML OF 50% GLUCOSE, OVER 15MINS. IV. Signature. Bleep
Not calcium carbonate as this doesn’t lower potassium levels, only cardio protective
How many mg are in 1 mL of a 1% lidocaine solution?
a 1% solution has 1g in 100ml
so 0.01g in 1ml = 10mg
An 18 year old gentleman presents to your GP practice, complaining of eczema on his hands. He regularly uses Eumovate ointment and an emollient. He says this flared up after he went swimming.
His skin is cracked and dry. With no signs of infection.
Write 1 prescription in GP to help his eczema
Beclometasone dipropionate 0.025% cream or ointment 1-2 times daily. 30g
A 45-year old woman has been admitted to the Cardiology Ward. She has MRSA endocarditis, and together with other antibiotics, she has been prescribed vancomycin 20mg/kg intravenously twice daily.
She weighs 56 kg.
Vancomycin is available in 500mg vials which cannot be re-used, and any residual must be discarded.
How many 500mg vials of vancomycin would be required for 7 days????
42 vials:
Single dose = 20mg/kg x 56kg
= 1120mg
= 3 vials (discarding the excess)
Daily dose = 6 vials
One week = 42 vials
A 65-year old woman with metastatic breast cancer has decided to start end-of-life care, and in particular, analgesia via a syringe driver.
Her recent analgesia has been regular morphine sulfate MR 30mg twice daily, and she has had the following “as required” over the last 24 hours:
08: 00 10mg morphine sulfate orally
14: 00 10mg morphine sulfate orally
22: 00 10mg morphine sulfate orally
She is due to be converted to morphine as a subcutaneous infusion. The dose 10 mg morphine orally is equivalent to 5 mg morphine subcutaneously.
The concentration of morphine sulfate for subcutaneous infusion is 50mg/50ml.
What rate (ml/hr) should the morphine sulfate subcutaneous syringe driver be set to provide the equivalent 24hr dose????
Current ORAL morphine sulfate dose in 24hr
= 30x2 (regular) + 10+10+10 (as required)
= 90 mg/24hr
10mg oral morphine = 5mg SC morphine
Equivalent dose = 45mg/24hrs
= 1.875 mg/hr
Concentration of SC morphine = 50mg/50ml
= 1 mg/ml
Therefore rate for 1.875 mg/hr
= 1.875 ml/hr
A 54-year old man is currently in Cardiac High Dependency Unit with cardiogenic shock. He requires a dobutamine infusion.
The available dobutamine ampoules are at a concentration of 250mg/20ml. This is to be diluted to a final concentration of 0.5mg/ml using 0.9% sodium chloride. The final volume of the syringe driver is 50ml.
How much 0.9% sodium chloride (mL) is required for this dilution??
Initial concentration = 250mg/20ml
= 12.5mg/ml
Total dose in 50ml = 0.5mg/mL x 50ml
= 25mg
Therefore volume of stock (12.5mg/ml) dobutamine required = 25mg / 12.5mg/mL
= 2mL
Therefore volume required make up to 50ml = 50 – 2
= 48mL
A 65-year old man is being reviewed with regards to angina. He is currently taking his GTN sublingual spray at least three times a week.
ECG – sinus rhythm 88/min, no ischaemic changes.
He is due further investigations.
In the meantime, he has been started on bisoprolol 2.5 mg orally daily.
Select the most appropriate monitoring option to assess the beneficial effects of this treatment:
Exercise tolerance
Heart rate
Left ventricular ejection fraction
Liver function tests
Postural blood pressure
PR interval
Spirometry
Exercise tolerance
What to monitor for effects of LMWH
anti-factor Xa activity
What to monitor for effects of DOACs
Clinical impression.
A 40yr man is reviewed in anaesthetic pre-op clinic.
PMH = Liver cirrhosis secondary to Hepatitis C, osteoarthritis, portal hypertension, previous variceal bleeds, depression
DH: Gabapentin, Morhpine, Naproxen, Propranolol, Rifaximin, Sertraline.
Examination = Pulse 80/min regular; BP 112/72 mmHg; RR 14/min; oxygen sats 97% RA; GCS 15/15
1. Select the TWO prescriptions where the dose should be altered or stopped entirely in this patient??
2. Select the TWO prescriptions that increases the risk of diarrhoea.
- Naproxen - increases GI bleed esp in patient with cirrhosis and ?varices. Morphine - opiates should be used with caution in hepatic cirrhosis.
- Propranolol and gabapentin.
Write a prescription for IV meds in hypoglycaemia
20% glucose, 50mls, IV, STAT.
Which of these drugs is most likely to interact with Theophyline? Ciprofloxacin Enoxaparin Ipratropium Prednisolone Salbutamol
Ciprofloxasin
