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1
Q

Rapid IV administration of loop diuretics can lead to what?

A

Tinnitus

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2
Q

IV loop diuretics should NEVER be given in combination with X?

A

Aminoglycosides as risk of ototoxicity

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3
Q

Spironolactone - with or without food?

A

With food

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4
Q

Hyperprolactinaemia is a side effect with most antipychotics, except?

A

Aripiprazole

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5
Q

Can an AChE inhibitor and memantine be given together?

A

NICE guidance states that the combination is NOT recommended.

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6
Q

Patients with epilepsy should not be given what anti malarials?

A

Chloroquine and mefloquine

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7
Q

metformin side effects

A

GI disturbance and metallic tast in mouth

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8
Q

Frothy pink sputum is indicative of what disease?

A

Heart failure

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9
Q

Outline gentamicin bacterial cover

A

Very active against gram neg.
Not active against anaerobes
Is active against pseudomonas

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10
Q

Treatment with gentamicin should ideally be limited to what duration?

A

7 days

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11
Q

When should treatment be offered to patients with stage 1 hypertension?

A

Treat stage 1 if patient is under 50 years and has one of the following: target organ damage, cardiovascular disease, diabetes or a CV risk >20%.

If the patient does not have any of these conditions, then offer lifestyle advice and review annually.

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12
Q

When should treatment be offered to patients with stage 2 hypertension

A

Treat all patients with stage 2 hypertension regardless of their age.

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13
Q

Step 1 hypertension treatment in patients <55 years

A

ACEi (or ARB if not tolerate)

OR a thiazide diuretic in patients with heart failure or at high risk

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14
Q

Step 2 hypertension treatment is patients <55 years

A

ACEi + CCB

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15
Q

Step 3 hypertension treatment in patients <55 years

A

ACEi + CCB+ thiazide diuretic

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16
Q

Step 1 hypertension treatment in patients >55 years or afro /carribbean

A

CCB or a thiazide diuretic if evidence of heart failure or at risk

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17
Q

Step 2 hypertension treatment in patients >55 years or afro/carribbean

A

CCB + ACEi/ARB (for black people of african or caribbean origin, consider an ARB in preference to an ACE inhibitor)

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18
Q

Step 3 hypertension treatment in patients >55 years or afrocarribbean

A

CCB+ ACEi + thiazide

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19
Q

When would a high dose thiazide diuretic be used over spironolate in step 4 hypertension?

A

If k+ is >4.5mmol/l then should not use spironolactone

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20
Q

How should isolated systolic hypertension be treated?

A

Should treat as normal

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21
Q

What is the BP target in diabetes?

A

140/80

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22
Q

What is the BP target in diabetes associated with target organ damage?

A

130/80

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23
Q

What is the target BP target in CKD?

A

130/80

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24
Q

What antihypertensive is used first line in pregnancy?

A

Labetolol usually (unless reason why they can’t have e.g. asthmatic)

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25
Finasteride MHRA alert
MHRA alert r/e reports of depression
26
Finasteride counselling points
Risk of depression S/E of breast enlargement, decreased libido, impotence Requires contraception and should be avoided in women of child bearing age. Report signs of male breast cancer.
27
Pre-disposing factors for tumour lysis syndrome?
Dehydration and renal impairment
28
how can cyclophosphamide induced cystitis be managed?
Mensa can be given | Increase the fluid intake 24-48 hours after IV administration can prevent cystitis
29
Anthracycline monitoring (doxorubicin, epirubicin)
Cardiomyopathy, can lead to HF
30
What formulations can be used to decrease cardiotoxicity associated with anthraycyclines?
Liposomal formulations - but these can cause foot and mouth syndrome.
31
How long should children with impetigo remain off school?
Should be kept off school until the lesions have crusted and healed or after 48 hours of starting treatment
32
Rust coloured sputum might indicate what?
Pneuomina
33
How often should curanail be applied?
Apply once a week
34
Ciclosporin monitoring
Hypertension is a common s/e need to monitor BP regularly. | Monitor FBC, LFTs, K and Mg
35
ACEi + ciclosporin interaction
Risk of hyperkalemia
36
NSAIDs + ciclosporin interaction
Risk of nephrotoxicity
37
Digoxin dose should be reduced by half if given with what 3 drugs?
Amiodarone, dronderone, quinine
38
If lithium is to be discontinued, how should it be withdrawn?
Withdraw over at least 4 weeks (preferably 3 months)
39
Theophylline and salbumatol nebulisers may lead to what electrolyte disturbance?
Hypokalemia
40
When should theophylline serum monitoring be carried out?
Measure 5 days after starting oral treatment and at least 3 days after any dose adjustement
41
How long does it take for NSAIDs to have their anti- inflammatory effect?
3 weeks
42
Which NSAIDs have the highest GI risk?
Piroxicam, ketoprofen
43
How should ringworm be treated? (drug, duration)
Topical clotrimazole terbinafine is an alternative treatment - but is not licensed in <16 years and is more expensive. Treatment should be continued 1-2 weeks after disappearance of infection
44
Scabies treatment
Permethrin (or malathion) - all members of household should be treated. Apply all other body for 8 hours. Apply twice, one week apart.
45
Headlice treatment
Dimeticone is product of choice Benzylbenzoate is less effect and not recommended in children Malathion - is not to be used in asthma
46
Step 1 asthma treatment in adults and children over 5 years
PRN SABA
47
Step 2 asthma treatment in adults and children over 5 years
Regular ICS
48
Step 3 asthma treatment in adults and children over 5 years
Consider adding a LABA - if some benefit but control still not adequate then increase ICS Discontinue if ineffective and increase ICS dose. Consider adding a LTRA or M/R theophylline
49
Step 4 asthma treatment in adults and children >5
Increase ICS dose - or add LTRA, m/r theophylline or an oral b agonist (but careful if already taking a LABA)
50
Step 1 asthma treatment in children <5 years
SABA PRN
51
Step 2 asthma treatment in children under 5
Add an ICS (if not appropriate then add LTRA)
52
Step 3 asthma treatment in children under 5 years
Add a LTRA Refer if <2 years to a specialist
53
Management of an acute asthma attack in adults
``` Oxygen (Target 94-98%) High dose SABA nebulisers Prednisolone 40-50mg for 7 days Ipratropium nebulisers Consider a single dose of IV Mg sulphate Routine use of abx is NOT recommended ```
54
Management of an acute asthma attack in children
Inhaled SABA using an MDI and spacer device Prednisolone for 3 days (dose depends on age) If SABA ineffective, consider adding ipratropium bromide Consider Mg sulphate to nebs of salbutamol
55
Which LABA is also licensed for short term symptom relief?
Formeterol - speed of onset is similar to salbutamol
56
What inhaler treatment should be offered to a patient with COPD and FEV >50%
LABA or LAMA
57
What inhaler treatment should be offered to a patient with COPD with FEV <50%
LABA/ICS or LAMA
58
What time of the day should montelukast be taken?
In the evening
59
What two cough agents might be offered to patients with a dry cough?
Dextrometorphan and pholcodiene
60
How could a cough in palliative care be managed?
Morphine is preferred (diamorphine and methadone can also be used - avoid methadone as had a long half life and may accumulate)
61
What is the first line treatment for mild-moderate UC?
Aminosalicylates
62
Sulfasalazine monitoring
Renal function should be monitored at start, after 3 months and then annually. FBC and LFTs
63
Why are bismuth antacids (such as pepto bismul) not recommended?
Bismuth antacids are not recommended because absorbed bismuth can be neurotoxic causing encephalopthy
64
Why are calcium containing antacids not recommended?
Can induce rebound acid secretion
65
Alginates should be avoided in what patients?
In patients with fluid retention avoid as contain large amounts of sodium
66
1st line treatment of GORD in pregnancy (after lifestyle)
Antacid or alginates
67
What is the drug of choice for cholestatic pruritus?
Colestyramine
68
What is the drug of choice for cholestatic pruritus in pregnancy?
Ursodeoxycholic acid
69
How should gallstones be treated?
Analgesia with paracetamol or NSAID Can give IM diclofenac No evidence for use of ursodeoxycholic acid
70
Treatment for oesophageal varices?
Terlipressin IV
71
Orlistat can be given to patients with a BMI of what?
BMI >30 | or a BMI >28 in the presence of other risk factors e.g. T2DM and HTN
72
When should orlistat be discontinued as it is considered ineffective?
Discontinue if weight loss has not exceeded 5% after 12 weeks.
73
1st line treatment for BPH?
Alpha blocker
74
You receive a prescription for sirolumus 1mg OM 28/7. Can you supply 56 x 500mcg tablets?
No- 500mcg tablet is not bioequivalent to the 1 and 2mg tablets and should not be used as a substitute.
75
What should be given to patients at high risk of chemo induced emesis ?
dexamethasone, 5HT3 antagonist and arepitant.
76
What can be given for methotrexate over dose?
Folinic acid (given as calcium folinate)
77
Cisplatin monitoring
Monitor FBC, audiology, electrolytes and renal function (risk of nephrotoxicity, cisplatin requires intensive hydration)
78
Routine pre-med with what is recommended before docetaxel administration?
antihistamine - to prevent severe hypersensitivity reactions
79
When is tamoxifen given in breast cancer?
Tamoxifen can be given to pre-menopausal women with oestrogen receptor positive breast cancer
80
When is anastrozole given in breast cancer?
Anastrozole can be given to post-menopausal women with oestrogen positive breast cancer
81
When should parkinsons treatment be initiated following diagnosis?
Treatment should not usually be started until symptoms cause significant disruption of daily activities
82
What are the 1st line treatment options for parkinons disease?
Levodopa, non-ergot derived dopamine agonists or MAOi
83
A patient on doxycyline has developed a headache and visual disturbances. What action do you take? A) advise them this is a normal side effect and to finish the course B) Advise them to make an appointment with their GP if it does go away in the next 24 hours C) Tell them to stop taking immediately and seek medical attention D) sell them paracetamol
C - headache and visual and disturbances when taking tetracyclines may be a sign of benign intracranial hypertension and treatment should be discontinued
84
What is herpes zoster?
Shingles
85
What is herpes simplex?
``` HSV-1 = cold sores HSV-2 = genital herpes ```
86
What is varicella zoster?
Chicken pox
87
Koplik spots are seen in what condition?
Measles (Fancy term for the spots inside the mouth)

Pre-reg (Rosie) (18 decks)

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