Questions Flashcards
Rapid IV administration of loop diuretics can lead to what?
Tinnitus
IV loop diuretics should NEVER be given in combination with X?
Aminoglycosides as risk of ototoxicity
Spironolactone - with or without food?
With food
Hyperprolactinaemia is a side effect with most antipychotics, except?
Aripiprazole
Can an AChE inhibitor and memantine be given together?
NICE guidance states that the combination is NOT recommended.
Patients with epilepsy should not be given what anti malarials?
Chloroquine and mefloquine
metformin side effects
GI disturbance and metallic tast in mouth
Frothy pink sputum is indicative of what disease?
Heart failure
Outline gentamicin bacterial cover
Very active against gram neg.
Not active against anaerobes
Is active against pseudomonas
Treatment with gentamicin should ideally be limited to what duration?
7 days
When should treatment be offered to patients with stage 1 hypertension?
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.
When should treatment be offered to patients with stage 2 hypertension
Treat all patients with stage 2 hypertension regardless of their age.
Step 1 hypertension treatment in patients <55 years
ACEi (or ARB if not tolerate)
OR a thiazide diuretic in patients with heart failure or at high risk
Step 2 hypertension treatment is patients <55 years
ACEi + CCB
Step 3 hypertension treatment in patients <55 years
ACEi + CCB+ thiazide diuretic
Step 1 hypertension treatment in patients >55 years or afro /carribbean
CCB or a thiazide diuretic if evidence of heart failure or at risk
Step 2 hypertension treatment in patients >55 years or afro/carribbean
CCB + ACEi/ARB (for black people of african or caribbean origin, consider an ARB in preference to an ACE inhibitor)
Step 3 hypertension treatment in patients >55 years or afrocarribbean
CCB+ ACEi + thiazide
When would a high dose thiazide diuretic be used over spironolate in step 4 hypertension?
If k+ is >4.5mmol/l then should not use spironolactone
How should isolated systolic hypertension be treated?
Should treat as normal
What is the BP target in diabetes?
140/80
What is the BP target in diabetes associated with target organ damage?
130/80
What is the target BP target in CKD?
130/80
What antihypertensive is used first line in pregnancy?
Labetolol usually (unless reason why they can’t have e.g. asthmatic)
Finasteride MHRA alert
MHRA alert r/e reports of depression
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.
Pre-disposing factors for tumour lysis syndrome?
Dehydration and renal impairment
how can cyclophosphamide induced cystitis be managed?
Mensa can be given
Increase the fluid intake 24-48 hours after IV administration can prevent cystitis
Anthracycline monitoring (doxorubicin, epirubicin)
Cardiomyopathy, can lead to HF
What formulations can be used to decrease cardiotoxicity associated with anthraycyclines?
Liposomal formulations - but these can cause foot and mouth syndrome.
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
Rust coloured sputum might indicate what?
Pneuomina
How often should curanail be applied?
Apply once a week
Ciclosporin monitoring
Hypertension is a common s/e need to monitor BP regularly.
Monitor FBC, LFTs, K and Mg
ACEi + ciclosporin interaction
Risk of hyperkalemia
NSAIDs + ciclosporin interaction
Risk of nephrotoxicity
Digoxin dose should be reduced by half if given with what 3 drugs?
Amiodarone, dronderone, quinine
If lithium is to be discontinued, how should it be withdrawn?
Withdraw over at least 4 weeks (preferably 3 months)
Theophylline and salbumatol nebulisers may lead to what electrolyte disturbance?
Hypokalemia
When should theophylline serum monitoring be carried out?
Measure 5 days after starting oral treatment and at least 3 days after any dose adjustement
How long does it take for NSAIDs to have their anti- inflammatory effect?
3 weeks
Which NSAIDs have the highest GI risk?
Piroxicam, ketoprofen
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
Scabies treatment
Permethrin (or malathion) - all members of household should be treated. Apply all other body for 8 hours. Apply twice, one week apart.
Headlice treatment
Dimeticone is product of choice
Benzylbenzoate is less effect and not recommended in children
Malathion - is not to be used in asthma
Step 1 asthma treatment in adults and children over 5 years
PRN SABA
Step 2 asthma treatment in adults and children over 5 years
Regular ICS
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
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)
Step 1 asthma treatment in children <5 years
SABA PRN
Step 2 asthma treatment in children under 5
Add an ICS (if not appropriate then add LTRA)
Step 3 asthma treatment in children under 5 years
Add a LTRA
Refer if <2 years to a specialist
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
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
Which LABA is also licensed for short term symptom relief?
Formeterol - speed of onset is similar to salbutamol
What inhaler treatment should be offered to a patient with COPD and FEV >50%
LABA or LAMA
What inhaler treatment should be offered to a patient with COPD with FEV <50%
LABA/ICS or LAMA
What time of the day should montelukast be taken?
In the evening
What two cough agents might be offered to patients with a dry cough?
Dextrometorphan and pholcodiene
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)
What is the first line treatment for mild-moderate UC?
Aminosalicylates
Sulfasalazine monitoring
Renal function should be monitored at start, after 3 months and then annually.
FBC and LFTs
Why are bismuth antacids (such as pepto bismul) not recommended?
Bismuth antacids are not recommended because absorbed bismuth can be neurotoxic causing encephalopthy
Why are calcium containing antacids not recommended?
Can induce rebound acid secretion
Alginates should be avoided in what patients?
In patients with fluid retention avoid as contain large amounts of sodium
1st line treatment of GORD in pregnancy (after lifestyle)
Antacid or alginates
What is the drug of choice for cholestatic pruritus?
Colestyramine
What is the drug of choice for cholestatic pruritus in pregnancy?
Ursodeoxycholic acid
How should gallstones be treated?
Analgesia with paracetamol or NSAID
Can give IM diclofenac
No evidence for use of ursodeoxycholic acid
Treatment for oesophageal varices?
Terlipressin IV
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
When should orlistat be discontinued as it is considered ineffective?
Discontinue if weight loss has not exceeded 5% after 12 weeks.
1st line treatment for BPH?
Alpha blocker
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.
What should be given to patients at high risk of chemo induced emesis ?
dexamethasone, 5HT3 antagonist and arepitant.
What can be given for methotrexate over dose?
Folinic acid (given as calcium folinate)
Cisplatin monitoring
Monitor FBC, audiology, electrolytes and renal function (risk of nephrotoxicity, cisplatin requires intensive hydration)
Routine pre-med with what is recommended before docetaxel administration?
antihistamine - to prevent severe hypersensitivity reactions
When is tamoxifen given in breast cancer?
Tamoxifen can be given to pre-menopausal women with oestrogen receptor positive breast cancer
When is anastrozole given in breast cancer?
Anastrozole can be given to post-menopausal women with oestrogen positive breast cancer
When should parkinsons treatment be initiated following diagnosis?
Treatment should not usually be started until symptoms cause significant disruption of daily activities
What are the 1st line treatment options for parkinons disease?
Levodopa, non-ergot derived dopamine agonists or MAOi
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
What is herpes zoster?
Shingles
What is herpes simplex?
HSV-1 = cold sores HSV-2 = genital herpes
What is varicella zoster?
Chicken pox
Koplik spots are seen in what condition?
Measles (Fancy term for the spots inside the mouth)
