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1
Q

Patient on HRT having withdrawal bleeds, wants a patch that won’t cause withdrawal bleeds?

A

Everol Conti self adhesive patch.

1 patch transdermal twice a week.

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2
Q

Scarlet fever management?

A

Phenoxymethylpenicillin 10days QDS PO (125mg)

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3
Q

INR range for bioprosthetic mitral valve?

A

2.5 (within 0.5 is always acceptable)

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4
Q

Missed pill advice for COCP?

A

9 completed days of HFI (hormone free interval) - consider emergency pill if UPSI

48 and <72hrs since last pill in week 1 - emergency pill not required if consistent pill taking in lass 7 days

If 2-7 pills missed - take the last missed pill ASAP then use barrier contraception for 7 days but emergency contraception not needed if there was consistent pill taking 7 days prior (backup for subsequent incorrect use)

If 2 or more missed pills in week prior to HFI then do not take the HFI

Qlaira pills
- 12hr margin but management depends on which day it was missed.

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5
Q

Missed pill advice for mini pill?

A

Most have a 3hr window

For desogestrel the window is 12hrs and drospirenone is 24rs.

If more than one pill has been missed only one should be taken. But if one has been missed you can take 2 in a 24hr period.

Use additional contraception for 2 days (or 7 days for drospirenone)

https://cks.nice.org.uk/topics/contraception-progestogen-only-methods/management/progestogen-only-pill/#missed-pill

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6
Q

Methotrexate contraception?

A

Contraception during and for at least 6 months after treatment in men and women.

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7
Q

Gemfibrozil interaction with common medication?

A

Simvastatin - increases risk of myopathy as gemfibrozil is a CYP inhibitor

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8
Q

When do you stop statin in myopathy?

A

If CK >5 times upper limit of normal or severe symptoms

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9
Q

How does fentanyl convert to oral morphine?

A

25mcg/hr patch of fentanyl = 60-90 MST

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10
Q

Treatment for moderate severe acne, having tried topical therapy?

A

Doxycycline

Lymecycline

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11
Q

Standard dose for tacrolimus?

A

Maintenance dose is commonly 1-2mg BD

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12
Q

Tacrolimus and dalteparin combination effect?

A

Hyperkalaemia

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13
Q

When do you stop antiplatelets before surgery?

A

7 days prior - exceptions are if there was recent vascular stenting

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14
Q

Allopurinol in AKI?

A

Need to be held - renally excreted and max dose is 100mg in renal failure

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15
Q

Reversal of high INR no bleeding?

A

Phytomenadione (vitamin K) 1-5mg orally

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16
Q

Does topiramate affect COCP/POP?

A

Yes reduces their efficacy so need to use alternative contraception

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17
Q

How can dabigatran interact with an antidepressant?

A

Increased risk of bleeding if used with citalopram for example

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18
Q

What is an acceptable rise in creatinine when starting an ACEI?

A

<30% is acceptable, if it rises to <30% do not stop, just repeat renal function tests in 1 week

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19
Q

Monitoring the affect of ACEI in heart failure?

A

Exercise tolerance - think NYHA classification is how we grade severity

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20
Q

Whats the usual increase of an insulin dose when the patient goes on glucocorticoids?

A

10% increase

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21
Q

What should non-HDL cholesterol have decreased by once started on statins?

A

> 40%

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22
Q

What is a normal INR?

A

0.8-1.2

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23
Q

Target INR in metallic valves?

A

3-4

24
Q

What to do in case of high INR +/- bleeding?

A

Major bleed - stop warfarin, give vit K1 by slow IV, give dried PCC (alt: FFP)

INR 5-8 no bleed - withhold 1-2 doses warfarin and reduce subsequent maintenance

INR 5-8 minor bleed - stop warfarin and give VitK by slow IV

INR >8 no bleed- stop warfarin, give vit K by MOUTH using IV preparation, repeat after 24hrs if still too high, restart warfarin when INR <5

INR >8 + minor bleed - stop, give Vit K, repeat vit K after 24hrs if needed, restart warfarin when INR <5

25
Q

Drugs that increase risk of bleeding even if INR in range?

A

NSAIDs
steroids
aspirin, clopidogrel

26
Q

Monitoring when starting someone on warfarin?

A

INR daily, or alternate days, until 2-3 on two consecutive occasions

(a meaningful INR can only be obtained 3–4 days after starting Tx)

Then, twice weekly for 1–2 weeks (this should be continued if HT, RF or bleed risk)

Then, weekly measurements until > two INR measurements are 2-3

Thereafter, longer intervals (for example, < 12 weeks, if agreed locally)

Once stable, changes seldom required.

27
Q

When to stop warfarin before surgery?

A

5 days before (converted to tinzaparin/LMWH)

Restart evening of surgery/next day

INR before surgery needs to be <1.5

28
Q

What to consider when prescribing DOACs?

A

eGFR

29
Q

If a pt on warfarin with INR in range is being Tx with clarithromycin?

A

continue warfarin at normal dose and re-check INR in 48 hours

30
Q

Enoxaparin/dalteparin/tinzaparin are contraindicated in?

A

with current (or history of) heparin-induced thrombocytopenia

high risk of bleeding (e.g. acute gastroduodenal ulcer, cerebral haemorrhage, conditions causing a predisposition to bleed, serious coagulation disorders)

within 3 months stroke (unless due to emboli)

31
Q

Dose of tinzaparin for 60kg patient in DVT Tx?

A

When calculating note that it can only be given in 1000unit increments

tinzaparin sodium 20000 units/mL injection
175 units/kg SC daily
60*175 = 10500
but can only be given in increments of 0.05ml which is 1000 units
therefore 11 000 units is practical for administration

32
Q

MOA of fondaparinux?

A

Synthetic pentasaccharide that inhibits activated factor X

33
Q

Treatment of heparin OD?

A

protamine sulfate

34
Q

Tamoxifen effect on INR?

A

If on warfarin then INR will increase on tamoxifen treatment

35
Q

What should you not prescribe on methotrexate?

A

Trimethoprim
Co-trimoxazole

36
Q

Effect of acute alcohol on warfarin?

A

Increases INR as it inhibits enzyme

Chronic alcohol intake will induce enzymes and reduce INR

37
Q

Name some side effects of citalopram?

A

Photosensitivity
Excess salivation

38
Q

Instructions for taking bisphosphonate tablet?

A

Weekly
Do not take within 2hrs of AdCal
Avoid food for 2hrs post dose
Take with full glass of water and stay upright for 30mins

39
Q

How to prevent alcohol relapse?

A

Acamprosate

40
Q

When would you Tx paracetamol OD with NAC before waiting for blood results?

A
  1. if taken >150 mg/kg
  2. staggered overdose
  3. if doubt over dose

Otherwise if plasma concentration on or above the treatment line (100mg/L at 4hrs)

NB: to avoid underestimating the potentially toxic paracetamol dose ingested by obese patients who weigh more than 110 kg, use a body-weight of 110 kg (rather than their actual body-weight) when calculating the total dose of paracetamol ingested (in mg/kg).

41
Q

King’s College Hospital criteria for liver transplantation (paracetamol liver failure)?

A

Arterial pH < 7.3, 24 hours after ingestion

or all of the following:

prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy

42
Q

Over how long do you infuse NAC?

A

Over 1hr

43
Q

Causes of hypernatraemia?

A

All Ds
dehydration
drips
drugs
diabetes insipidus

44
Q

Causes of low potassium?

A

DIRE

Drugs (loop i.e. furosemide + thiazide diuretics)
Inadequate intake/intestinal loss (D+V)
Renal tubular acidosis
Endocrine (Cushing’s + Conn’s syndromes)

45
Q

Causes of high potassium?

A

DREAD

Drugs (K+ sparing diuretics and ACEi)
Renal failure
Endocrine (Addison’s)
Artefact (very common, due to clotted sample)
DKA (NB when insulin is given the K+ drops requiring regular (hourly) monitoring +/− replacement)

46
Q

How to differentiate pre-renal from obstructive/intrinsic AKI using urea and creatinine?

A

Creatinine can rise with severe prerenal AKI but urea>creatinine rise usually

To differentiate this from intrinsic and obstructive AKI, multiply the urea by 10; if it exceeds the creatinine then this suggests a prerenal aetiology

Postrenal and intrinsic AKI has creatinine > urea

47
Q

Nephrotoxic abx?

A

gentamicin
vancomycin
tetracyclines

48
Q

Cause of high urea with normal creatinine?

A

If low Hb -> GI bleed

49
Q

When to alter thyroxine dosing according to TSH?

A

TSH

< 0.5 - lower dose
0.5-5 - keep dose
> 5 - increase dose

50
Q

What ABG abnormality can diuretics cause?

A

Metabolic alkalosis with thiazide diuretics esp at higher doses

51
Q

Does aspirin need to be stopped in AKI?

A

No - NSAID but doesn’t cause renal failure

52
Q

Which antibiotics do steroids interact with to cause Achilles tendon rupture?

A

Fluoroquinolones e.g. ciprofloxacin or moxifloxacin

53
Q

Abx used to treat bone infection with S/E of abx colitis?

A

clindamycin

54
Q

What Abx is contraindicated in MG?

A

Gentamicin - aminoglycosides may impair neuromuscular transmission

55
Q

Verapamil and BB interaction’?

A

Severe bradycardia

- Y6 PSA (8 decks)

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