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1
Q

Monitoring sodium valproate?

A

LFTs

NOT serum levels

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2
Q

How to monitor DOACs?

A

Cr clearance/eGFR

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3
Q

Ciclosporin monitoring?

A

Trough levels before dose

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4
Q

Digoxin monitoring?

A

6hrs post dose

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5
Q

For gentamicin - when to increase time between, and when to change dose?

A

If the pre-dose (‘trough’) concentration is high, the interval between doses must be increased.

If the post-dose (‘peak’) concentration is high, the dose must be decreased.

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6
Q

Carbamazepine effect on Na?

A

Causes hyponatraemia

Other SE: rash, dysarthria, ataxia, nystagmus

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7
Q

What to prescribe alongside valproate?

A

Vitamin D

Monitor LFTs

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7
Q

Define status epilepticus.

A

Convulsive status epilepticus is a prolonged convulsive seizure for 5 minutes or longer, or recurrent seizures one after the other without recovery in between.

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8
Q

Lamotrogine SE?

A

Rash

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9
Q

Valproate SE?

A

Tremor
Teratogenicity
Tubby (weight gain)

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10
Q

Safest anti-epileptic in pregnancy?

A

Lamotrogine

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11
Q

CCF treatment?

A

Upright
Oxygen
Nitrates
Furosemide
ACEi
Reduce and Na to reduce afterload.

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12
Q

Stable angina tx?

A

1st: BB - atenolol, bisoprolol. In decompensated HF: CCB like verapamil/diltiazem

2nd: combine BB + CCB (If inappropriate: long acting nitrate e.g. ivabradine, nicorandril)

Intolerant of both CCB/BB: long acting nitrate monotherapy

Response to treatment assessed 2-4 weeks

Prinzmetal’s angina - amlodipine may be effective

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13
Q

Chronic HF treatment?

A

AVOID any CCB (verapamil and nifedipine classes) in HFrEF

  1. Furosemide
  2. ACEi + BB(NB: not all licensed) - reduce morbidity and mortality
  3. K+ sparing - spironolactone, eplerenone

Other:
- amiodarone
- digoxin - no mortality effect
- sacubitril with valsartan (ARNI)
- ivabradine
- empagliflozin/ dapagliflozin

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14
Q

Why is digoxin only generally used in older patients?

A

Affects exercise tolerance

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15
Q

CCB rate control?

A

Vera and Dil

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16
Q

Rhythm control drugs AF?

A

Ami and Flec

CI in structural HD

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17
Q

GTN prescription?

A

“GTN spray (glyceryl trinitrate)” (can write 400 micrograms/metered dose if you want next to this)
“2 sprays sublingual”

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18
Q

BB in acute HF?

A

Worsen symptoms

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19
Q

Antihyperglycaemic CI in HF?

A

Pioglitazone

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20
Q

Laxative types?

A

BOSS
Bulk forming e.g. methylcellulose

Osmotic e.g. macrogol, lactulose, phosphate enema

Stool softening e.g. docusate sodium, arachis oil

Stimulant e.g. senna, bisacodyl, glycerol

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21
Q

Disadvantages of bulk forming?

A

Slow to work
Must drink fluids
Unsuitable for atony/faecal impaction

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22
Q

Disadvantages of osmotic laxatives?

A

Bloating
Unsuitable for obstruction with perforation risk

23
Q

Disadvantages of stimulant laxatives?

A

Cramping
Unsuitable for obstruction

24
Advantages of stool softeners?
Can be used for faecal impaction but beware when giving to pt who already have soft stools
25
UC management?
Mild <4, mod 4-6, severe >6 with systemic upset Mild to moderate: 1. Topical 5-ASA 2. Oral 5-ASA - if remission not achieved within 4 weeks; all left sided UCs 3. Topical/oral corticosteroid ADD Oral azathioprine or mercaptopurine - if 2 exacerbations in last year Severe: 1. Hospital admission 2. IV hydrocortisone (+/- IV ciclosporin) NB: methotrexate NOT used in UC tx
26
Crohn's management?
Steroids- topical, oral, IV Enteral feeding + stop smoking 5-ASA - not as effective as in UC Infliximab - refractory or fistulating Crohn's Add on aza/mercapto to induce remission. NB: azathioprine/mercapto never used alone to induce remission in Crohn's but used alone to maintain remission.
27
Can you use PPI to Tx GI SE of alendronic acid?
Np - bisphosphonates are direct irritants so PPIs don't improve symptoms
28
Emergency contraceptive pills?
Lenonorgestrel (Levonelle) - <3days, double if BMI >26. Ulipristal acetate - <5day
29
Examples of continuous HRT (no bleed)?
levonorgestrel 7 mcg/estradiol 50 mcg/24hrs weekly patch or estradiol 50/norethisterone acetate 170 /24 hours twice weekly patch
30
Above which BP should COCP be stopped?
> 160/95 mmHg
31
Main end of life medications?
1) Antisecretion - HYOSCINE 2) Agitation - MIDAZOLAM (10-20mg/24hrs) 3) Pain - MORPHINE 10mg/24hr if new 4) Nausea - CYCLIZINE 150mg/24hr
32
Alternative to morphine if not tolerated?
Oxycodone
33
Tx for bone pain?
Bisphosphonates
34
Tx for bowel colic, bladder spasm?
Antispasmodic (e.g. hyoscine butylbromide)
35
Opioid toxicity treatment?
IV 400 micrograms naloxone in 10mls 0.9% sodium chloride IV 0.5ml (i.e. 20 micrograms naloxone) every 2mins until respiratory recovery
36
Vomiting from gastric stasis?
Metoclopramide or domperidone
37
Vomiting from raised ICP?
Cyclizine
38
Can you use buprenorphine for breakthrough pain?
No because it has both agonist and antagonist properties and so may cause withdrawal or more pain in someone dependent on opioids
39
Antihistamine in anaphylaxis?
Chlorphenamine
40
Acute asthma management?
Oxygen Salbutamol 5mg neb Hydrocortisone IV* 100mg (or pred PO 40mg) Ipratropium* 500mcg neb (Theophylline)* (Magnesium sulphate 2g IV)* (Escalate, reassess every 15 min, repeat nebs) () indicate senior input * indicates if life threatening
41
Acute COPD management?
Oxygen (28%, aim 88-92%, unless peri-arrest) Salbutamol 5mg neb Hmm…oral pred 30mg ( in 5 mg!! tablets daily for 5 days) other oral steroids not appropriate Ipratropium 500 mcg neb Abx if evidence of infection (amox, clarithromycin, doxycycline) O SHI- Ah
42
Asthma ladder?
SABA 1. + ICS 2. + LABA 3. Increase ICS or add LTRA 4. Refer
43
Paediatric asthma ladder?
SABA 1. + VL ICS 2. + LABA >=5, +LTRA <5 3. Increase ICS or add LTRA/LABA 4. Refer SO same as adults except in young children you add LTRA as step 2
44
Patient is in HF, do you give them either cyclizine or metoclopramide?
metoclopramide NB: cyclizine S/E fluid retention, urinary retention, constipation, dry mouth
45
ECG when citalopram given with clarithromycin?
Long QT
46
Anticholinergic excess SE?
MAD - delirium (elderly), confusion RED - flushing, tachycardia DRY - dry mouth + eye, constipation, urinary retention BLIND - blurred vision Drugs such as amitriptylline, paroxetine, antipsychotics, cyclizine.
47
How long does it take for enzyme induction?
Days to weeks
48
How long does it take for enzyme inhibition?
Weeks to months
49
β-blockers and verapamil together?
Profound hypotension and asystole Verapamil is non-dihydropyridine
50
Difference between classes of CCBs?
Dihydropyridine = peripheral Non-dihydropyridine = more SA and AV node depression than peripheral action
51
MAOi and alcohol?
Hypertension
52
SE of BBs?
nightmares bradycardia hypotension bronchospasm cold extremities fatigue
53
What does 1: 1000 mean?
1g in 1000ml
54
What does 1% mean?
1g in 100ml

- Y6 PSA (8 decks)

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