Section 1: Prescribing Flashcards

1
Q

What type of HRT would you prescribe in a perimenopausal woman?

A

Without hysterectomy - give oestrogen + progestogen to prevent endometrial cancer e.g. levonorgestrel 7mcg/ estradiol 50mcg/ 24h via patch

If hysterectomy, give estradiol 50mcg/24h transdermal patch

Switch to continuous HRT with oestrogen + progestogen instead of 1 or 3 monthly regimes where progestogen only added on for 14 days if there is withdrawal bleeds

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2
Q

What are the starting doses for statins?

A

Atorvastatin - 20mg for primary prevention, 80mg for secondary prevention
Simvastatin - 40mg, increase if necessary up to 80mg if severe

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3
Q

What is the treatment for hypoglycaemia in a patient who is confused/ drowsy?

A

15g glucose IV i.e. 75ml 20% glucose IV

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4
Q

A patient is admitted 7 hours after an acute stroke, and appears slightly dehydrated but is haemodynamically stable. Write a prescription for an IV fluid that is most appropriate for this patient.

A

1L normal saline over 12h with potassium added e.g. 0.9% NaCl + 0.3% KCl. Glucose-containing fluids have the potential to exacerbate cerebral injury so this would not be a good choice of initial fluid replacement.

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5
Q

What QRisk score is considered ‘high risk of cardiovascular events’?

A

> 20% 10 year cardiovascular risk is considered high. Statin should be started at dose for primary prevention in high risk patients e.g. atorvastatin 20mg.

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6
Q

What is the first line treatment of a DVT/ PE?

A

DOAC e.g. rivaroxaban, apixaban - if this is contraindicated e.g. APLS, then start LMWH.

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7
Q

How do you treat AF that has been present for >48h?

A

If AF has been present for >48h, anticoagulate with DOAC/ LMWH for at least 3W (and 4W after) before DC
cardioversion.

If patient is high risk of thrombus/ non-adherent, perform an echo. This is due to risk of intracardiac thrombus and subsequent stroke when reverted to sinus rhythm.

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8
Q

What drug do you prescribe in a patient with hypertension and BPH?

A

Prazosin. It is an alpha blocker that is not 1st line in HTN or BPH but may be useful for patients with both.

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9
Q

How do you treat hypoglycaemia with impaired consciousness?

A

20g glucose IV i.e. 100ml 20% dextrose IV OR 200ml 10% dextrose IV. Also consider IM/ SC glucagon.

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10
Q

What are target HbA1c levels for a) patients on metformin b) patients on metformin + gliclazide?

A

a) 48mmol/mol - consider intensifying Tx if HbA1C >58

b) 53 mmol/mol

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11
Q

What is the average maintenance fluids and K+ required in an adult?

A

3L IV maintenance fluids per day i.e. 8 hourly bags of 1L with 40-60mmol day i.e. 20mmol in each 1L bag.

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12
Q

What is the dosage of adrenaline used in cardiac arrest?

A

IV 1mg of 1:10000 adrenaline.

The dose used in anaphylaxis is IM 0.5mg 1:1000 adrenaline.

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13
Q

What is 1st line Tx of diabetes in patients with renal impairment?

A

If eGFR <30, 1st line is sulfonylurea e.g. gliclazide - note increased risk of hypoglycaemia.

If eGFR >45, metformin is first line.

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14
Q

What is the 1st line fluid to prescribe in hypovolemic shock following initial bolus of 0.9% NaCl?

A

For hypovolaemic shock, burns and cardiopulmonary bypass, prescribe a colloid bolus to maintain intravascular pressure e.g. fluid challenge of 500ml gelofusine (gelatin) IV over 30 min.

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15
Q

Patient taking ramipril for hypertension presents to GP with a cough. What will you do with this prescription?

A

Start on trial of angiotensin receptor blocker. Cough is common in ACE-Is due to buildup of bradykinin.

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16
Q

What advice do you give patients taking statins about when to stop this?

A

Stop when taking clarithromycin, and if they develop unusual muscle pains (seek help in this case).

17
Q

What drug can you prescribe for immediate relief of indigestion?

A

Magnesium carbonate 10ml PO - this is an antacid that provides quick relief. Other options include aluminium hydroxide and magnesium trisilicate.

18
Q

What is the correct dosage of enoxaparin to prescribe in VTE prophylaxis?

A

For adults, 40mg S/C once daily, or 4000 units - may be prescribed either way

19
Q

What is the 1st line treatment for severe, hospital acquired bneumonia?

A

Piperacillin with tazobactam, broad spectrum cephalosporin or a quinoloe IV.

20
Q

What is an appropriate dose of Senna to prescribe for constipation?

A

2 tablets/ 15mg PO once nightly

21
Q

What do you prescribe for an NSTEMI?

A

Aspirin 300mg and clopidogrel 300mg PO STAT.

Also morphine, GTN s/l, etc.

22
Q

What do you check before starting a patient on ramipril?

A

Renal function. This affects dosage to be prescribed as ramipril is renally excreted.