Section 3 - Planning Management

Question 1

STEMI - what drugs to prescribe

Answer 1

ASPIRIN 300mg oral
GTN spray
MORPHINE 10mg IV + METOCLOPRAMIDE 10mg IV
Beta blocker

Question 2

NSTEMI - what drugs to prescribe

Answer 2

ASPIRIN 300mg oral
GTN spray
MORPHINE 10mg IV + METOCLOPRAMIDE 10mg IV
CLOPIDOGREL 300mg oral + LMWH
Beta blocker

Question 3

Acute LVF

Answer 3

GTN spray
MORPHINE 10mg IV + METOCLOPRAMIDE 10mg IV
FUROSEMIDE 40-80mg IV

Inadequate –> ISOSORBIDE DINITRATE infusion

Question 4

Narrow QRS SVT - prescribe?

Answer 4

ADENOSINE 6mg IV (then 12 then 12)

Question 5

Irregular narrow complex tachycardia (assume AF) - prescribe?

Answer 5

beta blocker / diltiazem

HF –> digoxin / amiodarone

Question 6

Polymorphic VT - prescribe?

Answer 6

magnesium 2g over 10 min

Question 7

VT - prescribe?

Answer 7

amiodarone 300mg IV over 20 min

Question 8

Anaphylaxis - prescribe?

Answer 8

adrenaline 500 mcg of 1:1000 IM
chlorphenamine 10mg IV
hydrocortisone 200mg IV

Question 9

Acute exacerbation of asthma - prescribe?

Answer 9

Salbutamol 5mg NEB
Moderate –> prednisolone 40mg oral
Severe –> hydrocortisone 100mg IV

Question 10

Pulmonary embolism - prescribe?

Answer 10

Morphine 5-10mg IV
Metoclopramide 10mg IV
LMWH

Low BP = IV gelofusine –> norad –> thrombolysis

Question 11

Bacterial meningitis - prescribe?

Answer 11

dexamethasone IV

cefotaxime 2g IV

Question 12

Hypoglycaemia - what give?

Answer 12

100mL 20% glucose IV

Can’t eat / no cannula –> glucagon 1mg IM

Question 13

Management of hyperglycaemia

Answer 13

IV fluids:

1. 1L stat
2. 1L over 1 hour
3. 1L over 2 hours (then 4, then 8)

Sliding scale insulin

Question 14

Acute renal failure - fluids?

Answer 14

500mL stat

1L 4 hourly

Question 15

Diabetes - annual review?

Answer 15

Check ACR

Question 16

Blood glucose lowering therapy in T2DM

Answer 16

HBA1c 48 or higher:

1a. Metformin 500mg OD PO
1b. low weight / Cr > 150 –> gliclazide 40mg OD PO
2. HBA1c –> increase to max dose
3a. Still high –> metformin + gliclazide
3b. Still high –> gliclazide + sitagliptin
4. STILL high –> add insulin (eg. glargine)

Question 17

Parkinson’s - what drugs?

Answer 17

Co-beneldopa or co-careldopa

V v mild –> consider ropinirole or rasagiline

Question 18

Genralised tonic clonic

Answer 18

sodium valproate

Question 19

absence seizure

Answer 19

sodium valproate / ethosuximide

Question 20

myoclonic seizure

Answer 20

sodium valproate

Question 21

tonic seizure

Answer 21

sodium valproate

Question 22

focal seizure

Answer 22

carbamazepine / lamotrigine

Question 23

Alzheimer’s

Answer 23

mild –> AChE inhibitors

moderate+ –> memantine