Planning Mx

Question 1

when choosing dose of ben pen what should you first check in BNF

Answer 1

AGE

• dose varies by age
• adults 1.2mg but kids less

Question 2

what kind of side effects can carbamazepine cause

Answer 2

it is a SEDATING antihistamine

• used mostly as an antiemetic
• can have ANTIMUSCARINIC effects

Question 3

what can you give if there is an inadequate response to furosemide in a STEMI

Answer 3

Furosemide 40-80mg iV
if inadequate response
Isosorbide Dinitrate infusion
+/- CPAP

Question 4

Anaphylaxis adrenaline dose

Answer 4

0.5mg = 500 micrograms
1 in 1000
IM adrenaline
repeat every 3-5 min

Question 5

Acute exacerbation of COPD/Asthma doses

Answer 5

Nebulised Salbutamol 5mg
Nebulised Ipr Bromide 0.5mg
IV Hydrocortison 100mg
PO Prednisolone 50mg

Question 6

Pneumonia CURB-65 mild / severe mx

Answer 6

mild - amoxicilin

severe - co-amoxiclav + clarithromycin (for atypicals)

Question 7

Pneumothorax primary (NO lung disease)

Answer 7

<2cm air rim –> conservative

>2cm air rim –> aspiration (2nd ICS MCL) on side of pneumothorax

Question 8

where is the air rim measured from

Answer 8

at the level of the hilum
from the lung edge
to the inside of the chest wall

Question 9

Pneumothorax secondary (lung disease OR >50Y smoker)

Answer 9

<1cm AR –> conservative
1-2cm AR –> aspirate
>2cm AR –> chest drain

Question 10

PE what to give for pain

Answer 10

morphine 10mg IV + metoclopramide 10 mg IV

Question 11

PE what to give for low bp

Answer 11

iV gelofusine –> norad –> thrombolysis

Question 12

PE Haemodynamically stable mx

Answer 12

1st: DOAC - 3m (6m if unprovoked)

apixaban + rivaroxaban require no previous LMWH, BUT dabigatran + edoxaban requir LMWH >5d

Question 13

PE Haemodynamically unstable mx

Answer 13

THROMBOLYSIS with ALTEPLASE 10mg IV STAT –> 90mg IV over 2 hours

Question 14

For LMWH dosing

Answer 14

1mg = 100 Units
treatment >10, 000 units
prophylaxis <10,000 units

Question 15

AKI Mx

Answer 15

1ST - cannula, catheter, strict fluid monitoring
2nd - 500ml fluid bolus –> 1L, 4 hourly
3rd - find cause

Question 16

Meningitis mx

Answer 16

IM ben pen in community (changes by weight)
IV ceftriaxone + ampicillin (if ELDERLY/NEONATE)
+/- ACICLOVIR (if behavioural changes)

Question 17

Status Epilepticus

Answer 17

lorazepam 0.1mg/kg –> 4mg

Diazepam/Midazolam (10mg)

Question 18

how does ACEi cause hyperkalaemia x2 ways

Answer 18

1. DIRECTLY through reduced aldosterone production due to inhibition of ACE
2. RENAL FAILURE - due to efferent vessels leaving the kidney relying on AT-II to constrict , to increasing BP in kidneys SO ACEi which decrease AT-II production, DECR RENAL BP –> renal damage

Question 19

FEVER + CHEMO

Answer 19

NEUTROPENIC SEPSIS

Question 20

MX of neutropenic sepsis

Answer 20

piperacillin + tazobactam IV + gentamicin IV

paracetamol

Question 21

what med change for sick addisons pts

Answer 21

INCR STEROIDS

Question 22

IF asthma pt is on NEBS in hospital, should you write up their PRN puffs of salb on drug chart

Answer 22

nO withhold it for now

Question 23

acute hF what diuretics

Answer 23

IV FUROSEMIDE 40MG

-increases dose in renal failure!!

Question 24

what to use for rate control in AF

Answer 24

1ST - Bisoprolol (CI in asthma)
2ND - CCB (CI if peripheral oedema)
3RD - DIGOXIN

Question 25

can cyclizine cause a dry mouth

Answer 25

YES it is a SEDATING antihistamine

-has anti-muscarininc SEs

Question 26

what are both haloperidol + metoclopramide

Answer 26

DOPAMINE ANTAGONISTS

-precipitate parkinsonian symptoms even n pts who don’t ahve PD

Question 27

so what anti emetic is safe to use in PD

Answer 27

DOMPERIDONE

-does not cross BBB

Question 28

if pt has carbamazepine what contraceptive is safe

Answer 28

it is an enzyme INDUCER
so basically none of the ORAL COCPs
only the progesterone IM injection is safe

Question 29

in acute gout what to give if both NSAIDs and colchicine are CI

Answer 29

IM STEROIDS