3. Data Interpretation

Question 1

INR <6?

Answer 1

Reduce warfarin dose

Question 2

INR 6-8

Answer 2

Omit warfarin for 2 days then reduce dose

Question 3

INR >8

Answer 3

Omit warfarin and give 1-5mg oral vitamin K

Question 4

INR >5 + Minor bleeding

Answer 4

Give IV Instead of oral vitamin K 1-3mg

Question 5

What drugs cause Hyperkaliemia

Answer 5

Aldosterone Antagonist (Spirololactone) + ACE-Inhibitors

Question 6

Drugs causing hypokalemia and hyponatremia?

Answer 6

Thiazide diuretics (Bendroflumethiazide, chlorthalidone, indapamide) + loop diuretics (Furosemide, bumetanide)

Question 7

Eg of thiazide diuretics

Answer 7

Bendroflumethiazide, chlorthalidone, indapamide)

Question 8

Eg loop diuretics

Answer 8

Furosemide, bumetanide

Question 9

Eg of ACEI-inhibitors

Answer 9

Ramipril, Lisinopril

Question 10

Eg of CCB

Answer 10

Amlodipine
Diltiazem
Nifedipine
Verapamil

Question 11

Side effect of ACE-I

Answer 11

Dry cough

Question 12

Side effect of BBlocker

Answer 12

Worsens asthmatics

Question 13

Side effect of CCB

Answer 13

Peipheral oedema and flushing

Question 14

Side effect of loop diuretic

Answer 14

Gout

Question 15

Side effect of K sparing

Answer 15

Gynecomastia

Question 16

Effects of NSAID (ibuprofen) on kidney?

Answer 16

raised urea, creatinine and potassium!!!!!!

Ibuprofen decreases renal blood fow by inhibiting prostaglandins that normally dilate blood vessels flowing into the kidney, especially if the patient has renal artery stenosis. Reduced blood flow to the kidney mimics hypotension and prerenal failure, which if prolonged causes intrarenal failure

Question 17

Effect of Erythromycin on INR?

Answer 17

erythromycin is an enzyme inhibitor, i.e. reduces
warfarin breakdown and thereby increases its plasma level, INCREASING INR

Question 18

What is neutropenic sepsis?

Answer 18

Any source of sepsis (in this case pneumonia) with neutrophils <1

Question 19

ABx for neutropenic sepsis?

Answer 19

START PIPERACILLIN WITH TAZOBACTAM IV, GENTAMICIN IV AND PARACETAMOL

Question 20

how does carbamazepine effect sodium?

Answer 20

carbamazepine can also cause
hyponatraemia (through SIADH)

Question 21

What condition to with hold digoxin?

Answer 21

Slow AF

Question 22

Circumstances to increase steroids?

Answer 22

When Addisonian patients become sick they should increase their intake of steroids (so-called ‘sick day rules’)
to provide adequate cortisol for the stress response

Question 23

Drugs that can trigger an asthma attack?

Answer 23

Ibuprofen is an NSAID which can trigger an asthma attack
Bisoprolol is a beta-blocker. Its side effects are bronchospasm (which would cause wheeze)

Question 24

What circumstance would you withhold salbutamol inhaler?

Answer 24

When also using nebulized salbutamol

Question 25

Treatment of acute heart failure?

Answer 25

40mg IV Furosemide

Question 26

What is fast AF?

Answer 26

AF with HR >100bpm

Question 27

first line Abx for gut infections?

Answer 27

Metronidazole is typically used for gastrointestinal infections because of its good effects on anaerobes which colonize the gut

Question 28

Skin infection first line Abx?

Answer 28

FLUCLOXACILLIN 500MG, 6-HOURLY FOR 7DAYS

Question 29

Abx for severe celluitis?

Answer 29

FLUCLOXACILLIN 1G, IV STAT

Question 30

Abx for bone infections?

Answer 30

E CLINDAMYCIN 500MG, 6-HOURLY FOR 7DAYS

Question 31

Two drugs that can cause antimuscarinic side effects?

Answer 31

Cyclizine and amytriptiline

Question 32

Side effect of carbimazole?

Answer 32

carbamazepine (Gabapentin alternative) Carbimazole

Question 33

Hydroxocobalamin

Answer 33

vitamin b12

Question 34

drugs that can precipitate parkinsonism?

Answer 34

Both metoclopramide and haloperidol are dopamine antagonists and can precipitate parkinsonian symptoms, even in patients who do not have Parkinson’s disease.

Question 35

Antiemetic that can be used in Parkinsonism?

Answer 35

It is useful to know that domperidone, another dopamine antagonist licensed for the treatment of nausea, is safe to use for patients with Parkinson’s disease as it does not cross the blood-brain barrier