Week 5

Question 1

Which of the following drugs does not pose a risk in a dehydrated patient?

• metformin
• bendroflumethiazide
• candesartan
• amlodipine
• naproxen

Answer 1

Amlodipine

Question 2

What is the most appropriate antibiotic regime in a patient with infective endocarditis and a prosthetic heart valve?

Answer 2

Vancomycin, Rifampicin and Gentamicin

Question 3

Which of the following signs are not indicative of AKI?

• Hyperkalaemia
• Hypokalaemia
• Increased urea
• Alkalosis
• Acidosis

Answer 3

Alkalosis

Question 4

What condition may patients on long-term thiazide or loop diuretics be more likely to develop?

Answer 4

Hypercalcaemia resulting in gout

Question 5

What are the two types of calcium channel blocker? What is the main benefit of each type?

Give examples of both

Answer 5

Dihydropyridines (e.g. amlodipine) - good at controlling blood pressure but have little effect on heart rate

Non-dihydropyridines (e.g. verapamil, diltiazem) - primary action is to slow heart rate

Question 6

Amongst others, what important renal-associated side effect do NSAIDs have with regards to electrolytes?

Answer 6

Sodium retention (and therefore water retention)

Question 7

What needs to be kept in mind regarding interaction between thiazide and loop diuretics?

Answer 7

Thiazides by themselves have quite a weak diuretic effect, however potency dramatically increases if a loop diuretic is used in conjunction

Risks severe hypokalaemia, hyponatraemia, hypotension and worsening renal function

Question 8

How do Lisinopril and Ramipril compare regarding duration of effect?

Answer 8

Lisinopril - long-acting control of BP

Ramipril - short-acting

Question 9

What is the working diagnosis in a patient presenting with hyponatraemia, hyperkalaemia and hypotension, until proven otherwise?

Answer 9

Addisonian crisis - potentially life-threatening

Question 10

What needs to be kept in mind when prescribing digoxin to patients with renal impairment?

Answer 10

Half-life increases to 90 hours

Question 11

What are the indications for dialysing a patient in the acute setting?

Answer 11

Hyperkalaemia, despite intervention

Persistent acidosis, despite intervention

Pulmonary oedema in combination with the above

Question 12

How do systolic and diastolic blood pressures typically change over time?

What is the gap between these two called?

Answer 12

As age increases, systolic BP typically rises

As age increases, diastolic typically rises until 50 or so, then starts to drop

The gap between systolic and diastolic BPs is called pulse pressure, and typically increases with age

Question 13

What are the A, B, C, D, Es that should be given in the event of heart failure, in order to reduce the risk of cardiac events?

Answer 13

A - ACE inhibitor/ARB

B - beta blocker

C - cholesterol-lowering agent i.e. statin

D - diuretic

E - eplerenone

Question 14

What is filtered and reabsorbed in the proximal convoluted tubule?

Answer 14

Filtered out

• HCO₃^-
• H₂O
• K⁺
• NaCl
• Nutrients

Reabsorbed

• H⁺
• NH₃

Question 15

What is filtered and reabsorbed in the distal convoluted tubule?

Answer 15

Filtered out

• NaCl
• H₂O
• HCO₃^-

Reabsorbed

• K⁺
• H⁺

Question 16

What needs to be kept in mind when prescribing anti-inflammatories (e.g. diclofenac) to a patient on a diuretic?

Answer 16

The efficacy of the diuretic is reduced, resulting in sodium retention and oedema