Section 1: Prescribing Flashcards
What type of HRT would you prescribe in a perimenopausal woman?
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
What are the starting doses for statins?
Atorvastatin - 20mg for primary prevention, 80mg for secondary prevention
Simvastatin - 40mg, increase if necessary up to 80mg if severe
What is the treatment for hypoglycaemia in a patient who is confused/ drowsy?
15g glucose IV i.e. 75ml 20% glucose IV
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.
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.
What QRisk score is considered ‘high risk of cardiovascular events’?
> 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.
What is the first line treatment of a DVT/ PE?
DOAC e.g. rivaroxaban, apixaban - if this is contraindicated e.g. APLS, then start LMWH.
How do you treat AF that has been present for >48h?
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.
What drug do you prescribe in a patient with hypertension and BPH?
Prazosin. It is an alpha blocker that is not 1st line in HTN or BPH but may be useful for patients with both.
How do you treat hypoglycaemia with impaired consciousness?
20g glucose IV i.e. 100ml 20% dextrose IV OR 200ml 10% dextrose IV. Also consider IM/ SC glucagon.
What are target HbA1c levels for a) patients on metformin b) patients on metformin + gliclazide?
a) 48mmol/mol - consider intensifying Tx if HbA1C >58
b) 53 mmol/mol
What is the average maintenance fluids and K+ required in an adult?
3L IV maintenance fluids per day i.e. 8 hourly bags of 1L with 40-60mmol day i.e. 20mmol in each 1L bag.
What is the dosage of adrenaline used in cardiac arrest?
IV 1mg of 1:10000 adrenaline.
The dose used in anaphylaxis is IM 0.5mg 1:1000 adrenaline.
What is 1st line Tx of diabetes in patients with renal impairment?
If eGFR <30, 1st line is sulfonylurea e.g. gliclazide - note increased risk of hypoglycaemia.
If eGFR >45, metformin is first line.
What is the 1st line fluid to prescribe in hypovolemic shock following initial bolus of 0.9% NaCl?
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.
Patient taking ramipril for hypertension presents to GP with a cough. What will you do with this prescription?
Start on trial of angiotensin receptor blocker. Cough is common in ACE-Is due to buildup of bradykinin.
