Commonly Used Drugs

Question 1

Warfarin - target INR

Answer 1

2-3 except for mechanical mitral valve 2.5-3.5

Question 2

INR 4.5-10 and no bleeding in a patient on warfarin

Answer 2

Stop warfarin
Consider reasons for elevated INR
Vit K is usually unnecessary

Question 3

INR >10 and no bleeding in a patient on warfarin

Answer 3

Stop warfarin
Administer 3-5mg vit K orally or IV
Measure INR in 12-24 hours
Resume warfarin at reduced dose once INR approaches therapeutic range

Question 4

High bleeding risk (eg recent major bleed or major surery) in the setting of high INR in a patient on warfarin. What else can you give in addition to vit K?

Answer 4

Prothrombinex-VF 15-30 IU/kg

Question 5

INR >1.5 with life-threatening (critical organ) bleeding in a patient on warfarin

Answer 5

Stop warfarin
Vit K 5-10mg IV
Prothrombinex-VF 50 IU/kg IV
FFP 150-300mL

Question 6

INR >2 with clinically significant bleeding (not life threatening) in a patient on warfarin

Answer 6

Stop warfarin
Vit K 5-10mg IV
Prothrombinex-VF 35-50 IU/kg IV

Question 7

Any INR with minor bleeding in a patient on warfarin

Answer 7

Stop warfarin

Repeat INR following day and adjust to maintain INR in the target therapeutic range

Question 8

Brand name for dabigatran?

Answer 8

Pradaxa

Question 9

Brand name for rivaroxaban?

Answer 9

Xarelto

Question 10

Brand name for apixaban?

Answer 10

Eliquis

Question 11

Which of the novel anticoagulants are listed for stroke prevention in non-valvular AF with at least one additional stroke risk factor?

Answer 11

dabigatran, rivaroxaban, apixaban
Careful with Cr Cl for all, careful with age and body weight with apixaban and beware of those with higher risk of bleeding with Pradaxa

Question 12

Which new anticoagulants are listed for the prevention of VTE in THR and TKR?

Answer 12

All of them: dabigatran, rivaroxaban, apixaban

Varying length of protocol

Question 13

Which novel anticoagulants are TGA approved for the treatment of DVT or PE?

Answer 13

rivaroxaban only

15mg BD for 3 weeks then 20mg daily

Question 14

Which of the novel anticoagulants is TGA approved for the prevention of recurrent VTE?

Answer 14

rivaroxaban only

20mg daily

Question 15

Empiric treatment options for symptomatic UTI?

Answer 15

Trimethoprim 300mg daily for 3 days (non pregnant)
Cephalexin 500mg q12h for 5 days
Amoxycillin with clavulanate 500/125mg q12h for 5 days
Nitrofuratoin (if resistance to antimicrobials above) 100mg q12h for 5 days

Question 16

ESBL (what is it) and how can you empirically treat it?

Answer 16

Extended-spectrum beta-lactamase producing isolate more likely in patients recently hospitalised, aged care, recently used Abs, DM, old age and recent travel in past 6 months to Southeast Asia
Tx with meropenem 500 to 1000mg IV q8h with ID advice

Question 17

Antibiotic prophylaxis for frequent recurrent UTIs

Answer 17

Trimethoprim 150mg nocte

Cephalexin 250mg nocte

Question 18

Which are the only oral drugs available for infections caused by Pseudomonas aeruginosa?

Answer 18

Quinolones

Question 19

Empirical therapy of symptomatic UTI in pregnant women?

Answer 19

Cephalexin 500mg q12h for 5 days
Nitrofuration 100mg q12h for 5 days
Amoxycillin+clavulanate 500/125mg q12h for 5 days

Question 20

Empiric therapy for line sepsis?

Answer 20

Usually coag neg staph or staph aureus
Send line tip and two sets of blood samples from another site for cultures
Gent 4 to 7mg/kg IV for first dose plus Vanc IV

Question 21

Empiric therapy for severe pyelonephritis

Answer 21

Gent IV plus amox/ampicillin 2g IV q6h (if penicillin hypersensitivity use Gent as single drug)
If Gent contraindicated use ceftriaxone 1g IV daily or cefotaxime 1g IV q8h

Question 22

Initial drug treatment of acute uncomplicated vulvovaginal candidiasis

Answer 22

Clotrimazole 10% vaginal cream as a single dose at night
Nystatin 5g vaginal cream q12h for 7 days
Fluconazole oral 150mg single dose

Question 23

1st, 2nd, 3rd line drug tx for uncomplicated hypertension

Answer 23

ACEi - perindopril erbumine 2 to 8mg daily
ARB - irbesartan 400 to 800mg daily
Ca Channel blocker - amlodipine 2.5 to 10mg daily or diltiazem CR 180 to 360mg daily or
verapamil SR 120 to 480mg daily
Thiazide diuretics - indapamide/ hydrochlorothiazide
B-blockers not recommended as first line therapy (atenolol 25-100mg orally, daily or metoprolol 25-100mg orally, BD)

Question 24

1st, 2nd, 3rd line drug tx for URTI

Answer 24

Majority - no tx unless lots of clinical features of S pyogenes present OR
Pts 2-25yrs old with sore throat in Indigenous communities
Pts of any age with existing rheumatic heart disease
Pts with scarlet fever
In which case tx is phenoxymethylpenicillin 500mg q12h PO for 10 days or if low compliance benzathine penicillin 900mg IM as single dose. If hypersensitive to penicillins give cephalexin 1g q12h for 10 days and if immediate hypersensitivity use azithromycin 500mg daily for 5 days

Question 25

1st, 2nd, 3rd line drug tx for depression

Answer 25

SSRI eg citalopram 20mg mane up to 40mg SNRI eg venlafaxine 75mg mane up to 375mg Mirtazapine 15 to 30mg nocte up to 60mg

Question 26

1st, 2nd, 3rd line drug tx for type II diabetes

Answer 26

1. Metformin 2. Metformin + GLP-1 agonist (liraglutide) or DPP-4 inhibitor (sitagliptin/vildagliptin) OR 2. Metformin + basal insulin OR 2. Metformin + sulfonylurea (glicazide, slipizide) (plus others such as acarbose/ thiazolidinediones if exogenous insulin avoidance is primary concern) 3. Basal bolus insulin regimen Check TGA licensed combinations

Question 27

1st, 2nd, 3rd line drug tx for dyslipidaemia

Answer 27

1. Statins eg atorvastatin 10 to 80mg daily 2. Ezetimibe 10mg daily 3. Bile acid binding resins eg cholestyramine 4. Fenofibrate 145 mg daily reduce dose in renal impairment

Question 28

1st, 2nd, 3rd line tx for OA

Answer 28

1. Paracetamol 1g q6h or 1.33g tds up to 4g max/24hrs 2. NSAID 3. Topical NSAID 4. Intraarticular corticosteroids

Question 29

1st, 2nd, 3rd line tx for GORD

Answer 29

1. PPI eg esomeprazole 20mg daily (30mins to 1hr prior to meal) or pantoprazole 40mg same as above 2. Surgery

Question 30

1st, 2nd, 3rd line tx for asthma

Answer 30

1. SABA PRN 2. ICS (low dose) plus SABA PRN 3. ICS+LABA (low dose) plus SABA PRN 4. ICS+LABA (med to high dose) plus SABA PRN

Question 31

1st, 2nd, 3rd line tx for anxiety

Answer 31

1. SSRI eg citalopram 10mg to max 40mg 2. Duloxetine 30mg daily to max 120mg daily 3. Venlafaxine CR 75mg orally mane post food to max dose 225mg daily

Question 32

1st, 2nd line drug tx for dermatitis

Answer 32

Face and Flexures 1. Hydrocortisone 1% daily or BD until dermatitis settles and switch to emollient 2. Desonide 0.05% lotion daily until settles and switch to emollient Elsewhere 1. Betamethasone valerate 0.02% or 0.05% 2. Betamethasone dipropionate 0.05%

Question 33

1st, 2nd, 3rd line tx for sleep disturbance

Answer 33

1. Sleep hygiene 2. Psychological/ behavioural therapy 3. Temazepam 10mg nocte, zolpidem CR 6.25mg bedtime 4. Melatonin prolonged release 2mg bedtime

Question 34

1st, 2nd, 3rd line empiric tx for gastroenteritis with severe disease

Answer 34

1. Ciprofloxacin 500mg q12h for 3 days 1. Norfloxacin 400mg q12h for 3 days 2. If SE Asia consider azithromycin 500mg daily for 3 days 3. If IV - ceftriaxone 2g IV for 3 days (but not for pts who develop diarrhoea after 48 hrs in hosp - consider C diff then)

Question 35

1st, 2nd, 3rd line tx for acute AF

Answer 35

1. Rhythm control - cardioversion with amiodarone 150 to 300mg IV infusion over 20 mins to 2 hrs OR D/C cardioversion 2. Rate control - atenolol 25mg to 100mg daily or metoprolol 25mg to 100mg BD (or digoxin) WITH prophylaxis against VTE dalteparin 120units/kg up to 10,000 units S/C BD or enoxaparin 1mg/kg SC BD or heparin infusion

Question 36

1st, 2nd, 3rd line oral contraception

Answer 36

1. Levlen/Microgynon 30 - ethinyloestradiol 30 and levonorgestrel 150 1. If acne - Diane-35 or Estelle-35 - ethinyloestradiol 35 and cyproterone 2000 1. Yasmin - ethinyloestradiol 30 and drospirenone 3000

Question 37

List alternatives to oral contraception

Answer 37

NuvaRing Implanon Mirena Copper IUD

Question 38

BP targets in uncomplicated hypertension

Question 39

BP targets in pts with associated end-organ damage or clinical conditions (stroke/TIA, CAD, diabetes, albuminuria)

Answer 39

130/80

Question 40

Non-pharmacological measures to reduce BP (in conjunction with pharm)

Answer 40

``` Smoking cessation Physical activity Reduce alcohol Moderate sodium restriction Healthy eating Weight reduction Management of OSA ```

Question 41

Drug tx of osteoporosis

Answer 41

1. Correct vit D and calcium first and continue supplementation throughout 2. Bisphosphonate eg alendronate 70mg once weekly on empty stomach OR risendronate 35mg once weekly on empty stomach (or 150mg once monthly on empty stomach) OR zoledronic acid 5mg IV over 15mins once per year (remain upright for 30 mins post taking bisphosphonates) 2. Denosumab 60mg SC once every 6 months

Question 42

What antihypertensives should not be combined?

Answer 42

B-blocker with verapamil/diltiazem (risk of heart block) | ACEI + ARB

Question 43

Triple whammy?

Answer 43

ACEi/ARB + diuretic + NSAID