Conditions (2)

Question 1

Name 2 drugs that can be given to attenuate alcohol withdrawal symptoms?

Answer 1

Name 2 drugs that Diazepam or Chlordiazepoxide hydrochloride (both long acting Benzodiazepines)

Question 2

What drug can be given in acute alcohol withdrawal?

Answer 2

Carbamazepine

Question 3

Inpatients that are being treated for alcohol withdrawal, what drug should you not give them if there is a possibility that they will go back to drinking (even if its a small ml of alcohol)?

Why?

Answer 3

Clomethiazole because when mixed with alcohol, it causes respiratory depression.

Question 4

What is first line treatment for delirium tremens?

(If patient is showing indications of delirium tremens they should be referred as an inpatient)

2nd line treatment?

Answer 4

First line: Oral lorazepam

Second line: Parental lorazepam (or haloperidol can also be given as an adjunctive therapy)

(Haloperidol is an anti-psychotic)

Question 5

Disulfiram is second line treatment for prevention of relapse in alcohol dependence (whilst they are going to cognitive behavioural therapy).

What are two drugs that are first line treatment?

Answer 5

Oral Naltrexone hydrochloride

Acamprosate calcium

Question 6

Name 3 antimuscarinics

Answer 6

Darifenacin

Oxybutynin

Tolterodine

Question 7

Name 3 sedating antihistamines.

Name 2 non-sedating antihistamines.

Answer 7

Sedating:

• Chlorphenamine
• Hydroxyzine
• Cyclizine

Non-sedating:

• Loratadine
• Cetirizine

Question 8

Name a drug that can be used for the ST treatment of Insomnia?

Answer 8

Zopiclone

Question 9

What drug can be given to treat/reduce flare ups of Gout

Answer 9

Allopurinol

Question 10

LT use of Amitriptyline can have what GI side effects and what can this lead to?

Answer 10

Reduced GI motility leading to constipation, which could possibly lead to haemorrhoids

Question 11

Give 5 indications of Pregabalin (a VGCC antagonists)

Answer 11

1. Central and peripheral neuropathic pain
2. Focal seizures with or without secondary generalised seizures
3. Generalised anxiety disorder
4. Fibromyalgia
5. Restless leg syndrome

Question 12

What 3 different category of drugs can be used for neuropathic pain?

Answer 12

1. Anticonvulsants
2. Tricyclic antidepressants
3. SSRIs

Question 13

A nose infection by a Staphylococcus agent can cause nose bleeds.

What drug can be given to treat them (give trade name as well).

Sprayed 4 times a day for 10 days.

Answer 13

Naseptin (trade name)

Chlorhexidine with Neomycin

Question 14

Patients taking TNFa inhibitors are at a higher risk of developing what cancer?

Answer 14

Nonmelanoma skin cancers - particularly SCC

Question 15

If a patient is on more than or equal to 7.5mg daily oral steroids for 3 months or more, what drug should you give them to protect them from osteoporosis (as they are at a high risk of it)?

Name the drug group and give 2 examples

Answer 15

A bisphosphonate (Alendronic acid or Risedronic acid)

Question 16

Name 2 side effects of Erythromycin.

If a patient has had a history of these SE and would prefer a different antibiotic, what would you give them instead?

Answer 16

Erythromycin can cause nausea and cramps.

Give the Clarithromycin instead.

Question 17

Name 2 topical antiseptics

Answer 17

Chlorhexidine

Triclosan

Question 18

Name 2 topical antipruritic agents

Answer 18

1. Topical menthol 1% in aqueous cream

2. Calamine lotion

Question 19

Quinolones have what effect on Theophylline and other drugs that are also metabolised by CYP450

Answer 19

Quinolones inhibit the metabolism of drugs via CYP450 enzymes, thus this drug levels are found at higher levels in the plasma.

High plasma Theophylline levels leads to an increased risk of convulsions

Question 20

Adcal D3 and Evacal D3 are 2 trade names for drugs.

What are these drugs made up of?

Answer 20

Colecalciferol (Vitamin D3) and Calcium carbonate

Question 21

Discuss the treatment plan for beta blockers after an MI

Answer 21

Give the beta blockers, initially at the lowest dose, then titrate up to the highest dose or the most tolerable dose before they leave the hospital.

The pt then stays on the beta blocker for 12 months. If they have heart failure or left ventricular systolic dysfunction, they stay on the beta blocker for life

Question 22

What is a common SE of bisphosphonates that are not taken properly?

What does the pt need to do to in order to not have this SE.

Give two other steps that the pt needs to do when taking this pill.

Answer 22

Oesophagitis.

Once you’ve taken this medication, you need to be upright for a whole 30 minutes (prevents indigestion).

Need to take the pill whole.

Can’t eat anything or take any other pills for 30 minutes after taking this pill because it can affect the efficacy of this pill.

Question 23

If a pt is taking a bisphosphonate and a calcium/bisphosphonate, describe how they can take it.

Answer 23

Don’t take the calcium and vitamin D (e.g. Adval-D3) within 4 hours of taking a bisphosphonate but ensure you take the calcium/vitamin D pill in the same day.

Question 24

Fully describe a treatment plan for a pt with DKA (5)

Answer 24

1. Need to replace 5-8L of fluid (as this tis the typical range of fluid loss in DKA). (Irregardless of them being severely ACIDOTIC, they still need) 0.9% Saline AND K+
2. Place an ECG to monitor whether they are hypo or hyperkalaemic
3. Give SHORT ACTING INSULIN INFUSION - 0.1unit/kg/hr
4. Once blood glucose is <15mmol/L - give them 5DW
5. Now change to LONG ACTING INSULIN INFUSION

Question 25

Give 4 criteria in the Joint British Diabetes Societies DKA criteria

Answer 25

• Glucose >11mmol.L or known DM
• pH <7.30
• HCO3- <15 mmol.L (metabolic acidosis)
• Ketones >3mmol.L or Ketone ++ urine dipstick

Question 26

Give 3 causes of DKA.

Answer 26

• Missed insulin dose
• MI
• Infection (e.g. chest)

Question 27

Common presentation of DKA

Answer 27

• Acetone smelling breath
• Kussmaul respiration (deep hyperventilation)
• Abdominal pain
• Vomiting
  (plus screen for possible causes - infection, MI, skipped insulin dose if a known diabetic)