Core Facts

Question 1

When should prophylactic heparin not be administered?

Answer 1

1. Bleeding
2. Ischaemic stroke (risk of bleeding into stroke)

Question 2

What is the maximum rate of infusion for potassium?

Answer 2

10mmol per hour

Question 3

Which drug class may cause peripheral oedema?

Answer 3

CCBs

Question 4

Which drugs may cause hyponatraemia?

Answer 4

All diuretics

Question 5

Which drug class may cause hyperkalaemia?

Answer 5

ACEi

Question 6

Which drug class may cause hypokalaemia?

Answer 6

Thiazide-like and loop diuretics

Question 7

Which drugs may cause agranulocytosis and neutropenia?

Answer 7

Antipsychotics and carbimazole

Question 8

Which drugs are used in acute and chronic HF?

Answer 8

Acute: furosemide
Chronic: ACEi

Question 9

Give the management for hyperkalaemia

Answer 9

1. Calcium gluconate (if ECG changes)
2. Fast acting (soluble) insulin 100 units in 100ml 20% dextrose IV over 30 minutes
3. Salbutamol nebuliser

Question 10

Give the enzyme inducers

Answer 10

P - phenytoin
C - carbamazepine
B - barbiturates
R - rifampicin
A - alcohol (chronic excess)
S - sulfonylureas (e.g. glipizide)

Question 11

Give the enzyme inhibitors

Answer 11

A - allopurinol
O - omeprazole
D - disulfiram
E - erythromycin
V - valproates
I - isoniazid
C - ciprofloxacin
E - ethanol (acute intoxication)
S - sulphonamidea

Question 12

Which drugs should be stopped prior to surgery?

Answer 12

I LACK OP

I - insulin (switched to variable rate if needed)
L - lithium (day before)
A - anticoagulants/antiplatelets
C - COCP/HRT (4 weeks before surgery)
K - K+ sparing diuretics (day of)
O - oral hypoglycaemics
P - perindopril and other ACEi (day of)

Metformin must be stopped due to risk of lactic acidosis.

Question 13

Which drugs must not be stopped prior to surgery?

Answer 13

Steroids

Patients on long term steroids may have adrenal atrophy and therefore be unable to mount an adequate stress response (resulting in profound hypotension)

Question 14

What are the side effects of steroids?

Answer 14

Stomach ulcers
Thin skin
oEdema
Right and left heart failure
Osteoporosis
Infection (incl. candida)
Diabetes (hyperglycaemia)
cushing’s Syndrome

Question 15

What are the side effects of NSAIDs?

Answer 15

No urine (renal failure)
Systolic dysfunction (heart failure)
Asthma
Indigestion
Dyscrasia (clotting abnormality)

Question 16

Describe fluid replacement in adults

Answer 16

500ml bolus (250ml if retaining) in 10 mins

If oliguric (not due to obstruction) give 1L over 2-4 hours

Question 17

How much maintenance fluid do adults need per day?

Answer 17

3L (2L in the elderly)

Usually NaCl and 5% dextrose combination

Question 18

How much potassium do adults need per day?

Answer 18

40mmol

Question 19

Describe fluid maintenance in children

Answer 19

0-10kg: 100ml per kilo
10-20kg: 50ml per kilo
20+kg: 20ml per kilo

Question 20

Describe fluid replacement in children

Answer 20

Deficit (mL) = %dehydration x weight (kg) x 10

%dehydration = ((well weight-current weight)/well weight)x100

Question 21

Describe the management of hypoglycaemia

Answer 21

Conscious: oral glucose

Unconscious: 200ml IV glucose 20% over 15 minutes

Question 22

Which antiemetics should be used post-operatively?

Answer 22

1. Cyclizine
2. Ondansetron

Question 23

Which antiemetic should be given in gastroparesis?

Answer 23

Metoclopramide - prokinetic

Question 24

Which antiemetic should be given in vertigo?

Answer 24

Prochlorperazine

Question 25

Which antiemetic should be given in palliative care?

Answer 25

Haloperidol

Question 26

Which drug should be used to treat drug-induced extra-pyramidal side effects?

Answer 26

Procyclidine hydrochloride

Question 27

Which drugs must be stopped in AKI due to the risk of worsening?

Answer 27

NSAIDs ACEi Diuretics Aminoglucosides (e.g. gentamicin) ARBs

Question 28

Which drugs may need to be stopped in AKI due to increased risk of toxicity?

Answer 28

Digoxin Lithium Metformin

Question 29

Which drugs cause hypernatraemia?

Answer 29

Effervescent tablets

Question 30

What are the features of digoxin toxicity?

Answer 30

Confusion Nausea Visual halos Arrhythmias

Question 31

What are the features of lithium toxicity?

Answer 31

Early: tremor Intermediate: tiredness Late: arrhythmias, seizure, coma, renal failure, dabetes insipidus

Question 32

What are the features of phenytoin toxicity?

Answer 32

Gum hypertrophy Ataxia Nystagmus Peripheral neuropathy

Question 33

What are the features of gentamicin and vacomycin toxicity?

Answer 33

Nephrotoxicity Ototoxicity

Question 34

Give the management of tachycardia

Answer 34

Beta blocker or diltiazem Adenosine (Use digoxin or amiodarone if in heart failure) (Give DC shock and amiodarone if dverse effects such as shock)

Question 35

Give the management of anaphylaxis

Answer 35

1. 15L O2 non-rebreathe 2. Adrenaline (500mcg of 1:1000 IM) 3. Chlorphenamine 4. Hydropcortisone

Question 36

Give the management of acute asthma exacerbations

Answer 36

1. 15L O2 non-rebreathe 2. Salbutamol nebuliser 3. Hydrocortisone (PO or IV) 4. Ipratropium nebuliser 5. Aminophylline (if life-threatening)

Question 37

Give the management of acute COPD exacerbations

Answer 37

1. 15L O2 non-rebreathe 2. Salbutamol nebuliser 3. Hydrocortisone (PO or IV) 4. Ipratropium nebuliser 5. Aminophylline (if life-threatening) +Abx if infective cause

Question 38

Give the management of chronic heart failure

Answer 38

1. ACEi 2. Beta blocker

Question 39

Give the management of COPD maintenance

Answer 39

1. Smoking cessation 2. SABA/SAMA (e.g. salbutamol/ipratropium) 3. + LABA/LAMA (e.g. salmeterol/tiotropium) 4. + ICS (e.g. beclometasone)

Question 40

Give the management of asthma maintenance

Answer 40

1. SABA (e.g. salbutamol) 2. + ICS (e.g. beclometasone) 3. + LABA (e.g. salmeterol) 4. +LTRA (e.g. montelukast)

Question 41

Give the management of AF

Answer 41

1. Stroke prevention (e.g. DOAC) 2. Rhythm control - cardioversion/amiodarone (must be within 48 hours of onset) 3. Rate control - beta blocker/diltiazem (may use digoxin if other methods fail)

Question 42

Which laxatives should be used when?

Answer 42

Impaction - docusate sodium (softener) Reduced motility - Senna (stimulant) Other - lactulose (osmotic)

Question 43

When should metformin not be used?

Answer 43

Not overweight Creatinine > 150 (use gliclazide instead)