Drugs

Question 1

What dose of adrenaline is given to a < 6 month old having an anaphylaxis reaction?

Answer 1

150mcg (0.15ml of 1:1000)

Question 2

What dose of adrenaline is given to a 6 month- 6yrs old having an anaphylaxis reaction?

Answer 2

150mcg (0.15ml of 1:1000)

Question 3

What dose of adrenaline is given to a 6-12year old having an anaphylaxis reaction?

Answer 3

300mcg (0.3ml of 1:1000)

Question 4

What dose of adrenaline is given to an adult (>12yrs) having an anaphylaxis reaction?

Answer 4

500mcg (0.5ml of 1:1000)

Question 5

In addition to adrenaline what other two drugs should be given for an anapylactic reaction?

Answer 5

Hydrocortisone

Chlorphenamine

Question 6

What is the most common electrolyte imbalance associated with Bisoprolol?

Answer 6

Hyponatremia

Question 7

You are in a GP clinic and change a dose of Ramipril from 5mg to 10mg OD. What action must be taken?

Answer 7

Book U+E’s to be monitored in 14 days time

Question 8

A patient is switched from furosemide to bumetanide, what is the strength relationship between the two drugs?

Answer 8

1mg Bumetanide = 40mg Furosemide

Question 9

An elderly lady in your practice has just been started on Aspirin, what additional medication should be prescribed?

Answer 9

Omeprazole

Question 10

You are prescribing naproxen to a patient for the first time (for pain). What 2 key things must you ask about in the history?

Answer 10

Allergies

History of stomach ulcers etc

Question 11

You are prescribing labetalol to a pregnant patient to control her blood pressure, what must you ask about in the history before starting this drug? (2)

Answer 11

Allergies

History of asthma

Question 12

What are the most common side effects of anti-cholinergic medicines?

Answer 12

Dry mouth, dry eyes, constipation and blurred vision

Question 13

Name three common medicines which cause hyperprolactinaemia?

Answer 13

Verapamil
Tramadol
Thioxanthenes (Zuclopenthixol, Flupenthixol - anti-pyschoctics)

Question 14

A 57 year old man is admitted to hospital with a 3 day history of LRTI and one day history of rash. He was started on antibiotics 3 days ago. What is the most likely drug responsible for his rash?

Answer 14

Amoxicillin

used for LRTI’s - note rashes are a common side effect of all penicillin medications

Question 15

What is first line drug management for shingles (Herpes Zoster) for an adult?

Answer 15

Aciclovir 800mg 5x/day for 7 days

Question 16

A 45 year old caucasian male presents with a BP of 170/110. What is the most appropriate drug/ dose to start him on?

Answer 16

Ramiprill 2.5mg

White <55

Question 17

What is the most important information that should be communicated to a patient about taking Gliclazide?

Answer 17

Can cause hypo’s (know symptoms)
Take with breakfast
Can cause weight gain

Question 18

You are starting a patient on carbimazole for hyperthyroidism, what is the main SE you should counsel them on?

Answer 18

Agranulocytosis (immediate help if sore throat, mouth ulcers, brusing, fever, malaise)

Question 19

A patient with UC presents for his 3 month review after being started on mesalazine, what monitoring should patients on mesalazine recieve?

Answer 19

Renal function (start, 3 months, yearly)

Question 20

What blood test should be conducted when starting steroids in a 60 year old man? What additional medications should be prescribed?

Answer 20

Glucose (can worsen diabetes)

Also prescribe PPI

Question 21

Name 2 common side effects of denosumab?

Answer 21

Hypocalcaemia (can be used to treat hypercalcemia)

Osteonecrosis of the jaw

Question 22

The chemotherapy agent Vinblastine is most commonly associated with which side effect?

Answer 22

Peripheral neuropathy

Question 23

How long after a prescription is dated can it be picked up?

Answer 23

6 months

Question 24

How long can the contraceptive pill be prescribed for on a single prescription?

Answer 24

6 months

Question 25

Which opiates can come in a patch?

Answer 25

Fentanyl | Buprenorphine

Question 26

How do you find the opiate conversion tables in the electronic BNF?

Answer 26

Guidance tab at the bottom | Prescribing in paliative care

Question 27

You are writing a prescription for a fentanyl patch (a 75 microgram patch) which should be given one every 72 hours. How do you write this prescription?

Answer 27

``` FENTANYL 75 (SEVENTY-FIVE) MICROGRAM PATCH Replace ONE (1) patch every 72 (SEVENTY-TWO) hours Supply FIVE (5) patches ```

Question 28

When replacing opiate patches what is the guidance around replacing the patches?

Answer 28

Replace at a different site! When starting take last dose of other opiates (i.e. oral MR) then immediately put patch on (as it takes a bit of time to work)

Question 29

A patient under the paliative care team is using fentanyl patches (equivalent to 180mg morphine daily) however needs extra support for breakthrough pain, what should she be prescribed?

Answer 29

Oromorph | 1/6 to 1/10 of daily dose (18 to 30mg)

Question 30

When increasing opiates what is the maximum change you should make?

Answer 30

Do not increase more than 50% of current dose | i.e. if on 100mg/ day don't go to more than 150mg/day

Question 31

When counselling for Warfarin vs. NOAC what are the main points which should be covered?

Answer 31

Warfarin - individualised treatment and INR is monitored - Diet has to be monitored more in warfarin - Much more monitoring requirement for warfarin - Reversible with vit K NOACS - Less monitoring and less lifestyle impact - Note Dabigatran can be reversed, others can't initially (so if high fall risk should Wafarin be considered?)

Question 32

What surface area should one fingertip unit of steroid cream cover?

Answer 32

Approx size of face or both palms

Question 33

Name three drugs which could help a patient trying to come off alcohol?

Answer 33

Naltrexone/ Baclofen- Make alcohol use less rewarding Acamprosate- Reduces craving Disulfiram- Causes sickness when alcohol ingested (v.low adherence)

Question 34

Name three side effects/ increased risks when taking the COC pill? When should this pill be taken?

Answer 34

Each day at same time for 21days, 7 day break Small risk of blood clots Very small risk of heart attacks and strokes Increased risk of breast cancer and cervical cancer

Question 35

What are bisphosphonates used for and what is the most common side effect of them? E.g Alendronic acid

Answer 35

Used to strengthen bones - Most common SE is inflammaton/ ulceration/ irritation of the oesophagus (So take 30min before food and don't lie down for 30min after)

Question 36

What is the most important side effect of rispiridone?

Answer 36

Hyperprolactinaemia | Change in periods, galactorrhea, painful intercourse, acne and hirsutism

Question 37

You are about to start a patient on ramiprill and are reviewing some bloods they have just had done, what key areas must you look at? (3)

Answer 37

``` Baseline potassium (ACEI can cause hyperkalaemia) Baseline renal function (ACEI cause decreased renal function, up to 25% increase in urea/creatinine is acceptable) - Px to return in 7-10days to have renal function monitored ```

Question 38

A patient is about to be started on treatment for their newly diagnosed pulmonary TB infection, what agents are started? - What must be checked before starting

Answer 38

``` Isoniazid - 6months Rifampicin- 6months Pyrazinamide- 2months Ethambutol- 2months All causes liver toxicity so check LFTs, also check kidney function and caution starting ethambutol if kidney pathology ```

Question 39

You are about to start a patient on Metronidazole, what is the single most important lifestyle factor you must council on?

Answer 39

ALCOHOL MUST BE AVOIDED - There is a very severe reaction - All AB's may have some small reaction but the reaction between alcohol and metronidazole is very severe

Question 40

Name 3 drugs which can cause lung fibrosis?

Answer 40

Amiodarone, methotrexate, nitrofurantoin (used for UTI) , bleomycin

Question 41

Name 6 common side effects of iron supplementation?

Answer 41

``` Constipation Black stools Diarrhoea Heartburn Nausea Abdominal/epigastric pain ```

Question 42

A patient is diagnosed with impertigo, what is the best treatment?

Answer 42

Fucidic acid | Flucloxacillin if very severe

Question 43

A patient on antibiotics complains of orange tears and orange urine, what is the most likely antibiotic they are taking?

Answer 43

Rifampicin

Question 44

Where does metoclopramide act and what are some of it's most important side effects?

Answer 44

Acts on the gut (so good for gastroenteritis, or other motility problems) - Can cause tardive dyskinesia and extra pyramidal problems