Key PSA facts Flashcards
(256 cards)
1
Q
Management of croup
A
- Drug : dexamethasone
- Dose : 150 micrograms / kg
- Route : Oral (PO) or IV
- Frequency : once only
1
Q
Pain relief in an MI
A
- Drug : morphine
- Dose : 2.5-5mg in elderly (5-10mg otherwise)
- Route : slow IV infusion
- Frequency : once only
2
Q
Fluid given in the initial treatment of DKA if systolic BP is <90
A
- Drug : sodium chloride 0.9%
- Volume 500 mililitres (ml)
- Route : intravenous (IV)
- Rate : Infusion over 10-15 minutes
3
Q
First line medication for severe acute asthme
A
- Drug : salbutamol
- Dose : 5 miligrams (5mg)
- Route : Nebulised (NEB)-oxygen-driven
- Frequency : Repeat every 20-30 min or as required
4
Q
Management of benzodiazepine overdose
A
- Drug : Flumazenil
- Dose : 200 micrograms
- Route : intravenous injection
- Duration : Over 15 seconds
5
Q
Management of aspirin overdose if presenting within an hour
A
- Drug : activated charcoal
- Dose : 50g
- Route : oral (PO)
- Frequency : once only
6
Q
Management of GORD in the medium-long term
A
- Drug : lansoprazole
- Dose : 30mg
- Route : oral (PO)
- Frequency : once daily
7
Q
Normal dosing of methotrexate in moderate - severe RA
A
-> 7.5mg once weekly
-> Max 20mg !!!!
8
Q
Normal dosing of glicalazide
A
- Initially 30mg before adjusting (OD)
- Max 120mg per day
9
Q
Normal dose of ibuprofen
A
- 400mg TDS
10
Q
Normal dosing of lisinopril
A
- Maintenance is usually 20mg OD
- Max 80mg
11
Q
Normal dosing of metformin
A
Usually 500mg TDS
12
Q
Drug likely to cause diarrhoea in the management of refeeding syndrome
A
Magnesium glycerophsophate
13
Q
what 2 medications, if prescribed together can cause serious cardiac SE and how would it present
A
VERAPAMIL + BB
Bradycardia
Hypotension
1st degree heart block
Pt might present with episodes of collapse
14
Q
How does the medication of a patient with know Addison’s need altering when acutely unwell
A
Double the dose of corticosteroid
15
Q
Medications likely to contribute to UGIB
A
- NSAIDS
- Oral bisphosphonates (e.g. alendronic acid)
- Oral steroids (e.g. prednisolone)
16
Q
Medication known to cause hyperglycaemia
A
Oral Prednisolone
Thiazide diuretics (e.g. bendroflumethazide)
17
Q
Fluids used for resuscitation in hypotensive and tachycardic patient
A
500ml 0.9% sodium chloride IV
18
Q
Management of acute anaphylactic reaction in an adult / child 12 or above
A
500 micrograms adrenaline IM (0.5 mL of 1:1000).
19
Q
Management of opioid toxicity
A
Naloxone 400 micrograms (mcg) IV
20
Q
Management of acute pulmonary oedema
A
- IV furosemide 40mg once only
21
Q
Management of anaphylaxis in a child aged 6-11 yrs
A
- IM adrenaline 300 micrograms
22
Q
Management of ascites due to liver cirrhosis
A
- Spironolactone 100mg OD oral
23
Q
Management of severe hypoglycaemia causing reduced consciouss and seizures
A
- 20% glucose 100ml IV
Both of these are equivalent to 15-20g glucose
24
Adverse effect of ondasetron
QT interval elongation
25
Antibiotic that can increase the effect of warfarin and in turn increase the risk of bleeding
- Macrolides (erythromycin, clarithromycin)
26
What type of diuretic has the highest incidence of causes hyponatraemia ?
Thiazide (Indapamide, bendroflumethazide)
27
What should be checked following blood transfusion to check for acute transfusion reaction
HR, BP and temperature, 15 mins later
28
what should be checked to monitor for possible adverse reaction following insulin-glucose infusion for hyperkalaemia ?
- Capillary blood glucose due to risk of hypoglycaemia
29
what should be checked after 4 days of antiobitoic treatment for pneimonia to check response
CRP
30
what is the best way to monitor the therapeutic effects of diuretics in fluid overload due to HF
Daily weights
31
what is the most appropraite way to monitor for the adverse effects of prescribed oxygen therapy in a smoker ?
- ABG after 30 mins due to risk of hypercapnia
32
What drugs are directly nephrotoxic ?
- Aminoglycosides (e.g gentamycin, vancomycin, amikacin)
- Amphotericin
- Cytotoxic chemo (e.g cisplatin)
33
What drugs contribute to AKI due to causing renal ischaemia, renal hypoperfusion, volume depletion
- Diuretics = volume depletion
- Immunosuppression (ciclpsporin, tacrolimus) = renal ischaemia
- Radiocontrast media = Renal ischaemia
- NSAIDs / COX-2 inhibitors = renal hypoperfusion
34
what fluids are prescribed in an AKI
Sodium chloride 0.9% IV
35
When would sodium bicarbonate 1.25% be the fluid of choice prescribed in AKI ?
AKI WITH hypovolaemia and metabolic acidosis
36
What is the most sensitive indicator of hypovolaemia suggest AKI is caused by dehydration ?
Postural rise in HR of >= 30bpm.
37
what medications should be stopped in an AKI?
D : Diuretics
A : ACEI/ARB
M : Metformin
N : NSAIDs
Allopurinol can accumulate, max dose 100mg
38
what Abx are safe to use in AKI ?
- Cephalosporins (e.g. ceftazidime)
- Carbapenem (e.g. meropenem)
39
what diuretic can be used in AKI for fluid overload
- Furosemide
- DO NOT use combination diuretics
- Thiazide diuretics are ineffective if eGFR <30
40
why are ACEI stopped in AKI ?
Can cause hyperkalaemia
41
when should ACEI / ARBs NOT be used
- Bilateral renal artery stenosis
- Renal artery stenosis if one kidney
- Widespread vascular disease
42
Main CI to heparin and erythromycin
- Heparin = not appropriate in ischaemic stroke
- Erythromycin = increases effects of warfarin and so INR
43
SE of steroids
S : Stomach ulcers
T : Thin skin
E : oEdema
R : Right and left sided HF
O : Osteoporosis
I : Infection
D : DM
S : cushing's Syndrome
44
SE / CI to NSAIDs
N : No urine (renal failure)
S : Systolic dysfunction (HF)
A : Asthma
I : Indigestion
D : Dyscrasia (clotting abnormalities)
45
Specific SE to thiazide diuretics and spironolactone
- Thiazide = gout
- Spironolactone = gynaecomastia
46
what is anti-emetic is given 1st line
Cyclizine ?
47
when is cyclizine CI and what is given instead >
- HF !!!
- Metaclopramide
48
When is metaclopramide and haloperidol not given as anti-sickness ?
- Parkinson's
49
what diuretics can cause hypokalaemia ?
- Loop diuretics (furosemide)
- Thiazide diuretics (bendroflumethazide, indapamide)
50
what medications can cause hyperkalaemia
- ACEI
- Potassium sparing dieuretics (spironolactone, amilordide)
- Heparin !
- Tacrolimus !
51
what medications should be reviewed in a confused elderly patient ?
- Antimuscarinics (e.g. bumetanide)
- Anticholinergics (cyclizine)
- Opioids
- Benzos
52
what should be avoided in asthmatics ?
- BB
- NSAIDs
53
what should be stopped in active infection
Methotrexate
54
Causes of hyponatraemia
- Hypovolaemic : D&V, Addison's, diuretics
- Euvolaemic : SIADH, hypothyroid, psychogenic polydisplasia
- Hypervolaemic : HF, renal failure, nutritional
55
Causes of hypernatraemian
- Dehydration
- Drugs (e.g. lithium)
- Drips
- DI
56
Causes of hyperkalaemia
- Drugs (K+ sparing diuretics, ACEI)
- Renal failure
- Endocrine (addison's)
- Artefact
- DKA
57
Causes of hypokalaemia
- Drugs (loop/thiazide)
- Inadequate intake or GI loss (D&V)
- Renal tubular acidosis
- Endocrine (Cushing's/conn's)
58
How can the cause of renal failure be determined ?
Based on relative increase of urea compared to creatinine
1. Pre renal : Urea rise >> creatinine.
2. Intrinsic : Urea rise << creatinine.
3. Post renal : Urea rise << creatinine + bladder / hydronephrosis may be palpable
59
How can LFTs be interpreted ?
1. Hepatocyte injury : bilirubin and AST/ALT
2. Cholestasis / obstruction : ALP
3. Synthetic function : albumin, vitamin K dependent clotting factors (1972)
60
what can an isolated raised ALP suggest ?
ALKPHOS
- A : any fracture
- L : Liver damage (post hepatic)
- K : Kancer
- P : Paget's disease of bone and Pregnancy
- H : Hyperparathyroid
- O : Osteomalacia
- S : Surgery
61
Major bleeding + on warfarin
STOP WARFARIN
Give 5-10mg IV vit K
Give prothrombin complex
62
INR 5-8 but no bleeding
Omit for 2 days
Reduce dose
63
INR 5-8 minor bleeding
Omit
1-5mg IV vit K
64
INR >8 no bleeding
Omit
1-5mg PO vit K
65
INR >8 + minor bleeding
Omit
1-5mg IV vit K
66
Management of tachycardia with adverse features
Synchronised DC shock up to 3 attempts
67
Management of tachycardia with BROAD QRS + regular
- If ventricular tachycardia : Amiodarone 300mg IV over 20-60 mins
- If previously confirmed SVT with BBB manage as regular narrow complex tachy
68
Management of tachycardia with IRREGULAR BROAD QRS
Seek expert help
69
Management of tachycardia with narrow regular QRS but no adverse signs
1. Vagal manoeuvres
2. Adenosine 6mg rapid IV bolus up to 18mg
70
Management of tachycardia with narrow irregular QRS
Probably AF -> rate control with BB or diltiazem
71
Example of pharmacodynamic drug interactions
- Sertraline and warfarin
- Warfarin and vit K foods
- ACEI and K+ containing salt
- Verapamil and BB
- Warfarin and NSAIDs
- Aminoglycosides and loop diuretics
72
Example of pharmacokinetic drug interactions
- Lithium salt and ramipril
- Rifampicin and COCP
- Warfarin and erythromycin and clarithromycin
73
what antibiotic would require extra protection in someone on the COCP
Rifampicin
74
If takin levonorgestrel emergency contraception but on carbamazpine for epilepsy what steps need to be taken ?
Double the dose
75
What can inhibit P450 enzyme system
- Isoniazid
- ciprofloxaciN
- etHanol
- azole antIfungals
- Buprion
- erythromycIn
- dilTiazem
- Omeprazole
- gRapefruit juice
- sSri
76
What can induce P450 system
- cIgarette smoke
- phenytoIn
- Dexamethasone
-barbitUrates
- Carbemazepine
- Ethanol
- Rifampicin
- St John's wort
77
Effect of St John's wort with certain medications
1. Cause organ transplant rejection if taken with ciclosporin
2. Increase risk of serotonin syndrome if given with citalopram
3. Decrease INR in pts on warfarin, increasing VTE risk
78
what is diclofenac CI in ?
IHD
79
Important info to tell pts commenced on labetalol
Report ANY non specific itching due to association with severe hepatocellular injury
80
Important information to tell pts on amiodarone
- Avoid direct sunlight and wear wide-spectrum suncreen due to risk of phototoxic reactions
81
when writing a prescription for an ACEI, when should they be given and why
- Nightly !!
- Due to risk postural hypotension
82
what needs checking prior to commencing vancomycin and why ?
- Creatinine
- Dose is adjusted based on kidney function
- + Nephrotoxicity and ototoxcicity = biggest SE
83
Important parameter to measure before commencing vancomycin
Serum creatining -> guides dosing + most common SE = nephrotoxicity and otoxicity
84
Important parameter to measure before commencing statin
- > ALT as used in caution in people with liver disease
85
Key facts regarding monitoring of lithium therapy
-> Check serum levels 12 hrs post dose
-> Toxicity effects manifest at 1.5mmol/l
-> FBC checked every 1-2 wks until stabilised
-> Routine lithiium level checks weekly, after each dose change and then 3mnthly after stabilisation
86
Change in what electrolyte will increase risk of lithium toxicity
- Reduced sodium
87
Key points regarding methotrexate monitoring
- FBC checked every 2-3 mnths once stabilised
- Drop in WCC / plts = stop immediately
- If LFTs abnormal = stop immediately
88
what is required at baseline before commencing amiodarone and why
- ECG
- CXR - risk of pulmonary toxicity
- U&Es
- TFTs : also required every 6 mnths
- LFTs
89
what needs to be checked at baseline before commencing olanzapine ?
Fasting blood glucose due to risk of hypergylcaemia and DM
90
what needs monitoring in digoxin ?
Serum creatinine due to risk of renal dysfunction
91
What needs checking at baseline when commencing SV ?
ALT due to association with hepatotoxicity
92
How long are weekly FBCs required when commencing clozapine
18 wks
93
Adverse drug reactions to gentamicin and vancomycin
Nephrotoxicity
Otoxicity
94
Adverse reaction to cephalosporins or ciprofloxacin
Clostridium difficile
95
Three adverse reactions to ACEI
- Hypotension
- Hyperkalaemia and hence AKI
- Cough
96
4 adverse reactions to BB
- Hypotension
- Bradycardian
- Wheeze in asthmatics
- Worsens acute HF
97
4 adverse reactions to CCB
- Hypotension
- Bradycardia
- Peripheral oedema
- Flushing
98
3 adverse reactions to aspirin
- Haemorrhage
- Peptic ulcers and gastritis
- Tinnitus in larger doses
99
6 adverse reactions to digoxin
- N&V
- Diarrhoea
- Blurred vision
- Confusion
- Drowsiness
- Xanthopsia - 'halo' vision
100
4 adverse effects of amiodarone
- Pulmonary fibosis
- Hypo and hyperthyroid
- Skin greying
- Corneal deposits
101
Early and intermediate adverse effects of lithium
- Early = tremor
- Intermediate = Tiredness
102
Late adverse effects of lithium
- Arrhythmias
- Seizures
- Coma
- Renal failure
- Diabetes insipidus
103
Adverse reactions to haloperidol
Dyskinesias (e.g. acute dystonic reactions, drowsiness)
104
Adverse reaction to clozapine
Agranulocutosis
105
Advers reactions to dexamtethasone and prednisolone
S : Stomach ulcers
T : thinning skin
oE : dema
R : Right and left HF
O : Osteoporosis
I : Infection
D : DM
S : cushing's Syndrome
106
Adverse reaction to fludrocortisone
Hypertension / sodium and water retention
107
Adverse reactions to ibuprofen
N : No urine (renal failure)
S : Systolic dysfunction (HF)
A : Astham
I : indigestion
D : Dyscrasia (clotting abnormality).
108
Adverse reactions to statins
- Myalgia
- Abdo pain
- Increased AST/ALT
- Rhabdomyolysis
109
Adverse drug reaction of lactic acidosis can be caused by ?
- Metformin
- Metformin should be stopped if pt goes into metabolic acidosis
110
GI bleed can be caused by?
NSAIDs - aspirin, ibuprogen
111
Increased anticoagulation can be caused. by ?
- Warfarin (with acute alcohol)
- Chronic alcohol reduces alcohol effect
112
Sweating, flushing and N&V can be caused by ?
Metronidazole
Disulfiram
113
warfarin can interact with what Abx and lead to a potentially serious ADR?
Erythromycin / clarithromycin
114
Management of hypoglycaemia in conscious patient
15-20g glucose by mouth
115
What conditions have a target INR of 2.5
- Bioprosthetic heart valve
- DVT or PE
- AF
- Cardioversion
- Dilated cardiomyopathy
- Mitral stenosis or regurgitation in patients with either atrial fibrillation, a history of systemic embolism, a left atrial thrombus, or an enlarged left atrium
- Acute arterial embolism requiring embolectomy
116
Prescription for the management of hyperkalaemia
- 50% dextrose 50ml + 10 units actrapid IV over 15 minutes
117
Management of hypothyroidism caused by amiodarone
- Continue amiodarone and commence levothyroxine
118
If a pt has an anaphylactic reaction to penicillin, what other class of antibiotic may they also have a cross-reactivity reaction with ?
Cephalosporins (e.g. Cefuroxime)
119
Management of hyperthyroid caused by amiodarone
withhold amiodarone
120
Management of scabies
- Drug : permethrin 5% cream
- Dose : apply to whole body
- Route : topical
- Frequency : Once weekly for 2 doses
121
Management of mild eczema flares
- Drug : hydrocortisone 1%
- Dose : 1 thin application
- Route : topical
- Frequency : once or twice daily
122
Management of non bullous impetigo
- Drug : hydrogen peroxide 1%
- Frequency : 2-3 times daily
- Route : topical
- Duration : 5-7
123
Management of cellulitis
- Drug : flucloxacillin
- Dose : 0.5-1g
- Route : Orally
- Frequency : Four times daily
- Duration : 5-7 days
124
Management of cutaneous warts (+where would you find this on BNF ?)
- Drug : salicylic acid 2%
- Route : topical
- Frequency : OD
- Dose : 1 application
- Duration : up to 3mnths
125
Management of cellulitis if penicillin allergic and pregnant
Erythromycin (would be clarithromycin if not pregnant)
126
Management of mild-moderate acne vulgaris
- Drug : adapalene (0.1%) with benzoyl peroxide (2.5%)
- Dose : 408mg
- Route : topical
- Frequency : once daily, evening
127
Important information / monitoring requirements of ciclosporin
- Will need regular renal function checks
- Serum creatinine every 2 wks for first 3 mnths and then check monthly
128
What is required contraception wise when commenced on isotretinoin
- Effective contraception 1mnth before,all way through treatment + pregnancy test every month throughout and effective contraception for a mnth after
129
what is deemed as effective contraception when being commenced on isotretinoin ?
1. One highly effective user independent method (IUD)
2. Two complimentary but user-dependent methods (COCP & condom use)
130
Common and rare adverse effect of tetracycline antibiotics
- Common = photosensitivity
- Rare = Idiopathic intracranial hypertension (should be stopped before commencing retinoids)
131
what 4 fluid types do you need to be appear of for the PSA
- Sodium chloride 0.9% 1000ml – 150mmol Na
- Potassium chloride 0.3% 1000ml – 40mmol K
- Potassium chloride 0.15% 1000ml – 20mmol K
- Glucose 5% 1000ml – 50g glucose
132
Where would you find the electrolyte concentrations of different fluids on the BNF
Fluids and electrolytes treatment summary
133
What are the daily requirements of water, Na and K and glucose?
-> 25-30ml/kg/24h water
-> 1mmol/kg/24h Na and K (and Cl)
-> 50-100g/24h glucose
134
At what rate should K+ be replaced no faster than and so at what rate should the possible potassium chloride bags me given at ?
- 10mmol/h
- Potassium chloride 0.3% (40mmol) minimum 4h
- Potassium chloride 0.15% (20mmol) minimum 2h
135
Fluid for emergency resus (hypotensive, tachycardia, CRT >3s)
Sodium chloride 0.9% 500ml 15m
136
Fluid for emergency hypoglycaemia (unconscious)
Glucose 20% 100ml 15m
(LOOK FOR THE OPTION EQUIVALENT TO 15-20g of glucose !)
137
Fluid for emergency hypokalaemia
Sodium chloride 0.9% / potassium chloride 0.3% 1000ml 4h
138
Fluid for emergency hypercalcaemia
Sodium chloride 0.9% 1000ml 4h
139
Maintenance fluid without deficit or loss
-> 25-30ml/kg/24h water
-> 1mmol/kg/24h Na and K
-> 50-100g/24h glucose
(aim 1000ml 8-12h)
140
Maintenance fluids if there are deficits or losses
- Minimum 30ml/kg/24h water
(aim 1000ml 4-6h)
- Ensure electrolytes replaced -> add potassium to sodium chloride if needed.
141
Fluids for emergency resus in a child
Sodium chloride 0.9% 10ml/kg 15m
142
Maintenance fluids with deficits or losses in a child
- 100ml/kg/24h for <10kg
- 50ml/kg/24h for 10-20kg
- 20ml/kg/24h for >20kg
Once calculated =
Sodium chloride 0.9%/glucose 5% Xml over 24 hrs
143
Symptoms of hypercalcaemia
- Stones : kidney / biliary
- Bones : Bone pain
- Groans : Abdo pain
- Moans : non specific Sx
- Thrones : constipation and polyuria
- Muscle tone : weakness, decreased reflexes
- Psychiatric overtones : confusion, depression and anxiety
144
ECG change in hypercalcaemia
Shortened QT
145
Symptoms / signs of emergency hypokalaemia
- Metabolic alkalosis
- Arrythmias
- Muscle weakness,
- Reduced reflexes
- Constipation
146
ECG changes in hypokalaemia
In hypokalaemia U have NO POT or NO T but a LONG PR and a LONG QT
-> U waves
-> NO potassium
-> No T waves
-> Long PR
-> Long QT
147
What other electrolyte needs to be checked in a pt with hypokalaemia ?
Magnesium
148
where can info regarding management of hypercholesterolaemia and initiation of statins be found
Dyslipidaemias treatment summary
149
Explain the different doses of atorvostatin and why its given
- Primary prevention : 20mg
- Secondary prevention (e.g. following MI) : 80mg
150
Where would you find information regarding the acute treatment of asthma in a child ?
BNFc - Asthma, acute treatment summary
151
Management of COPD exacerbation follWowing nebulisers
Prednisolone 30mg OD for 7-14 days
152
When is LTOT indicated in COPD ?
pO2 <7.3
153
When is NIV indicated in an acute exacerbation of COPD ?
pH <7.35
154
VTE prophylaxis in renal failure
Unfractionated heparin 5000 units subcut every 8-12 hrs
155
Options for treatment dose VTE
Apixaban or rivaroxaban
156
Prophylaxis VTE options
- Dalteparin, enoxaparin or tinzaparin) UNLESS renal failure then unfractionated heparin
- Dalteparin = fagmin
- Enozaparin = Clexane
157
Monitoring of LMWH, unfractionated heparin, DOACs and warfarin
1. LMWH – anti-factor Xa
2. Unfractioned heparin – aPTT
3. DOACs – monitor clinically
4. Warfarin – INR
158
Reversal of LMWH and unfractionated heparin
Protamine sulphate
159
Management of hypocalcaemia
Calcium gluconate 10% 10ml IV over 10 minutes
160
Signs and symptoms of hypocalcaemia
CATs go Numb
- C : Convulsions
- A : Arrythmias
- T : Tetany
- N : Numbness
Signs : trousseau's and chvostek's sign
161
Sign of hypocalcaemia on ECG
QT prolongation
162
Causes of hypocalcaemia
- Hypoparathyroidism
- Secondary hyperparathyroidism
- Vitamin D deficiency
- Blood transfusion
- Hypomagnesemia
- Steroids
163
Causes of hypercalcaemia
- Primary and tertiary
hyperparathyroidism
- Cancer
- Multiple
myeloma
- Sarcoidosis,
- TB
- Paget disease
- Thiazide diuretics
164
Management of severe hyperkalaemia
Calcium gluconate 10% 30ml IV
165
Symptoms / signs of hyperkalaemia
- Metabolic acidosis
- Arrythmias
- Muscle weakness,
- Reduced reflexes
- Diarrhoea
166
Signs of hyperkalaemia on ECG
- Absent P waves
- Prolonged QRS
- Peaked or ‘tall tented’
T waves
- Sine wave pattern
167
Causes of fall
- Tamulosin
- Aortic stenosis (SAD - Syncope, Angina, Dyspnoea)
168
Management of adrenal crisis in patient with addison's disease
Hydrocortisone 10mg IM / IV
169
GP management of suspected meninigitis
IM benzylpenicllin
IF penicillin allergic : cefoxatime 2g IM
170
Anti-emetic in vertigo / motion sickness / vestibular disorders
Cyclizine
171
Post operative anti-emetic
Ondansetron
172
Anti emetic in parkinsons
Domperidone
173
Anti emetic in hyperemesis gravidarum
Promethazine
174
Chemotherapy induced nausea
Acute : ondansetron
Chronic : metoclopramide
175
Risks of HRT
- Breast cancer
- Endometrial cancer
- Ovarian cancer
- VTE (stop 4-6 wks before surgery)
- Stroke
- CAD
176
HRT if uterus intact and LMP <12mo
- Oral sequential oestrogen + progestogen (Elleste-Duet 1mg or 2mg OR patch-sequential combined oestrogen + progestogen (Evorel Sequi)
First line = estradiol 1mg with norethisterone sequential
177
HRT for uterus intact with LMP >12mn
- Oral continuous combined oestrogen + progestogen (Elleste-Duet Conti), patch continuous combined oestrogen + progestogen (evorel conti), tibolone
First line = Estradiol 2mg + Norethisterone 1mg continuous
178
HRT post hysterectomy
Oral or patch oestrogen or tibolone
First line = estradiol 1mg tablets
179
Management of post menopausal osteoporosis
Alendronic acid or risedronate sodium
180
Vasomotor symptom control in someone who cannot take HRT
Clonidine
181
Management of menopausal atrophic vaginitis
Topical vaginal oestrogen (pessary or rinr)
182
what medications are prescribed in mcg and so need checking in prescription reviews
- Levothyroxine
- Tamsulosin,
- Digoxin
- Naloxone,
- Fludrocortisone
- Inhalers
- GTN spray
- Ipratropium nebs
183
what medications should be given in the morning ?
- Diuretics
- Steroids
184
What medications should be given at night ?
- Statins
- Night sedation
185
what medications are given weekly
- Methotrexate / folic acid
- Patches
- Larger bisphosphonate dose in women
186
Medications most likely to cause hypoglycaemia
- Insulin
- Sulphonureas (e.g. gliclazide)
187
Medications most likely to cause hyperglycaemia
- Steroids
- Antipsychotics
- Thiazides
- Beta blockers
- Tacrolimus
188
Medications likely to cause constipation
- Opioids (e.g. oramorph, tramadol)
- Iron
- CCBs
- Ondansetron, metoclopramide),
- Antacids that contain calcium
- Anticholinergics (antidepressants, antihistamines,
incontinence medications, antipsychotics)
189
Medications likely to cause diarrhoea
- Antibiotics (C. diff)
- Colchicine
- Metformin
- PPIs
- Alendronic acid
- Antacids that contain magnesium,
- Laxatives
190
Medications causing urinary retention
- Opioids
- Anticholinergics
191
Medications causing urinary incontinence
- Alpha-blockers
- Diuretics
- Anticholinesterase inhibitors
- Clozapine
192
Medications likely to cause confusion
Opioids
Sedatives
Anticholinergics
Steroids
193
Medications likely to cause falls
- Benzodiazepine
- Antidepressants (esp TCAs and SNRIs)
- MAO
- Antipsychotics,
- Opiates (e.g tramadol)
- Antihypertensives
- Parkinson’s medications (ropinirole, selegiline)
- Antimuscarincs (e.g. oxybutynin)
194
Medications that can cause gout
Diuretics
195
Medications that cause osteoporosis
Steroids
PPIs
LHRH agonists (Bureslin, goreslin)
196
Medications that cause HTN
NSAIDs
Steroids
Oral contraceptives
Mirabegron
197
Medications that cause high cholesterol
Steroids
Thiazides
198
How to find the table of drugs that cause X, Y, Z on the BNF
Search appendix 1 interactions
199
what medications should be stopped if intercurrent illness
Metformin
Statins
-Gliflozins
200
What medications should be stopped prior to surgery
- DOAC (48hrs)
- Clopidogrel (7d)
- Aspirin (7d)
- Warfarin (bridging plan)
201
Medications that worsen parkinsons symptoms
- Haloperidol
- Metoclopramide
- Antidepressants
- Olanzapine
202
Medications that worsen myasthenia gravis
- Antibiotics
- BB
- Local anesthetic
- Sedating drugs
203
Medications that worsen psoriasis
- BB
- Lithium
- Some antibiotics
204
Medications that worsen HF
- NSAIDs
- CCBs
- Thiazolidinediones (Pioglitazone)
205
If a patient is dehydrated due to diarrhoea and as a result hypotensive, what medications should be held ?
- BB
- CCB
- Both will worsen hypotension whilst dehydrated
206
Drugs that should be stopped in AKI
stop the DAMN drugs
D : Diuretics
A : ACEI/ARB
M : Metformin
N : NSAIDs
+ allopurinol -> can accumulate in renal dysfunction (max dose of 100mg till renal function improves)
207
Drugs that can cause oral candidiasis
- Antibiotis
- Steroids
- Immunosuppressants
- Inhaled steroids can also be a RF but if in the same question as antibiotics and oral steroids
208
Medication that can cause euglycemic DKA
SGLT-2 inhibitors (canagliflozin, dapagliflozin, empagliflozin)
209
Causes of drug induced hyponatraemia
Ramipril
Omeprazole
Thiazide diuretics
Loop diuretics
Sulphonylureas
Antidepressants
Carbamazepine
Hypnotics
210
What medication can cause hypoglycaemia, especially in combination with insulin or a sulfonyurea?
SGLT2 inhibitors
211
Medications likely to cause reflux
1. Bisphosphonates
2. CCB
3. Antimuscarinics (e.g. tolterodine)
212
what is important to check in the stem of the question in a patient prescribed paracetamol
Patients weight -> dose needs reducing to 500mg PO QDS if <50kg
213
what medication can cause Fournier's gangrene ?
SGLT2 inhibitors
214
What medication can accumulate in AKI and so has a max daily dose of 100mg
allopurinol
215
what can be used to treat hyperthyroid in someone who is trying to conceive or is pregnant ?
Propylthiouracil (PTU)
216
what is used for the management of constipation in a patient with diverticular disease who cannot tolerate a high fibre diet ?
' Bulk forming laxatives'
Ispagula husk
217
Management of cerebral oedema caused by brain mets
- Dexamethasone 0.5-10mg daily.
OR
- Methylprednisolone, 2-40mg, oral, once daily
218
Treatment of DVT / PE in pregnancy
LMWH
219
Management of Raynaud's
Nifedipine 5mg PO TDS
220
what medication must be stopped when commencing a macrolide antibiotic cue to increased risk of rhabdomyolysis when combined
Statin
221
Monitoring requirements on the COCP
Weight
Blood pressure
222
Management of an acute dystonic reaction
- Procyclidine hydrochloride
- 5-10mg
- IM / IV
223
What medication is CI in the context of peripheral vascular disease (e.g. ulcers)
BB
224
What medications can worsen biventricular HF
Corticosteroids
CCB
225
If glycaemic control is worst in the afternoon and needs to be improved, what is the simplest way to achieve it if on insulin?
Increase the morning biphasic insulin
226
what should be done with regards to insulin in the management of a pt with DKA
Stop short acting SC insulin
Continue long-acting insulin
Fixed-rate IV insulin given alongside fluid resus
227
If a pt on morphine sulphate develops AKI, what can the pain medication be changed too ?
Oxycodone
228
what can be used for restlessness and agitation in the palliative care setting ?
Haloperidol
229
what is used to prevent pneumococcal infection in children with sickle cell disease
phenoxymethylpenicillin
230
Medical management of intermittent claudication if supervised exercise programme fails
naftidrofuryl oxalate 100mg PO TDS.
231
What is used to REDUCE FREQUENCY AND SEVERITY of attacks in meniere's disase ?
Betahistine
232
co prescription of what 2 classes of drug increases the risk of respiratory depression
Opiates (e.g. morphine) and benzodiazepines (e.g. lorazepam)
233
Pt on statin complains of muscles aches - what is the appropriate action
- Check creatinine kinase
- If >5 times the upper limit of normal, stop statin and monitor the symptoms
234
Monitoring of carbimazole to guide ongoing treatment ?
- Thyroid function tests every 6 wks until TSH in reference range
- FBC is only done if clinical suspicion of infection
235
Complication of long term hydroxychloroquine use
Bull's eye maculopathy -> central scotoma, change in colour vision and vision distortions
236
Pt presents in polymorphic ventricular tachycardia, what is this in keeping with the diagnosis of and what medications can contribute to it ?
- Torsades de Pointes -> QT interval prolongation
- Citalopram, ranolazine, fluconazole = all found in appendix 1
237
Presentation of open-angle glaucoma
Painless peripheral visual field loss
Raised intra-ocular pressure
238
Managed of suspected glaucoma with raised intraocular pressure
Latanoprost
239
what are the 2 most common medications associated with an increased risk of fractures ?
Steroids
PPIs
240
what pts are classes as high risk for developing neural tube defects in pregnancy and therefore require the higher dose of folic acid
- Maternal folate deficiency
- Maternal vitamin B12 deficiency
- Previous history of having an infant with a neural tube defect / FHx
- Smoking
- Diabetes !!
- Obesity
- Use of antiepileptic drugs
- Sickle cell disease.
241
Main SE of metformin
- Nausea and diarrhoea
- MALA
242
Main SE of DDP inhibitors (e.g. linagliptin, sitagliprin)
PANCREATITIS
Nasopharyngitis
243
Main SE of thiazolidinedione (e.g. pioglitazone)
- Oedema
- HF
- Post-menopausal
- Osteoporosis
- Bladder cancer
244
Main SE of sulfonylureas (e.g. gliclazide)
Hypoglycaemia
Cholestasis
245
Main SE of SGLT-2 inhibitors ('flozin')
Euglycaemic ketoacidosis
Genital infections
246
Main SE of GLP-1 analogues (e.g. exenatide, semaglutide)
PANCREATITIS
Nausea
Diarrhoea
247
Main SE of a-glucosidase inhibitor (e.g. acarbose)
Bloating
Flatulence
Diarrhoea
248
is apixaban safe in pregnancy
NO
249
Is bendroflumethazide safe in pregnancy
NO
250
what can be used for breakthrough pain in pts receibing at least 25 mcg of transdermal fentanyl per hour
- Nasal fentanyl
- Max initial dose of 50mcg into one nostril
251
when would trimethoprim be preferred treatment over nitrofurantoin for a UTI ?
eGFR <45
252
Cholestatic jaundice can occur with what medication ?
Flucloxacillin
253
a what percentage rise can be expected when starting an ACEI and so remaining on the dose for another week and repeating U&Es would be appropriate ?
Creatinine rise of <20%
254
what should be done if signs of lithium toxicity / plasma lithium levels of >1.5
Stop lithium and refer to hospital for monitoring
255
