Passmed and past paper bits

Question 1

What maintenance fluids should you be prescribing in adults?

Answer 1

Volume - 25-30ml/kg/day

Na+/K+/Cl- = 1mmol/kg/day

50-100g of glucose

Question 2

What do you have to be wary of when prescribing 0.9% saline?

Answer 2

Large volume increase risk of hyperchloraemic metabolic acidosis

Question 3

What do you have to be wary of when prescribing Hartmann’s?

Answer 3

Large volume - risk of hyperkalaemia

Question 4

Which drugs in heart failure improve long term prognosis?

Answer 4

ACEi

Beta Blockers

Question 5

What drugs can cause SIADH?

Answer 5

Sulfonylureas
SSRI's
Tricyclic's
Carbamazepine
Vincristine
Cyclophosphamide

Question 6

Which drugs are taken at night?

Answer 6

Statins

Amitriptyline

Question 7

Which drugs are contraindicated in Asthma?

Answer 7

NSAID’s
Beta blockers
Adenosine

Question 8

What should be monitored at the start of treatment with quetiapine?

Answer 8

Prolactin

All antipsychotics:

• FBC, U&E, LFT
• Lipids and weight
• Fasting BM
• BP, ECG
• Cardiovascular risk assessment

Question 9

Why should dextrose be avoided in stroke patients?

Answer 9

Risk of cerebral oedema

Question 10

What drug should be given in acute heart failure for breathlessness and oedema?

Answer 10

IV furosemide 20-50 mg

Question 11

What VTE prophylaxis should be offered in orthopaedic patients?

Answer 11

Enoxaparin 100mg/ml
40mg
SC
OD

Question 12

What reasons are there to hold in renal injury?

Answer 12

Nephrotoxic drugs - ACEi, ARB etc.

Drugs that will accumulate

Question 13

Which drugs are nephrotoxic?

Answer 13

NSAIDs
Tetracyclines
Nitrofurantoin
Metformin
ACEi/ARB
Lithium

Question 14

Which drugs accumulate in renal failure?

Answer 14

Most antibiotics - penicillins, cephalosporins, vancomycin, gentamicin, streptomycin

Digoxin
Atenolol
Allopurinol
Methotrexate
Sulphonylureas
Furosemide
Opioids

May need dose adjustment

Question 15

When prescribing for breakthrough pain, what should you use?

Answer 15

Ideally the same drug

Make sure you check the dose will be effective (if time)

Question 16

When is nitrofurantoin contraindicated?

Answer 16

GFR <45

Even if taking folic acid supplements, choose trimethoprim

Question 17

What is first line in acute alcohol withdrawal?

Answer 17

Chlordiazepoxide

Give Pabrinex in alcohol dependence

Question 18

What should you do with regards to warfarin and surgery?

Answer 18

Stop 7 days before
Aim for INR <1.5
If >1.5 - give vit k

Question 19

What key information should be given when prescribing SSRI’s?

Answer 19

Suicidal ideations may worsen for 4 weeks
Shouldn’t stop abruptly
Dose can be increased

Question 20

Which drug is associated with cholestatic jaundice?

Answer 20

co-amoxiclav

Question 21

What is normal to happen with creatinine on starting ACEi therapy?

Answer 21

Small rise <20%

Doesn’t req. investigation or change of drug

Question 22

What is used to measure efficacy of furosemide?

Answer 22

Weight

Question 23

What is used to assess for beneficial effects of ACEi?

Answer 23

Exercise tolerance

Question 24

How much should you increase insulin dose by if it appears to be ineffective?

Answer 24

Around 10%

Question 25

What do you aim for when starting statin treatment?

Answer 25

>40% reduction in non-HDL cholesterol

Question 26

How would you monitor the beneficial effects of allopurinol?

Answer 26

Serum urate

Question 27

How would you monitor for beneficial effects of fluids?

Answer 27

Blood pressure

Question 28

How do you calculate the breakthrough pain dose for morphine?

Answer 28

Total daily dose/6

Question 29

How do you calculate new doses for morphine if the current dose isn't controlling pain sufficiently?

Answer 29

Calculate total daily dose (slow release + all break through) and divide this by number of doses (typically 2) for new SR Total dose/6 = new breakthrough

Question 30

What is the typical basic dose for morphine?

Answer 30

15mg BD slow release | 5mg oral morphine breakthrough

Question 31

How do you convert between codeine to morphine?

Answer 31

divide by 10

Question 32

How do you convert from oral morphine to IV morphine?

Answer 32

divide by 2

Question 33

What is used to treat acute dystonia?

Answer 33

Procyclidine

Question 34

What is the ideal infusion rate for 1L maintenance fluids?

Answer 34

8-12 hours

Question 35

How can you ensure a patient doesn't have withdrawal bleeding when on ERT?

Answer 35

Give oestrogen and progesterone Make sure the drug is given constantly as opposed to sequential regimes

Question 36

Which drugs are contraindicated in peripheral vascular disease?

Answer 36

Beta blockers | ACEi are cautioned

Question 37

Which drugs commonly exacerbate heart failure?

Answer 37

Calcium channel blockers | Steroids

Question 38

What is the typical dosing for omeprazole?

Answer 38

10-20mg daily

Question 39

What should you do if a urine dip is + for leucocytes and nitrites?

Answer 39

Immediately start treatment even if not v positive. 92% positive predicted value

Question 40

How is scarlet fever managed?

Answer 40

10 days phenoxymethylpenicillin

Question 41

When should IM glucagon not be given?

Answer 41

IV glucose feasible to give quickly Patient anti-coagulated

Question 42

How should beta blocker therapy in AF be monitored for positive effect?

Answer 42

Heart Rate

Question 43

How is antibiotic effectiveness in sepsis monitored?

Answer 43

Symptom resolution

Question 44

What should you do if statins cause a markedly raised CK?

Answer 44

Discontinue statin and see if symptoms/CK resolve Restart on lower dose

Question 45

What may cause a painful unilateral rash?

Answer 45

Herpes - Shingles

Question 46

Which anti-emetic should be used in patients at risk of extra pyramidal side effects or QT prolongation?

Answer 46

Cyclizine

Question 47

Which drugs commonly cause ankle oedema?

Answer 47

Amlodipine | NSAIDs - naproxen

Question 48

When should loperamide be taken?

Answer 48

After each loose stool

Question 49

What can cause serotonin syndrome?

Answer 49

Taking SSRI's can predispose to serotonin syndrome Taking a serotonin inducing drug such as tramadol can induce it Other drugs include: - ecstacy - amphetamines - TCA's - SSRI's etc.

Question 50

How is anti-psychotic induced Parkinsonism managed?

Answer 50

Anticholinergics

Question 51

What should be done to pain management in case of AKI in acute pain?

Answer 51

Change to oxycodone Fentanyl better in renal impairment but not for acute pain

Question 52

What should be done with amiodarone in case of thyrotoxicosis?

Answer 52

Withhold amiodarone

Question 53

What is used for drug induced N&V?

Answer 53

Haloperidol Ondansetron if chemo

Question 54

What is used for GI stasis/peristaltic failure induced N&V?

Answer 54

Metoclopramide or Domperidone

Question 55

What is used for anxiety related N&V?

Answer 55

Lorazepam

Question 56

What is used for N&V due to intracranial disease, vestibular disturbance, pharyngeal irritation or liver stretch?

Answer 56

Cyclizine + tex if raised ICP

Question 57

When is hyoscine used as an antiemetic?

Answer 57

Prophylaxis Motion sickness