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Prescribing Flashcards

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1
Q

hypotensive on examination, what drugs are contraindicated?

A

A blockers (eg. Doxasosin), B blockers, Calcium channel blockers (eg. Amlodopine), sedatives, tricyclics

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2
Q

Hypertensive on examination, what drugs are contraindicated?

A

Methylphenidate, NSAIDs, Oestrogens, Venlafaxine, Triptans

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3
Q

Low respiratory rate, what drug(s) to prescribe for likely cause(s)?

A

Naloxone to reverse opioids or Flumazenil to reverse benzos.

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4
Q

Bruising on examination, what drugs are contraindicated?

A

Anticoagulants (heparin, Warfarin, Apixaban, Antiplatelets (clopidogrel, ticagralor)

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5
Q

Confusion and sedation on examination, what drugs are contraindicated?

A

Central nervous system depressants eg Benzos

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6
Q

wheezing on examination, what drugs are contraindicated?

A

B blockers, NSAIDs

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7
Q

Low haemoglobin, what to prescribe to correct it?

A

Ferrous sulphate, Folic acid, Hydroxocobalamin

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8
Q

Low haemoglobin, What drugs are contraindicated?

A

NSAIDs, anticoagulants

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9
Q

Poor renal function, antibiotics to avoid?

A

Gentamicin, Ciprofloxacin, Cephalosporins (eg. Cephalexin, Cefuroxime, Ceftriaxone)

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10
Q

Poor renal function, drugs to avoid (not Abx)? (12)

A

Loop diuretics, Potassium sparing diuretics, NSAIDs, ACE inhibitors and ARBs, Digoxin, Lithium, Methotrexate, Opioids, Metformin, Gliclazide, Insulin, Allopurinol

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11
Q

Amiodarone has a common drug interaction with…?

A

Grapefruit, prelongs QT and causes arrhythmias

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12
Q

Warfarin has a common drug interaction with…(3 drugs other than vit K)?

A

Clarithromycin and Cranberry juice –> enhances anticoagulation, NSAIDs and Asprin –> bleeding risk due to gastric toxicity and antiplatelet

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13
Q

Verapamil has a common drug interaction with…?

A

Beta blockers

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14
Q

Aminoglycosides eg Gentamicin have a common drug interaction with…?

A

Loop diuretics eg Furosemide

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15
Q

Phenytoin has a common drug interaction with…?

A

Miconazole, causes phenytoin toxicity

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16
Q

Haloperidol has a common drug interaction with…?

A

Fluoxetine, haloperidol toxicity

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17
Q

Azathioprine has a common drug interaction with…?

A

Allopurinol, Azathioprine toxicity

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18
Q

Catecholamines (eg. dopamine, adrenaline) have a common drug interaction with…?

A

Monoamine oxidase inhibitors (eg. selegiline, isocarboxazid), hypertensive crisis

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19
Q

Ciclosporin has a common drug interaction with…?

A

St John’s Wort, loss of immunosuppression

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20
Q

COCP has a common drug interaction with…?

A

Rifampicin

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21
Q

Lithium has a common drug interaction with…?

A

Diuretics, Ace inhibitors, lithium toxicity

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22
Q

Methotrexate has a common drug interaction with…?

A

NSAIDs –> methotrexate toxicity causing neutropenia, deranged liver

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23
Q

Sildenafil has a common drug interaction with…?

A

Glyceryl trinitrate –> severe hypotension or MI

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24
Q

Salbutamol has a common drug interaction with…?

A

Atenolol, inhibits bronchodilator effect

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25
Phenelzine (MAOIs) has a common drug interaction with...?
Tyramine (salami, yeast extract) --> life threatening hypertensive crisis
26
ACE inhibitors have a common drug interaction with...?
Potassium containing salt eg Lo-Salt, risk of hyperkalemia
27
Ciprofloxacin has a common drug interaction with...?
Ferrous sulfate, reduces absorption of quinolone abx
28
Citalopram
29
Ace Inhibitors have a common drug interaction with...(2)?
NSAIDs --> increase risk of renal impairment, and Diuretics --> hypotension due to volume depletion
30
Peptic ulcer in PMHx, what drugs are contraindicated?
Aspirin and NSAIDs
31
Chronic Kidney disease in PMHx, what drugs are contraindicated?
NSAIDs, ACE inhibitors, clearance of many drugs slowed eg Gentamicin, digoxin ...
32
Chronic Heart Failure in PMHx, what drugs are contraindicated?
Calcium channel blockers, flecainide, tricyclics, NSAIDs, corticosteroids
33
Asthma in PMHx, what drugs are contraindicated?
B blockers, NSAIDs
34
Heart block in PMHx, what drugs are contraindicated?
B blockers, digoxin, verapamil
35
Parkinson's disease in PMHx, what drugs are contraindicated?
Antipsychotics eg. Haloperidol
36
Common drug types that may require a reduce dose in the elderly? (8)
Aminoglycosides (eg Gentamicin), Anticholinergics, Anticoagulants, Antipsychotics, B Blockers, Hypoglycemics, Opioids, Sedative hypnotics.
37
Drugs with potential teratogenic effect? (13)
ACE inhib, ARBs, Carbimazole, isotretinoin, lithium, methotrexate, oral contraceptives, phenytoin, sodium valproate, statins, thalidomide, trimethoprim, warfarin
38
Signs of severe hypovolaemia?
Dizziness, weakness, fatigue, thirst Low urine output Increased HR, decreased BP, decreased JVP signs of hepatic or cardiac ischemia
39
Maximum rate of IV infusion for potassium replacement?
10 mmol/hour ideally (max conc. 40mmol/L)
40
Daily requirement of potassium, sodium, or chloride?
1 mmol/kg/day
41
Daily requirement of glucose to limit starvation ketosis?
50-100g /day
42
Electrolytes lost in vomiting?
chloride, potassium, sodium, and bicarbonate
43
Electrolytes lost in diarrhoea?
sodium, potassium and magnesium
44
Daily requirement of water?
25-30mg/kg/day, (2L for 80kg person)
45
Fluid resuscitation in hypovolemic shock, initial step?
500ml crystalloid solution containing sodium over <15 mins.
46
Fluid resuscitation in hypovolemic shock, management after 1st fluid bolus...
reassess, further bolus of 250-500mls and reassess until 2000 mls given, then seek expert help
47
How many grams of glucose in 100mls of "glucose 5%"?
5 grams
48
(Types of) Drugs to stop before surgery? (7)
I LACK OP Insulin, lithium, Anticoagulants, COCP and HRT, K sparing diuretics, Oral HypOglycemics (high metformin, gliclazide, -flozins) perindopril and other ACE inhibs and ARBs.
49
Citalopram
50
Levothyroxine dose change, when to check TFT?
6-8 weeks
51
Levothyroxine, maintainable monitoring of TFT?
Annual
52
Amioderone monitoring requirements?
TFT before and every 6 months after
53
Digoxin monitoring requirements?
HR in hospital before treatment
54
Gentamicin monitoring requirements?
Plasma conc, narrow therapeutic window
55
Methotrexate monitoring requirements?
FBC before, 2 weeks for 2 months, monthly for 4 months, 3 monthly thereafter
56
Vitamin D deficiency blood test, measure and monitor?
Plasma 25-hydroxyvitamin D, monitor plasma calcium
57
Starting adalimumab, test to do?
Latent or active TB
58
Blood test for indication of risk of bleeding?
Anti-factor Xa activity
59
Lithium monitoring requirements?
measure serum lithium 12 hrs post dose, and every 3 months normally
60
causes of high potassium (not drugs) (4)
Excessive dietary intake, metabolic acidosis, renal failure, rhabdomyolysis/burns/trauma
61
How to protect the heart in Hyperkalaemia
10ml Calcium Gluconate 10% IV over 3-5 mins
62
How to lower serum potasium?
5-10 units insulin (Actrapid) and 50ml glucose 50% over 5-15 mins Salbutamol neb
63
How to excrete excess potassium?
Calcium Resonium
64
Contraindication to IM injection?
Pt is on warfarin
65
Ideal blood glucose conc. before meals? (mmol/L)
4 - 7 mmol/L
66
Ideal blood glucose conc. after meals? (mmol/L)
less than 9 mmol/L
67
3 indications for Gentamicin
bacterial endocarditis, neutropenic sepsis, surgical prophylaxis
68
When to measure serum gentamicin after once daily dose?
6-14 hours later
69
Omeprazole dose for GORD?
20mg once daily
70
Simvastatin dose for CVD prevention?
20-40mg once daily
71
when to measure serum vancomycin?
After 36 - 72 hours / 3 - 6 doses
72
How to manage hypokalaemia?
ready-to-use infusion of sodium chloride 0.9% and Potassium chloride 40mmol in 1L over 4 hours
73
Rhabdomyolysis blood results?
Super high CK and Hyperkalaemia
74
Co prescribing with what drug (2) drops max dose of statin to 20mg?
Diltiazem and Amlodopine
75
Blood test to monitor clozapine?
FBC - WCC agranulocytosis
76
Methotrexate monitoring blood tests?
FBC, U&Es, LFTs: baseline, weekly until stabilised, then every 2-3 months
77
Drugs that cause urinary retention (8 types)
Anticholinergics, general Anaesthetics, Alpha blockers, B blockers, Benzos, Calcium channel blockers, NSAIDs, Antihistamines, Alcohol
78
Drugs that may cause anaphylaxis (6)
B lactam abx (penicillin, cephalosporins), Aspirin and NSAIDs, chemotherapy, vaccines, parenteral iron injection, herbal remedies
79
Indication to stop statin?
Transaminase over 3x upper limit
80
How to change gentamicin prescription?
peak level --> change dose, trough level --> change frequency
81
Normal dose range for warfarin
1mg - 15mg
82
typical methotrexate prescription?
7.5 mg to 15mg weekly, (also often folate prescribed on different day)
83
treatment of methotrexate overdose?
Folinic acid
84
common interactions with methotrexate? (7)
Aspirin, Clozapine, Ciprofloxacin, NSAIDs, corticosteroids, Penicillin, Trimethoprim
85
Gram negative diplococci STI
Gonorrhoea
86
Hypoglycemia affecting consciousness, first line management?
Glucagon
87
contraindication to glucagon in management of hypoglycaemia
Fasted pt, alcohol induced, On a sulfonylurea eg gliclazide, adrenal insufficiency, chronic hypoglycemia
88
At what INR should you give vit K?
over 8 always, or over 5 if bleeding
89
1st Antiemetic for pt who is at risk of extrapyramidal SE and QT prolongation?
Cyclizine
90
Warfarin + CP450 enzyme inducer, INR?
decrease action of warfarin (metabolised faster), so INR decreases (time to clot is quicker)
91
Warfarin + CP450 inhibitor, INR?
warfarin not broken down for longer --> increased action --> increased INR (more runny)
92
Mnemonic for enzyme inducers?
NP + SC you can buy over the counter Nifampicin (+RIifampicin), Phenytoin. St john's wart, Cigarette smoke, CHRONIC alcohol.
93
Mneumonic for enzyme inhibitors?
FAAF OR IKEA + SC you are inhibited from buying OTC. eg. fluconazole, ACUTE alcohol, amioderone, fluoxitine, omeprazole, ritonavir, Isonaside, Ketoconazole, erythromycin, Allopurinol. SSRIs, Sodium valproate, Cimetidine, Ciprafloxacin.
94
CP450 inducer drugs that break the rules?
Rifampicin, Carbamazepine
95
Name an osmotic laxative
docusate sodium, Movicol
96
Name a stimulant laxative
Senna
97
Name a bulk-forming laxative
ispaghula husk
98
Normal obs under 3 months?
HR: 110 -170 RR: 25-60 Systolic BP: 60-105
99
Normal obs 3-6 months?
HR: 105-165 RR: 25-55 Systolic BP: 65-115
100
Normal obs 6m to 5 years?
HR: 85-150 RR: 20-40 Systolic BP: 70-120
101
Normal obs for 5-12 years?
HR: 70-135 RR: 16-34 Systolic BP: 80-130
102
Severe Liver cirrhosis, drugs to stop?
NSAIDs, ACE inhibitors, statins
103
drug induced cholestatic jaundice and hepatitis?
Flucloxacillin and co amox, Paracetamol, NSAIDs, Rifampicin, Methotrexate, Amioderone
104
First line management of ascites in liver cirrhosis?
Spironolactone
105
1st line management of overt hepatic encephalopathy
Lactulose 30-50ml TDS
106
How to manage oedema due to calcium channel blockers?
Stop the drug, should resolve
107
HB threshold for blood transfusion?
70 or less, 80 or less in ACS
108
Management for eclampsia seizure?
Magnesium sulfate
109
NSAIDs and ACE inhibitors sick day rule?
Stop if vomiting, diarrhoea, or signs of infection

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