Prescribing

Question 1

What to search in the BNF if:

a) you know what the treatment for the condition is?

b) you don’t know what the treatment for the condition is?

Answer 1

a) search under medication on the BNF

b) search under treatment summaries on the BNF

Question 2

Effect of calcineurin inhibitors (e.g. tacrolimus) on K+?

Answer 2

Can cause hyperkalaemia due to reduced renal excretion.

Question 3

How long prior to elective surgery should warfarin be stopped?

Answer 3

5 days

Question 4

In patients taking warfarin, what should be given the day before elective surgery if the INR is ≥1.5?

Answer 4

Vitamin K (phytomenadione)

Question 5

Mx of thyrotoxicosis due to amiodarone?

Answer 5

Withhold amiodarone at least temporarily to achieve control.

Question 6

Mx of hypothyroidism due to amiodarone?

Answer 6

Levothyroxine therapy (can continue amiodarone)

Question 7

Role of antivirals in shingles in people >50?

Answer 7

Reduces risk of post-herpetic neuralgia

Question 8

Can naproxen cause ankle oedema?

Answer 8

Yes

Question 9

Length of clotrimazole in pregnant women with vaginal candidiasis?

Answer 9

7 days

Question 10

When should loperamide be taken?

Answer 10

After every loose stool

Question 11

What monitoring is required during ciclosporin therapy?

Answer 11

Renal function

Question 12

Mx of hyperthyroidism in patients taking amiodarone?

Answer 12

Withold amiodarone

Question 13

Give 3 drugs which increase the risk of fractures

Answer 13

1) PPIs

2) Steroids

3) GnRH agonists e.g. buserelin, goserelin

Question 14

Give some drugs that increase the risk of falls

Answer 14

• benzos
• antidepressants (TCAs and SNRIs)
• MOAIs
• most antipsychotics
• opiates
• most antihypertensives e.g. diuretics, beta blockers

Question 15

What are 2 diabetic drugs that increase the risk of pancreatitis?

Answer 15

1. GLP-1 mimetics (e.g. exenatide)
2. DPP-4 inhibitors e.g. sitagliptin

Question 16

What diabetic medication can cause euglycaemic ketoacidosis?

Answer 16

SGLT-2 inhibitors e.g. canagliflozin

Question 17

Side effects of pioglitazone?

Answer 17

• oedema
• HF
• post-menopausal osteoporosis
• bladder cancer

Question 18

Apixaban in pregnancy?

Answer 18

Contraindicated

Question 19

Thiazides in pregnancy?

Answer 19

Contraindicated

Question 20

How can thiazides affect glucose?

Answer 20

Can cause hyperglycaemia

Question 21

Medical mx of orthostatic hypotension?

Answer 21

Trial of fludrocortisone 100mcg PO daily

Question 22

Important safety information about amitriptyline and alcohol?

Answer 22

Alcohol enhances the effects of amitriptyline –> avoid driving/operating heavy machinery

Question 23

When should ketones be checked in T1D?

Answer 23

When BMs >15

Question 24

Why should T1 diabetics seek medical help if they are unable to drink fluids due to N&V?

Answer 24

Due to risk of DKA –> need IV access

Question 25

Why is IV vancomycin not effective in C. diff?

Answer 25

Doesn't reach the bowel

Question 26

Why should calcium carbonate (and calcium containing foods) not be taken at the same time as iron?

Answer 26

Calcium decreases the absorption of iron

Question 27

How can SGLT-2 inhibitors result in postural hypotension?

Answer 27

Due to hypovolaemia as a side effect

Question 28

Who is at higher risk of tendon injury with quinolones (e.g. ciprofloxacin)?

Answer 28

1. Age ≥60 2. Pts on corticosteroids 3. Renal impairment

Question 29

What class of laxative is lactulose?

Answer 29

Osmotic

Question 30

Impact of taking lithium and thiazides together?

Answer 30

Thiazides can cauyse lithium toxicity

Question 31

What needs to be monitored in patients taking mineralocorticoid therapy?

Answer 31

U&Es

Question 32

What should be measured just before treatment with UH or LMWH?

Answer 32

Platelets Regular monitoring may be required if treatment >4 days

Question 34

Key side effect of lactulose?

Answer 34

Bloating (avoid in IBS)

Question 35

What are the 4 most common antibiotics that cause C. diff?

Answer 35

1. Clindamycin 2. Co-amoxiclav 3. Cephalosporins e.g. cefalexin, ceftriaxone 4. Ciprofloxacin

Question 36

What 2 medications can be used in the mx of NMS?

Answer 36

1. dantrolene 2. bromocriptine

Question 37

At what eGFR should you stop metformin?

Answer 37

<30

Question 38

Lansoprazole vs omeprazole in pregnancy?

Answer 38

Omeprazole > lansoprazole Lansoprazole is contraindicated

Question 39

What do you need to prescribe in DKA once the blood glucose drops below 14?

Answer 39

Glucose 10% IV at a rate of 125mls/hour e.g. 1000mls over 8 hours

Question 40

What fluid should be used to treat mild hypernatraemia?

Answer 40

IV glucose 5% e.g. 1000ml over 6h (if oral route not appropriate)

Question 41

What rate should you aim to reduce sodium by in hypernatraemia?

Answer 41

No quicker than 10 mmol/day Reduces risk of cerebral oedema

Question 42

Give 3 medications that increase the risk of an acute episode of gout?

Answer 42

1. Thiazide diuretics 2. Loop diuretics 3. Aspirin

Question 43

How does aspirin increase the risk of gout?

Answer 43

Reduces the urinary excretion of uric acid

Question 44

Why are beta blockers contraindicated in PAD?

Answer 44

They cause peripheral vasoconstriction and worsen ischaemia

Question 45

Why can furosemide precipitate digoxin toxicity?

Answer 45

As furosemide can lead to hypokalaemia

Question 46

Interaction between methotrexate and warfarin?

Answer 46

Trimethoprim increases the effects of warfarin --> risk of bleeding

Question 47

Interaction between baclofen and glycopyrronium bromide when taken together?

Answer 47

Can enhance antimuscarinic effects

Question 48

Recommended treatment for whooping cough (pertussis)?

Answer 48

Macrolides e.g. clarithromycin

Question 49

What is 2nd line for lower UTI in pregnancy?

Answer 49

Cefalexin and amoxicillin

Question 50

What medication can be used for prophylaxis of tension headaches?

Answer 50

Amitriptyline

Question 51

Mx of Lyme disease?

Answer 51

Doxycycline

Question 52

When is metronidazole gel best administered for BV?

Answer 52

At night (prevent leakage)

Question 53

What time gap is recommended between taking levothyroxine & oral iron?

Answer 53

4 hours Levothyroxine absorption is reduced by oral iron

Question 54

What can be a useful marker to assess clinical response to abx therapy?

Answer 54

CRP