Prescription review

Question 1

What drugs should you STOP if there’s an AKI

Answer 1

Lithium

NSAIDs

ACEi

Meformin

ABXs-> tetracyclines & nitro

Question 2

what drugs should you adjust dose if there’s an AKI

Answer 2

Methotrexate

Digoxin

B-blockers

Furosemide

ABXs

Question 3

What do you have to do with these drugs in an AKI:

Warfarin

Diazepam

Eyrthromycin

Rifampicin

Answer 3

Nothing

Leave them alone eh

Question 4

what ABXs are suicidal in renal failure

Answer 4

tetracyloines (e.g. doxycycilne)

nitro

Question 5

too much of these can cause what SEs…

1. K-sparring diuretics
2. thiazide diurectics
3. loop diuretics

Answer 5

ALL cause dehydration

1. HYPERkalemia

2 & 3 HYPOkalameia

Question 6

What drugs do these commonly interact with:

1. ACEi
2. Wafarin

Answer 6

1. NSAIDs
2. statins

Question 7

What do all these drugs have in common:

CCBs

Salbutmol (SABAs)

NSAIDs

Gent & vanc (aminoglycosides)

Answer 7

All common causes of SEs

So fucking guess them

Question 8

if you get some weired SEs, what drug is most likely the culprit

Answer 8

The one most recently started lol

Question 9

What part of the BNF do you look at for mangement of ADRs & poisoning shite

Answer 9

Poisonings & emergency treatment

Question 10

On aspirin or NSAIDs

Has asthma

Gets nasal polyps

What triad is this

Answer 10

SAMTERs

Hence why you try not use NSAIDs in asthma, only can’t be used in like 10% so vast majority are sound

Question 11

What drugs can worsen asthma & COPD?

(so fucking stop/avoid them eh)

Answer 11

NSAIDs

B-blockers

Adenosine

Question 12

What drugs can cause urine retention?

(so fucking stop/avoid them eh)

Answer 12

TCAs & Anticholinergics

Opioids

NSAIDs

Question 13

What drugs can bugger glucose control

Answer 13

Thiazides

Steroids

Anti-psychoics

Question 14

What drugs can casue pulomnary fibrosis

Answer 14

Methotrexate

Amiodarone

Sulfazalzine

Nitro

Question 16

what are the causes of an AKI

1. Pre-renal
2. Intrsinic
3. Post-renal

Answer 16

1.

Dehydation

Hypovolemia

Renal artery stenosis

2.

Drugs (ACEi & NSAIDs)

Renal tubular acidosis

Ischemia

Infectoin & inflammation

3.

Tumours

Strictures

Stones

BPH & prostate ca

3.

Question 17

Causes of jaundice

1. pre-hepatic ​
2. hepatic
3. post-hepatic

Answer 17

1.

Haemolysis

Gilberts

2.

Hepatitis

Cancer

Cirrhosis

3.

Stones

Tumours

PBC & PSC

Drugs (ABXs, steroids)

Question 18

what drugs cause drug-induced cholestasis

Answer 18

Steoirds

Antibiotics

Fluclox

Co-amox

Nitro

Question 20

if you get bradycardia as a result of digoxin, what should you do

Answer 20

Fucking stop it

Question 21

for prescription review questions, what are like the main things to check?

Answer 21

Allergies (peniclliin & Abxs)

Contraindications (asthma, parkinsons, peptic ulver)

SEs

Too much paracetamol

Wrong dose (too much/not enough)

Wrong frequency

Wrong route

Wrong time of day

Question 22

when should you NEVER prescibe diuretics

Answer 22

at night time

or esle they’ll piss the fucking bed

Question 23

if a pt complains of indigestion, what drugs shoudl you stop like

Answer 23

NSAIDS

Steroids

Question 24

What SEs are these most likely to cause

1. aspirin & NSAID
2. ACEi , NSAID, vanc & gent
3. diuretics
4. Pioglitazone
5. Metformin, aspirin
6. Morphine sulphate
7. morphine & metoclopramide
8. drowsiness
9. bradycardia

Answer 24

1. haematemesis
2. AKI
3. dehydration
4. hypoglycemia
5. fucked liver
6. constipation & urine retention
7. confusion (in old bugger)
8. TCAs & opioids
9. B-blockers, CCBs, Digoxin & Donepazil

Question 25

Donepazil is obvs a drug used to treat Alzheimers, what is a potential SE

Answer 25

Bradycardia

Question 26

what drugs should you withlold if eGFR takes a plumit

Answer 26

ACEi ARBs Diuretics

Question 27

If a patient is showing signs of sepsis, what drug in particlar whould you be worried about You should stop it eh

Answer 27

Methotrexate cause of the risk of neutropenic sepsis

Question 28

a pt gets worseing heart failure symptoms what drugs could be responsible

Answer 28

Steroids NSAIDs CCBs (verapapil)

Question 29

why might you see an contraceptive pill on a bloke's prescripton chart

Answer 29

he got his and his' wifes meds mixed up lol Not really progressive is it

Question 30

what is important to check regarding drugs for blood clot prophylaxis

Answer 30

**Right dose?** Treatment vs prophylactic

Question 31

is '1mg of paracetamol' ever right?

Answer 31

Fuck no Only ever prescribed as 1g or 500mg

Question 32

if someone has like chronic pain and TENS is an option, what should you just do

Answer 32

Pick it

Question 33

if a patient is completely fine and got no sympomts, but their bloods are fucking off the rails, what should you do

Answer 33

Send for another blood test lol clearly they're sound

Question 34

what drugs increases the risk of lithium toxicity?

Answer 34

ACEi & diurectics they both decrease lithium excretion

Question 35

**What drugs should you stop if any of the following occur:** heamoptysis acute ischemic stroke GI bleeding bleeding of any sort really

Answer 35

**Drugs that increase fucking bleeding** Warfarin Aspirin Heparin

Question 36

When should you stop taking steroids?

Answer 36

**If there's any -\> STEROIDS** Stomach ulces Thin skin oEdema Right heart failrue Osteoporosis Infection Diabetes Syndrome (Cushings) **Only if the steroid is the cause, otherwise if a pt is sick you double the fuckign dose**

Question 37

When should you stop taking NSAIDS

Answer 37

**If there's any -\> NSAID** No urine Systolic dysfunction (heart failure) Asthma Indigestion Dyscarisa (fucked blood)

Question 38

what drug might be fatal in an old geezer who's hypotensize

Answer 38

B-blocker

Question 39

what is the most common prescription error

Answer 39

Omission on admission Forgetting to add the drug on the clerking sheet lol

Question 40

what are considered as the 'high risk' drugs that you should always guess when in doubt

Answer 40

NSAIDs Steroids Anti-coags Anti-pscyhotics Insulin

Question 41

what is always essential to check very fuckign basic but q might try and catch you out

Answer 41

the pt's fucking name

Question 42

If a pt has a low HR and is on both CCB and B-blocker, what should you do

Answer 42

Just stop the one if you stop both they'll get like rebound tachycardia

Question 43

what ABxs should be avoided in penicllin allergies

Answer 43

Amox & co-amox Flucloxaccin Pippercilin & tazobactam (Tazocin)

Question 44

is ciprofloxacin safe to use in a penicllin allergy?

Answer 44

It absolutley is

Question 45

why are P450 enzyme inducers/inhibitors important

Answer 45

Cause most drugs are metabolised by this enzyme in the liver influences if the drug is gonna be more/less active very important for the likes of warfarin

Question 46

what affect fo enzyme INDUCERS have on other drugs

Answer 46

the inducer increases the acttivity of P450 enzyme so the metabolism of the inducer is increased causing the Metabolsim of other drugs to decrease so other drug shave a DECREASED effect

Question 47

What affect do enzyme INHIBITORS have on other drugs (e.g. warfarin)

Answer 47

the inhibitor decreases the acttivity of P450 enzyme so the metabolism of the inhibitor is decreases metabolism of other drugs is increased so other drug shave an INCREASED effect

Question 48

What are the enzyme INDUCERS

Answer 48

**PC BRAS** Phenytoin Carbamazapine Barbituates Rifampicin Alcohol Sulphonylureas

Question 49

What are the enzyme INHIBITORS

Answer 49

**AO DEVICES** Allopurinol & Amiodarone Omeprazole Disulfarum Erthyromycin Valporate Isoniazid Ciprofloxacin Ethanol Sulphonamides & Sertaline

Question 50

Are sulphonamides enzyme inducers or inhibitors also give examples

Answer 50

**Inhibitors** Trimethoprim Sulfazalazine

Question 51

Is grapefruit juice an enxyme inducer or inhibitor?

Answer 51

Inhibitor

Question 52

what part of the BNF might you find shite like hyperkalaemia

Answer 52

"Electrolyte Imbalance"

Question 53

Are barbituates enzyme inducers or inhibitors? also, what type of drug are they?

Answer 53

**Inducers** Seadatives

Question 54

**Warfarin & P450 enzyme** 1. what should you do to the warfarin dose if an enzyme INDUCER is precribed alongside 2. what should you do to the warfarin dose if an enzyme INHIBITOR is precribed alongside

Answer 54

**1. INCREASE DOSE** So theres an increased metabolism of the inducer which decreases metabolism of warfarin so warfarin has less effect dose needs to go up **2. DECREASE DOSE** So theres a decreassed metabolism of the inhibtior which increases metabolism of warfarin so warfarin has more of an effect dose needs to go down **INHIBITORS = INHIBIT the dose of warfarin**

Question 55

if the q is about contraception & HRT, and they are on a progesterone only and wanna change, what shoudl you give

Answer 55

A COMBINED one Just put down levonorgestrel and that'll be you

Question 56

you're wanting to prescribe an ABx for a UTI They have an eGFR of \<45 What drug can't you use

Answer 56

Nitro Nitro fucks the kidneys eh

Question 57

for Qs that ask which is the serious drug error, what do you always look for

Answer 57

wrong units, dose, route... contraindications interactions allergies

Question 58

what analgesic can cause sertotonin syndrome if used alongside SSRIs like citalopram

Answer 58

Tramadol

Question 59

what drugs are usually prescribed weekly, so if you see an OD next to them then it's clearly wrong

Answer 59

methorexate biophosphonates

Question 60

what sorta age and sex of a pt will deffo influence a drug if it's part of the question

Answer 60

young females might be on a teratogenic eh

Question 61

are SSRIs safe to use in the ealry stages of pregnancy

Answer 61

absolutely not

Question 62

if you have poor renal function, should you stop allopurinol

Answer 62

fuck yes

Question 63

whats more likely to fuck up your liver, metformin or methotrexate

Answer 63

Methotrexate

Question 64

what type of anti-hypertensive can't be described if there's ischemic ulcers

Answer 64

b-blockers

Question 65

if somone is on two loop diurectics or one loop and one thiazide, what shoudl you do

Answer 65

stop one eh