psa

Question 1

what is spironolactone

Answer 1

aldosterone antagonist which acts in the cortical collecting duct

Question 2

what is spironolactone used for

Answer 2

acites, hypertension (step 4 treatment), HF, nephrotic syndrome, conn’s syndrome

Question 3

2 adverse effects of spironolactone

Answer 3

hyperkalaemia, gynaecomastia

Question 4

6 drug causes of hyperkalaemia

Answer 4

ACE inhibitors
angiotensin II receptor blockers
spironolactone
heparin
amiloride
ciclosporin

Question 5

2 drug causes of hyperprolactinaemia

Answer 5

antipsychotics, metaclopramide

Question 6

first line inhalers for COPD

Answer 6

SABA or SAMA

Question 7

3 drugs that can cause gout

Answer 7

loop diuretics
thiazides
pyrazinamide

Question 8

how do thiazides work

Answer 8

inhibiting sodium reabsorption at the beginning of the distal convoluted tubule (DCT) by blocking the thiazide-sensitive Na+-Cl− symporter

Question 9

electrolyte imbalances caused by thiazide diuretics

Answer 9

hypokalaemia
hyponatraemia
hypercalcaemia

Question 10

Drugs to avoid in breastfeeding

Answer 10

antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines, clozipine
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone

Question 11

5 drug causes of hyponatraemia

Answer 11

thiazides
loop diuretics
sodium valproate
sulfonylureas
carbamazepine

Question 12

what drug can cause angioedema

Answer 12

ACEi

Question 13

mechanism of loop diuretics and name of 2

Answer 13

• furosemide, bumetanide
• inhibiting the Na-K-Cl cotransporter (NKCC) in the thick ascending limb of the loop of Henle, reducing the absorption of NaCl

Question 14

adverse effects of loop diuretics

Answer 14

hypotension
hyponatraemia
hypokalaemia, hypomagnesaemia
hypochloraemic alkalosis
ototoxicity
hypocalcaemia
renal impairment (from dehydration + direct toxic effect)
hyperglycaemia (less common than with thiazides)
gout

Question 15

what should you do with corticosteroids when patient on long term therapy is ill

Answer 15

double dose

Question 16

drugs that can cause impaired glucose tolerance

Answer 16

thiazides, furosemide (less common)
steroids
tacrolimus, ciclosporin
interferon-alpha
nicotinic acid
antipsychotics

Question 17

mechanism of metformin

Answer 17

acts by activation of the AMP-activated protein kinase (AMPK)
increases insulin sensitivity
decreases hepatic gluconeogenesis
may also reduce gastrointestinal absorption of carbohydrates

Question 18

adverse effects if metformin

Answer 18

GI upset
reduced B12 absorption
lactic acidosis with severe liver disease or renal failure

Question 19

contraindications to metformin

Answer 19

CKD -dose reviewed at eGFR<45, stopped at <30
- can cause lactic acidosis if taken during a period where there is tissue hypoxia (MI, sepsis etc)
- alcohol abuse

Question 20

5 drugs that can cause hyperkalaemia

Answer 20

ACE inhibitors
angiotensin II receptor blockers
spironolactone
heparin
amiloride
ciclosporin

Question 21

stimulant laxatives

Answer 21

senna, bisacodyl
most suitable unless bowel obstruction

Question 22

osmotic laxatives

Answer 22

lactulose, macrogol
draws water in so not recommended if already feeling bloated or dehydrated

Question 23

softener laxative

Answer 23

docusate - both softener and stimulant

Question 24

bulking laxatives

Answer 24

ispaghula husk
for inadequate fibre intake but takes at least 72h to work

Question 25

laxatives in opioid use

Answer 25

osmotic laxative + stimulant

Question 26

maintenance fluids (nil by mouth)

Answer 26

water 25-30ml/kg/day NA/K/Cl - 1mmol/kg/day glucose 50-100g/day (1000ml 5%dextrose solution = 50g)

Question 27

common drugs that cause confusion/delirium

Answer 27

sedative hypnotics (benzos) zopiclone analgesia (opioids) anticholinergics (atropine, oxybutynin) anticonvulsants (pregabalin) antidepressants (trazodone) antipsychotics metoclopramide electrolyte imbalance (low NA which can be caused by thiazide diuretic)

Question 28

CYP450 inhibitors

Answer 28

omeprazole (use lansoprazole if on clopidogrel) amiodarone SSRIs grapefruit juice cimetidine macrolides - erythromycin, clarithromycin

Question 29

what does giving atorvastatin and a macrolide do

Answer 29

increased muscle pain and tenderness dark coloured urine

Question 30

CYP450 inducers

Answer 30

carbamazepine barbiturates phenytoin rifampicin pioglitazone

Question 31

common drug interactions with methotrexate

Answer 31

NSAIDS - low platelet count trimethoprim - bone marrow suppression PPIs - increase level of methotrexate

Question 32

common drugs related to ototoxicity

Answer 32

gentamicin bumetanide furosemide (IV or if renal impairment) vancomycin

Question 33

precipitants of c.diff

Answer 33

co-amox ciprofloxacin cephalosporins clindamycin PPI low Mg low Na

Question 34

treatment for drug induced parkinsonism

Answer 34

procyclidine

Question 35

what eGFR should you withhold metformin

Answer 35

30

Question 36

normal fluid resus

Answer 36

500ml NaCl 0.9% over 10-15 mins repeat if BP still below 90mmHg

Question 37

drugs to stop pre-op

Answer 37

ACEi ARBs diuretics anticoagulants and antiplatelets HRT and COCP (4 weeks before) lithium NSAIDs

Question 38

3 T2DM drug changes pre-op

Answer 38

metformin - only stop lunchtime dose if TDS sulphonylureas (gliclazide) - omit morning dose on day of surgery SGLT-2 inhibitors (-gliflozins) - omit on day of surgery

Question 39

what does 1% w/v mean

Answer 39

1g/100ml

Question 40

what does 1% w/w mean

Answer 40

1g/100g