PSA

Question 1

what pain relief do you give for neuropathic pain?

Answer 1

• amitriptyline (10 mg oral nightly)
• pregabalin (75 mg oral 12 hourly);
• duloxetine (60 mg oral daily) is indicated in painful diabetic neuropathy.

Question 2

what is the max dose of paracetamol for adults?

Answer 2

4 g (i.e. 8 tablets of 500 mg each)

patients <50kg the MAXIMUM dose of Paracetamol is 500mg 6-hourly
i.e. 2g a day

Question 3

what class of drug causes hypokalaemia and hyperkalaemia?

Answer 3

Hypokalaemia : bendroflumethiazide and loop diuretics. Thiazide diuretic. Brand name is Neo-naclex.

Pneumonic : DIRE
Drugs (loop and thiazide)
Inadequate intake or intestinal loss
renal tubular acidosis
endocrine ( Cushing’s and Conns)

ACEinhibitor ( lisinopril) and aldosterone antagonists and potassium sparring diuretics (spironolactone) - causes hyperkalaemia

Pneumonic : DREAD
Drugs ( potassium sparing and ACE inhibitors)
Renal failure
Endocrine (Addisons)
artefact
DKA

Question 4

which anti-emetic drug should you avoid in Parkinson’s?

Answer 4

metoclopramide - crosses BBB so avoid

domperidone is dopamine agonist also but does not cross BBB so safe to use in Parkinson’s

Question 5

what is the max IV potassium per hour?

Answer 5

10mmol/hour

Question 6

what are the side effects of steroids

Answer 6

STEROIDS: Stomach ulcers, Thin skin, oEdema, Right and left heart failure, Osteoporosis, Infection (including Candida), Diabetes (commonly causes hyperglycaemia and uncommonly progresses to diabetes), and Cushing’s Syndrome.

Question 7

Side effects of anti-inflammatory drugs (NSAIDS)

Answer 7

NSAID: No urine (i.e. renal failure), Systolic dysfunction (i.e. heart failure), Asthma, Indigestion (any cause), and Dyscrasia (clotting abnormality).

Question 8

what are the side effects of anti-muscarinic drugs?

Answer 8

• oxybutinin
• can cause confusion in the elderly
• antimuscarinic agents commonly cause pupillary dilation, with loss of accommodation, dry mouth, and tachycardia (after a transient bradycardia)

Question 9

what are the caution for drugs in elderly?

Answer 9

• tramadol, cyclising and benzodiazepines

Question 10

which drug is an absolute CI for pts taking methotrexate?

Answer 10

trimethoprim : it is a folate antagonist

Question 11

what are the side effects of CCB like amlodipine?

Answer 11

• flushing, pulmonary oedema

Question 12

what are the causes of hypernatreamia?

Answer 12

• dehydration
• drips ( too much IV saline)
• drugs
• diabetes insipidus

Question 13

what are the causes of:
- high neutrophils ( neutrophilia)
- low neutrophils ( neutropenia)
- high lymphocytes ( lymphocytosis)

Answer 13

Neutrophilia:
- bacterial infection, tissue damage and steroids

Neutropenia:
- viral infection, chemotherapy or radiotherapy , clozapine (antipsychotic) and carbimazole (antithyroid)

Lymphocytosis:
- viral infection, lymphoma and CLL

Question 14

causes of low and high platelets?

Answer 14

Low platelets ( thrombocytopenia):

Reduced production:
- infection
- drugs such as penicillamine ( in RA)
- myelodysplasia, myelofibrosis, myeloma

Increased destruction:
- heparin
-hypersplenism
-DIC
-ITP
-HUS

High platelets:
- bleeding, tissue damage, postsplenectomy

primary:
-myeloproliferative disorders

Question 15

what are the causes of SIADH?

Answer 15

Pneumonic : SIADH

• small cell lung tumours
• Infection
  -abscess
• Drugs
• head injury

Question 16

what are the synethetic function of the liver and mention the clotting factors

Answer 16

▶ albumin
▶ vitamin K-dependent clotting factors (II, VII, IX and X) measured via
prothrombin time (PT)/international normalized ratio (INR).

Question 17

Causes of high alk phos?

Answer 17

ALKPHOS: Any fracture, Liver damage (posthepatic), K (for kancer), Paget’s disease of bone and Pregnancy, Hyperparathyroidism, Osteomalacia, and Surgery.

Question 18

what to do with the following TSH levels:

TSH range (mIU/L)
<0.5
0.5–5
>5

Answer 18

TSH range (mIU/L) <0.5 –> Change to thyroxine
0.5–5 –> Decrease dose
>5 –> Nil action – same dose Increase dose

Question 19

Examples of drugs with narrow therapeutic range?

Answer 19

• digoxin, theophylline, lithium, phenytoin, gentamicin

Question 19

What are the drug toxicity SE of :
- digoxin
-lithium
-phenytoin
- gentamicin/vancomycin

Answer 19

Digoxin –> Confusion, nausea, visual halos, and arrhythmias

Lithium–>Early: tremor
Intermediate: tiredness
Late: arrhythmias, seizures, coma, renal failure, and diabetes insipidus

Phenytoin –> Gum hypertrophy, ataxia, nystagmus, peripheral neuropathy, and teratogenicity

Gentamicin –> Ototoxicity and nephrotoxicity

Vancomycin –> Ototoxicity and nephrotoxicity

Question 20

what are the most important ways to interpret C-XRAY?

Answer 20

PRIM:

PA - can interpret heart size
AP - heart will APPEAR bigger

Question 20

what are the signs of pulmonary oedema?

Answer 20

ABCDE signs of pulmonary oedema:

Alveolar oedema (bat wings)
Kerley B lines (interstitial oedema)
Cardiomegaly
Diversion of blood to upper lobes (where vessels in upper zone are larger than in lower zone), and
pleural Effusions.

Question 21

what are the vitamin K dependant clotting factors?

Answer 21

2,7,9,10

Question 22

what to give if a patient is on warfarin and bleeding?

Answer 22

If there is a major bleed (i.e. causing hypotension or bleeding into a confined space
(i.e. brain or eye)):
* stop warfarin
* give 5–10 mg IV vitamin K
* give prothrombin complex (e.g. Beriplex®).

Question 23

what is the definition of neutropenic sepsis?
and tx?

Answer 23

neutropenia sepsis is neutrophils <1
treatment is : piperacillin with tazobactam and gentamicin

Question 24

signs of lithium toxicity?

Answer 24

confusion and even seizures, one would expect tremor and diarrhoea too.

Question 25

what is the risk associated with tamoxifen?

Answer 25

Tamoxifen increases the risk of venous thromboembolism, and a swollen leg could suggest a deep vein thrombosis ==> needs urgent medical attention

Question 26

what type of drug is gliclazide?

Answer 26

sulphonylurea - risk of hypoglycaemia so avoid missing meals

Question 27

How often should methotrexate be given?

Answer 27

It should ONLY BE given once a week. More regularly than that increases the risk of neutropenia.

Question 28

what happens to blood glucose levels when you are unwell

Answer 28

when unwell, blood glucose increases; therefore, higher basal doses are required. Failing to do so will increase the risk of diabetic ketoacidosis. Conversely, if patients reduce their oral intake (which many will when ill), there is a risk of hypoglycaemia if the insulin intake is not decreased.

Question 29

what is important about alendronic acid?

Answer 29

The tablet needs to be swallowed with a full glass of water and she should remain upright for 30min afterwards.
( to minimise gastric side effects)

Question 30

What does 1% mean?

Answer 30

A 1% solution contains 1 g in 100 mL

Question 31

When to stop aspirin

Answer 31

recent haemorrhagic stroke

Question 32

when to stop lisinopril?

Answer 32

When there is AKI and hyperkalaemia

Question 33

When to stop paracetomol?

Answer 33

Already taking co-codamol ( acceptable to withold co-codamol instead)

Question 34

When to stop ibuprofen

Answer 34

in AKI (stop all NSAIDS)

Question 35

what is the cheapest LMWH at present and therefore should use

Answer 35

Dalteparin

Question 36

What is the first line therapy for chronic heart failure?

Answer 36

• ACEi + BB

Question 37

When should you take ACEi?

Answer 37

In the evening due to the cause of postural hypotension

Question 38

How to get rate control on AF?

Answer 38

Use rate-limiting CCB (diltiazem or verapamil>) or BB (CI in asthma

Question 39

what drug to give to lower patients potassium rapidly?

Answer 39

10 units of actrapid in 50ml of 50% dextrose over 30 min IV.

Question 40

what SE is important to bear in mind for carbamazepine?

Answer 40

can cause SIADH and therefore lower sodium levels.

Question 41

When to avoid giving levetiracetam?

Answer 41

Someone with depression or very low mood.

Question 42

Give an example of a biguanide and common SE, and when to use

Answer 42

Metformin

SE : GI upset, lactic acidosis (mainly in liver/renal failure)

Only PO allowed in pregnancy

Use: patient overweight

Question 43

Give example of a sulfonylurea and its SE

Answer 43

Gliclazide
SE: Hypoglycaemia , weight gain and diarrhoea

CI : ketoacidosis , severe renal impairmenet ( creatinine of >150 mmol/L.

Use if patient normal/underweight

Question 44

Give an example of a thiazolidinediones

Answer 44

Pioglitazone
SE: weight gain, bone fracture , fluid retention

CI: HF, bladder cancer , ketoacidosis and hepatic impairment

Question 45

Example of SGLT-2 inhibitors

Answer 45

Dapagliflozin
SE: UTIs, hypoglycaemia, euglycaemic DKA, weight loss
CI: DKA, eGFR <15

Question 46

Example of DPP4 inhibtior

Answer 46

Sitagliptin

SE: URTI, headache and pancreatitis.
CI: pancreatitis, adjust dose if low GFR.

Question 47

Example of GLP-1 agonist

Answer 47

exenatide
SE: N+V, weight loss
CI: ketoacidosis.

Question 48

Who is at most risk of getting statin induce myopathy?

Answer 48

• Personal History or FHx
• previous Hx of muscular toxicity
• high alcohol intake
• renal impairment
• Hypothyroidism
• in the elderly

Question 49

What should you monitor before giving vancomycin?

Answer 49

Check serum creatinine.
classic SE are nephrotoxicity and ototoxicity.

Question 50

What to check before giving statin?

Answer 50

Serum ALT

Cautious in pts with a history of liver disease, as they are metabolised by the liver.
so hepatic impairment will increase their levels and risk of myopathy.

CI: if ALT > 3 times the normal range or active liver disease

Check LFTS 3 months and 12 months after starting statin