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1
Q

What drugs are enzyme inducers vs enzyme inhibitors?

A

Inhibitors: cimetidine, chloramphenicol, fluoexetine, sodium valporate, ciprofloxacin

Inducers: rifampicin, carbamezapine, phenytoinm topiramate

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2
Q

What drugs are stopped prior to surgery and when?

A
  • Lithium (1 day before)
  • Insulin (variable)
  • DOAC (24 hours or 48 hours if high bleeding risk)
  • Warfarin (bridging regimen)
  • Aspirin (1 week before)
  • K+ sparing (day of)
  • COCP/HRT (4 weeks before)
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3
Q

Emergency hypoglycaemia treatment in drowsy patient?

A

Glucose 20% 100ml in 15 minutes

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4
Q

Emergency hypokalaemia treatment?

A

sodium chloride 0.9% / potassium chloride 0.3% 1000ml in 4 hours

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5
Q

Emergency hypercalcaemia treatment?

A

sodium chloride 0.9% 1000ml in 4 hours

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6
Q

Maintenance fluids without losses and with losses (maintenance and replacement)?

A

25-30ml/kg/24h water
1mmol/kg/24h Na and K
50-100g/24h glucose

(aim 1000ml 8-12 hours)

Minimum 30ml/kg/24h water
ensure electrolytes replaced

(aim 1000ml 4-6 hours)

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7
Q

What are the different fluid types?

A

NaCl 0.9% 1000ml - 150 mmol Na
KCl 0.3% 1000ml - 40 mmol Ka
KCl 0.15% 1000ml - 20 mmol K
Glucose 5% 1000ml - 50g glucose

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8
Q

Side effects - hypoglycaemia and hyperglycaemia

A

hypoglycaemia: insulin, sulphonylureas

hyperglycaemia: steroids, antipsychotics, thiazides, beta blockers, tacrolimus

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9
Q

side effects - diarrhorea and constipation

A

diarrhoea - antibiotics, colchicine, metformin, PPIs, alendronic acid

constipation - opioids, CCBs, anticholinergics, some parkinson’s meds, some antiepileptics, nifedipine, ferrous sulphate

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10
Q

side effects - urinary incontinence and urinary retention

A

retention - opioids, anticholinergics, morphine sulphate, BDZ, NSAIDs, CCB

incontinence - diuretics, clozapine, alpha blockers

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11
Q

side effects - confusion and falls

A

confusion - opioids, sedatives, anticholinergics, morphine sulphate, metaclopramide

falls - BDZ, antidepressants, opiates

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12
Q

side effects - gout, osteoporosis, hypertension, high cholesterol

A

gout - diuretics, ticagrelor, aspirin
osteoporosis - steroids, PPIs
hypertension - NSAIDs, steroids, oral COCP
high cholesterol - steroids, thiazides

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13
Q

Which drugs are changed during a period of illness?

A

steroids - DOUBLED
metformin, statins, - glifozins, methotrexate - WITHHELD
Diabetes - continue insulin and other drugs but stop SGLT-2i

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14
Q

What drugs are given in mcg and grams?

A

levothyroxine, tamsulosin, digoxin, naloxone, fludrocortisone, inhalers, GTN spray, ipratropium nebs

paracetamol, lithium, calcium carbonate, NAC

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15
Q

VTE prophylaxis and DVT treatment:

A

therapeutic: DOAC

prophylaxis: LMWH (+ compression stockings) if renal failure then unfractionated heparin

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16
Q

What drugs cause cholestasis?

A

flucloxacillin, co-amoxiclav

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17
Q

What drugs cause pancreatic cancer?

A

nitrofurantoin, steroids, sulphonylureas

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18
Q

Reversal drugs in substance misuse?

A

Opioids (heroin) - methadone hydrochloride or buprenorphine or naloxone

BDZ - flumazenil

Aspirin and TCA - sodium bicarbonate

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19
Q

Treatment for Alzheimer’s?

A

Donepezil, rivastigmine

Memantime

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20
Q

What is used in constipation?

A

Stool softener - arachis oil
Bulking agents - isphagula husk
Stimulant laxative - senna
Osmotic laxative - lactulose or phosphate enema

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21
Q

What drugs should/could be prescribed alongside steroids?

A

bisphosphonate
H2 antagonists - ranitidine
PPI - omeprazole

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22
Q

Side effects of gentamicin, vancomycin and ciprofloxacin?

A

nephrotoxicity and ototoxicity

tendonitis/achilles tendon rupture

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23
Q

Side effects of ACEi, BB, CCB, diuretics?

A

ACEi - dry cough, AKI
BB - wheeze in asthmatics, worsens acute HF
CCB - flushing, peripheral oedema
Diuretics - AKI, spironolactone - gynaecomastia

NOTE: check U&Es prior to starting diuretics

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24
Q

Side effects of digoxin and amiodarone?

A

Digoxin - blurred vision, xanthopsia (disturbed yellow/green visual perception and halo sign

Amiodarone - ILD, skin greying, corneal deposits, hyperthyroidism and hypothyroidism - withhold

NOTE: anti-arrhythmics so monitor using HR

digoxin toxicity from hypokalaemia so check U&Es prior

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25
How to monitor steroids?
LFTs - stop when x3 upper limit of normal
26
Neutropenic sepsis treatment?
IV tazocin
27
Warfarin
bleed: stop, IV phytomenadione, PCC, restart when INR <5 no bleed, INR >8: stop, PO phytomenadione, restart when INR <5 no bleed, INR 5-8: withhold 1-2 doses target INR (2-3): DVT/PE, prosthetic valves target INR (3-4) recurrent DVT/PE Day before elective surgery oral phytomenadione given if INR >1.5
28
UTI treatment?
nitrofurantoin (FOR ALL EXCEPT 3RD TRI) 2nd line: amox or cefalexin NOTE: nitro contraindicated in renal failure
29
Neural tube defects?
400mcg folic acid until 12 weeks 5mg folic acid in high risk until birth - SCD, DIABETES, anti-epileptics, child with NTD 5mg till week 12: family history of NTD
30
ACEi and renal function?
if eGFR <25% or creatinine <30%: recheck in 2 weeks, don't change ACEi dose if GFR >25% or creatinine >30%: stop ACEi or reduce to previously tolerable dose
31
Palliative care management: - pain relief - breathlessness - constipation - N&V - restlessness - secretions
pain relief: use oxycodone rather than morphine if lower eGFR breathlessness: oxygen -> morphine sulphate IR 1mg PO -> lorazepam 0.5mg PRN SL constipation: anything apart from bulking agents N&V: metoclopramide, cyclizine, haloperidol, ondansetron Restlessness: haloperidol, lorazepam in parkinson's Secretions - hyoscine butylbromide NOTE: all patients prescribed a strong opioid should also be prescribed lactulose Dysphagia: give dex is tumour and SL GTN if oesophagitis or spasm
32
Missed pills in COCP and POP?
COCP: 1 missed pill: take it straight away and carry on as normal. If less than 7 pills in pack take back to back. If beginning of pack no and sex no additional contraception 2 missed pills: take most recent pill straight away and protection for 7 days. If had sex in last 7 days -> emergency contraception POP: 1 missed pill <3 hours: take it straight away and carry on as normal. 1 missed pill >3 hours: take most recent pill straight away and use condoms for 7 days
33
Acne treatment:
mild: benzoyl peroxide moderative: as above and oral abx (doxycycline -> erythromycin) severe: PO isotretinoin
34
What to know about rivaroxaban?
take with food
35
Drugs with EPS?
acute dystonia and parkinsonism - procyclidine tardive dyskinesia (involuntary movements) - tetrabenazine akathisia (restlessness) - propanolol
36
Important equations to know in calculation skills?
concentration = dose/volume 1g = 1ml 1% = 1g in 100ml infusion rate = dose / concentration
37
Hypocalcaemia treatment?
calcium gluconate 10% 10ml IV over 10 mins
38
Meningitis in community?
benpen IM or cefotaxime if allergic
39
How do you measure blood glucose control in a blood disorder (increases RBC production) or pregnancy?
Frutosamine (2 weeks)
40
Hyperemesis gravidaram antiemetic?
Promethazine
41
Oral candidiasis, vaginal candidiasis, BV, trichomoniasis (yellow/green discharge) treatment?
PO nystatin Clotrimazole and fluconazole if recurrent Metronidazole Metronidazole
42
Otitis media and externa treatment?
media: self resolve PO amox externa: gentamicin drops and hydrocortisone - otomize PO flucox and severe then cipro EAR INFECTIONS
43
Croup treatment?
PO dex NEB adrenaline if severe
44
HRT treatment?
pre-menopause: elleste-duet post-menpause and uterus: elleste - duet conti post-menopause and NO uterus: elleste - solo
45
Cystic fibrosis treatment?
infection: prophylactic tobramycin in pseudominas azithromycin
46
Side effect of tamsulosin?
floppy iris syndrome - stop prior to cataract surgery
47
What are the choices for emergency contraception?
Levonestregel: <72hr Ulipristal acetate: <120hr. CONTRAINDICATED IN ASTHMA
48
Contraceptive treatment?
COCP: microgynon 30 - ethinylestradiol with levonorgestrel POP: cerazette - desogestrel
49
Whooping cough treatment?
Azithromycin or clarithromycin
50
Statins - when to take it?
nightly if QRISK high it is 20mg
51
What can aspirin cause
IDA picture
52
Alendronic acid
reduces likelihood of vertebral and non-vertebral fractures small increased risk of atypical fractures
53
What is a good marker of correction of dehydration in the short and long term?
BP Urine output
54
What is a good monitoring option to assess the adverse effects of HRT?
BP stop if > 160/95
55
anti-sickness meds SE?
ondansetron - causes QTc prolongation metoclopramide - not used in cardiac problems and electrolyte abnormalities use cyclicine
55
GP status epilepticus
no IV access so use buccal midazolam or PR diazepamE
55
When do you take prednisolone?
in morning so can sleep
55
What drugs increase fracture risk?
PPIs Steroids GnrH agonists e.g. goserelin
56
What is the definition and management for orthostatic hypotension?
OH is defined as a reduction of systolic BP of at least 20 mm Hg or diastolic blood pressure of at least 10 mm Hg within 3 minutes of standing up treat cause supportive - fluids, leg crossing FLUDROCORTISONE
57
Minor surgery and major surgery insulin in diabetes?
On the day before the surgery, the patient’s usual insulin should be given as normal, other than once daily long-acting insulin analogues, which should be given at a dose reduced by 20 % Put on variable insulin infusion Diabetes and surgery
58
Fluid prescribing in children?
resuscitation: 0.9% NaCl 10ml/kg over 10 minutes or Hartmann's 10ml/kg over 10 mins maintenance (>28 days): 100 ml/kg/day for the first 10kg of weight, then 50ml/kg for next 10kg then 20ml PER 24 HOURS
59
Cellulitis treatment?
1. flucloxacillin 2. clarithromycin or erythromycin in pregnancy
60
SE of zopiclone?
Rebound insomnia after withdrawal following PROLONGED use
61
Diabetes in pregnancy
Labetalol taken and measured in community twice weekly to aim 135/85. for women with BP between 140/90 - 159/109 daily every 30 mins if over 159/109
62
Glucose prescription in DKA?
125ml/hour 10% glucose at 500ml
63
Wernicke's treatment?
Pabrinex (vitamin B substances with ascorbic acid) 2-3 pairs
64
SE of transplant immunosuppressants?
ciclosporin - gingivial hypertrophy tacrolimus - pancytopenia, peripheral neuropathy mycophenelate - myelosuppression
65
What to know about HRT?
vasomotor sx: 1. HRT 2. Clonidine hydrochloride 3. SSRI (off label) HRT continuous (o+p) HRT sequential (o + p. last few days) progesterone adjuncts - utrogestran (micronised) or medroxyprogesterone acete oestrogel can increase dose from 2 pumps to 4 pumps (3mg)
66
What fluids are given prior to surgery in a diabetic patient?
as a variable rate insulin infusion has been started, start IV infusion of potassium chloride with glucose and sodium chloride sodium chloride 0.45%/glucose 5%/potassium chloride 0.15% 1000ml over 12 hours
67
stepwise hypertension management on dual therapy?
ACEi and CCB -> add thiazide like diuretic bendroflumethiazide is thiazide diuretic indapamide and chlortiadone are thiazide-like diuretics, they are preferred
68
Most important advice when taking lithium carbonate?
drink plenty of water and have a balanced diet teratogenic but continued if benefits outweigh risk
69
most important info for emergency contraception levonorgesterol
if vomiting occurs within 3 hours take another headache is a very common side effect
70
What is malignant hyperthermia and how do you treat it?
severe reaction to drugs used in anaesthesia Mx: dantrolene sodium
71
Insulin adjustment and cbg?
Long acting: influences pre-prandial doses after overnight fast e.g. pre-breakfast reading Short acting: influence measurements made around daytime meals
72
VTE prophylaxis
dalteparin sodium 25,000 units/ml 5000 units
73
GCA treatment?
prednisolone - 60mg methylprednisolone 1g injection or IV if visual involvement
74
derm management: fungal infections (antifungals treatment summary)
1st line is topical antifungal - ketoconazole 2% cream or clotrimazole 1% spray 1 application, topical, daily oral antifungal 2nd line e.g. fluconazole
74
Post-MI antiplatelet continued for how long?
after 12 months stop second anticoagulant continue aspirin lifelong
74
depression mx
1. SSRI (sertraline, fluoxetine) 2. another SSRI 3. mirtazapine
74
diabetes mx
1. metformin 2. not tolerated -> another med 3. hba1c >58 despite dual anti hypo treatment gliclazide (sulphonylurea) cause weight gain Pioglitazone can't use in heart failure. and can cause bladder cancer
74
How do you monitor the effectiveness of addison's treatment?
resolution of symptoms - malaise and anorexia weight instead of serum cortisol levels (as can be normal)
74
monitoring for CAP clear up?
sputum culture
74
best antibacterial for atypical CAP?
clari/ery/dox
75
Mx for improving pain in shingles?
pregablin/ amitryptilin
76
Common prophylactic antibiotics before procedures
Antibacterial, use for prophylaxis
77
What drugs cause candida?
steroids and antibiotics
78
Patient on statin has side effects and CK x5 upper limit of normal?
stop statin and if symptoms resolve or CK returns to normal statin should be reintroduced at a lower dose
79
drugs causing pulmonary oedema?
CCB and NSAIDs
80
Amiodarone pt gets hyperthyroidism
withhold, at least temporarily
81
High BP on COCP - what do you do?
stop COCP and start POP

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