PSA Flashcards
(253 cards)
1
Q
What are the medications exacerbating heart failure?
A
- thazelidenodiones: pioglitazione
- Ca 2+ channel blockers verapamil: negative inotropic effect
- NSAID: should be used with caution as they cause fluid retention
- glucocorticoids should be used with caution as they cause fluid retention
- class I arrhythmic, flecainide
2
Q
Prescribing in patients with asthma and COPD
A
NSAIDs beta-blockers adenosine
3
Q
Psoriasis: exacerbating factors
A
Beta blockers
Lithium
Anti-malarias
Infliximab
Nsaid
4
Q
Prescribing in patients with epilepsy
A
Prescribing in patients with epilepsy:
*antibiotics: ciprofloxacin, levofloxacin *aminophylline, theophylline
Nicotinc theraphy: *bupropion
ADHD
NSAID*methylphenidate (used in ADHD) *mefenamic acid
5
Q
Which medications are taken weakly?
A
methotrexate, lithium
6
Q
Approximately what percentage of patients who are allergic to penicillin are also allergic to cephalosporins?
A
0.5-6.5%
7
Q
Types of penicillin
A
*phenoxymethylpenicillin *benzylpenicillin
FACT
*flucloxacillin
*amoxicillin *ampicillin
*co-amoxiclav (Augmentin) *co-fluampicil (Magnapen) *piperacillin with tazobactam (Tazocin) *ticarcillin with clavulanic acid (Timentin)
8
Q
what are the common side effects of Calcium Channel Blockers?
A
Headache and ankle swelling are common side-effects of calcium channel blockers.
9
Q
when using lithium, what parameters should be measured before prescrbing lithium ?
A
U&E
thyroid function should be checked every 6 months
FBC
ECG if cardo risk factors
10
Q
Clostridium difficile infection treatment 1st ine
A
metronnidazole 400 mg TDS 10-14 days
11
Q
C.Difficile infection first line
A
METRONIDAZOLE 400-500 MG PO TDS
12
Q
treatment of cellulitis in adults
A
FLUCLOXACILLIN 250 MG PO QDS
13
Q
what’s the therapeutic dose of lithium
A
0.4 - 1
14
Q
The following drugs should be used with caution in patients with ischaemic heart disease
A
- NSAIDs - oestrogens: e.g. combined oral contraceptive pill, hormone replacement therapy - varenicline
15
Q
What would you prescribe to the patient with angina on the bacground of asthma ?
A
atorvastatin 80 mg Adizem-SR 90mg bd (diltiazem modified-release)
16
Q
Rapid-acting insulin analogues
A
insulin aspart: NovoRapid insulin lispro: Humalog
17
Q
Short-acting insulins
A
soluble insulin examples: Actrapid (human, pyr), Humulin S (human, prb) may be used as the bolus dose in ‘basal-bolus’ regimes
18
Q
Intermidate-acting insulins
A
isophane insulin many patients use isophane insulin in a premixed formulation with
19
Q
Long-acting insulins
A
insulin determir (Levemir): given once or twice daily insulin glargine (Lantus): given once daily
20
Q
What are the inducers of the P450 system, the warfarin INR will decrease
A
*anti-biotics and anti-funguals: rifampicin *griseofulvin
*barbiturates: phenobarbitone
*anti-eplieptics: carbamazepine, phenytoin
21
Q
Inhibitors of the P450 system include - INR will increase
A
antibiotics: metronidazole, ciprofloxacin, erythromycin isoniazid cimetidine
amiodarone
allopurinol
anti-virals: ritonavir
omeprazole
imidazoles: ketoconazole, fluconazole
SSRIs: fluoxetine, sertraline
sodium valproate
acute alcohol intake
22
Q
Paracetamol dose
A
1g qds
23
Q
Ibuprofen dose
A
200-400mg tds
24
Q
Codeine dose
A
30-60mg qds
25
Co-codamol dose
8/500 2 tabs qds 30/500 2 tabs qds
26
Cyclizine dose
50mg tds
27
Metoclopramide dose
10mg tds
28
Amoxicillin dose
500mg tds
29
Clarithromycin dose
500mg bd
30
Lansoprazole dose
15-30mg od
31
Omeprazole dose
20-40mg od
32
Atenolol dose
25-100mg od
33
Ramipril dose
1.25-10mg od
34
Bendroflumethiazide\* dose
2.5mg od
35
Furosemide dose
20mg od - 80mg bd\*\*
36
Amlodipine dose
5-10mg od
37
Levothyroxine dose
25-200mcg od
38
Metformin dose
500mg od - 1g bd
39
how to assess how well type I diabetes is controlled?
- Hba1c% -home glucose readings
40
What is it that you are worried about in patients taking carbamizaole?
\*Neutropenia and agranulocytosis (sore throat) \*Thyroid Function Test
41
What's the mechanism of carbimazole?
Blocks TPO
42
Loop diuretics SE
Furosemide and bumetanide are loop diuretics that act by inhibiting the Na-K-Cl cotransporter in TAL Adverse effects: hypotension hyponatraemia hypokalaemia hypochloraemic alkalosis ototoxicity hypocalcaemia renal impairment (from dehydration + direct toxic effect) hyperglycaemia (less common than with thiazides) gout
43
The syndrome of inappropriate ADH secretion (SIADH) is characterised by hyponatraemia secondary to the dilutional effects of excessive water retention:
- sulfonylureas\* (glimperide) - SSRIs, tricyclics - carbamazepine - vincristine - cyclophosphamide
44
what is the starting dose of levothyroxine?
Start levothyroxine 25mcg od
45
dose of morphine in MI
2.5 mg
46
dose of metoclopramide in MI
10 mg IV
47
Prescribing errors: timing of medication
statins amitriptyline (to be taken at bedtime)
48
What volume of oramorph should he take when he experiences breakthrough pain
It is recommended that patients take one-sixth of their total oral morphine dose for breakthrough pain.
49
first line treatment in asthma exacerbation
\*40 mg prednisolone per oral \*5 mg nebulised salbutamol \*ipratropium bromide 0.5 mg QDS
50
what's tazocin?
piperacillin with tazobactam
51
What's the prophylactic dose of heparin post-operatively in high risk patients ?
ENOXAPARIN 40 MG S/C OD 12h before and than every 24h
52
How many hours post-operatively LMWH should be given?
LMWH, started 12 hours after surgery
53
what is the correct way to prescribe insulin glangarine?
22 UNITS
54
lactulose dose constipation
15 ml BD PO
55
Which one of the following is most likely to be responsible for reducing hypoglycaemic awareness?
atenolol (beta-blockers)
Beta blockers[edit]
These medicines are designed to blunt the β-effect of adrenalin and related substances. Hence, if hypoglycemia occurs in someone who is using this type of drug, he/she may not experience the typical adrenergic warning symptoms such as tremor and palpitations. Again, the result is hypoglycemic unawareness. As noted above, beta blockers will also prevent adrenalin from stimulating the liver to make glucose, and therefore may make the hypoglycemia more severe and/or more protracted.[11] Of all the hypoglycemia symptoms, sweating is typically not blocked by beta blockers
56
Which one of the following is an antihistamine used in the management of anaphylaxis?
Chlorphenamine
57
The following drugs should be avoided in pregnancy:
-ciprofloxacin -tetracycline -chloramphenicol -sulphonamides
58
The following drugs should be avoided in pregnancy -psychiatric drugs
lithium, benzodiazepines
59
The following drugs should be avoided in pregnacy
aspirin amiodarone carbimazole cytotoxic drugs methotrexate sulphonylureas
60
The following antibiotic drugs can be given to mothers who are breastfeeding:
penicillins, cephalosporins, trimethoprim
61
The following drugs can be given to mothers who are breastfeeding - endocrine:
glucocorticoids (avoid high doses), levothyroxine\*
62
The following drugs can be given to mothers who are breastfeeding in epilepsy:
sodium valproate, carbamazepine
63
The following drugs can be given to mothers who are breastfeeding in asthma:
salbutamol, theophyllines
64
The following drugs can be given to mothers who are breastfeeding:
tricyclic antidepressants, antipsychotics
65
The following drugs can be given to mothers who are breastfeeding:
hypertension: beta-blockers, hydralazine
66
The current BNF advice on how to take oral bisphosphonates:
Tablets should be swallowed whole with plenty of water while sitting or standing; to be taken on an empty stomach at least 30 minutes before breakfast (or another oral medicine); patient should stand or sit upright for at least 30 minutes after taking tablet'.
67
weeks post-partum presents for her routine post-natal check. Her urine dipstick today shows evidence of a urinary tract infection and she also complains of some mastitis.
A. Ibuprofen is commonly prescribed to breastfeeding women, particularly if mastitis develops B.A short course of trimethoprim is safe to take whilst breastfeeding C.Aspirin should be avoided for pain relief because of the risk of Reye syndrome in the infant
68
What do you prescribe for uncomplicated UTI?
TRIMETHOPRIM 200 MG PO BD
69
Exacerbations of chronic bronchitis
Amoxicillin or tetracycline or clarithromycin
70
Uncomplicated community-acquired pneumonia
Amoxicillin (Doxycycline or clarithromycin in penicillin allergic, add flucloxacillin if staphylococci suspected e.g. In influenza)
71
Pneumonia possibly caused by atypical pathogens
clarithromycin
72
Hospital-acquired pneumonia
co-amoxiclav or cefuroxime
73
More than 5 days after admission HAP
piperacillin with tazobactam OR a broad-spectrum cephalosporin (e.g. ceftazidime) OR a quinolone (e.g. ciprofloxacin)
74
HAP \<5 days
co-amoxiclav or cefuroxime
piepracylin \> 5 days
75
Acute pyelonephritis
CEFUROXIME
* Pyelonephritis
* Adult
* 250 mg twice daily
* oral
76
Acute prostatitis
**CIPROFLOXACIN**
By mouth
Adult
500 mg BD for 28 days.
77
'golden', crusted skin lesions typically found around the mouth
* Impetigo
* Topical fusidic acid - local
* Oral flucloxacillin - extensive
78
Cellulitis
Flucloxacillin
250–500 mg 4 times a day.
79
Cellulitis pen allergic
Clarithromycin or Clindomycin if penicillin-allergic
80
can be distinguished from cellulitis by its raised advancing edges and sharp borders
**Erysipelas**
Phenoxymethylpenicillin (erythromycin if penicillin-allergic)
Adult
500 mg every QDS
81
Animal or human bite
Co-amoxiclav (doxycycline + metronidazole if penicillin-allergic)
250/125 mg TDS
82
Mastitis during breast-feeding
Flucloxacillin
250 mg QDS
83
Throat infections
Phenoxymethylpenicillin
500 mg QDS
84
Throat infections pen allergic
(erythromycin alone if penicillin-allergic)
85
Features
facial pain: typically frontal pressure pain which is worse on bending forward
nasal discharge: usually thick and purulent
nasal obstruction: e.g. 'mouth breathing'
post-nasal drip: may produce chronic cough
sinusitis
Amoxicillin 500 mg TDS
or doxycycline or erythromycin
86
Otitis media
Amoxicillin 500 mg TDS (erythromycin if penicillin-allergic)
87
Otitis externa
chloroamphenicol
88
Periapical or periodontal abscess
Amoxicillin
500 mg TDS
89
painful bleeding gums with halitosis and punched-out ulcers on the gums
Metronidazole
Gingivitis: acute necrotising ulcerative
400 mg every 8 hours
90
**Gonorrhoea**
males: urethral discharge, dysuria
**500 mg**
Intramuscular ceftriaxone + oral azithromycin
1g single dose
91
Chlamydia
azithromycin 1g stat
92
Pelvic inflammatory disease
intramuscular ceftriaxone + oral doxycycline + oral metronidazole
93
Syphilis
Benzathine benzylpenicillin or doxycycline or erythromycin
94
vaginal discharge: 'fishy', offensive
asymptomatic in 50%
Bacterial vaginosis
Oral metronidazole or topical clindamycin
95
Watery diarrhea is the cardinal symptom of C. difficile–associated diarrhea (CDAD) with colitis (≥3 loose stools in 24 hours). Elevated WBC count
Clostridium difficile
500mg TDS metronidazole Second or subsequent episode of infection: vancomycin
96
A flu-like prodrome is usually followed by crampy abdominal pains, fever and diarrhoea which may be bloody
* Campylobacter enteritis
* Clarithromycin
97
**initially systemic upset as above**
* relative bradycardia
* abdominal pain, distension
* constipation:
* termed enteric fevers, producing systemic symptoms such as headache, fever, arthralgia
* Salmonella (non-typhoid)
* Ciprofloxacin
98
Shigellosis
Ciprofloxacin
99
Minimal glucocorticoid activity, very high mineralocorticoid activity
Fludrocortisone
Mineralocorticoid side-effects
fluid retention
hypertension
100
Glucocorticoid activity, high mineralocorticoid activity
Hydrocortisone
101
Predominant glucocorticoid activity, low mineralocorticoid activity
Prednisolone
102
Very high glucocorticoid activity, minimal mineralocorticoid activity
Dexamethasone
Betmethasone
103
Glucocorticoid side-effects
\*endocrine: impaired glucose regulation, increased \*appetite/weight gain, hirsutism, hyperlipidaemia \*Cushing's syndrome: moon face, buffalo hump, striae \*musculoskeletal: osteoporosis, proximal myopathy, \*avascular necrosis of the femoral head \*immunosuppression: increased susceptibility to severe \*infection, reactivation of tuberculosis \*psychiatric: insomnia, mania, depression, psychosis \*gastrointestinal: peptic ulceration, acute pancreatitis \*ophthalmic: glaucoma, cataracts \*suppression of growth in children \*intracranial hypertension
104
Mineralocorticoid side-effects
fluid retention hypertension
105
CAP pnenumonia in penicillin allergic man
500 mg BD clarithromycin
106
What's the aim metformin theraphy?
To reduce Hba1c% to less than 6.5
107
Bacterial Menigitis
2g IV ceftriaxone
108
barking cough and stridor in children managment
Croup=
DEXAMETHASONE
150 micrograms/kg for 1 dose.
109
high blood preassure in 75 year old man
1st line amlodipine 5 mg
110
tamoxiofen SE
Hot flushes are important to mention as they are so common. Venous thromoboembolism (VTE)
Tamoxifen is a Selective oEstrogen Receptor Modulator (SERM) which acts as an oestrogen receptor antagonist and partial agonist. It is used in the management of oestrogen receptor positive breast cancer
**Adverse effects**
* **menstrual disturbance:** vaginal bleeding, amenorrhoea
* **hot flushes:** 3% of patients stop taking tamoxifen **due to climateric side-effects**
* **VTE**
* **endometrial cancer\***
Tamoxifen is typically used for 5 years following removal of the tumour.
111
**what's the monitoring of digoxin?**
* ECG
* U&E (hypokalemia)
112
## Footnote
**Drugs to avoid in renal failure**
**antibiotics**: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin
113
Drugs likely to accumulate in chronic kidney disease - need dose adjustment
**FOAMS**
**F**rusemide
**O**pioids
**A**tenolol
**M**ethotrexate
114
Nephrotoxicity due to contrast media definitition
Contrast media nephrotoxicity may be defined as a 25% increase in creatinine occurring within 3 days of the intravascular administration of contrast media.
115
The BNF recommends different target gentamicin concentrations for patients with infective endocarditis
peak 3-5mg/litre, trough \< 1mg/litre
116
dose of omeprazole to be taken
20 mg OD
117
What are the three options for smoking cessation?
veranecline and buprion , nicotine replacement theraphy
118
A 60-year-old lady with metastatic endometrial cancer comes for review. She is currently taking MST (slow release morphine) 75mg bd but is unfortunately troubled with pruritus. You therefore decide to switch her to
OxyContin should therefore be 150 / 1.5 = 100mg per day
119
lithium monitoring tests:
U&E
TFT
120
Statins monitoring
LFTs at baseline, 3 months and 12 months
121
**ACE inhibitors**
**U&E**
* U&E prior to treatment
* U&E after increasing dose
* U&E at least annually
122
Amiodarone
TFT, LFT
TFT, LFT, U&E, CXR prior to treatment
TFT, LFT every 6 months
123
Methotrexate monitoring
FBC, LFT, U&E
## Footnote
The Committee on Safety of Medicines recommend 'FBC and renal and LFTs before starting treatment and repeated weekly until therapy stabilised, thereafter patients should be monitored every 2-3 months'
124
Azathioprine monitoring
FBC, LFT
* FBC, LFT before treatment
* FBC weekly for the first 4 weeks
* FBC, LFT every 3 months
125
Lithium monitoring
Lithium level, TFT, U&E
* TFT, U&E prior to treatment
* Lithium levels weekly until stabilised then every 3 months
* TFT, U&E every 6 months
126
Sodium valproate monitoring
* LFT
* LFT, FBC before treatment
* LFT 'periodically' during first 6 month
127
Glitazone monitoring
LFT
LFT before treatment
LFT 'regularly' during treatment
128
if the trough (pre-dose) level is high of the gentamycin....
the interval between the doses should be increased
129
if the peak (post-dose) level of gentamycin is high
the dose should be decreased
130
Drugs which decrease serum potassium
Thiazide diuretics
Loop diuretics
Acetazolamide
131
Drugs which increase serum potassium
ACE inhibitors
Angiotensin-2 receptor blockers
Spironolactone
Potassium sparing diuretics (amiloride, triamterene)
Potassium supplements (Sando-K, Slow-K)
132
emergency contraception
levonorgestrel 1.5 mg
133
digoxin monitoring
* Serum digoxin level just before next dose
* Ventricular rate at rest
134
Oculogyric crisis managment
Procyclidine 5 mg IV
135
medication that will not give monthly withdraval bleeds for HRT
Evorel Conti 50 mg and norethiestrone replacement theraphy
136
Which medications are causing confusion?
opiates (fentanyl)
benzodiazepines (tamazepam)
trazodone (TCA)
137
Which medications are not allowed in ischemic ulucer disease?
beta-blockers
138
Which drugs should be in caution in peripheral vascular disease?
ACE inhibitors
139
Which medications predispose to development of vaginal trush?
steroids and antibiotics
inhaled steroid not so much
140
What's the usual dose of omeprazole?
10 mg of omeprazole
20 mg if the symptoms persist
141
Insulin prescribing
142
Nitrofurantoin dose
100 mg BD for 3 days
143
What do you prescribe for scarlet fever?
phenoxymethylpenicillin 125 mg orally 6 hourly for 10 days
144
What should you monitor when presribing drugs that can lead to hyperkalemia?
K+ sparing diuretics: we need to monitor Potassium
145
**What advice should be given to patients taking methotrexate?**
The advice regarding effective contraception for ment and women as it is highly tetragoneic drug
146
What would you use in the treatment of neuropathic pain?
Tricyclic antidepressants
Amitryptyline
147
common side effects of TCAs
Think about the anti-cholinergic properties of TCAs:
* drowsiness
* dry mouth
* blurred vision
* constipation
* urinary retention
148
Which drugs cause hypokalemia?
Diuretics:
Loop (TAL)
Thiazide (DCT)
amiodorone
steroids
149
Which drug should be avoided when taking statins?
Gemofibrozil (fibrates)
It is a know cause for toxicity causing myopathy and rhabdomyloysis
150
What is the management of hypoglycemia in unconsious patient (not-insulin dependent)
15g glucose IV using 20% solution
151
What is the management of hypoglycemia in insulin-induced hypoglycemia?
1 mg glucagon IM
Won't work in drunks and has short duration of effect (20 min)
Insulin relase might cause rebound hypoglycemia
IM injections are also not ideal for anti-coagulated patietns (brusing).
152
How do you measure the effect of the treatment in the AF?
rate control drugs - heart rate would be controlled by measuring the heart rate.
153
What needs to be monitored with amiodorone?
checked for hypokalemia (it acts on Na,K channel)
* TFT, LFT, U&E, CXR prior to treatment
* TFT, LFT every 6 months
154
If patient is taking setraline and has hepatic impariemtn, what needs to be done?
The dose of sertareline would need to be reduced.
155
Long term urinary cathers are usally colonised. The speciment should only be sent for analysis if there is suspiciton of highly infective organism
156
157
If the statins are suspected to be the cause of myopathy and creatinine kinase is markedly elevated (more than 5 times upper limit of normal) , of if muscular symptoms are severe, statins should be discontinued.
If symptoms resolve and kretine kinase levels return to normal, statins should be re-introduced at lower dose.
158
what would you use for treatment of DVT first line
enoxaparin 1.5 mg/kg subcutaneous
159
What should be used if patient has kidney impairement and DVT?
unfractionated heparin rather than enoxaparin
160
when dalteparin is contradicted?
- heparin induced thrombocytopenia
- high risk of bleeding complications
(acute gastroduodenal ulucer)
- cerebral hemorrhage
- conditions predisposing to bleed.
- stroke
161
when atorvostatin should be prescribed?
- primary prevention if the cardiovascular risk is 10% or more 20 mg
- type I diabetic
- CKD GFR less than \<60
- secondary prevention
162
how is atorvostatin monitored?
Non-HDL
163
statins side effects
mylagia
disturbed liver function
GI
Sleep disturbance
Hedache tim
164
Which one of the following is a disadvantage of using a proton-pump inhibitor (PPI) long-term?
The BNF states that PPI's are used at the lowest effective dose for the shortest period and the need for long-term treatment should be reviewed periodically.
Long-term use of PPI's can mask the symptoms of gastric cancer. They can also increase the risk of osteoporosis and fractures -due to malabsorption of calcium and magnesium.
165
A 24-year old female presents to general practice with a few-weeks history of diarrhoea, passage of mucus, lethargy and abdominal discomfort relieved by defaection.
What do you prescribe?
## Footnote
**Loperamide 61%**
166
What's the mangment of IBS?
First-line pharmacological treatment - according to predominant symptom
## Footnote
pain: antispasmodic agents
constipation: laxatives but avoid lactulose
diarrhoea: loperamide is first-line
167
Mechanism of action of amino-salicylte drugs?
5-aminosalicyclic acid (5-ASA) is released in the colon and is not absorbed. It acts locally as an anti-inflammatory. The mechanism of action is not fully understood but 5-ASA may inhibit prostaglandin synthesis
168
Mesalasine side effects:
mesalazine is still however associated with side-effects such as GI upset, headache, agranulocytosis, pancreatitis\*, interstitial nephritis
169
Sulphasalzine side effects:
rashes, headache, Heinz body anaemia, megaloblastic anaemia
170
What antibiotics do you prescribe in acute appendicitis?
Co-amoxiclav TDS pending no penicillin allergy
171
What's the most common minimal and maximal doses of amitryptyline?
The min - 10 mg
Max - 75 mg
The common use of amitryptyline:
1) Neuropathic pain 10 mg
2) prophylaxis of: migrane and tension hedache
172
What is used as second line treatment of IBS?
amitryptyline 10 mg
173
what's the management of IBS?
First-line pharmacological treatment - according to predominant symptom
pain: antispasmodic agents (MEBEVERINE HYDROCHLORIDE)
constipation: laxatives but avoid lactulose
diarrhoea: loperamide is first-line
174
**What is maximal dose of beta-blockers?**
200 mg
175
What's the maximum dose of bendrofluemthazide?
10 mg
176
What's prazosin?
What's the maximum dose?
alpha 1 selective inhibitor
2 mg
177
What's the maixmal dose of spironolactone?
200 mg
178
What are the common side effects of metform?
gastrointestinal upsets are common (nausea, anorexia, diarrhoea), intolerable in 20%
reduced vitamin B12 absorption - rarely a clinical problem
lactic acidosis\* with severe liver disease or renal failure
179
What are the contradictions to metformin theraphy?
Contraindications\*\*
chronic kidney disease: NICE recommend that the dose should be reviewed if the creatinine is \> 130 µmol/l (or eGFR \< 45 ml/min) and stopped if the creatinine is \> 150 µmol/l (or eGFR \< 30 ml/min)
metformin may cause lactic acidosis if taken during a period where there is tissue hypoxia. Examples include a recent myocardial infarction, sepsis, acute kidney injury and severe dehydration
iodine-containing x-ray contrast media: examples include peripheral arterial angiography, coronary angiography, intravenous pyelography (IVP); there is an increasing risk of provoking renal impairment due to contrast nephropathy; metformin should be discontinued on the day of the procedure and for 48 hours thereafter
alcohol abuse is a relative contraindication
180
What are two mechanism of action of aspirin?
- anti-platlet
- COX-1 and COX-2 inhibitors
181
Why aspirin is causing iron deficency anemia?
Because of lack of protective effect of prostaglandin on the gastric mucosa
182
Which anti-diabetic agents can cause hypoglycemia?
Pioglitazone (thazelidenodiones) - PPARgamma inhibitors
Sulphonylureas (Glicazide)
183
What are two commonly used alpha blockers?
doxazosin
tamusolosin
184
What are the side effects of alpha blockers?
* postural hypotension
* drowsiness
* dyspnoea
* cough
185
What's ezetimbe?
Ezetimibe is a lipid lowering drug which acts on enterocytes to inhibit cholesterol absorption from the small intestine
186
Which drugs are causing urinary retention?
- Opioids
- anti-cholinergic (anti-depressants, anti-psychotics, detrusor relaxants)
- general anasthethic
- alpha adrenergic receptor agonist
- benzodiazepines
- NSAIDs
- Ca channel bloeckers
- anti-histamines
-
187
Which drugs can cause confusion ?
Anti-cholinergic
Ant-depressants
Anti-psychotics
Anti-convulsants
Less common - (histamine receptor antagonists)
188
What sort of insulin should be given in DKA patient?
short acting insulin at the rate of 0.1 units/kg/hour.
189
What's step 4 of the blood preassure monitoring?
Then decsion has to be made depning on the K
if the K\>4.5 thazide like diurectics (causes hypokalemia)
K\<4.5 spironolcatone (causes hyperkalemmia)
190
What's the folic acid prescribing dose?
It depends: high risk pregnant woman - 5 mg
in low-risk woman and no family hisotry of spina bifida
400 mg
191
What's the mechanism of action alendronic acid?
Reduces bone deminaralisation
Works on the osteoclasts, reducing its apoptosis
192
How does glicaside work?
Glisacide works by increasing insulin release from the pancreas
193
Learn about HRT and its key facts
194
What are methotrexate side effects?
mucositis
myelosuppression
pneumonitis
pulmonary fibrosis
liver cirrhosis
195
How biphosphonates should be given?
'Tablets should be swallowed whole with plenty of water while sitting or standing; to be given on an empty stomach at least 30 minutes before breakfast (or another oral medication); patient should stand or sit upright for at least 30 minutes after taking tablet'
196
what advice should be given to pregnant women and men taking methotrexate?
* women should avoid pregnancy for at least 3 months after treatment has stopped
* the BNF also advises that men using methotrexate need to use effective contraception for at least 3 months after treatment
197
How methotrexate should be monitored?
FBC, U&E and LFTs need to be regularly monitored. The Committee on Safety of Medicines recommend 'FBC and renal and LFTs before starting treatment and repeated weekly until therapy stabilised, thereafter patients should be monitored every 2-3 months'
198
which additional drug should be prescribed with methotrexate?
folic acid 5mg once weekly should be co-prescribed, taken more than 24 hours after methotrexate dosefolic
199
what's the starting dose of methotrexate?
the starting dose of methotrexate is 7.5 mg weekly (source: BNF)
200
what's the strenght of the methotrexate tablet?
only one strength of methotrexate tablet should be prescribed (usually 2.5 mg)
201
which drugs should not be prescribed with methotrexate?
avoid prescribing trimethoprim or cotrimoxazole concurrently - increases risk of marrow aplasia
202
Gentamycin:
How is it measured?
both peak (1 hour after administration) and trough levels (just before the next dose) are measured
203
what should be done if the through dose of gentamycin is high if the trough (pre-dose) level is high
* if the trough (pre-dose) level is high the interval between the doses should be increased
204
If the peak (post-dose) is high the dose should be decreased?
if the peak (post-dose) level is high the dose should be decreased
205
What are the macrolidies?
* erythomycin
* azythromycin
* clarithromycin
206
how do macrolides work?
- inhibit the action of 23S ribosomal subunit
207
What are the side effects of macrolides?
gastrointestinal side-effects are common. Nausea is less common with clarithromycin than erythromycin
cholestatic jaundice: risk may be reduced if erythromycin stearate is used
P450 inhibitor (see below)
208
What's the common interaction of statins?
statins should be stopped whilst taking a course of macrolides. Macrolides inhibit the cytochrome P450 isoenzyme CYP3A4 that metabolises statins. Taking macrolides concurrently with statins significantly increases the risk of myopathy and rhabdomyolysis.
209
Anaphyaxis drugs and disages adult
210
How does alluprinol work?
reduces serum urate by inhibiting the action of the enzyme xanthine oxidase
211
When shoul alluprinol be started?
two weeks after the acute attack has settled
212
What's the intial dose of alluprinol?
nitial dose of 100 mg od, with the dose titrated every few weeks to aim for a serum uric acid of \< 300 µmol/l
213
What are two common interactions of alluprinol?
Azathrophine
Cyclophoshamide
214
What are the monitoring actions of lithium?
lithium blood level should 'normally' be checked every 3 months. Levels should be taken 12 hours post-dose
thyroid and renal function should be checked every 6 months
215
What are other adverse features of lithium?
renal
thyroid
nephrotic syndrome
nephhrogenic diabetes inispidius
216
What are the side effects of hormone replacement theraphy?
Hormone replacement theraphy can cause Na and water retention, thus leading to increased blood preassure
217
Which patients shoudl discontinue the statin theraphy?
Patient should discontinue the statin theraphy if they liver enzymes are three times above the range
218
What dose of levothyroxine should be given to:
- patients above 50
- cardiac disease
- severe hypothyroidism
the initial starting dose should be 25mcg od with dose slowly titrated.
219
Following the change in thyroxine dose thyroid function tests should be checked every?
following a change in thyroxine dose thyroid function tests should be checked after 8-12 weeks
220
What's the therpaheuitc goal of lithium theraphy?
the therapeutic goal is 'normalisation' of the thyroid stimulating hormone (TSH) level. As the majority of unaffected people have a TSH value 0.5-2.5 mU/l it is now thought preferable to aim for a TSH in this range
221
What advice should be given to pregnant women taking levothyroxine?
women with established hypothyroidism who become pregnant should have their dose increased 'by at least 25-50 micrograms levothyroxine'\* due to the increased demands of pregnancy. The TSH should be monitored carefully, aiming for a low-normal value
222
What's the main interacton with levothyroxine?
iron: absorption of levothyroxine reduced, give at least 2 hours apart
223
Prophylaxis of deep-vein thrombosis, especially in surgical patients—moderate risk
20 mg for 1 dose, dose to be given approximately 2 hours before surgery, then 20 mg every 24 hours.
224
PCP treatment
co-trimoxazole
225
apiration pneumonia treatement
co-amoxiclav
226
Fungi pneumonia
amphotercin
227
CMV treatment
ganciclovir
228
Important safety information with flucoxacylin
* flucloxacillin should not be used in patients with a history of hepatic dysfunction associated with flucloxacillin
* flucloxacillin should be used with caution in patients with hepatic impairment
229
Cautions
For all MACROLIDES:
electrolyte disturbances (predisposition to QT interval prolongation); may aggravate myasthenia gravis; predisposition to QT interval prolongation
230
Managment of acute and subacute endocardits
Acute severe: Fuclox / vanc + gent IV
Subacute: Benpen + gent IV
231
Which SE would prompt you to switch from morphine to oxydone?
- Nausea
- Vomitting
- Pruritis
232
opioids in palliative care, starting points
if no comorbidities use 20-30mg of MR a day with 5mg morphine for breakthrough pain.
For example, 15mg modified-release morphine tablets twice a day with 5mg of oral morphine solution as required (p.r.n.)
233
What should be mentioned to all patients taking taking opioids?
patients should be advised that nausea is often transient. If it persists then an antiemetic should be offered
drowsiness is usually transient - if it does not settle then adjustment of the dose should be considered
234
What analgesia should be prescribed to patients with CKD?
opioids should be used with caution in patients with chronic kidney disease. Alfentanil, buprenorphine and fentanyl are preferred
235
How would you increase opioid dose?
When increasing the dose of opioids the next dose should be increased by 30-50%.
236
conversion of oral codeine to morphine
Oral codeine Oral morphine
Divide by 10
237
Oral tramadol conversion to Oral morphine
Divide by 10\*\*
238
The current BNF gives the following conversion factors for transdermal perparations to morphine
* a transdermal fentanyl
* a transdermal buprenorphine
a transdermal fentanyl 12 microgram patch equates to approximately 30 mg oral morphine daily
## Footnote
a transdermal buprenorphine 10 microgram patch equates to approximately 24 mg oral morphine daily.
239
Oral morphine \> Subcutaneous morphine
Divide by 2
240
Oral morphine \> Subcutaneous diamorphine
Divide by 3
241
Oral oxycodone \> Subcutaneous diamorphine
Divide by 1.5
242
Drugs causing a peripheral neuropathy
**mavin**
**Metronidazole**
**amiodorone**
**Vincrisitine**
**isoniazid**
**metronidazole**
243
Drugs causing Hypercalcaemia
drugs: thiazides, calcium containing antacids
244
What is the first-line insulin regime he should be offered?
In newly diagnosed adults with type 1 diabetes, the first-line insulin regime should be a basal–bolus using twice‑daily insulin detemir
245
Leflunomide monitoring
FBC/LFT and blood pressure
246
A 43-year-old woman who has rheumatoid arthritis is reviewed in clinic. She has responded poorly to methotrexate and consideration is being given to starting sulfasalazine. An existing allergy to which one of the following drugs may be a contradiction to the prescription?
Patients who are allergic to aspirin may also react to sulfasalazine
247
T score is Less than -1.5. what do you do?
Offer bone protection
## Footnote
**Alendronate**
248
Gout with dudoenal ulcer managament
**Diclofenac** and **indomethacin** are contraindicated because of his **duodenal ulcer**. **Colchicine** is a suitable alternative. **Allopurinol** should not be given in the acute phase, but is good for preventing recurrent attacks.
249
Which one of the following treatments may be beneficial in raynaulds disease?
Management
## Footnote
first-line: calcium channel blockers e.g. nifedipine
IV prostacyclin infusions: effects may last several weeks/mont
250
which painkillers are absolutely contradicted in patients on warfarin?
NSAIDS due to risk of GI bleed
251
peripheral vascular disease and therefore should be prescribed
clopidogrel 75 mg
atorvastatin 80 mg
252
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