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GP/OSCE - Year 4 > Safe prescribing 2 > Flashcards

Safe prescribing 2 Flashcards

1
Q
A
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2
Q

COPD severity scale in re to % of FEV1

A
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4
Q

Patient with: T2DM, COPD and HTN

What’s the target BP?

A

140/80

  • With diabetes alone and no microvascular or macrovascular complications target BP is 140/80
  • With CKD, Proteinuria, retinopathy etc this would reduce to 130/80
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5
Q

Pt with T2DM, COPD and HTN

Has had a productive cough & increased breathlessness for 5 days. On examination, he has coarse crackles to the base of his left lung on auscultation, a moderate polyphonic wheeze elsewhere & the following observations

Obs as follows on the picture

What do you do as a GP?

A

Call an ambulance 999 as he needs urgent hospital admission due to suspected sepsis

*even if CURB 65 is only 1, but if sepsis is suspected -> hospital admission is required

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6
Q

Patient with COPD, HTN and T2DM (on dual therapy)

What’s HbA1C target?

A

53 mmol/mol

  • if pt on dual therapy for their sugar - target is 53
  • step up in treatment if 58 mmol/mol
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8
Q

CURB 65 sore of 1

What antibiotics are adviced by PanMersey?

A

Amoxicillin AND Clarithromycin, or doxycycline

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9
Q

Classification of CKD

(according to eGFR and albumin: creatinine ratio)

A
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10
Q

CURB 65 score of 0; what antibiotics are adviced by PanMersey?

A

either amoxicillin or clarithromycin or doxycycline

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11
Q

What medication increases the risk of non-fatal pneumonia in COPD?

A

Seretide

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13
Q

What’s target BP in pt:

Diabetes with signs of micro or macrovascular disease aim for the lower blood pressure target

A

130/80

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14
Q

You review a patient who has had diarrhoea and vomiting. Looking at his records you see they have Diabetes Mellitus Type II and Heart Failure.

Thinking about the risk of Acute Kidney Injury, which medication would be the most appropriate to continue?

Metformine

Amlodipine

Ramipril

Furosemide

Naproxen

A

Amlodipine is CCB and is the only one out of this list that does not cause/ increase AKI

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15
Q

A 74 year old lady attends Accident and Emergency feeling breathless, complaining of a productive cough for the last 2 weeks. She is otherwise well in herself.

Her observations include a respiratory rate of 24/min, Oxygen saturations in room air of 94%, a pulse rate of 88/min and a blood pressure 100/74 mmHg.

What other marker do you need to complete her CURB-65 score?

A

Blood urea

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16
Q

What blood test would be most helpful in deciding if a patient presenting with chest infection symptoms requires antibiotic?

A

CRP

  • no antibiotic if it’s <20
  • consider delayed prescription if it’s 20-100
  • immediate antibiotic if it’s over 100
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17
Q

A lady presents with chest infection symptoms. Excluding respiratory disease and immunosuppression, what two co-morbidities, if present, would increase your likelihood of prescribing an antibiotic?

A
  • Diabetes Mellitus
  • Congestive Heart Failure
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18
Q

What are the benefits of delayed antibiotic prescription?

A
  • Reduced antibiotic resistance - around 40% of patients don’t use the delayed prescription
  • Reduced consultation rates in General Practice
  • A cost saving for the NHS
  • Reduced complications from antibiotic usage, e.g. Clostrium difficile infection
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19
Q

What (acute cardiac) condition binge drinking increase risk of?

A

AF

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20
Q

Can we give bisoprolol and verapamil together?

A

No. Do not combine VERAPAMIL with beta blockers

As verapamil is rate-limiting CCB -> together with other drugs it beings HR down extremely

*other CCB (non-rate limiting) e.g. Amlodipine can be combined with b- blockers

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21
Q

What can Metronidazole do to Warfarin?

A

Metronidazole is an inhibitor of P450 -> will inhibit the metabolism of other drugs (e.g. Warfarin) -> potentially levels of warfarin will raise/ become toxic

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22
Q

Is Lithium + NSAIDs good combination?

A

No. NSAIDs reduce Lithium exertion

23
Q

What antibiotics can cause Achilles tendonitis?

A

Ciprofloxacin (Quinolones)

If any problem in back of the ankle (Achilles tendon) after starting the antibiotic -> STOP it

24
Q

(4) bloods in investigation of Rheumatoid Arthritis

A
  • Rheumatoid factor
  • anti-CCP antibody
  • CRP
  • ESR
25
Q

What further Ix to perform in a man with UTI?

A
  • PR
  • PSA
  • cystoscopy

(this is because men do not usually get UTI -> therefore most would be considered as complicated)

26
Q

(3) side effects of Ramipril

A
  • cough (normally in first few months)
  • postural hypotension
  • renal failure (if bilateral renal artery stenosis)
27
Q

What do we do if a patient that was started on Ramipril develop a cough?

A

A. If occasional cough and a patient can cope with that -> may persist on Ramipril

B. If pt cannot cope with cough -> change to alternate e.g. Losartan (if HF), CCB (if HTN)

28
Q

How to start a patient on Metformin?

A

Gradually -> to avoid GI disturbance (SE)

Start at low dose -> once daily

* start one in the morning

* then increase by one a week -> until x4 tablets daily (x2 tablets twice a day)

29
Q

What GI side effects is Metformin associated with?

A
  • diarrhoea
  • nausea
  • anorexia
  • abdominal pain

SEs appear initially but they will subsidise

30
Q

What’s metformin association with lactic acidosis and kidney problems?

A

Metformin itself does not cause problems with the kidneys; but if something else causes AKI/reduced renal function -> then if use of metformin -> potential for lactic acidosis

Therefore, in AKI, we do reduce metformin (or stop it) to avoid lactic acidosis

31
Q

What are the long-term side effects of Omeprazole use?

A
  • reduced cognition (possible association with dementia)
  • osteoporosis

* however, the evidence for above SEs is not confirmed

* use of omeprazole is recommended only for short term (e.g. H.Pylori/GI upset management)

* sometimes when we stop Omeprazole -> a patient will have rebound symptoms -> if that happens, give Ranitidine

32
Q

What is the best time to take statins?

A

Night time -> most cholesterol is made at night

33
Q

What advice to give to a patient who is started on a statin?

A

If dark urine develops -> stop statin and get in touch with a doctor

*potential for rhabdomyolysis

34
Q

What’s the treatment aim for statins?

A

At least 40% reduction in LDL cholesterol

35
Q

What do we need to monitor and when if we start a patient on a statin?

A

LFTs at 3 months after we start treatment

This is to ensure it did not cause hepatitis

36
Q

Common side effects of statins

A
  • nausea
  • vomiting
  • pains and aches - general, mild ones
37
Q

Side effects of gliclazide

  • common ones (4)
  • rare (1)
A
  • Common: abdominal pain, nausea, hypoglycaemia, weight gain
  • Rare: agranulocytosis
38
Q

What (2) things we need to monitor when we start a patient on gliclazide

A
  • hypos -> monitor BM, explain to a patient how to recognise them
  • agranulocytosis: fever, bleeding/bruising/pale, monitor by doing an annual FBC
39
Q
A
40
Q

(2) potential side effects of Beclomethasone (inhaler) use

A
  • horse voice
  • candida - advice pt to rinse mouth after taking the puff
41
Q

Do ICS inhalers cause systemic steroid side effects?

A

Usually not

42
Q
A
43
Q

Explain to the patient:

Ramipril

  • aim
  • MoA (how does it work)
A
  • Aim: to lower your blood pressure and so reduce your risk of heart disease etc.
  • MoA: They work through your kidneys to make your blood vessels wider (dilate), this lowers the pressure inside them and so bringing your blood pressure down
44
Q

Explain to the patient:

How to take Ramipril

A

Take it once a day, usually in the morning but that doesn’t matter too much.

It is a lifelong medication (or at least until we decide to stop)

45
Q

Explain to the patient

Common side effects of Ramipril

A

A common side effect is:

  • a cough
  • it lowers blood pressure so you may feel dizzy

*if anything significant please speak to your GP

46
Q

How to explain to the patient a potentially Ramipril’s adverse effect on the kidney?

A
  • For most people this medication helps keep their kidneys healthy
  • for a small number it has the opposite effect
  • For this reason we need to check your kidney blood test 1-2 weeks after you start the prescription and after every time we increase the dose
  • We will need to see you back for a blood pressure check in X weeks to ensure it is helping otherwise we may need to adjust your treatment.
47
Q
A
48
Q

Explain to a patient - Metformin

  • aim of Rx
  • MoA
A
  • Aim: to lower your blood sugars and so reduce your risk of diabetic complications such as kidney, eye and sensation problems; and also to lower risk of developing heart disease
  • MoA: It works by stopping your liver making sugar, reducing the amount of sugar you absorb from you food, and makes your own body’s insulin work better
49
Q

Explain to a patient - Metformin

  • how to take it
A
  • Usually metformin will be taken twice a day but that can vary depending on your response to it
  • Take it until told to stop

GP/OSCE - Year 4 (8 decks)

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