Chapter 2 Qs

Question 1

Q2.1 Give an example of 2 drugs that should be stopped in a pt with haemoptysis

Answer 1

Antiplatelets: Aspirin

Anticoagulants: LMWH

Question 2

Q2.1 Give an example of 2 pescriptions that should be stopped in a hyperkalaemic patient

Answer 2

ACEi (ramipril)

IV fluid with added potassium

Question 3

Q2.2 What is the mechanism of action of the following antiemetics:

1. Metoclopramide:
2. Domperidone:
3. Cyclizine:

Answer 3

1. Metoclopramide: dopamine antagonist, crosses BBB, exacerbated parkinsonian symproms
2. Domperidone: dopamine antagonist Doesn’t cross BBB, safe in PD
3. Cyclizine: antihistamine anti-emetic

Question 4

Q2.3 How do ACE-i cause dry cough?

Answer 4

ACE-I cause dry cough through accumulation of bradykinin via reduced degradation by ACE.

Question 5

Q2.3 How do ACE-i’s cause hyperkalaemia?

Answer 5

ACE-i cause hyperkalaemia via reduced aldosterone production, and reduced K+ excretion in kidneys (aldosterone antagonists do this too).

Question 6

Q2.4. How do the following two drugs cause ‘stomach upset’:

1. Ibuprofen
2. Prednisolone

Answer 6

1. Ibuprofen, NSAID, inhibits prostaglandin synthesis needed for gastric mucosal protection.
2. Prednisolone, Oral steroids inhibit gastric epithelial renewal.

Both → indigestion/dyspepsia.

Question 7

Q2.4. How do the following two drugs cause renal falure:

1. Ibuprofen
2. Ramipril

Answer 7

1. Ibuprofen, NSAID inhibits prostaglandin synthesis → reduced renal artery diameter → reduced kidney perfusion + function.
2. Ramipril, ACEi, reduces angiotensin II production req for preserving glomerular filtration when blood flow is reduced

Question 8

Q2.6 Common PMHx contra-indication for Ibuprofen

Answer 8

Asthma: NSAIDs (e.g. ibuprofen) cause bronchoconstriction, so avoid unless strictly necessary + under supervision (not at home).

Question 9

Q2.6 Important to remember regarding PRN medications

Answer 9

For prescription to be valid, must write maximum PRN frequency – can’t just write “as required” on its own.

Question 10

Q2.6 CI for trimethoprim in a pt with RA?

Answer 10

Trimethoprim = folate antagonist, so CI with methotrexate (also folate antagonist) as risk of BM toxicity → pancytopenia + neutropenic sepsis.

Question 11

Q2.6 Important to remember in a septic pt on methotrexate

Answer 11

If on methotrexate + septic, must stop it pending exclusion of neutropenic sepsis.

Question 12

Q2.7 Important side effect on CCB

Answer 12

CCBs (e.g. amlodipine) cause ankle swelling. Do not use in HF.

Question 13

Q2.7 How long after an ischaemic stroke should we wait to start LMWH?

Answer 13

Stop LMWH (e.g.enoxaparin) for 2 months (duration varies throughout UK) following an ischaemic stroke

Question 14

Q.2.8 How to check how to manage warfarin and INR on the BNF

Answer 14

Check BNF for this by typing in “warfarin INR”/Oral anticoagulants in search bar.

If patient has high warfarin (INR 5-8), withhold a few doses.

If patient on warfarin with INR >2 (i.e. therapeutic), then do not give prophylactic heparin as increases risk of bleeding unnecessarily.

Question 15

Q2.9 Important trivia re asthma

1. Beta Blockers
2. NSAIDS
3. Apsirin (NSAID)

Answer 15

1. Beta-blockers; strictly CI (can precipitate bronchospasm)
2. NSAIDs; use with caution (can precipitate bronchospasm)
   
   • If asthmatic already on NSAID without problem, may continue.
3. Aspirin, although an NSAID, very rarely worsens asthma – so commonly (but cautiously) used.

Question 16

Q2.9 What is the maximum dose of aspirin?

Answer 16

300mg

Question 17

Q2.9 What is Co-amoxiclav

Answer 17

= amoxicillin + clavulanic acid.

Question 18

Q2.10 Common CI to microgynon

Answer 18

Microgynon ED is COCP – CI in migraine with aura, as significantly increases risk of stroke.

Question 19

Q2.10 Max dose of Bisoprolol (&important drug to NOT co-prescribe)

Answer 19

20 mg per day

Do NOT use with verapamil

Question 20

Q2.10 Route for Insulin?

Answer 20

All insulin is SC e.g. Novomix

except sliding scales using short-acting insulin (e.g. Actrapid or Novorapid) given by IV infusion.