Morphine has been prescribed. What do you need to remember to also prescribe? [1]
An antiemetic such as metoclopramide should also be given to prevent opioid-induced nausea.
opioids should be used with caution in patients with chronic kidney disease
- which drugs should be used instead? [+]
oxycodone is preferred to morphine in palliative patients with mild-moderate renal impairment
if renal impairment is more severe, alfentanil, buprenorphine and fentanyl are preferred
Acute pyelonephritis tx? [2]
Broad-spectrum cephalosporin: Cefalexin or quinolone: e.g Ciprofloxacin
Acute prostatitis tx? [2]
Quinolone: Ciprofloxacin or trimethoprim
Animal bite tx? [1]
Co-amoxiclav (doxycycline + metronidazole if penicillin-allergic)
Sinusitis tx? [1]
Phenoxymethylpenicillin
Otitis media tx? [1]
Amoxicillin (erythromycin if penicillin-allergic)
x?
Severe otitis externa tx? [1]
Flucloxacillin (erythromycin if penicillin-allergic)
Which abx should you avoid in patients with epilepsy? [1]
fluoroquinolones - e.g. levofloxacin
- Interact with GABA (which can mess up epilepsy)
What do you need to be careful with when prescribing insulin [1]
Has to as ‘units’ not ‘u’
When giving alendronate, what advice need to give about dentist? [1]
Need to see a dentist BEFORE starting
- then regular appointments
What would indicate someone is dry from their U&Es? [1]
Urea:Creatine > x10
Lithium excretion is significantly reduced by [drug class x3]
Lithium excretion is significantly reduced by ACE-inhibitors in this case lisinopril, diuretics (and particularly thiazides, in
this case bendroflumethiazide) and NSAIDs (not given here).
A person is presribed lithium, but needs a diuretic due to XS fluid.
Which is the safest to prescribe? [1]
Loop diuretic
Adults require [1] mmol KCl per day when nil by mouth.
Adults require 40–60 mmol KCl per day when nil by mouth.
When giving DKA insulin - which type should you give? [1]
Short acting
Give two key side effects of amlodopine (apart from peripheral oedema) [2]
Constipation (PCC)
Drowsiness
If on metformin and about to have surgery - how would you change the dose? [1]
If on TDS - hold lunch
If only one meal will be missed during surgery, and the patient has an eGFR greater than 60 mL/minute/1.73m2 and a low risk of acute kidney injury (and the procedure does not involve administration of contrast media), it may be possible to continue metformin hydrochloride throughout the peri-operative period—just the lunchtime dose should be omitted if the usual dose is prescribed three times a day.
Blood effect of amoxicillin? [1]
Causes low platelets
What are the electrolyte effects of indapamide? and other thiazides [4]
Low Na
Low K
High Ca (decrease the risk of stones)
Uric acid (hyperuricaemia) – can precipitate gout
State the effect of the following on Ca levels:
Glucocorticoids
Lithium
Thiazides
Loop
Phenytoin
Glucocorticoids:
- decrease
Lithium:
- increase
Thiazides:
- increase
Loop
- decrease (increase risk of stones)
Phenytoin:
- decrease
Which drug (apart from DIANA) should you also hold in renal failure? [2]
Metformin
Allopurinol
A patient is going into surgery tomorrow. Their INR is found to be 1.6. What do you do? [1]
Give oral vitamin K - want it to be < 1.5
ACE causes a shift in how much Cr and is considered normal? [1]
20%
