Mock Test Feedback

Question 1

Which drug classes are DOACs contraindicated with?

Answer 1

Bleeding risks
* Fluconazole, itraconazole, ketoconazole
* Carbamazapine
* Phenobarbital
* Phenytoin
* Rifampicin

Bleeding risk:
* SSRIs
* NSAIDs
* Anticoagulants (warfarin, LMWH, UFH etc)

HIV PIs: ritanovir, darunavir

Question 2

Which ARBs influence uric acid levels? [2]

Answer 2

Losartan: reduces uric acid

Olmesartan increases uric acid

Losartan is the only ARB that lowers uric acid.

Question 3

Which drugs do you stop on the day of the surgery? [+]

Answer 3

On the day:
- K sparing diuretics (as anaesthetic drugs like suzamethonum increase K)
- ACE / ARBs cause transient hypotension with anaesthetic induction (stop 24-48hrs before)

Question 4

Which increases somenlance more:
TCAs or BBs?

Answer 4

TCAs

Question 5

Which conditions do you have to use amitryptline with caution / CI in? [2]

Answer 5

Prostate hyperplasia
Intra ocular pressure

Question 6

How do you treat NMS? [1]

Answer 6

Dantrolene

Question 7

How do you treat opiod induced constipation? [2]

Answer 7

Lactulose or macrogol
AND
stimulant (senna)

Question 8

How do you give depot ariprizole? [1]

Answer 8

IM injection glute

Question 9

What is target glucose range in diabetics? [1]

Answer 9

4-12

Question 10

What would you do if omeprazole was indicate for a patient on clopidogrel? [1]

Answer 10

Clopidogrel and omperazole interact: so need to choose a drug that doesnt like: lansoprazole

Question 11

You give aminophylline for asthma.

This has a serious risk of which electrolyte imbalance? [1]

Answer 11

Serious hypocalcaemia

Question 12

In addisonian crisis - how do you treat mod/severe disease? [1]

Answer 12

Increase hydrocortisone to 50/100mg IV 6hrly

Leave fluticortisone

(if not severe - just double dose)

Question 13

How long do you increase hydrocortisone for in Addisionian crisis? [1]

Answer 13

Keep elevated levels for 48hrs

Question 14

How would you monitor Crohns flare tx effectiveness? [1]

Answer 14

Stool frequency

Question 15

What do you need to monitor when giving lithium? [+]

Answer 15

Renal (6 monthly)
Thyroid (6 monthly)
Hyperparathyroidism (Check Ca2+ annually)
Cardiac function (6 monthly)
Weight gain (6 monthly)

NB: if there are other influences, e.g. NSAID use - then renal is a priority

Question 16

A PD patient is NBM. Describe how you would provide their treatment and correct dose [2]

Answer 16

Rotigitone:
- if on co-beneldopa 25mg/100mg TDS - should be converted to 8mg/24hr patch. BUT in some hospitals - 4mg/h patch is used as the standard short term tx

If NG tube placed: co-beneldopa or selegiline are available as dispersible tablets or ropinirole, pramipexole and rasagiline can be crushed for NG
- E.g. if on co-beneldopa 25mg/100mg, could switch to co-beneldopa 25mg/100mg dispersible

Question 17

A patient who needs treating for Chlamydia but doesnt want to take a long course of Abx due to adherence issues.

What should they take? [1]

Answer 17

Doxycyline 1g PO, then 500mg PO daily for 2 days

Question 18

Key side effect of trimethoprim?

Answer 18

Increased K (acts like amiloride)

Question 19

Key side effect if pizotifen? [1]

Answer 19

Weight gain

Question 20

metoclopramide is only indicated for which two situations in children aged 1-18?

Answer 20

In children aged 1-18:
- Only indicated as a second line option for prevention of delayed chemotherapy induced N&V
- Post-op N&V

Anything else its not indicated

Question 21

What is key to note about oseltamavir tx? [1]

Answer 21

If egfr 30-60 need to reduce dose

Question 22

Name some key drugs that are Schedule 3 controlled drugs / have tightened legal classifications [+]

Answer 22

S3:
- Temazepam
- buprenorphine
- secobarbital
- gabapentin/pregabalin

Question 23

Which key abx are CI in severe penicillin allergy? [1]

Answer 23

Ceftriaxone / cefotaxime

Give clarithromycin instead

Question 24

Which abx should you advise concomittent barrier contraception in?

Answer 24

Inducers (CRAPGPS)
- NOT flucox etc

Question 25

What is key to advise about insulin degludec 200 units/6ml [1]

Answer 25

Most insulin: 100 units - need to advise that it contains a higher conc

Question 26

insulin degludec 200 units/6ml: one click of the device delivers how many units of insulin? [1] e.g. If need to give 6 units how many clicks would you give?

Answer 26

2 units - so would need 3 clicks - If it was 100 units / ml one click = 1 unit

Question 27

What is key side effect of terbinafine need to advise? [1]

Answer 27

Decreased appetites

Question 28

What length of time is advised not to exceed for insulin dosing? [1]

Answer 28

Regular admin. is supported 8 hrs in between normal dosing time is allowed tho

Question 29

which key abx are CI with MTX? [1]

Answer 29

Amoxicillin (icn. co-amox): increases the risk of acute MTX tox

Question 30

What is the most important parameter to monitor statin tx to assess effectiveness? [1]

Answer 30

**Non-HDL cholesterol** (not LDL cholesterol)

Question 31

If you want to give a drug like a cream - how should you prescribe it? [1]

Answer 31

**'topically'**

Question 32

Which drugs should you stop 7 days before surgery? [2]

Answer 32

Antiplatelets: so **aspirin OR / AND doacs**

Question 33

Which drugs should you hold in AKI? [+]

Answer 33

DIANA Also **Allopurinol**

Question 34

If need to decide between nsaid or paracetamol for analgesia - what should you look at? [+]

Answer 34

If for example - **elderly** or GI etc

Question 35

A patient is on warfarin is going to have surgery. What advise would you give them? [1]

Answer 35

**Stop 5 days before surgery**

Question 36

Which abx might cause jaundice? [1]

Answer 36

**Flucoxacillin** (or co-amox etc)

Question 37

A patient is on warfarin is going to have surgery. Their INR is measured and found to be > 1.5. What would you do? [1]

Answer 37

Warfarin sodium should usually be stopped 5 days before elective surgery; **phytomenadione (vitamin K1) by mouth** (using the intravenous preparation orally [unlicensed use]) **should be given the day before surgery if the INR is ≥1.5**

Question 38

What risk does IUD insertion have if given during C-section? [1]

Answer 38

Perforation

Question 39

If vancomycin is given and is found to be above the trough level - what should you do? [1]

Answer 39

Omit the next dose for 24hrs and recheck the vancomycin levels

Question 40

What is a dosing error for paracetamol that need to be aware of? [1]

Answer 40

If < 50 kgs then max dose is 60 mg / kg per day

Question 41

Glicazide is impaired in which organ failure? [1]1

Answer 41

Renal

Question 42

If a patient has stage 1 BP - what do you need to also assess for to ID if they should start drug tx or not? [1]

Answer 42

Need concurrent CVD; target organ damage; renal disease; QRISK > 10% Otherwise offer lifestyle advice

Question 43

Ciclosporin causes which electrolyte disturbances? [2]

Answer 43

Hyperkalaemia HypoMg

Question 44

Tacrolimus causes which electrolyte disturbances? [2] What other changes does it cause? [1]

Answer 44

↑ Hyperglycaemia / new-onset diabetes ⭐ Hyperkalaemia HypoMg

Question 45

Which drugs cause ankle oedema? [4]

Answer 45

NSAIDs CCBs Steroids Tamoxifen / anastrozole Thiazolidinediones CCBs, NSAIDs, steroids, oestrogen, pregabalin, pioglitazone

Question 46

A patient has AF. Which drugs would you need to check to ensure they don't have bradycardia? How would you change the medications?

Answer 46

**Verapamil, diltiazem X digoxin** - additive AV nodal suppression - **hold digoxin**

Question 47

A patient has recently had an MI. They have been started on new medication but they are experiencing dizziness. Which medication is the likely to be and why is this occurring?

Answer 47

**Post-MI + beta-blocker + dizziness** → **Dose-related bradycardia** **Why it happens:** * Beta-blockers ↓ sympathetic drive * Post-MI hearts rely more on sympathetic tone * Even “normal” doses can overshoot **Reduce dose or temporarily stop**

Question 48

When checking for dosing errors - what dose should dex. be for croup in children? [1]

Answer 48

**Mcg**

Question 49

Pregnant person with thrush - how do you treat? [1]

Answer 49

**Clotrimazole pessary** - Pregnant women need a longer duration of treatment, **usually about 7 days**, to clear the infection. Oral antifungal treatment should be avoided during pregnancy.

Question 50

PPIs can cause which important side effect? (Not electrolyte disfunction) [1]

Answer 50

Loose stools ## Footnote (>> that pred in a question)

Question 51

If a patient is presenting with hyperthyroidism secondary to amiodarone. What is the management plan? [1]

Answer 51

Hold the amiodarone

Question 52

Correct dose for hyperkalaemia with ECG changes? [1]

Answer 52

Calcium gluconate 100mg/mL 30mL IV

Question 53

Person requires migraine prophylaxis. When would you NOT give sumatriptan & what else would you give?

Answer 53

If PMH of hypertension - triptans are suboptimal **Aspirin** (900 mg PO) or **Ibuprofen**

Question 54

Presents with a stroke / TIA. What would you prescribe to reduce risk of reoccurrence?

Answer 54

DOAC

Question 56

You prescribe miconazole for oral thrush. Why might this not gain you full marks? [2]

Answer 56

Its absorbed systemically - if they have medications that on like warfarin, might increase the INR. Give nystatin instead

Question 57

Tacrolimus - what electrolyte changes? [1] Important AE? [1]

Answer 57

Hyper **K** Causes **tremor**

Question 58

Max dose of paracetamol in adults? [1]

Answer 58

4g

Question 59

Warfarin x which UTI tx can increase INR? [1]

Answer 59

Warfarin X trimethoprim!

Question 60

Important trimethoprim electrolyte changes? [1]

Answer 60

Hyper K

Question 61

What advice do you need to give if giving both Fe and Ca? [1]

Answer 61

Calcium decreases Fe absorption - take 2hrs apart

Question 62

Communication info for rivaroxaban? [1]

Answer 62

**Give with food** (can be crushed or mixed with water).

Question 63

What are indicators for hepatic necrosis following paracetamol OD? [2]

Answer 63

RUQ tenderness Hepatomegaly

Question 64

If giving salbumatol for acute asthma - double check what to make sure dont miss marks? [1]

Answer 64

Nebulised dose is different (5mg) to inhaled dose (100 mg)

Question 65

If unsure when prescribing antibiotics for length of time - where should you check length of prescription? [1]

Answer 65

Go to [e.g. skin infection..antiobiotic therapy]

Question 66

Describe how you treat faecal impaction? [1]

Answer 66

High dose senna / macrogrol then go to **PR bisacodyl or glycerol**

Question 67

What considerations do you need to make when a patient has a PMH of bariatric surgery? [1]

Answer 67

Unlikey to absorbed all drug - e.g. if on COCP - then might not be effective contraception