1
Q
What is the rule for breakthrough opioid dosing?
A
1/6 of the total 24-hr opioid dose.
2
Q
How do you convert oral to IV morphine?
A
Divide oral dose by 2.
3
Q
What is the daily adult maintenance fluid requirement?
A
25–30 mL/kg/day water
+ 1 mmol/kg/day Na⁺, K⁺, Cl⁻
+ 50–100 g glucose.
4
Q
What fluids are used for initial resuscitation?
A
500 mL 0.9% NaCl over <15 min.
5
Q
Morphine (opioid-naïve) oral starting dose?
A
5–10 mg PO 4-hourly.
6
Q
Morphine IV/SC starting dose (opioid-naïve)?
A
2.5–5 mg IV/SC every 4 hrs.
7
Q
Enoxaparin prophylactic dose (normal renal function)?
A
40 mg SC OD.
8
Q
Warfarin INR target for AF?
A
2–3.
9
Q
Maximum daily dose of paracetamol in adults?
A
4 g (1 g every 4–6 hrs).
10
Q
First-line antibiotic for CAP (non-severe)?
A
Amoxicillin
Allergy? –>
doxycycline/clarithromycin
11
Q
First-line antibiotic for HAP?
A
Co-amoxiclav or piperacillin-tazobactam.
12
Q
First-line antibiotic for UTI in non-pregnant women?
A
Nitrofurantoin.
13
Q
First-line antibiotic for cellulitis?
A
Flucloxacillin
Allergy? –> clarithromycin/doxycycline
14
Q
First-line antibiotic for bacterial meningitis in adults?
A
IV ceftriaxone ± dexamethasone.
15
Q
Which antibiotics are high risk for C. diff? (4)
A
- Clindamycin
- Cephalosporins (CEPH/F)
- Ciprofloxacin
- Co-amoxiclav.
16
Q
Macrolides (clarithromycin/erythromycin) + statins?
A
↑ risk of rhabdomyolysis.
17
Q
ACEi/ARB + spironolactone + NSAID?
A
“Triple whammy” → hyperkalaemia/renal failure.
18
Q
Why caution in Lithium + thiazide/ACEi/NSAID?
A
↑ lithium toxicity.
19
Q
Warfarin + antibiotics (e.g. macrolides, metronidazole)?
A
↑ INR → bleeding risk.
20
Q
What must you monitor for lithium therapy?
A
Lithium levels
Renal function
Thyroid function.
21
Q
What must you monitor for digoxin?
A
Digoxin levels
renal function/electrolytes (esp. K⁺).
22
Q
What must you monitor for gentamicin/vancomycin?
A
Trough/peak drug levels + renal function.
23
Q
What must you monitor for ACE inhibitors?
A
U&Es (K⁺, creatinine) - kidney function
24
Q
What must you monitor for methotrexate?
A
- FBC
- LFTs
- Renal function.
25
When should nitrofurantoin be avoided?
eGFR <30.
26
When are β-blockers contraindicated? (3)
Asthma
Bradycardia
Acute heart failure.
27
When are ACE inhibitors contraindicated? (3)
* Bilateral renal artery stenosis
* Pregnancy
* History of angioedema
28
When is NSAID use unsafe? (4)
Peptic ulcer disease
Renal impairment
Heart failure
Uncontrolled asthma
29
When should morphine be avoided?
Severe renal impairment (use fentanyl/oxycodone instead).
30
Amoxicillin rash occurs in which viral infection?
EBV (infectious mononucleosis).
31
Features of digoxin toxicity? (5)
Nausea
Vomiting
Visual halos
Arrhythmias
Confusion
32
Main opioid side effects? (4)
Constipation
Nausea/vomiting
Sedation
Respiratory depression
33
Serious adverse effect of carbimazole?
Agranulocytosis (sore throat warning).
34
Max rate of IV potassium replacement?
10 mmol/hour (peripheral line).
35
Normal daily sodium requirement?
1 mmol/kg/day.
36
Enoxaparin prophylaxis in CrCl <30?
20 mg SC OD.
37
Ibuprofen max daily dose?
2.4 g/day.
38
First-line Abx for pyelonephritis?
IV co-amoxiclav or cefuroxime.
39
Abx to avoid in pregnancy? (5)
Tetracyclines (e.g. doxy)
Quinolones (e.g. cipro)
Aminoglycosides (genta)
Trimethoprim (1st trimester) Sulphonamides (3rd trimester).
40
SSRI + MAOI?
Serotonin syndrome.
41
Amiodarone monitoring?
TFTs
LFTs
U&Es
chest X-ray (pulmonary fibrosis).
42
Methotrexate contraindication?
Pregnancy (teratogenic).
43
Carbamazepine side effects? (3)
Hyponatraemia
Rash
Agranulocytosis.
44
Valproate side effects? (3)
Teratogenic
Weight gain
Hepatotoxic
45
Key SSRI side effects? (3)
GI bleed risk
Hyponatraemia
Sexual dysfunction.
46
MAOI food interaction?
Tyramine → hypertensive crisis
Cheese/ liver/ pickled/ alcohol
47
Signs of serotonin syndrome? (4)
Agitation
Hyperreflexia
Clonus
Fever
48
Signs of neuroleptic malignant syndrome?
Rigidity
Fever
Autonomic instability
↑ CK
49
Sodium valproate contraindication?
Pregnancy (teratogenic).
50
Phenytoin side effects? (3)
Gum hypertrophy
Ataxia
Nystagmus
51
Lamotrigine side effect?
Stevens–Johnson syndrome.
52
Levetiracetam common side effect?
Mood changes, irritability.
53
Levothyroxine: when to take?
Morning, empty stomach.
54
Propylthiouracil serious side effect?
Hepatotoxicity.
55
First-line antiemetic in palliative care?
Cyclizine.
56
Antiemetic for opioid-induced nausea?
Metoclopramide or haloperidol.
57
Drug for secretions in dying patient?
hyoscine hydrobromide/ hyoscine butylbromide/ or glycopyrronium
58
Drug for agitation in last days of life?
Midazolam
59
Drug for dyspnoea in palliative care?
Morphine (low dose).
60
first line investigation for ? lung cancer?
chest xray
61
What is ued to guide whether pts with acute bronchitis require abx?
CRP levels
62
What might you see in blood results with sarcoid? (other than raised ACE)
hypercalcaemia
63
sugar control for pt with t2Dm?
aim for HbA1c of 48 but only add second drug if rises to 58
64
is warfarin safe in breastfeeding?
yes
65
drugs that can cause SIADH?
sulfonylureas
SSRI
carbamezapine
vincristine
66
common prescribing errror for clopi?
it is OD not /TDS
67
can you give tazocin to pts with penicillin allergy
no
68
ACE inhibitors and pregnancy?
avoid
69
If describing a patch med what do you put as dose?
e.g 1 path
70
Route of admin for a cream?
topical
71
How do you give furosemide for symptomatic relief of odema
IV
72
common frequency/cimings meds?
what should be prescribed in the morning? (2)
diuretics + steroids
73
common drugs that cause hypo? (2)
insulin
sulphonureas
74
common drugs that cause hyperglycaemia? (5)
steds
antipsychotics
thiazides
BB
tacrolimus
75
common drugs that cuase urinary retention? (2)
opioids
anticholinergic
76
common drugs that cuase urinary retention? (4)
A blockers (tamulosin)
diuretics
anticholinesterase inhibitors (Donepezil)
clozapine
77
Common drugs that cause confusion? (3)
opioids
sedatives
anticholinergics
78
Common drugs that cause osteoporosis? (3)
steds
PPI
LHRH
79
Meds that should be doubled if intercurrent illness?
steds
80
Meds that should be stopped if intercurrent illness (3)
metformin
statin
-gliflozin
81
Drugs that worsen parkinsons?
haliperidol - look out for any osrt of antipsychotic
antiemetics (metoclopramide)
antidepressants
82
Drugs that worsen myasthenia gravis? (4)
abx
BB
Local anaesthetics
sedating drugs
83
Drugs that worsen psoriasis? (3)
BB
Lithium
abx
84
Drugs htat worse HF? (3)
NSAID
CCB
Piglitazone
85
HRT - which is patch and which is talbet?
Evorel - patch
Eleste - tablet
86
HRT - when do you give estrogen only?
post hysterecotmy
87
HRT when do you give continous or sequenrial?
LMP <12 - sequential - type in SEQUI
LMP >12 - continous type in CONTI
88
Vasomotor symptoms in someone who cna ttake HRT?
clonidine or SSRI
89
HRT do you give patch or oral?
prescribe patch to be safe
look our for RF for oral e.g. cancer or VTE risk
90
do not replace K faster than what?
10mmol//h
91
Mx of emergency hypokalaemia?
sodium chloride 0.9%/ potassium chloride 0.3%
1000ml /4hr
92
Mx emergnacy hypercalcaemia?
sodium chloride 0.9% 1000ml 4hr
93
Mx emergancy hypo?
glucose 20%
100ml
15 min
94
difference in mx maintenance fluids in someone with and without deficits or losses?
with losses - 1000ml 4-6 hr and minimum 30ml/kg/24hr
95
KCL - 0.3% 1000ml contains how much potassium?
40mmol
96
KCL 0.15% contains how much potassium?
20mmol K
97
Emergancy resus fluids for chldren?
sodium chloride 0.9% 10ml/kg
10m
98
Maintenace fluids without defecits or losses for children?
100ml/kg/24hr <10kg
50 *** 10-20
20 *** >20
99
How much sodium is in NaCl 0.9%
150
100
In a stroke what must you make sure is not in bag 1?
glucose
101
If asked to titrate up pain meds go up by how much?
33%
102
antidote for opioid poisoning?
naloxone - 400-800mcg repeated at 1 min intervals
103
which laxative do you prescribe with analgesia?
docusate
104
pt has HF what do you need to make sure do if prescribing fluids?
dont overload
consdier 250 in 10 mins
105
Pt has tried SSRI and mirtazapine, what might be a good next option?
SNRI e.g. duloxetine
106
Mx schizophrenia?
aripoprazole 10mg
107
Management of mania is usually what? in what form?
antipsychotic such as olanzapine, haloperidol, quetiapine, risperidone
PO rather than IM 1st line
108
Lithium toxicity, when do you treat ?
signs of toxicity or over 1.5
if neither just reduce dose and retake levels
109
if someone is stopped meds abruotly, what should you consider?
giving them some of the drug
110
Patient is in respiratory failure and question is about which drugs should we reduce or stop?
oxygen - think of a chronic COPD retainer
buprenorphine - think resp depression
/gabapentin
BB often stoped
mirtazapine
111
if question is about prognosis in COPD, consider?
statin
more likely to die from cardiac than lung disease
112
Drugs with anticholingergic activity negate the beneficial effect of which sort of drugs?
acetylchoninesterase inhibitors
113
Antiemetic for post op
ondansetron
114
antiemetic for palliative care?
cyclizine
haloperidol
levopromazine
115
antiemetic for parkinsons?
domperidone
116
antiemetic for hyperemesis gavidarum
first line is cyclizine, promethazine
second line metoclopramide or demperidone
117
PRescribing triptan - consider?
BP
118
Transfusion can cause which electolyte abnormalities?
hypocalcaemia
hyperkalaemia
Year 5
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