PSA prep

Question 1

What thromboprophylaxis should patients be given post surgery:

Answer 1

1. LMWH (10 days followed by aspirin for further 28 days)

OR

2. LMWH for 28 days w/ stockings until discharge or rivaroxaban

Optimal answer:
Enoxaparin sodium 100mg/ml injection

Question 2

First line IV treatment for hypoglycaemia

Answer 2

1. Glucose 10% (100-200mls) over 15 minutes

Question 3

Drugs contributing to hyperkalaemia

Answer 3

1. All heparins (due to inhibition of aldosterone synthesis)
2. ACEi (potassium retention)
3. Tacrolimus (reduced potassium excretion)

Question 4

What drug needs to be stopped 7 days before surgery:

Answer 4

antiplatelet agents e.g. aspirin

Question 5

Drugs which may lead to a confusional state:

Answer 5

1. codeine
2. diazepam retention
3. glucocorticoids (e.g. prednisolone)

Question 6

Drugs which may cause hyponatraemia

Answer 6

1. Bendoflumethiazide
2. SSRI (such as citalopram due to inappropriate ADH secretion)

Question 7

Which Abx for UTI needs to be avoided in patients with eGFR of less than 45

Answer 7

avoid nitrofurantoin!

give trimethoprim

Question 8

1st line tx for alcohol withdrawal

Answer 8

Benzodiazepines 1st line

Chlordiazepoxide hydrochloride

Question 9

BNF guidance: if INR > 1.5 on day before surgery what should be given

Answer 9

PHYTOMENADIONE (vitamin K) 1-5mg PO , IV preparation

Question 10

monitoring of what indicates effective treatment with furosemide

Answer 10

weight

Question 11

most appropriate option to monitor for adverse effects of carbimazole

Answer 11

FBC

neutropenia is a less common but serious side effect of carbimazole –> FBC should be measured

Question 12

Most appropriate method to monitor effects of perindopril for heart failure

Answer 12

improved exercise tolerance

Question 13

antipsychotic monitoring

Answer 13

Question 14

mechanism of action of digoxin

Answer 14

• decreases conduction through AVN slowing ventricular rate in AF and flutter
• increases force of cardiac muscle contraction due to inhibition of Na+/K+ pumps

Question 15

Monitoring of digoxin in toxicity

Answer 15

8-12 hrs post last dose

1. ECG
2. U&Es

toxicity may occur at low concentrations if hypokalaemia is present

Question 16

most important adverse effects to be aware of in patients taking carbimazole

Answer 16

1. FBC
2. TFTs

why?
- neutropenia
- agranulocytosis

MoA
- used for thyrotoxicosis , given high doses for 6 weeks until patient becomes euthyroid before being reduced