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Flashcards in Chapter 2 Qs Deck (23):
1

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

Antiplatelets: Aspirin

Anticoagulants: LMWH

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

ACEi (ramipril) 

IV fluid with added potassium 

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Q2.2 What affect do these drugs have on K+ 

1. Bendroflumethiazide

2. Lisinopril

1. Bendroflumethiazide, thiazide diuretic, hypokalaemia 

2. Lisinopril, ACEi, hyperkalaemia

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

1. Metoclopramide:

2. Domperidone: 

3. Cyclizine:

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

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Q2.3 Name one drug which results in a dry cough as a SE 

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

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Q2.3 What affects do the following drugs have on electrolytes: 

1. Lisinopril

2. Bendroflumethiazide

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

2. Bendroflumethiazide, is a thiazide diuretic which causes hypokalaemia (loop diuretics do this too) 

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

1. Ibuprofen

2. Prednisolone

1. Ibuprofen, NSAID, inhibits prostaglandin synthesis needed for gastric mucosal protection.

2. Prednisolone, Oral steroids inhibit gastric epithelial renewal.

Both → indigestion/dyspepsia.

 

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

1. Ibuprofen

2. Ramipril

1. Ibuprofen, NSAID inhibits prostaglandin synthesis → reduced renal artery diameter → reduced kidney perfusion + function.

2. Ramipril, ACEi, reduces angiotensin II profuction req for preserving glomerular filtration when blood flow is reduced

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Q2.5. Give an example of a drug type that should be stopped if patient is constipated

STOP opioids e.g. co-codamol, codeine

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Q2.6 Common PMHx contra-indication for Ibuprofen 

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

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Q2.6 Important to remember regarding PRN medications

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

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Q2.6 CI for trimethoprim in a pt with RA on methotrexate 

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

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

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

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Q2.7 Important side effect on CCB

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

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

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

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

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.

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Q2.9 Important trivia re asthma

1.Beta Blockers

2.NSAIDS

3. Apsirin (NSAID) 

  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.

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Q2.9 What is the maximum dose of aspirin?

300mg

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Q2.9 What is Co-amoxiclav

= amoxicillin + clavulanic acid.

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Q2.10 Common CI to microgynon

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

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

 20 mg per day

 

Do NOT use with verapamil

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Q2.10 Rout for Insulin?

All insulin is SC e.g. Novomix

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