QuestionPrescription
QuestionComment
How do you know its BD for 6 days / QDS for 3 etc? BNF doesn't say this?
17174
QuestionComment
BNF says 'total dose per course should not exceed 6 mg' 
38079
User
subscriber
Afia
User
subscriber
Abscess Body
QuestionComment
where does it say how many days?
31863
User
subscriber
RNA Retrograde
QuestionComment
surely "until symptoms resolve" is correct
39921
User
subscriber
Biopsy Cystic
QuestionComment
got it right but got marked wrong loll
61581
User
subscriber
Vaccine Complement
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2706
Gout flare
Topic
75
GP
# Drug choice feedback

This gentleman most likely has gout. In the acute setting, the first line agent is usually any NSAID. In light of his chronic kidney disease, this is contra-indicated and the second line agent colchicine has to be used. Recall that allopurinol is not used in the acute setting as it is not effective may prolong the gout attack if started.

# Dose/Route/Frequency/Duration feedback

The recommended dose is 500 micrograms. It can be given twice to four times a day, as long as the maximum dose given is 6mg. Therefore, the answer given for the duration has to correspond to the dose and frequency chosen.
6773
PrescriptionAnswer
PrescribeAnswerData
500 micrograms
PrescribeAnswerData
colchicine 500 microgram tablets
PrescribeAnswerData
Until symptoms resolve
PrescribeAnswerData
three times daily (TDS)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
500 micrograms
PrescribeAnswerData
colchicine 500 microgram tablets
PrescribeAnswerData
Until symptoms resolve
PrescribeAnswerData
twice daily (BD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
500 micrograms
PrescribeAnswerData
colchicine 500 microgram tablets
PrescribeAnswerData
Until symptoms resolve
PrescribeAnswerData
four times daily (QDS)
PrescribeAnswerData
oral (PO)
Case Presentation: A 53-year-old gentleman presents to his GP with severe pain in his left big toe. It has become swollen, tender and erythematous over the last 12 hours.


## PH

Hypertension, chronic kidney disease

## DH

Ramipril 5mg PO OD (allergy to Naproxen)

## On examination

Alert and oriented. Left 1st metatarsophalangeal joint noted to be red, swollen, extremely tender with florid synovitis.

Temperature 36.8°C, HR 85, RR 16, BP 129/81, O<sub>2</sub> 98% RA, GCS 15, Weight 82kg

## Investigations

None

# Prescribing Request

Write a prescription for one drug that is most appropriate for treating his condition acutely.