QuestionMultiA
QuestionChoice
33944
i
Bisacodyl;5mg;Oral (PO);Nightly
QuestionChoice
33940
e
Furosemide;40mg;Intravenous infusion (IV);Daily
QuestionChoice
33939
d
Ceftriaxone;2g;Intravenous infusion (IV);Daily
QuestionChoice
33937
b
Metformin hydrochloride;500 mg;Oral (PO);Three times daily
QuestionChoice
33942
g
Paclitaxel;135mg/m2;Intravenous infusion;On day 1 and day 8, repeat every 3 weeks for 6 cycles
QuestionChoice
33936
a
Enalapril maleate;20 mg;Oral (PO);Daily
QuestionChoice
33938
c
Gentamicin;700mg;Intravenous infusion (IV);12-hourly
QuestionChoice
33943
h
Warfarin sodium;5 mg;Oral (PO);Daily
QuestionChoice
33941
f
Cisplatin;75mg/m2;Intraperitoneal infusion;On day 2, repeat every 3 weeks for 6 cycles
QuestionComment
'deafness' in furoesmide - frequency not known in BNF. I dont think this can be used as an answer 
6857
User
subscriber
Giggy G
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
2732
Ototoxicity & dosing error
Topic
9
Internal Medicine
1. Ototoxicity is a recognised side effect of all aminoglycoside. The exact mechanism of gentamicin-related ototoxicity remains unknown.Furosemide is known to cause deafness, especially in patients with renal impairment. Ototoxicity is also a known side effect of cisplatin, a chemotherapy medication that interferes with DNA replication. The ototoxicity is likely to be dose-related and accumulative.
2. The correct dose of gentamicin for Gram-positive bacterial endocarditis is usually about 1mg/kg every 12 hours. Hence, the correct dose for this patient should be 70mg not 700mg IV 12-hourly
6799
c e f
c
Case presentation: A 65-year-old woman is admitted to hospital with native valve infective endocarditis. On the third day of her admission, she develops pulmonary oedema secondary to decompensated heart failure. She also complains of tinnitus and bilateral hearing loss. Her weight is 70kg. PH: Hypertension, Type 2 diabetes mellitus, GORD, Mitral valve prolapse DH: Her current regular prescriptions are listed below


**On examination**:
Pansystolic murmur that is heard loudest at the apex and radiates to the axilla, coarse crackles at both lung bases, peripheral oedema until the level of mid-shins

**Investigations**:

- Transthoracic echocardiograms shows presence of vegetation at mitral valves
- Positive blood cultures (streptococcus viridans)

Question 1: Select the THREE prescriptions that are most likely to be contributing to the hearing loss. (mark them with a tick in column A)
Question 2: Select the ONE prescription that contains a serious dosing error. (mark it with a tick in column B)