QuestionMultiA
QuestionChoice
33756
d
Dalteparin sodium;5000 units;subcutaneous (SC);Daily
QuestionChoice
33753
a
Tacrolimus (Adoport ®);4mg;oral (PO);Twice daily
QuestionChoice
33757
e
Metformin;500mg;oral (PO);Thrice daily
QuestionChoice
33761
i
Paracetamol;1g;oral (PO);Four times daily
QuestionChoice
33755
c
Piperacillin-tazobactam;4.5mg;intravenous (IV);Four times daily
QuestionChoice
33760
h
Nifedipine (Tensipine® MR);10mg;oral (PO);Twice daily
QuestionChoice
33758
f
Atorvastatin;20mg;oral (PO);Daily
QuestionChoice
33759
g
Ramipril;10mg;oral (PO);Daily
QuestionChoice
33754
b
Carbamazepine;1g;oral (PO);Twice daily
QuestionComment
so is it fair to say "uncommon side effects" > more likely than "frequency not known"
39682
User
subscriber
Biopsy Cystic
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
2708
Dosing error & BM suppresion
Topic
9
Internal Medicine
1. Oral use of tacrolimus commonly causes anaemia, leucopenia and thrombocytopenia. The risk of any bone marrow lineage failure is relatively insignificant compared to tacrolimus. ACEi rarely or very rarely cause pancytopenia. Paracetamol causes mainly agranulocytosis although frequency is not known. Atorvastatin, heparin, piperacillin-tazobactam and carbamazepine causes mainly thrombocytopenia.
2. Piperacillin-tazobactam is commonly used as the first line treatment in neutropenic sepsis. Doses are usually 4.5g 6-hrly. The dose prescribed for this patient is likely to represent a transcription error of g to mg.
6775
a
c
Case presentation: A 65-year-old gentleman is admitted to the respiratory ward following a chest infection. PH. Renal transplant, Seizure, Type 2 Diabetes, Hypertension. DH. His regular medicines are listed (below). Weight 70kg.




 **On Examination**
Multiple purpuric rash noted on his ankles bilaterally.


 **Investigation**

||||
|--------------|:-------:|---------------|
|Haemoglobin|100 g/L|(M) 130 - 170, (F) 115 - 155|
|White Cell Count|0.5x10<sup>9</sup>/L|3.0 - 10.0|
|Platelets|70x10<sup>9</sup>/L|150 - 400|



Question 1: Select the ONE prescriptions that is most likely to be a cause of his pancytopenia. (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).