QuestionMultiA
QuestionChoice
33873
d
Allopurinol;900mg;Oral (PO);Daily
QuestionChoice
33872
c
Spironolactone;25mg;Oral (PO);Daily
QuestionChoice
33876
g
Gliclazide;40mg;Oral (PO);Daily
QuestionChoice
33874
e
Simvastatin;40mg;Oral (PO);Nightly
QuestionChoice
33871
b
Enalapril maleate;10mg;Oral (PO);Twice daily
QuestionChoice
33877
h
Zopiclone;3.75mg;Oral (PO);Nightly as required
QuestionChoice
33870
a
Bisoprolol fumarate;5mg;Oral (PO);Daily
QuestionChoice
33875
f
Metformin hydrochloride;500 mg;Oral (PO);Three times daily
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
2723
Dosing error & drugs causing hyperkalemia
Topic
74
Elderly Care
1. Both enalapril and spironolactone are known to cause hyperkalaemia. Enalapril is an angiotensin-converting enzyme inhibitor (ACE-i). It contributes to hyperkalaemia by inhibiting aldosterone synthesis. Spironolactone is an aldosterone antagonist. Aldosterone mediates the reabsorption of sodium and excretion of potassium in the distal tubules and collecting ducts of nephrons.
2. Up to 900mg of allopurinol can be prescribed in a day but must be done in divided doses. The maximum per dose is 300mg.
6790
b c
d
Case presentation: A 65-year old man is admitted to the geriatric ward following a fall at home. He complains of generalised muscle weakness and lethargy.  


PH: Congestive heart failure, Diabetes Mellitus , Gout, Hypercholesterolaemia, Insomnia DH: Her current regular prescriptions are listed below


 **On examination**: Chest is clear with no added lung sounds. Heart sounds I + II + 0. Abdomen soft and non tender.


 **Vital signs**: BP 122/78, Temperature 36.5°C, HR 80, O2 Sat 99% (room air), RR 18


 **Investigations**:


 - ECG: Flat P wave and tall tented T wave


||||
|--------------|:-------:|---------------|
|Haemoglobin|135   g/L|(M) 130 - 170, (F) 115 - 155|
|White Cell Count|5x10<sup>9</sup>/L|3.0 - 10.0|
|Platelets|280x10<sup>9</sup>/L|150 - 400|
|Mean Cell Volume (MCV)|91 fL|80 - 96|
|Neutrophils|5x10<sup>9</sup>/L|2.0 - 7.5|
|Lymphocytes|2x10<sup>9</sup>/L|1.5 - 4.0|
|Sodium|140 mmol/L|135 - 145|
|Potassium|6.1 mmol/L|3.5 - 5.3|
|Urea|7 mmol/L|2.5 - 7.8|
|Creatinine|280 µmol/L|60 - 120|



Question 1: Select the TWO prescriptions that are most likely to be a cause of his hyperkalaemia (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)