QuestionMultiA
QuestionChoice
33927
f
Omeprazole;20mg;Oral (PO);Daily
QuestionChoice
33926
e
Metoclopramide hydrochloride;100mg;Oral (PO);8-hourly when required
QuestionChoice
33928
g
Allopurinol;100 mg;Oral (PO);Daily
QuestionChoice
33923
b
Metformin hydrochloride;500 mg;Oral (PO);Three times daily
QuestionChoice
33922
a
Chlorpromazine hydrochloride;150 mg;Oral (PO);Daily
QuestionChoice
33925
d
Ibuprofen;400mg;Oral (PO);4-hourly when required
QuestionChoice
33924
c
Fluoxetine;40 mg;Oral (PO);Daily
QuestionComment
4-hourly ibuprofen is also a significant dosing error??
18842
User
subscriber
Chronic Hypertension
QuestionComment
So is 8-hourly 100mg metoclopramide no...?
59435
User
subscriber
R.H
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
2730
Hyperprolactinaemia & dosing error
Topic
76
Obstetrics and Gynaecology
1. Hyperprolactinaemia is a common or very common side effect of chlorpromazine and an uncommon side effect of metoclopramide. Both chlorpromazine and metoclopramide have dopamine D2 receptor antagonistic property, leading to disinhibition of excessive prolactin production. Hyperprolactinaemia is also rare or very rare side effect of all selective serotonin reuptake inhibitors (SSRI). A SSRI like fluoxetine is thought to cause hyperprolactinaemia by inducing a 5HT receptor–mediated stimulation of prolactin secretion.
2. The correct dose of metoclopramide for acute migraine should be 10mg and not 100mg.
6797
a c e
e
Case presentation: A 35-year old woman presents to her GP with amenorrhoea. She reports that she has missed her period and that her menstrual cycle has been irregular for the past few months. She also notices white, milky discharge from her breasts. Besides that, she also informs that she has been trying to conceive for two years but is not successful. PH: Type 2 Diabetes Mellitus, Schizophrenia, Depression, Migraine, GORD, Gout 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. Normal pelvic examination, normal breast examination


 **Investigation:**
Negative human chorionic gonadotrophin (HCG) pregnancy test
Serum prolactin: 850 mIU/L (<500)


Question 1: Select the THREE prescriptions that are most likely to be contributing to the hyperprolactinaemia (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)