QuestionMultiA
QuestionChoice
33859
f
Bumetanide;1mg;Oral (PO);Daily
QuestionChoice
33858
e
Simvastatin;40mg;Oral (PO);Daily
QuestionChoice
33856
c
Chlortalidone;50mg;Oral (PO);Daily
QuestionChoice
33857
d
Cetirizine hydrochloride;10mg;Oral (PO);Daily
QuestionChoice
33860
g
Fluoxetine;100mg;Oral (PO);Daily
QuestionChoice
33854
a
Amlodipine;5mg;Oral (PO);Daily
QuestionChoice
33855
b
Losartan potassium;50mg;Oral (PO);Daily
QuestionChoice
33861
h
Colecalciferol (Vit D3);800 units;Oral (PO);Daily
QuestionComment
Hyponatremia is rare in fluoxetine and unknown in losartan. How do we know which one to put since supposedly we dont need much theory to be able to do the PSA
11842
User
subscriber
Kinin Lymph
QuestionComment
Do ARBs not cause hyponatraemia too
19143
User
subscriber
Axillary Dominant
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
2721
Dosing error & drugs causing hyponatremia
Topic
92
General Practice
1. Chlortalidone is a thiazide-like diuretic that inhibits the Na+/Cl- cotransporter at the distal convoluted tubule of nephron, leading to reduced Na+ reabsorption. Bumetanide is a loop diuretic that acts on the Na+-K+-2Cl− symporter (NKCC2) in the thick ascending limb of the loop of Henle to inhibit sodium, chloride and potassium reabsorption. Both chlortalidone and bumetanide are known to cause hyponatraemia. Hyponatraemia is also a recognised side effect of fluoxetine. BNF cautions against prescribing fluoxetine to elderly patients with significant hyponatraemia i.e. serum sodium less than 130 mmol/L due to risk of exacerbating or precipitating hyponatraemia.
2. The maximum daily dose of fluoxetine is 60mg.
6788
c f g
g
Case presentation: A 45-year old man attends his GP appointment complaining of nausea and tiredness. PH: Hypertension, Allergic rhinitis, Hypercholesterolaemia, Peripheral oedema, Vitamin D deficiency DH: His 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 125/80, Temperature 36.5°C, HR 80, O2 Sat 99% (room air), RR 18


 **Investigations**:

||||
|--------------|:-------:|---------------|
|Haemoglobin|130   g/L|(M) 130 - 170, (F) 115 - 155|
|White Cell Count|5x10<sup>9</sup>/L|3.0 - 10.0|
|Platelets|300x10<sup>9</sup>/L|150 - 400|
|Mean Cell Volume (MCV)|90 fL|80 - 96|
|Neutrophils|5x10<sup>9</sup>/L|2.0 - 7.5|
|Lymphocytes|2x10<sup>9</sup>/L|1.5 - 4.0|
|Sodium|125 mmol/L|135 - 145|
|Potassium|4 mmol/L|3.5 - 5.3|
|Urea|7 mmol/L|2.5 - 7.8|
|Creatinine|109 µmol/L|60 - 120|
|Thyroid Stimulating Hormone|3.8 mU/L|0.3 - 4.2|
|Free T4|17 pmol/L|9 - 25|


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