Section 1
Consider the following clinical scenarios and assume that the patient is on no
prescribed medication when you see them, even if this seems unrealistic. Consulting
the BNF as needed, please write a valid and relevant in-patient prescription in each
case. Write the dosage frequency using x1, x3 daily etc rather than od or tds. You do
not need to write up IV fluids. You may write drug names in capitals but this is not
compulsory. Remember that there are almost always several acceptable drugs for any
clinical indication.
1a A 62-year-old man with type 2 diabetes and hypertension is admitted with a 3-
day history of increasing cough and shortness of breath, and a temperature of
up to 38.2°C. His BMI is approximately 31kg/m2. On examination there are
signs of right lower lobe consolidation. Blood pressure varies between 144/91
and 163/103 mm Hg. Electrolytes and creatinine are within the normal range.
Random blood glucose is 14. 3 mmol/L, fasting total cholesterol is 6.1 mmol/L,
HDL cholesterol 0.96 mmol/L and triglycerides 3.4 mmol/l.
Pneumonia: beta-lactam and/or macrolides, oxygen +/- bronchodilators
Hypertension: eg ACEI + CCB
Diabetes: metformin OR insulin given high figure
Dyslipidaemia: statinfibrate evidence base poor
1b A 73-year-old woman is admitted with a fractured neck of femur following a fall.
She had been lying on the floor of her flat for at least 24 hours and was found to
have a calf deep vein thrombosis and a lower urinary tract infection. There were
no other abnormalities found on admission and she was not known to have any
other illnesses before her accident. She has moderately severe pain and
surgery is planned but for the moment she is not “ nil by mouth”.
Analgesia: opioids
DVT: LMW heparin
UTI: eg amoxicillin, nitrofurantoin
No warfarin pre-op
Section 2
Consider the following prescriptions in the context of the given brief clinical scenarios,
assuming that these are the drugs prescribed long-term before admission to hospital.
Comment on them briefly, in the form of bullet points and a total of no more than 150
words, with regard to therapeutic appropriateness and possible risks for patient safety.
Please look up the BNF as ne
2a. A 65-year-old man has COPD and permanent atrial fibrillation with mild
heart failure. He is admitted with an infective exacerbation of the COPD.
Prescription:
Verapamil modified release 120 mg x1 daily
Bisoprolol 5 mg x1 daily
Clarithromycin 500 mg x 2 daily
Warfarin 4 mg x 1 daily (INR 2.8)
Lisinopril 20 mg x1 daily
Furosemide 40 mg x1 daily
Beta-blocker: relative contra-indication in COPD-but changing
Beta-blocker + verapamil: contra-indicated
Clarithromycin+ warfarin: CYP450 interaction
Possible hypotension with multiple drugs
Lack of specific COPD therapy
In no more than 150 words comment on the appropriateness and safety of the following
prescribed drug regimes.
2b A 72-year-old woman has Parkinson’s disease and develops nausea on
initiation of treatment. She has had isolated systolic hypertension for at least 5
years. A few weeks later she develops distressing visual hallucinations. Her
blood pressure is 117/62 mm hg seated and 98/55 mm Hg standing.
Prescription:
Co-careldopa 250/25 1 tablet x 4 daily
Metoclopramide 10 mg x 3 daily
Prochlorperazine 5 mg x 1 at bedtime
Irbesartan 150 mg x 1 daily
Postural hypotension, hallucinations: high dose of cocareldopa
Consider lower dose of irbesartan and/or whether should be used at all
Metoclopramide and prochlorperazine both anti-emetic
Both worsen symptoms of PD
Atypical antipsychotic preferred in PD to either of above
Section 4
You can show how you worked out the answers to these problems but indicate very
clearly your final answer, as only this will be marked.
4a Dopamine is to be administered at a dose of 5 mcg/kg/min to a patient
weighing 75 kg. The stock solution contains 400 mg dopamine in 250 ml. At
what rate should the infusion pump be set in ml/hour?
14.06 (14) ml/hr
(3.75%)
4b An ampoule of adrenaline contains the drug at a dilution of 1:10,000. What
quantity, in milligrams, is contained in 0.4 ml of this solution?
0.04 mg
4c Dobutamine is made up to a concentration of 4 mg/ml in 5% dextrose. The
infusion pump is set at a rate of 12 ml/hour. What dose of dobutamine is the
patient getting, in mcg/min?
800 mcg/min
4d An immunosuppressant drug should be given by mouth at a total daily dose of
200 mcg/kg, divided into two doses 12 hours apart. It is available in 4 mg
tablets. How many tablets should you give, on each occasion, to a man
weighing 80 kg?
Two
