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Good evening, everyone. Happy Tuesday evening. Thank you all for joining and welcome to our third session of our PSA for IM GS series. Um You well have seen me before in the previous sessions. I'm Viv. Um I'm one of the mind, the bleep F one colleagues and I'm also an academic um S FP year two doctor um in Peninsula. Um This series was designed by myself and my colleague, Magda. Um And today we're really lucky to have um a guest with us. Um This is Doctor Carly Jones. She's an academic foundation doctor working in Peninsula and she's also a previous hospital pharmacist with a special interest in primary care. So she's just on the call at the moment. Um And she'll begin speaking in a moment. I'll just go through a little bit of the background what we're going to be achieving today. Um And a few disclaimers. Um So we'll just quickly discuss um as you should be aware if you've watched our previous lectures. Um This course is sort of a live version and an add on to son's course who's our prescribing lead at mind the bleep. Um All of that course is available for free, you can access it directly on the mind the bleep website. Um And that's a QR code, but it's also all on youtube. Likewise, if you have missed sessions one and two from this series, they're all available on Medal and they should be on youtube in a few days. Um We really recommend that you do watch her videos. Um As I've said on the whatsapp group, um It's a really great basis for a lot of what we're gonna be covering. Um and lots of question practice and worked through questions. So I do really recommend checking that out. Um So the next thing I wanted to mention was, ah, so as of as it, all of our sessions have been so far, we really do use a PSA blueprint. So that's effectively a guide to all of the sections, all eight sections of the PSA and sort of what they might ask you about. Obviously, it doesn't go into every single medication that could come up, but it is a useful resource. So I would probably highlight this QR code on your phones. Now, just have it with you in the session. We've got some screenshots as well. Um Just a few little desk came up. Um Obviously, all of us are full time doctors who are doing this voluntarily on the side. We do our absolute best to make it as accurate as we can be. There may be mistakes just like you would if you were at work, just let us know if there's a mistake and we'll correct it if anything is unclear or anything you feel needs to be clarified message in the chat during this session. Um If you're watching this on youtube, um after the session or a medal, please just drop us a comment. Um And our full disclaimer and privacy policy is all available on our website with those links. Um I'll just quickly run over our learning objectives before Carly starts. So today we're gonna be covering two sections of the PSA slightly less um highly weighted, but definitely a place where you can grab some easy marks with some a bit of practice. Um So those, those are adverse drug reactions questions which we'll start with and then the calculation section, um I know the calculation section was one that I was very nervous for. So this will be a really good way just to practice some questions. Um Carly will explain a little bit but do make sure you've got your BNF up and ready. Um We've got a poll format for today. So we'll be putting a question, giving you about 30 seconds to a minute to answer the question and then we'll be going through obviously your timings and the real thing may differ a bit, but we want to do this with a bit of time pressure just to sort of mimic exam conditions. Um And then Carly will go through all of the answers. Um So those sort of the learning objectives which hopefully everyone's able to meet by the end of the session. Um I've just got on the next slide, the appendix again, this is, this is all in the PSA blueprint. So that was a QR code I shared earlier. It just goes through some topics from different subspecialties in each of the sections. Um Some people love this table find it really useful to structure their vision. Um And some people use it a little bit less. It's just worth knowing what is out there so that you can pick and choose what resources support you. Um I will probably hand over at this point to Carly um just to talk us through. Um I think this slide is pretty important because it does show you sort of what, what questions and what drugs might come up. Um But I will introduce Carly now, um myself and Magda in the, on the chat Manning that so any questions send them our way and we'll try and answer them as quickly as we can. Um If anything's worth addressing to everyone, um then we'll flag it and we'll come back to it at the end. Um Enjoy the session, everyone. Lovely. Thank you, Viv Hi, everyone. Like we've said, I'm Carly. So yeah, we're gonna be talking through adverse drug reactions and then calculations. So the first half we'll just focus on Ir so the QR code that they've put on earlier and this is just a bit of an interpretation of the blueprints are kind of what they're aiming to get out of you by asking these questions and what sort of things you can kind of focus your revision on. But yeah, so that's it. Questions and they two maps each. So there's four different types I won't read through all of them. But yeah, if you just, it's probably worth just really familiarizing yourself with those types, but I'll just quickly get on with it. And then, so you've probably all had a look at the example from the PSA website. Um We won't go through it in too much detail, but it's more just kind of the type of question that they're wanting to an like wanting. So in this example, they're kind of expecting you to interpret clinically what's going on, but then also be able to use the B NF to come up with an appropriate treatment. Um So I'll just quickly a lot of the PSA is using the B NF in quite an efficient way and knowing what to look for. So this is from the nice B NF. So I think you can use medicines complete and the nice B NF and B NFC. Um It's kind of up to you which one you prefer. Um And I know there's a really good um, presentation from Sona about how to use the B NF and get the most out of it and things. But essentially, I don't know if you, most of you have done this example already. But essentially, it's recognizing that this is like an anaphylaxis situation. And I've just put a couple of screenshots from the B NF here. So there's a few ways you can kind of get to the answer. So whether you look for treatment, summaries, kind of find anaphylaxis that way or if you already know the drug, just search in that way, like searching for adrenaline and then obviously just picking the dose out from that. But I weren't draw on that one. Cos with it being on the website, you've probably all had a look at that already. Um So essentially, yeah, like they said, if you can all have the B NF open on whichever form that you prefer. Um And then please do use the polls just to make it a little bit more fun and inactive. Um Ignore that bit about microphone, but please use the chat and then like they've said, we can collect any common questions and we'll go through them at the end. So, um first question, um So I've tried to set it out similarly to, so we'll give you 30 seconds, but if you wanna have a quick read, I'll read it out and then if you wanna start having a little look and through the B NF and figuring out how you'd go about tackling this. Um So a 76 year old male presents to his GP with impaired hearing following a recent hospital admission for a prolonged course of antibiotics. So, on examination, you notice he's got grossly reduced, bilateral sensory neural hearing loss. So the question is which of these, uh, which of the following antibiotics are most likely to have caused this? Yeah, you just pop your answer on the poll. Hi, everyone. Just make sure you use the poll to record your answer rather than the chat today. Yes, guys, I think most people are getting there also. Like they've said it is quite time pressure today. So please don't feel under too much pressure because you will have more time in the exam. It's just so we can try and rattle through as many as possible. Yeah. Should we stop it there? We'll give you five seconds to have 53 responses out of I think 98 on the call. Sorry, I was being a bit harsh fab car. So it looks like 91% have gone and 3% for c 3% for D 1% for A&E, that's fine. Yeah. So, yeah, 90% of your Yeah, Gentamicin. Um I'll just pop the next word on. So essentially it's one of them things that if you can try and remember certain classes cause certain like obvious rare type side effects. The Gentamicin is one of them quite common exam questions. Um So yeah, just a few little bits like B NF and any like important safety information where M HRA have done like safety alerts, they're really good exam questions to kind of just have, you're not gonna remember them all and nobody can, but just to like, have in your mind like Gentamicin a bit of a red flag about all that causes something unusual. Um So yeah, there's just a bit of a list of like other things that can cause. Um But yeah, in terms of searching for the B NF and things we can go through that if you feel unconfident in terms of what to search for. But I think a quick strategy if you have no idea and you've got maybe all trying to like best answers. So if you've got either maybe gentamicin and meropenem as a bit rarer antibiotics, maybe you're not so familiar then go to them and just kind of search like your hearing loss, deafness, autotoxicity. That's the, probably the way I'd go about trying to figure out the answer. Um But yeah, it's just one of them random side effects. That is quite a good one just to have in the back of your mind. Um But well done everybody. That's good. Um Next question. So if you wanna start looking up, I'll just read it out. Um An 87 year old female is frightened by ambulance to Ed with aura and confusion over the last 24 hours. So she's had a recent attendance to her GP with worsening right knee pain, past medical history, oa hypertension and a previous right hip fracture. The only med she is on is Ramipril 1.25. So which of these newly prescribed medications is likely to have caused this acute presentation and then, yeah, just pop your answers on the pole again if that's ok. Give you another 30 seconds. Everyone. Yeah. Sorry. This might be a bit of a nasty question cos I suppose it could lead you down to a different, well, we'll see, but it looks like most people are getting the right answer, which is good. All right. Five seconds left. Right. Smashing. Yeah. So the route I was thinking on this one is more about checking your like interactions. So, nsaids and ace inhibitors. So, yeah, oral ibuprofen, which yeah, most people seem to get 63% so well done. Um, essentially a way of there's not really a, like a hard and frustrated of how to check interactions. Either some of the common ones is worth just being aware of any of your kind of acute. Well, nephrotoxic like, ok, I call a medication, it's good just to kind of have in the back of your mind. Um, but yeah, particularly Ibuprofen and Ramipril. There isn't really a quick way of doing it. It's just kind of spotting those medication causes. Um, and obviously in the elderly as well, they're more at risk of AK I um So that's kind of what the question was getting at, but I appreciate it might have been a bit misleading. There wasn't any like renal function results or anything there. So that's possibly why that was a bit more tricky. But yeah, well done. Um, next question. Um, so we've got a 66 year old female. She's here at the GP for routine blood tests. Um, so if you just have a little look through those blood results and then the question is just ask him which of these medications is most likely to have caused the electrolyte disturbance. And then we've got furosemide, Ramipril, omeprazole, bumethanide or senna. And then if you just pop your answers in the chat as well. Oh, yeah, and the apronym that they put in the chart is very good. All right guys, about 20 seconds left. And should we have a look at the answer? Sorry, my seconds counting isn't very good. Um So yeah, well done. Again. Most people 6% knew that that was Ramipril. Um We did have 25% of people think frusemide and I can kind of see where you're going with that. You can, again, any diuretics are gonna cause electrolyte imbalances. Um But this is kind of focusing in on the potassium. Um So yeah, Ramipril is known to cause hyperkalemia. If it was the frusemide, we'd expect a hyperkalemia. Um So yeah, I can see it's a bit of a throw off question. Because you, it's actually doing the opposite. Um But yeah, there's a lot, I think with kind of drugs that cause electrolyte disturbances. I've just put this little side on by no means. Is it an exhaustive list? Because, well, essentially I've been picking through the B NF for a long time trying to put all of them on. Um But it's just kind of worth knowing similar to, there's not an acronym that I really use to kind of learn in this. But I would just say any of you kind of any of the drugs that are acting on those like either sodium potassium exchange, which you don't even really have to learn the mechanisms. But just to be aware of where they're involved if they're acting on like the kidneys, um then realistically they might have some sort of potassium sodium effect. Um A common one, I'd say PPIs with you like magnesium sodium hypernatremia. So it's a bit sneaky. A lot of medications do just have a naturally high sodium content. So that's just another little thing to be aware of. So particularly e vescent medications, but lithium and sodium is a big one for interactions and also like toxicity. Um But realistically like any of your diuretics, they're kind of like the big alarm for electrolyte disturbances, I would say as a first part of call. But yeah, in this particular example, hyperkalemia is mainly like spinal elect. So your potassium sparing your ace inhibitors, um nsaids and beta blockers, but less so. Um but yeah, so that's just another thing to be aware of. Um if you're not sure as well. It does usually have on the tab on the B NF like under the renal impairment section. Um So, yeah. Oh, thanks though. Sorry. Right. That's good. Um Next one. So a 79 year old male is taking Warfarin for recurrent dvts. So his past medical history is prostate cancer. DVTs um which was on lifelong Warfarin four. his drug history. So he only takes Warfarin 5 mg once a day and his target I nr was 3.5. So he's come for his I NR check and it's 8.1. His last I nr was a month ago and that was three. So when you examine him, there's no signs of bleeding, no history of any bleeding. What is the most appropriate course of action? I'm sorry. This one's quite takes a bit longer. Yeah, I feel like this might have been a bit of a mean question. So sorry. And if it takes you a bit longer, that's perfectly understandable. Cos it is, it's one of them ones that you're gonna have to like look at and just really pick apart in the B NF which exactly which action you're gonna take. I will say I'm impressed by how quickly you are answering these. It took me a while to put them together to put the question. So that's very impressive. We'll give you another 10 seconds smashing, right? So the answer is um b so you would hold the Warfarin give Vitamin K orally and then restart the Warfarin when the I nr is less than five. We did have quite a mixed picture between orally your IV. Um Yeah, luckily no one said continue the current dose. That's fine. So, yeah, this is quite a trick question. So that I'm not surprised there was a bit of a split 5050 cos it took me a while to just double check. Um So essentially there's quite a few tricks in this question. So you have to kind of know which section of the VNF to look at. Um So you can look up Warfarin or you can look up hemorrhage. If you are aware that Vitamin K which is the antagonist to Warfarin is a phytum and aion, then it's, it's just a few little tricks that unfortunately the PSA is sometime throw in and it's just one of them things that you kind of have to learn. Um So yeah, if there's um I'm just gonna check, I haven't actually got this wrong. Yeah. So what you do essentially is the I nr is over eight, it was 8.1 and there's no bleeding. So exactly as it says, hold the Warfarin give vitamin kit um by mouth. But the, the tricky thing is here, you use the IV preparation orally. So that's where the trick question comes in. Um But yeah, I mean, it's just one of the things once you've seen it, once just get used to like picking that section apart, it's quite a nasty question. So, like you bolded very well on that. So, yeah, now you're aware of it. It's just knowing where to look and how to interpret the I nr results. Is there any bleeding and then picking the right answer? So, yeah, well done. But that was the tricky one grand. Um move on to the next one. So a 64 year old male presents to a GP with acute onset, severely tender right ankle. So you examine him, um swollen my ankle, severe pain on palpation. The patient is not allowing you to examine fully due to movement on pain, due due to pain on movement. Sorry. Um He's got a personal history of a recent admission for py arthritis and rheumatoid arthritis and his drug history is prednisoLONE 10 mg daily. And the question is which of the five medications may have contributed to this acute presentation? And again, this might be a bit sneaky. But yeah, if you put your answers on the poll, just give another 15 seconds. Mhm. Um We've got six on replies but 100 and seven online if you're not sure, just have a go um, the session will be more useful if you try your best to attempt all of the questions Oh no, a couple more in. Yeah, like they says absolutely no harm. If you don't know the answer, that's the point of going through them. So can you move them? Yeah. So the answer was b which, er, Ciprofloxacin? So most of you got them. Right. So well done. Um, a little bit of a split on this one is a, again, quite a sneaky one that unfortunately you just have to either remember or be able to use the B NF really efficiently. Um But for quinolones, which Ciprofloxacin is that type of antibiotic, there are so many safety alerts. Um It's untrue, but a big one is tendonitis and tendon damage. So that's kind of what the history was pointing to. Um Yeah, either like a ruptured tendon. Um So the idea that he'd had a recent admission for Ciprofloxacin. Um So essentially the M hra L I don't know if I popped it on. Yeah. Um So again, it's just one of these ty alerts that are within the B NF. Um and it's worth having a look at. Um So, yeah, there's quite a lot of alerts realistically over sixties are more prone to it increase with the use of steroids. Um Yeah, so that's that one. There's also just some other um other alerts. So, convulsions is another one like lowers the seizure threshold. So it's just worth having a look at quinolones and kind of cos I think it's just a quite an easy exam question for them to throw at you. And if you've not come across it, you, you're not gonna know which is totally fair. But at least, hopefully if you've seen it here, then it kind of sticks in your mind a little bit. But yeah, I'd just go and have a good look through the quinolone, like safety information not to get too bogged down in it. But more just then hopefully in the exam, something might trigger from the back of your mind. Um Grand sir. Uh next question, a 66 year old female presents to a GP with a two week history of edema, which of the following newly started medications is likely to be the cause. So you've got cause sorry. Um So answers are frusemide, Inda amLODIPine, Losartan or Bisoprolol. The Yeah, and that looks beautifully answered. Well done. Grand. Should we go to the m? Sounds good, Carly. Yeah, lovely. Um Yeah, so the answer was C which is amLODIPine. So that's the calcium channel blocker. Um And like edema, peripheral edema is kind of one of those classical newly started on a drug or newly started on a drug. What's the likely cause? Um So it's just one of them again, that's kind of worth having on your list of like common drugs, common side effects. Um Yeah, I think what events do we get? So in death might improve the mind will all come, I suppose. Maybe I'm not sure whether you're thinking of lines along the lines of well, like treating the edema rather than a cause. But yeah, just kind of be like, really read the question in terms of, are they asking me which medication would I want to start for edema or what side effects type of thing? Um But yeah, they'll probably be better written questions in the actual PSA so that's partly also my fault. So, apologies if that's confused anybody. Um But yeah, no, that was generally very well answered. So I'll do. Um So we'll move on. I hope that bit was OK. Again, we can go through any of the B NF bits if you want to at the end. Um So calculations, this is probably a lot of people's least favorite parts of a PSA exam cos it, it is quite challenging. Um But essentially, like they've said, just have a good look through the blueprint. Um Again, there's it questions. So some of them have like a clinical scenario, but it's just kind of really about picking out of the question, what's relevant, how, how, what's gonna help you answer the question basically. Um But yeah, and just, well, I put a couple of tips and I think the next slide. Yeah. So essentially there's no real hard and fast thing about how like how to get through your calculations. It is just doing a lot of practice and like checking your answers and things. Um So a few tips. It's really confusing like milligrams, micrograms, all of that jazz is quite complicated. So in terms of trying to get your answer as close as you can, I'd recommend once you've got, once you've kind of done your numbers, just try and keep all of your units the same. Um What I always do is to go back and like check my answers through just like does it look like an appropriate dose? Also? You don't have to do this and if you've not got time fine, but if you do, you can always like, while you're doing, working out, go to the B NF and be like, is this a sensible dose? Does it make sense? Um, C 1 B1 is a very common thing which I think was on the calculations lectures you had before. Um, but essentially it's working out what you need from what you've got, but we'll, what we'll do is go through some questions. If you've got a pen and paper, I always like to do my answers written out fully. Um It just helps me pick up any mistakes that I've made. And also just to when I'm like round and down or that type of thing, it just makes it so much easier, but it's a bit old fashioned, but it's worth doing. So if you've got a pen and paper or if you wanna write them in your note section on your phone or something, then that'll probably help but yeah, we'll get wisdom of the questions again. This first one I put on, I can't remember if I've done this one and it was quite hard. Yeah. So it might take you a wee bit of time, but we'll try and get through as like many as we can just cos then we can go back and go through them more thoroughly if we need to. But yeah, so if we put the first one on um so a patient weighing 60 kg is prescribed IV dopamine 4 mcg per kilogram per minute. And the question wants you to calculate the infusion rate in mils per hour. Um The stock that we've got is dopamine 200 mg in 50 mils of glucose and then just have a look. It may take you slightly more than a minute but just do your best and obviously in the real thing, you'll have more time and the more practice you have, it's just kind of getting you methods like which methods you use and things. Yeah. So please don't worry about putting a wrong answer on the chat. It really, really doesn't matter. We'll give you another 45 seconds. Just co calculations can take a bit longer. Yeah, I have to admit it did take me a while and then to double check it to make sure I hadn't actually got the answer wrong for you all. So yeah, don't be too harsh on yourself if you're struggling in the time. And also, as we've said, just to disclaim it in case any of my calculations are wrong, I can only apologize any kind. Ok. That's, it looks like we've got quite a few responses. Should we do the answers? Oh, yeah, just in the interest of time I'll just, we'll go through the answer. Um, but well done to everyone who had a go, it's, I'll probably put the worst question first. Um, So like I said, in terms of looking at the question, oh Magda, sorry, did you want to say something? Yeah. Um So yeah, 60 kg is important. You need to know obviously what the dose actually is, what rates they want the answer in. Um And then obviously what you've got to work with. So I've kind of just highlighted the important parts of the question that you need to be able to pick out. Um So yeah, well done. The answer is 3.6 which 52% got right. Um Anyone who didn't get that answer, please don't stress, they take a lot of time to get used to and they are designed to be difficult. Um So I'll just pop through my work and tell if you did it slightly different and still got the right answer then that's absolutely fine. Um But yeah, so essentially what you need to work out first is what dose you actually need. So it's 4 mcg per kilogram. So four times 60 is 240. Um but they, we know the end units, they want it in per hour. So then you need to times it by 60 minutes. Um So we know the amount per hour is 14 14,400 mcg. Um Like I said before, because we then need to what our solution that we're working with is in milligrams. So we try and keep all the units the same. So divide by 1000 to get the amount of drug you need in milligrams. Um And then essentially this is where kind of your C one V one business comes in. It's just a bit of a trick of, I always kind of forget which thing I need to divide by what, but essentially, it's what you've got. What is it? So essentially it's 200 mg and 50 mil. So I'm trying to work out. Um Yeah, you do have a calculator. Um Oh, we definitely did. Yeah, I'm sure it's like a drop down calculator on the P SA website. Um So yeah, essentially how many mils there are uh like how many one mil is not 0.25 mg. So essentially 250 mil is nah 0.25. Um So then essentially, you know, you've got two lots of, so you've got two amounts of milligrams to work out the meals. And even as I'm saying this, I'm confusing myself. So my apologies. Um So we can go through it essentially later. Um But realistically, you need to work out naught 0.25 times 14.4 to give you 3.6 mils per hour. If you want to sense, check yourself, I usually try and go back a little bit and try and work out. We won't do it now just in the interest of time. Um But try and plug your numbers backwards to try and get your amount what you had previously if that makes sense just more to see. Um And then when I did this, obviously in the B NF that just has for this example, it doesn't give you an exact dose, it just gives you the micrograms per kilogram. Um But some other drugs will have a another way of admin it. So you can see, yes, like 3.6 MS per hour actually does make sense. Um But unfortunately, the B NF doesn't have it. So yeah, I do the calculations backwards to try and get your numbers that you started with. I'm sorry. That's really confusing. But these questions are really tricky. This is worth two marks. There are easier two marks to get, but it's just really worth if you can figure it out and just keep practicing these kind of um what you've got versus what you need to get and just really plugging the numbers in. Um It's essentially picking out what numbers you need and having to do it just in a logical order, like that works quite well, I think. But yeah, we'll skip. So please don't be harsh on yourself if you didn't get the one, it's a tricky one. Um Right. We'll move on to the next one. So you draw up 30 mils of a 2% lidocaine in a syringe. How many milligrams of lidocaine is there in 30 mils? And then if you pop your answer on the chat, on the, not on the chat. Sorry, on the pole. Um I think we haven't got too many questions for the end of this session. So we'll give you two minutes to answer this one. If you've got any questions as you go along, please feel free to message on the chat. All right, about another 45 seconds. We 40 responses so far. All right, Carly, you've had nearly 60 answers. So I rec and uh the correct answer was 600 which let me just check. Oh, actually, I apologize if this is my mistake. I can really, I do apologize. Let me just go to my work grand. So yeah, when it's a 2% it's important to remember. It's grams per 100 mil vo Magar. If I'm talking rubbish and I've made a mistake, please interrupt me. Um But yeah, so essentially 2 g in 100 mil solution. So in 30 mil, so to get so realistically, what you need to work out is how many grams would there be in 30 mil um So to do that, I kind of usually make either say um so work out how much would be in 300 mil and then divide by 10. So there would be, it's not me making a mistake. I'm just thinking. No, sorry. So yeah, ignore me. Um So in 10 mils they'll be um naught 0.2 g and then to get to what you need for 30 mils you times that by three. But you can do that like a multitude of ways just to try and balance the numbers on either side. So if you've got naught 0.6 g in 30 mils, what the question is asking is how many milligrams? So to get from grams to milligrams or vice versa, you're either times or dividing by 1000. Um So yeah, so it would be naught 0.6 g which is what is throwing a lot of you off, I think and that's why you've gone naught 0.6 milligrams. But yeah, it's actually 600 mg. So yeah, it's just a case of you which units we want and just making sure you really read the question in terms of, are they asking for grams? Mils? It's just confusing. Cos you're basically going from 2 g in 100 and then needing to work out how many that is in milligrams. Really? So yeah, the percentages always throw me off. So if it's like a 1% it we per volume, I have to look it up every time to see what that means. Because even despite how many years of doing these questions, it really confuses me. So it's just one of them things to get stuck in your head. Cos obviously in the exam, you don't have the luxury of Googling. Um But yeah, so percentage is like weight per volume. Um Yeah, it's just one of them things that you need to learn unfortunately and then just practicing convert in between like grams, milligrams, micrograms. Essentially, it's just really concentrating on the question and just taking your time, which I appreciate in a pressure time, pressure thing. That's what we all do. And it's an easy, easy to make, but it's a shame to lose two marks when you've done all the right work and out. So yeah, I would just add um for those of you who did get a which was the majority don't stress. It does happen. Um Often the simple calculation questions will be two or three steps, but sometimes they're a bit mean and they'll add in an extra step like in this question. So always check what units they want your answer in because sometimes you might do the question very quickly. And actually you've not like in this case, not converted it to the right units. So it's really tricky. Um And as Carly sort of said throughout the session, reading the question fully will prevent you from submitting. But yeah, please don't stress. It's like once you've made the mistake, you'd rather m make the mistake now. And then the next time you get a question like this, you'll be more thorough and reread it and it is time pressure. We all do it. I do it all the time and misread things. So don't be harshing yourself. That's fine. Um Right next question. Um So a patient weighing 90 kg is prescribed subcu tinzaparin for treatment of A DVT just they're not pregnant. Um So you have a stock of Tinzaparin which is 20,000 units in two mil. How many mils should be administered? And just you, you will need your B NF for this one as well. So just to make things extra difficult, yeah, these questions where you have to kind of reference something to find out the dose. They do just take a bit more time. But yeah, I thought I'd just throw one in there. Sorry, everyone, I've been a bit late to start my timer but I'll give you another minute, minute and a half. OK. All right. Another 30 seconds. Everyone grand. Is that about 30 seconds? Sorry again, my time is terrible. Um But yeah, it looks like quite a few answers. So the most common one is C which yeah, from memory. Yeah. So 1.6 mil again, this is probably not the nicest question. Um But yeah, so you need to look up Tinzaparin and the B NF and then look at which. So yeah, there's two different strengths as well. So that's another little trip. So there's 10,000 units and then also the 20,001, which is the one that the question asked for. I think I did put my working out on here. Yeah. So initially like with any of these questions, 175 units per kilogram. So yeah times 3 kg per unit to make up that. And then essentially, um again, the workings are a little bit difficult, but it's basically going back to that kind of C one V one equals C one C two V two principle. Um So yeah, you know what you've got, which is the 2000 in 20,000, sorry, in two mils. Um So it just takes a little bit of working out to figure out the maths the right way. But once it's kind of clicked in your head about how you get your numbers you need. But yeah, so the essentially the answer uh 1.57 which rounds up to 1.6 to make a gable dose. Um But yeah, so well done to everyone who got that one is again not the nicest question. So you're all doing very well. Um Hopefully this one's a bit nicer. Um So next one is Mister Smith takes Warfarin for a current dvts. He usually takes five and sixes on alternate days. Um So he is having Warfarin as 1 mg or 5 mg tablets you need to give him 14 days. How many um how many 1 mg tablets are required for a 14 day supply grand? Are we looking? All right. Answer wise. Yeah, I think it's that most people maybe we just give 1015 more seconds grand. Um So yeah, the answer which you think most people got was seven. So yeah, these type of questions, they're actually quite simple compared to a lot of the others. But um it's mainly just about kind of common sense um working them out. So yeah, obviously, if you've got fives and then six is on alternate days, you're gonna have seven days where you need 6 mg. Um And then yeah, obviously seven tablets of 1 mg to make up the dose. Yeah, we done for that one. Um grand. So next question is Missus Brown is loaded with digoxin for af and then she needs to be started on a maintenance dose of nt 0.75 mg orally once a day. How many tablets should you give? Um So the stock you have is digoxin 250 mcg tablets. We'll give you about another one minute. When should we go through the answer? Um Yes. Im 1 90% of S3 which yeah, this is quite a well, it just depends really in terms of, again, this is mainly looking at your micrograms to milligrams. Um So yeah, it's a quite a straightforward conversion but again, it's just knowing your units and like reading the question and just um like being aware of what, which units you need and milligrams to micrograms that kind of conversion. Um But yeah, so it's an important one just to be aware of that. I think I saw a practice question. It was like naught 0.25 MGS of DGE is equivalent to 250 mic micro gram tablets. So yeah, it's just more of another one to watch out for. It's a bit sneaky. Um But yeah, that's all the questions. Thank you very much for like doing the polls and things and yeah, we've got any questions I think favor for you popping back on. I'm on. Hello. Um Thank you so much, Carly for that. Um I would say the calculation questions were tricky but equally you'd rather prep for tricky questions and then be pleasantly surprised on the day. I am going to just, oh Magda has already answered that if there's a square question. Um Would you have access to a scientific calculator? You shouldn't be allowed to bring your own calculator. So centers officially aren't meant to allow you to bring in anything of your own. They have, they're meant to provide paper pens and the computer. Um If Shruti, if you're able to send that question into our email, then we can just have a look at it. Um Cos that shouldn't really have come up. Um So I've sort of distracted. Um, thank you so much, Carly. Um, if anyone's got any questions related to the questions, Carly's gone through, she's hanging around and we can go back through them. Um, just to flag obviously, we've got, the next lecture is next week, it's a bit of a heftier section. It's covering sort of specialty, prescribing out of any of our sessions. This is definitely one where watching sos lectures will help. Um There's a possibility we'll extend it slightly because there is a lot to cover, but effectively, we'll just go over some of the specialty specific things. Um Sort of like in that table I showed you at the beginning. Um and we'll do a range of question topics. So a bit of prescription writing a bit of um prescription review. Um And then the week after we've obviously got the following session, um I will send out the feedback form in a second. I've just put a specific box for you to give feedback specifically to Carly. Um We are all as doctors at the mercy of portfolios and um appraisals. So giving feedback to her would be really, really great as well as generic feedback on the. Um We've just got somebody asking, could you explain the Warfarin question again, please? We did have two Warfarin questions, I think, but Carly, you were able to pop back. Yeah, of course. Um Was it the adverse drug reaction one or the calculation one that you wanted to put on if you just pop it in the chat on which one? Um the calculation one. Yeah, that's fine. Um Yeah. So I think I've seen this example. I think there is another one on Sonos presentation of similar where essentially so realistically he is having so for a 14 day supply and he's on 5 mg one day six, the next day, 56, that kind of pattern. So in a 14 day period, he'll have seven days where he takes 5 mg, which you can have with just using the 5 mg tablets. But then he'll have seven days where he needs 6 mg. Um So then it'll be a 5 mg and a 1 mg tablet. So all the question, it just wants to know how many of the 1 mg will we need to supply? So because he's only having seven days where he needs the extra one, then the answer will just be seven. But how I'd seen where other people have written them out essentially do a table of like especially if it's more complicated doses than like six and five a table of like day 12345, like so on. And then kind of you put in which dose you need. So 5 mg for one day would equate to 15 mg tablet and then kind of you put a table of like 51 and then 51, it sounds complicated. But essentially if you do a table of it and then add up how many 1 mg you need at the end. That'll give you your answer. So, same for if it was um 7 mg and 5 mg, alternate days, you'd just then go through and put in like obviously every day he needs a 5 mg tablet, but there's only seven of seven of those days where you're having to add on the extra doses. So every alternate day will have Yeah, exactly. Yeah. Five plus 1 mg to make it 6 mg for the seven days. Yeah, I would just add, I'm a very visual person when it comes to calculations. And even though when Carly broke it down, it was a lot simpler in my head. I would have to write out um Monday, Tuesday, Wednesday, Thursday and think about it. Um and draw it out. You get an a four piece of paper, I think both sides. So you do have space to like jot things down. Um And if it helps you conceptualize things, then those are the sorts of questions where 15 seconds of conceptualizing you'll get the mark. Um The questions that aren't worth agonizing over are the ones where you really have no idea. Or you're feeling too time pressured and too stressed. You're gonna spend six minutes on this question and it's just a mark is a mark, but it's not worth a big proportion of your time. Um Magda has sent in all the links to this previous session recordings. This should be on Medal tonight, if not tomorrow. Um this session and then on youtube shortly. Yeah. So yeah, I would just recommend if you can't conceptualize it, just use your pen and paper to help you jot it down. Um Has anyone got any other questions for Carly or for me or Magda? Um The feedback form is above um Once you fill out, you should be able to get your certificate sort of instantly just if you're happy to give Carly some visit feedback, I put my name there as well. Um That would be amazing. Um Carly, if you're just happy to go back down the slides, um sort of where like back through them. Yeah. Oh, sorry, sorry. Love actually the right one. Uh Next. Yes. Yeah, sorry. Um That's just the QR code there. Everyone for son's recording. No, sorry. That's the QR code for the Google form which we're trialing. Um Ideally if you guys send us in um if everyone, if everyone's able to send in questions in advance and we can cover them, but we didn't get many questions for today, which is fine, but just be aware that if you have questions and you want them in advance, we'll accept them through there. How many hours of non core do you get per webinar? Ah, that's, it's a bit interesting that the certificate says a 0.6 it should say one hour because that's what it's scheduled for. Um, I will have a little look through and see if there's anything I can do to change that. Um, unofficially, you don't need to actually upload a certificate onto Hors. You can just log it as one hour, but it's nice to have lots of certificates and lots of things. If there is any question at the end of the year. Did you really go to this? Um, So that's why it's, it's good when you can go to things that have certificates. Um, but even if certificates is the wrong thing, you should be able to log it on Horace as the full hour. Um, but I will check that for you, Ronan because I'm not sure why that's happened. I think we're slowly getting people leaving the court, which is absolutely fine. It's been a long day for all of us. Um Oh, lovely, thanks, Carly. These are the session recordings, um, which are relevant to our next session, which I recommend watching. Um, uh, next file if you wouldn't mind. I'm not too sure what the next one was. Um These are also on youtube and these are the series, um, if you have a commute to work and you're on a bus, um, they're quite good to watch on the go. Um These are the same that I show in every session, but just some of the recommended resources um that I recommend there was a bit of chat on about using sort of one resource using past the PSA my university really didn't recommend us to use it because they felt it was outdated. All the universities really love it. I wouldn't use any of one resource too much. Um, and I've sent in the past sort of the BPS practice papers which I think are really helpful and they have free questions as well. Um The formatting is what takes a while to get your around. And so any system that emulates the exam, so you're feeling a bit stressed, you've got to use a calculator online, the formats. Um the way it is that will be really helpful in preparing the issue with books and question banks is they're not physically different to the test. Um And so that's just something to bear in mind. I think I'm rambling on a bit. If anyone's got any more questions, please send um for the sake of the recording, we'll say the sessions ending now. So, thank you all very much for joining. Um I will be hovering here for a few minutes. If anyone has anything else they need to ask, we're very, very happy to answer. Yeah, thank you. Yes. Should I will send the link? That's fine. Um Two