3/12 Flashcards
In what situation do you increase the morphine dosage someone is on?
How do you do this?
How do you calculate breakthrough dosage?
If someone is needing to use breakthrough 3x/day increase the daily dose
- 30-50% increase (30% in elderly)
Breakthrough = 1/6th of daily dosage
In what situations do you use oxycodone over morphine?
What must be considered when you start a pt on opioids?
When renal impairment use oxycodone as majority of it is metabolised in the liver
ABC
Antiemetic - ondansetron
Breakthrough pain
Constipation relief - senna
DD of peripheral causes of vertigo
Identifying features of all
Peripheral vertigo - more likely to come and go and not assoc. with central/cerebellar signs
BPPV
- otolith stone in the semicircular canals
- can come out of nowhere/triggered by head movement
- diagnosed with Dix-Hallpike (makes it worse as puts stone properly into semicircular)
- managed with Epley which puts it back in
Meninere’s disease
Vertibular neuritis/labyrnithitis
- often following URTI
- N+V !!
- lasts hrs to days
Labrythnititis comes with hearing loss and tinnitus
Rule of 3’s
- 3 days in bed
- 3 weeks off work
- 3 months off balance
Ménière’s disease (MEN get STVs)
- sensiorueal hearing loss
- tinnitus
- vertigo
Manage with tinnitus therapy and hearing aids/grommets
Prevent with reduced salt, caffeine, alcohol and stress
Episode of visible haematuria in older man with no other symptoms
Blood found on mid-urine diptix
Refer to urology - likely to be bladder cancer
What is a mixed culture in a urine sample most likely to mean?
Contaminated sample