AAFP Flashcards
FFP vs Vitamin K vs PCC
FFP
- normalize INR 13-48 hours
−Need ABO testing
−30-60 minutes to thaw
−15ml/kg - approx 1L (4units) for 70kg
* May need 30ml/kg
Vit K
- normalize INR 12-24 hours
−10mg IV (over 30min)
− 3/100,000 anaphylaxis
PCC
* Pooled human plasma
* Stored as a powder
−ABO testing not required
−Volume <100ml
* Contains II, IX, X, varying amounts
VII and Protein C and S
* Rapidly reverse INR: 3-15 minutes
In life-threatening bleeding, on warfarin…
Vitamin K 10mg IV + 4 factor PCC (Kcentra)
INR 2-4, give 25U/kg
INR 4-6, give 35U/kg
INR> 6, give 50U/kg
Chemical Eye Burn. Which is worse Alkali or Acid?
Alkali
Irrigate, Irrigate, Irrigate
Orbital fracture physical exam?
Restricted upward gaze
Subconjunctival hemorrhage. Treatment?
No
Do nothing.
Avoid staining
Post-splenectomy vaccines?
Pneumococcal
HIb
Meningococcal
> 14 days before/after splenectomy (vaccine)
Compartment syndrome. Do not wait for which 2 P’s?
Pallor and Pulselessness
Tetanus Prophylaxis
Clean >10 years since last dose
Dirty >5 year
Safe in pregnancy
Whom do you place on prophylactic antibiotics?
High-risk site – (hand, foot), High-risk mechanism – (bites)
High-risk patients (immunocompromised, prosthetic valve)
Toddler’s Fracture – Is it “Abuse”?
- Its no ABUSE
- Most common fx in age 9 mos – 3 yrs
that present with a limp (29 of 100) - Spiral fracture of distal tibia
- Best seen on oblique view
- May be occult
- Below knee walking cast x 3 weeks
Epistaxis treatment
− Anterior: packing, silver nitrate sticks,
electrocautery, topical tranexamic acid (TXA)
− Posterior – balloon packing
ENT Emergencies: Throat
- Parapharyngeal infection (Lemierre’s Disease)
− Septic thrombophelbitis of the Internal jugular vein
− Typical age group 15-30
− Fusobacterium necrophorum: Gram Neg(-) anaerobe - Peritonsillar abscess
−Most common 20-40 yrs of age - Retropharyngeal abscess
−Most common 2-4 yrs of age - Epiglottitis
−More common in adults than children
- Wrist and finger extension test against resistance?
Radial nerve
Make OK sign? which nerve
Median nerve
Abduction of fingers? Which nerve?
Ulnar nerve
Burn Identification
*1st degree – involve only epidermis – a bad sunburn
*2nd degree
- Superficial partial thickness- epidermis plus upper layers of papillary dermis
- Deep partial thickness - - involves deeper layers of dermis (reticular dermis)
*3rd degree (full-thickness) – down to and including subcutaneous fat
(requires skin grafting)
*4th degree – includes muscle, tendon, bone
Which phase in elder is usually affected when prescribing medication?
Phase 1 (oxidation, cytochrome P450) in the liver may be reduced with age
Phase 2 (conjugation) usually unaffected
Pharmacokinetics vs Pharmacodynamics:
Pharmacokinetics: What the body does to the drug.
Pharmacodynamics: What the drug does to the body.*
Beers’ Top Drugs to Avoid in elderly
- Diphenhydramine, hydroxyzine, and first generation
antihistamines - Clonidine
- Amiodarone, class 1 antiarrhythmic drugs
- Digoxin >0.125 mg daily
- All benzodiazepines
- Glyburide, chlorpropamide
- Indomethacin, meperidine
Which medication causes Cholinergic rebound syndrome (agitation, borborygmi, diarrhea)?
Sudden cessation of amitriptyline may cause
a cholinergic rebound syndrome
ADE Mimic Disease?
Bradycardia: Digoxin, verapamil, and propranolol; slow cardiac conduction (note: Verapamil increases digoxin levels 50-75%)
Weight loss: Theophylline and digoxin may cause nausea and dysgeusia (food tastes bad).
Clonidine and amitriptyline cause dry mouth (harder to eat) and photophobia.
Verapamil, clonidine, and amitriptyline causes what in elderly?
Constipation in elderly
Verapamil, propranolol causes what in elderly?
Fluid retention and Edema
Metoclopramide causes what in elderly?
Parkinsonism
Theophylline causes what in elderly?
Tremor
Aspirin and theophylline causes what in elderly?
Exacerbate GERD
Pharmacokinetic changes with age?
Absorption
What increases with age?
Fat store
