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Year 6 > ADR > Flashcards

ADR Flashcards

1
Q

SE of thiazides?

A

dyslipidaemia (inhibits lipoprotein lipase in capillaries  more lipoproteins), gout

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2
Q

SE of Ciprofloxacin?

A

Tinnitus

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3
Q
  • ACEi + NSAIDs can result in what?
A

AKI

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4
Q
  • ACEi (i.e. carvedilol) + K-sparing diuretic (i.e. amiloride) can cause what?
A

Hyperkalaemia

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5
Q

Digoxin side effects?

A

o SEs: N&V, blurred vision, xanthopsia (disturbed yellow/green vision incl. ‘halo’ vision)
o MoA: antagonises K+ at myocyte Na/K-ATPase limiting Na+ influx  Ca2+ accumulates inside the cell, prolonging the action potential  lowing of heart rate
 Hypokalaemia  enhances digoxin effect
 Hyperkalaemia  reduces digoxin effect

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6
Q

What can’t be given alongside trimethoprim?

A

Methotrexate

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7
Q

Side effects of amiodarone?

A

hyper/hypothyroid, skin greying, corneal deposits
o Mx: withhold amiodarone if thyrotoxic

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8
Q

Alcohol + metformin?

A

lactic acidosis

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9
Q

ETOH excess + wafarin?

A

Excessive anticoagulation (bleeding risk)

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10
Q

Alcohol + metronidazole/disulfiram?

A

Sweating, flushing, N&V

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11
Q

IV fluid choice if hypernatraemic/hypoglycaemic?

A

5% dextrose

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12
Q

IV fluid choice if ascites?

A

Human albumin solution (HBS)

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13
Q

IV fluid choice if bleeding shock

A

Blood transfusion (crystalloid first if no blood available)

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14
Q

Resuscitation fluid:

A

o Sodium chloride 0.9%
o 500mL bolus  250-500mL PRN bolus (if HF and still fluid deplete, use 500mL)
o Over 15 minutes

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15
Q

When should you give an ACEi?

A

In the evening

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16
Q

Insulin requirements with steroids?

A

Increased

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17
Q

When to decrease insulin?

A

Alcohol, reduced calories, reduced renal function

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18
Q

COCP rules when having surgery?

A

Stop 4 weeks before and start 2 weeks after

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19
Q

First line for vasomotor symptoms in menopause?

A

SSRIs eg. fluoxetine

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20
Q

What statin should be taken in the evening?

A

Simvastatin

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21
Q

What drugs can’t be taken alongside statins?

A

macrolides (clarithromycin, erythromycin)

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22
Q

SEs of statins?

A

Myositis

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23
Q

Statin Monitoring

A

o Baseline bloods:
 Full lipid profile (non-fasting)
 LFTs
 TSH
 U&Es
 CK (only if persistent, generalised, unexplained muscle pains  if ≥5x ULN, repeat after 7/7):
* RFs: CKD, hypothyroid, FHx/PMHx of hereditary muscular disorders, history of unexplained muscle pain, liver disease, ETOH excess, ≥70yo w/ polypharmacy
* If still ≥5x ULN, do not offer statin
* If <5x ULN, offer statin at a reduced dose
 HbA1c (for high risk of DM patients)
o 3 months:
 Full lipid profile (non-fasting)
 LFTs
 HbA1c (for high risk of DM patients)
o 6 months:
 LFTs

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24
Q

Effect of warfarin and statins?

A

High INR (only in some people)

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25
Q

When to stop a statin when looking at the LFT results?

A

IF >3x the upper limit of normal (ALT/AST)

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26
Q

When should a statin be stopped?

A

-Severe muscle pains
-Creatinine kinase >5x ULN
-Prescribing macrolides
-LFTs >3x ULN

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27
Q

How do you treat delirium aggression?

A

IM haloperidol (give lorazepam in Parkinson’s)

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28
Q

Aggression medical treatment?

A

Oral lorazepam first line, IM lorazepam second line

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29
Q

Alcohol avoidance is recommended with which drugs?

A

ABx (metronidazole, doxycycline)
Benzodiazepines
sedating antihistamines
Fluoxetine
Disulfiram
Statins (must stay within limits
Warfarin

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30
Q

Treatment for neuropathic pain?

A

o 1st line neuropathic pain:
 Amitriptyline (10mg oral nightly)
 Pregabalin (75mg oral 12-hourly)
o 1st line diabetic neuropathy  duloxetine (60 mg oral daily)

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31
Q

Drugs to avoid in heart failure?

A

o Thiazolidinediones (pioglitazone) - fluid retention
o NSAIDs/glucocorticoids - caution: fluid retention [75mg aspirin exception]
o Verapamil - negative inotropic effect
o Class I antiarrhythmics (flecainide) - negative inotropic and proarrhythmic effects

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32
Q

Drugs to take at night?

A

Statins, amitrytiptiline

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33
Q

Treatment for insomnia?

A

o 1st line: Z-drugs (Zopiclone)
o 2nd line / severe insomnia: BDZ (Nitrazepam; 2-4w)

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34
Q

When do you consider blood tranfusion for iron deficiency ?

A
  • Severely symptomatic
  • Hb <70g/L
     Raises Hb by 10g/L per unit given
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35
Q

What is the first line management for iron deficiency anaemia?

A

o 1st line: ferrous sulphate, 200mg, PO, TDS [take with food]
 Given until Hb normal + further 3 months to replace stores
 Consider SE as a cause of non-compliance if Hb not rising (constipation, black tarry stools)
 Reduce to BD if side effects are prominent and reassess in 2-4 weeks

36
Q

Liver enzymes and drugs: ALT : ALP >5

A

 Paracetamol
 NSAIDs
 Statins
 Amiodarone

37
Q

Liver enzymes and drugs: ALT : ALP <2

A

 Co-amoxiclav
 Erythromycin
 Chlorpromazine
 Hormonal contraception

38
Q

Liver enzymes and drugs: ALT : ALP 2-5

A

 Phenytoin
 Sulphonamides
 Carbamazepine

39
Q

Steroid side effects?

A

 Stomach ulcers
 Thin skin (easy bruising)
 (O)edema
 Right (and left) heart failure
 Osteoporosis
 Infection
 Diabetes
 Syndrome (Cushing’s)

40
Q

NSAID cautions and CIs?

A

 No urine (renal failure)
 Systolic dysfunction
 Asthma
 Indigestion
 Dyscrasia of the blood (clotting abnormality)

41
Q

What to stop in acute HF?

A

Beta Blocker

42
Q

Drugs that increase bleeding (aspirin, heparin, warfarin) not to be given to those?

A

 Suspected of bleeding
 At risk of bleeding
* Prolonged PT in liver disease
* Acute ischaemic stroke (haemorrhagic transformation; ≤2 months)
 On enzyme inhibitors (i.e. erythromycin) and warfarin

43
Q

Which antihypertensives can cause bradycardia?

A

BB and CCBs

44
Q

Which antihypertensives can cause Electrolyte disturbances?

A

ACEi, diuretics

45
Q
  • CCBs side effects?
A

peripheral oedema, flushing

46
Q
  • Diuretics side effects?
A

renal failure, gout (loop diuretics), gynaecomastia (spironolactone)

47
Q

First line for nausea?

A

 1st line (most cases)  Cyclizine, 50mg 8-hourly, IM/IV/oral
* SE: fluid retention (not for HF)
 2nd line  Metoclopramide, 10mg 8-hourly, IM/IV/oral
* Avoid in Parkinson’s (DA antagonist) – use domperidone (does not cross BBB)
* Avoid in young women (risk of dyskinesia i.e. acute dystonia)

48
Q

Beware of warfarin and which antibiotic?

A

+ ciprofloxacin / erythromycin

49
Q

o Neutropenic sepsis can be caused by what?

A

Piptazobactam (Tazocin) + Gentamicin

50
Q

digoxin SE and what to not give alongside?

A

o Arrhythmia + hypotension, (no BB or non-DHP as can cause hypotension)

51
Q

Prescription review pneumonic?

A
  • PReSCRIBER
    o Patient details (3 identifying factorsOR addressograph)
    o Reaction (allergy + reaction to drug)
    o Sign the front of the chart
    o check for Contraindications to each drug
    o check Route for each drug
    o prescribe IV fluids if needed
    o prescribe Blood clot prophylaxis if needed
    o prescribe anti-Emetics if needed
    o prescribe pain Relief if needed
52
Q

Ciprofloxacin side effect?

A

Tinnitus

53
Q

SE of Metoclopramide?

A

Exacerbates parkinsonism (crosses BBB, unlike domperidone)

54
Q

K+-sparing diuretics SE?

A

Hyperkalaemia

55
Q

Loop diuretics SE?

A

Hypokalaemia, gout

56
Q

Trimethoprim SE?

A

Neutropenic sepsis

57
Q

Opiates SE?

A

Constipation
Urinary retention

58
Q

Thiazolidinedione SE?

A

Fluid retention

59
Q

Enoxaparin (heparin) SE?

A

Bleeding (≤2m after a stroke)

60
Q

Amiodarone SE?

A

Hyper/hypothyroid
Corneal deposits
Skin greying

61
Q

barbiturates, opioids, BDZs + alcohol = what?

A

o Sedation

62
Q
  • ACEi + NSAIDs = ?
A

AKI

63
Q

metronidazole, disulfiram + ETOH = ?

A

o Sweating, flushing, N&V

64
Q

MAO-I, RIMA + ETOH = ?

A

o Hypertensive crisis

65
Q

Upper gastrointestinal bleeding caused by alcohol and what?

A

Aspirin, NSAIDs

66
Q

Monitoring with ciclosporin?

A

U&Es monitoring regularly required. Every 2 weeks for first 3 months

67
Q

What is required alongisde steroids?

A

Gastroprotection and bone protection
(regular BM monitoring also required)

68
Q

1st line for diabetic neuropathy?

A

Duloxetine - 60mg oral daily

69
Q

Which medications should be taken in the evening?

A

Statins and amitriptyline

70
Q

which DOAC must be taken with food?

A

Rivaroxaban

71
Q

Which DOAC must be taken whole?

A

Dabigatran

72
Q

Safest SSRI in IHD?

A

Sertraline

73
Q

Communication points for SSRIs?

A
  • NEVER STOP SUDDENLY
  • MAY WORSEN SYMP TOMS BEFORE IMPROVING THEM
  • MAY TAKE A FEW WEEKS TO WORK
  • WORKS BEST WITH ADJUNCTS LIKE TALKING THERAPY
74
Q

SSRI SEs?

A

Safest in IHD: Sertraline ~ think safe ticker
* SSRI <18s – Fluoxetine
* SEs: GI upset, peptic ulcer, insomnia, reduced libido

75
Q

Methotrexate monitoring

A

Monitor FBC, renal and liver function (reports of blood dyscrasias (any disease of the blood) and liver cirrhosis)

76
Q

Dabigatran is the only reversible DOAC, with what agent?

A

idarucizumab

77
Q

Management of stable popliteal aneurysm?

A

femoral-distal bypass (indications: S/S, in vivo thrombus, >2cm aneurysm)
 Indications for bypass surgery generally… aneurysm, trauma, occlusion

78
Q

Management of acute popliteal aneurysm?

A

Embolectomy ± femoral-distal bypass

79
Q

o RFs of AAA?

A

HTN, smoking, hypercholesterolaemia, gender (males have inc. risk, but females have inc. rupture risk)

80
Q

Screening for AAA?

A

o Screening = males ≥65yo  single abdominal USS:
 3 – 4.5 fu scan in 12 months
 4.5 – 5.5 fu scan in 3 months
 >5.5 2ww referral to vascular

81
Q

Ix for AAA?

A

o 1st  USS abdomen (always 1st line for diagnosis)
o 2nd  CTA/CT (required for pre-operative planning)  MRA/MRI (if contrast allergy)
o Other: ESR (raised), CRP, FBC, BC

82
Q
  • Complications (AAA)?
A

Rupture, embolism (trash foot), thrombus, DVT (pressure), fistulation

83
Q

Medical management for AAA?

A

Statins, aspirin, BP management

84
Q

When is surgery performed electively for AAA?

A

Aneurysms growing >1cm in one year, aneurysms lager than 5.5cm at screening

85
Q
A

Year 6 (26 decks)

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