All most important things from notes and mocks that you need to remember Harry Flashcards
common cause or urticara
aspirin
when can you not give sumatriptan
hx of hypertension and high BP
if you cant give sumatriptan what do you give instead for migraine
aspirin or ibuprofen
resus fluids in a child
sodium chloride 10ml/kg
two drugs contributing to postural hypotension
flozins and BB
what medications should you suspend in a suspected head injury
anything causing bleeding - antiplatelet , anticoag
drowsines and confusion drugs - amitritpylline sand zopilcone - would be problematic in context of acute head injruy
dexamethasone prescirbed at night why might this be a problem
can cause insomnia if night that is why normally prescribed in the morning
gestational diabetes what tx summary can you find it in
diabetes pregnancy and breast feeding
in what drug next - what should you check
check they are on optimal doses of that drug thus meaning they are on the maximum or if you can give them another
hypercalcaemia what do you treat with
sodium chloride IV 1ltr over 4hrs
post emergency contraception what should happen
preg test
wiht iron supplementation what is the most important info
dont take calcium and iron together
considered does mean defo measure
what feature suggest heaptic necrosis in paraceamol overdose
RUQ tenderness
during mineralcortiocid therap what needs to be measured
UandE - k and na , bp fluid balance
what things are useful to monitor benefits of treatemnet and assess effectiveness
self reporting of symtpoms severity and freqeyncy
best way to measure a ong acting insulin to tittrate up
monitor pre breakfast fasting capillary blood glucose
somone not maintainign sats on 24% venturi mask what do you do
chnage to 28% venturi
given that oxygen saturation is below the limit - fio2 should be increased under controlled conditions
normal strength of novarapid
100 units/ml
A 44-year-old man is admitted to the acute medical unit diagnosed with acute coronary syndrome. He usually takes 140inits of insulin degludec (Tresiba 200inits/ml) twice daily and Novorapid with meals. The insulin is unavailable overnight and he has forgotten his pen device. What is the most appropriate course of action?
Administer 140 units of insulin Tresiba (100units/ml)
never chnage the dose just the concentraiotn as it just a differenence in volume
You are the FY1 on call overnight. You are asked by nursing staff to review a patient with type 1 diabetes mellitus who has suffered from hypoglycaemia at 0700. He takes Lantus 20 units at night and a variable dose of Humalog with meals. He has had a carbohydrate snack and his CBG is now 4.5mmol/l. What is the correct course of action?
Give usual dose of Humalog with breakfast
stiill give usual insulin dont change the regime
A 78 year-old lady who lives with her daughter is admitted with general decline. Her daughter administers the patients twice daily insulin dose at 0800 and 2000. The dose is 40 units twice daily. She reports that her mother has had repeated overnight hypoglycaemia. What should you prescribe on the insulin chart?
Reduce evening insulin dose by 20%
rule of thumb adjust by 20% fro hypos
hypers can be 10%
A 64 year old man is admitted electively the evening before a right hemi-colectomy. He is taking once daily insulin lantus (glargine) at 2200 at a dose of 50 units. What is the correct course of action?
Prescribe 40 units lantus at 2200
surgery rule of thumb drop by 20%
Following left mastectomy a 55 year-old woman with type 1 diabetes is feeling ready to eat lunch. She is on VRII (Variable rate insulin infusion). The capillary blood glucose is 6.8mmol/l. She has had an appropriate dose of long acting insulin the previous evening. She usually takes Apidra (insulin glulisine) with meals. What is the correct course of action?
Give Apidra with lunch and stop VRII 30 minutes later
long acting is always continued alongside VRII - short actings have a 15-30min onset of action which is also why we ask to inject before meals - there needs to be an overlap period
A75-year old man is admitted to hospital. He takes Insuman basal 40 units twice daily for type 2 diabetes mellitus. His insulin pen device is broken and the same insulin is unavailable that evening. What is the most appropriate course of action?
Administer 40 units of an alternative intermediate-acting insulin such as Insulatard.
do bisphosphonates cause reducting in kindey function
yes
2 meds that contribute to anoxeria
metoformin
rivastigmine
more likely to cause dka SGLT-2 or insulin
SGLT-2
montior adverse affects of ceft
FBC
how quickly does fertility return with the implant
straight away
sumatriptain muscle se
muscle ache
on inuslin infusion waiting for surgery what do you give with
%5 dextrose with potasium over 8-12hr
beneficial monitoring parameter in addisions disease with someone on hyrdrocortisone
weight
not serum cortisol as this would depend on when you take the steriods
nephrotoxic drugs
NSAID
acei
vancomyin
aminoglycosides
ciclosporin
tacrolimus
zoledndroni acid
hepatotoxic drugs
coamox
amiodarone
methotrexate
valp
isoniazid
rifampicin
pancreatitis
valp
liraglutide
DDP4 i - gliptiins
blood dyscrasis and disorders - seek immediate help if sx fever rash outh ulcers, bleeding burising
carbamazepine
aminosalicylates
lamotrigine
valp
carbimazole
phenytoin
methotrexate
trimethoprim
doxy advice
swallow with plenty of fluid
GTN tablets discard when
after 8 weeks
how long do you need to take levo before caffine and break
30 mins
how do you take phenytoin
with or after food
do you have to take warfarin at the same time each day
yes and dont make major changes in die or alcohol consumption
smoking cessation increase the concentration of what drugs
theophylline and antipyshcoics and ropinerole
peak level to high
reduce dose but keep same freq
trough level to hihg
increase itnerval between dosese eg TDS to BD
what drugs taken in morning
diuretics and steriods
what drugs taken in evening
statins and sedatives
intercurrent illness what do you do to steriods
insulin
and sglt2
double
reduce
hold sglt2
galactorrhea causing meds
metoclopramide
olanzapine
citalopram
surgery and diabetes what do you do
reduce long acting dose t 20%
metformin surgery
day before and day of unlesss TDS so hold post break
gliclacizde surgery
held day of
what drugs need stopping before surgery
insulin lihtum anticoag cocp hrt
k sparing diuretics
oral hyoglycaemiacs
adn acei
for pain always start with - esepcially even if eldery in neuropathuc pain
paracetamol
how much hydrocrotisone shoudl you take in surgery if you have been taking long term pred
25-50 mg
do patches take time to work
exmaples
yes
morphine, fent , buprenorpine and oxycodone
does doxycylcine affect cocp taking
no
precipitants of c.diff
omeprazole, low mg , low na , co-amox
ciprofloxacin, cindamyicn , cephalopsporin
ck raised in
neuroleptci laignnat syndrome
and myositis
dose of sri in preg
lowest dose possible
emergency resus fluid
bolus NaCL 500ml 10min
250 in old or HF
emergnecy hypercal
nacl 0.9% 1L 4hr
emergency hypog fluid
glucose 10% 200ml 15min
or
glucose 20% 100ml 15min
emergency hypok
nacl 0.9% / kcl 0.3% in 4hr 1L
maintainance fluids no losses
8-12hr
maintianace fluid with losses
replace in 4-6hr
children emergency resus fluid
nacl 0.9% 10ml/kg 10min
maintaince fluids in kids
100/50/20 for each 10kg incriment
examples of cyclical with uterus hrt regimnes
evorel sequi
elleste duet
examples of continuous regimes for HRT
evorel conti - patch
elleste duet conti
kliofem
no uterus what do i give
elleste solo or tibolone
enzyme inducers PCBRASS
phenytoin
carbmazepne
barbituates
rifampicin
alcohol - chronic
sulphonluyeras
smoking
john wart
topiramate
enzyme inhibtors sickface.com
sodium valp
isonisazid
cimitedine
ketoconazole
fluconazole
alchol acute and grapefruit
chloremphicol
erthymocin
sulphonamide
ciprofloxacin
omeprimazole
metronidazole
se metformin
egfr stop under 30
n v
diarrhoea
ddp4 - gliptins se
pancreatiits and nasopharyngitis
piolitazone se
heart failure
bladder cancer
oedema
post menopausal op
weight gain
sulphonylurea se
hypo
weight gain
sglt2 i se
DKA
gential infection
forneuier
glp-1 agonist exantide ,seraglutide se
panreaciits
weight loss
n and v
examples of basal insulin
lantus humulin
