anki_export Flashcards
cyP450 inducers
PC BRAS:
P henytoin
C arbamazepine
B arbiturates
R ifampicin
A lcohol (chronic excess)
S ulphonylureas
CYP450 inhibitors
AODEVICES:
A llopurinol
O meprazole
D isulfiram
E rythromycin
V alproate
I soniazid
C iprofloxacin
E thanol (acute intoxication)
S ulphonamides
Drugs to stop before surgery
I LACK OP :
I nsulin -sliding scale
L ithium - stop day before
A nticoagulants/antiplatelets - variable some may stop others may need bridging with LMWHC
OCP/HRT - stop 4 weeks before surgery
K -sparing diuretics - day of surgery
O ral hypoglycaemics
P erindopril and other ACE-inhibitors.- stop day of surgery
Steroid side effects
STEROIDS:
Stomach ulcers
Thin skin
oEdema
Right and left heart failure
Osteoporosis
Infection (including Candida )
Diabetes (commonly causes hyperglycaemia and uncommonly progresses to diabetes)
Cushing’s Syndrome
NSAID cautions and contraindications
NSAID:
No urine (i.e. renal failure)
Systolic dysfunction (i.e. heart failure)
Asthma
Indigestion (any cause) and
Dyscrasia (clotting abnormality). While aspirin is technically a NSAID it is not contraindicated in renal or heart failure
antihypertensive side effects
For antihypertensives always think of the side effects in three categories:
a. Hypotension (including postural hypotension) that may result from all groups of antihypertensives.
b. Dividing the groups of antihypertensives into two mechanistic categories:
1. Bradycardia may occur with beta-blockers and some calcium-channel blockers.
2. Electrolyte disturbance can occur with angiotensin converting enzyme (ACE) inhibitors and diuretics.
c. Individual drug classes have specific side effects:
1. ACE-inhibitors can result in a dry cough.
2. Beta-blockers can cause wheeze in asthmatics; worsening of acute heart failure (but helps chronic heart failure).
3. Calcium-channel blockers can cause peripheral oedema and flushing.
4. Diuretics can cause renal failure. Loop diuretics (e.g. furosemide) can also cause goutand potassium-sparing diuretics (e.g. spironolactone) can cause gynaecomastia.
when should metaclopramide be avoided?
- Patients with Parkinson’s disease due to the risk of exacerbating symptoms.
- Young women due to the risk of dyskinesia i.e. unwanted movements especially acute dystonia.
causes of macrocytic anaemia
B12/folate deficiency
excess alchol
liver disease
hypothyroidism
Haematological diseases (‘M’s : myeloproliferative disease, myelodysplastic, multiple myeloma)
causes of thrombocytopenia
Reduced production:
- infection (usually viral)
- drugs (esp. penicillamine (e.g. in rheumatoid arthritis treatment))
- myelodysplasia, myelofibrosis, myeloma
Increased destruction:
- heparin
- hypersplenism
- disseminated intravascular coagulation (DIC)
- idiopathic thrombocytopenic purpura (ITP)
- haemolytic uraemic syndrome/ thrombotic thrombocytopenic purpura
causes of raised urea
Raised urea indicates kidney injury or upper gastrointestinal (GI) haemorrhage. A raised urea usually indicates renal failure; however because it is a breakdown product of amino acids (such as globin chains in haemoglobin) it can also reflect an upper GI bleed where haemoglobin has been broken down by gastric acid into urea which is subsequently absorbed into the blood. The same phenomenon occurs if you eat a big (and bloody) steak. Thus a raised urea with normal creatinine in a patient who is not dehydrated (i.e. does not have prerenal failure) should prompt a look at the haemoglobin; if this has dropped then the patient probably has an upper GI bleed.
how to look at liver function Tests
One can assess the liver by looking at markers of:
● Hepatocyte injury or cholestasis such as:
- bilirubin
- alanine aminotransferase (ALT) and the less commonly measured aspartate aminotransferase (AST)
- alkaline phosphatase (alk phos or ALP)
● Synthetic function (i.e. the proteins it makes):
- albumin
- vitamin K
- dependent clotting factors (IIVII “ IX and X) measured via PT/INR. PSA”
causes of raised ALP
ALKPHOS:
Any fracture
Liver damage (posthepatic)
K (for kancer)
Paget’s disease of bone and Pregnancy
Hyperparathyroidism
Osteomalacia and
Surgery.
Maximun rate of IV potassium
10mmol/hr
Causes of microcytic anaemia
Iron deficiency anaemia
Thalassaemia
Sideroblastic anaemia
Causes of Normocytic anaemia
- anaemia of chronic disease
- acute blood loss
- haemolytic anaemia
- renal failure (chronic)
