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PSA exam cards > Basics of prescribing > Flashcards

Basics of prescribing Flashcards

1
Q

Which drugs are P450 inducers?

A

Phenytoin

Carbamazepine

Barbituates

Rifampicin

Alcohol (chronic abuse)

Sulphonylureas

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2
Q

Which drugs are P450 inhibitors?

A

AO DEVICES

Allopurinol

Omeprazole

Disulfiram

Erythromycin

Valproate

Isoniazide

Ciprofloxacin

Ethanol (acute intoxication)

Sulphonamides

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3
Q

What is the PReSCRIBER mnemonic?

A

The mnemonic used for prescribing checks of drugs.

Patient details

Reactions

Sign front of chart

Contraindications

Route of drug

IV fluid if needed

Blood clot prophylaxis

anti-Emetic if needed

Relief if needed of pain

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4
Q

What are the side effects of steroid medications?

A

“STEROIDS”

Stomach ulcer

Thin skin

oEdema

Right and left heart failure

Osteoporosis

Infection

Diabetes

cushings Syndrome

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5
Q

Safety consideration of NSAID’s?

A

No urine

Systolic dysfunction

Asthma

Indigestion

Dyscrasia (clotting abnormality)

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6
Q

How do you choose which fluid replacement to presscribe?

A

Give all patients 0.9% saline unless they are hypernatraemic or hypoglycaemic (5% dextrose instead).

Has ascites: give human albumin solution instead as it maintains oncotic pressure.

Haemorrhagic shock: give blood transfusion but a crystalloid first if no blood available.

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7
Q

Common side effects of Thiazide diuretics?

A

Gout

Hypokalaemia

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8
Q

Common side effects of Spiranolactone?

A

Hyperkalaemia

Gynaecomastia

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9
Q

Common side effects of diuretics in general?

A

Renal failure. Prescribe with caution.

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10
Q

When would you give a STAT infusion of 500ml 0.9% saline?

A

To a patient whom was haemodynamically unstable

  • Tachycardic
  • Hypotensive

You would give 250ml in this situation to a patient with heart failure.

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11
Q

In what situation would you give a patient 1L fluid over 2-4 hours? (0.9% saline)

A

A patient whom was oliguric.

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12
Q

How can you roughly predict the level of fluid depletion in a patient using basic observations?

A

500ml depleted: reduced urine output <30ml/hr

1L depleted: olguric and tachycardic

> 2L: reduced urine output, tachycardic and shocked.

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13
Q

What is the maximum rate in which potassium can be infused?

A

Potassium should not be infused at a faster rate than 10mmol/hour.

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14
Q

What are the general fluid requirements of a patient in 24 hours?

A

Adults 3L IV fluid

Elderly 2L IV fluid

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15
Q

What is a basic fluid regime for a patient?

A

“1 salty 2 sweet”

1L of 0.9% saline and 2L of 5% dextrose

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16
Q

How much potassium does a patient require each dayt?

A

Around 40mmol/L a day (put 20mmol of KCl/day in 2 bags)

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17
Q

What is the prophylactic dose of LMWH?

A

5000 units

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18
Q

When should metocloperamide be avoided?

A

In patients with Parkinsons disease

In young women as it increases the risk of dyskinesias

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19
Q

Which anti-emetic is best for patients with heart failure?

A

Metocloperamide 10mg 8 hourly IM/IV

20
Q

What is the first line treatment for patients with neuropathic pain?

A

Amitryptilline or Pregabalin

21
Q

Which weight threshold means that you reduce paracetamol dose?

A

Body weight of 50kg

22
Q

Some side effects (including neurological) of anti-muscarinic drugs

A

Eg. Oxybutynin

Increased confusion, pupillary dilation with loss of accommodation, dry mouth and tachycardia (after transient bradycardia)

23
Q

Which drugs should not be taken/used with caution alongside methotrexate?

A

Methotrexate can cause renal impairment so any medications that can lead to this same outcome should be used with caution.

24
Q

What are the consequences of using calcium channel blockers and beta blockers together?

A

They are both rate limiting drugs so can therefore result in a

  • bradycardia
  • asystole
  • hypotension
25
Q

Causes of hypernatraemia?

A

All begin with a D

  • Dehydration
  • Drips
  • Drugs - effervescent tablets with a high sodium content
  • Diabetes insipidus
26
Q

What are the causes of microcytic anaemia?

A

Thalassaemia

Anaemia of chronic disease

Iron deficiency anaemia

Lead poisoning

Sideroblastic anaemia

27
Q

What are the causes of normocytic anaemia?

A

Anaemia of chronic disease

Acute blood loss

Haemolytic anaemia

Renal failure (chronic)

28
Q

What are the causes of macrocytic anaemia?

A

B12/folate deficiency

Excess alcohol

Liver disease

Hypothyroidism

Haemotological diseases beginning with an M - ‘Megaloblastic’, ‘Myeloproliferative’, ‘Myelodysplastic’, ‘Multiple myeloma’.

29
Q

What are the causes for high neutrophils?

A

Bacterial infection

Tissue damage

Steroids

30
Q

What are the causes for low neutrophils?

A

Viral infection

Chemotherapy

Clozapine

Carbimazole

31
Q

What are the causes for high lymphocytes?

A

Viral infection

Lymphoma

Chronic lymphocytic leukaemia

32
Q

What are the causes of low platelets?

A

Reduced production or increased destruction

Reduced production - drugs, malignancies, infection (usually viral)

Increased destruction - Heparin, hypersplenism, DIC

33
Q

What are the causes of high platelets?

A

Reactive during bleeding, tissue damage, postsplenectomy and malignancies

34
Q

How do you split the different causes of hyponatraemia?

A

Hypovolaemic

Euvolaemic

Hypervolaemic

35
Q

What are the hypovolaemic causes for hyponatraemia?

A

Fluid loss (especially diarrhoea and vomiting)

Addison’s disease

Diuretics (any type)

36
Q

What are the euvolaemic causes of hyponatraemia?

A

Syndrome of inappropriate antidiuretic hormone (SIADH)

Psychogenic polydipsia

Hypothyroidism

37
Q

What are the causes of hypervolaemic hyponatraemia?

A

Heart failure and renal failure are the most common causes

38
Q

What are the causes of hypokalaemia?

A

DIRE

Drugs (loop and thiazide diuretics)

Inadequate intake or intestinal loss (diarrhoea/vomiting)

Renal tubular acidosis

Endocrine (Cushing’s and Conn’s syndrome)

39
Q

What are the causes of hyperkalaemia?

A

DREAD

Drugs (potassium sparing diuretics and ACE inhibitors)

Renal failure

Endocrine (Addison’s disease)

Artefact (very common due to clotted sample)

DKA (note that when insulin is given to treat DKA the potassium drops, requiring regular (hourly) monitoring +/- replacement

40
Q

If a patient has a raised urea with a normal creatinine and unaffected/unchanged eGFR, what is this likely to indicate?

A

You should check the haemoglobin as the patient has likely had an UGIB.

41
Q

What are some of the features of Digoxin toxicity?

A

Confusion

Nausea

Visual halos

Arrythmias

42
Q

What are some of the signs of Lithium toxicity?

A

Tremor (coarse)

Oliguria

X - ataXia

I - Increased reflexes

C - confusion, coma, decreased consciousness

43
Q

What are some of the signs of phenytoin toxicity?

A

Gum hypertrophy

Ataxia

Nystagmus

Peripheral neuropathy

Teratogenicity

44
Q

What are some of the side effects from Gentamicin and Vancomycin toxicity?

A

Nephrotoxicity and Ototoxicity

45
Q

Important side effect of carbamazepine?

A

Can cause hyponatraemia

PSA exam cards (1 decks)

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