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My Pham Notes > Chapter 14, 15 & 16: Vaccines, anaesthesia, emergency treatment of poisoning > Flashcards

Chapter 14, 15 & 16: Vaccines, anaesthesia, emergency treatment of poisoning Flashcards

1
Q

What vaccines are indicated for a patient with Sickle cell anaemia for prophylaxis of infection?

A

Pneumonococcal vaccineInfluenza type B vaccine+ Anual Influenza vaccinePoss Hepatitis BProphylactic penicillins also consideredRemember HYDROXYCARBAMIDE (anti-cancer drug) can reduce the frequency of sickle cell crises!!

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2
Q

Which anti-malarial treatment is suitable for short trips as it only needs to be taken for 1-2 days before and 7 days after the trip?

A

Malarone- Proguanil + Atovaquone

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3
Q

Which antibiotic can be used for malarial prophylaxis?

A

Doxycycline

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4
Q

How long is malarial prophylaxis usually indicated for after leaving the area?

A

4 weeks(apart from malarone- 7 days)

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5
Q

Any illness within __ months of returning from travel to a malarial region should be referred to their GP

A

within 3 months especially

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6
Q

Which anti-malarials are unsuitable for a patient with a history of EPILEPSY?

A

ChloroquineMefloquineEMC (epilepsy)

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7
Q

Which anti-malarial is to be avoided in renal impairment?

A

Proguanil

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8
Q

Which two anti-malarials can be continued at their normal doses in pregnancy?

A

ChloroquineProguanilCPP (pregnancy)

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9
Q

Which drug, safe to be used in pregnant women at the usual dose, should folic acid be taken with?

A

ProguanilEspecially in 1st trimester

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10
Q

Where travels require two different regimens for two diff areas, what should be done?

A

Regimen for the higher risk area should be used for the whole journey

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11
Q

Which antibiotic, that can be used for falciparum malaria treatment, should be avoided in pregnancy?

A

Doxycycline- effects teeth and bone developmentQuinine and clindamycin used instead

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12
Q

What anti-malarial drug can possibly cause ocular toxicity when its used at higher doses for Rhumatoid Arthritis / Lupus etc?

A

ChloroquineHydroxychloroquine also causes this

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13
Q

Which anti malarial drug has been associated with neuropsychiatric reactions, and should be discontinued if patients experience nightmares, anxiety, depression, confusion?

A

MefoloquineIt is contraindicated in those with a history of psychiatric disorders or convulsions.

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14
Q

What drug do impregnated mosquito nets contain?

A

Permethrin

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15
Q

Incubation period for whooping cough

A

6 - 21 days

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16
Q

Incubation period for chicken pox

A

7 - 21 days (1-3 weeks)

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17
Q

Incubation period for mumps

A

14 - 21 days

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18
Q

Incubation period for rubella (german measles)

A

14 - 21 days

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19
Q

Incubation period for measles

A

7 - 14 days

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20
Q

Which vaccine leaves a blister immediately after/ a crusty spot (papule) at the injection site 2-6 weeks after it?

A

TB (BCG) VaccineIt usually leaves a small scar

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21
Q

When is the TB (BCG) vaccine given?

A

babies (neonate), children and adults under the age of 35 who are considered at risk of catching tuberculosis (TB). Not given to anyone over the age of 35, as there’s no evidence that it works for people in this age group

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22
Q

When is the 5 in 1 DTaP/IPV/Hib Jab first doses given?DiptheriaTetanusPertussis (whooping cough)PolioHeamophilus influenza type B

A

2 months 3 month4 months (8,12,16 weeks)remember: 5 in 1 = 2, 3, 4

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23
Q

When is the Pneumococcal vaccine (PCV) given? And booster?

A

2 months4 months Booster 12-13 months

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24
Q

When is Meningitis C first vaccine doses given?And booster ?

A

3 months4 months Booster :12-13 months

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25
Q

When is rotavirus (stomach bug) vaccine given?

A

2 months3 months

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26
Q

When is the Meningitis C/ heamophilus influenza B (Hib) booster given?

A

12 - 13 months

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27
Q

When is the pneumococcal vaccine (PCV) booster given?

A

12 -13 months

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28
Q

When is the first dose of the MMR jab given?

A

12- 13 months

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29
Q

The 5 in 1 DTap/IPV/Hib vaccine is firstly given at 2,3,4 months old. A Heamophillus influenza B (Hib) booster is then given at 12 months with Men C. When is the next dose, containing only diphtheria, polio, tetanus and pertussis, given?

A

Between 3 years 4 months and 5 years (before they start school)

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30
Q

How many doses of the 5 in 1 (DTaP/ IPV/ Hib) vaccine is there in total?

A

3 doses to start, then a another of Hib at 12 months and the rest at 3 years 4 months, then a fifth dose of just Tetanus, Diptheria and Polio needed in high school (13-18 years)Remember it is active against 5 in 1 and5 doses doses

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31
Q

What vaccine is given to girls aged 12- 13 years?

A

HPV (human papillomavirus- cervical cancer) 2 dose schedule: first 11- 13 years (must be given before 15), second 6-12 months later

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32
Q

When is the final dose of Tetanus, diphtheria and polio (only 3 of the 5 in 1 jab) given?

A

13-18 years

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33
Q

When is the (newly introduced 2015) children annual LIVE nasal spray flu vaccine (FLUENZ) given?

A

2, 3, 4 years for sureThose in their 1st and 2nd year school (5+ 6 years) possiblyIf they are at particular risk they can get it up to 17 years

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34
Q

Adults aged __ and over are eligible for the NHS Flu Jab free?

A

65

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35
Q

Mr H has a BMI of 36. What jab does this make him eligible for free of charge?

A

NHS Flu JabFree for those very overweight

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36
Q

Mrs M has been on long term corticosteroid therapy for her stage 5 Asthma. What vaccine is she eligible for and why?

A

Flu vaccine Long term steroids: immune system suppressed. Asthma

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37
Q

What 6 ingredients do vaccines sometimes contains, excluding the virus itself?

A

Thiomersal (mercury, a preservative)Aluminium adjuvants: inactive vaccine adsorbed onto aluminium to enhance immune responseStabilizers: Gelatine, AlbuminFormaldehydeAntibioticsEggs

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38
Q

Neonates at risk should receive what two vaccines?

A

BCG (TB)Hepatitis B

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39
Q

Give examples of LIVE vaccines?

A

MMR

BCG

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40
Q

What age can the meningitis C vaccine booster be given?

A

13 - 15 years

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41
Q

What vaccine is indicated for women of child bearing age if they have not previously received the 2 jabs for it?

A

MMR vaccineBut must exclude pregnancy before hand! do not give vaccines to pregnant women bar the flu vaccine

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42
Q

What vaccine is indicated for 70 year olds (hint: not the flu vaccine- over 65s)

A

Varicella zoster vaccine (shingles)

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43
Q

What vaccine is indicated for parenteral drug misusers?

A

Hep B

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44
Q

Patients with certain medical conditions such as asthma, COPD, neurological conditions, diabetes, HIV, are eligible for the flu vaccine from what age?

A

6 months!

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45
Q

Food hygiene is recommended in areas where there is poor sanitation to prevent what diseases?

A

Hepatitis ATyphoidCholera Travellers diarrhoea

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46
Q

Food hygeine is recommended in areas where there is poor sanitation. This involves sticking to hot, freshly prepared foods and avoiding what?

A

Green salads, uncooked vegetablesOnly eat fruit that can be peeledOnly bottled water or tap water that has been boiled or treated with sterilising tablets

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47
Q

When should LIVE vaccines be avoided?

A

In individuals who are immunocompromised

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48
Q

How should post-vaccine pyrexia be managed in infants (1-12 months)?

A

Paracetamol (dose for over 2 months: 60mg [2.5ml] followed by second dose 4-6 hours later if needed)Can use Ibuprofen if needed: for over 3 months

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49
Q

How long does the yellow fever vaccine provide immunity for before requiring re-vaccination?

A

10 years

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50
Q

How long can doxycycline be used for malaria prophylaxis?

A

2 years

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51
Q

Is DEET safe to use in pregnancy and breast feeding?

A

No

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52
Q

Is there a link between the MMR vaccine and bowel disease/ Autism?

A

NO- CSM have ruled this out

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53
Q

Can the MMR vaccine be given if a child is hypersensitive to Eggs?

A

Yes!

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54
Q

What are the common SE’s of the MMR jab?

A

Malaise, fever, rash - can occur a week after the vaccine

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55
Q

Can MMR and Yellow fever vaccines be given on the same day?

A

No- leave at least 4 week interval

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56
Q

Can antipyretics/ analgesics (paracetamol etc) be given BEFORE live vaccine administration?

A

No- may decrease immune response so avoid before but can give it after

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57
Q

If two live vaccines need to be given, when should they be given?

A

Give them on the same day- if not possible then give 4 weeks apart. this is so that you reduce the interference of immune response to the first vaccine by the second one. NB: a Live and an inactive vaccine may be given at any time in relation to each other… same with parenteral and intranasal.

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58
Q

Pregnant women can be vaccinated against ____ at 28-32 weeks pregnancy and pass it onto their newborn?

A

Pertussis (whooping cough)

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59
Q

Antibodies of human origin are termed as what?

A

Immunoglobulins

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60
Q

What are the two types of human immunoglobulin?

A

NormalDisease- specific

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61
Q

Normal immunoglobulin is available from regional Public health labs for the control and outbreak of what 3 conditions?For any other indications, where should the immunoglobulins be purchased from?

A

Hepatitis A MeaslesRubellaAll other indications- purchased from the manufacturer

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62
Q

What disease-specific immunoglobulin would you not be able to get from public health labs?

A

Tetanus - get this from manufacturer, hospital pharmacies

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63
Q

True or false:Hepatitis B immunoglobulin required by transplant centres should be obtained commercially

A

TRUE

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64
Q

How is normal immunoglobulin administered for protection of conditions?

A

Intramuscular injection

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65
Q

What is normal immunoglobulin?

A

Non-specificHas antibodies for conditions such as measles, mumps, rubella, Hepatitis A and other viruses that would affect the general population

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66
Q

After how long of an injection of normal immunoglobulin are you protected?

A

Immediately

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67
Q

Normal immunglobulin for protection is administered via IM. For what indication would you give it IV?

A

Replacement therapy

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68
Q

Is immunoglobulin recommended for Hep A protection in travellers?

A

No Hep A vaccine by itself is recommended for individuals visiting high risk areas

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69
Q

Public Health England recommends normal immunoglobulin in addition to Hep A vaccine in which individuals?

A
  • If in close contact with Hep A positive people- > 60 years- Chronic liver disease/Hep B or C positive- HIV infection
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70
Q

In non-immune patients who have had exposure to measles can be given the MMR vaccine, although this is not suitable for prophylaxis as the effect is too slow. In what patient groups would this be inappropriate for, and what should be given instead?

A

IM normal immunoglobulin for the following patient groups:Non-immune pregnant women (if clinically appropriate- it will not prevent infection but may prevent clinical attack)Infants under 9 months

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71
Q

True or false: After a pregnant woman is exposed to rubella, it is recommended they have IM immunoglobulin to prevent infection

A

No It is not recommended and it does not prevent infection in non-immune patients. However, it may reduce the risk of a clinical attack so may reduce the risk to the foetusIt should only be used if termination of pregnancy is not possible, and should be given as soon after the exposure

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72
Q

Risk of rubella transmission in pregnant women to the foetus is greatest in the first how many weeks of gestation?

A

Great risk in the first 11 weeks

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73
Q

Females of childbearing age should avoid getting pregnant until how long after getting the MMR vaccine?

A

At least 4 weeks

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74
Q

True or false:Pregnant women should have the MMR vaccine

A

False Live vaccines should not be administered routinely to pregnant women because of the theoretical risk of fetal infection but where there is a significant risk of exposure to disease

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75
Q

If a patient requires rabies prophylaxis after a bite, where should the rabies immunglobulin be administered?

A

Bite should be washed with soapy waterAll of the dose should be injected around the site of the wound; if this is difficult or the wound has completely healed it can be given in the thigh (remote from the site used for vaccination).

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76
Q

If a patient is bitten in a high risk rabies area, what should happen?

A

Bite should be washed with soapy water Specific rabies immunoglobulin should be injected into site of wound when possible (if not, thigh) Rabies vaccine should also be given IM at a different site

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77
Q

How do you manage tetanus prone wounds?

A

Tetanus immunoglobulin should be used Wound cleansingAntibacterial prophylaxis if appropriate (Ben Pen, co-amox, or metronidazole)Tetanus vaccine

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78
Q

How do you treat established cases of tetanus?

A

Tetanus immunoglobulin MetronidazoleWound cleansing

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79
Q

Varicella-zoster immunoglobulin is recommended in what patient groups?

A

Increased risk of severe infection in those who have few/no antibodies to the virus:Neonates, pregnant women, immunosuppressed

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80
Q

In immunocompromised patients on long term antiviral prophylaxis, if they are exposed to the virus, what is the recommendation regarding their antiviral prophylaxis?

A

Increase the dose temporarily

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81
Q

Immunosuppressed patients receiving regular intravenous immunoglobulin replacement therapy only require varicella-zoster immunoglobulin if the most recent dose was administered more than how many weeks before exposure?

A

3 weeks

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82
Q

What is the anti-D (Rho) immunoglobulin used for?

A

In rhesus-negative pregnant women to prevent sensitisation if e.g. gives birth to a rhesus-positive baby

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83
Q

Is the MMR vaccine live or inactivated?

A

Live

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84
Q

Is the BCG vaccine live or inactivated?

A

Live

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85
Q

Is the influenza vaccine live or inactivated?

A

Inactivated

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86
Q

Are live or inactivated vaccines more likely to require booster injections?

A

Inactivated

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87
Q

Vaccination in HIV depends on their immunity status, however there are 3 vaccines that should always be avoided. What are these?

A

BCGTyphoidYellow fever

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88
Q

What vaccines are recommended in asplenic patients?

A

InfluenzaPneumococcalHaemophilus influenza type B with meningococcal type CMeniningococcal (B and ACWY)

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89
Q

From what age is the influenza vaccine recommended in adults?

A

65 years

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90
Q

From what age is the pneumococcal vaccine recommended in adults?

A

65 years

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91
Q

From what age is the varicella-zoster vaccine recommended in adults?

A

70 years(At 80 years, they are no longer eligible)

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92
Q

How is the cholera vaccine given?

A

Orally

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93
Q

How long does the diphtheria vaccine last?

A

10 years

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94
Q

A Hep A booster dose is given how long after the initial dose?

A

6-12 months after

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95
Q

Primary immunisation of Hep B requires how many doses?

A

3

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96
Q

HPV vaccination is how many doses if the first dose is given before 15 years of age?What time frame?

A

2 Second dose to be given 6-24 months after the initial one

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97
Q

HPV vaccination is how many doses if the first dose is given after 15 years of age?Within what time frame?

A

3 All in the space of a 12 month period

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98
Q

What are the ideal months for influenza vaccination?

A

Between September and early November

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99
Q

True or false:People with diabetes are recommended to get the flu vaccine

A

TRUE

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100
Q

True or false:Morbidly obese patients are recommended to get the flu vaccine

A

TRUE

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101
Q

What is the MMR vaccination regimen in children?

A

2 doses1st dose at 1 year of age2nd dose at 3 years 4 months (before starting school)

102
Q

Menningococcal vaccination is not recommended after what age?

A

25 years

103
Q

Pertussis vaccine is prophylaxis against what condition?

A

Whooping cough

104
Q

What book can you refer to if you need advice of immunisation against infectious diseases?

A

Green Book

105
Q

Is the rabies vaccine indicated in pregnancy?

A

Yes if there is substantial risk of exposure to rabies and rapid access to post-exposure prophylaxis is likely to be limited.

106
Q

The rotavirus vaccine is given via what formulation?

A

Oral suspension

107
Q

For tetanus prone wounds, what antibacterial prophylaxis options are there/

A

Ben Pen, co-amox or metronidazole

108
Q

Typhoid vaccine comes in what 2 formulations?

A

Oral capsuleIM injection

109
Q

How long does the typhoid vaccine last for?However, how often should you have a booster if typhoid risk continues?

A

Lasts for 10 yearsBooster every 3 years if risk continues

110
Q

How long does the yellow fever vaccine last?

A

10 years is the accepted time period(However probably lasts for life)

111
Q

In areas where sanitation is poor, good food hygiene is important to prevent what 4 conditions?

A

Hepatitis ATyphoidCholeraOther diarrhoea diseases

112
Q

What website can healthcare professionals and travellers go on to find the latest information on immunisation whilst travelling?

A

Nathnac

113
Q

What is the MHRA warning regarding vaccines?

A

Reports of death in neonates receiving live vaccines following exposure to TNF-a

114
Q

IM vaccines should not be given to what group of patients?What is the alternative route of administration that should be done in these patients?

A

Those with bleeding disorders e.g. thrombocytopenia, haemophiliaDeep subcut is an alternative

115
Q

What is the advice regarding a patient needing MMR and yellow fever vaccine?

A

MMR vaccine should not be administered on the same day as yellow fever vaccine; there should be a 4-week minimum interval between the vaccines

116
Q

What is the advice regarding a patient needing MMR and varicella-zoster vaccine?

A

MMR and varicella-zoster vaccine can be given on the same day or separated by a 4-week minimum interval.

117
Q

What is the green book advice regarding immunisation in children born to mothers receiving immunosuppressant biological therapy?

A

Live vaccines should be delayed until 6 months of ageSo not eligible to receive rotavirus then

118
Q

What is the advice regarding pregnant women receiving live vaccines?

A

Should not happen due to risk of foetal infection Should not travel to high risk areas but if this is not possible, the vaccine must be given as the benefit outweighs the risk

119
Q

What is the risk of patients with adrenal atrophy (resulting from long-term corticosteroids) undergoing surgery?How is this avoided?

A

Fall in blood pressure unless corticosteroid cover is provided during anaesthesia and in the immediate post-op period

120
Q

What do you need to consider in patients undergoing surgery who are on MAOIs?

A

Interactions with drugs used in surgery e.g. pethidine

121
Q

TCAs don’t need to be stopped for surgery, but what is the risk associated with these during the surgical period?

A

Risk of arrhythmias and hypotension NB - there may be dangerous interactions with vasodilator drugs

122
Q

When should lithium be stopped before major surgery?

A

24 hours before

123
Q

For minor surgery, how are patients on lithium managed?

A

Continue lithium at normal dose but monitor fluid and electrolytes

124
Q

Why would potassium sparing diuretics need to be stopped before surgery?

A

Hyperkalaemia may develop if renal perfusion is impaired or if there is tissue damage

125
Q

How are patients on potassium sparing diuretics managed for surgery?

A

Stop it the morning of surgery

126
Q

How are patients on ACEi and ARBs managed for surgery?Why?

A

Discontinue 24 hours before surgery Severe hypotension can occur after induction of anaesthesia

127
Q

Aspiration of gastric contents can be a complication of anaesthesia, especially in cases like emergency surgery. This can also be the case in patients with GORD / delayed gastric emptying.What is done to prevent this?

A

Prophylaxis against acid aspiration - H2 antagonist orally 1-2 hours before surgery

128
Q

What do you need to ensure in patients receiving neuromuscular blocking drugs (relaxes diaphragm, abdomen, vocal cords) during surgery?

A

Should always have their respiration assisted/controlled until the drug has been inactivated or antagonised

129
Q

What is used to reverse the effects of non-depolarising neuromuscular blocking drugs?

A

Anticholinesterases - neostigmine

130
Q

When adrenaline is being administered with a local anaesthetic, should a low or high concentration of adrenaline be used?

A

Low concentration (no more than 1 in 200,000) - total dose should not exceed 500 micrograms

131
Q

Do local anaesthetics cause dilation or constriction of blood vessels?

A

Dilation

132
Q

Why is adrenaline added to local anasethetic?What is the risk?

A

Diminishes local blood flow, slowing the rate of absorption and thereby prolonging the anaesthetic effect. The risk is ischaemic necrosis so should not be given in digits (toes and fingers) or appendages

133
Q

Local anaesthetic with adrenaline can help prolong the anaesthetic by decreasing blood flow around the area. In what patient groups would you not want to give this with adrenaline?

A

In patients with severe hypertension or unstable cardiac rhythm

134
Q

What is used in lidocaine toxicity?

A

Intralipid

135
Q

What is used for benzodiazepine toxicity?

A

Flumazenil

136
Q

What is used for digoxin toxicity?

A

Digoxin-specific antibody

137
Q

What is used for heparin toxicity?

A

Protamine sulphate

138
Q

What is used for opioid toxicity?

A

Naloxone

139
Q

What is used for paracetamol toxicity?

A

Acetylcysteine

140
Q

What is the MHRA advice surrounding the use of acetylcysteine?

A

Reminder for possible need to continue treatment even after the recommended 3 dose regimen over 21 hoursThis is on an individual patient case-by-case basis

141
Q

What two places can you find information on poisoning?

A

ToxbaseUK National Poisons Information Service

142
Q

Within how much time of poisoning should activated charcoal ideally be taken?

A

Within 1 hour

143
Q

Activated charcoal should not be used in the poisoning of what substances?

A

Petroleum distillates, corrosive substances, alcohols, malathion, cyanides and metal salts including iron and lithium salts

144
Q

What is the treatment of choice for severe aspirin poisoning?

A

Haemodialysis

145
Q

In opioid poisoning, are the patient’s pupils pinpoint or dilated?

A

Pinpoint

146
Q

What is the disadvantage of naloxone administration in opioid poisoning?

A

Has a shorter duration of action of many opioids so may require repeated doses Can however be given via continuous infusion

147
Q

When would you consider the use of activated charcoal in paracetamol overdose?

A

If paracetamol in excess of 150 mg/kg is thought to have been ingested within the previous hour.

148
Q

In what situations would you give acetylcysteine in paracetamol overdose?

A
  • If on the treatment line on the paracetamol overdose graph-Who present 8–24 hours after taking an acute overdose of more than 150 mg/kg of paracetamol- Staggered overdose if ingested more than 150mg/kg, if patient’s risk of toxicity is uncertain- Patients with features of hepatic injury, jaundice
149
Q

When is a paracetamol overdose classed as staggered?

A

If they have taken a toxic dose over more than 1 hour

150
Q

The paracetamol treatment graph is unrelieable in what kind of overdose?

A

Staggered

151
Q

What is the dosing regimen for acetylcysteine in paracetamol overdose?

A

1st infusion for 1 hour 150mg/kg2nd infusion for 4 hours 50mg/kg3rd infusion for 16 hours 100mg/kg

152
Q

Does TCA overdose result in dilated or pinpoint pupils?

A

Dilated

153
Q

What is used to treat bradycardia in acute overdose of beta blockers?

A

Atropine

154
Q

Therapeutic lithium concentrations are usually within what range?

A

0.4–1 mmol/litre

155
Q

What lithium level is associated with serious toxicity?

A

> 2 May need treatment with haemodialysis

156
Q

Oxygen should be administered to patients with what types of poisoning?

A

Cyanide Carbon monoxide

157
Q

What is used for ethylene glycol and methanol poisoning?

A

FomepizoleEthanol

158
Q

All these side effects are linked to suxamethonium except:- Malignant hyperthermia- Hyperkalaemia- Myopathies- Hypertension

A

HypertensionIt is used as part of general anaesthesia and causes hypotension

159
Q

Sodium thiosulphate is used for what type of poisoning?

A

Cyanide

160
Q

For a child born in the UK, what 4 vaccines should they have at 8 weeks?

A

1st 6 in 1 vaccine1st Rotavirus 1st Pneumococcal1st Men B

161
Q

For a child born in the UK, what 2 vaccines should they have at 12 weeks?

A

2nd 6 in 1 vaccine2nd Rotavirus

162
Q

For a child born in the UK, what 3 vaccines should they have at 16 weeks?

A

3rd 6 in 1 vaccine2nd Men B2nd pneumococcal

163
Q

For a child born in the UK, what 2 vaccines and 2 boosters should they have at 12 months?

A

Hib and Men C1st MMRBooster pneumococcal and booster Men B

164
Q

Under the NHS child vaccination programme, what age should healthy children get the flu vaccine and how is this given?

A

Flu vaccine given via nasal spray From the age of 2 to 9 (pre-school to Year 5)

165
Q

For a child born in the UK, what 1 vaccines and 1 booster should they have 13-18 years?

A

3 in 1 booster (diphtheria, tetanus, polio)Men ACWY

166
Q

What does the 6 in 1 vaccine protect against?

A

Diphtheria, tetanus, pertussis (whooping cough), polio, haemophilus influenzae type b (Hib) and hepatitis B

167
Q

True or false: Some flu vaccines contain egg so you need to be careful if the patient has an egg allergy

A

TRUE

168
Q

Can you continue glaucoma medication during surgery?

A

Yes

169
Q

When administering live vaccines, why should the alcohol/disinfectant be allowed to dry before administering?

A

As it may inactivate the vaccine

170
Q

What is the only childhood vaccine where paracetamol is recommended as part as the routine immunisation schedule?

A

Men BDose 1 — 2.5 mL (60 mg) as soon as possible after vaccination.Dose 2 — 2.5 mL (60 mg) 4–6 hours after the first dose.Dose 3 — 2.5 mL (60 mg) 4–6 hours after the second doseOther than this, parents should not routinely give their children paracetamol to prevent fever

171
Q

What is the most widely used IV anaesthetic and why?

A

Propofol Associated with rapid recovery and less hangover effect than other intravenous anaesthetics.

172
Q

What is an advantage of etomidate over propofol in anaesthesia?

A

Causes less hypotension

173
Q

What are the advantages and disadvantages of etomidate for anaesthesia?

A

Rapid recovery without a hangover effectCauses less hypotension However can cause muscle movements but this can be minimised by opioid/benzodiazepine before induction

174
Q

Is ketamine used in anaesthesia?What are the disadvantages?

A

Rarely in adultsIt is used mainly for paediatric anaesthesia, particularly when repeated administration is required (such as for serial burns dressings)The main disadvantage of ketamine is the high incidence of hallucinations, nightmares, and other transient psychotic effects; these can be reduced by a benzodiazepine such as diazepam or midazolam.

175
Q

For inhaled anaesthetics, to prevent hypoxia, the inspired gas mixture must contain what % oxygen at all times?

A

Minimum of 25% oxygenHigher concentrations of oxygen (greater than 30%) are usually required during inhalational anaesthesia when nitrous oxide is being administered.

176
Q

The “flurane” anaesthetics are what formulation?

A

Volatile liquid

177
Q

What is a rare but serious side effect of anaesthesia?What are the symptoms?

A

Malignant hyperthermiaRapid rise in temperature, increased muscle rigidity, tachycardia, and acidosis.

178
Q

What type of anaesthetics carry the highest risk of malignant hyperthermia?

A

Volatile anaesthetics (fluranes)Suxamethonium

179
Q

How do you treat malignant hyperthermia?

A

Dantrolene

180
Q

How do you treat convulsions caused by overdose/poisoning?

A

If over 5 minutes in duration must give IV Diazepam or Lorazepam. If IV not available give buccal midazolam or rectal diazepam.

181
Q

How can you treat toxicity from carbamazepine, phenobarbital, quinine, theophylline or dapsone?

A

Repeated doses of charcoal

182
Q

Symptoms of aspirin poisoning?

A

Hyperventilating, tinnitus, deafness, sweating.

183
Q

How do you treat aspirin poisoning?

A

Treat using charcoal and sodium bicarbonate to increase the urinary excretion (make sure to correct the K+ concentration before)

184
Q

Symptoms of paracetamol poisoning?

A

Nausea and vomiting

185
Q

How do you treat paracetamol poisoning?

A

Acetylcysteine-most effective when given 8 hours after ingestion

186
Q

How do you treat antidepressant poisoning? e.g Tricylic antidepressants, SSRIs

A

Activated charcoal to limit absorption and sodium bicarbonate to increase urinary excretion and stop arrhythmias

187
Q

What TWO drugs can you use to treat dystonia from an overdose on phenothiazines ie chlorpromazine or prochlorpromazine?

A

Procyclidine or diazepam

188
Q

What is used to treat benzodiazepine overdose?

A

Flumazenil

189
Q

What is used to treat a betablocker overdose?

A

Atropine IV (reverses bradycardia)

190
Q

What is used to treat calcium channel blocker overdose? (HINT-4)

A

Charcoal, calcium chloride, calcium gluconate, atropine (for bradycardia)

191
Q

What are the signs of lithium toxicity?

A

> 2mmol/L plasma concentration and symptoms including vomiting, ataxia, tremor, convulsions, coma

192
Q

How do you treat lithium toxicity?

A

Haemodialysis ie increase fluid intake to increase urine output

193
Q

How do you treat a cocaine or MDMA overdose?

A

IV diazepam to reduce agitation and cooling measures to reduce hyperthermia

194
Q

How do you treat iron poisoning?

A

Desferrioxamine mesilate (deferoxamine)

195
Q

Signs of theophylline toxicity?

A

Agitation, tachycardia, hyperglycemia, hypokalaemia

196
Q

How do you treat theophylline toxicity?

A

Repeated doses of activated charcoal, manage hypokalaemia with IV KCL, short acting beta blocker e.g esmolol for severe tachycardia

197
Q

How do you treat digoxin toxicity?

A

Antidote is digifab (a digoxin specific antibody)

198
Q

How do you treat heparin toxicity?

A

Protamine sulphate IV

199
Q

Which drugs are activated charcoal especially effective in? (5)

A
  1. Carbamazepine2. Dapsone3. Phenobarbital4. Quinine5. Theophylline
200
Q

S&S: Alcohol

A

Movement, brain e.g. ataxia and nystagmus

201
Q

S&S: Aspirin

A

Deafness & Tinnitus

202
Q

Treatment Options: Aspirin (3)

A
  1. Activated charcoal2. Sodium bicarbonate3. Dialysis
203
Q

S&S: Opioids

A

Respiratory depression & Pinpoint pupils

204
Q

Treatment: Opioids

A

Naloxone

205
Q

S&S: Paracetamol

A

Initially: Just nausea and vomitingLater: Encephalopathy, haemorrhaging, cerebral oedema

206
Q

Treatment: Paracetamol

A

IV Acetylcysteine - 3 consecutive infusions

207
Q

S&S: TCAs

A

Dry mouth

208
Q

Treatment: TCAs (3)

A
  1. Charcoal2. Sodium bicarbonate3. IV Lorazapam
209
Q

S&S: SSRIs

A

Tremor, nystagmus, sinus tachycardiaSerotonin syndrome: - Confusion, agitation, restlessness- Sweating, HYPERthermia, HYPERtension

210
Q

Treatment: SSRIs (2)

A
  1. Charcoal2. IV lorazapam
211
Q

S&S: Antipsychotics

A

NAME?

212
Q

Treatment: Antipsychotics (2)

A
  1. Charcoal2. Procyclidine for EPSEs
213
Q

S&S: BDZ

A

Drowsiness, Movement disorders & Respiratory depression

214
Q

Treatment: BDZ

A

Charcoal & Flumazenil (specialist)

215
Q

S&S: Beta blockers

A

Bradycardia, Lightheadedness & Hypotension, Hypoglycaemia

216
Q

Treatment: Beta Blockers

A
  1. Atropine2. IV Glucagon
217
Q

S&S: Calcium channel blockers

A

Hypotension, Heart Block, Arrythmias

218
Q

Treatment: Calcium channel blockers (4)

A
  1. Charcoal2. Calcium chloride / Calcium gluconate3. Atropine4. Insulin and glucose
219
Q

S&S: Iron Salts

A

Abdominal pain, vomiting blood & rectal bleeding

220
Q

Treatment: Iron Salts

A

Desferrioxamine mesilate

221
Q

Causes: Lithium (4) - Reduced excretion

A
  1. Dehydration2. Renal function deterioration3. Infections4. Co-administration with NSAIDs/Diuretics
222
Q

S&S: Lithium

A

Weakness, Muscle tremor, Electrolyte imbalance, Dehydration, Hypotension

223
Q

Treatment: Lithium (3)

A
  1. Haemodialysis2. Fluids3. Gastric lavage
224
Q

S&S: Cocaine, ecstasy, amfetamines

A

Wakefulness, Paranoia & Hallucinations

225
Q

Managment: Cocaine, ecstasy, amfetamines

A

Diazepam For ecstasy - methylenedioxymethamfetamine

226
Q

S&S: Theophylline

A

Fast and sick

227
Q

Management: Theophylline (5)

A
  1. Repeated doses of charcoal (MR)2. Ondansetron for vomiting3. IV potassium chloride4. IV lorazapam5. Short acting beat blocker
228
Q

Management: Digoxin

A

Digifab

229
Q

Management: Dabigatran

A

Idarucizumab

230
Q

Management: Warfarin

A

Vitamin K (PHYTOMENADIONE)

231
Q

What is more likely to occur in poisoning, hypertension or hypotension?

A

HypotensionTreat by elevating foot of bed and giving IV sodium chloride or a colloid to increase plasma volume.

232
Q

If someone is having a convulsion as a result of an overdose/ poisoning, what can be done?

A

Leave if under 5 minsIV diazepam or lorazepam (NB benzo’s should NOT be given by IM route)If IV not available:Buccal midazolam (not licensed for adults or children unfer 3 months)Rectal diazepam

233
Q

What is activated charcoal effective at reversing?

A

Poisons in the GI system, reduces absorption, the sooner its given the better, efficacy reduced after 1 hour after ingestion of poison. Repeated doses of charcoal effective for: Carbamazepine, phenobarbital, quinine, theophylline, dapsone.

234
Q

Symptoms of aspirin poisoning? How to treat?

A

hyperventilatingtinnitus!!!deafness !!!sweatingTREAT USING CHARCOAL, SODIUM BICARBONATE TO INCREASE URINARY EXCRETION, CORRECT K+ CONC BEFORE GIVING THIS.

235
Q

What are the early symptoms of paracetamol poisoning? what is the antidote?

A

Nausea and vomitingLiver damage at its max 3-4 days afterAcetylcysteine - most effective when given up to 8 hours after ingestion

236
Q

How to treat antidepressant overdose?

A

Activated charcoal to limit absorptionSodium bicarbonate to stop arrhythmias

237
Q

How could you treat Dystonias resulting from overdose of phenothiazines and related drugs?

A

Procyclidineor Diazepam

238
Q

Overdose of benzo’s?

A

Flumazenil

239
Q

Overdose of beta blockers?

A

Atropine IV- corrects bradycardia

240
Q

How do we treat Calcium channel blocker overdose?

A

CharcoalCalcium chlorideCalcium gluconate Atropine for bradycardia

241
Q

How to treat Lithium toxicity?

A

Heamodyalisisincrease fluid intake to increase urine output (but don’t use diuretics)

242
Q

How to manage Cocaine overdose?

A

IV Diazepam to reduce agitationCooling measures for hyperthermia Similar treatment for ecstasy (MDMA) poisoning

243
Q

What is the treatment for an Iron overdose?

A

desferrioxamine mesilate

244
Q

What are the signs of lithium toxicity? What about if it is severe (i.e. plasma conc over 2.0)?

A

Vomitting Diarrhoea Ataxia (uncontrolled body movement)TremorTwitchingSlurred speech Severe:ConvulsionsComarenal failurehypotension

245
Q

What are the signs of Theophylline toxicity?

A

Hint: theophylline comes from the same family as caffeine. Think what happens when you took too many pro plus?!AgitationRestlessnessDilated pupilsTachycardia Vomiting Hyperglycaemia Severe hypokalaemia may also develop

246
Q

How is theophylline toxicity managed?

A

Repeated doses of activated charcoalManage hypokalaemia with Infusion of potassium chlorideShort acting beta blocker e.g. esmolol for severe tachycardia

247
Q

Somebody has been stung by a bee and has had a severe anaphylactic reaction to it. How should this be managed?

A

EpipenIM adrenaline/ epinephrine

248
Q

Signs of digoxin toxicity?

A

Nausea & vomiting & diarrhoeaabdominal paindizziness & confusion, deliriumvision disturbance (blurred or yellow vision). Cardiac disturbance: irregular heartbeatventricular tachycardia

249
Q

What is the antidote for digoxin toxicity?

A

DigiFabA digoxin specific antibody

250
Q

What is the reversal agent for heparin toxicity?

A

Protamine sulphate injection

251
Q

What is methaemoglobinaemia? What is the reversal agent?

A

Higher than normal level of methemoglobin in the blood caused by oxidative stress. Methemoglobin results in a reduced ability to release oxygen to tissues and thereby hypoxia (tissue death) occurs. Reversal agent: Methylthioninium chloride injection

252
Q

Treatment of iron poisoning?

A

Desferrioxamine mesilate (Deferoxamine) Used for hemochromatosis, a disease of iron accumulation that can be either genetic or acquired

My Pham Notes (22 decks)

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