Chapter 3 Flashcards
Causes of hypernatraemia
4Ds Dehydration Drips (too much saline) Drugs Diabetes insipidus
3 drugs that can cause neutropenia - which symptom would you be most worried about?
Carbimazole (hyperthyroid treatment)
Clozapine
Carbamazepine
Sore throat
2 drugs that can cause thrombocytopenia
Heparin
Penacillamine (RA)
2 drugs that can cause SIADH
Antipsychotics
Carbamazepine
Note that this can cause hyponatraemia
High urea, normal creatinine, not dehydrated - what is the cause?
Upper GI bleed
Which drugs can cause neutrophilia?
Steroids
Blood change - steroids
Neutrophilia
Blood change - heparin
Thrombocytopenia
Blood change - penacillamine
Thrombocytopenia
Blood change - clozapine
Neutropenia
Blood change - carbimazole
Neutropenia
Electrolyte disturbance - ACEinhibs
Hyperkalaemia
Electrolyte disturbance - K+ sparing diuretics
Hyperkalaemia
5 drugs that can cause an intrinsic AKI
ACEinhibs NSAIDs Gentamicin Vancomycin Tetracyclines
3 drugs that can cause intrahepatic deranged LFTs
Statins
paracetamol OD
rifampicin
5 drugs that can cause cholestasis/posthepatic deranged LFTs
Flucloxacillin co-amoxiclav steroids nitrofurantoin sulphonylureas
Which 3 Abx can cause cholestasis?
Flucloxacillin
nitrofurantoin
co-amoxiclav
Which ABG would this give? Rapid breathing due to disease or anxiety
Respiratory alkalosis
Which ABG would this give? COPD, restrictive chest wall problems
Respiratory acidosis
Which ABG would this give? Vomiting, diuretics, Conn’s, eating disorders
Metabolic alkalosis
Which ABG would this give? DKA, renal failure, alcohol
Metabolic acidosis
Hyperkalaemia - which ABG?
Metabolic acidosis
Hypokalaemia - which ABG?
Metabolic alkalosis
Which drug can cause ST depression?
Digoxin
6 main drugs that require monitoring
Digoxin Phenytoin Theophylline Lithium Vancomycin Gentamicin
Sign of toxicity of what? Visual halos
Digoxin
Sign of toxicity for what? Diabetes insipidus
Lithium
Sign of toxicity for what? Gingival hypertrophy
Phenytoin
Ciclosporin
Sign of toxicity for what? Ataxia
Phenytoin
Sign of toxicity for what? Nystagmus
Phenytoin
Sign of toxicity for what? Peripheral neuropathy
Phenytoin
Sign of toxicity for what? Ototoxicity, nephrotoxicity
Vancomycin
Gentamicin
Sign of toxicity for what? Tremor
Lithium
Most patients are on a high dose, once daily regimen of what dose of gentamicin?
5-7mg/kg
Some patients can be on a divided daily dose of gentamicin
Who?
How often?
How much?
Severe renal failure (GFR<20) - 12 hourly
Infective endocarditis - 8 hourly
1-2mg/kg
Which dose regimen of gentamicin requires measuring serum concs at particular times and adjusting frequency accordingly?
By how much would you adjust the frequency?
Once daily dosing
12 hours
Which dose regimen of gentamicin requires measuring peaks (when?) and troughs (when?)
If the peak is out of range, what do you do?
If the trough is out of range, what do you do?
Who are ranges different for?
Divided daily dosing
Adjust dose
Adjust interval
Infective endocarditis
When can you start plotting a paracetamol normogram to see whether they are eligible for NAC treatment?
4 hours post ingestion
Target INR on warfarin
Target INR if recurrent VTE or metal heart valves
- 5
3. 5
In whom is target INR 3.5?
Recurrent VTE
Metal heart valves
Name the problem to which this is the solution:
1) Stop warfarin
2) Give 5mg IV phytomenadione
3) Give prothrombin complex
Major bleed
Name the problem to which this is the solution:
1) Stop warfarin for 2 days
2) Reduce dose
INR 5-8 no bleed
Name the problem to which this is the solution:
1) Stop warfarin
2) IV phytomenadione
3) Restart warfarin when INR<5
INR >5, minor bleed
Name the problem to which this is the solution:
1) Stop warfarin
2) Oral phytomenadione
3) Restart warfarin when INR<5
INR >8, no bleed
What is the protocol for a major bleed?
Look up oral anticoagulant treatment summary on BNF
1) Stop warfarin
2) 5mg IV phytomenadione
3) Dried prothrombin complex
When would you just reduce the dose of warfarin
INR 2.5-5
Common anticonvulsant known to cause hyponatraemia
Carbamazepine (through SIADH!)
Electrolyte disturbance - carbamazepine
Hyponatraemia (through SIADH!)
In a seizing patient, when should you start IV lorazepam?
After 5 minutes
Sign of toxicity for what? Arrhythmias
Lithium, digoxin
Sign of toxicity for what? Teratogenicity
Phenytoin
