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PSA > communicating info > Flashcards

communicating info Flashcards

1
Q

Allopurinol- stop

A

stop immediately if rash - severe cutaneous adverse reaction (SCAR), drug reaction with eosinophilia and systemic symptoms (DRESS), SJS

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2
Q

allopurinol initiated

A

delay until inflammation settled.
100mg od with titration to serum uric acid <300umol/l. lower if reduced GFR.
Colchine

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3
Q

allopurinol- indications

A

after first gout attack. especially if >= 2 attacks in 12 months. tophi, renal disease, uric acid stones, prophylaxis for cytotoxics or diuretics. Lesch-Nyhan lifelong.

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4
Q

allopurinol interactions

A

azathioprine: high levels of 6-mercaptopurine, use 25% dose if must co-prescribe.
Cyclophosphamide: reduces renal clearance therefore marrow toxicity.
Theophylline: increases plasma conc and inhibits breakdown.

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5
Q

aspirin potentiates

A

oral hypoglycaemics, warfarin, steroids.

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6
Q

aspirin indication

A

IHD

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7
Q

asprin contraindication

A

under 16 due to reyes syndrome, unless kawasaki

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8
Q

verapamil- indications

A

angina, HTN, arrhthmias.

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9
Q

verapamil- cautions and se

A

NOT WITH BETA BLOCKERS- heart block. SE: heart failure, constipation, hypotension, bradycardia, flushing

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10
Q

Diltiazem- indications

A

angina, hypertension.

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11
Q

Diltiazem- se and cautions

A

caution with hf and beta blockesr. SE: hypotension, bradycardia, hf, ankle swelling

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12
Q

nifedipine, amlodipine, felodipine - indications

A

HTN, angina, raynauds. dihydropyridines.

Peripheral smooth vascular muscle. SE: flushing, headache, ankle swelling.

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13
Q

Ciclosporin- how

A

T cell reduces clonal proliferations by reducing IL-2.

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14
Q

Ciclosporin- se

A

increased fluid, BP, K, hair, gums, glucose.
neprhotox, hepatotox, fluid retention, hypertenision, hyperk, hypertrichosis, gingical hyperplasia, tremor, impaired glucose tolerance, hyperlipid, susceptible to sev infection.

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15
Q

ciclosporin- indications

A

organ transplantation, RA, psoriasis, UC, red cell aplasia.

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16
Q

digoxin mechanism

A

increases cardiac muscle contraction force with inhibition of na/k atpase pump, and vagal stimulation. slows av node conductino slowing ventricular rate in af.

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17
Q

digoxin monitoring

A

only in suspected toxicity. measured 8-12 hours after last dose.

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18
Q

digoxin toxicity range

A

can be toxic even in thereaputic range. liklihood from 1.5-3mcg/l.

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19
Q

digoxin tox sx

A

unwell, lethargy, N&V, anorexia, confusion, yellow green vision, arrhthmias (av block, bradycardia), gynaecomastia.

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20
Q

digoxin tox causes

A

hypokalaemia (more easily bound to na/k pump. thiazides and loop), age, renal failure, MI, low mag, high ca, high na, acidosis, low abulmin, hypothermia.
Drugs: amiodarone, quinidine, verapamil, diltiazem, spironolactone( competes for secretion from distal convoluted tubule therefore reduced excretion), ciclosporin,

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21
Q

digoxin tox mx

A

digibind, correct arrhythmias, monitor K

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22
Q

gentamicin- indication

A

IE, topical for otitis externa

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23
Q

gentamicin adverse effects

A

ototoxicity- auditory or vestibular nerve damage irreversible.
nephrotoxicity- acculumates in renal filaure, acute tubular necroriss. increased risk with furosemid. lower dose and more frequent monitoring.

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24
Q

gentamicin CI

A

myasthenia gravis

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25
Q

gentamicin dosing

A

monitor plasma conc. both peak (1hr post adm, and trough (just before next dose) meausred. if trough level is high the interval between doses is increased. if peak dose high then decrease dose.

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26
Q

heparin indications

A

activate antithrombin iii. unfractionated: thrombin, xa, ixa xia xiia inhibit. LMWH incrases antithrombin ii on factor xa.

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27
Q

heparin adverse effects

A

bleeding, thrombocytopaenai, osteoporisis , high k

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28
Q

standard heparin

A

IV, short acting. for high risk of bleeding, rapid termination, and renal failure.
. bleeding and heparin induced thrombocytopaenia (HIT) and osteoporosis (lower risk in LMWH).

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29
Q

heparin monitoring

A

standard- APTT. LMWH: anti-factor Xa (not routine).

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30
Q

HIT

A

Heparin induced thrombocytopaenia. immune mediated ,abs form to platelet factor 4 and heparin complexes. bind to platelet and induce activation. 5-10 days after tx. low platelets but prothrombotic. >50% reduction in platelets, thrombosis, skin allergy.

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31
Q

heparin od

A

protamine sulphate, only partially revers with LMWH

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32
Q

Lithium therapueitc range

A

0.4-1mmol/l

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33
Q

lithium toxicity causes

A

dehydration, renal failure, diuretics (thiazides), ace in, arb, nsaiods, metronidazole/

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34
Q

lithium tox range

A

> 1.5mmol/l

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35
Q

lithium tox sx

A

coarse tremor, hyperreflexia, acute confusion, polyuria, seizure, coma

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36
Q

liothium tox mx

A

volume resuscitation with normal saline, haemodialysis, sodium bicarbonate (urinary alkilinsation).

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37
Q

macrolides examples

A

erythromycin, clarithromycin, azithromycin.

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38
Q

macrolide adverse effects

A

prolonged qt, gi side effects, cholestatic jaundice, P450 inhibit, azithromycin associated with hearing loss and tinnitius.

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39
Q

macrolide interaction

A

statins stopped as inhibit p450 so increases myopathy and rhabdomyolysis.

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40
Q

metformin

A

biguanide. t2dm, polycysitc ovarian syndrome and nash

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41
Q

metform mechanism

A

activates ampk, increases insulin sens, decresases hepatic gluconeogenesis, reduce gi carb abs.

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42
Q

metformin adverse effects

A

gi upset (nausea, anorexia, diarrhoea), reduced b12 abs, lactic acidosis (sev liver disease or renal failure)

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43
Q

metformin contraindications

A

CKD (review if cr >130 or gfr <45 or stopped if cr >150 or gfr <30)
lactic acidosis- recent mi, sepsis, aki, dehydration.
idodine containing contraast media: peripheral arterial angiography, coronary angiography, IVP. discontinue on day and 48 hours after
alcohol relative.

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44
Q

starting metformin

A

titrate up to reduce gi se. modified release if se difficult.

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45
Q

octreotide

A

long acting analogue somatositatin.

d cells of pancrease inhibits growth hormone, glucagon and insulin.

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46
Q

octretide uses

A

variceal haemorrhage, acromegaly, carcinoid syndrome, pancreatic surgey complications, VIPoma, refractory diarrhoea.

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47
Q

octreotide adverse effects

A

gallstones (secondary to biliary stasis)

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48
Q

paracetamol od mx

A

activated charcoal if <1hr.
N-acetylcysteine (NAC)- if staggered od, doubt of time of ingestion OR plasma con on or above treatment line of 100mg/l at 4 hours and 15mg/l at 15 hours, regardless of RF for hepatotox.
Infused over 1 hour (reduce anaphylatoid reactions).
liver transplant- kings college hospital criteria.

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49
Q

Salicylate od mx

A

urinary alkalinisation with iv bicarb. haemodialysis

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50
Q

opiod od

A

naloxone

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51
Q

benzodiazepine od

A

fulmazenil. supportive care. risk of seizures with fulmazenil. only really used in severe and iatrogenic

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52
Q

TCA od

A 
Iv bicarb (reduce seizure risk and arrythmias
Quinidine antiarrhymia class 1a, 1c (flecainide) are contraindicated as prolong depolarisation. correct acidosis.
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53
Q

lithium od

A

mild-mod- fluid resus with normal saline. haemodialysis. sodium bicarb- urinary alkinisation–> promotes excretion

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54
Q

warfarin od

A

vit k, prothrombin complex

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55
Q

heparin od

A

protamine sulphate

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56
Q

beta blocker od

A

if bradycardia: atropine

if resistant glucagon

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57
Q

ethylene glycol od

A

ethanol (competitive for alcohol dehydrogenase), limits toxic metabolites. fomepizole (inhibits alcohol dehydrogenase). haemodialsysi.

58
Q

methanol od

A

fomepizole or ethanol, haemodialysis

59
Q

organophosphate/insecticide

A

atropine

60
Q

digoxin od

A

digibind (digoxin specific antibody fragments)

61
Q

iron

A

desferrioxamine (chelation)

62
Q

lead

A

dimercaprol, calcium edetate

63
Q

carbon monoxide

A

100% ox, hyperbaric o2

64
Q

cyanide

A

hydroxocobalamin, amyl nitrite, sodium nitrite and sodium thiosulfate.

65
Q

phosphodiesterase type V inhibitors ex

A

sildenafil (viagra), tadalafil, vardenafil

66
Q

phosphodiesterase type V inhibitors CI

A

patients on nitrates and nicorandil, hypotension, recent stroke/mi (<6months)

67
Q

phosphodiesterase type V inhibitors SE

A

visual disturbances (blue discoloration (BLUE PILLS), non-arteritic anterior ischaemic neuropathy), nasal congestion, flushing, GI, headahce.

68
Q

Potassium sparing diuretics- classification and examples

A 
sodium channel blockers- amiloride, triamterene
aldosterone antagonists (spironolactone, eplerenone)
69
Q

amiloride- type, where works, used?

A

type- sodium channel blocker at distal convoluted tubule. weak. with thiazide/loop to maintatain potassium levels.

70
Q

spironolactone type where use

A

aldosterone antagonist, at cortical collecting duct. used in ascites (secondary hyperaldosteronism)- large dose 100-200mg. HF, nephortic syndrome, conns.

71
Q

asthma cautions

A

nsaids, beta blockers, adenosine.

72
Q

epilepsy cautions

A

alcohol, cocaine, amphetamines,
ciprofloxacin, levofloxacin,
theophylline and aminotheophylline,
bupropion, methylphenidate, mefanamic acid.
withdrawl of benzos, baclofen, hydroxyzine.
and p450 inhib or enhancers

73
Q

HF cautions

A

thaizolidinediones, verampil, nsaids/glucocorticoids (fluid retention), low dose aspirin allowed on risk benefit, class i antiarrythmics (flecainide)

negative ionotropic effects for above.

74
Q

IHD cautions

A

nsaids, oestrogens (cocp, hrt), varenicline

75
Q

renal failure cuations

A

tetracycline, nitrofurantoin, nsaids, lithium, metformin,
dose adjustment for antibiotics, digoxin, atenolol, methotrexate, sulphonylureas, fureosemide, opioids.
safe: erthromycin, rifampicin, diazepam, warfarin

76
Q

pregancy cautions

A

tetracycline, aminoglycosides, sulphonamides, trimethoprim. quinolones.

ACE in, ARB, statins, warfarin, sulfonylureas, retinoids (including topical), cytotoxic.

antiepileptics: sodium valproate, carbaemaqpine, phytoin.

77
Q

quinolones ex

A

ciprofloxacin, levofloxacin. inhibit dna synthesis.

78
Q

quinolones adverse effects

A

lower seizure threshold, tendon damage, cartilage damage (thus not used in children), long QT interval

79
Q

quinolones ci

A

pregnant and breastfeeding, G6PD

80
Q

tamoxifen what and how long

A

serm: selective eostrogen receptor modulator. ER pos cancer 5 years.

81
Q

tamoxifen adverse effects. lower risk?

A

menstrual disturbance, bleeding, amenorrhea, hot flushes, VTE, endometrial cancer. raloxifene pure oestrogen receptor antagonist therefore lower endometrial cancer risk

82
Q

breast feeding allowed abx

A

penicillins, cephalosporins, trimethoprim

83
Q

breast feeding allowed endocrine

A

glucocorticoids, levothyroxine

84
Q

breast feeding allowed epilepsy

A

sodium valporate, carbamazepine

85
Q

breast feeding allowed asthma

A

salbutamol, theophyllines

86
Q

breast feeding allowed psych

A

TCA, antipsych

87
Q

breast feeding allowed HTN

A

beta blockers, hydralazine

88
Q

breast feeding allowed coag

A

warfarin and heparin

89
Q

breast feeding allowed cardio

A

digoxin

90
Q

breast feeding avoid abx

A

ciprofloxacin, tetracycline, chloramphenicol, sulphonamides

91
Q

breast feeding avoid psych

A

lithium benzodiazepine, clozapine.

92
Q

breast feeding avoid cardip

A

aspirin, amiodarone

93
Q

breast feeding avoid others

A

carbimazole, methotrexate, sulfonylureas, cytotoxic.

94
Q

antipyschotics monitoring

A

FBC, U&E, LFT- prior, annual.
lipids, weight- prior, 3 months, annual
fasting glucose, prolactin- begin, 6 months, annual.
BP- baseline, frequently with dose titration
ECG: baseline
cardio risk assessment.
Clozapine: FBC initially weekly

95
Q

VTE prophylaxis assessment

A

medical reduced mobility for 3 + days.
Surgical: hip/knee replacement, hip frac, general with >90mins surgery, pelvic, lower limb with general and >60mins, acute surgical with inflamm or intraabdo, any significant mobility reduction.

RFs: cancer/chemo, >60yrs, clotting disorder, >35 BMI, dehyration, comorb, critical care, HRT, COCP, varicose veins, pregnant/<6wks post partum.

96
Q

types of VTE prophylaxis

A

mechanical and pharm

97
Q

Mechanical VTE prophylaxis

A

anti-embolism compression stockings, intermittent pneumatic compression device.

98
Q

Pharm VTE prophylaxis

A

fondapariunux sodium SC inj
LMWH- enoxaparin reduced dose in renal impairment
UFH- ckd instead of LMWH

99
Q

pre and post surgical vte advise

A

stop cocp/hrt 4 weeks before

mobilisation, hydration

100
Q

hip prophylaxis

A 
LMWH 10 days then aspirin (75or150mcg) for 28 days
or
LMWH for 28 days with stockings until dx
or 
Rivaroxaban
101
Q

elective knee prophylaxis

A 
aspirin (75 or 150mcg) for 14 days. 
or 
LMWH for 14 days with stockings until dx
or 
rivaroxaban
102
Q

fragility frac of pelvis hip, prox femur prophylaxis

A

1 month VTE if risk
LMWH- 6-12 hours post surgery
or
fondaparinux sodium at 6 hours post providing low bleeding risk .

103
Q

SSRI adverse effects

A

GI, GI bleeding (give PPI if on NSAID also), counselled for increased agitation and anxiety after.
fluoxetine and paroxetine increased drug interactions

104
Q

citolopram cardio

A

prolonged qt interval. dose dependent. CI with congenital qt syndrome, or preexisting, or with meds that prlong.
Max dose 40mg adults, 20mg for >65yrs, 20mg for hepatic impairment.

105
Q

SSRI interactions

A

NSAIDs- give PPI
warfarin/heparin- consider mirtazapine
triptans/MAOIs- increase serotonin syndrome risk

106
Q

SSRI initiation

A

reviewed at 2 weeks. review at 1 week if <30 or high suicide risk. continue at least 6 months after remission as reduces relapse

107
Q

SSRI discontinuations

A

mood change, restlessness, sleeping diff, unsteady, sweating, GI sx, paraesthesia.

108
Q

SSRI preganancy

A

risk benefit. first trimester- cardiac deformities
3rd trimester peristent pulmonary hypertension.
Paroxetine: increased congenital malform esp first trimester

109
Q

TCA SE:

A

drowsy, dry mouth, blurred vision, constipation, urinary retention, QT lenghten

110
Q

Retinoids adverse effects

A

teratogenicity- 2 forms of contraception.
dry skin, eyes lips and mouth
low mood
raised triglycerides, hair thinning, nose bleeds, intracranial hypertension, photosens

111
Q

psoriasis triggers

A

trauma, alcohol, beta blockers, liithiym, antimalarias (quinine), NSAIDs, ACE in, infliximab
withdrawl of steroids.

112
Q

POP counselling- starting when, se

A

up to and including day 5- immediate protection. otherwise first 2 days condoms.

same time every day wihtout break

irregular bleeding

113
Q

missed pills pop

A

<3hrs: continue
>3hrs: take missed pill asap, continue with pack and use condoms until pill taking reestablished for 48 hours.

diarrhoea- assume missed but continue taking,
inducers reduce efficaccy.

114
Q

lithium adverse effects

A

n and v, diarrhoea, fine tremor, nephrotox (polyuria, nephorgenic DI, thyroid hypo.
ECG: t wave inversion or flattening.
weight gain
idiopathic intracranial hypertension
leucocytosis
hyperparathyroid, resultant hypercalcaemia

115
Q

lithium monitoring

A

12 hours post dose
at start- weekly and after each change until stable
once established- 3 months lithium level
after dose change- one week later and weekly until stable
TFT, U&E 6 months
info book, alert card, record book

116
Q

GAD mx

A

educatino, active monitoring.
low intensity psych intervention (non-facilitated self-help or induvidual guided self help, or psychoeducational groups.

high intensity psychological intervention (CBT, applied relax), drug treatment.
Specialist input.

DRUGS: sertraline.
SSRI/SNRI (duloxetine, venlafaxine.
pregabalin if not tolerated.

117
Q

paracetmol dose

A

1g QDS

118
Q

ibuprofen dose

A

200-400mcg tds

119
Q

codeine dose

A

30-60mg qds

120
Q

cocodamol 8/500 or 30/500

A

2 tabs qds

121
Q

cyclizine dose

A

50mg tds

122
Q

metoclopramide dose

A

10mg tds

123
Q

amoxicillin dose

A

500mg tds

124
Q

clarithromycin dose

A

500mg bd

125
Q

lansoprozole dose

A

15-30mg od

126
Q

omeprazole dose

A

20-40mg od

127
Q

aspirin dose

A

75-300mg od

128
Q

clopidogrel dose

A

75-300mg od

129
Q

simvastatin dose

A

10-80mg on

130
Q

atenolol dose

A

25-100mg od

131
Q

ramipril dose

A

1.25-10mg od

132
Q

bendroflumethiazide dose

A

2.5mg od

133
Q

furosemide dose

A

20mg od- 80mg bd

134
Q

amlodipine dose

A

5-10mg od

135
Q

levothyroxine dose

A

25-200mcg od

136
Q

metforim dose

A

500mg od - 1g bd

137
Q

COCP CI

A

UKMEC 1: no restriction

2: advantages
3: disadvantages outweigh
4: unacceptable health risk

138
Q

UKMEC 3

A

> 35 yrs, smoking >15 cigareets/day, BMI >35

first degree relative thrombus <45 years, HTN, immbility, BRCA1/2, gallbladder disease, DM diagonsis >20 year

139
Q

UKMEC 4

A

> 35 with >15 cigareets/day, migraine with aura, thromboembolic disease hx, thombogenic mutation, history stroke or IHD, breast feeding <6 weeks pp, uncontrolled HTN, current breast cancer, major surgery prolonged immobilisation. DM diagnosis >20 years.

140
Q

penicillin containing

A

phenoxymethylpenicillin, benzylpenicillin, flucloxacillin, amoxicillin, ampicillin, co-amoxiclav (augmentin), co-fluampici l(magnapen), piperacillin with tazobactam (tazocin), ticarcillin with claculanic acid (timentin)

141
Q

bisphosphonates

A

oral or iv.

daily weekly or monthly.

142
Q

methotrexate

A

weekly

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