Concentrated Questions Flashcards
1
Q
Daily req of water
A
20-30ml/kg/day
2
Q
Daily req of Na/K/CL
A
1mmol / kg / day
3
Q
Daily req of glucose I
A
50-100g/day
4
Q
What is resusc fluids
A
NaCL
NO K!!!
5
Q
How quick do you give resusc fluids
A
15 mins
6
Q
Normal fluids given iver
A
8-12 hours
7
Q
Typical maintenance
A
One salt two sugar with KCL in each sugar
8
Q
If giving multiple bags of NaCl be aware of
A
Hyperchloraemia
9
Q
How much fluid can you prescribe at once
A
No more than 1 day worth
10
Q
Most fluid bags are how many litres
A
1 litre
11
Q
How many bags of NaCl can you give in a day
A
1
12
Q
How much resusc fluids for kids
A
20mls per kg in 15 mins
13
Q
Maintenance fluids for kids
A
100ml /kg/ day first 10kg
50ml/kg/ day next 10kg
20ml/kg/day for weight over 20kg
14
Q
Can’t give aspirin in kids due to
A
Reye’s syndrome
15
Q
What do you need to consider with fluid prescribing post operative my
A
Renal impairment due to either contrast or hypo volaemia
Bleeding intra and post op
16
Q
Stopping warfarin before surgery
A
5 days
17
Q
Stopping noacs before surgery
A
48hoirs
18
Q
When to stop clopidogrel before surgery
A
Hold morning of surgery
19
Q
When do you stop aspirin before surgery
A
7 days before
20
Q
Name 4 drugs you withhold preop to prevent renal impairment
A
ACEI (hold morning of)
Metformin (hold 48 hours pre and post op)
NSAIDS (limit use pre and post op)
Gentamicin (avoid)
21
Q
All surgical pets are prescribed
A
VTE prophylaxis (dalteparin) - different doses for prophylaxis and treatment
22
Q
When do you need to half the dose of paracetamol
A
<50kg or significant renal dysfunction
23
Q
When do you avoid NSAIDS
A
Asthma
Renal impairment
GI ulcer or bleed
24
Q
Morphine is excreted via
A
Kidneys use oxy in impairment
25
4 common side effects of morphine
Itch nausea constipation drowsiness
26
What form of pain relief is given in Pts with poor swallow
Patch
27
5 class of drugs which exhibit anticholinergic activity and hence increased risk of falls and impaired cognition
```
Antidepressants
Antipsychotics
Antiemetics
Antihistamines
Benzos
```
28
What causes hupovokaemix hyponatraemia
D+V
| Diuretics - loops and thiazides
29
What causes euvolaemic hyponatraemia
Hypothyroid
Addisons
SIADH - ppis ssris carbamazepine
30
What causes hupeevolaemic hyponatraemia
Liver failure
Renal failure
Heart failure
31
Drug causes of hyperkalaemia
ACEI
ARBS
Spironolactone / amiloride
Metformin NSAIDS gentamicin ( impair renal excretion)
32
Name 5 drugs which cause hyperglycaemia
```
Olanzapine (2nd gen antipsychotixsh
Pred
Tacrolimis (calcineurin inh)
Beta blockers
Thiazides
```
33
4 drugs which cause hypoglycaemia
Insulin
Sulphonylureas (gliclazide)
Pioglitazone
SGLT2
(NOT Metformin)
34
What is the normal QT
Male <440
| Female <470
35
If long QT and untreated can lead to
Torsades de pointed
36
Treat torsades
Cardio vert and mgso4
37
Name 7 causes of long QT
Antipsychotics (haloperidol/ olanzapine)
Antidepressants (citalopram and venlafaxine)
Antiemetics (ondansetron)
Beta blockers (sotalol)
Flecaimide
Amiodarone
Abx- ciprofloxacin and erythromycin
38
CANNOT CO PRESCRIBE AZATHIOPRINE WITH
allopurinol (risk of life threatening myelosuppressjon)
39
Where is warfarin broken down in the body
Liver
40
INR .....,, by p450 inhibitors
Increases
41
INR ...... by p450 inducers
Decrease
42
Name p450 inhibitors
```
Sodium valproate
Isoniazid
Cimetidine
Ketokonazol
Fluconazole
Alcohol (binge)
Chloramphenicol
Erythromycin
Sulphonamides
Ciprofloxacin
Omeprazole
Metronidazole
```
43
P450 inducers examples
```
St John’s Wart
Carbamazepine
Rifampicin
Alcohol (chronic)
Phenytoin
Griseofulvin (anti fungal)
Phenobarbitone
Sulphonylureas
```
44
When do you stop the statin if CK raised
If five times limit of normal or symptoms intolerable
45
When do you stop statins with abn LFTs
If three times limit of normal
46
What do you need to advise the other about warfarin other than bleeding risk and monitoring
Limit alcohol use
47
How often do you take bisphosphonates usually
Same day each week
48
How do you take bisphosphonates
Take on empty stomach and sit straight or stand for thirty minutes after it
49
What are the main risks of bisphosphonates (3)
Osteonecrosis of jaw
Atypical fractures
Upper GI effects
50
What decreases the absorption of bisphosphonates
Calcium salts
Food and drink
NSAIDS
51
How often do T1DM monitor insulin
4 times a day (before meals and befor bed)
52
Targwt hba1c
48
53
Target glucose levels before and after meals
4-7
| 5-9
54
What changes are made to insulin if unwell
BMs higher so higher nasal doses required
55
Pills decrease risk of
Endometrial and ovarian cancer
56
Pill increases risk of
Breast cancer
57
Tamoxifen increases risk of (3)
Endometrial and ovarian ca
| VTE risk
58
Tamoxifen does what to warfarin
Increase efficacy
59
Common side effect of tamoxifen
Hot flushes
60
When do you stop Metformin
If egfr less than 30
61
When should sulphonylureas be give.
Morning
62
When should statins be given
Night
63
How long does it take for antidepressants to work in
6 weeks
64
Anti hypertensive in pregnancy
Labetolol
65
Common side effect of SSRI
Dry mouth
66
Symptoms of serotonin syndrome
Agitation
Pyrexia
Hallucinations
67
What three drugs cause agranulocytosis
Carbimazole
Carbamazepine
Clozapine
68
What must you check before starting azathioprine
TPMT activity
69
Methotrexate must be coprescribed with
Folic acid ( give on days not taking methotrexate)
70
UTI and pregnant give
Amoxicillin
71
What causes profuse vomiting when combined with metronidazole
Alcohol
72
1:1000 means
1g in 1000mls
73
1:10000 means
1g in 10000mls
74
4 side effects of ACEI
Dry cough
Hyperkalaemia
Renal failure
Postural hypotension
75
4 side effects of beta blockers
Erectile dysfunction
Bradycardia
Fatigue
Cold extremities
76
3 side effects of ccbs
Ankle swelling
Headache
Flushing
77
Side effects for diuretics
Hypokalaemia
78
Two side effects of spironolactone
Hyperkalaemia
| Gynaecomastia
79
Where do you find the warfarin and bleeding guidance
Oral anti coags
80
Phenytoin side effects
Gum hyperteophy
| Hirsuitism
81
3 side effects of carbamazepine
Rash
Hyponatraemia
Dry mouth
82
Na valproate side effects 3
Teratogenic
Weight gain
Tremor
83
Lamotrigine se 1
Rash (SJS)
84
SSRI side effect 4
Sick
SIADH
Reduced libido
Insomnia
85
TCAs
Anticholinergic (confusion agitation)
86
3 maoi
Hypertension
Jaundice
Hyperthermia
87
Insulin 3 se
Hypos
Lipohypeetrophy
Hypokalaemia
88
Metformin 2 se
Lactic acidosis
| Weight loss
89
Sulphonylureas gliclazide 2
Hypos
| Weight gain
90
Three SE of pioglitazone
Hepatotoxic
Fractures
Bladder cancer
91
Se of acarbose
Flatulence
92
5 sulphasalazine
```
Myelosuppression
Hepatitis
Oligospermia
Rash
Renal failure
```
93
4 gold
GN
Myelosuppressjon
Erythroderma
Thrombocytopenia
94
4 penicillamien
GN
Myasthenia
Lupus
Taste disturbance
95
Chloroquine 2
Retinopathy
| Tinnitus
96
4 methotrexate
Hepatotoxicity
Pneumonitis
Myelosuppressjon
Mucositis
97
2 anti tnf drug
Reactivation of TB
| Infection
98
Cyclophosphamide 1
Haemorrhaging cystitis
99
Azathioprine 1
Myelosuppressjon
100
Cyclophosphamide 5
Tremor nephritis
| Hyper trichosis gum hyperplasia burning hands and feet
101
Rifampicin 2
Red orange secretions
| Hepatitis
102
Isoniazid 2
Neuropathy
| Hepatitis
103
Pyrazinamide 1
Hepatitis
104
Ethambutol
Optic neuritis
E = eye
105
Haloperidol 2
Dystonia
| Qt prolongation
106
Where can I find info on how to treat a dystonia
Dystonia and other reactions bnf
107
Rispweidone olanzapine
Metabolic syndrome
108
COCP 4
Clots oedema cervical and breast cancer pressure (hypertension)
109
Depot contraception
Osteoporosis
| Delayed fertility return
110
9 se of steroids
Cushing’s diabetes thin skin psychosis osteoporosis hypokalaemia infections neutrophilia falls
111
7 amiodarone
```
Thyroiditis
Pulmonary fibrosis
Peripheral neuropathy
Myopathy
Slate grey skin
Hepatitis
Metallic taste
```
112
2 adenosine
Sense of impending doom
| Flushing
113
Symptoms of lithium overdose
Tremor
| Ataxia dysarthria coma convulsions N+D hypothyroidism nephrogenic DI
114
Gentamicin is toxic to what
Ototoxic and nephrotoxicity
115
C diff risk in
```
Cephalosporin
Co amoxiclav
Clindamycin
Ciprofloxacin (quinolones)
Clarithromycin (macrloides)
```
116
Hyponatraemia main ones
SSRI diuretics
117
Hyperkalaemia
Na bicarb
| Fluids
118
Hypokalaemia
Salbutamol
Insulin
Diuretics
119
Hyperkalaemia
```
Spironolactone
ACEI
NSAIDS
Trimethoprim
Cyclosporine
Tacrolimus
```
120
Hypocalcaemia
Loops
Bisphosphonates
Phenytoin
121
Hypercalcaemia
Thiazides
122
8 drugs that damage liver
```
Paracetamol
Statins
Valproate
Nitrofurantoin
Methotrexate
Antifungals
Amiodarone
RIP (TB)
```
123
Monitor warfarin with
INR
124
Monitor vanc with
Trough (after 48 hours therapy or before 4th dose)
125
2 ways to monitor valproate
LFTs FBCs
126
3 ways to monitor statins
Lipids
TFTs
UandE
127
Monitor phenytoin
ECG and trough
128
Three ways to monitor methotrexate
FBC UandE LFTs
129
How to monitor gentamicin
Level 6-14 hours post dose and UandE
130
How to monitor digoxin
UandE
| Digoxin level 6 hours post dose
131
How to monitor azathioprine
FBCs
| LFTs
132
How to monitor antifungals
LFTs
133
How to monitor antipsychotics
Prolactin
Weight
Lipids
Clozapine - WCCs (FBC)
134
How to monitor amiodarone
TFTs
LFTs at baseline then 6myhs
CXR before
K baseline
135
What do you monitor with ACEI
BP
| UandE (creatinine urea K Na eGFR)
136
How to treat hypo
75mls 20% glucose IV or IM glucagon but use IV if they have a cannula
137
24 hour insulin requirement usually
0.3 units per kg per 24 hours
138
How do you determine when to give the next dose of gent
Creatinine clearance
139
Which drugs are in micro grams
Levothyroxine
| Digoxin
140
What do you give in Parkinson’s who develop and unsafe swallow
Rotigotine oatch
141
Se of rotigotine oatch
Drowsiness
142
What pain relief do you use in crcl <30
Oxycodone
143
What drugs cause extrapyramidal side effects and what disease should they not be used in
What can be used as an alternative
Metoclopramide
Haloperidol
Parkinson’s
Domperidone
144
What is indapamide
Thiazide
145
What’s the go to for severe severe pain
5mg IV morphine
146
What should you not coprescribe acei with but is not in the BNF
asthma
147
If high risk of a vte but needing to come off warfarin post op
Bridge with LMWH as can be more easily reversed
148
When to stop Metformin
Stop in near sepsis or if creatinine clearance >150
149
Why can diclofenac cause low consciousness
Increase in creatinine
150
What’s the dose of calcium gluconate in hyperkalaemia
10mls 10%
151
What can calcium gluconate also be used to treat
Hypocalcaemia
152
Great hypercalcaemia
Fluids
153
Acute flare of Crohns or Uc
IV hydrocortisone
154
C diff once off infection.
Oral metronidazole
155
C diff more than once
Oral vanc
156
Symptoms of an acute dystonic reaction
Painful eye and neck spasms
157
How to treat acute dystonic reactions
Procyclidine hydrochloride 5mg/ml injection
158
How to prescribe HRT to avoid withdrawal bleeding
Same dose continuously instead of two patches a week when each patch is on for 24 hours
159
What drugs should you avoid in PVD due to peripheral vasoconstriction
Beta blockers
| ACEI in severe disease
160
Why should steroids not be stopped abruptly
Risk of adrenal suppression.
161
Symptoms of scarlet fever
```
Macular red rash
Strawberry tongue
Red throat
Fever
>38•c
```
162
Treat scarlet fever with
Phenoxymethylpenicillin
163
How do you take rivaroxaban
Taken with food
164
Co amoxiclav commonly causes what
Jaundice
165
When’s do you consider the rise in creatinine when starting and ACEI
(>20%)
166
Monitoring of treatment in heart failure
Exercise tolerance
167
What is the target for starting a statin
After 3 months of treatment a >40% reduction in LDL
168
500mls of fluid over
4-6 hours
169
1 litre of fluid over
10-12 hours
170
What are the main drugs that cause urinary retention
```
Morphine (opiates)
Anticholinergic a
General anaesthetics
Alpha agonists
Benzos
NSAIDS
CCBs
Antihistamines
Alcohol
```
171
With abn LFTs when do yin stop statin (needs to be because of statin)
If >3x upper limit of normal
172
Common drugs to cause diarrhoea
ACEI
| Aledronic acid
173
Name two drugs that can cause ankle oedema
Amlodipine
| Naproxen
174
First line in nerve pain in elderly
Paracetamol
175
When do you take loperamide
After each loose stool
176
Well known toxicity of cephalosporin
Renal
