Core Facts Flashcards
When should prophylactic heparin not be administered?
- Bleeding
- Ischaemic stroke (risk of bleeding into stroke)
What is the maximum rate of infusion for potassium?
10mmol per hour
Which drug class may cause peripheral oedema?
CCBs
Which drugs may cause hyponatraemia?
All diuretics
Which drug class may cause hyperkalaemia?
ACEi
Which drug class may cause hypokalaemia?
Thiazide-like and loop diuretics
Which drugs may cause agranulocytosis and neutropenia?
Antipsychotics and carbimazole
Which drugs are used in acute and chronic HF?
Acute: furosemide
Chronic: ACEi
Give the management for hyperkalaemia
- Calcium gluconate (if ECG changes)
- Fast acting (soluble) insulin 100 units in 100ml 20% dextrose IV over 30 minutes
- Salbutamol nebuliser
Give the enzyme inducers
P - phenytoin
C - carbamazepine
B - barbiturates
R - rifampicin
A - alcohol (chronic excess)
S - sulfonylureas (e.g. glipizide)
Give the enzyme inhibitors
A - allopurinol
O - omeprazole
D - disulfiram
E - erythromycin
V - valproates
I - isoniazid
C - ciprofloxacin
E - ethanol (acute intoxication)
S - sulphonamidea
Which drugs should be stopped prior to surgery?
I LACK OP
I - insulin (switched to variable rate if needed)
L - lithium (day before)
A - anticoagulants/antiplatelets
C - COCP/HRT (4 weeks before surgery)
K - K+ sparing diuretics (day of)
O - oral hypoglycaemics
P - perindopril and other ACEi (day of)
Metformin must be stopped due to risk of lactic acidosis.
Which drugs must not be stopped prior to surgery?
Steroids
Patients on long term steroids may have adrenal atrophy and therefore be unable to mount an adequate stress response (resulting in profound hypotension)
What are the side effects of steroids?
Stomach ulcers
Thin skin
oEdema
Right and left heart failure
Osteoporosis
Infection (incl. candida)
Diabetes (hyperglycaemia)
cushing’s Syndrome
What are the side effects of NSAIDs?
No urine (renal failure)
Systolic dysfunction (heart failure)
Asthma
Indigestion
Dyscrasia (clotting abnormality)
Describe fluid replacement in adults
500ml bolus (250ml if retaining) in 10 mins
If oliguric (not due to obstruction) give 1L over 2-4 hours
How much maintenance fluid do adults need per day?
3L (2L in the elderly)
Usually NaCl and 5% dextrose combination
How much potassium do adults need per day?
40mmol
Describe fluid maintenance in children
0-10kg: 100ml per kilo
10-20kg: 50ml per kilo
20+kg: 20ml per kilo
Describe fluid replacement in children
Deficit (mL) = %dehydration x weight (kg) x 10
%dehydration = ((well weight-current weight)/well weight)x100
Describe the management of hypoglycaemia
Conscious: oral glucose
Unconscious: 200ml IV glucose 20% over 15 minutes
Which antiemetics should be used post-operatively?
- Cyclizine
- Ondansetron
Which antiemetic should be given in gastroparesis?
Metoclopramide - prokinetic
Which antiemetic should be given in vertigo?
Prochlorperazine
Which antiemetic should be given in palliative care?
Haloperidol
Which drug should be used to treat drug-induced extra-pyramidal side effects?
Procyclidine hydrochloride
Which drugs must be stopped in AKI due to the risk of worsening?
NSAIDs
ACEi
Diuretics
Aminoglucosides (e.g. gentamicin)
ARBs
Which drugs may need to be stopped in AKI due to increased risk of toxicity?
Digoxin
Lithium
Metformin
Which drugs cause hypernatraemia?
Effervescent tablets
What are the features of digoxin toxicity?
Confusion
Nausea
Visual halos
Arrhythmias
What are the features of lithium toxicity?
Early: tremor
Intermediate: tiredness
Late: arrhythmias, seizure, coma, renal failure, dabetes insipidus
What are the features of phenytoin toxicity?
Gum hypertrophy
Ataxia
Nystagmus
Peripheral neuropathy
What are the features of gentamicin and vacomycin toxicity?
Nephrotoxicity
Ototoxicity
Give the management of tachycardia
Beta blocker or diltiazem
Adenosine
(Use digoxin or amiodarone if in heart failure)
(Give DC shock and amiodarone if dverse effects such as shock)
Give the management of anaphylaxis
- 15L O2 non-rebreathe
- Adrenaline (500mcg of 1:1000 IM)
- Chlorphenamine
- Hydropcortisone
Give the management of acute asthma exacerbations
- 15L O2 non-rebreathe
- Salbutamol nebuliser
- Hydrocortisone (PO or IV)
- Ipratropium nebuliser
- Aminophylline (if life-threatening)
Give the management of acute COPD exacerbations
- 15L O2 non-rebreathe
- Salbutamol nebuliser
- Hydrocortisone (PO or IV)
- Ipratropium nebuliser
- Aminophylline (if life-threatening)
+Abx if infective cause
Give the management of chronic heart failure
- ACEi
- Beta blocker
Give the management of COPD maintenance
- Smoking cessation
- SABA/SAMA (e.g. salbutamol/ipratropium)
- LABA/LAMA (e.g. salmeterol/tiotropium)
- ICS (e.g. beclometasone)
Give the management of asthma maintenance
- SABA (e.g. salbutamol)
- ICS (e.g. beclometasone)
- LABA (e.g. salmeterol)
- +LTRA (e.g. montelukast)
Give the management of AF
- Stroke prevention (e.g. DOAC)
- Rhythm control - cardioversion/amiodarone (must be within 48 hours of onset)
- Rate control - beta blocker/diltiazem (may use digoxin if other methods fail)
Which laxatives should be used when?
Impaction - docusate sodium (softener)
Reduced motility - Senna (stimulant)
Other - lactulose (osmotic)
When should metformin not be used?
Not overweight
Creatinine > 150
(use gliclazide instead)
