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PSA Part II > Data Interpretation > Flashcards

Data Interpretation Flashcards

1
Q

What are some causes of a neutropenia?

A

Clozapine (agranulocytosis)
Carbimazole
Chemo/radiotherapy
(Viral infection- most common in real life)

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2
Q

What are some drug causes of neutrophilia?

A

Steroids

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3
Q

What are some drug causes of thrombocytopenia?

A

Penicillamine - reduces production

Heparin

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4
Q

What can cause hypovolaemic hyponatraemia?

A

Diuretics

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5
Q

What are some causes of hypokalaemia?

A 
DIRE:
Drugs- loop and thiazide diuretics
Inadequate intake or intestinal loss
Renal tubular acidosis 
Endocrine (cushings and conns syndrome)
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6
Q

What are some causes of hyperkalaemia?

A 
DREAD:
Drugs e.g. K-sparing diuretics and ACEI
Renal failure
Endocrine (addisons disease)
Artefact: common, due to clotted sample
DKA
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7
Q

What are some drug causes of AKI?

A 
(NB all renal)
Nephrotoxic antibiotics, especially gentamicin, vancomycin and tetracyclines
ACEI 
NSAIDs
Radiological contrast
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8
Q

What drugs may cause cholestasis?

A 
NB: All cause posthepatic (obstructive)
Flucloxacillin
Coamoxiclav
Nitrofurantoin
Steroids
Sulphonylureas
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9
Q

What drugs may cause hepatitis and cirrhosis?

A

Paracetamol OD
Statins
Rifampicin

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10
Q

What does a raised urea indicate?

A

Kidney injury or upper GI haemorrhage (break down of Hb tourea)

Therefore also look at Hb of a patient with raised urea in patients with normal Cr who are not dehydrated.

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11
Q

How should you change the levothyroxine dose according to a patient’s TFTs for the PSA?

A

Target TSH range 0.5-5 mIU/L
5: Increase dose

Unless grossly hypo/hyperthyroid, change by smallest increment offered

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12
Q

How can you roughly calculate the normal PaO2 from a patient on oxygen?

A

Subtract 10 from the FiO2. if the PaO2 exceeds the calculated number then the patient is not hypoxic.

E.g. Patient on 60% O2 with FiO2 of 30kPa is hypoxic- expect 50kPa+

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13
Q

What are the most common drugs requiring monitoring to ensure they stay within their therapeutic index?

A 
Digoxin
Theophylline
Lithium
Phenytoin
Abx e.g. gentamicin and vancomycin
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14
Q

How should you manage a patient with an inadequate drug response and low serum drug level

A

Increase dose- generally by smallest increment possible.

Especially important if a drug has zero-order kinetics e.g. phenytoin as a small dose increase will cause a large clinical effect, with higher risk of toxicity

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15
Q

How should you manage a patient with adequate response to a drug and reduced or normal drug levels?

A

No change in dose required- clinical effect more important.

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16
Q

How should you manage a patient with adequate response to a drug and high drug levels?

A

Decrease dose

17
Q

How should you manage a patient with adequate response to a drug and high drug levels and/or evidence of toxicity?

A

Omit drug for few days

Exception: Gentamicin- high serum level without signs of toxicity –> decreased frequency by 12 hours rather than reducing dose

18
Q

How should you manage a patient on gent with high serum levels and no signs of toxicity?

A

Decrease dose frequency by 12 hours rather than reducing dose

19
Q

How would you manage a patient with evidence of toxicity, regardless of drug levels?

A

3 options:

1) Stop drug +/- alternative if required
2) Supportive measures (usually IV fluids)
3) Give antidote if one available

20
Q

What are features of digoxin toxicity?

A

Confusion
Nausea
Visual halos
Arrhythmias

21
Q

What are features of lithium toxicity?

A

Early: Tremor
Intermediate: Tiredness
Late: Arrhythmias, seizures, coma, renal failure, DI

22
Q

What are features of phenytoin toxicity?

A

Gum hypertrophy
Cerebellar symptoms: Ataxia, nystagmus
Peripheral neuropathy
Teratogenicity

23
Q

What are features of gentamicin toxicity?

A

Ototoxicity

Nephrotoxicity

24
Q

What are features of vancomycin toxicity?

A

Ototoxicity

Nephrotoxicity

25
Q

What are the target INRs for most patients on warfarin?

A

2.5

26
Q

In what instances would patients have a target INR of 3.5?

A

Recurrent thromboembolism while on warfarin

Metal replacement heart valve

27
Q

What are indications for giving emergency reversal of warfarin in a patient?

A

Major bleed e.g. causing hypotension or bleeding into a confined space e.g. brain or eye

28
Q

How would you manage a patient requiring emergency reversal of warfarin?

A

Stop warfarin
Give 5-10mg IV vitamin K
Give prothrombin complex (e.g. Beriplex)

29
Q

How would you manage a patient who is over anticoagulated with an INR >6?

A

Reduce warfarin dose

30
Q

How would you manage a patient who is over anticoagulated with an INR 6-8?

A

Omit warfarin for 2 days then reduce dose

31
Q

How would you manage a patient who is over anticoagulated with an INR >8?

A

Omit warfarin and give 1-5mg oral vitamin K

32
Q

How would you manage a patient who has minor bleeding with INR >5?

A

Omit warfarin, give 1-5mg oral vitamin K

PSA Part II (3 decks)

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