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PSA > Drug management of conditions > Flashcards

Drug management of conditions Flashcards

1
Q

What is the immediate management of acute coronary syndrome?

A

300mg aspirin + GTN +/- O2 +/- morphine

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2
Q

What is the management of stable angina (immediate and long term)

A

GTN
b-blocker AND/OR CCB

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3
Q

what is the acute management of a PE? (two drug options) and what is the reason you would choose one over the other?

A

Anticoagulation with rivaroxaban (first line) or LMWH (dalteparin/enoxaparin).

Choose rivaroxaban mostly unless:
- needs IV/subcut
- has severe renal impairment
- anti-phospholipid syndrome

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4
Q

What is the management pathway for acute asthma attack in an adult or child?

A
  • salbutamol (inhaler or neb) + oral pred (or IM methylprednisolone)

+/- ipratropium bromide neb
+/- magnesium sulphate IV

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5
Q

What is the management of dyspepsia?

A

PPI + H.pylori test + treatment

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6
Q

What is the treatment for H pylori infection?

A

PPI + Amoxicillin + clarithromycin/metronidazole (7 days)

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7
Q

when should you use oestrogen only HRT and what do you search to find this on BNF?

A

only when patient has had hysterectomy
Search estradiol and then pick the form you want

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8
Q

when should you use cyclical combined HRT and what do you search to find this on BNF?

A

if still having periods/last period was less than 12 months ago

estradiol with norethisterone (if patch look for evorel sequi and if oral look for elleste-duet)

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9
Q

when should you use continuous combined HRT and what do you search to find this on BNF?

A

if periods stopped (last one more than 1 year ago) or looking to stop bleeds

estradiol with norethisterone (if patch look for evorel conti and if oral look for elleste-duet conti)

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10
Q

What are some contra indications to the COC and what should you search on BNF to find it?

A

contraindications:
- over 35 + smoke (15+ per day)
- thromboembolic disease
-migraine with aura
- breast feeding <6 weeks post partum
- uncontrolled hypertension
- breast cancer

Look up hormonal contraceptives and ctrl f: gedarel

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11
Q

what are the rules around COC use and surgery?

A

must be stopped 1 month before hand and restarted 2 weeks after

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12
Q

which contraceptive types are good for heavy painful periods?

A

COC, IUS, implant (stops them)

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13
Q

which contraceptive types are more unpredictable with your periods?

A

POP, IUD, injection

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14
Q

How do you decide what anti-hypertensives to give to whom?

A

If age 55+ or black = amlodipine
If under 55 or diabetic = ramipril

if black and diabetic use losartan instead of ramipril

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15
Q

what venous thromboembolic prophylaxis would you use first line in all cases except renal failure?

And what would you use in renal failure cases?

A

LMWH (dalteparin)

unfractioned heparin for renal impiraiment

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16
Q

how do you find opioid conversions on bnf and what are some key ones?

A

go to prescribing in palliative care and go to the pain management with opioids section

Oral morphine to subcut morphine = divide by 2

Oral codeine to oral morphine = divide by 10

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17
Q

what antihistamine should be used for allergy?

A

certirizine

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18
Q

what is the pharmacological tx of choice for urge and stress incontinence?

A

Stress = duloxetine

urge = tolterodine, oxybutynin (not in elderly), mirabegron

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19
Q

who should be on a statin and whats the drug of choice?

A

those with CVD risk >10%,
T1DM (over 40 or had it more than 10 years, neuropathy)
over 85

atorvastatin

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20
Q

what is the management of CAP?

A

Mild mod = PO amox 5 days

sev = Amox and Doxy 5 days

21
Q

what is the management of HAP?

A

non sev = PO amox 5 days

sev = IV amox and gent 7 days

22
Q

What is the management of penumonia caused by mycoplasma?

A

doxycylcine

23
Q

what is the management of pneumonia caused by pneumocystis

A

co trim

24
Q

what is the management of c diff

A

oral vanc or if sev oral vanc and IV met

25
Q

what is the management of an acute COPD exacerbation (antibiotic)?

A

PO amox 5 days

26
Q

what is the management of endocarditis (Abx)

A

native valve = amox and gent
prosthetic valve = vanc and gent
IVDU = fluclox
dental work = penicillin and gent

27
Q

what is the treatment for hyperkalaemia?

A

To stabilise cardiac membrane = 10ml 10% IV calcium gluconate over 10mins

To lower K = 10 units insulin in 50mls of 50% dextrose

28
Q

What is the treatment for hypoglycaemia in unresponsive pt?

A

100mls 20% glucose in 5 mins

29
Q

what are the requirements for maintenance fluid?

what would you prescribe for a 60kg person?

A

25mls/kg water + 1mmol/kg K, Na, Cl + 50-100g/day glucose

30
Q

For maintenance fluids - what are the amounts you are looking for?

what kind of fluids are you looking to give for an 60kg person?

A

25-30mls/kg water
1mmol/kg Na, K, Cl
50-100g glucose

1500-1800mls
60mmol Na, K, Cl
50-100g glucose

0.18%NaCl + 4% dextrose + 20mmol KCl
0.18% NaCl + 4% dextrose + 40mmol KCl

60mmol Na, K, 80g glucose but 120mmol Cl ??

31
Q

what mmol of K are the avaliable solutions equal to?

A

potassium chloride 0.15% = 20mmol K
potassium chloride 0.3% = 40mmol K

32
Q

what is needed to give everyone their required maintenance glucose?

A

4% glucose = 40g per litre of fluid
5% glucose = 50g per litre of fluid

so would need 2 bags of 4% per day or 1-2 bags of 5% per day for maintenance

33
Q

how many mmol of NaCl are the avalible solutions equal to?

A

0.9% NaCl = 154mmol Na and Cl
0.18% NaCl = 30mmol Na and Cl

34
Q

what does 1% mean

A

1% means 1g in 100mls (or 10mg in 1ml)

35
Q

what is a low urine output?

A

less than 30ml per hour

36
Q

how to calculate fluid in paeds?

A

1000mls for first 10kg +
500mls for second 10kg +
20mls/kg for each other kg

So for 40kg child =
1000 for first 10kg
500 for second 10kg
20x20=400 for rest

= 1900mls per day

37
Q

what drugs significantly reduce lithium excretion?

A

ACEi, NSAIDs, diuretics

38
Q

In which type of resp failure do you use bipap vs cpap

A

Type 1 = CPAP
Type 2 = BiPAP

39
Q

what are the sick rules for steroids?

A

double the dose!

40
Q

what should you monitor in DKA to check for improvement?

A

serum ketones

41
Q

what antacid should you write for management of dyspepsia?

A

magnesium carbonate

42
Q

what is the management of non infectious chronic diarrhoea?

A

loperamide 2mg up to 3hrly

43
Q

what are the drug options for constipation?

A

Senna (stimulant laxative) - can worsen abdo cramps

Lactulose (osmotic laxative) - can worsen bloating

Phosphate enema (osmotic laxative) - not to be used in acute abdo/IBD + can worsen bloating

Isphagula husk (bulking agent) - not to be used in impaction - takes days to work

docusate sodium (stool softener) - good for faecal impaction

44
Q

what insulin therapy is needed in DKA?

A

stop short acting + continue long acting + start fixed rate IV insulin

45
Q

what is the first line management of post herpetic neuralgia?

A

paracetamol or codeine
if doesnt work can then try neuropathic pain meds

46
Q

what is a key piece of info that should be given to patients on loperamide?

A

take loperamide regularly and after every loose stool

47
Q

what is the first line treatment for drug induced parkinsonism?

A

procyclidine

48
Q

what should you do if a patient on morphine develops an AKI?

A

switch to oxycodone as its metabolised by the liver so no effect on kidneys

fentanyl patch is good but not in acute pain as takes a while to work

49
Q

what should you do if you get thyrotoxicosis while on amiodarone?

A

temporarily withhold amiodarone

PSA (2 decks)

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