Drug management of conditions Flashcards
What is the immediate management of acute coronary syndrome?
300mg aspirin + GTN +/- O2 +/- morphine
What is the management of stable angina (immediate and long term)
GTN
b-blocker AND/OR CCB
what is the acute management of a PE? (two drug options) and what is the reason you would choose one over the other?
Anticoagulation with rivaroxaban (first line) or LMWH (dalteparin/enoxaparin).
Choose rivaroxaban mostly unless:
- needs IV/subcut
- has severe renal impairment
- anti-phospholipid syndrome
What is the management pathway for acute asthma attack in an adult or child?
- salbutamol (inhaler or neb) + oral pred (or IM methylprednisolone)
+/- ipratropium bromide neb
+/- magnesium sulphate IV
What is the management of dyspepsia?
PPI + H.pylori test + treatment
What is the treatment for H pylori infection?
PPI + Amoxicillin + clarithromycin/metronidazole (7 days)
when should you use oestrogen only HRT and what do you search to find this on BNF?
only when patient has had hysterectomy
Search estradiol and then pick the form you want
when should you use cyclical combined HRT and what do you search to find this on BNF?
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)
when should you use continuous combined HRT and what do you search to find this on BNF?
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)
What are some contra indications to the COC and what should you search on BNF to find it?
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
what are the rules around COC use and surgery?
must be stopped 1 month before hand and restarted 2 weeks after
which contraceptive types are good for heavy painful periods?
COC, IUS, implant (stops them)
which contraceptive types are more unpredictable with your periods?
POP, IUD, injection
How do you decide what anti-hypertensives to give to whom?
If age 55+ or black = amlodipine
If under 55 or diabetic = ramipril
if black and diabetic use losartan instead of ramipril
what venous thromboembolic prophylaxis would you use first line in all cases except renal failure?
And what would you use in renal failure cases?
LMWH (dalteparin)
unfractioned heparin for renal impiraiment
how do you find opioid conversions on bnf and what are some key ones?
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
what antihistamine should be used for allergy?
certirizine
what is the pharmacological tx of choice for urge and stress incontinence?
Stress = duloxetine
urge = tolterodine, oxybutynin (not in elderly), mirabegron
who should be on a statin and whats the drug of choice?
those with CVD risk >10%,
T1DM (over 40 or had it more than 10 years, neuropathy)
over 85
atorvastatin
what is the management of CAP?
Mild mod = PO amox 5 days
sev = Amox and Doxy 5 days
what is the management of HAP?
non sev = PO amox 5 days
sev = IV amox and gent 7 days
What is the management of penumonia caused by mycoplasma?
doxycylcine
what is the management of pneumonia caused by pneumocystis
co trim
what is the management of c diff
oral vanc or if sev oral vanc and IV met
what is the management of an acute COPD exacerbation (antibiotic)?
PO amox 5 days
what is the management of endocarditis (Abx)
native valve = amox and gent
prosthetic valve = vanc and gent
IVDU = fluclox
dental work = penicillin and gent
what is the treatment for hyperkalaemia?
To stabilise cardiac membrane = 10ml 10% IV calcium gluconate over 10mins
To lower K = 10 units insulin in 50mls of 50% dextrose
What is the treatment for hypoglycaemia in unresponsive pt?
100mls 20% glucose in 5 mins
what are the requirements for maintenance fluid?
what would you prescribe for a 60kg person?
25mls/kg water + 1mmol/kg K, Na, Cl + 50-100g/day glucose
For maintenance fluids - what are the amounts you are looking for?
what kind of fluids are you looking to give for an 60kg person?
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 ??
what mmol of K are the avaliable solutions equal to?
potassium chloride 0.15% = 20mmol K
potassium chloride 0.3% = 40mmol K
what is needed to give everyone their required maintenance glucose?
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
how many mmol of NaCl are the avalible solutions equal to?
0.9% NaCl = 154mmol Na and Cl
0.18% NaCl = 30mmol Na and Cl
what does 1% mean
1% means 1g in 100mls (or 10mg in 1ml)
what is a low urine output?
less than 30ml per hour
how to calculate fluid in paeds?
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
what drugs significantly reduce lithium excretion?
ACEi, NSAIDs, diuretics
In which type of resp failure do you use bipap vs cpap
Type 1 = CPAP
Type 2 = BiPAP
what are the sick rules for steroids?
double the dose!
what should you monitor in DKA to check for improvement?
serum ketones
what antacid should you write for management of dyspepsia?
magnesium carbonate
what is the management of non infectious chronic diarrhoea?
loperamide 2mg up to 3hrly
what are the drug options for constipation?
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
what insulin therapy is needed in DKA?
stop short acting + continue long acting + start fixed rate IV insulin
what is the first line management of post herpetic neuralgia?
paracetamol or codeine
if doesnt work can then try neuropathic pain meds
what is a key piece of info that should be given to patients on loperamide?
take loperamide regularly and after every loose stool
what is the first line treatment for drug induced parkinsonism?
procyclidine
what should you do if a patient on morphine develops an AKI?
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
what should you do if you get thyrotoxicosis while on amiodarone?
temporarily withhold amiodarone
