Errors Flashcards
What is the initial dosing regime of warfarin?
5mg initially
Monitor every 1-2 days
What interacts with warfarin OTC and what is the interaction?
Miconazole- enzyme inhibitor exacerbates bleeding
What is the antidote for warfarin
Phytomenadione (Vitamin K)
What is the appropriate length of treatment with warfarin for calf DVT?
6 weeks
What is the appropriate length of treatment for provoked VTE with warfarin?
3 months
What is the appropriate length of treatment for unprovoked DVT with warfarin?
3 months minimum
What to if a patient is experiencing a major bleed?
1) stop warfarin
2) IV phytomenadione
3) fresh frozen plasma
What to do with elective surgery?
Stop warfarin 5 days before
What to do in emergency surgery with a patient on warfarin?
Delay 6-12 hours
Or with
IV phytomenadione + dried prothrombin complex
How should patients be managed initially if they have an MI
Morphine IV Metoclopramide Oxygen Nitrate Aspirin MMONA
How should patients be managed long term following an MI?
Ace Inhibitor Clopidogrel (1 year for NSTEMI, atleast 4 weeks in STEMI) Statin Aspirnin B-Blocker G-GTN ACS BAG
What strength of adrenaline is administered in cardiac arrest and what can be given IV if a defibrilator is present?
1 in 1000
IV amiodarone
When should diuretics be taken and why?
Morning because if taken at night, it can cause sleep disturbances due to frequent urination
Where are loop diuretics indicated?
Odema
Heart Failure
Severe Hypertension
Where are thiazide diuretics indicated?
Odema
Hypertension
What side effects can occur with bendroflumethiazide?
Hypo of most electrolytes
Gout
Hyperglycaemia
Hypercalcaemia
What form of laxatives should not be for opioid-induced constipation?
Bulk forming laxatives
What form of laxatives should be for opioid-induced constipation?
Stimulant or Osmotic laxatives
What form of laxatives should be used for children?
1) Macrogol + Dietary Advice
2) Stimulant Laxatives
3) Lactulose
What is simeticone?
Simeticone is an anti-foaming agent incorporated in antacids too relieve flatulence.
What is used in palliative care for the treatment of hiccups?
Simeticone
Why are bismuth-containing antacids not adviced?
Absorbed bismuth can be neurotoxic, with the possibility of inducing encephalothapy.
What are the two tests which can be done to determine `the presence of H.pylori
1) C13 breath test
2) Stool antigen test
When should H.pylori testing not be conducted?
They should not be conducted in those taking an anti-secretory within the last 2 weeks or an antibiotic within the last 4 weeks of conducting the test
What are the treatment regimes for H.pylori?
PPI+ 2 Abx
PPI + (Clarithromycin/Amoxicillin/Metronidazole) + (Clarithromycin/Amoxicillin/Metronidazole)
What conditions have been linked with the use of PPIs?
Osteoporosis, Lupus and C.Difficile infections
What is the definition of an arrhythmia?
Irregular heartbeats
What is AF?
The most common form of arrhythmia with extremely rapid and uncontrolled electrical activity in the atria and variable conduction through the AV node.
What is the first line drug treatment for AF?
Rate control
Beta Blockers - excluding sotalol
Verapamil
Diltiazem
What is the second line drug treatment for AF?
Rate control
Beta Blockers - including sotalol
Flecainide
Amiodarone
What TWO risks should patients who are suffering from AF be assessed on?
Risk of Stroke- CHADS2 VASC
HASBLED - Risk of bleeding
What is the Vaughan Williams classification for anti-arrhythmic drugs?
Class 1 - Na+ channel blockers
Class 2 - \Beta blockers
Class 3 - Sotalol and Amiodarone
Class 4 - Ca2+ channel blockers
What treatments are available for supraventricular tachycardia and which the preferred option?
Cardiac Glycosides
Adenosine
Verapamil
Adenosine is the preferred treatment
What treatments are available for ventricular arrhythmias?
Lidocaine
Sotalol
What treatments are available for both supraventricular and ventricular?
Amiodarone
Beta Blockers
What is the dosing of digoxin?
Up to 125mcg - HF
125-250mcg - AF
What are the SEs associated with digoxin?
Nausea Vomiting Blurred Vision Yellow Vision Confusion Diarrhoea Bradycardia
What is the target concentration of digoxin in the plasma and what is the toxic range?
1-2mcg/L - Normal
1.5-3mcg/L - Toxic
What are the risk factors of digoxin toxicity?
Hypomagnesia, Hypokalaemia, Hypercalcaemia, Hypoxia and Renal Impairment
How can digoxin toxicity be treated?
Atropine or in very severe cases, Digoxin-Specific Antibody (Digumab) can be used
What is Amiodarone?
Amiodarone is a drug that is used for rhythm control in AF and can also be used in supraventricular and ventricular arrhythmias.
What is the dosing regime for amidoarone?
200mg TDS- Week 1
200mg BD- Week 2
200mg OD- Week 3 onwards
What precipitates Torsades De Pointes?
Bradycardia (Beta Blockers, Hypokalaemia and QT interval prolongation)
What is the treatment for Torsades De Pointes?
Magnesium Sulphate IV
What monitoring is required for Amiodarone and how often should this be conducted?
Thyroid Serum Potassium Lungs Liver Monitoring should be conducted every 6 months
What is the target INR for patients on warfarin?
2.5 +/- 0.5
What is the target INR for patients on warfarin for recurrent DVT
3.5 +/- 0.5
What to do in the following situationsw:
1) INR > 5 + no bleeding
2) INR > 8 + no bleeding
3) INR > 5 + minor bleeding
4) INR > 5 + minor bleeding
1) Withdraw 1-2 doses
2) Omit warfarin + oral phytomenadione
3) Omit warfarin + IV phytomenadione
4) Omit warfarin + IV phytomenadione
What are the advantages of NOACs in comparison to warfarin?
1) No INR needed
2) Low risk of bleeding
3) No monitoring required
What is involved in the management of a stroke:
Short Term:
Long Term:
Short Term:
Alteplase
Aspirin or Clopidogrel 24-48 hours after thrombolysis
Long Term:
Statin started 48 hours irrespective to cholesterol level
Aspirin/Dipyridamole/Clopidogrel started
Aim to lower BP below <130/80 - Beta blockers are NOT recommended
What is the target Hba1c for a women who has diabetes in pregnancy and what should be given for supplementation?
Target Hba1c for women who have pre-existing diabetes -> 48mmol/mol
Supplementation - Folic Acid 5mg
What is the ideal antidiabetic drug in pregancy planning?
Isophane insulin
What should be done in type 2 diabetic women post - birth?
They should continue metformin or resume the glibenclamide
What are the signs and symptoms of DKA?
Sweet smelling breath, high blood ketones, severe hyperglycaemia, drowsiness, polyuria
What is the treatment for DKA?
Soluble insulin, saline, K+ unless anuria, long acting insulin and add glucose once conc is <14mmol/L, and continue till pH is above 7.3
How often should type 1 diabetics monitor their blood glucose?
It should be monitored no more than 2 hours before and every 2 hours for long journeys
What should patients do when their blood glucose is :
<4mmol/L
5mmol/L
<4mmol/L - do not drive
5mmol/L - take a carbohydrate before driving
For which drugs do patients need to record their blood glucose BD even if they are not driving?
Drugs that cause hypos, such as SUs, meglitinides and Insulin
What should be done for patients who are experiencing a hypo while driving?
Find a safe place to park up, turn off the engine and eat and wait for 45 mins before blood sugar levels reach the norm
What are the signs of lactic acidosis?
The signs of lactic acidosis are: Dyspnoea Hypothermia Abdominal pain Muscle cramps Asthenia (weakness)
What should be done to treat SU-induced hypoglycaemia?
Hospital admission
When should pioglitazone be continued?
If there is >0.5% weight loss over 6 months
What are the risk factors associated with osteoporosis?
Elderly, over 65, underweight, smoker and alcohol drinker, corticosteroid therapy and a family history
