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Prereg ultimate revision - :) > EXTRA REVISION NOTES > Flashcards

EXTRA REVISION NOTES Flashcards

1
Q

Normal Serum Potassium levels:

A

3.5 - 5.3 mmol/L

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2
Q

6 DRUGS CAUSING HYPOKALEAMIA -

A 
A - AMINOPHYLLINE/THEOPHYLLINE
B - BETA AGONISTS E.G. Salbutamol
C - CORTICOSTEROIDS
D - DIURETICS - LOOP + THIAZIDE
E - ERYTHROMYCIN & MACROLIDES
I - INSULIN

Imbalance causes cardiac SE e.g.
palpitations, arrhythmias

Hypokaleamia predisposes patients
taking to digoxin toxicity

TREATMENT
-Mild-moderate: Oral replacement
therapy (Sando-K tabs)
-Severe: IV Potassium (KCL) in Nacl

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3
Q

6 DRUGS CAUSING HYPERKALEMIA

A 
T - TRIMETHOPRIM
H - HEPARINS
A - ACE/ARBS
N - NSAIDS
Ks - K+ SPARRING DIURETICS e.g.
spironolactone, amiloride
B - BETA BLOCKERS
TREATMENT -
Acute Severe Hyperkaleamia
(>6.5mmol/L)
- Urgent Hospital treatment
- IV Cacl /Calcium gluconate
- IV soluble insuling with glucose
- Salbutamol (nebulisation or slow
IV injection)

Mild to moderate -
- Ion exchange resins to remove
excess potassium (calcium
resonium)

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4
Q

Normal Serum Sodium levels:

A

133-146 mmol/L

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5
Q

4 DRUGS CAUSING HYPONATREMIA

A

★ SSRIs
★ DIURETICS
★ DESMOPRESSIN/ VASOPRESSIN
★ CARBAMAZEPINE

Lithium - hyponatremia predisposes to
lithium toxicity
Effects - headache, confusion, seizures

TREATMENT -
● Mild to moderate - Oral supplements
(sodium chloride/bicarbonate)
● Severe - IV NACL

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6
Q

4 DRUGS CAUSING HYPERNATREMIA

A 
❖ Sodium bicarbonate / chloride
❖ Corticosteroids
❖ Effervescent formulations
❖ Androgens + Oestrogens
Effects - Thirst, fatigue, confusion
Reduce dietary sodium intake
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7
Q

Normal Serum Calcium levels:

A

2.20 - 2.60 mmol/L

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8
Q

DRUGS CAUSING HYPOCALCEMIA

A 
❖ Rifampin
❖ Phenytoin
❖ Phenobarbital
❖ Alendronate, risedronate,
zoledronic acid

Mild-moderate hypocalceamia -
oral calcium supplements often given with
Vit D

Severe Hypocalceamia - IV slow calcium
gluconate 10% (to prevent arrhythmias) with
ECG monitoring

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9
Q

DRUGS CAUSING HYPERCALCEAMIA

A 
❖ Hydrochlorothiazide and other
thiazide diuretics
❖ Lithium
❖ Excessive intake of vitamin D, A,
calcium
TREATMENT -
- Correct dehydration with IV NaCl
- Bisphosphonates and pamidronate
used
- Discontinue drugs causing
hypercalceamia
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10
Q

Normal Serum Magnesium levels:

A

0.6 - 1.00 mmol/L

PPIs can cause HYPOMAGNESIA

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11
Q 
DRUGS WHICH PROLONG
QT-INTERVAL
(Extended interval between the heart
contracting and relaxing + can increase
risk of abnormal heart rhythms and
sudden cardiac arrest)

Clue - 7 ANTI drug classes + 1 ABX + I NTD

A

❖ Lithium

❖ Macrolide antibiotics - erythromcyin

❖ Anti-psychotics - Haloperidol,
Quinine, Chlorpromazine

❖ Antihistamines - hydroxyzine

❖ Antidepressants - Venlafaxine,
SSRIs, TCAs

❖ Antiarrhythmics - Amiodarone,
flecainide, sotalol

❖ Anti-emetics - Domperidone,
Ondansetron

❖ Anti-fungals - Fluconazole,
ketoconazole

❖ Anti-malarials - Chloroquine,
Mefloquine

❖ Sildenafil
❖ Methadone

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12
Q

PHOTOXIC DRUGS - Increases sensitivity of the skin to sunlight

A 
➔ Quinine
➔ Amiodarone
➔ Retinoids
➔ Tetracyclines e.g. Doxycyline
➔ Sulfasalzine
➔ Hydrochlorothiazide
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13
Q

DRUGS THAT IMPACT EYESIGHT

A
  • LINEZOLID
  • ETHAMBUTOL
  • ISOTRETINION ( DRUY EYES)
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14
Q

OVERDOSE ANTIDOTES !!!!

A 
★ Opioids - Naloxone
★ Benzodiazepines - Flumazenil
★ Iron - Desferrioxamine
★ Paracetamol - Acetylcysteine
★ Warfarin - Phytomenadione
★ Unfractionated Heparin -
Protamine
★ Apixaban/edoxaban/rivaroxoban -
Andexanet Alfa
★ Dabigatran - Idarucuzimab
★ Methotrexate - Folinic acid
★ Copper - Penicillamine
★ Digoxin - DigiFab
★ BB + CCB - Glucagon
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15
Q

NEPHROTOXICITY SIGNS+SYMPTOM

A 
➢ Nausea / Vomiting
➢ Diarrhoea
➢ Dehydration
➢ Reduced urination
➢ Confusion
➢ Drowsiness
Monitor CrCl or eGFR
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16
Q

NEPHROTOXIC DRUGS

A

NEPHROTOXIC DRUGS -

Cardiovascular drugs:

  • ACE-Inhibitors
  • ARBs
  • Diuretics

Antibiotics:

  • Aminoglycosides (e.g.Gentamicin)
  • Gylcopeptides (e.g. Vancomycin)
  • Nirofurantoin (Avoid if eGFR<45ml/m)
  • Trimethoprim / Tetracyclines

Immunosuppressants:

  • Ciclosporin
  • Tacrolimus
  • Methotrexate

Lithium / NSAIDs / Metformin

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17
Q

DRUGS EXACERBATING AKI - DAMN

A

D - Diuretics
A - ACE Inhibitors
M - Metformin
N - NSAIDS

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18
Q

HEPATOXICITY SIGNS+SYMPTOMS

A 
➢ Jaundice - yellowing of skin + eye
➢ Itching (Pruritis)
➢ Abdominal pain in the upper right
quadrant
➢ Fatigue / Loss of appetite
➢ N+V / Rash / Fever / Weight loss
➢ Dark or tea colored urine

Monitor LFTs, Creatinine Kinase, Serum
Transaminases

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19
Q

HEPATOTOXIC DRUGS -

A

Anti-epileptics: Sodium Valproate,
Carbamazepine, Phenytoin

Anti-fungals: Fluconazole, Ketoconazole

Antibiotics: Isoniazid, Rifampicin,
tetracyclines

***Risk of cholestatic jaundice and
hepatitis with:
- Flucloxacillin
- Co-amoxiclav

Antipsychotics, sotalol, Amiodarone, labetolol, methotrexate,
paracetamol, pioglitazone

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20
Q

ANTI-MUSCARINIC DRUGS -

A 
❖ Antimuscarinics -
Tiotropium, umeclidinium, glycopyronium,
Atropine, Scopolamine, Ipratropium,
oxybutynin, hyoscine, tolterodine,
solifenacin

CI (systemic) - Angle-closure glaucoma,
Severe UC, urinary retention

❖ Anti-histamines -
Sedating - Chlorphenamine, hydroxyzine,
promethazine, cyclizine

❖ Antipsychotics
1st Generation: Chlorpromazine,
prochlorperazine, haloperidol
2nd Generation: Clozapine

❖ Tricyclic antidepressants
Amitriptyline, clomipramine

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21
Q

ANTIMUSCARINIC EFFECTS

A 
➢ Dry mouth
➢ Constipation
➢ Blurred vision
➢ Drowsiness
➢ Nausea OR vomiting
➢ Urinary Retention
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22
Q

SEDATING ANTIHISTAMINES

A 
SEDATING ANTIHISTAMINES
Causes sedation as they are highly lipid
soluble and readily cross the BBB:
➔ Sedative activity used where
sleep maybe disturbed due to
pruritus
➔ Sedating antihistamines also
have significant antimuscarinic
activity
Examples of sedating antihistamines:
● Chlorphenamine (e.g. Piriton)
● Hydroxyzine
● Ketotifen
● Promethazine (E.g. Phenergan)
● Diphenhydramine (E.g. benadryl)

** Performance of skilled tasks such as
operating machinery or driving maybe
affected ***

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23
Q

NON-SEDATING ANTIHISTAMINES

A

Penetrate the blood-brain barrier only to
a slight extent - less sedative effects

1st line choice -
★ Cetirizine (e.g. Piriteze)
★ Loratadine (e.g. Claritin)
★ Fexofenadine (e.g. Allegra)

Other non-sedating antihistamines -
● Acrivastine
● Desloratadine

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24
Q

MHRA MEDICATION RECALL

CLASSES →

A

Class 1 - Defect presents a
life-threatening or serious risk to health
** Requires Immediate action **

Class 2 - Defect may cause
mistreatment or harm to patient but is
not life-threatening or serious
** Action recall within 48hrs **

Class 3 - Defect is unlikely to cause
harm to patient
** Action recall within 5 days **

Class 4 - No threat to patient
** Advise caution with use **

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25
Q

4 ANTIFOLATE DRUGS -
(Concomitant use will lead to
teratogenicity + blood dysrcasias):

A

❖ Phenytoin
❖ Methotrexate
❖ Trimethoprim
❖ Co-Trimoxazole

26
Q

GI BLEED SIGNS + SYMPTOMS

A 
★ Vomiting bright red blood
★ Vomiting coffee-like material
★ Passing Black tarry stools
★ Rectal bleeding
★ Lightheadedness
★ Shortness of breath
★ Abdominal Pain
*Risk minimized by co-prescribing PPI
to suppress stomach acid production
27
Q

DRUGS THAT INCREASE THE RISK OF

GI BLEED -

A 
● Corticosteroids
● Carbocisteine
● DOAC e.g Rivaroxaban
● Anti-platelets e.g. Aspirin
● Warfarin
● NSAIDs
● SSRIs
28
Q

4 ANTIPSYCHOTICS THAT INDUCE

HYPERGLYCEMIA - CiROQ

A

C - Clozapine
R - Risperidone
O - Olanzapine
Q - Quetiapine

29
Q

DRUGS THAT COLOUR URINE -

A 
● Senna – red/yellow
● Dantron containing preparations
e.g. co-danthramer,
co-danthrusate – red
● Sulfasalazine – yellow-orange
● Phenindione – pink/orange
● Triamterene containing
preparations e.g. co-triamterzide,
Frusene – blue in some lights
● Levodopa containing
preparations e.g. co-beneldopa,
co-careldopa – reddish/darker in
colour
● Entacapone – reddish-brown
● Nefopam – pink
● Clofazimine – red
● Nitrofurantoin – yellow/brown
● Rifabutin – orange-red
● Rifampicin – orange-red
● Deferiprone – reddish-brown
30
Q

DRUGS CAUSING RESPIRATORY

DEPRESSION (RD)

A 
➔ Pregabalin / Gabapentin
➔ Opioids - morphine, tramadol,
heroin, or fentanyl
➔ Benzodiazepines - tamazepam
➔ Alcohol
➔ Barbiturates - phenobarbital
31
Q

SIGNS + SYMPTOMS OF RESPIRATORY DEPRESSION

A 
● Fatigue
● Confusion
● Headache / Dizziness
● Nausea and/or vomiting
● Fluctuations in BP
● Abnormal breathing sounds e.g.
whistling or crackling sound
● Apnea (abnormally long pauses
in between breaths followed by a
long sigh)
● Bluish or grayish skin
● Rapid heart rate
32
Q

MORPHINE SIDE EFFECTS -

A 
M - Myosis
O - Out of it (Sedation)
R - Respiratory Depression
P - Pneumonia (Aspiration)
H - Hypotension
I - Infrequency (Constipation)
N - Nausea
E - Emesis
33
Q

DRUGS THAT CAUSE WEIGHT GAIN -

A 
● Insulin
● Sulphonylureas
● Steroids
● Antipsychotics
● Carbamazepine
34
Q

DRUGS WHICH LOWER SEIZURE

THRESHOLD -

A

❖ Antidepressants
❖ Antipsychotics
❖ Opioids - especially tramadol
❖ Quinolones e.g. ciprofloxacin + NSAID combo

35
Q 
CYP 450 ENZYME INDUCERS
These will induce the enzyme to clear
substrates, leading to a decreased
concentration
SCRAP GPS
3 ANTI-EPILEPTICS 
1 HERBAL
1 ABX 
1 ANTIDIABETIC MED 
1 ANTIFUNGAL
A 
S - ST.JOHN’S WORT
C - CARBAMAZEPINE
R - RIFAMPICIN / RIFABUTIN
A - ALCOHOL (CHRONIC)
P - PHENYTOIN

G - GRISEOFULVIN
P - PHENOBARBITAL
S - SULPHONYLUREAS

36
Q

CYP 450 ENZYME INHIBITORS
These will inhibit the enzyme from clearing
substrates leading to an increased concentration
SICKFACES.COM GAVID

A 
S - SODIUM VALPROATE
I - ISONIAZID
C - CIMETIDINE
K - KETOCONAZOLE
F - FLUCONAZOLE
A - ALCOHOL (BINGE)
C - CHLORAMPHENICOL
E - ERYTHROMYCIN (macrolides)
S - SULFANAMIDE -TRIMETHOPRIM
.
C - CIPROFLOXACIN
O - OMEPRAZOLE
M - METRONIDAZOLE
G - GRAPEFRUIT
A - AMIODARONE
V - VERAPAMIL
I - ITRACONAZOLE
D - DILTIAZEM
37
Q

CYP 450 ENZYME SUBSTRATES

  • INHIBITORS WILL INCREASE THEIR CONC
  • INDUCERS WILL REDUCE THEIR CONC
A 
➔ STATINS
➔ WARFARIN
➔ ORAL CONTRACEPTIVES
➔ TRICYCLIC
ANTIDEPRESSANTS
38
Q

SEPSIS

A 
SEPSIS -
★ Sepsis is a life-threatening reaction
to an infection. It happens when your
immune system overreacts to an
infection and starts to damage your
body's own tissues and organs.
★ If not treated immediately, sepsis
can result in organ failure and death.
Yet with early diagnosis, it can be
treated with antibiotics.
HOW TO SPOT SEPSIS IN ADULTS -
❖ Slurred speech or confusion
❖ Extreme shivering or muscle pain
❖ Passing no urine (in a day)
❖ Severe breathlessness
❖ It feels like you’re going to die
❖ Skin mottled or discoloured
high temperature (fever) or low body temp,
a fast heartbeat, fast breathing
HOW TO SPOT SEPSIS IN CHILDREN
1. Is breathing very fast
2. Has a ‘fit’ or convulsion
3. Looks mottled, bluish, or pale
4. Has a rash that does not fade
when you press it
5. Is very lethargic or difficult to
wake
6. Feels abnormally cold to touch
If you spot any of these signs, call 999
or go straight to A&E
A child under 5 may have sepsis if he or
she:
1. Is not feeding
2. Is vomiting repeatedly
3. Has not passed urine for 12
hours
39
Q

SHOCK

A 
SHOCK -
A serious life threatening condition
where vital organs in the body are not
getting enough blood flow resulting n
organ failure

Causes:
Bleeding, cardiac event, loosing bodily
fluids e.g. severe vomiting, allergic rct

Signs of shock:

  • Cold clammy skin
  • Sweating
  • Rapid shallow breathing
  • Weakness + dizziness
  • Nausea or vomiting
  • Thirst
  • Yawning

SEPTIC SHOCK - Life-threatening
condition that happens when your blood
pressure drops to a dangerously low
level after an infection

40
Q

ANAPHYLAXIS:
Anaphylaxis is a severe, life-threatening,
hypersensitivity reaction.

Signs & Symptoms ?

A 
★ Feeling lightheaded or faint
★ breathing difficulties: fast /
shallow breathing
★ a fast heartbeat
★ clammy skin
★ confusion and anxiety
★ collapsing or losing
consciousness
★ other allergy symptoms: an itchy,
raised rash (hives), angioedema
41
Q

ANAPHYLAXIS TREATMENT

A 
TREATMENT -
★ Start cardiopulmonary
resuscitation (CPR) immediately.
★ Call 999 for an ambulance 999
★ Begin initial treatment for
anaphylaxis:

Intramuscular adrenaline /epinephrine
should be given as 1st line treatment for
anaphylaxis.

A repeat dose of intramuscular
adrenaline/epinephrine (1mg/ml) should
be given after a 5-minute interval if there
is no improvement in the patient’s
condition.

ADRENALINE DOSES:
➔ 5 years or below: 150 mcg

➔ 6-11 years: 300 mcg

➔ 12+ years: 500 mcg

42
Q

MUMPS

A

MUMPS
Contagious viral infection

SYMPTOMS -
● painful swellings in the side of the
face under the ears (the parotid
glands)
● Headaches
● Joint pain
● a high temperature
TREATMENT - No cure
● Plenty of rest and fluids
● Painkillers e.g. Paracetamol
● Warm or cool compress to the
swollen glands to help relieve pain
43
Q

MEASLES

A 
MEASLES
Usually starts with cold-like symptoms,
followed by a rash a few days later.
Some people may also get small spots
in their mouth.
The first symptoms of measles include:
● a high temperature
● a runny or blocked nose
● sneezing
● a cough
● red, sore, watery eyes
Small white spots (KOPLIK spots) may appear inside the
cheeks and on the back of the lips a few
days later.
Measles rash - (Not itchy) & Red/brown
❖ Starts on the face and behind the
ears before spreading to the rest
of the body.
❖ The spots of the measles rash
are sometimes raised and join
together to form blotchy patches
44
Q

RUBELLA “German Measles”

A 
RUBELLA “German Measles”
A red or pink spotty rash that feels
rough.
- swollen glands in your neck,
aching fingers, wrists, or knees
and a high temperature.
MMR Vaccine - 2 doses can give
lifelong protection against measles,
mumps, and rubella.
45
Q

MENINGITIS

A

MENINGITIS
An infection of the protective membranes
that surround the brain and spinal cord
(meninges).

Symptoms of meningitis develop suddenly
and can include:
● a high temperature
● cold hands and feet
● vomiting
● confusion
● breathing quickly
● muscle and joint pain
● pale, mottled or blotchy skin
● spots or a rash
● headache
● a stiff neck
● a dislike of bright lights
● being very sleepy or difficult to wake
● fits (seizures)
Babies may also:
● refuse feeds / be irritable
● have a high-pitched cry
● stiff body/ floppy or unresponsive
● have a bulging soft spot on the top
of their head (Fontanele)
Meningitis rash starts as small, red pinpricks
before spreading quickly into red or purple
blotches.
The meningitis glass test -
● Press the side of a clear glass firmly
against the skin
● Spots/rash may fade at first
● Keep checking
● Fever with spots/rash that do not
fade under pressure is a medical
emergency

Call 999 for an ambulance or go to your
nearest A&E if you think you or your child
might be seriously ill.

46
Q

SCARLET FEVER

A 
SCARLET FEVER
The first signs can be flu-like symptoms,
including a high temperature, a sore
throat and swollen neck glands (a large
lump on the side of your neck).

A blanching rash usually develops on the trunk 12–48 hours after initial symptoms, before spreading to the rest of the body and flexures.

the rash is red/pink and makes your skin feel
rough, like sandpaper.
White coating on tongue aka - strawberry tongue

Refer to GP for Treatment with antibiotics e.g. phenoxymethylpenicillin

47
Q

IMPETIGO

A

IMPETIGO
Highly contagious skin infection that often
starts with sores or blisters on the face or
hands that burst and leave crusty,
golden-brown patches.
They can look a bit like cornflakes stuck to
your skin.

Treatment -
- topical fusidic acid

  • if widespread oral flucloxacillin
48
Q

GLANDULAR FEVER

A

Glandular fever
Mostly affects teenagers and young adults.
It gets better without treatment, but it can
make you feel very ill and last for weeks.

SYMPTOMS:
● a very high temperature or you feel
hot and shivery
● a severe sore throat
● swelling either side of your neck –
swollen glands
● extreme tiredness or exhaustion
● tonsillitis that is not getting better

Don’t treat sore throat with ABX e.g. amoxicillin as it can cause maculopapular rash if glandular fever

49
Q

PARACETAMOL MAX DOSAGE

A 
PARACETAMOL MAX DOSAGE
● 3-5 Months - 60mg
● 6-23 Months - 120mg
● 2-3 Years - 180 mg
● 4-5 years - 240 mg
● 6-7 years - 250 mg
● 8-9 years - 375 mg
● 10-11 years - 500 mg
● 12-15 years - 750 mg
● 16+ years - 1000mg

Maximum of 4 times a day

50
Q

IBUPROFEN MAX DOSAGE

A 
IBUPROFEN MAX DOSAGE
● 3-5 months:
50mg TDS (150 mg)
● 6-11 months:
50mg QDS (200 mg)
● 1-3 years:
100mg TDS (300 mg)
● 4-6 years:
150mg TDS (450 mg)
● 7-9 years:
200mg TDS (600 mg)
● 10-11 years:
300mg TDS (900 mg)
● 12-17 years:
400mg QDS (1200mg)
51
Q

Montelukast

A

MHRA - risk of neuropsychiatric reactions

Be alert of speech impairment and ocd symptoms, hallucinations, sleep disorders and suicidal behaviour

52
Q

Adrenaline doses

A

1 month - 5 yrs = 150mcg

6-11yrs = 300mcg

12+ = 500mcg

Repeat adrenaline after 5 min interval if necessary

53
Q

Urinalysis antispasmodics

A

Solifenacin or tolterodine

54
Q

Ulcerative colitis acute flare up to avoid

A

Loperamide or codeine die to paralytic ileus as it increases risk of toxic mega colon

55
Q

Ulcerative colitis inflammation location

A

Rectum and colon

56
Q

Proctitis treatment

A

Inflammation of rectum

Give suppositories

1st line aminosalicyclate (rectal) mesalazine or sulfasalazine

57
Q

Extensive colitis treatment

A

Oral treatment

High dose oral aminosalicylate

58
Q

Left sided colitis

A

Enemas

59
Q

Proctosigmoditis

A

Foam preparation

60
Q

Crohns disease location

A

Inflammation of GI tract from mouth to anus

61
Q

PPI cautions

A

Lansoprazole - take 30-60 mins before food

PPI cautions -

  • mask symptoms of gastric cancer
  • increased risk of fractures and osteoporosis
  • increased risk of GI infections e.g C. difficile
  • hypomagnesia

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