From Questions Flashcards
In haemodynamically stable SVT what medication is used 1st line in asthmatics after vagal manoeuvres?
Verapamil
Adenosine is contraindicated in asthmatics
conversion of PO codeine → PO morphine
divide by 10
conversion of PO tramadol → PO morphine
divide by 10
conversion of PO morphine → PO oxycodone
divided by 1.5 - 2
*BNF says 1.5
conversion of PO morphine → SC morphine
divide by 2
conversion of PO morphine → SC diamorphine
divided by 3
PO oxycodone → SC diamorphine
divide by 1.5
drugs CI in peptic ulcer disease
- aspirin
- NSAIDS
drugs CI in CKD
- NSAIDS
- ACEi
- drug clearance of many is slowed e.g. gentamicin, digoxin
drugs CI in chronic heart failure
- CCB
- negative inotropies e.g. flecainide
- TCA
- NSAIDs
- corticosteroids
drugs CI in heart block
- verapamil
- digoxin
- beta-blockers
antiplatelet for ACS (medically treatment)
- aspirin lifelong + ticagrelor 12 months
- if aspirin CI then clopidogrel lifelong
anti-platelet after PCI ACS
- aspirin (lifelong) + prasurgrel/ticagrelor (12 months)
- if aspiring CI then clopidogrel lifelong
anti-platelet for TIA and ischaemic stroke
- clopidogrel (lifelong)
- aspirin + dipyridamole (lifelong)
antiplatelet for peripheral arterial disease
- clopidogrel lifelong
- aspirin lifelong
types of rapid acting insulin
NovoRapid
Humalog
Actrapid
Humilin S
when prescribing must write name of specific type
what electrolyte abnormality is associated with heparins?
hyperkalaemia
what is target INR for day before surgery? If not what to do?
aim for 1.5
can give vitamin K (phytomenadione) iV or oral depending
what is the target when starting statin treatment?
aim for a > 40% reduction in non-HDL cholesterol 3/12 after starting
what drugs cause gynaecomastia?
DISCO
digoxin
isoniazid
Spironolactone
Cimetidine
Omeprazole
contraindications for sildenafil ?
nitrates
nicorandil related drugs
hypotension
recent stroke or MI (last 6/12)
what electrolyte imbalance precipitates digoxin toxicity?
low potassium
what electrolyte imbalance caused by digoxin?
high potassium
when do you not need to stop metformin for surgery?
- < 1 meal missed
- eGFR > 60
- low risk AKI
what should metformin be stopped for surgery?
- > 1 meal missed
- AKI risk
warfarin and surgery (pre-op)
- aim INR 1.5
- elective - stop 5.7 before, INR > 1.5 PO vitamin K
- emergency, can delay 6-12 hrs → IV vitamin K
- emergency no delay → IV vitamin K + prothrombin complex
what anti-emetic should be avoided in PD? which to be used?
avoid metoclopromaide because crosses BBB
use domperidone as doesn’t cross
when shouldn’t you prescribe cyclizine? what to give instead?
fluid retention
use metoclopramide
what antibiotic to be cautious of with warfarin?
clarithromycin and erythromycin
what medication used if hypotensive + arrhythmia?
digoxin
CCB and beta-blocker can worsen hypotension
what drugs can cause a low neutrophil count?
clozapine
carbimazole
how to differentiate types of AKI?
- pre renal - urea > creatinine
- renal urea - urea < creatinine
- post-renal - urean < creatinine
causes of intrinsive renal failure?
INTRINSIC
- ischaemia (pre-renal → ATN)
- nephrotoxic Abx - gent, vanc, tetracyclines
- tablets - NSAIDS, ACei
- radiological contrast
- injury → rhabdo
- negatively birefringent (gout)
- syndromes (glomerulonephritis)
- inflammation (vasculitis)
- cholesterol emboli
what ratio of AST to ALT in alcoholic hepatitis?
AST > ALT
what are cholestatic drugs?
- flucloxacillin
- co-amoxiclav
- nitrofurantoin
- steroids
- sulphonylureas
INR target for warfarin
- 2-3 → AF, DVT, cardioversion, cardiomyopathy, MI
- 3-4 → recurrent VTE on warfarin, mechanical valve
counselling for ACEi
- teratogenic
- raised potassium
- caution with D+V
counselling tamoxifen
- Increases risk of endometrial cancer
- Increases efficacy of warfarin à high INR
- Side effects: hot flushes, VTE risk
when do steroid patient need bone protection?
> more than 3/12 of treatment
monitoring for statins
- Risk factors → CK
- No risk factors → ALT
- Check LFTs at 3 and 12 months
- Stop if taking a macrolide
- Caution in CYP-i
how to adjust basal/bolus insulin regiments?
- High/low before breakfast / at night → increase/decrease evening** **long** **acting
- High/low before lunch / dinner / bed → increase/decrease rapid** **acting** in **meal before
adjusting BD pre-mixed regimens
- High/low before bed AND before breakfast → increase/decrease evening insulin
- High/low before lunch AND before evening meal → increase/decrease morning insulin
how to mix solution for insulin infusions?
50 units actrapid insulin in 50mL of 0.9% sodium chloride
what are the steroid strengths?
G - glucocorticoid, M - mineralocorticoid
- hydrocortisone - G1, m1
- prednisolone - G4, M 0.8
- fludrocortisone - G15, M150
- aldosterone - G0, M500
- dexamethasone - G40, M0
what is the topical steroid ladder?
Help Every (eumovate) Busy (betnovate) Dermatologist (dermovate)
- low potency - hydrocortisone + clobetasone
- medium potency - betamthasone
- high - mometasone, clobetasol
what abx should you hold statins with?
macrolide
e.g. clarithromycin and erythromycin
how many mmol for:
- 3% potassium in 1L
- 15% potassium in 1L
- 3 = 40 mmol
- 15 = 20 mmol
what drugs can predispose to candida infections?
amoxicillin
clarithromycin
prednisolone
SGLT2 potentially
1st line for eczema topical (after emollient)
1% hydrocortisone cream
management of short term constipation (Adult)
- bulk forming laxative (ispaghula husk)
- add/swap to osmotic laxative (lactulose)
- stimulant if soft stool but complaining of hard to pass (bisacodyl, senna)
management of opioid induced constipation (adults)
- osmotic laxative + stimulant (lactulose + biscodyl/senna)
- naloxegol if no response
DON’T give bulk forming
management of faecal impaction (adults)
- high dose oral macrogol if hard stool
- stimulant added (senna) - if soft or no response to 1
- no response to oral - soft stool PR bisacodyl, hard stool PR glycerol
management of constipation in children
- conservative + behavioural measures
- macrogol 1st line
- add stimulant if unresponsive
who can’t have ondansetron as 1st line post-op N&V?
- long QTc
- drugs that prolong QTc e.g. anti-psychotics
what is the anti-emetic of choice for pt at risk of EPSE + QT prolongation?
cyclizine
