General Flashcards
(159 cards)
1
Q
Which antiemetics are good for motion sickness or vestibular nausea?
A
Anticholinergics or antihistamines?
Hyoscine
Cyclizine
Prochlorperazine
2
Q
What are the positives and negatives of using levomepromazine as an anti-emetic?
A
Good for if you don’t know why they’re specifically nauseous (i.e. lots of things going on) (bc blocks lots of receptors), anxiety, sedation, antipsychotic effects
SEs: anticholinergic effects (dry mouth, sedation), hypotension, sedative
3
Q
What dose of adrenaline for adults in anaphylaxis? Where do you give it?
A
Adrenaline 1:1000 0.5mg (0.5ml) IM once only
(300mcg EpiPen or adrenaline autoinjector)
Give into the anterolateral aspect of the thigh
4
Q
Which antiemetics are good if you want to slow colonic transit?
A
Ondansetron causes constipation
5
Q
What dose haloperidol work on to target nausea?
A
dopamine receptor antagonist
6
Q
Which antiemetics can cause extrapyramidal SEs?
A
Haloperidol
Metoclopramide
Domperidone (doesn’t cross BBB so not as bad as the others)
7
Q
Generally speaking, describe what is given for secondary prevention after ischaemic stroke/TIA?
A
- Antiplatelet (75mg clopidogrel OD) if no AF
- 80mg atorvastatin OD
- Antihypertensive to keep SBP <130mmHg
- Anticoagulation if indicated (e.g. AF) w/ warfarin
8
Q
Which antiemetics are good for raised ICP?
A
Cyclizine + steroid
9
Q
How much maintenance fluids do people need?
A
25-30 ml/kg/day
10
Q
Diagnostic criteria of diabetes?
A
HbA1c >=48 mmol/mol
Fasting glucose >= 7 mmol/L
Random blood glucose / OGTT >= 11.1 mmol/L
Once if symptomatic, or on 2 occasions of asymptomatic
11
Q
What types of laxatives are the following? A. Ispaghula husk B. Docusate sodium C. Methyl cellulose D. Magnesium salts E. Sodium salts
A
Osmotic: lactulose, Mg salts, Na salts, phosphate enema
Stimulant: senna, docusate sodium, bisacodyl, glycerin suppository
Bulking agents: ispaghula husk, methyl cellulose
12
Q
What class are gliptins?
A
DPP-4 inhibitors
13
Q
Outline how you calculate rate of delivery (mL/hr) if a pt needs x mg/kg/hr of a solution of concentration y mg / z mL
A
- Multiply x by pt’s weight
- Don’t forget to check all the units match up!
- Divide by the concentration of the solution
14
Q
List the drugs used in the longterm management of ACS
A
- 75mg aspirin
- 75mg clopidogrel / prasugrel / ticagrelor / warfarin sodium / rivaroxaban
- B-blocker if not CI (propranolol hydrochloride, carvedilol if L ventricular dysfunction) (if CI and NO LV dysfunction can use verapamil hydrochloride instead)
- Consider ACEi if LV dysfunction, or ARB if heart failure
- Nitrates for angina
15
Q
If metformin isn’t tolerated or is contraindicated, what is given for T2DM?
Why might it be contraindicated?
A
Contraindicated if eGFR <30
Can give gliptin, sulfonylurea (e.g. gliclazide) or pioglitazone
16
Q
What dose prochlorperazine work on to target nausea?
A
Phenothiazine
Mainly dopamine antagonist but also H1 and 5-HT
17
Q
2 side effects of gliflozins (SGLT-2 inhibitors)
A
UTI (increase urinary glucose excretion)
Weight loss
18
Q
What can be given for overactive bladder?
A
Anticholinergic:
Oxybutynin immediate release
Tolterodine immediate release
Darifenacin
You MUST say immediate release
19
Q
How often should young pts with T1DM check their BM?
A
At least 5 times a day
20
Q
What is 4th line medical Tx for T2DM and when do you step up to this?
A
Step up if triple Tx not effective, not tolerated, or contraindicated AND BMI>35
Metformin + sulfonylurea (e.g. gliclazide) + GLP-1 mimetic
21
Q
What dose cyclizine work on to target nausea?
A
Anti-histamine and anit-cholinergic
22
Q
What dose of which statin for primary and secondary prevention of cardiovascular disease?
A
Primary = atorvastatin 20mg od Secondary = atorvastatin 80mg od
23
Q
Spironolactone is what type of antihypertensive?
A
Aldosterone antagonist
24
Q
What are the positives and negatives of using haloperidol as an anti-emetic?
A
Good for chemical toxicity (e.g. drugs, metabolic, chemo), hiccups, agitation, antipsychotic effects
SEs: extrapyramidal effects (D2 antagonist)
25
3 side effects of sulfonylureas
Hypoglycaemia
Weight gain
Hyponatraemia
Diarrhoea
26
What blood glucose levels for pre-diabetes?
HbA1c 42-47 mmol/mol
| Fasting glucose 6.1-6.9 mmol/L
27
What's found in 5% glucose?
50g/L glucose
28
What is the dose of immediate release metformin?
- 500mg OD for 1 week w/ breakfast
- Then 500mg bd for 1 week w/ breakfast & dinner
- Then 500mg tds w/ breakfast, lunch & dinner
Max 2g/day
29
How do ACEi's like Ramipril work? What are the effects on electrolytes?
- Inhibit ACE converting ang I -> ang II -> reduced aldosterone
- Stops aldosterone working on DCT where it ~ reabsorbs Na and H2O and excretes K
So you get increased serum K, and lower Na, H2O and BP
30
Which antiemetics block histamine?
Prochlorperazine
Levomepromazine
Cyclizine
31
Side effects of statins?
- GI disturbance
- Sleep disturbance
- Headache
- Myalgia (myopathy, myositis, rhabdo)
- Disturbed liver function
32
1 example of a thiazolidinediones
Pioglitazone
33
What dose levomepromazine work on to target nausea?
Lots and lots of receptors! Blocks dopamine, Ach, 5-HT, histamine
34
When do you not use bulking agent laxatives like ispaghula and methyl cellulose
```
Obstruction
Faecal impaction
Swallowing difficulty (mixed with water to take)
```
35
What do you give for a TIA and when?
If suspected TIA w/in last week:
o 300mg aspirin stat
Unless:
• Bleeding disorder or taking an anticoagulant, as will need immediate admission for assessment and imaging to rule out haemorrhage
• Taking low-dose aspirin -> continue this dose until reviewed by specialist
• Contraindicated
36
Describe the 4 stages of shock
- 1: <750ml <15% loss. CRT 3s, mild tachy.
- 2: 750-1500ml 15-30% loss. CRT 5s, cool peripheries, tachy, increased DBP and decreased PP, anxious.
- 3: 1500-2000ml 30-40% loss. Low V pulse, marked tachy, decreased SBP, v narrow PP, postural drop 20-30 mmHg, tachypnoea, oliguria, confusion, agitation.
- 4: 2-2.5L >40% loss. Cold skin, thready pulse, v tachy, v low BP, low GCS or LOC, oliguria/anuria.
37
What is the dose of modified release metformin?
- 500mg od for 10 days w/ dinner
| - Increase by 500mg every 10 days up to 2g OD w/ dinner
38
2 examples of loop diruetics
2 examples of loop diruetics
39
Which antihypertensives can cause hyperlipidaemia?
Thiazide diuretics
40
Briefly describe what is given for an ischaemic stroke?
- Thrombolysis w/ IV alteplase if <4.5hrs since Sx onset
- Thrombectomy if <24hrs since Sx onset (and other criteria met)
- 300mg aspirin stat, then od for 2w
- Possibly antihypertensives
41
What fluids do you give to someone who's NBM?
Maintenance
AND
Replace loss
42
What is 3rd line oral Tx for T2DM? When do you step up to this?
Step up if HbA1c > 58 mmol/mol
Keep metformin
Add insulin
Add either:
- Sulfonylurea + gliptin/pioglitazone/SGLT-2 inhibitor
- Pioglitazone + SGLT-2 inhibitor
- Sulfonylurea e.g. gliclazide
43
Max rate of K peripherally?
10mmol/L/hour
44
How do loop diuretics like furosemide work? What are the effects on electrolytes?
- Loop diuretic
- Inhibits luminal Na-K-Cl cotransporter in thick ascending limb
- Increases excretion of Na, K and Cl -> low levels of these
Although beware can cause AKI which will -> high K, and deranged urate and creatinine
45
How much glucose does someone need/day?
50-100g/day i.e. 1 or 2 bags of 5% dextrose
46
What are the positives and negatives of using cyclizine as an anti-emetic?
Good for nausea caused by central/vestibular causes, raised ICP, motion-sickness, and good for bowel obstruction and irritation of the oesophagus
SEs: anticholinergic effects e.g. dry mouth, urinary retention, restlessness
47
2 side effects of metformin
GI upset
| Lactic acidosis
48
Give 2 examples of SABAs
salbutamol and terbutaline
49
Prescribe a one dose TX for chlamydia
1g azithromycin po once only
50
What dose ondansetron work on to target nausea?
5-HT3 (serotonin) receptor antagonist
51
Give the different types of shock and examples of each
- Distributive e.g. sepsis, anaphylaxis, neurogenic
- Hypovolaemia e.g. haemorrhage, burns, fluid loss
- Cardiogenic e.g. ACS, HF, arrhythmia, cardiomyopathy
- Obstructive e.g. massive PE, cardiac tamponade
52
Doses of adrenaline (anaphylaxis) for children of different ages
- 1mo-5yo 150micrograms IM
- 6-11yo 300micrograms
- 12-17yo 500micrograms
NB 150micrograms = 1:1000 0.15ml
53
How much does 1 unit of insulin ~ drop blood glucose by?
3 mmol/L
54
Which antiemetic is preferred for hyperemesis gravidarum?
Oral (or IM) antihistamine e.g. cyclizine or promethazine
55
Give an example of an ACEi
Ramipril
56
1st line medications to terminate seizures?
Benzo:
10mg Midazolam buccal
4mg Lorazepam IV
10mg Diazepam rectal / IV
57
What dose of unfractionated heparin in treating unstable angina?
5000 units loading dose by IV injection
58
What can be given in CKD for anaemia and when is it given?
Hb <100 AND Sx/signs of anaemia -> EPO-stimulating agents (e.g. darbepoetin)-> Hb 100-1120
59
What's found in Hartmann's?
```
131 Na
111 Cl
5 K
29 Lactate
2 Ca
```
60
Furosemide is what type of drug?
Loop diuretic
61
Give an example of a loop diuretic
Furosemide
62
Prescribe something for regurgitation in infants
Gaviscon infant (or Alginic acid) 2 sachets oral PRN
Mix with feeds (or water if breastfed) and give after every feed, up to 12 sachets per day, trial for 1-2 weeks
63
Describe the COPD step-up management pathway
SABA/SAMA PRN
->
- If asthma features suggestive of steroid responsiveness (previous asthma/atopy, high eosinophils, FEV1 >400ml variation, >20% PEFR diurnal variation): SABA/SAMA PRN + regular LABA+ICS
- Otherwise: SABA PRN + regular LABA+LAMA
->
SABA PRN + regular LABA+LAMA_ICS
64
Which antihypertensives are first line in CKD?
ACEi e.g. lisinopril, ramipril, enalapril
| ARB e.g. losartan, irbesartan
65
Antidote for benzos
Flumazenil
66
When do you give lipid lowering agents in CKD and which ones?
o Start a statin if not on dialysis
| Also give ezetimibe with simvastatin if G3/4 (GFR 15-60)
67
What is given for metabolic acidosis?
Sodium bicarbonate
68
What's given for hyperkalaemia to stabilise the myocardium?
10mL 10% IV Calcium Gluconate
| Can give 20mL instead, but probs best to start w/ 10mL and see response
69
Give an example of an aldosterone antagonist
Spironolactone
70
What's the standard dose of warfarin?
5-10mg od
71
```
What types of laxatives are the following?
A. Senna
B. Lactulose
C. Phosphate enema
D. Sodium bisacodyl
E. Glycerin suppository
```
Osmotic: lactulose, Mg salts, Na salts, phosphate enema
Stimulant: senna, docusate sodium, bisacodyl, glycerin suppository
Bulking agents: ispaghula husk, methyl cellulose
72
When do you give a fluid bolus?
```
o SBP < 100 mmHg
o HR > 90 bpm
o Cap refill > 2s or peripheries cold
o RR > 20 bpm
o NEWS2 score > 4
o Passive leg raising (PLR) suggests fluid responsiveness
```
73
What's found in 0.9% NaCl?
154 Na
| 154 Cl
74
Which antiemetic can be used if you're not sure of the exact cause of the nausea and lots of things could be contributing to it?
Levomepromazine (targets lots of different receptors)
75
How do aldosterone antagonists like spironolactone work? What are the effects on electrolytes?
- Stops aldosterone working on DCT where it ~ reabsorbs Na and H2O and excretes K
So you get increased serum K, and lower Na, H2O and BP
76
What are the diabetic and hypertensive target sugars and bps in CKD?
HbA1c <53
BP <130/80
77
What dose of aspirin acutely in ACS?
300mg chewed or dispersed in water
78
Where do furosemide and budesonide work?
Loop diuretics: inhibit Na-K-Cl cotransporter in ascending limb
79
What laxatives to use/not use if obstructed?
Don't use stimulant or bulking
Use osmotic like lactulose, magnesium/sodium salts, phosphate enema
80
What tool do you use to decide whether to prescribe a statin? When do you prescribe?
QRISK >10%
81
Which antiemetic is good for hiccups?
Haloperidol
82
What do you need to consider regards blood glucose levels in diabetics before surgery?
- Measure BM before surgery
- Remember need to be NBM
- Acceptable range to proceed to surgery is 4-12 mmol/L, blood ketones <3mmol/L, urinary ketones < +++
- If too high, re-check in 1hr, possibly start variable rate IV insulin infusion
83
Do you start/continue statins if someone has an ischaemic stroke?
Don't start them, but continue them if already on them long-term
84
What anticoagulation is given for secondary prevention after ischaemic stroke/TIA? When is it started?
Dose-adjusted warfarin (INR 2-3) (or direct thrombin or factor Xa inhibitor if non-valvular AF)
TIA:
• Start immediately once haemorrhage excluded
Non-disabling ischaemic stroke:
• Start w/in 14 days
Disabling ischaemic stroke:
• Defer until after 14d
• (Aspirin 300mg for first 14d)
85
What are the positives and negatives of using prochlorperazine as an anti-emetic?
Good for motion-sickness, anxiety, sedative
| SEs: pretty sedative, prolongs QT, hypotension, dry mouth
86
Ramipril is what type of antihypertensive?
ACEi
87
Which antiemetics are good for nausea caused by chemicals e.g. drugs, chemo, metabolic causes
D2 antagonists:
Haloperidol
Metoclopramide
Domperidone
88
How do you reverse the effects of warfarin?
Reverse w/ prothrombin complex concentrate (PCC) and IV vitamin K
89
Which antiemetics cause anticholinergic SEs like dry mouth, and possibly urinary retention?
Prochlorperazine
Levomepromazine
Hyoscine
Cyclizine
90
What dose of aspirin for secondary prevention of CVD?
75mg od po
91
What can you give for hypoglycaemia (drug + dose)? Give 2 options
If conscious and no swallow issues:
4-7 glucotabs po stat
Otherwise: Glucagon 1mg IM stat
92
What's in plasmalyte?
140 Na, 5 K, 1.5 Mg, 98 Cl, 27 Acetate, 23 Gluconate
93
2 side effects of thiazolidinediones
Weight gain
| Fluid retention
94
Which antiemetics block Ach?
Levomepromazine
Hyoscine
Cyclizine
95
Prescribe a fluid bolus
500ml NaCl 0.9% (or Hartmann's) over 15 mins
| 250ml if heart failure
96
Which antiemetics should be avoided in Parkinson's and why?
D2 antagonists cause worsening of extrapyramidal SEs:
Haloperidol
Metoclopramide
97
Which antiemetics are also sedating or anxiolytic?
Sedating and anxiolytic:
Prochlorperazine
Levomepromazine
Anxiolytic:
Haloperidol
98
Which antiemetics are good if the oesophagus is irritated?
Cyclizine
99
When is warfarin indicated?
TIA
Prophylaxis of embolus in rheumatic heart disease or AF
Prophylaxis after prosthetic heart valve
Prophylaxis and Tx of VTE and PE
100
What class is gliclazide?
sulfonylurea
101
If someone has long QT, which anti-emetics are good/bad?
Good:
Levomepromazine, hyoscine, cyclizine, ondansetron
Bad:
Prochlorperazine, domperidone, metoclopramide
102
How much electrolytes do you need in maintenance?
1 mmol/kg/day Na, Cl, K
103
What do you give for acute heart failure?
- High flow O2
| - 40mg IV furosemide
104
If someone's on an ACEi and trying to get pregnant, what should you do?
Swap them to labetalol
105
What are the positives and negatives of using hyoscine as an anti-emetic?
Good for motion-sickness, bowel obstruction, drying secretions if you have lots of them
SEs: anticholinergic effects e.g. dry mouth, restlessness
106
Which DM medication should be avoided if GFR<45?
SGLT2i (empagliflozin, canagliflozin)
107
What do you need to inform people taking sulfonylureas like gliclazide and why?
Can cause hypoglycaemia so advise to eat regular meals and watch for signs of hypo.
Need to inform DVLA if group 1 licence and more than 1 hypo requiring assistance from another person in the last year.
108
List what drugs you give for an NSTEMI
- O2
- GTN sublingual/IV/buccal or IV isosorbide dinitrate
- 5-10mg IV diamorphine hydrochloride / morphine once only or over 3-5 mins (with 10mg metoclopramide)
- 300mg aspirin
- 300mg clopidogrel/ prasugrel/ ticagrelor
- 5000 units unfractionated heparin / LMWH / fondaparinux sodium
- B-blocker if not contraindicated (else diltiazem or verapamil hydrochloride)
109
Which antiemetics should you avoid if hypotensive?
Prochlorperazine
| Levomepromazine
110
What are the positives and negatives of using domperidone as an anti-emetic?
Good for gastric stasis (prokinetic) and Parkinson's (D2 receptor antagonist but doesn't cross BBB)
SEs: prolongs QT, extrapyramidal effects from D2 block
111
What dose hyoscine work on to target nausea?
anti-cholinergic
112
Dose of metoclopramide?
10mg tds po
113
What do you do if on warfarin and major bleed?
Stop warfarin
5mg IV vit K
Prothrombin complex concentrate (otherwise FFP)
114
When do you not use stimulant laxatives like senna?
Obstruction
| Not long-term BC of colonic atony and low K
115
Do you give antihypertensives if someone has a haemorrhagic stroke?
Aim for SBP 130-140mmHg from 1hr until 7d after Sx onset
Offer bp lowering meds if:
Present <6hr after Sx onset
SBP 150-220mmHg
• Rapid bp lowering if SBP >220mmHg
GCS > 5
No underlying structural cause of the haemorrhage (tumour, AV malformation, aneurysm)
Not going to have neurosurgery to evacuate the haematoma
Don’t have a massive haematoma w/ poor prognosis
116
Side effects of loop diuretics like furosmide?
```
hypotension
hyponatraemia
hypokalaemia, hypomagnesaemia
hypochloraemic alkalosis
hypocalcaemia
ototoxicity
renal impairment (from dehydration + direct toxic effect)
hyperglycaemia (less common than with thiazides)
gout
```
117
What dose of clopidogrel acutely in ACS?
300mg po
| before PCI if having PCI
118
How is metformin prescription changed for surgery and why?
Stop when pre-op fast begins if pt will miss >1 meal or there's sig risk of AKI.
If on >od metformin -> variable rate IV insulin infusion.
Otherwise only give insulin if glucose >12mmol/L on 2 consecutive occasions.
Don't recommence until pt e+d and normal renal function
119
What are the positives and negatives of using metoclopramide as an anti-emetic?
Good for gastric stasis or pseudo-obstruction (prokinetic) and chemical imbalance e.g. drugs (chemo) /cytokines/metabolic
SEs: prolongs QT, extrapyramidal effects (blocks D2) (can't use in Parkinson's)
120
What drug should be stopped in a STEMI? When can it be restarted?
ACEi (and ARBs)
Restart w/in 24 hrs of the MI
121
Which antiemetics are good/bad for bowel obstruction versus gastric stasis?
Gastric stasis -> prokinetics like metoclopramide / domperidone
Bowel obstruction -> anticholinergics like hyoscine or cyclizine
AVOID pro-kinetics bc risk of perforation
AVOID ondansetron in both bc causes constipation
122
Which antiemetics are good for PREVENTING nausea i.e. started with chemo or given immediately post-io?
Ondansetron
123
When is thrombolysis given in stroke and what is given?
Give IV alteplase if:
- ischaemic stroke
- <4.5hrs since Sx onset
- intracranial haemorrhage excluded through imaging
- BP been lowered to <185/110mmHg
124
What class are gliflozins?
SGLT-2 inhibitors
125
When do you prescribe Metformin for GDM?
Fasting plasma glucose >7
Or
Fasting plasma glucose > 5.6 or 2 hour plasma glucose >7.8
AND
No improvement after 1-2 weeks of lifestyle changes
126
What ecg changes for different levels of hyperkalaemia?
K>5.5: peaked T waves (repolarisation abnormalities)
K>6.5: wide P waves, PR segment lengthens, absent P waves (progressive atrial paralysis)
K>7: prolonged QRS interval, aberrant QRS morphology, high grade AV block with
ventricular escape rhythms, conduction blocks (LBBB, RBBB, fascicular blocks) sinus
bradycardia, slow AF, sine wave appearance (pre-terminal rhythm)
127
3 side effects of GLP-1 agonists (-tides)
N&V
Pancreatitis
Weight loss
128
Give 2 examples of LABAs
salmeterol and formoterol
129
What dose of clopidogrel for secondary prevention of CVD?
75mg od po for up to 12 months post event
130
What's the normal and minimum expected urine output?
1 ml/kg/hour is normal
| Aim for at least 0.5 ml/kg/hour
131
Name 2 drugs which can be used with nicotine replacement therapy
Name 2 drugs which can be used with nicotine replacement therapy
132
What are the positives and negatives of using ondansetron as an anti-emetic?
Good for preventing nausea (e.g. if going to receive chemo or immediately post-op)
SEs: constipating, slows colonic transit
133
If metformin isn't tolerated or is contraindicated, what is given 2ND LINE for T2DM? When do you step up to this?
Step up if HbA1c >58 mmol/mol
Either:
- Gliptin + pioglitazone / sulfonylurea
- Pioglitazone + sulfonylurea
Sulfonylurea e.g. gliclazide
134
2 examples of sulfonylureas
Gliclazide
| Glimepiride
135
What are the 1st and 2nd line antiplatelets for secondary prevention after ischaemic stroke/TIA?
1st line: 75mg clopidogrel OD
2nd line: modified-release dipyridamole 200 mg bd
136
When do you step up therapy from metformin and to what? (i.e. 2nd line Tx)
HbA1c > 58 mmol/mol
Keep metformin
Add in:
- gliptin, sulfonylurea (e.g. gliclazide), pioglitazone or SGLT-2i
137
What do you do if on warfarin and INR >8.0?
Stop warfarin
No bleeding: 1-5mg vit K po (IV preparation given po)
Minor bleeding: 1-3mg IV vit K
Repeat vit K dose if INR still too high after 24 hrs
Restart warfarin when INR < 5.0
138
What's best to give for pain relief in ACS? What should you give with it?
5-10mg IV morphine / diamorphine hydrochloride once only, or over 3-5 mins
(with 10mg metoclopramide)
139
What do you do if on warfarin and INR 5.0-8.0?
No bleeding:
Withhold 1 or 2 doses + reduce subsequent maintenance dose
Minor bleeding:
Stop warfarin, give IV vit K 1-3mg, restart when INR < 5.0
140
Which antihypertensives are contraindicated in pregnancy and why? What's the 1st line alternative?
ACEi
- affect foetal/neonatal bp control and renal function
- skull defects
- oligohydramnios
1st line alternative = labetalol
141
What dose metoclopramide work on to target nausea?
D2 receptor antagonist
142
When is oral theophylline used in COPD?
after trials of short and long-acting bronchodilators or to people who cannot used inhaled therapy
143
When is anticoagulation indicated for secondary prevention after ischaemic stroke/TIA?
o ONLY if another indication e.g. cardiac source of embolism (AF/atrial flutter), cerebral venous thrombosis, arterial dissection
o ONLY if no contraindications e.g. haemorrhage excluded, no uncontrolled HTN, HAS-BLED score
144
Five an example of a LAMA
tiotropium
145
List what drugs you give for a STEMI?
- 300mg aspirin
- P2Y12-receptor antagonist e.g. 300mg clopidogrel / ticagrelor
- 5000 units unfractionated heparin or LMWH (e.g. enoxaparin sodium)
- O2 to >94% sats (88-92 in COPD)
- 5-10mg IV diamorphine hydrochloride / morphine once only or over 3-5 mins (with 10mg metoclopramide)
- Sublingual gtn or IV gtn/isosorbide dinitrate
- Insulin if hyperglycaemic
- PCI within 90 mins of diagnosis!!!! Or thrombolysis if not available (tPA/tenecteplase/alteplase)
146
1 side effect of gliptins (DPP-4 inhibitors)
Increased risk of pancreatitis
147
Which antihypertensives may exacerbate psoriasis?
Beta-blockers
148
3 types of laxatives and 2 examples of each
Osmotic: lactulose, Mg salts, Na salts, phosphate enema
Stimulant: senna, docusate sodium, bisacodyl, glycerin suppository
Bulking agents: ispaghula husk, methyl cellulose
149
Give an example of a SAMA
Ipratropium
150
Which antiemetics block serotonin?
Prochlorperazine
Levomepromazine
Ondansetron
Metoclopramide
151
Describe how aspirin is given for an ischaemic stroke
o ASAP, w/in 24hrs, but AFTER haemorrhage ruled out by imaging
o 300mg PO STAT
If dysphagia: 300mg rectally or by enteral tube
o Continue 300mg PO OD for 2w (or until discharge, when switched to long-term antithrombotic Tx)
o PPI if previous dyspepsia ass.w. aspirin
o Alternative antiplatelet if allergic or genuinely intolerant (hypersensitivity or Hx of severe dyspepsia from low-dose aspirin)
152
What route are GLP-1 agonists (-tides) given?
SC
153
Do you give antihypertensives if someone has an ischaemic stroke?
Lower BP to <185/110mmHg if candidate for IV thrombolysis
```
Otherwise only lower BP if hypertensive emergency AND one of:
Hypertensive encephalopathy
Hypertensive nephropathy
Hypertensive cardiac failure / MI
Aortic dissection
Pre-/eclampsia
```
154
What class if pioglitazone?
thiazolidinediones
155
What medications can be used to treat DM in CKD? Give an example of each
Metformin
SGLT2i (empagliflozin, canagliflozin)
GLP-1 agonists (liraglutide)
156
What class is glimepiride?
sulfonylurea
157
If metformin isn't tolerated or is contraindicated, what is given 3RD LINE for T2DM? When do you step up to this?
Add in insulin if HbA1c >58
158
What dose domperidone work on to target nausea?
D2 receptor antagonist
159
Which antiemetics block dopamine?
Prochlorperazine
Levomepromazine
Haloperidol
Domperidone (although doesn't cross BBB so ok in Parkinson's)
