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General Flashcards

1
Q

Which antiemetics are good for motion sickness or vestibular nausea?

A

Anticholinergics or antihistamines?
Hyoscine
Cyclizine
Prochlorperazine

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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

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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

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4
Q

Which antiemetics are good if you want to slow colonic transit?

A

Ondansetron causes constipation

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5
Q

What dose haloperidol work on to target nausea?

A

dopamine receptor antagonist

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6
Q

Which antiemetics can cause extrapyramidal SEs?

A

Haloperidol
Metoclopramide

Domperidone (doesn’t cross BBB so not as bad as the others)

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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
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8
Q

Which antiemetics are good for raised ICP?

A

Cyclizine + steroid

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9
Q

How much maintenance fluids do people need?

A

25-30 ml/kg/day

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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

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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

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12
Q

What class are gliptins?

A

DPP-4 inhibitors

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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
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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
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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

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16
Q

What dose prochlorperazine work on to target nausea?

A

Phenothiazine

Mainly dopamine antagonist but also H1 and 5-HT

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17
Q

2 side effects of gliflozins (SGLT-2 inhibitors)

A

UTI (increase urinary glucose excretion)

Weight loss

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18
Q

What can be given for overactive bladder?

A

Anticholinergic:
Oxybutynin immediate release
Tolterodine immediate release
Darifenacin

You MUST say immediate release

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19
Q

How often should young pts with T1DM check their BM?

A

At least 5 times a day

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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

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21
Q

What dose cyclizine work on to target nausea?

A

Anti-histamine and anit-cholinergic

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22
Q

What dose of which statin for primary and secondary prevention of cardiovascular disease?

A 
Primary = atorvastatin 20mg od
Secondary = atorvastatin 80mg od
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23
Q

Spironolactone is what type of antihypertensive?

A

Aldosterone antagonist

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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)

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25
Q

3 side effects of sulfonylureas

A

Hypoglycaemia
Weight gain
Hyponatraemia
Diarrhoea

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26
Q

What blood glucose levels for pre-diabetes?

A

HbA1c 42-47 mmol/mol

Fasting glucose 6.1-6.9 mmol/L

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27
Q

What’s found in 5% glucose?

A

50g/L glucose

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28
Q

What is the dose of immediate release metformin?

A
  • 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

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29
Q

How do ACEi’s like Ramipril work? What are the effects on electrolytes?

A
  • 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

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30
Q

Which antiemetics block histamine?

A

Prochlorperazine
Levomepromazine
Cyclizine

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31
Q

Side effects of statins?

A
  • GI disturbance
  • Sleep disturbance
  • Headache
  • Myalgia (myopathy, myositis, rhabdo)
  • Disturbed liver function
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32
Q

1 example of a thiazolidinediones

A

Pioglitazone

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33
Q

What dose levomepromazine work on to target nausea?

A

Lots and lots of receptors! Blocks dopamine, Ach, 5-HT, histamine

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34
Q

When do you not use bulking agent laxatives like ispaghula and methyl cellulose

A 
Obstruction
Faecal impaction
Swallowing difficulty (mixed with water to take)
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35
Q

What do you give for a TIA and when?

A

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

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36
Q

Describe the 4 stages of shock

A
  • 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.
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37
Q

What is the dose of modified release metformin?

A
  • 500mg od for 10 days w/ dinner

- Increase by 500mg every 10 days up to 2g OD w/ dinner

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38
Q

2 examples of loop diruetics

A

2 examples of loop diruetics

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39
Q

Which antihypertensives can cause hyperlipidaemia?

A

Thiazide diuretics

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40
Q

Briefly describe what is given for an ischaemic stroke?

A
  • 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
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41
Q

What fluids do you give to someone who’s NBM?

A

Maintenance
AND
Replace loss

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42
Q

What is 3rd line oral Tx for T2DM? When do you step up to this?

A

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
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43
Q

Max rate of K peripherally?

A

10mmol/L/hour

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44
Q

How do loop diuretics like furosemide work? What are the effects on electrolytes?

A
  • 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

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45
Q

How much glucose does someone need/day?

A

50-100g/day i.e. 1 or 2 bags of 5% dextrose

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46
Q

What are the positives and negatives of using cyclizine as an anti-emetic?

A

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

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47
Q

2 side effects of metformin

A

GI upset

Lactic acidosis

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48
Q

Give 2 examples of SABAs

A

salbutamol and terbutaline

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49
Q

Prescribe a one dose TX for chlamydia

A

1g azithromycin po once only

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50
Q

What dose ondansetron work on to target nausea?

A

5-HT3 (serotonin) receptor antagonist

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51
Q

Give the different types of shock and examples of each

A
  • 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
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52
Q

Doses of adrenaline (anaphylaxis) for children of different ages

A
  • 1mo-5yo 150micrograms IM
  • 6-11yo 300micrograms
  • 12-17yo 500micrograms

NB 150micrograms = 1:1000 0.15ml

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53
Q

How much does 1 unit of insulin ~ drop blood glucose by?

A

3 mmol/L

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54
Q

Which antiemetic is preferred for hyperemesis gravidarum?

A

Oral (or IM) antihistamine e.g. cyclizine or promethazine

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55
Q

Give an example of an ACEi

A

Ramipril

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56
Q

1st line medications to terminate seizures?

A

Benzo:
10mg Midazolam buccal
4mg Lorazepam IV
10mg Diazepam rectal / IV

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57
Q

What dose of unfractionated heparin in treating unstable angina?

A

5000 units loading dose by IV injection

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58
Q

What can be given in CKD for anaemia and when is it given?

A

Hb <100 AND Sx/signs of anaemia -> EPO-stimulating agents (e.g. darbepoetin)-> Hb 100-1120

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59
Q

What’s found in Hartmann’s?

A 
131 Na
111 Cl
5 K
29 Lactate
2 Ca
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60
Q

Furosemide is what type of drug?

A

Loop diuretic

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61
Q

Give an example of a loop diuretic

A

Furosemide

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62
Q

Prescribe something for regurgitation in infants

A

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

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63
Q

Describe the COPD step-up management pathway

A

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

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64
Q

Which antihypertensives are first line in CKD?

A

 ACEi e.g. lisinopril, ramipril, enalapril

 ARB e.g. losartan, irbesartan

65
Q

Antidote for benzos

A

Flumazenil

66
Q

When do you give lipid lowering agents in CKD and which ones?

A

o Start a statin if not on dialysis

 Also give ezetimibe with simvastatin if G3/4 (GFR 15-60)

67
Q

What is given for metabolic acidosis?

A

Sodium bicarbonate

68
Q

What’s given for hyperkalaemia to stabilise the myocardium?

A

10mL 10% IV Calcium Gluconate

Can give 20mL instead, but probs best to start w/ 10mL and see response

69
Q

Give an example of an aldosterone antagonist

A

Spironolactone

70
Q

What’s the standard dose of warfarin?

71
Q 
What types of laxatives are the following?
A. Senna
B. Lactulose
C. Phosphate enema
D. Sodium bisacodyl
E. Glycerin suppository
A

Osmotic: lactulose, Mg salts, Na salts, phosphate enema
Stimulant: senna, docusate sodium, bisacodyl, glycerin suppository
Bulking agents: ispaghula husk, methyl cellulose

72
Q

When do you give a fluid bolus?

A 
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
Q

What’s found in 0.9% NaCl?

A

154 Na

154 Cl

74
Q

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?

A

Levomepromazine (targets lots of different receptors)

75
Q

How do aldosterone antagonists like spironolactone work? What are the effects on electrolytes?

A
  • 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
Q

What are the diabetic and hypertensive target sugars and bps in CKD?

A

HbA1c <53

BP <130/80

77
Q

What dose of aspirin acutely in ACS?

A

300mg chewed or dispersed in water

78
Q

Where do furosemide and budesonide work?

A

Loop diuretics: inhibit Na-K-Cl cotransporter in ascending limb

79
Q

What laxatives to use/not use if obstructed?

A

Don’t use stimulant or bulking

Use osmotic like lactulose, magnesium/sodium salts, phosphate enema

80
Q

What tool do you use to decide whether to prescribe a statin? When do you prescribe?

A

QRISK >10%

81
Q

Which antiemetic is good for hiccups?

A

Haloperidol

82
Q

What do you need to consider regards blood glucose levels in diabetics before surgery?

A
  • 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
Q

Do you start/continue statins if someone has an ischaemic stroke?

A

Don’t start them, but continue them if already on them long-term

84
Q

What anticoagulation is given for secondary prevention after ischaemic stroke/TIA? When is it started?

A

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
Q

What are the positives and negatives of using prochlorperazine as an anti-emetic?

A

Good for motion-sickness, anxiety, sedative

SEs: pretty sedative, prolongs QT, hypotension, dry mouth

86
Q

Ramipril is what type of antihypertensive?

87
Q

Which antiemetics are good for nausea caused by chemicals e.g. drugs, chemo, metabolic causes

A

D2 antagonists:
Haloperidol
Metoclopramide
Domperidone

88
Q

How do you reverse the effects of warfarin?

A

Reverse w/ prothrombin complex concentrate (PCC) and IV vitamin K

89
Q

Which antiemetics cause anticholinergic SEs like dry mouth, and possibly urinary retention?

A

Prochlorperazine
Levomepromazine
Hyoscine
Cyclizine

90
Q

What dose of aspirin for secondary prevention of CVD?

A

75mg od po

91
Q

What can you give for hypoglycaemia (drug + dose)? Give 2 options

A

If conscious and no swallow issues:
4-7 glucotabs po stat

Otherwise: Glucagon 1mg IM stat

92
Q

What’s in plasmalyte?

A

140 Na, 5 K, 1.5 Mg, 98 Cl, 27 Acetate, 23 Gluconate

93
Q

2 side effects of thiazolidinediones

A

Weight gain

Fluid retention

94
Q

Which antiemetics block Ach?

A

Levomepromazine
Hyoscine
Cyclizine

95
Q

Prescribe a fluid bolus

A

500ml NaCl 0.9% (or Hartmann’s) over 15 mins

250ml if heart failure

96
Q

Which antiemetics should be avoided in Parkinson’s and why?

A

D2 antagonists cause worsening of extrapyramidal SEs:
Haloperidol
Metoclopramide

97
Q

Which antiemetics are also sedating or anxiolytic?

A

Sedating and anxiolytic:
Prochlorperazine
Levomepromazine

Anxiolytic:
Haloperidol

98
Q

Which antiemetics are good if the oesophagus is irritated?

99
Q

When is warfarin indicated?

A

TIA
Prophylaxis of embolus in rheumatic heart disease or AF
Prophylaxis after prosthetic heart valve
Prophylaxis and Tx of VTE and PE

100
Q

What class is gliclazide?

A

sulfonylurea

101
Q

If someone has long QT, which anti-emetics are good/bad?

A

Good:
Levomepromazine, hyoscine, cyclizine, ondansetron

Bad:
Prochlorperazine, domperidone, metoclopramide

102
Q

How much electrolytes do you need in maintenance?

A

1 mmol/kg/day Na, Cl, K

103
Q

What do you give for acute heart failure?

A
  • High flow O2

- 40mg IV furosemide

104
Q

If someone’s on an ACEi and trying to get pregnant, what should you do?

A

Swap them to labetalol

105
Q

What are the positives and negatives of using hyoscine as an anti-emetic?

A

Good for motion-sickness, bowel obstruction, drying secretions if you have lots of them
SEs: anticholinergic effects e.g. dry mouth, restlessness

106
Q

Which DM medication should be avoided if GFR<45?

A

SGLT2i (empagliflozin, canagliflozin)

107
Q

What do you need to inform people taking sulfonylureas like gliclazide and why?

A

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
Q

List what drugs you give for an NSTEMI

A
  • 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
Q

Which antiemetics should you avoid if hypotensive?

A

Prochlorperazine

Levomepromazine

110
Q

What are the positives and negatives of using domperidone as an anti-emetic?

A

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
Q

What dose hyoscine work on to target nausea?

A

anti-cholinergic

112
Q

Dose of metoclopramide?

A

10mg tds po

113
Q

What do you do if on warfarin and major bleed?

A

Stop warfarin
5mg IV vit K
Prothrombin complex concentrate (otherwise FFP)

114
Q

When do you not use stimulant laxatives like senna?

A

Obstruction

Not long-term BC of colonic atony and low K

115
Q

Do you give antihypertensives if someone has a haemorrhagic stroke?

A

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
Q

Side effects of loop diuretics like furosmide?

A 
hypotension
hyponatraemia
hypokalaemia, hypomagnesaemia
hypochloraemic alkalosis
hypocalcaemia
ototoxicity
renal impairment (from dehydration + direct toxic effect)
hyperglycaemia (less common than with thiazides)
gout
117
Q

What dose of clopidogrel acutely in ACS?

A

300mg po

before PCI if having PCI

118
Q

How is metformin prescription changed for surgery and why?

A

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
Q

What are the positives and negatives of using metoclopramide as an anti-emetic?

A

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
Q

What drug should be stopped in a STEMI? When can it be restarted?

A

ACEi (and ARBs)

Restart w/in 24 hrs of the MI

121
Q

Which antiemetics are good/bad for bowel obstruction versus gastric stasis?

A

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
Q

Which antiemetics are good for PREVENTING nausea i.e. started with chemo or given immediately post-io?

A

Ondansetron

123
Q

When is thrombolysis given in stroke and what is given?

A

Give IV alteplase if:

  • ischaemic stroke
  • <4.5hrs since Sx onset
  • intracranial haemorrhage excluded through imaging
  • BP been lowered to <185/110mmHg
124
Q

What class are gliflozins?

A

SGLT-2 inhibitors

125
Q

When do you prescribe Metformin for GDM?

A

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
Q

What ecg changes for different levels of hyperkalaemia?

A

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
Q

3 side effects of GLP-1 agonists (-tides)

A

N&V
Pancreatitis
Weight loss

128
Q

Give 2 examples of LABAs

A

salmeterol and formoterol

129
Q

What dose of clopidogrel for secondary prevention of CVD?

A

75mg od po for up to 12 months post event

130
Q

What’s the normal and minimum expected urine output?

A

 1 ml/kg/hour is normal

 Aim for at least 0.5 ml/kg/hour

131
Q

Name 2 drugs which can be used with nicotine replacement therapy

A

Name 2 drugs which can be used with nicotine replacement therapy

132
Q

What are the positives and negatives of using ondansetron as an anti-emetic?

A

Good for preventing nausea (e.g. if going to receive chemo or immediately post-op)
SEs: constipating, slows colonic transit

133
Q

If metformin isn’t tolerated or is contraindicated, what is given 2ND LINE for T2DM? When do you step up to this?

A

Step up if HbA1c >58 mmol/mol

Either:

  • Gliptin + pioglitazone / sulfonylurea
  • Pioglitazone + sulfonylurea

Sulfonylurea e.g. gliclazide

134
Q

2 examples of sulfonylureas

A

Gliclazide

Glimepiride

135
Q

What are the 1st and 2nd line antiplatelets for secondary prevention after ischaemic stroke/TIA?

A

1st line: 75mg clopidogrel OD

2nd line: modified-release dipyridamole 200 mg bd

136
Q

When do you step up therapy from metformin and to what? (i.e. 2nd line Tx)

A

HbA1c > 58 mmol/mol

Keep metformin
Add in:
- gliptin, sulfonylurea (e.g. gliclazide), pioglitazone or SGLT-2i

137
Q

What do you do if on warfarin and INR >8.0?

A

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
Q

What’s best to give for pain relief in ACS? What should you give with it?

A

5-10mg IV morphine / diamorphine hydrochloride once only, or over 3-5 mins

(with 10mg metoclopramide)

139
Q

What do you do if on warfarin and INR 5.0-8.0?

A

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
Q

Which antihypertensives are contraindicated in pregnancy and why? What’s the 1st line alternative?

A

ACEi

  • affect foetal/neonatal bp control and renal function
  • skull defects
  • oligohydramnios

1st line alternative = labetalol

141
Q

What dose metoclopramide work on to target nausea?

A

D2 receptor antagonist

142
Q

When is oral theophylline used in COPD?

A

after trials of short and long-acting bronchodilators or to people who cannot used inhaled therapy

143
Q

When is anticoagulation indicated for secondary prevention after ischaemic stroke/TIA?

A

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
Q

Five an example of a LAMA

A

tiotropium

145
Q

List what drugs you give for a STEMI?

A
  • 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
Q

1 side effect of gliptins (DPP-4 inhibitors)

A

Increased risk of pancreatitis

147
Q

Which antihypertensives may exacerbate psoriasis?

A

Beta-blockers

148
Q

3 types of laxatives and 2 examples of each

A

Osmotic: lactulose, Mg salts, Na salts, phosphate enema
Stimulant: senna, docusate sodium, bisacodyl, glycerin suppository
Bulking agents: ispaghula husk, methyl cellulose

149
Q

Give an example of a SAMA

A

Ipratropium

150
Q

Which antiemetics block serotonin?

A

Prochlorperazine
Levomepromazine
Ondansetron
Metoclopramide

151
Q

Describe how aspirin is given for an ischaemic stroke

A

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
Q

What route are GLP-1 agonists (-tides) given?

153
Q

Do you give antihypertensives if someone has an ischaemic stroke?

A

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
Q

What class if pioglitazone?

A

thiazolidinediones

155
Q

What medications can be used to treat DM in CKD? Give an example of each

A

Metformin

SGLT2i (empagliflozin, canagliflozin)

GLP-1 agonists (liraglutide)

156
Q

What class is glimepiride?

A

sulfonylurea

157
Q

If metformin isn’t tolerated or is contraindicated, what is given 3RD LINE for T2DM? When do you step up to this?

A

Add in insulin if HbA1c >58

158
Q

What dose domperidone work on to target nausea?

A

D2 receptor antagonist

159
Q

Which antiemetics block dopamine?

A

Prochlorperazine
Levomepromazine
Haloperidol
Domperidone (although doesn’t cross BBB so ok in Parkinson’s)

Prescribing PSA / Management (8 decks)

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