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General Things Flashcards

1
Q

What are the 3 types of interferon, what cells are they produced by and what is their main action?
What are they used to treat?

A

Interferon alpha, beta and gamma

Alpha - leucocytes, antiviral and some anti-cancer
Beta - fibroblasts, antiviral action
Gamma - NK cells, macrophage activation and weak antiviral action

Alpha - hep B&C, kaposi sarcoma, renal cell cancer (SE: flu-like reaction and depression)
Beta - MS, reduces frequency and severity of relapses
Gamma - chronic granulomatous disease and osteoporosis

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2
Q

Daily fluid requirements?
Na, Cl and K?
Glucose?

A

25-30 ml/kg/day water

1 mol/kg/day of Na, Cl and K

50-100g glucose/day (to limit starvation ketosis if fasting)

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3
Q

Does the amount of glucose prescribed in fluids change based on the patient’s weight?

A

No

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4
Q

Specific risks associated with prescribing saline?

Hartmann’s?

A

Hypercloraemic metabolic acidosis

Contains K so do not use in patients with/at risk of hyperkalaemia

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5
Q

How to work out anion gap in metabolic acidosis?

A

Na - (Cl+HCO3), normal range = 4-12

OR

(Na+K) - (Cl+HCO3), normal range = 10-18

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6
Q

Causes of anion gap metabolic acidosis?

A

MUDPILES CAT

Methanol
Urea
DKA
Paraldehyde
Iron/Isoniazid
Lactate
Ethanol
Salicylates

Carbon monoxide
Aminoglycosides
Theophylline

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7
Q

Causes of normal anion gap metabolic acidosis?

A

HARDASS

Hyperalimentation (TPN feeds)
Addison's disease
Renal tubular acidosis
Diarrhoea
Acetazolamide
Spironolactone
Saline infusion
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8
Q

How to work out maintenance fluid replacement for a kid?

A

100ml/day for every kg 0-10kg

50ml/day for every kg 11-20kg

20ml/day for every kg >20kg

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9
Q

Max rate of K infusion via peripheral line?

A

10mmol/hour

Any higher than 20mmol/hr needs cardiac monitoring

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10
Q

Shock with warm peripheries?

A

Neurogenic shock

From loss of sympathetic or hyper-parasympathetic innervation - marked vasodilation

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11
Q

Allograft?
Isograft?
Autograft?
Xenograft?

A

Allo - to a non-identical relative

Iso - between identical twins

Auto - within yourself

Xeno - to another unrelated person

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12
Q

7 P450 enzyme inducers?

A 
Phenytoin
Carbamazepine
Rifampicin
Phenobarbitone
St John's Wort
Chronic alcohol intake
Smoking (smokers need to take more aminophylline)
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13
Q

12 P450 inhibitors?

A 
Ciprofloxacin and erythromycin
Isoniazid
Cimetidine
Omeprazole
Amiodarone
Allopurinol
-azole antifungals
Fluoxetine and Sertraline
Valproate
Acute alcohol intake
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14
Q

As bisphosphonates take around 3 days to work (7 days for maximal effect), what else can be used acutely?
Advice for long term management of hypercalcaemia in malignancy?

A 
Calcitonin 
Steroids (sarcoidosis)

Diuretics - esp in patients who cannot tolerate aggressive fluid resuscitation

Long term:

  • Increase fluid intake
  • No need to have low Ca diet (as gut absorption usually reduced)
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15
Q

Why is hyperkalaemia usually associated with acidosis?

A

K and H are competitors - as K levels rise fewer H ions can enter the cell

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16
Q

Causes of hypokalaemia with alkalosis?

A
  • vomiting
  • thiazide/loop diuretics
  • Cushing’s syndrome
  • Conn’s syndrome (primary hyperaldosteronism)
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17
Q

Causes of hypokalaemia with acidosis?

A
  • Diarrhoea
  • renal tubular acidosis
  • acetazolamide
  • partially treated DKA
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18
Q

Deficiency of what other mineral can cause K deficiency?

A

Mg

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19
Q

Drugs which can cause SIADH?

A 
Carbamazepine
Sulfonylureas
SSRI's
Tricyclics
Vincristine
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20
Q

What malignancy can cause SIADH?

A

Small cell lung cancer

also pancreas and prostate

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21
Q

Neurological causes of SIADH?

A

Stroke
SAH
Subdural haemorrhage
Meningitis/encephalitis/abscess

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22
Q

Infections which cause SIADH?

A

TB

Pneumonia

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23
Q

Can PEEP cause SIADH?

Can porphyrias cause SIADH?

A

Yes

Yes

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24
Q

Management of SIADH?

A

Slow correction to avoid central pontine myelinosis

Fluid restriction

Demeclocycline: reduces responsiveness of collecting tubule cells to ADH

Captains (ADH antagonists)

25
Causes of hyperkalaemia?
``` AKI Drugs - spironolactone, ACEI, ARB, ciclosporin, heparin/LMWH, B blockers Metabolic acidosis Addison's Rhabdomyolysis Massive blood transfusion ``` Food: - salt substitutes (contain K instead of Na) - bananas, oranges, kiwi, avocado, spinach, tomato
26
In acute pancreatitis what happens to: - glucose? - K? - Ca? - Mg?
Hyperglycaemia Hypokalaemia (vomiting) Hypocalcaemia Hypomagnesaemia (vomiting)
27
Causes of hypocalcaemia?
- VitD deficiency (osteomalacia) - CKD - hypoparathyroidism - Pseudohypoparathyroidism - Rhabdomyolysis - Mg deficiency - Massive blood transfusion - acute pancreatitis Blood samples contaminated with EDTA give falsely low Ca
28
Acute management of severe hypocalcaemia?
IV Ca gluconate 10ml, 10% over 10 mins ECG monitoring Further management depends on cause
29
Causes of hypernatraemia? | Management?
Dehydration Osmotic diuresis (e.g. HHS) Diabetes insipidus Excessive saline Correct hypernatraemia slowly and cautiously, can predispose cerebral oedema and seizures General rate is no greater than 0.5mmol/hour
30
What are the general causes of hyperuricaemia? What can cause increased synthesis of urea? Decreased excretion?
Increased cell turnover or decreased renal excretion of uric acid Increased synthesis: - Myeloproliferative disorders - Exercise - Cytotoxics - Psoriasis - Lesch-Nyhan disease - Diet rich in purines Decreased excretion: - Drugs: low-dose aspirin, diuretics, pyrazinamide - pre-eclampsia - alcohol - renal failure - lead
31
2 main causes of hypokalaemia with hypertension?
Cushing's syndrome | Conn's syndrome
32
Raised ALP and raised Ca?
Bone mets | Hyperparathyroidism
33
Raised ALP and low Ca?
Osteomalacia | Renal failure
34
Generally, what is reabsorbed in kidney?
``` Na, Ca, Cl, Mg H2O HCO3 Glucose AA ```
35
Generally, what is excreted in kidney?
K, H, urea | Creatinine
36
Where do PTH and aldosterone work?
PTH proximal part of distal convoluted tubule (same as thiazides) Aldosterone distal part of distal convoluted tubule (same as spironolactone)
37
H1 antagonist antiemetic examples? MOA? What are they esp good for? SE?
- Cyclizine, promethazine, diphenhydramine - Block H1 receptors in brain - Motion sickness - Sedation
38
Antimuscarinic antiemetic example? MOA? Esp good for? SE?
Hyoscine (scopolamine) - Block muscarinic M1 ACh receptors in brain - Motion sickness - Dry mouth, tachycardia, constipation
39
5-HT3 receptor antagonist antiemetic examples? MOA? SE?
- Ondansetron - Block 5-HT3 receptors in the CTZ in the medulla, as well as same receptors in GI tract - Constipation, diarrhoea, headache
40
Dopamine antagonist antiemetic examples?
- Chlorpromazine, haloperidol, prochlorperazine, metoclopramide, domperidone - D2 antgonists in the CTZ of the medulla (except domperidone) and also the GI tract - SE: diarrhoea, EPSE (except domperidone)
41
NK1 antagonist amtiemetic examples?
Blocks NK1 receptors in the GI tract and CTZ blocking the effects of substance P (which evokes vomiting) SE: constipation, headaches
42
Antidiarrhoeal drug examples? MOA? SE?
- Main thing is electrolyte replacements - Loperamide, diphenoxylate - bind mu-opioid receptors in GI tract (less of an effect on the brain) - SE: constipation, sedation, respiratory depression
43
Laxative examples?
Lspaghula husk - bulk forming Lactulose - osmotic - hepatic constipation Senna - stimulant purgative - increases electrolyte/water secretion
44
Hyponatraemia causes with urinary Na >20mmol/L?
Sodium depletion/renal loss (often hypovolaemic): - diuretics: thiazides, loops - Addison's - renal failure If patients euvolaemic: - SIADH (urine osmolality often >500mmol/kg) - Hypothyroidism
45
Hyponatraemia causes with urinary Na <20mmol/L?
Sodium depletion/extra-renal loss: - diarrhoea, vomiting, sweating - burns - rectal adenoma Water excess (often hypervolaemic and oedematous): - secondary hyperaldosteronism (HF, cirrhosis) - nephrotic syndrome - IV dextrose - psychogenic polydipsia
46
Causes of hyperlipidaemia which result in predominant hypercholesterolaemia? What is predominantly raised in the other causes?
High cholesterol: - nephrotic syndrome - cholestasis - hypothyroidism Other things cause hypertriglyceridaemia (diabetes, obesity, alcohol, thiazides, unopposed oestrogen, liver disease)
47
Management of acute hyponatraemia (<48 hours)
Typically hypertonic saline (3%) is given - can correct more quickly than in chronic as less risk of demyelination
48
Management of chronic hypovolaemia if: - hypovolaemic cause (renal failure, diuretics, addison's)? - euvolaemic cause (SIADH)? - hypervolaemic cause (HF, liver failure, nephrotic syndrome)?
Hypovolaemic: 0.9% saline Give as trial initially, if Na falls then likely alternative diagnosis such as SIADH Euvolaemic: fluid restrict to 500ml/day. Consider demeclocycline/vaptans Hypervolaemic: fluid restrict to 500ml/day. Consider loop diuretics/vaptans
49
Complication of correcting sodium too quickly? Rate it should be done? Symptoms of complication?
Central pontine myelinosis Na+ level raised by 4-6mmol/L each day Symptoms appear after 2 days: - dysarthria, dysphagia - paraparesis/quadraparesis - seizures, confusion, coma - locked in syndrome
50
Indications for cyclizine?
Indications: Central causes nausea Movement related Bowel obstruction
51
Indications for Dexamethasone as antiemetic?
Intracranial disease | Bowel obstruction
52
Indications and contraindications for domperidone antiemetic?
Indications: Gastric stasis Parkinson's - doesn't cross BBB Contra: Bowel obstruction
53
Indications and contraindications for metoclopramide antiemetic?
Indications: gastric stasis Contra: Not in parkinson's Not in bowel obstriction
54
Indications and contraindications for haloperidol as anti-emetic?
Chemical causes e.g. opioid | Metabolic causes
55
Indications and contraindications for lorazepam as antiemetic?
Anxiety-related
56
Indications and contraindications for ondansetron antiemetic?
chemo-induced
57
Causes of hypophosphataemia?
``` Alcohol excess Acute liver failure DKA Refeeding syndrome Primary hyperparathyroidism Osteomalacia ``` Consequences: - RBC haemolysis - WCC and platelet dysfunction - Muscle weakness and rhabdomyolysis - CNS dysfunction (resp depression etc)
58
When is a 150ml bolus of 3% NaCl typically given?
Acute hypovolaemia Na <120

Finals Revision (29 decks)

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