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PSA > Gold Notes > Flashcards

Gold Notes Flashcards

1
Q

Fluid prescription

A
  • 2 sweet 1 salty – 2L 5% dextrose and 1L 0.9% saline
  • 3L a day if usually & 2L if elderly
  • 40mmol KCl a day
  • If oliguric <30mL per day then 1L over 2-4 hrs
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2
Q

Renal excreted drugs

A

Diuretics (stop in poor kidney function)
ACEi & ARBs
Allopurinol
Digoxin
Abx – tetracycline, nitrofurantoin
Lithium
Metformin

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3
Q

Hepatic excreted drugs

A

Statins

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4
Q

When do you take rivaroxaban?

A

With breakfast

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5
Q

When do you take ACEi?

A

night

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6
Q

When do you take TCAs?

A

Night

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6
Q

When do you take furosemide and diuretics?

A

Morning

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7
Q

When do you take metformin?

A

With meal or immediately after

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8
Q

When do you take levothyroxine?

A

Before breakfast

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9
Q

When do you take loperamide?

A

After loose stool

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10
Q

When do you take bisphosphonates?

A

Take at least 30 minutes before food
Be upright for 30 minutes after swallowing
Take with full glass of water

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11
Q

Surgery & drugs:
Insulin
Long term corticosteroids
Lithium
Anti-coagulants/Anti platelets
COCP
K sparing diuretics
Oral hypoglycaemics
Perindopril & ACEi

A

Insulin - variable infusion

Long term corticosteroids - change to high dose hydrocortisone

Lithium - day before

Anti-coagulants/Anti platelets:
Aspirin = 7 days before
DOAC = 24hr prior in minor & 48 hrs major
Unfractionated Hep = 4 hrs prior
Warfarin = Stop 5 day prior – prescribe LMWH in interim

COCP - stop 4 week prior and start 2 week after

K sparing diuretics - day of op

Oral hypoglycaemics - day of op

Perindopril & ACEi - day of op

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12
Q

What drugs cause GI bleeds?

A

NSAIDs

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13
Q

Hypotension drug cause

A

Ca channel blockers i.e. Diltiazem Verapamil
Beta blockers
Alpha blockers
Isosorbide nitrate
Amiodarone
Bromocriptine

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14
Q

Bradycardia drug cause

A

Diltiazem
Ivabradine
Verapamil
Amiodarone
Digoxin

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15
Q

Hyperkalaemia drug cause

A

Digoxin
Renal failure
Endocrine – Addison’s
ACEi + ARBs
DKA
Heparin
Aspirin + NSAIDs
Trimethoprim
Ciclosporin
K+ sparing diuretics

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16
Q

Hypokalaemia drug causes

A

Thiazide & loop diuretics
PPIs
Penicillin
Verapamil
V+D

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17
Q

Hyponatraemia drug causes

A

SSRIs
ACEi + ARBs
Amiodarone
Diuretics – loop & thiazide
Carbamazepine
Amitriptyline
Antipsychotics
PPIs
Sulfonylureas – Gliclazide
MDMA

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18
Q

Thrush drug causes

A

ABX
Steroids

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19
Q

Sedation drug causes

A

Opioids, barbs, bentos

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20
Q

Ototoxicity & nephrotoxicity

A

Gentamicin
Vancomycin

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21
Q

C.diff cause

A

Broad spec ABX - cephalosporin or ciprofloxacin

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22
Q

Gynaecomastia cause

A

Spironolactone, digoxin, Cannabis, Oestrogen, GnRH

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23
Q

Lung fibrosis causes

A

Amiodarone, cytotoxic drugs, Methotrexate, sulfasalazine, bromocriptine, cabergoline, nitrofurantoin

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24
Q

Stevens Johnson syndrome causes

A

Allopurinol

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25
Q

Urticaria causes

A

Aspirin
Penicillin
NSAIDs
opiates

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26
Q

Impaired glucose tolerance

A

Steroids, thiazide diuretics, furosemide, antipsychotics

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27
Q

Urinary retention causes

A

TCAs (amitriptyline), anticholinergics, opioids, NSAIDs

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28
Q

Thrombocytopenia causes

A

Quinine, NSAIDs, furosemide, Penicillin, carbamazepine, valproate, heparin

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29
Q

Increase QT interval - MADE CAT

A

Macrolides – clarithromycin, erythromycin, azithromycin
Anti-psychotics & Anti-depressants
Digoxin
Electrolyte: hypocalcaemia, hypokalaemia, hypomagnesaemia
Ciprofloxacin
Anti-arrhythmics: amiodarone, sotalol,
TCA
Myocarditis
Hypothermia
Subarachnoid haemorrhage

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30
Q

Cause diarrhoea

A

Lansoprazole
Alendronic acid

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31
Q

Cause dyspepsia

A

Alendronic acid
Prednisolone

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32
Q

Cause ankle swelling

A

Ca2+ channel blockers
Naproxen

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33
Q

Anti-muscurinic Sx

A

Cyclizine
Amitriptylline

34
Q

ACE-i side-effects

A

Cough
Hyperkalaemia
Caution with V+D = risk of AKI
CI in pregnancy

35
Q

Thiazide-like diuretics side effects

A

Gout
Hypokalaemia
Hyponatraemia
Impaired glucose tolerance
Hypercalcaemia
Impotence
Dehydration

36
Q

Calcium channel blocker side-effects

A

Headache
Flushing
Ankle oedema
Bradycardia

37
Q

Beta-blocker side effects

A

Bronchospasm (especially in asthmatics)
Fatigue
Cold peripheries
Bradycardia
Sleep disturbances
ED
Beta-blockers reduce hypoglycaemic awareness

38
Q

Alpha blockers side effects

A

Postural hypotension

39
Q

Loop diuretics side effect

A

Hypokalaemia
Fatigue
Headache
Metabolic alkalosis
Muscle spasms

40
Q

Amiodarone side effects

A

Bradycardia
Hyper/hypothyroidism
Pulmonary fibrosis/pneumonitis
Liver fibrosis/hepatitis
Jaundice
Taste disturbance
Persistent slate grey skin discolouration
Raised serum transaminases
Nausea
Constipation (particularly at the start of treatment)
Increases QT interval

41
Q

Amoxicillin side effects

A

Rash with infectious mono

42
Q

Co-amoxiclav and flucloxacillin side-effects

A

Cholestasis

43
Q

Erythromycin side-effects

A

GI upset
Prolongs QT

44
Q

Ciprofloxacin side effects

A

Lowers seizure threshold
Tendonitis
Prolongs QT

45
Q

Doxycycline side effects

A

Photosensitivity

46
Q

Trimethoprim side-effects

A

Rashes, including photosensitivity
Pruritus
Suppression of haematopoiesis

47
Q

Metform side-effects

A

GI upset
Lactic acidosis

48
Q

Sulphonylureas side effects

A

Hypoglycaemic episodes
Increased appetite and weight gain
Syndrome of inappropriate ADH secretion
Liver dysfunction (cholestatic)

49
Q

Glitazones side effects

A

Weight gain
Fluid retention
Liver dysfunction
Fractures

50
Q

Gliptins side effect

A

Pancreatitis

51
Q

Glucocorticoid side-effects (STEROIDS)

A

Stomach ulcers, acute pancreatitis
Thin skin
Edema
Right & L HF
Osteoporosis & Ophthalmic (cataracts, glaucoma)
Immunosuppression, Neutrophilia
Diabetes - impaired glucose regulation - increased appetite/weight gain, hirsutism, hyperlipidaemia
Syndrome Cushing’s - moon face, buffalo hump, striae

Psychiatric: insomnia, mania, depression, psychosis

Give bisphosphonates for osteoporosis protection if >3month course
NEVER STOP STEROIDS ABRUPTLY

52
Q

Carbamezapine side-effects

A

Neutropenia!!
Lethargy
Drowsiness

53
Q

Mineralocorticoid side-effects

A

Fluid retention
Hypertension

54
Q

TCA side-effects

A

Dizzy
Hallucinations
Vision problems
Agranulocytosis
Anti-muscarinic SEs (dry mouth, brady then tachycardia with palpitations, constipation, red, blurred vision, pupillary dilation)

55
Q

Neutropenic sepsis Mx

A

Piperacillin with tazobactam

56
Q

Bacterial meningitis pre-hospital and hospital Mx

A

Benpenicillin 600mg IM

Cefotaxime 8g IM/IV divided by 4 = 2g QDS

57
Q

Tonsilitis Mx

A

Phenoxymethylpenicillin 500mg QDS 5-10 days
o 250mg if <12yrs

Clarithromycin 250mg-500mg BD 5 days

58
Q

Skin infection Mx

A

Flucloxacillin 500mg QDS

59
Q

Pulmonary oedema Mx

A

IV furosemide 20-50mg

60
Q

Asthma Mx (OHSHITME)

A
  • Oxygen
  • Salbutamol 2.5-5mg NEB
  • Hydrocortisone IV 100mg or pred 40mg PO
  • Ipratropium bromide 500 micrograms
  • Theophylline
  • MgSO4 2g IV
  • Escalate
61
Q

VTE prophylaxis

A

Enoxaparin
o 40mg SC OD – surgical high risk, orthro surg, med pt.
o 20mg SC OD – surg mod risk

Dalteparin
o 5000u SC OD
- Remember TEDs – CI is PAD

62
Q

PT or DVT Mx

PE if haemodynamically unstable

A

PE or DVT Tx
DOAC – Rivaroxaban PO
o 15mg PO for 21days

Or apixaban
o 10mg BD PO

If Antiphospholipid syndrome = LMWH i.e. dalteparin

PE haemodynamically unstable
- UFH infusion
- Thrombolytic therapy – alteplase

63
Q

Nause MX

A

Cyclizine
o 50mg 8 hrly IM/IV/Oral
o Be aware can cause fluid retention

Metoclopramide
o 10mg 8 hrly IV/IM in HF

Ondansetron
o 4mg or 8mg 8hrly IV/oral

64
Q

Pain Mx

A

Paracetamol
o 1g 6 hrly
o Mild pain

Codeine
o 30mg 6hrly Oral
o Mild pain

Co codamol
o 30/500 2 tablets 6 hrly oral
o Severe pain

65
Q

Hypoglycaemia Mx

A

Conscious: PO glucose
o 10-20g child
o 15-20g adult

Unconscious: IM glucagon
o 1mg

Severe: IV glucose
o 10% Child 5mL/kg
o 10% Adult 200mL over 15 mins
o 20% 100mL over 15mins

66
Q

Hypercalcaemia Mx

A
  • Emergency 1L 0.9% NaCl over 4-6 hrs (aim for 1-3L over 24 hrs)

IV Bisphosphonate: Zoledronic acid (Pamidronate 2nd line)

Admit and monitor

Symptomatic control: Laxatives, Anti-emetics
- Others: Calcitonin, Furosemide, Dialysis

67
Q

Hypothyroidism Mx

A

Levothyroxine
o 50-100mcg OD morning
o 25mcg PO - elderly, ischemic heart disease or severe hypothyroidism starting dose
o Pregnancy increase dose by at least 25-50 micrograms due to the increased demands of pregnancy.
o Thyroid function tests should be checked after 8-12 weeks

68
Q

Hyperkalaemia Mx

A

Acute severe
o 1st = calcium gluconate 10% over slow IV injection

Not severe
o 10 units of actrapid in 50ml of 50% dextrose IV over 10-15mins
o Salbutamol NEB 5mg

69
Q

Crohns Mx

A

ACUTE
o Mild - mod:
- PO mesalasine or budesonide
- Mod - severe flare: Predinosolone PO
- If severe extensive disease = IV corticosteroids
* 1st = PO pred or IV hydrocortisone
budesonide (if above not suitable/CI)
* 2nd = sulfasalazine (↓effective, but ↓SE)
Add on (if ≥2 inflammatory exacerbations in 12m or steroid dose can’t be reduced) = azathioprine
If unsuitable/CI: Methotrexate w corticosteroid

MAINTANENCE: (NO steroids)
o 1st = Azathioprine
o 2nd = MXT
* If fistulising Crohn’s: metro / ciprofloxacin & Azathioprine (AZT)

70
Q

UC Mx

A

ACUTE
- Mild - mod
 Distal disease: topical Mesalazine (preferable PO aminosalicylate)
 More extensive: PO mesalazine.
 Failed = PO corticosteroid
o Severe flare: (>6 bowel motions/day and systemically unwell)
 IV corticosteroids
 If can’t tolerate: IV ciclosporin

MAINTENANCE:
o PO aminosalicylate (mesalasine) → if not, sulfasalazine
o Frequent relapse, give azathioprine

71
Q

Drugs which may worsen seizure control in epilepsy

A
  • Alcohol, cocaine, amphetamines
  • Ciprofloxacin, levofloxacin
  • Aminophylline, theophylline
  • Bupropion
  • Methylphenidate (used in ADHD)
  • Mefenamic acid
72
Q

Mx of epilepsy

A

Focal seizures
- Carbamazepine or lamotrigine

All other seizures
- 1st LINE: Sodium valproate
o NEVER GIVE SODIUM VALPORATE TO WOMEN – JUST DON’T. EVER.
- 2nd LINE: Lamotrigine or carbamazepine
o GIVE THE WOMEN LAMOTRIGINE

73
Q

C.Diff management

A
  • 1st line mild/mod/severe = vancomycin PO 125 mg every 6hours/QDS for 10 days
  • Life threating = vancomycin 500mg PO QDS with metronidazole 500mg IV TDS 10days
74
Q

Palliative care meds

A
  • Change frequent injections to a syringe driver
  • Pain: morphine sulphate 10mg/ 24hr
  • Nausea: Cyclizine 150mg / 24hrs
  • Secretions: Hyoscine butylbromide 60mg / 24hrs or Hyoscine hydrobromide 1.2 / 24hrs
  • Agitation: Midazolam 10-20mg / 24hrs
75
Q

Anti-emetic for:
1. post operative nausea
2. Palliative care
3. Vertigo/motion sickness/vestibular disorders
4. Chemotherapy
5. PD
6. Opioid induced

A
  1. post operative nausea - ondansetron
  2. Palliative care - cyclizine, haloperidol, levopromazine
  3. Vertigo/motion sickness/vestibular disorders - cyclising
  4. Chemotherapy
    Acute: Ondansetron
    Chronic: Metoclopramide
    Dexamethasone
  5. PD - dompeidone
  6. Opioid induced - haloperidol, metoclopramide
76
Q

Bulk forming laxatives:
examples
mechanism
pros
cons

A

Ispahgula
(Fybogel®)

MOA: Works like dietary fibre by adding bulk to stool so increases faecal mass and stimulates peristalsis

Pros: Widely available
More convenient than increasing dietary fibre for many

Cons: Takes 2-3 days to work
Adequate fluid intake necessary

77
Q

Osmotic laxatives:
examples
mechanism
pros
cons

A

Macrogol (Movicol)
Lactulose

MOA: Increases fluid in large bowel by trapping water

Pros: Produces soft stools with large volume
Macrogol acts quick
(4-6hrs)

Cons: Abdo cramps, flatulence
Lactulose: CI - bloating, long to act (1-3d)

78
Q

Stool softeners:
examples
mechanism
pros
cons

A

Sodium docusate

Reduces surface tension of stool, allowing water to penetrate and soften

Pros: Does not require large fluid intake

Cons: SE: cramps, diarrhoea
CI: already soft stools

79
Q

Stimulant laxatives:
examples
mechanism
pros
cons

A

Senna
Bisacodyl 15-30mg oral nightly

MOA: Causes peristalsis by stimulating the myenteric plexus

Pros: rapid effect (6-12)

Cons: Avoid in bowel obstruction
SE: abdo cramps, diarrhoea

80
Q

Fluid therapy

A

For maintenance fluids:
- 25-30 ml/kg/day of water and
- 1 mmol/kg/day of potassium, sodium and chloride and
- 50-100 g/day of glucose to limit starvation ketosis
0.9% saline
* If large volumes are used there is an increased risk of hyperchloraemic metabolic acidosis

Hartmann’s
* Contains potassium and therefore should not be used in patients with hyperkalaemia

81
Q

Inducers of P450

A

PCBRASS

Phenytoin
Carbamazepine

Barbiturates
Rifampicin
Alcohol (Chronic)
Sulfonylureas – Gliclazide
Smoking
St Johns Wort

82
Q

Inhibitors of P450 (INR increases)

A

GOAA DEVICES

Grapefruit & Cranberry juice
Omeprazole
Allopurinol
Anti-fungal – FLUCONAZOLE
Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol (acute intoxication)
Sulphonamides

= higher bleeding risk

83
Q
A

PSA (6 decks)

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