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Key PSA facts Flashcards

1
Q

Management of croup

A
  • Drug : dexamethasone
  • Dose : 150 micrograms / kg
  • Route : Oral (PO) or IV
  • Frequency : once only
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1
Q

Pain relief in an MI

A
  • Drug : morphine
  • Dose : 2.5-5mg in elderly (5-10mg otherwise)
  • Route : slow IV infusion
  • Frequency : once only
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2
Q

Fluid given in the initial treatment of DKA if systolic BP is <90

A
  • Drug : sodium chloride 0.9%
  • Volume 500 mililitres (ml)
  • Route : intravenous (IV)
  • Rate : Infusion over 10-15 minutes
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3
Q

First line medication for severe acute asthme

A
  • Drug : salbutamol
  • Dose : 5 miligrams (5mg)
  • Route : Nebulised (NEB)-oxygen-driven
  • Frequency : Repeat every 20-30 min or as required
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4
Q

Management of benzodiazepine overdose

A
  • Drug : Flumazenil
  • Dose : 200 micrograms
  • Route : intravenous injection
  • Duration : Over 15 seconds
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5
Q

Management of aspirin overdose if presenting within an hour

A
  • Drug : activated charcoal
  • Dose : 50g
  • Route : oral (PO)
  • Frequency : once only
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6
Q

Management of GORD in the medium-long term

A
  • Drug : lansoprazole
  • Dose : 30mg
  • Route : oral (PO)
  • Frequency : once daily
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7
Q

Normal dosing of methotrexate in moderate - severe RA

A

-> 7.5mg once weekly
-> Max 20mg !!!!

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8
Q

Normal dosing of glicalazide

A
  • Initially 30mg before adjusting (OD)
  • Max 120mg per day
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9
Q

Normal dose of ibuprofen

A
  • 400mg TDS
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10
Q

Normal dosing of lisinopril

A
  • Maintenance is usually 20mg OD
  • Max 80mg
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11
Q

Normal dosing of metformin

A

Usually 500mg TDS

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12
Q

Drug likely to cause diarrhoea in the management of refeeding syndrome

A

Magnesium glycerophsophate

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13
Q

what 2 medications, if prescribed together can cause serious cardiac SE and how would it present

A

VERAPAMIL + BB

Bradycardia
Hypotension
1st degree heart block

Pt might present with episodes of collapse

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14
Q

How does the medication of a patient with know Addison’s need altering when acutely unwell

A

Double the dose of corticosteroid

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15
Q

Medications likely to contribute to UGIB

A
  • NSAIDS
  • Oral bisphosphonates (e.g. alendronic acid)
  • Oral steroids (e.g. prednisolone)
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16
Q

Medication known to cause hyperglycaemia

A

Oral Prednisolone
Thiazide diuretics (e.g. bendroflumethazide)

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17
Q

Fluids used for resuscitation in hypotensive and tachycardic patient

A

500ml 0.9% sodium chloride IV

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18
Q

Management of acute anaphylactic reaction in an adult / child 12 or above

A

500 micrograms adrenaline IM (0.5 mL of 1:1000).

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19
Q

Management of opioid toxicity

A

Naloxone 400 micrograms (mcg) IV

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20
Q

Management of acute pulmonary oedema

A
  • IV furosemide 40mg once only
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21
Q

Management of anaphylaxis in a child aged 6-11 yrs

A
  • IM adrenaline 300 micrograms
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22
Q

Management of ascites due to liver cirrhosis

A
  • Spironolactone 100mg OD oral
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23
Q

Management of severe hypoglycaemia causing reduced consciouss and seizures

A
  • 20% glucose 100ml IV

Both of these are equivalent to 15-20g glucose

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24
Q

Adverse effect of ondasetron

A

QT interval elongation

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25
Q

Antibiotic that can increase the effect of warfarin and in turn increase the risk of bleeding

A
  • Macrolides (erythromycin, clarithromycin)
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26
Q

What type of diuretic has the highest incidence of causes hyponatraemia ?

A

Thiazide (Indapamide, bendroflumethazide)

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27
Q

What should be checked following blood transfusion to check for acute transfusion reaction

A

HR, BP and temperature, 15 mins later

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28
Q

what should be checked to monitor for possible adverse reaction following insulin-glucose infusion for hyperkalaemia ?

A
  • Capillary blood glucose due to risk of hypoglycaemia
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29
Q

what should be checked after 4 days of antiobitoic treatment for pneimonia to check response

A

CRP

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30
Q

what is the best way to monitor the therapeutic effects of diuretics in fluid overload due to HF

A

Daily weights

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31
Q

what is the most appropraite way to monitor for the adverse effects of prescribed oxygen therapy in a smoker ?

A
  • ABG after 30 mins due to risk of hypercapnia
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32
Q

What drugs are directly nephrotoxic ?

A
  • Aminoglycosides (e.g gentamycin, vancomycin, amikacin)
  • Amphotericin
  • Cytotoxic chemo (e.g cisplatin)
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33
Q

What drugs contribute to AKI due to causing renal ischaemia, renal hypoperfusion, volume depletion

A
  • Diuretics = volume depletion
  • Immunosuppression (ciclpsporin, tacrolimus) = renal ischaemia
  • Radiocontrast media = Renal ischaemia
  • NSAIDs / COX-2 inhibitors = renal hypoperfusion
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34
Q

what fluids are prescribed in an AKI

A

Sodium chloride 0.9% IV

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35
Q

When would sodium bicarbonate 1.25% be the fluid of choice prescribed in AKI ?

A

AKI WITH hypovolaemia and metabolic acidosis

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36
Q

What is the most sensitive indicator of hypovolaemia suggest AKI is caused by dehydration ?

A

Postural rise in HR of >= 30bpm.

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37
Q

what medications should be stopped in an AKI?

A

D : Diuretics
A : ACEI/ARB
M : Metformin
N : NSAIDs

Allopurinol can accumulate, max dose 100mg

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38
Q

what Abx are safe to use in AKI ?

A
  • Cephalosporins (e.g. ceftazidime)
  • Carbapenem (e.g. meropenem)
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39
Q

what diuretic can be used in AKI for fluid overload

A
  • Furosemide
  • DO NOT use combination diuretics
  • Thiazide diuretics are ineffective if eGFR <30
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40
Q

why are ACEI stopped in AKI ?

A

Can cause hyperkalaemia

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41
Q

when should ACEI / ARBs NOT be used

A
  • Bilateral renal artery stenosis
  • Renal artery stenosis if one kidney
  • Widespread vascular disease
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42
Q

Main CI to heparin and erythromycin

A
  • Heparin = not appropriate in ischaemic stroke
  • Erythromycin = increases effects of warfarin and so INR
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43
Q

SE of steroids

A

S : Stomach ulcers
T : Thin skin
E : oEdema
R : Right and left sided HF
O : Osteoporosis
I : Infection
D : DM
S : cushing’s Syndrome

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44
Q

SE / CI to NSAIDs

A

N : No urine (renal failure)
S : Systolic dysfunction (HF)
A : Asthma
I : Indigestion
D : Dyscrasia (clotting abnormalities)

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45
Q

Specific SE to thiazide diuretics and spironolactone

A
  • Thiazide = gout
  • Spironolactone = gynaecomastia
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46
Q

what is anti-emetic is given 1st line

A

Cyclizine ?

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47
Q

when is cyclizine CI and what is given instead >

A
  • HF !!!
  • Metaclopramide
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48
Q

When is metaclopramide and haloperidol not given as anti-sickness ?

A
  • Parkinson’s
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49
Q

what diuretics can cause hypokalaemia ?

A
  • Loop diuretics (furosemide)
  • Thiazide diuretics (bendroflumethazide, indapamide)
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50
Q

what medications can cause hyperkalaemia

A
  • ACEI
  • Potassium sparing dieuretics (spironolactone, amilordide)
  • Heparin !
  • Tacrolimus !
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51
Q

what medications should be reviewed in a confused elderly patient ?

A
  • Antimuscarinics (e.g. bumetanide)
  • Anticholinergics (cyclizine)
  • Opioids
  • Benzos
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52
Q

what should be avoided in asthmatics ?

A
  • BB
  • NSAIDs
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53
Q

what should be stopped in active infection

A

Methotrexate

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54
Q

Causes of hyponatraemia

A
  • Hypovolaemic : D&V, Addison’s, diuretics
  • Euvolaemic : SIADH, hypothyroid, psychogenic polydisplasia
  • Hypervolaemic : HF, renal failure, nutritional
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55
Q

Causes of hypernatraemian

A
  • Dehydration
  • Drugs (e.g. lithium)
  • Drips
  • DI
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56
Q

Causes of hyperkalaemia

A
  • Drugs (K+ sparing diuretics, ACEI)
  • Renal failure
  • Endocrine (addison’s)
  • Artefact
  • DKA
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57
Q

Causes of hypokalaemia

A
  • Drugs (loop/thiazide)
  • Inadequate intake or GI loss (D&V)
  • Renal tubular acidosis
  • Endocrine (Cushing’s/conn’s)
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58
Q

How can the cause of renal failure be determined ?

A

Based on relative increase of urea compared to creatinine

  1. Pre renal : Urea rise&raquo_space; creatinine.
  2. Intrinsic : Urea rise &laquo_space;creatinine.
  3. Post renal : Urea rise &laquo_space;creatinine + bladder / hydronephrosis may be palpable
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59
Q

How can LFTs be interpreted ?

A
  1. Hepatocyte injury : bilirubin and AST/ALT
  2. Cholestasis / obstruction : ALP
  3. Synthetic function : albumin, vitamin K dependent clotting factors (1972)
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60
Q

what can an isolated raised ALP suggest ?

A

ALKPHOS

  • A : any fracture
  • L : Liver damage (post hepatic)
  • K : Kancer
  • P : Paget’s disease of bone and Pregnancy
  • H : Hyperparathyroid
  • O : Osteomalacia
  • S : Surgery
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61
Q

Major bleeding + on warfarin

A

STOP WARFARIN
Give 5-10mg IV vit K
Give prothrombin complex

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62
Q

INR 5-8 but no bleeding

A

Omit for 2 days
Reduce dose

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63
Q

INR 5-8 minor bleeding

A

Omit
1-5mg IV vit K

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64
Q

INR >8 no bleeding

A

Omit
1-5mg PO vit K

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65
Q

INR >8 + minor bleeding

A

Omit
1-5mg IV vit K

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66
Q

Management of tachycardia with adverse features

A

Synchronised DC shock up to 3 attempts

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67
Q

Management of tachycardia with BROAD QRS + regular

A
  • If ventricular tachycardia : Amiodarone 300mg IV over 20-60 mins
  • If previously confirmed SVT with BBB manage as regular narrow complex tachy
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68
Q

Management of tachycardia with IRREGULAR BROAD QRS

A

Seek expert help

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69
Q

Management of tachycardia with narrow regular QRS but no adverse signs

A
  1. Vagal manoeuvres
  2. Adenosine 6mg rapid IV bolus up to 18mg
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70
Q

Management of tachycardia with narrow irregular QRS

A

Probably AF -> rate control with BB or diltiazem

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71
Q

Example of pharmacodynamic drug interactions

A
  • Sertraline and warfarin
  • Warfarin and vit K foods
  • ACEI and K+ containing salt
  • Verapamil and BB
  • Warfarin and NSAIDs
  • Aminoglycosides and loop diuretics
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72
Q

Example of pharmacokinetic drug interactions

A
  • Lithium salt and ramipril
  • Rifampicin and COCP
  • Warfarin and erythromycin and clarithromycin
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73
Q

what antibiotic would require extra protection in someone on the COCP

A

Rifampicin

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74
Q

If takin levonorgestrel emergency contraception but on carbamazpine for epilepsy what steps need to be taken ?

A

Double the dose

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75
Q

What can inhibit P450 enzyme system

A
  • Isoniazid
  • ciprofloxaciN
  • etHanol
  • azole antIfungals
  • Buprion
  • erythromycIn
  • dilTiazem
  • Omeprazole
  • gRapefruit juice
  • sSri
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76
Q

What can induce P450 system

A
  • cIgarette smoke
  • phenytoIn
  • Dexamethasone
    -barbitUrates
  • Carbemazepine
  • Ethanol
  • Rifampicin
  • St John’s wort
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77
Q

Effect of St John’s wort with certain medications

A
  1. Cause organ transplant rejection if taken with ciclosporin
  2. Increase risk of serotonin syndrome if given with citalopram
  3. Decrease INR in pts on warfarin, increasing VTE risk
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78
Q

what is diclofenac CI in ?

A

IHD

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79
Q

Important info to tell pts commenced on labetalol

A

Report ANY non specific itching due to association with severe hepatocellular injury

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80
Q

Important information to tell pts on amiodarone

A
  • Avoid direct sunlight and wear wide-spectrum suncreen due to risk of phototoxic reactions
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81
Q

when writing a prescription for an ACEI, when should they be given and why

A
  • Nightly !!
  • Due to risk postural hypotension
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82
Q

what needs checking prior to commencing vancomycin and why ?

A
  • Creatinine
  • Dose is adjusted based on kidney function
    • Nephrotoxicity and ototoxcicity = biggest SE
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83
Q

Important parameter to measure before commencing vancomycin

A

Serum creatining -> guides dosing + most common SE = nephrotoxicity and otoxicity

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84
Q

Important parameter to measure before commencing statin

A
  • > ALT as used in caution in people with liver disease
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85
Q

Key facts regarding monitoring of lithium therapy

A

-> Check serum levels 12 hrs post dose
-> Toxicity effects manifest at 1.5mmol/l
-> FBC checked every 1-2 wks until stabilised
-> Routine lithiium level checks weekly, after each dose change and then 3mnthly after stabilisation

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86
Q

Change in what electrolyte will increase risk of lithium toxicity

A
  • Reduced sodium
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87
Q

Key points regarding methotrexate monitoring

A
  • FBC checked every 2-3 mnths once stabilised
  • Drop in WCC / plts = stop immediately
  • If LFTs abnormal = stop immediately
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88
Q

what is required at baseline before commencing amiodarone and why

A
  • ECG
  • CXR - risk of pulmonary toxicity
  • U&Es
  • TFTs : also required every 6 mnths
  • LFTs
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89
Q

what needs to be checked at baseline before commencing olanzapine ?

A

Fasting blood glucose due to risk of hypergylcaemia and DM

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90
Q

what needs monitoring in digoxin ?

A

Serum creatinine due to risk of renal dysfunction

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91
Q

What needs checking at baseline when commencing SV ?

A

ALT due to association with hepatotoxicity

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92
Q

How long are weekly FBCs required when commencing clozapine

A

18 wks

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93
Q

Adverse drug reactions to gentamicin and vancomycin

A

Nephrotoxicity
Otoxicity

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94
Q

Adverse reaction to cephalosporins or ciprofloxacin

A

Clostridium difficile

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95
Q

Three adverse reactions to ACEI

A
  • Hypotension
  • Hyperkalaemia and hence AKI
  • Cough
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96
Q

4 adverse reactions to BB

A
  • Hypotension
  • Bradycardian
  • Wheeze in asthmatics
  • Worsens acute HF
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97
Q

4 adverse reactions to CCB

A
  • Hypotension
  • Bradycardia
  • Peripheral oedema
  • Flushing
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98
Q

3 adverse reactions to aspirin

A
  • Haemorrhage
  • Peptic ulcers and gastritis
  • Tinnitus in larger doses
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99
Q

6 adverse reactions to digoxin

A
  • N&V
  • Diarrhoea
  • Blurred vision
  • Confusion
  • Drowsiness
  • Xanthopsia - ‘halo’ vision
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100
Q

4 adverse effects of amiodarone

A
  • Pulmonary fibosis
  • Hypo and hyperthyroid
  • Skin greying
  • Corneal deposits
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101
Q

Early and intermediate adverse effects of lithium

A
  • Early = tremor
  • Intermediate = Tiredness
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102
Q

Late adverse effects of lithium

A
  • Arrhythmias
  • Seizures
  • Coma
  • Renal failure
  • Diabetes insipidus
103
Q

Adverse reactions to haloperidol

A

Dyskinesias (e.g. acute dystonic reactions, drowsiness)

104
Q

Adverse reaction to clozapine

A

Agranulocutosis

105
Q

Advers reactions to dexamtethasone and prednisolone

A

S : Stomach ulcers
T : thinning skin
oE : dema
R : Right and left HF
O : Osteoporosis
I : Infection
D : DM
S : cushing’s Syndrome

106
Q

Adverse reaction to fludrocortisone

A

Hypertension / sodium and water retention

107
Q

Adverse reactions to ibuprofen

A

N : No urine (renal failure)
S : Systolic dysfunction (HF)
A : Astham
I : indigestion
D : Dyscrasia (clotting abnormality).

108
Q

Adverse reactions to statins

A
  • Myalgia
  • Abdo pain
  • Increased AST/ALT
  • Rhabdomyolysis
109
Q

Adverse drug reaction of lactic acidosis can be caused by ?

A
  • Metformin
  • Metformin should be stopped if pt goes into metabolic acidosis
110
Q

GI bleed can be caused by?

A

NSAIDs - aspirin, ibuprogen

111
Q

Increased anticoagulation can be caused. by ?

A
  • Warfarin (with acute alcohol)
  • Chronic alcohol reduces alcohol effect
112
Q

Sweating, flushing and N&V can be caused by ?

A

Metronidazole
Disulfiram

113
Q

warfarin can interact with what Abx and lead to a potentially serious ADR?

A

Erythromycin / clarithromycin

114
Q

Management of hypoglycaemia in conscious patient

A

15-20g glucose by mouth

115
Q

What conditions have a target INR of 2.5

A
  • Bioprosthetic heart valve
  • DVT or PE
  • AF
  • Cardioversion
  • Dilated cardiomyopathy
  • Mitral stenosis or regurgitation in patients with either atrial fibrillation, a history of systemic embolism, a left atrial thrombus, or an enlarged left atrium
  • Acute arterial embolism requiring embolectomy
116
Q

Prescription for the management of hyperkalaemia

A
  • 50% dextrose 50ml + 10 units actrapid IV over 15 minutes
117
Q

Management of hypothyroidism caused by amiodarone

A
  • Continue amiodarone and commence levothyroxine
118
Q

If a pt has an anaphylactic reaction to penicillin, what other class of antibiotic may they also have a cross-reactivity reaction with ?

A

Cephalosporins (e.g. Cefuroxime)

119
Q

Management of hyperthyroid caused by amiodarone

A

withhold amiodarone

120
Q

Management of scabies

A
  • Drug : permethrin 5% cream
  • Dose : apply to whole body
  • Route : topical
  • Frequency : Once weekly for 2 doses
121
Q

Management of mild eczema flares

A
  • Drug : hydrocortisone 1%
  • Dose : 1 thin application
  • Route : topical
  • Frequency : once or twice daily
122
Q

Management of non bullous impetigo

A
  • Drug : hydrogen peroxide 1%
  • Frequency : 2-3 times daily
  • Route : topical
  • Duration : 5-7
123
Q

Management of cellulitis

A
  • Drug : flucloxacillin
  • Dose : 0.5-1g
  • Route : Orally
  • Frequency : Four times daily
  • Duration : 5-7 days
124
Q

Management of cutaneous warts (+where would you find this on BNF ?)

A
  • Drug : salicylic acid 2%
  • Route : topical
  • Frequency : OD
  • Dose : 1 application
  • Duration : up to 3mnths
125
Q

Management of cellulitis if penicillin allergic and pregnant

A

Erythromycin (would be clarithromycin if not pregnant)

126
Q

Management of mild-moderate acne vulgaris

A
  • Drug : adapalene (0.1%) with benzoyl peroxide (2.5%)
  • Dose : 408mg
  • Route : topical
  • Frequency : once daily, evening
127
Q

Important information / monitoring requirements of ciclosporin

A
  • Will need regular renal function checks
  • Serum creatinine every 2 wks for first 3 mnths and then check monthly
128
Q

What is required contraception wise when commenced on isotretinoin

A
  • Effective contraception 1mnth before,all way through treatment + pregnancy test every month throughout and effective contraception for a mnth after
129
Q

what is deemed as effective contraception when being commenced on isotretinoin ?

A
  1. One highly effective user independent method (IUD)
  2. Two complimentary but user-dependent methods (COCP & condom use)
130
Q

Common and rare adverse effect of tetracycline antibiotics

A
  • Common = photosensitivity
  • Rare = Idiopathic intracranial hypertension (should be stopped before commencing retinoids)
131
Q

what 4 fluid types do you need to be appear of for the PSA

A
  • Sodium chloride 0.9% 1000ml – 150mmol Na
  • Potassium chloride 0.3% 1000ml – 40mmol K
  • Potassium chloride 0.15% 1000ml – 20mmol K
  • Glucose 5% 1000ml – 50g glucose
132
Q

Where would you find the electrolyte concentrations of different fluids on the BNF

A

Fluids and electrolytes treatment summary

133
Q

What are the daily requirements of water, Na and K and glucose?

A

-> 25-30ml/kg/24h water
-> 1mmol/kg/24h Na and K (and Cl)
-> 50-100g/24h glucose

134
Q

At what rate should K+ be replaced no faster than and so at what rate should the possible potassium chloride bags me given at ?

A
  • 10mmol/h
  • Potassium chloride 0.3% (40mmol) minimum 4h
  • Potassium chloride 0.15% (20mmol) minimum 2h
135
Q

Fluid for emergency resus (hypotensive, tachycardia, CRT >3s)

A

Sodium chloride 0.9% 500ml 15m

136
Q

Fluid for emergency hypoglycaemia (unconscious)

A

Glucose 20% 100ml 15m

(LOOK FOR THE OPTION EQUIVALENT TO 15-20g of glucose !)

137
Q

Fluid for emergency hypokalaemia

A

Sodium chloride 0.9% / potassium chloride 0.3% 1000ml 4h

138
Q

Fluid for emergency hypercalcaemia

A

Sodium chloride 0.9% 1000ml 4h

139
Q

Maintenance fluid without deficit or loss

A

-> 25-30ml/kg/24h water
-> 1mmol/kg/24h Na and K
-> 50-100g/24h glucose

(aim 1000ml 8-12h)

140
Q

Maintenance fluids if there are deficits or losses

A
  • Minimum 30ml/kg/24h water
    (aim 1000ml 4-6h)
  • Ensure electrolytes replaced -> add potassium to sodium chloride if needed.
141
Q

Fluids for emergency resus in a child

A

Sodium chloride 0.9% 10ml/kg 15m

142
Q

Maintenance fluids with deficits or losses in a child

A
  • 100ml/kg/24h for <10kg
  • 50ml/kg/24h for 10-20kg
  • 20ml/kg/24h for >20kg

Once calculated =
Sodium chloride 0.9%/glucose 5% Xml over 24 hrs

143
Q

Symptoms of hypercalcaemia

A
  • Stones : kidney / biliary
  • Bones : Bone pain
  • Groans : Abdo pain
  • Moans : non specific Sx
  • Thrones : constipation and polyuria
  • Muscle tone : weakness, decreased reflexes
  • Psychiatric overtones : confusion, depression and anxiety
144
Q

ECG change in hypercalcaemia

A

Shortened QT

145
Q

Symptoms / signs of emergency hypokalaemia

A
  • Metabolic alkalosis
  • Arrythmias
  • Muscle weakness,
  • Reduced reflexes
  • Constipation
146
Q

ECG changes in hypokalaemia

A

In hypokalaemia U have NO POT or NO T but a LONG PR and a LONG QT

-> U waves
-> NO potassium
-> No T waves
-> Long PR
-> Long QT

147
Q

What other electrolyte needs to be checked in a pt with hypokalaemia ?

148
Q

where can info regarding management of hypercholesterolaemia and initiation of statins be found

A

Dyslipidaemias treatment summary

149
Q

Explain the different doses of atorvostatin and why its given

A
  • Primary prevention : 20mg
  • Secondary prevention (e.g. following MI) : 80mg
150
Q

Where would you find information regarding the acute treatment of asthma in a child ?

A

BNFc - Asthma, acute treatment summary

151
Q

Management of COPD exacerbation follWowing nebulisers

A

Prednisolone 30mg OD for 7-14 days

152
Q

When is LTOT indicated in COPD ?

153
Q

When is NIV indicated in an acute exacerbation of COPD ?

154
Q

VTE prophylaxis in renal failure

A

Unfractionated heparin 5000 units subcut every 8-12 hrs

155
Q

Options for treatment dose VTE

A

Apixaban or rivaroxaban

156
Q

Prophylaxis VTE options

A
  • Dalteparin, enoxaparin or tinzaparin) UNLESS renal failure then unfractionated heparin
  • Dalteparin = fagmin
  • Enozaparin = Clexane
157
Q

Monitoring of LMWH, unfractionated heparin, DOACs and warfarin

A
  1. LMWH – anti-factor Xa
  2. Unfractioned heparin – aPTT
  3. DOACs – monitor clinically
  4. Warfarin – INR
158
Q

Reversal of LMWH and unfractionated heparin

A

Protamine sulphate

159
Q

Management of hypocalcaemia

A

Calcium gluconate 10% 10ml IV over 10 minutes

160
Q

Signs and symptoms of hypocalcaemia

A

CATs go Numb

  • C : Convulsions
  • A : Arrythmias
  • T : Tetany
  • N : Numbness

Signs : trousseau’s and chvostek’s sign

161
Q

Sign of hypocalcaemia on ECG

A

QT prolongation

162
Q

Causes of hypocalcaemia

A
  • Hypoparathyroidism
  • Secondary hyperparathyroidism
  • Vitamin D deficiency
  • Blood transfusion
  • Hypomagnesemia
  • Steroids
163
Q

Causes of hypercalcaemia

A
  • Primary and tertiary
    hyperparathyroidism
  • Cancer
  • Multiple
    myeloma
  • Sarcoidosis,
  • TB
  • Paget disease
  • Thiazide diuretics
164
Q

Management of severe hyperkalaemia

A

Calcium gluconate 10% 30ml IV

165
Q

Symptoms / signs of hyperkalaemia

A
  • Metabolic acidosis
  • Arrythmias
  • Muscle weakness,
  • Reduced reflexes
  • Diarrhoea
166
Q

Signs of hyperkalaemia on ECG

A
  • Absent P waves
  • Prolonged QRS
  • Peaked or ‘tall tented’
    T waves
  • Sine wave pattern
167
Q

Causes of fall

A
  • Tamulosin
  • Aortic stenosis (SAD - Syncope, Angina, Dyspnoea)
168
Q

Management of adrenal crisis in patient with addison’s disease

A

Hydrocortisone 10mg IM / IV

169
Q

GP management of suspected meninigitis

A

IM benzylpenicllin
IF penicillin allergic : cefoxatime 2g IM

170
Q

Anti-emetic in vertigo / motion sickness / vestibular disorders

171
Q

Post operative anti-emetic

A

Ondansetron

172
Q

Anti emetic in parkinsons

A

Domperidone

173
Q

Anti emetic in hyperemesis gravidarum

A

Promethazine

174
Q

Chemotherapy induced nausea

A

Acute : ondansetron
Chronic : metoclopramide

175
Q

Risks of HRT

A
  • Breast cancer
  • Endometrial cancer
  • Ovarian cancer
  • VTE (stop 4-6 wks before surgery)
  • Stroke
  • CAD
176
Q

HRT if uterus intact and LMP <12mo

A
  • Oral sequential oestrogen + progestogen (Elleste-Duet 1mg or 2mg OR patch-sequential combined oestrogen + progestogen (Evorel Sequi)

First line = estradiol 1mg with norethisterone sequential

177
Q

HRT for uterus intact with LMP >12mn

A
  • Oral continuous combined oestrogen + progestogen (Elleste-Duet Conti), patch continuous combined oestrogen + progestogen (evorel conti), tibolone

First line = Estradiol 2mg + Norethisterone 1mg continuous

178
Q

HRT post hysterectomy

A

Oral or patch oestrogen or tibolone

First line = estradiol 1mg tablets

179
Q

Management of post menopausal osteoporosis

A

Alendronic acid or risedronate sodium

180
Q

Vasomotor symptom control in someone who cannot take HRT

181
Q

Management of menopausal atrophic vaginitis

A

Topical vaginal oestrogen (pessary or rinr)

182
Q

what medications are prescribed in mcg and so need checking in prescription reviews

A
  • Levothyroxine
  • Tamsulosin,
  • Digoxin
  • Naloxone,
  • Fludrocortisone
  • Inhalers
  • GTN spray
  • Ipratropium nebs
183
Q

what medications should be given in the morning ?

A
  • Diuretics
  • Steroids
184
Q

What medications should be given at night ?

A
  • Statins
  • Night sedation
185
Q

what medications are given weekly

A
  • Methotrexate / folic acid
  • Patches
  • Larger bisphosphonate dose in women
186
Q

Medications most likely to cause hypoglycaemia

A
  • Insulin
  • Sulphonureas (e.g. gliclazide)
187
Q

Medications most likely to cause hyperglycaemia

A
  • Steroids
  • Antipsychotics
  • Thiazides
  • Beta blockers
  • Tacrolimus
188
Q

Medications likely to cause constipation

A
  • Opioids (e.g. oramorph, tramadol)
  • Iron
  • CCBs
  • Ondansetron, metoclopramide),
  • Antacids that contain calcium
  • Anticholinergics (antidepressants, antihistamines,
    incontinence medications, antipsychotics)
189
Q

Medications likely to cause diarrhoea

A
  • Antibiotics (C. diff)
  • Colchicine
  • Metformin
  • PPIs
  • Alendronic acid
  • Antacids that contain magnesium,
  • Laxatives
190
Q

Medications causing urinary retention

A
  • Opioids
  • Anticholinergics
191
Q

Medications causing urinary incontinence

A
  • Alpha-blockers
  • Diuretics
  • Anticholinesterase inhibitors
  • Clozapine
192
Q

Medications likely to cause confusion

A

Opioids
Sedatives
Anticholinergics
Steroids

193
Q

Medications likely to cause falls

A
  • Benzodiazepine
  • Antidepressants (esp TCAs and SNRIs)
  • MAO
  • Antipsychotics,
  • Opiates (e.g tramadol)
  • Antihypertensives
  • Parkinson’s medications (ropinirole, selegiline)
  • Antimuscarincs (e.g. oxybutynin)
194
Q

Medications that can cause gout

195
Q

Medications that cause osteoporosis

A

Steroids
PPIs
LHRH agonists (Bureslin, goreslin)

196
Q

Medications that cause HTN

A

NSAIDs
Steroids
Oral contraceptives
Mirabegron

197
Q

Medications that cause high cholesterol

A

Steroids
Thiazides

198
Q

How to find the table of drugs that cause X, Y, Z on the BNF

A

Search appendix 1 interactions

199
Q

what medications should be stopped if intercurrent illness

A

Metformin
Statins
-Gliflozins

200
Q

What medications should be stopped prior to surgery

A
  • DOAC (48hrs)
  • Clopidogrel (7d)
  • Aspirin (7d)
  • Warfarin (bridging plan)
201
Q

Medications that worsen parkinsons symptoms

A
  • Haloperidol
  • Metoclopramide
  • Antidepressants
  • Olanzapine
202
Q

Medications that worsen myasthenia gravis

A
  • Antibiotics
  • BB
  • Local anesthetic
  • Sedating drugs
203
Q

Medications that worsen psoriasis

A
  • BB
  • Lithium
  • Some antibiotics
204
Q

Medications that worsen HF

A
  • NSAIDs
  • CCBs
  • Thiazolidinediones (Pioglitazone)
205
Q

If a patient is dehydrated due to diarrhoea and as a result hypotensive, what medications should be held ?

A
  • BB
  • CCB
  • Both will worsen hypotension whilst dehydrated
206
Q

Drugs that should be stopped in AKI

A

stop the DAMN drugs

D : Diuretics
A : ACEI/ARB
M : Metformin
N : NSAIDs

+ allopurinol -> can accumulate in renal dysfunction (max dose of 100mg till renal function improves)

207
Q

Drugs that can cause oral candidiasis

A
  • Antibiotis
  • Steroids
  • Immunosuppressants
  • Inhaled steroids can also be a RF but if in the same question as antibiotics and oral steroids
208
Q

Medication that can cause euglycemic DKA

A

SGLT-2 inhibitors (canagliflozin, dapagliflozin, empagliflozin)

209
Q

Causes of drug induced hyponatraemia

A

Ramipril
Omeprazole
Thiazide diuretics
Loop diuretics
Sulphonylureas
Antidepressants
Carbamazepine
Hypnotics

210
Q

What medication can cause hypoglycaemia, especially in combination with insulin or a sulfonyurea?

A

SGLT2 inhibitors

211
Q

Medications likely to cause reflux

A
  1. Bisphosphonates
  2. CCB
  3. Antimuscarinics (e.g. tolterodine)
212
Q

what is important to check in the stem of the question in a patient prescribed paracetamol

A

Patients weight -> dose needs reducing to 500mg PO QDS if <50kg

213
Q

what medication can cause Fournier’s gangrene ?

A

SGLT2 inhibitors

214
Q

What medication can accumulate in AKI and so has a max daily dose of 100mg

A

allopurinol

215
Q

what can be used to treat hyperthyroid in someone who is trying to conceive or is pregnant ?

A

Propylthiouracil (PTU)

216
Q

what is used for the management of constipation in a patient with diverticular disease who cannot tolerate a high fibre diet ?

A

’ Bulk forming laxatives’

Ispagula husk

217
Q

Management of cerebral oedema caused by brain mets

A
  • Dexamethasone 0.5-10mg daily.

OR

  • Methylprednisolone, 2-40mg, oral, once daily
218
Q

Treatment of DVT / PE in pregnancy

219
Q

Management of Raynaud’s

A

Nifedipine 5mg PO TDS

220
Q

what medication must be stopped when commencing a macrolide antibiotic cue to increased risk of rhabdomyolysis when combined

221
Q

Monitoring requirements on the COCP

A

Weight
Blood pressure

222
Q

Management of an acute dystonic reaction

A
  • Procyclidine hydrochloride
  • 5-10mg
  • IM / IV
223
Q

What medication is CI in the context of peripheral vascular disease (e.g. ulcers)

224
Q

What medications can worsen biventricular HF

A

Corticosteroids
CCB

225
Q

If glycaemic control is worst in the afternoon and needs to be improved, what is the simplest way to achieve it if on insulin?

A

Increase the morning biphasic insulin

226
Q

what should be done with regards to insulin in the management of a pt with DKA

A

Stop short acting SC insulin
Continue long-acting insulin
Fixed-rate IV insulin given alongside fluid resus

227
Q

If a pt on morphine sulphate develops AKI, what can the pain medication be changed too ?

228
Q

what can be used for restlessness and agitation in the palliative care setting ?

A

Haloperidol

229
Q

what is used to prevent pneumococcal infection in children with sickle cell disease

A

phenoxymethylpenicillin

230
Q

Medical management of intermittent claudication if supervised exercise programme fails

A

naftidrofuryl oxalate 100mg PO TDS.

231
Q

What is used to REDUCE FREQUENCY AND SEVERITY of attacks in meniere’s disase ?

A

Betahistine

232
Q

co prescription of what 2 classes of drug increases the risk of respiratory depression

A

Opiates (e.g. morphine) and benzodiazepines (e.g. lorazepam)

233
Q

Pt on statin complains of muscles aches - what is the appropriate action

A
  • Check creatinine kinase
  • If >5 times the upper limit of normal, stop statin and monitor the symptoms
234
Q

Monitoring of carbimazole to guide ongoing treatment ?

A
  • Thyroid function tests every 6 wks until TSH in reference range
  • FBC is only done if clinical suspicion of infection
235
Q

Complication of long term hydroxychloroquine use

A

Bull’s eye maculopathy -> central scotoma, change in colour vision and vision distortions

236
Q

Pt presents in polymorphic ventricular tachycardia, what is this in keeping with the diagnosis of and what medications can contribute to it ?

A
  • Torsades de Pointes -> QT interval prolongation
  • Citalopram, ranolazine, fluconazole = all found in appendix 1
237
Q

Presentation of open-angle glaucoma

A

Painless peripheral visual field loss
Raised intra-ocular pressure

238
Q

Managed of suspected glaucoma with raised intraocular pressure

A

Latanoprost

239
Q

what are the 2 most common medications associated with an increased risk of fractures ?

A

Steroids
PPIs

240
Q

what pts are classes as high risk for developing neural tube defects in pregnancy and therefore require the higher dose of folic acid

A
  • Maternal folate deficiency
  • Maternal vitamin B12 deficiency
  • Previous history of having an infant with a neural tube defect / FHx
  • Smoking
  • Diabetes !!
  • Obesity
  • Use of antiepileptic drugs
  • Sickle cell disease.
241
Q

Main SE of metformin

A
  • Nausea and diarrhoea
  • MALA
242
Q

Main SE of DDP inhibitors (e.g. linagliptin, sitagliprin)

A

PANCREATITIS
Nasopharyngitis

243
Q

Main SE of thiazolidinedione (e.g. pioglitazone)

A
  • Oedema
  • HF
  • Post-menopausal
  • Osteoporosis
  • Bladder cancer
244
Q

Main SE of sulfonylureas (e.g. gliclazide)

A

Hypoglycaemia
Cholestasis

245
Q

Main SE of SGLT-2 inhibitors (‘flozin’)

A

Euglycaemic ketoacidosis
Genital infections

246
Q

Main SE of GLP-1 analogues (e.g. exenatide, semaglutide)

A

PANCREATITIS
Nausea
Diarrhoea

247
Q

Main SE of a-glucosidase inhibitor (e.g. acarbose)

A

Bloating
Flatulence
Diarrhoea

248
Q

is apixaban safe in pregnancy

249
Q

Is bendroflumethazide safe in pregnancy

250
Q

what can be used for breakthrough pain in pts receibing at least 25 mcg of transdermal fentanyl per hour

A
  • Nasal fentanyl
  • Max initial dose of 50mcg into one nostril
251
Q

when would trimethoprim be preferred treatment over nitrofurantoin for a UTI ?

252
Q

Cholestatic jaundice can occur with what medication ?

A

Flucloxacillin

253
Q

a what percentage rise can be expected when starting an ACEI and so remaining on the dose for another week and repeating U&Es would be appropriate ?

A

Creatinine rise of <20%

254
Q

what should be done if signs of lithium toxicity / plasma lithium levels of >1.5

A

Stop lithium and refer to hospital for monitoring

Finals (92 decks)

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