M+M Drugs/ Examinations Flashcards
1
Q
Name 5 general side effects of antipyschotics?
A
Weight gain, dizziness, drowsiness, headaches, stomach upset, memory problems, fatigue, motor (parkinsonain etc)
2
Q
What are the two very serious side effects of antipyschotics?
A
Agranulocytosis - fever, rash, sore throat
Neuroleptic malignant syndrome- Hyperthermia, tachycardia, hypotension, seizures
3
Q
SSRI’s - How/ how often do you take?
A
Tablet OD
4
Q
SSRI - Length of tx
A
Stop 6 months after better but taper off
5
Q
SSRI - Time to working
A
4-6 weeks
6
Q
SSRI - SE’s to counsel (5)
A
2 weeks (GI disturbance and increased anxiety)
Low sex drive
Dry mouth
Drowsiness
7
Q
SSRI - Tests and monitoring (1)
A
Review in 2 weeks
8
Q
SSRI -
Contraindications (2)
A
Suicide risk
Past psych illness
Heart conditions (long-QT)
9
Q
SSRI - Supplementary advice (2)
A
www.mind.org.uk
Don’t stop abruptly
10
Q
Methotrexate - How to take (3)
A
Once weekly tablet
(Injection also available)
- Folic acid on other day
11
Q
Methotrexate - Length of treatment
A
Long term
12
Q
Methotrexate - Time to working
A
1 to 3 months
13
Q
Methotrexate - Tests (details and frequency) - (4)
A
FBC, U+E’s, LFT’s
Baseline
@2weeks til stable
2-3 monthly
14
Q
Methotrexate - Side effects (3)
A
Alopecia
Headaches
GI Disturbance
15
Q
Methotrexate - Complications (3)
A
Pulmonary toxicity - SOB
Liver toxicity - Warn about alcohol
Myelosuppresion- Warn about infections (if you do get an infection then stop AB’s)
16
Q
Methotrexate - Contraindications (3)
A
Immune deficiency
Pregnant/ breast feeding
Hepatic impairment
17
Q
Methotrexate - Supplementary (3)
A
No NSAIDS, aspirin
Get flu jab annual
Arthritisresearch.org.uk
18
Q
Lithium - How to take? (2)
A
Tablet, capsule or syrup
OD or BD
19
Q
Lithium - Length of treatment
A
Long term
20
Q
Lithium - Time to working
A
1-2 weeks
21
Q
Lithium - Tests at baseline (4)
A
FBC, U+E, TFT’s, ECG
22
Q
Lithium - Monitoring (3)
A
Check after 5 days
Then every week till stable for 4 wks
Then every 3 months
23
Q
Lithium - Side effects (4)
A
GI (abdo pain/ nausea)
Metallic taste
Fine tremor
Water symptoms (thirst, polyuria, oedema)
(plus lithium toxicity)
24
Q
Lithium - Complications to warn about (3)
A
Lithium toxicity (GI symptoms, ataxia, drowsiness)
Renal toxicity
Hypothyroidism
25
Lithium - Contraindications (4)
Pregnancy/ breastfeeding
Problems with heart
Problems with kidneys
Problems with thyroid
26
Lithium - Supplementary (1)
www.bipolaruk.org.uk
27
Atypical anti-psychotics - Mechanism for patients
Schizophrenia causes over-activity of chemicals which transmit messages in the brain
Medication helps block some of these messages
28
Atypical anti-psychotics - How to take
Tablet OD or depot injection (weekly)
29
Atypical anti-psychotics - Length of treatment
Quite a while, we want you to be stable and keep you there
30
Atypical anti-psychotics - Time to working
Immediately but may not feel full effects for a few days to weeks
31
Atypical anti-psychotics - tests
Occasional LFT's
32
Atypical anti-psychotics - Important side effects (3)
Weight gain
Movement problems
Drowsiness
33
Atypical anti-psychotics - complications (2)
Neuroleptic malignant syndrome (fever and stiff muscles)
| Agranulocytosis (sore throat, rash, infection)
34
Atypical anti-psychotics - contraindications (2)
Liver failure
| Pregnancy (caution- risk benefit)
35
Levodopa - Mechanism for patients
Works to replace dopamine in your brain
| As bits of your brain have stopped making it in PD
36
Levodopa - How to take
Tablet 3-4x daily with food
37
Levodopa - Length of treatment
For as long as keeps working, after 5 years most see end dose deterioration
38
Levodopa - Time to working
Immediately but a few days to a few weeks to see full effects
39
Levodopa - Tests
None
40
Levodopa - Important SE's (3)
Psychosis and mania
N+V
Movements you can't stop (dyskinesias)
41
Levodopa - Complications (1)
End dose deterioration and on off effects
42
Levodopa - Supplementary info
www.parkinsons.org.uk
43
Bisphosphonates - Mechanism
Stops your body breaking bone down and helps it to build bone back up
44
Bisphosphonates - Supplementary advice
Exercise, stopping smoking and eating a good diet are all just as important
45
Bisphosphonates - How to take (4)
Either weekly tablet or smaller dose daily
With full glass of water
At least 30 mins before food and stay upright for at least 30 mins
46
Bisphosphonates - Length of treatment
Long term
47
Bisphosphonates - Baseline tests (1)
Dental checkup (risk of osteonecrosis of jaw)
48
Bisphosphonates - Important SE's (3)
Headache
Heartburn, bloating or indigestion
GI upset (diarrhoea)
49
Bisphosphonates - Complications (1)
Osteonecrosis of jaw
50
Bisphosphonates - Contraindications (3)
Pregnancy
Dysphagia
Stomach ulcers
51
Diazepam - Contraindications (3)
Respiratory depression
Neuromuscular weakness
Pulmonary insufficiency
Pyschosis
52
Diazepam - Indications (5)
```
Muscle spasms
Anxiety
Agitation
Insomnia
Panic attacks
Alcohol withdrawal
```
53
Diazepam - How to take?
Oral tablet TDS
| Or IM injection
54
Diazepam - Time to working?
Immediate
55
Diazepam - Tests?
None
56
Diazepam - Important SE's (3)
Drowsiness
Confusion
Lightheadedness
57
Diazepam - Complications (2)
```
Muscular weakness (SOB)
Dependence
```
58
Steroids - What are they?
Steroids naturally occur in your body and help your dampen down your immune system. When we give you steroid tablets we're just giving you more of what your body already has to help it fight your immune system.
Note they are not the same as the steroids body builders use
59
Steroids - How long to take for and chance of side effects?
Short course <2weeks = Unlikely SE's
| Long course >2weeks = Possible SE's
60
Steroids - Side effects (9)
```
1- Weight gain (via appetite increase)
2- Increased risk of infection (look out for it)
3- Increase risk diabetes
4- Increase blood pressure
5- Hair thinning
6- Skin thinning, bruising, poor healing, stretch marks
7- Mood and behaviour changes
8- Stomach ulcers (give with PPI)
9- Osteoporosis
```
61
Steroids - How to stop
Don't stop suddenly if been taking for more than 3 weeks
62
Steroids - Symptoms of withdrawal (3)
Weak and tired
Nausea and vomiting
Abdo pain and diarrhoea
63
Name the 9 steps of a parkison examination
1) General inspection - Walking aids etc
2) Gait - Stooped, shuffling, festinating, reduced arm swing
- Pull test
FACE
3) Glabellar tap
4) Speech
5) Poverty of expression
ARMS
6) Tremor exam (rest, action should improve) - distract
7) Akinesia (thumb to fingers, play piano)
8) Tone and rigidity
FUNCTION
9) Write, handle coins
64
Name the framework of an Ank Spond examination
(Normal spine plus plantar fascitis, Achilles tendonitis, shoulder and hip for peripheral arthritis)
65
What are the components of spine exam? (6) - Specific detail for Feel and Special tests
General inspection
Gait
Look
Feel (paraspinal muscles, vertebral bodies, SI joints)
Move
Special tests (Back against wall - AS, schobers, straight leg raise, femoral nerve stretch)
66
What are the components of an opthalmoscope examination? (9)
```
1- General inspect (glasses, scars, discharge, swelling, redness)
2- Lighting comment
3- Red reflex
4- Warn closeness
5- Disc (nasal, CCC)
6- Quadrants
7- Look into light (Macula)
8- Repeat other eye
9- Summary (neuro exam, testing VA, fields, movements, reflexes)
```
67
Name fundoscopy examination findings in diabetic eye disease (4)?
Dot and blot haemorrhages
Cotton wool spots
Hard exudates
Microaneuryms
68
Name fundoscopy examination findings in Glaucoma? (1)
Large cup
69
Name fundoscopy examination findings in Papilloedema? (1)
Lost contour of disc
70
Name fundoscopy examination findings in Central Retinal Venous Oclusion? (2)
Haemorrhage and exudates
71
Name fundoscopy examination findings in Central Retinal Artery Oclusion? (1)
Cherry red spot
72
Name fundoscopy examination findings in AMD? (1)
Drusen deposits
73
What should be check in an examination of CNII?
```
3 Acuity (Snellen, colour, near)
3 Reflexes (D/C, RAPD, accomodation)
3 Fields (Gross, finger test, blind spot)
1 Opthalmoscopy
```
74
What should be tested for CN3/4/6?
Draw H with red pin
| Accomodation
75
What is seen in a R trochlear nerve palsy?
On left gaze the right eye will be too far up (as superior oblique failed)
76
What is seen in a L occulomotor nerve palsy?
L eye points down and out, can't adduct L eye
77
What is the function the inferior oblique muscle?
Elevates eye and turns laterally
78
What is the function of the superior oblique muscle?
Depresses eye and turns eye laterally
79
What components of the trigeminal nerve should be tested?(5)
```
Fine sensation (3 branches)
Offer pinpick sensation
Muscles of mastication
Offer jaw jerk reflex
Offer corneal reflex
```
80
What are the components of a test of CN8?
Whisper test
Rinne's
Weber's
Romberg
81
In a hand examination which nerve is being tested with wrist and finger extension?
Radial nerve
82
In a hand examination in little finger abduction?
Ulnar nerve
83
In a hand examination thumb abduction?
Median nerve
84
What are the components of a hip exam? Specific any that are specific to hip in more detail?
1) Intro - Pain/ hip replacement
2) Inspection (include footwear)
3) Gait
4) Look (include Trendelenburg and leg length)
5) Feel (temp, trochanter)
6) Move (flex, extend, rotate I/E, ab/aduct)
7) Special (Thomas')
85
What are the components of a knee exam?
```
Intro
Gen inspection
Gait
Look
Feel
Move
Special (ACL/ PCL/ MCL/ LCL/ McMurray)
```
86
Give two CI to Carbamazepine (pharma)?
Warfarin
| COCP
87
What things should be assessed on the feel component of a hand exam? (6)
```
Temperature
Thenar/ hypothenar
Duputrens
Sensation
Anatomical snuffbox
Wrists and all joints
```
88
Name the special tests for a shoulder examination? (6)
```
Supraspinatus
Teres minor/ infraspinatus
Subscapularis
Instability
Scarf test
Hawkings test (impingement)
```
89
What power tests should be done in a hand exam? - Include functional (6)
```
Wrist and finger extension (radial)
Abduct little finger (ulnar)
Abduct thumb (median)
Power grip
Ok sign pincer
```
Pick up coin (function)
90
What should ALWAYS be counselled on in a drug explanation station?
Allergies
91
What is the apparent leg length, where is it measure from?
Measured from xiphisternum or medial malleolus
92
What does a discrepancy in the apparent leg length suggest?
Spinal or pelvic deformity (for example scoliosis)
93
What does a discrepancy in the true leg length suggest?
Shortening of the limb (deformity or fracture)
94
What is the true leg length, where is it measure from?
ASIS to medial malleolus
95
Name 4 differentials for elbow pain?
Olecranon bursitis > Localised swelling over olecranon
Lateral epicondlyitis (Tennis)
Medial epicondylitis (Golfers)
Cubital tunnel syndrome (Ulnar nerve entrapment)
96
What are the components of an elbow exam? Give at least one sub-component of each (5)
Intro (include pain)
Look (include carrying angle)
Feel (include olecranon, temprature, biceps tendon)
Move (flex, extend, pronate, supinate)
Special tests (hands pronated)
- LE: Wrists up (extend) whilst palpating LE - Tennis
- ME: Wrists down (flex) whilst palpating ME - Golf
97
What are the steps of a cerebellar exam (and specific sub components)? (6)
Inspection
Gait - ataxic, tightrope walking
Romberg - Sensory ataxia (not cerebellar)
Face- Nystagmus, saccades, speech (+lengthy)
Arms - Tone, finger nose, arms up and cerebellar rebound, dydiadochokinesia
Legs - Coordination
Full neuro exam and exclude Parkinson's etc.
98
What investigations would you do for suspected CES?
```
LL Neuro
Spinal exam (disc prolapse)
Abdominal exam (bladder)
PR exam (sphincter tone)
```
99
Where to motor neurons deccusate?
Medulla
100
Where do the dorsal columns deccusate?
Brainstem
101
What information is carried by the dorsal columns?
Fine touch and proprioception
102
What information is carried by the spinothalamic tracts?
Pain and temperature
103
Where do the spinothalamic tracts deccusate?
Level of exit
104
What are the components of a balance examination?
```
General inspection
Gait - including heel/toe
Rombergs and unterbergers test
Cerebellar exam (DANISH)
Proprioception and lower limb sensation
Offer dix-hallpike
```
105
What are the components of a tremor exam?
```
General inspection (rest tremor)
Gait (Parkinsonian or Ataxic)
Tremor (action, intention)
Distract to exagerate
Hyperthyroid (quick feel of neck)
```
