[MAN] Planning management Flashcards
Summarise HASBLED score.
HTN
Abnormlal renal / liver function
Stroke
Bleeding tendency
Labile INR
Elderly >65
Drugs (aspirin/NSAID) or alcohol
Explain how you interpret HASBLED score
0= low risk, start anticoag if necescary 1-2 = consider anticoag 3+ = high risk of major bleeding
NOTE: this has been replaced by the ORBIT score
What route of administration contraceptive must you give for women on enzyme inducer?
NOT ORAL (as functioning dose will be affected)
Important rules when taking biphosponates
once weekly preparations
do not take together with calcium - as calcium reduces biphossphonate absorption
avoid food for 2 hours (reduces absorption)
swalow with a full gla s of water and remain upright for 30mins
what is 1% weight/volume if volume is 100ml
1g
so
1% of a solution i 1g/100ml
do you need to measure plasma digoxin regularly?=
NO - unless you suspect toxicity or non compliiance
what should INR be on day before surgery
<1.5
what do you need to do if INR is >1.5 on day before surgery
give ORAL VIT K
what must you do to ALL ANTICOAGULANTS (incl aspirin) before surgey?
STOP THEM 5 DAYS BEFORE
INCL ASPIRIN
Why must you stop metformin the day before surgery?
if GFR <60
because otherwise there is a risk it will cause LACTIC ACIDOSIS or ISCHAEMIA (incl AKI)
what is first line therapy for DM in CKD
SULPHONYLUREA
NOT metformin if GFR less than 30
what must you do if pt on ACEi develops a cough
STOP ACEi
change to ARB
what ix must you do if on antipsychotic and some CV RF eg smoking
ECG 1 week after prescription
this will establish pt QT interval while on olanzapine
where can you search details about converting pred to other steroid doses in BNF
“GLUCOCORTICOID THERAPY”
what drug quickly solves dyspepsia / indigestion?
“ANTACID”
e.g. Magnesium carbonate
what is the BEST INDICATOR of resolution of DKA
serum ketones
What can you give if pt is having a MILD ALLERGIC REACTION (not bad enough for adrenaline)? Or if they still have symptoms, but are stable, after adrenaline?
give oral chlorphenamine
What time of day must you never give diuretics?
in the EVENING (or patients will be up all night passing urine!)
Which antiemetic is contraindicated in parkinsons?
Metoclopramide
What is the effect of ALCOHOL on GLUCOSE?
It causes HYPOGLYCAEMIA
What are common side effects of tramadol?
Agitation and hallucinations (especially in elderly)
What must you take into consideration when prescribing weak opioids to elderly>
their side effect profile
- codeine causes constipation
- tramadol causes agitation and hallucinations
What weak opioid is best in elderly with diarrhoea
Codeine
What is the fastest clinical marker to show improvement of pneumonia
RR
If a patient’s pain is not controlled on paracetamol, what are the options?
Codeine or Tramadol
Treatment option for severe HAP?
Pip-taz
Ceftazidime
Ceftriaxone
Cefuroxime
NOTE: if MRSA confirmed or suspected, add vancomycin/teicoplanin
Can be found under ‘Respiratory system infections’ on the BNF
Treatment option for non-severe HAP?
Co-amoxiclav
If pen-allergic: doxycycline
Can be found under ‘Respiratory system infections’ on the BNF
What is an example of an antacid? What is the normal dose?
Magnesium carbonate 10mL 3 times daily
Dose to be taken with water
NOTE: contraindicated with hypophosphataemia
Productive cough + SOB?
Main differentials include heart failure and pneumonia
Antibiotics for epiglottitis
cefotaxime/ceftriaxone
also give steroids
+ rifampicin to close contacts
Short-term anxiolytic (e.g. anxious about an invasive procedure)
Diazepam
Chlordiazepoxide
Lorazepam
Oxazepam
Benzodiazepines are the mainstay of short-term management of severe anxiety.
What is the first-line treatment for non-bullous localised impetigo?
Hydrogen peroxide 1% cream apply 2-3 times a day for 7 days
If he was systemically unwell or at higher risk of complications, a topical (e.g., fusidic acid) or oral (e.g., flucloxacillin) antibiotic should be offered. Clarithromycin is a suitable alternative for patients who are penicillin allergic.
What is the recommended treatmetn for whooping cough?
Macrolides e.g. clarithromycin
What can be used to induce ovulation in women with anovulatory cycles?
Clomifene
NOTE: Weight loss (in overweight and obese women) and metformin can restore ovulation, but in women with polycystic ovary syndrome (PCOS).
What test would confirm anovulatory cycles?
Mid-luteal progesterone
If bacterial conjunctivitis does not resolve, what can be give?
Chloramphenicol or fusidic acid may be used in the management of bacterial conjunctivitis, but they are not recommended first-line as most cases self-resolve within a few days.
A delayed prescription can be given with advice to use the medication if symptoms have not begun to resolve after 3 days.
What type of medication (class) is beclometasone?
Inhaled corticosteroid
An appropriate prescription for ashtma would be: Beclometasone 200–400 micrograms inhaled twice daily
What is the dose and medication for suspected meningococcal disease in a 2 year old in the GP setting?
Benzylpenicillin 600mg IM
Which drug is used in the management of stress incontinence?
Duloxetine (e.g. 40mg PO twice daily)
Duloxetine is a serotonin-noradrenaline reuptake inhibitor (SNRI) which sphincter tone, resulting in a reduction in symptoms of stress incontinence.
Above which blood pressure is urgent admission indicated?
180/100 mmHg in combination with signs of end-organ damage such as retinal haemorrhage or papilloedema, or life-threatening symptoms.
What is the most appropriate analgesia for acute severe pain seconday to limb fracture?
The BNF recommends a starting dose of up to 5mg intravenous morphine every 4 hours, which can be titrated according to the response (the dose can also be adjusted more frequently during the titration phase).
Typically in the setting of acute pain in opioid-naive patients, IV morphine is administered in 2.5mg increments with re-assessment after each dose to guide the need for further analgesia.
It should be noted that there are many caveats to this; for example, the dose may need to be reduced in the elderly or those with poor renal function or increased in those who are already taking long-acting opioid medications. Opioids are also often avoided in cases of significant head injury where they may complicate examination findings and worsen respiratory depression.
Is fentanyl stronger or weaker than morphine?
around 100 times more potent than morphine
A fentanyl patch is slow-release and would not be helpful in managing the acute pain
What is the medical management of ectopic pregnancy?
IM methotrexate
If medical management fails or if the ectopic pregnancy ruptures, surgery will be required (salpingotomy or salpingectomy, depending on the status of the contralateral fallopian tube).
What is the medical management for termination of pregnancy up to 24 weeks gestation?
Vaginal misoprostol can be used following mifepristone to terminate pregnancy up to 24 weeks.
What is the first line medication in myasthenia gravis?
Pyridostigmine
First-line treatment is an acetylcholinesterase (AChE) inhibitor such as pyridostigmine. This effectively increases the concentration of acetylcholine within the synaptic cleft to allow for symptomatic relief.
What can be used in acute myasthenic crises?
Prednisolone
Patients would usually present with symptoms associated with respiratory failure requiring intubation and ventilation.
What is the recommended antibiotic in patients with cellulitis who are allergic to penicillin?
Clarithromycin 500mg PO
(Erythromycin in pregnant)
Where can you find information medical management of insect bites?
If you look at the insect bites and stings section it says: “Antibacterials are not recommended for an insect bite or sting unless the patient has signs or symptoms of an infection. For the management of patients with a suspected infection, see Cellulitis and erysipelas.”
What might the following symptoms suggest: reduced level of consciousness, worsening ascites and possible coagulopathy suggested by the bruising (PMH: alcoholic cirrhosis)?
Hepatic encephalopathy
Acutely, this patient should be prescribed lactulose 30-50ml three times daily; this is the first-line management of overt hepatic encephalopathy and has been shown to reduce mortality. Rifaximin (550mg PO BD) is a potential second-line option.
What is the first line management for overt hepatic encephalopathy?
Lactulose 30-50ml three times daily
Rifaximin (550mg PO BD) is a potential second-line option.
What is the first line pharmacological management of GORD?
Alginic acid 2 doses as required up to 12 doses a day (for a child aged 1-23 months with weight 4.5kg and above).
What is the most appropriate management for an eclamptic seizure (in a pregnant patient with known pre-eclampsia)?
Administer IV magnesium sulfate 4g
Labetalol is a beta-blocker used in the management of hypertension in pregnancy and pre-eclampsia, and should also be commenced here, but is less urgent than administering magnesium sulfate to prevent complications of the seizure including coma, fetal damage or death.
What is the most appropriate management of CAP in a patient who is pregnant and has a penicillin allergy?
Erythromycin 500mg PO
NOTE: Doxycycline 200mg PO is incorrect as tetracycline antibiotics are contraindicated in pregnancy.
If a patient is having a migraine and is vomiting severely, what route can triptans be administered by?
Subcut
Intranasally
What is the adrenaline dose in anaphylaxis?
Adrenaline 500 micrograms IM (0.5 mL of 1:1000).
What dose of folic acid should be given during pregnancy if the woman has a first degree relative with spina bifida?
folic acid 5mg PO daily (high dose) until week 12 of pregnancy
Patients at low risk of conceiving a child with neural tube defects should take folic acid at a lower dose of 400 micrograms daily.
Why should patients over the age of 50 be given antiviral treatment for shingles?
to reduce the risk of long term post-herpetic neuralgia
Dose: Aciclovir 800mg PO 5 times a day for 7 days
Treatent of second episode of Clostridium difficile infection in the last 12 weeks
oral fidaxomicin 200mg BD
For severe croup not controlled with corticosteroids, what should be given?
Nebulised adrenaline 1:1000 should be given
The dose is 400 micrograms/kg (max 5mg)
This can be administered by diluting 1:1000 adrenaline solution with sterile sodium chloride 0.9%.
Medical management of ascites for cirrhosis of the liver and malignant disease.
Spironolactone 100mg OD
What is the first-line therapy for the management of haemodynamically stable patients with pulmonary embolism?
Either apixaban or rivaroxaban, providing there are no contraindications.
These drugs are generally given for 3-6 months, depending on whether the episode of venous thromboembolism was provoked or unprovoked. The patient has a normal renal function, and therefore a DOAC is preferable to LMWHs such as dalteparin sodium; these are recommended to be given second-line according to the latest guidance.
When is unfractionated heparin used in PE management?
For massive PE
Alternative: thrombolytic agents such as alteplase
Reversal agent for benzodiazepine toxicity?
Flumazenil
What treatment is appropriate when salicyclate concentration exceeds 700mg/L (in an overdose)?
Haemodialysis
Other indication: severe metabolic acidosis/
Best antibiotic choices for suspected meningitis/meningococcal sepsis in child under 3 months old?
IV cefotaxime and amoxicillin
In children over 3 months old, IV ceftriaxone is used.
What is the first line antihypertensive in a diabetic patient?
ACE inhibitor (regardless of age or ethnicity - ARB if black)
ACE inhibitors have been shown to reduce microalbuminuria and slow the progress of nephropathy in those with diabetes.
How might losartan cause AKI?
pre-renal acute kidney injury secondary to dehydration/hypovolaemia
If this happens, WITHHOLD the causative medication
