Management Flashcards
Epilepsy medication
After 2nd seizure
Generalised: sodium valporate
Partial/focal: carbamazepine
Epilepsy and driving
Can’t drive for 6 months following seizure.
Established epilepsy- must be fit free for 12 months
Antiepileptics and pregnancy
Sodium valproate contraindicated
Epilepsy second line drugs
Lamotrigine
Phenytoin
Levetiracetam
Topiramate
Acute management of seizures
Usually spontaneously stop but >5 minute= status epilepticus- MEDICAL EMERGENCY must come to hosp. At home can give benzo e.g diazepam (rescue med) rectally, intranasalle/ under tongue.
In hosp: benzos, infusion of antiepileptic or GA.
Antiepileptics and contraception
Sodium valproate- if child bearing must be taking contraception.
For all antiepileptics: if COCP given must have 30 micrograms of ethinylestradiol.
They all require high amount of contraception to work.
AKI treatment
Supportive + stop any potentially nephrotoxic drugs
Drugs to be stopped in AKI
NSAIDs (except aspirin at cardiac dose e.g. 75mg od)
Aminoglycosides
Angiotensin II receptor inhibtiors
Diuretics
Drugs that may worsen an AKI
Metformin
Lithium
Digoxin
Hyperkalaemia treatment
IV calcium gluconate to stabilise the cardiac membrane.
Insulin/ dextrose infusion and nebulised salbutamol (beta agonist) to shift potassium from extracellular to intracellular compartment
Calcium resonium
Loop diuretics
Dialysis (if AKI with persistent hyperkalaemia)
Animal or human bites
Co-amoxiclav
Risk of HIV, hepatitis C
Anthrax
Ciprofloxacin
Tetanus wound.
Patient had full course of vaccine, last dose <10 years ago
no vaccine or tetanus Ig required.
Tetanus wound:
Patient had full course of vaccine but >10 years ago
If tetanus prone wound- reinforcing dose of vaccine
If high-risk wound- reinforcing dose of vaccine + tetanus immunoglobulin
Tetanus wound: Patient vaccine history if incomplete or unknown
Reinforcing dose of vaccine
If tetanus prone or high-risk wound: add tetanus Ig
Stress incontinence
Pelvic floor exercises
Reduce caffeine
Surgery
Duloxetine
Urge incontinence
Bladder retraining
Antimuscarinics: oxybutynin (avoid in frail older women), tolterodine, darifenacin
Mirabegron
Stevens-johnson syndrome
Cease all medications (caused by lamotrigine) obtain IV fluid access and begin fluid hydration
TCA overdose
Bicarbonates to prevent CV complications.
IV lipid emulsion- binds free drug
Benzodiazepine overdose
Flumazenil
Respiratory depression due to magnesium sulphate
Calcium gluconate
Paracetamol OD
NAC
if <1 hour- actiavted charcoal
Salicylate OD
IV bicarbonate
haemodialysis
Opioids OD
Naloxone
Lithium OD
Normal saline, haemodialysis if severe.
~ Sodium bicarb
Warfarin antidote
Vitamin K, prothrombin complex
Heparin antidote
Protamine sulphate
Trigeminal neuralgia (neuropathic pain)
Carbamazepine
Neuropathic pain e.g. diabetic neuropathy, post herpetic neuralgia, prolapsed intervertebral disc
Amitriplyline, duloxetine, gabapentin, pregabalin
Prostatic hyperplasia
alpha blocker e.g. doxazosin, indoramin, prazosin, tamulosin etc
Torsades de pointes
IV Magnesium sulphate
Ethylene glycol (anti freeze) antidote
Fomepizole, ethanol, haemodialysis
Organophosphate poisoning
Atropine
Beta blocker OD
Glucagon
Pelvic Inflammatory Disease
Oral ofloxacin + oral metronidazole OR IM ceftriaxone + oral doxycycline + oral metronidazole
If not severe can leave intrauterine device in
COPD exacerbation
prednisolone. If sputum is purulent or clinical signs of pneumonia–> amoxicillin, clarithromycin or doxycycline
What treatment is contraindicated in myoclonic or absence seizures?
Carbamazepine
