Medicine Flashcards
What dies 8.4% sodium aqueous solution mean?
8.4g of sodium per 100ml
What does 0.9% saline mean
0.9g of sodium in 100ml
- Write 1 prescription to lower potassium in hyperkalaemia.
2. Write a prescription to protect the heart in hyperkalaemia
1 .date, time… 10UNITS OF ACTRAPID IN 50ml 50% DEXTROSE, IV, OVER 15mins, sign+bleep
2. date, time… 20ml 10% CALCIUM GLUCONATE, IV, OVER 5mins, sign+bleep
general principle of fluids
2 sweet, 1 salty.
1L of 0.9% NaCl with 20mmol KCl over 8hrs
1L of 0.9% NaCl with 20mmol KCl over 8hrs
1L of 5% dextrose with 20mmol KCl over 8hrs
When to avoid dextrose
head injury e.g. stroke!!!
name some low molecular weight heparins
Enoxaparin
Tinzaparin
what to monitor with LMWH
platelets
potassium
Max length of time before needing INR check?
what time of day is it usually taken?
what about change in dose?
- 12 weeks.
- In morning
- After 2 days
What common drugs are used with caution with warfarin
NSAIDs (ibuprofen, aspirin a bit too)
How to monitor the response to treatment of diuretics
weight loss
How to monitor the response to treatment of ace inhibitors
Exercise tolerance
How to monitor the response to treatment of antibiotics
CRP
How to monitor the response to treatment of polymylagia rheumatica
ESR
How to monitor the response to treatment of HIV meds
HIV RNA levels
Digoxin monitoring
- levels taken when
- toxicity Ix
- risks of toxicity
Take 6 hours after last dose.
Toxicity if over 2üg/L
Hypokalaemia increases toxicity risk
Monitor U+E and renal function
If ?toxicity = U+E, digoxin levels and ECGS
sick day insulin for T1 and T2 DM
T1DM = Increase quick acting by 10% if BM between 10-13mmol/L
Monitor ketones
T2DM = Increase insulin by 20% if BM between 10-15mmol/L
Prescription of morphine for pain
10mg every 4 hours.
Rescue opioids for breakthrough pain
1/6 to 1/10 of background dose.
how much to increase morphine by
1/2 to 1/3
Meaning of co-codamol 8/500
500g paracetamol
8g codeine
max paracetamol dose for a day
4g
How to increase levothyroxine
By 25micrograms a change
ADR of carbimazole and monitoring
FBC as can cause neutropenia and agranulocytosis
When to take lithium levels
trough = 12 hours after last dose. Can delay morning dose to take sample
gentamicin monitoring
Peak concentration = sample 1hr after last dose. If this is high (over 10mg’L) REDUCE dose.
Trough concentration = sample taken before administration of next dose. If high (over 2mg/L), INCREASE time between doses.
Long term steroids and sick day rules
double dose of steroids when acutely unwell.
Paracetamol OD.
- dose which is toxic
- use of NAC
- > 150mg/kg within 1 hour.
- Use empirically if presenting after 8hrs of ingestion.
- Can only use NAC after paracetamol levels after 4hrs of ingestion are known and compared to nomogram.
- Give if staggered OD (longer than 1hr).
BNF = Poisoning, emergency treatment
BIPHASIC INSULIN REGIME.
- HIGH BM before lunch/dinner?
- HIGH BM before bed/breakfast
- LOW BM before lunch/dinner?
- LOW BM before bed/breakfast
- Increase breakfast dose by 10%
- Increase evening meal dose by 10%
- Reduce breakfast dose by 10%
- Reduce evening meal dose by 10%
What reduction in what parameter do you want to see with statin use and what to do if it is wrong?
What to see a 40% REDUCTION in the NON-HDL cholesterol. If not achieved: 1. check adherence. 2. increase atorvastatin dose 3. consider ezetimibe
Monitoring of LFT and creatinine kinase with statins
- LFTs - look at transaminases, if OVER 3X UPPER NORMAL LIMIT, stop!
- CK - if OVER 5X UPPER NORMAL LIMIT, stop!
Man got severe diarrhoea, what should he do with metformin meds?
If severe D+V, consider stopping metformin.
Adrenaline:
- 1 : 10,000 meaning?
- 1 : 1000 meaning?
- 100micrograms/ml –> 1 mg in 10 mL
2. 500micrograms/0.5ml –> 1mg/ml
BASAL BOLUS INSULIN:
- What time of day will tell you whether their pre-lunch bolus is right?
- What time of day will tell you whether their post-breakfast dose is right?
- What time of day will tell you whether their evening meal dose is right?
- Pre-evening meal BM
- Pre-lunch
- Bedtime
Name 5 drugs which increase risk of hyperglycaemia
Steroids, anti-psychotics, tacrolismus, beta-blockers, thiazide diuetics.
Name 6 drugs which increase risk of raised cholesterol
Systemic steroids Diuretics (thiazide and loop) Most antipsychotics Cyclosporine (and less frequently tacrolimus) Most HIV medications SGLT2 inhibitors (-flozins)
Drugs to be used in caution in heart failiure
Pioglitazone
Verapamil
NSAIDs
How many mmol of K in 0.15% and 0.3% KCl?
- 15% = 20mmol/L
0. 3% = 40mmol/L
What to do with the patients insulin regime in DKA
Stop short acting
Continue long acting
Start a fixed rate IV insulin infusion.
Mx for 1st case and 2nd case of c.diff
1st = Metronidazole 2nd = Vancomycin
Good drugs for post-op nausea
Cyclizine (no QT effects) Ondansetron Promethazine Prochlorperazine BNF treatment summaries = DROPERIDOL but should only be prescribed by specialist for PONV
