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3MB Buzzwords > MFE > Flashcards

MFE Flashcards

1
Q

Causes of delirium

A

DELIRIUMS

Drugs and Alcohol (Anti-cholinergics, opiates, anti-convulsants, recreational)
Eyes, ears and emotional disturbances
Low Output state (cardio, resp)
Infection
Retention
Ictal (seizure activity)
Under-hydration/Under-nutrition
Metabolic disorders
Subdural hematoma, sleep deprivation

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2
Q

Define Orthostatic hypotension

A

Decrease in systolic blood pressure of 20 mmHg or a decrease in diastolic blood pressure of 10 mmHg within three minutes of standing when compared with blood pressure from the sitting or supine position.

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3
Q

Lilliputian hallucination refers to the delusion of seeing tiny people / creatures

A

Alcohol withdrawal syndrome

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4
Q

Constipation is a common cause of delirium in elderly inpatients, particularly in those taking _________ analgesia

A

Opiate

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5
Q

There is likely a deprivation of liberty if..

A

The person is subject to continuous supervision and control and
The person is not free to leave

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6
Q

Which drugs cause constipation?

A

Opiates, calcium channel blockers and some antipsychotics

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7
Q

Medications for pain

A

Morphine
Diamorphine
Oxycodone
Alfentanyl (for those with renal failure)

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8
Q

Medications for breathlessness

A

Therapeutic oxygen
Morphine
Midazolam

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9
Q

Medications for nausea and vomiting

A

Levomepromazine
Cyclizine
Haloperidol
Metoclopramide

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10
Q

Medications for restlessness and confusion

A

Haloperidol
Levomepromazine
Midazolam

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11
Q

Medications for respiratory tract secretions

A

Hyoscine hydrobromide/butylbromide
Glycopyrronium

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12
Q

Which drug classes cause delirium?

A

Anti-cholinergics, opiates, anti-convulsants, recreational

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13
Q

Mx for constipation

A

Exclusion of underlying causes - colorectal cancer
Lifestyle modifications - increase dietary fibre, adequate fluid intake, adequate activity levels

First-line laxative: bulk-forming laxative first-line, such as ispaghula
Second-line: osmotic laxative, such as a macrogol

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14
Q

A 67 year old man was electively admitted for a total hip replacement. On the third day postoperatively he is reviewed on the ward.

He is acutely confused with impaired concentration, agitation, tremor, sweating and tachycardia. He swats at his bed clothes as though trying to kill insects.

What is the underlying cause of his delirium?

A

Alcohol withdrawal - lilliputian hallucination refers to the delusion of seeing tiny people / creatures. This can be a sign of delirium tremens due to alcohol withdrawal

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15
Q

Seizure threshold lowering drugs

A

Antibiotics: Imipenem, penicillins, cephalosporins, metronidazole, isoniazid
Antipsychotics
Antidepressents: Bupropion, Tricyclics, Venlafaxine
Tramadol
Fentanyl
Ketamine
Lidocaine
Lithium
Antihistamines

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16
Q

Dementia alongside two of the three features: fluctuating attention and concentration, recurrent well-formed visual hallucinations, spontaneous Parkinsonism

A

LBD

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17
Q

Breakthrough pain medication is calculated as…

A

Sixth of the total daily dose

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18
Q

Medications that cause postural hypotension

A

Nancy Doesn’t Always Bring Lollipops And Apples

Nitrates
Diuretics
Anticholinergics
Beta-blockers
L-Dopa
Antidepressants
ACE inhibitors

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19
Q

Medications associated with falls due to other mechanisms

A

BAAC DOO

Benzodiazepines
Antipsychotics
Anticonvulsants
Codeine
Digoxin
Opiates
Other sedatives

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20
Q

Gastrointestinal disturbance (nausea, vomiting, abdominal pain), dizziness, confusion, blurry or yellow vision, and arrhythmias.

A

Acute digoxin toxicity

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21
Q

Dry eyes, dry mouth, hypotension (often postural) and delirium

A

Side-effects of an anticholinergic drug such like amitriptyline

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22
Q

If there is a bleeding ulcer, stop _______

A

NSAIDs

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23
Q

If there is kidney failure, stop _______

A

ACE inhibitor

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24
Q

If there is severe hyponatraemia, stop _______

A

Antidepressant

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25
Q

ACE-i and CCB cause..

A

Postural hypotension

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26
Q

Thiazides can cause..

A

Dehydration

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27
Q

Amitriptyline can cause..

A

Anti-cholinergic side effects

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28
Q

Laxatives and anti-emetics can cause..

29
Q

Signs to recognise when a patient might be dying

A

LAST BREATH
Lethargy
Altered mental status
Skin changes (blue, mottled, cold hands and feet)
Tablets and oral intake diminished
Breathing changes (rattled, rapid, intermittent)

30
Q

Treatable conditions that can mimic dying

A

Opioid toxicity
Sepsis
Hypercalcaemia
Hypoglycaemia
Uraemia/AKI

31
Q

Which anticipatory medication is given in pain/SOB

32
Q

Which anticipatory medication is given in distress/agitation

33
Q

Which anticipatory medication is given in nausea

A

Levomepromazine

34
Q

Which anticipatory medication is given in respiratory secretions

A

Hyoscine butylbromide

35
Q

If already established on background oral opioid..

A

Generally, use same opioid for background and prn
Use approx. 1/6 background dose as breakthrough prn dose
Switch background oral opioid to syringe driver if not managing to swallow

36
Q

When giving opioids, if renal function severely impaired..

A

Consider alfentanil

37
Q

Visual impairment with visual hallucinations in the evening/low light

A

Charles Bonnet syndrome

38
Q

_______ can decrease the absorption of tetracycline antibiotics (e.g. doxycycline)

A

Oral iron (e.g. ferrous sulfate)

Give iron at least 3 hours before or 3 hours after tetracycline

39
Q

_____________ can prolong bleeding times and cause gastrointestinal toxicity. These effects are aggravated when given with anticoagulants (e.g. warfarin)

A

Naproxen, and other NSAIDs

Monitor INR + bleeding signs. Alter warfarin dose to ensure ref range

40
Q

Clarithromycin inhibits the CYP3A4 enzyme responsible for metabolising ____________, subsequently increasing the plasma concentration

A

Simvastatin

Withhold simvastatin while administering clarithromycin

41
Q

Methotrexate is a substrate for OAT1 and/or OAT3 so can compete with __________ which are involved in the active renal secretion of drug

A

NSAIDs

Avoid NSAIDs with methotrexate and use alternative analgesia

42
Q

Example of a beneficial additive/synergistic interaction

A

Ramipril inhibits the ACE enzyme from converting angiotensin I to angiotensin II, causing increased vasodilation due to inhibition of bradykinin breakdown

Amlodipine causes the direct relaxation of the vascular smooth muscles

No action is required unless hypotension occurs

43
Q

Example of a harmful additive/synergistic interaction

A

Enoxaparin with apixaban

Additive anti-Xa activity. This increases the risk of bleeding

44
Q

Example of an antagonism interaction

A

Propranolol (blocks b2 which can make asthma worse) with salbutamol

45
Q

Omeprazole with clopidogrel interaction

A

Omeprazole can decrease the antiplatelet effects of clopidogrel (give cimetidine instead)

46
Q

SSRIs with NSAIDs interaction

A

Can increase GI bleading

47
Q

Methotrexate with trimethoprim interaction

A

Risk of severe bone marrow suppression & subsequent pancytopenia (monitor FBC and give folinic acid as an antidote)

48
Q

Verapamil with beta-blockers interaction

A

Additive cardiac depression effects (leading to bradycardia, asystole, sinus arrest) so never give verapamil in IV

49
Q

ACE inhibitors with potassium-sparing diuretics (e.g. spironolactone/eplerenone) interaction

A

Increases the risk of hyperkalaemia and acute kidney injury

50
Q

Which drug causes unexplained rhabdomyolysis?

51
Q

Absorption of levothyroxine is reduced by…

A

Food and caffeine as well antacids, calcium and iron supplements)

52
Q

Long-term side effects of taking omeprazole

A

Osteoporosis, Clostridium difficile infection, hypomagnesaemia and vitamin B12 deficiency

53
Q

Omeprazole drug interactions

A

SSRI
Clopidogrel
Methotrexate

54
Q

Key counselling point of taking amlodipine?

A

Dizzy so blood pressure monitoring will be required during treatment

55
Q

Amlodipine drug interactions

A

Simvastatin - rhabdomyolysis
Diltiazem and verapamil - arrythmias
Ramipril - hypotension

56
Q

Joint pain (arthralgia), muscle discomfort (myalgia), nausea & vomiting, flatulence, constipation and gastrointestinal discomfort

A

Atorvastatin

57
Q

Excess dosing of causes symptoms of hyperthyroidism

A

Levothyroxine

58
Q

Dizziness, flushing, palpitations, headaches, peripheral oedema (usually leg swelling) and headaches

A

Amlodipine

59
Q

Dry cough
Hyperkalaemia
Angioedema

60
Q

Rampiril drug interactions

A

NSAIDs - hyperkalaemia
Lithium

61
Q

Bisoprolol interactions

A

Verapamil, diltiazem and amiodarone - heart block

62
Q

Gastrointestinal and taste disturbances
Weight loss

63
Q

Don’t mix _____ or _____ with ciprofloxacin or doxycyclin

A

Calcium or ferrous sulphate

64
Q

P450 inducers

65
Q

P450 inhibitors

A

+ Alcohol + Sodium Valproate

66
Q

___________ is a calcium channel blocker. Common side effects include ankle swelling and facial flushing. There is some evidence to suggest this drug is protective against osteoporosiS

A

Amlodipine

67
Q

_____________ can cause muscle pains and gastrointestinal side effects. It can also cause deranged liver function tests, however, it does not impact bone health

A

Atorvastatin

68
Q

Which antipsychotic is given if a patient has PD?

A

Lorazepam

If urgent then atypical antipsychotic: quetiapine and clozapine

3MB Buzzwords (13 decks)

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