Miscellaneous Flashcards
Spinal cord syndromes?
Multiple endocrine neoplasia?
MEN venn diagram?
Nephrotic/nephritic syndromes?
Triad of nephrotic syndrome? Consequence?
- Proteinuria (> 3g/24hr) causing
- Hypoalbuminaemia (< 30g/L) and
- Oedema
Loss of antithrombin-III, proteins C and S and an associated rise in fibrinogen levels predispose to thrombosis. Loss of thyroxine-binding globulin lowers the total, but not free, thyroxine levels.
Stomas?
- In emergency when the bowel has perforated the risk of an anastomosis is much greater, particularly when the anastomosis is colon-colon.
- End colostomy is often safer and can be reversed later.
- Resection of the sigmoid colon + formation of end colostomy = Hartmans procedure.
- Whilst left sided resections are more risky, ileo-colic anastomoses are relatively safe even in the emergency setting and do not need to be defunctioned.
Target INRs?
Starting on warfarin?
- Decide on target INR and duration of therapy
- Consider need for bridging LMWH until INR in target range
- Decide on loading regime
- Standard = 10 mg
- Sensitive - >65 years, ↑baseline INR, cardiac failure, liver disease, nutritional deficiencies, body weight <50kg, etc = 5mg
- Measure INR daily
- Prescribe warfarin based upon INR measurements
What to do when INR is too high and no bleeding?
What to do when INR is too high and minor bleeding? (epistaxis, haematoma)
What to do if INR too high and major bleeding?
(intracranial, GI bleeding, intraocular, pericardial bleeds, compartment syndrome, shock)
- Stop warfarin
- Re-start when INR <5.0
- IV vitamin K 5-10mg
- Prothrombin complex concentrate (PCC)
What is prothrombin complex concentrate?
AKA: PCC, octaplex
- Produced by fractionation of pooled plasma from non-UK donors
- Contains factors II, VII, IX and X
- IV infusion
- Re-check clotting 20 minutes after injection
3ml/min via syringe driver (10 ml/min if life threatening)
How to monior unfractionated heparin?
APTT
Name some combination insulins?
Humalog Mix50 and Humalog Mix25
Long-acting mixed with a bit of rapid-acting
How to prescribe regular insulin?
- Name of insulin & brand name
- Type of device
- Exact time & units to be given
- Then simply sign!
Example of common insulin regime?
Some will be on different doses at different times
- Humalog Mix50 14 units OM
- Humalog Mix50 10 units lunch & tea
So write it up on the SAME prescription
- Humulog Mix50 12 units morning & night
- Actrapid 6 units with every meal
So write TWO SEPARATE prescriptions
Why is LMWH better than unfractionated?
Lower risk of HIT (heparin induced thrombocytopenia) and longer half life (mainly given OD)
Example of someone starting on warfarin? (pic)
Coverage and indications of gentamycin?
- Aminoglycoside
- Broad spec (anaerobes, streptococci, pneumococci)
- Endocarditis, biliary sepsis, pyelonephritis, CNS infections
Initial doses of gent?
Usually 5-7mg/kg (1-2mg/kg in CKD)
How to prescribe gentamicin?
- Height and weight(actual and IBW)
- Prescribe initial dose (7 mg/kg)
- Work out when gentamicin and creatinine levels need to be taken (6-14 hours after start of first dose)
- Take gent & creat levels (every dose)
- Once have results use the Hartford normogram to work out whether to:
- Stop gentamicin if too high
- To work out the dosing interval
- Prescribe doses until next gentamicin level required
Levels should be checked every 3rd day/dose, check cr daily.
Document this on gent administration record - on drug chart, in dose write ‘as per chart’.
Coverage and indications of vancomycin?
Glycopeptide (bactericidal)
Only aerobic & anaerobic gram-positive bacteria
IV usually, oral ONLY if local GI effect needed
Resistant staph infections, C. diff
Adverse effects of vancomycin?
- Red man syndrome
- Flushing, fever, histamine-related anaphylactoid reaction
- Nephrotoxicity, ototoxicity
- Neutropenia, thrombocytopenia
Prescribing vanc?
- Indication & duration
- Target trough levels:
- 10-20 mg/L = normal trough
- 15-20 mg/L = if treating for less susceptible strains or MRSA/more complication infections
- Baseline characteristics:
- BMI = weight/height2
- Creatinine clearance = CrCl (NOT eGFR). Calculated using Cockcroft-gault equation
- Loading dose is based on weight (1-2g)
- Maintenance dose based on CrCl and find out time of first vancomycin trough level (total no of doses includes loading dose)
- 1-1.5g every 12 hours if normal renal function
- Take trough level before 4th dose
- Prescribe initial maintenance dose until dose after trough level due
- Check vancomycin trough level
- Decide on subsequent dosing level and monitoring
Interpreting vanc trough levels?
Bristol stool chart?
C.diff toxin and blood GDH level results?
(Glutamate dehydrogenase)
How to reverse NOACs?
- No ‘antidote’
- Can give tranexamic acid, mefanamic acid, terlipressin, vitamin K
- Discuss with Haematology EARLY for advice
Prescription requirements for controlled drugs?
- In indelible ink
- The name and address of the patient
- The dose
- The form of the preparation
- The strength of the preparation
- The total volume/dose in words and figures
- Signed and dated by the prescriber, be dated, specifying the prescriber’s address
Example of NAC prescription?
VTE risk factors?
Contraindications to VTE prophylaxis?
- Concurrent use of anticoagulants
- Acute stroke
- Thrombocytopenia (platelets <75x109/l)
- Bleeding disorders
- Acute liver failure
- Untreated inherited bleeding disorders (e.g. haemophilia)
- Active bleeding
Patterns of transferase rise?
- ALT > AST in chronic disease
- AST > ALT in cirrhosis
Posterior MI
WPW
Management of delirium?
Determine Cause (A-E) - collateral history
Look at meds
Bloods/Imaging
Validated screening tool (CAM tool)
3 distinct clinical entities in delirium?
Hyperactive: Agitated
Mixed = Hypoactive - Hyperactive
Hypoactive = hypoalert, withdrawn, confused
