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PSA Notes > Notes > Flashcards

Notes Flashcards

1
Q

How much K does a patient need in a day?

A

1 mmol / kg / day

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2
Q

What does the rate of infusion of K cannot exceed?

A

> 10 mmol / hr

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3
Q

Max dose of paracetomal in a day

A

1g QDS

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4
Q

What do enzyme inducers do?

A

Increase the metabolism of drugs thus leading to a decreased effect

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5
Q

Enzyme inducers

A 
Phenytoin
Carbamazepine
Barbituates 
Rifampicin 
Chronic alcohol excess 
Sulphonyureas 
St Johns wort
Smoking
Topiramate
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6
Q

What do enzyme inhibitors do?

A

Increase metabolism of drugs and therefore more of the drug in the body

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7
Q

Enzyme inhibitors

A 
Allopurinol 
Omeprazole
Disulfiram 
Ciprofloxacin 
Acute alcohol excess 
Sulphonamines 
Grapefruit juice
Amoidarone
SSRIs
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8
Q

How much can transaminases be raised before statins have to be discontinued?

A

3x the upper limit of normal

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9
Q

Examples of drugs prescribed in micrograms

A

Digoxin

Levothyroxine

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10
Q

Paracetomal and what drug together often mean too much of the drug?

A

Co-codamol

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11
Q

What does 1% mean?

A

1g in 100ml

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12
Q

Prescribed name as tazocin

A

Piperacillin with tazobactam

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13
Q

How long before surgery does the COCP have to be stopped?

A

4 weeks before

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14
Q

How long before the surgery does lithium have to be stopped?

A

1 day

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15
Q

How long before surgery should potassium sparing diuretics and ACEIs be stopped?

A

Day of

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16
Q

How long before surgery should anticoagulants be stopped?

A

7 days

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17
Q

Examples of anticoagulants

A

Warfarin

Heparin

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18
Q

Examples of antiplatelets

A

Aspirin
Clopidogrel
Dipyramidole

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19
Q

Should metformin be stopped before surgery?

A

Yes, as NBM -> lactic acidosis

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20
Q

What should be done to insulin when having surgery?

A

A sliding scale should be started

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21
Q

What should be stopped if a patient is bleeding?

A

Any antiplatelets etc or prophylactic anticoagulation

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22
Q

What do ACEIs contribute to?

A

Renal failure

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23
Q

How many hourly is 3x daily?

A

8 hourly

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24
Q

How many hourly is 4x daily?

A

6 hourly

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25
Q

Does co amoxiclav contain penicillin?

A

Yes

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26
Q

Does amoxicillin contain penicillin?

A

Yes

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27
Q

Does tazocin contain penicillin?

A

Yes

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28
Q

What is a specific condition that prophylactic heparin is contraindicated in?

A

Acute ischemic stroke (as risk of bleeding into the stroke)

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29
Q

What would an enzyme inhibitor e.g. erythromycin do to INR?

A

Increase warfarins effect i.e. Increase INR

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30
Q

S/Es steriods

A 
Stomach ulcers
Thin skin 
Confusion 
Oedema
Right and left HF 
Osteoporosis 
Infection (including candida)
Hyperglycaemia 
Cushings
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31
Q

What are NSAIDs contraindicated in?

A

Heart failure
Renal failure
Asthma

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32
Q

S/Es NSAIDs

A 
Renal failure
Systolic dysfunction 
Indigestion 
Clotting abnormalities 
Ulceration
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33
Q

S/Es antihypertensives

A

Hypotension

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34
Q

S/Es BBs

A

Bradycardia
Wheeze in asthmatics
Worsening of acute HF

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35
Q

S/Es of CCBs

A

Bradycardia
Peripheral oedema
Flushing

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36
Q

S/Es of loop diuretics

A

Renal failure
Hypokalaemia
Gout

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37
Q

S/Es K+ sparing diuretics

A

Hyperkalaemia

Gynaecomastia

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38
Q

S/Es TTD

A

Hypokalaemia

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39
Q

S/Es ACEIs

A

Hyperkalaemia

Dry cough

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40
Q

S/Es ARBs

A

Hyperkalaemia

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41
Q

If a patient is vomiting, how should antiemetics be given?

A

Non oral routes i.e. IM/IV/SC

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42
Q

Should a patient who is NBM still receive their medication?

A

Yes

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43
Q

As a general rule, never prescribe more than how many Litres of fluid for a sick patient?

A

2 litres

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44
Q

How much fluid does a patient need for maintenance fluids as a general rule?

A

3L adult per 24 hrs

2L elderly per 24 hrs

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45
Q

What is a saying for maintenance fluids in 24 hours?

A

2 sweet and 1 salt

  • 2L 5% dextrose
  • 1L 0.9% saline
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46
Q

Rough amount of K needed in an adult per day

A

40 mmol

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47
Q

So if giving 3 litres per day for maintenance, how many bags do you need to give over what time?

A

3x 1L bags 8 hourly

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48
Q

So if giving 2 Litres per day for maintenance, how many bags do you need to give over what time?

A

2x 1L bags 12 hourly

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49
Q

What is the prophylactic DVT dose for LMWH?

A

5000 units dalteparin OD S/C

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50
Q

When should a patient not wear compression stockings in DVT prophylaxis?

A

Peripheral artery disease as may cause acute limb ischaemia

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51
Q

What can cyclizine cause?

A

Peripheral oedema

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52
Q

Who should metaclopramide be avoided in?

A 
PD (exacerbates symptoms)
Young women (risk of dyskinesia)
Bowel obstruction
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53
Q

Pain relief prescription for someone in no pain

A

No regular painkillers

PRN paracetomal 1g up to 6 hourly oral

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54
Q

Pain relief prescription for someone in mild pain

A

Regular paracetomal QDS 1g

As required codeine 30mg up to 6 hrs or tramadol

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55
Q

Pain relief prescription for someone in severe pain

A

Regular co codamol 30/500 2 tablets 6 hourly

As required morphine sulphate 10mg up to 6 hourly oral

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56
Q

What is oromorph and what is the dose?

A

Liquid morphine sulphate

10mg/5ml

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57
Q

What is the maximum dose of ibruprofen?

A

400 mg 8 hrly

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58
Q

1st line Tx for neuropathic pain

A

Amitriptyline 10mg oral at night OR

Pregabalin 75 mg oral BD

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59
Q

Treatment of painful diabetic neuropathy

A

Duloxetine 60 mg oral OD

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60
Q

What does co codamol contain?

A

30mg codeine

500mg paracetomal

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61
Q

What is the antiemetic of choice in parkinsons disease and why?

A

Domperidone

Does not cross the BBB

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62
Q

What kind of drugs are metoclopramide and domperidone?

A

Anti sickness - dopamine antagonists

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63
Q

What kind of drug is cyclizine?

A

Anti-histamine anti-emetic

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64
Q

If a patient is constipated, what drugs should be withheld?

A

All opiate derived drugs

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65
Q

What is trimethoprim contraindicated with?

A

Methotrexate

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66
Q

Why is trimethoprim contraindicated with methotrexate?

A

Risk of bone marrow toxicity - leading to pancytopenia and neutropenic sepsis

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67
Q

All diuretics can cause what?

A

Hyponatraemia

However when they contribute to dehydration then can get hypernatremia too

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68
Q

How long should patients who have suffered from acute strokes NOT take thromboprophylaxis for?

A

2 months (duration varies)

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69
Q

What is INR?

A

Standardized version of prothrombin time

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70
Q

What are the PT and INR a measure of?

A

Overall clotting factor synthesis or consumption

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71
Q

Normal INR

A

1

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72
Q

What does a high INR mean?

A

Higher risk of bleeding

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73
Q

Target INR on warfarin

A

2 - 3

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74
Q

Should patients already on warfarin be put on thromboprophylaxis?

A

No

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75
Q

What should CCBs be not used with and why?

A

Beta blockers

Due to risk of bradycardia (at worst asystole) and hypotension

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76
Q

Cardioprotective aspirin dose

A

75 mg

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77
Q

Treatment dose aspirin

A

300 mg

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78
Q

Give an example of something the COCP is contraindicated with

A

Migraine with aura (increased risk of stroke)

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79
Q

What type of insulin is novomix?

A

Short and medium term insulins

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80
Q

What route is all insulin?

A

Subcut (except for sliding scale insulins = infusion)

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81
Q

S/E clozapine

A

agranulocytosis - resulting in neutropenia

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82
Q

K+ monitoring when treating DKA

A

When insulin is given, the K+ drops requiring regular (hourly) monitoring +/- replacement

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83
Q

What does a raised urea indicate?

A

Upper GI bleed

AKI/dry

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84
Q

What to look at is there is a raised urea with a normal creatinine in someone who is euvolaemic?

A

Hb

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85
Q

How is the synthetic function of the liver assessed?

A

Albumin

PT/INR

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86
Q

Isolated bilirubin rise means what?

A

Haemolysis

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87
Q

Drugs causing hepatitis

A

Paracetomal
Statins
Rifampicin

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88
Q

Drugs causing cholestasis

A 
Flucloxacillin 
Co amoxiclav 
Nitrofurnatoin 
Steriods
Sulphonyureas
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89
Q

Common drugs requiring monitoring

A 
Digoxin 
Theophylline
Lithium 
Phenytoin 
Gentamicin 
Vancomycin
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90
Q

Presentation of digoxin toxicity

A

Confusion
Nausea
Visual halos
Arrythmias

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91
Q

Presentation of lithium toxicity

A 
Tremor
Fatigue
Arrythmias
Seizures
Coma 
Renal failure
Diabetes insipidus
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92
Q

Presentation of phenytoin toxicity

A 
Gym hyperplasia
Ataxia
Nystagmus 
Peripheral neuropathy 
Teratogenicity
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93
Q

Presentation of gentamicin toxicity

A

Ototoxicity

Nephrotoxicity

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94
Q

Presentation of vancomycin toxicity

A

Ototoxicity

Nephrotoxicity

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95
Q

What happens on a gent chart when the concentration lies above the 48 hour line?

A

Repeat the gentamicin level and only redose when the conc. < 1 mg/L

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96
Q

Treatment of paracetomal overdose

A

At least 4 hours after ingestion -> if the paracetomal level is below the line, the patient DOES NOT require NAC
If staggered overdose was taken or time of ingestion is unknown, treatment with NAC is advised

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97
Q

Target INR if on warfarin with recurrent TE or metal replacement heart valves

A

3.5

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98
Q

What to do if a patient has a major bleed and a patient is on warfarin?

A
  1. Stop warfarin
  2. Give 5 - 10 mg IV Vitamin K
  3. Give prothrombin complex (e.g. beriplex)
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99
Q

How to manage warfarin is INR <6

A

Reduce warfarin dose

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100
Q

How to manage warfarin if INR 6 - 8

A

Omit warfarin for 2 days then reduce dose

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101
Q

How to manage warfarin if INR > 8

A

Omit warfarin and give 1 - 5 mg oral vit K

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102
Q

Treatment of neutropenic sepsis

A

IV tazocin (piperacillin with tazobactam) + gentamicin

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103
Q

S/E carbamazepine

A

Hyponatraemia (through SiADH)

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104
Q

What is the adequate choice to treat a seizure lasting longer than 5 minutes?

A

Lorazepam

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105
Q

If a patient has addisons disease and becomes unwell, what must be done?

A

Increase steriod dose

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106
Q

What does right sided heart failure result in?

A

Peripheral oedema and raised JVP

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107
Q

What does left sided heart failure result in?

A

Bilateral creps and SOB

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108
Q

What is the mainstay of treatment in acute heart failure?

A

Furosemide

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109
Q

What is bumetanide and what is it used for?

A

A loop diuretic reserved for patients resistance to furosemide

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110
Q

Tx AF if rate < 100 bpm

A

Not termed fast AF and does NOT require rate control

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111
Q

When is DC Cardioversion not required in the acute setting of AF?

A

Abscence of adverse features e.g. chest pain, heart failure, hypotension/syncope

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112
Q

Tx PE

A

Treatment dose LMWH

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113
Q

What are the LMWH?

A

Enoxaparin
Dalteparin
Tineaparin

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114
Q

Regular morphine vs PRN morphine dose

A

1/6 of total daily dose given 4 - 6 hourly

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115
Q

If a patient with chronic pain is requiring higher doses of PRN, what does this mean?

A

The regular dose requires adjustment

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116
Q

Tx STEMI

A 
02
Aspirin 300mg 
Morphine 5-10mg IV
Metoclopramide 10mg IV 
GTN
PCI or thrombolysis 
BB (unless CId)
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117
Q

Tx NSTEMI

A

All the same as STEMI except instead of PCI, clopidogrel 300mg oral + enoxaparin 1mg/kg S/C

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118
Q

Tx acute HF

A 
O2
Sit patient up 
Morphine and metoclopramide
GTN
Furosemide 40 - 80mg 
If no response -> isosorbide dinitrate infusion +/- CPAP
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119
Q

Tx of MI in shockable rhythm

A
  1. Synchronised DC shock up to 3x
  2. Amoidarone 300mg IV over 10 - 20 mins + repeat shock
  3. Amoidarone 900mg over 24 hrs
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120
Q

What is an irregular narrow complex tachycardia probably?

A

AF

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121
Q

Tx polymorphic VT (torsades de pointes)

A

2mg Mg over 10 mins

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122
Q

Tx SVT

A

Adenosine

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123
Q

Tx anaphylaxis

A 
O2
Adrenaline 500mg of 1:1000 IM 
Repeat if no effect 
IV adrenaline
Chlorphenamine 10mg IV
Hydrocortisone 200mg IV
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124
Q

Tx acute asthma

A 
02
Salbutamol 5mg Neb
Hydrocortisone 100mg IV or prednisolone 40 - 50 mg oral 
Ipratropium 500mcg neb 
Theophylline
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125
Q

Oxygen in acute COPD

A

28% O2 safe starter then ABG 30 mins later

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126
Q

Tx suspected bacterial meningitis in primary care

A

1.2g BenPen IM

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127
Q

Tx suspected bacterial meningitis in secondary care

A 
02
Fluids
IV dexamethasone
LP +/- CT head
2g ceftoaxmine IV
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128
Q

Tx seizure

A

Lorazepam 2 - 4mg IV or diazepam IV or midazolam buccal
Repeat if still fitting after 2 mins
Phenytoin infusion
Intubate then propofol

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129
Q

Tx Stroke

A

If CT shows haemorrhage DO NOT GIVE thrombolysis or aspirin
If < 80 + onset < 4 - 5 hours = thrombolysis
Aspirin 300 mg oral

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130
Q

Tx hyperglycaemia

A

IV fluids; stat then over 1 hour then 2, 4 + 8 hours

Sliding scale insulin

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131
Q

HONK vs DKA Tx

A

Same Tx however in HONK 1/2 the rate of fluids

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132
Q

Tx opoiod toxicity

A

Naloxone

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133
Q

Tx benzos overdose

A

Flumazenil

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134
Q

Tx Chronic heart failure

A 
ACEI
BB 
If isnt working add
- ARB
- hydralazine and IMN
- spironolactone
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135
Q

Tx HTN < 55

A

ACEI

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136
Q

Tx HTN > 55

A

CCB

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137
Q

Tx HTN black people

A

CCB

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138
Q

CHADSVASC Score and Tx

A

0 = aspirin 75mg
1 = either aspirin or warfarin (INR aim 2.5)
2 or more = warfarin (INR aim 2.5)

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139
Q

Rate control AF

A
  1. Beta blocker or diltiazem

2. Digoxin

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140
Q

Cardioversion AF

A

Electrical
Pharmacological (amoidarone 5mg/kg IV over 20 - 120 min)
Will require anticoagulation if > 48 hours onset

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141
Q

Tx Angina

A

GTN PRN
2ndry prevention
BB or CCB

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142
Q

Tx Asthma

A 
SABA
ICS
LABA
LTRA / theophylline
Oral steriods
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143
Q

Tx smoking cessation

A

Nicotine replacement therapy
Bupropion
Varenciline

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144
Q

Tx T2DM

A

Metformin
Gliclazide
Sitagliptin
Insulin

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145
Q

Tx COPD

A

SAMA or SABA PRN
LABA or LAMA (stop SAMA)
LABA + LAMA + ICS

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146
Q

Tx PD

A

Co-benledopa or co-carledopa
Mild / younger
- ropinirole (dopamine agonist)
- rasagiline (MOA-inhibitor)

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147
Q

Tx generalised epilepsy

A

Sodium valproate

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148
Q

Tx absence seizures

A

Sodium valproate or ethosuximide

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149
Q

Tx myoclonic seizures

A

Sodium valproate

150
Q

Tx tonic seizures

A

Sodium valproate

151
Q

Tx focal seziures

A

Carbamazepine or lamotrigine

152
Q

S/E lamotrigine

A

SJS/rash

153
Q

S/E carbamazepine

A 
Rash 
Dysarthria 
Ataxia
SIADH
Nystagmus 
Hyponatraemia
154
Q

S/E phenytoin

A

Gym hyperplasia
Ataxia
Peripheral neuropathy
Hepatotoxicity

155
Q

S.E valproate

A

Tremor
Teratogenicity
Weight gain

156
Q

Tx Alzheimers

A 
Mild/moderate - Ach inhibitors 
- donepezil 
- Rivastigmine
- galantamine 
Mod - severe NMDA antagonist 
- memantine
157
Q

Tx CD (inducing remission)

A

Mild flare 30 mg prednisolone oral

severe flare 100mg hydrocortisone QDS and can use rectal if rectal involvement

158
Q

Maintaining remission of CD

A

Azathioprine or 6-metcaptopurine

159
Q

Tx RA (maintaining remission)

A
  1. Methotrexate and DMARD (e.g. sulphazalaine or hydroxychloroquine)
  2. Biologic Tx
160
Q

Tx flare RA

A

Short term steriods

NSAIDs

161
Q

What has to be checked before starting azathioprine?

A

TMPT level

162
Q

Tx pyrexia

A

Paracetomal

163
Q

If there is evidence of obstruction, what should not be given?

A

Metoclopramide

Laxatives

164
Q

Tx chronic diarrhoea

A

Loperamide 2mg oral up to 3 hourly

Codeine 30mg oral 6 hourly

165
Q

Tx insomnia

A

Zopiclone 7.5 mg (3.75 mg elderly)

166
Q

What is the stool softener laxative and what is it good for?

A

Docusate

Good for faecal impaction

167
Q

What is the stimulant laxative and what may it worsen?

A

Senna

Cramps

168
Q

What are the osmotic laxatives and what may they exacerbate?

A

Phosphate enema
Lactulose
May exacerbate bloating

169
Q

What contraindicated in the acute abdomen?

A

Laxatives

170
Q

What infections is metronidazole good for and why?

A

GI infections

Because of its good effects on anaerobes which colonise the gut

171
Q

1st line antibiotic for skin infections

A

Flucloxacillin

172
Q

S/Es antimuscarinic drugs

A

Dry mouth
Constipation
Visual disturbance

173
Q

Tx vit B12 deficiency

A

Hydroxocobalamin

174
Q

Examples of drugs that can precipitate parkinsonian symptoms even in patients without PD

A

Metoclopramide

Haloperidol

175
Q

What is the anti emetic of choice in PD and why?

A

Domperidone

Does not cross the BBB

176
Q

What does the treatment dose of dalteparin depend on?

A

Weight

177
Q

Is ramipiril teratogenic and when?

A

Yes, 1st trimester

178
Q

S/Es tamoxifen

A

Increased risk of endometrial cancer
Increased efficacy of warfarin leading to increased INR
Increased risk of DVT

179
Q

S/E metformin

A

Lactic acidosis

180
Q

S/E sulphonyureas

A

Hypos

181
Q

How often is methotrexate taken?

A

Weekly

182
Q

What can ACEIs do in the elderly?

A

Increases risk of AKI if unwell

183
Q

How long can SSRIs take to work?

A

Up to 6 weeks

184
Q

What is serotonin syndrome and what is the Px?

A

Life threatning complication of SSRIs

Agitation, fever, hallucinations

185
Q

HbA1c aim in diabetic pts

A

48

186
Q

How many months is HbA1c over?

A

3 months

187
Q

When unwell, how do you adjust the dose of insulin?

A

When unwell your blood glucose increases and therefore your dose of insulin required also increases. However, if oral intake decreases if you are unwell, insulin may also need to be decreased

188
Q

How should biphosphonates be taken?

A

With a full glass of water

Remain upright for 30 mins after

189
Q

How often are bisphosphonates taken?

A

Weekly

190
Q

Food and alendronic acid

A

Food should be avoided 2 hours after alendronic acid as it decreases absorption

191
Q

1% = ?

A

1 g in 100ml

192
Q

1 g = ? mg

A

1000 mg (3 DPs)

193
Q

1 g = ? mcg

A

1000,000 (6DPs)

194
Q

Gent and low egfr

A

Egfr < 20 - high doses of gentamicin are not recommended

195
Q

On a gentamicin chart if the point falls on the boundary line between the two intervals, what dosing interval should be chosen?

A

Longer dosing interval

196
Q

If a patient in the scenario has pain, make sure they have what prescribed?

A

Regular painkillers as well as PRN

197
Q

When should ACEIs be given and why?

A

At night

Cause postural hypotension

198
Q

Tx Hyperkalaemia

A
  1. Short acting insulin (e.g. 10 units actarapid) in 100ml of 20% dextrose over 30 min IV
  2. Salbutamol 2.5 - 5mg stat
  3. Calcium resonium (takes few days to work)
  4. Dialysis
    Calcium gluconate stabilizes cardiac membrane
199
Q

What is the safest anti-epileptic in pregnancy?

A

Lamotrigine

200
Q

What hyperglycemic medication should not be used when renal impairemnt?

A

Metformin

201
Q

Monitoring requirements statin

A

Creatinine kinase level at baseline

LFTs (3 + 12 months)

202
Q

What scenarios are statins contraindicated in?

A

Active liver disease

Serum transaminases > 3x normal

203
Q

Monitoring requirements phenytoin

A

Trough level taken on day 14
If no seizures (i.e. a therapeutic level of the dose) - then the dose dosent need increased
If S/Es despite a normal trough level then decrease the dose if seizure control adequate

204
Q

Serum concs of lithium > ? are likely to manifest with toxic effects

A

1.5 mmol / L

205
Q

Sampling time for lithium

A

12 hours after last dose

206
Q

Are FBCs routinely done for patients on lithium?

A

No

207
Q

Lithium monitoring requirmenets

A

Weekly
Then after each dose change
Every 3 months thereafter

208
Q

Lithium and diet

A

Patients advised to avoid making changes to their diet as increased Na in their diet can increase the risk of lithium toxicity

209
Q

Methotrexate and LFTs

A

Should not be started if LFTs are abnormal as there is a risk of cirrhosis

210
Q

Monitoring methotrexate

A

FBC one stable every 2 - 3 months
Renal function
LFTs

211
Q

How is methotrexate predominately excreted?

A

Renally

212
Q

Monitoring requirements olanzapine

A

Fasting BMs at baseline and regular intervals -> hyperglycaemia and DM can occur

213
Q

Pts starting on an antipsychotic - who needs an ECG?

A

Patients with CVS disease or assosiated RFs

214
Q

Monitoring requirements OCP

A

BP

215
Q

What is needed when starting amoidarone and why?

A

CXR

Risk of pulmonary toxicity

216
Q

Monitoring requirements amoidarone

A

Baseline CXR
T4 T3 + TSH
Serum transaminase
K+ (hypokalaemia caution)

217
Q

What should patients be advised of when starting carbimazole and why?

A

Sore throat
Carbimazole induced bone marrow suppression and agranulocytosis
FBC and neutrophil count required

218
Q

What should be checked for a multiple daily dose regimen of gentamicin?

A

Both pre and post dose levels at regular intervals

219
Q

Monitoring requirements ACEIs

A

U + Es at baseline and after every dose change

220
Q

When do you measure plasma digoxin concentration?

A

Not unless toxicity, non compliance or inadequate effect

221
Q

How is digoxin predominatelty excreted?

A

Renally excreted and pts at risk of renal dysfunction have increased risk of toxicity

222
Q

Monitoring of valproate

A

LFTs at baseline and regular intervals

223
Q

Does valproate cause renal toxicity?

A

NO

224
Q

Monitoring clozapine

A

FBC checked for first 18 weeks then more spaced out intervals

225
Q

Monitoring warfarin

A

INR daily / alternative days at start then longer intervals then every 12 weeks

226
Q

What should be fixed before starting a bisphosphonate and what should be monitored during?

A

Ca + vit D

227
Q

When starting warfarin, what can be prescribed alongside to stablilise the dose and why?

A

Heparin

As it has a pro coagulant effect initially

228
Q

S/E aspirin

A

PUD
Gastritis
Tinintus
Haemorrhage

229
Q

S/E digoxin

A 
Nausea and vomiting
Diarrhoea
Blurred vision 
Confusion 
Drowsiness
Xanthopsia
230
Q

S/E Amoidarone

A

Pulmonary fibrosis
Thyroid disease
Skin greying
Corneal deposit

231
Q

S/E lithium

A 
Tremor
Tiredness
Arrythmias 
Seizures
Coma
Renal failure 
Diabetes insipidus
232
Q

S/E haloperidol

A

Dyskinesias

233
Q

S/E fludrocortisone

A

HTN / Na + H20 retention

234
Q

S/E statins

A

Myalgia
Abdominal pain
LFTs abnormal
Rhabdomyolysis

235
Q

Drugs with a narrow therapeutic index

A

Warfarin
Digoxin
Phenytoin

236
Q

Drugs which require careful dosage control

A

Anti HTNs

Anti diabetic drugs

237
Q

Acute alcohol effect on warfarin

A

Increases its effects

238
Q

Chronic alcohol effect on warfarin

A

Decreases its effects

239
Q

What should NSAIDs not be co prescribed with, especially in the elderly who already have a history of renal impairment?

A

ACEIs

240
Q

What is the brand name for co amoxiclav?

A

Augmentin

241
Q

What reverses the effects of heparin?

A

Protamine

242
Q

Tx hypoglycaemia

A

If conscious - sugar rich snack
If unconscious/cant swallow - IV 20% glucose (or 10%) over 15 - 20 mins
Glucagon

243
Q

S/Es opiods

A

Constipation
Resp depression
Drowsiness

244
Q

What is lithium excretion significantly decreased by?

A

ACEIs
Diuretics
NSAIDs

245
Q

What titration increments should thyroxine be done in?

A

25 - 50 mcg doses

246
Q

What may happen to patients when recovering from renal failure?

A

May enter a ‘polyuric phase’ in which their urine output increases and fluid input may not be in keeping of this pace

247
Q

What should never happen to anti epileptic drugs?

A

Should never be stopped abruptly unless patient is toxic and in the hospital where emergency treatment of seizures can be instigated

248
Q

How much maintenance fluids does an adult generally require per day?

A

3 litres (8 hourly)

249
Q

How much maintenance fluids does an elderly person generally require per day?

A

2 litres (12 hourly)

250
Q

How much K does a patient require in a day if NBM?

A

40 - 60 mmol

251
Q

What odd S/E can BB have?

A

Fatigue

Erectile dysfunction

252
Q

Tx of acute manifestation of COPD

A

Salbutamol

Ipratropium bromide

253
Q

What types of NIV exist?

A

BPAP

CPAP

254
Q

What resp failure requires CPAP?

A

Type 1

255
Q

What resp failure requires BPAP?

A

Type 2

256
Q

In a diabetic patient, what can excessive alcohol lead to?

A

Life threatning hypoglycaemia

257
Q

What are patients on steriods at risk of?

A

HTN

258
Q

Statins should be stopped when taking what drug?

A

Clarithromycin

259
Q

Tx immediate relief of dyspepsia

A

Magnesium carbonate
Aluminium hydroxide
Co-magaldrox

260
Q

When should senna not be given?

A

If colitis or cramps

261
Q

What is the beneficial monitoring of aminothyline done by?

A

O2 sats

262
Q

How long can consolidation on a CXR due to pneumonia take to clear?

A

Up to 6 weeks

263
Q

Monitoring tacrolimus

A

Trough level before the dose

264
Q

What is an increased resp drive triggered by?

A

Hypoxia

Hypercapnia

265
Q

How to assess response to DKA Tx?

A

Serum ketones

Serum glucose normalizes rapidly after commencing insulin sliding scale

266
Q

What can the only presentation of renal impairment be?

A

Malaise

267
Q

What does co-dydramol contain?

A

Dihydrocoedine

268
Q

When can vit K be given by mouth?

A

If no active bleeding

269
Q

When should diuretics not be given and why?

A

Shouldnt be given at night as will be up all night peeing

270
Q

How often are metoclopramide and cyclzine given?

A

6 hourly

271
Q

When should a patient have a blood transfusion?

A

< 70 g/L

< 100 in ischaemic heart disease

272
Q

How long should oral iron replacement be given for?

A

Until Hb is in normal range and then for a further 3 months to replenish stores

273
Q

Can dextrose be used for fluid resus?

A

No

274
Q

Can you give 1L stat in resuscitation?

A

Yes

275
Q

What is flecanide contraindicated in?

A

Structural heart disease

276
Q

What is a serious complication of statins?

A

Myositis (presents as cramps)

277
Q

What heart condition should ACEI be avoided in?

A

Aortic stenosis

278
Q

First line treatment for acute otitis media

A

Amoxicillin

279
Q

What drugs should be avoided in myasthenia gravis?

A

Antimuscarinics/anticholinergics

280
Q

Treatment of epiglottitis

A

Cefotaxime

281
Q

What is the mainstay of treatment of severe anxiety?

A

Benzodiazepines e.g. diazepam

282
Q

If start on floxetine, what is a rare S/E to look for?

A

Rash

283
Q

When should an efficacy assessement be done for depression treatment?

A

4 weeks after starting treatment

284
Q

When is enoxaparin dose altered?

A 
Low egfrs (< 30)
Adults < 50kg
285
Q

What drugs should be prescribed at a lower dose if an adult is < 50 kg?

A

Paracetomal

Enoxaparin

286
Q

What is a common S/E of all heparins?

A

Hyperkalaemia

287
Q

How long before surgery are antiplatelets stopped?

A

7 days

288
Q

Are ARBs nephrotoxic?

A

Yes

289
Q

What can allopurinol accumulate in?

A

Renal dysfunction

290
Q

What can steriods cause particularly in the elderly?

A

Confusion

291
Q

How do citalopram and other SSRIs cause hyponatraemia?

A

Through innapropriate ADH secretion

292
Q

What is important general pain relief advice?

A

Same drug is used for regular and breakthrough pain relief

293
Q

When should nitrofurantoin be avoided?

A

Pregnancy

eGFR < 45

294
Q

What INR is needed for surgery?

A

1.5 or under

295
Q

What should be done if the INR > 1.5 the day before surgery?

A

Vitamin K 1-5mg IV

296
Q

What should rivaroxaban be taken with?

A

Food

297
Q

1 nanogram = ? mcg

A

Move 3 DPs to get to mcg

298
Q

What drug can cause cholestatic jaundice?

A

Co amoxiclav

299
Q

Citalopram and gabigatran together cause what?

A

Increased risk of bleeding

300
Q

When ACEIs are started, what should be expected?

A

A small rise in creatinine (<20%)

301
Q

How is the treatment efficacy of furosemide mointored?

A

Weight reduction

302
Q

How is the treatment efficacy of treatment of congestive heart failure moinotred?

A

Exercise tolerance

303
Q

How much insulin should be added to manage a tranisent rise in BM caused by steriods?

A

Increase in usual insulin dose by 10%

304
Q

Statins ideal effects after 3 months

A

> 40% reduction in non-HDL cholesterol

305
Q

Treatment of acute dystonic reactions

A

Anti muscarinics 1st line

Benzodiazepines

306
Q

Anti muscarinic drugs

A

TCAs
BBs
Ipratropium bromide
SSRIs

307
Q

What condition are BB contraindicated in?

A

Asthma

Peripheral vascular disease

308
Q

What drugs can worsen acute heart failure?

A

Corticosteriods

CCBs

309
Q

Steriods and intercurrent illness

A

Steriods must be continued through intercurrent illness as they may have chronic adrenal suppression and therefore steriods should not be stopped abruptly

310
Q

What may an increased dose of insulin in the evening lead to?

A

More hypos in the early morning

311
Q

What happens when miss one COCP?

A

The patient can still be protected from pregnancy. They should take the missed pill and todays pill even if taking 2 pills in one day. Does not need extra contraception.

312
Q

Methotrexate and conception

A

Both men and women should avoid conception while taking it and for 6 months after stopping it

313
Q

Beneficial monitoring of antibiotic treatment

A

If symptoms resolve

314
Q

Statins and muscular Cx

A

If muscular symptoms or CK elevated over 5x normal, then treatment should be discontinued
If symptoms resolve and CK returns to normal, then the statin should be reintroduced at a lower dose.

315
Q

1st line Tx for HTN patients who have DM

A

Regardless of age / race - 1st line Tx is ACEI/ARB

316
Q

When should simvastatin be used cautionally in renal impairment?

A

Used in caution if > 10 mg /day with an eGFR low

317
Q

What should sertraline be used with caution in?

A

Renal impairment

318
Q

What can diclofenac worsen and how?

A

Heart failure
It causes renal hypoperfusion which has deleterious effects on the heart function due to the release of vasoconstrictive mediators

319
Q

1st line Tx HTN in pregnancy

A

Labetolol

320
Q

Which anti emetic is of choice in a patient who is at risk of extrapyramidal S/Es and QT prolongation?

A

Cyclizine

321
Q

What is recommended for initial fluid resuscitation?

A

Fluid bolus 500ml NaCl 0.9% or plasmalyte over 15 mins is recommended

322
Q

S/Es ciclosporin

A

Hyperkalaemia

Nephrotoxicity

323
Q

When looking for dosing errors, what is important to look at?

A

Check if the patient is elderly

324
Q

What can all PPIs cause?

A

Loose stools and diarrhoea

325
Q

What can alendronic acid cause?

A

Diarrhoea

326
Q

What can naproxen cause?

A

Ankle oedema

327
Q

Tx of thrush during pregnancy

A

Prolonged therapy required

Systemic therapy not recommended

328
Q

Tx C diff

A

Metronidazole

Vancomycin - repeated infections / metronidazole no effect

329
Q

Insulin changes in DKA

A
  1. Fluid resus
  2. Short acting insulin S/C should be STOPPED
  3. Long acting insulin should be CONTINUED
  4. Fixed rate IV insulin
330
Q

What is the simplest Tx of acute pain in an elderly person?

A

Paracetomal

331
Q

When should loperamide be taken?

A

After each loose stool

332
Q

Dose of loperamide

A

2mg / dose

333
Q

SSRIs + what can precipitate serotonin syndrome?

A

Serotonin inducing drugs (e.g. tramadol)

334
Q

Tx of antipsychotic induced parkinsonism (particularly tremor)

A

Procyclidine hydrochloride (anti-cholinergic drugs)

335
Q

What should be checked before starting azathioprine?

A

TPMT levels

336
Q

What should patients starting treatment with apixaban be told to look out for?

A

Any bruising or signs of bleeding

337
Q

Are fentanyl patches appropriate for acute pain?

A

No

338
Q

What is the painkiller which is appropriate where strong analgesia is needed in the context of renal impairment? Why?

A

Oxycodone - it is metabolized by the liver

339
Q

What can morphine cause?

A

Urinary retention

340
Q

Max dose of loperamide in a day

A

16 mg

341
Q

What can cyclizine exacerbate?

A

Heart failure

342
Q

What is topiramate contraindicated with?

A

COCP

343
Q

Tx alcohol withdrawal

A

Chlordiazepoxide hydrochloride

344
Q

Why is BB contrainidcated in PVD?

A

It worsens ischemia

345
Q

S/E of TTD

A

Hyponatraemia

346
Q

What can prednisolone worsen?

A

Heart failure

347
Q

S/E tacrolimus

A

Hyperkalaemia

348
Q

What is the dosing of allopurinol?

A

300 mg PO OD

Reduced to 100 mg whilst renal function is poor

349
Q

What can SSRIs cause an increase in?

A

Bleeding

350
Q

Blood glucose and nicotine replacement therapy

A

Monitoring of BMs should be carried out when commencing nicotine replacement therapy. Especially if have diabetes as they may require less insulin or need to reduce the amount of nicotine replacement

351
Q

What is the first choice treatment in a pt with confirmed DVT or PE?

A

Apixaban or rivoroxaban

LWMH if unsuitable

352
Q

When should you not used maintenance fluids containing glucose?

A

After cerebral injury (excessive glucose containing fluids have the potential to exacerbate cerebral injury)

353
Q

Who should statins be offered to?

A

Pts with CV risk > 10%

354
Q

What is the starting dose of statins for primary prevention?

A

20mg

355
Q

Who is metformin contraindicated in?

A

Pts with significant renal impairment
Who are acutely unwell
Tissue hypoxia likely

356
Q

What is aspirin a cause of?

A

Iron deficiency anaemia

357
Q

What does pioglitazone have the potential to cause?

A

Hypoglycaemia

358
Q

Drugs that may cause urinary retention

A 
Morphine and other opiod analgesics (esp in elderly post op period)
Anticholinergics
Anaesthetics 
A-adrenoceptor agonists
Benzodiazepines
NSAIDs
CCBs 
Antihistamines 
Alcohol
359
Q

Drugs that can cause confusion

A 
Anticholinergics 
Opiods
Benzodiazepines
Metoclopramide
Antipsychotics 
Antidepressants
Anticonvulsants

Uncommon

  • digoxin
  • BB
  • prednisolone
  • NSAIDs
  • Antibiotics
360
Q

What is indicated in a patient with a long history of alcohol abuse and disorientation who may have or are at risk of wernickes encephalopathy?

A

IV vit B (pabrinex)

361
Q

What is the insulin rate in DKA Tx?

A

Fixed rate insulin 0.1 units / kg / hr

362
Q

What is recommended for the prevention of neural tube defects? When is it taken until?

A

Folic acid

  • 5mg in high risk parents
  • 400 mcg in lower risk parents

From conception until 12 weeks pregnancy

363
Q

What does alendronic acid reduce?

A

Fractures

364
Q

What is used for HRT in a women with an intact uterus?

A

Oestrogen is combined with progesterone which decreases the risk of endometrial carcinoma assosiated with unopposed oestrogen

365
Q

Presentation of anaphylaxis

A 
Vasodilation 
Hypotension 
Tachycardia
Bronchospasm 
Interstitial pneumonitis
urticaria 
Angioedema 
Bronchospasm 
Tissue oedema
366
Q

Drugs that may cause anaphylaxis

A 
NSAIDs / aspirin 
B lactam antibiotics 
Chemo 
Vaccines
Parenteral iron injections
Herbal preparations
367
Q

How is allopurinol’s therapeutic effect monitored?

A

Serum urate

368
Q

What is used to assess the beneficial effect of IV fluids when dehydrated?

A

BP

369
Q

How is HRT monitored and when must it be stopped in relation to this?

A

BP

Stop if systolic > 160 or diastolic > 95

370
Q

If you are on a statin and transaminases are > 3x upper limit of normal, what do you do?

A

Discontinue

PSA Notes (1 decks)

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