OSPE Flashcards
Organophosphorus poisoning
Remove contaminated clothing, wash the skin with soap and water Clear the secretions from the mouth and pharynx manually with finger and
suction
Gastric lavage can be given but can wait until the patient is stable
Atropine 2-4mg IV every 10-15minutes (until atropinization is achieved)
Pralidoxime: 1-2gram slow IV infusion or 250mg of obidoxime
Methanol poisoning
Keep the patients in a quiet dark room, protect the eyes from light
Gastric lavage with sodium bicarbonate
Supportive measures to maintain ventilation and BP
Combating acidosis – Sodium bicarbonate i.v. infusion at a dose of 1 Eq/kg IV
Potassium chloride infusion – to treat hypokalemia due to alkali therapy
Ethanol –10% ethyl alcohol at a loading dose of 10 ml/kg IV. Followed by a maintenance dose of 1.5 mL/kg/hr IV
Fomepizole –Fomepizole 15 mg/kg loading dose IV. Followed by a maintenance dose of 10 mg/kg every 12 hours IV
Hemodialysis to clear methanol and its toxic metabolite
Folate therapy
emergency management of anaphylactic shock.
- Put the patient in reclining position
- Administer oxygen at high flow rate
- Perform CPR (if needed)
- Inj. Adrenaline 0.5 mg (0.5 ml of 1:1000 solution) IM, STAT * repeat every 10 minutes if patient does not improve
- Inj. chlorpheniramine 10 mg IM or slow IV * Inj. hydrocortisone 100 mg IV
xerostomia
Tablet Pilocarpine HCL (salagen)
5mg
Disp: 21 tablets
Sig: take 1 tablet three times daily 1⁄2 hour prior to meal
or
Bethanechol tablets
25mg
Disp: 30 tablets
Sig: take 1 tablet up to 5 times daily
neurologist prescribed neostigmine
Myasthenia gravis
How does the drug help?
-Inhibits AChE activity at MEP
-ach levels increase in NMJ
-relieves symptoms
abdominal bloating inability to pass urine, and they were relieved by administering bethanechol.
Post-operative paralytic ileus/ urinary retention
How this drug helps.
-Bethanechol is a cholinomimetic - acts on muscarinic (M3) receptors on the smooth muscles of GIT and bladder - restores GIT peristatic activity and bladder detrusor muscle contraction
metronidazol and ethanol interaction
Interaction of metronidazole with ethanol will produce disulfiram-like reaction.
*Mention any other two drugs that cause similar reaction with
ethanol. Chlorpropamide and Cefoperazone.
decreased bp and urine output.dopamine given
-Cardiogenic shock with oliguria
-low dose: D1 receptors dilate renal,mesenteric and coronary vessels which cuase increase GFR and urine output
mod dose: heart stimulated via beta 1 causing increased CO but decreased tachycardia
farmer exposed to this insecticide—sweating, lacrimation, difficulty in breathing, abdominal cramps
a)Mention 1 life-saving drug used in this condition Atropine
b) Explain pharmacological basis for its use
Atropine blocks all muscarinic & central side effects due to excess ACh
upper respiratory tract infection caused by Streptococcus pneumoniae.
Cap. Amoxicillin 500mg TDS Dispense 15 caps
Take 1 cap thrice daily x 5 days
Prescription for upper respiratory tract infection caused by S. pneumoniae
- Amoxicillin (500mg) 1 cap thrice daily x 5 days
- Amoxicillin (500 mg)with Clavulanic acid (125 mg) – 1 tab thrice daily x 5 days
- Azithromycin 500mg – 1 tab thrice daily x 3 days
- Ciprofloxacin 500mg – 1 tab twice daily x 5 days
- Doxycycline 100mg BD X 1 day and then 1 tab daily x4 days
Prescribe for a 40-year-old female patient with mild bronchial asthma.
- Salbutamol MDI 100 μg/puff (or) terbutaline MDI 250 μg/ puff
- Dispense 1 inhaler
- Take 2 puffs stat, synchronizing with deep inspiration - Repeat after 20 min s.o.s
prescription for a 30-year-old patient (weight 55 kg) with newly- diagnosed sputum +ve (category I) pulmonary TB.
- Tab. Isoniazid 300 mg
- Cap Rifampicin 600 mg
- Tab Pyrazinamide 1500 mg
- Tab Ethambutol 1000mg
- Tab Pyridoxine 10mg
- Dispense 60 tablets each
- Take I tab each daily for 2 months - Review after 1 month
Prescription for sputum positive TB- Continuous phase
- Tab isoniazid 300 mg
- Cap. rifampicin 600 mg
- Tab. pyridoxine 10 mg
- Dispense 120 tablets of each
- Take 1 tablet once daily for 4 months - Review after 4 months
Ethambutol:
a) Explain why the drug above should not be used in patients aged below 5 years?
b) State 1 joint-related complication cause by the above drug.
- Causes loss of visual acuity/ color vision/ field defect (due to optic neuritis)
- Children may not be able to report early visual impairment
-Hyperuricemia leading to gouty arthritis
budesonide
a) Which group does this drug belong to?
Inhalational steroids
b) List 2 precautions to be taken when patient is receiving the drug
- Use spacer
- Gargle after every dose (to wash off deposited drug on oral mucosa)
c) State 2 other drugs belonging to the same group that can be used in asthma
- Fluticasone
- Beclomethasone
Prescription for Intensive phase treatment of 52-year-old female patient with newly diagnosed sputum positive pulmonary tuberculosis
For intensive phase of the treatment 2 drugs i.e., INH and Rifampicin are not enough. They are used for maintenance phase to eradicate the persistent bacilli and prevent relapse.
For intensive phase treatment with 4 drugs i.e., INH, Rifampicin, Pyrazinamide and Ethambutol/Streptomycin is required for 2 months.
The objectives are:
1. To make the patient non-infectious as early as possible by rapidly killing the dividing bacilli by using 4 drugs
2. To prevent the emergence of drug resistant bacilli
3. To prevent relapse
4. To reduce the total duration of effective therapy
You diagnosed him with pulmonary TB & prescribed him INH + rifampicin along with other drugs.
What instructions will you give to the patient?
- Greet the patient and explain why are you prescribing the medications.
- Each tablet to be taken on empty stomach before breakfast
- There may be reddish orange discoloration of body fluids (saliva, sweat, urine, tears), which is harmless
- Regular follow-up and liver function tests are required - Do not stop the drug during the treatment period
Instructions to use Salbutamol inhaler
1) Remove mouthpiece cover & check that it is clean
2) Shake inhaler well. Hold it upright with thumb on base & 1 or 2 fingers on top of canister 3) Breathe out gently via mouth
4) Place mouthpiece of inhaler in mouth between the lips & close lips around it tightly. 5)Start breathing in slowly via mouth. Press down the canister to release 1 dose while continuing to breathe in deeply & steadily
6) Remove inhaler from mouth & hold breath for 10 seconds (or as long as it is comfortable) 7) Breathe out slowly
8) If another dose is required, wait for ≥ 1 min. Shake inhaler well & repeat steps 3 – 7
9) Replace mouthpiece cover after use
Management of status asthmaticus:
- Nebulized salbutamol (5 mg) + ipratropium (0.5 mg)
- Hydrocortisone hemisuccinate 100 mg IV stat, followed by 100 mg IV 4- hourly
- Salbutamol 0.4 mg IM (may be added)
- High flow, humidified O2 inhalation
- NaHCO3 + saline (to correct acidosis & dehydration)
- Intubation & mechanical ventilation if required
- Antibiotics (to treat chest infection) if any
Management of status epilepticus
refer book
Prescription for Grandmal seizure-not preg,not child bearing age
Tablet Sodium valproate 200 mg
Dispense 45 tablets
Take one tablet thrice daily for 15 days Do not stop medication even a single tab Review after two weeks
Prescription for febrile convulsion
Rectal diazepam 0.5 mg/kg
Dispense 2 tubes
Tear the tip and insert rectally during the onset of attack If the convulsion persists the child must be hospitalized. Paracetamol syrup to reduce temperature.
Criticize
➢Petit mal epilepsy is due to the generation of T type Ca2 currents in thalamus. Drugs that block T type Ca 2 channels, e g sodium valproate or ethosuximide are useful to treat petit mal epilepsy
➢Phenytoin acts by prolonging the inactivated state of Na channels. Hence it is not useful in petit mail epilepsy
petit mail epilepsy
Cap Ethosuximide 250 mg
Dispense 30 capsules
Take one capsule twice daily after food Do not stop medication
Review after two weeks
or sodium valproate
phenytoin instructions
Take the drug as prescribed and even a single dose should not be missed
* Maintain oral hygiene
* Regular follow up is required to see if the dose is adequate or there is any adverse effect
* Blood tests for plasma concentration measurement will be done during the next visit
* Drug may cause blurring of vision, sedation
* Phenytoin may cause heart problems.Check with your doctor if you have
chest pain, dizziness, or tiredness.
* This medicine may cause liver problems. Check with your doctor if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin.
* This medicine may cause serious skin reactionswhich can be life-threatening and require immediate medical attention. Report to the doctor if you have fever, rash and sore throat.
Carbamazepine-DPC
- Take the medicine as prescribed and even a single dose should not be missed
- Regular follow up is required to see if the dose is adequate
- Blood tests will be done during the next visit to check leukocyte count and to measure drug levels
- Drug may cause sedation and vertigo (do not drive, avoid machinery work and avoid taking
alcohol) - This medicine may cause serious skin reactions (e.g., Stevens-Johnson syndrome and toxic epidermal necrolysis), which can be life-threatening and require immediate medical attention. Report to the doctor if you have fever, rash and sore throat.
- Check with your doctor immediately if blurred vision, difficulty in reading, or any other changes in vision occur during treatment. Your doctor may want you to have your eyes checked by an eye doctor.
- Exposure to sunlight, even for brief periods of time, may cause skin rash, itching, redness or other discoloration of the skin, or a severe sunburn. Avoid getting exposure to the sun light directly, wear protective cloths and sunglass.
- This can cause liver toxicity and report to the doctor if you observe yellow colouration of skin and eye.
DPC - Valproate
- Take the drug as prescribed and even a single dose should not be missed
- Regular follow up is required to see if the dose is adequate
- Blood tests will be done during the next visit to check for liver enzyme levels and for platelets
- Liver problems may occur while you are using this medicine, and some may be serious. Check with your doctor immediately if you are having more than one of these symptoms: abdominal or stomach pain or tenderness, clay-colored stools, dark urine, decreased appetite, fever, headache, itching, loss of appetite, nausea and vomiting, skin rash, swelling of the feet or lower legs, unusual tiredness or weakness, or yellow eyes or skin.
- Pancreatitis may occur while you are using this medicine. Tell your doctor immediately if you have sudden and severe stomach pain, chills, nausea, vomiting, or fever.
- Drug may cause sedation. Do not drive, avoid machinery work and avoid taking alcohol.
- There may be hair loss and curling of hair. Do not worry about that.
- There may be increase of weight. Take balanced diet and do regular exercise.
phenytoin. adr
The condition is gum hyperplasia.
The drug causing this complication is phenytoin.
It causes gum hyperplasia because
i) it inhibits the enzyme collagenase responsible for breakdown of collagen of connective tissue.
ii) It increases platelet derived growth factors which induce gingival fibroblast and promote local angiogenesis.
This complication can be minimized by taking proper oral hygiene by brushing teeth twice a day and other oral hygienic measures.
Treatment of Aphthous Ulcer
Tetracycline capsule, 250 mg. 1 capsule dissolved in 180 mL of water; rinse with this suspension four times daily for 4 to 5 days
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