Part _ Data interpretation Flashcards
can carbamazepine lower sodium
yes
slow AF on digoxin what should you do
stop digoxin
in asthma exacerbation do you withhold the salbutamol inhaler
yes as you will be starting a salbutamol nebuliser
pt with fast AF both BB and diltiazem CI what can you give
digoxin
if ALT rises in statin use what do yo do
if less than 3 times limit do not exlcde
if over discountinue
if taking levy for hypo and sx not improved after 3 months of tx what should you do if sx still present
slowly titrate dose
major bleed on warfarin what do you do
dried prothobmin complex 50 units/kg IV or FFP
when should you withold amiodarone
in thyrtoxicosis
when do you stop a statin if ck is raised
only if 5 times the limit of ck
if sx resolve and ck level sreturn to nromal - restart statin at lower dose
in addition to aspirin and gtn spray what else should be added fro person with unstabel angina
statin 80mg
diltizaem - as was asthmatic in stem - if not bb
in hf what drugs imrpove long term prognosis
ACEi and BB
2nd line therapy inclued sglt-2 and spironolcatone
how can you reduce the risk of contrast-induced nephropathy
adeuatw hydration pre and post scan
the evidence base currently supports the use of intravenous 0.9% sodium chloride at a rate of 1 mL/kg/hour for 12 hours pre- and post- procedure. There is also evidence to support the use of isotonic sodium bicarbonate
N-acetylcysteine has been given in the past but recent evidence suggests it is not effective*
A 60-year-old man who has type 1 diabetes mellitus complains of reduced hypoglycaemic awareness. what drugs can cause this and why
Atenolol is a beta-blocker, which can mask the symptoms of hypoglycaemia, such as tachycardia and tremors, by blocking the effects of adrenaline. This can lead to reduced hypoglycaemic awareness in patients with diabetes mellitus. Additionally, beta-blockers may impair glucose metabolism and delay recovery from hypoglycaemia.
Liver disease can impair the synthesis of vitamin K and hence increase a patients prothrombin time and INR. The other factors induce the P450 enzyme system and will therefore decrease a patients INR.
true
for COPD PT what should the target O2 sats be
Management of COPD patients
prior to availability of blood gases, use a 28% Venturi mask at 4 l/min and aim for an oxygen saturation of 88-92% for patients with risk factors for hypercapnia but no prior history of respiratory acidosis
steriods commonly cause which one of these 3
insomnia
hyperkalamia
hypotension
isnomina
also cause hypok and hypertension
he BNF suggests gradual withdrawal of systemic corticosteroids if patients have:
received more than 40mg prednisolone daily for more than one week
received more than 3 weeks treatment
recently received repeated courses
Hba1c 48 as a percentage
6.5%
does metronidazole affect warfarin
yes inhbits enxyme so INR increases
can sulphonlyureas cause SIADH
yes this causing low sodium
common meds that cause SIADH
sulphyureas
SSRI
TCA
carbmazepine
vincritsine
cyclophosphamide
General factors that may potentiate warfarin
liver disease
P450 enzyme inhibitors (see below)
cranberry juice
drugs which displace warfarin from plasma albumin, e.g. NSAIDs
inhibit platelet function: NSAIDs
A 30-year-old woman with type 1 diabetes mellitus is reviewed in clinic. She is currently using a ‘basal-bolus’ insulin regime consisting of three injections of a rapid-acting insulin analogue accompanied by intermediate-acting insulin once a day.
Select the two most appropriate investigations to assess how well controlled her diabetes is.
HbA1c and review hme blood gluocse readigns
should you give IV glucose in stroke pt
no as risk of cerebral oedema
The most recent TFTs show a suppressed TSH indicating over replacement. Even though she is asymptomatic the dose should be decreased to reduce risk of what
decreased to reduce the risk of osteoporosis and atrial fibrillation. The BNF recommends adjusting the dose by 25mcg in this age group.
side effects of levy
hyperthyroidism: due to over treatment
reduced bone mineral density
worsening of angina
atrial fibrillation
two interactions of levothyroxine
iron, calcium carbonate
absorption of levothyroxine reduced, give at least 4 hours apart
intial starting dose of levo in elederyl or isc HD
The BNF recommends that for patients with cardiac disease, severe hypothyroidism or patients over 50 years the initial starting dose should be 25mcg od with dose slowly titrated.
Other patients should be started on a dose of 50-100mcg od
if change to thyroxine dose when sohodl it be mesured again
8-12 weeks
women with established hypothyrodisim should have dose of levo increased by how much
women with established hypothyroidism who become pregnant should have their dose increased by at least 25-50 micrograms levothyroxine due to the increased demands of pregnancy.
‘My shoulder and leg muscles feel weak’ - with what drug
Proximal myopathy is common with longer term steroid use. Some of the other side-effects may of course be secondary to either the methotrexate or ongoing rheumatoid disease.
maintainance values
25-30 ml/kg/day of water and
approximately 1 mmol/kg/day of potassium, sodium and chloride and
approximately 50-100 g/day of glucose to limit starvation ketosis
So, for a 80kg patient, for a 24 hour period, this would translate to:
2 litres of water
80mmol potassium
two improtant things to tell pt about aledronate
stop tx and seek medicla advice if heartburn or pain on swallowing
regular dental checkups
carbimazole sore throat what to test
FBC
TFT
Thyroid function tests should also be performed to see whether the patient is still thyrotoxic and to ensure they have not become hypothyroid.
