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PSA Stuff > Pass Medicine > Flashcards

Pass Medicine Flashcards

1
Q

What factors may exacerbate psoriasis?

A
  • trauma
  • alcohol
  • drugs : BB, lithium, antimalarials, NSAIDs and ACE-i, infliximab
  • WD of systemic steroids
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2
Q

A 64-year-old man is diagnosed as being hypertensive. He is known to suffer from chronic heart failure secondary to alcoholic cardiomyopathy (NYHA class I). Which one of the following medications is contraindicated?

  • lisinopril
  • indapamide
  • verapamil
  • bisoprolol
A

V

The following medications may exacerbate heart failure:

  1. thiazolidinediones: pioglitazone is contraindicated as it causes fluid retention
  2. verapamil: negative inotropic effect
  3. NSAIDs/glucocorticoids: should be used with caution as they cause fluid retention.
    low-dose aspirin is an exception - many patients will have coexistent cardiovascular disease and the benefits of taking aspirin easily outweigh the risks
4. class I antiarrhythmics :
flecainide (negative inotropic and proarrhythmic effect)
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3
Q

Can a pt continue warfarin in pregnancy?

A

No! CI

most are swtiched to LMWH for whole of pregnancy

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4
Q

Which of the following should be avoided in pt with chronic heart failure ?

  • ibuprofen
  • PCM
  • oral codeine
  • tramadol
A

ibuprofen
- NSAIDs may cause fluid retention in heart failure

(low-dose aspirin is an exception)

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5
Q

what drugs are harmful in pregnancy?

A

Antibiotics

  • tetracyclines
  • aminoglycosides
  • sulphonamides and trimethoprim
  • quinolones: the BNF advises to avoid due to arthropathy in some animal studies
Other drugs
- ACE inhibitors, angiotensin II receptor antagonists
- statins
- warfarin
- sulfonylureas
- retinoids (including topical)
cytotoxic agents

The majority of antiepileptics including valproate, carbamazepine and phenytoin are known to be potentially harmful. The decision to stop such treatments however is difficult as uncontrolled epilepsy is also a risk

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6
Q

which drugs should be used with caution in patients with asthma?

A

NSAIDs
BB
adenosine:
-

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7
Q

What Abx for Rx of exacerbations of chronic bronchitis?

A

Amoxicillin
Tetracycline
Clarithromycin

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8
Q

Abx for lower UTI

A

Trimethoprim
(nitrofurantoin)

Alternative : amox or cephalosporin

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9
Q

Abx for acute pyelonephritis

A

Broad spectrum cephalosporin (e.g. cefotaxime) or quinolone (e.g. cipro)

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10
Q

Abx for acute prostatitis

A

Quinolone (e.g. cipro) or trimethoprim

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11
Q

Abx uncomplicated community-acquired pneumonia

A

Amoxicillin (doxy or clarithromycin in penicillin allergic, add fluclox if staphylococci suspected e.g. in influenza)

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12
Q

Abx for pneumonia possible caused by atypical pathogens

A

Clarithromycin

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13
Q

Abx HAP

A

Within 5 days of admission: co-amox or cefuroxime

More than 5 days after admission: tazocin OR a broad spectrum cephalosporin (e.g. ceftazidime) OR a quinolone (e.g. cipro)

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14
Q

What pts are classified as needing a statin for secondary prevention of CV events?

& what dose

A

Known ischaemic heart disease OR

Cerebrovascular disease OR

Peripheral arterial disease

ATORVASTATIN 80MG OD

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15
Q

What pts are classified as needing a statin for primary prevention of CV events?

& what dose?

A

QRISK >/= 10%

OR

most T1DM

OR

CKD if eGFR <60

20 MG ATORVASTATIN (consider titrating up if non-HDL has not fallen by >= 40%)

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16
Q

What drug to treat cellulitis?

A

Fluclox

or if allergic, clarithromycin, erythromycin

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17
Q

Treatment of c/diff

A

oral Metronidazole 10-14 days

vanc

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18
Q

What is the WHO analgesic ladder?

A

Step 1: Non-opioid analgesics

  • paracetamol
  • non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin

Step 2 : Mild opioid analgesics

  • codeine
  • dihydrocodeine

Step 3 :Strong opioid

  • analgesics
  • morphine
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19
Q

Should you prescribe an anti-inflammatory to a pt already taking aspirin?

A

As the patient is already taking aspirin it is best to avoid anti-inflammatories. Prescribing an anti-inflammatory to a patient taking aspirin both negates the anti-platelet effect and increases the risk of gastrointestinal bleeding.

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20
Q

Rx for urgency incontinence

A
  • Oxybutynin hydrochloride/
  • Tolterodine tartrate/
  • Darifenacin

(#1 CI in frail, older women)

start at lowest dose

Mirabegron if (the above) anticholinergics are CI

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21
Q

Rx for SVT

A

vasovagal manouvres

6mg adenosine (if no asthma)

if this fails

give 12 mg?

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22
Q

Classification of asthma attack

A 
Moderate: 
PEFR 50-75% best or predicted
Speech normal
RR < 25 / min
Pulse < 110 bpm
Severe:
PEFR 33 - 50% best or predicted
Can't complete sentences
RR > 25/min
Pulse > 110 bpm
Life-threatening:
PEFR < 33% best or predicted
Oxygen sats < 92%
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma
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23
Q

Rx severe asthma attack

A

high-flow oxygen
inhaled short-acting beta2 agonist (salbutamol)
steroid:
- either oral prednisolone or IV hydrocortisone

Ipratropium bromide is useful if the response to the above treatment is poor but it is not a first-line drug.

24
Q

What time of day should you give the first dose of an antihypertensive?

A

at night

to avoid first-dose postural hypotension

25
Q

Rx angina, already on GTN spray

A

BB, (if CI: CCB)

aspirin and statin (all pts with any form of CVD should take these)

26
Q

Rx suspected meningitis in ED

A

cefotaxime + amoxicillin

27
Q

Emergency contraception

A

Levonorgestrel (within 72hrs - 3 days)

Ulipristal acetate (120hrs - 5 days)

28
Q

what patients should hartmans not be used in?

A

those with hyperkalaemia - it contains potassium

29
Q

Give some endocrine SEs of glucocorticoids and some MSK ones

A

endo:
- increased appetite/wt gain, hirtuism, hyperlipid

MSK:
- osteoporosis, proximal myopathy, AVN FH

30
Q

When should you add a 2nd drug to a T2DM pt taking metformin?

A

can titrate up & encourage lifestyle changes to aim for HbA1c of 48 mmol/mol, but should only add a second drug if the HbA1c rises to 58 mmol/mol (7.5%)

31
Q

what is the level classified as hypoxiaemic in spo2 terms

A

<94%

32
Q

Drug causes of SIADH & what does SIADH do to electrolytes?

A 
sulfonylureas (glimepiride and glipizide)
SSRIs, tricyclics
carbamazepine
vincristine
cyclophosphamide

HYPONATRAEMIA

33
Q

mineralcorticoid SEs

& example

A
  • fluid retention
  • hypertension

Fludrocortison
Hydrocortisone

34
Q

How to prevent contrast-induced nephropathy?

A
  • adequate hydration

- IV 0.9% NaCl

35
Q

When does BNF suggest gradual WD of systemic corticosteroids?

A

if patients have:

  • received more than 40mg prednisolone daily for more than one week
  • received more than 3 weeks treatment
  • recently received repeated courses
36
Q

what should all patients with CVD be taking?

A

a statin

& aspirin (or clopidogrel if stroke or have PAD)

37
Q

What are some important thing to communicate to pt regarding alendronic acid?

A
  • 30 mins before breakfast
  • osteonecrosis of the jaw –> routine dentist
  • oesophageal reactions: stop taking & seek medical attention if heartburn or pain on swallowing develops
38
Q

what is hypoglycaemic awareness & what drug can reduce it?

A

ability to experience / percieve the symptoms of hypoglycaemia

beta blockers

39
Q

Impetigo Rx

A

Topical fusidic acid

Oral flucloxacillin or erythromycin if widespread

40
Q

Cellulitis Rx (if near the eyes or nose)

A

Co-amoxiclav (clarithromycin, + metronidazole if penicillin-allergic)

41
Q

Erysipelas Abx

A

Flucloxacillin (clarithro, erythro or doxy if penicillin allergic)

42
Q

Animal or human bite Abx

A

Co-amox (doxy + metronidazole if penicillin allergic)

43
Q

Mastitis during breast-feeding Abx

A

Flucloxacillin

44
Q

Abx throat infections

A

Phenoxymethylpenicillin (erythromycin alone if penicillin allergic)

45
Q

Abx sinusitis

A

Amoxicillin or doxycycline or erythromycin

46
Q

Abx Otitis media

A

Amoxicillin (E if pen-allergic)

47
Q

Abx Otitis externa

A

Fluclox (E if pen-allergic)

[a combined topical Abx and corticosteroid is generally used for mild/moderate cases of otitis externa]

48
Q

Abx periapical or peridontal abscess

A

amox

49
Q

Gingivitis: acute necrotising ulcerative Abx

A

Metronidazole

50
Q

Gonorrhoea Abx

A

IM ceftriaxone + oral azithromycin

51
Q

Chlamydia Abx

A

Doxycycline or azithromycin

52
Q

PID Rx

A

Oral ofloxacin + oral metronidazole

OR

IM ceftriaxone + oral doxycycline + oral metronidazole

53
Q

Syphilis Rx

A

Benzathine benzylpenicillin

OR

Doxycycline or erythromycin

54
Q

BV Rx

A

PO or topical metronidazole

OR

topical clindamycin

55
Q

Rx campylobacter enteritis

A

Clarithromycin

56
Q

Rx Salmonella (non-typhoid)

A

Ciprofloxacin

57
Q

Rx Shigellosis

A

Ciprofloxacin

PSA Stuff (18 decks)

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