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ΩΩ 4 Bateman - PSA + Pharmacology > Pass the PSA > Flashcards

Pass the PSA Flashcards

1
Q

What drugs do you need to stop before surgery?

A

I LACK OP

  1. Insulin
  2. Lithium - day before
  3. Anticoagulants
  4. COCP/HRT - 4 weeks
  5. K-sparing diuretics - day of surgery
  6. Oral hypoglycaemics
  7. Perindopril and other ACE inhibitors
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2
Q

What is the mnemonic helps you to remember to prescirbe the essentials of prescribing?

A

PReSCRIBER

  1. Patinet details
  2. Reaction
  3. Sign the front of the chart
  4. Contraindications
  5. Route
  6. IV fluids
  7. Blood clot prophylaxids
  8. AntiEmetic
  9. Pain Relief
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3
Q

What are two common drugs that both contain penicillin?

A
  1. Co-amoxiclav
  2. Tazocin
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4
Q

What are the four most common contraidications to be aware of?

A
  1. Drugs that increase bleeding shouldn’t be given to patients who are bleeding.
  2. Steroid side effects
    • ​​Stomach ulcers, Thin skin, Edema, Right and left heart failure, Osteoporosis, Infection, Diabetes, Cushing Syndrome
  3. NSAIDs safety considerations
    • ​​No urine, Systolic dysfunction, Asthma, Indigestion, and Dyscrasia
  4. Side effects for antihypertensives
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5
Q

What are the side effects for hypertensives?

A
  1. Hypotension (including the earliest symptom, postural hypotension)
  2. ​​Dividing the groups of antihypertensives into two mechanistic categories:
    • Bradycardia may occur with beta-blockers and some calcium-channel blockers.
    • Electrolyte disturbance can occur with ACE-inhibitors and diuretics
  3. Individual drug classes have specific side effects:
    • ACE-inhibitors can result in a dry cough.
    • Beta-blockers can cause wheeze in asthmatics; they can also cause worsening of acute heart failure (but help chronic heart failure).
    • Calcium-channel blockers can cause peripheral oedema and flushing.
    • Diuretics can cause renal failure. Thiazide diuretics (e.g. bendroflumethiazide) can also cause gout, and potassium-sparing diuretics (e.g. spironolactone) can also cause gynaecomastia.
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6
Q

Which fluid do you given during replacement?

What do you give in different situations?

A

Give all patients 0.9% saline (normal saline, a crystalloid) unless the patient:

  1. Is hypernatraemic or hypoglycaemi
    Give 5% dextrose instead.
  2. Has ascites
    Give human-albumin solution (HAS) instead. The albumin maintains oncotic pressure; furthermore, the higher sodium content of 0.9% saline will worsen ascites.
  3. Is shocked from bleeding
    Give blood transfusion, but a crystalloid first if no blood available.
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7
Q

How much fluid do you need to give to a patient requiring replacement fluid?

A
  1. If tachycardic or hypotensive give 500 mL bolus immediately (250 mL if history of heart failure) then reassess patient.
  2. If only oliguric (and not due to urinary obstruction (e.g. an enlarged prostate)) then give 1L over 2–4 h then reassess patient.
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8
Q

How can you roughly predict how fluid depleted a patient is?

A

It is possible to roughly predict how fluid-depleted an adult patient is by using their observations and knowing which are affected first:

  1. Reduced urine output (oliguric if <30 mL/h; anuric if 0 mL/h) indicates 500 mL of fluid depletion
  2. Reduced urine output plus tachycardia indicates 1 L of fluid depletion
  3. Reduced urine output plus tachycardia plus shocked indicates >2 L of fluid depletion.
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9
Q

What is the maximum rate of infusion for IV potassium?

A

10 mmol/hour

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10
Q

How much maintenance fluid is needed for patients?

A
  1. As a general rule, adults require 3 L IV fluid per 24 hours and the elderly require 2 L.
  2. Adequate electrolytes are provided by 1 L of 0.9% saline and 2 L of 5% dextrose (1 salty and 2 sweet).
  3. To provide potassium, bags of 5% dextrose or 0.9% saline containing potassium chloride (KCl) can be used but this should be guided by urea and electrolyte (U&E) results; with a normal potassium level, patients require roughly 40 mmol KCl per day (so put 20 mmol KCl in two bags).
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11
Q

How fast do you give fluids to a patient?

A
  1. If giving 3 L per day = 8-hourly bags (24 ÷ 3).
  2. If giving 2 L per day = 12-hourly bags (24 ÷ 2).
  3. Prescribing fluids in real life, you must:
  4. Check the patient’s U&E to confirm what to give them.
  5. Check that the patient is not fluid overloaded (e.g. increased jugular venous pressure (JVP), peripheral and pulmonary oedema).
  6. Ensure that the patient’s bladder is not palpable (signifying urinary obstruction) if giving replacement fluids because of ‘reduced urine output’.
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12
Q

What class of drug is metoclopramide?

Who should this be avoided in?

A
  1. Dopamine antagonist antiemtic
  2. Parkinson’s disease
  3. Young women, due to the risk of dyskinesia
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13
Q

What is a good first line antiemtic?

When should this not be used?

What else should be used?

A
  1. Cyclizine 50mg
  2. Not used for cardiac cases (as it can worsen fluid retention)
  3. Metoclopramide 10mg instead
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14
Q

When patients weigh less than 50kg what is the MAXIMUM dose of paracetamol?

A

500mg 6-hourly

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15
Q

What electrolyte disturbances does an ACE ibhibitor and thiazide diuretic cuase?

A
  1. ACE inhibitor - hyperkalaemia
  2. Thiazide diuretic - hypokalaemia
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16
Q

What are two common drugs common to causing indigestion?

A
  1. NSAID
  2. Steroid
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17
Q

What class of drug is oxybutinin?

A

Antimuscarinic

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18
Q

What age group is oxybutinin more potent in?

A
  1. Elderly
    Can cause confusion
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19
Q

What antiemtic can cause drowsiness?

A
  1. Cyclizine
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20
Q

Which drugs should be used with caution with methotrexate?

A

NSAIDS

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21
Q

What is the mechanism of action of trimethorpim?

A

Folate antagonist

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22
Q

When there is active infection which drug should be stopped?

Why can this be done?

A
  1. Methotrexate
  2. Has a long half life
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23
Q

What is a side effect of calcium-channel blockers?

A

Peripheral oedema

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24
Q

What two blood pressure lowering medications should never be given together?

A

Calcium channel blocker and beta blocker

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25
Q

What is the correct route of administration for all insulin except a sliding scale?

A

SC

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26
Q

WHAT DO YOU DO TO THE LEVOTHROXINE DOSE WITH THE FOLLOWING TFT RESULTS?

A
  1. TSH <0.5 - Decrease dose
  2. TSH 0.5-5 - Same dose
  3. TSH >5 Increase dose
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27
Q

What are examples of drugs which need to be monitored?

A
  1. Digoxin
  2. Theophylline
  3. Lithium
  4. Phenytoin
  5. Gentamicin
  6. Vancomycin
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28
Q

How much Gentamicin will a patient recieve?

When is this changed?

What will happen then?

A
  1. 5-7mg/kg once daily
  2. In patients with severe renal failure or endocarditis
  3. Divided into TWO daily doses
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29
Q
  1. What time do you check the gentamicin dose?
  2. When is this not used?
  3. What is used instead?
A
  1. 6-14h
  2. In divided dosing
  3. 1hr post dose + through (just before next dose)
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30
Q
  1. What product in paracetamol poisioning is toxic?
  2. What product is needed to convert NAPQI into a non-toxic substance?
A
  1. NAPQI
  2. Glutathione
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31
Q

What are the vitamin K clotting factors?

A

2, 7, 9, and 10

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32
Q

What do you do in a major bleed while on warfarin?

A
  1. Stop warfarin
  2. Give 5-10 mg IV vitamin K
  3. PRothrombin complex (e.g. Beriplex)
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33
Q

What drugs are used to correct ECG changes in AF?

A
  1. Beta-blockers - not in asthmatics
  2. Diltiazem - can worsen fluid retention
  3. Digoxin
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34
Q

WHAT IS THE APPROPRIATE THERAPY FOR CELLULITIS?

A

500mg flucloxacillin 6 hourly for 7 days

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35
Q

What is the appropriate therapy for CHF?

A

IV furosemide 40mg IV

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36
Q

Which two drugs can cause side effects such as dry mouth and double vision?

A
  1. Cyclizine
  2. Amitriptyline
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37
Q

What is an example of a drug that can cuase neutropenia (agranulocytosis)?

A

Carbimozole

38
Q

What antipsychotic can exaccerbate parkinson’s symptoms?

A

Haloperidol

39
Q

What drug can be used in acute gout?

A

Depo-Medrone (steroid)

40
Q

WHAT CLASS OF ANTIHYPERTENSIVES CANNOT BE USED IN PREGNANCY AND WHAT SHOULD IT BE CHANGED WITH?

A
  1. ACE Inhibitors
  2. Labetalol before conception
41
Q

What is tomoxifen increase the risk of?

42
Q

What do sulfonylureas increase the risk of (e.g. gliclazide)?

A

Hypoglycaemia

43
Q

How often is monitoring of FBC with methotrexate?

44
Q

What can increase the toxicity of ACE inhibitors in the elderly?

A

Diarrhoea and vomiting

45
Q

What drug needs to be prescribed alongside steroids in the elderly?

A

Bisphosphonates

46
Q

What are the administering instructions for bisphosphonates?

A

Take on an empty stomach and sit upright for at least 30 minutes after taking

47
Q

What is the breast cancer risk for taking HRT?

A

There is an increased risk for more than 10 years after stopping compared with women who have never used HRT

48
Q

HOW MANY MG ARE IN 1ML OF A 1% LIDOCAINE SOLUTION?

A

1% = 1g in 100ml

10mg

49
Q

The IV preparation contains 250 micrograms/mL. Express this as a

percentage?

50
Q

An adult male patient is given an intramuscular injection of 0.5 mg of adrenaline 1 in 1000 for the treatment of suspected anaphylaxis after being stung by a bee.

What volume of solution was he given?

A

1 in 1000 = 1g per 1000ml

1000mg per 1000ml

0.5ml

51
Q

A 57-year-old male patient, weighing 80 kg, is given 4 mL of furosemide 50 mg in 5 mL solution by slow IV injection.

What dose (in milligrams) of furosemide was given?

52
Q

Later on, you decide to give the same patient a further 75 mg of furosemide.

How many millilitres of 50 mg/5 mL solution do you need to give?

53
Q

While working on a paediatric ward, you are asked by a staff nurse to double-check a dose calculation. An 11-year-old girl, weighing 30 kg, requires a 2 mg/kg slow IV bolus dose of antibiotic X. The ampoule contains 80 mg in 2 mL.

What volume of solution is required?

A
  1. 2x30 = 60mg
  2. 60/80 = 0.75
  3. 0.75 x 2 = 1.5ml
54
Q

Baby Leon weighs 3 kg and requires a daily maintenance dose of IV digoxin of 25 micrograms. Digoxin is available as 500 micrograms/2 mL ampoules.

What volume do you need to give?

A
  1. 25/500 = 0.05
  2. 0.1ml
55
Q

Mary Bett, a 50 kg, 62-year-old patient, has a swollen left calf. Investigations reveal the following:

  • D-dimer – positive
  • Wells’ score – 6
  • Serum creatinine – 64 μmol/L (creatinine clearance >30 mL/min).

You decide to initiate treatment dose enoxaparin (LMW heparin) at a dose of 1.5 mg/kg (or 150 units/kg).

What dose do you give? Express the dose in both ‘mg’ and ‘units’

A
  1. 1.5x50 = 75 mg
  2. 150x50 =7,500 units
56
Q
A

455mg every 36h

57
Q
  1. How much sodium chloride (NaCl) 0.9% would you need to add to an ampoule of hydralazine 20 mg/2 mL to make a 1 mg/mL dilution?
  2. How much of the 1 mg/mL solution would you need to administer 5 mg?
58
Q

A neurosurgical patient is prescribed phenytoin 300 mg daily, which she is being given in capsule form. A few days after her operation, she complains of difficulty swallowing the capsules and the nurse asks you if you can re-prescribe phenytoin in liquid form.

Phenytoin is available as a liquid, but it contains phenytoin base rather than the sodium salt of phenytoin found in the capsules.

A
  1. Look in the BNF
  2. 100mg salt is equal to 92mg base
  3. 276mg
59
Q

WHAT IS THE ACRONYM FOR CORRECT PRESCRIBING?

A
  1. P – patient details
  2. Re – reaction (allergy plus the reaction)
  3. S – sign the front of the chart
  4. C – check contraindications to each drug
  5. R – check route for each drug
  6. I – prescribe intravenous fluids if needed
  7. B – prescribe blood clot prophylaxis if needed
  8. R – prescribe pain relief if needed
  9. E – prescribe antiemetic if needed
60
Q

What would you prescribed for a PE?

A
  1. Dalteparin, number of units for thwir weight, SC
61
Q

What is the first line drug for acute exaccerbation of asthma?

A
  1. 5 mg nebulised salbutamol
62
Q

What drug can you prescribe for mycocardial ischaemia?

A
  1. GTN spray two puffs
63
Q

What is the first line for AF?

A
  1. Diltiazem 120 mg oral
64
Q

What is an appropriate first line for hyperkalaemia?

A
  1. Actrapid - 10 units in 100ml of 20% dextrose over 30 mins IV
65
Q

What is an appropriate drug and dose for seizures in a pregnant lady?

A
  1. Lamotrogine - 25 mg orally
66
Q

What is an appropriate medication to start for a type 2 diabetic who has a high creatinine?

A

Gliclazide - 40 mg oral with dirst meal

67
Q

WHAT MONITORING IS NEEDED FOR VANCOMYCIN IN RENAL IMPAIRMENT?

A
  1. Monitor creatinine
68
Q

What needs to be measured before starting treatment with Simvastatin?

69
Q

What is the normal reference range for lithium?

A

0.8 - 1.0 mmol/l

70
Q

When should methotrexate not be started?

A

If liver tests are abnormal

71
Q

What needs to be checked at baseline before starting clozapine?

A

Fasting blood glucose

72
Q

What parameter should you check when monitoring the combined pill?

A
  1. Blood pressure
73
Q

What needs to be cheked before comencing treatment on amiodarone?

A

Baseline X-ray

74
Q

What should you check with a patinet presenting with sore throat taking carbimazole?

A

Neutrophil count

75
Q

What is the peak concentration of gentamicin 1-hour (peak) concentration aimed at?

76
Q

What should you be measuring when starting a patient on ramipril?

A
  1. Urea and electrolytes
77
Q

What should you monitor when starting a patinet on Digoxin?

A

Creatinine

78
Q

What should you monitor when starting a patinet on sodium valporate?

79
Q

WHAT IS THE ADVERSE REACTION FOR GENTAMYCIN AND VANCOMYCIN?

A
  1. Nephrotoxicity
  2. Ototoxicity
80
Q

Which antibiotics commonly cause C.diff infection?

A
  1. Cephlasporins
  2. Ciprofloxacin
81
Q

What are some medicaitions with a narrow therapeutic index?

A
  1. Warfarin
  2. Digoxin
  3. Phenytoin
  4. Theophylline
82
Q

What two antihypertensives when together can cause severe hypotension?

A

Beta-blockers and Calcium channel blockers

83
Q

How long does CYP450 induction and inhibition take?

A
  1. Induction takes weeks
  2. Inhibition takes hours
84
Q

What is an adverse drug reaction of MAOIs?

A
  1. Hypertensive crisis
85
Q

What is an adverse drug reaction of metformin?

86
Q

What do ACE inhibitors to do potassium?

A

Cause hyperkalaemia

87
Q

What drug may cause abdominal pain and dark stools?

A
  1. NSAIDs
  2. Bleeding in stomach and into the stools
88
Q

What is contained with co-trimoxazole?

A
  1. Sulfamethoxazole and trimethoprim
89
Q

What is amilroide?

A
  1. Potassium-sparing diuretic
90
Q

What is first line substance in a hypoglycaemic patient who is conscious?

A

10-20g oral glucose

ΩΩ 4 Bateman - PSA + Pharmacology (8 decks)

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