Pass the PSA Flashcards by Justyna Gromala

Name drugs that are enzyme inducers

PC BRAS

Phenytoin
Carbamazepine

Barbiturates
Rifampicin
Alcohol (chronic excess)
Sulphonylureas

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Name drugs that are enzyme inhibitors

AO DEVICES

Allopurinol
Omeprazole

Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol (acute intoxication)
Sulphonamides

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Which drugs should be stopped before surgery?

I LACK OP

Insulin
Lithium
Anticoagulants/antiplatelets
COCP/HRT
K-sparing diuretics
Oral hypoglycaemics
Perindopril and other ACEi

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Side effects of steroids

STEROIDS

Stomach ulcers
Thin skin
oEdema
Right and left heart failure
Osteoporosis
Infection (including candida)
Diabetes (commonly causes hyperglycaemia and uncommonly progresses to Diabetes)
Syndrome (Cushing’s)

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Side effects of NSAIDs

NSAID

No urine (renal failure)
Systolic d/f (i.e. heart failure)
Asthma
Indigestion
Dyscrasia (clotting abnormality)

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How much maintenance fluid in volume?

adults: 3L/24h

elderly: 2L/24h

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In which patient groups should metoclopramide be avoided?

pts with PD (risk of exacerbating symptoms)

young women (due to risk of dyskinesia, esp. acute dystonia)

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What do you usually give as replacement fluid?

500 mls 0.9% saline (250 mld if pt has a hx of heart failure)

unless:
- pt hypernatraemic or hypoglycaemic, then give 5% dextrose
- pt has ascites, then give human albumin solution (HAS) instead, NaCl can make the ascites worse
- pt is shocked from bleeding, then give blood, if no blood is available then give crystalloid

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How much fluid in an oliguric patient?

1L over 2-4h, then reassess

make sure the patient is not urinary obstructed

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What maintenance fluids should be given to provide adequate electrolytes?

over 24h: 2 salty 1 sweet

2L 0.9% NaCl
1L 5% dextrose

supplement K+ based on U&Es, pts require about 40mmol KCl per day, so add 20 mmol to two bags total).

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How slowly does KCl have to be given?

Should NOT be given faster than 10 mmol/h

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typical antiemetic

cyclizine 50mg 8hrly IM/IV/oral

-> not in HF because causes fluid retention -> give metoclopramide then

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What is the maximum dose of paracetamol in people under 50kg? /24h

500 mg 6hrly

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What type of antiemetic is cyclizine?

anti-histamine

therefore safe in PD

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How do ACEi cause cough?

accumulation of bradykinin via reduced degradation by ACE

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How do ACEi cause hyperkalaemia?

decreased aldosterone production leading to decreased K+ excretion.

remember: kind of like in Addison’s

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Causes of a raised ALP?

alkphos

Any fracture
Liver damage (posthepatic)
K for Kancer
Paget’s disease of bone and Pregnancy
Hyperparathyroidism
Osteomalacia
Surgery

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Valsartan - type of medication

Angiotensin II receptor antagonists

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Celecoxib drug class

NSAID

(Can be used in OA)

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Do you need to stop amlodipine (istin) in AKI?

it is a CCB and has no effects on electrolytes or renal function

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how does ibuprofen cause AKI?

decreases renal BF by inhibiting prostaglandins which normally dilate BVs flowing into the kidneys, especially if the patient has RAS.

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what medication is Tritace?

it is an ACE-i

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what is the INR target for AF?

2-3

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what do INR values mean? What is bleedy and what is clotty?

the higher the more bleedy

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INR is too high - what action do you take dependent on the value? (If there is no bleeding vs bleeding)

No bleeding: - 5-8: omit warfarin for 2 days then reudce dose - >8: omit warfarin and give 1-5mg PO Vit K Bleeding: - 5-8: omit warfarin and give 1-5mg IV vit K - >8: omit warfarin and give 1-5mg Vit K IV If there is a major bleed, omit warfarin, give 5-10mg Vit K IV and give prothrombin ocmplex

what dose of Vit K should you give in a patient with to high INR? what route?

1-5mg PO

What is the commonest antibiotic regimen for neutropenic sepsis? | also, what route?

piperacillin tazobactam gentamicin -> IV (po abx are never sufficient for neutropenic sepsis)

What OTC medication can lower the effectiveness of trimethoprim?

folate

What is the mainstay of treatment in acute heart failure?

Furosemide (in acute settings give IV)

What medication is the brand name Lanoxin?

digoxin

What features indicate that DC cardioversion is required in an acute setting?

Adverse features e.g. - chest pain - HF - low BP - Syncope

Which antibiotics can you prescribe for whooping cough?

azithromycin clarithromycin erythromycin co-trimoxazole

what would you prescribe first line in an 8 month old weighing 8 kilos with whooping cough?

Azithromycin 80 mg PO OD

What drugs are given in Graves disease?

propranolol to ease sx anti-thyroid drugs (under specialist advice ) - carbimazole (usually 1st line) - propylthiouracil radioiodine treatment is another option

How long are anti-thyroid drugs usually given for?

12-18 months

How are triptans prescribed?

Dose 50 or 100 mg oral ONCE ONLY (not PRN)

What medication taken with SSRIs have a high risk of serotonin syndrome?

triptans

What is the first line treatment in GORD in babies?

1-2 week trial of alginate therapy (gaviscon infant, alginic acid, alginate)

How often should children with T1DM on long acting insulin measure their blood glucose levels?

at least 5 times a day

What is the antidote to opioid overdose?

naloxone

which antihypertensive drugs are known to cause leg swelling?

calcium channel blockers (peripheral oedema, particularly leg swelling) bisoprolol causes leg swelling very rarely

What medication class is gliclazide?

sulfonylurea

common SE of sulfonylureas (2)

- hypoglycaemic episodes (more common with long-acting preparations such as chlorpropamide) - weight gain

What drug class is gliclazide? What are important SE to consider?

sulfonylurea can cause weight gain and drops in blood sugar levels

Name different penicillin antibiotics

phenoxymethylpenicillin benzylpenicillin flucloxacillin amoxicillin ampicillin co-amoxiclav (Augmentin) co-fluampicil (Magnapen) piperacillin with tazobactam (Tazocin) ticarcillin with clavulanic acid (Timentin)

Can you give Tazosin in penicillin allergy?

no it is piperacillin with tazobactam

Which 2 of the following medications most likely caused dry mouth and double vision? A. omeprazole B. cyclizine C. amitriptyline D. Ibuprofen E. enoxaparin

B and C Cyclizine is a sedating antihistamine which is mainly used as an antiemetic, it is known to have anti-muscarinic SE. Amitriptyline is a TCA. Can be used for neuropathic pain too. Known to have antimuscarinic SE.

Carbimazole rare SE

drug induced neutropenia go to GP if sore throat etc.!

What type of medication is domperidone?

dopamine antagonist anti-emetic

Can you use domperidone in patients with Parkinson's disease?

Yes it is a DA antagonist however, it does not cross the BBB and therefore can be used in PD.

in a patient with chronic hyperkalaemia is it better to use a CCB or ACEi?

CCB is safer

What are the indications for unfractionated heparin?

?in pts at high risk of bleeding complications because of the short activity and reversibility ?check this

What is the concern in prescribing a COCP in a patient with epilepsy taking carbamazepine?

carbamazepine is an enzyme inducer and could reduce the effectiveness of the COCP

Which drugs are contraindicated in patients with Asthma?

adenosine beta blockers NSAIDs

Which psychiatric medication is known to exacerbate psoriasis?

Lithium

Which factors (incl. meds) exacerbate psoriasis?

- trauma - alcohol - drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab - withdrawal of systemic steroids - Streptococcal infection may trigger guttate psoriasis.

1st line treatment to lower K+ in hyperkalaemia what is second line? | include doses

10 U of actrapid insulin in 100 mL 20% dextrose over 30 minutes (Salbutamol 2.5-5mg nebulised is second line)

What are the best medications for focal epilepsy? Which one is preferred in pregnancy / pts wanting to conceive?

lamotrigine carbamazepine lamotrigine is safer in pregnancy

How do you change insulin treatment in DKA?

stop short acting continue long acting as normal start insulin FIXED rate with fluids (not variable rate)

1st line pain management in shingles

paracetamol

How should loperamide be taken?

initial dose of 4mg 2mg after each loose stool do not exceed 16 mg/24h

do antidepressants work right away? how long does it take to see effects?

It may take up to 6 weeks for the effects of antidepressants to become visible

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