Pass the PSA Flashcards
Name drugs that are enzyme inducers
PC BRAS
Phenytoin
Carbamazepine
Barbiturates
Rifampicin
Alcohol (chronic excess)
Sulphonylureas
Name drugs that are enzyme inhibitors
AO DEVICES
Allopurinol
Omeprazole
Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol (acute intoxication)
Sulphonamides
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
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)
Side effects of NSAIDs
NSAID
No urine (renal failure)
Systolic d/f (i.e. heart failure)
Asthma
Indigestion
Dyscrasia (clotting abnormality)
How much maintenance fluid in volume?
adults: 3L/24h
elderly: 2L/24h
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)
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
How much fluid in an oliguric patient?
1L over 2-4h, then reassess
make sure the patient is not urinary obstructed
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).
How slowly does KCl have to be given?
Should NOT be given faster than 10 mmol/h
typical antiemetic
cyclizine 50mg 8hrly IM/IV/oral
-> not in HF because causes fluid retention -> give metoclopramide then
What is the maximum dose of paracetamol in people under 50kg? /24h
500 mg 6hrly
What type of antiemetic is cyclizine?
anti-histamine
therefore safe in PD
How do ACEi cause cough?
accumulation of bradykinin via reduced degradation by ACE
How do ACEi cause hyperkalaemia?
decreased aldosterone production leading to decreased K+ excretion.
remember: kind of like in Addison’s
Causes of a raised ALP?
alkphos
Any fracture
Liver damage (posthepatic)
K for Kancer
Paget’s disease of bone and Pregnancy
Hyperparathyroidism
Osteomalacia
Surgery
Valsartan - type of medication
Angiotensin II receptor antagonists
Celecoxib drug class
NSAID
(Can be used in OA)
Do you need to stop amlodipine (istin) in AKI?
no
it is a CCB and has no effects on electrolytes or renal function
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.
what medication is Tritace?
it is an ACE-i
what is the INR target for AF?
2-3
what do INR values mean? What is bleedy and what is clotty?
the higher the more bleedy
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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