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Pass The PSA Flashcards

1
Q

Drugs to Stop Before Surgery
I LACK OP

A

Insulin - variable

Lithium - 1d
Anticoagulants/ antiplatelets - variable
COCP/ HRT - 4wks
K-sparing diuretics - day of

Oral hypoglycaemics - variable
-Prils (ACEi) - day of

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2
Q

PReSCRIBER

A

Patient details
Reaction (+ allergen)
Sign
Contra
Route
?
IV fluids
Blood clot proph
antiEmetic
pain Relief

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3
Q

STEROIDS Side Effects

A

Stomach ulcers
Thin skin
Edema
Right and left HF
Osteoporosis
Infection incl. candida
Diabetes/ hyperglycaemia
Cushing’s

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4
Q

NSAIDs Considerations

A

No urine
Systolic dysfunction
Asthma
Indigestion
Dysfunctional clotting

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5
Q

Pain Relief

A

Regular
paracetamol 1g 6hrly
co-codamol 30/500 2 tablets 6hrly

PRN
paracetamol 1g up to 6hrly
codeine 30mg up to 6hrly
morphine sulphate (10mg/5ml) 10mg up to 6hrly

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6
Q

Replacement Fluid

A

0.9% normal saline

UNLESS
- ^Na or v glucose (use 5% dextrose)
- ascites (HAS)
- bleeding and shocked (ideally transfuse)

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7
Q

Replacement: Speed

A

500ml bolus (250ml if HF) and then reassess

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8
Q

IV Potassium Speed

A

No more than 10mmol/hr

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9
Q

Maintenance Fluids

A

Most require 3L per 24hrs (2L elderly)

1 salty 2 sweets for electrolytes

add 2x 20mmol KCL to these

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10
Q

Metoclopramide: Caution

A

Parkinson’s
Young women (risk of dyskinesia e.g., acute dystonia)

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11
Q

Confusion in Elderly

A

Antimuscarinic e.g., oxybutynin
- confusion, pupil dilation, v accom, dry mouth, tachy

Tramadol

Opioid

Cyclizine

Benzos

Amitriptyline

Steroids

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12
Q

Methotrexate

A

STOP in active infection

Contra - trimethoprim (folate ant, bone marrow suppression)

FBC, U&E, LFTs 1-2wkly until stable (then 2-3mthly)

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13
Q

Hypernatraemia Causes

A

Dehydration
Dips
Drugs
Diabetes insipidus

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14
Q

WCC

A

^Neut
= bacteria, inflam, steroids

v Neut
= virus, chemo/ radio, clozapine, carbimazole

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15
Q

PLT

A

High
= bleeding, infection, inflam, cancer, post-splenectomy, myeloproliferative disorders

Low
= virus, penicillamine, heparin, hypersplenism, DIC, ITP, HUS

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16
Q

Hypokalaemia DIRE

A

Diuretics (loop, thiazide)
Intake/ intestinal loss
RTA
Endocrine (Cushing’s, Conns)

17
Q

Hyperkalaemia DREAD

A

Drugs (K-sparing diuretic, ACEi)
Renal failure
Endocrine (Addison’s)
Artefact
DKA

18
Q

SIADH Causes

A

Small cell lung cancer
Infection
Abscess
Drugs (carbamazepine, antipsych)
Head injury

19
Q

Thyroxine Dose Change

A

TSH
<0.5 = decrease dose
0.5-5 = no change
>5 = increase dose

20
Q

Phenytoin Toxicity

A

Zero order kinetics

Small dose increase = large clinical effect

SE: gum hypertrophy, ataxia, nystagmus, peripheral neuropathy, teratogen

Total plasma-phenytoin concentration for optimum response is 10–20 mg/litre (or 40–80 micromol/ litre).

21
Q

Lithium Toxicity

A

SE: tremor, fatigue, arrhythmia, seizure, coma, renal failure, diabetes insipidus

22
Q

Gentamicin

A

Measure 6-14hr after last infusion was started

For multiple daily dose regimen in endocarditis
- one-hour (‘peak’) serum conc should be 3–5 mg/L
- pre-dose (‘trough’) conc should be <1 mg/L

Serum-gentamicin concentration should be measured after 3 or 4 doses, then at least every 3 days and after a dose change (more frequently in renal impairment)

23
Q

Salbutamol

A

Stop inhaler if having nebs

24
Q

AF Rate Control

A
  1. b-clocker (not if asthma)
  2. CCB (not if oedema esp. dilt)

? 3. digoxin

25
Q

STEMI

A

Morphine 5-10mg IV
Oxygen
Nitrate (GTN spray/ tablet)
Aspirin 300mg

+ primary PCI or thrombolysis

26
Q

Acute HF

A

O2 if <95%
Sit them up
Morphine
GTN
Furosemide IV 40-80mg
Isosorbide dinitrate infusion +/- CPAP

27
Q

Anaphylaxis

A

A-E
15L O2 non-rebreathe
Remove cause
IM Adrenaline 500 micrograms
Repeat at 5min if no improvement
Refractory
- IV adrenaline by expert, IV fluids

28
Q

Lamotrigine

A

SE: rash, rarely Steven-Johnsons

29
Q

Carbamazepine

A

SE: rash, dysarthria, ataxia, nystagmus, SIADH (v Na), neutropenia

30
Q

Phenytoin

A

SE: ataxia, PN, gum hyperplasia, hepatotoxicty

31
Q

Sodium valproate

A

SE: tremor, teratogen, weight gain

32
Q

Levetiracetam

A

SE: fatigue, mood disorder, agitation

32
Q

Azathioprine/ 6-Mercaptopurine

A

Metab to inactive component by TPMT

Check TPMT activity before prescribing

33
Q

Carbimazole

A

SE: bone marrow suppression, agranulocytosis (neutropenia)

Watch out for sore throat etc

34
Q

Do not give in Parkinsons

A

Metoclopramide

Haloperidol

(Dopamine antagonists - precipitate Parkinsonism)

Domperidone okay as doesn’t cross BBB

35
Q

ACE Inhibitors

A

Teratogenic so convert to labetolol before conception

36
Q

Tamoxifen

A

SE: endometrial cancer, VTE, ^INR, hot flushes,

37
Q

Steroids >3months

A

Offer bisphosphonates to v OP

Esp elderly e.g., PMR

PPT (3 decks)

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