Pass the PSA Flashcards
Effect of erythromycin on warfarin
can increase warfarin effect
Steroid Side effects
- stomach ulcers
- thin skin
- oedema
- right and left heart failure
- osteoporosis
- infection
- diabetes
common side effect of ACEi
dry cough
common side effects of beta blockers
- can increase wheeze in asthmatics
also beware of NSAID use in asthmatics
common side effects of calcium channel blockers
- peripheral oedema
- flushing
common side effects of potassium sparing diuretics
gynaecomastia
Avoid metoclopramide in which patietns
- Parkinsons –> risk of exacerbating symptoms
- Young women –> risk of dyskinesia
Anti-emetic choices
Nauseated patients
1. cyclizine 50mg 8 hourly (causes fluid retention)
2. metoclopramide 10mg 8 hourly (if heart failure)
3. ondansetron 4mg or 8mg 8-hourly
Non-nauseated (as-required)
1. cyclizine 50mg 8 houlry
2. metoclopramide 10mg 8 hourly
Analgesic choices:
no pain
mild pain
severe pain
No pain
1. No regular
2. As required : 1g paracetamol 6hourly (max dose 4g)
Mild pain
1. Paracetamol 1g 6 hourly oral
2. As required: up to 30mg codeine 6 hourly (or tramadol)
Severe pain
1. co-codamol 30/500, 2 tablets 6 hourly oral
2. as required: morphine sulphate 10mg/5ml (10mg up to 6 hourly)
Analgesic choice: neuropathic pain
1st line: amitriptylline (10mg oral nightly)
or
Pregabalin 5mg oral 12 hourly
If painful diabetic neuropathy
–> duloxetine 60mg oral daily
side effects of antimuscarinic drugs
e.g. oxybutynin
- pupilary dilatation
- dry mouth
- loss of accomodation reflex
- tachycardia (after transient bradycardia)
common drugs that may worsen confusion in the elderly
- tramadol (avoid)
- cyclizine (can cause drowsiness)
- benzodiazepines
which antiocoagulant should not be given post stroke
enoxaparin due to risk of haemorrhagic transformation
causes of neutrophilia
high neutrophils
- bacterial infection
- tissue damage (inflammation / infarct etc)
- steroids
causes of neutropenia
viral infection
chemotherapy
clozapine (anti-psychotics)
carbimazole (anti-thyroid)
how to interpret and change levothyroxine dose following tft (TSH) results
< 0.5 then reduce dose
0.5-5 nil action , same dose
> 5 then increase dose
Confusion, nausea, visual halos and arrhytmias is associated with what toxicity
digoxin
Features of lithium toxicity
early: tremor
Intermediate: tiredness
late: arrhytmias, seizures, coma, renal failure and diabetes insipidus
Features of phenytoin toxicity
- gum hypertrophy
- ataxia
- nystagmus
- peripheral neuropathy
- teratogenecitiy
Ototoxicty and nephrotixicity is associated with which two drugs
- gentamicin
- vancomycin
gentamicin monitoring for divided faily dosing regimes
1 hour post dose (PEAK)
Normal range in infective endocarditis (3-5)
Normal range in everything else (5-10)
If out of range adjust dose
Trough: before next dose
Normal range in infective endocarditis (<1)
Normal range in everything else (<2)
Action if out of range: adjust dose interval
Warfarin management: major bleed
- stop warfarin
- give 5-10mg IV vitamin K
- give prothrombin complex
INR 5-8
No bleeding: omit warfarin for 2 days then reduce dose
Minor bleeding: omit warfarin and give 1-5mg IV vitamin K
INR >8
No bleeding: omit warfarin and give 1-5mg PO vitamin K
Minor bleeding: omit warfarin and give 1-5mg IV vitamin K
treatment of neutropenic sepsis
Piperacillin with tazobactam IV, gentamicin IV and paracetamol (if pyrexic) .
some drug causes of hyponatraemia
furosemide
carbamazepine
which is the only calcium channel blocker used for treatment of AF
- DILTIAZEM
avoid if presence of peripheral oedema as CCB can worsen fluid retention
AF treatment
Any adverse features: chest pain, heart failure, crepitations, oedema / raised JVP, or syncope
If adverse features: DC CARDIOVERT (not if symptoms more than 48 hours, then need to anticoagulation for 4 weeks first)
BB contraindicated in asthmatics
Digoxin
Narrow complex regular tachycardia management
- vagal manouvers
- adenosine 6mg rapid IV bolus
- if unsuccessful give 12mg
- then further 12 mg
irregular narrow complex tachycardia management
- BB or diltiazem
If heart failure
- digoxin or amiodarone
Ventricular tachycardia mx
amiodarone 300mg IV over 20-60 mins then 900mg over 24hrs
Anaphylaxis mx
ABCDE
Adrenaline 500 micrograms of 1:1000 IM
Chlorphenamine 10mg IV
Hydrocortisone 200mg IV
bacterial meningitis in the community treatment
1.2g benzylpenicillin
what is given in benzodiazepine overdose
flumazenil
ramipril and pregnancy
ACEi teratogenic in pregnancy should be avoided
lamotrigine side effects
rash
rarely: steven johnson syndrome
carbamazepine side effects
rash
dysarthria
ataxia
nystagmus
reduced sodium
phenytoin side effects
ataxia
peripheral neuropathy
gum hyperplasia
hepatotoxicity
sodium valproate side effects
tremor
teratogenicity
weight gain
levetiracetam side effects
- fatigue
- mood disorders
- agitation
treatment option for PE
confirmed PE
LMWH : dalteparin
or LMWH followed by oral anticoagulant (dabigatran or edoxaban)
chronic heart failure management
- BB (bisoprolol) or ACEi (ramipril)
ARBs –> candesartan if ACEi not tolerated
If not tolerated then add spironolactone
Note
- when initiating ACEi, ARB: monitor sodium, potassium, BP and renal function 1-2 weeks following treatment.
Avoid CCB in CHF w/ reduced ejection fraction as can reduce cardiac contractility.
ACEi best prescribed at what time of day
- in the evening due to postural hypotension
recap hypertension guidelines
asthma acute treatment summary
- salbutamol nebs
- If severe or life threatening then add ipratropium bromide
- magnesium sulphate
prednisolone should be prescribed but won’t help acute breathlessness
Atrial fibrillation management
if within 48hours: DC cardioversion
more than 48hours:
- rate control: BB or CCB
Add digoxin if not controlled w/ monotherapy
hyperkalaemia management
To stabilise membrane : calcium gluconate
reduce potassium
1. 10 units of actrapid in 100mls of 20% dextrose over 30 mins IV
- salbutamol
- calcium resonium
diabetes management
- lifestyle first
- metformin (if overweight)
- sulphonylurea (if normal or underweight )
–> gliclazide
when prescribing a statin what MIGHT NEED TO be checked
baseline ck
if increased risk of myopathy
if not then serum ALT will suffice as statins are metabolised in the liver
–> 3 and 12 months post starting treatment
what serum concentration of lithium is likely to manifest with toxic effects
serum concentration above 1.5
therapeutic reference range 0.4-0.8
when taking olanzapine what measurement must be taken:
fasting blood glucose
hyperglycaemia and diabetes can occur in patients prescribed antipsychotic drugs
monitoring for a patient on amiodarone
Liver function tests required before treatment and then every 6 months.
Serum potassium concentration should be measured before treatment.
Chest x-ray required before treatment.
Recap STEMI management
Recap NSTEMI management
Write a prescription for one drug that is most appropriate as maintenance treatment for coronary artery spasm
Prinzmetal or variant angina associated with coronary artery vasospasm.
Tx: isosorbide mononitrate or calcium channel blocker
Do not use BB!! may aggravate coronary artery spasm.
e.g. felodipine 5mg m/r PO daily
