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MLA Content > Pass the PSA > Flashcards

Pass the PSA Flashcards

1
Q

Effect of erythromycin on warfarin

A

can increase warfarin effect

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2
Q

Steroid Side effects

A
  1. stomach ulcers
  2. thin skin
  3. oedema
  4. right and left heart failure
  5. osteoporosis
  6. infection
  7. diabetes
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3
Q

common side effect of ACEi

A

dry cough

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4
Q

common side effects of beta blockers

A
  • can increase wheeze in asthmatics

also beware of NSAID use in asthmatics

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5
Q

common side effects of calcium channel blockers

A
  • peripheral oedema
  • flushing
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6
Q

common side effects of potassium sparing diuretics

A

gynaecomastia

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7
Q

Avoid metoclopramide in which patietns

A
  1. Parkinsons –> risk of exacerbating symptoms
  2. Young women –> risk of dyskinesia
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8
Q

Anti-emetic choices

A

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

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9
Q

Analgesic choices:
no pain
mild pain
severe pain

A

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)

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10
Q

Analgesic choice: neuropathic pain

A

1st line: amitriptylline (10mg oral nightly)

or

Pregabalin 5mg oral 12 hourly

If painful diabetic neuropathy
–> duloxetine 60mg oral daily

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11
Q

side effects of antimuscarinic drugs

A

e.g. oxybutynin

  1. pupilary dilatation
  2. dry mouth
  3. loss of accomodation reflex
  4. tachycardia (after transient bradycardia)
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12
Q

common drugs that may worsen confusion in the elderly

A
  1. tramadol (avoid)
  2. cyclizine (can cause drowsiness)
  3. benzodiazepines
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13
Q

which antiocoagulant should not be given post stroke

A

enoxaparin due to risk of haemorrhagic transformation

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14
Q

causes of neutrophilia

A

high neutrophils

  • bacterial infection
  • tissue damage (inflammation / infarct etc)
  • steroids
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15
Q

causes of neutropenia

A

viral infection

chemotherapy

clozapine (anti-psychotics)

carbimazole (anti-thyroid)

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16
Q

how to interpret and change levothyroxine dose following tft (TSH) results

A

< 0.5 then reduce dose

0.5-5 nil action , same dose

> 5 then increase dose

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17
Q

Confusion, nausea, visual halos and arrhytmias is associated with what toxicity

A

digoxin

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18
Q

Features of lithium toxicity

A

early: tremor
Intermediate: tiredness
late: arrhytmias, seizures, coma, renal failure and diabetes insipidus

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19
Q

Features of phenytoin toxicity

A
  • gum hypertrophy
  • ataxia
  • nystagmus
  • peripheral neuropathy
  • teratogenecitiy
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20
Q

Ototoxicty and nephrotixicity is associated with which two drugs

A
  • gentamicin
  • vancomycin
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21
Q

gentamicin monitoring for divided faily dosing regimes

A

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

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22
Q

Warfarin management: major bleed

A
  1. stop warfarin
  2. give 5-10mg IV vitamin K
  3. 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

23
Q

treatment of neutropenic sepsis

A

Piperacillin with tazobactam IV, gentamicin IV and paracetamol (if pyrexic) .

24
Q

some drug causes of hyponatraemia

A

furosemide

carbamazepine

25
Q

which is the only calcium channel blocker used for treatment of AF

A
  • DILTIAZEM

avoid if presence of peripheral oedema as CCB can worsen fluid retention

26
Q

AF treatment

A

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

27
Q

Narrow complex regular tachycardia management

A
  1. vagal manouvers
  2. adenosine 6mg rapid IV bolus
  3. if unsuccessful give 12mg
  4. then further 12 mg
28
Q

irregular narrow complex tachycardia management

A
  1. BB or diltiazem

If heart failure
- digoxin or amiodarone

29
Q

Ventricular tachycardia mx

A

amiodarone 300mg IV over 20-60 mins then 900mg over 24hrs

30
Q

Anaphylaxis mx

A

ABCDE

Adrenaline 500 micrograms of 1:1000 IM

Chlorphenamine 10mg IV

Hydrocortisone 200mg IV

31
Q

bacterial meningitis in the community treatment

A

1.2g benzylpenicillin

32
Q

what is given in benzodiazepine overdose

A

flumazenil

33
Q

ramipril and pregnancy

A

ACEi teratogenic in pregnancy should be avoided

34
Q

lamotrigine side effects

A

rash

rarely: steven johnson syndrome

35
Q

carbamazepine side effects

A

rash

dysarthria

ataxia

nystagmus

reduced sodium

36
Q

phenytoin side effects

A

ataxia

peripheral neuropathy

gum hyperplasia

hepatotoxicity

37
Q

sodium valproate side effects

A

tremor

teratogenicity

weight gain

38
Q

levetiracetam side effects

A
  • fatigue
  • mood disorders
  • agitation
39
Q

treatment option for PE

A

confirmed PE

LMWH : dalteparin

or LMWH followed by oral anticoagulant (dabigatran or edoxaban)

40
Q

chronic heart failure management

A
  1. 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.

41
Q

ACEi best prescribed at what time of day

A
  • in the evening due to postural hypotension
42
Q

recap hypertension guidelines

A
43
Q

asthma acute treatment summary

A
  1. salbutamol nebs
  2. If severe or life threatening then add ipratropium bromide
  3. magnesium sulphate

prednisolone should be prescribed but won’t help acute breathlessness

44
Q

Atrial fibrillation management

A

if within 48hours: DC cardioversion

more than 48hours:
- rate control: BB or CCB

Add digoxin if not controlled w/ monotherapy

45
Q

hyperkalaemia management

A

To stabilise membrane : calcium gluconate

reduce potassium
1. 10 units of actrapid in 100mls of 20% dextrose over 30 mins IV

  1. salbutamol
  2. calcium resonium
46
Q

diabetes management

A
  1. lifestyle first
  2. metformin (if overweight)
  3. sulphonylurea (if normal or underweight )
    –> gliclazide
47
Q

when prescribing a statin what MIGHT NEED TO be checked

A

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

48
Q

what serum concentration of lithium is likely to manifest with toxic effects

A

serum concentration above 1.5

therapeutic reference range 0.4-0.8

49
Q

when taking olanzapine what measurement must be taken:

A

fasting blood glucose

hyperglycaemia and diabetes can occur in patients prescribed antipsychotic drugs

50
Q

monitoring for a patient on amiodarone

A

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.

51
Q

Recap STEMI management

A
52
Q

Recap NSTEMI management

A
53
Q

Write a prescription for one drug that is most appropriate as maintenance treatment for coronary artery spasm

A

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

54
Q
A

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