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1
Q

Enzyme inducers - mnemonic

A

PC BRAS

Phenytoin, Carbamazepine, Barbituates, Rifampicin, Alcohol, Sulphonylureas

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2
Q

Enzyme Inhibitors - mnemonic

A

AODEVICES

Allopurinol, Omprazole, Disulfiram, Erythromycin, Valproate, Isoniazid, Ciprofloxacin, Ethanol (acute), Sulphonamides

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3
Q

Drugs To stop before surgery - mnemonic

A

I LACK OA

Insulin, Lithium (day before), Anticoag/plt, COCP/HTR (4/52 before), ACEi and K sparing diuretics (day of)

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4
Q

CI to NSAIDs - mnemonic

A 
NSAID 
No urine
Systolic dysfunction
Asthma
Indigestion
Dyscrasia (clotting abnormality)
* Aspirin although NSAID, is not CI in RF, HR, asthma
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5
Q

Fluid replacement: which fluid?

A

All pts 0.9% saline unless:
Hypernatreamia or hypoglycaemia - use 5% dextrose
Ascites - use human albumin solution (HAS, in saline high Na content will worsen ascites)
Shocked - gelofusine (colloid)
Bleeding - like for like but colloid first if no blood available

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6
Q

Principles of fluid replacement

A

Start by assessing HR, BP, UO
If tachycardic/hypotensive = 500ml STAT (250ml if HF) then reassess
If only oliguric w/o obstruction = 1L / 2-4hrs and reassess
Reduced UO = 500ml depletion
Reduced UO + tachycardia = 1L depletion
Reduced UO + tachy + hypo = 2L depletion
Do not prescribe >2L at once, needs to be reassessed

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7
Q

Principles of fluid maintenance

A

Adults = 3L fluid (8h bag); Elderly 2L fluid (12h bag)
1 salt 2 sweet = 1L saline and 2L 5% dextrose for daily
K = 40mmol/day, so put 20mmol at a time into bad (max rate 10mmol/h)
Reassess OU, overload, obstruction

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8
Q

CI to DVT prophylaxis

A

Majority of pts LMWH and TED stockings
Recent ischaemic stroke - no blood thinning for 2 months
Peripheral arterial disease - no TED

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9
Q

When to avoid metoclopramide?

A 
PD patients (it is Da antagonist), will exacerbate symptoms (domperidone is also Da antagonist but does not cross BBB so more safe)
Young women, risk of dyskinesia (esp acute dystonia)
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10
Q

Antiemetic choices - first line

A

Cyclizine 50mg TDS IV/IM/PO but causes fluid retention

Metoclopramide 10mg up to TDS if HF

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11
Q

Pain relief - example

A

WHO ladder
Paracetamol 1g up to QDS ± Codeine 30mg up to QDS ± Morphine sulphate 10mg up to QDS (usually Oromorph 10mg/5ml)
Neuropathic pain = amitryptilline 10mg PO nightly or pregabalin 75mg BD
Diabetic neuropathy = duloxetine 60mg PO OD

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12
Q

Causes of thrombocytopenia

A
  1. Reduced production (infection esp viral, penicillamine in RA pt, myelodysplasia, myelofibrosis, myeloma)
  2. Increased destruction (heparin, hypersplenism, DIC, ITP, HUS, TTP
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13
Q

Causes of hyponatraemia

A
  1. Hypovolaemic (fluid loss esp D&V, addison’s, diuretics)
  2. Euvolaemic (SIADH, psychogenic polydipsia, hypothyroid)
  3. Hypervolaemic (HF, RF, low albumin, hypothyroid(
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14
Q

Causes of SIADH - mnemonic

A 
SIADH
SCLC
Infection
Abscess
Drugs (carbamazepine and antipsychotics)
Head injury
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15
Q

Causes of Hypokalaemia - mnemonic

A 
DIRE
Drugs (loop and thiazide diuretics)
Inadequate intake / loss (D&V)
RTA
Endocrine (cushing's and conn's)
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16
Q

Causes of Hyperkalaemia - mnemonic

A 
DREAD
Drugs - K sparing diuretics and ACEi
Endocrine - addison's
Artefact (clotted sample)
DKA
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17
Q

Raised urea indicates?

A

AKI or Upper GI haemorrhage

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18
Q

Types and causes of AKI

A

Pre-renal (70%): dehydration, sepsis, blood loss, RAS)
Intrinsic (10%): ATN 2* to pre-renal AKI, ACEi, NSAIDs, contrast, rhabdomyolysis, gout, vasculitis, glomerulonephritis, gentamycin, vancomycin, tetracyclines)
Post-renal (20%): obstruction

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19
Q

Drug toxicity: Digoxin

A

Confusion, nausea, visual halos and arrythmias

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20
Q

Drug toxicity: Lithium

A

Tremor, tiredness, arrythmias, seizures, coma, RF, DI

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21
Q

Drug toxicity: Phenytoin

A

Gum hypertrophy, ataxia, nystagmnus, peripheral neuropathy, teratogenicity

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22
Q

Drug toxicity: Gentamicin

A

Ototoxicity and nephrotoxicity

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23
Q

Drug toxicity: Vancomycin

A

Ototoxicity and nephrotoxicity

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24
Q

Common drugs requiring monitoring

A

Digoxin, theophylline, lithium, phenytoin, gentamycin, vancomycin, warfarin, clozapine

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25
Q

Drug causes: thrombocytopenia

A

Penicillamine (RA, wilson’s)

Heparin

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26
Q

Drug SE: cholestasis

A

Flucloxacillin, co-amoxiclav, nitrofurantoin, sulphonylureas

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27
Q

Drug SE: AKI

A

ACEi; NSAIDs; gentamycin, vancomycin, tetracyclines

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28
Q

Drug SE: hypokalaemia

A

Loop and thiazide diuretics

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29
Q

Drug SE: hyperkalaemia

A

K sparing diuretics and ACEi

30
Q

Drug SE: neutropenia

A

Clozapine

Carbimazole (antithyroid)

31
Q

Drug interactions: Methotrexate and trimethoprim

A

Both folate antagonists with risk of bone marrow toxicity, leading to pancytopenia and neutropenic sepsis

32
Q

Drug interactions: Verapamil and B blockers

A

Risk of bradycardia and systole and hypotension.

33
Q

Warfarin: high INR and bleed

A

Stop warfarin
5-10mg IV vikamin K
Prothrombin complex (e.g. Beriplex)

34
Q

How to manage high INR in warfarin

A

<6 reduce warfarin dose
6-8 omit for 2 days then reduce dose
>8 omit and give 1-5mg oral vit K
* If bleeding give 5-10mg IV vit K

35
Q

What is a common regimen for neutropenic sepsis

A

IV piperacillin with tazobactam and gentamycin

36
Q

1st line management of PD

A

Levodopa + Carbidopa (peripheral dopa decarboxylase inhibitor)
Known as Co-careldopa

37
Q

Epilepsy 1st line management depending on seizure type and SE

A

Grand mal - Na Valproate (SE teratogenic, tremor, weight gain)
Absence - Na Valproate
Myoclonic - Na Valproate
Tonic - Na Valproate
Focal - carbamazepine (SE rash, ataxia, nystagmus, hyponatraemia / lamotrigine (SE rash, SJS syndrome)
Phenytoin SE ataxia, peripheral neuropathy, gum hyperplasia, hepatotoxicity

38
Q

Crohn’s disease - inducing remission

A

Prednisolone 30mg OD PO

If severe hydrocortisone 100mg QDS IV + supporting care (±rectal roids)

39
Q

What to check before starting azathioprine?

A

TMPT (10% population)

40
Q

RA - treatment

A

Methotrexate + One DMARD (sulfasalazine or hydroxychloroquine)
Flare: Short term roids IM methylprednisolone 80mg + NSAIDS & PPI

41
Q

Insomnia on ward

A

Review meds - e.g. pred should only be given at night

Zopiclone 7.5mg oral nightly in adults (3.75mg nightly in elderly)

42
Q

Principles of COPD management

A
  1. SAMA or SABA PRN
  2. 1 If FEV1 >50% = LABA / LAMA
  3. 2 If FEV1 <50% = LABA+ICS / LAMA
  4. LAMA & ICS+LABA
43
Q

Management of TIIDM: general principles

A
  1. Education and diet/exercise advice
  2. CV risk management: Aspirin 75mg and Simvastatin 20-40mg OD
  3. Annual review of complications: ACR (diabetic nephropathy), Opthal review, HTN
  4. Metformin 500mg PO with breakfast (but if not overweight gliclazdie 40mg with breakfast)
  5. Increase to max tolerated dose
  6. Add gliclazide or if already on gliptin (DPP-4i e.g. sitagliptin)
  7. Insulin
44
Q

Principles of asthma management

A
  1. SABA PRN
    • ICS 200-800 ug/d
    • LABA (and assess for response, if none increase ICS to 800, if still poor ?leukotriene antagonist or SR theophylline)
  4. ICS to max of 2mg/d ± oral B agonist / theophylline / leukotriene r antagonist
  5. Oral steroid in lowest effective form (specialist)
45
Q

CHA2DS2Vasc score

A 
CCF 
HTN
Age >75 (2pnt)
DM
Stroke/TIA Hx (2pnt)
Vascular disease (IHD/PVD) 
Age 65-75
Sex (F)
If 0 = aspirin 75mg
If 1 = aspirin / warfarin INR 2-3
If 2+ = warfarin INR 2-3
46
Q

AF rhythm control - why and how?

A

Young / symptomatic / first episode / due to treated precipitant (e.g. sepsis or electrolyte)
Cardioversion - DC or pharmacological (amiodarone 5mg/kg IV over 20-120 min + anticoagulation

47
Q

AF rate control - why and how?

A

Everyone not for rhythm control with HR >90

  1. B block or CCB (e.g. diltiazem 120 mg OD) Verapamil + B block = brady
  2. If CI or needed, add digoxin. Load then start 62.5-125 ug/d
48
Q

Principles of management of stable angina

A
  1. GTN spray PRN; RF modification
  2. Depending on CI either BB or CCB (amlodipine/diltiazem)
  3. Increase as tolerated
  4. Add other from 2. or if CI long acting nitrate (isosorbide mononitrate) or K channel activator e.g. nicorandil
  5. PCI / CABG
49
Q

Principles of management: HTN

A

Ambulatory / at home BP measurements to confirm
Treat if >150/95 or if 135/85 when IDH, PVD, CRD
Target <140/85 or <135/85 at home
1. ACEi if <55. If black or >55 use CCB
2. Add other
3. Add thiazide
4. Alpha or beta block or further diuretic. Expert advice

50
Q

Principles of management: chronic HF

A

ACEi (e.g. lisinopril 2.5mg OD + B blocker (e.g. bisoprolol 1.25mg OD)
Increase as tolerated
Add ARB (if mild); Add hydralazine 25mg TDS and isosorbide mononitrate 20mg 8 hourly if black; Add spronolactone / epleranone in other pts

51
Q

Principles of management: STEMI

A 
ABCDE + 15L O2
Aspirin 300mg PO
Morphine 10mg IV + Metoclopramide 10mg IV
GTN spray / tablet 
PCI
B block 
CCU
52
Q

Principles of management: NSTEMI

A

ABCDE + 15L O2
Aspirin 300mg PO
Morphine 10mg IV + Metoclopramide 10mg IV
GTN spray / tablet
Clopidogrel 300mg PO and LMWH (e.g. enoxaparin 1mg/kg bd SC)
B block
CCU

53
Q

Principles of management: LVF

A

ABCDE + 15L O2
Aspirin 300mg PO
Morphine 10mg IV + Metoclopramide 10mg IV
GTN spray / tablet
Furosemide 40-80mg IV
If inadequate response isosorbide denigrate infusion ± CPAP
CCU

54
Q

Principles of management: Anaphylaxis

A 
ABCDE + 15L O2
Remove cause (e.g. blood transfusion)
Adrenaline 500ug 1:1000 IM
Chlorphenamine 10mg IV
Hydrocortisone 200mg IV
If wheeze Tx as for asthma)
Drug chart allergies box
55
Q

Principles of management: GI bleeding

A 
ABCDE + 15L O2
IV access + catheter
Colloid (gelofuscine)
CX 6 units
Stop NSAIDs, aspirin, warfarin, heparin
Correct clotting abnormalities
Endoscopy
56
Q

Osmolality equation

A

2 x (Na + K) + urea + glucose

57
Q

Managing constipation

A
  1. Stool softener: docusate sodium, arachis oil PR (CI nut allergy). For faecal impaction
  2. Bulking agent: isphagula husk. CI stool impaction, colonic atony. Works over days
  3. Stimulant: Senna / bisacodyl. CI acute abdomen, exacerbates cramps
  4. Osmotic: Lactulose, phosphate enema. CI acute abdomen, exacerbates bloating
58
Q

Methotrexate - route, frequency and monitoring

A

Non non oncological reasons 1 a week.
If more regular = risk of neutropenia and other SE
Folic acid co-prescribed
Initially monitor 1-2 weekly until stable

59
Q

Warfarin colouring

A 
White = 0.5mg
Brown = 1mg
Blue = 3mg
Pink = 5mg
60
Q

What should be started alongside oral steroids >3mo

A

Bisphosphonates (bone protection), esp try in elderly

61
Q

What does 1% mean (e.g. 1% lignocaine)

A

1g in 100ml (or 10mg/ml) for weight:volume

1g in 100g for weight:weight

62
Q

Drug SE: ACEi

A

Hypotension, electrolyte, AKI, dry cough

63
Q

Drug SE: BB

A

Hypotension, bradycardia, Ex Asthma, worsen AHF (but good for CHF)

64
Q

Drug SE: CCB

A

Hypotension, bradycardia, peripheral oedema, flushing

65
Q

Drug SE: Heparin

A

Haemorrhage (esp RF or <50kg), heparin induced thrombocytopenia

66
Q

Why must warfarin be co-prescribed with heparin?

A

Targets fit K dépendant factors. Initially lowers protein C and S therefore procoagulant in first few days. Cover with LMWH until INR >2

67
Q

What is the relationship between digoxin and K

A

Competes with K at myocyte Na/K/ATPase, limiting Na influx. Since Ca outflow relies on Na inflow = ++ Ca in cells = lengthens AP and slows HR.
Low K augments digoxin effect; high K limits effect

68
Q

Drug SE: amiodarone

A

IPF, thyroid disease (both hyper and hypo, chemically similar to iodine hence amIODarone), skin greying, corneal deposits.

69
Q

Drug SE: simvastatin

A

Myalgia, abdo pain, increased ALT/AST, rhabdomyolysis (measure CK)

70
Q

Drugs with potent interaction with alcohol

A

GI bleeding: NSAIDS
Increased anticoagulation: warfarin (acute alcohol, chronic = pro coagulation)
Sweating, flushing, N&V (bad hangover): metronidazole and disulfiram
Sedation: barbituates, opiods, benzos
Lactic acidosis: metformin
Hypertensive crisis: MOA inhibitors

71
Q

What is a common precipitant of gout?

A

Bendroflumethizide and other thiazide diuretics

72
Q

What to give for acute dystonia

A

SE typical antipsychotics - procyclidine

Will act against antiDa effects on basal ganglia

Final Prep (19 decks)

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