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Pass the PSA Flashcards

1
Q

What are the commonest enzyme inducers?

A

PC BRAS

Phenytoin
Carbamazepine
Barbituates
Rifampicin
Alcohol (chronic excess)
Sulphonylureas
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2
Q

What are the most common enzyme inhibitors?

A

AO DEVICES

Allopurinol
Omeprazole
Disulfaram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol (acute)
Sulphonamides
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3
Q

Which long term drug should be increased in surgery?

A

Steroids

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4
Q

Which drugs should be stopped before surgery?

A

I LACK OP

Insulin
Lithium
Anticoagulants
COCP
K sparing diuretics
Oral hypoglycaemic
Perindopril and other ACEis
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5
Q

What are the contraindications to drugs which increase bleeding?

A

Those who are bleeding
Those who might be bleeding
Those who are at risk of bleeding (e.g. liver failure)

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6
Q

Should prophylactic heparin be given to an acute ischaemic stroke patient?

A

No - because it risks bleeding into the stroke causing haemorrhagic transformation

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7
Q

What are the contraindications to steroid use?

A

Remember the side effects - STEROIDS

Stomach ulcers
Thin skin
oEdema
Right and left heart failure
Osteoporosis 
Infection
Diabetes
Syndrome of Cushing..
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8
Q

What are the contraindications to NSAID use?

A

NSAID

No urine (i.e. renal failure) 
Systolic dysfunction (heart failure)
Asthma
Indigestion
Dysgrasia (abnormal clotting)
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9
Q

What are the contraindications to antihypertensive use?

A

Hypotension
Bradycardia if beta blockers and CCB
Electrolyte disturbances if ACEi and diuretics

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10
Q

What are the side effects of ABCD antihypertensives?

A

ACEi - dry cough, angioedema
Beta blockers - wheeze, worsens acute HF
CCB - peripheral oedema, flushing
Diuretics - renal failure, (loop -> gout, K sparers -> gynaecomastia)

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11
Q

What is the maximum rate at which IV potassium can be delivered?

A

10mmol/hr

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12
Q

When might you give 5% dextrose over 0.9% saline?

A

Hypernatraemia

Hypoglycaemia

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13
Q

When would you give gelofusine over 0.9% saline?

A

If systolic BP <90

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14
Q

Which three parameters should be assessed to determine fluid response and future dosing?

A

BP
HR
Urine output

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15
Q

What is the definition of oliguria and what does it mean for the patient’s fluid balance?

A

<30ml/hr

Means they are 500ml dry

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16
Q

What fluid prescription should be given fro someone who is dehydrated with tachycardia or hypotension?

A

500ml bolus or 250 in HF

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17
Q

How much maintenance fluids do adults need?

A

3L/24hrs - 8 hourly bags

2L/24hrs if elderly - 12 hourly bags

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18
Q

How much potassium should be given daily for maintenance?

A

Provided not in renal failure
We need 40mmol/day
Therefore put 20mmol in 2 bags each day

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19
Q

What are the common antiemetic doses?

A

Cyclizine - 50mg 8 hourly IM/IV/PO
Metoclopramide - 10mg 8 hourly IM/IV/PO

Use metoclopromide over cyclizine in HF as the latter causes fluid retention

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20
Q

When should you not use metoclopramide?

A

Parkinson’s patients

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21
Q

What is a typical codeine dose for mild/moderate pain?

A

30mg up to 6 hourly oral

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22
Q

What is a typical co-codamol dose for severe pain?

A

Co-codamol 30/500, 2 tablets 6 hourly PO

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23
Q

What is the prescription for neuropathic pain?

A

Amitryptiline 10mg PO ON
Pregabalin 75mg PO 12hrly
Duloxetine 60mg PO OD

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24
Q

What effect do thiazide diuretics have on potassium levels?

A

Causes hypokalaemia

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25
Q

Other than anti-emesis, what property does cyclizine have?

A

Anti-histamine

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26
Q

What should be done for a patient on methotrexate with a UTI?

A

Withold the methotrexate (if septic) and prescribe nitrofurantoin (NOT trimethoprim)

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27
Q

Which antihypertensive commonly causes peripheral oedema?

A

CCBs

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28
Q

How would you manage a patient with bradycardia and peripheral oedema on verapamil and bisoprolol?
And why?

A

Stop the verapamil:

1) NEVER give verapamil to a patient already on beta blockers
2) CCBs cause peripheral oedema, so stop verapamil rather than adding furosemide
3) Don’t stop 2 rate controllers at the same time as it would likely cause a rebound tachy

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29
Q

What is Novomix and by which route is it administered?

A

A mixture of short and medium acting insulin given SC

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30
Q

For how long following stroke should prophylactic enoxaparin be held?

A

2 months

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31
Q

What is a typical dose of bisoprolol?

A

10mg OD PO

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32
Q

What are the causes of hypernatraemia?

A

Dehydration
Drip - excess saline?
Drugs - particularly effervescent/iv preparations

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33
Q

Which drugs might cause a thrombocytopenia?

A

Penicillamine

Heparin

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34
Q

What are causes of hypokalaemia?

A

DIRE

Drugs - Thiazides, loops
Inadequate intake/excess loss
Renal tubular acidosis
Endo - Cushings and Conns

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35
Q

What are the causes of hyperkalaemia?

A

DREAD

Drugs - ACEi, ARBs
Renal failure
Endocrine - Addison's
Artefact
DKA
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36
Q

In which type of AKI is urea raised more than creatinine is?

A

Pre-renal

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37
Q

When and how should Vitamin K be given to a warfarin patient?

A

Give as oral if INR>8 without bleeding

Give IV if any major or minor bleeding alongside PCC

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38
Q

What type of drug is Bumetanide and when is it used?

A

A loop diuretic used in patients resistant to furosemide

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39
Q

Which drugs are used for rate control in fast AF, and when would you not use each of them?

A

Bisoprolol - asthmatics
Diltiazem - fluid overload
Digoxin

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40
Q

Management of STEMI?

A 
Abcde
O2 aiming for 94-98%
300mg aspirin 
5mg IV morphine
10mg IV metoclopramide
GTN spray/tablet
Beta blockers unless brady/asthmatic/CCF
Primary PCI or Alteplase 
Transfer to CCU
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41
Q

NSTEMI management?

A 
Abcde
O2 aiming 94-98%
300mg aspirin 
5mg IV morphine 
10mg IV metoclopramide 
GTN 
Clopidogrel 300mg and LMWH
Beta blocker unless CI
CCU transfer
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42
Q

Acute heart failure management?

A 
ABCDE
Sit up
O2 aiming 94-98%
5mg IV morphine
10mg IV metoclopramide
GTN spray/tablet
Furosemide 40mg IV
Isosorbide infusion if furosemide ineffective
CPAP if above fails
CCU transfer
43
Q

Anaphylaxis management?

A 
ABCDE
O2 high flow
Remove the cause ASAP
Adrenaline 500mcg of 1:1000
10mg IV Chlorphenamine
200mg IV Hydrocortisone
Asthma Rx if wheezy
44
Q

Acute asthma management?

A 
ABCDE
100% O2
Salbutamol 5mg NEB
Hydrocortisone 100mg IV (if severe/LT), 50mg PO pred if moderate
Ipratropium 500mcg NEB
Theophyline if LT
45
Q

PE management?

A 
ABCDE
High flow O2
5mg morph 10mg meto IV
LMWH e.g. Tinzaparin SC (Rx dose)
If hypotensive -> IV gelofusine -> noradrenaline -> thrombolysis
46
Q

GI bleed management?

A 
ABCDE
15L O2
2 large bore cannulae
Catheter
Fluids (crystalloid)
Cross match 6 units
Correct clotting abnormalities (FFP or PTC if on warfarin)
Endoscopy + terlipressin + banding 
Stop aspirin, warfarin etc
Call surgeons if needed
47
Q

Bacterial meningitis management?

A 
A-E
O2
IV fluids
Dexamethasone IV
CT head -> LP
2g cefotaxime 
Conider ITU
48
Q

Status epileptics management?

A 
A-E
O2
Recovery position
Lorazepam IV/buccal midazolam
Repeat after 5 mins
Call anaesthetics
Phenytoin/phenobarbitone infusion
Rapid sequence induction (propofol/sodium thiopental)
49
Q

Acute ischaemic stroke management?

A 
A-E
Investigations - glucose, CT head
300mg Aspirin once haemorrhage excluded
Thrombolysis if <4.5hrs
Thrombectomy if <6 hours
Stroke unit transfer
50
Q

DKA management?

A

A-E
IV fluid replacement (generally bolus ->maintenance) with KCl unless anuric
Insulin IV 0.1U/kg/hr
Monitor everything
Once BM<14 - start 10% dextrose at 125ml/hr + NaCl
Continue IV insulin till patient able to eat/drink, bridge with SC insulin for 1 hour before stopping infusion

51
Q

AKI management?

A 
A-E
Cannulate and catheterise
Fluid monitoring
500ml bolus STAT
1L 4 hourly
Investigate cause and comps
52
Q

What are the components of the CHA2DS2-VASc score?

A 
Congestive heart failure
Hypertension
Age >75 (2pts)
Diabetes
Stroke/TIA (2pts)
Vascular disease
Age 65-74
Sex (female)

0 - 75 aspirin OD
1 - aspirin or warfarin
2 or more - Warfarin (target INR 2.5)

53
Q

Chronic asthma mangagement protocol?

A
  1. SABA PRN
  2. Add 400mcg steroid INH
  3. Add LABA, assess response and adjust dose, if no response -> stop and up steroid dose
  4. Consider LTRA or upping steroid dose further
  5. Steroid tablets
54
Q

Name one of each of the following:

Stool softener
Bulking agent
Stimulant laxative
Osmotic laxative

A

Stool softener - Docusate sodium
Bulking agent - Isphagula husk
Stimulant laxative - Senna, Bisacodyl
Osmotic laxative - Lactulose, phosphate enema

55
Q

What is the first line management of PD?

A

Co-careldopa (Levodopa + dopa decarboxylase inhibitor

56
Q

What might be used instead of co-careldopa in first line management of mild PD?

A

Dopamine agonist e.g. Ropinirole

MAO-A inhibitors - Rasgiline

57
Q

What are the side effects of Lamotrigine?

A

Rash

Sometimes SJS

58
Q

What are the side effects of Carbamazepine?

A 
Rash
Hyponatraemia
Dyarthria
Ataxia
Nystagmus
59
Q

What are the side effects of Phenytoin?

A

Peripheral neuropathy
Gum hypertrophy
Hepatotoxicity
Ataxia

60
Q

What ar the side effects of valproate?

A

Tremor
Teratogenicity
Weight gain

61
Q

How would you induce remission in a mild and severe Crohns flare?

A

Mild - 30mg PO Prednisolone

Severe - 100mg IV Hydrocortisone

62
Q

How would you maintain remission in Crohns?

A

Azathioprine or 6-mercaptopurine

Check TPMT first

63
Q

What is the management of rheumatoid arthritis?

A

Start Methotrexate and a DMARD (sulfasalazine/hydroxychloroquine) ASAP
During a flare:
Short term IM methylpred
Short term Ibuprofen with lansoprasole

64
Q

Aside from being a sedating antihistamine used as an antiemetic, what other side effects might cyclizine cause?

A

Anti-muscarinics (urine retention, constipation, dry mouth etc)

65
Q

What is hydroxycobalamin used for?

A

B12 deficiency

66
Q

Which two anti-emetics are not safe for use in PD?

A

Metoclopramide

Haloperidol

67
Q

Which antiemetic does not cross the BBB, and is those particularly safe in PD?

A

Domperidone

68
Q

Which anti-diabetic drug confers risk of lactic acidosis?

A

Metformin

69
Q

Do sulphonylureas (e.g. gliclazide) confer risk of hypoglycaemic episodes?

A

Yes

70
Q

How frequently is methotrexate taken by RA patients?

A

Weekly

71
Q

What medication should be co-prescribed with methotrexate?

A

Folic acid

72
Q

What should be done on commencement of steroid therapy in someone likely to be on the medication for more than 3 months?

A

Co-prescribe bisphosphonates due to osteoporosis risk

73
Q

How much of a drug in 1% solution is in:
100ml
1ml

A 
100ml = 1g
1ml = 10mg
74
Q

What is the treatment dose of Dalteparin and Enoxaparin?

A 
Dalteparin = 15000 units
Enoxaparin = 12000 units
75
Q

What is the starting dose of Ramipril for symptomatic HF?

A

1.25mg

76
Q

What time of day should ACEi be taken?

A

18:00 (ON)

77
Q

What is the prescription for insulin in hyperkalaemia?

A

Actrapid
IV
10 units in 100ml of 5% dextrose over 30 mins

78
Q

What must you measure before starting a patient on vancomycin and why?

A

UnE (Cr clearance) - as vancomycin is renally excreted

79
Q

Which blood test should be done before starting a patient on a statin?

A

LFT - statins are metabolised by the liver.

80
Q

What blood tests must be done before starting methotrexate?

A

FBC
LFT
UnE
HcG

81
Q

WHat is a contraindication to methotrexate use (other than pregnancy)

A

Deranged LFTs due to risk of cirrhosis

82
Q

What effect does sodium depletion have on lithium levels?

A

Causes them to rise.

83
Q

What should be monitored in patients on digoxin?

A

UnEs/serum Creatinine

84
Q

Common ADRs to Gentamicin and Vancomycin?

A

Nephrotoxicity

Ototoxicity

85
Q

Common ADRs to all antibiotics?

A

C dif colitis

86
Q

Common ADRs to ACEis>

A

Hyperkalaemia
Dry cough
Hypotension

87
Q

Common ADRs to B blockers

A

Bradycardia
Wheeze in asthmatics
Worsens acute heart failure
Fatigue

88
Q

Common ADRs to CCBs?

A

Peripheral oedema
FLushing
Bradycardia

89
Q

Common ADRs to heparin?

A

Haemorrhage

Thrombocytopaenia

90
Q

Common ADRs to warfarin?

A

Haemorrhage

91
Q

Common ADRs to aspirin?

A

Haemorrhage

Gastritis/PUD

92
Q

Common ADRs to digoxin?

A

N/V/D

Blurred vision

93
Q

Common ADRs to amiodarone?

A

Interstitial lung disease
Thyroid disease
Grey skin
Thrombophlebitis

94
Q

Common ADRs to Lithium?

A

Early tremor
Intermediate tiredness
Late arrhythmias, seizures, coma, renal failure, DI

95
Q

Common ADRs to haloperidol?

A

Dyskinesia

96
Q

Common ADRs to Dex and Pred?

A

STEROIDS

Stomach ulcers
Thin skin
Edema
Right and left HF
Osteoporosis
Infection
Diabetes
Syndrome of Cushing
97
Q

Common ADRs to statins?

A

Myalgia
Abdo pain
LFT derangement
Rhabdomyolysis

98
Q

What class of drug is amiloride, and what biochemical side effect does it commonly have?

A

Potassium sparing diuretic commonly associated with Hyperkalaemia

99
Q

What should be given to a conscious and alert patient who is hypoglycaemic?

A

10-20g of glucose

100
Q

Which of the following drugs should be stopped before surgery?

Metformin
Microgynon
Enoxaparin
Aspirin
Bisoprolol
Novomix 30
Paracetamol
Lansoprazole
A 
Metformin
Microgynon
Enoxaparin
Aspirin
Novomix
101
Q

By how much should steroids be increased in long term users who are acutely unwell?

A

Double the dose

102
Q

What drug would you give for the immediate relief of dyspepsia?

A

10ml PO Magnesium carbonate (antacid)

103
Q

What is the main contraindication to lactulose use?

A

Bloating

104
Q

What is the first line management of GAD?

A

Citalopram NOT Propranolol

Other Finals Decks (3 decks)

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