Pass the PSA book notes Flashcards
Which common drugs are enzyme inducers?
PC BRAS: Phenytoin Carbamazepine Barbituates Rifampacin Alcohol Sulphonylureas
Which common drugs are enzyme inhibitors?
AO DEVICES: Allopurinol Omeprazole Disulfiram Erythromycin Valporate Isoniazid Ciprofloxacin Ethanol Sulphonamide
Which common drugs should be stopped before surgery?
I LACK OP
Insulin Lithium Anticoagulants COCP/ HRT K-sparing diuretics Oral hypoglycaemics Perindopril and other ACE-i
What are the rules regarding long term steroid therapy and surgery?
Patients on long term steroid therapy often have adrenal atrophy so therefore are unable to mount the physiological stress response to surgery leading to hypotension
Steroid dose should be doubled (as with ‘sick day rules’). At induction, patients should be given IV steroids to prevent hypotension
What happens if warfarin and erythromycin are taken together?
Erythromycin is an enzyme inhibitor -> increased levels of warfarin -> increased INR -> increased bleeding
What are the common side effects of steroids?
STEROIDS
Stomach ulcers Thick skin Edema Right and left heart heart failure Osteoporosis Infection Diabetes Syndrome (of Cushing)
What are the common side effects of NSAIDs?
NSAID
No urine (renal failure) Systolic dysfunction (heart failure) Asthma exacerbation Indigestion (stomach ulcers) Dyscrasia (clotting abnormality)
What are the common side effects of ACE-i?
Dry cough
Hypotension
Hyperkalaemia
What are the common side effects of beta-blockers?
Wheeze in asthmatics
Bradycardia
Hypotension
Worsening of acute heart failure (but helps chronic HF)
What are the common side effects of CCBs?
Hypotension
Bradycardia
Peripheral oedema
Flushing
When should a patient be prescribed an alternative to 0.9% saline? (3 reasons)
- If they are hypernatraemic or hypoglycaemic (when 5% dextrose should be given instead)
- If they have ascites. Human albumin solution (HAS) should be given instead
- If shocked from bleeding- a crystalloid such as blood should be given instead. If none available, do not delay and administer a bolus of saline anyway.
What is the maximum rate at which IV K+ should be given?
10mmol/ hour (can be given higher by the pros)
How much fluid should be prescribed in someone who is tachycardic or hypotensive?
500ml bolus immediately (250ml if HF)
How much fluid should be prescribed in someone who is oligouric (not due to obstruction)?
1L over 2 hours and then assess
What are the general rules regarding maintenance fluids?
An adult needs 3L of fluid a day, the elderly require 2L
2 sweet, 1 salty
1mmol/kg/day of K+, Na+, Cl-
50-100g of glucose/day
Which antiemetic should be avoided in parkinsons disease?
Metoclopramide
What are the 3 first line treatments for neuropathic pain?
Amitriptyline
Pregablin
Duloxetine
3 causes for hypernatraemia?
3 Ds
Dehydration
Diabetes insipidus
Drugs- effervescent tablet preparations
Causes of microcytic anaemia?
Iron deficiency
Thalassaemia
Sideroblastic anaemia
Causes of normocytic anaemia?
Anaemia of chronic disease
Acute blood loss
Haemolytic anaemia
Renal failure (chronic)
Causes of macrocytic anaemia?
B12 folate deficiency
Excess alcohol
Liver disease
Hypothyroidism
Causes of hypokalaemia?
DIRE
Drugs (loop and thiazide diuretics)
Inadequate intake/ intestinal loss (diarrhoea/ vomiting)
Renal tubular acidosis
Endocrine (cushings, conns)
Causes of hyperkalaemia?
DREAD
Drugs (potassium sparing diuretics) Renal failure Endocrine Artefact (clotted) DKA
What are the causes for raised Alk phos?
ALK PPHOS
Any fracture Liver damage Kancer Pagets disease of bone Pregnancy Hyperparathyroidism Osteomalacia Surgery