Pass the PSA Mocks Flashcards
anticoag and metform pre surgery
Stop all anticoagulants pre surgery, stop metformin day of surgery
max daily alendronate
10mg
paracetamol and cocodamol combo OD - how to change?
stop paracetamol if combo OD and leave co-codamol as stronger.
crucial step in checking for prescribing errors
Be alarmed if you see any ‘grams’ in units – uncommon and usually massive OD. Check all dose units.
another ACEx side effect
can be dizziness
watch aspirin dosing
Watch for aspirin dosing – only 300mg for short periods in stroke / MI, then should be moved down to 75mg.
co codamol dosign
Max co codamol paracetamol dose is 2 tabs QDS (as 500mg in each co-codamol tab)
aspirin doesn’t cause this unlike other NSAIDs
Aspirin doesn’t cause renal failure
drowsy pt stop some drugs
obviously stop any benzos but also If drowsy, stop any opioids including codeine!
warfarin induced OD
Don’t stop warfarin on induced OD, stop the interactant (commonly erythromicin)
pre op alteratioins on bb, ccb, aspirin
Avoid altering beta blockers or calcium blockers pre-op. stop antiplatelets like aspirin.
common trick in Qs about prescribing erros
Watch out for mg/g units being wrong either way! Common trick!
lithium toxicity possible trigger
Lithium excretion much reduced by ACEx, thiazides, and NSAIDs i.e. kidney toxics – can lead to toxic!
changing thyroxine doses
Only change levothyroxine in 25mcg increments eitherway
if unfamiliar with normal dosing for a drug, check what?
Check MAX doses if unfamiliar with it
fluid balance Qs
With FLUID balance questions, match input to output! Look at U/O and oral intake and match.
increasing dosing how
Always increase dosing by smallest possible increment, esp with narrow range e.g. phenytoin
sodium already low, what drugs to avoid?
Do not start SIADH risky drugs i.e. carbamazepine in patients with already low sodium
normal pt no electro probs what bag of fluid when NBM
If given a ‘normal’ patient NBM and no electrolyte info, give standard 8hr 1 L normal saline +20KCl
pen allergic - carbapanems?
There is 10% cross reactivity with carbapanems with penicillin allergic patients.
first step acute Qs
When asked what to do first acutely, always follow ABCDE order as usual
kidney disease T2DM and tried lifestyle
. SU drugs 1st line if kidney disease and type 2 diabetes + tried lifestyle change.
COPD stable obs
Start on 24% venturi COPD if stable obs
fluid deplete
Fluid – check over what time, picture real life – STAT needed in acutely deplete pts
ACEx angio oedema
Angio-oedema withACEx occurs slowly, months later
ACEx test renal function
Test renal 2 wks post starting ACEx.
statins info warnings
Statins are taken at night. stop statins alongside clarythromicin. Don’t drink grapefruit juice ‘dietary restriction’.
antipsychotics starting thing
Antipsychotics – need starting ECG and baseline bloods+lipids. Recheck lipids 3monthly, gluc 6mo.
unwell but on ISupp
Immunosuppresants are stopped during illness e.g. UTI and methotrexate
steroid sick day rules
Sick day rules steroids – double the normal daily dose for duration of illness!
if long term steroids
1% solution is what you foolish papaladoop?
A 1% solution contains 1 g in 100 mL.
Thus there are 10 mg in 1 mL. !!! YOU KEEP FORGETTING THIS. JUST USE YOUR MATHS BRAIN FFS LOL.
deciding on codeine vs tramadol
Tramadol can cause agitation / hallucination in the elderly, codeine produces constipation – weigh these risks up based on pt profile i.e. bowels.
pen allergic and on methotrexate
Nitrofurantoin for UTI in pen allergic patients on methotrexate.
pneumonia HAP
Pneumnia guidelinles – HAP – tazocin first.
laxative broad contraindications
No lactulose if bloated! No stimulants if cramping or colitis.
codeine starting dose
Codeine start at 30mg 6 hourly. (don’t leap straight to morphine!!!)
indigestion
Indigetion – magnesium carbonate 10ml.
kidney impaired ACEx may show as what?
kidney impairment and ACEx may present as malaise!
facial flushing anti HTN
Amlodipine can cause facial flushing
enox needs these pre starting
Enoxaparin need minimum eGFR of 30 and minimum weight 50kg
rv paracetamol dose with
adult <50kg
AKI approach
With deviated electrolytes and acute kidney injury, focus on removing the nephrotoxics rather than on the electrolytes too much (unless massive deviation)
if unsure what’s gone wrong
If unsure, always double check dosese – esp old people, e.g. citalopram dose is lower in over 65s
Hb levels for transfusion
Low Hb -> only transfuse if severely sympto and Hb <70. If IHD be more careful even if Hb higher. Better option is ferrous sulphate which increases by 10 a week the Hb
ferrous sulphate
Better option is ferrous sulphate which increases by 10 a week the Hb
acute anxiolytic
If asked for acute anxiolytic, given diazepam or beta blocker.
sodium valproate starting
Sodium valproate – need LFTs to start, don’t routinely check vit D baseline.
on steroids, wcc high
Remember steroids can cause leucocytosis (high WCC – check other markers to exclude infection)
adjusting dosing with patient in mind
Always adjust dosing vs your own patient not the normal range – i.e. with phenytoin if getting gum changes and dysrarthira then reduce dose if in range and no seizures. #
hypotensive bleeding patient
In a bleeding Q asking about ‘first step’ and pt is hypotensive – stat saline first, then transfuse! Remember ABCDE approach
FFP given when
FFP given only if PT 1.5 x normal limits
v low glucose and cannula in
100ml 20% glucose IV if severe hypoglyc and IV access
severe UC flare
Severe UC flar >6 motions a day and systemic upset – thus IV hydrocort/fluids
milder UC flare
If milder flare, give 30mg pred OD PO.
approach with cal gluconate and hyperkal
Repeat calcium gluconate 10% every 15 mins up to 50ml total until ECG stable in hyperkal.
AF there longer than 48 hrs, check the Q details!!
If AF there for 48 hrs+, then resort to other drugs not cardioverting agents.
asthmatic with AF
Use digoxin in ashmatics with AF
warfarin bleeding first step always
If haemo stable, reversing warfarin most important step in bleeding pt, not transfusing.
rotate insulin injection site
Rotate insulin site or get lipodystrophy and variable insulin absorption.
excess alcohol young type 1 DM
Excess alcohol is high risk for HYPOlycaemia in young diabetic adults.
monitor this when giving phenytoin
IV phenytoin needs ECG monitor as assoc with arrythmias.
monitoring aminophylline
Even for aminophylline, you take a theophylline level to monitor.
best markerk for abx clearing chest inf
Best marker abx for CAP working – oxygen sats/ABG then resp rate
on fluoxetine and new rash
If new rash with fluoxetine, discontinue as may be first sign of systemic reaction
adverse effects of COCP
Adverse COCP affects- weight gain, irritability, new headaches +/- HTN
m gravis with incontinence CAUTION
M gravis can’t have anticholinergics – esp relevant in bladder incontinence – give duloxetine.
