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Learning from Mistakes > Pass the PSA RT > Flashcards

Pass the PSA RT Flashcards

1
Q

list the CYP450 drug inducers and their effect

A

decrease effective drug level

: Phenytoin, Carbamazepine, Barbiturates, Rifampicin, Alcohol (chronic excess), Sulphonylureas

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2
Q

CYP450 inhibitors and their effects

A

increase the effective drug level

: Allopurinol, Omeprazole, Disulfarim, Erythromycin, Valproate, Isoniazid, Ciprofloxacin, Ethanol (acute intoxication), Sulphonamides.

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3
Q

list drugs to be stopped before surgery

A

Insulin, Lithium, Anticoagulants, Antiplatelets, COCP/HRT, K / potassium sparing diuretics, Oral hypoglycaemics, ACEx / ARB
COCP stopped 4 weeks before. Lithium one day before. Diuretics/ACEx day of surgery.

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4
Q

COCP and surgery

A

stop 4 weeks before, start 2 weeks ater

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5
Q

lithium and surgery

A

stop one day before

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6
Q

common drugs metabolised by CYP450 and thus at risk of interactions with other drugs

A 
warfarin
COCP
theophylline
steroids
tricyclics
pethidine
statins
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7
Q

prescribing routine

A 
Patient details
Reaction / allergies
Sign chart
Check contraindications
Check route for each drug
Prescibe intravenous fluids if needed
Prescribe VTE prophylaxis if needed
Prescribe anti-emetic if needed
Prescribe analgesia if needed
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8
Q

pro bleeding drugs, stop if bleeding risk/bleeding

A

PRO-BLEEDING DRUGS – aspirin, ‘parins, warfarins, DOACs -> stop if active bleeding or risk of bleed

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9
Q

steroid side effects

A

stomach ulcers, thin skin, oedema, heart failure, osteoporosis, infection, diabetes, Cushing’s syndrome

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10
Q

NSAIDs side effects

A

– renal failure, heart failure, asthma, indigestion, clotting abnormalities (aspirin is okay in renal and heart failure and asthma)

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11
Q

beta blockers, calantag risks

A

– low blood pressure, bradycardia

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12
Q

electrolyte disturbance

A

ACEx, diuretics

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13
Q

ACEx side effect

A

cough

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14
Q

beta blockers and asthma

A

worsen acute HF/wheeze

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15
Q

calcium channel blockers side effects

A

peripheral oedema, flushing

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16
Q

diuretics side effect

A

renal failure

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17
Q

spironolactone side effects

A

high potassium, gynaecomastia

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18
Q

furosemide side effect

A

GOUT

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19
Q

meds with NBM patients

A

still receive oral drugs

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20
Q

antiemetic dosing

A

Antiemetics don’t change dose regardless of the route e.g. cyclizine 50mg 8 hourly, metaclopramide 10mg 8 hourly

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21
Q

max IV potassium rate

A

Don’t give IV potassium at more than 10mmol/hour ever.

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22
Q

describe process for prescribing replacement fluids

A

Replacement: give 0.9% saline unless:

  • Sodium high or sugar low -> give 5% dextrose
  • They have ascites -> give human-albumin solution instead (saline will worsen)
  • Very low systolic blood pressure <90mmHg (try colloids as stays in vasc space)
  • Shocked from bleeding -> give blood
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23
Q

speed of replacement fluids

A
  • If shocked (obs off) -> 500ml stat and reassess obs + UO

- If oliguric -> 1L over 2-4 hours with careful monitoring of obs + UO response

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24
Q

how to estimate how fluid deplete someone is

A

500ml if UO alone reduced, 1L if UO reduced and tachy, 2L if signs of shock and low UO

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25
Q

example of standard adult maintenance fluids regime

A

Adults – 3L total / 24hr, Elderly – 2L total / 24 hr 8 hourly bags adult, 12 hourly elderly
Standard regime of 1L saline, 2L 5% dextrose provides adequate levels of most things
Add 20mmol of KCl in two of the bags (need 40mmol per day) – but be led by U+Es!

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26
Q

what should be done before each bag of fluids?

A

reasses pt

fluid status
palpate bladder
U+Es

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27
Q

contraindication compression stockings

A

peripheral vascular disease

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28
Q

what not to give if recent ischaemic stroke

A

Don’t give heparin or warfarin to recent ischaemic stroke

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29
Q

choice of antiemetic

A
  • cyclizine is a good choice in almost all cases, except cardiac, give metaclop then.
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30
Q

who to avoid metaclopramide in?

A

Avoid metoclopramide in Parkinson’s or young women (dyskinesia risk)

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31
Q

paracetamol prescribing

A

no more than 4 grams a day, check not OD through co-presc co-codamol, PRN.

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32
Q

prescribing regular pain relief exmples

A
  • paracetamol 1 g 6hourly OR co-codamol 30/500 2 tablets 6 hourly
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33
Q

pain relief PRN prescribing standard regimes

A

paracetamol 1g 6 hourly, codeine 30mg 6 hourly, MST 10mg 6 hourly, ibuprofen 400mg 8 hourly

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34
Q

prescribing for neuropathic pain

A

pregabalin 75mg 12 hourly, duloxetine specifically for diabetic neuropathy pain

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35
Q

drugs that can cause low potassium

A

thiazides, loop diuretics (NB all diuretics cause low sodium)

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36
Q

drugs that can cause high potassium

A

ACE inhibitors, spironolactone (potassium, sparing diuretics)

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37
Q

drugs that can trigger indigestion/uclers

A
  • ibuprofen / NSAIDs, oral steroids
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38
Q

common drugs that trigger AKI

A

NSAIDs, ACE inhibitors

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39
Q

drugs causing constipation

A

opiates, esp codeine

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40
Q

avoid this drug in asthma or bronchoconstriction

A

NSAIDs (obvs BBs too)

can continue aspirin if no evidence of wheeze, only exception

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41
Q

their favourite drug error

A

They like questions with co-codamol and paracetamol combined OD – CHECK

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42
Q

what never to co prescribe with methotrexate

A

Never prescribe folate-inhibiting Abx with methotrexate! E.g. trimethoprim

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43
Q

what should you do with ISupp drugs if signs of sepsis / raised inflamm markers?

A

– if signs of sepsis / raised inflamm markers, WITH-HOLD

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44
Q

specific time limit for no LMWH/heparins post isch stroke

A

no heparin-style VTE prophylaxis for 2 months post stroke!

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45
Q

deal with calcium channel blocker peripheral oedema

A

key side effect to know is peripheral oedema. Stop if so. + stop any furosemide or diuretic used to ‘treat’. Due to the drug, not heart failure.

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46
Q

what shouldn’t be given alongside warfarin

A

Don’t give LMWH alongside warfarin – too much bleeding risk.

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47
Q

what shouldn’t be prescribed alongside verapamil?

A

Don’t give verapamil alongside bisoprolol – risk of bradycardia and hypotension

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48
Q

IV insulin

A

– only for sliding scale – only short-acting insulins i.e. Novorapid, Actrapid

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49
Q

common drugs causing SIADH and hyponat

A

carbamazepine and antipsychotics

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50
Q

microcytic anaemia

A

– iron deficiency anaemia, thalassaemia, sideroblastic anaemia

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51
Q

normocytic anaemia

A

– ACD, acute blood loss, haemolytic anaemia, chronic RF

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52
Q

macrocytic anaemia

A

B12/folate deficient, excess alcohol, liver disease, hypothyroid, ‘M’ diseases of the blood i.e. multiple myeloma, myelodysplasia, myeloproliferative disorder

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53
Q

high neutrophils

A

– bacterial infection, tissue damage (inflam, infarct, ca), steroids

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54
Q

low neutrophils

A

– viral infections, clozapine, carbimazole, carbamazepine, chemotherapy

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55
Q

high lymphocytes

A

viral infection, lymphoma, CLL

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56
Q

high platelets

A

reactive = bleeding, tissue damage (x3), post-splenectomy

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57
Q

low platelets

A
  • infection, drugs (penicillamine-RA), myeloma (Ms), heparin, DIC, ITP, HUS
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58
Q

hypernatraemia

A

– dehydration, drips (excess IV saline), drugs with high sodium, diabetes insipidus

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59
Q

hyponat hypovol

A

fluid loss (D+V), diuretics, Addison’s

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60
Q

hyponat euvol

A

SIADH, hypothyroidism, psychogen polydipsia

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61
Q

hyponat hypervol

A

heart failure, renal failure, liver failure

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62
Q

SIADH causes

A

– SCLC, infection, abscess, drugs (carbamazepine, antipsych), head injury

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63
Q

hypokalaemia

A

– drugs (loop and thiazide diuretics), inadequate intake / GI loss, renal tubular acidosis, endocrine (Cushing’s, Conn’s)

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64
Q

hyperkalaemia

A

drugs (K-sparing diuretics, ACE inhibitors), renal failure, Addison’s, haemolysed sample, DKA

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65
Q

elevated urea

A

If elevated, either AKI or upper GI bleed (normal creatinine, not dehydrated)

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66
Q

pre renal AKI incl urea/cr and causes

A

70% - urea rise outstrips creatinine rise e.g. urea 19 but creat normal range – cause is dehydration / shock of any cause (sepsis, bleeds, renal artery stenosis)

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67
Q

renal AKI incl urea/cr and causes

A

10% - urea just raised, creatinine very high e.g. urea 9, create 300 –

ischaemia
drug damage
inflammation

cause is ischaemia, nephrotoxic Abx, ACEx, NSAIDs, imaging contrast, rhabdomyolysis, gout crystals, GN, vasculitis, cholesterol
Nephrotoxic Abx = gentamicin, vancomycin, tetracyclines

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68
Q

post renal AKI incl urea/cr and causes

A

20% - obstruction - urea just raised, creatinine very high e.g. urea 9, create 300 – cause is stones, cancers, BPH, aneurysm

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69
Q

Hepatocyte injury / cholestasis markers

A

bilirubin, ALT, AST, ALP

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70
Q

liver synthetic function

A

albumin, clotting factors

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71
Q

raised ALP

A
  • fracture, posthepatic liver damage, cancers, Paget’s, pregnancy, hyperparathyroid osteomalacia, surgery
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72
Q

prehepatic jaundice

A

– isolated raised bilirubin – haemolysis, Gilbert’s

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73
Q

hepatic juanidce

A

bilirubin raised, AST/ALT raised – hepatitis, cirrhosis, ca, HF, fatty liver

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74
Q

post hepatic jaundice

A

– bilirubin raised, ALP raised – stones, cholestatic drugs, PB/SC, tumours

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75
Q

drugs causing cholestasis

A

fluclox, coamox, nitrofurantoin, steroids, sulphonylureas

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76
Q

TSH levels

A

– normal is 0.5-5, decrease thyroxine if lower, increase if higher

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77
Q

low t4 and cause

A
  • hypothyroid. If TSH high – primary, if TSH low – secondary i.e. pituitary
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78
Q

high t4 and cause

A

– hyperthyroid. If TSH low – primary, is TSH high – secondary i.e. pit tumour

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79
Q

digoxin ECG changes

A

igoxin – ST segments down-sloping in all leads

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80
Q

narrow therpeutic index drugs

A

digoxin, theophylline, lithium, phenytoin, gentamicin, vancomycin

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81
Q

digoxin toxicity

A

confused, nausea, visual halos, arrhythmia

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82
Q

lithium toxicity

A

= tremor then tiredness then arrhythmia / seizure / coma / RF

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83
Q

phenytoin toxicity

A

= gum hypertrophy, ataxia, nystagmus, peripheral neuropathy

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84
Q

gent/vanc toxciity

A

ototoxic

nephrotoxic

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85
Q

to remember with poor kidneys and vanc/gent

A

need reduced doses than normal toa void toxiity

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86
Q

treating drug toxicigy

A
  1. Stop drug 2. Give IV fluids 3. Give antidote if available
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87
Q

drug monitoring - altering dose

A

– if out of range at 1hr post dose, increase dose. If out of range just before next dose, adjust interval of dosing.

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88
Q

gentamicin doseing

A

high dose regimen 5-7mg/kg for most, if renal failure then divided-daily-dosing at 1mg/kg. nomogram – should fall within 24 hr area when plotted, switch if falls outside this.

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89
Q

paracetamol OD

A

– if plasma level above the line 4 hrs after ingestion , NAC is needed

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90
Q

warfarin and INR responses

A

aim 2.5 for most, 3.5 for metallic valves. If major bleed – STOP it, give PT complex + 5-10mg IV vitamin K. if INR > 8, give 1-5mg oral vit K and omit. If 6-8 omit for 2 days and lower dose.

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91
Q

anti HTN drugs and illness

A

should normally stop antihypertensives when someone is unwell as vitals usually off

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92
Q

bHCG +Ve urine dip, remembe what drug change

A

Ensure you cancel the COCP prescription if someone is bHCG positive on urine dip!

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93
Q

none of this drug type in pregnancy

A

No folate antagonists in pregnancy!! Neural tube defects. So no trimethoprim etc

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94
Q

in hosp on neb salbutamol, stop what?

A

inhaler prescrioption

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95
Q

acute pulmonary oedema, vitals off

A

40mg IV furosemide

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96
Q

AF+asthma

A

digoxin,

might not have calcium channel blockers and can’t havebeta blockers

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97
Q

emergency drug apporach

A

ABCDE approach always – will usually ask re specific management, but don’t forget basic resus if not yet done in Q! e.g. prescribing oxygen / fluids

98
Q

STEMI drugs

A

15L oxygen non rebreather, 300mg aspirin, morphine 5-10mg IV with 50mg cyclizine IV, GTN spray / tablet, bisoprolol 2.5mg

99
Q

NSTEMI drugs to add

A

clopidogrel 300mg and fondaparinux 2.5mg OD s/c

100
Q

acute LVF drugs

A

morphine 5-10mg IV with cyclizine 50mg IV, GTN spray/tab, furosemide 40mg IV +/- repeat dose

101
Q

Adverse features+tachy >125bpm drugs

A

DC shock synchro x3, amiodarone 300mg IV over 10-20mins, followed by 900mg over 24 hrs

102
Q

Narrow complex tachy drugs

A

irregular – possible AF = beta blocker / diltiazem, digoxin or amio if HF, if regular = vagal then adenosine 6mg rapid IV, repeated twice more

103
Q

broad complex tachy and drugs

A

regular = amio 300mg over an hour, then 900mg over 24hrs, SVT+BBB = treat as narrow complex SVT, irregular = if torsades de pointes give magnesium 2g over 10 mins

104
Q

anaphylaxis drugs

A

– oxygen, adrenaline 500 mcg of 1 in 1000 IM, chlorphenamine 10mg IV, hydrocortisone 200mg IV, amend allergies box!!

105
Q

acute asthma dugs

A

oxygen, 5mg salbutamol neb, 100mg hydrocortisone IV if deadly / pred 40-50mg oral if moderate, 500mcg ipratropium nebs, aminophylline if deadly only

106
Q

acute COPD ex drugs

A

add antibiotics if evidence of infection. Move down from high flow O2 to 28% Venturi and review with regular ABGs

oxygen, 5mg salbutamol neb, 100mg hydrocortisone IV if deadly / pred 40-50mg oral if moderate, 500mcg ipratropium nebs, aminophylline if deadly only

107
Q

pneumonia drugs

A

amoxicillin, co-amox, clarithromycin etc (depends on HAP/CAP, typical/atyp)

108
Q

PE drugs

A

– oxygen, morphine 5-10mg IV, cyclizine 50mg IV, enoxaparin treatment dose (1.5mg/kg/24 hours UNLESS risk factor, in which case 1mg/kg/12hrs). if adverse – thrombolyse, ITU

109
Q

GI bleeding management drugs

A

– oxygen, cannula x2, catheter+fluid monitor, saline 500ml bolus, x match 6 units of blood, correct clotting if PT >1.5x normal (give FFP unless warfarinised, in which case give PT complex), if platelets «50 give platelets too, do OGD, stop NSAIDs/aspirin/warf/heparin (8Cs)

110
Q

bacterial meningitis drus

A

if GP, 1.2g benzylpenicillin. High flow oxygen, dexamethasone IV, LP +/- CT, 2g cefotaxime, consider ITU (prob acyclovir cover too, but quite toxic IV)

111
Q

seizures/stat epilepticus drugs/manage

A

ABCDE, secure airway, prevent aspiration of vomit, screen provoking factors, if 5+ minutes then lorazepam 2-4mg IV or buccal midazolam 10mg, repeat diazepam 10mg IV if still fitting, phenytoin infusion last resort, then intubation with propofol

112
Q

stroke drugs, manage

A
  • if any evidence of bleed on CT then discuss with neurosurgeons + don’t give aspirin / thrombolysis. If ischaemic = thrombolyse if <4.5 hrs ago + under 80 yrs, 300mg aspirin, stroke unit
113
Q

DKA drugs, management

A

– fluids are key (1L saline stat then extra 1L bags over 1hr then 2 hrs then 4 hrs then 8 hrs), 50 units Actrapid in 50ml 0.9% saline at 0.1units/kg/hr. aim dec ketones 0.5 /hr. add 20-40mmol KCl to bags depending on K levels on VBGs. Add 10% dextrose at 125ml/hr once glucose <14. Find trigger and treat!

114
Q

HHS drugs and management

A

– very high sugars and osmolarity (2Na+2K+urea+gluc) + crucially, NO ketones. Similar management to DKA except insulin may not be needed. Give prophylactic LMWH. Insulin rate if needed is 0.05u/kg/hr

115
Q

hypoglyc<3 manage

A

can eat -> give juice/biscuits, can’t eat -> IV 100ml 20% glucose. If no cannula, give 1mg IM glucagon.

116
Q

acute renal failure management / drugs

A

cannula+strict fluid monitoring, 500ml IV stat then 1L 4 hourly, find cause + order bloods, ABG, urinalsis, US kidneys, check drugs for nephrotoxics. Complications fluid overload, hyperkalaemia, acidosis. U+Es and fluid balance are the most crucial!

117
Q

acute poisoning /OD manage/drugs

A
  • IV fluids and pain relief if not OD on pain relief. If within 1 hour, pump stomach and irrigate bowel if Lithium or iron, consider charcoal. Give generous fluids. NAC for paracetamol if above nomogram line. Naloxone if opiates. Flumazenil if benzo OD.
118
Q

chronic HF prescribing

A

– lisinopril 2.5mg daily, bisoprolol 1.25mg daily, if can’t use ACEx do candesartan 4mg daily. If can’t have either do hydralazine or nitrate. Increase doses as needed. Add spironolactone 25mg daily if still not achieving symptom relief. Specialist reassessment to consider sacubritril valsartan, digoxin, ivabradine.

119
Q

AF stroke prevention

A

CHA2DS2VASc score – score 1 anticoag men, score 2 anticoag women. HASBLED score – don’t anticaog if 3+ score.

120
Q

AF treatment prescribe

A

rhythm control if acute presentation <48 hrs -> d/c cardiovert, amiodarone, flecanide if not StructHD. Rate = >48hrs -> start with either bisoprolol 2.5mg or diltiazem 120mg daily. Combo therapy of the two +/- digoxin if not working to control symptoms.
Digoxin monotherapy only if sedentary AF.

121
Q

signs more likley stable angina

A

if exertion / emotion triggered and no vom / sweating.

122
Q

STEMI diagnose

A

– if trop raised, NSTEMI if depression or normal ECG. STEMI if ST elevation or new LBBB. Check 12 hour trop to see if cont rise.

123
Q

stable angina manage drug

A

GTN spray PRN, aspirin / statin / BP mods, an antianginal + one of atenolol or amlodipine. Inc dose if still symptoms. If uncontrolled on 2x antianginals, refer for PCI or CABG.

124
Q

COPD chronic drugs;/mx

A

smoking cessation + nicotine replacement + bupropion /vareniciline for cravings. Only start inhaled therapies once smoking advice+vax+physio+comorbids dealt with and they have SOB. Offer salb + tiotropium. If steroid responsive, move to salmeterol + ICS. If not, do salmeterol + long acting muscarinic.

125
Q

asthma drug guidelines

A

SABA PRN then low dose ICS then inhaled LABA (in MART format), then consider increasing ICS dose or adding LTRA, refer after this

126
Q

diabetes cons mx

A

lifestyle advice, cardio secondary prevention (75mg aspirin if >50 type 2 or any cardiac RFs) (atorvastatin 20mg if any RF or >40 in T2DM), annual complications review = ACR (indicates kidney damage or need for ACEx if >3mg/mmol).

127
Q

type 2 diabetes drugs order

A

lifestyle intervention + >48 HbA1c 1. Metformin 2. If rises to 58+, add any of other oral drugs 3. Add insulin on top of triple therapy if still 58+

128
Q

side effects with metformin

A

Always try modified release metformin before deciding they can’t have Metformin

129
Q

pioglitazone warning

A

Be careful with pioglitazone if heart failure, bladder ca risk or bone fracture risk.

130
Q

glutides

GLP1 agonists continue

A

Only continue GLP1 agonists if HbA1c reduces by 11+ and they lose weight.

131
Q

Parkinsonsdrugs

A

first line is co-beneldopa or co-careldopa unless the pt has very mild disease and is concerned about the finite period of benefit -> then give ropinirole (dop ag) or rasagiline (MAOi

132
Q

epilepsy drugs

A

2 unprovoked seizures or 1 with features suggestive of high risk of recurrence

133
Q

myolconic siezure dtug

A

valproate male, levetiracetam female

134
Q

tonic seiz drugs

A

valproate male, lamotrigine female

135
Q

no thank

A

-

136
Q

abscence seiz drugs

A

ethosuximide or valproate

seizure drugs are valproate for everything but focal which is carbamazepine

137
Q

gen tonic clonic seiz drugs

A

¬valproate for males, lamotrigine for females

138
Q

common antiepiletpic SEs

A

lamotrigine = rash

carbamazepine = rash, dysarth, nystagmus,

phenytoin = ataxia, gum hyperplasia, peripheral neuropathy,

valproate = tremor, teratogenic, weight gain

Levetiracetam = fatigue, mood disorders, agitation

139
Q

alzhimer’s drugs

A

if mild / moderate -> donepezil, rivastigmine, galantamine, if moderate/severe then give memantine.

140
Q

Chron’s remission drugs

A

mild flare = 20-40mg prednisolone OD, severe flare = 100-500mg hydrocortisone TDS IV, if any rectal disease, use rectal hydrocortisone too.

141
Q

Chron’s maintaining remission

A

azathioprine or 6 mercaptopurine (which is the metabolised product)

142
Q

azathioprine check pre prescribin

A

Must check TPMT enzyme levels before starting azathioprine as some people have very low levels and will need artificially lower dosing to avoid liver + BM toxicity.

143
Q

rheumarth chronic managemtnt

A

methotrexate, other DMARD, then try infliximab

144
Q

paracetamol max daily dose

A

4 grams

145
Q

laxatives caution

A

caution! Never give if evidence of obstruction!

146
Q

types of laxative

A 
Osmotic = lactulose or phosphate enema (avoid in acute abdo or IBD)
Stimulant = Senna, bisacodyl (avoid in acute abdo)
147
Q

bulking agent, stool softener

A

Bulking agent = isphagula husk (good for impaction)

Stool softener = docusate sodium PO or arachis oil rectally (good for impaction, beware nut allergy for the oil)

148
Q

diarrhoea drugs

A

– ONLY treat if non infectious cause! It is flushing out the bug. After negative MC+S, can give loperamide 2mg up to 3 hourly or codeine 30mg oral up to 6 hourly.

149
Q

insomnia dtugs

A

start with 7.5mg zopiclone for adults and 3.75mg for elderly (try sorting the environment etc first as it is a falls risk!)

150
Q

HTN guidelines

A

t2dm or less than 55non blak = ACEx, then CCB/thiazide then triple then alpha or spiro

old or black = CCB, then add ACEx or thiazide, then triple, then alpha or spiro

151
Q

BP targets

A

younger than 80

140/90

over 80

150/90

152
Q

salbutamol warnings

A

ensure to counsel about overuse if getting tachycardia / tremor

153
Q

steroids counselling

A

3 weeks+ course to be avoided if possible as then adrenal dependent
no sudden stopping

154
Q

abx prescribing

A

With abx, start with the lower dose in the range e.g. if 0.5-1g 6 hourly, start @ 500mg

155
Q

cyclizine side effects counsel

A

has some antimuscarinic side effects + sedating action

156
Q

amitriptyline warning

A

can worsen antimuscarinic effects in combo + worsen cog decline in old

157
Q

neutropaenia drugs

A

carbamazepine, carbimazole, clozapine

158
Q

vasc dement

A

75mg aspirin daily + antiHTN drug (Depending on potassium)

159
Q

consider dx in elderly confused

A

also consider NPH and B12 deficiency

160
Q

dopamine antagonist common drugs, beware

A

Metaclopramide and haloperidol -> beware in Parkinson’s + endo

*although, domperidone (same mech) can be used as doesn’t cross BBB

161
Q

beware with allergie

A

TAKE CARE WITH ALLERGIES – question stem will often mention one, ensure you process that and bear in mind – often rules out the first line. Sneaky.

162
Q

treat PE

A

PE – treat with treatmnet dose low molecular weight heparin (check correct for weight provided)

163
Q

contraception Qs

A

they like to ask about drugs that induce enzymes and affect efficacy

164
Q

contraception contraindications

A

migraine, hypertension, porphyrias, breast ca, any coag disorder, 15+ cigarettes daily >35yrs, SLE, any VTE history, <6 weeks postpartum, stroke Hx

165
Q

warning for prescribing by weight

A

CHECK maximum dose (when you calculate by mg/kg you may exceed this – in this case, use max recommended)

166
Q

antihypertensive drugs preg

A

Offer anti HTN drugs to women pregnant with chronicBP > 140/90. Labetalol > nifedipine > methyldopa

167
Q

gout and renal impairmeetn

A

Give IM methylpred in gout if severe and renal imairment, alongside colcicine.

168
Q

want to conceive and on ramipril

A
  • stop ACEx as teratogenic + convert to labetalol with f/up – blood pressure does not fall until the second trimester
169
Q

breast ca + tamoxifen

A

increases risk of VTE so warn about DVT+PE. Tamoxifen also increases risk of endometrial ca. common side effect of hot flushes.

170
Q

gliclazdie SU and hypoglyc

A

counsel on this risk – take regular meals + take tab with breakfast.

171
Q

key methotrexate info

A

they like this topic. Need regular FBC to check for neutropaenia. Only take once a week. Never give alongside folate antagonists e.g. trimethoprim cotrimoxazole. Give folate too.

172
Q

alcohol and drug

A

acute intoxication inhibits enzymes whereas chronic excess induces ( either bad with things like warfarin). Warfarin tabs are colour coded by mg size.

173
Q

warfarin remember for Qs

A

major adverse effect is bleeding. Avoid inducers/inhibitors

174
Q

starting on ACEx

A

inc risk hyperkalaemia, cough common, be careful if unwell (D+V) as inc risk of AKI. ACEx and diuretics can cause renal failure. Monitor 2 weeks post starting ACEx, especially in CKD.

175
Q

steroids long term

A

if predicted to take for >3 months, and elderly, start on bisphosphonate eg. Alendronate. Consdier giving PPI too as small inc risk of peptic ulcers. Long term risk of hyperglycaemia. Never stop abruptly or get Addisonian crisis. Risk of HTN. (learn steroid risks and SEs)

176
Q

antidepresants counsel

A

– always counsel about seeking help as some may feel worse in the initial phase after starting them. May take six weeks for improv.

177
Q

citalopram

A

makes you more photosenstive. SSRIs can cause dry mouth.

178
Q

Agitation, raised temp and hallucination

and on SSRI

A

s = serotonin syndrome, life threatening. on

179
Q

insulinand ill

A

Always counsel that increases in basal insulin are needed when ill. But don’t increase regular insulin unless eating!

180
Q

rotate insulin sites

A

Must rotate injection sites or get lipodystrophy.

181
Q

bisphosphonates counsel

A

once weekly usually. Don’t take alongside Adcal at same time of day. Avoid food 2 hours after alendronate. Take with full glass of water and remain upright for 30 mins afterwards.

182
Q

HRT counselling

A

risk of breast ca higher for combined OP HRT than oestrogen-only. Excess breast ca persists for 10 years post HRT stopping. No inc risk with vaginal preparations. Not protective vs RFs e.g. HD

183
Q

calculation Qs

A

write them out on paper! Do common sense test at the end.

184
Q

1% prepartion =

A

1g in 100ml / 10mg in 1 ml

185
Q

enoxaparin

A

need good renal func

186
Q

presc abx

A

If Abx prescribed, should have stop/review date. Generally 5 days unless UTI,bone.

187
Q

clinical improv and abx

A

convert to oral

188
Q

when to give acex and diuretics

A

Prescribe ACEx for the evening as risk of postural drop. Give diuretics in the am

189
Q

when to give drugs

A

follow bnf

190
Q

other drugs in Q stem

A

Ensure you get the right dose for the right indication. If any other drugs are mentioned in the stem, you must always check for interactions.

191
Q

exam tip!

A

always look at wording

may ask FIRST drug needed etc

192
Q

manage hyperkal

A

– insulin and dextrose first, second line salbutamol. The cal gluc. E.g. 10 units actraid in 100ml of 20% dextrose.

193
Q

best antiepileptic in preg

A

Lamotrigine excellent safety profile in pregnancy!

194
Q

when phenytoin for seizures

A

Phenytoin only for stat epilepticus or no swallow as can go IV

195
Q

when to avoid metformin

A

if creatinine >150. Better for overweight pt as suppresses appetite

196
Q

why choose SU over metformin

A

Choose sulphonylurea if normal or underweight e.g. gliclazide (oral hypoglycaemic)

197
Q

statins and myopathy

A
  • a personal or family history of muscular disorders, previous history of muscular toxicity, a high alcohol intake, renal impairment, hypothyroidism, and in the elderly. Check CK in these patients. Other patients can just have ALT
198
Q

statins monitoring

A

– LFTs on starting (can’t start if 3x normal), again at 3 and 12 months. Must stop if 3x rise.

199
Q

drug tip

A

Always consider drug doses in context of pt – if too many SEs but ‘normal’ level, reduce and vice versa.

200
Q

lithium counselling

A

See lithium toxicity effects at 1.5mmol/L +. Take levels at 12 hrs post last dose. Take levels weekly until stable then 3 monthly. Sodium depletion inc risk of toxicity – stable diet.

201
Q

methotrexate monitoring

A

as with Lithium, regular FBC until stable, then 3 monthly. Only CXR if suspect SEs. Stop immediately if drop in WBCs/platelets. Don’t start if liver deranged. Toxicity more likely in renal dysfunction.

202
Q

startingon antipsych

A

take baseline glucose! Can cause hyperglyc / diabetes. Only do baseline ECG if cardiac risk factors.

203
Q

repeat presc COCP

A

Always retake BP when represcribing COCP .

204
Q

amiodarone start and monitor

A

– baseline CXR is needed! Risk of pulmonary fibrosis. Monitor LFTs regularly. No renal probs with amio. Commence with caution if hypokalaemia – risk of arrhythmia.

205
Q

agranulo drug moniotring

A

Always check FBC + neutrophils with anyone on agranulo risking drug + symptom/temps. (their favourites are carbimazole, clozapine, carbamazepine)

206
Q

tip for drugs needing levels

A

Each of the drugs needing ‘levels’ have a monitoring section with specifics for levels required and when to take.

207
Q

ACEx monitor

A

regular U+E monitoring and at every dose change.

208
Q

when digoxin in AF

A

may be used in pt with risk of arrhythmia or hypotension instead of other `

209
Q

digoxin monitor

A

Monitor serum creatinine for digoxin. Don’t routinely take plasma levels unless toxicity.

210
Q

valproate SEs

A

hepatotoxicity, teratogenicity, pancreatitis

211
Q

when clozapine and monitor

A

Clozapine only once failed on 2 other antipsych for schizophrenia.WEEKLY FBC for 18 weeks of treatment, then less often.

212
Q

Low GCS + acidotic

A

metformin probably causing lactic acidosis.

213
Q

Broad spec Abx (cephalosporin/ciprofloxacin) SE

A

c diff

214
Q

heparins and underweight

A

if underweight <50kg – low platelets

215
Q

aspirin SEs

A

haemorrahge, peptic ulcers, gastritis, tinnitus in large doses

216
Q

digoxin SEs

A

xanthopsia (yellow/green visual perception incl halo vision).

Low potassium augments digoxin (toxic), high K+ reduces (doesn’t work)

nausea,vom, diarrhoea, confusion, drowsy,

217
Q

amiodarone SEs

A

pulmonary fibrosis, thyroid either way, skin greying, corneal deposits

218
Q

lithium SEs

A

early = tremor, then tiredness, late = arrhythmia, seizure, coma, RF, D insipidus

219
Q

haloperidol SEs

A

dyskinesias + drowsiness

220
Q

fludrocortisone SEs

A

hypertension, sodium/water retention

221
Q

NSAIDS SEs

A

– renal failure, heart failure, asthma, indigestion, dyscrasia (clottingoff)

222
Q

corticosterois SEs

A

stomach ulcers, thin skin, oedema, heart failure, osteoporosis, infection, hyperglycaemia, Cushing’s Syndrome

223
Q

statins SEs

A

myalgia, abdo pain, liver enzymes up, rhabdomyolysis

224
Q

dealing with statin myalgia

A

check CK + urine dip and exclude rhabdomyolysis, if symptoms unacceptable, switch to less myalgic statin e.g. atorva better than simva

225
Q

synergistic effect bb and vera

A

beta blocker + verapamil = profound low BP and astyole

226
Q

GI bleeding always check for these drugs

A

NSAIDs (aspirin, ibuprofen)

227
Q

increased anticoag on warf

A

– acute alcohol + warfarin,

228
Q

cause of hypertensive crisis

A

– Monoamine oxidase inhibitors (mocoblemide, resalagine)

229
Q

Sweating/flushingvomiting –

A

disulfarim+metronidazole

230
Q

nausea and vom with alcohol and abx

A

alcohol and metronidazole

231
Q

sedating drugs

A

barbiturates, opioids, benzos

232
Q

doxy SE

A

photosensitive rash

233
Q

types of NSAIDs

A

aspirin, ibuprofen, naproxen, diclofenac (Motifene)

234
Q

never co prescribe these

A

Never co-prescribe ACE inhibitors and NSAIDs!!!

235
Q

brand names of drugs

A

Always look up any brand name as it masks the nature of the drug.

236
Q

also a pot sparing diuretic

A

amiloride

237
Q

Excess INR – no bleeding –

A

give phytomenadione (vitK1)

238
Q

excess INR with bleeding

A

give vit K and prothrombin conc

239
Q

pt with AF and thnn new abx and haematuria

A

If they give you a pt with AF and then they get haematuria with a new Abx, consider interaction with warfarin or anticaog.

240
Q

anaphylaxis #1

A

secure airway

then adreneline and drugs

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