Pass the PSA - Section 2 Flashcards
IV Fluids - the two types/causes
Maintenance
Replacement
When would you not give 0.9percent sodium in replacement fluids?
If the patient i:
hypernatremia, hypoglycemic
has ascites
shocked from bleeding
What replacement do you give if the patient is hypernatremic or hypoglycemic?
5 percent dextrose
What replacement do you give if the patient has ascites?
Human albumin solution
What do you give if someone is shocked from bleeding and there is no blood available?
Crystalloid solution (normal saline)
In hospital, all patients need
Thromboprophylaxis in the form of LMWH
Dalteparin 5000 units daily, sub cut and compression stocks for VTE prophy
When do you not prescribe anti coag
if bleeding risk including recent ischemic stroke
When to not prescribe compression stockings
if peripheral arterial disease due to risk of acute limb ischemia
Anti emetics - when to avoid metoclopramide
Young women - it can cause dyskinesia
Parkinson’s disease - it can worsen it
Two drugs to give if a patient is nauseated or is not nauseated but needs anti emetics PRN
Cyclizine 50mg 8hours IM/IV/Orally
Metoclopramide 10mg 8hourly IM/IV/PO
Which anti-emetic is for when someone is definitely nauseated?
ondansetron 4mg or 8mg 8hourly IV/oral
When to avoid Cyclizine, what to use instead
any cardiac issue as can worsen fluid retention
give metoclopramide 10mg instead
When to avoid antihypertensives
In hypotension
Beta blocker SE
Bradycardia
Wheeze in asthma
Worsening of acute heart failure
CCB SE
Bradycardia
Oedema
Flushing
ACEi SE
Dry cough
Hyperkalemia
Thiazide diuretics SE
Hypokalemia
Gout
What is neo-naclex-K
Bendroflumethiazide and a potassium replacement drug
Potassium sparing diuretics SE
Gynaeocomastia
Steroids SE / CI
Stomach Ulcers
Thin skin
Edema
Osteoporosis
Infections
Diabetes
Cushings Syndrome
NSAIDS se
No urine (renal failure)
Systolic dysfunction - Heart failure
Asthma
Indigestion
Dyscrasia (clotting abnormalities)
Pain relief PRN if no pain currently
Paracetamol 1g 6 hourly
Mild pain regular inpatient meds
Paracetamol 1g 6 hourly
Mild pain PRN
Codeine 30mg 6hrly oral
Severe pain regular inpatient meds
Co-codamol 30/500 2 tablets 6hrly oral
Severe pain PRN
Morphine sulphate 10mg/5ml up to 6hrly PO
Why do you avoid tramadol in the elderly?
Confusion
Name another drug causing confusion in the elderly
Antimuscarinics e.g. oxybutynin
Symptoms of antimuscarinic toxicity
Tachycardia after transient bradycardia
Pupillary dilation with loss of accommodation
Urinary retention
Constipation
