Passmed and past paper bits Flashcards
What maintenance fluids should you be prescribing in adults?
Volume - 25-30ml/kg/day
Na+/K+/Cl- = 1mmol/kg/day
50-100g of glucose
What do you have to be wary of when prescribing 0.9% saline?
Large volume increase risk of hyperchloraemic metabolic acidosis
What do you have to be wary of when prescribing Hartmann’s?
Large volume - risk of hyperkalaemia
Which drugs in heart failure improve long term prognosis?
ACEi
Beta Blockers
What drugs can cause SIADH?
Sulfonylureas SSRI's Tricyclic's Carbamazepine Vincristine Cyclophosphamide
Which drugs are taken at night?
Statins
Amitriptyline
Which drugs are contraindicated in Asthma?
NSAID’s
Beta blockers
Adenosine
What should be monitored at the start of treatment with quetiapine?
Prolactin
All antipsychotics:
- FBC, U&E, LFT
- Lipids and weight
- Fasting BM
- BP, ECG
- Cardiovascular risk assessment
Why should dextrose be avoided in stroke patients?
Risk of cerebral oedema
What drug should be given in acute heart failure for breathlessness and oedema?
IV furosemide 20-50 mg
What VTE prophylaxis should be offered in orthopaedic patients?
Enoxaparin 100mg/ml
40mg
SC
OD
What reasons are there to hold in renal injury?
Nephrotoxic drugs - ACEi, ARB etc.
Drugs that will accumulate
Which drugs are nephrotoxic?
NSAIDs Tetracyclines Nitrofurantoin Metformin ACEi/ARB Lithium
Which drugs accumulate in renal failure?
Most antibiotics - penicillins, cephalosporins, vancomycin, gentamicin, streptomycin
Digoxin Atenolol Allopurinol Methotrexate Sulphonylureas Furosemide Opioids
May need dose adjustment
When prescribing for breakthrough pain, what should you use?
Ideally the same drug
Make sure you check the dose will be effective (if time)
When is nitrofurantoin contraindicated?
GFR <45
Even if taking folic acid supplements, choose trimethoprim
What is first line in acute alcohol withdrawal?
Chlordiazepoxide
Give Pabrinex in alcohol dependence
What should you do with regards to warfarin and surgery?
Stop 7 days before
Aim for INR <1.5
If >1.5 - give vit k
What key information should be given when prescribing SSRI’s?
Suicidal ideations may worsen for 4 weeks
Shouldn’t stop abruptly
Dose can be increased
Which drug is associated with cholestatic jaundice?
co-amoxiclav
What is normal to happen with creatinine on starting ACEi therapy?
Small rise <20%
Doesn’t req. investigation or change of drug
What is used to measure efficacy of furosemide?
Weight
What is used to assess for beneficial effects of ACEi?
Exercise tolerance
How much should you increase insulin dose by if it appears to be ineffective?
Around 10%
What do you aim for when starting statin treatment?
> 40% reduction in non-HDL cholesterol
How would you monitor the beneficial effects of allopurinol?
Serum urate
How would you monitor for beneficial effects of fluids?
Blood pressure
How do you calculate the breakthrough pain dose for morphine?
Total daily dose/6
How do you calculate new doses for morphine if the current dose isn’t controlling pain sufficiently?
Calculate total daily dose (slow release + all break through) and divide this by number of doses (typically 2) for new SR
Total dose/6 = new breakthrough
What is the typical basic dose for morphine?
15mg BD slow release
5mg oral morphine breakthrough
How do you convert between codeine to morphine?
divide by 10
How do you convert from oral morphine to IV morphine?
divide by 2
What is used to treat acute dystonia?
Procyclidine
What is the ideal infusion rate for 1L maintenance fluids?
8-12 hours
How can you ensure a patient doesn’t have withdrawal bleeding when on ERT?
Give oestrogen and progesterone
Make sure the drug is given constantly as opposed to sequential regimes
Which drugs are contraindicated in peripheral vascular disease?
Beta blockers
ACEi are cautioned
Which drugs commonly exacerbate heart failure?
Calcium channel blockers
Steroids
What is the typical dosing for omeprazole?
10-20mg daily
What should you do if a urine dip is + for leucocytes and nitrites?
Immediately start treatment even if not v positive.
92% positive predicted value
How is scarlet fever managed?
10 days phenoxymethylpenicillin
When should IM glucagon not be given?
IV glucose feasible to give quickly
Patient anti-coagulated
How should beta blocker therapy in AF be monitored for positive effect?
Heart Rate
How is antibiotic effectiveness in sepsis monitored?
Symptom resolution
What should you do if statins cause a markedly raised CK?
Discontinue statin and see if symptoms/CK resolve
Restart on lower dose
What may cause a painful unilateral rash?
Herpes - Shingles
Which anti-emetic should be used in patients at risk of extra pyramidal side effects or QT prolongation?
Cyclizine
Which drugs commonly cause ankle oedema?
Amlodipine
NSAIDs - naproxen
When should loperamide be taken?
After each loose stool
What can cause serotonin syndrome?
Taking SSRI’s can predispose to serotonin syndrome
Taking a serotonin inducing drug such as tramadol can induce it
Other drugs include:
- ecstacy
- amphetamines
- TCA’s
- SSRI’s etc.
How is anti-psychotic induced Parkinsonism managed?
Anticholinergics
What should be done to pain management in case of AKI in acute pain?
Change to oxycodone
Fentanyl better in renal impairment but not for acute pain
What should be done with amiodarone in case of thyrotoxicosis?
Withhold amiodarone
What is used for drug induced N&V?
Haloperidol
Ondansetron if chemo
What is used for GI stasis/peristaltic failure induced N&V?
Metoclopramide or Domperidone
What is used for anxiety related N&V?
Lorazepam
What is used for N&V due to intracranial disease, vestibular disturbance, pharyngeal irritation or liver stretch?
Cyclizine
+ tex if raised ICP
When is hyoscine used as an antiemetic?
Prophylaxis
Motion sickness
