Passmed PSA Mushkies Flashcards
1
Q
2 medications taken at night?
A
- Statins
2. Amitryptiline
2
Q
Hypoglycaemia conscious pt Mx?
A
10-20g short-acting carbohydrate (e.g. a glass of lucozade or non-diet drink, 3 or more glucose tablets, glucose gel)
3
Q
Paracetamol dose?
A
1g QDS
4
Q
Ibuprofen dose?
A
200-400mg TDS
5
Q
Codeine dose?
A
30-60mg QDS
6
Q
Co-codamol 8/500 or coc-codamol 30/500 dose?
A
2 tabs QDS
7
Q
Cyclizine dose?
A
50mg TDS
8
Q
Metoclopramide dose?
A
10mg TDS
9
Q
Amoxicillin dose?
A
500mg TDS
10
Q
Clarithromycin dose?
A
500mg BD
11
Q
Lansoprazole dose?
A
15-30mg OD
12
Q
Omeprazole dose?
A
20-40mg OD
13
Q
Aspirin dose?
A
75-300mg OD
14
Q
Clopidogrel dose?
A
75-300mg OD
15
Q
Simvastatin dose?
A
10-80mg ON
16
Q
Atenolol dose?
A
25-100mg OD
17
Q
Ramipril dose?
A
1.25-10mg OD
18
Q
Bendroflumethiazide dose?
A
2.5mg OD
19
Q
Furosemide dose?
A
20mg OD - 80mg BD
20
Q
Amlodipine dose?
A
5-10mg OD
21
Q
Levothyroxine dose?
A
25-200mcg OD
22
Q
Metformin dose?
A
500mg OD - 1g BD
23
Q
Indapamide MOA?
A
Thiazide-like diuretic
24
Q
Normal hypothyroid pt starting dose?
A
50-100mcg OD
25
When should hypothyroidism starting dose be lower (25mcg OD then slowly titrated?
1. Cardiac disease pts
2. Severe hypothyroidism pts
3. >50y/o pts
26
Following a change in thyroxine dose, when should TFTs be checked?
After 8-12 weeks
27
Therapeutic goal of hypothyroidism Mx?
Normalisation of the TSH (0.5-2.5 mU/l)
28
Hypothyroid pregnant woman dose change?
Increased by at least 25-50mcg, aiming for a low-normal TSH value
29
4 s/e of thyroxine therapy?
1. Hyperthyroidism
2. Reduced BMD
3. Worsening of angina
4. AF
30
Interactions of levothyroxine?
1. Iron (absorption of levothyroxine reduced, give at least 4 hours apart)
2. Calcium carbonate
31
What should be checked every 6m in a pt on lithium?
U&E and TFTs
32
Lithium range?
0.4-1
33
When should lithium level be checked?
12 hours post dose
34
When should ciclosporin level be checked?
Trough levels immediately before dose
35
When should digoxin level be checked?
At least 6 hours post dose
36
When should phenytoin levels be checked?
1. Do not need be measured routinely, but trough levels, immediately before dose should be checked if:
a. Adjustment of phenytoin dose
b. Suspected toxicity
c. Detection of non-adherence to the prescribed medication
37
Toxic paracetamol dose?
150mg/kg
38
When should IV acetylcysteine be started?
1. There is a staggered overdose or there is doubt over the time of paracetamol ingestion, regardless of the plasma paracetamol concentration; or
2. The plasma paracetamol concentration is on or above a single treatment line joining points of 100 mg/L at 4 hours and 15 mg/L at 15 hours, regardless of risk factors of hepatotoxicity
39
Paracetamol OD w/in 1hr Mx?
Activated charcoal
40
Duration of acetylcysteine infusion?
1 hour (to reduce the number of adverse effects)
41
Acetylcysteine complication?
Anaphylactoid reaction (non-IgE mediated mast cell release)
42
Mx of acetylcysteine anaphylactoid reaction?
Stopping the infusion, then restarting at a slower rate
43
Criteria for liver transplantation after paracetamol OD?
King's College Hospital criteria
44
King's College Hospital criteria?
For paracetamol liver failure --> liver transplantation
1. Arterial pH < 7.3, 24 hour after ingestion
OR all of the following
a. PT > 100s
b. Creatinine > 300umol/l
c. Grade III/IV encephalopathy
45
Staggered OD defn?
If all tablets were not taken within 1 hour
46
Classification of insulin?
1. By manufacturing process
| 2. By duration of action
47
Insulin manufacturing process types?
1. Porcine
2. Human sequence
3. Analogues
48
What are the different subtypes of insulin based on duration of action?
1. Rapid acting analogues
2. Short acting
3. Intermediate acting
4. Long acting analogues
5. Premixed preparations
49
What is the onset, peak and duration of rapid acting insulin?
```
O = 5 mins
P = 1 hour
D = 3-5 hours
```
50
What is the onset, peak and duration of short acting insulin?
```
O = 30 mins
P = 3 hours
D = 6-8 hours
```
51
What is the onset, peak and duration of intermediate acting insulin?
```
O = 2 hours
P = 5-8 hours
D = 12-18 hours
```
52
What is the onset, peak and duration of long acting insulin?
```
O = 1-2 hours
P = flat profile
D = up to 24 hours
```
53
What are some rapid acting insulin analogues?
1. Insulin aspart = NovoRapid
| 2. Insulin lispro = Humalog
54
What are some short acting insulins?
1. Actrapid (soluble)
| 2. Humulin (soluble)
55
What are some intermediate acting insulins?
Isophane insulin, often used in premixed formulation with long acting insulin
56
What are some long acting insulins?
1. Insulin detemir = Levemir = Od or BD
| 2. Insulin glargine = Lantus = OD
57
What is a premixed insulin preparation?
1. Combine intermediate acting insulin with with either:
2. Rapid acting insulin analogue OR
3. Soluble insulin
58
Why is gentamicin given parenterally?
It is poorly lipid soluble
59
2 forms of gentamicin?
1. IV = e.g. for IE
| 2. Topical = e.g. for otitis externa
60
2 s/e of gentamicin?
1. Ototoxicity = irreversible, due to auditory or vestibular nerve damage
2. Nephrotoxicity = accumulates in renal failure, lower doses and more frequent monitoring required
61
C/I of gentamicin?
Myasthenia gravis
62
Dosing of gentamicin?
1. Due to the significant ototoxic and nephrotoxic s/e, has to be monitored
2. Both peak (1 hour after administration) and trough levels (just before the next dose) are measured
3. If the trough (pre-dose) level is high the interval between the doses should be increased
4. If the peak (post-dose) level is high the dose should be decreased
63
Cytochrome P450 inducers?
PC BRASSS
1. Phenytoin
2. Carbamazepine
3. Barbiturates
4. Rifampicin
5. Alcohol (Chronic)
6. Sulfonylureas
7. Smoking
8. St Johns Wort
64
Cytochrome P450 inhibitors?
AO DEVICES GR
1. Allopurinol, amiodarone, antifungals
2. Omeprazole
3. Disulfiram
4. Erythromycin
5. Valproate
6. Izoniazid
8. Ciprofloxacin, Clarithromycin
9. Ethanol (acute)
10. Sulphonamides, SSRIs
11. Grapefruit juice
12. Ritonavir
65
Examples of drugs which interact with enzyme inhibitors/inducers?
When Chickens Tickle Chickens, They Prefer Smiling
1. Warfarin
2. COCP
3. Theophylline
4. Corticosteroids
5. Tricyclics
6. Pethidine
7. Statins
66
Narrow therapeutic range drugs that have many interactions?
Guys With Large Dongles Totally Make Perfect Internet Connections
1. Gentamicin
2. Warfarin
3. Lithium
4. Digoxin
5. Theophylline
6. Methotrexate
7. Phenytoin
8. Insulin
9. Ciclosporin
67
Metformin interaction?
Concomitant use of Metformin and Cimetidine decrease the excretion of Metformin, resulting in increased exposure of Metformin and elevated risk of Metformin Associated Lactic Acidosis (MALA). It is recommended to reduce the dose of Metformin when Cimetidine is co-prescribed.
68
Gentamicin interaction?
Loop diuretics (renal failure risk)
69
ACE inhibitor interactions?
1. Potassium-sparing diuretic (hyperkalaemia)
| 2. Metformin (enhances hypoglycaemic effect)
70
Statin interactions?
1. Macrolide
| 2. Amiodarone (increased statin conc and thus risk of rhabdo)
71
Thiazide interactions?
1. PPI (hyponatraemia)
| 2. Lithium (increased toxicity)
72
P450 inducer INR effect?
INR will decrease
73
P450 inhibitor INR effect?
INR will increase
74
HF management?
1. First-line treatment for all patients is both an ACE-inhibitor and a beta-blocker*. Generally, one drug should be started at a time
2. Scond-line treatment is now either an aldosterone antagonist, angiotensin II receptor blocker or a hydralazine in combination with a nitrate
3. If symptoms persist cardiac resynchronisation therapy or digoxin** should be considered. An alternative supported by NICE in 2012 is ivabradine.
4. The criteria for ivabradine include that the patient is already on suitable therapy (ACE-inhibitor, beta-blocker + aldosterone antagonist), has a heart rate > 75/min and a left ventricular fraction < 35%
5. Diuretics should be given for fluid overload
6. Offer annual influenza vaccine
7. Offer one-off*** pneumococcal vaccine
75
3 s/es of statins?
1. Myopathy
2. Liver impairment
3. Intracerebral haemorrhage in pts who've previously had a stroke
76
2 c/is to statins?
1. Macrolides
| 2. Pregnancy
77
Who should receive a statin?
1. All with established CVD
2. Anyone with QRISK >10%
3. Patients with type 1 diabetes mellitus who were diagnosed more than 10 years ago OR are aged over 40 OR have established nephropathy
78
When to increase atorvastatin 20mg dose?
If non-HDL has not reduced for >=40%
79
When use 80mg atorvastatin dose?
1. Known IHD
2. Cerebrovascular disease
3. Peripheral arterial dsease
80
When use 20mg atorvastatin dose?
1. QRISK >10%
2. Most T1DM
3. CKD if eGFR < 60ml/min/m2
81
General factors that may potentiate warfarin?
1. Liver disease
2. P450 enzyme inhibitors
3. Cranberry juice
4. Drugs which displace warfarin from plasma albumin e.g. NSAIDs
5. Inhibit plt function e.g. NSAIDs
82
Drugs to be avoided in breastfeeding?
1. Ciprofloxacin
2. Tetracycline
3. Chloramphenicol
4. Sulphonamides/Sulfonylureas
5. Lithium
6. Benzos
7. Aspirin
8. Carbimazole
9. Methotrexate
10. Cytotoxics
11. Amiodarone
83
3 drugs that should be used with caution in asthma?
1. NSAIDs
2. BBs
3. Adenosine
84
Amlodipine starting dose?
5mg
85
WHO analgesia ladder step 1?
Non-opioid analgesics
1. Paracetamol
2. NSAIDs, incl. aspirin
86
WHO analgesia ladder step 2?
Mild opioid analgesics
1. Codeine
2. Dihydrocodeine
87
WHO analgesia ladder step 3?
Strong opioid analgesics
| 1. Morphine
88
3 drugs that decrease serum potassium?
1. Thiazide diuretics
2. Loop diuretics
3. Acetozolamide
89
5 drugs that increase serum potassium?
1. ACEi
2. ARBs
3. Spironolactone
4. K sparin giuretics
5. Sando-K
90
Minimal glucocorticoid activity, very high mineralocorticoid activity?
Fludrocortisone
91
Glucocorticoid activity, high mineralocorticoid activity?
Hydrocortisone
92
Predominant glucocorticoid activity, low mineralocorticoid activity?
Prednisolone
93
Very high glucocorticoid activity, minimal mineralocorticoid activity?
Dexamethasone, betamethasone
94
Bisphosphonates MOA?
Bisphosphonates are analogues of pyrophosphate, a molecule which decreases demineralisation in bone. They inhibit osteoclasts by reducing recruitment and promoting apoptosis.
95
Uses of bisphosphonates?
1. Osteoporosis
2. Hypercalcaemia
3. Paget's
4. Pain from bone metastases
96
5 s/e of bisphosphonates?
1. Oesophagitis/ulcers
2. Osteonecrosis of the jaw
3. Atypical stress fractures
4. Acute phase response
5. Hypocalcaemia
97
BNF taking bisphosphonates advice?
'Tablets should be swallowed whole with plenty of water while sitting or standing; to be given on an empty stomach at least 30 minutes before breakfast (or another oral medication); patient should stand or sit upright for at least 30 minutes after taking tablet'
98
When should bisphosphonates be stopped after 5 years?
1. Pt < 75y/o
2. Femoral neck T-score of >-2/5
3. Low risk according to FRAX/NOGG
99
What % of pts with asthma experience bronchospasm after NSAIDS?
10-20%, risk is greater in those with nasal polyps
100
2 C/I to adenosine?
Asthma and COPD
101
Mx of urge incontinence?
Oxybutynin 5mg PO BD
102
Drugs C/I in HF?
1. Glitazones (thiazolidinediones) as causes fluid retention
2. Verapamil = -ive inotropic effect
3. NSAIDs/glucocorticoids as they cause fluid retention
4. Class I antiarrhythmics
103
Factors that may potentiate warfarin?
1. Liver disease
2. P450 inhibitors
3. Cranberyy juice
4. NSAIDs (displace warfarin from plasma albumin + inhibit plt function)
104
Dalteparin dose?
2500-5000 units SC OD
105
Enoxaparin dose?
40mg SC OD
106
Exacerbation of chronic bronchitis?
Amoxicillin/tetracycline/clarithromcyin
107
Acute prostatitis?
Quinolone or trimethoprim
108
Impetigo?
Topical fusidic acid/oral flucloxacillin/erythromycin if widespread
109
Animal/human bite?
Co-amoxiclav
110
Sinusitis?
Amoxicillin
111
Gonorrhoea?
IM ceftriaxone + oral azithromycin
112
Chlamydia?
Doxycycline
113
PID?
Metronidazole + doxycycline + IM ceftriaxone
114
Salmonella (non-typhoid) or shigellosis?
Ciprofloxacin
115
Otitis externa?
Flucloxacillin
116
Atenolol dose?
50mg PO BD
117
Bisoprolol dose?
10mg PO OD
118
Metoprolol dose?
50-100mg PO BD
119
Propranolol dose?
40mg PO BD
120
Verapamil dose?
80-120mg PO TDS
121
Diltiazem dose?
60mg PO BD
122
Nifedipine dose?
20-30mg PO OD
123
Isosorbide mononitrate dose?
10-20mg PO BD/TDS
124
Metronidazole dose for C.diff?
400mg PO TDS 14 days
125
Vancomycin dose?
125mg PO QDS
126
What drug reduces hypoglycaemic awareness?
BBs
127
Lactulose dose?
15ml PO BD
128
Macrogol dose?
2 Sachets PO BD
129
Movicol dose?
2 Sachets PO BD
130
Senna dose?
7.5mg PO BD
131
Docusate dose?
100mg PO QDS
132
Laxative types?
1. Osmotic
2. Stimulants
3. Bulk forming
4. Stool softeners
133
Osmotic laxatives?
1. Lactulose
2. Macrogol
3. Rectal phosphates
134
Stimulant laxatives?
1. Senna
2. Docusate
3. Bisacodyl
4. Glycerol
135
To only which pt group should Co-danthramer be prescribed?
Palliative pts due to its carcinogenic potential
136
Bulk forming laxatives?
1. Isphagula husk
| 2. Methylcellulose
137
Faecal softeners
1. Arachis oil enemas
| 2. Not commonly prescribed
138
O2 prior to obtaining blood gases for a COPD pt?
1. 27% Venturi mask at 4L/min, aiming for O2 sats of 88-92%
| 2. 94-98% if pCO2 is normal
139
Maintenance wate?
30ml/kg/day
140
Maintenance K, Na and Cl?
1mmol/kg/day
141
Maintenance glucose?
50-100g/day
142
2 loop diuretics?
1. Furosemide
| 2. Bumetanide
143
Metronidazole P450?
Inhibitor
144
ACS Morphine dose?
2.5mg IV
145
ACS metoclopramide dose?
10mg IV
146
Aminophylline dose?
5mg/kg if not already on a xanthine
147
Aminophylline rate of infusion?
500mcg/kg/hour
148
Lansoprazole dose?
30mg PO OD
149
Omeprazole dose?
40mg PO PD
150
Pantoprazole dose?
40mg PO OD
151
Ranitidine dose?
150mg PO BD
152
Cefotaxime dose?
1g/2g IV STAT
153
Ceftriaxone dose?
1g/2g IV STAT
154
Benzypenicillin dose?
1.2g/2.4g IV or IM STAT
155
Anaphylaxis hydrocortisone dose?
200mg IV
156
Anaphylaxis chlorphenamine dose?
10mg IV
157
Adenosine svt dose?
6mg IV STAT
158
Verapamil svt dose?
2-5-5mg IV STAT
159
Hydrocortisone asthma dose?
100mg IV QDS
160
Ipratropium asthma dose?
500mcg Neb QDS
161
What % of pts allergic to penicillin are also allergic to cephalosporins?
0.5-6.5%
162
Emergency contraception doses?
1. Levonorgestrel 1.5mg PO STAT
| 2. Ulipristal acetate 30mg PO STAT
163
Levonorgestrel MOA?
Stops ovulation and inhibits implantation
164
Ulipristal MOA?
SPRM
165
When should you have gradual withdrawal of systemic steroids?
1. Received >40mg prednisolone for >1 week
2. Received more than 3 weeks tx
3. Recently received repeat courses
166
Fluoxetine dose?
20mg PO OD
167
Citalopram dose?
20mg PO OD
168
Sertraline dose?
50mg PO OD
169
Paroxetine dose?
20mg PO OD
170
Gentamicin peak target?
3-5mg/litre
171
Gentamicin trough target?
<1mg/litre
172
Drug causes of SIADH
1. Sulfonylureas
2. SSRIs, TCAs
3. Carbamazepine
173
2 weekly medications?
1. Bisphosphonates
| 2. Methotrexate
174
5 s/e of tamoxifen?
1. Menstrual disturbance
2. Hot flushes
3. VTE
4. Endometrial cancer
5. Osteoporosis
175
Flucloxacillin dose?
250-500mg PO QDS
176
Trimethoprim dose?
200mg PO BD
177
Nitrofurantoin dose?
50mg PO QDS
