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Passmed PSA Mushkies Flashcards

1
Q

2 medications taken at night?

A
  1. Statins

2. Amitryptiline

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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)

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3
Q

Paracetamol dose?

A

1g QDS

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4
Q

Ibuprofen dose?

A

200-400mg TDS

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5
Q

Codeine dose?

A

30-60mg QDS

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6
Q

Co-codamol 8/500 or coc-codamol 30/500 dose?

A

2 tabs QDS

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7
Q

Cyclizine dose?

A

50mg TDS

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8
Q

Metoclopramide dose?

A

10mg TDS

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9
Q

Amoxicillin dose?

A

500mg TDS

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10
Q

Clarithromycin dose?

A

500mg BD

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11
Q

Lansoprazole dose?

A

15-30mg OD

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12
Q

Omeprazole dose?

A

20-40mg OD

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13
Q

Aspirin dose?

A

75-300mg OD

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14
Q

Clopidogrel dose?

A

75-300mg OD

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15
Q

Simvastatin dose?

A

10-80mg ON

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16
Q

Atenolol dose?

A

25-100mg OD

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17
Q

Ramipril dose?

A

1.25-10mg OD

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18
Q

Bendroflumethiazide dose?

A

2.5mg OD

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19
Q

Furosemide dose?

A

20mg OD - 80mg BD

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20
Q

Amlodipine dose?

A

5-10mg OD

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21
Q

Levothyroxine dose?

A

25-200mcg OD

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22
Q

Metformin dose?

A

500mg OD - 1g BD

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23
Q

Indapamide MOA?

A

Thiazide-like diuretic

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24
Q

Normal hypothyroid pt starting dose?

A

50-100mcg OD

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25
Q

When should hypothyroidism starting dose be lower (25mcg OD then slowly titrated?

A
  1. Cardiac disease pts
  2. Severe hypothyroidism pts
  3. > 50y/o pts
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26
Q

Following a change in thyroxine dose, when should TFTs be checked?

A

After 8-12 weeks

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27
Q

Therapeutic goal of hypothyroidism Mx?

A

Normalisation of the TSH (0.5-2.5 mU/l)

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28
Q

Hypothyroid pregnant woman dose change?

A

Increased by at least 25-50mcg, aiming for a low-normal TSH value

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29
Q

4 s/e of thyroxine therapy?

A
  1. Hyperthyroidism
  2. Reduced BMD
  3. Worsening of angina
  4. AF
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30
Q

Interactions of levothyroxine?

A
  1. Iron (absorption of levothyroxine reduced, give at least 4 hours apart)
  2. Calcium carbonate
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31
Q

What should be checked every 6m in a pt on lithium?

A

U&E and TFTs

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32
Q

Lithium range?

A

0.4-1

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33
Q

When should lithium level be checked?

A

12 hours post dose

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34
Q

When should ciclosporin level be checked?

A

Trough levels immediately before dose

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35
Q

When should digoxin level be checked?

A

At least 6 hours post dose

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36
Q

When should phenytoin levels be checked?

A
  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
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37
Q

Toxic paracetamol dose?

A

150mg/kg

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38
Q

When should IV acetylcysteine be started?

A
  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
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39
Q

Paracetamol OD w/in 1hr Mx?

A

Activated charcoal

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40
Q

Duration of acetylcysteine infusion?

A

1 hour (to reduce the number of adverse effects)

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41
Q

Acetylcysteine complication?

A

Anaphylactoid reaction (non-IgE mediated mast cell release)

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42
Q

Mx of acetylcysteine anaphylactoid reaction?

A

Stopping the infusion, then restarting at a slower rate

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43
Q

Criteria for liver transplantation after paracetamol OD?

A

King’s College Hospital criteria

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44
Q

King’s College Hospital criteria?

A

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

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45
Q

Staggered OD defn?

A

If all tablets were not taken within 1 hour

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46
Q

Classification of insulin?

A
  1. By manufacturing process

2. By duration of action

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47
Q

Insulin manufacturing process types?

A
  1. Porcine
  2. Human sequence
  3. Analogues
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48
Q

What are the different subtypes of insulin based on duration of action?

A
  1. Rapid acting analogues
  2. Short acting
  3. Intermediate acting
  4. Long acting analogues
  5. Premixed preparations
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49
Q

What is the onset, peak and duration of rapid acting insulin?

A 
O = 5 mins
P = 1 hour
D = 3-5 hours
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50
Q

What is the onset, peak and duration of short acting insulin?

A 
O = 30 mins
P = 3 hours
D = 6-8 hours
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51
Q

What is the onset, peak and duration of intermediate acting insulin?

A 
O = 2 hours
P = 5-8 hours 
D = 12-18 hours
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52
Q

What is the onset, peak and duration of long acting insulin?

A 
O = 1-2 hours
P = flat profile
D = up to 24 hours
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53
Q

What are some rapid acting insulin analogues?

A
  1. Insulin aspart = NovoRapid

2. Insulin lispro = Humalog

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54
Q

What are some short acting insulins?

A
  1. Actrapid (soluble)

2. Humulin (soluble)

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55
Q

What are some intermediate acting insulins?

A

Isophane insulin, often used in premixed formulation with long acting insulin

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56
Q

What are some long acting insulins?

A
  1. Insulin detemir = Levemir = Od or BD

2. Insulin glargine = Lantus = OD

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57
Q

What is a premixed insulin preparation?

A
  1. Combine intermediate acting insulin with with either:
  2. Rapid acting insulin analogue OR
  3. Soluble insulin
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58
Q

Why is gentamicin given parenterally?

A

It is poorly lipid soluble

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59
Q

2 forms of gentamicin?

A
  1. IV = e.g. for IE

2. Topical = e.g. for otitis externa

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60
Q

2 s/e of gentamicin?

A
  1. Ototoxicity = irreversible, due to auditory or vestibular nerve damage
  2. Nephrotoxicity = accumulates in renal failure, lower doses and more frequent monitoring required
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61
Q

C/I of gentamicin?

A

Myasthenia gravis

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62
Q

Dosing of gentamicin?

A
  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
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63
Q

Cytochrome P450 inducers?

A

PC BRASSS

  1. Phenytoin
  2. Carbamazepine
  3. Barbiturates
  4. Rifampicin
  5. Alcohol (Chronic)
  6. Sulfonylureas
  7. Smoking
  8. St Johns Wort
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64
Q

Cytochrome P450 inhibitors?

A

AO DEVICES GR

  1. Allopurinol, amiodarone, antifungals
  2. Omeprazole
  3. Disulfiram
  4. Erythromycin
  5. Valproate
  6. Izoniazid
  7. Ciprofloxacin, Clarithromycin
  8. Ethanol (acute)
  9. Sulphonamides, SSRIs
  10. Grapefruit juice
  11. Ritonavir
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65
Q

Examples of drugs which interact with enzyme inhibitors/inducers?

A

When Chickens Tickle Chickens, They Prefer Smiling

  1. Warfarin
  2. COCP
  3. Theophylline
  4. Corticosteroids
  5. Tricyclics
  6. Pethidine
  7. Statins
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66
Q

Narrow therapeutic range drugs that have many interactions?

A

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
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67
Q

Metformin interaction?

A

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.

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68
Q

Gentamicin interaction?

A

Loop diuretics (renal failure risk)

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69
Q

ACE inhibitor interactions?

A
  1. Potassium-sparing diuretic (hyperkalaemia)

2. Metformin (enhances hypoglycaemic effect)

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70
Q

Statin interactions?

A
  1. Macrolide

2. Amiodarone (increased statin conc and thus risk of rhabdo)

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71
Q

Thiazide interactions?

A
  1. PPI (hyponatraemia)

2. Lithium (increased toxicity)

72
Q

P450 inducer INR effect?

A

INR will decrease

73
Q

P450 inhibitor INR effect?

A

INR will increase

74
Q

HF management?

A
  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
Q

3 s/es of statins?

A
  1. Myopathy
  2. Liver impairment
  3. Intracerebral haemorrhage in pts who’ve previously had a stroke
76
Q

2 c/is to statins?

A
  1. Macrolides

2. Pregnancy

77
Q

Who should receive a statin?

A
  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
Q

When to increase atorvastatin 20mg dose?

A

If non-HDL has not reduced for >=40%

79
Q

When use 80mg atorvastatin dose?

A
  1. Known IHD
  2. Cerebrovascular disease
  3. Peripheral arterial dsease
80
Q

When use 20mg atorvastatin dose?

A
  1. QRISK >10%
  2. Most T1DM
  3. CKD if eGFR < 60ml/min/m2
81
Q

General factors that may potentiate warfarin?

A
  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
Q

Drugs to be avoided in breastfeeding?

A
  1. Ciprofloxacin
  2. Tetracycline
  3. Chloramphenicol
  4. Sulphonamides/Sulfonylureas
  5. Lithium
  6. Benzos
  7. Aspirin
  8. Carbimazole
  9. Methotrexate
  10. Cytotoxics
  11. Amiodarone
83
Q

3 drugs that should be used with caution in asthma?

A
  1. NSAIDs
  2. BBs
  3. Adenosine
84
Q

Amlodipine starting dose?

85
Q

WHO analgesia ladder step 1?

A

Non-opioid analgesics

  1. Paracetamol
  2. NSAIDs, incl. aspirin
86
Q

WHO analgesia ladder step 2?

A

Mild opioid analgesics

  1. Codeine
  2. Dihydrocodeine
87
Q

WHO analgesia ladder step 3?

A

Strong opioid analgesics

1. Morphine

88
Q

3 drugs that decrease serum potassium?

A
  1. Thiazide diuretics
  2. Loop diuretics
  3. Acetozolamide
89
Q

5 drugs that increase serum potassium?

A
  1. ACEi
  2. ARBs
  3. Spironolactone
  4. K sparin giuretics
  5. Sando-K
90
Q

Minimal glucocorticoid activity, very high mineralocorticoid activity?

A

Fludrocortisone

91
Q

Glucocorticoid activity, high mineralocorticoid activity?

A

Hydrocortisone

92
Q

Predominant glucocorticoid activity, low mineralocorticoid activity?

A

Prednisolone

93
Q

Very high glucocorticoid activity, minimal mineralocorticoid activity?

A

Dexamethasone, betamethasone

94
Q

Bisphosphonates MOA?

A

Bisphosphonates are analogues of pyrophosphate, a molecule which decreases demineralisation in bone. They inhibit osteoclasts by reducing recruitment and promoting apoptosis.

95
Q

Uses of bisphosphonates?

A
  1. Osteoporosis
  2. Hypercalcaemia
  3. Paget’s
  4. Pain from bone metastases
96
Q

5 s/e of bisphosphonates?

A
  1. Oesophagitis/ulcers
  2. Osteonecrosis of the jaw
  3. Atypical stress fractures
  4. Acute phase response
  5. Hypocalcaemia
97
Q

BNF taking bisphosphonates advice?

A

‘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
Q

When should bisphosphonates be stopped after 5 years?

A
  1. Pt < 75y/o
  2. Femoral neck T-score of >-2/5
  3. Low risk according to FRAX/NOGG
99
Q

What % of pts with asthma experience bronchospasm after NSAIDS?

A

10-20%, risk is greater in those with nasal polyps

100
Q

2 C/I to adenosine?

A

Asthma and COPD

101
Q

Mx of urge incontinence?

A

Oxybutynin 5mg PO BD

102
Q

Drugs C/I in HF?

A
  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
Q

Factors that may potentiate warfarin?

A
  1. Liver disease
  2. P450 inhibitors
  3. Cranberyy juice
  4. NSAIDs (displace warfarin from plasma albumin + inhibit plt function)
104
Q

Dalteparin dose?

A

2500-5000 units SC OD

105
Q

Enoxaparin dose?

A

40mg SC OD

106
Q

Exacerbation of chronic bronchitis?

A

Amoxicillin/tetracycline/clarithromcyin

107
Q

Acute prostatitis?

A

Quinolone or trimethoprim

108
Q

Impetigo?

A

Topical fusidic acid/oral flucloxacillin/erythromycin if widespread

109
Q

Animal/human bite?

A

Co-amoxiclav

110
Q

Sinusitis?

A

Amoxicillin

111
Q

Gonorrhoea?

A

IM ceftriaxone + oral azithromycin

112
Q

Chlamydia?

A

Doxycycline

113
Q

PID?

A

Metronidazole + doxycycline + IM ceftriaxone

114
Q

Salmonella (non-typhoid) or shigellosis?

A

Ciprofloxacin

115
Q

Otitis externa?

A

Flucloxacillin

116
Q

Atenolol dose?

A

50mg PO BD

117
Q

Bisoprolol dose?

A

10mg PO OD

118
Q

Metoprolol dose?

A

50-100mg PO BD

119
Q

Propranolol dose?

A

40mg PO BD

120
Q

Verapamil dose?

A

80-120mg PO TDS

121
Q

Diltiazem dose?

A

60mg PO BD

122
Q

Nifedipine dose?

A

20-30mg PO OD

123
Q

Isosorbide mononitrate dose?

A

10-20mg PO BD/TDS

124
Q

Metronidazole dose for C.diff?

A

400mg PO TDS 14 days

125
Q

Vancomycin dose?

A

125mg PO QDS

126
Q

What drug reduces hypoglycaemic awareness?

127
Q

Lactulose dose?

A

15ml PO BD

128
Q

Macrogol dose?

A

2 Sachets PO BD

129
Q

Movicol dose?

A

2 Sachets PO BD

130
Q

Senna dose?

A

7.5mg PO BD

131
Q

Docusate dose?

A

100mg PO QDS

132
Q

Laxative types?

A
  1. Osmotic
  2. Stimulants
  3. Bulk forming
  4. Stool softeners
133
Q

Osmotic laxatives?

A
  1. Lactulose
  2. Macrogol
  3. Rectal phosphates
134
Q

Stimulant laxatives?

A
  1. Senna
  2. Docusate
  3. Bisacodyl
  4. Glycerol
135
Q

To only which pt group should Co-danthramer be prescribed?

A

Palliative pts due to its carcinogenic potential

136
Q

Bulk forming laxatives?

A
  1. Isphagula husk

2. Methylcellulose

137
Q

Faecal softeners

A
  1. Arachis oil enemas

2. Not commonly prescribed

138
Q

O2 prior to obtaining blood gases for a COPD pt?

A
  1. 27% Venturi mask at 4L/min, aiming for O2 sats of 88-92%

2. 94-98% if pCO2 is normal

139
Q

Maintenance wate?

A

30ml/kg/day

140
Q

Maintenance K, Na and Cl?

A

1mmol/kg/day

141
Q

Maintenance glucose?

A

50-100g/day

142
Q

2 loop diuretics?

A
  1. Furosemide

2. Bumetanide

143
Q

Metronidazole P450?

144
Q

ACS Morphine dose?

145
Q

ACS metoclopramide dose?

146
Q

Aminophylline dose?

A

5mg/kg if not already on a xanthine

147
Q

Aminophylline rate of infusion?

A

500mcg/kg/hour

148
Q

Lansoprazole dose?

A

30mg PO OD

149
Q

Omeprazole dose?

A

40mg PO PD

150
Q

Pantoprazole dose?

A

40mg PO OD

151
Q

Ranitidine dose?

A

150mg PO BD

152
Q

Cefotaxime dose?

A

1g/2g IV STAT

153
Q

Ceftriaxone dose?

A

1g/2g IV STAT

154
Q

Benzypenicillin dose?

A

1.2g/2.4g IV or IM STAT

155
Q

Anaphylaxis hydrocortisone dose?

156
Q

Anaphylaxis chlorphenamine dose?

157
Q

Adenosine svt dose?

A

6mg IV STAT

158
Q

Verapamil svt dose?

A

2-5-5mg IV STAT

159
Q

Hydrocortisone asthma dose?

A

100mg IV QDS

160
Q

Ipratropium asthma dose?

A

500mcg Neb QDS

161
Q

What % of pts allergic to penicillin are also allergic to cephalosporins?

162
Q

Emergency contraception doses?

A
  1. Levonorgestrel 1.5mg PO STAT

2. Ulipristal acetate 30mg PO STAT

163
Q

Levonorgestrel MOA?

A

Stops ovulation and inhibits implantation

164
Q

Ulipristal MOA?

165
Q

When should you have gradual withdrawal of systemic steroids?

A
  1. Received >40mg prednisolone for >1 week
  2. Received more than 3 weeks tx
  3. Recently received repeat courses
166
Q

Fluoxetine dose?

A

20mg PO OD

167
Q

Citalopram dose?

A

20mg PO OD

168
Q

Sertraline dose?

A

50mg PO OD

169
Q

Paroxetine dose?

A

20mg PO OD

170
Q

Gentamicin peak target?

A

3-5mg/litre

171
Q

Gentamicin trough target?

A

<1mg/litre

172
Q

Drug causes of SIADH

A
  1. Sulfonylureas
  2. SSRIs, TCAs
  3. Carbamazepine
173
Q

2 weekly medications?

A
  1. Bisphosphonates

2. Methotrexate

174
Q

5 s/e of tamoxifen?

A
  1. Menstrual disturbance
  2. Hot flushes
  3. VTE
  4. Endometrial cancer
  5. Osteoporosis
175
Q

Flucloxacillin dose?

A

250-500mg PO QDS

176
Q

Trimethoprim dose?

A

200mg PO BD

177
Q

Nitrofurantoin dose?

A

50mg PO QDS

Medicine and Surgery Mushkies (52 decks)

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