passmed q errors Flashcards
for STEMI immediate mx if allergy to aspirin give what
clopi 300mg once only
or
ticagrelor 180mg once only
what is atorvastatin starting dose for primary prevention
20mg
what blood test abnormality can tacrolimus cause
PANcytopaenia
should co-codamol be stopped in an AKI
yes due to risks of adverse effects with renal excretion
2 drugs that can cause fluid retention
CCBs
Corticosteroids - Systemic corticosteroids (prednisolone) commonly cause fluid retention via the stimulation of mineralocorticoid receptors, which lead to sodium and water retention
can ondansetron cause constipation
yes by delayed colonic transit
unprotected sex a few ago and this is her DHx: carbamazepine 300mg PO TDS, salbutamol 200 micrograms inhaler PRN, beclometasone dipropionate 200 micrograms inhaler BD, regular multivitamins
levonergestrel < 12h
-dose usually 1.5mg BUT she is on an enzyme inducer so need a higher dose = 3mg
BNF “When used orally as an emergency contraceptive, the effectiveness of levonorgestrel could be reduced in women taking enzyme-inducing drugs (and for up to 4 weeks after stopping); a copper intra-uterine device should preferably be used instead. If the copper intra-uterine device is undesirable or inappropriate, the dose of levonorgestrel should be increased to a total of 3 mg taken as a single dose; pregnancy should be excluded following use, and medical advice sought if pregnancy occurs.”
what is cimetidine
CYP450 inhibitor
-slows down metabolism of drugs increasing their toxicity
what is important to check when using trimethoprim or co-trimoxazole in pts with renal impairment
Trimethoprim in patients at risk of AKI –> potassium is the most important electrolyte to check
with a statin at 3m when you check LFTs what is a sign that they should be stopped
if transaminases are raised MORE THAN 3X ULN –> STOP statin and repeat LFTs in 1 month
- if they are only slightly raised (less than 3xULN) then you don’t need to stop the statin, just recheck them in 1month
For T1DM if his glucose is high before breakfast what should the change be to his evening insulin eg if it is 15 U in evening
Titrating insulin with glucose-
increase in 10% in previous dosage if pre-meal BM >7
-15 U increase to 16.5U but round this
how to step down analgesia post op
use the reverse pain ladder strong opiod weak opiod NSAIDs paracetamol
what is the equivalent dose of morphine PO to dihydrocodeine PO
10mg morphine PO = 100mg dihydrocodeine PO
-there is a table in ‘prescribing for palliative care’
anti emetic for post-op analgesia
ondansetron
cyclizine - CI in HF
prochlorperazine - CI in PD
for hypo unconscious pt in hosp with cannulae
tx with IV Glucose 10% 150ml 15 minutes
drugs CI in breastfeeding
fluoxetine
tetracycline
aspirin
lithium carbonate
GBS + mothers - swab + - at risk of neonatal sepsis - have what drug prophylactically
Ben pen sodium 3g IV
pt with diabetes + evidence fo nephropathy what drug ot start
lisinopril
what to give for uTI if trimethoprim (eg not resistant or on folate antag) and nitro (low renal ftn eGFR<45) not suitable
fosfomycin
abruptly stopping SSRis / antidepress leads to what
discountinuation symptoms
- restless
- irritable
what does co-careldopa lead to that pts shld be warned about
excess daytime sleepiness
-warn pts about this risk + need to use caution whilst driving or operating machinery
what should pts be told about haloperidol with regards to mvmnt disorders
Haloperidol is an anti-psychotic that is used to treat schizophrenia and other psychoses.
It is linked to extra-pyramidal effects such as AKATHISIA due to it being a dopamine D2 receptor antagonist. - Akathisia is a movement disorder associated with restlessness and inability to stay still.
why should you tell pts to keep their diet stable with warfarin
warfarin is a vit k antagonist that promotes anticoagulation
-foods with lots of vit K eg GREEN LEAFY VEG + lIVER can interefere with how it works
what is the amount of glucose in 1L 10% dextrose over 8h that will be given in 2h
so amount of glucose in 10% dextrose = 10mg in 100mL = 100mg in 1000mL
given over 8h
so over 2h
100mg / 4 = 25mg
A 38-year-old patient suffers from hypomagnesaemia. She is prescribed a magnesium sulphate infusion of 10g once-daily for five days in a 0.9% sodium chloride solution. The concentration of magnesium sulphate should not exceed 20%.
What is the minimum volume of 0.9% sodium chloride required to safely make up the magnesium sulphate solution?
A concentration of 20% is 20kg in 100L = 20mg in 0.1mL = 200mg in 1mL. Since the patient requires 10g of magnesium sulphate, the minimum volume of 0.9% sodium chloride is: 10g ÷ 200mg/mL = 50mL.
Concentration ratios (20% in this case) are based on units of kilogram and litre as they belong to the International System of Units (SI units) which are used by convention.
cholestatic jaundice with what drug
macrolide - you get incr ALP compared to ALT
NB. clindamycin can cause hepatic jaundice , with raised ALT and AST vs lower ALP
atorvastatin 3m after starting what to measur
LFTs - measure before starting, measure at 3m and 12m afterwards as it is known to be hepatoxic
straight after medical TOP with mifepristone what should you measure
BP - you can get severe hypotension
UPT - likely still + so do it at 3 weeks
pt on Palliative care - they want to make his PO morphine into SC infusion - calculate how much , convert it and what should be the PRN dose of SC as well
The patient is currently on a total of 200mg morphine sulphate PO a day (75mg 12 hrly regular Morphine sulphate and 5 doses of 10mg/5mL of Oramorph® = 150mg + 5 x10mg = 200mg). To convert into subcutaneous infusion, the regular dose has to be half the daily amount of PO morphine sulphate (200/2 = 100mg) and the PRN dose one sixth the total amount given regularly (1/6 x 100 = 16.7mg)
with DKA on fixed rate insulin infusion what are the targets with regards to what drops etc and by how much - ketones + glucose
Ketone reduction should be >0.5mM/h
Glucose reduction >3mM/h
-if these targets are not met then you should increase insulin rate by 1U/hour increments hourly until ketones fall at target rates
