Past Exam Qu's Flashcards
What factors do we need to consider when loading warfarin?
Age- use lower loading dose in the elderly as target INR is achieved with a much lower maintenance dose
Ethnicity- Indo-Asians and Afro-Caribbeans require higher doses
Albumin- warfarin is 99% protein-bound therefore a decline in albumin results in lower dose requirements
Smoking
Indication
What is the most common method for monitoring UFH therapy?
APTT (activated partial thromboplastin time)
A fixed therapeutic range for the aPTT of 1.5 to 2.5 times the control value has become widely accepted,
What is the Haemoglobin reference range in females?
120 - 150
What is the target levels for the TDM drug Phenobarbitone?
How long does it take to reach steady state?
How long is its half life?
10 - 40mg/L
3-4 weeks to reach steady state
long half life of 5 days
What is the target levels for the TDM drug carbamazepine? When should levels be looked at?
4-10 mg/L
Take a trough at least 2 weeks after starting or dose change
What is the target levels for the TDM drug Phenytoin? when should levels be looked at?
10-20mg/L
A trough level should be taken 2-4 weeks after starting
Around 90% of potassium in our body is intracellular, 10% is in extracellular fluid. This 10% is what we are referring to when we say our target potassium range is 3.5- 5.3- the extracellular potassium concentration
This means that K+ biochemistry results are a poor reflection of total body potassium
What are the signs of hyperkaleamia?
Weakness Paralysis Confusion Parasthesia (tingling) Vomitting ECG changes (Resting membrane potential, shorter Action potentials)
What is the treatment for hyperkalaemia?
Severe: K+ >6.5mmol/L/ any ECG changes
URGENT treatment with 10-20ml of Calcium Gluconate 10% by slow IV injection over 2 mins. This temporarily protects against myocardial excitability.
Then give an IV injection of SOLUBLE INSULIN (5-10 units) with glucose 50% to drive potassium into cells and reduce serum potassium concentration.
Nebulised/ Slow IV salbutamol may also be used- use with caution in those with Cardiovascular disease.
Any acidosis should be corrected with sodium bicarbonate infusion
Ion-exchange resins can be used to remove excess potassium in mild hyperkaleamia or moderate if there are no ECG changes
Calcium gluconate 10% by IV injection over 2 mins is used for treatment of Hypocalceamia. Is this correct?
NO this is how we administer for hyperkaleamia
In hypocalceamia with use calcium gluconate infused over 30 mins
What do we use calcitonin for?
HYPERCALCAEMIA
It is a hormone that acts to reduce blood calcium (Ca2+), opposing the effects of parathyroid hormone (PTH).
What is digoxins half life?
around 40 hours
What are the symptoms of macrocytic anaemia?
Glossitis SOB angular stomatitis altered bowel habit anorexia- weight loss tachycardia bilateral peripheral neuropathy
According to the NICE classification of CKD, what level of renal impairment does a CrCl/ GFR of 48ml/min indicate?
Moderate
What is the interaction between amiodarone and digoxin?
Amiodarone increases plasma levels of digoxin- so we need to HALVE the dose of digoxin
Is there an interaction between Lithium and diclofenac?
YES there is an interaction between lithium and all NSAID’s:
excretion of lithium reduced by NSAIDs (increased risk of toxicity)
Amiodarone has a long half-life; there is a potential for drug interactions to occur for several weeks (or even months) after treatment with it has been stopped
dizziness, vision problems, seeing halos around lights; loss of coordination feeling weak or tired nausea, vomiting, constipation; numbness or tingling; tremors; abnormal liver function tests and thyroid function tests Slate grey skin
What is the normal range for prothrombin time?
Prothrombin times is the average time range for blood to clot and is usually about 10 to 14 seconds
What is the treatment guidelines for cellulitis? What if streptococcal infection is confirmed?
What is they are penicillin allergic?
Flucloxacillin
Strep confirmed: Benzylpenicillin/ Pen V
Penicillin allergic: clindamycin or clarithromycin or vancomycin
What is a pharmacodynamic interaction?
The effects of one drug are changed by the presence of another drug at its site of action.
For example, 2 drugs competing for a particular receptor: Beta2 agonist such as salbutamol competing with a beta blocker such as propranolol.
The root cause analysis process
Identify problem define problem understand problem identify root cause corrective action monitor systme
How is Vancomycin administered?
As a slow IV infusion (NOT IV BOLUS OR IM INJECTION) at no more than 10mg/min, over at least 60 mins to avoid red man syndrome
Do corticosteroids cause hypo or hyperkaleamia?
HYPOKALEAMIA
Pseudomonas aeruginosa is a common Gram-negative bacteria causing infections such as hospital acquired pneumonia. What antibiotics are active against this?
aminoglycosides- gent, amikacin
quinolones- ciprofloxacin, moxifloxacin
cephlasporins- cetriaxones, ceftazadime
carbapenems- meropenem
Note: most penicillins DONT- we use amox and gent for HAP at work- amok added for gram positive cover
Why can HbA1C reflect glucose levels over a period of 3 months?
Because red blood cells in the human body survive for 8-12 weeks before renewal, measuring glycated haemoglobin (or HbA1c) can be used to reflect average blood glucose levels over that duration, providing a useful longer-term gauge of blood glucose control.
Normal target: < 42 mmol/mol
Those with diabetes: < 48 mol/mol
What are the target BM’s in adults with T2DM?
On waking?
Before meals?
After meals?
on waking: 5–7mmol/l
before meals at other times of the day:
4–7mmol/l
90 minutes after meals: 5–9mmol/l.
