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IK6 - PSA and prescribing > Planning management > Flashcards

Planning management Flashcards

1
Q

How would you calculate PRN/”as needed” dose of opioids?

A

1/6 of total daily dose of opioids

give PRN option of every 4-6 hours

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2
Q

Acute management of STEMI

A
  1. ABC, O2 on non-rebreath if low sats (caution COPD)
  2. Ix to confirm Dx (ECG)
  3. aspirin 300mg PO + ticagrelor 180mg
  4. morphine 5-10mg IV + cyclizine 50mg IV
  5. GTN spray/tablet
  6. Primary PCI or thrombolysis
  7. beta-blocker, bisoprolol 2.5mg PO (CI LV failure or asthma)
  8. transfer to CCU
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3
Q

describe MONA BASH

A

management of ACS

MONA BASH (morphine, oxygen, nitrates, aspirin, beta-blocker, ACEi, statin, heparin)

  • statin high dose - all ACS pt e.g. atorvastatin 80mg PO
  • ACEi - if indicated by BP
  • heparin - for all non-ST MI
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4
Q

acute management of NSTEMI

A
  1. A-E, oxgen
  2. Ix + Dx
  3. aspirin 300mg
  4. morphine 5-10mg IV + cyclizine 50mg IV
  5. GTN spray/tablet
  6. clopidogrel 300mg oral or LMW heparin (tinzapari)/fondaparinex 2.5mg OD SC
  7. beta-blocker (bisoprolol 2.5mg, CI LV failure, asthma)
  8. transfer to CCU
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5
Q

management of acute left ventricular failure

A
  1. A-E, oxgen
  2. Ix + Dx
  3. sit patient up
  4. morphine 5-10mg IV + cyclizine 50mg IV
  5. GTN spray/tablet
  6. fruosemide 40-80mg IV (repeat as required/tolerated)
  7. inadequate response isosorbide dinitrate infusion + CPAP
  8. transfer to CCU
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6
Q

management of tachycardia w/ haemodynamic compromise?

A
  • signs - shock, syncope, MI, HF
  • DC cardioversion
  • amiodarone given alongside, if successful need 900mg amiodarone/24 hours
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7
Q

management of broad QRS tachycardia in haemodynamically stable patient

A
  • irregular
    • AF with BBB - treat as narrow
    • pre-excited AF - amiodarone
    • polymorphic VT (torsades) - magensium sulphate 2g over 10 minutes
  • regular
    • VT - amiodarone 300mg IV over 20-60mins, 900mg/24hr after
    • previously confirmed SVT + BBB - adenosine
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8
Q

management of narrow QRS tachycardia in stable patient

A
  • irregular
    • likely AF - rate control beta-blocker, diltiazem
      • if evidence of HF consider digoxin or amiodarone
  • regular
    • vagal manoeuvres
    • adenosine 6mg IV, repeat 12mg if no success (up to 2)
    • failure - consider atrial flutter (beta-blocker to rate control)
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9
Q

acute management of anaphylaxis

A
  1. A-E, oxygen
  2. History, examination, Ix
  3. Remove cause (e.g. drug or transfusion)
  4. Adrenaline 500 micrograms (mcg) of 1:1000 IM
  5. Chlorphenamine 10mg IV
  6. Hydrocortisone 200mg IV
  7. Salbutamol nebuliser if wheeze
  8. Amend drug chart allergies as required
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10
Q

acute management of pneumonia

A
  1. A-E
  2. high flow oxygen
  3. antibiotics
  4. paracetamol if fever/pain
  5. if low BP or tachy - IV fluids
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11
Q

acute management of PE

A
  1. A-E
  2. High flow O2
  3. Morphine 5-10mg IV + Cyclizine 50mg IV
  4. LMWH e.g. tinzaparin 175 units/kg SC daily
  5. If low BP → fluids, contact ICU, consider thrombolysis
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12
Q

acute managemnet of GI bleed

A

8 C’s

  1. A-E + oxygen
  2. Cannula x 2
  3. Catheter + strict fluid monitoring
  4. Crystalloid bolus
  5. Cross-match 6 units
  6. Correct clotting abnormalities
  7. If PT/APTT > 1.5 normal range give FFP
  8. If warfarin give prothrombin complex
  9. If platelets < 50 and active bleeding - transfuse platelets
  10. Camera - Endoscopy
  11. Culprits → Stop trigger drugs - NSAIDs, aspirin, warfarin, heparin
  12. Call surgeons is severe
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13
Q

management of hypoglyacemia

A

BM < 3 mmol/L

  • can eat - sugar rich snack (juice, biscuit)
  • unable to eat (drowsy/vomiting) - 100mL 20% glucose or 50mL 50% glucose IV
  • unable to eat and no cannula - IM glucagon 1mg
    • less effective in malnourished + alcoholics (no glycogen stores)
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14
Q

summary of HTN management in GP

A
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15
Q

describe the steps in managing HTN

A
  • step 1 - monotherapy
    • ACEi/ARB - HTN + T2DM; < 55 not AC
    • CCB - > 55 or AC without T2DM
  • step 2 - dual therapy
    • ACEi/ARB + CCB or thiazide like diuretic
    • CCB + ACEi/ARB or thiazide like diuretic
  • step 3 - triple therapy
    • ACEi/ARB + CCB + thiazide diuretic
  • step 4
    • low dose spironolactone if serum K + < 4/5
    • alpha or beta blocker if serum K+ > 4.5
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16
Q

what are the BP targets?

A
  • < 80 years - clinic < 140/90
  • > 80 years - clinic < 150/90
17
Q

what are the methods of cardioversion?

A
  • electrical (DC)
  • pharmacological
    • flecanide - no structural heart defect
    • amiodarone - structural heart defect
18
Q

summarise management of AF

A
  • stroke prevention (CHADS VASC and HAS BLED determine anticoagulation requirement)
  • Control heart rate or rhythm
    • Rhythm control
      • < 48 hours onset of AF if young/symptomatic AF/1st episode/AF due to treated precipitant
      • Cardioversion
        • Electrical (DC)
        • Pharmacological - flecanide (no structural heart disease); amiodarone (structural heart disease)
    • Rate control
      • > 48 hours
      • Bisoprolol or CCB e.g. diltiazem
      • Depends on CI
      • Dual therapy - any of beta-blocker, digoxin or diltiazem
19
Q

what are contraindications for atenolol

A

hypotension, bradycardia, asthma, acute heart failure

20
Q

contarindications for CCB

A

hypotension, bradycardia, peripheral oedema

21
Q

summarise the management of Crohn’s

A
  • Inducing remission
    • Prednisolone 20-40mg PO oral
    • Severe - hydrocortisone 100-500mg TDS/QDS or as required IV
    • IV fluids, NBM, antibiotics
    • If rectal disease give rectal hydrocortisone as well
  • Maintaining remission Azathioprine
    • Must check TPMT levels prior to initiating drug, if low start on lower dose
    • Methotrexate - if absent TPMT
22
Q

what is last line of RA treatment? indication for it?

A

TNF alpha inhibitors e.g. infliximab

failure to respond to 2 DMARDS

23
Q

for stool softeners give:

  • example:
  • CI:
  • information:
A

for stool softeners give:

  • example: docusate sodium (stimulant at high doses), arachis oil (rectally)
  • CI: arachis oil if nut allergy
  • information: good for impaction, reduced gut motility
24
Q

for bulking agents give:

  • example:
  • CI:
  • information:
A

for bulking agents give:

  • example: isphagula hulk
  • CI: faecal impaction
  • information: can take days to develop effect
25
Q

for stimulant laxatives give:

  • example:
  • CI:
  • information:
A

for stimulant laxatives give:

  • example: senna, bisacodyl
  • CI: bisacodyl - acute abdomen
  • information: can exacerbate abdominal cramps
26
Q

for osmotic laxatives give:

  • example:
  • CI:
  • information:
A

for osmotic laxatives give:

  • example: lactulose, phosphate enema
  • CI: phosphate enema - acute abdomen, IBD
  • information: can exacerbate bloating
27
Q

management of chronic diarrhoea

A

Loperamide 2mg PO 3 hourly

codeine 30mg oral up to 6 hourly

28
Q

management of insomnia (PSA exam purpose)

A
  • 7.5mg zopliclone OD night for adults
  • 3.75mg zopiclone OD night for elderly

IK6 - PSA and prescribing (11 decks)

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