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- Y6 PSA > Pre-exam things > Flashcards

Pre-exam things Flashcards

1
Q

Drugs which cause urinary retention?

A

Alpha agonists e.g. phenelzine
Benzodiazepines
NSAIDs
CCBs
Antihistamines
Alcohol
Anticholinergics
General anaesthetics

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2
Q

Drugs which cause confusion?

A

Uncommon:
- H2 antagonists
- digoxin
- BB
- steroids
- NSAIDS
- antibiotics

Common: antidepressants, anticholinergics, antipsychotics, anticonvulsants.

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3
Q

Folic acid timing in pregnancy?

A

Before conceiving and until 12 weeks gestation

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4
Q

When do you offer 5mg folic acid instead of 400mcg?

A

FH or personal history of NTD in either partner
Antiepileptics
Coeliac disease
Diabetes
Thalassemia trait
Obese >30kg/m2

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5
Q

Effect of grapefruit juice on statins?

A

Inhibits CYP3A4 so increases statin toxicity

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6
Q

Effect of clarithromycin on statin?

A

Inhibits CYP34A so increases statin so predisposes to toxicity

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7
Q

Why can HRT cause hypertension?

A

Causes sodium and fluid retention

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8
Q

What biochemistry suggests stopping statins?

A

ALT 3x upper limit of normal

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9
Q

Alternative to metoclopramide in opioid induced nausea?

A

Cyclizine

NB: metoclopramide can cause QT prolongation and EPSEs are a common side effect. This is a problem in someone already taking antipscyhotics for example.

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10
Q

When should you give IV over IM?

A

When the person already has a cannula

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11
Q

Colecalciferol diarrhoea and dyspepsia?

A

No - they are very uncommon side effects. More likely to cause GI discomfort.

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12
Q

How is loperamide taken?

A

Max 16mg/day

First dose is 4mg then 2mg after each loose stool.

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13
Q

What % of patients respond to any one drug in depression?

A

50%

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14
Q

Most common SE of GLP1?

A

Vomiting

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15
Q

Postpartum antihypertensives?

A

1st enalapril
2nd nifedipine/amlodipine (if AfroCar)

Consider combination of both or trial of labetalol (!asthma!)

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16
Q

How do drugs increase digoxin toxicity ?

A

Promoting hypokalaemia or hypomagnasaemia e.g.
- loop
- thiazide

Increasing plasma concentration of digoxin e.g.
- amiodarone
- amlodipine + CCBs
- K sparing diuretic spironolactone
- quinine

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17
Q

3 causes of hypernatraemia.

A

Thiazides
Loops
Lithium (DI)

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18
Q

3 drugs that prolong QT

A

Citalopram
Venlafaxine
Amiodarone

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19
Q

Causes of DRESS?

A

fever, lymphadenopathy, eodinophilia (type IV reaction)

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20
Q

citalopram + NSAID =

A

increased risk of GI bleeding

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21
Q

Hepatic encephalopathy,how to monitor response to lactose?

A

Stool chart - constipation means ammonia gets absorbed more from stools which may precipitate encephalopathy

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22
Q

Ramipril or amlodipine more likely to cause postural hypotension?

A

Ramipril

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23
Q

Venlafaxine monitoring?

A

ECG and BP - higher risk of QT prolongation in those with pre-existing CVD

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24
Q

Omeprazole and clopidogrel?

A

Reduced efficacy of clopidogrel

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25
Q

Gout precipitants?

A

Aspirin is an NSAID and can precipitate gout attacks.

Ramipril is an ACE-1 inhibitor and can also trigger gout.

Thiazide diuretics can also precipitate gout.

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26
Q

Causes of dry eyes?

A
  • bisoprolol
  • amitriptyline
  • chlorpheniamine

This occurs through inhibition of aqueous production, either directly or via an anti-muscarinic effect

27
Q

Tenofovir 3-6 monthly monitoring of…?

A

URINALYSIS - associated with renal impairment due to damage sustained to the proximal tubule which can progress to Fanconi syndrome so BHIVA recommend 3-6monthly urinalysis for blood or protein

28
Q

How is rivaroxaban taken?

A

With food

29
Q

When to use trimethoprim over nitrofurantoin?

A

When eGFR is <45 you should avoid nitrofurantoin

30
Q

Post-elective hip replacement anticoagulants?

A

Rivaroxaban
OR enoxaparin

(amongst others but these are the main ones)

31
Q

Intranasal prescription for breakthrough pain?

A

Fentanyl 50mcg/actuation nasal spray
1 spray to one nostril
Repeated once after 10mins if required

32
Q

Instructions for COCP taken with enzyme inducing drugs?

A

Switch to alternative method

After stopping the enzyme inducer use alternative contraception for 4 weeks before returning to the oral contraceptive.

33
Q

How much prednisolone for bell’s palsy?

A

60mg OD

34
Q

Which anticoagulants DOACs need parenteral LMWH in the first few days?

A

Dabigatran
Edoxaban
Both need 5 days parenteral LMWH prior to initiation

35
Q

What should tacrolimus not be coprescribed with?

A

Clarithromycin, erythromycin
could cause AKI as they inhibit metabolism of tacrolimus

36
Q

Inducers and Inhibitors stories.

A

Enzyme inducers:
St John was a Barber (barbiturate/phenobarbitone) chronically smoking phenytoin and drinking alcohol, and eating carbz (carbamazepine) with his red (rifampicin) fun grizzly bear (griseofulvin)

Enzyme inhibitors;
Sarah was depressed (fluoxetine, sertraline) and having seizures (valproate). She sometimes binged alcohol so had to take omeprazole and often got gout (allopurinol). She panicked which gave her tachycardia(amiodarone) so went to hospital. Unluckily she saw on the XR that she also got miliary TB (iSawniazid) from her HIV(ritonavir) She had to be admitted and got a pneumonia (ciprofloxacin, erythromycin) followed by thrush (fluconazole) from abx.

37
Q

What should simvastatin be carefully prescribed with?

A

CCBs - they all increase levels of simvastatin so increase risk of rhabdo

Max dose of simvastatin you can give is 20mg if taking it with CCBs

ALSO: all statins should not be prescribed with clarithromycin.

38
Q

Which abx should you be cautious with in penicillin allergic pt?

A

Cefalexin
Meropenem/aztreonam

39
Q

Pt on warfarin, which drugs alter levels?

A

Daily INR if taking:
Warfarin AND….
antibiotics - penicillins and clari
tramadol
fluconazole
omeprazole
amiodarone
corticosteroids at high dose

40
Q

Constipating medications?

A

o antacids (aluminium and calcium salts),
o anticholinergics (e.g. oxybutynin or hyoscine),
o antidepressants (e.g. TCAs, SSRIs),
o muscle relaxants (e.g. baclofen),
o iron supplements,
o opioids and derivatives.

41
Q

Calcium affects absorption of which 4 drugs?

A

o Quinolones (e.g. norfloxacin) or tetracyclines (e.g. doxycyclines)
o Bisphosphonates (e.g. alendronic acid)
o Iron tablets
o Levothyroxine

42
Q

Lactulose and movicol together?

A

No - both osmotic laxatives

43
Q

Tramacet contains?

A

PARACETAMOL and tramadol

43
Q

Agitation in PD?

A

Lorazepam 500 micrograms PO stat

44
Q

Severe asthma respiratory rate in adults vs children?

A

Adult severe asthma is RR >25
But in child it is >40 (2-5yrs) or >30 (>5yrs)

45
Q

Lithium + triptan risk?

A

Serotonin syndrome

46
Q

Mild jaundice from HRT, what do you do?

A

Stop the HRT

Other reasons for stopping: chest pain, breathlessness, DVT-like, stomach pain, neuro effects, hepatitis, jaundice, hepatomegaly, BP 165/95, immobility, new RF.

47
Q

Epiglottitis tx?

A

Cefotaxime or ceftriaxone
2nd line: chloramphenicol if there is a penicillin allergy.

48
Q

Side effects of MMR vaccine?

A

Rash one week after
Febrile seizures 6-11 days after
Parotid swelling in 1%
IPT within 6 weeks very rarely
More common SE with first dose rather than second

49
Q

Lithium and ACEi?

A

Risk of lithium toxicity as excretion is reduced

50
Q

Drugs which may worsen seizure control in epilepsy?

A

alcohol, cocaine, amphetamines
ciprofloxacin, levofloxacin
aminophylline, theophylline
bupropion
methylphenidate (used in ADHD)
mefenamic acid

51
Q

When to taper steroids?

A

received more than 40mg prednisolone daily for more than one week

received more than 3 weeks treatment

recently received repeated courses

52
Q

2 things to check 6 monthly on lithium?

A

U&Es
TFTs

53
Q

Drug causes of SIADH (and hyponatraemia)?

A

sulfonylureas* - some
SSRIs, tricyclics
carbamazepine
vincristine
cyclophosphamide

54
Q

X % of patients who are allergic to penicillin are also allergy to cephalosporins

A

0.5-6.5% of patients who are allergic to penicillin are also allergy to cephalosporins

55
Q

Third line HF drugs and when to recommend each?

A

Hydralazine - Afro-Caribbean

Digoxin - coexistent AF

ARNI sacubitril-valsartan - HFrEF <35%

Ivabradine - >75bpm and HFrEF

56
Q

PPH medications?

A
  1. IV oxytocin – injection then infusion
  2. Ergometrine slow IV or IM
  3. Carboprost IM
  4. Misoprostol sublingual

Found under “obstetrics”

57
Q

ITU drug for serotonin syndrome?

A

cyproheptadine

58
Q

Tx for severe neuroleptic malignant syndrome?

A

Dantrolene
Bromocriptine

59
Q

Drugs that cause retention.

A

General anaesthetics
Alpha-adrenoceptor agonists
Benzodiazepines
NSAIDs
CCBs
Alcohol
Antihistamines

Obvious ones:
Anticholinergics (e.g. antipsychotics, antidepressants, detrusor relaxants)
Opioids

60
Q

Drugs causing confusion.

A

Anticonvulsants
H2 receptor antagonists
Digoxin
Beta-blockers
NSAIDs

Obvious:
Anticholinergics (e.g. antipsychotics, antidepressants, detrusor relaxants)
Antipsychotics
Antidepressants
Corticosteroids

61
Q

Causes of cholestasis.

A

Flucloxacillin
Co-amoxiclav
Nitrofurantoin
Steroids
Sulphonylureas
OCP

62
Q

Causes of thrombocytopenia.

A

Penicillamine
Heparin
Valproate
Salicylates
Chloroquine

63
Q

Causes of neutropenia.

A

Clozapine
Carbimazole
Cytotoxics e.g. Methotrexate
Chloramphenicol
Carbamazapine

- Y6 PSA (8 decks)

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