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Phase 4 Question Knowledge > Prepare for the PSA notes flashcards > Flashcards

Prepare for the PSA notes flashcards

1
Q

What are the four fluids to prescribe?

A

Sodium chloride 0.9% 1000ml- 150mmol Na
Potassium chloride 0.3% 1000ml- 40mmol K
Potassium chloride 0.15% 1000ml- 20 mmol K
Glucose 5% 1000ml- 50g glucose

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2
Q

Daily requirements for fluids?

A

25-30ml/kg/24h water
1mmol/kg/24h Na and K (and Cl)
50-100g/24h glucose

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3
Q

What is the fastest you can replace potassium?

A

10mmol/h

Potassium chloride 0.3% (40mmol) minimum 4h
Potassium chloride 0.15% (20mmol) minimum 2h

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4
Q

Emergency resuscitation?

A

Sodium chloride 0.9% 500ml 10m

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5
Q

Emergency hypoglycaemia?

A

Glucose 20% 100ml 15m

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6
Q

Emergency hypokalaemia?

A

Sodium chloride 0.9%/ Potassium choride 0.3% 1000ml 4h

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7
Q

Emergency hypercalcaemia?

A

Sodium choride 0.9% 1000ml 4h

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8
Q

Maintenance fluids without defecits or losses

A

25-30ml/kg/24h water
1mmol/kg/24h Na and K (and Cl)
50-100g/24h glucose

Aim 1000ml 8-12h

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9
Q

Maintenance fluids with defecits or losses e.g. Na or K low, vomiting or diarrhoea?

A

Minimum 30ml/kg/24h water
Ensure electrolytes replaced

Aim 1000ml 4-6h

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10
Q

Emergency resuscitation paeds

A

Sodium choride 0.9% 10ml/kg 10m

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11
Q

Maintenance fluids without defecits or losses paeds

A

100ml/kg/24h for up to 10kg

50ml/kg/24h for 10-20kg

20ml/kg/24h for >20kg

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12
Q

Stroke or head injury and fluids?

A

Avoid 5% glucose in the first bag- can worsen cerebral oedema

Potentially consider after that/ if glucose is low

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13
Q

How to prescribe furosemide in heart failure?

A

IV

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14
Q

Anticoagulation?

A

Treatment dose- apixaban or rivaroxaban

Prophylactic dose- LMWH (dalteparin, enoxaparin or tinzaparin) unless renal failure then unfractioned heparin

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15
Q

Reversal agents for anticoagulants?

A

LMWH- monitor anti-factor Xa- reversal protamine sulphate

Unfractioned heparin- monitor aPTT- reversal protamine sulphate

DOACs- monitor clinically- reversal andexanet alpha (apixaban and rivaroxaban)

Dabigatran- idarucizumab

Warfarin- monitor INR- reversal Vitamin K, PCC (beriplex, octaplex)

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16
Q

Where to find bleeding and INR for warfarin in the BNF?

A

Haemorrhage- within oral anticoagulation

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17
Q

Where to find adrenal crisis in the BNF?

A

Adrenal insufficiency

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18
Q

Illness and on steroids?

A

Double the dose

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19
Q

UTI treatment?

A

Safest drug to prescribe to all is nitrofurantoin

Except the third trimester of pregnancy- choose amoxicillin

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20
Q

What to search for prescribing HRT?

A

Estradiol + norethisterone

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21
Q

HRT further considerations?

A

Cyclical/sequential vs continuous

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22
Q

Cyclical/sequential HRT?

A

If still having periods- can be monthly or three-monthly- causes bleeds

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23
Q

Continuous HRT?

A

If no periods- will not cause bleeds

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24
Q

Oestrogen and progesterone or oestrogen only?

A

Oestrogen + progestogen- have a womb

Oestrogen only- no womb

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25
Q

Different formulations of HRT?

A

Tablets, patches, gels, passaries, rings

If vaginal symptoms only- lubricant and moisturiser

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26
Q

HRT key-

Uterus intact + LMP <12mo

A

Oral sequential combined oestrogen + progestogen (Elleste-Duet 1mg or 2mg)

OR patch sequential combined oestrogen + progestogen (Evorel Sequi)

First line drug name for these is estradiol with norethisterone

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27
Q

HRT key-

Uterus intact + LMP >12mo

A

Oral continuous combined oestrogen + progestogen (Elleste-Duet Conti)

Patch continuous combined oestrogen + progestogen (Evorel Conti)

Tibolone

First line drug name is also estradiol with norethisterone

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28
Q

HRT key-

Post-hysterectomy

A

Oral or patch oestrogen (Elleste-Solo) or tibolone

First line drug name estradiol

Estradiol also called estradiol valerate

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29
Q

Post menopausal osteoporosis?

A

Alendronic acid

Risendronate sodium

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30
Q

Vasomotor symptoms in someone who cannot take HRT?

A

Clonidine (or SSRI)

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31
Q

Menopausal atrophic vaginitis?

A

Topical vaginal oestrogen

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32
Q

Emergency contraception?

A

Will either be levonorgestrel or ulipristal acetate- no IUD prescription in PSA

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33
Q

Hormonal contraceptives?

A

COCP- Microgynon 30 (ethinylestradiol with levonorgestrel)

POP- Cerazette (desogestrel)

34
Q

Gentamicin normogram summary?

A
  1. How long after the dose was the gentamicin level checked? (x axis)
  2. What was the gentamicin level (y axis)

Map on to normogram to see when next dose should be- if it says 36 hours that would be 36 hours after first dose

35
Q

Peak and trough levels?

A

Peak level is 6-14 hours- use the Hartford nomogram

Trough level if >14h- if <1mg another dose can be given safely

36
Q

Gentamicin peak level too high?

A

Reduce dose

37
Q

Gentamicin trough level too high?

A

Increase time between doses

38
Q

Insulin?

A

Rapid acting (novorapid), short acting, intermediate acting, long acting (levemir), mixed ‘biphasic’ insulin

If BM > 15 then 4 units Novorapid

39
Q

Diabetes and surgery summary?

A

Oral antidiabetics-
Metformin- continue, no lunchtime dose

DPP4, thiazolidinedione, GLP-1 analogue- continue

Sulfonylurea- (gliclazide)- omit on day

SGLT-2- omit the day before and on day

Insulin-
Long acting- reduce by 20% then continue
All other insulins- stop

40
Q

If vomiting in an antiemetic question?

A

Prescribe IV or IM

41
Q

Vertigo/motion sickness/vestibular disorders nausea?

A

Cyclizine

42
Q

Post-operatively nausea?

A

Ondansetron

43
Q

Palliative care nausea?

A

Cyclizine, haloperidol, levopromazine

44
Q

Chemotherapy induced nausea?

A

Acute- ondansetron

Delayed- metoclopramide

45
Q

Parkinson’s disease antiemetic?

A

Domperidone

46
Q

Hyperemesis gravidarum antiemetic?

A

Promethazine

47
Q

What to check in the prescription review section?

A

Dose/units

Frequency/timing

Route

48
Q

Examples of mcg drugs?

A

Levothyroxine
Tamsulosin
Digoxin
Naloxone
Fudrocortisone
Inhalers
GTN spray
Ipratropium nebs

49
Q

mg (0 to low 100s)

A

Most medications

50
Q

mg (low 100s to g)

A

Some antibiotics
Metformin
Some antiepileptics

51
Q

g

A

Paracetamol
Lithium
Calcium carbonate
NAC

52
Q

Morning?

A

Diuretics

Steroids

53
Q

Night?

A

Statins

Night sedation

54
Q

Activity?

A

Parkinson’s medications

55
Q

With meals?

A

Insulin, Creon

56
Q

Weekly?

A

Bisphosphonates (although check dose)

Methotrexate/folic acid

Patches

57
Q

PR?

A

Laxatives (enemas, suppositries)

Diazepam

Diclofenac

58
Q

IM?

A

Depot

Some sedatives

Some antipsychotics

59
Q

Hypoglycaemia?

A

Insulin

Sulphonylureas (Gliclazide)

60
Q

Hyerglycaemia?

A

Steroids

Antipsychotics

Thiazides

Beta blockers

Tacrolimus

61
Q

Constipation?

A

Opioids

Iron

CCBs

Some diuretics, antiemetics

62
Q

Diarrhoea?

A

Antibiotics (C.diff), metformin, PPIs

63
Q

Urinary retention?

A

Opioids, anticholinergics

64
Q

Urinary incontinence?

A

Alpha-blockers, diuretics

65
Q

Stop prior to surgery?

A

DOACs (48 hours)

Clopidogrel (7 days)

Warfarin (bridging plan)

(COCP 4 weeks)

66
Q

Worsen Parkinson’s disease?

A

Antipsychotics (haloperidol)

Antiemetics (metoclopramide)

Antidepressants

67
Q

Worsen myasthenia gravis?

A

Antibiotics

Beta-blockers

Local anaesthetic

Sedating drugs

68
Q

Worsen psoriasis?

A

Beta-blockers

Lithium

Some antibiotics

69
Q

Worsen HF?

A

NSAIDs

CCBs

Pioglitazone

70
Q

Drugs that impair renal function?

A

Stop the DAMN drugs-

Diuretics

ACEi/ARBs

Metformin

NSAIDs

Use appendix 1

71
Q

Oral candidiasis?

A

Antibiotics

Inhaled corticosteroids

Immunosuppressants

72
Q

Oral thrush treatment?

A

Nystatin

73
Q

Euglycaemic ketoacidosis?

A

-gliflozins

Also associated with Fournier’s gangrene/ nec fasc

74
Q

Serotonin syndrome drugs?

A

Triptans

MAOIs

Ondansetron

Tricyclic

Other SSRIs, SNRIs

75
Q

NAC graph?

A

On poisoning section

76
Q

Morphine PRN dose?

A

1/6 of their 24 hour requirement- prescribed to nearest 5mg

77
Q

Providing information common topics?

A

Oral hypoglycaemics- side effects, symptoms of hypoglycaemia

Methotrexate- teratogenic, when to take, folic acid, agranulocytosis

Warfarin- what to do in the event of high INR +/- bleeding

Contraception- missed pills/emergency
contraception

Salbutamol inhaler

78
Q

Methotrexate and folate?

A

Once a week, take folate and methotrexate on different days of the week

Prevents mucositis and myelosuppression

Monitor FBC, renal and liver function

79
Q

Diabetes drugs side effects?

A

Learn

80
Q
A

Phase 4 Question Knowledge (33 decks)

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