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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
Different formulations of HRT?
Tablets, patches, gels, passaries, rings If vaginal symptoms only- lubricant and moisturiser
26
HRT key- Uterus intact + LMP <12mo
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
27
HRT key- Uterus intact + LMP >12mo
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
28
HRT key- Post-hysterectomy
Oral or patch oestrogen (Elleste-Solo) or tibolone First line drug name estradiol Estradiol also called estradiol valerate
29
Post menopausal osteoporosis?
Alendronic acid Risendronate sodium
30
Vasomotor symptoms in someone who cannot take HRT?
Clonidine (or SSRI)
31
Menopausal atrophic vaginitis?
Topical vaginal oestrogen
32
Emergency contraception?
Will either be levonorgestrel or ulipristal acetate- no IUD prescription in PSA
33
Hormonal contraceptives?
COCP- Microgynon 30 (ethinylestradiol with levonorgestrel) POP- Cerazette (desogestrel)
34
Gentamicin normogram summary?
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
Peak and trough levels?
Peak level is 6-14 hours- use the Hartford nomogram Trough level if >14h- if <1mg another dose can be given safely
36
Gentamicin peak level too high?
Reduce dose
37
Gentamicin trough level too high?
Increase time between doses
38
Insulin?
Rapid acting (novorapid), short acting, intermediate acting, long acting (levemir), mixed ‘biphasic’ insulin If BM > 15 then 4 units Novorapid
39
Diabetes and surgery summary?
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
If vomiting in an antiemetic question?
Prescribe IV or IM
41
Vertigo/motion sickness/vestibular disorders nausea?
Cyclizine
42
Post-operatively nausea?
Ondansetron
43
Palliative care nausea?
Cyclizine, haloperidol, levopromazine
44
Chemotherapy induced nausea?
Acute- ondansetron Delayed- metoclopramide
45
Parkinson's disease antiemetic?
Domperidone
46
Hyperemesis gravidarum antiemetic?
Promethazine
47
What to check in the prescription review section?
Dose/units Frequency/timing Route
48
Examples of mcg drugs?
Levothyroxine Tamsulosin Digoxin Naloxone Fudrocortisone Inhalers GTN spray Ipratropium nebs
49
mg (0 to low 100s)
Most medications
50
mg (low 100s to g)
Some antibiotics Metformin Some antiepileptics
51
g
Paracetamol Lithium Calcium carbonate NAC
52
Morning?
Diuretics Steroids
53
Night?
Statins Night sedation
54
Activity?
Parkinson's medications
55
With meals?
Insulin, Creon
56
Weekly?
Bisphosphonates (although check dose) Methotrexate/folic acid Patches
57
PR?
Laxatives (enemas, suppositries) Diazepam Diclofenac
58
IM?
Depot Some sedatives Some antipsychotics
59
Hypoglycaemia?
Insulin Sulphonylureas (Gliclazide)
60
Hyerglycaemia?
Steroids Antipsychotics Thiazides Beta blockers Tacrolimus
61
Constipation?
Opioids Iron CCBs Some diuretics, antiemetics
62
Diarrhoea?
Antibiotics (C.diff), metformin, PPIs
63
Urinary retention?
Opioids, anticholinergics
64
Urinary incontinence?
Alpha-blockers, diuretics
65
Stop prior to surgery?
DOACs (48 hours) Clopidogrel (7 days) Warfarin (bridging plan) (COCP 4 weeks)
66
Worsen Parkinson’s disease?
Antipsychotics (haloperidol) Antiemetics (metoclopramide) Antidepressants
67
Worsen myasthenia gravis?
Antibiotics Beta-blockers Local anaesthetic Sedating drugs
68
Worsen psoriasis?
Beta-blockers Lithium Some antibiotics
69
Worsen HF?
NSAIDs CCBs Pioglitazone
70
Drugs that impair renal function?
Stop the DAMN drugs- Diuretics ACEi/ARBs Metformin NSAIDs Use appendix 1
71
Oral candidiasis?
Antibiotics Inhaled corticosteroids Immunosuppressants
72
Oral thrush treatment?
Nystatin
73
Euglycaemic ketoacidosis?
-gliflozins Also associated with Fournier's gangrene/ nec fasc
74
Serotonin syndrome drugs?
Triptans MAOIs Ondansetron Tricyclic Other SSRIs, SNRIs
75
NAC graph?
On poisoning section
76
Morphine PRN dose?
1/6 of their 24 hour requirement- prescribed to nearest 5mg
77
Providing information common topics?
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
Methotrexate and folate?
Once a week, take folate and methotrexate on different days of the week Prevents mucositis and myelosuppression Monitor FBC, renal and liver function
79
Diabetes drugs side effects?
Learn
80

Phase 4 Question Knowledge (35 decks)

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