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PSA > Prescribing > Flashcards

Prescribing Flashcards

1
Q

Fluid management: Emergency resus?

A

500ml 0.9% NaCl over 15 m

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2
Q

Fluid management: Emergency hypoglycaemia

A

20% glucose 100ml over 15 mins

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3
Q

Fluid mx: emergency hypoK

A

1L 0.9% NaCl/ 0.3% KCL over 4 hours

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4
Q

Fluid mx: emergency hyperCa

A

1L 0.9% NaCl over 4 hours

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5
Q

Fluid management: maintenance fluids without loss

A

25-30ml/kg/day H2O
1mmol/kg/day Na/k/cl
50-100g glucose per day

over 8 hours = adult
over 12 hours = elderly

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6
Q

Fluid mx: maintenance with deficits of loss eg: Na or K low/ d&V

A

Minimum 30ml /kg/ day water

1L

over 4-6 hours

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7
Q

emergency resus CHILD?

A

10ml/kg 0.9% Nacl over 15 mins

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8
Q

maintenance fluids without deficits of loss in PAEDS?

A

100ml/kg/day first 10 kg

50ml/kg/day next 10-20kg

20ml/kg/day > 20 kg

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9
Q

ecg change in hyperCa

A

short QT

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10
Q

ECG changes in hypoK + symptoms

A

sx: metabolic aklaosis, arrhythmias, muscle weakness, reduced reflexes, constiatpion

In hypoK U have no Pot or no T but a long PR and long QT

  • no u waves
  • no t waves
  • long qt
  • long PR
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11
Q

maximum speed to replace K?

How fast to replace
0.3% KCL
0.15% KCL

A

10mmol/ hour

0.3 % (40 mmol)= 4 hours

0.15% (20mmol) = 2 hours

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12
Q

volume and rate of maintenance and replacement?

A

1L over 4-6 hours

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13
Q

volume and rate of maintenance only?

A

1L over 8-12 hours

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14
Q

Prescribing ONCE ONLY:

Acute pain MI?

A

5-10mg morphine IV

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15
Q

Prescribing ONCE ONLY: acute asthma

A

5mg salbutamol nebulised

0.5mg ipatropium bromide nebs

40-50mg prednisolone oral

100mg IV hydrocortisone

others:
MgSo4, aminophyilline, IV salbutamol

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16
Q

Prescribing ONCE ONLY: Acute heart failure

A

IV 40mg furosemide

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17
Q

Prescribing ONCE ONLY: Acute anaphylaxis

A

500mcg (0.5mg) IM 1:1000 adrenaline

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18
Q

Prescribing ONCE ONLY: AF onset < 48 hours

Rate?
- contraindications?

Rhythm?
- contraindications?

A

Rate:
- BB = asthma
- Verampil / diltiazam = heart failure
- digoxin = if above unsuitable / CCF

Rhythm
- Flecainide = no IHD / structural heart disease
- Amiodarone = IHD

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19
Q

Prescribing ONCE ONLY: SVT?

Second line if contraindicated? what is the contraindication?

A

IV adenosine 6mg -12mg -12mg

ASTHMA => veramapil

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20
Q

Prescribing ONCE ONLY: bradycardia?

A

IV atropine

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21
Q

Prescribing ONCE ONLY: VT stable

A

IV amiodarone

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22
Q

Prescribing ONCE ONLY: Torsades de pointes?

A

IV MgSo4

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23
Q

Prescribing REGULAR hospital medications: VTE

A

LWMH eg: enoxaparin, dalteparin, tinz

UFH if renal failure

Fondaparinux

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24
Q

Prescribing REGULAR hospital medications: IECOPD

A

salbutamol
ipatropium
hydrocortisone / pred
abx
aminophylline
NIV

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25
Q

Prescribing REGULAR hospital medications: reflux oesphagitis

A

lansoprazole
ompeprazole

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26
Q

Prescribing REGULAR hospital medications: On going pain (ladder)

Neuropathic pain?Prescribing REGULAR hospital medications:

A
  1. paracetamol ± nsaids (ppi)
  2. weak opioid eg:
    - codeine
    - tramadol
    - co codamol
  3. strong opioid
    - morphine
    - oxycodone = renal impairement preferred
    - diamorhpine
    - fentanyl
    - buprenorphine

Neuropathic pain:
- amitrypillin
- pregablin
- gabapentin

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27
Q

Medication for trigeminal neuralgia pain?

A

carbamezapine

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28
Q

Prescribing REGULAR hospital medications: Anti-emetics

  1. Vertigo/ motion sickness
  2. Post op (contraindications?
  3. palliative care
  4. Chemo induce
    - acute
    - delayed
  5. parkinsons
  6. hyperemesis gravidarum
A
  1. cyclizine
  2. ondasetron (long qt)
  3. Cyclizine, haloperidole, levopromazine
  4. chemo acute = ondansetron, delayed= metoclopramide
  5. PD = domperidone
  6. HG = promethazine
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29
Q

Prescribing REGULAR hospital medications: Laxatives

  1. bulk forming 1
  2. stimulants 2
  3. softeners 1
  4. osmotic 2
A

bulk:
- isphagula husk

stimulants:
- senna
- bisacodyl

softener:
- bisacodyl

osmotic
- lactulose
- macrogol

30
Q

what to type into BNF to find pain mangement

A

chronic pain / neuropathic pain

31
Q

what to type into bnf to find anti-emetics

A

nausea TS

32
Q

what to type into bnf for laxatives

A

constipation TS

33
Q

HTN medication in pregnancy

A

labetalol
nifedipine
methylodopa

34
Q

Prescribing in GP: gout acute and chronic

A

acute:
- NSAIDS = avoid in PUD
- colchichine
- intraarticular steroid injection

chronic
- allopurinol = start 2-4 weeks after attack

35
Q

electrolyte disturbance with SSRI?

A

hypoNa

36
Q

What to search in bnf for depression + anxiety mx?

A

treatment summary: antidepressant drugs

37
Q

mx of acute anxiety in hospital ?

A

benzodiazepines eg:
- diazepam / lorazempan

38
Q

medications to avoid in children?

A

opiates & aspirin

39
Q

adverse effects of anticholinergics 6

A
  1. dry mouth
  2. dry eyes and blurred vision
  3. constiopation
  4. urinary retention
  5. orthostatic 6. hypotension
    sedation
40
Q

Drugs with potential teratogenic effects/ avoid in child bearing age 11

A
  1. ACEi/ ARB
  2. carbimazole
  3. warfarin
  4. statins
  5. phenytoin
  6. na valproate
  7. trimethoprime
  8. COCP
  9. MTX
  10. isotretinooin
  11. lithium
40
Q

drugs that should be prescribed at lower doses in the elderly

A
  1. aminoglycosides = aki
  2. hypoglycaemics
  3. anticholingerics
  4. anticoagulants
  5. antipyschotics = tardive dyskinesia
  6. bb = hypotension
  7. opioids
  8. sedation
41
Q

contraindicated drugs in PUD? 2

A

NSAIDS
aspirin

42
Q

contraindicated drugs in CKD? 3

A

NSAIDS
ACEi
slower clearance of drugs eg: digoxin / gent

43
Q

contraindicated drugs in chronic heart failure 5

A
  1. calcium channel bockers eg: verampil / diltizaime
  2. iontopes eg: flecainide
  3. TCA
  4. NSAIDS
  5. steroids
43
Q

drugs contraindicsted in asthma 2

A

nsaids
beta blockers

43
Q

drugs contraindicated in parkinsons disease 2

A

metoclopramide
haloperidol

43
Q

drugs contraindicated in heart block 3

A

beta blockers
digoxin
verampil

44
Q

drug interaction with amiodarone?
why?

A

grapefruit juice
- inhibition of metabolism systems => cardiac arrhythmias due to prolonged QT

44
Q

drug interaction with warfarin + effect

A

clarithromycin => increase INR / anticoagulation (inhibitor)

45
Q

drug interaction with phenytoin + effect

A

miconazole => phenytoin toxicity

46
Q

drug interaction with haloperidol + effect?

A

fluoextine = haloperidol toxicity

47
Q

drug interaction with azathioprine + effect

A

allopurinol > aza toxicity

48
Q

drug interaction with adrenaline / NA + effect

A

MAOS => HTN crisis

49
Q

drug interaction with ciclosporin + effect

A

st johns wort => enzyme induction + loss of immunosupression

50
Q

drug interaction with lithium + effect

A

diuretics / nsaids => reduced renal function = lithium toxicity

51
Q

drug interaction with MTX + effect

A

NSAIDS = reduced renal clearance and toxicity (neutropneia and deranged LFT)

trimethoprim = folate antagonism

52
Q

drug interaction with salbutamol + effect

A

BB => both target receptor bronchodilator effect

53
Q

drug interaction with ACEi due to similar mechanism?

A

NSAIDS = reduced renal

54
Q

drug interaction with warfarin due to similar mechanism

A

nsaids / aspirin = bleeding

55
Q

drug interaction with diuretics due to similar action

A

ACEI = volume depletion

56
Q

drugs to avoid in bradycardia 3

A

BB
CCB
digxoin

57
Q

drugs to avoid in hypotension 6

A

nitrates
bb
ccb
alpha blockers
TCA
sedatives

58
Q

drugs to avoid in HTN 3

A

oestrogen
nsaids
venlfexaine

59
Q

what drugs exacerbate anaemia (low Hb) and should be stopped?

A

anticoagulatns
nsaids

60
Q

treatment of low Hb? 3

A

ferrous sulphate
folic acid
hydroxycolamin b12

61
Q

drugs that are contraindicated / prescribed with caution in renal failure? 12

A
  1. diuretics (loops/ potassium sparing)
  2. ACEi/ ARB
  3. Nsaids
  4. aminoglycisdes eg: gent
  5. digoxin
  6. lithium
  7. abx eg: cipro / cephalosproin
  8. MTX
  9. opoiods
  10. metformin
  11. sulfonylureas
  12. insulin
62
Q

drugs that should be prescribed with caution / contraindicated in impaired liver function 5

A

benzodiazepines
metformin
nsaids
statins
warfarin

63
Q

drugs contraindicated with poor left ventricular function? 5

A

nsaids
metformin
pioglitazones
class 1 antiarrthymics eg: flecainde
CCB

64
Q

mx of IBS?

A

antispasmodic eg: mebeverine

loperamide = if diarrhoea main concern

laxative (Avoid lactulose!)

65
Q
A
66
Q
A

PSA (5 decks)

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