Prescribing in conditions Flashcards
1
Q
which drugs should always be continued during surgery? (3)
A
BB
CCB
corticosteroids
2
Q
which drugs should be stopped during surgery?
A
Insulin (convert so sliding scale)
Lithium
Anticoagulants/antiplatelets - stop 7 days before
COCP - stop 4 weeks before
K - K+ sparing diuretic + ACE-I (stop on day)
3
Q
what decolonization therapy is prescribed for MRSA?
A
nasal mupirocin
chlorhexidine body washes
vancomycin
teicoplanin
4
Q
what kind of bacteria is c.diff?
A
gram +ve
5
Q
what is prescribed for C.Diff?
A
first line -metronidazole
second line- vancomycin
6
Q
what is prescribed for infective endocarditis?
A
gentamycin + benzylpenicillin
7
Q
what is prescribed for menigioccocal disease?
A
cefotaxime
ceftriaxone
IM benzylpenicillin
8
Q
what is used to assess severity of pneumonia?
A
Confusion Urea > 7 RR > 30 BP < 90 Age 65
9
Q
what is prescribed in CAP?
A
low severity- amoxicillin (oral) - if penicillin allergic clarithromycin/erythromycin
moderate- amoxicillin + clarithromycin/erythromycin
severe- co-amoxiclav + erythromycin/clarithromycin
10
Q
what is prescribed in pylonephritis?
A
co-amoxiclav or ciprofloxacin ORAL or IV
11
Q
which antibiotic can cause tendon damage?
A
cefotaxime
12
Q
which antibiotic cannot be used in glandular fever?
A
amoxicillin (any penicillins) - gives rash
13
Q
what is prescribed in neutropenic sepsis?
A
IV tazocin
14
Q
what is the prescribing pattern for HTN?
A
step 1:
A: ACE-I or ARB - under 55
C: CCB if over 55 or black
step 2:
A+ C
step 3:
A+C+D (diuretic- thiazide)
step 4:
all + BB + senior review
15
Q
electrolyte S/E of ACE-I?
A
hyperkalaemia
hyponatraemia
16
Q
when should ACE-I be avoided?
A
renal disease
PVD
17
Q
what should be prescribed in acute congestive heart failure?
A
UNLOAD FAST:
Upright Nitrate Loop diuretic Oxygen ACE-I Digoxin
Fluids - reduce
Afterload
Sodium restrict
Test - ABG, K+, ECG etc
18
Q
what class of drug is losartan and give an electrolyte S/E?
A
ARB
hyperkalaemia
19
Q
what class of drug is amlodipine and give a S/E?
A
CCB
leg oedema
20
Q
when should amlodipine be avoided?
A
biventricular heart failure
21
Q
what is prescribed in hypoglycaemia?
A
if conscious- 20g oral glucose
if unconscious- IV glucose 20% in 100ml
22
Q
what is prescribed in severe flare of UC?
A
IV hydrocortisone + fluid bolus
23
Q
what is prescribed in mild flare of UC?
A
oral prednisolone - 30mg over 24hrs
24
Q
what would you do to warfarin if INR <6 but not in target range?
A
reduce and re-mreasure in 2 days
25
what would you do to warfarin if INR was 6-8?
omit warfarin for 2 days, then reduce the dose
26
what would you do if INR >8?
omit warfarin and give vitamin K (1-5mg)
27
what is given for blood clot prophylaxis?
dalteparin 5000 units (LMWH) sub cut
28
treatment for PE/DVT?
dalteparin 15,000 units
29
what is given for neuropathic pain?
amitryptilline 10mg
30
S/E of COCP?
migraine
stroke
DVT/PE
31
what can be given as emergency contraception?
copper IUD- 5days
| levonestrogel pill - 72 hours
32
what are the 4 different types of laxatives and give an example of each?
bulk forming
osmotic - lactulose
stimulant - senna, bisacodyl
stool softening - docusate
33
when are stimulants contraindicated?
obstruction
34
what is prescribed for hyperkalaemia?
calcium gluconate
10 units insulin (actrapid)
10ml of 20 units glucose
neb salbutamol
35
what is prescribed for secretions in palliative care?
hyoscine bromide
36
what is prescribed for agitation in palliative care?
midazolam
37
what is prescribed for pain in palliative care?
morphine 10mg/24hrs
38
what is prescribed for nausea in palliative care?
cyclizine 150mg/24 hours
39
what is prescribed for stable angina?
GTN spray
40
what is prescribed in a STEMI?
```
MONAT-
Morphine
Oxygen if needed
Nitrates - GTN
Aspirin 300mg
Ticagrelor 300mg
+PCI within 2 hours + fondaparinux if no PCI within 2 hours
```
41
what is prescribed in an NSTEMI?
MONAT + PCI within 24-48hours + fondaparinux if no PCI available
42
what is the long-term treatment post MI?
```
CRABS:
Clopidogrel
Ramipril
Aspirin
BB
Statin
```
43
what is prescribed in chronic heart failure?
ACE-I (if not tolerated then hydralazine + isosorbide trinitrate)
BB (if congested)
Spironolactone
(ABS)
44
what is prescribed in AF that has been going on for >48hours?
rate control=
verapamil or diltiazem (vera + dilly)
BB
45
what is prescribed in AF that has been going on for <48 hours?
Amiodarone
Flecanide (Amy + Fleck)
or DC conversion
anticoagulate if >48 hours - DOAC or Warfarin
46
what is prescribed in anaphylaxis?
neb salbutamol
500micrograms of 1:1000 IM adrenaline
IV chlorphenamine
200mg IV hydrocortisone
47
what is prescribed in acute asthma attack?
Oxygen
Salbutamol IV 2.5-5mg
Hydrocortisone
Ipratropium bromide
Theophylline + MgSO4 + senior review
48
what is prescribed in a generalised, absence or myoclonic seizure?
sodium valproate
49
what is prescribed in a focal seizure?
carbamazepine or lamotrigine
50
what must be prescribed with sodium valproate?
vitamin D supplements
51
name some drugs that need to be monitored?
```
lithium
phenytoin
gentamycin
vancomycin
methotrexate
amiodarone
digoxin
statins
carbimazole
ciclosporin
theophylline
antipsychotics
ACE-I
```
52
what needs to be monitored for phenytoin?
ECG
53
monitoring for ACE-I?
renal function/K+
54
monitoring for methotrexate?
FBC
55
monitoring for digoxin?
serum creatinine
56
monitoring for clozapine?
FBC
57
monitoring for olanzapine?
fasting blood glucose
58
monitoring for COCP?
BP
59
monitoring for carbimazole?
FBC (agranulocytosis)
60
monitoring for tacrolimus?
trough level
61
monitoring for ciclosporin?
renal function
62
monitoring for statins?
lipid profile + LFT's
creatinine kinase in those at risk of developing a myopathy
63
when do you transfuse blood in iron deficiency?
if severely symptomatic or Hb<70
64
what is prescribed to prevent alcohol withdrawal?
chlordizaepoxide + thiamine/pabrinex
65
what is prescribed to assist with addiction to alcohol?
acamprosate
66
what is prescribed in dyskinesia/parkinsonism caused by drugs such as antipsychotics?
procyclidine
67
what is prescribed in neuroleptic malignant syndrome?
dantrolene
| bromocriptine
68
what is prescribed in serotonin syndrome?
benzodiazepine
| cyproheptadine
69
what is prescribed in a oculogyric crisis?
procylcidine
70
what is prescribed in hepatic encephalopathy?
lactulose
71
is warfarin safe during breast feeding?
yes
72
is warfarin safe during pregnancy?
no- teratogenic
73
what is prescriebd during fluid resuscitation?
500ml NaCL over 15 mins (if renally impaired 250ml)
| re-assess and if not responding repeat up to 2000ml
74
what fluids are prescribed during resuscitation of hypoglycamia ?
500ml 5% dextrose over 15 mins
75
what are the steps of the WHO pain ladder and give examples of each level?
step 1 non-opioid: paracetamol, ibuprofen, aspirin
step 2 weak opioid: codeine, tramadol, co-codamol
step 3 strong opioids: morphine, fentanyl
76
what is prescribed in morphine overdose?
naloxone
77
how is breakthrough pain calculated?
1/6th of total pain relief given in day
78
what can be given for neuropathic pain?
amitryptilline
gabapentin
duloxetine
pregabalin
79
what is prescribed for trigemninal neurlagia?
carbamazepine
80
what is given in hypoglycaemia if no IV access?
IM glucagon
81
what is prescribed in DKA?
fluid - 1000ml NaCL over 1 hour
| insulin therapy- 0.1 units/kg/hour - actrapid IV
82
what is measured to ensure response to DKA therapy?
ketones
| cap glucose
83
what is prescribed in HHS?
fluids - 1L 0.9% Nacl
prophylactic heparin
insulin - give later as blood glucose should respond to the fluids first
84
what is prescribed in iron overload/poisoning?
desfurroxamine
85
what is prescriebd in benzodiazepine overdose?
flumanezil
86
what drugs are prescribed during cardiac arrest?
```
adrenaline 1mg IV
amiodarone 300mg (after 3rd shock if shockable rhythm)
```
87
What is the aim for TSH in patients taking levothyroxine?
0.4-2.5 mU/L (0.4-5.0)
88
measurements for effectiveness of thyroid treatment?
TSH 2-3 months later
| resolution of symptoms
89
what kind of fluid is used in replacement of massive parecentesis (>5L)?
20% human albumin solution
90
what is given for SVT?
IV adenosine
91
what is the recommended fluids to give a patient in DKA?
NaCl + Potassium 40mmol -> up to 5.5 K+
92
what should be given as fluid resusitation?
500ml NaCL over 15 mins (250ml if frail or renal failure)
| re-assess if not responding and repeat up to 2000ml
93
what should be given as fluid maintenance?
2 sweet and 1 salty-
1L NaCL 0.9% + 20 mmol KCL over 8hrs
1L 5% dextrose + 20mmol KCL over 8 hrs
1L 5% dextrose + 20 mmol KCL over 8 hours
94
what should be given as post-herpetic pain relief?
amitryptilline
95
what should be given as first pain relief in the elderly and why?
paracetamol - avoid NSAIDs in the elderly as they are more vulnerable to the effects such as gastrotoxicity
96
what is a well known S/E of ciclosporin?
nephrotoxicity
97
what should be used for acute pain relief for severe pain in renal failure?
oxycodone rather than morphine !!!!
98
what should be done if there is hyperthryoidism caused by amiodarone?
with hold amiodarone until there is control and then can consider restarting with carbamazepine treatment
99
what is prescribed to increase factor VIII levels in von willerbands disease?
desmopressin
100
what is prescribed for a patient with c.diff and ileus?
metronidazole IV (will not be effective orally if prescribed via tablet form)
101
first line for acute cluster headache?
100% O2
102
what must be monitored in children taking steroids (i.e in chronic condition or asthma)?
growth chart
103
what is first line for osteoporosis prophylaxis in a patient with GORD?
raloxifene !!
| alendronic acid -> cannot be prescribed in GORD
104
name some drugs that exacerbate asthma?
NSAID's (mechanism unknown)
BB
ACE-I (due to dry cough)
105
what is the most dangerous reactant to warfarin?
SIMVASTATIN - anticoagulant effects are drastically increased
106
what should be given in a patient requiring anticoagulant prophylaxis who is needle phobic?
DOAC instead of dalteparin (oral)
107
name some topical corticosteroids?
budeosinde
beclamethasone
hydrocortisone
108
name some ICS?
budesonide
beclamethasone
hydrocortisone
109
name a LABA?
formoterol
110
what is given for tremor in huntingtons disease?
haloperidol
111
what is prescribed in HAP (severe)?
Piperacillin with tazobactam
112
what is prescribed in HAP with MRSA?
ADD to piperacillin and tazobactam:
| vancomycin or teicoplanin
113
management of status epilepticus?
Diazepam 10−20 mg given rectally, repeated once 15 minutes later if status continues to threaten, or midazolam 10 mg given buccally.
IV lorazepam
IV phenytoin
anaesthetic input
114
drug to lower ICP?
mannitol
115
drug management of ischaemic stroke?
aletplase within 4.5hours
| aspirin
116
first line for gout <72 hours ?
colchicine/OTC NSAID's
117
first line for gout >72 hours/not responding to OTC meds?
diclofenac
| naproxen
118
management of hypercalcaemia?
```
fluids NaCl (0.9%)
bisphopshonates
```
119
management of SVT?
Adenosine
120
management of croup? (barking cough)
dexamethasone
121
management of whooping cough? (pertussis)
clarithromycin
122
management of acute hypertension?
amlodipine
123
management of insomnia?
zopiclone
| temazepam
124
management of PCP?
co-trimoxazole + prednisolone
125
what is one drug you can give as part of treatment of refeeding syndrome?
Pabrinex
126
what can be given to relieve nausea post op?
odansetron
metoclopramide
Cyclizine
