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PSA > PSA 1 > Flashcards

PSA 1 Flashcards

1
Q

Describe the PReSCRIBER mneumonic.

A

For new drug charts
Patient details
Reaction (i.e. allergy plus the reaction)
Sign the front of the chart
check for Contraindications to each drug
check Route for each drug
prescribe IV fluids if needed
prescribe Blood clot prophylaxis if needed
prescribe antiEmetic if needed
prescribe pain Relief if needed

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2
Q

What is contraindicated in acute ischaemic stroke?

A

Prophylaxctic heparin due to risk of bleeding into the stroke

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3
Q

What are the potential SEs with steroid use?

A

Stomach ulcers
Thin skin
oEdema
Right and left HF
Osteoporosis
Infection (including candida)
Diabetes (commonly causes hyperglycaemia, can progress to diabetes)
Cushing’s Syndrome

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4
Q

What are the potential SEs with NSAID use?

A

No urine (i.e. renal failure)
Systolic dysfunction (i.e. heart failure)
Asthma
Indigestion
Dyscrasia (clotting abnormality)

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5
Q

When can we use aspirin when we wouldn’t typically use other NSAIDs?

A

Can be used in renal or HF, and in asthma

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6
Q

Give two SEs of calcium channel blockers?

A

Peripheral oedema and flushing

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7
Q

Give an example and an SE of loop diuretics

A

Furosemide, can cause gout

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8
Q

Give an example and an SE of potassium-sparing diurectics

A

Spironolactone, can cause gynaecomastia

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9
Q

How should NBM patients be given their oral medication?

A

As normal, with a small amount of water

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10
Q

Which fluid do we give when a patient has ascites?

A

Human-albumin solution (HAS) instead of 0.9% saline, as albumin maintains oncotic pressure (saline will worsen ascites)

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11
Q

Which fluid do we give when a patient is shocked with a systolic BP <90mmHg?

A

Gelofusine (a colloid) instead as it has a high osmotic content so stays intravascularly, thus maintaining BP for longer

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12
Q

Which fluid do we give if patient is shocked from bleeding?

A

Give blood transfusion, or a colloid first if no blood available.

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13
Q

How much fluid do we give for fluid replacement, and how fast?

A

If tachycardia or hypotensive give 500ml bolus immediately (250ml if HF) then reassess, especially HR, BP and U.O. to assess response and speed of next bag of IV fluid.

If only oliguric (and not due to urinary obstruction e.g. BPH) then give 1L over 2-4hr then reassess.

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14
Q

What is the maximum amount of fluid you should prescribe a sick patient?

A

Up to 2L, and then they would need to be very ill (reduced UO plus tachycardia plus shocked)

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15
Q

How much maintenance fluids do patients generall require?

A

Adults 3L per 24hr and the elderly 2L per 24hr
Adequate electrolytes are provided by 1L of 0.9% saline and 2L of 5% dextrose (1 salty and 2 sweet)

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16
Q

How much potassium do patients require epr day?

A

With a normal potassium level, patients require roughly 40mmol KCL per day (so put 20mmol KCL in two bags)

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17
Q

How do thiazide diuretics cause hypokalaemia?

A

Increasing potassium excretion by the kdiney

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18
Q

How do ACEi cause dry cough?

A

Accumulation of bradykinin via reduced degradation by ACE

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19
Q

How do ACEi cause hyperkalaemia?

A

Reduced aldosterone production and thus reduced K+ excretion in the kidneys

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20
Q

Which diurectics cause hypokalaemia?

A

Loop and thiazide diuretics

21
Q

How do steroids lead to ulceration?

A

Inhibit gastric epithelial renewal

22
Q

Why can’t patients taking methotrexate take trimethoprim?

A

Both are folate antagonists, so taking both increases risk of bone marrow toxicity. This can lead to pancytopenia and neutropenic sepsis.

23
Q

How do you alter the methotrexate dose for a patient with sepsis?

A

Withhold pending exclusion of neutropenic sepsis.

24
Q

What does neutrophilia indicate?

A

Bacterial infection
Tissue damage
Steroid use

25
Q

What does neutropenia indicate?

A

Viral infection
Chemo/radiotherapy
Clozapine
Carbimazole

26
Q

What does lymphocytosis indicate?

A

Viral infection
Lymphoma
Chronic lymphocytic leukaemia

(High lymphocytes)

27
Q

What conditions might decrease the production of platelets?

A

Infection (usually viral)
Drugs (esp. penicillamine)
Myelodysplasia, myelofibrosis, myeloma

28
Q

What conditions can increase the destruction of platelets?

A

Heparin use
Hypersplenism
DIC
ITP
HUS/thrombotic thrombocytopenic purpura

29
Q

Give three causes of hypovolaemia hyponaetraemia

A

Fluid loss (especially diarrhoea/vomiting)
Addison’s disease
Diuretics

30
Q

Give three causes of euvolaemic hyponaetraemia.

A

SIADH
Psychogenic polydipsia
Hypothyroidism

31
Q

Give four causes of hypervolaemia hyponaetraemia.

A

HF
Renal failure
Liver failure (causing hypoalbuminaemia)
Nutritional failure (causing hypoalbuminaemia)
Thyroid failure

32
Q

Give five causes of SIADH

A

Small cell lung tumours, infection, abscess, drugs (esp carbamazepine and antipsychotics) and head injury

33
Q

Give four causes of hypokalaemia

A

DIRE
Drugs (loop and thiazide diuretics)
Inadequate intake or intestinal loss (D/V)
Renal tubular acidosis
Endocrine (Cushing’s and Conn’s)

34
Q

Give five causes of hyperkalaemia

A

DREAD
Drugs (potassium-sparing diurectics and ACEi)
Renal failure
Endocrine (addison’s disease)
Artefact (very common, due to clotted sample)
DKA (note that when insulin is given to treat DKA the potassium drops)

35
Q

What does raised urea indicate?

A

Kidney injury or upper GI haemorrhage (haemoglobin can be broken down into urea by gastric acid)

36
Q

What does a solitary raised bilirubin typically indicate?

A

Haemolysis

37
Q

What might a raised alk phos indicate?

A

Any fracture
Liver damage
K (for Kancer)
Paget’s disease of bone and Pregnancy
Hyperparathyroidism
Osteomalacia
Surgery

38
Q

What does a raised bilirubin and AST/ALT indicate?

A

Intrahepatic:
Fatty liver
Hepatitis
Cirrhosis
Malignancy

39
Q

What does a raised bilirubin and ALP indicate?

A

Obstructive jaundice

40
Q

Which drugs cause cholestasis?

A

Flucloxacillion, co-amoxiclav, nitrifurantoin, steroids and sulphonylureas

41
Q

How does digoxin toxicity present?

A

Confusion, nausea, visual halos and arrhythmias

42
Q

How does lithium toxicity present?

A

Early: tremor
Intermediate: tiredness
Late: arrhythmias, seizures, coma, renal failure and diabetes insipidus

43
Q

How does phenytoin toxicity present?

A

Gum hypertrophy, ataxia, nystagmus, peripheral neuropathy and teratogenicity

44
Q

How does gentamicin and vancomycin toxicity present?

A

Ototoxicity and nephrotoxicity

45
Q

What is gentamicin?

A

An IV aminoglycoside antibiotic used for severe infections

46
Q

How do we manage over-anticoagulation?

A

If INR < 6, reduce dose
If between 6-8, omit for 2 days and then reduce dose
If >8, omit and give 1-5mg oral vitamin K

47
Q

What is a common side effect of diltiazem use?

A

It can worsen fluid retention and should be avoided

48
Q

What dopaminergic anti-emetic can be used in PD?

A

Domperidone, as it does not cross the blood-brain barrier

PSA (1 decks)

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