PSA 1

Question 1

What drugs should be stopped before surgery and when?

(other than diabetic drugs)

Answer 1

4 weeks before: HRT + COCP

one day before: lithium

day of surgery: ACE inhibitors, ARBs and K+ sparing diuretics

variable: anticoagulants + antiplatelets
(not required to know how long before for PSA as variable between health boards)

mnemonic - I LACK OP:
insulin
lithium
anticoagulants + antiplatelets
COCP + HRT
K+ sparing diuretics
Oral hypoglycaemics
perindopril + others ACEs

Question 2

What drugs increase P450 enzyme system activity?

(therefore decreased drug conc. in body and maybe increased dose of medication required)

Answer 2

PC BRAS
(more enzymes = more police going around the body looking to break down drugs)

Phenytoin
Carbamazepine

Barbiturates
Rifampicin
Alcohol excess (chronic)
Sulphonylureas

Question 3

What drugs decrease P450 enzyme system activity?

(therefore increased drug conc. in body and maybe decreased dose of medication required)

Answer 3

AO DEVICES
(devices which get around the enzyme police)

Allopurinol
omeprazole

disulphiram
erythromycin
valproate
isoniazid
ciprofloxacin
ethanol (acute)
sulphonamides (will start with sulf)

Question 4

What should be done with steroids

1. when sick
2. during surgery

Answer 4

1. take double the dose
2. IV steroids

(as in long term steroid use patients have adrenal atrophy and therefore have a decreased physiological response to illness)

Question 5

What drugs should be stopped in AKI?

Answer 5

NSAIDs
Aminoglycosides
ACEi + ARB
Diuretics

stop due to increased risk of toxicity (but will not worsen AKI):
metformin
lithium
digoxin

Question 6

T/F: Stop anticoagulants and antiplatelets in haemoptysis

Answer 6

true

Question 7

What drugs can cause hyperkalaemia?

Answer 7

ACE + ARBs
potassium sparing diuretics
trimethoprim / co-trimoxazole

Question 8

What drugs should not be prescribed in Parkinson’s

Answer 8

haloperidol (Serenace/Haldol)
metoclopramide (Maxalon)
prochlorperazine (Stemetil)
chlorpromazine

NOTE: domperidone is dopamine antagonist but does not cross Blood-brain barrier therefore is fine to prescribe

Question 9

What are the side effects of steroids?

Answer 9

STEROIDS
stomach ulcers
thin skin
oEdema
Right and left HF
osteoperosis
infection
diabetes (impaired glucose tolerance)
cushing’s Syndrome

Question 10

What fluid should you give a hypernatraemic patient

Answer 10

5% dextrose

Question 11

What fluid should be given in ascites?

Answer 11

human albumin solution

Question 12

Generally, how fluid depleted is a patient if they are:
1. oliguric (<30ml/hr)
2. oliguric + tachycardic
3. oliguric, tachycardic + shocked

Answer 12

1. 500ml
2. 1 litre
3. 2 litres

Question 13

How much maintenance fluid is required for nil by mouth
1. adults
2. elderly

Answer 13

1. 3 litres
2. 2 litres

Question 14

How much potassium should be given as maintenance?

Answer 14

40mmol

place 20mmol in each fluid bag

Question 15

How should 3l daily maintenance be given

Answer 15

1 bag of NaCl
2 bags 5% dextrose

(1 bag of NaCl enough sodium for the day)

Question 16

When should the following nit-emetics not be given?

1. metoclopramide
2. cyclizine

Answer 16

1. • parkinsons
   • young woman (high risk of dyskinesia)
2. cardiac pathology
   (as can worsen fluid retention - in this case give metoclopramide)

Question 17

What should be given for

1. neuropathic pain
2. neuropathic pain in diabetic neuropathy

Answer 17

1. amitriptyline or pregabalin
2. duloxetine