PSA Flashcards
1
Q
What is the first line treatment for dyspepsia?
1) For immediate relief
2) For prophylaxis / long term prevention
A
1) Magnesium carbonate (antacid)
2) Omeprazole (PPI)
2
Q
Give two causes of dyspepsia
A
Corticosteroids
NSAIDs
CCB
BBs
3
Q
What is the first line treatment for croup?
A
Dexamethasone PO
Nebulised adrenaline if severe
4
Q
What is the first line treatment for depression or generalised anxiety?
A
SSRI e.g. sertraline or citalopram
5
Q
Give two common side effects of SSRIs
A
Anxiety
Dry mouth
Sexual dysfunction
GI (constipation / diarrhoea)
6
Q
What is the treatment for Otitis Media?
A
Analgesia - Paracetamol or ibuprofen
Antibiotics - Amoxicillin 7d PO (Clarithromicin if allergic)
7
Q
What is the treatment for overactive bladder?
A
Oxybutynin Hydrochloride
Be careful! Anticholinergics are contraindicated in patients with myaesthenia gravis.
8
Q
What is the treatment for hypothyroidism?
A
Levothyroxine sodium
Take 30 mins before breakfast/caffeine/other meds
Monitor TSH every 2-3 months then annually once stable.
9
Q
What is the treatment for hyperthyroidism?
A
Carbimazole
Be careful! Carbimazole can cause bone marrow suppression (neutropenia/agranulocytosis). Stop if any signs of neutropenia.
10
Q
What is the first line treatment for acute asthma?
A
1) Salbutamol inhaled high dose
2) Salbutamol nebulised
3) Oral prednisolone (+ normal ICS)
4) Neb ipratropiumbromide
5) Magnesium sulphate IV
6) Aminophylline IV
11
Q
What is the treatment for unstable angina?
A
[MONA]
Morphine
Oxygen
Nitrates - GTN
Antiplatelets - Aspirin + Clopidogrel
12
Q
What is the treatment for chronic asthma?
A
SABA inhaled
ICS (if SABA needed >3x/wk)
If ICS not enough + LTRA e.g. montelukast
Or MART (ICS + LABA)
13
Q
What is the treatment for COPD chronic and exacerbation?
A
Chronic:
1) SABA
2) LABA
3) ICS
4) If cannot inhale then Modified Release Theophylline
5) Azithromycin prophylaxis for infection
Exacerbations:
1) SABA nebulised
2) Oral prednisolone
3) Oxygen
14
Q
What is the treatment for shingles?
A
Aciclovir PO 7d.
15
Q
What is the treatment for anaphylaxis?
A
500 ug adrenaline (0.5ml) 1:1000
(repeat every 5 mins)
Chlorphenamine IV 10mg
Hydrocortisone IV 200mg
16
Q
What is the treatment for osteoporosis?
A
Bisphosphonates e.g. alendronic acid
17
Q
How do you take bisphosphonates?
A
Before breakfast
Tall drink of water
Sit upright for 30 mins after
18
Q
What is the treatment for hypercholesterolaemia?
A
Statin e.g. Simvastatin
19
Q
When should statins be taken?
A
Once nightly
20
Q
What is a serious adverse effect of bisphosphonates?
A
Osteonecrosis of the jaw
21
Q
What should patients be advised to report when taking statins?
A
Any unexplained muscle pain or weakness.
22
Q
What food should patient’s on statins avoid?
A
Grapefruit juice
23
Q
What is the treatmentfor bipolar disorder?
A
Lithium carbonate
Sodium valproate is an alternative if Lithium is contraindicated
24
Q
How is lithium monitored?
A
Routine serum-lithium monitoring should be performed weekly after initiation and after each dose change until concentrations are stable, then every 3 months for the first year, and every 6 months thereafter. Samples taken 12 hours after the dose.
25
What is the first line treatment for migraine?
Ibuprofen/Aspirin/Sumatriptan [All are first lines]
NB: Seizure risk, risk of coronary artery disease, controlled hypertension and elderly are all contraindications for sumatriptans.
26
What drug is contraindicated in patients with migraine with aura and why?
COCP
Increases risk of stroke.
27
True or false, lithium dose depends on weight?
True. <50kg or >50kg
28
What is the first-line treatment for BPH?
Tamsulosin Hydrochloride
Micturition syncope and postural hypotension are contraindications.
29
What do you give for DVT/PE thromboprophylaxis in a surgical/hospital setting?
LMWH e.g. dalteparin
| Then post discharge DOAC e.g. apixaban
30
When is unfractionated heparin preferred to LMWH?
Renal impairment
| Mechanical heart valve
31
What do you give for DVT/PE thromboprophylaxis in a primary care setting?
Apixaban (DOAC) or LMWH
32
True or false, warfarin is safe in pregnancy?
False. Its teratogenic
LMWH is the choice in pregnancy.
33
How often should you monitor INR when on warfarin?
Daily early on then every 12 weeks once stable.
| Patient is given a treatment booklet and alert card.
34
True or false, metformin is contraindicated in renal impairment?
True. If eGFR is less than 30. Risk of lactic acidosis.
Sulfonylurea is preferred.
35
True or false, metformin induces weight loss?
True.
36
What is the treatment for acute gout?
Ibuprofen or Colchicine
Remember to give a PPI with Ibuprofen!
37
What is the treatment for chronic gout?
Allopurinol
38
What is a very common side effect of allopurinol?
Rash
39
What is the treatment for erectile dysfunction?
Sildenafil (oral phosphodiesterase type 5 inhibitor)
Take 1 hour before. Onset may be delayed if taken with food.
40
What is the first line treatment for alcohol dependence?
Acamprosate Calcium
Naltrexone
Disulfiram
If suspected Wernicke's then Thiamine!
41
What is the first line treatment for delirium tremens?
Oral lorazepam
42
What is the first line treatment for nausea?
Cyclizine or Ondansetron
43
What is the treatment for trigeminal neuralgia?
Carbamazepine
44
What advice would you give someone taking carbamazepine?
Seek immediate help if bleeding, bruising, mouth sores.
45
How do you monitor carbamazepine?
Plasma concentrations after 1-2 weeks
NB: Thai or Han chinese risk of HLA-B 1502 allele --> stevens johnson syndrome
46
True or false COCP is contraindicated in people who are over 35 and smoke?
True. >15 cigarettes/day.
47
What is the first line treatment for Crohn's disease?
Methotrexate
48
How often is methotrexate taken?
Once weekly
49
True or false, methotrexate is contraindicated in active infection.
True.
50
What patient advice would you give to a patient starting on methotrexate?
Seek immediate help if you experience a sore throat or bruising.
51
What is the first line treatment for focal seizures?
Carbamazepine / Lamotrigine
52
What is the first line treatment for generalised seizures?
Sodium valproate / Lamotrigine
53
How long must you not drive for following a seizure?
1 year
54
True or false, it is acceptable to write Tazocin on a prescription?
False. Its a brand name.
Piperacillin with tazobactam is preferred.
55
What is the first line treatment for cluster headaches?
Sumatriptan SC injection
| 100% oxygen
56
Name 2 drugs to stop prior to surgery?
[I LACK OA]
```
Insulin
Lithium
Antiplatelets
COCP/HRT
K-sparing diuretics
Oral hypoglycemics e.g. metformin
ACEi
```
57
What is the maximum dose of paracetamol per day?
4g / day
58
What is the WHO opiate ladder?
NSAID / Paracetamol
Weak Opiate: Codeine, Tramadol
Strong Opiate: Morphine, Oxycodone
59
True or false, Tazocin is safe for patients with penicillin allergies?
False
60
True or false, ACEi can cause hyperkalaemia?
True.
61
What is the treatment for H. pylori?
Triple therapy [PAM]
- PPI
- Amoxicillin
- Metronidazole
62
What is the treatment for allergic rash (not anaphylaxis)?
Chlorphenamine (PO)
63
How often do you give adrenaline in anaphylaxis?
Every 3-5 minutes
IV 1mg
[Amiodarone also given IV 300mg if shockable]
64
What is the first line treatment for acne?
Benzoyl peroxide (Topical)
```
Topical Erythromycin/Clindamycin (2nd line)
Tetracycline PO (3rd line)
```
65
What is the treatment for alcohol withdrawal?
Chlordiazepoxide hydrochloride PO QDS
66
What is the first line treatment for constipation?
Lactulose 15ml BD PO (osmotic)
67
What is a first line treatment for nausea?
Cyclizine or Ondansetron
68
Name two drugs you should stop perioperatively
```
Lithium
Antiplatelets
COCP/HRT
K-sparing diuretics
Oral Hypoglycemics e.g. metformin
ACEi
```
69
Give two side effects of steroids.
```
Stomach ulcers
Thin skin
Oedema
Osteoporosis
Infection
Diabetes
Cushing's
```
70
Give two contraindications for NSAIDs
```
Renal failure
Heart failure
Asthma
Indigestion
Dyscrasia (clotting abnormality)
```
71
True or false, spironolactone can cause gynecomastia?
True
Switch to eplerenone if this is the case
72
What is the maximum infusion rate for IV potassium?
10 mmol/hr
73
Give two side effects of calcium channel blockers
Flushing
| Peripheral oedema
74
True or false, metoclopramide makes parkinson's worse?
True
75
What are normal replacement fluids?
0.9% saline 500ml bolus (STAT)
[If heart failure then 250ml]
76
If a patient is hypernatraemic or hypoglycemic what replacement fluids would you prescribe?
5% Dextrose (not 0.9% saline!)
77
If a patient has ascites, would you prescribe 0.9% saline?
No. Human Albumin Solution (HAS)
78
What level of urine output is oliguric?
<30 ml/hr
79
What is the rate of maintenance fluids for a healthy adult and an elderly adult?
Healthy: 3L/day (8hrly)
Elderly: 2L/day (12hrly)
80
True or false, bendroflumethiazide causes hypokalaemia?
True
81
If a patient is septic, methotrexate should be stopped, true or false?
True
82
True or false, metformin is contraindicated in renal failure?
True. Metformin is excreted via the kidneys
83
True or false, beta blockers are contraindicated in asthma?
True
84
What route is insulin almost always given?
SC
[Sliding scales are IV]
85
If a patient's TSH is 0.2, should their levothyroxine dose change?
Yes. It should be decreased.
<0.5 - Decrease dose
0.5 - 5 - Keep the same
>5 - Increase dose
86
When is a paracetamol normogram sampled?
4 hours after intake
87
True or false, carbamazepine can cause hyponatremia?
True
88
How do you adjust warfarin if INR is above range?
>8 with bleeding = IV Phytomenadione (Vit K) + Stop
>8 no bleeding = Oral Vit K + Stop
>5 with bleeding = IV Phytomenadione + Stop
>5 no bleeding = Withhold 1-2 warfarin doses and reduce subsequent maintenance doses.
89
What is the treatment for heart failure?
[DAB]
Diuretic: Furosemide (Loop diuretic)
ACEi
BB
90
What is the treatment for AF?
Haemodynamically stable:
Rate: Atenolol / Diltiazem / Verapamil
Rhythm: Amiodarone / Flecanide
NB: Rhythm control has to be within the first 48 hours or there is a risk of stroke due to clots being released. Rate control is safe even after 48 hours.
91
What is the treatment for bacterial meningitis in primary care and secondary care?
Primary: Benzylpenicillin IM
Secondary: Cefotaxime IM / IV
92
What is the first line treatment for PE?
LMWH e.g. Tinzaparin
93
What is the first line treatment for a seizure?
Lorazepam IV
Diazepam Rectal
Midazolam Buccal
94
What is the treatment for DKA?
1 L NaCL 0.9% over 1 hour then over 2hr then 4hr then 8hr. K+ supplementation. Fixed insulin. When BM <14 add dextrose.
95
What is the first line treatment for parkinson's disease?
Levodopa + Carbidopa
[Effective for around 2-5 years].
96
What should be checked when commencing someone on Azathioprine?
TPMT activity
97
What is the first line treatment for mild and severe Alzheimer's?
Mild: Acetylcholinesterase inhibitor (rivastigmine, donepezil, galantamine)
Severe: NMDA antagonist e.g. Memantine
98
What is the first line treatment for cellulitis?
Flucloxacillin or clarithromycin (if pen allergic)
99
True or false, cyclizine can have antimuscarinic side effects?
True
Dry mouth / Constipation / Blurred vision / Urinary retention
100
What is the first line for pain relief in a STEMI?
GTN spray or tablet
101
What is a 1% solution?
1g in 100ml
102
True or false, Ramipril is safe in pregnancy?
False. It is teratogenic.
103
What should patient's be advised when taking tamoxifen?
Risk of VTE and risk of endometrial cancer
104
What should patients taking sulfonylureas be warned about?
Don't skip meals. Risk of hypoglycemia.
105
What do you monitor in a patient taking methotrexate?
FBC 1-2 weekly.
| Check for neutropenia
106
True or false, citalopram makes you photosensitive?
True.
107
What should patients taking steroids for more than 3 months be given?
Bisphosphonates
108
True or false, food should be avoided for 2 hours after taking bisphosphonates as it reduces absorption?
True
109
What is it important to check when prescribing statins?
Liver function as they are metabolised by the liver
110
What is it important to check when prescribing vancomycin?
Renal function. It is renally excreted.
111
How often is Lithium checked?
Weekly until stable, then every 3 months afterwards.
112
What should be checked when prescribing Olanzapine?
Fasting blood glucose. It can cause hyperglycemia
113
What should you check when prescribing COCP?
Blood pressure / Pregnancy status / Active cancer / VTE risk
114
What must you check before prescribing digoxin?
Renal function. It is renally excreted.
115
What should be monitored when prescribing clozapine?
FBC due to risk of neutropenia.
116
What should you check before prescribing sodium valproate?
Pregnant/risk of pregnancy
| LFTs (hepatotoxic)
117
What should you check before commencing someone on ACEi?
Renal function
118
True or false, methotrexate and trimethoprim can be combined safely?
False. Bone marrow suppression.
119
True or false, amiodarone can cause pulmonary fibrosis?
True
120
True or false, erythromycin can increase INR?
True
121
Do steroids cause hyperglycemia or hypoglycemia?
Hyperglycemia
122
True or false, bendroflumethiazide makes gout worse?
True
123
True or false, COCP is contraindicated in patients with migraine + aura?
True
124
By what increment should levothyroxine be adjusted?
Minimum adjustments, typically 25-50 ug
125
True or false, carbamazepine can cause SIADH?
True
126
If a patient has renal impairmentand cannot have metformin, what is the first line hypoglycemic?
Sulfonylurea e.g. Gliclazide
127
What level of venturi should be first line in COPD?
Venturi 24%
128
How often do patients on methotrexate require blood tests?
Every 3-4 weeks
129
When should you not give lactulose?
If bloating (contraindication)
130
When should you not give a stimulant laxative?
If colitis or cramps
131
Why would you not prescribe a bulking agent for fast relief?
They take a long time to to work
132
What is the key variable to measure in DKA?
Ketone level
133
What is the normal level of vancomycin?
Trough level of 10-15 mg/L
| No change to meds if in this range
134
At what time should you not rescribe thiazide diuretics?
Don't prescribe them at nightor patient's will be needing to go to the toilet during the night
135
What is the first line treatment for diarrhoea?
Loperamide
136
What is the key side effect of ferrous sulfate?
Constipation
137
What is the threshold for blood transfusion?
<70g/L
[<100g/L if pre-surgical]
138
How is ferrous sulfate given?
Orally until levels normalise and then for another 3 months after
139
What is an alternative antibiotic to use if a patient with pneumonia is allergic to penicillin/amoxicillin?
Doxycycline
140
What is the first line for a UC flare up?
IV Hydrocortisone if severe
| Oral prednisolone if mild
141
In fast AF, what would you give if patient cant have BB?
Digoxin
142
What is the first line for reversal of heparin?
Protamine
143
How do you reverse hypoglycemia in a conscious patient?
15–20 g of fast-acting carbohydrate. This is available in approximately 3–4 heaped teaspoonfuls of sugar dissolved in water, 4–7 glucose tablets, or 150–200 mL of pure fruit juice.
144
What is the max dose of citalopram in over 65s?
20mg
145
What must you monitor when giving IV phenytoin?
ECG as it is associated with cardiac arrhythmias
146
True or false, thrombolysis is never indicated in DVT?
True
147
What is the treatment for epiglotitis?
Cefotaxime
148
What is the treatment for acute and chronic anal fissures?
Acute (<6weeks):
- Bulk forming laxative (isphagula)
- Paracetamol/ibuprofen
- Topical lidocaine
Chronic (>6weeks):
- GTN rectal ointment
149
What route of furosemide is most appropriate in acute pulmonary oedema?
IV not oral
150
True or false, Rivaraoxaban is an acceptable form of VTE prophylaxis?
True
151
What volume/rate is glucose given for hypoglycemia?
Glucose 10% 100-200ml over 20mins
| Glucose 20% 50-100ml over 20 mins
152
When treating DKA, what do you change about a patient's short acting and long acting current treatments?
Stop short acting e.g. Humulin
Continue long acting e.g. Glargine
Add fixed rate insulin
153
True or false, Tramadol can induce serotonin syndrome?
True
154
How can you monitor the treatment of congestive heart failure?
Weight loss (immediately due to reduced oedema)
155
What is the advantage of oxycodone?
Useful if renal impairment
156
True or false, beta blockers are contraindicated in peripheral vascular disease?
True
157
Give a drug that can exacerbate heart failure
Steroids
| CCBs
158
Why should you not stop long-term steroids e.g. prednisolone suddenly?
Risk of adrenal suppression
159
If glucose control is poor in the evening, how do you correct a patient's insulin regime?
Increase morning biphasic dose.
| Long-term changes are better than short term soluble insulin changes.
160
What should you monitor if you start a patient on a potassium sparing diuretic e.g. eplerenone?
Potassium levels after 1 week
161
What must you check prior to starting someone on amiodarone?
Serum potassium levels
162
True or false, no routine blood monitoring is required for SSRIs?
True
163
At what level of CK would you stop a statin?
>5x normal upper limit
| Stop and restart at lower dose when symptoms resolve
