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FINALS REVISION > PSA > Flashcards

PSA Flashcards

1
Q

Why must clozapine be re-titrated after 48 hours?

A

failure to do so increases the risk of orthostatic hypotension, which may be accompanied by cardiac or respiratory arrest

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2
Q

Do ACEi doses need to be retitrated and why?

A

Yes, they should be retitrated gradually to avoid first dose hypotension

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3
Q

What does oral ferrous/iron interact with?

A

Interacts with quinolones (e.g. ciprofloxacin), reducing their absorption

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4
Q

Which medications should be avoided in patients with G6PD deficiency?

A 
Aspirin
Anti-malarials
Nitrofurantoin
Ciprofloxacin
Co-trimoxazole
  • haemolytic anaemia
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5
Q

What condition can cause massively raised CK in patients on statins?

A

Rhabdomyolysis

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6
Q

What are the CYP450 inhibitors?

A

Diltiazem

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7
Q

Can you take diltiazem with a statin?

A

diltiazem is a CYP450 inhibitor and increases the concentration of statins in serum.
should reduce the dose of statin when prescribing alongside diltiazem

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8
Q

What does the COCP interact with to reduce its efficacy? (inducer or inhibitor)

A

CYP450 inducers increase the rate of metabolism of COCP and reduce its bioavailability and therefore its efficacy

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9
Q

Can you give miconazole with warfarin?

A

Miconazole is a CYP450 inhibitor - warfarin builds up and INR increases

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10
Q

What drugs does acute ingestion of alcohol affect?

A

Warfarin

Metronidazole

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11
Q

What interaction between amfetamines and SSRIs?

A

serotonin syndrome

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12
Q

Why can’t you give GTN spray with sildenafil?

A

Hypotension/MI as a result of the pharmacodynamic interactions of both

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13
Q

What foods are warfarin takers advised to avoid?

A

leafy greens with high vitamin K

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14
Q

Give a drug-food interaction for ACEi

A

Patients who have swapped normal salt for Lo-Salt are at risk of hyperkalaemia if they take ACEi or spironolactone/amiloride (another K-sparing diuretic)

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15
Q

What food should be avoided with CCBs such as felodipine?

A

grapefruit juice - inhibit CYP450, increase the bioavailabiluty of felodipine - increase side effects such as flushing/oedema/collapse

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16
Q

What does grapefruit juice interact with?

A

CCB
statins
immunosuppressants
anti-arrhythmics

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17
Q

What medications can lithium interact with to cause lithium toxicity?

A

ACEi prevent the renal clearance of lithium causing lithium toxicity

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18
Q

Can you take rifampicin with COCP?

A

rifampicin is inducer - reduces the bioavailability of COCP

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19
Q

What happens if you take BB with CCB?

A

additive effect - hypotension, bradycardia, asystole

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20
Q

give an example of an interaction between BB and CCB?

A

timolol eye drops and oral verapamil

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21
Q

what happens if both warfarin and nsaid?

A

GI bleed

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22
Q

What is the interaction between warfarin and some macrolides such as erythromycin/clarithromycin?

A

macrolide inhibits enzyme. this increases bioavailability of warfarin and thus the INR

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23
Q

What is the interaction between carbamazepine and emergency contraceptives?

A

carbamazepine is an inducer and reduces the efficacy.

dose of emergency contraceptive should be doubled

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24
Q

What is the interaction between glucosamine and warfarin?

A

INR increases

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25
Q

how does st johns wort interact with SSRIs

A

increases the risk of Serotonin syndrome

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26
Q

how does st johns wort interact with MAOIs

A

hypertensive crisis

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27
Q

how does st johns wort interact with contraceptive

A

reduces contraceptive cover

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28
Q

What electrolyte abnormality is seen in vit D toxicity?

A 
hypercalcaemia 
confusion
dehydration
muscle weakness
vomiting
stones bones moans groans
29
Q

what is the effect of hyponatraemia on lithium toxicity?

A

increases lithium toxicity

30
Q

What drugs to stop before surgery?

A

I LACK OP

Insulin

Lithium
Anticoagulants/Antiplatelets
COCP/HRT
K-sparing diuretics

Oral hypoglycaemics
Perindopril (all ACEi)

31
Q

What are the enzyme inducers?

A

PC BRAS

Phenytoin
Carbamazepine
Barbiturates
Rifampicin
Alcohol (chronic excess)
Sulfonylureas
32
Q

What are the enzyme inhibitors?

A

AO DEVICES

Allopurinol
Omeprazole

Disulfiram
Ethanol (acute consumption)
Valproate
Isoniazid
Ciprofloxacin
Erythromycin
Sulfonamides
33
Q

What is the effect of bendroflumethiazide on potassium levels

A

bendroflumethiazide causes hypokalaemia

loop and thiazide diuretics cause hypokalaemia

34
Q

what is the effect of ACEi on potassium levels?

A

ACEi cause hyperkalaemia

35
Q

what route to give insulin

A

SC

IV only if sliding scale actrapid

36
Q

what medication should you stop if hyperkalaemia?

A

ACEi

37
Q

what electrolyte abnormality with carbamazepine

A

hyponatraemia - seizures

38
Q

what are side effects of diltiazem

A

oedema

they worsen fluid retention

39
Q

what treatment for STEMI

A

MONAT

Morphine (5-10mg)
Oxygen only if desaturing
Nitrates (GTN 2 puffs sublingual)
Aspirin 300mg
Ticagrelor 180mg /clopidogrel 300mg
40
Q

what should you give if stemi pt undergoing PCI

A

Prasugrel

41
Q

what treatment if no PCI in stemi patient?

A

fondaparinux

42
Q

what treatment for nstemi/unstable angina

A

MONAT

Morphine 5-10g
Oxygen if indicated
Nitrates (2 puffs sublingual GTN)
Aspirin 300mg
Ticagrelor 180 or clopidogrel 300mg
43
Q

what long term treatment for ACS

A

CRABS

Clopidogrel 75mg
Ramipril
Aspirin
Beta blocker
Statin
44
Q

what treatment for chronic heart failure

A

ACEi - ARB if intolerated

Beta blocker - bisoprolol

45
Q

in heart failure, if ARB and ACEi not tolerated, what to prescribe

A

hydralazine and nitrate

46
Q

if symptoms of chronic HF continue despite treatment with ACEi and BB, what to prescribe

A

spironolactone/amiloride

47
Q

how to treat ACUTE heart failure

A

UNLOAD FAST - diuretics

Upright position
Nitrates
Loop diuretic
Oxygen
ACEi
Digoxin

Fluids (decrease)
Afterload (decrease)
Sodium restrict

48
Q

how to treat angina

A

GTN

BB
CCB if no BB (verapamil/diltiazem)

49
Q

how to treat angina if CCB+BB combo not enough

A

ivabradine

50
Q

what secondary prevention for stable angina

A

statin
aspirin
ACEi if patient has diabetes

51
Q

describe treatment pathway for HTN if under 55

A
  1. A
  2. A + C or A+D
  3. A + C + D
52
Q

describe treatment pathway for HTN if diabetic of any age

A
  1. A
  2. A + C or A+D
  3. A + C + D
53
Q

describe treatment pathway for >55 or afro-caribbean

A
  1. C
  2. C + A or C + D
  3. A + C + D
54
Q

If patient still hypertensive after triple treatment, what to give if low potassium

A

k-sparing diuretic if less than 4.5mmol

55
Q

if patient still hypertensive after triple treatment with HIGH potassium, what to give

A

alpha or beta blocker

56
Q

how to treat AF - rate control

A

Beta blocker or rate limiting CCB (verapamil or diltiazem)

57
Q

if AF rate not controlled with one drug, what to give

A

two of three:

  1. beta blocker
  2. diltiazem
  3. digoxin
58
Q

when to start rhythm control in AF

A

if less than 48 hours, can start with amiodarone or flecainide
if more than 48 hours, anticoagulate first

59
Q

what investigations needed before amiodarone

A

CXR - amiodarone can cause interstitial lung disease
TFT
LFT
U&E

60
Q

what anticoagulant for AF

A

warfarin

DOAC - apixaban, rivaroxiban, dabigatran

61
Q

supraventricular tachy - immediate treatment

A

IV adenosine 6mg bolus

62
Q

SVT treatment in asthmatic

A

no adenosine, use verapamil instead

63
Q

treatment for ventricular tachy

A

amiodarone via central line
lidocaine
procainamide

64
Q

treatment for pericarditis

A

nsaid and colchicine

65
Q

treatment for anaphylaxis in adult

A

IM adrenaline 500mcg

then oral cetirizine or IV chlorphenamine

66
Q

treatment for anaphylaxis in child 6-12

A

IM adrenaline 300mcg

67
Q

treatment for anaphylaxis in 6m-6y

A

IM adrenaline 150mcg

68
Q

treatment for patent ductus arteriosus to close the duct

A

indomethacin or ibuprofen

69
Q

treatment to keep PDA duct open

A

prostaglandin E1

FINALS REVISION (17 decks)

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