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Finals > PSA > Flashcards

PSA Flashcards

1
Q

Paracetamol prescription + when to lower

A

1g QDS PO

If <50kg or severe liver failure give 500mg QDS instead

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2
Q

Ibuprofen prescription

A

400mg QDS PO

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3
Q

Hypoglycaemia

A

10% 200ml (10-15g) glucose over 15 minutes

Or glucose 20% 50-100ml over 15 mins

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4
Q

DKA

A

50 units (0.5ml) insulin in 50ml normal saline

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5
Q

Hyperkalaemia - drugs to give

A

10 units actrapid in 50ml 50% glucose over 30 minutes

10ml 10% calcium gluconate over 10 mins

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6
Q

Pulmonary oedema

A

IV furosemide 20-50mg OD

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7
Q

What to give if INR >1.5 day before surgery

A

phytomenadione

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8
Q

Codeine dose

A

30-60mg QDS PO

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9
Q

Drugs causing hypernatraemia

A 
Diuretics
Sodium bicarbonate
Sodium chloride
Corticosteroids
Anabolic steroids
Adrenocorticotrophic steroids
Androgens
Oestrogens
Lithium due to diabetes insipidus
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10
Q

Drugs causing hyponatraemia

A

Eplerenone – mineralocorticoid receptor antagonist
Loop diuretics
Thiazides - indapamide
Drugs that cause SIADH (carbamazepine, omeprazole, SSRI/ TCA, fluoxetine, sertraline, SU, vincristine, cyclophosphamide, chlorpromazine)

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11
Q

Drugs causing hyperkalaemia

A

Eplerenone, spironolactone
ARBs, ACEi – block aldosterone production NSAIDS + Impaired excretion of K (metformin, gentamicin)
Trimethoprim
Dalteparin, Enoxaparin /any heparin – inhib aldosterone synthesis
Tacrolimus
Amiloride, triamterene = potassium sparing diuretic
Ciclosporin

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12
Q

Drugs causing hypokalaemia

A

Thiazide
Loop diuretics
Acetazolamide
Salbutamol

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13
Q

Increased QTc

A

o Second generation anti-psychotics (olanzapine)
o Anti-depressants - venlafaxine, citalopram
o Anti-emetics - mainly ondansetron but also metoclopramide - Cyclizine is drug of choice in those at risk
o Sotalol
o Anti-arrhythmics - flecainide, amiodarone
o Antibiotics - ciprofloxacin, erythromycin
o Ketoconazole
o Methadone

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14
Q

Increased INR

A 
o	Sodium valproate 
o	Isoniazid
o	Cimetidine
o	Ketoconazole
o	Fluconazole
o	Alcohol (binge)
o	Chloramphenicol
o	Erythromycin 
o	Sulphonamides
o	Quinolones e.g. Ciprofloxacin
o	Omeprazole
o	Metronidazole 
o	Others - tamoxifen
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15
Q

Decreased INR

A

o PCBRAS

Phenytoin
Carbamazepine
Barbituates
Rifampicin
Alcohol (chronic)
SU
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16
Q

2 drugs that can cause pancytopenia

A

Azathioprine and allopurinol

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17
Q

Diarrhoea

A 
o	Alendronic acid 
o	Lansoprazole and all other PPIs
o	NSAIDS
o	Metformin
o	SSRI
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18
Q

Vancomycin monitoring - what to do

A

Measure trough levels just before dose - 10-20mg/L

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19
Q

Lithium monitoring

A

Take 12 hours post dose - aim for 0.4 –1  mmol/litre

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20
Q

Digoxin monitoring

A

6 hours post dose

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21
Q

What phenytoin level aim for

A

The usual total plasma-phenytoin concentration for optimum response is 10–20 mg/litr - trough level

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22
Q

When to stop statins

A

Stop if LFT > 3x upper limit of normal or if CK is > 5x upper limit normal

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23
Q

Best opioid for renal failure

A

fentanyl patches

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24
Q

What opioid is good if sx of nausea/ hallucinations

A

oxycodone (constipation)

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25
Q

100mg of codeine/ tramadol/ dihydrocodeine = how much oral morphine

A

10mg

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26
Q

Should aspirin be avoided in breast feeding

A

Yes due to risk of Reyes syndrome

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27
Q

Drugs that worsen seizure control in epileptics

A 
alcohol, cocaine, amphetamines
ciprofloxacin, levofloxacin
aminophylline, theophylline
bupropion
methylphenidate (used in ADHD)
mefenamic acid
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28
Q

Things that increase INR

A 
liver disease
P450 enzyme inhibitors (see below)
cranberry juice
drugs which displace warfarin from plasma albumin, e.g. NSAIDs
inhibit platelet function: NSAIDs
antibiotics: ciprofloxacin, clarithromycine/erythromycin
isoniazid
cimetidine,omeprazole
amiodarone
allopurinol
imidazoles: ketoconazole, fluconazole
SSRIs: fluoxetine, sertraline
ritonavir
sodium valproate
acute alcohol intake
quinupristin
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29
Q

What drug reduces hypo awareness

A

Beta blocker

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30
Q

How to take bisphosphonates

A

The current BNF advice on how to take oral bisphosphonates is ‘Tablets should be swallowed whole with plenty of water while sitting or standing; to be taken on an empty stomach at least 30 minutes before breakfast (or another oral medicine); patient should stand or sit upright for at least 30 minutes after taking tablet’.

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31
Q

Unsafe drugs in pregnancy

A 
Antibiotics
tetracyclines e.g. doxy
aminoglycosides e.g. gent 
sulphonamides and trimethoprim
quinolones e.g. ciprofloxacin
Other drugs
ACE inhibitors, angiotensin II receptor antagonists
statins
warfarin
sulfonylureas
retinoids (including topical)
cytotoxic agents
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32
Q

Things that precipitate lithium toxicity

A

dehydration
renal failure
drugs: diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole.

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33
Q

Where to find benzodiazepine conversions

A

Hypnotics and anxiolytics

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34
Q

Asthma acute management - where to find

A

Airways disease, obstructive

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35
Q

Where to find steroid dose conversions

A

Glucocorticoid therapy

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36
Q

How to find combined pill on BNF

A

ETHINYLESTRADIOL WITH DESOGESTREL

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37
Q

How to find hyperkalaemia on BNF

A

Fluids and electrolytes

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38
Q

where to find drugs to stop before surgery

A

Surgery and long term medication

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39
Q

what drug should be stopped when starting an ACEi

A

Potassium sparing diuretics e.g spironolactone due to risk of hyperkalaemia

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40
Q

where to find info on ACEi

A

Drugs affecting the renin-angiotensin system

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41
Q

Where to find pneumonia

A

respiratory infections, antibacterial therapy

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42
Q

Where to find infective endocarditis

A

Cardiovascular system infections, antibacterial therapy

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43
Q

Enoxaparin dose

A

100mg/ml

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44
Q

Where to find b12 deficiency/ anaemia

A

Megaloblastic anaemia

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45
Q

Where to find notifiable diseases

A

antibacterial

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46
Q

where to find osteomyelitis

A

Musculoskeletal infections

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47
Q

Bad side effect of gliptins

A

Pancreatitis, angioedema

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48
Q

Alternative to HRT if not want hormones

A

Clonidine

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49
Q

What to do if miss POP

A

If over 12 hours late - take pill as soon as you remember, continue normal regime, use barrier methods for 2 days

50
Q

Reversal agent for heparin

A

Protamine sulfate

51
Q

Interaction between clopidogrel and omeprazole

A

Reduced clopidogrel efficacy

52
Q

What anticoagulant to use in heparin induced thrombocytopenia

A

Argatroban

53
Q

When to stop anticoags/ anti platelets before surgery

A

Warfarin - 5 days before, bridge with LMWH
LMWH - day before
Aspirin/ clopidogrel - 7d before

54
Q

ACEi - when to stop dose

A

<20% rise in creatinine, <15% fall in GFR - cont

> 20%, >15% remeasure in 2w

If >30% rise in creatinine or >25% rise in GFR - stop

55
Q

SE of ACEi

A

Angioedema, High K+, cough, hypoglycaemia, first dose hypotension

56
Q

SE of CCB

A

peripheral oedema, headache, flushing, constipation

57
Q

SE of beta blockers

A 
Bradycardia
Bronchoconstriction in asthma
Erectile dysfunction 
Claudication 
Reduced hypo sensitivity
Insomnia
58
Q

drugs causing angioedema

A

Nicorandil, ACEi, NSAID, gliptins

59
Q

Drugs causing flushing

A

Nitrates, nicorandil, CCB, vasodilators, morphine, cholinergic drugs, tamoxifen

60
Q

What diuretic precipitates gout

A

Loop - furosemide

61
Q

What drugs are contraindicated in PVD/ Leg ulcers

A

Beta blockers - ACEi if critical limb ischaemia

62
Q

drugs that exacerbate heart failure

A 
Diltiazem, verapamil
Prednisolone
NSAIDS
Thiazolidinediones – water retention
Cyclizine – water retention -> pulmonary oedema
63
Q

what to monitor in eplerenone and spironolactone

A

Potassium levels

64
Q

What to give for hypoglycaemia if patient unconscious in hospital and on anticoagulants

A

20% 50-100ml glucose solution

65
Q

what to do if myopathy and raised CK when on statin

A

Stop statin, monitor for improvement in sx and CK then consider restarting statin at a lower dose

66
Q

What drug type should not be prescribed with beta blockers?

A

CCBs e.g. verapamil, diltiazem is better

67
Q

Gentamicin levels

A

Peak - 5-10

Trough (1 hour before) <2

68
Q

Furosemide interaction with gentamicin/ vancomycin

A

Gent - nephrotoxicity + ototoxicity

Vanc - Ototoxicity

69
Q

Drugs contraindicated with methotrexate

A

NSAID, trimethoprim, ciprofloxacin

Trimethoprim and methotrexate = folate antagonists and taken together there is an increased risk of bone marrow toxicity and neutropenic sepsis

70
Q

When to withdraw methotrexate treatment

A

If significant drop in WCC, development of stomatitis or diarrhoea

71
Q

What drug when given with ciprofloxacin can increase risk of seizures

A

NSAID - e.g. ibuprofen

72
Q

What abx should be stopped in diarrhoea

A

Clindamycin - can cause colitis

73
Q

Abx that can cause photosensitivity and tooth discolouration

A

doxycycline

74
Q

TB drug that can cause visual disturbance

A

Ethambutol

75
Q

Drugs that can cause serotonin syndrome

A

SSRI’s, MOAi, Bupropion, TCA, opioids, carbamazepine, triptans, lithium, metoclopramide, ondansetron, tramadol

76
Q

Why cant take TCA with alcohol

A

Can cause respiratory depression

77
Q

What is the max dose of citalopram in elderly

A

20mg

78
Q

SE of glucocorticoids e.g. pred

A

Hyperglycaemia, osteoporosis, peptic ulceration, proximal myopathy, mood changes, weight gain

79
Q

SE of mineralocorticoids e.g. fludrocortisone

A

Hypertension, water retention, hypernatraemia, hypokalaemia, hypocalcaemia

80
Q

Drugs that worsen GORD

A

Reduce oesophageal sphincter tone: CCBs, anticholinergics, theophylline, benzodiazepines and nitrates

Alpha-blocker, anticholinergics (e.g. oxybutynin), benzodiazepines, beta-blockers, bisphosphonates, CCBs, corticosteroids, nitrates, theophyllines, TCAs, SSIRs

Bisphosphonate’s cause irritation of oesophagus

81
Q

What maintenance fluid should be voided in stroke patients

A

Dextrose - increases the risk of cerebral oedema

82
Q

When to start N-acetylcysteine without awaiting blood levels

A

If staggered dose

If taken > 150mg/kg

83
Q

What dose of atorvastatin should be given in primary prevention vs secondary prevention

A

10mg ON vs 80mg ON

84
Q

What to monitor for digoxin

A

Monitor for reduction in ventricular rate

For plasma-digoxin concentration assay, blood should be taken at least 6 hours after a dose.

Monitor serum electrolytes and renal function. Toxicity increased by electrolyte disturbances

85
Q

How to write in dose for inhaler

A

number of puffs

86
Q

Drugs given ON

A

Statins, SU, sleeping tablets, Amitriptyline, Senna

87
Q

Which antiemetic causes extrapyramidal side effects and which should be avoided in heart failure

A

Metoclopramide - EPSE

Cyclizine - causes fluid retention so should be avoided

88
Q

how to tell how much fluid depletion to correct

A

Urine output <30ml/hr = 500ml
Urine < 30 + tachycardia = 1L
Urine + tachycardia + hypotension = 1.5-2L

89
Q

Which AF medication is contradicted for people with stuctural heart defect

A

Flecainide

90
Q

Drugs for pharmacological VTE prophylaxis

A 
low molecular weight heparin (LMWH)
dabigatran
rivaroxaban
apixaban
fondaparinux
unfractionated heparin (UFH) (for patients with renal failure)
91
Q

Drugs to use with caution in ischaemic heart disease

A

NSAIDs
oestrogens: e.g. combined oral contraceptive pill, hormone replacement therapy
varenicline

92
Q

Signs of opioid overdose

A

intractable nausea, hallucinations,

drowsiness, myoclonic jerks, pinpoint pupils and respiratory depression

93
Q

What antiemetic to give with morphine in adults and kids

A

Adults: metoclopramide
Children: ondansetron

94
Q

Drugs to stop prior to surgery

A

Insulin:

  • Sliding scale for major surgery
  • Reduce bedtime dose and omit morning dose in minor surgery

Lithium:
- day before for major surgery otherwise continue

Anticoagulants and Antiplatelets:

  • Warfarin 5 days before with LMWH bridging (give a dose of vitamin K if the INR >1.5 on the day before surgery)
  • Antiplatelets 5-7 days before
  • Aspirin is variable and is occasionally continued, may stop a week before

COCP/HRT:
- 4 weeks before any major invasive surgery

K sparing diuretics:
- on day of surgery

Oral hypoglycaemics:

  • Metformin 48h before and restart 4 days later when renal function is okay
  • Omit others on morning of operation

Perindopril and ACEi:
- 24 hours before in some cases

95
Q

Adrenaline dose for cardiac arrest vs anaphylaxis

A

Cardiac arrest - 1mg 10ml 1:10000 slow IV

Anaphylaxis - 0.5mg 0.5 1:1000 IM

96
Q

What to give in acute bradycardia

A

Atropine 500mcg IV

97
Q

SVT drug treatment

A

Adenosine 6mg IV (followed by 2 further 12mg doses)

98
Q 
Palliative care meds for:
Resp distress
Secretions 
Confusion + hallucinations 
Confusion w.out hallucinations 
N+V
A 
Resp distress - oramorph
Secretions - hyoscine butylbromide
Confusion + hallucinations - haloperidol
Confusion alone - midazolam 
N+V - haloperidol or cyclizine
99
Q

What laxative to use when

  • acute/ opioid
  • faecal impaction
  • chronic/ elderly/ pregnant
A

For acute and opiate constipation, use a stimulant laxative such as senna (7.5-15mg
PO ON)

For faecal impaction, use an osmotic laxative such as Macrogol oral powder
(Movicol) 1-2 sachets PO OD/BD/TDS

For chronic constipation or in elderly/pregnant patients, use a bulk laxative such as
Ispaghula husk (Fybogel) 1 sachet PO BD
100
Q

One drug that can dangerously increase INR when given with warfarin

A

erythromycin

101
Q

NSAID contraindications

A

Clotting issues, renal failure, dyspepsia/ indigestion, asthma, heart failure

Aspirin not contraindicated in HF, Renal failure, asthma

102
Q

Fluid boluses what to give and when

A

Normally - 500ml 0.9% NaCl over 15 mins

If also have heart failure - 250ml 0.9% NaCl over 15 mins

103
Q

What type of patient should not be given metoclopramide/ haloperidol

Domperidone is safe as does not cross BBB

A

Parkinsons patient

104
Q

Drugs contraindicated in asthma

A

Beta blocker, NSAID,

105
Q

contraindications for COCP

A 
Current breast cancer
smoking if >35yo 
hypertension >160
migraine with aura 
PVD
106
Q

Drugs causing low platelets

A

Penicillamine, heparin

107
Q

Normal TSH range

A

0.5-5

If <0.5 decrease dose
If >5 increase dose

108
Q

Drugs that can cause cholestasis

A

Flucloxacillin, coamoxiclav, nitrofurantoin, erythromycin, carbamazepine, chlorpromazine, OCP, steroids and sulphonylureas.

109
Q

Lithium toxicity

A

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

110
Q

Reversal agent for benzodiazepines

A

Flumazenil

111
Q

Complication associated with clindamycin

A

Antibiotic induced colitis

112
Q

Drugs with anticholinergic/ Antimuscarinics SE

A 
prochlorperazine 
Cyclizine
Hyoscine butylbromide 
Atropine
Cyclopentolate 
oxybutynin 
ipra/tiotropium 
clozapine/ onlanzapine 
amitriptyline
113
Q

What does hydroxocobalamin treat

A

Vit B12 deficiency

114
Q

What does tamoxifen increase the risk of

A

VTE, endometrial cancer

115
Q

What drug should always be given alongside methotrexate

A

Folic acid

116
Q

Pain relief in kids + what antiemetic to give with morphine

A

<3m - paracetamol
>3m - paracetamol and ibuprofen

Give ondansetron alongside morphine in kids

117
Q

TB drug causing orange/red tears/urine
TB drug causing gout
TB drug causing optic neuritis

A

Rifampicin - urine
Pyrizinamide - gout
Ethambutol

118
Q

What drug causes red man syndrome

A

Vancomycin

119
Q

What abx causes maculopapular rash with EBV

A

Amoxicillin

120
Q

Drugs causing photosensitivity

A

tetracyclines, SSRI, cipro, amiodarone, retinoids

121
Q

Drugs that can cause pulmonary fibrosis

A

BANS ME

Bleomycin, Amiodarone, Nitrofurantoin, Sulfasalazine, MEthotrexate

122
Q

Drugs that can cause neuropathy

A

Amiodarone, isoniazid, metronidazole, nitrofurantoin, vincristine, phenytoin

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