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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
100mg of codeine/ tramadol/ dihydrocodeine = how much oral morphine
10mg
26
Should aspirin be avoided in breast feeding
Yes due to risk of Reyes syndrome
27
Drugs that worsen seizure control in epileptics
``` alcohol, cocaine, amphetamines ciprofloxacin, levofloxacin aminophylline, theophylline bupropion methylphenidate (used in ADHD) mefenamic acid ```
28
Things that increase INR
``` 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 ```
29
What drug reduces hypo awareness
Beta blocker
30
How to take bisphosphonates
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'.
31
Unsafe drugs in pregnancy
``` 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 ```
32
Things that precipitate lithium toxicity
dehydration renal failure drugs: diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole.
33
Where to find benzodiazepine conversions
Hypnotics and anxiolytics
34
Asthma acute management - where to find
Airways disease, obstructive
35
Where to find steroid dose conversions
Glucocorticoid therapy
36
How to find combined pill on BNF
ETHINYLESTRADIOL WITH DESOGESTREL
37
How to find hyperkalaemia on BNF
Fluids and electrolytes
38
where to find drugs to stop before surgery
Surgery and long term medication
39
what drug should be stopped when starting an ACEi
Potassium sparing diuretics e.g spironolactone due to risk of hyperkalaemia
40
where to find info on ACEi
Drugs affecting the renin-angiotensin system
41
Where to find pneumonia
respiratory infections, antibacterial therapy
42
Where to find infective endocarditis
Cardiovascular system infections, antibacterial therapy
43
Enoxaparin dose
100mg/ml
44
Where to find b12 deficiency/ anaemia
Megaloblastic anaemia
45
Where to find notifiable diseases
antibacterial
46
where to find osteomyelitis
Musculoskeletal infections
47
Bad side effect of gliptins
Pancreatitis, angioedema
48
Alternative to HRT if not want hormones
Clonidine
49
What to do if miss POP
If over 12 hours late - take pill as soon as you remember, continue normal regime, use barrier methods for 2 days
50
Reversal agent for heparin
Protamine sulfate
51
Interaction between clopidogrel and omeprazole
Reduced clopidogrel efficacy
52
What anticoagulant to use in heparin induced thrombocytopenia
Argatroban
53
When to stop anticoags/ anti platelets before surgery
Warfarin - 5 days before, bridge with LMWH LMWH - day before Aspirin/ clopidogrel - 7d before
54
ACEi - when to stop dose
<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
SE of ACEi
Angioedema, High K+, cough, hypoglycaemia, first dose hypotension
56
SE of CCB
peripheral oedema, headache, flushing, constipation
57
SE of beta blockers
``` Bradycardia Bronchoconstriction in asthma Erectile dysfunction Claudication Reduced hypo sensitivity Insomnia ```
58
drugs causing angioedema
Nicorandil, ACEi, NSAID, gliptins
59
Drugs causing flushing
Nitrates, nicorandil, CCB, vasodilators, morphine, cholinergic drugs, tamoxifen
60
What diuretic precipitates gout
Loop - furosemide
61
What drugs are contraindicated in PVD/ Leg ulcers
Beta blockers - ACEi if critical limb ischaemia
62
drugs that exacerbate heart failure
``` Diltiazem, verapamil Prednisolone NSAIDS Thiazolidinediones – water retention Cyclizine – water retention -> pulmonary oedema ```
63
what to monitor in eplerenone and spironolactone
Potassium levels
64
What to give for hypoglycaemia if patient unconscious in hospital and on anticoagulants
20% 50-100ml glucose solution
65
what to do if myopathy and raised CK when on statin
Stop statin, monitor for improvement in sx and CK then consider restarting statin at a lower dose
66
What drug type should not be prescribed with beta blockers?
CCBs e.g. verapamil, diltiazem is better
67
Gentamicin levels
Peak - 5-10 | Trough (1 hour before) <2
68
Furosemide interaction with gentamicin/ vancomycin
Gent - nephrotoxicity + ototoxicity | Vanc - Ototoxicity
69
Drugs contraindicated with methotrexate
NSAID, trimethoprim, ciprofloxacin Trimethoprim and methotrexate = folate antagonists and taken together there is an increased risk of bone marrow toxicity and neutropenic sepsis
70
When to withdraw methotrexate treatment
If significant drop in WCC, development of stomatitis or diarrhoea
71
What drug when given with ciprofloxacin can increase risk of seizures
NSAID - e.g. ibuprofen
72
What abx should be stopped in diarrhoea
Clindamycin - can cause colitis
73
Abx that can cause photosensitivity and tooth discolouration
doxycycline
74
TB drug that can cause visual disturbance
Ethambutol
75
Drugs that can cause serotonin syndrome
SSRI's, MOAi, Bupropion, TCA, opioids, carbamazepine, triptans, lithium, metoclopramide, ondansetron, tramadol
76
Why cant take TCA with alcohol
Can cause respiratory depression
77
What is the max dose of citalopram in elderly
20mg
78
SE of glucocorticoids e.g. pred
Hyperglycaemia, osteoporosis, peptic ulceration, proximal myopathy, mood changes, weight gain
79
SE of mineralocorticoids e.g. fludrocortisone
Hypertension, water retention, hypernatraemia, hypokalaemia, hypocalcaemia
80
Drugs that worsen GORD
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
What maintenance fluid should be voided in stroke patients
Dextrose - increases the risk of cerebral oedema
82
When to start N-acetylcysteine without awaiting blood levels
If staggered dose | If taken > 150mg/kg
83
What dose of atorvastatin should be given in primary prevention vs secondary prevention
10mg ON vs 80mg ON
84
What to monitor for digoxin
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
How to write in dose for inhaler
number of puffs
86
Drugs given ON
Statins, SU, sleeping tablets, Amitriptyline, Senna
87
Which antiemetic causes extrapyramidal side effects and which should be avoided in heart failure
Metoclopramide - EPSE | Cyclizine - causes fluid retention so should be avoided
88
how to tell how much fluid depletion to correct
Urine output <30ml/hr = 500ml Urine < 30 + tachycardia = 1L Urine + tachycardia + hypotension = 1.5-2L
89
Which AF medication is contradicted for people with stuctural heart defect
Flecainide
90
Drugs for pharmacological VTE prophylaxis
``` low molecular weight heparin (LMWH) dabigatran rivaroxaban apixaban fondaparinux unfractionated heparin (UFH) (for patients with renal failure) ```
91
Drugs to use with caution in ischaemic heart disease
NSAIDs oestrogens: e.g. combined oral contraceptive pill, hormone replacement therapy varenicline
92
Signs of opioid overdose
intractable nausea, hallucinations, | drowsiness, myoclonic jerks, pinpoint pupils and respiratory depression
93
What antiemetic to give with morphine in adults and kids
Adults: metoclopramide Children: ondansetron
94
Drugs to stop prior to surgery
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
Adrenaline dose for cardiac arrest vs anaphylaxis
Cardiac arrest - 1mg 10ml 1:10000 slow IV | Anaphylaxis - 0.5mg 0.5 1:1000 IM
96
What to give in acute bradycardia
Atropine 500mcg IV
97
SVT drug treatment
Adenosine 6mg IV (followed by 2 further 12mg doses)
98
``` Palliative care meds for: Resp distress Secretions Confusion + hallucinations Confusion w.out hallucinations N+V ```
``` Resp distress - oramorph Secretions - hyoscine butylbromide Confusion + hallucinations - haloperidol Confusion alone - midazolam N+V - haloperidol or cyclizine ```
99
What laxative to use when - acute/ opioid - faecal impaction - chronic/ elderly/ pregnant
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
One drug that can dangerously increase INR when given with warfarin
erythromycin
101
NSAID contraindications
Clotting issues, renal failure, dyspepsia/ indigestion, asthma, heart failure Aspirin not contraindicated in HF, Renal failure, asthma
102
Fluid boluses what to give and when
Normally - 500ml 0.9% NaCl over 15 mins | If also have heart failure - 250ml 0.9% NaCl over 15 mins
103
What type of patient should not be given metoclopramide/ haloperidol Domperidone is safe as does not cross BBB
Parkinsons patient
104
Drugs contraindicated in asthma
Beta blocker, NSAID,
105
contraindications for COCP
``` Current breast cancer smoking if >35yo hypertension >160 migraine with aura PVD ```
106
Drugs causing low platelets
Penicillamine, heparin
107
Normal TSH range
0.5-5 If <0.5 decrease dose If >5 increase dose
108
Drugs that can cause cholestasis
Flucloxacillin, coamoxiclav, nitrofurantoin, erythromycin, carbamazepine, chlorpromazine, OCP, steroids and sulphonylureas.
109
Lithium toxicity
Early: tremor Intermediate: tiredness Late: arrhythmias, seizures, coma, renal failure and diabetes insipidus
110
Reversal agent for benzodiazepines
Flumazenil
111
Complication associated with clindamycin
Antibiotic induced colitis
112
Drugs with anticholinergic/ Antimuscarinics SE
``` prochlorperazine Cyclizine Hyoscine butylbromide Atropine Cyclopentolate oxybutynin ipra/tiotropium clozapine/ onlanzapine amitriptyline ```
113
What does hydroxocobalamin treat
Vit B12 deficiency
114
What does tamoxifen increase the risk of
VTE, endometrial cancer
115
What drug should always be given alongside methotrexate
Folic acid
116
Pain relief in kids + what antiemetic to give with morphine
<3m - paracetamol >3m - paracetamol and ibuprofen Give ondansetron alongside morphine in kids
117
TB drug causing orange/red tears/urine TB drug causing gout TB drug causing optic neuritis
Rifampicin - urine Pyrizinamide - gout Ethambutol
118
What drug causes red man syndrome
Vancomycin
119
What abx causes maculopapular rash with EBV
Amoxicillin
120
Drugs causing photosensitivity
tetracyclines, SSRI, cipro, amiodarone, retinoids
121
Drugs that can cause pulmonary fibrosis
BANS ME Bleomycin, Amiodarone, Nitrofurantoin, Sulfasalazine, MEthotrexate
122
Drugs that can cause neuropathy
Amiodarone, isoniazid, metronidazole, nitrofurantoin, vincristine, phenytoin

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