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PSA Flashcards

1
Q

Enzyme inducers

A 
CRAP GPS
!!!!!Sulphonylureas (gliclazide)
Carbemazepine
Rifmapicin
Alcohol (chronic)
Phenytoin
!!!!!!Griseoflulvin
!!!!Phenobarbitone
St johns Wort

also tobacco, topiramate

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2
Q

Enzyme inhibitors

A

Some Certain Silly Damn Compounds Annoyingly Inihbit Enzymes Grrr Mother (fucker)

Sodium Valproate
Cipro
!!!Sulphonamide- sulfalazine, SSRIs!!!
Diltiazem, disulfiram
Cimetidine/omeprazole
Antifungals, amiodraone, alcohol (acute)
Isoniazid
Erythromycin/clarithro
Grapefruit juice
Metronidazole
  • chloramphenicol
  • allopurinol
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3
Q

Drugs to stop before operation

A

I LACK OP

  • Insulin (put on sliding scale)- stop on day
  • Lithium- 1 day before
  • Anticoag/antiplts (1 week, warfarin 5 days, NSAIDs 1 day)
  • COCP
  • K-sparing diuretic
  • Oral hypoglycaemic- stop for NBM period, metformin- 24 hour prior
  • Perinidopril (or any ACEI, ARB)- ~1 day
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4
Q

rule for people on LT steroids and ill/having op

A
  • douuble dose to prevent addisonian crisis
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5
Q

Drugs causing hyperkalaemia

A 
THANKS Cycle
- Trimthoprim
- Heparin
- ACEI/ARBs
- NSAIDs
- K sparing 
- Suxamethonium
C- cyclosporin!!
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6
Q

drugs causing hypokaelamaemia

A

BAD FIT

  • beta 2 agonists
  • Amphotericin B
  • DIgoxin
  • Furosemide
  • Insulin
  • Thiazide
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7
Q

drusg causing hypernatraemia

A

SO SAD

  • Sodium chloride/bicarb
  • Oestrogen
  • Steroids
  • Androgens
  • Diuretics
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8
Q

Drugs causing hyponatraemia

A 
ABCDEFGH
- ACEI/Antids- SSRI/ antipsych
(- Brivaracetam, betablockers
!!!! - Carbamazepine
- Desmopressin/Diuretics
- Ethosuximide
- Furosemide
!!!!- Gliclazide
- Heparin

PPIs

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9
Q

Nephrotoxic drugs

A 
DAMN
Diuretic
ACEi/ARBs/Abx (gent, nitrofurantoin, vanc)
Metformin
NSAIDs
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10
Q

drugs causing lung fibrosis

A

BANS Me

  • Bleomycin
  • Amiodarone
  • Nitrofurantoin
  • Sulfalazine
  • Methotrexate
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11
Q

drugs causing retention

A 
NO PEE NO ABC
N- NSAID
O- opioids
A- Amitriptyline/anticholinergics
B- benzos
!!!!! C- CCBS
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12
Q

drugs exacerbating HF

A

VISA

  • Verapamil and other CCBs
  • Ibuprofen!
  • Steroids!
  • Antiarrhtymics– flecainide\
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13
Q

Drugs triggering epilepsy

A

MAMA

  • Methylphenidate (ADHD)
  • Alcohol, amphetamine
  • Mefenamic acid
  • Aminophylline, theophylline
  • cipro, levofloxacin- fluoroquinolones
  • bupropion
  • inducers

when withdrawn- benzos, baclofen, hydoxyzine
inducers/inhibitors

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14
Q

How long should you assume a course of abx is for / for review if it isnt stated in the BNF

A

PO- 5 days

IV- 3 days

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15
Q

what is the maximum dose for paracetemol

A

500mg up to 4 hourly
1g up to 6 hourly

max 4g per day

dont put PRN- put max dose up to

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16
Q

how big increments should levothyroxine dosages be increase/decreased by

A

25-50mcg

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17
Q

what drugs most commonly cause bronchospasm and should not be px in asthmatics

A
  • NSAIDs
  • Beta blockers
  • Ispaghula Husk
  • adenosine
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18
Q

Immediate management of acute asthma attack

A 
OSHITME
O2
Salbutamol
Hydrocortisone IV/ pred PO
Ipratropium
Theophylline:aminophylline infusion
Mg Sulfate
Escalate

NB- give SABA before SAMA as SAMA needs longer to work

monitor sats for therapeutic effect- serum conc does not indicate clinical efficacy

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19
Q

Life threatening asthma?

A

33, 92, CHEST

<33%- PEFR
<92%- Sats
Cyanosis
Hypotension
Exhaustion- pCO2 is higher end of normal- beginning to tire
Silent chest
Tachycardia
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20
Q

Severe, mod and mild asthma attack?

A

Severe: PEFR 33-50%, cant complete sentences >=25 RR, >110 HR

Mild: 50-75% PEFR

Mild >75% PEFR

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21
Q

LT tx asthma

A
  1. SABA/SAMA
  2. +ICS (beclo, pred)
    • Montelukast (LTRA)
    • LABA (often combined with ICS in MART)(salmeterol/formeterol) +- LTRA
  5. high dose ICS, LAMA (tio), theophyline
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22
Q

tx of cough being going on for 10d, non productive, pt well in self, no PMHx

A

SABA- likley viral, can give SABA to relieve sx of cough >10d

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23
Q

LT management of COPD

A
  1. SABA/SAMA
  2. LABA or LAMA
    • ICS
  4. azithromycin prophylactically

discontinue SAMA if LAMA added

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24
Q

Management of COPD exacerbation

A
  1. SABA+SAMA Nebs
  2. pred PO short course
  3. Aminophylline add on
    ITU transfer and CPAP

abx- doxy/co-amox/clarithro

24%/28% venturi until ABG done/high pCO2 (retainer)

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25
most important info to tell person starting ACEI
- come back in 1-2w for renal tests
26
what do you in person being tx for pneumonia monitor to assess response to abx
RR | Consolidation on CXR and creps on ausculation take longer to clear up (weeks)
27
Tx severe and moderate Croup
Severe 1. neb budesonide (when no access) 2. IV dex once access 3. Neb adrenaline and corticosteroids Moderate- oral dexa/pred
28
targets for HTN
140/90 (135/85 home) if above of equal to 80y/o--> 150/90 (145/85 home)
29
when do you tx stage 1 HTN
- if home testing >135/85 - <80 and other RFs incl diabetes, renal disease, target organ damage, CVD, elevated CV risk (>10%) - otherwise give lifestyle advice
30
stages of HTN
140/90 , 135/85- 1 160/100-180/120, home 150/95- 2 >180 or >120-- severe
31
management of severe HTN
same day specialist referral
32
HTN tx
<55 and white - ACEI/ARB - CCB - Thiazide like - spironolactone if K =<4.5 - alpha blocker, beta blocker if K >4.5 Afro carribbean/ >55yo - CCB - ACEI/ARB - Thiazide like - spironolactone if K =<4.5 - alpha blocker, beta blocker if K >4.5
33
Sx of Pheochromocytoma
- postural hypotension - palpitations - abdo pain - tx resistant severe HTN - heat intolerance/sweating/flushing - nausea - feelings of apprehension
34
Ix ?pehochromocytoma
- urinary free catecholamines (adrenaline, norad, dopamines)
35
what drug do you use to tx HTN in pehochromocytoma pre-surgery?
non selective alpha blocker- phenoxybenzemine | - betablocker
36
tx MI
MONA - Morphine - O2- not if sats ok - Glyceryl trinitrate or IV nitrogycerine (pain)- not isosorbide as this is slower acting - Aspirin 300mg + antiemetics if feeling nauseous BASH- secondary prev - Beta blocker - ACEI - Statin- (atorvostatin dose is 80mg after MI rather than 40mg) - Heparin - Dual antiplt (asp, clopi/ticagrelor)
37
Tx acute HF/fluid overload- crackles, high JVP, SOB
ventilation Furesomide IV (bolus or infusion) Fluid restrict daily weights and UE once stabilised: - betablockers if HFREF and no bradycardia/heart block- prognosis - ACEI/ARB- sx - aldosterone antagonist if HFREF- prognosis
38
LT management of HF with reduced ejeciton fraction
1. betablocker, ACEI/ARB - reduce mort/morb 2. furosemide /bumetanide- sx relief Spironolactone amiodarone, digoxin, ivabradine- specialist
39
name 2 alpha blockers
doxazosin | terazosin
40
name 3 CCBs
nifedipine felodipine amlodipine
41
name 2 thiazide like diuretics
- bendroflumethiazide | - indapamide
42
name 3 K sparing diuretics
spironolactone eplerenone amiloride
43
tx of acute pulmonary oedema
acute SOB - furesomide 80mg IV stat - bumetanide if HF fluid overload resistant to furesomide
44
tx of acute presentation of AF
Not stable - emergency electrical cardioversion Stable - Pharmac carvdioversion- flecainide, amiodarone - Rate control- betablocker IV, verapamil IV avoid verapamil in HF avoid betablocker in asthma
45
a 80 year oldspatient presents with palpitations and SOB, he says this started 3 days ago. His ECG shows AF- how would you manage?
>48hours since sx onset AND pt is elderly- both contraindications to cardioversion-- avoid amiodarone and flecainide rate control only- betablocker/verapamil would only rhythm control/cardiovert if have been on anticoag for 4-6w beforehand
46
tx of paroxysmal AF
symptomatic 1. beta-blcoker, sotalol or diltiazem 2. flecainide, amiodarone, dronedarone, propafenone 3. digoxin monotherapy pill in pocket- flecaindie, propafenone ablation (LA)
47
non acute presentaiotn of AF- LT management
1st line- beta blocker, diltiazem, or verapamil (rate) | consider digoxin as monotherpay if above fails
48
who do you not give diltiazem/verapamil to?
CCBs HF fluid overload
49
general dosing rule when starting a px in PSA
- start at the lower end of the range
50
general rule for PSA when selecting options concerning dose increase/decrease
- chose smallest increment, unless theres signs of toxicity
51
Medical pt DVT/PE prophylaxis
1. LMWH, fondaparinux renally impaired- 'use of unfractionated heparin may be preferable'-- dalteparin monograph- despite BNF tx summary for vte saying either use is good-- use heparin in renally impaired!
52
prophylaxis of DVT/VTE in surgical pt
different for eacho kind of suregry- CHEKC TX SUMMARY
53
tx of DVT/VTE
1. apixaban/rivaroxaban 2. LMWH then dabigatran 3. LMWH with warfarin NB- dose adjust LMWH for low eGFR and adults <50kg!!!!
54
what colour ewarfarin pills mean waht doses
White 0.5mg Brown 1mg Blue 3mg Pink 5mg
55
how long does warfarin take to become fully effective
3 days
56
what condition can effect warfarin effect
hyperthyroidism - increase warfarin coag effects - smaller doses Hypothyroid and those given carbimazole - loss of coag effect - increase doses
57
CI warfarin
- haemorrhagic stroke - clinically sig bleed - pregnancy (1st and 3rd trimester) - within 72hour of major surgery - concomittant tx where interactions increase bleed risk - within 48hours postpartum
58
if a q is -- a pt taking warfarin starts taking an inducer/inhibitor and their INR decreases/increases- what drug do you chose when asks which drug contributed to the INR
the inducer/inhibit (not warfarin
59
instructions taking rivaroxaban
with food
60
Mr Smith comes wants to discuss a stroke he had 1 week ago and his lasting symptoms. You notice he is still taking warfarin- what's wrong w this?
shouldnt take anticoags until 2 weeks post isch stroke
61
what is the reversal agent of dabigatran
idarucizumab
62
who is dabigatran good for
those who have had heparin induced thrombocytopenia
63
Direct Xa inhibitors
Rivaroxiban, apixaban, edoxaban
64
reverseal agent fro direct Xa inhibitors
Andexanet
65
what is an indirect Xa inhibitor
fondaparinux
66
what do you monitor in fondaparinux tx
antifactor Xa
67
what do you monitor and how do you reverse heparin
APPT | protamine
68
how do you monitor LMWH and how do you reverse
Antifactor Xa | protamine
69
why would you give a lower dose of rivaroxaban
>80yo <60kg <30 Cr clearance
70
warfarin reversal according to INR and bleeding status
- only give vit K if bleeding or INR >8 - Bleeding- IV vit K. - >8 no bleeding- Oral vit K. _________________ 3-5, no bleeding- stop for 1-2days and recheck in 1w 5-8 and no bleeding- withhold 1 or 2 doses, reduce subsequent maintenance dose >5 + bleeding (minor, major)- reverse with phytomenadione IV! >8 and no bleeding- stop warfarin and give phytomenadione ORAL! Major bleeding of any kind - stop warfarin, give phytomenadione IV - give prothrombin (2,7,9,10) - FFP NB- different dosages of phytomenadione concerning minor and major bleeding
71
what common drugs do you withhold in a pt with low Hb
NSAIDs, aspirin
72
how long does it take for aspirin to wear off
7 days
73
aspirin SE
dyspepsia v. rarely worsen asthma ok on kidneys
74
when should you stop clopi pre op
1 week
75
when should you stop warfarin pre-op
5 days
76
what common drug interacts with clop to increase risk of bleeding
omezoprazole
77
what drug increases risk of bleeding when px with an NSAID or dabigatran
citalopram
78
name some 1st gen atnipsychotics
haloperidol | chlorpromazine
79
name seom 2nd gen antipsychotics
olanzapine repisirdone quetiapine
80
what is the atypical atypical antipsychotic
clozapine
81
what SEs do atypical antipsychotics tend to cause
Metabolic - Wt gain - hyperprolactinaemia - hyperlpidaemia - hyperglycaemia, diabetes - HTN QT prolongation
82
when do you medicate depression
- mod-severe - persisted for 2y - persisted despite other interventions
83
Serotinergic medications- name them
- Tramadol - Codeine - TCA - SSRIs - amphetamines
84
what dangers are there of seritonergic medications
- lower seizure threshold - hyponatraemia Serotonin syndrome - tremor - hyperreflexia - rigid - ocular clonus - altered mental state - autonomiic- hyperthermia, tachy, HTN, flushed, diaphoresis,
85
tx of serotonin syndrome
- cyproheptadine | - benzo for agitation
86
tx alcohol withdrawal
chlordiazepoxide
87
Tx of the different dementias
Alzheimer's 1. galantamine/donepezil/rivastigmine 2. THEN memantine Parkinsons 1. donepezil, rivastigmine, galantamine 2. memantine Lewy Body 1. Donepezil or rivastigmine 2. galantamine 3. memantine Vasc Dementia 1. Antiplt and HTN control - only give other drugs if mixed Frontotemporal ro MS - DO NOT give ACHesterase inhibis or memantine
88
tx parkinsons
1. co-careldopa 2. Non ergot DA agonist- apomorphine, pramipexole, rotigotine or MAOB inhibi- rasagiline if motor SE/fluctuations develop - off above tx plus - COMT inhibitors (antacapone) only consider ergot- derived DA agonists- bromociptine, cabergoline-- if on-ergots have not helped
89
SE parksinsons meds
chorea postural hypotension hallucinations, impulse control issues
90
CI parkinsons meds
- psychosis - Neuroleptic malignant syndrome - rhabdomyolysis - dyskinesias, dystonia
91
what class of drugs interact with parkinsons meds
antipsychotics
92
tx SAH
1. Nimodipine | 2. Mannitol
93
What drugs can cause confusion in the elderly
- Prochloperazine (sedation) - Anticholinergics, antihistamines - Sulphonylureas- gliclazide, glibenclamide - beta blockers * **- Steroids (pred) Sedatives: - hypnotics/anxio- lorazepam, benzos - opioids - TCAs - sedatvie antihistamines (all except cetrizine, acrivastine, fexofenadine, loratadine)
94
What drugs can cause falls in elderly
``` !!!! - alpha blockers (doxasosin, tamsulosin) - AntiHTN - beta blockers !!!! - antidepressants - hypnotics, benzos !!!! - nitrates ```
95
what can cause hypothermia in the elderly
- sedatives- benzos, TCA, opioids, chlopromazine - decrease mobility- antipsychotics, antiparkinsons drugs, hypnotics - vasodilation- CCBs- amlodipine-- flushing, oedema
96
what causes resp depression
opioids | benzos- avoid diazepam
97
what drugs do you pre-preemptively prescribe
- Morphine , diamorphine , Oxycodone in renal impairment - Haloperidol, cyclizine (antiemetic) - Hyoscine butyl/hydrobromide , glycopyrronium (secretions) - Midazolam, diazepam, lorazepam (sedation) - Haloperidol- restlessness - hiccup- metoclopramide, baclofen, nifedipine
98
Contraindications for px hyoscine hydro/butylbromide, glycopyrronium
Antimuscarinic (anti-motility action on gut): - paralytic ileus - symptomatic reflux
99
difference between hyoscine butylbromide and hydrobromide
Butyl - does NOT cross BBB - less drowsiness and central antiemetic action Hydro - does cross BBB - drowsiness
100
What drugs are dangerous in pregnancy
SAFE Mums Take Really Good Care Sulphonamides (sulfasalzine, trimeth), Sodium Valproate Aminoglycosides (gent, streptomycin) Fluoroquinolones and quinolones (cipro, levo, oflo) sEnna (avoid near full term) ``` Metronidazole, methotrexate Tetracycline (doxy), topiramate, TIOTROPIUM Ribavirin, retinoids (even TOP) Griseofluvin Chloramphenicol ``` Also: - high dose vit A - thalidomide - warfarin - antidiabeteics instead of metformin and insulin - antiHTNs except labetalol, nifedipine, methyldopa
101
vte prophylaxis in preg
LMWH
102
tx VTE in pregnancy
apixaban/rivaroxaban or LMWH with dabigatran after
103
high BP tx pregnancy
1. labetalol 2. Nifedipine 3. Methyldopa IV Mg sulphate if severe switch all pre-existing antiHTNs to the above fi women want to become/have become
104
tx pregnancy HTN emergency
IV Mg sulphate- give 1st if headache/flashign lights present oral/IV labetalol Oral nifedipine IV hydralazine
105
tx of hyperglycaemia in preg/gestational diabetes (starting after 24/40)
- change diet and exercise for 1-2w Then after 2w: 1. Metformin 2. +-Insulin
106
what should pregnant diabetic women be px (other than antidiabetic meds)?
folic acid- high risk for neural tube defects
107
how to prevent focal seizures in pregnant pt eg cerebral tumour
- Lamotrigine (and carbamazepine) | which is also 1st line for non-pregnant people
108
Contraindications for COCP
- vasc disease - Hx of IHD/stroke - major surgery with prologned immbolisation - known thrombotic mutations - AF - BMI >35 - Age !!>35!! - smoker >15 cigs - Migraine with aura - Fam hx of VTE in 1st degree relative aged !!<45!! - personal hx VTE
109
procedure fro missed COCP pills
- 'missed'- taken >24 hours apart - take missed as soon as rememebr and then resume normal taking - may mean taking 2 together - no additional precuations needed 2 missed pills - take most recent missed asap, may mean take 2 together - abstain from sex/take barrier methods for 7 days - if next 7 days run into free pill time- start next pack without pill free time - emergency contraception if have had sex
110
COCP monitoring
wt and BP only
111
when may you need to px a different dose of levonorgestrel for emergency contraception
- double it when an inducer is being taken
112
Levonorgestrel missed pill procedure
- 3 or 12 horu window - take asap - use protection for 2 days - emergency contraception may be needed
113
what is a non hormonal drug that can be used to px sx of menopause
clonidine
114
if the person has a uterus, what kind of HRT should be used
Combined- as unopposed oestrogen--> endometrial cancer eg yasmin
115
name some oestrogen only brands
elleste-solo | evorel
116
what type of HRT do you use in a person still with periods
Also good for menopausal sx Cyclical- elleste duet Evorel sequi
117
what type of HRT do you use in a person who no longer has periods?
Continuous >50yo >1yr <50 >2yrs
118
How do you step up steroid creams in eczema
Help Every Bloody Dermatologist Hydrocortisone Emumovate (clobestasone) Betnovate (betamethasone 1%) Dermovate (clobestasol propionate) NB - aq cream not recommended generally - reaction risk
119
what is used in severe eczema flares in children (TOP)
tacrolimus | pimecrolimus
120
Antiemetics
1, cyclizine (not in cardiac cases- use metoclop) serotonin antags- ondansetron histamine antags- promethazine, cyclizine DA antag- domperidone, metoclop N+V from migraine- prochloperzine, metoclop (oral or injection if vomiting)
121
when is metoclop CIed
- Parkinsons- use domperidone - young women- increase risk of dyskinesia - Obstruction- prokinetic and risks of perf - caution in older adults
122
Constipation
1, Bulk forming - ispaghula husk - good for ST consti and hard stools - avoid if already have sx (takes time to work) - avoid in in asthmatics (bronchospasm) - also 1st line in fissures and haemorrhois 2. Stimulant - bisacodyl, Na picosulfate, senna - avoid in preg - good for soft stool - 1st line in opioid/post op consti - CI- colitis, cramps 3, Faecal softener - Docusate, glycerol 4 Osmotic - lactulose, macrogol (movicol) - good for hard stools - CI= bloating - Avoid in IBS! - 2nd line in fissures - 1st line in faecal impaction (high dose) 5. Ph enemas
123
How do you manage post op/opioid constipation
- avoid bulk forming | - use stimulant eg senna/biscodyl
124
How to manage person who is faecally impacted but passing no stools (faceal loading on AXR or hard stool fel in rectum)-- laxative wise
- osmotic- high dose movicol THEN - other laxatives - phos enema
125
how to tx constipation with acute fissure
1. Isapghula husk (bulk) 2. Lactulose (osmotic) glyceryl trinitrate ointment topical lidocaine paracetemol/NSAID
126
tx haemorrhoids
- avoid opioids (constipation) - bulk forming- isphaghula husk - topical - lidocaine, cinchocaine - topical steroid based ointments- anusol
127
tx diarrhoea
loperamide
128
tx Acute pancreatitis
O2, analgesia, IV fluids analgesia IV abx for infected pancreatic necrosis and/or assoc cholangitis-- - cipro, penicillin, ceftriaxone, metronidazole
129
tx chronic pancreatitis
- Ceon (lipase, protease, amylase) - analgesia incl. gabapentin, amitriptyline - steroids if autoimmune
130
when do you tx diabetes
- immediately if any evidence of organ damage (vision blurring, renal failure, vasc disease) - if no sx/mild- could repeat GTT and hba1c
131
monitoring of diabetes
hba1c 3-6 monthly until stable, then every 6m | foot, eye, U&E annually
132
diabetes diagnostic criteria
48mmol/L hba1c | 11.1 random, 7 fasting
133
tx pf T2DM
1. metformin - monitor UEs 2. DPP4s- -gliptins 3. pioglitazone 4. sulphonylureas eg gliclazide 5. SGLT-2 inhibits -gliflozin 6. glucagon like peptide 1 rec agonists -tide 7. insulin
134
CI and SE metformin
<30 eGFR / Cr >150/Ur risk of lactic acidosis SE - Lactic acidosis - kidney dysfunction - GI - anorexia - B12 absorption reduction
135
SE pioglitazone
wt gain bladder cancer !!!!# risk !!!!visual impairment (retinal ischaemia, macular oedema)
136
SE sulphonylureas
gliclazide - hypoglycaemia - hyponatraemia - wt gain and hunger - GI issues
137
SE SGLT-2 inhibitors
Gliflozin - wt loss - Fournier's gangrene!! (penis)
138
targets for BM for diabetics
AM/before meals - 4-7mmol/L After meals/PM - 9mmol/L (1.5hr after meal) if not hitting AM tagrt change PM insulin dose and vice versa
139
how much do you change insulin dose by if someone dosent hit their BM target
10% (up or down)
140
how do you manage a conscious and stable pt who has a low BM
- 20g glucogel, long acting CHO when glucose >4mmol/L- biscuits, milk- aviod fake milk and chocolate - fruit juice, sugary snack
141
How do you manage an unconscious/drowsy pt with a low BM
SC or IM glucagon 1mg stat, wiat 10 mins, then... - glucose 10%100-200ml (10-20g) or 20% 50-100ml (10-20g) - 50% not recommended - if the pt already has IV access, go straight for IV - Long acting CHO as soon as pt recovered and blood conc is >4mmol/L
142
What do you do with a diabetic's insulin regime during the tx of a hypo
- do not omit insulin, but the tx regime does need review - if the pt is unconscious- stop any insulin infusions and restart it when gluc >3.5mmol/L, concurrent glucose 10% infusion should be sconsidered
143
advice for diabetics on insulin for driving
- carry out BMs 2 hours before drivign and every 2 hours during jounreys - should always be >5mmol/L when driving
144
when do diabetics need to inform the DVLA of their condition?
- when they are taking antidiabetic medication | - no need to if managed by lifestyle only
145
How do you manage a pt's diabteic meds who is trying to cnoceive?
- stop all antidiabetic meds - switch them to 1. insulin 2. metformin - px folic acid as high risk of neural tube defects
146
what medication risks hyperglycaemia in diabetic patients, and if going on it, the pt must be informed of the risk and how they may want to adjust their meds
steroids
147
Tx of DKA
- Fluids - Insulin - K - glucose 10% once BM <14
148
Fluids given to an adults in DKA
Shocked (systolic <90) - 500ml NaCl over 15min - give another if systolic remains <100 Not Shocked (systolic >90) - 1L NaCl over an hour - then 250ml/hour until euvolaemic
149
Insulin regime given to adult in DKA
Bolus - 50units actrapid in 50ml of NaCl (1u/mL) Infusion - 0.1u/kg/hour - fall in glucose should not exceed 5mm/hour
150
Potassium regime given to adult in DKA
Start once K is normal | - rate should not exceed 10mmol/hour (or 20mmol/hour in severe cases)
151
when should glucose be given in DKA
10% | - once BM is <14
152
What fluids are given to paediatric cases of DKA
Shocked - 20ml/kg bolus over 15min - if still shocked, give 10ml/kg - up to 40ml/kg - then give inotropes Deficit (48hours) - %dehydration x Kg x 10 Maintenance (24hours) - 100ml/kg/day 1st 10kg - 50ml/kg/day 2nd 10kg - 20ml/kg/day rest of wt - up to 80kg Hourly rate= (deficit/48) + maintenance per hour
153
what insulin regime do you give to a paediatric pt in DKA
Bolus- 50u in 50ml NaCl - infusion 0.1u/kg/hour in NaCl 0.9% (same as in adult)
154
K regime given to paediatric case of DKA
- ensure every 500ml bag of NaCl contains 20mmol of K (40mmol/L) - rate does nto exceed 10mmol/hour
155
what do you do with a diabetics normal insulin regime during the tx of a DKA
- carry on basal doses and give when due - stop short acting doses - stop insulin driver (short acting)
156
When and how do you stop an insulin infusion after a DKA
- once pH is normal and blood ketones <1 or 0.3mmol/L - pt is eating and drinking - only take off !!!!1 hour !!! after having a meal - give first SC usually regime and bolus at least 30mins before the insulin is stopped, 60mins for insulin pump
157
How do you tx rhabdomyolysis
- Na bicarbonate to alkalise the urine and reduce myoglobin in renal tubules - stop any statins - IV fluids - dialysis
158
what do you tx paracetemol poisoning with
- acetylcysteine
159
what do you dilute acetylcysteine in
- glucose 5% or NaCl 0.9%
160
what should amiodarone be diluted in
5% glucose incompatible with NaCl!!!
161
how many infusions are needed of acetylcysteine
3
162
how do you tx paracetemol overdose ingested within 1 hour
activated charcoal
163
aspirin overdose- signs on investigation
- metabolic acidosis - hypokalaemia - high salicylate level
164
hwo do you tx aspirin overdose
- activated charcoal if within 1 hour - correct the hypokalaemia - Na bicarb IV to tx acidosis
165
Side effects of Lithium
``` LITHIUMS Leukocytosis !!!! Insipidus Tremors (Coarse overdoxse, fine SE) Hypothyroidism Increased wt !!!! Upset stomach- vomiting !!! Muscle weakness; Movement- hypereflexia, seizures, ataxia, dystonia; !!!Metallic taste !!!Skin conditions (acne, exacerbates psoriasis) ```
166
sx of lithium toxicity
``` Tremor (coarse), seizures D+N+V Anorexia disorientation/confusion blurred vision Lethargy, drowsiness, coma renal failure arrhythmia may look like cerebellar signs ```
167
management of Lithium toxicity
withhold Li increase fluid intake withhold diuretics may need haemodialysis
168
What states can increase risk of Lithium toxicity
hyponatraemia dehydration renal function detioration *****ACEI, diuretics (particularly thiazides), NSAIDs- stop these in toxicity
169
sx and signs of digoxin toxicity
sx - Anorexia, N+V, diarrhoea - malaise, weakness - palpitations, syncope - hallucination, blurred vision, xanthopsia (loss of colour vision) - Neurotoxicity signs - arrhythmias (any), bradycardia - hypotension
170
what drugs interact with digoxin
Diuretics - thiazide like diuretics - spironolactone CCBs - verapamil Inhibitors- PPIs - atorvostatin - amiodarone - ciclosporin
171
What conditions predispose to digoxin toxicity
``` hypokalaemia, hypomagnesia, hypercalcaemia alkalosis hypoxia infection renal dysfunction hypothyroidism ```
172
tx digoxin toxicity
- stop digoxin - measure plasma conc immediately if sx severe, 6 hours post dose ideally - UE, K, HR, BP, cardiac rhythm - stop any other drug that may be affecting electrolyte imbalance - DIGIBAND- antibody fragment specific to digoxin
173
what must you check before starting IV vanc
UEs
174
what may the rapid infusion of vancomycin result in
must be infused over at least 1 hour, otherwise: - cardiogenic shock - cardiac arrest - anaphylaxis - red man syndrome- histamine release, within first few mins of starting the infusion
175
toxicity sx of vancomycin
- ototoxicity - neutropenia - red man syndrome - renal dysfunction, nephrotoxic - TEN, SJS - phlebitis - N+V - fever and chills
176
sx of gentamicin toxicity
- tinnitus, deafness, balance issues, vertigo - renal dysfunction/failure - colitis - stomatitis - neutropenia
177
Theophylline monitoring after infusion for SABA/SAMA resistant acute asthma attack
serum conc | cardiac monitoring for adverse effects (earliest signs will show)
178
when do you take digoxin serum conc measurements
- only if ?toxicity | - 8-12hour after dose
179
when do you take vanc serum conc measurements
- predose (through) taken before 3rd and 6th dose
180
monitorign for gent IV/IM administration
dosaging- Weight, renal function OD serum conc 1 hour post administration
181
sx of vit. D toxicity
- hypercalcemia - dehydration - muscle weakness - vomiting - Loss of appetitie
182
tx Vit D toxicity
``` stop vit D restrict Ca IV fluids corticosteroids bisphosphonates ```
183
methotrexate toxicity sx
- pallor, GI bleeding- thrombocytopenia - N+V - dysuria, anuria - Lymphopenia- stomatitis- withdraw
184
predisposition states to methotrexate toxicity
- folate deficiency - hypoalbuminaemia - ascites or effusions (act as depot) - trimethoprim, corticosteroids, cipro, aspirin, NSAIDs
185
prevention of methotrexate toxicity
folic acid 5mg taken on a differen day to the methotrexate dose
186
INteractions with methotrexate
Trimethoprim NSAIDs, aspirin Cipro Corticosteroids
187
Phenytoin toxicity sx
- sore gums - slurred speech - nystagmus - confusion - hyperglycaemia - rash, SJS, TENS - agranulocytosis - brady
188
tx of pheyntoin toxicity
acivated charcoal - supportive - brady- atropine, epinephrine - antiemetics - haemodialiysis - if mild sx eg sore gums, slightly slurred speech--> reduce dose of phenytoin
189
what drug interacts with phenytoin and increases levels of phenytoin in blood
chloramphenicol
190
Managenent of anaphylaxis
1. high flow O2 (ABCDE) 2. IM adrenaline 3. antihismines- cetrizine, chlophenamine IV stat - hydrocortisone only if refractory or ongoing asthma/shock sx - SABA/SAMA if wheezing Refractory - adrenaline infusion after 2 IM doses - Hydrocortisone
191
tx of mild allergy eg pruritis, macular rash
chlorphenamine
192
what drugs can you not give in pen allergy
-cillines Cephalosporins - cefalexin - cefuroxime - ceftazidime - ceftriaxone - cefotaxime Carbapenems - meropenem - doripenem
193
if pt has nut allergy- what should you check that the drug doesnt have in it
Arachis oil (look in 'medicinal forms') eg naseptin cream (used for staph intranasal carriage)
194
what drugs do you NEED to px by brand name/look at dosages according to brand in the BNF
``` !Warfarin Oral tacrolimus !Diltiazem Some antiepileptics Lithium !Theophylline Insulin ```
195
Name a mineralocorticoid steroid, what is it's action, SE of administration
Fludrocortisone - water retention (acts like aldosterone) SE - HTN - hypernatraemia - hypokalaemia - hypocalcaemia - oedema
196
Name a mineralocorticoid glucocorticoid steroid, what is it's action, SE of administration
Prednisolone - acts like cortisol increases glucose in blood by promoting gluconeogenesis and reducing glucose uptake in muscle and adipose tissue SE - hyperglycaemia - leukocytosis (suspect if in absence of raised CRP) - GI bleed, peptic ulcer - Oedema ( have week mineralocorticoid action causing Na and water retention - HF exacerbation - immunosupression - Cushings syndrome
197
sx of Cushing;s syndrome
- mood disturbance , depression - fatigue - cognitive issues - ghih BP - muscle weakness (prox) - acne - slow healing cuts - fragile skin, thin hair - striae - wt gain, buffalo hump - hirtuism - periods- irreg/absent - skin darkening (ACTH excess)
198
a pt with RA is having a hip replacement soon. SHe is on prednisolone, alendronic acid, PRN ibuprofen and paracetemol, omezoprazole. How would you change her meds before the op
- double her hydrocortisone (and not fludrocortisone if also on that) - when people on LT steroids- double dose if having Op/infection to avoid addisonian crisis
199
when do you need to titrate down steroid dosing rather than just stopping the steroid
- >40mg pred a day >1w - >3w tx - repeat dosages in evening - pts have multiple courses - pt has short course <1yr since stopping LT therapy
200
How do you tx adrenaladdisonian crisis
- hydrocortisone (can add on fludrocortisone) as hydro as both mineralocorticoid and glucocorticoid action
201
Name some Cepahlosporins
anything cef-
202
name some fluoroquinolones
ciprofloxacin | levofloxacin
203
name some aminoglycosides
amikacin | gent- nephro, ototoxic
204
name a monobactam
- aztreonam
205
name a carbapenem
meropenem
206
name some macrolides
azithromycin clarithromycin erythromycin clindamycin
207
name a glycopeptide abx
vanc
208
name some tetracyclines
- tetracycline - doxycycline - trimethoprim
209
tx H.pylori
PPI plus amox with clarithro or metronidazole
210
drugs that CAUSE c.diff
!!!!- macrolides- erythro, clarithro, clinda, azithro - amoxicillin/ampicillon - cephalosporins esp 1st and 2nd gen -cephalexin, cefazolin, cefoxitin, cefuroxime !!!!!- fluoroquinolones- levofloxacin, ofloxacin, ciprofloxacin
211
tx of c diff
vanc fidaxomicin metro do NOT px loperamide
212
PID tx
doxy with metro PLUS IM ceftriaxone or ofloxacin and mtro if pen allergic
213
tx gonorrhoea
IM ceftriazone or IM gent plus oral azithro
214
tx chlamydia
azithromycin or erythro in women of childbearing age doxy if not (teratogenic)
215
tx meningitis in 3m-50yo
cefotaxime OR ceftriaxone give Vanc if hx of multiple abx uses in last 3m/pt travelled to hgih prevalence areas
216
tx of impetigo
Bullous or unwell/widespread non-bullous - fluclox - erythro if pen allergic/preg localised/widespread non-bullous and pt not ill 1. hydrogen peroxide topical 2. fusidic acid- offer if around eyes
217
bullous vs non-bullous impetigo
Bullous - small vesicles--> large flaccid blisters Non-bullous - small vesicles
218
What causes impetigo
Staph aureus | Strep pyogens
219
Impetigo sx
- golden crust from ruptures vesicles - normal vitals - non-bullous- pink macule, vesicles or pustule, then erosions with honey coloured crust - bullous- larg flaccid bullae
220
prophylaxis and tx of animal/human bites
tx summary- skin infections and abx Prophylaxis - coamox/doxy with metronidzole if pen allergy tx- fusidic/fluclox, clarithro,erythro
221
tx lyme disease
- doxy | - amox
222
tx mastitis
- fluclox, erythro if pen allergic | - if not healing- metro or coamox- as these are effective against anaerobes
223
TB prophylaxis tx
3m isoniazid and rifampicin or 6 months isoniazid
224
tx Pneumonia
HAP - coamox/doxy PO high risk/severe- IV Taz/cefriaxone - if ?MRSA- add vanc CAP - amox or doxy/erythro/clarithro severe- IV coamox with clarithro or oral erythro
225
tx UTI
non preg, children- nitro, trimeth, amox men- nitro, trimeth preg- even if asx- nitro (avoid at term), amox
226
tx pyelonephritis
non preg, males, children - PO- cefalexin - IV- amikacin, ceftriaxone, cefuroxime preg - PO cefalexin - IV cefuroxime
227
tx recurrent uti
- 1 off doses (either post trigger or nightly) of trimetho, nitro, amox
228
what drugs cause QT prolongation
``` Antipsychs Antidepressants- TCA, SSRIs (citalopram), SNRI venlafaxine Quinolones- cipro, levo Macrolides- azithro Amiodarone Ondansetron, metoclopramide ```
229
what abx are considered broad spec
- carbapenems- mero - Piperacillin tazobactam - Aminoglycosides- gent
230
tetracyclines SE
Tetracycline, doxycycline - photosensitivity - MG worsened - SLE worsened - CI in 12 years or under
231
what is co-trimoxazole
Sulfamethoxazole and trimethoprim -- used for pneumocystis pneumonia (pneumocystis jirovecii fungi) and prophylaxis
232
SE co-trimoxazole
agranulocytosis | peripheral neuropathy
233
SE linezolid
- used for MRSA sometimes, incl pneumonia - optic neuropathy - blood disorder particularly if used >10d
234
what drug has dilsifuram like reaction with alcohol
metronidazole
235
resus fluids paeds
10-20ml/kg bolus
236
DKA % deficit in children
Mild- 5% - 7.2-7.3 pH or - 10-15 bicarb Mod 7% - 7.1-7.2 or - 5-10 bicarb Severe 10% - 7.1 or - <5 bicarb
237
how do you replace fluid depletion % in paeds
% dehyd x kg x 10 | - replace over 24 hours
238
adult maintenance fluids
25-30ml/kg/day (3L , 2L for elderly/frail) 2 sweet (5% glucose), 1 salty (NaCl) per 24hours (8 hourly bags, or 12 hourly if frail/sick) 1mmol/kg/day- round down to nearest 10 K- do not exceed 10mmol/hour 50-100g glucose per day
239
how many mol of K in different % of fluid
KCl 0. 3%- 40mmol/L 0. 15%- 20mmol/L
240
How much urine will a healthy pt pass per hour
1ml/kg/hour fluid replacement- 0.5ml/kg/hour aim
241
sx fluid overload
``` - Cough, white frothy sputum pleural effusion, ascites, oedema SOB, dyspnoea HTN, tachy S3/4 heart sounds ```
242
when do you use different kind of colloids
Gelofusine- pts with profound/refractory shock (stays in intravasc space longer) human albumin solution- kidney and liver failure
243
when would you use glucose 5% instead of NaCl maintenance
- hypernatraemia (or use NaCl 0.45%) | - hypoglycaemia
244
what maintenance fluids would you use in pt who is hypokalaemia
saline with 0.3% KCl (40mmol/L)- max 10mmol/hour rate of K
245
what fluids would you use for maintenance in hyperkalaemia or hyponatramea
0.9% NaCl
246
NSAID contraindications
- AKI/CKD - indigestion, GI bleed risk, peptic ulcer - haemorrhagic stroke, sig bleed, active bleeding - severe HF
247
How would you start opioid naive pts on morphine
IV morphine at 2.5mg and increased in 2.5mg increments with reassessment after each dose and need for more or start on codeine morphien 10mg/5ml liquid PRN Oral - 20-30mg morphine MR with 5mg for breakthrough calculate total daily dose in 24hours- x a regular background medication
248
calculation of breakthrough dosages
PRN doses that are each 1/10-1/6 of the background dose, 2-4 hourly
249
what opioids are ok to give in renal impairmeent
oxycodone | fentanyl
250
opioid SE
- constipation - drowsiness - dry mouth - confusion, hallucinations, delirium - falls - nausea - uncommon- retention, pruritis, myoclonus, seizures - resp depression
251
how do you go about increasing background dose if pt is taking max PRNs and still in pain
Dose of background + breakthrough doses= total daily dose - increase total daily dose by 1/3 -1/2
252
what must you include when px controlled drugs in community/OP
- pt address and NHS no. - dose- PRN not allowed- 'one as directed- allowed - form eg tablet, capsule, oral liquid - total number of dose untis/ quantitiy supplied in both words and figures (days not allows) - unsused spaced blanked out
253
post op analgesia
- paracetemol/NSAIDs | - then straight to morphine rather than codeine/tramadol- IV
254
tx neuropathic pain
1st- amitriptyline, duloxetine, pregabline, gabapentin - post herpetic pain- lidocaine patch - back pain- NSAID, oramorph, amitriptyline
255
what do you do if a pt is overdosing on paracetemol, with co-codamol and paracetamol being px and overall >4g per day and still in pain
take them off the paracetamol rather than the co-codamol if they’re still in pain (and put them on something else)
256
if pt is in constant pain, what drug chart do you write their analgesic px
put px on regular medications chart rather than as required chart and put ‘up to X hourly’
257
how do you tx hypocalcaemia
Ca gluconate 10% (10g in 100ml)
258
how do you tx hypokalaemia
K 0.3% (40mmol/L)-- no more then 10mmol/hour rate
259
ECG changes for hyperkalaemia
- tall tented t waves - u wave (dip after QRS) - loss of p waves - PR prolonged - QRS widening
260
tx hyperkalaemia (>6)
1. Ca gluconate 10ml 10% solution over 5 mins 2. IV 5-10u insulin actrapid with 50ml 50% glucose over 5 mins (25g) 3. salbutamol neb - Na bicarb to correct metabolic acidosis - oral Ca resonium/polystyrene/veltassa- bind to K for elimination - stop ACEI, ARBs, NSAIDs, K supplements, K sparing diuretics
261
what do you mix Ca gluconate in with if pt is taking digoxin in hyperkalaemia
100ml glucose 5% over 20min (rather than 10ml of 10% over 5min)
262
when should you suspect that a pseudohyperkalaemia reading has occurred
K is only abnormal reading on blood | pt is clinically well, no ECG abnormalities
263
what must you put in dose box when px insulin
- solution it is mixed with eg actrapid 10units in 50mL glucose 50% given over 5 mins
264
Causes of hyperkalaemia
``` DREAD Drugs Renal failure, rhabdomyolysis Endocrine Artefact (haemolysed) DKA ```
265
what drugs cause hyperkalaemia
``` THANKS CYCLE Trimethoprim Heparin ACEI/ARB NSAIDs K sparing diuretics Suxamethonium Cycle- ciclosporin ```
266
what is high phosphate commonly seen in
CKD
267
tx high phosphate in non dialysis pt
Ph binders- Ca carbonate, Ca acetate
268
tx with iron overloaded pt
eg tranfusion, stomach ache, thalassaemic - desferrioxamine
269
SE of anticholinergics/animuscarinics
- retention, constipation - dry mouth - drowsiness, memory loss, confusion - exacerbation of glaucoma
270
Anticholinergic drugs
- TCA- amitriptyline * ***- Paroxetine and other SSRIs - palliative- hyoscine hydro/butylbromide, glycopyrronium - Antispamsodics- buscopan (ie hyoscine) - urinary antispasmodics- ***solifenacin, ***tolterodine, oxybutynin - antiemetics/histamines- cyclizine, haloperidol, levomepromazine, prochlorperizine, metoclopramide, chlorphenamine ****- Antipsychotics- olanzapine, quetiapine,
271
what drugs do you need to take at a specific time
Morning: - paroxetine- morning (disturbs sleep) - Steroids - bisphonates - 30min before breakfast Night - statins - ramipril- (1st dose hypoTN) - mirtazapine, amitrptyline - thiazides/diuretics in day (peeing in night)
272
what drug class should you avoid in Myaesthenia Gravis
anticholinergics
273
how do you tx overactive bladder in MG
Duloxetine or mirabegron
274
name some non sedating antihistamines
- cetirizine (although can cause drowsiness in children) - fexofenadine - acrivastine
275
name some sedative antihistamines
cyclizine, promethazine
276
what antihistammines would you use for hayfever
any
277
What drugs may need their plasma conc taking during the course
``` !- Lithium - Digoxin- only if renally impaired/suspect toxicity - Aminoglycosides - IV vanc !- Teicoplanin !- Cipro in CKD - theophylline - ciclosporin ```
278
Safety netting for carbimazole, trimethoprim, methotrexate?
any signs of infection, sore throat (agranulocytosis)
279
what drug is grpahs used for to work out how manhy hours between infusions should be in relation to post dose conc?
Gentamicin
280
when should you stop methotrexate
active infection | dnot tx this infection with trimethoprim
281
INR target
0.8-1.1 no warfarin 2-3 on warfarin 2.5(-3.5) on warfarin + mechanical heart valve
282
when should you take rivaroxiban
with food
283
what electrolyte disturbance increases risk of Digoxin toxicity
hypokalaemia
284
what electrolyte disturbance increases risk of Lithium toxicity
hyponatraemia
285
what types of antipsychotics cause what profile of sx?
1st gen-haloperidol, prochloperazine- parkinsonian, movement disorders 2nd gen- quetiapine, olanzapine- metabolic-- wt gain, diabetes, prolactin
286
what drugs are ototoxic/can lead to hearing loss?
``` Aminoglycosides Vanc Topical otic preparations- tea tree loop diuretics- bumetanide antineoplastics- cisplatin, carboplatin salicylate- aspirin Quinine tadalafil, sildenafil ```
287
what drugs can cause constipation
``` Ferrous fumarate buscopan alosterone antags ACEI opioids ```
288
What drugs can cause diarrhoea
- Methotrexate - Glibenclamide (sulfonylurea) - Metformin - Abx
289
what drugs can cause GI bleed
NSAIDs Alendronic acid- take on empty stomach, with WATER, upright for 30min after, eat least 30min before breakfast oral steroids all should have PPI px with them in LT course sign of methotrexate toxicity
290
What drugs can cause lung fibrosis
``` BANS ME Bleomycin Amiodarone Nitrofurantoin Sulfalazine Methotrexate ```
291
what drugs can cause drowsiness
``` benzos opioids mirtazapine amitriptyline antihistamines- promethazine, alimemazine, cyclizine, chlophenamine ```
292
non sedating antihistamines
``` acrivastine bilastine cetrizine fexofenadine loratadine ```
293
common drugs that cause liver disease/injury
ALT:ALP >5 (ALT higher)- hepatic - paracetemol - NSAIDs- eg dlicofenac - Statins - amiodarone ALT:ALP <2 (ALP higher)- cholestatic - co-amox, erythro - chlorpromazine - hormonal contraception ``` both raised: Phenytoin sulfonamides carbamazepine fluclox, anti-TB eg isoniazid methotrexate azathioprine aciclovir ```
294
what do different aspects of the LFT mean
ALP, GGT- cholestatic bili, ALT, AST- hepatic uncong bili- haemolytic GGT- alcoholic, anorexia, hyperthyroid, myotonic dystrophy
295
what drug effects can be increased in liver disease?
- benzos- sedation - antipysychs- agitation - opioids- consti - !!diuretics- electrlyte issues - Na Val- thrombocytopenia - NSAIDS and !!anticoags- gastric/oes variceas - NSAIDs and NaCl ascites
296
drugs that precipitate and should be stopped in AKI
``` DAMN Diuretics ACEI/ARB/Abx (gent) Metformin NSAIDs ``` ``` aciclovir contrast media cisplatin amphtericin vanc Lithium cocaine ``` aspirin is an NSAID but ok on kidneys and very rarely worsens asthma
297
what condition would you not give k sparing diuretics, as it increases risk of hyperkalaemia
CKD
298
what type of diuretic is ineffective in severe CKD
thiazide like- tak ethem off it and switch them to furosemide if fluid overloaded
299
what drugs SE oedema
CCB- amlodipine, verapamil, nifedipine NSAIDs corticosteroids pioglitazone esp if no evidence of HF on echo
300
what 2 drugs risk heart block when put together
verapamil, betablocker
301
Drugs that cause HF exacerbation
``` VISA Verapamil, diltiazem ibuprofen and other NSAIDs steroids antiarrhythmics- flecainide ``` pioglitazone Levothyroixine-- can exacerbate, so titrate up
302
Hypotension causing drugs
diuretics betablockers alpha blocker- tamsulosin CCB, ACEI, ARB
303
Durgs that affect the thyroid
amiodarone Lithium Interferons tyrosine kinase inhibitors
304
drugs that cause tremor
``` salbutamol Lithium (coarse in overdose, fine as SE) ```
305
drugs that can cause SJS/TEN, and erythema mulitforme
- antiepileptics- carbamazepine, phenytoin, lamotrigine, oxcarbazepine - penicillins - statins - vancomycin erythema mulitforme - penicillins - NSAIDs - nitrofurantion - sulfomadies - anticonvulsants
306
A pt comes back to the GP with a rash, after being treated for a sore throat eralier in the week. Her symtpoms have also got worse, with muscle aches, worsening sore throat, and fatigue- why?
EBV-- amoxicillin rash can also occur if amoxicillin is given to pt with CMV or ALL/CLL
307
drugs that cause agranulocytosis
clozapine carbimazole azathioprine, methotrexate co-trimoxazole, trimethoprim phenytoin**** Mirtazipine****
308
3 drugs that can cause wt gian
Gliclazide (sulphonylureas) Mirtazapine valproate
309
Drug induced haemolytic anaemia
``` antimalarials- promaquine, chloroquine nitrofurantoin quinolones radburicase sulphonamide- co-trimazole ``` risks of this increases in those with G6PD
310
what can cause drug induce torsade des pointes
``` erythro cipro levofloxacin fluconzole satalol ```
311
what drugs can cause QT prolongation
- macrolides- azithromycin - quinolones- cipro, levo - amiodarone - antipsychitcs (esp 1st gen) TCA, SSRI (citalopram esp) Ondansetron
312
weird SE of latanoprost
darken iris
313
SE SSRIs
BLEEDING! Hyponatraemia- give TCA instead (not amitriptyline as this also causes hyponat) sleep disturbances QT prolongation
314
what 2 SSRIs must not be taken together when transitioning to one or the other, whilst others can have their doses tapered
- fluclox and amitriptyline- one must be stopped fully before the other is started
315
SE TCA
``` - serotonin syndrome hyponatraemia antichol- drowsy, dry mouth, constipation, retention - confusion QT prolognation glaucome ```
316
2 SE of K sparring eg amiloride, eleprenone
gynaecomastia | hyperkalaemia
317
2 SE thiazide like diuretics, what can they precipitate, when should you take it
gout hypokalaemia precipitate Lithium toxicity (other diuretics do too, but esp thiazide like) morning- makes you pee !
318
what antiHTN/diuretic meds cause hyperkalaemia, and whihc hypokalaemia?
``` Hyper ACEI ARB K sparing (salbutamol lol) ``` Hypo Loop thiazide- like
319
what time shoudl ACEI be taken
bed time (hypotension;dizziness)
320
SE laxatives
Hypokalaemia isphagula husk- bronchospasms
321
SE methotrexate
``` diarrhoea myelosupression stomatitis- withdraw abnoral LFTs, cirrhosis pulmonary fibrosis ```
322
SE quinolones, what affect their absoprtion
``` tendon rupture (esp >60, taking steroids) QT prolongation seizures- cipro ``` absorption reduced by iron
323
SE parkinsons meds
Postural hypotension Ergot DA rec agonists eg carbergoline, bromociptine-- cardiac fibrosis (also CI)
324
SE amiodarone
thyroid liver arrythmias pulomary fibrosis
325
what must GTN not be taken with
sildenafil- severe hypotension, risking MI
326
statin SE
rhabdomyolysis hepatitis/jaundice - check CK before if prone to muscle aching, dont use if >3x normal limit, or lower dose if raised but <3x - if muscles ache during --> CK-- if >5x, repeat measurement in 7 days after stoppng statin-- if still >5x- sdo not restart, if came down, restart at low dose
327
SE steroids
``` hyperglycaemia leukocytosis GI bleed, peptic ulcer oedema HF exacerbation Cushings OP ```
328
drusg not adminstered daily to look out for on px review qs
Weekly - bisphosphonates - methotrexate - buprenorphine 2-3months - Hydroxocobalamin - goserelin (prostate cancer) - Fentanyl (2-3months) - gentamicin
329
what drug should not be given with clopidogrel as increases risk of bleeding further
omezoprazole
330
what two drugs taken toegtehr cause heart block
CCB and bisoprolol
331
interacitons with methotrexate
trimethoprim NSAIDs and aspirin corticosteroids ciprofloxacin
332
what 2 drug classes taken toegtehr risk resp depression
benzos and opioids
333
interactions with metronidazole
- alcohol | - warfarin- increase INR
334
SE of metronidazole LT use
peripheral neuropathy ad blood disorders
335
what drug given with simvastatin, should cause you to lower the dose of simva to 20mg
amlodipine
336
what drugs reduce efficacy of COCP
- carbamazepine and other old antiepileptics eg griseofluvin - rifampicin (rifabutin) - and the other inducers!
337
what marcolide can be used with warfarin
azithro | others are inhibitors eg erythro, clarithro
338
what interacts with st johns wort
SSRIs- serotonin syndrome (has serotingeric properties) Warfarin- reduces INR MAOIs- HTN crisis redcued contraception effectiveness
339
what effects absorption of qiunolones eg cipro
iron
340
what combination of 3 drugs will cause an AKI
diuretic ACEI NSAID even NSAID and ACEI only too
341
what drug can mask tremor from hypercalcaemia and also mask signs of hypoglycaemia
betablockers
342
when shoudl clopi/aspirin be stopped pre-op
1 week
343
when should warfarin be stopped preop
5 days
344
when should metformin be stopped preop
2 days
345
max ibuprofen dose daily
2.4g (600mg QDS)
346
pt comes in with jaundice, nausea, fever, 3d hx of severe RUQ pain- paraceteol has not helped the pain- what do you px for her pain?
IM diclofenac or opioid analgesia BNF recommends for cholangitis-- Charcot's triad-- fever, RUQ, jaundice
347
A COPD pt comes in and her is put on O2 therpay- what perameter would you measure after 30mins to monitor for adverse effects of O2
ABG- CO2 retainers at risk of going into hypercapnic resp failure (T2)
348
a pt has pleuritic chest pain, SOB and dizziness- CTPA shows saddle embolus-- she has a BP systolic <90mmHg- what do you initially give her?
thrombolyse in massive PE! (pe causing BP systolic <90mmHg) Alteplase
349
what do you do if predose (trough) level of gent is above the threshold
increase period of time between doses to aid clearance, as trough concs are driven by clearance
350
what do you do if postdose (peak) level of gent is above the threshold
decrease dose as peak concs are driven by dose
351
acute tx of manic episode
1. antipsychs- olanzapine, quetiapine, risperidone | 2. Lithium (if response has not been optimal)
352
-
-
353
when starting atorvostatiin for secondary prevention (eg angina, intermittent claudication)- what does do you need to start it on
80mg would be 20mg for primary prevention apart from if theres potential for interactions, or high risk of adverse effects
354
causes of a reduced INR on a stable dose of warfarin
``` Enzyme INDUCERS - CRAP GPS Carbemazepine Rifmapicin Alcohol (chronic) Phenytoin Griseoflulvin Phenobarbitone Sulphonylureas eg gliclazide/St johns Wort also tobacco ```
355
causes of increase in INR on a stable warfarin dose
Enzyme INHIBITORS Some Certain Silly Damn Compounds Annoyingly Inibit Enzymes Grrr Mother ``` Sodium Valproate Cipro Sulphonamide- sulfalazine, SSRIs Diltiazem Cimetidine/omezoprazole Antifungals, amiodraone, alcohol (acute) Isoniazid Erythromycin/clarithro Grapefruit juice Metronidazole ``` - chloramphenicol - liver disease!!!
356
SE of LT glucocorticoid steroid use
INsomnia an dpsych issues
357
hwo can you tell from U&Es that pt is dehydrated
Urea:Cr ratio is >10
358
how many mmol of Na is in a 1L bag of NaCl 0/9%
154
359
what analgesics should you avoid in IHD
oral NSAIDS as they risk fluid retention
360
what analgesic should be avoided during breast feeding
aspirin- risk of Reyes syndrome in baby
361
drugs for stable angina
- rate limiting- beta blocker or diltiazem/verapamil - aspirin - statin
362
SE bisphos
dyspepsia, oesophagitis- stop taking and seek med attention Constipation Oesteonecorsis of the jaw
363
instructions on taking bisphospnates
- empty stomach - at least 30min before breakfast - with water - swallow whole - sit upright/stand for at least 30min after taking - once a week
364
what electrolyte imbalance do all diuretics cause
hyponatraemia
365
meds that exacerbate psoriasis
``` Lithium beta blockers antimalarials NSAIDs ACEI ```
366
prev and tx of migraine
tx- triptans, naproxen/NSAID | prevent- Propan/topiramate/amitriptyline
367
hwo do you manage mild hyperkalaemia (<6, no ECG changes, no symptoms)
give fluids and stop increasing potassium meds (THANKS CYCLE)
368
what do you do in calculation question if the pt is obese or underweight
use ideal weight if given, of give max if underweight- use actual body weight ie use the lower weight
369
where can you find calculations for ideal body weight, eGFR, Cr clearance in the BNF?
'prescribing in renal impairement'
370
how does carbamazepine affect Na levels
hyponatraemia
371
what antidiabetics can cause hypoglycaemia
insulin suphonylureas (gliclazide, tolbutamide, glimepride) SGLT-2 inhibis- ertulifloxin
372
When would you stop amiodarone due to SEs? What SEs should you consider reducing doose
STOP: - optic neuritis - thyrotoxicosis - hyperthyroidism (risk of refractory thyrotoxicosis) REDUCE - hypothyroid (or just tx hypo) - minor hypothyroidism- or just tx - bradycardia
373
what drug can you add in severe neutropenic sepsis (not in BNF)
IV Gent (STAT)
374
common/serious interactions PSA ask about
Inducers/inhibis: - contraception and an inducer (eg carbemazepine) - amiodarone and warfarin /cipro/erythro/clarithro (increase INR) - clarithro and statin (rhabdo) - theophylline with inhibis eg cipro - Warfarin with inhibs/inducers eg cipro, azithro, clarithro, erythro , pehytoin - verapamil/diltiazem and BB (block) - hyperkalaemic drugs - QT prolongation drugs (antipsych, ondansetron, cipro, levo, azithro, TCA, SSRI (citalopram), Amiodarone)
375
drusg that interact with amiodarone
Amiodarone is an inhibitor: - warfarin (increased INR) - digoxin (dig tox) - statin (rhabdo) - other QT prolongatiors (abx, antipsych, antid, ondansetron) Torsades de pointes - quinidine - propafenone
376
what time of day should steroids be taken
morning
377
what causes increased urea
GI bleed dehydration HTN states renal disease
378
when can pts use nasal fentanyl
those using at least 25mcg transdermal per hour
379
when should you avoid nitrofurantoin
full term preg | eGFR <45
380
when would you give oral phytomenadione pre=op?
if INR >=1.5 day before surgery
381
1st line tx for acute dystonic reaction (eg SE antipsychotics)
procyclidine IM/IV
382
what % of KCl do you use for maintenance
0.3%
383
what is a continuous combined option for oral contraception
levonorgestrel/estradiol
384
what is a continuous combined option for contraception transdermal
femseven sequi weekly patch without interval
385
what is a cyclical combined PO option for contraception
yasmin
386
management of scarlet fever
phenoxymethylpen PO if cannot intake orally- IV benzylpen
387
impornat advice for methotrexate
- take contraception during and for 6m after taking | THEN avoid NSAIDs
388
when would you not px ondansetron for PONV (is 1st line usually)
pt already on QTc prolonging meds
389
what is mor elikley to cause ankle swelling, NSAID or ACEI
NSAID
390
1st line for pain over where herpetic rash was 2 days ago
1st line paracetemol if pain is more LT, then go on with neuropathic pain meds
391
when should people take loperamide
after each loose stool
392
what does a low TSH mean in treated hyperthyroidism
you are over treating- decrease levothyroxine dose
393
causes of SIADH (hyponatraemia, high urinary Na)
- SSRIs, TCAs - carbamazepine - vincristine - cyclophsophamide - glimepride (sulphonylurea) - SCLC - panc/prostat cancer - stroke - SAH - meningitis/encephalitis/abscess - TB, pneumonia - PEEP
394
no need to give O2 in MI if sats are ok
-
395
what O2 do you give in COPD pts
28% venturie at 4L/min aim- 88-92% adjust to 94-98% if pCO2 normal on gas
396
baseline ix for antipsychs
``` BP BMI/wt FBC UE LFT fasting blood glucose ECG lipids prolactin ```
397
what fluids should be avoided in patients who have had a stroke
Glucose 5% (risk cerebal oedema)
398
what are the two antihistammines used in anaphylaxis (not immediate management)
cetrizine | chlorphenamine
399
tx fo N+V in pregnancy
1. cyclizine or promethazine- if not improvement in 24hours then: 2. metoclopramide, or ondasetron
400
what drugs can precipitate digoxin tox
Promote hypoMg/K - loops - thiazides INcrease plasma comc - amiodarone - CCBs - spironolactone - Quinine
401
what reduces efficacy of levothyroxine
iron salts | Ca
402
how to calc BMI
kg/m2
403
what drugs cause drug reaction with eosinophilia and systemic sx (fever, lymphadenopathy, lover dysfunc)?
- allopurinol - anti-epileptics - sulphonamides (eg co-trimoxazole)
404
corneal abrasion- sx and tx
- trauma hx - painful red eye - 'feeling of something in it' tx- topical broad spec abx
405
what would you px maxidex (dexamethasone eye drops)
redness, swelling and other sx due to inflamm or allergy of the eye injury of cornea caused by chemical, heat burns, or foreign body
406
chlamydia vs gonorrhoea histologically
both gram-negative (pink) Gonorrhoea- diplococci chlamydia - intracellular, coccoid/rod shaped
407
tx biliary sepsis ie cholangitis- RUQ pain, BG wall thickened on USS, obstructive jaundice + sepsis sx
- gram -ve, anaerobic - tazocin or cephalosporin - if pen allergic- cipro, gent - + metronidazole
408
meningococcal septicaemia tx
benzylpen before admission in primary care <3m or >50 - IV ceftriaxone and amox >3m- IV ceftriaxone chloramphenicol if pen or cephalosporin hypersensivity
409
prophylaxis of migraine
- propanolol - topiramate - amitriptyline
410
what does NICE say to do if renal function declines after upping dose of ACEI
- stop or reduce dose if eGFR declines by >=25% - close UE monitoring - stop other nephrtoxic drugs
411
prophylaxis of baby from pertussis who isnt vaccinated
clarithro, erythro
412
management of ascites (due to malginancy, cirrhosis)
- spironolactone | - furosemide as adjunct
413
sx of decomp liver disease
- melaena- low plt/clotting factors - jaundice - ascites
414
status/refractory epilepsy
- ABCDE - glucose 50ml 50% and/or IV thiamine (250mg) (pabrinex) - (diazepam PR OR) midazolam 10mg (0.5mg/kg children) buccally - Lorazepam IV 0.1mg/kg - phenytoin infusion 15mg/kg rate 50mg/min - GA- propofol
415
hwat pH does BV occur
>4.5
416
management of aortic dissection
is a HTN emergency - labetalol IV 50mg STAT - repeat every 5min - max 200mg
417
difference in sx and tx between alcohol withdrawal, delirium tremens and wernickes
Wtihdrawal- N+V - chlordiazepoxide Delirium tremens- hallucinations agitation, confusion - lorazepam Wernicke's- cerebellar signs - thiamine
418
interactions and SE PPIs
- clopi- bleeding - COCP - digoxin SE- hypomagnesia (confusions, arrythmias, seizures, psychiatric sx)
419
how do you tx the hypomagnesia that may occur from PPIs
mild- stop PPI Severe - IV Mg
420
PC: PV discharge Findings on microscopy of discharge: clue cells, no lactobacilli diagnosis?
- BV - lactobacilli are normally there and keep pH low - absence means BV is overgrowing and vaginal pH is likely to be high
421
resp SE of tricagrelor
progressive SOB
422
when do you do a needle thoracentesis vs a chest drain insertion for a PTX
Needle thoracentesis 2nd ICS mid-clav - if spontaneous/primary - if secondary but <2cm Chest drain- above 5th ICS mid-axilla - secondary ie COPD/asthma and >2cm
423
what dose of bisop would you use for rate control in AF
1.25mg (HF dose) | rather than 5-10mg (HTN/angina dose)
424
when is gelofusin used
pancreatitis- colooid so stays intravac longer
425
in diabetic, what does alcohol excess do to glucose serum
hypoglycaemia (stimulates insulin production)
426
what time do SC anticoags get administered in hospitals
6pm- nursing staff convenience
427
what do you measure to monitor DKA response
serum ketones
428
what do you use in impetigo widespread
orals>topicals
429
what anti hypertensive exacerbates gout
thiazide like diuretics
430
ekectrlyte imbalance from carbamazepine
hyponatraemia
431
where can you find amounts of cream/ointmenets in g that should be used according to body part
'skin conditions, management' tx summary
432
when should the statin dose be increased ?
if a >40% reduction in non-HDL lipids has not occured within 3 months of starting
433
post MI- how long should aspirin and clopi be 300mg for
~<1w
434
tx of pericarditis
1. - NSAID- ibuprofen - Colchicine - Steroids
435
what does 'isotonic' mean
solution with same osmotic pressure as other solution (blood, intracellular fluid) eg NaCl 0.9%, 5% glucose
436
what does 'hypertonic' mean
having higher osmotic pressure than body fluid eg 3% saline
437
how long should a patient be on ferrous fumarate for
3 months then stop it and recheck the FBC and ferrtin studies
438
standard and high risk dose of folic acid
0.4mg and 5mg for first 12 weeks of the pregnancy
439
high urea without high Cr means?
GI bleed
440
when should you take statin
at night

Finals (15 decks)

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