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Finals > PSA > Flashcards

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
Q

most important info to tell person starting ACEI

A
  • come back in 1-2w for renal tests
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26
Q

what do you in person being tx for pneumonia monitor to assess response to abx

A

RR

Consolidation on CXR and creps on ausculation take longer to clear up (weeks)

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27
Q

Tx severe and moderate Croup

A

Severe

  1. neb budesonide (when no access)
  2. IV dex once access
  3. Neb adrenaline and corticosteroids

Moderate- oral dexa/pred

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28
Q

targets for HTN

A

140/90 (135/85 home)

if above of equal to 80y/o–> 150/90 (145/85 home)

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29
Q

when do you tx stage 1 HTN

A
  • 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
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30
Q

stages of HTN

A

140/90 , 135/85- 1
160/100-180/120, home 150/95- 2
>180 or >120– severe

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31
Q

management of severe HTN

A

same day specialist referral

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32
Q

HTN tx

A

<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
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33
Q

Sx of Pheochromocytoma

A
  • postural hypotension
  • palpitations
  • abdo pain
  • tx resistant severe HTN
  • heat intolerance/sweating/flushing
  • nausea
  • feelings of apprehension
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34
Q

Ix ?pehochromocytoma

A
  • urinary free catecholamines (adrenaline, norad, dopamines)
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35
Q

what drug do you use to tx HTN in pehochromocytoma pre-surgery?

A

non selective alpha blocker- phenoxybenzemine

- betablocker

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36
Q

tx MI

A

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)
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37
Q

Tx acute HF/fluid overload- crackles, high JVP, SOB

A

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
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38
Q

LT management of HF with reduced ejeciton fraction

A
  1. betablocker, ACEI/ARB - reduce mort/morb
  2. furosemide /bumetanide- sx relief
    Spironolactone
    amiodarone, digoxin, ivabradine- specialist
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39
Q

name 2 alpha blockers

A

doxazosin

terazosin

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40
Q

name 3 CCBs

A

nifedipine
felodipine
amlodipine

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41
Q

name 2 thiazide like diuretics

A
  • bendroflumethiazide

- indapamide

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42
Q

name 3 K sparing diuretics

A

spironolactone
eplerenone
amiloride

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43
Q

tx of acute pulmonary oedema

A

acute SOB

  • furesomide 80mg IV stat
  • bumetanide if HF fluid overload resistant to furesomide
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44
Q

tx of acute presentation of AF

A

Not stable
- emergency electrical cardioversion

Stable

  • Pharmac carvdioversion- flecainide, amiodarone
  • Rate control- betablocker IV, verapamil IV

avoid verapamil in HF
avoid betablocker in asthma

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45
Q

a 80 year oldspatient presents with palpitations and SOB, he says this started 3 days ago. His ECG shows AF- how would you manage?

A

> 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

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46
Q

tx of paroxysmal AF

A

symptomatic

  1. beta-blcoker, sotalol or diltiazem
  2. flecainide, amiodarone, dronedarone, propafenone
  3. digoxin monotherapy

pill in pocket- flecaindie, propafenone

ablation (LA)

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47
Q

non acute presentaiotn of AF- LT management

A

1st line- beta blocker, diltiazem, or verapamil (rate)

consider digoxin as monotherpay if above fails

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48
Q

who do you not give diltiazem/verapamil to?

A

CCBs

HF
fluid overload

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49
Q

general dosing rule when starting a px in PSA

A
  • start at the lower end of the range
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50
Q

general rule for PSA when selecting options concerning dose increase/decrease

A
  • chose smallest increment, unless theres signs of toxicity
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51
Q

Medical pt DVT/PE prophylaxis

A
  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!

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52
Q

prophylaxis of DVT/VTE in surgical pt

A

different for eacho kind of suregry- CHEKC TX SUMMARY

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53
Q

tx of DVT/VTE

A
  1. apixaban/rivaroxaban
  2. LMWH then dabigatran
  3. LMWH with warfarin

NB- dose adjust LMWH for low eGFR and adults <50kg!!!!

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54
Q

what colour ewarfarin pills mean waht doses

A

White 0.5mg
Brown 1mg
Blue 3mg
Pink 5mg

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55
Q

how long does warfarin take to become fully effective

A

3 days

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56
Q

what condition can effect warfarin effect

A

hyperthyroidism

  • increase warfarin coag effects
  • smaller doses

Hypothyroid and those given carbimazole

  • loss of coag effect
  • increase doses
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57
Q

CI warfarin

A
  • 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
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58
Q

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

A

the inducer/inhibit (not warfarin

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59
Q

instructions taking rivaroxaban

A

with food

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60
Q

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?

A

shouldnt take anticoags until 2 weeks post isch stroke

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61
Q

what is the reversal agent of dabigatran

A

idarucizumab

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62
Q

who is dabigatran good for

A

those who have had heparin induced thrombocytopenia

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63
Q

Direct Xa inhibitors

A

Rivaroxiban, apixaban, edoxaban

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64
Q

reverseal agent fro direct Xa inhibitors

A

Andexanet

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65
Q

what is an indirect Xa inhibitor

A

fondaparinux

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66
Q

what do you monitor in fondaparinux tx

A

antifactor Xa

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67
Q

what do you monitor and how do you reverse heparin

A

APPT

protamine

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68
Q

how do you monitor LMWH and how do you reverse

A

Antifactor Xa

protamine

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69
Q

why would you give a lower dose of rivaroxaban

A

> 80yo
<60kg
<30 Cr clearance

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70
Q

warfarin reversal according to INR and bleeding status

A
  • 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

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71
Q

what common drugs do you withhold in a pt with low Hb

A

NSAIDs, aspirin

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72
Q

how long does it take for aspirin to wear off

A

7 days

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73
Q

aspirin SE

A

dyspepsia
v. rarely worsen asthma
ok on kidneys

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74
Q

when should you stop clopi pre op

A

1 week

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75
Q

when should you stop warfarin pre-op

A

5 days

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76
Q

what common drug interacts with clop to increase risk of bleeding

A

omezoprazole

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77
Q

what drug increases risk of bleeding when px with an NSAID or dabigatran

A

citalopram

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78
Q

name some 1st gen atnipsychotics

A

haloperidol

chlorpromazine

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79
Q

name seom 2nd gen antipsychotics

A

olanzapine
repisirdone
quetiapine

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80
Q

what is the atypical atypical antipsychotic

A

clozapine

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81
Q

what SEs do atypical antipsychotics tend to cause

A

Metabolic

  • Wt gain
  • hyperprolactinaemia
  • hyperlpidaemia
  • hyperglycaemia, diabetes
  • HTN

QT prolongation

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82
Q

when do you medicate depression

A
  • mod-severe
  • persisted for 2y
  • persisted despite other interventions
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83
Q

Serotinergic medications- name them

A
  • Tramadol
  • Codeine
  • TCA
  • SSRIs
  • amphetamines
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84
Q

what dangers are there of seritonergic medications

A
  • lower seizure threshold
  • hyponatraemia

Serotonin syndrome

  • tremor
  • hyperreflexia
  • rigid
  • ocular clonus
  • altered mental state
  • autonomiic- hyperthermia, tachy, HTN, flushed, diaphoresis,
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85
Q

tx of serotonin syndrome

A
  • cyproheptadine

- benzo for agitation

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86
Q

tx alcohol withdrawal

A

chlordiazepoxide

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87
Q

Tx of the different dementias

A

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

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88
Q

tx parkinsons

A
  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

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89
Q

SE parksinsons meds

A

chorea
postural hypotension
hallucinations, impulse control issues

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90
Q

CI parkinsons meds

A
  • psychosis
  • Neuroleptic malignant syndrome
  • rhabdomyolysis
  • dyskinesias, dystonia
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91
Q

what class of drugs interact with parkinsons meds

A

antipsychotics

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92
Q

tx SAH

A
  1. Nimodipine

2. Mannitol

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93
Q

What drugs can cause confusion in the elderly

A
  • 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)
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94
Q

What drugs can cause falls in elderly

A 
!!!! - alpha blockers (doxasosin, tamsulosin)
- AntiHTN
- beta blockers
!!!! - antidepressants
- hypnotics, benzos
!!!! - nitrates
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95
Q

what can cause hypothermia in the elderly

A
  • sedatives- benzos, TCA, opioids, chlopromazine
  • decrease mobility- antipsychotics, antiparkinsons drugs, hypnotics
  • vasodilation- CCBs- amlodipine– flushing, oedema
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96
Q

what causes resp depression

A

opioids

benzos- avoid diazepam

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97
Q

what drugs do you pre-preemptively prescribe

A
  • Morphine , diamorphine , Oxycodone in renal impairment
  • Haloperidol, cyclizine (antiemetic)
  • Hyoscine butyl/hydrobromide , glycopyrronium (secretions)
  • Midazolam, diazepam, lorazepam (sedation)
  • Haloperidol- restlessness
  • hiccup- metoclopramide, baclofen, nifedipine
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98
Q

Contraindications for px hyoscine hydro/butylbromide, glycopyrronium

A

Antimuscarinic (anti-motility action on gut):

  • paralytic ileus
  • symptomatic reflux
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99
Q

difference between hyoscine butylbromide and hydrobromide

A

Butyl

  • does NOT cross BBB
  • less drowsiness and central antiemetic action

Hydro

  • does cross BBB
  • drowsiness
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100
Q

What drugs are dangerous in pregnancy

A

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
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101
Q

vte prophylaxis in preg

A

LMWH

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102
Q

tx VTE in pregnancy

A

apixaban/rivaroxaban
or
LMWH with dabigatran after

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103
Q

high BP tx pregnancy

A
  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

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104
Q

tx pregnancy HTN emergency

A

IV Mg sulphate- give 1st if headache/flashign lights present

oral/IV labetalol
Oral nifedipine
IV hydralazine

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105
Q

tx of hyperglycaemia in preg/gestational diabetes (starting after 24/40)

A
  • change diet and exercise for 1-2w

Then after 2w:

  1. Metformin
  2. +-Insulin
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106
Q

what should pregnant diabetic women be px (other than antidiabetic meds)?

A

folic acid- high risk for neural tube defects

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107
Q

how to prevent focal seizures in pregnant pt eg cerebral tumour

A
  • Lamotrigine (and carbamazepine)

which is also 1st line for non-pregnant people

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108
Q

Contraindications for COCP

A
  • 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
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109
Q

procedure fro missed COCP pills

A
  • ‘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
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110
Q

COCP monitoring

A

wt and BP only

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111
Q

when may you need to px a different dose of levonorgestrel for emergency contraception

A
  • double it when an inducer is being taken
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112
Q

Levonorgestrel missed pill procedure

A
  • 3 or 12 horu window
  • take asap
  • use protection for 2 days
  • emergency contraception may be needed
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113
Q

what is a non hormonal drug that can be used to px sx of menopause

A

clonidine

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114
Q

if the person has a uterus, what kind of HRT should be used

A

Combined- as unopposed oestrogen–> endometrial cancer

eg yasmin

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115
Q

name some oestrogen only brands

A

elleste-solo

evorel

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116
Q

what type of HRT do you use in a person still with periods

A

Also good for menopausal sx
Cyclical- elleste duet
Evorel sequi

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117
Q

what type of HRT do you use in a person who no longer has periods?

A

Continuous

> 50yo >1yr
<50 >2yrs

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118
Q

How do you step up steroid creams in eczema

A

Help Every Bloody Dermatologist

Hydrocortisone
Emumovate (clobestasone)
Betnovate (betamethasone 1%)
Dermovate (clobestasol propionate)

NB - aq cream not recommended generally - reaction risk

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119
Q

what is used in severe eczema flares in children (TOP)

A

tacrolimus

pimecrolimus

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120
Q

Antiemetics

A

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)

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121
Q

when is metoclop CIed

A
  • Parkinsons- use domperidone
  • young women- increase risk of dyskinesia
  • Obstruction- prokinetic and risks of perf
  • caution in older adults
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122
Q

Constipation

A

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
  1. 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)
  1. Ph enemas
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123
Q

How do you manage post op/opioid constipation

A
  • avoid bulk forming

- use stimulant eg senna/biscodyl

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124
Q

How to manage person who is faecally impacted but passing no stools (faceal loading on AXR or hard stool fel in rectum)– laxative wise

A
  • osmotic- high dose movicol
    THEN
  • other laxatives
  • phos enema
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125
Q

how to tx constipation with acute fissure

A
  1. Isapghula husk (bulk)
  2. Lactulose (osmotic)

glyceryl trinitrate ointment
topical lidocaine
paracetemol/NSAID

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126
Q

tx haemorrhoids

A
  • avoid opioids (constipation)
  • bulk forming- isphaghula husk
  • topical - lidocaine, cinchocaine
  • topical steroid based ointments- anusol
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127
Q

tx diarrhoea

A

loperamide

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128
Q

tx Acute pancreatitis

A

O2, analgesia, IV fluids
analgesia

IV abx for infected pancreatic necrosis and/or assoc cholangitis–
- cipro, penicillin, ceftriaxone, metronidazole

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129
Q

tx chronic pancreatitis

A
  • Ceon (lipase, protease, amylase)
  • analgesia incl. gabapentin, amitriptyline
  • steroids if autoimmune
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130
Q

when do you tx diabetes

A
  • immediately if any evidence of organ damage (vision blurring, renal failure, vasc disease)
  • if no sx/mild- could repeat GTT and hba1c
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131
Q

monitoring of diabetes

A

hba1c 3-6 monthly until stable, then every 6m

foot, eye, U&E annually

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132
Q

diabetes diagnostic criteria

A

48mmol/L hba1c

11.1 random, 7 fasting

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133
Q

tx pf T2DM

A
  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
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134
Q

CI and SE metformin

A

<30 eGFR / Cr >150/Ur
risk of lactic acidosis

SE

  • Lactic acidosis
  • kidney dysfunction
  • GI
  • anorexia
  • B12 absorption reduction
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135
Q

SE pioglitazone

A

wt gain
bladder cancer
!!!!# risk
!!!!visual impairment (retinal ischaemia, macular oedema)

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136
Q

SE sulphonylureas

A

gliclazide

  • hypoglycaemia
  • hyponatraemia
  • wt gain and hunger
  • GI issues
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137
Q

SE SGLT-2 inhibitors

A

Gliflozin

  • wt loss
  • Fournier’s gangrene!! (penis)
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138
Q

targets for BM for diabetics

A

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

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139
Q

how much do you change insulin dose by if someone dosent hit their BM target

A

10% (up or down)

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140
Q

how do you manage a conscious and stable pt who has a low BM

A
  • 20g glucogel, long acting CHO when glucose >4mmol/L- biscuits, milk- aviod fake milk and chocolate
  • fruit juice, sugary snack
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141
Q

How do you manage an unconscious/drowsy pt with a low BM

A

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
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142
Q

What do you do with a diabetic’s insulin regime during the tx of a hypo

A
  • 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
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143
Q

advice for diabetics on insulin for driving

A
  • carry out BMs 2 hours before drivign and every 2 hours during jounreys
  • should always be >5mmol/L when driving
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144
Q

when do diabetics need to inform the DVLA of their condition?

A
  • when they are taking antidiabetic medication

- no need to if managed by lifestyle only

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145
Q

How do you manage a pt’s diabteic meds who is trying to cnoceive?

A
  • stop all antidiabetic meds
  • switch them to 1. insulin 2. metformin
  • px folic acid as high risk of neural tube defects
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146
Q

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

A

steroids

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147
Q

Tx of DKA

A
  • Fluids
  • Insulin
  • K
  • glucose 10% once BM <14
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148
Q

Fluids given to an adults in DKA

A

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
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149
Q

Insulin regime given to adult in DKA

A

Bolus
- 50units actrapid in 50ml of NaCl (1u/mL)

Infusion

  • 0.1u/kg/hour
  • fall in glucose should not exceed 5mm/hour
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150
Q

Potassium regime given to adult in DKA

A

Start once K is normal

- rate should not exceed 10mmol/hour (or 20mmol/hour in severe cases)

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151
Q

when should glucose be given in DKA

A

10%

- once BM is <14

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152
Q

What fluids are given to paediatric cases of DKA

A

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

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153
Q

what insulin regime do you give to a paediatric pt in DKA

A

Bolus- 50u in 50ml NaCl
- infusion 0.1u/kg/hour in NaCl 0.9%

(same as in adult)

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154
Q

K regime given to paediatric case of DKA

A
  • ensure every 500ml bag of NaCl contains 20mmol of K (40mmol/L)
  • rate does nto exceed 10mmol/hour
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155
Q

what do you do with a diabetics normal insulin regime during the tx of a DKA

A
  • carry on basal doses and give when due
  • stop short acting doses
  • stop insulin driver (short acting)
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156
Q

When and how do you stop an insulin infusion after a DKA

A
  • 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
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157
Q

How do you tx rhabdomyolysis

A
  • Na bicarbonate to alkalise the urine and reduce myoglobin in renal tubules
  • stop any statins
  • IV fluids
  • dialysis
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158
Q

what do you tx paracetemol poisoning with

A
  • acetylcysteine
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159
Q

what do you dilute acetylcysteine in

A
  • glucose 5% or NaCl 0.9%
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160
Q

what should amiodarone be diluted in

A

5% glucose

incompatible with NaCl!!!

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161
Q

how many infusions are needed of acetylcysteine

A

3

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162
Q

how do you tx paracetemol overdose ingested within 1 hour

A

activated charcoal

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163
Q

aspirin overdose- signs on investigation

A
  • metabolic acidosis
  • hypokalaemia
  • high salicylate level
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164
Q

hwo do you tx aspirin overdose

A
  • activated charcoal if within 1 hour
  • correct the hypokalaemia
  • Na bicarb IV to tx acidosis
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165
Q

Side effects of Lithium

A 
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)
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166
Q

sx of lithium toxicity

A 
Tremor (coarse), seizures
D+N+V
Anorexia
disorientation/confusion
blurred vision
Lethargy, drowsiness, coma
renal failure
arrhythmia
may look like cerebellar signs
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167
Q

management of Lithium toxicity

A

withhold Li
increase fluid intake
withhold diuretics
may need haemodialysis

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168
Q

What states can increase risk of Lithium toxicity

A

hyponatraemia
dehydration
renal function detioration

*****ACEI, diuretics (particularly thiazides), NSAIDs- stop these in toxicity

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169
Q

sx and signs of digoxin toxicity

A

sx

  • Anorexia, N+V, diarrhoea
  • malaise, weakness
  • palpitations, syncope
  • hallucination, blurred vision, xanthopsia (loss of colour vision)
  • Neurotoxicity

signs

  • arrhythmias (any), bradycardia
  • hypotension
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170
Q

what drugs interact with digoxin

A

Diuretics

  • thiazide like diuretics
  • spironolactone

CCBs
- verapamil

Inhibitors- PPIs

  • atorvostatin
  • amiodarone
  • ciclosporin
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171
Q

What conditions predispose to digoxin toxicity

A 
hypokalaemia, hypomagnesia, hypercalcaemia
alkalosis
hypoxia
infection
renal dysfunction
hypothyroidism
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172
Q

tx digoxin toxicity

A
  • 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
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173
Q

what must you check before starting IV vanc

A

UEs

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174
Q

what may the rapid infusion of vancomycin result in

A

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
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175
Q

toxicity sx of vancomycin

A
  • ototoxicity
  • neutropenia
  • red man syndrome
  • renal dysfunction, nephrotoxic
  • TEN, SJS
  • phlebitis
  • N+V
  • fever and chills
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176
Q

sx of gentamicin toxicity

A
  • tinnitus, deafness, balance issues, vertigo
  • renal dysfunction/failure
  • colitis
  • stomatitis
  • neutropenia
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177
Q

Theophylline monitoring after infusion for SABA/SAMA resistant acute asthma attack

A

serum conc

cardiac monitoring for adverse effects (earliest signs will show)

178
Q

when do you take digoxin serum conc measurements

A
  • only if ?toxicity

- 8-12hour after dose

179
Q

when do you take vanc serum conc measurements

A
  • predose (through) taken before 3rd and 6th dose
180
Q

monitorign for gent IV/IM administration

A

dosaging- Weight, renal function

OD serum conc 1 hour post administration

181
Q

sx of vit. D toxicity

A
  • hypercalcemia
  • dehydration
  • muscle weakness
  • vomiting
  • Loss of appetitie
182
Q

tx Vit D toxicity

A 
stop vit D
restrict Ca
IV fluids
corticosteroids
bisphosphonates
183
Q

methotrexate toxicity sx

A
  • pallor, GI bleeding- thrombocytopenia
  • N+V
  • dysuria, anuria
  • Lymphopenia- stomatitis- withdraw
184
Q

predisposition states to methotrexate toxicity

A
  • folate deficiency
  • hypoalbuminaemia
  • ascites or effusions (act as depot)
  • trimethoprim, corticosteroids, cipro, aspirin, NSAIDs
185
Q

prevention of methotrexate toxicity

A

folic acid 5mg taken on a differen day to the methotrexate dose

186
Q

INteractions with methotrexate

A

Trimethoprim
NSAIDs, aspirin
Cipro
Corticosteroids

187
Q

Phenytoin toxicity sx

A
  • sore gums
  • slurred speech
  • nystagmus
  • confusion
  • hyperglycaemia
  • rash, SJS, TENS
  • agranulocytosis
  • brady
188
Q

tx of pheyntoin toxicity

A

acivated charcoal

  • supportive
  • brady- atropine, epinephrine
  • antiemetics
  • haemodialiysis
  • if mild sx eg sore gums, slightly slurred speech–> reduce dose of phenytoin
189
Q

what drug interacts with phenytoin and increases levels of phenytoin in blood

A

chloramphenicol

190
Q

Managenent of anaphylaxis

A
  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
Q

tx of mild allergy eg pruritis, macular rash

A

chlorphenamine

192
Q

what drugs can you not give in pen allergy

A

-cillines

Cephalosporins

  • cefalexin
  • cefuroxime
  • ceftazidime
  • ceftriaxone
  • cefotaxime

Carbapenems

  • meropenem
  • doripenem
193
Q

if pt has nut allergy- what should you check that the drug doesnt have in it

A

Arachis oil (look in ‘medicinal forms’)

eg naseptin cream (used for staph intranasal carriage)

194
Q

what drugs do you NEED to px by brand name/look at dosages according to brand in the BNF

A 
!Warfarin
Oral tacrolimus
!Diltiazem
Some antiepileptics
Lithium
!Theophylline
Insulin
195
Q

Name a mineralocorticoid steroid, what is it’s action, SE of administration

A

Fludrocortisone
- water retention (acts like aldosterone)

SE

  • HTN
  • hypernatraemia
  • hypokalaemia
  • hypocalcaemia
  • oedema
196
Q

Name a mineralocorticoid glucocorticoid steroid, what is it’s action, SE of administration

A

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
Q

sx of Cushing;s syndrome

A
  • 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
Q

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

A
  • 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
Q

when do you need to titrate down steroid dosing rather than just stopping the steroid

A
  • > 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
Q

How do you tx adrenaladdisonian crisis

A
  • hydrocortisone (can add on fludrocortisone)

as hydro as both mineralocorticoid and glucocorticoid action

201
Q

Name some Cepahlosporins

A

anything cef-

202
Q

name some fluoroquinolones

A

ciprofloxacin

levofloxacin

203
Q

name some aminoglycosides

A

amikacin

gent- nephro, ototoxic

204
Q

name a monobactam

205
Q

name a carbapenem

206
Q

name some macrolides

A

azithromycin
clarithromycin
erythromycin
clindamycin

207
Q

name a glycopeptide abx

208
Q

name some tetracyclines

A
  • tetracycline
  • doxycycline
  • trimethoprim
209
Q

tx H.pylori

A

PPI plus amox with clarithro or metronidazole

210
Q

drugs that CAUSE c.diff

A

!!!!- macrolides- erythro, clarithro, clinda, azithro
- amoxicillin/ampicillon

  • cephalosporins esp 1st and 2nd gen -cephalexin, cefazolin, cefoxitin, cefuroxime

!!!!!- fluoroquinolones- levofloxacin, ofloxacin, ciprofloxacin

211
Q

tx of c diff

A

vanc
fidaxomicin
metro

do NOT px loperamide

212
Q

PID tx

A

doxy with metro PLUS IM ceftriaxone or ofloxacin and mtro if pen allergic

213
Q

tx gonorrhoea

A

IM ceftriazone or IM gent plus oral azithro

214
Q

tx chlamydia

A

azithromycin or erythro in women of childbearing age

doxy if not (teratogenic)

215
Q

tx meningitis in 3m-50yo

A

cefotaxime OR ceftriaxone

give Vanc if hx of multiple abx uses in last 3m/pt travelled to hgih prevalence areas

216
Q

tx of impetigo

A

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
Q

bullous vs non-bullous impetigo

A

Bullous
- small vesicles–> large flaccid blisters

Non-bullous
- small vesicles

218
Q

What causes impetigo

A

Staph aureus

Strep pyogens

219
Q

Impetigo sx

A
  • 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
Q

prophylaxis and tx of animal/human bites

A

tx summary- skin infections and abx

Prophylaxis
- coamox/doxy with metronidzole if pen allergy

tx- fusidic/fluclox, clarithro,erythro

221
Q

tx lyme disease

A
  • doxy

- amox

222
Q

tx mastitis

A
  • fluclox, erythro if pen allergic

- if not healing- metro or coamox- as these are effective against anaerobes

223
Q

TB prophylaxis tx

A

3m isoniazid and rifampicin

or 6 months isoniazid

224
Q

tx Pneumonia

A

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
Q

tx UTI

A

non preg, children- nitro, trimeth, amox
men- nitro, trimeth
preg- even if asx- nitro (avoid at term), amox

226
Q

tx pyelonephritis

A

non preg, males, children

  • PO- cefalexin
  • IV- amikacin, ceftriaxone, cefuroxime

preg

  • PO cefalexin
  • IV cefuroxime
227
Q

tx recurrent uti

A
  • 1 off doses (either post trigger or nightly) of trimetho, nitro, amox
228
Q

what drugs cause QT prolongation

A 
Antipsychs
Antidepressants- TCA, SSRIs (citalopram), SNRI venlafaxine
Quinolones- cipro, levo
Macrolides- azithro
Amiodarone
Ondansetron, metoclopramide
229
Q

what abx are considered broad spec

A
  • carbapenems- mero
  • Piperacillin tazobactam
  • Aminoglycosides- gent
230
Q

tetracyclines SE

A

Tetracycline, doxycycline

  • photosensitivity
  • MG worsened
  • SLE worsened
  • CI in 12 years or under
231
Q

what is co-trimoxazole

A

Sulfamethoxazole and trimethoprim

– used for pneumocystis pneumonia (pneumocystis jirovecii fungi) and prophylaxis

232
Q

SE co-trimoxazole

A

agranulocytosis

peripheral neuropathy

233
Q

SE linezolid

A
  • used for MRSA sometimes, incl pneumonia
  • optic neuropathy
  • blood disorder particularly if used >10d
234
Q

what drug has dilsifuram like reaction with alcohol

A

metronidazole

235
Q

resus fluids paeds

A

10-20ml/kg bolus

236
Q

DKA % deficit in children

A

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
Q

how do you replace fluid depletion % in paeds

A

% dehyd x kg x 10

- replace over 24 hours

238
Q

adult maintenance fluids

A

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
Q

how many mol of K in different % of fluid

A

KCl

  1. 3%- 40mmol/L
  2. 15%- 20mmol/L
240
Q

How much urine will a healthy pt pass per hour

A

1ml/kg/hour

fluid replacement- 0.5ml/kg/hour aim

241
Q

sx fluid overload

A 
- Cough, white frothy sputum
pleural effusion, ascites, oedema
SOB, dyspnoea
HTN, tachy
S3/4 heart sounds
242
Q

when do you use different kind of colloids

A

Gelofusine- pts with profound/refractory shock (stays in intravasc space longer)

human albumin solution- kidney and liver failure

243
Q

when would you use glucose 5% instead of NaCl maintenance

A
  • hypernatraemia (or use NaCl 0.45%)

- hypoglycaemia

244
Q

what maintenance fluids would you use in pt who is hypokalaemia

A

saline with 0.3% KCl (40mmol/L)- max 10mmol/hour rate of K

245
Q

what fluids would you use for maintenance in hyperkalaemia or hyponatramea

246
Q

NSAID contraindications

A
  • AKI/CKD
  • indigestion, GI bleed risk, peptic ulcer
  • haemorrhagic stroke, sig bleed, active bleeding
  • severe HF
247
Q

How would you start opioid naive pts on morphine

A

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
Q

calculation of breakthrough dosages

A

PRN doses that are each 1/10-1/6 of the background dose, 2-4 hourly

249
Q

what opioids are ok to give in renal impairmeent

A

oxycodone

fentanyl

250
Q

opioid SE

A
  • constipation
  • drowsiness
  • dry mouth
  • confusion, hallucinations, delirium
  • falls
  • nausea
  • uncommon- retention, pruritis, myoclonus, seizures
  • resp depression
251
Q

how do you go about increasing background dose if pt is taking max PRNs and still in pain

A

Dose of background + breakthrough doses= total daily dose

  • increase total daily dose by 1/3 -1/2
252
Q

what must you include when px controlled drugs in community/OP

A
  • 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
Q

post op analgesia

A
  • paracetemol/NSAIDs

- then straight to morphine rather than codeine/tramadol- IV

254
Q

tx neuropathic pain

A

1st- amitriptyline, duloxetine, pregabline, gabapentin

  • post herpetic pain- lidocaine patch
  • back pain- NSAID, oramorph, amitriptyline
255
Q

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

A

take them off the paracetamol rather than the co-codamol if they’re still in pain (and put them on something else)

256
Q

if pt is in constant pain, what drug chart do you write their analgesic px

A

put px on regular medications chart rather than as required chart and put ‘up to X hourly’

257
Q

how do you tx hypocalcaemia

A

Ca gluconate 10% (10g in 100ml)

258
Q

how do you tx hypokalaemia

A

K 0.3% (40mmol/L)– no more then 10mmol/hour rate

259
Q

ECG changes for hyperkalaemia

A
  • tall tented t waves
  • u wave (dip after QRS)
  • loss of p waves
  • PR prolonged
  • QRS widening
260
Q

tx hyperkalaemia (>6)

A
  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
Q

what do you mix Ca gluconate in with if pt is taking digoxin in hyperkalaemia

A

100ml glucose 5% over 20min (rather than 10ml of 10% over 5min)

262
Q

when should you suspect that a pseudohyperkalaemia reading has occurred

A

K is only abnormal reading on blood

pt is clinically well, no ECG abnormalities

263
Q

what must you put in dose box when px insulin

A
  • solution it is mixed with

eg actrapid 10units in 50mL glucose 50% given over 5 mins

264
Q

Causes of hyperkalaemia

A 
DREAD
Drugs
Renal failure, rhabdomyolysis
Endocrine
Artefact (haemolysed)
DKA
265
Q

what drugs cause hyperkalaemia

A 
THANKS CYCLE
Trimethoprim
Heparin
ACEI/ARB
NSAIDs
K sparing diuretics
Suxamethonium
Cycle- ciclosporin
266
Q

what is high phosphate commonly seen in

267
Q

tx high phosphate in non dialysis pt

A

Ph binders- Ca carbonate, Ca acetate

268
Q

tx with iron overloaded pt

A

eg tranfusion, stomach ache, thalassaemic

  • desferrioxamine
269
Q

SE of anticholinergics/animuscarinics

A
  • retention, constipation
  • dry mouth
  • drowsiness, memory loss, confusion
  • exacerbation of glaucoma
270
Q

Anticholinergic drugs

A
  • 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
Q

what drugs do you need to take at a specific time

A

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
Q

what drug class should you avoid in Myaesthenia Gravis

A

anticholinergics

273
Q

how do you tx overactive bladder in MG

A

Duloxetine or mirabegron

274
Q

name some non sedating antihistamines

A
  • cetirizine (although can cause drowsiness in children)
  • fexofenadine
  • acrivastine
275
Q

name some sedative antihistamines

A

cyclizine, promethazine

276
Q

what antihistammines would you use for hayfever

277
Q

What drugs may need their plasma conc taking during the course

A 
!- Lithium
- Digoxin- only if renally impaired/suspect toxicity
- Aminoglycosides
- IV vanc
!- Teicoplanin
!- Cipro in CKD
- theophylline
- ciclosporin
278
Q

Safety netting for carbimazole, trimethoprim, methotrexate?

A

any signs of infection, sore throat (agranulocytosis)

279
Q

what drug is grpahs used for to work out how manhy hours between infusions should be in relation to post dose conc?

A

Gentamicin

280
Q

when should you stop methotrexate

A

active infection

dnot tx this infection with trimethoprim

281
Q

INR target

A

0.8-1.1 no warfarin
2-3 on warfarin
2.5(-3.5) on warfarin + mechanical heart valve

282
Q

when should you take rivaroxiban

283
Q

what electrolyte disturbance increases risk of Digoxin toxicity

A

hypokalaemia

284
Q

what electrolyte disturbance increases risk of Lithium toxicity

A

hyponatraemia

285
Q

what types of antipsychotics cause what profile of sx?

A

1st gen-haloperidol, prochloperazine- parkinsonian, movement disorders

2nd gen- quetiapine, olanzapine- metabolic– wt gain, diabetes, prolactin

286
Q

what drugs are ototoxic/can lead to hearing loss?

A 
Aminoglycosides
Vanc
Topical otic preparations- tea tree 
loop diuretics- bumetanide
antineoplastics- cisplatin, carboplatin
salicylate- aspirin
Quinine
tadalafil, sildenafil
287
Q

what drugs can cause constipation

A 
Ferrous fumarate
buscopan
alosterone antags
ACEI
opioids
288
Q

What drugs can cause diarrhoea

A
  • Methotrexate
  • Glibenclamide (sulfonylurea)
  • Metformin
  • Abx
289
Q

what drugs can cause GI bleed

A

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
Q

What drugs can cause lung fibrosis

A 
BANS ME
Bleomycin
Amiodarone
Nitrofurantoin
Sulfalazine
Methotrexate
291
Q

what drugs can cause drowsiness

A 
benzos
opioids
mirtazapine
amitriptyline
antihistamines- promethazine, alimemazine, cyclizine, chlophenamine
292
Q

non sedating antihistamines

A 
acrivastine
bilastine
cetrizine
fexofenadine
loratadine
293
Q

common drugs that cause liver disease/injury

A

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
Q

what do different aspects of the LFT mean

A

ALP, GGT- cholestatic
bili, ALT, AST- hepatic
uncong bili- haemolytic
GGT- alcoholic, anorexia, hyperthyroid, myotonic dystrophy

295
Q

what drug effects can be increased in liver disease?

A
  • benzos- sedation
  • antipysychs- agitation
  • opioids- consti
  • !!diuretics- electrlyte issues
  • Na Val- thrombocytopenia
  • NSAIDS and !!anticoags- gastric/oes variceas
  • NSAIDs and NaCl ascites
296
Q

drugs that precipitate and should be stopped in AKI

A 
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
Q

what condition would you not give k sparing diuretics, as it increases risk of hyperkalaemia

298
Q

what type of diuretic is ineffective in severe CKD

A

thiazide like- tak ethem off it and switch them to furosemide if fluid overloaded

299
Q

what drugs SE oedema

A

CCB- amlodipine, verapamil, nifedipine

NSAIDs
corticosteroids
pioglitazone

esp if no evidence of HF on echo

300
Q

what 2 drugs risk heart block when put together

A

verapamil, betablocker

301
Q

Drugs that cause HF exacerbation

A 
VISA
Verapamil, diltiazem
ibuprofen and other NSAIDs
steroids
antiarrhythmics- flecainide

pioglitazone
Levothyroixine– can exacerbate, so titrate up

302
Q

Hypotension causing drugs

A

diuretics
betablockers
alpha blocker- tamsulosin
CCB, ACEI, ARB

303
Q

Durgs that affect the thyroid

A

amiodarone
Lithium
Interferons
tyrosine kinase inhibitors

304
Q

drugs that cause tremor

A 
salbutamol
Lithium (coarse in overdose, fine as SE)
305
Q

drugs that can cause SJS/TEN, and erythema mulitforme

A
  • antiepileptics- carbamazepine, phenytoin, lamotrigine, oxcarbazepine
  • penicillins
  • statins
  • vancomycin

erythema mulitforme

  • penicillins
  • NSAIDs
  • nitrofurantion
  • sulfomadies
  • anticonvulsants
306
Q

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?

A

EBV– amoxicillin

rash can also occur if amoxicillin is given to pt with CMV or ALL/CLL

307
Q

drugs that cause agranulocytosis

A

clozapine
carbimazole
azathioprine, methotrexate
co-trimoxazole, trimethoprim

phenytoin**
Mirtazipine**

308
Q

3 drugs that can cause wt gian

A

Gliclazide (sulphonylureas)
Mirtazapine
valproate

309
Q

Drug induced haemolytic anaemia

A 
antimalarials- promaquine, chloroquine
nitrofurantoin
quinolones
radburicase
sulphonamide- co-trimazole

risks of this increases in those with G6PD

310
Q

what can cause drug induce torsade des pointes

A 
erythro
cipro
levofloxacin
fluconzole
satalol
311
Q

what drugs can cause QT prolongation

A
  • macrolides- azithromycin
  • quinolones- cipro, levo
  • amiodarone
  • antipsychitcs (esp 1st gen)
    TCA, SSRI (citalopram esp)
    Ondansetron
312
Q

weird SE of latanoprost

A

darken iris

313
Q

SE SSRIs

A

BLEEDING!
Hyponatraemia- give TCA instead (not amitriptyline as this also causes hyponat)
sleep disturbances
QT prolongation

314
Q

what 2 SSRIs must not be taken together when transitioning to one or the other, whilst others can have their doses tapered

A
  • fluclox and amitriptyline- one must be stopped fully before the other is started
315
Q

SE TCA

A 
- serotonin syndrome
hyponatraemia
antichol- drowsy, dry mouth, constipation, retention
- confusion
QT prolognation
glaucome
316
Q

2 SE of K sparring eg amiloride, eleprenone

A

gynaecomastia

hyperkalaemia

317
Q

2 SE thiazide like diuretics, what can they precipitate, when should you take it

A

gout
hypokalaemia

precipitate Lithium toxicity (other diuretics do too, but esp thiazide like)
morning- makes you pee !

318
Q

what antiHTN/diuretic meds cause hyperkalaemia, and whihc hypokalaemia?

A 
Hyper
ACEI
ARB
K sparing
(salbutamol lol)

Hypo
Loop
thiazide- like

319
Q

what time shoudl ACEI be taken

A

bed time (hypotension;dizziness)

320
Q

SE laxatives

A

Hypokalaemia

isphagula husk- bronchospasms

321
Q

SE methotrexate

A 
diarrhoea
myelosupression
stomatitis- withdraw
abnoral LFTs, cirrhosis
pulmonary fibrosis
322
Q

SE quinolones, what affect their absoprtion

A 
tendon rupture (esp >60, taking steroids)
QT prolongation
seizures- cipro

absorption reduced by iron

323
Q

SE parkinsons meds

A

Postural hypotension

Ergot DA rec agonists eg carbergoline, bromociptine– cardiac fibrosis (also CI)

324
Q

SE amiodarone

A

thyroid
liver
arrythmias
pulomary fibrosis

325
Q

what must GTN not be taken with

A

sildenafil- severe hypotension, risking MI

326
Q

statin SE

A

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
Q

SE steroids

A 
hyperglycaemia
leukocytosis
GI bleed, peptic ulcer
oedema
HF exacerbation
Cushings
OP
328
Q

drusg not adminstered daily to look out for on px review qs

A

Weekly

  • bisphosphonates
  • methotrexate
  • buprenorphine

2-3months

  • Hydroxocobalamin
  • goserelin (prostate cancer)
  • Fentanyl (2-3months)
  • gentamicin
329
Q

what drug should not be given with clopidogrel as increases risk of bleeding further

A

omezoprazole

330
Q

what two drugs taken toegtehr cause heart block

A

CCB and bisoprolol

331
Q

interacitons with methotrexate

A

trimethoprim
NSAIDs and aspirin
corticosteroids
ciprofloxacin

332
Q

what 2 drug classes taken toegtehr risk resp depression

A

benzos and opioids

333
Q

interactions with metronidazole

A
  • alcohol

- warfarin- increase INR

334
Q

SE of metronidazole LT use

A

peripheral neuropathy ad blood disorders

335
Q

what drug given with simvastatin, should cause you to lower the dose of simva to 20mg

A

amlodipine

336
Q

what drugs reduce efficacy of COCP

A
  • carbamazepine and other old antiepileptics eg griseofluvin
  • rifampicin (rifabutin)
  • and the other inducers!
337
Q

what marcolide can be used with warfarin

A

azithro

others are inhibitors eg erythro, clarithro

338
Q

what interacts with st johns wort

A

SSRIs- serotonin syndrome (has serotingeric properties)
Warfarin- reduces INR
MAOIs- HTN crisis
redcued contraception effectiveness

339
Q

what effects absorption of qiunolones eg cipro

340
Q

what combination of 3 drugs will cause an AKI

A

diuretic
ACEI
NSAID

even NSAID and ACEI only too

341
Q

what drug can mask tremor from hypercalcaemia and also mask signs of hypoglycaemia

A

betablockers

342
Q

when shoudl clopi/aspirin be stopped pre-op

343
Q

when should warfarin be stopped preop

344
Q

when should metformin be stopped preop

345
Q

max ibuprofen dose daily

A

2.4g (600mg QDS)

346
Q

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?

A

IM diclofenac or opioid

analgesia BNF recommends for cholangitis– Charcot’s triad– fever, RUQ, jaundice

347
Q

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

A

ABG- CO2 retainers at risk of going into hypercapnic resp failure (T2)

348
Q

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?

A

thrombolyse in massive PE! (pe causing BP systolic <90mmHg)

Alteplase

349
Q

what do you do if predose (trough) level of gent is above the threshold

A

increase period of time between doses

to aid clearance, as trough concs are driven by clearance

350
Q

what do you do if postdose (peak) level of gent is above the threshold

A

decrease dose

as peak concs are driven by dose

351
Q

acute tx of manic episode

A
  1. antipsychs- olanzapine, quetiapine, risperidone

2. Lithium (if response has not been optimal)

353
Q

when starting atorvostatiin for secondary prevention (eg angina, intermittent claudication)- what does do you need to start it on

A

80mg

would be 20mg for primary prevention

apart from if theres potential for interactions, or high risk of adverse effects

354
Q

causes of a reduced INR on a stable dose of warfarin

A 
Enzyme INDUCERS
- CRAP GPS
Carbemazepine
Rifmapicin
Alcohol (chronic)
Phenytoin
Griseoflulvin
Phenobarbitone
Sulphonylureas eg gliclazide/St johns Wort
also tobacco
355
Q

causes of increase in INR on a stable warfarin dose

A

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
Q

SE of LT glucocorticoid steroid use

A

INsomnia an dpsych issues

357
Q

hwo can you tell from U&Es that pt is dehydrated

A

Urea:Cr ratio is >10

358
Q

how many mmol of Na is in a 1L bag of NaCl 0/9%

359
Q

what analgesics should you avoid in IHD

A

oral NSAIDS as they risk fluid retention

360
Q

what analgesic should be avoided during breast feeding

A

aspirin- risk of Reyes syndrome in baby

361
Q

drugs for stable angina

A
  • rate limiting- beta blocker or diltiazem/verapamil
  • aspirin
  • statin
362
Q

SE bisphos

A

dyspepsia, oesophagitis- stop taking and seek med attention

Constipation

Oesteonecorsis of the jaw

363
Q

instructions on taking bisphospnates

A
  • empty stomach
  • at least 30min before breakfast
  • with water
  • swallow whole
  • sit upright/stand for at least 30min after taking
  • once a week
364
Q

what electrolyte imbalance do all diuretics cause

A

hyponatraemia

365
Q

meds that exacerbate psoriasis

A 
Lithium
beta blockers
antimalarials
NSAIDs
ACEI
366
Q

prev and tx of migraine

A

tx- triptans, naproxen/NSAID

prevent- Propan/topiramate/amitriptyline

367
Q

hwo do you manage mild hyperkalaemia (<6, no ECG changes, no symptoms)

A

give fluids and stop increasing potassium meds (THANKS CYCLE)

368
Q

what do you do in calculation question if the pt is obese or underweight

A

use ideal weight if given, of give max

if underweight- use actual body weight

ie use the lower weight

369
Q

where can you find calculations for ideal body weight, eGFR, Cr clearance in the BNF?

A

‘prescribing in renal impairement’

370
Q

how does carbamazepine affect Na levels

A

hyponatraemia

371
Q

what antidiabetics can cause hypoglycaemia

A

insulin

suphonylureas (gliclazide, tolbutamide, glimepride)

SGLT-2 inhibis- ertulifloxin

372
Q

When would you stop amiodarone due to SEs? What SEs should you consider reducing doose

A

STOP:

  • optic neuritis
  • thyrotoxicosis
  • hyperthyroidism (risk of refractory thyrotoxicosis)

REDUCE

  • hypothyroid (or just tx hypo)
  • minor hypothyroidism- or just tx
  • bradycardia
373
Q

what drug can you add in severe neutropenic sepsis (not in BNF)

A

IV Gent (STAT)

374
Q

common/serious interactions PSA ask about

A

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
Q

drusg that interact with amiodarone

A

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
Q

what time of day should steroids be taken

377
Q

what causes increased urea

A

GI bleed
dehydration
HTN states
renal disease

378
Q

when can pts use nasal fentanyl

A

those using at least 25mcg transdermal per hour

379
Q

when should you avoid nitrofurantoin

A

full term preg

eGFR <45

380
Q

when would you give oral phytomenadione pre=op?

A

if INR >=1.5 day before surgery

381
Q

1st line tx for acute dystonic reaction (eg SE antipsychotics)

A

procyclidine IM/IV

382
Q

what % of KCl do you use for maintenance

383
Q

what is a continuous combined option for oral contraception

A

levonorgestrel/estradiol

384
Q

what is a continuous combined option for contraception transdermal

A

femseven sequi weekly patch without interval

385
Q

what is a cyclical combined PO option for contraception

386
Q

management of scarlet fever

A

phenoxymethylpen PO

if cannot intake orally- IV benzylpen

387
Q

impornat advice for methotrexate

A
  • take contraception during and for 6m after taking

THEN avoid NSAIDs

388
Q

when would you not px ondansetron for PONV (is 1st line usually)

A

pt already on QTc prolonging meds

389
Q

what is mor elikley to cause ankle swelling, NSAID or ACEI

390
Q

1st line for pain over where herpetic rash was 2 days ago

A

1st line paracetemol

if pain is more LT, then go on with neuropathic pain meds

391
Q

when should people take loperamide

A

after each loose stool

392
Q

what does a low TSH mean in treated hyperthyroidism

A

you are over treating- decrease levothyroxine dose

393
Q

causes of SIADH (hyponatraemia, high urinary Na)

A
  • SSRIs, TCAs
  • carbamazepine
  • vincristine
  • cyclophsophamide
  • glimepride (sulphonylurea)
  • SCLC
  • panc/prostat cancer
  • stroke
  • SAH
  • meningitis/encephalitis/abscess
  • TB, pneumonia
  • PEEP
394
Q

no need to give O2 in MI if sats are ok

395
Q

what O2 do you give in COPD pts

A

28% venturie at 4L/min

aim- 88-92%
adjust to 94-98% if pCO2 normal on gas

396
Q

baseline ix for antipsychs

A 
BP
BMI/wt
FBC
UE
LFT
fasting blood glucose
ECG
lipids
prolactin
397
Q

what fluids should be avoided in patients who have had a stroke

A

Glucose 5% (risk cerebal oedema)

398
Q

what are the two antihistammines used in anaphylaxis (not immediate management)

A

cetrizine

chlorphenamine

399
Q

tx fo N+V in pregnancy

A
  1. cyclizine or promethazine- if not improvement in 24hours then:
  2. metoclopramide, or ondasetron
400
Q

what drugs can precipitate digoxin tox

A

Promote hypoMg/K

  • loops
  • thiazides

INcrease plasma comc

  • amiodarone
  • CCBs
  • spironolactone
  • Quinine
401
Q

what reduces efficacy of levothyroxine

A

iron salts

Ca

402
Q

how to calc BMI

403
Q

what drugs cause drug reaction with eosinophilia and systemic sx (fever, lymphadenopathy, lover dysfunc)?

A
  • allopurinol
  • anti-epileptics
  • sulphonamides (eg co-trimoxazole)
404
Q

corneal abrasion- sx and tx

A
  • trauma hx
  • painful red eye
  • ‘feeling of something in it’

tx- topical broad spec abx

405
Q

what would you px maxidex (dexamethasone eye drops)

A

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
Q

chlamydia vs gonorrhoea histologically

A

both gram-negative (pink)

Gonorrhoea- diplococci

chlamydia - intracellular, coccoid/rod shaped

407
Q

tx biliary sepsis ie cholangitis- RUQ pain, BG wall thickened on USS, obstructive jaundice + sepsis sx

A
  • gram -ve, anaerobic
  • tazocin or cephalosporin
  • if pen allergic- cipro, gent
    • metronidazole
408
Q

meningococcal septicaemia tx

A

benzylpen before admission in primary care

<3m or >50 - IV ceftriaxone and amox
>3m- IV ceftriaxone

chloramphenicol if pen or cephalosporin hypersensivity

409
Q

prophylaxis of migraine

A
  • propanolol
  • topiramate
  • amitriptyline
410
Q

what does NICE say to do if renal function declines after upping dose of ACEI

A
  • stop or reduce dose if eGFR declines by >=25%
  • close UE monitoring
  • stop other nephrtoxic drugs
411
Q

prophylaxis of baby from pertussis who isnt vaccinated

A

clarithro, erythro

412
Q

management of ascites (due to malginancy, cirrhosis)

A
  • spironolactone

- furosemide as adjunct

413
Q

sx of decomp liver disease

A
  • melaena- low plt/clotting factors
  • jaundice
  • ascites
414
Q

status/refractory epilepsy

A
  • 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
Q

hwat pH does BV occur

416
Q

management of aortic dissection

A

is a HTN emergency

  • labetalol IV 50mg STAT
  • repeat every 5min
  • max 200mg
417
Q

difference in sx and tx between alcohol withdrawal, delirium tremens and wernickes

A

Wtihdrawal- N+V
- chlordiazepoxide

Delirium tremens- hallucinations agitation, confusion
- lorazepam

Wernicke’s- cerebellar signs
- thiamine

418
Q

interactions and SE PPIs

A
  • clopi- bleeding
  • COCP
  • digoxin

SE- hypomagnesia (confusions, arrythmias, seizures, psychiatric sx)

419
Q

how do you tx the hypomagnesia that may occur from PPIs

A

mild- stop PPI
Severe
- IV Mg

420
Q

PC: PV discharge

Findings on microscopy of discharge: clue cells, no lactobacilli

diagnosis?

A
  • BV
  • lactobacilli are normally there and keep pH low
  • absence means BV is overgrowing and vaginal pH is likely to be high
421
Q

resp SE of tricagrelor

A

progressive SOB

422
Q

when do you do a needle thoracentesis vs a chest drain insertion for a PTX

A

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
Q

what dose of bisop would you use for rate control in AF

A

1.25mg (HF dose)

rather than 5-10mg (HTN/angina dose)

424
Q

when is gelofusin used

A

pancreatitis- colooid so stays intravac longer

425
Q

in diabetic, what does alcohol excess do to glucose serum

A

hypoglycaemia (stimulates insulin production)

426
Q

what time do SC anticoags get administered in hospitals

A

6pm- nursing staff convenience

427
Q

what do you measure to monitor DKA response

A

serum ketones

428
Q

what do you use in impetigo widespread

A

orals>topicals

429
Q

what anti hypertensive exacerbates gout

A

thiazide like diuretics

430
Q

ekectrlyte imbalance from carbamazepine

A

hyponatraemia

431
Q

where can you find amounts of cream/ointmenets in g that should be used according to body part

A

‘skin conditions, management’ tx summary

432
Q

when should the statin dose be increased ?

A

if a >40% reduction in non-HDL lipids has not occured within 3 months of starting

433
Q

post MI- how long should aspirin and clopi be 300mg for

434
Q

tx of pericarditis

A
    • NSAID- ibuprofen
      - Colchicine
      - Steroids
435
Q

what does ‘isotonic’ mean

A

solution with same osmotic pressure as other solution (blood, intracellular fluid)

eg NaCl 0.9%, 5% glucose

436
Q

what does ‘hypertonic’ mean

A

having higher osmotic pressure than body fluid

eg 3% saline

437
Q

how long should a patient be on ferrous fumarate for

A

3 months

then stop it and recheck the FBC and ferrtin studies

438
Q

standard and high risk dose of folic acid

A

0.4mg and 5mg for first 12 weeks of the pregnancy

439
Q

high urea without high Cr means?

440
Q

when should you take statin

Finals (15 decks)

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