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Phase 4 > PSA > Flashcards

PSA Flashcards

1
Q

enzyme inducers?

A

PC BRAS: Phenytoin, Carbamazepine, Barbiturates, Rifampicin, Alcohol (chronic excess), Sulphonylureas

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2
Q

enzyme inhibitors?

A

AODEVICES: Allopurinol, Omeprazole, Disulfiram, Erythromycin, Valproate, Isoniazid, Ciprofloxacin, Ethanol (acute intoxication), Sulphonamides

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3
Q

patient on warfarin started on erythromycin for infection. what happens?

A

the addition of erythromycin (an enzyme inhibitor) can sometimes and unpredictably cause a dangerous rise in international normalized ratio (INR) if the warfarin dose is not decreased

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4
Q

drugs to stop before surgery?

A

I LACK OP: Insulin, Lithium, Anticoagulants/antiplatelets, COCP/HRT, K-sparing diuretics, Oral hypoglycaemics, Perindopril and other ACE-inhibitors.

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5
Q

when to stop COCP/HRT before surgery?

A

4 weeks before surgery

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6
Q

when to stop Li before surgery?

A

day before

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7
Q

when to stop ACEi before surgery?

A

day of

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8
Q

when to stop anticoag/antiplatelet before surgery?

A

variable

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9
Q

when to stop oral hypoglycaeimc/insulin before surgery?

A

variable

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10
Q

patient on long term steroids and for surgery. what do?

A

double daily steroid dose before induction of anaesthesia. (sick day rules)

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11
Q

PReSCRIBER mnemonic?

A 
Patient details
Reaction (i.e. allergy plus the reaction)
Sign the front of the chart
check for Contraindications to each drug
check Route for each drug
prescribe Intravenous fluids if needed
prescribe Blood clot prophylaxis if needed
prescribe antiEmetic if needed and
prescribe pain Relief if needed.
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12
Q

Does co-amoxiclav have penicillin?

A

yes

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13
Q

SE/Contraindications for steroids?

A

STEROIDS: Stomach ulcers, Thin skin, oEdema, Right and left heart failure, Osteoporosis, Infection (including Candida), Diabetes (commonly causes hyperglycaemia and uncommonly progresses to diabetes), and Cushing’s Syndrome.

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14
Q

safety considerations with NSAIDS? (CI for nsaids)

A

NSAID: No urine (i.e. renal failure), Systolic dysfunction (i.e. heart failure), Asthma, Indigestion (any cause), and Dyscrasia (clotting abnormality).

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15
Q

anti-HTN, main SEs?

A

A) Hypotension (including the earliest symptom, postural hypotension) that may result from all groups of antihypertensives.

B)mechanistic categories:

1.
Bradycardia may occur with beta-blockers and some calcium-channel blockers.

2.
Electrolyte disturbance can occur with angiotensin converting enzyme (ACE)-inhibitors and diuretics (see Chapter 3).

C)
Individual drug classes have specific side effects:

1.
ACE-inhibitors can result in a dry cough.

2.
Beta-blockers can cause wheeze in asthmatics; they can also cause worsening of acute heart failure (but help chronic heart failure).

3.
Calcium-channel blockers can cause peripheral oedema and flushing.

4.
Diuretics can cause renal failure. Thiazide diuretics (e.g. bendroflumethiazide) can also cause gout, and potassium-sparing diuretics (e.g. spironolactone) can also cause gynaecomastia.

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16
Q

Common SE ACEi

A

dry cough

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17
Q

Common SE BB

A

wheeze in asthmatic, worsen acute HF

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18
Q

Common SE CCB

A

peripheral oedema and flushing

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19
Q

Common SE diuretics, thiazide and K sparing

A

Diuretics can cause renal failure.
Thiazide can cause gout
K sparing can cause gynaecomastia

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20
Q

should you give NBM patient oral medication, including before surgery?

A

YES

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21
Q

Fluid replacement - when not to give normal saline?

A
  • hypernateraemic or hypoglycaemic - give 5% dextrose
  • has ascites - give human albumin solution (HAS) instead. [The albumin maintains oncotic pressure; furthermore, the higher sodium content of 0.9% saline will worsen ascites.]
  • shocked from bleeding - blood tranfusion, but if taking long time give crystalloid in meantime. NO COLLOID.
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22
Q

fluid assessment - pt only oliguric (<30ml/hr) with no urinary obstruction (eg. BPH)

A

normal saline 1L over 2-4 hours then reassess

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23
Q

fluid assessment - pt tachy or hypo

A

normal saline 500ml bolus (15min) then reassess [HR, BP, UO]. (250ml if HF)

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24
Q

rough prediciton of amount of fluid depletion from HR, BP and UO?

A

reduced urine output (oliguric if <30 mL/h; anuric if 0 mL/h) indicates 500 mL of fluid depletion

•
reduced urine output plus tachycardia indicates 1 L of fluid depletion

•
reduced urine output plus tachycardia plus shocked indicates >2 L of fluid depletion.

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25
Q

max IV K rate?

A

cannot give more than 10mmol/hr

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26
Q

Maintenance fluids?

A

adults 3L. Elderly 2L (per day)
Adequate electrolytes are provided by 1 L of 0.9% saline and 2 L of 5% dextrose (1 salty and 2 sweet).

•
To provide potassium, bags of 5% dextrose or 0.9% saline containing potassium chloride (KCl) can be used but this should be guided by urea and electrolyte (U&E) results; with a normal potassium level, patients require roughly 40 mmol KCl per day (so put 20 mmol KCl in two bags)

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27
Q

how often to give maintenance fluids bags?

A

if 3L ; 8 hourly (24/3)

if 2L; 12 hourly (24/2)

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28
Q

what to do before Rx fluids?

A

check U&E.
check no fluid overload - eg. increased JVP, peripheral or pulmonary oedema
check bladder not palpable- if palpable shows urinary obstruciton

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29
Q

CI to compression stockings?

A

peripheral arterial disease

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30
Q

CI to prophylactic LMWH?

A

active bleeding / risk of bleeding (eg. ischaemic stroke)

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31
Q

CI for metoclopramide (DA antagonist) ?

A

PD patient

young woman - risk of dyskinesia, esp dystonia.

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32
Q

Antiemetic choice if nauseated?

A

REGUALR

  • cyclizine 50 mg 8 hourly IM/IV/oral for most cases but causes fluid retention
  • metoclopramide 10 mg 8 hourly IM/IV if heart failure
  • ondansetron 4mg or 8mg 8-hourly IV/oral
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33
Q

CI for cyclizine?

A

cyclizine is a good first-line treatment for almost all cases except cardiac cases (as it can worsen fluid retention), where metoclopramide 10 mg 8 hourly IM/IV/oral is safer.

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34
Q

antiemetic choice if not nauseated?

A

AS REQUIRED

  • cyclizine 50 mg up to 8 hourly IM/IV/oral for most cases but causes fluid retention
  • metoclopramide 10 mg up to 8 hourly IM/IV if heart failure
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35
Q

Analgesia - No pain

A

Regular - Nil

As required- Paracetamol 1g up to 6 hourly oral

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36
Q

Analgesia - Mild pain

A

regualr - Paracetamol 1g up to 6 hourly oral

as required - 30mg up to 6 hourly oral

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37
Q

Analgeisa - Severe pain

A

regualr - cocodamol (30/500),2 tablets 6 hourly

as required - morphine sulphate (10mh/5ml) 10mg up to 6 hourly oral

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38
Q

when to add nsaid for pain?

A

An NSAID (e.g. ibuprofen 400 mg 8 hourly) may be introduced at any stage regularly or ‘as required’ if not contraindicated.

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39
Q

neuropathic pain?

A

the first line treatment is amitriptyline (10 mg oral nightly) or pregabalin (75 mg oral 12 hourly);

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40
Q

diabetic neuropathy pain?

A

duloxetine (60 mg oral daily)

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41
Q

paracetamol daily max dose?

A

4 g

so max 1g 6 hourly

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42
Q

pt <50kg , max paracetamol dose?

A

max 500mg 6 hourly

so 2g/day max.

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43
Q

electrolytes and thiazides?

A

thiazides like bendroflumethazide (eg. Neo-naclex) can cause low K
NB loop and thiazides both cause low K

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44
Q

electrolyes and ACEi?

A

can cause hyper K

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45
Q

domperidone v metoclopramide?

A

both DA antagonists
metoclopramide can cross BBB act on DA receptors so CI in PD
domperidone cannot corss BBB, so fine in PD.

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46
Q

why gastric discomfort with nsaid/ibuprofen?

A

Ibuprofen inhibits prostaglandin synthesis needed for gastric mucosal protection from acid. It is therefore at risk of influencing inflammation and ulceration.

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47
Q

why gastric discomfort with steroids>?

A

Oral steroids inhibit gastric epithelial renewal, thus predisposing to ulceration.

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48
Q

why low renal function and NSAIDs?

A

Ibuprofen inhibits prostaglandin synthesis which reduces renal artery diameter (and blood flow) and thereby reduces kidney perfusion and function.

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49
Q

why low renal func and ACEi?

A

Ramipril, an ACE-inhibitor, reduces angiotensin-II production necessary for preserving glomerular filtration when the renal blood flow is reduced.

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50
Q

ACEi and NSAIDs together on renal func?

A

In effect, NSAIDs combined with ACEi are a double threat to renal perfusion. The combination nips tight the afferent artery (the way in) and opens up the efferent artery (the way out).

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51
Q

why ACEi and dry cough?

A

ACE-inhibitors are thought to cause a dry cough through accumulation of bradykinin via reduced degradation by ACE.

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52
Q

why ACEi and hyper k?

A

ACE-inhibitors cause hyperkalaemia through reduced aldosterone production and thus reduced potassium excretion in the kidneys

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53
Q

antimuscarinic drugs and elderly?

A

Oxybutynin is an antimuscarinic drug, used for the treatment of urinary frequency/urgency. Antimuscarinic drugs can cause confusion, particularly in the elderly. While many drugs can precipitate acute confusion in elderly patients, the clues in this case are the accompanying symptoms – antimuscarinic agents commonly cause pupillary dilation, with loss of accommodation, dry mouth, and tachycardia (after a transient bradycardia). This is a typical presentation of antimuscarinic toxicity. Of note, the British National Formulary (BNF) recommends a lower dose of oxybutynin in elderly patients.

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54
Q

elderly pt with new confusion - ddx?

A

, including acute intracranial event, infection, electrolyte disturbance, urinary retention, and/or constipation

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55
Q

some drug causes of acute confusion in elderly?

A

Tramadol -an opioid, is notorious for causing confusion in the elderly and ought to be avoided unless absolutely necessary. It is an unwise choice of analgesic for the treatment of osteoarthritis

Cyclizine, an antiemetic, can cause drowsiness and confusion, based partly on its propensity to cause anticholinergic effects. Reduced doses are recommended in elderly patients.

Diazepam, a benzodiazepine, should be used with extreme caution in the elderly and only for short courses

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56
Q

nsaids and methotrexate?

A

Ibuprofen and other NSAIDs should be used with caution in patients on methotrexate due to an increased risk of nephrotoxicity

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57
Q

trimethoprim and methotrexate?

A

Trimethoprim is a folate antagonist, and is a direct contraindication to patients taking methotrexate (another folate antagonist) due to the risk of bone marrow toxicity. This can lead to pancytopenia and neutropenic sepsis. The trimethoprim should therefore be stopped.

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58
Q

infection and methotrexate?

A

Methotrexate is contraindicated in active infection and should be withheld. Owing to it’s long half life, one missed dose should not affect control of the RA.

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59
Q

post TIA and heparin proph?

A

This patient suffered an acute stroke one week ago and should therefore not be taking heparin thromboprophylaxis during this initial period (the exact period varies throughout the UK but is typically a few months).

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60
Q

verapamil and BB?

A

Verapamil should not be used with beta-blockers due to the risk of bradycardia (or at worst asystole) and hypotension (unless under expert supervision).

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61
Q

insulin for DM, IV or SC?

A

Novomix 30® (a combination of short and medium acting insulin) is never given IV; as a rule all insulin is s/c except for sliding scales using short-acting insulin (e.g. Actrapid® or NovoRapid®) given by IV infusion.

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62
Q

steroids and FBC?

A

may cause neutrophilia

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63
Q

2 drugs causing neutropenia

A

clozapine (antipsychotic), carbimazole (antithyroid)

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64
Q

drugs causing low platelets?

A

penicillamine (in RA tx) –> reduced production

heparin –> increased destruction

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65
Q

causes of hyponatreamia?

A

hypovolaemic : fluid loss, diuretics, Addisons’

euvolaemic: SIADH, psychogenic polydipsia, hypothyroid
hypervolaemic: HF, renal failure, liver failure (causing hypoalbuminaemia), nutritional failure (causing hypoalbuminaemia), thyroid failure (hypothyroid)

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66
Q

causes of hypernatraemia?

A

all with ‘d’
dehydration; drips (i.e. too much IV saline); drugs (e.g. effervescent tablet preparations or intravenous preparations with a high sodium content); diabetes insipidus (which is effectively the opposite of syndrome of inappropriate antidiuretic hormone (SIADH).

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67
Q

causes of hypokalaemia

A 
DIRE 
diuretics - loop and thiazide 
Inadequate intake or intestinal loss (d&v) 
renal tubular acidosis 
endo (Cushing's and Conn's)
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68
Q

causes of hyperkalaemia

A 
DREAD 
drugs (k sparing diuretics and ACEi) 
endo (Addisons) 
artefact (clotted sample) 
DKA (note that when insulin is given to treat DKA the potassium drops, requiring regular (hourly) monitoring +/− replacement )
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69
Q

nephrotoxic abx?

A

gentamicin, vancomycin, tetracyclines

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70
Q

causes of intrinsic AKI

A 
INTRINSIC 
Ischaemia (due to prerenal AKI, causing acute tubular necrosis) Nephrotoxic antibiotics∗∗
Tablets (ACEI, NSAIDs)
Radiological contrast
Injury (rhabdomyolysis)
Negatively birefringent crystals (gout)
Syndromes (glomerulonephridites)
Inflammation (vasculitis)
Cholesterol emboli
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71
Q

a raised urea with normal creatinine in a patient who is not dehydrated (i.e. does not have prerenal failure)?

A

upper GI bleed

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72
Q

drugs causing biliary cholestasis?

A

Flucloxacillin, CO-AMOXICLAV, nitrofurantoin, steroids and sulphonylureas.

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73
Q

TSH target range?

A

target range ∼0.5–5 mIU/L

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74
Q

gentamicin - high serum level (without signs of toxicity); what do?

A

pre-empt a decrease in frequency by 12 h rather than reducing the dose, e.g. changing from every 24 h (daily) to every 36 h

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75
Q

digoxin toxicity?

A

Confusion, nausea, visual halos, and arrhythmias

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76
Q

Li toxicity?

A

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

77
Q

phenytoin toxicity?

A

Gum hypertrophy, ataxia, nystagmus, peripheral neuropathy, and teratogenicity, dysarthria

78
Q

gentamicin toxicity?

A

Ototoxicity and nephrotoxicity

79
Q

vancomycin toxicity?

A

Ototoxicity and nephrotoxicity

80
Q

warfarin , INR 5-8

A

if no bleeding - Omit warfarin for 2 days then reduce dose

if bleeding - Omit warfarin and give 1-5mg IV vitamin K

81
Q

warfarin, INR >8

A

no bleeding - Omit warfarin and give 1-5mg PO vitamin K

bleeding - Omit warfarin and give 1-5mg IV vitamin K

82
Q

Formula for serum osmolality?

A

2(Na + K) + urea + gluc

83
Q

BB Ci?

A

hypotension, bradycardia, asthma, and acute heart failure

84
Q

Ccb ci?

A

hypotension, bradycardia, and peripheral oedema

85
Q

AED SEs : lamotrogine

A

Rash, rarely Stevens–Johnson syndrome

86
Q

AED SE: carbamazepine

A

Rash, dysarthria, ataxia, nystagmus, ⇓Na

87
Q

AED SE: phenytoin

A

Ataxia, peripheral neuropathy, gum hyperplasia, hepatotoxicity

88
Q

AED SE: sod valproate

A

Tremor, teratogenicity, weight gain

89
Q

AED SE: levetiracetam

A

Fatigue, mood disorders and agitation

90
Q

What to check before prescribing azathioprine or 6-mercaptopurine?

A

Thipurine S-methyl transferase (TPMT) levels.
Need for metabolising. Increases risk of liver and bone marrow toxicity
Lower dose aza if TPMT low
Methotrexate if TPMT absent

91
Q

CI to laxatives?

A

bowel obstruction

92
Q

Laxatives: Stool softener?

A

Good for faecal impaction; reduced gut motility

eg. docusate sodium (stimulant at higher levels) Arachis oil (rectal)

CI: arachis oil - nut allergy

93
Q

Laxatives: bulking agents?

A

can take days to develop effect

eg. isphagula husk; usually for colonic atonic, reduced gut motility.

CI isphagula husk - faecal impaction

94
Q

stimulant laxatives

A

nb may exacerbate abdominal cramps

eg. Senna, bisacodyl
ci: bisacodyl - Acute abdominal

95
Q

osmotic laxatives

A

max exacerbate bloating

eg. lactulose, phosphate enema

CI to phosphate enema - acute abdomen, inflammatory bowel disease

96
Q

relief for chronic non-infective diarrhoea

A

loperamide 2mg oral up to 3 hourly

or codeine 30mg oral up to 6 hourly which will also give pain relief.

97
Q

drug induced neutropenia, eg?

A

carbimazole

carbamazepine

98
Q

CI for prescribing COCP?

A

age >35 (avoid age >50), smoker, and BMI >30 kg/m2, family history of venous thromboembolism in a first degree relative <45 years of age, long-term immobilisation, and history of superficial thrombophlebitis.

99
Q

patient with carbamazepine wants contraception. what to consider?

A

make sure meds are not oral affected by enzyme inducing drugs including carbamazipeine.
particularly, avoid COCP as efficacy affected.
Parenteral progesterone only best

100
Q

ramipril and pregnancy?

A

teratogenic in 1st trimester. prescribe labetalol instead

101
Q

tamoxifen

A
  • hot flushes are SE
  • increases risk of endometrial ca
  • increases risk of VTE
  • increases efficacy of warfarin, so increases INR
102
Q

sulphnylureas and hypos?

A

eg. gliclazide

increases risk of hypoglycaemia. Do not take at bedtime as more risk of nocturnal hypos

103
Q

what not to take with methotrexate?

A

no folate anatagonsits!

eg. trimethoprim,co-trimoxazole

104
Q

warfarin tablets: colour and dose?

A

white (0.5 mg), brown (1 mg), blue (3 mg), and pink (5 mg

105
Q

steroids, what to prescribe with ?

A
  • risk of osteoporosis if >3 months, prophylaxis with bisphosphonate
  • gastric irritation if at risk, PPI or H2 anatgonist
106
Q

steroids - at risk of what?

A
  • long term therapy increases risk of hyperglycaemia ; monitor BMs
  • risk of osteoporosis
  • risk of gastric irritation/ulcers
  • risk of HTN
  • if stopped suddenly, addisonian crisis
107
Q

T1DM and illness

A

when unwell, blood glucose increases; therefore, higher basal doses are required. Failing to do so will increase the risk of diabetic ketoacidosis. Conversely, if patients reduce their oral intake (which many will when ill), there is a risk of hypoglycaemia if the insulin intake is not decreased.

108
Q

if rx bisphosphonates and calcium (eg. alendronic acid and adcal) beware what?

A

ca salts reduce absorption of bisphosphonates and should not be taken at same time of day.

109
Q

combined oestrogen progesterone HRT, Breast ca risk lower or higher?

A

higher, esp if continuous HRT preparation

110
Q

1% solution means what?

A

1g in 100ml

111
Q

1 in a 1000 meaning>

A

1g in 1000ml

112
Q

oliguric patient with tachycardia, normal BP and raised na, k, ur and creat. What to prescribe?

A

fluids as oliguric + tachy
no hypotensive, so crystalloid (normal saline, harmans, or 5% dex)
as na and k raised, give 5% dex
as tachy, oliguric, deranged u&e, she is very dehydrated : prerenal aki.
so give 500ml iv challenge or 1l stat over 1 h.

113
Q

what time of day to give diuretics?

A

in the morning to prevent diuresis at night

114
Q

first drug to give to lower K in hyperkalaemia?

A

short acting insulin eg.
novorapid 10 units in 100 ml of 20% dextrose over 30 min IV
(could do in 50ml of 50% dex but irritates veins)

115
Q

levetiracetam SE?

A

Worsens depression

116
Q

CI for metformin?

A

creatinine >150mmol/l cause lactic acidosis

117
Q

RFs increasing risk of myopathy with statins ?

A

a personal or family history of muscular disorders, previous history of muscular toxicity, a high alcohol intake, renal impairment, hypothyroidism, and in the elderly

118
Q

what to check when Rx simvastatin?

when rf of myopathy and no rfs

A

ck if rf
alt if no rf (transaminases (i.e. ALT or AST) should be checked 3 and 12 months after starting treatment (by requesting liver function tests (LFTs)).

119
Q

SE of vancomycin?

A

nephrotoxicity and ototoxicity.

rarely, neutropenia (needs at be on more than 1 week), thrombocytopenia

120
Q

what to check before commencing vancomycin?

A

u&e

renally excreted.

121
Q

electrolyte change and Li toxicity?

A

Sodium depletion is known to increase the risk of lithium toxicity

122
Q

what do If LFT abnormal and RA

A

do not give methotrexate.

risk of liver cirrhosis

123
Q

what to check before commencing olanzapine?

A
  • prolactin (for all antipsychotic drugs)
  • lipids and BMI
  • fasting blood glucose (risk of hyperglycaemia and DM)
124
Q

what to check before commencing amiodarone?

A
  • T3, T4, TSH
  • LFTs
  • CXR
  • serum K
125
Q

CI to carbimazole?

A
  • pregnancy (congenital malformations if in 1st trimester)

- acute pancreatitis hx (as can cause it)

126
Q

SE heparin?

A

Haemorrhage (especially if renal failure or <50 kg), heparin-induced thrombocytopaenia
hyperkalaemia - esp dalteparin and all heparins(due to inhibition of aldosterone synthesis)

127
Q

what to prescribe with warfarin initially?

A

Haemorrhage (note that ironically warfarin has a procoagulant effect initially, as well as taking a few days to become an anticoagulant; thus heparin should be prescribed alongside warfarin and continued until the INR exceeds 2

128
Q

SE aspirin

A

Haemorrhage, peptic ulcers and gastritis, tinnitus in large doses

129
Q

digoxin SE?

A

Nausea, vomiting and diarrhoea, blurred vision, confusion and drowsiness, xanthopsia (disturbed yellow/green visual perception including ‘halo’ vision)

130
Q

K and digoxin?

A

lower with high K

Digoxin competes with potassium at the myocyte Na+/K+ ATPase, limiting Na+ influx. Since Ca2+ outflow relies on Na+ influx, Ca2+ accumulates in the cell. This lengthens the action potential and slows the heart rate. This summary is important because changes in serum K+ at the receptor can compete with digoxin; low K+ augments digoxin effect. High levels limit the effect

131
Q

amiodarone se

A

Interstitial lung disease (pulmonary fibrosis), thyroid disease (both hypo- and hyperthyroidism), skin greying, corneal deposits

132
Q

haloperidol SE

A

Dyskinesias, e.g. acute dystonic reactions, drowsiness

133
Q

fludrocortisone SE

A

Hypertension/sodium and water retention

134
Q

statin SE

A

Myalgia∗, abdominal pain, increased ALT/AST (can be mild), rhabdomyolysis (can be just mildly increased creatine kinase though)

135
Q

Mx of statin induced myalgia?

A

exclude rhabdomyolysis (with creatine kinase (CK) level and urine dip). Otherwise, if symptoms unacceptable or CK very high (>2,000): (i) ensure needs statin, then (ii) reduce the dose; then (iii) switch to other statin with lower risk of myalgia (risk of myalgias: simvastatin > atorvastatin > pravastatin > fluvastatin) or a fibrate.

136
Q

why stop metformin before surgery?

A

to prevent lactic acidosis in the case of renal compromise.

137
Q

on co-codamol and renal failure?

A

patient may be drowsy

138
Q

new dx of DMT2 and CKD. what is 1st line drug to start?

A

gliclazide

metformin CI if eGFR <30 ml/min

139
Q

when to give blood transfusion for fe def anaemia

A
  • severely symptomatic and cannot wait for effect of oral iron replacement (in fe def Hb rises by 10g/l/week on oral fe replacement)
  • have Hb <70 g/L; <100g/L in IHD
140
Q

what are examples of oral Fe replacement?

A

ferrous sulphate/gluconate/fumarate etc.

141
Q

se of oral fe replacement ?

A

constipation ; most common cause of non compliance
also give laxative
also, offensive black stools

142
Q

how long to have oral fe replacement?

A

until hb normal range, then for further 3 months

143
Q

steroids and fbc abnormality?

A

leucocytosis

144
Q

drug which increases phenytoin conc?

A

chloramphenicol

145
Q

severe flare of UC?

A

> 6 bowel motions/day and systemically unwell

first line tx is iv hydrocortisone 100mg 6 hourly

146
Q

alcohol in DM

A

life threatening hypoglycaemia

147
Q

electrolyte imbalance and digoxin toxicity?

A

low K predisposes to digoxin toxicity

148
Q

indication to stop fluoxetine in pt?

A

rash! - impending systemic reaction?

149
Q

SE of microgynon?

A

wt gain, irritability, new headaches , htn

150
Q

NMS, esp occulogyric crisis, what dx?

A

procyclidine

151
Q

PONV first line?

A

ondansetron

152
Q

SE of ondansetron?

A

prolongation of QTc

use cyclizine instead.

153
Q

if fluid challenge, what dose in what time?

A

500ml in less than 15 mins

or IL in less than 30 mins

154
Q

eplenerone and ciclosporin

which electrolyte abnormality?

A

hyperkalaemia

155
Q

ankle oedema drug causes?

A

amlodipine, naproxen

156
Q

drugs increasing conc of digoxin?

A

amiodarone, ccb, spiro, quinine

157
Q

drugs causing digoxin tox by hypokalaemia, hypomagnesia>

A

loop and thiadie diuretics

158
Q

interaction with levothyroxine?

A

ca and fe salts reduce efficacy of levo

rx at diffeent time of day.

159
Q

DRESS syndrome?

A

= drug reaction with eosinophilia and systemic symptoms.

eosinophilia, systemic symps including. fevr, lymphadenopathy, liver dysfunc.

example of delayed hypersensitivy reacion type IV.

common drug previpirants - allpurinol, AEDs (eg. carbamazepine), sulphonamides (co-trimoxazole)

160
Q

AGEP

A

acute genralised exanthematous puStulosis (AGEP)
severe cutaneous reaction secondary to abx.
usually penicillin abx and sulphonamides (eg. trimethoprim)
associated with liver dysfunc

161
Q

SLUDGE symptoms ?

A

SLUDGE (Salivation, Lacrimation, Urination, Defecation Gastrointestinal upset: emesis]

Remember if on anti-muscarinic, can cause opposite of above (esp if elderly)

162
Q

CI to COCP?

A

Uncontrolled hypertension (particularly ≥160 / ≥100)
Migraine with aura (risk of stroke)
History of VTE
Aged over 35 and smoking more than 15 cigarettes per day
Major surgery with prolonged immobility
Vascular disease or stroke
Ischaemic heart disease, cardiomyopathy or atrial fibrillation
Liver cirrhosis and liver tumours
Systemic lupus erythematosus (SLE) and antiphospholipid syndrome
BMI above 35 is UKMEC 3 for the combined pill

163
Q

1 missed pill for cocp?

A

> 72 hours since last pill
(missed pill means more than 24 hours late)

take missed pill asap, no extra contraception needed.
(only need extra if >1 pill missed)

164
Q

1 missed pill for traditional POP?

A

> 26 hours since last pill
(missed pill means more than 3 hours late)

take missed pill asap + extra contra for 48 hrs

165
Q

1 missed pill for desogestrel POP?

A

> 36 hours late since last pill
(missed pill means more than 12 hours late)

take missed pill asap + extra contra for 48 hours

166
Q

drugs causing SJS/TEN?

A

anticonvulsants, sulfa-containing drugs, antibiotics, nonsteroidal anti-inflammatory drugs, and uric acid-lowering agents

167
Q

drugs causing DRESS?

A

anticonvulsants, anti-infectious (antibiotics, antituberculosis, and antiviral) agents, sulfonamides, and uric acid-lowering medications

168
Q

drugs causing AGEP (acute generalised exanthematous pustulosis) ?

A

pristinamy- cin, ampicillin/amoxicillin, quinolones, hydroxychloroquine, anti-infective sulfonamides, terbinafine, and diltiazem

nb think lesions + fever + leucocytosis

169
Q

drugs causing GBFDE (generlaised bullous fixed drug eruptions) ?

A

antibiotics, including cephalosporins, penicillins, and anti-infective sulfonamides, followed by nonsteroid anti-inflammatory drugs

170
Q

aspirin ci?

A

<16 = reye’s syndrome
active peptic ulcers (beware when hx)
hx of hypersensitivity to aspirin or any nsaid
avoid in preg (3rd tri) and BF if possible
bleeding disorder
haemophilia

171
Q

SE of warfarin?

A 
haemorrhage 
teratogenic,  but can use in BF
skin necrosis 
purple toes
heparin induced thrombocytopaenia 
hyperkalaemia
172
Q

heparin (unfractionated) v LMWH?

A

both parenteral forms
Heparin IV or SC ; LMWH SC
Heparin initiates rapidly + short acting, and easily reversible
LMWH longer acting, but harder to reverse
LMWH - reduced risk of heparin induced thrombocytopenia

173
Q

Periop and warfarin; what do?

A

stop 5 days before. day of op if INR >/= 1.5, give IV vit K PO
restart warfarin evening post op or next day if haemostasis achieved.

If high risk of VTE (vte within last 3/12, AF with TIA/stroke, mitral mechanical valve) give bridging therapy with LMWH tx dose. this needs to be stopped 24 h before surgery.

174
Q

Paracetamol - cautions?

A

body wt <50kg
chronic alcohol consumption
chornic dehydration
chronic malnutrition

175
Q

PRN morphine dose/breakthrough pain morphine dose?

A

1/6th of 24hr morphine dose
repeat 2-4 hrs as required, max 6 times in a day
fentanyl also licensed for breakthrough pain

176
Q

morphine oral dose to parenteral dose relation ?

A

parenteral dose 1/2 of oral dose

177
Q

BDZ and opioid?

A

cause additive CNS depression - drowsy aand resp depression

do not co prescribe of possible

178
Q

when to use CrCl rather than eGFR?

A

for toxic drugs, elderly patients and patients at extremes of muscle mass (BMI <18 or >40)

179
Q

Short acting BDZ?

A

Eg. temazepam
act for shorter time and have no hangover effect next day.
good if hepatic impairment
worse withdrawal effect than with long acting BDZ

180
Q

Drugs commonly causing urinary retention:

esp if post op and old

A 
morphine 
anticholinergics (antipsychotics, antidepressants, anticholinergic, detrusor relaxants) 
GA
alpha adrenoceptor agonists
BDZ
NSAID
CCB 
antihistamine
alcohol
181
Q

Started on statin and ALT raised, do you stop?

A

if ALT raised <3 times upper limit, continue statin at same dose.
if >3 times, stop statin

182
Q

high trough pre dose, what do?

A

increase dosing period

183
Q

high peak post dose , what do?

A

decrease dose

184
Q

interactions with OCP?

A

all anticonvulsants of older gen except sodium valporate (newer like lamotrigine not liver enzyme inducres but sitll should be avoided)

rifampicin (liver inducer) - including in rifabutin

griseofulvin - contra failure and menstrual irregularities. (antifungal)

185
Q

indications for sodium bicarb infusion in TCA overdose ?

A

metabolic acidosis
neuro - sirzures, neuroexcitability
cardiac - broad qrs/arrhythmia
hypotension

186
Q

metronidazole + alcohol?

A

disulfiram like reaction - flushing, headache, tachy

avoid alcohol while on it + 48h after stopping

187
Q

hypoglycaemia and pt unconcious, what do?

A 
glucose 20% 50-100ml (or gluc 10% 100-200ml 2nd line) 
given stat (15 min)
188
Q

DKA, what insulin?

A

soluble insulin 50 units in sodium chloride 0.9% 50ml by infusion at rate of 0.1 units/kg/h

Phase 4 (4 decks)

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