PSA Flashcards
1
Q
What is the first line treatment for severe pulmonary oedema in acute heart failure?
A
Furosemide 40mg IV
2
Q
What should be monitored to assess the beneficial effects of diuretics?
A
Weight
3
Q
Give a contraindication for compression stockings.
A
peripheral vascular disease
4
Q
What is the treatment dose and prophylactic dose of dalteparin for VTE?
A
Treatment - 15000units
Prophylactic - 5000units
5
Q
What is the first line management for hypoglycaemia in an unconcious patient?
A
Glucose 20% IV 100ml over 15 mins.
6
Q
Which antibiotics can be used in acne that is not responding to topical treatments?
A
Tetracycline, oxytetracycline and doxycycline.
7
Q
What are the main side effects of steroids?
A
S - stomach ulcers T - thin skin E - edema R - right and left HF O - osteoporosis I - infection D - diabetes S - cushings syndrome
also: non-infective raise in WCC and confusion in the elderly
8
Q
What would happen if you stopped long-term steroids suddenly?
A
Addisonian crisis
9
Q
What are some contraindications of NSAID use?
A
N - no urine S - systolic failure A - asthma I - indigestion D - Dyscrasia (abnormal platelets)
10
Q
Which antihypertensive class causes a dry cough?
A
ACE inhibitors
11
Q
Which class of drugs causes a mild rise in creatinine?
A
ACE inhibitors
12
Q
Which 2 antihypertensive classes should be avoided in peripheral vascular disease?
A
ACE inhibitors
Beta blockers
13
Q
At what time of day should ACE inhibitors be given?
A
Night to avoid posutral hypotension
14
Q
How do you measure the beneficial effects of ACE inhibitors?
A
exercise tolerance
15
Q
How do you measure the beneficial effects of beta blockers?
A
HR
16
Q
Which antihypertensive class has no effect on electrolytes?
A
Calcium channel blockers
17
Q
What is the first line treatment for alcohol withdrawal?
A
Benzodiazepines i.e. chlordiazepoxide
18
Q
What is the treatment give in alcohol induced vitamin B1 deficiency?
A
Pabrinex (thiamine)
19
Q
Which drug reduces the pleasure induced from drinking alcohol?
A
Acamprosate
20
Q
What are the contraindications of cyclizine?
A
HF
21
Q
What are the contraindications of metocloparmide?
A
Parkinsons
Bowel obstruction
22
Q
What is the dose of cyclizine?
A
50mg 8 hourly IM/IV
23
Q
What is the dose of metoclopramide?
A
10mg 8 hourly IV
24
Q
What is the dose of paracetamol?
A
1g 6 hourly PO
25
What is the dose of ibuprofen?
200-400mg 8 hourly PO
26
What is the dose of codeine?
30-60mg 6 hourly PO
27
What is the dose of co-codamol?
2 tablets 6 hourly
28
What is the dose of aspirin?
75-300mg daily
29
What is the dose of clopidogrel?
75-300 daily
30
What is the dose of simvastatin?
10-80mg nightly
31
What is the dose of atenolol?
25-100mg daily
32
What is the dose of ramipril?
1.25-10mg daily
33
What is the dose of bendroflumethiazide?
2.5mg daily
34
What is the dose of furosemide?
20mg daily - 80mg bd
35
What is the dose of amlopdipine?
5-10mg daily
36
What is the dose of omeprazole?
20-40mg od
37
What is the dose of lansoprazole?
15-30mg daily
38
What is the dose of levothyroxine?
25-200 micrograms daily
39
What is the dose of metformin?
500mg daily - 1g bd
40
What is first line analgesia in neuropathic pain?
paracetamol
41
Which painkiller must be avoided in patients with a risk of serotonin syndrome?
Tramadol
42
What is the rule with drug choice for breakthrough pain?
Generally breakthrough pain should be treated with the same drug that is being given as continued pain relief. E.g. if a patient is on a fentanyl patch, give fentanyl nasal spray
43
In renal impairment, what should be used in place of morphine for acute pain?
Oxycodone or fentanyl nasal spray
44
Which antibiotics can be used first line in UTI?
3 days for women, 7 days for men
nitrofurantoin - avoid at term pregnancy and renal failure
trimethoprim - avoid in pregnancy
45
What is the acronym to remember acute heart failure management?
```
UNLOAD FAST
upright position
nitrates
loop diuretics
oxygen
ACEi
digoxin
fluid restriction
afterload restriction
sodium restriction
Test: ABG, ECG, potassium, digoxin levels
```
46
Which four drugs should be used in chronic HF?
beta blocker
spironolactone (improves prognosis)
furosemide (improves sx)
ACEi
47
Which 2 drugs may exacerbate HF?
diltiazem
| prednisolone
48
Which drug types can predispose someone to vaginal candida?
antibiotics
| steroids
49
What is the first line pharm in T2DM?
metformin
50
What is the CI of metformin?
renal impairment
51
What is the second line mx in T2DM?
gliclazide
52
What are the SE of gliclazide?
hypoglycaemia
| weight gain
53
What is the first line treatment for hypoglycaemia in a concious patient?
oral glucose 10-20g
54
How do you treat a severe (systemically unwell with >6 bowel movements) UC flare?
IV hydrocortisone and fast fluids
55
How do you treat a mild UC flare?
oral prednisolone 30mg over 24 hours
56
In an over-anicuagulated patient, if the INR if <6 what do you do?
reduce warfarin
57
In an over-anicuagulated patient, if the INR is between 6-8, what do you do?
omit for 2 days the reduce dose
58
In an over-anicuagulated patient, if the INR is >8, what do you do if the patient is not bleeding?
give oral vitamin K 1-5mg
59
In an over-anicuagulated patient, if the INR is >8, what do you do if the patient is bleeding?
give IV vitamin K 1-3mg
60
Is warfarin safe in breastfeeding?
yes
61
Is warfarin safe in pregnancy?
no - congenital malformations/foetal haemorrhage
62
What must you do when starting a patient on warfarin?
Starting warfarin: procoagulant in the first few days so you must bridge for 2 days with LMWH
63
What should be done if 1 COCP is missed?
Take missed pill and todays pill (2 at the same time) and continue
64
What should be done if 2 COCP are missed?
Take the last missed pill and todays pill (cannot take 3 at the same time) and the use 7d additional contraception
65
What should be done if 3 COCP are missed?
take EC if in first 7 days of pack, skip the week off in last 7 days of pack
66
What should be done if a women is >3hours late taking POP?
>3 hours late (>12 hours if desogestrel pill) then take EC and take missed and used additional contraception for 3d
67
What are the three options for emergency contraception and how long to they protect for?
Levonogestrel 72 hours
Ulipristal 120 hours – CI in breastfeeding and asthma
IUD 120 hours
68
Which route of HRT is preferred in high VTW risk patients?
patch
69
What are the SE of HRT?
o Increased risk of breast cancer (in progesterone preparations)
o Increased risk of endometrial cancer (never give oestrogen alone in a woman with a uterus)
o Increased risk of VTE – transdermal is best for this
o Increased risk of IHD
o Decreased risk of colon cancer
70
Which type of HRT should women with a uterus be given?
Combined oestrogen and progesterone (protects against endometrial cancer)
71
If glycaemic control in the afternoon needs to be improved, how do you do that?
Increase morning insulin
72
If a diabetic paient is taking a short course of steroids and getting hyperglycaemia as a result, how do you adjust their insulin regime?
Increase biphasic insulin by 10%
73
How do you monitor the beneificial effects of statin use?
There should be a 40% reduction in non-HDL cholesterol after 3 months of treatment, if not increase the dose.
74
What should be done when a statin is causing significant myopathy/CK rise?
Discontinue statin then restart when CK levels return to normal.
75
What is the first line fluid resus in hypovolaemia?
give 500ml NaCl 0.9% over 15 mins IV
76
What is the first line fluid resus in hypoglycaemia or hyponatramia?
5% glucose
77
What is the rule of thumb for maintenance fluids?
2 sweet and 1 salty:
- 1L 0.9% NaCl + 20mmol KCl over 8 hours
- 1L 5% dextrose +20mmol KCl over 8 hours
- 1L 5% dextrose +20mmol KCl over 8 hours
78
In what circumstances would you give 250ml fluid bolus instead of 500ml?
frail, thin, renal failure, HF
79
What rout is insulin ALWAYS given unless in a sliding scale?
SC
80
What are the 4 different kinds of laxatives?
```
BOSS
Bulk forming
Osmotic - lactulose
Stimulants - senna, sodium picosulfate, bisacodyl
Stool softeners - docusate
```
81
What drug is used to treat hepatic encephalopathy?
Lactulose
82
How do you treat hyperkalaemia?
- IV calcium gluconate
- 10 units actrapid, 100mls 20% IV dextrose
- calcium resonium
- salbutamol nebuliser
83
Which drugs together can cause rhabdomyolisis?
Statins and macrolides
84
Why must trimethoprim be avoided with methotrexate?
Nephrotoxic
85
What drug is used to treat secretions in palliative care?
hyoscine butylbromide
86
Which drugs can be used to treat agitation in palliative care?
midazolam and haloperidol
87
Which drug is typically used for pain in palliative care?
morphine
88
Which drug is typically used for nausea in palliative care?
cyclizine
89
What are the MONAT drugs used in acute MI mx?
```
Morphine
Oxygen
Nitrates
Aspirin
Ticagrelor/clopidogrel
```
90
What are the CRABS drugs used in long term MI mx?
```
Clopidogrel
Ramipril
Aspirin
Beta blocker
Statin
```
91
How do you treat fast AF that has been there >48 hours?
```
'Dil and Vera'
Diltiazem
Verapamil
Or beta blockers
Or digoxin
Plus VTE proph
```
92
How do you treat fast AF that that has been there <48 hours?
'Ami and Flec'
Amiodarone/flecanide
Or DC cardioversion
93
How do you treat anaphylaxis?
500micrograms (0.5ml) of 1:1000 adrenaline IM
10mg cholphenamine IV
200mg hydrocortisone IV
94
What is the mneumonic used for asthma attacks?
```
OSHITME
Oxygen
Salbutamol
Hydrocortisone or prednisolone
Ipratropium
Thoephylline
Magnesium sulphate
```
95
What drug is used to treat generalised seizures?
sodium valproate
96
What drug is used to treat focal seizures?
carbamazepine
97
What does a high TSH indicate in levothyroxine treatment?
poor adherence
98
Which two drugs should be stopped in heart failure as they may worsen it?
verapamil
| diltiazem
99
Why must beta blockers, ACE inhibitors and calcium channel blockers be prescribed together with caution?
Risk of heart block
100
Which type of diuretic can precripitate hypokalaemia, hypercalcaemia, hyponatraemia and gout?
thiazide
101
Which drug class may worsen urinary incontinence?
diuretics
102
Which two antihypertensives worsen hyperkalaemia?
ACEi
| ARBs
103
Which types of drugs are potassium conserving?
Potassium sparing diuretics (aldosterone antagonsist) e.g. spironolactone, eplerenone
ACEi
ARBs
104
Why mustnt nitrates and sildenafil be used together?
risk of cardiovascular collapse (double whammy of vasodilator)
105
How long should VTE prophylaxis be continued after the first instance of unprovoked VTE?
6 months
106
Why must anticoagulants not be prescribed with NSAIDs?
GI bleeding risk
107
Which conditions are worsened by TCAs?
```
dementia
narrow angle glaucoma
cardiac conduction abnormalities
prostatism
hx of urinary retention
```
108
What are the anticholingeric side effects?
cant see
cant pee
cant spit
cant shit
109
Which electrolyte abnormality can be worsened by SSRIs?
hyponatraemia
110
What is the max time that someone should be on benzodiazepines?
4 weeks - remember to wean off to avoid withdrawal
111
Which two conditions have a risk of worsening with first generation anti-psychotics?
parkinsons
| LBD
112
Acetylcholinesterase inhibitors used in dementia mx should not be used if a patient has what?
peristent bradycarsia, heart block, reccurent unexplained syncope or concurrent mx with antihypertensives,
113
Which 5 drug types should be avoided in low GFR?
```
digoxin
direct thrombin inhibitors
factor Xa inhibitors
NSAIDs
colchicine
metformin
```
114
Which drugs are likely to cause constipation?
antimuscarinin, anticholinergic, oral iron, opioids, verapamil, aluminium antacids
115
Which two GI drugs should be avoided in parkinsons?
Prochlorperazine or metoclopramide
116
Which two conditions can be worsened by ipratropium/tiotropium?
narrow angle glaucoma
| urinary retention
117
What is the first line mx for RA?
DMARDs e.g. methotrexate
118
Why must beta blockers be used in caution with diabetics who have frequent hypoglycaemic episodes?
risk of beta blockers suppressing the sx of hypoglycaemia
119
What does the use of oestrogens increase the risk of?
endometrial ca
breast ca
VTE
120
List the drugs that are likely to cause falls in the elderly?
benzos
antipsychotics
vasodilators
hypnotic z-drugs
121
What should be co-prescribed with long term opioid use?
laxative
