PSa Flashcards
1
Q
STEMI Mx (5)
A
- O2 if hypoxic
- GTN spray +/- morphine + metoclopramide
- 300mg Aspirin
- P2Y12
- Fondaparinux/Unfractionated heparin
2
Q
Long term drug Mx of STEMI? (4) Alternative to B-blocker? When can this be used?
A
- Aspirin - indefinite
- P2Y12 - 12 months
- ACEi - indefinite
- B-blocker - indefinite
B-blocker only if reduced LVEF
Verapamil/Diltiazem as alternative if normal LVEF
3
Q
Acute HF Mx (3)
A
- 15L O2
- Slow IV diamorphine + metoclopramide + furosemide
- Nitrates (if SBP >90)
4
Q
SVT Mx (3)
A
DC shock if unstable 1. 15L O2 2. Vagal manoeuvres 3. Adenosine (6-12-12)/ verapamil in asthmatics DC shock if no improvement
5
Q
Acute asthma Mx
A
- 15L O2
- Salbutamol Neb
- Ipratropium bromide Neb (for severe and above)
- Oral prednisolone
6
Q
Signs of severe asthma attack? (4)
A
- Unable to complete sentences
- HR >110
- RR >25
- PEFR <50%
7
Q
Signs of a life-threatening asthma attack? (7)
A
- SpO2 <92%
- PEFR <33%
- Cyanosis/confusion
- Hypotension
- Exhaustion (normal or rising PaCO2)
- Silent chest
- Tachy/bradyarrhythmias
8
Q
When can you discharge a patient after a severe of life threatening attack? (2)
A
- Stable on discharge medication for 24h
- PEFR >75%
9
Q
Bacterial meningitis Mx >55?
A
Ceftriaxone + amoxicillin
10
Q
Bacterial meningitis Mx <55?
A
Ceftriaxone
11
Q
Bacterial meningitis prophylaxis for contacts? (2)
A
Cipro or rifampicin
12
Q
Bacterial meningitis Mx in children? (> 3m)
A
<3m = cefotaxime + amox >3m = ceftriaxone
13
Q
Mx of anaphylaxis
A
Adrenaline:
6m-5y = 150mcg
6y-12y = 300mcg
>12 = 500mcg
Hydrocortisone:
6m-5y = 50mg
6y-12y = 100mg
>12 = 200mg
Chlorphenamine (look up doses)
14
Q
How often can adrenaline be given in anaphylaxis?
A
Every 5 mins
15
Q
How much adrenaline in EpiPen?
A
300mcg
16
Q
How long should patients be admitted for with anaphylaxis?
A
Monitoring for at least 24h due to biphasic response
17
Q
Acute COPD exacerbation Mx (4)
A
- 15L O2
- SABA neb
- Ipratropium bromide NEB
- Oral prednisolone 5days
18
Q
Abx used for infective COPD exacerbation? (3)
A
- Amox
- Clarithromycin
- Doxycycline
19
Q
O2 prescribing in COPD patient? (2)
When is BiPaP indicated? (2)
A
Acutely unwell = 15L high flow
Otherwise 28% 4L Venturi until ABG results.
BiPaP if RR >30 or pH <7.3
20
Q
Abx Mx of pneumonia? (3)
A
CURB 1 = amox
CURB 2 = Amoxicillin (+ clarithromycin if atypical)
CURB 3 = Co-Amoxiclav + clarithromycin
21
Q
PE Mx? (3)
A
- 15L O2
- Morphine + metoclopramide
- LMWH/DOAC
22
Q
Status Mx?
A
- 4mg lorazepam
- 4mg lorazepam
- Phenytoin
23
Q
What is the Mx for: tonic-clonic, absence and atonic/myoclonic seizures?
A
Tonic-clonic = lamotrigine (G) or valproate (B)
Absence = ethosuxamide (G) or valproate (B)
Atonic/myoclonic = levetiracetam (G) or valproate (B)
24
Q
Which drugs can worsen seizure control? (9)
A
Fun things: alcohol, cocaine, amphetamines
Abx: ciprofloxacin, levofloxacin
Bronchodilators: amino/theophylline
ADHD: methylphenidate
Mefenamic acid
25
Which AED for pregnancy/women of child bearing age?
Lamotrigine
26
Main SEs of carbamazepine? (4)
Hyponatraemia
Ataxia
Dizziness
SJS
27
```
DKA Mx (3)
Rate of insulin infusion?
```
1. Fluids 1L NaCl (1-2-2-4-4-6) - start KCl in second bag
2. Insulin infusion
3. Dextrose when BM <14 (125ml/hr)
rate = 1unit/mL at 0.1 units/kg/hr
28
When can insulin be stopped in DKA? (3) What about their normal regime?
```
until:
ketones <0.3mmol/L
pH >7.3
AND
patient is able to eat and drink.
```
Stop short acting, continue long acting
29
What are the complications of DKA? (4)
- Gastric stasis
- Thromboembolism (dehydration)
- Arrhythmia secondary to hyperkalaemia
- AKI
30
What can trigger a hypo in diabetics? (5)
- Viral infection
- Alcohol
- Exercise
- New medication
- Alcohol
31
Chronic HF Mx? (2)
1. ACEi + B-blocker
| 2. + Aldosterone antagonist (spiro/eplerenone)
32
Drugs to avoid in chronic HF? (5)
1. Pioglitazone - fluid retention
2. NSAIDs - except 75mg aspirin
3. Glucocorticoids - fluid retention
4. Verapamil - negative ionotropic effect
5. Flecanide - negative ionotropic effect
33
Chronic AF Mx (2)
1st line = B-blockers or CCBs
| 2nd line = dual therapy or + digoxin for asthmatics
34
When is rhythm control preferred in AF ? (3) What is required prior to this?
1. 1st presentation
2. <65
3. HF due to AF
3 weeks anticoagulation required
35
Stable angina Mx (5)
| When is CCB not recommended?
All patients:
1. Aspirin
2. Statin
3. GTN
Prevention:
1. B-blocker/RL CCB
2. B-blocker + RL CCB
No CCB if congestive HF
36
T1DM BM monitoring? (2)
| Target BM? (2)
1. Before meals
2. Before bed
5-7 on waking
4-7 at other time of day
37
Drug Mx of T2DM? (3)
1. Metformin
If HbA1C >58:
2. + oral hypoglycaemic
3. + oral hypoglycaemic
38
Metformin considerations (2) and contraindications (2)
Are they:
Severely underweight
Creat >150
CI:
Lactic acidosis
eGFR <30
39
Sulphonylureas considerations/SEs (4) and contraindications (2)
Consider:
1. Weight gain
2. Hyponatraemia
3. Hypoglycaemia
4. Hepatotoxicity
CI:
1. Breastfeeding
2. Pregnancy
40
When are Gliptins (DPP-4i) preferred?
When eGFR <30 (metformin CI)
41
Gliflozins (SGLT-2i) SEs (3)
1. recurrent UTI
2. WL
3. Fournier's gangrene
42
GLP-1s (exenatide) SEs? (3)
N+V
Pancreatitis
WL
43
If insulin dose is insufficient, how much should it be increased by?
10%
44
Which class of drugs can reduce hypoglycaemic awareness?
B-blockers
45
When should TFTs be checked after thyroxine dose change?
8-12 weeks
46
SEs of thyroxine?
1. Angina
2. OP
3. Hyperthyroidism
4. AF
47
Which medications reduce thyroxine effectiveness?
Iron + calcium therapy
48
P450 inducers
```
Phenytoin
Carbamazepine
Barbituates
Rifampicin
Alcohol (chronic)
Sulphonylureas
```
49
P450 inhibitors
Allopurinol
Omeprazole
```
Disfulram
Ethanol (acute)
Valproate
Isoniazid
Ciprfloxacin
Erythromycin
Sulphonamides
```
50
What should you advise someone taking warfarin? (3)
1. Keep warfarin alert card
2. If dose is missed, can be taken within 6h
3. Take dose at same time each day
51
What should you advise a woman whose missed 1 pill?
Take 2 next day - no additional contraception is required
52
What should you advise a woman who has missed ≥2 pills? (2) What additional information is required? (3)
- Take 2 pills on the day of realisation
- **Use condoms** until **7** consecutive days of pill taking
If:
1st week of cycle = emergency contraception
2nd week = no EC
3rd week = omit pill free period
53
When might the efficacy of COCP be reduced? (3)
- P450 inducers
- Vomiting **within 2h** of taking the pill
- Medication inducing D&V
54
How should you council a woman about taking the COCP? (4)
- Sex during break: intercourse during a pill free period is only affective if the next pack is **started on time**
- Other contraception: if the pill is started in the first 5 days of the cycle then no other contraception is necessary, outside this window condoms should be used for the first **7 days**
- Timing: should be taken at the same time every day
- STIs: can still get them
55
What are the absolute CI for COCP? (5)
Migraine with aura
Current breast cancer
History of stroke or IHD
>35 years old smoking >15 cigarettes/day
Breastfeeding <6 weeks
56
What are the main advantages of COCP? (4)
1. Lighter, regular and less painful periods
2. Highly effective if taken diligently
3. **Reduces** risk of ovarian and endometrial cancer
4. Can help acne
57
What are the main disadvantages of COCP? (4)
1. Hormonal SEs
2. Increased risk of VTE
3. Increased risk of cervical and breast cancer
4. Increased risk of IHD (esp in smokers)
58
Abx avoided in pregnancy? (4) CTCS
Chloramphenicol
Tetracyclines
Ciprofloxacin
Sulphonamides
59
Psych drugs avoided in pregnancy? (2)
Lithium
| Benzos
60
'Other' drugs avoided in pregnancy? MACCAS
```
Methotrexate
Aspirin
Carbimazole
Cytotoxic drugs
Amioderone
Sulphonylureas
```
61
Valproate monitoring (2)
LFT and FBC before starting
LFT at 6 month
62
Methotrexate SEs (4)
Hepatotoxic
Myelosupression
Pulmonary fibrosis
Reduced fertility
63
```
Methotrexate monitoring? (3)
What to do in these scenarios:
1. Abnormal baseline LFTs
2. Agranulocytosis
3. Reduced renal function
```
FBC, LFT + U+E:
1. Before starting
2. Weekly until stable
3. Every 2-3months when stable
1. Don't even start - risk of cirrhosis
2. STOP immediately
3. Consider reduced dose due to renal excretion and risk of toxicity
64
Antipsychotic monitoring
Before:
1. FBC/LFT/U+E
2. Lipids
3. Weight
4. Prolactin
5. BP
6. Fasting glucose
3 months:
1. Lipids
2. Weight
6 months:
1. Prolactin
2. Glucose
Annual:
All 6 + CVS risk assessment
65
What to do with high CK and statin?
stop and if symptoms resolve, restart at lower dose. If no resolution then fibrate.
66
Amioderone monitoring? (4)
Before starting: TFT/CXR/LFT/U+E
6monthly:
TFT + LFT (periodically not just with suspected toxicity)
67
Lithium monitoring? (3)
| What to do when lithium levels too high? (2)
LFT + TFT:
1. Before
2. 6 monthly
Lithium levels weekly until stable then 3 monthly
Stop lithium and drugs which impact renal function
68
What is the most important parameter to assess abx effectiveness with pneumonia?
Resp rate
69
Assessing response to DKA treatment?
Ketone levels - acidosis is most critical
70
When to reassess U+Es after starting ACEi? When should they be stopped? (2)
1-2 weeks
| Rise in creatinine by 30% OR fall in eGFR by 25%
71
What needs to monitored when initiating nicotine replacement therapy?
Blood glucose levels - esp in existing diabetics
72
When would you need to measure plasma digoxin levels?
| What is the normal monitoring parameter?
Only when toxicity is suspected (6h post dose)
| Normal = U+E - renal excreted
73
How much replacement fluid and how fast in these scenarios:
1. Oliguric
2. Oliguric + tachycardic
3. Oliguric + tachycardic + shock
1. 500mL depletion - give 1L NaCl over 2-4h
2. 1L depletion - 500mL STAT
3. 2L depletion - 500mL STAT fluid challenge
74
Presentation + Mx of chlamydia? Pregnancy?
Dysuria, urethral discharge + cervicitis
Doxycycline
Pregnancy = azithromycin
75
Presentation + Mx of gonorrhoea? (1st + 2nd)
Odourless green/yellow discharge
```
1st = IM ceftriaxone
2nd = Oral cefixime + azithromycin
```
76
Presentation + Mx of genital herpes?
Painless genital ulceration + inguinal lymphadenopathy
Mx = Oral acyclovir
