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PSa Flashcards

1
Q

STEMI Mx (5)

A
  1. O2 if hypoxic
  2. GTN spray +/- morphine + metoclopramide
  3. 300mg Aspirin
  4. P2Y12
  5. Fondaparinux/Unfractionated heparin
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2
Q

Long term drug Mx of STEMI? (4) Alternative to B-blocker? When can this be used?

A
  1. Aspirin - indefinite
  2. P2Y12 - 12 months
  3. ACEi - indefinite
  4. B-blocker - indefinite
    B-blocker only if reduced LVEF

Verapamil/Diltiazem as alternative if normal LVEF

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3
Q

Acute HF Mx (3)

A
  1. 15L O2
  2. Slow IV diamorphine + metoclopramide + furosemide
  3. Nitrates (if SBP >90)
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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
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5
Q

Acute asthma Mx

A
  1. 15L O2
  2. Salbutamol Neb
  3. Ipratropium bromide Neb (for severe and above)
  4. Oral prednisolone
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6
Q

Signs of severe asthma attack? (4)

A
  • Unable to complete sentences
  • HR >110
  • RR >25
  • PEFR <50%
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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
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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%

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9
Q

Bacterial meningitis Mx >55?

A

Ceftriaxone + amoxicillin

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10
Q

Bacterial meningitis Mx <55?

A

Ceftriaxone

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11
Q

Bacterial meningitis prophylaxis for contacts? (2)

A

Cipro or rifampicin

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12
Q

Bacterial meningitis Mx in children? (> 3m)

A 
<3m = cefotaxime + amox
>3m = ceftriaxone
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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)

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14
Q

How often can adrenaline be given in anaphylaxis?

A

Every 5 mins

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15
Q

How much adrenaline in EpiPen?

A

300mcg

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16
Q

How long should patients be admitted for with anaphylaxis?

A

Monitoring for at least 24h due to biphasic response

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17
Q

Acute COPD exacerbation Mx (4)

A
  1. 15L O2
  2. SABA neb
  3. Ipratropium bromide NEB
  4. Oral prednisolone 5days
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18
Q

Abx used for infective COPD exacerbation? (3)

A
  1. Amox
  2. Clarithromycin
  3. Doxycycline
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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

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20
Q

Abx Mx of pneumonia? (3)

A

CURB 1 = amox
CURB 2 = Amoxicillin (+ clarithromycin if atypical)
CURB 3 = Co-Amoxiclav + clarithromycin

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21
Q

PE Mx? (3)

A
  1. 15L O2
  2. Morphine + metoclopramide
  3. LMWH/DOAC
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22
Q

Status Mx?

A
  1. 4mg lorazepam
  2. 4mg lorazepam
  3. Phenytoin
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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)

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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

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25
Q

Which AED for pregnancy/women of child bearing age?

A

Lamotrigine

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26
Q

Main SEs of carbamazepine? (4)

A

Hyponatraemia
Ataxia
Dizziness
SJS

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27
Q 
DKA Mx (3) 
Rate of insulin infusion?
A
  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

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28
Q

When can insulin be stopped in DKA? (3) What about their normal regime?

A 
until: 
ketones <0.3mmol/L
pH >7.3 
AND
patient is able to eat and drink.

Stop short acting, continue long acting

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29
Q

What are the complications of DKA? (4)

A
  • Gastric stasis
  • Thromboembolism (dehydration)
  • Arrhythmia secondary to hyperkalaemia
  • AKI
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30
Q

What can trigger a hypo in diabetics? (5)

A
  • Viral infection
  • Alcohol
  • Exercise
  • New medication
  • Alcohol
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31
Q

Chronic HF Mx? (2)

A
  1. ACEi + B-blocker

2. + Aldosterone antagonist (spiro/eplerenone)

32
Q

Drugs to avoid in chronic HF? (5)

A
  1. Pioglitazone - fluid retention
  2. NSAIDs - except 75mg aspirin
  3. Glucocorticoids - fluid retention
  4. Verapamil - negative ionotropic effect
  5. Flecanide - negative ionotropic effect
33
Q

Chronic AF Mx (2)

A

1st line = B-blockers or CCBs

2nd line = dual therapy or + digoxin for asthmatics

34
Q

When is rhythm control preferred in AF ? (3) What is required prior to this?

A
  1. 1st presentation
  2. <65
  3. HF due to AF

3 weeks anticoagulation required

35
Q

Stable angina Mx (5)

When is CCB not recommended?

A

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
Q

T1DM BM monitoring? (2)

Target BM? (2)

A
  1. Before meals
  2. Before bed

5-7 on waking
4-7 at other time of day

37
Q

Drug Mx of T2DM? (3)

A
  1. Metformin
    If HbA1C >58:
    • oral hypoglycaemic
    • oral hypoglycaemic
38
Q

Metformin considerations (2) and contraindications (2)

A

Are they:
Severely underweight
Creat >150

CI:
Lactic acidosis
eGFR <30

39
Q

Sulphonylureas considerations/SEs (4) and contraindications (2)

A

Consider:

  1. Weight gain
  2. Hyponatraemia
  3. Hypoglycaemia
  4. Hepatotoxicity

CI:

  1. Breastfeeding
  2. Pregnancy
40
Q

When are Gliptins (DPP-4i) preferred?

A

When eGFR <30 (metformin CI)

41
Q

Gliflozins (SGLT-2i) SEs (3)

A
  1. recurrent UTI
  2. WL
  3. Fournier’s gangrene
42
Q

GLP-1s (exenatide) SEs? (3)

A

N+V
Pancreatitis
WL

43
Q

If insulin dose is insufficient, how much should it be increased by?

A

10%

44
Q

Which class of drugs can reduce hypoglycaemic awareness?

A

B-blockers

45
Q

When should TFTs be checked after thyroxine dose change?

A

8-12 weeks

46
Q

SEs of thyroxine?

A
  1. Angina
  2. OP
  3. Hyperthyroidism
  4. AF
47
Q

Which medications reduce thyroxine effectiveness?

A

Iron + calcium therapy

48
Q

P450 inducers

A 
Phenytoin 
Carbamazepine 
Barbituates 
Rifampicin 
Alcohol (chronic)
Sulphonylureas
49
Q

P450 inhibitors

A

Allopurinol
Omeprazole

Disfulram 
Ethanol (acute) 
Valproate 
Isoniazid
Ciprfloxacin
Erythromycin
Sulphonamides
50
Q

What should you advise someone taking warfarin? (3)

A
  1. Keep warfarin alert card
  2. If dose is missed, can be taken within 6h
  3. Take dose at same time each day
51
Q

What should you advise a woman whose missed 1 pill?

A

Take 2 next day - no additional contraception is required

52
Q

What should you advise a woman who has missed ≥2 pills? (2) What additional information is required? (3)

A
  • 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
Q

When might the efficacy of COCP be reduced? (3)

A
  • P450 inducers
  • Vomiting within 2h of taking the pill
  • Medication inducing D&V
54
Q

How should you council a woman about taking the COCP? (4)

A
  • 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
Q

What are the absolute CI for COCP? (5)

A

Migraine with aura

Current breast cancer

History of stroke or IHD

> 35 years old smoking >15 cigarettes/day

Breastfeeding <6 weeks

56
Q

What are the main advantages of COCP? (4)

A
  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
Q

What are the main disadvantages of COCP? (4)

A
  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
Q

Abx avoided in pregnancy? (4) CTCS

A

Chloramphenicol
Tetracyclines
Ciprofloxacin
Sulphonamides

59
Q

Psych drugs avoided in pregnancy? (2)

A

Lithium

Benzos

60
Q

‘Other’ drugs avoided in pregnancy? MACCAS

A 
Methotrexate
Aspirin
Carbimazole 
Cytotoxic drugs 
Amioderone
Sulphonylureas
61
Q

Valproate monitoring (2)

A

LFT and FBC before starting

LFT at 6 month

62
Q

Methotrexate SEs (4)

A

Hepatotoxic
Myelosupression
Pulmonary fibrosis
Reduced fertility

63
Q 
Methotrexate monitoring? (3)
What to do in these scenarios: 
1. Abnormal baseline LFTs
2. Agranulocytosis 
3. Reduced renal function
A

FBC, LFT + U+E:

  1. Before starting
  2. Weekly until stable
  3. Every 2-3months when stable
  4. Don’t even start - risk of cirrhosis
  5. STOP immediately
  6. Consider reduced dose due to renal excretion and risk of toxicity
64
Q

Antipsychotic monitoring

A

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
Q

What to do with high CK and statin?

A

stop and if symptoms resolve, restart at lower dose. If no resolution then fibrate.

66
Q

Amioderone monitoring? (4)

A

Before starting: TFT/CXR/LFT/U+E

6monthly:
TFT + LFT (periodically not just with suspected toxicity)

67
Q

Lithium monitoring? (3)

What to do when lithium levels too high? (2)

A

LFT + TFT:
1. Before
2. 6 monthly
Lithium levels weekly until stable then 3 monthly

Stop lithium and drugs which impact renal function

68
Q

What is the most important parameter to assess abx effectiveness with pneumonia?

A

Resp rate

69
Q

Assessing response to DKA treatment?

A

Ketone levels - acidosis is most critical

70
Q

When to reassess U+Es after starting ACEi? When should they be stopped? (2)

A

1-2 weeks

Rise in creatinine by 30% OR fall in eGFR by 25%

71
Q

What needs to monitored when initiating nicotine replacement therapy?

A

Blood glucose levels - esp in existing diabetics

72
Q

When would you need to measure plasma digoxin levels?

What is the normal monitoring parameter?

A

Only when toxicity is suspected (6h post dose)

Normal = U+E - renal excreted

73
Q

How much replacement fluid and how fast in these scenarios:

  1. Oliguric
  2. Oliguric + tachycardic
  3. Oliguric + tachycardic + shock
A
  1. 500mL depletion - give 1L NaCl over 2-4h
  2. 1L depletion - 500mL STAT
  3. 2L depletion - 500mL STAT fluid challenge
74
Q

Presentation + Mx of chlamydia? Pregnancy?

A

Dysuria, urethral discharge + cervicitis

Doxycycline
Pregnancy = azithromycin

75
Q

Presentation + Mx of gonorrhoea? (1st + 2nd)

A

Odourless green/yellow discharge

1st = IM ceftriaxone 
2nd = Oral cefixime + azithromycin
76
Q

Presentation + Mx of genital herpes?

A

Painless genital ulceration + inguinal lymphadenopathy

Mx = Oral acyclovir

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