PSA Flashcards by Sheryl O'Hare

Name 2 osmotic laxatives

Macrogol

Lactulose

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Name 2 stimulant laxatives

Senna

Docusate

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Medication used to treat vertigo

Prochlorperazine

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HMG-CoA reductase inhibitor example

Simvastatin

Atorvastatin

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Alendronic acid commonly used for which condition

Osteoporosis

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Name 2 drugs for male pattern baldness

Finasteride

Minoxidil

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Name 2 drugs for smoking cessation

Bupropion

Vareniciline

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Codeine is safe to use in children. True or false?

False

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Name 8 drugs that are teratenogenic

Methotrexate
ACE inhibitor 
ARB 
Carbimazole 
Isotretinoin 
Lithium 
Phenytoin
Sodium valproate 
Warfarin 
Statin

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Name 2 drugs contraindicated in peptic ulcer disease

Aspirin

NSAID

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Name 2 types of drugs contraindicated in CKD

NSAID

ACE inhibitor

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CCBs are contraindicated in heart failure. True or false?

True

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Name 2 drugs contraindicated in asthma?

B-blocker

NSAID

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Which class of drugs are contraindicated in parkinsons disease?

Anti-psychotics (haloperidol)

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Warfarin interacts with which antibiotic?

Clarithromycin

- enhanced anticoagulation

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Warfarin interacts with which 3 medications

Clarithromycin
NSAIDs
Aspirin

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Ciclosporin interacts with which herbal medication

St johns wart

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Why should you avoid using ACE inhibitors together with diuretics?

Hypotension

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If a patient has a bradycardia, avoid prescribing which classes of drugs? (3)

Beta blocker
Cardiac glycoside (digoxin)
CCB (verapamil)

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A HIGH/LOW respiratory rate may be one of the important signs of opioid analgesic or benzodiazepine intoxication

Low

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Name 2 types of drugs which can exacerbate anaemia

NSAIDs

Anti-coagulants

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Drugs that should be contra-indicated / prescribed with caution when renal function is reduced (6)

Loop diuretic 
ACE inhibitor 
potassium-sparing diuretic
gentamicin 
NSAIDs
Lithium
Digoxin

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First line treatment for IBS

Dietary changes
Ispaghula husk - fibre drink (bulk-forming laxative)
Loperamide
Mebeverine (anti-spasmodic)

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When diarrhoea is the prominent symptom in IBS, which drug should be used first line?

Loperamide

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Amitriptyline is second line treatment for IBS. True or false?

True | - only use if all first line agents have not been effective

Which class of drug is indapamide?

Thiazide like diuretic

For pt with hypertension that is resistant to treatment with three drugs, what is next options?

Spironolactone Doxazosin The options for Step 4 treatment are (i) low-dose spironolactone (25 mg PO daily) if the blood potassium level is ≤4.5 mmol/L, and (ii) if blood potassium level is >4.5 mmol/L, an alpha-blocker or beta-blocker

Don't mix CCB and beta blocker. True or false?

True

Which drug is commonly used to treat hypertension in pregnancy?

Methyldopa

Management of acute pulmonary oedema?

IV Furosemide 10mg/ml | High conc oxygen

What is the important drug interaction between verapamil and beta blocker

Bradycardia

Name 5 culprit drugs for constipation

Opioids (coedine, tramadol) | Anti-cholinergics (TCAs, mirabegron, parkinsons drugs)

Name 5 culprit drugs for diarrhoea

``` Antibiotics Colchicine Lithium Metformin PPI ```

Name 5 culprit drugs for dyspepsia

Anti-inflammatory (NSAID, aspirin) Bisphosphonates Steroids Metformin

Name some culprit drugs for falls (Dizziness)

Anti-hypertensives | CNS suppressant drugs (opioids, benzo)

Which antibiotic can cause hearing loss?

Gentamicin

Which 2 types of drugs should be avoided in asthmatics

Beta blocker | NSAIDs

Which anti-psychotic should not be used in parkinsons disease?

Haloperidol

Oestrogen / progesterone is pro-thrombotic?

Oestrogen

Name some drugs which cause respiratory depression

Morpine, oxycodone Benzo: diazepam, lorazepam gabapentinoids

Name 3 drugs which can cause a tremor?

Salbutamol Levothyroxine Aminophyline

Name 3 classes of drug which can cause bruising

Anti-platelet Anti-coagulant Corticosteroids

Name 5 drugs which can impair renal functin

``` NSAIDs ACE inhibitor Diuretics (furosemide) Gentamicin Radiological contrast agents ```

Name 5 drugs which can impair liver function

``` Paracetamol Statin Tuberculosis drugs (isoniazid) amiodarone anti-epileptic drug ```

Digoxin is rarely a cause of renal impairment. true or false?

True

Donepezil can cause tachy/brady cardia?

Bradycardia

What are typical early features of digoxin toxicity?

Bradycardia Nausea Vomiting Diarrhoea

First line treatment of hypertension in patient with T2DM of any age?

ACE inhibitor / ARB

First line treatment of hypertension in patient of african/american descent?

CCB

Treatment for resistant hypertension (4th line) if potassium is BELOW 4.5 mmol/L

Spironolactone

Name 3 types of drug that can exacerbate heart failure?

NSAIDs CCB (verapamil) Anti-arrhythmic drugs

Statins are safe in pregnancy. True or false?

False

Loop diuretics - electrolyte side effect

HYPOkalaemia | Renal impairment

Gentamicin levels should be taken X hours after the start of the infusion

between 6-14 hours

Pt starts statin - what is monitoring requirement

Check LFTs at 3 months and 12 months

Lithium levels should be taken at which time after administration?

6 hours post dose

Digoxin levels should be taken at which time after administration?

6 hours post dose

Name 4 drugs which cause hyponatraemia

``` Loop diuretics Thiazide diuretics SSRI TCA PPI ```

ACE inhibitors cause hypo/hyperkalaemia?

Hyperkalaemia

2 treatment options for confirmed PE?

``` Anticoagulation - unfractionated heparin IV Thrombolysis - streptokinase - alteplase ```

Maintenance fluid in patient with renal impairment

20-25ml/kg/day 1000ml over 8-12 hours

Potassium daily requirements

1mmol/kg/day

Maintenance fluid in patient without renal impairment

25-30ml/kg/day

ANY type 2 diabetic regardless of age or ethnicity should be treated with whihc antihypertensive first line?

ACE inhibitor

First line medication for erectile dysfunction

Sildenafil

High TSH level with High T4 level suggests issues with compliance to levothyroxine. True or false?

True

Important common side effects of omeprazole

Nausea Diarrhoea abdominal pain

Which of the following drugs is most liekly to cause exacerbation of heart failure? - spironolactone - lisinopril - metoprolol - diclofenac - metformin

Diclofenac | - NSAIDs increase the risk of cariovascular events including MI, stroke, exacerbation of heart failure

Which medication is contraindicated in asthma?

Bisoprolol

Treatment of acute severe hyperkalaemia

Calcium gluconate 10% solution 10ml IV infusion

21 week pregnant woman with hypertension. What is first line management?

Labetolol

Patient with anaphylaxis. IM adrenaline administered but patient still has life threatening symptoms/signs. What is the next step in management? - IV hydrocortisone - Neb salbutamol - IM adrenaline - IV chlorphenamine

IM adrenaline - if patient doesn't respond after 2 doses of IM adrenaline, IV adrenaline can be attempted by a specialist. Antihistamines (IV chlorphenamine) are 2nd line treatment

SSRIs are known to increase/decrease risk of GI bleeding

Increase | - can deplete platelets

Sertraline and which herbal medication can increase the risk of seratonin syndrome

St Johns wort

Which medication blocks the effect of opioid overdose?

Naloxone IV

Name a treatment of endocarditis

IV benzylpenicillin

Atropine increases/decreases the heart rate?

Increases | - used to treat bradycardia due to beta blocker

WHat is the most likely adverse effect of nexplanon implant?

Irregular bleeding

Which medication is known to cause bone marrow suppression | - pancytopenia

Methotrexate

Fractional inhaled nitric oxide testing is used in which condition and why?

Used in asthma - aid chronic management - aid diagnosis - not used in acute setting

Gentamicin requires both PRE and POST dose serum testing. True or false?

True | - to monitor for effects of nephrotoxicity and ototoxicity

In a patient receiving ONCE DAILY gentamicin, it is more important to check PRE/POST dose serum?

PRE

Patient started on statin at 3 month review ALT is raised. What do you do?

By how much is it raised? | - if it is raised LESS than 3 times the upper limit of normal, continue at current dose

Treatment of DKA

IV access established sodium chloride 0.9% 1000 mL over 1 hour (not too fast) an infusion of soluble insulin 0.1 unit/kg/hour.

Diclofenac causes which electrolyte abnormality

Hyperkalaemia

Amlodipine can cause headache. True or false?

True

Treatment of chlamydia in pegnancy?

Erythromycin

Name 2 medications that can cause hypothyroidism

Lithium | Amiodaraone

Management of acute pericarditis

NSAIDs - ibuprofen

When prescribing vancomycin - which blood results should you pay close attention to when deciding dosing?

Renal | - creatinine

FIrst line Tx CAP

Amoxicillin

First line Tx CAP if penicillin allergic

Clarithromycin

Metformin is known to cause - weight loss - weight gain

Weight loss

Bacterial meningitis - protein: low/high - glucose: low/high

Protein high | Glucose low

With warfarin, increased INR means more likely to have thinner/thicker blood?

thinner

Name 3 medications used in mild alzheimers

Donepezil Rivastigmine Galantamine

What type of laxative is fybogel? - osmotic - bulk-forming

Bulk-forming

Which drug is most important to lower portal hypertension - bisoprolol - propranolol - amlodipine - nifedipine

Propranolol

Immediate management of acute AF in unstable patient

DC cardioversion

What is te standard infusion rate of potassium?

10mmol/hr

First line anti-emetic in pregnancy

Cyclizine

Ibuprofen is contra-indicated in pregnancy. True or false?

True

How much potassium should be used in Tx of DKA along with 0.9% NaCl if the K+ level is above 5.5

None - just 0.9% NaCl alone

How much potassium should be used in Tx of DKA along with 0.9% NaCl if the K+ level is between 3.5-5.5 - 20mmol - 40mmol

40mmol

What is the immediate treatment of acute pulmonary oedema?

IV furosemide

Name 2 examples of VTE prophylaxis

Dalteparin | Rivaroxaban

What is first line IV treatment of hypoglycaemia?

IV 20% glucose

Dalteparin causes which electrolyte imbalance?

Hyperkalaemia

Which medications are typically stopped up to 7 days before surgery?

Anti-platelets : aspirin, clopidogrel | Anti-coagulants

Whenever a patient has an AKI, which anti-hypertensives are stopped temporarily?

ACE inhibitor | ARBs

Allopurinol should be stopped during AKI. True or false?

True

Prednisolone, synthetic steroid, can cause hyperglycaemia. True or false?

True

SSRI cause hypo/hyper natraemia?

Hyponatraemia

It is generally advised that THE SAME / DIFFERENT opiate drug should be prescribed for both regular and breakthrough pain relief?

THE SAME | - ie if fentanyl regular then give fentanyl breakthrough

First line treatment in alcohol withdrawal

Chlordiazepoxide hydrochloride

If patient usually on warfarin but stopped prior to surgery. If INR is > 1.5 on the day before surgery, how should this be managed?

Administer IV vitamin K

Small rise in creatinine after starting ACE inhibitor. What should you do?

Continue - but monitor U+Es in 1 week

Corticosteroids cause blood glucose levels to increase / decrease?

Increase

First line treatment for adult CAP mild/mod

Amoxicillin

First line treatment for adult CAP if penicillin allergic mild/mod

Doxycycline OR | Clarithromycin

First line treatment for severe CAP if penicillin allergic

Levofloxacin

First line treatment for SEVERE CAP

IV Co-amoxiclav + oral doxycycline

Bacterial meningitis 2 Treatments

IV ceftriaxone | IV dexamethasone

Viral encephalitis treatment

IV aciclovir

Treatment in epiglottitis

IV cefotaxime

Treatment of NON SEVERE c.diff infection?

oral metronidazole

Treatment of SEVERE c.diff infection?

oral vancomycin + IV metronidazole

Triple antibiotic therapy for GI sepsis

IV amox, met, gent

When can you NOT give trimethoprim in pregnancy

DO NOT give in FIRST TRIMESTER

When can you NOT give nitrofurantoin in pregnancy

DO NOT give in TERM baby

Treatment of gonorrhoea

IM ceftriaxone

Treatment of chlamydia

Oral doxycycline

Treatment of syphilus

IM benpen

Treatment of septic arthritis

Flucloxacillin

First line anti-hypertensive agent in patient of any age with diabetes

ACE inhibitor / ARB

Pt with HTN on triple therapy (ACEI + CCB + diuretic), K+ is LESS than 4.5....which agent will you add in

Spironolactone

Pt with HTN on triple therapy (ACEI + CCB + diuretic), K+ is MORE than 4.5....which agent will you add in?

Alpha blocker | Beta blocker

Afro-carribean patient first line HTN medication despite age?

CCB

First line anti-hypertensive in pregnancy

Labetolol | 2nd line is nefedipine

Which class of medications is acetazolamide?

Carbonic anhydrase inhibitor

Furosemide causes hypo/hyper kalaemia

Hypokalaemia

Thiazide diuretics cause what K+ abnormality

Hypokalaemia

Unpleasant GI side effects to metformin, what do you do?

Prescribe Metformin MR

2 options for absence seizure treatment

Sodium valproate | Ethosuximide

2 options for focal seizures treatment

Lamotrigine | Carbemazapine

SSRI and which drug interact

NSAID

Treatment of acute dystonia

Procyclidine

Heparin is safe in pregnancy. True or false?

True

Why should aspirin be avoided in patient's taking warfarin?

Increased risk of bleeding

Treatment of ischaemic stroke within 4.5 hours

Thrombolysis using alteplase

If a patient is on long term corticosteroid herapy - during periods of stress (ie intercurrent infection / trauma / surgery) what should you do with steroid dose? - same - decrease - increase - stop temporarily

Increase

Pt on warfarin, INR 5-8, no bleeding - what do you do

Withold one / two doses of warfarin

pt on warfarin, INR 5-8, minor bleeding - what do you do ?

Administer IV Vitamina K

Which medication is used for thrombolysis in stroke patient?

Alteplase

In DKA what should you do with insulin?

Stop short acting insulin | Carry on as usual with long acting insulin

Blood-glucose concentration < 4 mmol/litre, with or without symptoms, and conscious and able to swallow - what is the management

Oral carbohydrate Oral glucojuice Glucose tablet o If necessary, repeat treatment after 15 minutes, up to a maximum of 3 treatments in total

Blood-glucose concentration < 4 mmol/litre, with or without symptoms, and conscious and able to swallow. Tried 3x oral glucose but no improvement. What do you do?

IM glucagon / IV glucose 10%

In patients who have a hypo that are on ANTI-COAGULATION. What is best management? - IM glucagon or IV glucose

IV glucose

Patient having hypo with decreased conscious level or unconscious in community - what is first line option

IM glucagon

Patient having hypo with decreased conscious level or unconscious on anticoagulation - what is first line option

IV glucose

Patient having hypo who is unconscious and in hospital | - what is first line option

IV glucose

First line anti-emetic in parkinsons patient

Domperidone

First line anti-emetic in pregnancy

Cyclizine

First line post op anti emetic

Ondansetron

Side effect of ondansetron

Prolongation of QTc

Name 2 first line anti-emetics used in chemotherapy

Ondansetron | Prochlorperazine

Anti-emetic used in palliative care often

Levomepromazine

Common routine maintenance fluid

NaCl

Resuscitation of patient with IV - fluid - volume - time

0.9% NaCl / Hartmans 500ml Stat (15 mins)

Resuscitation of ELDERLY/RENAL IMPAIRMENT/CARDIAC FAILURE patient - fluid - volume - time

0.9% NaCl / Hartmans | 250ml over 15 mins OR 500ml over 30 mins

Fluid resuscitation in severe sepsis

4-5% human albumin solution

The rate of administration of POTASSIUM must not exceed X mmol/hr

10 mmol/hr MAX

Fluid resuscitation in child

a bolus over <10 minutes of a glucose-free crystalloid containing sodium in the range of 131-154 mmol/L is used (sodium chloride 0.9% with or without potassium OR Hartmann’s solution) o 20mL/kg for children/young people o 10-20mL/kg for term neonates

Which fluid is used for replacement in children?

Sodium chloride with potassium

Maintenance fluid in children

Maintenance = sodium chloride 0.9% or Hartmann’s solution o 100ml/kg/day for first 10kg o 50ml/kg/day for next 10kg o 20ml/kg/day for after this

Which fluid is commonly used for replacement if D&V ?

0.9% NaCl or Hartmans

Which fluid is commonly used for dehydration

Dextrose-saline

Emergency resuscitation - what is the best fluid to prescribe?

NaCl 0.9%

When would you use 0.18% NaCl ?

Baby with meningitis | - don't use as FY1 therefore wont be in exam

When would you use 0.45% NaCl ?

In Hypernatraemia

Always use which fluid in resuscitation?

NaCl 0.9%

Which type of laxative used for constipation in pregnancy?

bulk forming laxative first line - ispagla husk also lactulose

What is the only anti-emetic safe in parkinsons?

Dmperidone

What is treatment summary for nausea

Nausea and labrynth disorder

What is treatment summary for meningitis

Central nervous system infection

What is treatment summary for anticoagulation

Type in anticoagulation

Treatment summary for constipation / laxatives

Constipation

Treatment summary for AF, SVT, VT etc

Arrhythmias

Treatment summary for acute asthma

Asthma acute

Treatment summary for chronic asthma

Asthma chronic

Treatment summary for endocarditis

Cardiovascular infections

Treatment summary for c.diff

Gastrointestinal

Treatment of dry eye

Hypermellose

Treatment summary for STIs

Genital infection

Treatment summary for CAP

Respiratory infections

Treatment summary for BPH

Urogenital infection

Which drug that is not one of the 4 C antibiotics, can increase the risk of developing C. diff ?

Omeprazole

If a patient has been given 2 lots of NaCl already on a fluid prescription chart you should not administer further NaCl for fear of Nacl overload. What should you prescribe instead?

Glucose 5% and potassium chloride 0.3% solution is best

What is the daily requirement for NaCl ?

80 mmol

How much Na Cl is in a L of 0.9% NaCl

154 mmol

What is the daily requirement for potassium>

80 mmol

0.3% potassium chloride contains how much potassium in mmol?

40 mmol

Patient on transdermal pathch for HRT but having withdrawal bleeds. What do you do to stop the withdrawal bleeds?

Switch to continuous HRT formulation

Which medication is contraindicated in peripheral arterial disease?

Bisoprolol

If both oral steroid and ICS are used in a patients DHx - which one is most likely to cause candidiasis?

oral steroid

How long should both men and woman use effective contraception for after stopping methotrexate and before trying to conceive?

6 months

What is best management for nausea and vomiting in a patient with acute small bowel obstruction?

NG ryles tube | - drug therapy would have little benefit in this patient as there is obstruction

Which anti-emetic should not be used at all in bowel obstruction?

Metochlopramide

How does alcohol cause hypoglycaemia?

By inhibiting gluconeogenesis

INCREASED INR means increased/decareased anticoagulant effect?

Increased

All hormonal contraceptives are contraindicated in patients with current / past breast cancer. True or false?

True

Someone on long term steroids for RA is ill. What do you do to steroid dose?

Double it

SSRIs cause increased bleeding / clotting ?

bleeding

Prolonged prothrombin time increases/decreases risk of bleeding?

Increases

Which 2 things does raised urea usually indicate?

Renal failure | Upper GI haemorrhage

Staggered OD of paracetamol, what do you do?

Treat with NAC

How much adrenaline is given for treatment of anaphylaxis

500 micrograms 1:1000

HHS management is more common in T1DM or T2DM ?

T2DM

HHS management is the same as DKA management. True or false?

True - IV fluid bolus stat 500ml NaCl over 15 mins - IV fixed rate insulin infusion

Oestrogen / progesterone is required for HRT to protect the uterus?

Progesterone (protects against unopposed oestrogen to minimise risk of cancer)

Emergency treatment of hypoglycaemia in an unconscious patient in hospital?

15g IV 20% glucose

High / Low TSH indicates poor adherance to thyroxine medication in patient with hypothyroidism?

High Tsh

In GP and suspect patient has meningitis. What treatment do you administer

Benzylpenicillin -> transfer to hospital for IV ceftriaxone + IV dex

In a patient who is on anticoagulation and is hypoglycaemic, which is preferred 1) IV glucose 2) IM glucagon

1) IV glucose

Paediatric resuscitation fluids

20ml/kg over 10 mins 0.9% NaCl

Name some drugs which can cause urinary retention?

morphine, benzodiazepines, NSAIDs, CCBs, antihistamines, alcohol, anticholinergics, alpha-adrenoceptor agonists

Stop DOAC how many days before surgery?

2 days

Which drugs should you stop in AKI ?

ACE inhibitor / ARB NSAID Furosemide

Which people do you avoid giving adenosine to?

Asthmatics

Which drug is known to cause thrombophlebitis?

Amiodarone

Name 3 ways to control rhythm in AF

DC cardioversion Prarmacological cardioversion - flecanide - amiodarone

Which investigation is used as an early indicator of diabetic nephropathy?

Albumin creatine ratio | - microalbuminaemia indicates need for ACE inhibitor

What are 3 licensed drugs in mild/moderate alzheimers?

Donepezil Galantamine Rivastigmine

Name 2 stimulant laxatives

Senna | Bisocodyl

1% (as in 1% lidnocaine) means

1g in 100ml = 1000mg in 100ml = 10mg in 1 ml

0.1% (as in 0.1% lidnocaine) means

0.1g in 100ml 100mg in 100ml 1mg in 1 ml

Adrenaline 1 in 1000 =

1g in 1000ml

How to find overdoses (including alcohol) in the BNF

poisoning

What do you give first line in alcohol withdrawal

Chlordiazepoxide | Diazepam

What do you give in an alcoholic to prevent relapse?

Acamprost

Heavy drinker with agitation, confusion, paranoia, hallucinations. What is this and what do you prescribe?

Delirium tremens | Prescribe lorazepam

What is long term management of ACS

``` ACE inhibitor Statin Clopidogrel Beta blocker Aspirin ```

How to find digoxin toxicity on the BNF

Cardiac glycosides

Antibiotics used in the management of neutropenic sepsis ?

Piperacillin + Tazocin

Emergency management of hyperkalaemia

10-20ml 10% calcium gluconate | IV insulin 8-10 units in 100ml Dextrose 20%

Interaction between tramadol and SSRI

Serotonin syndrome

Therapeutic drug monitoring: If the peak is high increase/decrease the dose?

Decrease

Therapeutic drug monitoring: If the trough is high, increase/decrease the interval between doses

Increase the interval between doses

monitoring requirement for digoxin?

Renal function

monitoring requirement for vancomycin?

Renal function

Management of trigeminal neuralgia

Carbemazapine

1st line laxative in pregnanct

Bulk forming - ispagula husk

What is cyclizine contraindicated in?

Heart failure

Which anti-emetic is typically used for motion sickness?

Cyclizine

If you are prescribing fluids and patient has already received enough sodium for the day, what should you prescribe?

5% glucose + potassium if they need potassium

For surgery - what do you do with steroid dose?

Increase

Oral diabetic drugs and surgery

Omit on day of operation

You have omitted warfarin 5 days before surgery as suggested. If you check the patient's INR on the morning of operation and it is greater than 1.5 what do you do?

Give IV vitamin K

Which class of drugs can exacerbate heart failure >

CCB

Patients on steroids are at risk of hypertension / hypotension>

Hypertension

Naproxen can cause ankle oedema. True or false?

True

When are stimulant laxatives contraindicated?

When there is cramping