PSA Flashcards
Name 2 osmotic laxatives
Macrogol
Lactulose
Name 2 stimulant laxatives
Senna
Docusate
Medication used to treat vertigo
Prochlorperazine
HMG-CoA reductase inhibitor example
Simvastatin
Atorvastatin
Alendronic acid commonly used for which condition
Osteoporosis
Name 2 drugs for male pattern baldness
Finasteride
Minoxidil
Name 2 drugs for smoking cessation
Bupropion
Vareniciline
Codeine is safe to use in children. True or false?
False
Name 8 drugs that are teratenogenic
Methotrexate ACE inhibitor ARB Carbimazole Isotretinoin Lithium Phenytoin Sodium valproate Warfarin Statin
Name 2 drugs contraindicated in peptic ulcer disease
Aspirin
NSAID
Name 2 types of drugs contraindicated in CKD
NSAID
ACE inhibitor
CCBs are contraindicated in heart failure. True or false?
True
Name 2 drugs contraindicated in asthma?
B-blocker
NSAID
Which class of drugs are contraindicated in parkinsons disease?
Anti-psychotics (haloperidol)
Warfarin interacts with which antibiotic?
Clarithromycin
- enhanced anticoagulation
Warfarin interacts with which 3 medications
Clarithromycin
NSAIDs
Aspirin
Ciclosporin interacts with which herbal medication
St johns wart
Why should you avoid using ACE inhibitors together with diuretics?
Hypotension
If a patient has a bradycardia, avoid prescribing which classes of drugs? (3)
Beta blocker
Cardiac glycoside (digoxin)
CCB (verapamil)
A HIGH/LOW respiratory rate may be one of the important signs of opioid analgesic or benzodiazepine intoxication
Low
Name 2 types of drugs which can exacerbate anaemia
NSAIDs
Anti-coagulants
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
First line treatment for IBS
Dietary changes
Ispaghula husk - fibre drink (bulk-forming laxative)
Loperamide
Mebeverine (anti-spasmodic)
When diarrhoea is the prominent symptom in IBS, which drug should be used first line?
Loperamide
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
