PSA Flashcards
Who is eligible for blood transfusion in iron deficiency anaemia?
Are severely symptomatic and cannot tolerate or wait for the effect of iron- replacement (in iron-deficiency anaemia, the Hb usually rises by 10 g/L/week on oral iron replacement), or
• Have Hb <70 g/L (some recommend using a higher cut-off of 100 g/L in patients with ischaemic heart disease).
which medications may cause hyperkalaemia?
- ACEi
- ARB
- K+ sparing diuretics
- dalteparin/heparins: inhibition of aldosterone synthesis
- tacrolimus: reduced potassium excretion
- ciclosporin
- trimethoprim
which medications should be stopped in AKI?
- NSAIDS (other than aspirin)
- ACEi
- ARB
- Diuretics incl. loop
- Allopurinol
which drugs should be stopped on the day of surgery?
insuline
oral hypoglycaemics
ACEi, ARB, K+ sparing
What should be stopped the day before surgery?
lithium
what should be stopped a week before surgery/5 days
aspirin/anticoagulatns and antiplatelets
what should be stopped 4w before surgery?
COCP
which drugs commonly cause confusion?
benzos morphine/co-codamol prednisolone/glucocorticoids anticonvulsants antipsychotics antidepressants metoclopramide digoxin
which drugs may cause hyponatraemia?
ACEi carbamazepine SSRI TCA opiates PPI vincristine/cyclosphopshamide
If on fentanyl patches - how is breakthrough pain managed?
patients receiving >=25mcg/h fentanyl patch can use fentanyl nasal spray
max dose = 50 mcg spray /one nostril, repeated after 10 mins
max 2 sprays per pain episode
every 4 h
What is first line in treating alcohol withdrawal?
chlordiazepoxide
When should warfarin be stopped before surgery?
5 days
what should be given if INR >1.5 on the day of surgery?
phytomenadione (vitamin K 1-5mg PO) (USING IV preparation)
what is some advice for taking rivaroxaban?
take with food
advice for COCP and topiramate?
change to an alternative method of contraception until 4w after taking topiramate (enzyme inducer)
which antibiotic may cause cholestatic jaundice?
co-amoxiclav
if this happens it is an absolute contraindication to having co-amoxical again
How are ACEi monitored?
U&E before ACEi and during treatment
How are ARBs monitored?
U&E during treatment to monitor K
What changes in blood results are expected after newly starting an ACE/ARB?
A small rise in creatinine (<=20% is expected with new ACEi/ARB -> do nothing and remeasure in a week)
how is furosemide treatment monitored?
daily weights
what should patients be monitored for when starting ciclosporin?
hxicity (baseline U&E and renal function every 2w until stable)
hypertension (regular BP monitoring)
How would you treat a transient rise in blood glucose after steroids in IDDM?
Increase insulin dosing by 10%
what is the target of statin treatment?
> 40% reduction in non-HDL cholesterol after 3m
what are the side effects of thiazide diuretics ?
gout
electrolyte disturbance
dyslipidaemia
what are the side effects of beta blockers?
wheeze
worsening of acute HF (helps chronic)
what are the side effects of CCB?
peripheral oedema
flushing
side effects of potassium sparing diuretics?
gynaecomastia
side effects of steroids?
stomach ulcers thin skin edema RHF/LHF osteoporosis Infection Diabetes
Side effects of NSAIDs?
No urine (renal failure) Systolic dysfunction (HF) Asthma Indigesttion Dyscrasia
causes of hypokalaemia?
DIRE loop diuretics thiazide diuretics D&V RTA Endo (cushings and conns)
causes of hyperkalaemia?
DREAD Drugs (k+ sparing/acei) renal failure endocrine (adossons) artefact dka
causes SIADH?
SIADH small cell lung tumour infection (tb, pneumonia) abscess drugs (carmamazepine and antipsychotics) head injury
other: positive end-expiratory pressure (PEEP)
porphyrias
causes of raised alp?
ALKPHOS Any fracutre liver damage (post hep) Kancer Paget's of bone/pregnancy hyperparathyroid osteomalacia surgery
what is lithium excretion reduced by?
NSAIDS
ACEi, thiazides (if giving a diuretic give loop)
when should metformin be avoided?
If GFR <30 _> LACTIC ACIDOSIS
use sulphnylurea or DPPG-4
SEs of ACEi?
ACE 1 Angioedema (after around 4w) cough elevated K 1st dose low bp
What is given for short term relief of heartburn?
magnesium carbonate
long term: omeprazole
what is a normal pre-trough dose of vancomycin?
10-15mg/L
When should abx be reviewed
after 3 days when MC&S is back
treatment for mild and severe CAP?
MILD: amoxicillin
severe: co-amoxicalv and clarithromycin
treatment for mild and severe HAP?
non-severe: co-amoxiclav/doxycycline
severe: piperacillin/tazobactam
How does K+ level affect digoxin?
hypokalaemia - increased digoxin effect
hyperkalaemia - reduced digoxin effect
Causes of hypernatraemia?
nephrogenic DI
lithium
hypercalcaemia
hypokalaemia
Which drugs are contraindicated in asthmatics?
beta blocker
NSAID
adenosine
what is a benign leucocytosis?
leucocytosis and normal CRP if on steroids
when is enoxaparin dose adjusted?
low eGFR
weight <50kg
management of hyperkalaemia?
10 ml 10% calcium gluconate 125 ml 20% dextrose 10 u insulin salbutamol nebs calcium resonium 15 mg 8 hourly
what is the management of oral candidiasis?
nystatin 100,000U QDS 7days
miconazole oral gel, 2.5 mL QDS, 7 days
when are Beta blockers contraindicated?
asthma hypotension metabolic acidosis uncontrolled HF cardiogenic shock bradycardia 2nd AV block, 3rd AV block severe peripheral arterial disease
What is first line in treating acute dystonic reaction?
antimuscarinics (procyclidine)
What fluid is used for the ‘sweet’ bag?
glucose 5%/Kcl 0.3%
what range should plasma glucose be kept in after stroke?
5-15 mmol
which HRT is best to avoid withdrawal bleeding?
continuous release rather than a sequential product
levonorgestrel 7microgram/estradial 50 micrograms/24 hours weekly patch
Which medications are likely to exacerbate symptoms of heart failure?
corticosteroids (pred)
calcium channel blockers (diltiazem)
what is the treatment for scarlet fever ?
phenoxymethylpenicillin for 10 days
125 mg 6 hourly
what should be monitored before starting treatment with amiodarone?
potassium
when a statin causes myopathy and CK is elevated what should you do?
stop statin and start at a lower dose if symptoms resolve
how to convert between oral codeine to morphine?
/10
how to convert between oral tramadol to oral morphine
/10
how to convert between morphine to oral oxycodone?
/1.5-2
how to convert oral morphine to subcut morphine?
/2
how to convert oral morphine to subcut diamorphine?
/3
how to convert oral oxycodone to subcut diamorphine?
/1.5
how to convert oral moprhine to transdermal fentanyl?
/2.4-3.6
how to convert oral morphine to subcut alfentanil?
/30
how to convert oral morphine to transdermal buprenorphine patch?
/2.4
how is breakthrough morphine calculated?
1/6 of daily dose morphine
which opioids are preferred in mild/mod renal impairment and severe?
mild/moderate: oxycodone
severe: alfentanil,buprenorphine and fentanyl
when should metoclopramide be avoided?
bowel obstruction, GI perforation or following gastric surgery
pro-kinetic
best anti-emetic for dysmotility and stasis?
metoclopramide or domperidone
best anti-emetic for chemically mediated nausea?
ondansetron
haloperidol
levomepromazine