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Year 6 Medicine > PSA > Flashcards

PSA Flashcards

1
Q

Who is eligible for blood transfusion in iron deficiency anaemia?

A

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).

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2
Q

which medications may cause hyperkalaemia?

A
  • ACEi
  • ARB
  • K+ sparing diuretics
  • dalteparin/heparins: inhibition of aldosterone synthesis
  • tacrolimus: reduced potassium excretion
  • ciclosporin
  • trimethoprim
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3
Q

which medications should be stopped in AKI?

A
  • NSAIDS (other than aspirin)
  • ACEi
  • ARB
  • Diuretics incl. loop
  • Allopurinol
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4
Q

which drugs should be stopped on the day of surgery?

A

insuline
oral hypoglycaemics
ACEi, ARB, K+ sparing

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5
Q

What should be stopped the day before surgery?

A

lithium

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6
Q

what should be stopped a week before surgery/5 days

A

aspirin/anticoagulatns and antiplatelets

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7
Q

what should be stopped 4w before surgery?

A

COCP

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8
Q

which drugs commonly cause confusion?

A 
benzos
morphine/co-codamol
prednisolone/glucocorticoids
anticonvulsants
antipsychotics
antidepressants
metoclopramide
digoxin
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9
Q

which drugs may cause hyponatraemia?

A 
ACEi
carbamazepine
SSRI
TCA
opiates
PPI
vincristine/cyclosphopshamide
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10
Q

If on fentanyl patches - how is breakthrough pain managed?

A

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

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11
Q

What is first line in treating alcohol withdrawal?

A

chlordiazepoxide

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12
Q

When should warfarin be stopped before surgery?

A

5 days

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13
Q

what should be given if INR >1.5 on the day of surgery?

A

phytomenadione (vitamin K 1-5mg PO) (USING IV preparation)

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14
Q

what is some advice for taking rivaroxaban?

A

take with food

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15
Q

advice for COCP and topiramate?

A

change to an alternative method of contraception until 4w after taking topiramate (enzyme inducer)

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16
Q

which antibiotic may cause cholestatic jaundice?

A

co-amoxiclav

if this happens it is an absolute contraindication to having co-amoxical again

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17
Q

How are ACEi monitored?

A

U&E before ACEi and during treatment

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18
Q

How are ARBs monitored?

A

U&E during treatment to monitor K

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19
Q

What changes in blood results are expected after newly starting an ACE/ARB?

A

A small rise in creatinine (<=20% is expected with new ACEi/ARB -> do nothing and remeasure in a week)

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20
Q

how is furosemide treatment monitored?

A

daily weights

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21
Q

what should patients be monitored for when starting ciclosporin?

A

hxicity (baseline U&E and renal function every 2w until stable)
hypertension (regular BP monitoring)

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22
Q

How would you treat a transient rise in blood glucose after steroids in IDDM?

A

Increase insulin dosing by 10%

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23
Q

what is the target of statin treatment?

A

> 40% reduction in non-HDL cholesterol after 3m

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24
Q

what are the side effects of thiazide diuretics ?

A

gout
electrolyte disturbance
dyslipidaemia

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25
Q

what are the side effects of beta blockers?

A

wheeze

worsening of acute HF (helps chronic)

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26
Q

what are the side effects of CCB?

A

peripheral oedema

flushing

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27
Q

side effects of potassium sparing diuretics?

A

gynaecomastia

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28
Q

side effects of steroids?

A 
stomach ulcers
thin skin
edema
RHF/LHF
osteoporosis
Infection
Diabetes
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29
Q

Side effects of NSAIDs?

A 
No urine (renal failure)
Systolic dysfunction (HF)
Asthma
Indigesttion
Dyscrasia
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30
Q

causes of hypokalaemia?

A 
DIRE
loop diuretics
thiazide diuretics
D&V
RTA
Endo (cushings and conns)
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31
Q

causes of hyperkalaemia?

A 
DREAD
Drugs (k+ sparing/acei)
renal failure
endocrine (adossons)
artefact
dka
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32
Q

causes SIADH?

A 
SIADH
small cell lung tumour
infection (tb, pneumonia)
abscess
drugs (carmamazepine and antipsychotics)
head injury

other: positive end-expiratory pressure (PEEP)
porphyrias

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33
Q

causes of raised alp?

A 
ALKPHOS
Any fracutre
liver damage (post hep)
Kancer
Paget's of bone/pregnancy
hyperparathyroid
osteomalacia
surgery
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34
Q

what is lithium excretion reduced by?

A

NSAIDS

ACEi, thiazides (if giving a diuretic give loop)

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35
Q

when should metformin be avoided?

A

If GFR <30 _> LACTIC ACIDOSIS

use sulphnylurea or DPPG-4

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36
Q

SEs of ACEi?

A 
ACE 1
Angioedema (after around 4w)
cough 
elevated K
1st dose low bp
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37
Q

What is given for short term relief of heartburn?

A

magnesium carbonate

long term: omeprazole

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38
Q

what is a normal pre-trough dose of vancomycin?

A

10-15mg/L

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39
Q

When should abx be reviewed

A

after 3 days when MC&S is back

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40
Q

treatment for mild and severe CAP?

A

MILD: amoxicillin
severe: co-amoxicalv and clarithromycin

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41
Q

treatment for mild and severe HAP?

A

non-severe: co-amoxiclav/doxycycline

severe: piperacillin/tazobactam

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42
Q

How does K+ level affect digoxin?

A

hypokalaemia - increased digoxin effect

hyperkalaemia - reduced digoxin effect

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43
Q

Causes of hypernatraemia?

A

nephrogenic DI
lithium
hypercalcaemia
hypokalaemia

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44
Q

Which drugs are contraindicated in asthmatics?

A

beta blocker
NSAID
adenosine

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45
Q

what is a benign leucocytosis?

A

leucocytosis and normal CRP if on steroids

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46
Q

when is enoxaparin dose adjusted?

A

low eGFR

weight <50kg

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47
Q

management of hyperkalaemia?

A 
10 ml 10% calcium gluconate
125 ml 20% dextrose 
10 u insulin
salbutamol nebs
calcium resonium 15 mg 8 hourly
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48
Q

what is the management of oral candidiasis?

A

nystatin 100,000U QDS 7days

miconazole oral gel, 2.5 mL QDS, 7 days

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49
Q

when are Beta blockers contraindicated?

A 
asthma
hypotension
metabolic acidosis
uncontrolled HF
cardiogenic shock
bradycardia
2nd AV block, 3rd AV block
severe peripheral arterial disease
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50
Q

What is first line in treating acute dystonic reaction?

A

antimuscarinics (procyclidine)

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51
Q

What fluid is used for the ‘sweet’ bag?

A

glucose 5%/Kcl 0.3%

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52
Q

what range should plasma glucose be kept in after stroke?

A

5-15 mmol

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53
Q

which HRT is best to avoid withdrawal bleeding?

A

continuous release rather than a sequential product

levonorgestrel 7microgram/estradial 50 micrograms/24 hours weekly patch

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54
Q

Which medications are likely to exacerbate symptoms of heart failure?

A

corticosteroids (pred)

calcium channel blockers (diltiazem)

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55
Q

what is the treatment for scarlet fever ?

A

phenoxymethylpenicillin for 10 days

125 mg 6 hourly

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56
Q

what should be monitored before starting treatment with amiodarone?

A

potassium

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57
Q

when a statin causes myopathy and CK is elevated what should you do?

A

stop statin and start at a lower dose if symptoms resolve

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58
Q

how to convert between oral codeine to morphine?

A

/10

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59
Q

how to convert between oral tramadol to oral morphine

A

/10

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60
Q

how to convert between morphine to oral oxycodone?

A

/1.5-2

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61
Q

how to convert oral morphine to subcut morphine?

A

/2

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62
Q

how to convert oral morphine to subcut diamorphine?

A

/3

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63
Q

how to convert oral oxycodone to subcut diamorphine?

A

/1.5

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64
Q

how to convert oral moprhine to transdermal fentanyl?

A

/2.4-3.6

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65
Q

how to convert oral morphine to subcut alfentanil?

A

/30

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66
Q

how to convert oral morphine to transdermal buprenorphine patch?

A

/2.4

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67
Q

how is breakthrough morphine calculated?

A

1/6 of daily dose morphine

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68
Q

which opioids are preferred in mild/mod renal impairment and severe?

A

mild/moderate: oxycodone

severe: alfentanil,buprenorphine and fentanyl

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69
Q

when should metoclopramide be avoided?

A

bowel obstruction, GI perforation or following gastric surgery
pro-kinetic

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70
Q

best anti-emetic for dysmotility and stasis?

A

metoclopramide or domperidone

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71
Q

best anti-emetic for chemically mediated nausea?

A

ondansetron
haloperidol
levomepromazine

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72
Q

best anti-emetic for visceral/serosal causes?

A

cyclizine

levopromazine

73
Q

best anti-emetic for raised intra-cranial pressure?

74
Q

best anti-emetic for vestibular nausea?

75
Q

SE/CI cyclizine?

A

irritant SC

severe heart failure

76
Q

SE/CI ondansetron?

A

constipating

causes prolonged QT

77
Q

SE/CI haloperidol?

A

lowers seizure threshold

PD

78
Q

SE/CI metoclopramide/domperidone?

A

BO with colic
PD
cardiac conduction disorders
young women - SE movement disorders

79
Q

SE/CI levomepromazine?

A 
long half life
sedating
lowers seizure threshold
severe heart failure
PD
80
Q

First line anti-emetic in post-op nausea and vomtiing?

A

ondansetron

81
Q

what is the drug of choice for those at risk of QT prolongation/ESPE?

82
Q

bolus for fluid resuscitation/shock?

A

0.9% saline 500ml /15 mins

1L/30mins

83
Q

Drugs causing dyspepsia?

A

NSAIDs
steroids
bisphosphonate

84
Q

Drugs causing ankle oedema?

A

CCB
Naproxen
Insulin

85
Q

How should insulin be managed in DKA?

A

Stop short acting
keep long acting
FRII

86
Q

Monitoring of ciclosporin?

A

renal function before starting

during therapy: serum Cr every 2 weeks for first 3 months then monthly

87
Q

Common SE of GLP-1 analogue?

88
Q

which opioid is recommended in renal impairment?

A

oxycodone - metabolised completely by liver

causes less sedation,vomiting and pruritic

89
Q

which drugs may cause urinary retention?

A 
morphine and other opioid analgesics:
anticholinergics
general anaesthetics
alpha agonists
benzos
NSAIDs
CCBs
Antihistamines
Alcohol
90
Q

what can cause microcytic anaemia?

A 
TAILS
thalassaemia
anaemia of chronic disease
iron deficiency anemia
lead poisoning
sideroblastic anaemia
91
Q

what can cause normocytic anaemia?

A 
MR I CALM
Marrow failure
renal failure
Iron deficiency (early)
Aplastic anaemic, Acute blood loss
Leukaemia
Myelofibrosis
92
Q

what can cause macrocytic anaemia?

A 
Alcoholism
Myelodysplastic syndrome, multiple myeloma
Hypothyroid, Haemolytic anaemia
Liver failure
Folate/B12 deficiency
93
Q

what can cause high platelets?

A

reactive: bleeding, tissue damage, post-splenectomy
primary: MPD

94
Q

what can cause low platelets?

A

Increased destruction: heparin, hypersplenism, DIC, ITP, HUS/TTP
Reduced production: Infection (viral), drugs (penicillaemine), MDS, PMF, myeloma

95
Q

Causes pre-renal AKI?

A

dehydration/shock

96
Q

Causes intrinsic renal AKI?

A 
INTRINSIC
Ischaemia
Nephrotoxic antibiotics
Tablets (ACEi, NSAIDs)
Radiological contrast
Injury
Negatively birefringent crystals
Syndromes (glomerulonephritis)
Inflammation
Cholesterol emboli
97
Q

Post renal cause AKI?

A

Bladder/hydronephrosis
luminal (stones)
mural (transitional cell carcinoma)
extra-mural (BPH)

98
Q

How many units is 1mg LMWH

A

1mg = 100u

99
Q

Advice for taking steroids?

A

Regular BM monitoring
gastroprotection
>3m treatment need bone protection

100
Q

side effects SSRI?

A

photosensitivity
dry mouth
serotonin syndrome

101
Q

what is a 1% solution

102
Q

what does 1:1000 mean

103
Q

what does 1 in 10000 mean

A

1g in 10000 ml

0.1 mg/ml

104
Q

what is the fluid requirement per day for average and elderly person?

A 
average= 25-30ml/kg/day
elderly = 20-25ml/kg/day

1mmol/kg/day Na, K, Cl

105
Q

Enzyme inducers?

A 
PC BRAS
Phenytoin
Carbamazepine
Barbiturates
Rifampicin
Alcohol
Sulphonylurea

Induction takes weeks to establish

106
Q

Enzyme inhibitors?

A 
ZAG DEVICES
zoles (omeprazole, ketoconazole, fluconazole)
allopurinol
grapefruit juice
disulfiram
erythromycin
valproate
isoniazid
ciprofloxacin
ethanol
sulphonamides

Inhibition takes hours/days

107
Q

SE amiodarone?

A

hyper/hypothyroid
skin greying
corneal deposits

108
Q

Alcohol ADRS?

A 
UGIB (aspirin and NSAIDs)
XS anticoagulation (warfarin)
Sweating, flushing, N&V (metronidazole, disulfiram)
Lactic acidosis (metformin)
Hypertensive crisis (MAO-I,RIMA)
Sedation (barbiturates, opioids, BDZ)
109
Q

When should antihypertensives be initiated

A 
clinic BP>=140/90 and ABPM average >=135/85
AND<80 
AND one of:
end organ damage
CVD
renal disease
diabetes
QRISK >10%
110
Q

What is the waking BM target in diabetes?

A

5-7

other targets 4-7

111
Q

what is insulin infusion made up of?

A

50 units act rapid insulin in 50 ml 0.9% saline

112
Q

normal vol of insulin?

A

100u in one ml

113
Q

biphasic insulin regime?

A

0.5-0.8u/kg
2/3 in morning
1/3 in even

114
Q

how to work out decrease in blood glucose with addition of 1U insulin?

A

Total daily dose (in units)

100/TDD = decrease in blood glucose mmol/L with addition of 1U insulin

115
Q

What is given alongside insulin infusion?

A

IV glucose

medical: 1L 5% glucose + 0.3% K at 100ml/h
surgical: 1L 5% glucose + 0.3% K at 80ml/h

continue basal long acting insulin but omit short acting

116
Q

Checklist for stopping variable rate insulin infusion?

A

E+D normall
taken long acting insulin >= 1 hour nefore
taken mixed/rpaid insulin at usual meal time and wait 30 mins before stopping VRII
monitor CBG QDS for >=24h

117
Q

Give examples of oestrogen only HRT?

A

PO: elleste solo (OD)
Transdermal: evorel (2x weekly)
PV gel: sandrena (OD)

118
Q

Which adjunct progesterones can be used for oestrogen only HRT?

A

IUS Mirena (4years)
Medroxyprogesterone acetate
Utrogestan

119
Q

which oestrogen + progesterone HRT are available for cyclical/sequential?

A

PO: elleste duet (OD)
transdermal: evorel sequi (2X weekly)

120
Q

What are the monthly and 3 monthly cyclical HRT regimes and when are they indicated

A

monthly (for regular periods and menopause sx)
oestrogen for 28 days, progesterone for last 14

3 monthly (for irregular periods and menopause sx)
oesterogen for 3months and progesterone for the last 14 days
121
Q

what are the types of continuous combined HRT?

A

PO: kilovance (OD)
Transdermal: evorel conti (twice weekly)

122
Q

Drugs causing gynaecomastia?

A 
DISCO
digoxin
isoniazid
spironolactone - switch to eplerenone
cimetidine
omeprazole
123
Q

Valproate side effects?

A 
VALPROATE
Vomiting, nausea
anorexia
liver toxicity
pancreatitis
retention of weight
oedema
alopecia
teratogenicity/tremors
enzyme inhibition
124
Q

sildenafil CIs?

A

nitrates (may potentiate massive vasodilation)
hypotension
recent stroke or MI (wait 6m)

125
Q

sildenafil SE?

A 
Visual disturbance - blue discolouration
nasal congestion
flushing 
GI side efects
headache
126
Q

management of digoxin toxicity?

127
Q

precipitating factors for digoxin toxicity?

A 
7H + drugs
Hypokalaemia
Hypomagnesaemia
Hypothermia
Hypothyroid
Hypoalbuminaemia

Hypernatraemia
Hypercalcaemia

Drugs: amiodarone,quinidine, verapamil, diltiazem, spiro, ciclosporin

128
Q

Which medications should be used with caution in ischaemic heart disease?

A

NSAIDs
oestrogens: e.g. combined oral contraceptive pill, hormone replacement therapy
varenicline

129
Q

which medications may exacerbate heart failure?

A

thiazolidinediones
pioglitazone is contraindicated as it causes fluid retention
verapamil - negative inotropic effect
NSAIDs/glucocorticoids
should be used with caution as they cause fluid retention

class I antiarrhythmics
flecainide (negative inotropic and proarrhythmic effect)
130
Q

When do you need gradual withdrawal of steroids?

A

received more than 40mg prednisolone daily for more than one week
received more than 3 weeks treatment
recently received repeated courses

131
Q

which drugs are taken weekly?

A

methotrexate

bisphosphonates(alendronate)

132
Q

which drugs may cause SIADH? (hyponatraemia)

A 
sulfonylureas* (glimepiride and glipizide)
SSRIs, tricyclics
carbamazepine
vincristine
cyclophosphamide
133
Q

which drugs may cause nephrogenic DI (hypernatraemia)?

A

lithium
hypercalcaemia
hypokaelamia

134
Q

when should prescribing sweet/glucose fluids be avoided?

A

5% glucose should be avoided in patients who have had a stroke due to the increased risk of cerebral oedema.

135
Q

what is the advice for taking bisphosphonates?

A

‘Tablets should be swallowed whole with plenty of water while sitting or standing; to be taken on an empty stomach at least 30 minutes before breakfast (or another oral medicine); patient should stand or sit upright for at least 30 minutes after taking tablet’.

136
Q

what are the adverse effects of bisphosphonates?

A

oesophageal reactions: oesophagitis, oesophageal ulcers (especially alendronate)
osteonecrosis of the jaw
increased risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate
acute phase response: fever, myalgia and arthralgia may occur following administration
hypocalcaemia: due to reduced calcium efflux from bone

137
Q

which drugs should be avoided in epilepsy?

A 
alcohol, cocaine, amphetamines
ciprofloxacin, levofloxacin
aminophylline, theophylline
bupropion
methylphenidate (used in ADHD)
mefenamic acid
138
Q

first line statin for patients with established CVS disease?

A

atorvastatin 80 mg

atorvastatin 20mg for primary prevention

139
Q

what are the laxative groups?

A

osmotic laxatives
stimulant
bulk-forming
faecal softners

140
Q

factors that may potentiate warfarin?

A 
liver disease
P450 enzyme inhibitors (see below)
cranberry juice
drugs which displace warfarin from plasma albumin, e.g. NSAIDs
inhibit platelet function: NSAIDs
141
Q

what reduces hypoglycaemic awareness?

A

beta blockers

142
Q

Which opioids are preferred if chronic kidney disease?

A

mild: oxycodone
severe: alfentanil, buprenorphine and fentanyl are preferred

143
Q

options for pharmacological VTE prophylaxis?

A

NICE recommend the following options for pharmacological VTE prophylaxis:
low molecular weight heparin (LMWH)
dabigatran
rivaroxaban
apixaban
fondaparinux
unfractionated heparin (UFH) (for patients with renal failure)

144
Q

How should gentamicin dose be adjusted if trough levels are raised?

A

The interval between the doses should be increased if the trough levels are raised.
ie keep dose the same but change from TDS to BD

145
Q

Which antibiotic for exacerbations of chronic bronchitis?

A

Amoxicillin or tetracycline or clarithromycin

146
Q

what antibiotic for uncomplicated CAP?

A

Amoxicillin (Doxycycline/erythromycin or clarithromycin in penicillin allergic)
add flucloxacillin if staphylococci suspected e.g. In influenza

147
Q

which antibiotic for pneumonia caused by atypical?

A

clarithromycin

148
Q

which antibiotic for HAP?

A

Within 5 days of admission: co-amoxiclav or cefuroxime

More than 5 days after admission: piperacillin with tazobactam OR a broad-spectrum cephalosporin (e.g. ceftazidime) OR a quinolone (e.g. ciprofloxacin)

149
Q

Which antibiotic for a lower urinary tract infection?

A

Trimethoprim or nitrofurantoin. Alternative: amoxicillin or cephalosporin

150
Q

Which antibiotic for acute pyelonephritis?

A

Broad-spectrum cephalosporin or quinolone

151
Q

Which antibiotic for acute prostatitis?

A

Quinolone or trimethoprim

152
Q

Which antibiotic for impetigo?

A

Topical hydrogen peroxide, oral flucloxacillin or erythromycin if widespread

153
Q

Which antibiotic for cellulitis?

A

Flucloxacillin (clarithromycin, erythromycin or doxycycline if penicillin-allergic)

154
Q

Which antibiotic for cellulitis near the eyes or nose?

A

Co-amoxiclav (clarithromycin, + metronidazole if penicillin-allergic)

155
Q

which antibiotic for erysipelas?

A

Flucloxacillin* (clarithromycin, erythromycin or doxycycline if penicillin-allergic)

156
Q

which antibiotic for animal or human bite?

A

Co-amoxiclav (doxycycline + metronidazole if penicillin-allergic)

157
Q

Which antibiotic for mastitis during breast feeding?

A

Flucloxacillin

158
Q

which antibiotic for throat infection?

A

Phenoxymethylpenicillin (erythromycin alone if penicillin-allergic)

159
Q

which antibiotic for sinusitis?

A

Phenoxymethylpenicillin

160
Q

which antibiotic for otitis media?

A

Amoxicillin (erythromycin if penicillin-allergic)

161
Q

which antibiotic for otitis externa?

A

Flucloxacillin (erythromycin if penicillin-allergic)

162
Q

which antibiotic for periapical or periodontal abscess?

A

Amoxicillin

163
Q

which antibiotic for gingivitis?

A

Metronidazole

164
Q

which antibiotic for gonorrhoea?

A

Intramuscular ceftriaxone

165
Q

which antibiotic for chlamydia?

A

Doxycycline or azithromycin

166
Q

Which antibiotic for pID?

A

Oral ofloxacin + oral metronidazole or intramuscular ceftriaxone + oral doxycycline + oral metronidazole

167
Q

Which antibiotic for syphilis?

A

Benzathine benzylpenicillin or doxycycline or erythromycin

168
Q

which antibiotic for BV?

A

Oral or topical metronidazole or topical clindamycin

169
Q

which antibiotic for c.diff?

A

First episode: oral vancomycin

Second or subsequent episode of infection: oral fidaxomicin

170
Q

Which antibiotic for campylobacter?

A

Clarithromycin

171
Q

which antibiotic for shigella/salmonella?

A

Ciprofloxacin

172
Q

Drugs which may cause anorexia?

A

metformin

rivastigmine

173
Q

Drug causes of a raised prolactin?

A

metoclopramide, domperidone
phenothiazines
haloperidol
very rare: SSRIs, opioids

174
Q

What is recommended for DVT prophylaxis following knee replacement surgery?

A

LMWH for 14 days
Aspirin 75 mg PO daily for 14 days
Rivaroxaban 10 mg for 14 days
Apixaban or dabigatran if none of the above options can be used

175
Q

How to calculate bolus for children?

A

20 ml/kg over <10 mins

176
Q

medications causing raised CK?

A

Statin

Haloperidol/ 1st generation antipsychotics

177
Q

Which drugs are associated with hepatocellular liver injury?

A 
ALT:ALP >5
paracetamol
NSAIDs
Statins
Amiodarone
178
Q

Which drugs are associated with cholestatic liver injury?

A 
ALT:ALP <2
co-amoxiclav
doxcycline
erythromycin
chlorpromazine
hormonal contraception
179
Q

which drugs are associated with a mixed liver injury picture?

A

ALT:ALP 2-5
phenytoin
sulphonamides
carbamazepine

Year 6 Medicine (18 decks)

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