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HYMS Y5 > PSA > Flashcards

PSA Flashcards

1
Q

Drugs which are enzyme inducers?

**Increase enzyme activity = decrease drug concentration.

A 
Phenytoin
Carbamazepine
Barbituates
Rifampicin
Alcohol (chronic excess)
Sulphonylureas

**PC BRAS

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2
Q

Drugs which are enzyme inhibitors?

**Decrease enzyme activity = increase drug concentration.

A 
Allopurinol
Omeprazole
Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol (acute intoxication)
Sulphonamides

**AO DEVICES

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3
Q

Drugs to stop before surgery?

A 
Insulin
Lithium
Anticoagulants/ antiplatelets
COCP/ HRT
K-sparing diuretics
Oral hypoglycaemic
Perindopril and other ACEi's

**I LACK OP

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4
Q

How long before surgery should you stop the COCP/ HRT?

A

4 weeks before surgery.

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5
Q

How long before surgery should you stop lithium?

A

The day before surgery.

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6
Q

How long before surgery should you stop potassium sparing diuretics/ ACEi’s?

A

The day of surgery.

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7
Q

What is an absolute contraindication to the prescription of gentamicin?

A

Myasthenia Gravis.

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8
Q

Gentamicin dose should be calculated according to what?

A

Ideal body weight.

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9
Q

How should you dose gentamicin if a patient weighs less than the stated ideal body weight?

A

Calculate the dose manually using 5-7mg/kg/day.

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10
Q

Most common prescribing regimen used for gentamicin?

A

Once daily dosing.

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11
Q

The dose interval of gentamicin on a once daily dosing regimen is determined by what?

A

The Hartford Nomogram.

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12
Q

How are doses of gentamicin normally rounded?

A

To the nearest 40mg (as gentamicin comes in 40mg ampoules).

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13
Q

Maximum dose of gentamicin?

A

560mg per day.

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14
Q

When should gentamicin levels be checked?

A

6-12 hours after the dose.

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15
Q

What should you do if a gentamicin level is not checked within the window?

A

Wait until blood levels are <1mg/L and then give the second dose.

**2nd dose cannot be given within 24 hours though.

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16
Q

When might the multiple daily dosing regimen for gentamicin be used?

A

For IE, neonatal sepsis or paediatrics.

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17
Q

What should be avoided in patients taking metronidazole?

A

Alcohol consumption

**Avoid during treatment and for 48 hours after metronidazole course completion.

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18
Q

If a patient with infection has a low BP, what should you withhold?

A

Anti-hypertensives.

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19
Q

How should metronidazole tablets be taken?

A

Should be swallowed whole during or after a meal with a glass of water.

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20
Q

How is warfarin monitored?

A

INR.

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21
Q

How is unfractionated heparin monitored?

A

APTT.

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22
Q

How are DOACs monitored?

A

No regular monitoring.

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23
Q

Reversal of warfarin?

A

Vitamin K ± PCC

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24
Q

Reversal of dabigatran?

A

Idarucizumab.

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25
Q

DOAC reversal?

A

None.

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26
Q

Anticoagulants to avoid if a patient has poor renal function?

A

Dabigatran + Rivaroxaban.

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27
Q

3 drugs that warfarin can interact with that are not enzyme inducers/ inhibitors?

A 
COCP
Theophylline
Corticosteroids
Tricyclics
Pethidine
Statins
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28
Q

When should warfarin be stopped prior to surgery?

A

Stop 3-5 days prior to surgery + check INR is <1.5 before surgery.

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29
Q

When should rivaroxaban + apixaban be stopped prior to surgery?

A

Stop 48 hours prior to surgery.

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30
Q

When should clopidogrel + ticagrelor be stopped prior to surgery?

A

Stop 5 days prior to surgery.

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31
Q

When should aspirin be stopped prior to surgery?

A

Continue it unless there is a high risk of bleeding associated with the surgery (neurosurgery/ prostatectomy).

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32
Q

Management of a patient taking warfarin with major bleeding?

A

Stop warfarin
Give urgent phytomenadione IV
Give urgent PCC (factors II, VII, IX + X)

**FPP can be used as an alternative if PCC not available

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33
Q

Preferred anticoagulants in patients with creatinine clearance of <15?

A

LMWH then UFH

OR

LMWH then warfarin

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34
Q

Anticoagulant preferred in patients who are haemodynamically unstable?

A

UFH

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35
Q

What are the normal daily fluid requirements for patients?

A

25-30ml/kg/day of water.
1mmol/kg/day of Na+, K+ and Cl-.
50-100g/day glucose.

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36
Q

How much glucose does 100ml 5% glucose contain?

A

5g (50g in 1L).

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37
Q

What is the Holliday-Segar formula?

A

100ml/kg/day for the first 10kg of weight.

50ml/kg/day for the next 10kg of weight.

20ml/kg/day for any weight over 20kg.

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38
Q

How do you calculate drip rate?

A

Drip rate = (Total volume of fluid (ml) / total time required for delivery (hours)) x drop factor (number of drops per ml).

**Drip rate gives you the number of drops required per hour. In order to convert to drops per minute, divide by 60.

39
Q

How are the doses of insulin for a basal bolus regimen calculated?

A

0.5-0.75 units/kg/day
50% given as long acting basal insulin in am
Other 50% is split into 3 doses and given as short acting insulin at breakfast, lunch and tea

40
Q

How are the doses of insulin for a twice daily biphasic regimen calculated?

A

0.5-0.75 units/ kg/ day.
Split into 2 doses.
2/3 given in the am.
1/3 given in the pm.

41
Q

Insulin used for DKA?

A

Short acting

Normall Actrapid

42
Q

How is the short acting insulin used to treat DKA dosed?

A

0.1 unit/kg/ hour.

43
Q

Why shouldn’t you give glucagon to diabetics who chronically misuse alcohol?

A

It is ineffective as these patients have depleted glycogen stores.

**Use 100mL 20% glucose instead.

44
Q

Pioglitazone + Novomix 30 can cause what?

A

Pulmonary oedema

45
Q

What do tetracyclines cause in children?

A

Tooth discolouration + pitting of tooth enamel.

46
Q

What do you prescribe as fluid resuscitation for children?

A

20ml/kg of a glucose free crystalloid over <10 minutes.

47
Q

What do you prescribe as fluid resuscitation for neonates?

A

10-20ml/kg of a glucose free crystalloid over <10 minutes.

48
Q

What should the sodium content in fluids used for children be?

A

131 - 154mmol/L

**This is basically NaCl or Hartmann’s.

49
Q

4 drug classes that are proven to be safe in pregnancy?

A

Paracetamol
Beta lactam antibiotics
Steroids
Bronchodilators

50
Q

Indications for high dose (5mg) folic acid in pregnancy?

A 
Previous baby with spina bifida
FHx spina bifida
AEDs
Coeliac disease
Diabetes
BMI >/= 30
SCD/ thalassemia
51
Q

When is a loading dose of IV aminophylline required prior to infusion?

A

If the patient is not taking oral theophylline.

52
Q

NSAIds + CCBs used in combination can precipitate what?

A

Heart failure.

53
Q

Opioids antidote?

A

Naloxone.

54
Q

Benzodiazepines antidote?

A

Flumezanil.

55
Q

SSRIs antidote?

A

None.

Treat acidosis with sodium bicarbonate.

56
Q

TCAs antidote?

A

Serum alkalisation.

57
Q

Paracetamol antidote?

A

NAC.

58
Q

Aspirin/ salicylate antidote?

A

Serum alkalisation.

59
Q

Digoxin antidote?

A

Digibind.

60
Q

Insulin/ beta blockers antidote?

A

Glucagon.

61
Q

Iron salts antidote?

A

Desferroxamine mesylate.

62
Q

Methanol/ ethylene glycol antidote?

A

Ethanol.

63
Q

Dabigatran antidote?

A

Prax bind.

64
Q

Who should be given high dose nicotine patches for NRT?

A

Those who smoke >/=10 a day.

65
Q

Who should be given medium dose nicotine patches for NRT?

A

Those who smoke <10 a day.

66
Q

When should a patient be given the higher dose of levonorgestrel as emergency contraception?

A

If BMI >26 or body weight >70kg.

67
Q

What type of hormonal contraception should you prescribe for a women with a uterus who has had a period in the last year?

A

Oral/ transdermal sequential combined HRT.

68
Q

What type of hormonal contraception should you prescribe for a woman with a uterus whose last period was >1 year ago OR who has been on HRT for a year?

A

Oral/ transdermal continuous combined HRT.

69
Q

What type of hormonal contraception should you prescribe for a woman who does not have a uterus?

A

Oral/ transdermal oestrogen.

70
Q

Types of oral sequential combined HRT?

A

Elleste Duet tablets

1/2mg oestradiol + 1mg norethisterone.

71
Q

Types of transdermal sequential combined HRT?

A

Evorel sequi patches
Elleste Duet Conti
50mcg oestradiol + 170mcg norethisterone.

72
Q

Types of oral continuous combined HRT?

A

Elleste Duet Conti

2mg oestradiol + 1mg norethisterone.

73
Q

Types of transdermal continuous combined HRT?

A

Evorel conti patches

50mcg oestradiol + 170mcg norethisterone.

74
Q

Types of oral unopposed oestrogen HRT?

A

Elleste solo

1mg/2mg oestradiol

75
Q

Types of transdermal unopposed oestrogen HRT?

A

Evorel patch

25/50/75/100mcg oestradiol.

76
Q

Indications for transdermal HRT therapy?

A
  • Individual preference
  • Poor symptom control with oral HRT.
  • GI disorder affecting oral absorption.
  • Previous or FHx of VTE
  • BMI >30
  • Variable blood pressure control
  • Migraine
  • Current use of hepatic inducing enzyme medication
  • Gall bladder disease
77
Q

What should you prescribe for post-menopausal osteoporosis?

A

Bisphosphonates + calcium and vitamin D supplement (e.g. Adcal D3).

78
Q

Breakthrough dose of morphine?

A

1/6th total daily dose of morphine

79
Q

What is preferred to morphine in palliative patients with mild-moderate renal impairment?

A

Oxycodone

80
Q

What is preferred to morphine in palliative patients with severe renal impairment?

A

Fentanyl/ Buprenorphine

81
Q

When increasing opioid dose, how much should the dose be increased by?

A

30-50%.

82
Q

Oral codeine to oral morphine?

A

Divide by 10

83
Q

Oral tramadol to oral morphine?

A

Divide by 10

84
Q

Oral morphine to oral oxycodone?

A

Divide by 1.5/2

85
Q

A 12mcg transdermal fentanyl patch equates to how much PO morphine daily?

A

30mg

86
Q

A 10mcg transdermal buprenorphine patch equates to how much PO morphine daily?

A

24mg

87
Q

PO morphine to SC morphine?

A

Divide by 2

88
Q

PO morphine to SC diamorphine?

A

Divide by 3

89
Q

PO oxycodone to SC diamorphine?

A

Divide by 1.5

90
Q

Number of tablets required = ?

A

Number of tablets = dose required/ dose in tablet.

91
Q

Infusion rate = ?

A

Total volume in mL/ Total time in hours

92
Q

Volume of liquid medication needed?

A

What you want x what it’s in

DIVIDED BY

What you’ve got

93
Q

How much glucose in 100mL 5% glucose?

A

5g per 100mL

HYMS Y5 (11 decks)

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