PSA Flashcards
Adren Doses:
Anaphylaxis
Non-Shock
Adren: (Anaphylaxis):
- < 6mo: IM 0.1-0.15mg (1:1000)
- 6mo – 6yo: IM 0.15mg (1:1000)
- 6-12yo: IM 0.3mg (1:1000)
- Adult: IM 0.5mg (1:1000)
Adren: (Non-Shockable Rhythm: PEA/Asystole):
- IV 1mg (1:10,000)
HC (Anaphylaxis, Asthma)
Chlorpheniramine
Atropine
HC: 200mg (Anaphylaxis), 100mg (Asthma)
Chlorpheniramine: 10mg
Atropine: 0.5mg (Post-MI BradyC)
Hyperkalaemia Doses
Ca2+ Gluconate: 10ml (10%)
Insulin/Dextrose Infusion: (Hyperkalaemia): 10 Units Actrapid + 50ml Dextrose (50%)
Hypoglycaemia Doses
- Conscious, Orientated: 15-20g Fast-acting Carbohydrate
- Conscious, Disorientated: 1.5-2 tubes of Glucogel
- Unconscious: IM Glucagon 1mg
- Prolonged/Persistent: IV 20% Glucose 100ml (over 15mins)
Morphine Doses
Naloxone Doses
Morphine: (MI): IV 10mg (w/ IV Metacloperamide 10mg)
Naloxone: IV 0.4mg
Drugs prescribed in Micrograms
Drugs taken weekly
Digoxin
Levothyroxine
Methotrexate (Non-oncological)
Alendronate
Indications for Fluid Resus + Mx
- Syst BP < 100
- HR > 90
- RR > 20
- CRT > 2s
- NEWS > 5
IV 0.9% NaCl 500ml over 15min
Routine Maintenance Fluid:
H2O
K+/Na+/Cl-
Glu
25-30ml/Kg/day H2O
1mmol/Kg/day K+/Na+/Cl-
100g/day Glu
ADR of: Amlodipine Beta-blockers ACEi Amiodarone
Amlodipine: Periph Oedema
Beta-blockers: Changes in BP, BradyC, ED
ACEi: Dry Cough, Changes in BP
Amiodarone: BradyC, Pulmon Fibrosis, Thyroid Dysfunction
ADR of: Ferrous Supplements Warfarin/Aspirin/NSAIDs Statins Metformin
Ferrous Supplements: Constipation
Warfarin/Aspirin/NSAIDs: Bleeding, Gastritis
Statins: Gastritis, Myopathy
Metformin: Lactic Acidosis
ADR of: Benzos/TCA’s/Gabapentin Prednisolone Phenytoin Clozapine Alendronate
Benzos/TCA’s/Gabapentin: Drowsiness, Falls
(TCA’s: Blurred vision, Dry mouth/Xerostomia)
Prednisolone: Changes in BP
Phenytoin: Skin Reactions
Clozapine: Agranulocytosis
Alendronate: Gastritis
CVS Drug Montioring: Statins ACEi Amiodarone Furosemide Anti-coags
Statins (LFTs) ACEi (U+E) Amiodarone (TFT, LFT, Serum K+) Furosemide (Weight) Anti-coags (Pt reports of bruising)
Rheum Drug Monitoring:
Methotrexate
Azathioprine
Cyclosporin
Methotrexate (FBC, LFT, U+Es)
Azathioprine (TMPT/FBC, LFT)
Cyclosporin (Reg U+Es)
Neuro Drug Monitoring:
Lithium
Na+ Valproate
Lithium (Li, TFT, U+E)
Na+ Valproate (LFT)
Endo Drug Monitoring:
Glitazones
OCP
Glitazones (LFT)
OCP (BP)
Drugs Contraindicated in Pregnancy - 7
ACEi/ARB’s Antibiotics Cytotoxic Agents (Azathioprine, Cyclophosphamide, Methotrexate) Statins Sulfonylureas (Glicazide) Retinoids (Incl topical) Warfarin
Drugs Contraindicated in Asthma:
NSAIDs
Beta-blockers
Adenosine
Drugs Contraindicated in AKI:
ACEi/ARBs, Antihypertensives, NSAIDs Contrast Opiates (Codeine, Morphine) Penicillins, Aminoglycosides (Gentamicin), Sulphonamides Immunosupp (Tacrolimus, Cyclosporin) Allopurinol
Drugs Contraindicated in HF:
Glitazones
CCB (Amlodipine safe), Class I + II Antiarrythmics (Flecainide, Bisoprolol), Alpha-blockers
NSAIDs
Glucocorticoids (Pred, Dexamethasone, HC)
Drugs Causing Hyperkalaemia:
K+ sparing (ACEi/ARBs, Spironolactone) NSAIDs Beta-blockers Heparin Yasmin contraception Trimethoprim Immunosupp (Tacrolimus, Cyclosporin)
Drugs Causing Hypokalaemia:
Loop/Thiazides Diuretics Insulin Beta-Agonists, Theophyllines Laxatives Topiramate
Drugs Causing Hypernatraemia:
Lithium
Vit A/D
Drugs Causing Hyponatraemia:
SSRi TCAs Anti-psychotics AEDs (Carbamazepine) ChemoTx
(CYP450 Inhib): (Raised INR):
A: Allopurinol O: Omeprazole D: Disulphiram E: Erythromycin V: Valproate I: Isoniazid C: Ciprofloxacin E: Ethanol S: Sulphonamides
(CYP450 Induc): (Lowered INR):
P: Phenytoin C: Carbamazepine B: Barbiturates R: Rifampicin A: Alcohol (Chronic Excess) S: Sulphonlyureas
Pre-Op Med to Stop
Anti-Coag’s, Anti-platelets, NSAIDs ACEi/ARBs, Diuretics Lithium, MAOi PO DM HRT/OCP (4wks before) ST Drugs (Vitamins)
Pre-Op Med to Cont
Beta-blockers + other CVS drugs AEDs Steroids + other Immunosupp Asthma Inhalers PPi/H2-Antag Thyroid Med Anti-D, Anxiolytics, Anti-psychotics, Anti-PD
Serotonergic SE’s
Restlessness/Agitation Headaches N+V Sexual Dysfunction Weight changes
Muscarinic SE’s:
Dry Mouth
Hot, dry, flushed skin
Urinary Retention
Histaminic SE’s:
Sedation
N+V
Miscellaneous Insulin Rules
Never Omit during Illness
If Resistant: Raise by ~ 10%
Rise in AM dose => Drop in PM BM
When to take Rivoroxaban
w/ Food
Alendronate Instructions
Before breakfast (Empty stomach)
Sat up during and after for 30mins
w/ plenty of Water
Avoid eating Food for 2hrs after + Avoid taking w/ Ca2+ Supplements (=> Reduced Absorption)
Beta-blocker Contras
w/ CCB
PVD
When to take Statins/Amitriptyline
At night before bed
Digoxin Monitoring
Measure Serum Digoxin levels 6 hourly
Monitor U+Es
Statin Discontinuation
If Serum Transaminases > 3 x Baseline
If Sx resolve: Restart at lower dose
CCB +
CCB + Pred => Worsening of HF
CCB + Naproxen => Oedema
SSRi Warnings, Interactions + Monitoring
Reduced mood in first month
+ DOAC => Bleeding
+ Tramadol => Serotonin Synd
(No routine Monitoring)
Alendronate Interactions
+ Pred => Dyspepsia
+ PPi => Diarrh
Opioid Toxicity/AKI Mx
Switch Morphine for Oxycodone (Semi-opioid)
Post-Op N+V Mx
IV Cyclizine
Diarrh Mx + Instructions
Loperamide taken as 4mg + 2mg after each loose stool (max 16mg/day)
GTN Rules
Repeat after 5 mins
If no benefit after 2: Call Ambulance
Maj Bleeding Mx
IV Phytomenadione (Vit K) + Prothrombin Complex
Anti-Coag Warning + Monitoring
Avoid IM Injections
Recheck INR after 48hrs
(Heparin requires 6 hourly APTT)
Carbimazole Indication + SE
Graves D (HyperTh) Neutropenia, Agranulocytosis
Hypoglycaemia Tx
IV 20% Glucose 100ml (15mins)
ATTB Tx SE
R+I: Accelerated metabolism of OCP
R+I+P: Hepatotoxicity
I: Periph Neuropathy (Pyridoxine)
E: Retrobulbar Neuritis
Co-Amox SE
Jaundice
Nitrofurantoin Contras
eGFR < 45 3rd Trimester (Neonatal Haemolysis) (Avoid Trimethoprim in 1st Trimester)
Contras:
Aspirin/Heparin/Warfarin
NSAIDs
Aspirin/Heparin/Warfarin: Bleeding, Stroke
NSAIDs: AKI, HF, Asthma, Indigestion, Bleeding D
Contras/SE:
Anti-HT
(Beta-blockers, CCB)
(Diuretics)
Anti-HT: HypoT
Beta-blockers, CCB (Verapamil/Diltazem): BradyC
Diuretics: Electrolyte disturbance, Renal Fail
(Beta-blockers: Asthma, Acute HF)
(Amlodipine: Periph Oedema)
(ACEi: Dry Cough, Hyperkalaemia)
(Loop: Gout, Hypokalaemia)
Comm cause of Dyskinesia/PD Sx
Metocloperamide, Haloperidol (crosses BBB)
Antiemetic
Cyclizine
Fluid Prescribing (Maintenance)
Adults: 3L (1 Salty + 2 Sweet)
Elderly: 2L
(K+: 40mmol/day)
Step-up Pain Mx
No Pain: No Reg, Paracetamol PRN (1g QDS)
Mild Pain: Paracetamol Reg, Codeine PRN (30mg QDS)
Severe Pain: Co-codamol Reg, Morphine PRN (10mg QDS)
Insulin Route
All SC Except SA (Novorapid, Actrapid)
AF Types Mx
Slow AF: Rhythm Control (Amiodarone, Beta-blocker, DC - If < 48hrs)
Fast AF: Rate Control (Beta-blocker - Contra: Asthma, CCB - Contra: Fluid retention, Digoxin)
1st Line Hypnotic (Insomnia)
Zopiclone
Grams in 1% sol
1g in 100ml
10mg in 1ml
PE 1st Line Tx
SC Dalteparin
Mild Pain in ACS
SL GTN
1st Line Tx for lowering Hyperkalaemia
IV Actrapid 10 Units in 100ml of Dextrose 20% over 30mins
1st line Diabetic control
If Overweight: Metformin
If Underweight/Cr > 150: Gliclazide
Statin monitoring
ALT (Baseline, 3 months, 12 months)
If Myopathy Risk Factors: CK
Lithium Monitoring
Serum conc should be measured 12hrs after last dose
Lithium levels can be affected by Dietary Sodium Intake
Lithium levels should be checked weekly at start and after each dose change then 3 monthly
Methotrexate monitoring
Baseline LFT monitoring FBC monitoring (Once stable every 2-3 months) - Drop in WBC/RBC/Plt => Stop Methotrexate
Amiodarone monitoring
Baseline CXR
TFTs, LFTs
(Caution in Pt’s w/ Hypokalaemia)
Carbimazole monitoring
FBC (esp Neutrophil Count)
Gentamicin monitoring
For a multiple daily dosing regimen: Pre and Post dose levels should be monitored
Renally excreted => Renal monitoring
Digoxin monitoring
Serum Cr (Renally excreted) Serum digoxin levels only needed if: Toxicity, Non-compliance, Inadequate Effect
Na+ Valproate monitoring
Serum LFTs
+/- => Pancreatitis: Amylase/Lipase
Clozapine monitoring
FBC Weekly for 18wks
Drugs with narrow Therapeutic window
Warfarin
Digoxin
Phenytoin
Common ADR of:
Beta-agonists
Beta-blockers
Beta-agonists: TachyC/HyperT, Heat Intolerance, Tremor
Beta-blockers: BradyC/HypoT, Cold Intolerance, Fatigue
Warfarin Interactions
Erythromycin, Clarithromycin (CYP450 Inhib) => Raised INR
Aspirin in AKI/Surg
Co-codamol in AKI
Aspirin can continue (Should be stopped in Surg)
Co-codamol cannot
Drugs interacting w/ Lithium
Lithium affected by NSAIDs/Diuretics/ACEi
If Diuretic needed: Furosemide safest
Dose adjustment Rules
Amend doses by least amount
Fluid guidelines
2 Salty + 1 Sweet
If High Na+: Give Dextrose, If Low Na+: Give NaCl
Never give KCl > 20mmmol/hr
DM control w/ CKD
Sulphonylureas safer than Metformin
Vent Mx:
T1RF
T2RF
T1RF: CPAP
T2RF: BPAP
HypoT after Fluid Bolus given Mx
IV Colloid (Gelofusine)
Statin interaction w/ Clarithromycin
Stop Statin
Sign of Pneumonia Resolution
SpO2
RR
SSRi Monitoring
Suicide Assessment
Tacrolimus Monitoring
Pre-dose levels
ABx Prescribing
Requires Indication + Duration (R/v day)
Prescribing Timings
If given nightly (Statin, Senna)
Pain Mx
If constant: Regular Meds, If Variable: PRN
Start Mild + Titrate up
Cyclizine SE’s
Acetylcholinesterase Inhib SE’s
Cyclizine: Antimuscarinic (Anti-SLUDGE)
AChi: Cholinergic Crisis (SLUDGE)
Mild Allergy Mx
PO Chlorpheniramine
Raised INR w/ Bleeding
IV Vit K (Slow Infusion)
HF (w/ Asthma)
ACEi (taken at night)
