PSA Flashcards
Notes made off the Pass the PSA book, Medlearn tips, and any questions done off Passmed and Quesmed
1
Q
Enzyme inducers
A
PC BRAS
- Phenytoin
- Carbamazepine
- Barbiturates
- Rifampicin
- Alcohol (chronic excess)
- Sulphonylureas
Increase enzyme activity thus decreased drug concentration
2
Q
Enzyme inhibitors
A
AODEVICES
- Allopurinol
- Omeprazole
- Disulfiram
- Erythromycin
- Valproate
- Isoniazid
- Ciprofloxacin
- Ethanol (acute intoxication)
- Sulphonamides
3
Q
Drugs that should be stopped before surgery
A
I LACK OP
- Insulin
- Lithium
- Anticoagulants/antiplatelets
- COCP/HRT
- K-sparing diuretics
- Oral hypoglycaemics
- Perindopril and other ACE-i
4
Q
3 drug (classes) that interact with digoxin and how
A
Erythromycin (a macrolide antibiotic) increases plasma concentration of digoxin, by inhibiting metabolism therefore ↑ toxicity.
Bendroflumethiazide (and loop diuretics) cause ↓ K+ and this enhances potential cardiac toxicity of digoxin.
Calcium-channel blockers, especially verapamil and including nifedipine ↑ plasma digoxin levels with an ↑ risk of A-V block and bradycardia.
5
Q
Thiazide diuretic action
A
Works by inhibiting sodium reabsorption at the beginning of the distal convoluted tubule (DCT)
6
Q
Simvastatin x macrolide interaction
A
Increased risk of myopathy/MSK side effects
7
Q
When is loperamide contraindicated?
A
Suspicion of dysentery
Inflammatory bowel disease
Bacterial enterocolitis
8
Q
When can amoxicillin cause an erythematous rash outside of a penicillin-allergy?
A
Infectious mononucleosis
ALL
CLL
9
Q
Essentials of prescribing
A
PReSCRIBER
Pt details
Reaction (i.e. allergy)
Sign front of chart
Contraindications of drug
Route of drug
IV fluids needed?
Blood clot prophylaxis needed?
anti-Emetic needed?
pain Relief needed?
10
Q
Side effects of steroids
A
STEROIDS
Stomach ulcers
Thin skin
oEdema
Right and left heart failure
Osteoporosis
Infection
Diabetes
cushing’s Syndrome
11
Q
Max rate IV potassium can be given at
A
10mmol/hour
12
Q
General maintenance fluids per 24 hours
A
Adults = 3L/day
Elderly = 2L/day
13
Q
Cyclizine indication, dose, frequency, route, side effect
A
Anti-emetic
Cyclizine 50mg 8 hourly IM/IV/oral
Causes fluid retention so avoid in cardiac cases
14
Q
Metoclopramide dose, frequency, route, side effect
A
Anti-emetic
Metoclopramide 10mg up to 8 hourly IM/IV if heart failure
Exacerbates Parkinson’s disease/risk of dyskinesia especially in women
15
Q
Prescription indicated in painful diabetic neuropathy
A
Duloxetine 60mg oral daily
16
Q
Prescription indicated in neuropathic pain
A
Amitriptyline 10mg oral nightly
OR
Pregabalin 75mg oral 12 hourly
17
Q
Maximum dose of paracetamol if pt <50kg
A
500mg 6-hourly
18
Q
Which dopamine agonist is safe to use in Parkinson’s as an anti-emetic and why?
A
Domperidone
Does not cross the blood-brain barrier thus does not act on central dopamine receptors to exacerbate parkinsonian sx
19
Q
Signs of antimuscarinic toxicity
A
Confusion in elderly
Pupillary dilatation
Loss of accommodation
Dry mouth
Tachycardia (after transient bradycardia)
20
Q
Trimethoprim x methotrexate interaction
A
Both are folate antagonists thus should not be used in conjunction
Increased risk of bone marrow toxicity, leading to pancytopaenia and neutropenic sepsis
21
Q
One instance when prophylactic enoxaparin is inappropriate
A
Following acute ischaemic stroke due to risk of haemorrhagic transformation
22
Q
Drugs that can cause neutropaenia
A
Clozapine
Carbimazole
23
Q
Causes of macrocytic anaemia
A
B12/folate deficiency
Excess alcohol
Liver disease (including non alcohol)
Hypothyroidism
Haematological diseases beginning with M: myeloproliferative, myelodysplastic, multiple myeloma
24
Q
Drugs that can cause thrombocytopaenia
A
Penicillamine
Heparin
25
Drugs that can cause SIADH
Carbamazepine
Antipsychotics
26
Causes of hypokalaemia
DIRE
Drugs (loop and thiazide diuretics)
Inadequate intake/intestinal loss (diarrhoea/vomiting)
Renal tubular acidosis
Endocrine (Cushing's and Conn's)
27
Causes of hyperkalaemia
DREAD
Drugs (potassium-sparing diuretics and ACEi)
Renal failure
Endocrine (Addison's)
Artefact (clotted sample)
DKA
28
Intrinsic causes of AKI
INTRINSTIC
Ischaemia
Nephrotoxic antibiotics
Tablets (ACEi, NSAIDs)
Radiological contrast
Injury (rhabdomyolysis)
Negatively birefringent crystals (gout)
Syndromes (glomerulonephritides)
Inflammation (vasculitis)
Cholesterol emboli
29
Nephrotoxic antibiotics include
Gentamicin
Vancomycin
Tetracyclines
30
Causes of raised ALP
ALKPHOS
Any fracture
Liver damage (post hepatic)
Kancer lol
Paget's disease of bone and Pregnancy
Hyperparathyroidism
Osteomalacia
Surgery
31
Drugs that cause cholestasis
Flucloxacillin
Co-amoxiclav
Nitrofurantoin
Steroids
Sulphonylureas
32
CXR signs of pulmonary oedema
ABCDE
Alveolar oedema (bat wings)
kerley B lines (interstitial oedema)
Cardiomegaly
Diversion of blood to upper lobes
pleural Effusions
33
QRS complex deflections seen in left and right bundle brunch block
QRS > 3 small squares wide
WiLLiaM = left BBB
MaRRoW = right BBB
34
Features of gentamicin and vancomycin toxicity
Ototoxicity
Nephrotoxicity
35
Typical gentamicin treatment if no renal failure
IV gentamicin 5-7mg/kg once daily
36
INR targets
a) typical
b) recurrent thromboembolism
c) metal replacement heart valves
a) 2.5
b) 3.5
c) >2.5 (depends on valve)
37
What is protocol for a warfarin patient with a major bleed?
*causes hypotension or bleeding in confined space
1. STOP WARFARIN
2. 5-10mg IV vitamin K
3. Prothrombin complex (Beriplex)
38
What to do when warfarin pt is not bleeding and INR is:
a) 5-8,
b) >8?
a) Omit warfarin for 2 days then reduce dose
b) Omit warfarin and give 1-5mg PO vitamin K
39
What to do when warfarin pt is bleeding and INR is:
a) 5-8,
b) >8?
a) Omit warfarin and give 1-5mg PO vitamin K
b) Omit warfarin and give 1-5mg IV vitamin K
40
Anaphylaxis adrenaline dose in an adult
Adrenaline 500 micrograms of 1:1000 IM
41
Bacterial meningitis antibiotics
2g cefotaxime IV
If immunocompromised:
+ 2g ampicillin IV
42
Seizure lasting >5 minute initial drugs
Lorazepam 2-4mg IV
OR
Diazepam 10mg IV
OR
Midazolam 10mg buccal
43
Seizure tx not responding benzodiazepines treatment
Phenytoin 15-20 mg/kg IV
44
Antidote to benzodiazepine overdose
Flumazenil
45
Drugs contraindicated in bundle branch block
Beta-blockers as there is a risk of causing bradycardia or complete heart block
46
Oliguria definition
Urine output less than 0.5ml per kg body weight per hour or <400mls in 24 hours
47
ECG changes showing LV hypertrophy
Prolonged QRS (broad)
Tall R wave (>5 squares)
Left axis deviation
Inverted T waves in V5/ V6 (if severe)
48
Rhythm control for AF mx
ONLY IF PRESENTS <48 HOURS
1. Electrical cardioversion
2. Pharmacological cardioversion
- flecanide (if no structural HD)
- amiodarone (if structural HD)
49
Rate control for AF mx
WHEN PRESENTATION >48 HOURS
1a. Beta-blocker
- bisoprolol 2.5mg daily
OR
1b. CCB
- diltiazem 20mg daily
depending on contraindications
2. Digoxin monotherapy in non-paroxysmal AF
50
What test should diabetics get annually and why?
Albumin-creatinine ratio
- check for diabetic nephropathy
- predictor of CVD if >/= 3mg/mmol
51
Parkinson's medication and drug class
1. Co-beneldopa, co-careldopa
= levodopa + peripheral dopa decarboxylase inhibitor
2. Ropinirole
= dopamine agonist
3. Rasagiline
= monoamine oxidase inhibitor
52
Drug choice for myoclonic seizures
Valproate (men)
Levetiracetam (women)
53
Drug choice for tonic seizures
Valproate (men)
Lamotrigine (women)
54
Drug choice for focal seizures that are not myoclonic/tonic
Carbamazepine or lamotrigine
55
Drug choice for absence seizures
Ethosuximide or valproate
56
Drug choice for generalised tonic-clonic seizures
Valproate (men)
Lamotrigine (women)
57
Medication for mild-moderate dementia and drug class
AChE inhibitors
1. Donepezil
2. Rivastigmine
3. Galantamine
58
Medication for moderate-severe dementia and drug class
NMDA antagonist (acts on glutamate receptors)
1. Memantine
59
Lamotrigine side effects
Rash
RARE = Stevens-Johnson syndrome
60
Carbamazepine side effects
Rash
Dysarthria
Ataxia
Nystagmus
Hyponatraemia
61
Phenytoin side effects
Ataxia
Peripheral neuropathy
Gum hyperplasia
Hepatotoxicity
62
Sodium valproate side effects
Tremor
Teratogenicity
Weight gain
63
Levetiracetam side effects
Fatigue
Mood disorders
Agitation
64
Mild Crohn's flare prescription
Prednisolone 20-40mg daily orally
65
Severe Crohn's flare prescription
IV hydrocortisone 100-500mg three to four times daily or PRN
66
Non-infective chronic diarrhoea treatment
Loperamide 2mg oral up to 3 hourly
OR
Codeine 30mg oral up to 6 hourly
67
Examples of stool softeners
Docusate sodium
Arachis oil (rectal)
68
Example of bulking agent
Isphagula husk
69
Example of stimulant laxative
Senna
Bisacodyl
70
Example of osmotic laxatives
Lactulose
Phosphate enema
71
Contraindications for laxatives
Arachis oil (stool softener): nut allergy
Bisacodyl: acute abdomen
Bulking agents: faecal impaction, colonic atony, reduced gut motility
Phosphate enema: acute abdomen, IBD
72
Warfarin tablet colours and respective dose
White = 0.5mg
Brown = 1mg
Blue = 3mg
Pink = 5mg
73
Instructions on how to take alendronic acid
Once weekly tablet
- needs to be swallowed with a full glass of water
- must remain upright for 30 minutes afterwards
- food should be avoided 2 hours after taking to decrease risk of malabsorption
- should not be taken at same time as calcium and iron to decrease risk of malabsorption
74
Breast cancer risk after stopping HRT
Excess risk of breast Ca persists for more than 10 years after stopping HRT compared with women who have never used HRT
75
What does 1% of a drug mean?
1g in 100mL (weight/volume)
OR
10mg in 1mL (weight/volume)
OR
1g in 100g (weight/weight)
76
Which drug formulations differ as a result of the salt-factor?
Phenytoin
Digoxin
Sodium fusidate
*when salt vs base preparations of the drug are not biochemically equivalent and given narrow therapeutic index of above drugs, must take caution to ensure if change formulation (i.e. oral phenytoin salt to IV phenytoin base) correct dose calculated
77
Tx for hypoglcaemia
1. IV Glucose 20% solution 50-100ml within 20 minutes
2. IV Glucose 10% solution 100-200ml within 20 minutes
78
What rise in creatinine is expected post starting ACEi?
20%
- continue w treatment and monitoring
79
What % reduction in which lipids is the aim of statin treatment for 3 months?
>40% reduction in non-HDL cholesterol
80
Prescription requirements for Controlled Drugs
1. Must be written in the doctors own handwriting except for computer generated prescriptions.
2. Must state the name of the drug.
3. Must state the formulation of the drug.
4. Must state the concentration of the drug.
5. Must state the total quantity in words and figures.
6. Must be signed and dated by the prescriber.
81
Fentanyl patch dose is equal to what morphine dose?
25microgram fentanyl patch = 90mg morphine
100microgram fentanyl patch = 360mg morphine
82
When's the best time to give ACEi?
Evening as they can cause postural hypotension
83
When's the best time to give diuretics?
Morning as they causes subsequent diuresis, don't wanna piss all night
84
What is the only ACEi advised to be taken in the morning?
Perindopril
85
What is the 1-hour (peak) serum concentration for treatment of endocarditis with gentamicin?
3-5 MG/L
86
What do you need to monitor in pts undergoing digoxin?
Serum creatinine
- digoxin renally excreted, higher risk of toxicity if kidneys fucked
87
What should be checked before starting sodium valproate?
ALT
- SV associated w hepatotoxicity
- should be measured regularly
88
ADR to gentamicin and vancomycin
Nephrotoxicity
Ototoxicity
89
ADR to cephalosporins/ciprofloxacin
Clostridium difficile colitis
90
ADRs to ACEi
Hypotension
Electrolyte abnormalities
AKI
Dry cough
91
ADRs to beta-blockers
Hypotension
Bradycardia
Wheeze in asthmatics
Worsens acute heart failure
92
ADRs to CCBs
Hypotension
Bradycardia
Peripheral oedema
Flushing
93
ADRs to diuretics
Hypotension
Electrolyte abnormlaities
AKI
Subclass-dependent effects
- spironolactone causes gynaecomastia
94
ADRs to heparins
Haemorrhage
- especially if renal failure or < 50kg
Heparin-induced thrombocytopaenia
95
ADRs to warfarin
Haemorrhage
- initially procoagulant effect so needs to bridged with heparin
96
ADRs to aspirin
Haemorrhage
Peptic ulcers
Gastritis
Tinnitus in large doses
97
ADRs to digoxin
Nausea
Vomiting and diarrhoea
Blurred vision
Confusion and drowsiness
Xanthopsia
- disturbed yellow/green visual perception including 'halo' vision
98
ADRs to amiodarone
Interstitial lung disease (pulmonary fibrosis)
Thyroid disease
Skin greying
Corneal deposits
99
ADRs to lithium
Early - tremor
Intermediate - tiredness
Late - arrhythmias, seizures, coma, renal failure, diabetes insipidus
100
ADRs to haloperidol
Dyskinesias
- acute dystonic reactions
Drowsiness
101
ADRs to clozapine
Agranulocytosis
102
ADRs to dexamethasone and prednisolone
STEROIDS
Stomach ulcers
Thin skin
oEdema
Right and left heart failure (stupid)
Osteoporosis
Infection (incl. Candida)
Diabetes (as in hyperglycaemia)
cushing's Syndrome
103
ADRs to fludrocortisone
Hypertension
Sodium and water retention
104
ADRs to NSAIDs
NSAID
No urine (renal failure)
Systolic dysfunction (heart failure)
Asthma
Indigestion (any cause)
Dyscrasia (clotting abnormality)
105
ADRs to simvastatins
Myalgia
Abdo pain
Increased ALT/AST (can be mild)
Rhabdomyolysis (can be mild CK increase)
106
Most common enzyme inhibitors
Ketoconazole
Ciprofloxacin
Erythromycin
Grapefruit juice
107
Which drugs can cause GI bleeding?
NSAIDs
108
Which drugs can cause increased anticoagulation?
Warfarin
Chronic alcohol use
109
Which drugs can cause lactic acidosis?
Metformin
110
Which drugs can cause hypertensive crisis?
Monoamine oxidase inhibitors
111
Which drugs can cause sedation?
Barbiturates
Opioids
Benzodiazepines
112
Which drug interaction can cause sweating, flushing, nausea and vomiting?
Metronidazole and disulfiram
113
What is medicines reconciliation?
Process which ensures medicines prescribed on admission correspond to those that the patient was taking before admission if they are still safe and appropriate
114
Which medications require daily INR monitoring when initiating or discontinuing them due to their interactions with warfarin?
Remember… WARFOAC
Warfarin daily INR monitoring until stable:
Antibiotics
Regular tramadol
Fluconazole
Omeprazole
Amiodarone
Corticosteroids (high dose)
115
What is essential when prescribing vancomycin?
A loading dose of vancomycin is essential to ensure therapeutic levels are reached rapidly
- prescribe a loading dose of vancomycin based on actual body weight when initiating IV vancomycin
- loading dose is based on actual body weight and is irrespective of renal function
116
Different Humalog preparations
117
Name drugs to use with caution in penicillin-allergic pts
118
What would you expect to use in anticipatory medication for your palliative pt?
*from palliative lecture
119
Overview of which anti-emetic to use depending on the cause
*from palliative lecture
120
Overview of which laxative to use depending on the action needed
- include contraindications
*from palliative lecture
120
Overview of which laxative to use depending on the action needed
- include contraindications
*from palliative lecture
121
What should be done for patients with Addison's when they are admitted?
For patients taking long term steroids for Addison’s disease (usually more than 3 weeks) it is essential that steroid doses
are doubled at times of stress to reduce the risk of an adrenal crisis
122
What is the IV paracetamol dose every 4-6 hours?
NOTE: < 50kg, need a lower dose!!
123
Which drug class should not be mixed with statins, and why?
Amlodipine, diltiazem or verapamil (CCBs) can increase the levels of simvastatin, which may increase the risk of myopathy or rhabdomyolysis
124
What does an overdose in opioids result in?
Respiratory depression
Hypotension
Somnolence
Central nervous system depression which can progress to stupor, coma or death
125
Name common preparations of morphine and oxycodone
126
Which drug classes increase the risk of tacrolimus toxicity?
Macrolides
- erythromycin, clarithromycin
Azoles
- clotrimazole, fluconazole
*toxicity leads to nephrotoxicity/AKI
127
Which drugs would interact with warfarin to increase INR?
128
Which drugs would interact with warfarin to decrease INR?
129
Which medications reduce hypoglycaemic awareness in diabetic pts?
Beta-blockers
130
Concurrent use of which two inhalers will lead to what sort of anti-muscarinic side effects?
The concurrent use of ipratropium nebuliser and a LAMA-containing inhaler may increase anti-muscarinic side effects such as urinary retention, constipation, blurred vision and dry mouth
131
Which medications need at least 2 hours of administration from calcium salts?
Quinolones (e.g. norfloxacin, ciprofloxacin)
Tetracyclines (e.g. doxycycline)
Bisphosphonates (e.g. alendronic acid)
Oral iron supplements
Levothyroxine
*administration together leads to reduced absorption of the drugs above
**antacids (gaviscon/peptac) also contain calcium salts
