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PSA Flashcards

1
Q

Name 5 enzyme inducers.

A

Rifampicin
Phenytoin
Barbiturates
Carbamazepine
Alcohol (chronic use)

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2
Q

Name 5 enzyme inhibitors.

A

AO DEVICES
Allopurinol
Omeprazole
Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol (acute intoxication)
Sulphanamides

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3
Q

Name 5 drugs to be stopped before surgery.

A

I LACK OP

Insulin- May start a sliding scale.

Lithium- stop day before
Anticoagulants/anti platelets- person and procedure dependent.
COCP/HRT- 4wks prior
K+ Sparring drugs- day of.

Oral hypoglycaemics- if patient has not eaten then can lead to lactic acidosis.
Lisinopril and other ACEi

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4
Q

If a patient requiring replacement fluid is either hypernatremic or hypoglycaemic, which fluid should be given?

A

Give 5% dextrose, instead of usual 0.9% normal saline.

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5
Q

If a person has ascites, which fluid is given for replacement?

A

Human albumin solution is given as opposed to 0.9% normal saline.
NB- Na can worsen ascites.

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6
Q

How much replacement fluid should you prescribe?

A

If the patient is tachycardic or hypotensive then need 500ml stat. In the case of HF, then 250ml stat. Their BP, HR and UO should be monitored.
If the patient is oliguric, but no sign of urinary obstruction, then 1L over 2-4hrs.

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7
Q

What rate should IV K+ be given?

A

No more than 10mM per hour.
If more is needed then requires cardiac monitoring.

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8
Q

How much maintenance fluid is given?

A

Adult person needs 3L maintenance fluid over 24hrs. This is usually made up of 1 salty (NaCl) and 2 sweet (5% dextrose).
Also check U+Es, if not deranged then need 40mM KCl, which can be added as 20mM KCl to 2 bags.

In elderly patients, usually 2L are required over 24hrs.

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9
Q

How long should maintenance fluids run for?

A

If prescribing 3L then each bag will run over 8hrs.
If prescribing 2L then each bag will run over 12hrs.

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10
Q

What is prescribed for VTE prophylaxis?

A

Compression stockings
S/C dalteparin 5000 units

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11
Q

When should VTE prophylaxis not be prescribed?

A

If the patient is having an active bleed or at risk of increased bleeding then do not prescribe dalteparin.
If a patient has absent lower limb pulses, or PAD, then do not prescribe compression stockings.

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12
Q

When should anti-emetics be avoided?

A

Metoclopramide in Parkinson’s disease as it can exacerbate symptoms. Also avoid in young women as it can cause increased dyskinesia.

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13
Q

What is the maximum dose of of paracetamol for a patient <50kg?

A

500mg 6hrly

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14
Q

What should you remember about methotrexate?

A

Do not use with trimethoprim as both are folate antagonists, can therefore cause BM toxicity.
Don’t use with NSAIDs and penicillin.
Withhold in acute infection.

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15
Q

How is insulin delivered?

A

Always S/C
Never IV, unless in the case of a sliding scale.

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16
Q

What should be determined in the case of hyponatremia?

A

The fluid status- this will indicate the cause.

Hypovolaemic- Loss of fluid, diuretics, Addison’s disease.
Euvolaemic- SIADH, hypothyroidism.
Hypervolaemic- Renal failure, heart failure, liver failure.

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17
Q

What are the potential causes of hypernatremia?

A

Drugs
Drips
Dehydration
Diabetes insipidous

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18
Q

What are the causes of high neutrophil count?

A

Bacterial infection
Tissue damage
Steroids

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19
Q

What are the causes of low neutrophil count?

A

Viral infection
Clozapine
Carbimazole
Chemo/radiotherapy

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20
Q

What are the causes of high lymphocyte count?

A

CLL
Viral infection
Lymphoma

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21
Q

What are the causes of hypokalaemia?

A

DIRE
Diuretics I.e. loop and thiazide
Inadequate intake
Renal tubular acidosis
Endocrine- Cushings or Conns.

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22
Q

What are the causes of hyperkalaemia?

A

DREAD
Drugs I.e. ACEi or K+ sparring
Renal failure
Endocrine I.e. Addison’s
Artefact
DKA

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23
Q

What are the causes of an increased AlkPhosp?

A

ALCPHOS-

Any fracture
Liver damage
Cancer
Pagers disease or pregnancy
Hyperparathyroidism
Osteomalacia
Surgery

24
Q

What is the target range for TSH?

A

0.5-5miU/L

Should aim for TSH within this target range when prescribing thyroid medications.

25
Q

What can be interpreted from a white area on a CXR?

A

Pleural effusion- unilateral and solid.
Pneumonia- unilateral and fluffy
Pulmonary oedema- bilateral and fluffy
Pulmonary fibrosis- bilateral and honeycomb.

26
Q

How do you work out the expected [O2]?

A

If a person is on 60% O2, the expected [O2] is 60-10= 50kPa.

Therefore if the patient has a [O2] of 43kPa, they are hypoxic.

27
Q

What are the different types of respiratory failure?

A

Type 1- Most common, fast normal breathing. Low PO2 with normal/low PCO2.

Type 2- Less common, slow shallow breathing. Low PO2 with high PCO2.

28
Q

Which drugs are commonly monitored?

A

Drugs with small therapeutic window.
Phenytoin
Digoxin
Lithium
Gentamicin
Vancomycin
Theophylline

29
Q

What is the mechanism of Warfarin?

A

Vitamin K antagonist, therefore reduced VitK dependent CF I.e. 2,7,9,10. This causes an increase in PT and so an increase in INR.

30
Q

What is the target INR for a patient on Warfarin?

A

2.5
Unless they have recurrent VTE whilst on warfarin, in which case it is 3.5.

31
Q

How is over anticoaggulation with warfarin managed?

A

If major bleeding or bleeding into a confined space I.e. eye/brain- then withhold warfarin, administer 5-10mg IV VitK and give prothrombin complex.

If INR 5-8:
No bleeding- Withold warfarin fro 2 days then reduce dose.
Minor bleeding- Withhold warfarin, give IV VitK 5-10mg.

If INR>8:
No bleeding- Withhold warfarin and give PO VitK 1-5mg.
Minor bleeding- Withhold warfarin, IV VitK 5-10mg.

32
Q

How is unstable tachycardia managed?

A

DC cardio version up to 3 shocks.

300mg IV amiodarone over 10-20mins. Followed by DC cardio version. Followed by 900mg IV amiodarone over 24hrs.

33
Q

How is stable narrow regular tachycardia managed?

A

Valsalva manoeuvres
Adenosine 6mg then 12mg then 18mg
If not resolving then seek expert assistance.

34
Q

How is stable narrow irregular tachycardia managed?

A

?AF.
Manage with BB, diltiazem etc.

35
Q

How is stable broad regular tachycardia managed?

A

VT- Manage with amiodarone 300mg IV over 10-20 mins. Then 900mg IV over 24hrs.

36
Q

How is stable broad irregular tachycardia managed?

A

Seek medical expert.
If tornadoes de pointes then Mg 2g over 10 mins.

37
Q

How much oxygen should be administered in a COPD patient in the acute setting?

A

If in Peri arrest then high flow O2 to prevent death by hypoxia.
If not periarrest then 28% O2.
Review ABG in both cases to guide O2 administration.

38
Q

How is a secondary pneumothorax managed?

A

Always needs treating.
Chest drain if >2cm, >50yrs old or SOB present.
Aspirate if above not present.

39
Q

How is primary pneumothorax managed?

A

If <2cm and no SOB then discharge with outpatient FU in 4wks.
If >2cm or experiencing SOB then two attempts to aspirate, after this chest drain should be considered.

40
Q

How is meningitis managed?

A

Primary care- IM benzylpenecillin 1.2g.

Secondary care- IV cefotaxime.

If >55yrs OR immunocompromised then add ampicillin.

41
Q

How is status epilepticus managed

A

Either IV lorazepam 2-4mg OR 10mg of either but also midazolam or rectal diazepam.
After 5 mins repeat
After 5 mins start IV phenytoin 15-20mg/kg.
After 5 mins alert ITU

42
Q

What is the difference between DKA and HHS?

A

DKA is common result of hyperglycaemia in T1DM. Hyperglycaemia + urinary ketones + low pH.

HHS is common result of hyperglycaemia in T2DM. Hyperglycaemia, hyperosmolar (>340) and non-ketotic.

They are managed the same but HHS with a lower insulin dose than DKA.

43
Q

What are the indications of a HAASBLED score?

A

0- low bleeding risk, start anticoaggulation.
1-2- low/moderate bleeding risk, start anticoaggulation.
>=3- high bleeding risk, consider alternative to anticoaggulation- this will require annual review.

44
Q

How is a patient cardioverted in AF?

A

DC cardio version
Pharmacological- flecanide if no structural heart disease, or amiodarone if structural heart disease.

45
Q

What are the 3 important management points of stable angina?

A

GTN as req
Secondary prevention via aspirin, statin and lifestyle mods
Anti-anginal med + either BB or CCB.

NB if still experiencing angina add additional anti-angina med, add CCB or BB (not previously added). Otherwise add long acting nitrate or potassium channel activator.

46
Q

Which drugs should be started in T2DM if there are significant CV RF present?

A

Start aspirin 75mg if CV RF or >50yrs.
Start statin 20mg of CV RF or >40yrs.

47
Q

What is the significance of reviewing ACR in diabetics?

A

Can indicate early nephropathy.
ACR>/= 3mg/mmol start ACEi for renal protection.

48
Q

Which drugs should be considered for treating Parkinson’s?

A

Co-beneldopa or co-carledopa (levodopa + peripheral dopa dercaboxylase inhibitor i.e. carbidopa)

If mild Parkinson’s symptoms and worried about long term effects of above meds consider dopamine against i.e. ropinirole or MAO inhibitor rasagiline.

49
Q

What are the AED used?

A

Generalise tonic clonic- M valproate, F lamotrigine.
Myoclonic- M valproate, F levatiracetam.
Focal- carbamazepine or lamotrigine.
Absence- ethoxusimide or valproate.

50
Q

How is Crohns managed?

A

Inducing remission- Steroid I.e. 20-40mg prednisolone daily if mild/moderate. If severe then 100-500mg IV hydrocortisone + supportive management. Can use topical hydrocortisone if evidence of rectal disease.

Maintaining remission- azathioprine or mercaptopurine. Check TMPT levels first, if low (increase risk of BM and liver toxicity) then lower dose of azathioprine, if absent then consider methotrexate as alternative.

51
Q

How is RA managed?

A

Methotrexate
Additional DMARDs- trialing up to 2.
If not controlled then need TNF a inhibitors I.e. infliximab.

Flares controlled by short term IM methylprednisolone 80mg or temporary NSAIDs.

52
Q

What single medication is used to stop clot expansion in VTE?

A

LMWH I.e. enoxaparin, dalteparin. These do not thrombocytes the clot, but will stop clot expansion and so stat treatment dose is prescribed.

53
Q

What is the optimal time to prescribe an ACEi?

A

Night time as they can cause postural hypotension.

54
Q

What one medication can be used to manage hyperK?

A

Actarapid/Novorapid- 10U in 100ml of 20% dextrose. To be given over 30mins.

55
Q

When is Metformin not used in T2DM management?

A

If Cre >150uM, as increased risk of lactic acidosis.
If eGFR<30.

PSA (1 decks)

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