PSA Flashcards
Dosage of LMWH for surgical
20mg SC- low risk- 2hrs pre
40mg SC high risk - 12 hrs pre
Reversal agent of LMWH
Protamine sulphate
Types of LMWH
Daltaparin/enoxiparin sodium
Fondaparinux
SE of LMWH
Heparin induced thrombo
Hyperkalaemia
Avoid in GFR <15
Tx of DVT/PE
Apixiban 10mg BD 7 days
Then 5mg BD 3 months
When to avoid DOACs
Pregnancy
GFR <15
Treatment of A fib
Beta blocker- atenolol 50-100mg OD
or RL CCB- verapamil or diltiazem
Apixiban 5mg BD if CHADVASC
When to use each antiemetic
Haloperidol- drug and chemical
Metoclopramide- GIT
Ondansetron- chemo and abdo surgery
Cyclizine- CNS and ear
Tx of DKA
1L saline- 1hr, then 2hr, then 4, 8
Insulin FRII
Start glucose when <14
Tx of HHS
1hr saline 2 hrs
When to stop insulin for surgery
Stop short acting
Give VRII
Reduce long by 20%
When to stop lithium for surgery
Day before
When to stop warfarin and DOACs for surgery
5 days for warfarin
2 days for DOACs
When to stop COCP for surgery and start again
4 weeks
restart 2 weeks after using POP in-between
When to stop sulphonylureas for surgery
day of surgery
When to stop ACEi, ARB and spironolactone for surgery
Day of surgery
What to do to steroid dose for surgery
Doubler it
When to start VRII for surgery
T1DM
>1 meal missed- stop metformin too
Poor BM >69
Post MI
Drugs that inhibit CYP450
Azoles/amiodarone/allopurinol
Macrolides
Valproate
Cipro
Statins
Steroids SE
Stomach ulcers
Thin skin
Oedema
Right/Left HF
OP
Infections
Diabetes
Syndrome- Cushing
NSAIDs SE
No urine- Renal
Systolic dysfunction_HF
Asthma
Indigestion
BlooD clotting abnormal
SE of ACEi
Dry cough
Prescribe ARB instead
SE of BB
Asthma
Worsen acute HF
ED
CCB SE
Peripheral oedema and flushing
Verpamil Constipation
Diuretics SE
Renal failure
loop- fureosomide- gout, hypokalaemia
Thiazide- hypokalaemia, gout
Spirono- hyperkalaemia, gynaecologist
Diuretics SE
Renal failure
loop- fureosomide- gout, hypokalaemia
Thiazide- hypokalaemia, gout
Spirono- hyperkalaemia, gynaec
Trimethoprim SE
Agranulocytosis
Neutropaenic sepsis
Folate
Drugs causing low neutrophils
Clozapine
Carbimazole
WCC in bacterial vs viral
Neutrophils high- Bacterial
Lymphs high- viral
Cause of low plts
Heparin
DIC
ITP- child post URTI
HUS- E coli- diarrhoea, haemolytic anaemia, low plt, renal failure
TTP- “, fever and neuro
Urea vs creatinine rise in AKI
Urea> creatine in pre renal
Creatinine> in intrinsic and post
Cholestatic drugs
Co amox
Fluclox
Steroids
Nitro
Sulphonyl
Target O2 for no resp failure vs T2 resp failure
> 94%
COPD- 88-92%
What oxygen delivery for acute COPD
High flow if bad but titrate to
Blue Venturi
24% can go up to 28%
Nasal Cannula flows
1L
2L
4L- may cause irritation
What O2 to give in emergency
Non rebreather Mask
15L
Gentamicin and vancomycin SE
Ototoxicity and nephrotoxicity
Lithium SE
Early- tremor
Intermediate- tiredness
Later- arrhythmia, seizure, DI
Paracetamol OD treatment
<1hr- activate charcoal
Measure 4hrs- graph- NAC
Tx of Warfarin OD
INR 5-8 no bleeding- miss 2 doses
5-8 minor bleed- stop and IV vit K restart when <5
> 8 no bleeding- stop, PO vit K, restart <5
Minor bleed >8- “ IV vit k
Major Bleed- Stop, IV vit K 5mg, IV PCC
AE-Asthma Tx
Salbutamol, Neb. 5mg
Ipratropium bromide, Neb. 0.5mg (500mcg)
Hydrocortisone, IV 100mg / PO 50mg
SE of sulphonylureas
Hypog
Weight gain
Info for patients taking steroids
Regular BM monitoring
PPI
>3m- bisphosphonates
SE of bisphosphonates
Osteonecrosis
Oesophageal reactions
Atypical femur fracture
Monitoring with statins
CK if lose in risk of myopathy
ALTs
When to stop statins
Taking macrolide
CI of ACEi
Aortic stenosis
Which drugs are contraindicated with lithium
ACEi, thiazides, loops
NSAIDs
Use CCBs
Rapid acting insulin
Nororapid
Humalog
Short acting insulin
Actrapid
Humulin S
Long acting
Lantus
Levemir
Intermediate insulin
Humulin I
Insulatard
Hypoglycaemia treatment
Conscious- BM<4- glucotabs
Unconscious- IM glucagon
or Glucose 20% 100ml if IV access
When to add to metformin for DM
When Hb1ac >58
Thiazaolidinedione CI
HF and bladder cancer
CI drugs in HF
TVNG
Thiazola
Verapamil
NSAIDs
Glucocorticoids
Steroid ladder
Hydrocortisone
Clobetasone
Betamethasone
Clobetasol
When does the LFTs make you stop taking statins
ALT/AST x3 ULN
Opioids used in renal failure
Fentanyl
Alfentanil
Buprenorphine
Dihydrocoedine to morphine oral
/10
Morphone oral to SC
/2
Morphine oral to oxycodone
/1.5
Used to be 2
Non palliative opioid dosing
Oromorph 2.5-5
4 hourly
Conversion of modified release
Half the immediate BD
Anti emetic in Parkinsons
Doperidone
When to take diuretics
Morning
Tx of hyperkalaemia
10ml 10% Ca gluconate
125ml of 20% dextrose
10U insulin
Drugs causing urinary retention
Opioids
Anticholinergics
GA
A adrenal agonists
Benzos
NSAIDs
CCBs
Antihistamine
Drugs causing confusion
Morphine
Metoclopramide
Anti-cholinergics, psychotics, depressants, convulsants
Folic acid dosage
400mcg
5mg- prev NTD, DM, epilepsy, obese, SCD, IBD, thala
Drugs causing hyponatraemia through SIADH
SSRI , TCA
PPI
Sulphonylurea
Carbamazepine
Monitoring with ACE/ARB
U&E before
Expect small rise <20% creatinine
What to monitor with cyclosporin
Nephrotox- U&E
HTN- BP
How long should antiplatelets be stopped before surgery
7 days
Including aspirin
When to stop allopurinol
In decreased renal function
Breakthrough pain for fentanyl patch
If on >25mcg fentanyl
Nasal fentanyl
When is nitrofurantoin CI
GFR< 45
At term
Tx of alcohol withdrawal
Chlordiazepoxide
If INR >1.5 on day of surgery who stopped taking warfarin what do you give
Phytomenadione
Vit K
2mg PO
Info for taking SSRI
Do not stop suddenly
Suicide ideation may increase for up to 4 weeks
How to take rivaroxiban
With food
Effects of toprimate with POP
Induces CYP450
Decrease POP
Need another contraception
Drugs inducing CYP450
Phenytoin
Carbamazepine
Barbituates
Rifampicin
Toprimate
Sulphonylurea
How to monitor furosemide
Weight
SE of trimethoprim
Tubular dysfunction
Hyperkalaemia
Tx of Migraine
Triptan and NSAID
Prophylaxis- toprimate or propanolol
Toprimate is teratogenic
SE of toprimate
Teratogenic- cleft lip
Reduced POP efficacy
Pregnancy thrush
Oral metronidazole BD 7d 400mg