PSA Flashcards
Resus fluids
500ml bolus over 15 mins
Reassess
Following fast bolus, adjust dose accordingly (250-500ml)
Replacement fluids needed in tachycardia and low BP
- tachycardia = usually 1-2L fluid depleted
- BP only starts going with more than 2L
maintenance fluid requirements
3 L over 24 hrs
1 salty, 2 sweet (1L normal saline, 2L 5% dextrose)
K+ (40-60mmol/24hrs)
K infusion rate and concentration
Rate <10 mmol/hr
Infusion concentration <40 mmol/L
Enzyme inducers
PC BRAS
Phenytoin
Carbamazepine
Barbiturates
Rifampicin
Alcohol (chronic)
Sulphonlyurea
Enzyme inhibitors
AO DEVICES
Allopurinol
Omeprazole
Disulfuram
Valproate
Isoniazid
Ciprofloxacin
Ethanol (acute intoxication)
Sulphonamides
interactions of paracetamol
- alcohol = hepatotoxic
- flucloxacillin = metabolic acidosis
- warfarin = inc INR
interactions of NSAIDs
- SSRIs/warfarin/DOAC/steroids = inc bleeding risk
- ACEi = hyperkalaemia
- Diuretics = AKIi
interactions of opioids
- alcohol = CNS depressant
- SSRI/ St John Wart/ Sumitriptan = serotonin syndrome
interactions of steroids
- aspirin = GI bleeding
- digoxin = dig toxicity
- erythromycin/citalopram = hypokalaemia
- antifungals = inc exposure of steroids
disulfram reactions
ketoconazole
metronidazole
where to find opioid conversations
prescribing palliative care
where to find benzo dose conversions
hypontoics and anxiolytics
how to find treating hyperkalaemia
fluids and electrolytes
how to find menorrhagia
heavy menstrual bleeding
where to find vaccination schedule
immunisation schedule
where to find vaccination schedule
immunization schedule
where to find what drugs to stop before surgery
surgery and long term medication
where to find what drugs to stop before surgery
surgery and long term medication
where to find overdoses and poisoning
poisoning, emergency treatments
where to find overdoses and poisoning
poisoning, emergency treatments
GP stuff/hypoglycaemia
medical emergencies in community
diabetes, surgery, medical illness
surgery in diabetic patients
where to find pneumonia management?
respiratory system infection, antibacterial therapy
where to find infective endocarditis management?
cardiovascular system infections, antibacterial
where to find DI management?
posterior pituitary hormones and anatagonists
calculating concentration
mass of solute (g) / volume of solution (mL) x 100
in g/mL
1:100
1g in 100mL
1000mg in 100mL
10mg in 1mL
= 1%
1:100
1g in 100mL
1000mg in 100mL
10mg in 1mL
= 1%
1:1000
1g in 1000mL
1000mg in 1000mL
1mg in 1mL
= 0.1%
1:1000
1g in 1000mL
1000mg in 1000mL
1mg in 1mL
= 0.1%
1:10,000
1g in 10,000mL
1000mg in 10,000mL
0.1mg in 1mL
= 0.01%
kg to mcg
kg to g (x1000)
g to mg (x1000)
mg to mcg (x1000)
key opioid conversations
codeine PO to morphine PO (divide by 10)
morphine PO to morphine IM/IV/SC (divide by 2)
important to remember when prescribe morphine sulphate
prepared as 2.5mg aliquots
round to nearest
better to over dose
Fentanyl patch prescription
1 application
topical
rattling breath sound tx
hyoscine hydrobromide
Glycopyronnium bromide
pain and breathlessness tx
morphine
agitation tx
midazolam
nausea tx
haloperidol
POP prescription
noethisterone
levonorgestrel
desogestrel
prescribing COCP e.g. microgynon
ethinylestradiol 30mcg/ levonorgestrel 50mcg
monophasic 21-day tablets
COCP 1 missed pill
take missed pill straight away
continue rest of pack as normal
COCP 2+ pills missed
take most recent missed pill
abstain/use condoms for 7 days
if recent intercourse in 7 days = emergency contraception
if < 7 pills left in pack after missed pill
start next pack back to back
no rest or withdrawal bleed
POP patient info
take within 3 hours (or 12 if desogestrel)
need 48hrs to re-establish
POP patient info
take within 3 hours (or 12 if desogestrel)
need 48hrs to re-establish
POP patient info
take within 3 hours (or 12 if desogestrel)
need 48hrs to re-establish
POP patient info
take within 3 hours (or 12 if desogestrel)
need 48hrs to re-establish
POP patient info
take within 3 hours (or 12 if desogestrel)
need 48hrs to re-establish
POP patient info
take within 3 hours (or 12 if desogestrel)
need 48hrs to re-establish
vomiting patient info with pill
if sick within 2 hours of taking pill, take another
diarrhoea patient info with pill
if severe lasting >24 hours, act as if missed pill
COCP risks
inc risk of VTE/MI/stroke
inc risk of breast and cervical Ca
POP risk
inc risk of ovarian cysts and breast Ca
HRT risks
VTE
ischaemic stroke
breast and endometrial Ca
hint about finding contraception on BNF
type brand name in = will give you prescription drug equivalent
prescribing COC patch
estradiol 50mcg per 24 hours, levongestrel 7mcg per 24 hours
transdermal patch
1 application
once a week
prescribing COC vaginal ring
search vaginal ring
ethenylestradiol with etonogestrel
1 unit
once a month, for 7 days
prescribing POC implant
etonogestrel
1 implant
subdermal
once only
1st line management of T2DM
diet, exercise, weight loss for 6-8 weeks
when is second line diabetic treatment started?
when HbA1c > 53 even after 1st line treatment
SGLT-2 inhibitor SE
weight loss
euglycaemic ketoacidosis
DPP-4 inhibitor examples
who to prescribe
sitagliptin, linagliptin
elderly and obese
GLP-1 inhibitor examples
important info
semaglutide, exenatide
weight loss, SC injfection
contraindications of thiazdinediones
HF
bladder Ca
Hx of DKA
when is insulin therapy started in T2DM
if HbA1c > 58 mmol/mol despite max non-insulin treatment
insulin regimes
- Basal: long acting insulin given OD/BD
- Biphasic: LA and SA insulin given BD with meds
- Basal-bolus: basal + SA bolus doses with meds
names of long acting insulins
Humulin
Glargine (Lantus)
Detemir
hypoglycaemia treatment
alert: juice, oral glucose
unconscious: 100ml 20% glucose, 200ml 10% glucose, glucagon 1mg IM
when can’t you use glucagon
in malnourished, fasting, liver disease, on sulphonlyurea
how to monitor after hypoglycaemia?
recheck every 10-15 minutes until >4 mmol/mol
once alert give long acting carbs
what to do if hypoglycaemia is due to basal insulin?
reduce dose by 10-20%
what to do if hypoglycaemia is due to bolus insulin?
reduce dose by 2-4 units
what to do if hypoglycaemia is due to sulphonylurea?
reduce dose e.g. gliclazide down by 40mg
if have hyperglycaemia and metformin, what do to?
increase by 500mg
if have hyperglycaemia and on insulin, what to do?
if fasting BMs are high = inc LA insulin by 10%
where to find important diabetes treatment summary?
Diabetes, Surgery and Medical Illness
what to do with warfarin if major bleed?
stop warfarin
give phytomenadione IV
give PCC
what to do with warfarin and minor bleed (no matter what INR)?
stop warfarin
give phytomenadione IV
restart warfarin when INR < 5
what to do with warfarin is INR > 8.0 but no bleed?
stop warfarin
give phytomenadione PO
restart warfarin when INR < 5
what to do with warfarin if INR 5-8 but no bleed?
withhold 1-2 doses
reduce maintenance dose
what does PCC contain?
2, 7, 9, 10
neural tube prevention in sickle cell
folic acid 5mg PO OD until birth
what happens if eGFR drops by <25% or creatinine increases by < 30% on ACEi?
do not modify dose
re-check levels in 2 weeks
what happens if eGFR drops by >25% or creatinine increases by > 30% on ACEi?
investigate other causes e.g. volume depletion
consider drugs which may contribute
stop ACEi
OR
reduce dose to previosuly tolerable dose and re-check in 5 days
what does FFP contain?
all clotting factors, slower admin
what does cryo contain?
factors 8, 13, fibrinogen, vWF
what is the indication for cryo?
fibrinogen deficiency
dysfibrinogenaemia
important points to remember about U&Es
eGFR trend
pre-renal AKI: urea rises more
post/intrinsic: creatinine rises more
what is the vancomycin dose calculated on?
creatinine clearence
what is trough level of vancomycin?
10-20
if vancomycin trough is 21-25, what to do?
reduce dose by 25%
repeat pre-dose level after 48 hrs
if vancomycin trough is >25, what to do?
do not administer further vancomycin until trough <20
example maintenance fluid regime
- Saline 0.9% + 20mmol KCL (/8 hrs)
- Dextrose 5% + 20mmol KCL (/8 hrs)
- Dextrose 5% + 20mmol KCL (/8 hrs)
Rapid acting insulin
- effect
- duration
- examples
- start after 10 mins
- last ~4 hours
- e.g. novorapid
Short acting insulin
- effect
- duration
- examples
- start after 30 mins
- last ~ 8 hours
- e.g. Actrapid
Immediate acting insulin
- effect
- duration
- examples
- start after 1 hour
- last ~16 hours
- e.g. Humulin I
Long acting insulin
- effect
- duration
- examples
- start after 1 hour
- last ~ 24 hours
- e.g. Lantus
gentamicin toxicities and CI
ototoxic, nephrotoxic
CI: MG
peak and trough of gentamicin
peak (1 hour after admin)
trough (just before next dose)
what to do if trough (pre-dose) is high?
increase interval between doses
what to do if peak (post-trough) is high?
dose should be decreased
