PSA Flashcards
What anti emetic can worsen parkinson symptoms and why
Metoclopramide
crosses BBB and acts on central dopamine receptors
What is Neo-naclex
bendroflumethiazide
Drugs causing hypokalaemia
Thiazides,any diuretic but spiro
Drugs causing hyperkalaemia
ACEi
What drugs are CI in asthmatics
beta blockers
NSAIDs
aspirin
ACEi can exacerbate
Causes of high neutrophils
infection
inflammation
steroids
Filgrastim- GCSF
Causes of low neutrophils
Chemo
Clozapine
Carbimazole
Viral infection
Causes of thrombocytopenia
Reduced production - drugs eg penicilllamine, Myelofibrosis, myeloma, myelodysplasia
Increased destruction - heparin, DIC, ITP, TTP, HUS
Causes of hyponatraemia
hypovolameic - diuretics, d+v, addisons
euvolaemic - SIADH (inc carbamazepine causing SIADH)
hypervolaemic - heart failure, renal failure
Causes of hypernatraemia - D’s
Dehydration, Drips (IV fluids), Diabetes insipidus
Causes of hyperkalaemia (DREAD)
Drugs eg ACEi and potassium sparing diuretics (spiro)
Renal failure
Endocrine eg Addisons
Artefact
DKA
If a pt has a high urea but normal creatinine and isn’t dehydrated, what blood result should you look at and why?
Hb as an elevated urea in the absence of raised creatinine or dehydration can indicate an upper GI bleed
Prerenal causes of AKI
Dehydration.
Renal artery stenosis
Renal causes of AKI
ATN
Nephrotoxic abs eg gent, vans and tetracyclines
ACEi and NSAIDs
Radiological contrast
Rhabdo
Gout
Glomeruloniphridities
Vasculitis
Post renal causes
Stones
fibrosis
tumours
BPH
Prostate cancer
Differeing between prerenal, renal and post renal causes based off U&E results
urea rise > creatinine - Pre renal. Eg (ur 19, Cr 342)
Urea rise <creatinine - Renal and Post (eg ur 7.5, CR 324). To differentiate bladder and hydronephrosis may be palpable
LFTs in prehepatic jaundice
Increased bilirubin
Normal ALT/AST/ALP
LFTs in hepatic jaundice
Increased bilirubin
Increased AST/ALT
LFTs in post hepatic jaundice
Increased bilirubin
Increased ALP
What drugs can cause cholestasis (post hepatic)
Flucloxacillin
Co amoxiclav
Nitrofurantoin
Steroids
sulphonylureas
What change needs to occur to thyroxine in each result? Normal range 0.5-5
If TSH now <0.5 following levothyroxine
If TSH now 0.5-5
If TSH now >5
decrease dose
maintain same dose
increase dose
Signs of pulmonary oedema on cxr
Batwing sign
Kerley B lines
Cardio thoracic ratio increased
Diversion of blood - larger vessels in upper
Pleural effusions
Features of digoxin toxicity
confusion, nausea, arrythmias, visual halos
Features of lithium toxicity
Early - coarse tremor
Late - coma, seizures, confusion, arryhtmias
Features of phenytoin toxicity
gum hypertrophy,
ataxia, nystagmus, peripheral neuropathy
Features of gentamicin and vancomycin toxicity
ototoxic and nephrotoxic
Target INR for its on warfarin. When is this this target different
2.5
3.5 if recurrent VTE whilst on warfarin
If there is a major bleed in a pt on warfarin what are 3 steps that should be done
stop warfarin
give IV vit K
Consider need for prothrombin complex
If there is no bleeding but INR is 5-8 what should be done
If there is no bleeding but INR is >8, what should be done
omit warfarin for 2 days then reduce dose
omit warfarin and give Vit K slow injection
how do NSIADs like ibuprofen cause renal failure
reduce prostaglandins which usually dilate renal arteries. Reduces blood flow to kidneys and mimics prerenal failure.
What electrolyte imbalance can carbamazepine cause
hyponatraemia due to it causing SIADH
What drugs should be stopped perioperatively?
(and what to type in treatment summaries if cant rememeber)
combined contraceptives
anti platelets
anti coags
oral hypoglycaemics and insulin should be switched to a sliding scale
(surgery and long term meds
and oral anticoagulation)
How much paracetamol in 30/500 co codamol
How much paracetamol in 8/500 co-codamol
500mg
every preparation has 500mg!!
If also prescribed with paracetmol make sure they aren’t over their daily allowance (4g for >50kg, 2g for <50kg)
what meds can cause lithium levels to increase and why
ACEi
diuretics
NSAIDs
Because they reduce renal excretion of lithium
whihc insulins are rapid acting
lispro
aspart
humulin
by how many microgram increments in levothyroxine titrated up or down
25-50 micrograms
Why can carbamazepine decrease sodium levels
bc can cause SIADH
maintenance fluids rule
2 salty, 1 sweet + potassium
2x 1L Normal saline
1x 1L glucose
40-60mmol K
if metformin contraindicated, what is first line
either pioglitazone or sulfonylureals
Which hypoglycaemic cause hypoglycaemia and weight gain
sulfonylureas and thiaziodiones (glitazones)
Information for its on statins
take at night
not used in active liver disease
seek medical assistance if muscle cramps
avoid grapefruit
stop statins if on clarithro
which diabetic drug is contraindicated in heart failure
pioglitazone - thiazolidiones
Drugs that can cause cholestasis
Cocp
Co amox
Erythro
Fluclox
Prochlorperazone
Sulphonylureas
Fibrates
Drugs that cause hepatic injury
Paracetamol
Valproate
Phenytoin
Isoniazid, rifampicin, pyrazinamide
Statins
Alcohol
Amiodarone
Nitrofurantoin
What crises can bisoprolol (and other beta blockers) precipitate?
Myasthenia gravis crisis
What are the aminoglycosides examples
Gentamicin
Neomycin
What are the aminoglycosides. Examples
Gentamycin
Neomycin
When should creatinine clearance be used instead if eGFR
Older adults
When prescribing and monitoring pts on toxic meds eg Vanc, Gent
Extremes of muscle mass
When prescribing and monitoring pts on DOACs
Two ways in which doses can be adjusted in renal impairment
Reducing the dose
Increasing the interval between doses
Which fluid is best for aki
Saline
Avoid hartmanns due to potassium content
What diuretics should be used in CKD and in what circumstance?
Which ones should be avoided and why?
Loop (furosemide) can be used for fluid overload and hyperkalaemia in CKD
Thiazides tend to be ineffective in ckd
Potassium sparing should be avoided bc of hyperkalaemia risk
When should ACEi be avoided in ckd
If b/l renal artery stenosis
How do ACEi work
Block ACE, inhibit production of angiotensin II. Prevents vasoconstriction of the efferent arteriole so reduces bp
What electrolyte must you check before ACEi started and when should this be re checked
Potassium. Recheck 7 days after starting or increasing dose
Drug for fast AF if HF with reduces EF
Digoxin
What can a CCB and beta blocker cause when co prescribed
HB
Recommended requirements for maintenance fluids and electrolytes
1mmol/kg per day K, Na, Cl
50-100g per day glucose
25-30ml/kg/day of water (20-25 if frail or HF)
How much potassium per hr max
10mmol per hr
Good fluid regime for NBM pt with normal electrolytes
NaCl 0.18%/glucose 4% with 40mmol/l of Potassium
Benzo antidote
Flumazenil
Toxidrome for amitriptyline
Coma,
hypertonia
+ anticholinergic sx:
- Dilated pupils
- Urinary retention
- Tachycardia
Toxidrome for heroin
(Opioid triad)
Coma
Constricted pupils
Reduced RR
Toxidrome for ecstasy
Delirium,
Tachycardia
Agitation
Dilated pupils
Hyperthermia
(Sympathetic overdrive)
Toxidrome for barbiturates
Hypotonia
Coma
Hypotension
Hyporeflexia
(Think that some are used as anaesthetic agents)
How does activated charcoal work
Reduces absorption by binding to poisons in gut
Antidote for cholinergic poisoning
Atropine
Antidote for iron poisoning
Desferrioxamine
Antidote for digoxin
DifiFAB
Antidote for methanol poisoning
Fomepizole
Antidote for beta blocker toxicity
Glucagon
Antidote for warfarin posioning
Phytomenadione (vit k)
Which drug overdoses is dialysis good for
Ethanol
Ethylene glycol
Lithium salts
Methanol
Salicylates eg aspirin (can also use urine alkalisation for these)
What do up to 10% of pts receiving NAC develop wothin the first hr
If this occurs, what should you do
Rash and bronchospasm
Stop infusion, give antihistamine (Iv chlorphenamine) and bronchodilator (salbutamol).
Once sx subsided restart the infusion at a slower rate
Rx of a staggered paracetamol overdose
Give NAC irregardless of plasma paracetamol concentration
What imaging could be done in iron overdose and why
Axr
Iron tablets are radio opaque so in large doses they may be visible
Side effect of desferroxamine
Orange red urine
Half life of naloxone
Significance of this
20-40mins
Repeat dosing often required
Acid/base balance in salicylate (aspirin) toxicity
Metabolic acidosis
Symptoms of salicylate poisoning
N+v
Diarrhoea
Metabolic acidosis - increased RR
Tachycardia
Sweating
Rx of salicylate (aspirin) poisoning
Activated charcoal if within 1 hr
IV fluids
Urine alkalinisation with Sodium bicarb
Haemodialysis
How often should you repeat salicylate concentration
Every 2hrs
Side effect of using flumazenil in a pt who has benzo dependence
May precipitate withdrawal symptoms
what abx should never be co prescribed with methotrexate and why
trimethoprim (co-trimoxazole)
Can cause severe myelosupression
what drug should be co prescribed with methotrexate
how often is it taken and when is it taken in relation to methotrexate
folic acid once weekly
24hrs after methotrexate
how long after stoppingg methotrexate should women not get pregnant and men wear contraception for
6 months
what ix should be done before starting a pt on amiodarone and why
what should be checked every 6 months
TFT - can cause both hypo and hyper
CXR - risk of pulmonary fibrosis
U+E - for potassium
LFTs - hepatotoxic
LFTs and TFTs every 6 mo
Rx of hypoglycaemia
See uhl guidelines and cards in ‘endo’ pack
How many mg/ml of glucose in 10% glucose?
How many in 20%?
100 mg
200mg
How much glucose are you aiming to give in mild/mod hypoglycaemia
15-20g
When should the dvla be informed in diabetes
Normal and occupational
If on insulin (or any meds if occupational)
If suffered hypo whilst driving
If had more than 1 ep of severe hypo in last 12 months (or any if occupational)
First step of rx for dka
(And how much)
Fluid replacement
If BP<90 then 500ml 0.9%NaCl over 15mins
If BP>90 then 1l 0.9%NaCl over 1hr
What should you do with a patients normal insulin regime when in DKA
what about if on pump
Continue longacting as normal
stop short acting
If pump gives long acting give pump. Stop function of short acting
T2DM may get DKA if they are taking what type of hypoglycaemic medication
SGLT2 inhibitors
Which abx can interact with warfarin to increase the anti coag effect
Erythromycin
What should pts on warfarin be issues with
A yelllw anticoagulant book to record INT
Once a stable INR is achieved, how often does it need monitoring
Every 12 weeks
Where on the bnf to find info about high INR or bleeding on warfarin
Treatment summaries
Oral anticoagulation
Haemorrhage
What is digoxin, its moa and its indication
Cardiac glycoside
Increased force of myocardial contraction
HF and svt
What electrolyte imbalance increases the risk of digoxin toxicity
Hypokalaemia as myocardium more sensitive
Presentation of digoxin toxicity
Pretty vague
N+v
Diarrhoea
Malaise
Weakness
Palpitations
Confusion
Hallucinations
Arrhythmias
Is the dose of lithium tablets the same as lithium liquids
No!
Which drugs should you prescribe as brand specific
Insulin
Lithium
Monitoring requirements for lithium plus timings
ECG every 6-12 mo
TFTs every 6mo
U+Es every 6mo
Ca every 6mo
BMI every 6mo
How many hrs after a lithium dose should lithium lebels be checked
12hrs
What electrolyte imbalance can precipitate lithium toxicity
Hyponatraemia - beware diuretic use
When should metformin be avoided in T2DM?
- patient is not overweight
- creatinine is over 150 due to risk of lactic acidosis
What drug should be used fist line in T2DM when metformin is contraindicated?
Sulphonylurea- eg gliclazide
How long before surgery should HRT and COCP be stopped?
4 weeks
How long before surgery should lithium be stopped?
day before
How long before surgery should ACEi be stopped?
day of surgery
Which tb drug causes peripheral neuropathy?
What do you co prescribe
Isoniazid
Pyridoxine
common side effect of beta blockers
diarrhoea
first line long term drug rx for chronic hf
beta blocker and ACEi first line
amiodarone monitoring
LFTS and TFTs every 6 months
CXR at start of treatment
