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PSA > PSA > Flashcards

PSA Flashcards

1
Q

how to enzyme inducers work

A

increases P450 enzyme activity -> hastening metabolism of other drugs -> therefore they have a reduced effect and may need an increased dose

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2
Q

how do enzyme inhibotors work

A

reduced P450 enzyme activity->increased level of other drugs thefore may need doses reducing

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3
Q

common enzyme inducers

A

PC BRAS
phenytoin
carbamazepine
barbiturates
rifampicin
alcohol (chronic excess)
sulphonylureas

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4
Q

common enzyme inhibitors

A

AODEVICES
allopurinol
omeprazole
disulfiram
erythromycin
valproate
isoniazid
ciprofloxacin
ethanol (acute intoxication)
sulphonamides

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5
Q

drugs to increase during surgery

A

if on long term steroids need an IV dose on induction anaesthesia

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6
Q

drugs to stop before surgery

A

I LACK OP
inuslin
lithium
anticoagulants/antiplatelets
COCP/HRT
K sparing diuretics
oral hypoglycaemics
perindopril and other ACEi

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7
Q

when to stop COCP and HRT before surgery

A

4w

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8
Q

when to stop lithium before surgery

A

day before

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9
Q

when to stop potassium sparing diuretics before surgery

A

day of

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10
Q

when to stop ACEi before surgery

A

day of

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11
Q

how does erythromycin effect warfarin

A

increase its effect and PT/INR

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12
Q

how do enzyme inhibitors affect warfarin

A

increase its effect and PT/INR

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13
Q

when is prophylactic heparin CI

A

acute ischaemic stroke due to risk of bleeding

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14
Q

SE/CI steroids

A

stomach ulcers
thin skin
oedema
R and L heart failure
osteoporosis
infection - candida
diabetes
cushings syndrome

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15
Q

cautions/CI NSAIDs

A

no urine - renal failure
systolic dysfunction - HF
asthma
indigestion
dyscrasia - clotting abnormality

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16
Q

SE anti hypertensives

A

hypotension
bradycardia with BB and some CCB
electrolyte disturbances with ACEi and diuretics

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17
Q

SE ACE i

A

dry cough

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18
Q

SE BB

A

wheeze in asthmatics
worsen acute HF

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19
Q

SE CCB

A

periheral oedema
flushing

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20
Q

SE diuretics

A

renal failure
loop diuretics (furosemide)=gout
postassium sparign diuretics (spironolactone)=gynaecomastia

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21
Q

what fluid to give as a replacement

A

0.9% saline

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22
Q

what fluid replacement to give if patient hypernatraemic or hypoglycaemic

A

5% dextrose

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23
Q

what fluid replacement to give if patient has ascites

A

human albumin solution

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24
Q

what fluid replacement to give if a patient bleedint

A

blood

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25
Q

how much fluid replacement to give

A

tachyacrdia cand hypotensive: 500ml bolus (250ml if HF) and assess response
if only oliguric: 1L over 2-4h and reassess

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26
Q

what maintenance fluids to give

A

general = 3L/d, elderly=2L
1L 0.9% saline and 2L 5% dextrose
if normal potassium level add 20mmol KCl to 2 of the bags
if giving 3L give bags 8 hourly

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27
Q

VTE prophylaxis

A

LMWH e.g. dalteparin 5000 units SC and compression stocks
dont give LMWH if leeding or ishcaemic stroke
no compression stockings in PAD

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28
Q

what antiemetic to prescribe if nauseated

A

REGULAR
-cyclizine 50mg 8 hourly IM/IV oral UNLESS FLUID RETENTION
- metoclopramide 10mg 8 hrly if HF

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29
Q

antiemetic to prescribe if not nauseated

A

AS REQUIRED
- -cyclizine 50mg up to 8 hourly IM/IV oral UNLESS FLUID RETENTION
- metoclopramide 10mg up to 8 hrly if HF

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30
Q

when to avoid metoclopramide

A

patients with parkinsons - may exacerbate sx
young women as risk dyskinesia

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31
Q

what to prescribe in non pain

A

non regular
PRN: paracetamol 1g up to 6hrly oral
+/- NSAID

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32
Q

what to prescribe in mild pain

A

regular: paracetamol 1g 6 hrly oral
PRN: codeine 30mg up to 6 hrly oral (can use tramadol)
+/- NSAID

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33
Q

what to prescribe in severe pain

A

regular: co-codamol 30/500 2 tablets 6hrly oral
PRN: morphine sulphate 10mg up to 6 hrly oral
+/- NSAID

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34
Q

1st line mx neuropathic pain

A

amitryptiline (at night)
pregabalin 12 hrly
duloxetine in painful diabetic neuropathy

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35
Q

causes of microcytic anaemia

A

iron deficiency
thalassaemia
sideroblastic anaemia

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36
Q

causes normocytic anaemia

A

anaemia of chronic disease
acute blood loss
haemolytic anaemia
renal failure - chronic

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37
Q

causes macrocytic anaemia

A

B12/folate deficiency
excess alcohol
liver disease
hypothyroid
haem: myeloproliferative, myelodysplastic, multiple myeloma

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38
Q

causes hypernatraemia

A

dehydration
too much IV saline
drugs:
diabetes insipidus

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39
Q

causes high neutrophils (neutrophilia)

A

bacterial infection
tissue damage: inflammation/infarct/malignancy
steroids

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40
Q

causes low neutrophils (neutropenia)

A

viral infection
chemo/radio
CLOZAPINE
CARBIMAZOLE

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41
Q

causes high lymphocytes (lymphosytosis)

A

viral infection
lymphoma
chronic lymphocytic leukaemia

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42
Q

causes low platelets (thrombocytopenia)

A

REDUCED PRODUCTION
infection - viral
drugs: penicillamine
myelodysplasia, myelofibrosis, myeloma

INCREASED DESTRUCTION
heparin
hypersplenism
DIC
ITP
HUS/thrombotic thrombocytopenic purpura

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43
Q

causes high platelets (thrombocytosis)

A

REACTIVE
bleeding
tissue damage: infection, inflamamtion, malignancy
post-splenectomy
PRIMARY
myeloproliferative disorders

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44
Q

causes hypovolaemic hyponatraemia

A

fluid loss: D+V
addisons disease
diuretics

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45
Q

causes euvolaemic hyponatraemia

A

SIADH
psychogenic polydipsia
hypothyroid

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46
Q

causes hypervolaemic hyponatraemia

A

HF
renal failure
liver failure
nutritional failure
hypothyroid

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47
Q

causes SIADH

A

small cell lung tumours
infection
abscess
drugs: CARBAMAZEPINE, ANTIPSYCH
HI

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48
Q

causes hypokalaemia

A

loop and thiazide diuretics
inadequate intake or intestinal loss (D+V)
renal tubular acidosis
endocrine: cushings, conns

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49
Q

causes hyperkalaemia

A

drugs: potassium sparing diuretics and ACEi
renal failure
addisons disease
artefact - clotted sample
DKA

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50
Q

what can cause raised urea

A

kidney injury
upper GI haemorrhage
big/raw steak

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51
Q

causes pre-renal AKI

A

dehydration - sepsis, blood loss, renal artery stenosis

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52
Q

causes renal/intrinsic AKI

A

ischaemia
nephrotoxic abx: gentamicin, vancomycin, tetracyclines
ACEi
NSAIDs
radiological contrast
rhabdomyolysis
gout
glomerulonephritides
vasculitis
cholesterol emboli

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53
Q

post renal AKI causes

A

in lumen: stone
wall: tumour, fibrosis
external pressure: BPH, prostate ca, lymphadenopathy, aneurysm

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54
Q

causes increased ALP

A

fracture
liver damage
cancer
pagets disease
pregnancy
hyperparathyroidism
osteomalacia
surgery

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55
Q

how to alter levothyroxien based off TSH

A

<0.5 = decrease dose
0.5-5 = leave as is
>5 = increase dose

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56
Q

causes raised bilirubin only

A

haemolysis
gilberts and crigler-najjar syndromes

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57
Q

causes increased bilirubin and AST/ALT

A

fatty liver
hepatitis
cirrhosis
malignancy
metabolic: wilsons, haemochromatosis
HF

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58
Q

causes increased bilirubin and ALP

A

gallstone
flucloxacillin, coamox, nitrofurantoin, steroids, sulfonylureas
cholangiocarcinoma
primary biliary cirrhosis, sclerosing cholangitis
pancreatic or gastric ca
lymph node

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59
Q

features digoxin toxicity

A

confusion
nausea
visual halos
arrhythmias

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60
Q

sx lithium toxicity

A

early: tremor
intermediate: tired
late: arrhythmas, seizures, coma, renal failure, diabetes insipidus

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61
Q

sx phenytoin toxicity

A

gum hypertrophy
ataxia
nystagmus
peripheral neurpathy
teratogenicity

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62
Q

sx gentamicin toxicity

A

ototoxic
nephrotoxic

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63
Q

sx vancomycin toxicity

A

ototoxic
nephrotoxic

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64
Q

how is once daily gentamicin dosing monitored

A

measure level 6-14h after last infusion started
use a nomogram to look whether need to alter frequency of the dose

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65
Q

how is divided daily gentamicin dosing monitored

A

take a peak level (1h before dose) and a trough level (just before dose). if peak outside range adjust dose, if trough outside range adjust dose interval

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66
Q

mx major bleed inpatient on warfarin

A

stop warfarin
5-10mg IV vit k
prothrombin compelx

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67
Q

mx INR <6

A

reduce warfarin dose

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68
Q

mx INR 6-8

A

omit warfarin for 2d then reduced dose

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69
Q

mx INR >8

A

omit warfarin and give 1-5mg oral vit K

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70
Q

mx INR >5 and minor bleeding

A

IV vit K 1-3mg

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71
Q

STEMI mx

A

ABC and 15L oxygen non-rebreather mask
aspirin 300mg oral
morphine 5-10mg IV with metoclompramide
GTN spray/tablet
primary PCI or thrombolysis
B blocker (atenolol 5mg) unlesss LVF/asthma
transfer CCU

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72
Q

NSTEMI mx

A

ABC and 15L oxygen non-rebreather mask
aspirin 300mg oral
morphine 5-10mg IV with metoclompramide
GTN spray/tablet
clopidogrel 300mg oral and LMWH e.g. enoxaparin
B blocker (atenolol 5mg) unlesss LVF/asthma
transfer CCU

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73
Q

acute LVF max

A

ABC and 15L oxygen non-rebreather mask
sit patient up
morphine 5-10mg IV with metoclompramide
GTN spray/tablet
furosemide 40-80mg IV
if inadequate response, isosorbide dinitrate infusion +/- CPAP
transfer CCU

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74
Q

adverse features in arrhythmia

A

shock
syncope
myocardial ischaemia
HF

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75
Q

mx arrhythmia with adverse feartures

A

synchronised DC shock up to 3 attempts

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76
Q

mx broad QRS, regular tachyarrhytmia (likely VT)

A

amiodarone 300mg IV over 20-60m

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77
Q

mx SVT with BBB

A

adenosine 6mg, then 12mg, then 12mg

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78
Q

mx tachyarrhythmia with narrow regular QRS

A

vagal manoevres
adenosine 6mg rapid IV bolus, then 12mg, then 12mg

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79
Q

mx tachycarrhythmia with narrow QRS but irregular

A

likely AF
rate control=BB
digoxin or amiodarone if HF

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80
Q

anaphylaxis acute mx

A

A-E and 15L O2 non rebreath mask
remove cause
adrenaline 500mcg 1:1000 IM
chlorphenamine 10mg IV
hydrocortisone 200mg IV
asthma tx if wheeze
amend drug chart allergies

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81
Q

mx acute exacerbation asthma

A

A-E
100% oxygen via non rebreath mask
salbutamol 5mg neb
hydrocortisone 100mg IV if sev, 40-50mg oral pred if mod
ipratropium 500mcg neb
theophylline if life threatening

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82
Q

mx acute exacerbation COPD

A

A-E
100% oxygen via non rebreath mask - however ABG ASAP as may need to reduce
salbutamol 5mg neb
hydrocortisone 100mg IV if sev, 40-50mg oral pred if mod
ipratropium 500mcg neb
theophylline if life threatening
abx if infective exacerbation

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83
Q

CURB 65 criteria

A

confusion (AMT<8)
urea >7.5
RR >30
BP <90
age >65

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84
Q

CURB 65 interpretation

A

0/1 = at home
>/= 2 = at hospital
>/= 3 = consider ITU

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85
Q

pneumonia mx

A

A-E
high flow oxygen
abx : amoxicillin or coamox
paracetamol
IV fluids

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86
Q

PE mx

A

A-E
high flow oxygen
morphine 5-10mg IV and metoclopramide 10mg IV
LMWH

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87
Q

GI bleeding mx

A

A-E and oxygen 15L non-rebreath mask
2 large bore cannulae
catheter
crystalloid or colloid
cross match 6 units
correct clotting abnormalities
endoscopy
stop cause: nsaids, aspirin, warfarin, heparin
cal surgeons if sev

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88
Q

mx bacterial meningitis

A

A-E
high flow oxygen
IF fluids
dexamethasone IV
LP +/- CT head
cefotaxime IV
consider ITU

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89
Q

max seizures

A

A-E
recover position
oxygeb

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90
Q

mx status epilepiticus

A

A-E
recovery position
oxygen
lorazepam 2-4mg IV or diazepam 10mg IV or buccal midazolam IV
repeat loraz after 2m x 2
inform anaesthetist
phenytoin
intubate and propofol

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91
Q

mx acute stroke

A

A-E
CT head to exclude haemorrhage
consider thrombolysis
aspirin 300mg
transfer to stroke unit

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92
Q

mx hypoglycaemua (BM <3)

A

eat sugary snack
IV glucose 100ml 20%
if no cannular IM glucagon 1mg

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93
Q

mx hhyperglycaemia

A

A-E
IV fluid: 1L stat, 1L over 1hr, 1L over 2h, 1L over 4h, 1L over 8h,
sliding scale insulin
look for trigger: infection, MI, missed insulin, monitor BM/K/pH

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94
Q

mx AKI

A

A-E
cannula, catheter, monitor fluids
IV fluid: 500ml stat then 1L every 4h
look for cause and complications
monitor U+E and fluid balance

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95
Q

mx chronic HF

A

ACE i
BB
if inadequate: candesartan, isosorbide mononitrate, spironolactone

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96
Q

mx HTN

A
  1. <55= ACEi
    >55 or afrocaribean=CCB
  2. ACEi and CCB
  3. add indapamide
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97
Q

AF rhytm control

A

if young/sx/first episode/due to precipitant
cardiovery: electrical or amiodarone, need anticoag first if >48h since onset

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98
Q

AF rate control

A

if HR>90
BB - propanolol or rate limiting CCB - diltiazep. then add digoxin

99
Q

anticoag AF

A

1=consider DOAC
2=DOAC

100
Q

mx stable angina

A

GTN spray for sx
secondary prevention: aspirin, statin, reduced CV risks
anti0anginal: BB, CCB

101
Q

mx parkinsosn

A

co-beneldopa or co-careldopa
unless v mild: dopamine agonist (ropinerole) or MAO i (rasagiline)

102
Q

SE lamotrigine

A

rashs
SJS

103
Q

SE carbamazepine

A

rash
dysarthria
ataxia
nystagmus
low Na

104
Q

SE phenytoin

A

ataxia
peripheral neuropathy
gum hyperplasia
hepatotoxicity

105
Q

SE sodium valproate

A

tremor
teratogenicity
wt gain

106
Q

mx alzheimers

A

mild/mod= acetylcholinersterase i - donepezil
mod/sev = NMDA antagnoist - memantine

107
Q

inducing remission in crohns

A

mild= oral pred
sev=hydrocortisone IV
rectal disease=rectal hydrocortisone

108
Q

maintaining remission crohns

A

azathioprine

109
Q

mx RA

A

methotrexate + another DMARD (sulfasalazine)
flare=Im methylpred, nsaids,
not responding to 2 DMARDS= TNF a inhibitords - infliximab

110
Q

stool softeners

A

docusat sodium
used for faecal impaction

111
Q

bulking agents

A

isphagula husk
takes days to work
CI=faecal impaction, colonic atony

112
Q

stimulant laxatives

A

senna, bisacodyl
may exacerbate abdo cramps
CI=acute abdo

113
Q

osmotic laxatives

A

lactulose, phosphate enema
may exacerbate bloating
CI enema in acute abdo

114
Q

ramipril in pregnancy

A

ramipril is teratogenic on first trimester
convert to labetalol first line

115
Q

how to take oral bisphosphonates

A

THE TABLET NEEDS TO BE SWALLOWED WITH A FULL GLASS OF WATER AND SHE
SHOULD REMAIN UPRIGHT FOR 30 MIN AFTERWARDS

116
Q

insulin doses when unwell

A

unwell, blood glucose increases therefore higher basal doses are required. Failing to do so will
increase the risk of diabetic ketoacidosis. Conversely, if patients reduce their oral intake (which many will when
ill) there is a risk of hypoglycaemia if the insulin intake is not decreased.

117
Q

steroids and bone density

A

steroids increase the risk of osteoporosis, particularly in the elderly. If a patient is predicted to take
steroid therapy for greater than 3 months (as is typical in polymyalgia rheumatica), prophylactic treatment with a
bisphosphonate (e.g. alendronic acid) is an option.

118
Q

what does 1% mean

A

1 g in 100mL (or 10mg in 1mL) for weight/volume (w/v)
calculations; or
1 g in 100 g for weight/weight (w/w) calculations.

119
Q

important units to write out in full

A

micrograms
units / international units

120
Q

prescriber pnuemonic

A

P – patient details
Re – reaction (allergy plus the reaction)
S – sign the front of the chart
C – check contraindications to each drug
R – check route for each drug
I – prescribe intravenous fluids if needed
B – prescribe blood clot prophylaxis if needed
E – prescribe antiemetic if needed
R – prescribe pain relief if needed.

121
Q

ADR gentamicin

A

Nephrotoxicity, ototoxicity

122
Q

ADR vancomycin

A

Nephrotoxicity, ototoxicity

123
Q

ADR cephalosporins, ciprofloxacin (or most broad spectrum abx)

A

Clostridium difficile colitis

124
Q

ADR ACE-inhibitors, e.g. lisinopril

A

Hypotension, electrolyte abnormalities, acute kidney injury, dry cough

125
Q
A
125
Q

ADR Beta-blockers, e.g. bisoprolol

A

Hypotension, bradycardia, wheeze in asthmatics, worsens acute heart

failure (but helps chronic heart failure)

126
Q

ADR Calcium-channel blockers, e.g.
diltiazem

A

Hypotension, bradycardia, peripheral oedema, flushing

127
Q

ADR Diuretics, e.g. furosemide,
bendroflumethiazide, spironolactone

A

Hypotension, electrolyte abnormalities, acute kidney injury, subclass-
dependent effects

128
Q

ADR heparins

A

Haemorrhage (especially if renal failure or <50 kg), heparin-induced

thrombocytopaenia

129
Q

ADR warfarin

A

Haemorrhage (note that ironically warfarin has a pro-coagulant effect
initially as well as taking a few days to become an anti-coagulant; thus
heparin should be prescribed alongside warfarin and continued until the
INR exceeds 2.

130
Q

ADR aspirin

A

Haemorrhage, peptic ulcers and gastritis, tinnitus in large doses

131
Q

ADR digoxin

A

Nausea, vomiting and diarrhoea, blurred vision, confusion and drowsiness, xanthopsia (disturbed yellow/green visual perception including ‘halo’ vision)

changes in serum K+ at the receptor can compete with digoxin; low K+ augments digoxin effect. High levels limit the effect

132
Q

ADR amiodarone

A

-Hyperthyroid
-Hypothyroid
-Pulmonary toxicity
-Raised serum transaminases
-Persistent -slate grey skin
-Phototoxicity - need to wear suncream
-Corneal microdeposits:causes glare

133
Q

ADR lithium

A

Early – tremor
Intermediate – tiredness
Late – arrhythmias, seizures, coma, renal failure, diabetes insipidus
-electrolyte imbalance: particularly sodium (reduced salt intake can cause increase lithium level)
-EPSE
-hyperthyroid
-hypothyroid
-QT interval prolongation
-wt gain

134
Q

ADR haloperidol

A

Dyskinesias, e.g. acute dystonic reactions, drowsiness

135
Q

ADR clozaapine

A

Agranulocytosis (requires intensive monitoring of full blood count)

136
Q

ADR dexamethasone and pred

A

ASSOCIATED WITH LONG TERM USE - consider secondary prevention to reduce
-GI discomfort
-cataracts
-impaired healing
-Immunosuppression
-Mood changes
-Candidiasis
-Cushings
-Increased cholesterol
-Osteoporosis
-Hyperglycaemia
-Reduced K
-Sodium retention

137
Q

ADR fludrocortisone

A

Hypertension/sodium and water retention

138
Q

ADR NSAIDs (ibuprofen)

A

NSAID: No urine (renal failure), Systolic dysfunction (heart failure),
Asthma, Indigestion (any cause), Dyscrasia (clotting abnormality)

139
Q

ADR simvastatin

A

Myalgia, abdominal pain, increased ALT/AST (can be mild),
rhabdomyolysis (can be just mildly increased creatine kinase though)

140
Q

drugs with a narrow therapeutic window

A

warfarin
digoxin
phenytoin
theophylline

141
Q

drugs requiring careful dosage control

A

antiHTN
antidiabetic

142
Q

alcohol and drugs causing GI bleed?

A

nonsteroidal anti-inflammatory drugs,
including aspirin and ibuprofen

143
Q

what does alcohol and metfotmin cause

A

lactic acidosis

144
Q

alcohol and which drugs increase anticaog

A

warfarin (with acute alcohol due to
enzyme inhibition); chronic alcohol causes
enzyme induction and thus reduces
anticoagulant effect

145
Q

what drug interacts woth alcohol causing hypertensive crisis

A

monoamine oxidase
inhibitors

146
Q

how do metronidazole and disuliram react with alcohol

A

Sweating, flushing, nausea and
vomiting

147
Q

alcohol and which drugs cause sedation

A

barbiturates,
opioids and
benzodiazepines

148
Q

where are opioid conversions

A

Prescribing in palliative care

149
Q

prescribing warfarin

A

WILL NOT GET ASKED TO PRESCRIBE WARFARIN IN AN EXAM - OTHER THAN THE DAY 1 DOSE (the only thing shown in BNF=10mg)

150
Q

best parenteral anticoag to use in PSA

A

enoxaparin as less options

151
Q

best DOAC to use in PSA

A

rivaroxaban

152
Q

breahtrhough dose pain relief

A

1/10 TO A ⅙ TOTAL 24HR DOSE)

153
Q

how often is modified release tablet morphine given

A

BD

154
Q

preventing constipaiton opiooids

A

movicol laxative

155
Q

PRN morphine

A

can give 2-4 hourly = max doses per day

156
Q

when is oxycodone good

A

renal impairment

157
Q

CI oxycodone

A

resp depression, HI, chronic constipation, cor pulmonale, delayed gastric emptying, acute abdo

158
Q

where to find insulin types

A

search insulin and treatment summary

159
Q

how to approach biphasic insulin changes

A

Biphasic insulin changes: wherever problem is need to adjust dose 12h before. E.g. if hypo in morning need to reduce evening dose, if hyperglycaemic in evening need to increase morning dose. Usually change by approx 10%

160
Q

SE aminophylline/theophylline

A

hypokalaemia

161
Q

sx aminophylline/theophylline toxicity

A

N+V, agitation, restlessness, dilated pupils

162
Q

what effects aminophylline/theophylline clearance

A

Clearance increased by: smoking,
Clearance reduced by: HF, liver failure, viral infections

163
Q

where to find conversion table of steroids

A

SEARCH GLUCOCORTICOID IN BNF

164
Q

how is methotrexate taken

A

weekly
do not take folic acid on same day

165
Q

which abx does atorvastatin interact with

A

clarithromycin
withold the statin while on

166
Q

monitoring DOAC

A

-Renal funct
-Baseline clotting, FBC, LFT
-?wt (for Cr clearance)
-Factor Xa - if extremes of bw or clotted on a doac

167
Q

counselling advice DOAC

A

-Indication
-Dose info- explain loading regime
-Duration
-Interacting medications
-Over the counter meds to avoid-ibuprofen and aspirin
-To inform healthcare professionals - dentist

168
Q

monitoring amiodarone

A

-TFT and LFT baseline and then 6m
-CXR baseline

169
Q

counselling amiodarone

A

-Sunscreen
-Breathing problems
-Vision problems
-Liver toxicity- know signs

170
Q

ADR carbimazole

A

-rash
-pruritus
-agranulocytosis
-bone marrow suppression
-jaundice
-acute pancreatitis

171
Q

monitorign carbimazole

A

-TFT/WBC

172
Q

counselling carbimazole

A

-how to recognise signs bone marrow suppression
-Effective contraception as teratogenic
-Signs acute pancreatitis

173
Q

monitoring corticosteroids

A

-BP
-Wt
-Glucose
-Potassium
-triglycerides

174
Q

counselling corticosteroids

A

-need a steroid emergency card: says what to do if unwell and informs medical professionals
-not to abruptly stop if: had 40mg or more pred daily for 1wk, repeat doses in evening, more than 3w tx, recently received repeated courses (especially if taken for more than 3w), short course within a yr of stopping long term

175
Q

ADR methotrexate

A

-stomatitis
-stevens johnsons syndrome
-toxic epidermal necrolysis
-blood disorders
-hepatotoxicity
-interstitial pneumonitis

176
Q

monitoring methotrexate

A

-FBC/LFT/U+E/eGFR/TFT: every 2w when start then every 6mly
-CXR
-pregnancy/breastfeeding as need to avoid

177
Q

counselling methotrexate

A

-reduced fertility while taking
-weekly: how to take
-immediately report features of blood disorders, liver toxicity, resp effects
-avoid OTC NSAID: aspirin and ibuprofen
-alert card
-take folic acid once weekly alongside it but on a different day

178
Q

monitoring ramipril/ACEi

A

-U+E
-eGFR
-BP

179
Q

monitoring lithium

A

-eGFR/TFT/cardiac function
(renally excreted)

180
Q

monitoring digoxin

A

-eGFR, U+E
-Dont need to routinely check serum level

181
Q

ADR phenytoin

A

-gingival hypertrophy
-hirsutism
-tremor
-leukopenia
-aplastic anaemia
-blood disorders
-dyskinesia
-hepatotoxicity
-stevens johnson syndrome
-pneumonitis

182
Q

monitoring phenytoin

A

-LFTs/FBC

183
Q

ADR atorvastatin

A

-hepatitis
-jaundice
-interstitial lung disease
-rhabdomyolysis

184
Q

monitoring atorvastatin

A

-TFT/LFT/lipid profile/eGFR
-LFT within 3m and then at 12m

185
Q

ADR theophylline

A

-hypokalaemia
-N+V
-tremor
-palpitations

186
Q

monitoring theophylline

A

-level after 5-7d
-U+E, LFT
-smoking
-increased monitoring if HF, alcoholics, or liver dysfunction

187
Q

counselling theophylline

A

-smokers need a high dose (smoking 20-40/d), if stop need a dose reduction 20-33%

188
Q

ADR sodium valproate

A

-anaemia
-hyponatraemia
-SIADH
-bone marrow failure
-pancreatitis

189
Q

monitoring sodium valproate

A

-LFTs: repeat 1st within 6m

190
Q

counselling sodium valproate

A

-if female need to be on a pregnancy prevention programme, however if get pregnant on it dont stop taking
-advise signs pancreatitis/liver/blood disorders

191
Q

features hypokalaemia

A

muscle weakness/hypotonia/hyporeflexia/cramps/tetany, cardiac palpitations/arrhythmias

192
Q

features hyperkalaemia

A

asx, muscle weakness/fatigue, cardiac palpitations/arrhythmias

193
Q

features hyponatraemia

A

mild anorexia, headache, muscle cramp, irritability, seizures, confusion, reduced GCS, coma

194
Q

features hypernatraemia

A

thirst, tired, confusion, irritability, seizures, coma

195
Q

causes hypernatraemia

A

sodium bicarb
Steroids
Oestrogens
Sodium chloride
Androgens
liquorice

196
Q

drugs increasing risk GI bleed

A

Nsaids
SSRIs
Antiplatelet: aspirin, clopidogrel
Anticoag: warfarin
Corticosteroids: pred
Bisphosphonates: alendronate, risedronate
Doxycycline

197
Q

drugs causing wt gain

A

Lithium
Antipsychotics: olanzapine one of the worse
Corticosteroids
SSRIs
Sulphonylureas
Amitriptyline
Sodium valproate
insulin

198
Q

features hypovolaemia

A

HR>90, systolic BP<100, non visible JVP, decreased GCS, fluid loss (bleeding/burns)

199
Q

resus fluids adult

A

500ml sodium chloride 0.9% over less than 15m

200
Q

resus fluids paeds

A

children= 20ml/kg less than 10mins
neonate=10-20ml/kg over less than 10m
CAN USE FOR NEONATES AND CHILDREN: 0.9% SODIUM CHLORIDE 20ML/KG OVER LESS THAN 10M

201
Q

vol maintenance fluids adult

A

25-30ml/kg/d unless elderly, renal impairment, cardiac patient, malnourised at risk of refeeding syndrome when use 20-25ml/kg/d

202
Q

electrolyte requirements adults

A

1mmol sodium, potassium and chloride

50-100 g /d glucose (gluc 5% contains 5g/100ml) - 1-2L day gluc 5% will fulfill needs

giv e potassium even if K currently normal, only dont if hyperkalaemic. K max 10mmol/hr. 0.15% =20mmol, 0.3%=40mol. FLUIDS AND ELECTROLYTES TX SUMMARY. Give 40mmol/L

203
Q

caution with 5% glucose

A

Patients with ischaemic stroke
Severe traumatic brain injury
Impaired glucose tolerance

204
Q

mx hypoglycaemia adults

A

ADULTS = Glucose 10% 150ml in 15 minutes (THINK 10% X 15MINS =150ML)

(if cant swallow

205
Q

phosphate replacement

A

search phosphate and look at hypohophataemia guidance

=9mmol in 90ml!! (worked out using the above info)

206
Q

fluids and meds considerations

A

If NBM consider they will be having meds IV - consider med diluents - account for this in maintenance e.g. 1g paracetamol in 100ml. IV tazocin
IV meds may contain high sodium: fosfomycin, paracetamol, benzyl penicillin
Oral effervescent tabs contain high sodium

207
Q

mx acute dystonic rxn

A

procyclidine

208
Q

how much K per day

A

1mmol/Kg

209
Q

when are BB CI

A

PVD

210
Q

when are ACEi CI

A

critical ischaemia

211
Q

what worsens biventricular failure

A

corticosteroids
CCB

212
Q

what can cause thrush

A

oral corticosteroids
abx

213
Q

what to not stop abruptly

A

steroids as can cause adrenal crisis

214
Q

mx scarlett fever

A

phenoxymethylpenicllin 10d

215
Q

methotrexate and contraception

A

M nd F need during tx and for 6m after stopping

216
Q

checking response to BB in AF

A

HR

217
Q

monitoring sertraline

A

no bloods

218
Q

how to manage a statin causing myopathy

A

if CK increased over 5x norm or sev sx then stop
if sx resolve start again at a lower dose

219
Q

anti-emetics in post op N+V

A

ondansetron 1st line but can prolong QT therefore use cyclizine if risk

220
Q

mx shingles

A

aciclovir

221
Q

shingles sx

A

painful
well demarcated vesicular rash in dermatomal distribution

222
Q

causes ankle oedema

A

amlodipine
naproxen

223
Q

mx c diff

A

oral vancomycin

224
Q

mx DKA in T1DM

A

stop short acting insulin
continue long actin insulin
fixed rate IV insulin
fluid resus

225
Q

when to take loperamide

A

after each loose stool

226
Q

advice starting apixaban

A

report bruising or other sings bleeding immediately

227
Q

analgesia in renal impairment

A

oxycodone

228
Q

mx bleeding and shock on warfarin

A

prothrombin complex or fresh frozen plasma

229
Q

SE amiodarone

A

thyrotoxicosis - temporarily suspend amiodarone

230
Q

common causes hyperkalaemia

A

dalteparin
ramipril
tacrolimus

231
Q

when to stop aspirin before surgery

A

1wk before

232
Q

stop in AKI

A

ACEi
ARB
allopurinol

233
Q

SE pred

A

hyperglycameia
confusion

234
Q

how to answer dosing error qs

A

check freq drugs
then units
then dose

235
Q

UTI and poor renal funct

A

dont give nitrofurantoin in poor renal funct as it doesnt work

236
Q

INR and surgery

A

if INR >1.5 on day of surgery need vit K

237
Q

how to take rivaroxaban

A

with food to improve absorption

238
Q

topiramate and hormones

A

progesterone only preparations are reeduced by topiramate

239
Q

what can fluclox cause (liver)

A

cholestatic jaundice

240
Q

Cr increase and ACEi

A

small increase (20%) normal when start

241
Q

how to monitor furosemide tx

A

wt

242
Q

monitoring carbimazole

A

FBC - can cause neutropenia

243
Q

monitoring HF sx

A

exercise tolerance

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