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PSA Flashcards

1
Q

what is the mnemonic for drugs that need to be stopped pre surgery?

A

I LACK OP
Insulin
Lithium
Anticoagulants
COCP/HRT
K-sparing diuretics
Oral hypoglycaemic agents
Perindopril (ACE-is)

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2
Q

what does the PReSCRIBER mnemonic stand for?

A

Patient details
Reactions
Sign the front of the chart
Contraindications
Route
IV fluids
Blood clot prophylaxis
antiEmetics
pain Relief

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3
Q

when should anti-platelets and anticoagulants not be given?

A

patients who are bleeding, suspected of bleeding, or at risk of bleeding

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4
Q

when should prophylactic heparin not be given in the IP setting?

A

(generally) it shouldn’t be given in acute ischaemic stroke

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5
Q

which drugs are enzyme inducers?

A

PC BRAS
Phenytoin
Carbamazepine
Barbituates
Rifampicin
Alcohol (chronic)
Sulfonylureas

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6
Q

what is the effect of enzyme inducers on other drugs?

A

inc enzyme activity
-> dec drug concentration

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7
Q

which drugs are enzyme inhibitors?

A

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

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8
Q

what is the effect of enzyme inhibitors on other drugs?

A

dec enzyme activity
-> inc drug conc

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9
Q

what are the side effects of steroids?

A

STEROIDS
Stomach ulcers
Thin skin
oEdema
Right and left heart failure
Osteoporosis
Infection
Diabetes(hyperglycaemia)
Syndrome - cushings

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10
Q

what safety considerations should be remembered for NSAIDS?

A

NSAID
No urine (renal failure)
Systolic dysfunction (heart failure)
Asthma
Indigestion
Dyscrasia (clotting abnormality)

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11
Q

what are the 3 categories of side effects of antihypertensives?

A

a. hypotension (all)
b. 2 mechanisms:
1. BBs/CCBs can cause bradycardia
2. ACE-is and diuretics can cause electrolyte disturbance
c. individual classes have specific s/es:
ACE-is eg ramipril - dry cough
BBs - wheeze in asthmatics, worsening of acute HF
CCBs eg amlodipine - peripheral oedema
diuretics - renal failure
thiazides Ds - gout
K-sparing Ds eg spiro - gynaecomastia

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12
Q

what fluid should be given in most patients for fluid replacement?

A

0.9% saline

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13
Q

what fluid should be given in hypernatraemic or hypoglycaemic patients for replacement?

A

5% dextrose

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14
Q

what fluid should be given in patients with ascites for replacement?

A

HAS

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15
Q

what fluid should be given in patients shocked from bleeding (replacement)?

A

blood transfusion
crystalloid first if no blood available

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16
Q

how much fluid should be given to a tachycardic or hypotensive patient?

A

500ml bolus (250 if hx of HF)
then reassess

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17
Q

how much fluid should be given to a patient who is not tachy/hypotensive but is oliguric?

A

1L over 2-4h then reassess

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18
Q

how can fluid depletion be estimated clinically?

A

reduced urine output - 500ml fluid depletion
reduced urine output plus tachy - 1L fluid depletion
red UO plus tachy plus shocked - 2L +

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19
Q

what is the maximum rate that IV potassium should be given?

A

10mmol/hour

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20
Q

how much fluid should be given as maintenance?

A

3L most adults, 2L /day elderly
3L - give 8hourly bags, 2L - give 12 hourly bags

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21
Q

when should a patient not be prescribed anti-embolic stockings?

A

peripheral arterial disease

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22
Q

when should metoclopramide be avoided?

A

parkinsons disease - exacerbation of sx
young women - risk of dyskinesia

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23
Q

what should be prescribed for a nauseated pt?

A

regular antiemetic
cyclizine 50mg 8 hourly IM/IV/PO - avoid in HF
metoclopramide 10mg 8 hourly IM/IV if HF
ondansetron 4mg or 8mg 8 hourly IV/PO

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24
Q

what should be prescribed for a patient who is not nauseated?

A

PRN antiemetic
cyclizine 50mg up to 8 hourly IM/IV/PO - avoid in HF
metoclopramide 10mg up to 8H IM/IV if HF

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25
Q

what pain relief should be prescribed for a patient with no pain?

A

PRN paracetamol 1g 6h PO

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26
Q

what pain relief should be prescribed for a patient with mild pain?

A

regular paracetamol 1g 6H
PRN codeine 30mg up to 6h PO

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27
Q

what pain relief should be prescribed for a patient with severe pain?

A

co-codamol 30/500 2 tablets 6h PO
PRN morphine 10mg/5ml, 10mg up to 6H PO (then SC then IV if needed)

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28
Q

what to be aware of with paracetamol

A

ensure they aren’t on it 4hourly (max dose is 4g/day)
ensure they arent on both paracetamol and co-codamol

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29
Q

what is the max dose of paracetamol in patients <50kg?

A

500mg 6hourly

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30
Q

why might cyclizine need to be reviewed in a confused elderly patient?

A

anticholinergic effects -> can cause confusion and drowsiness

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31
Q

what are the most important results of an FBC?

A

Hb, WCC, plt

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32
Q

what are the main causes of hypernatraemia?

A

Ds
dehydration
drips
drugs
diabetes insipidus (opposite of siadh)

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33
Q

causes of hyponatraemia: hypovolaemic

A

fluid loss (D+V)
addisons
diuretics

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34
Q

causes of hyponatraemia: euvolaemic

A

SIADH
psychogenic polydipsia
hypothyroidism

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35
Q

causes of hyponatraemia: hypervolaemic

A

HF
renal failure
liver failure (hypoalbuminaemia)
nutritional failure (hypoalbumin)
nutritional failure
thyroid failure

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36
Q

what are the causes of SIADH?

A

SIADH
Small cell lung tumours
Infection
Abscess
Drugs (esp carbamazepine and antipsychotics)
Head injury

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37
Q

what are the causes of hypokalaemia?

A

DIRE
Drugs (loop and thiazide diuretics)
Inadequate intake or intestinal loss
Renal tubular acidosis
Endocrine (cushings and conns)

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38
Q

what are the causes of hyperkalaemia?

A

DREAD
Drugs (potassium sparing diuretics and ACE-is)
Renal failure
Endocrine (addisons)
Artefact
DKA (insulin given - drops K, need replacement)

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39
Q

what are the 3 types of AKI?

A

pre-renal (70%)
intra/intrinsic renal (10%)
post-renal (20%)

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40
Q

what are the causes of pre-renal AKI?

A

dehydration/shock - sepsis, blood loss
renal artery stenosis

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41
Q

what biochemistry is seen in pre-renal AKI?

A

urea rise&raquo_space; creat rise
eg Ur 19, Creat 110

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42
Q

what are the causes of intra renal AKI?

A

INTRINSIC
Ischaemia (due to prerenal aki - causing ATN)
Nephrotoxic abx
Tablets (ACEI, NSAIDs)
Radiological contrast
Injury (rhabdomyolysis)
Negatively birefringent crystals (gout)
Syndromes (glomerulonephritis)
Inflammation (vasculitis)
Cholesterol emboli

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43
Q

What are the causes of postrenal AKI?

A

lumen - stone or sloughed papilla
wall - tumour, fibrosis
external pressure: BPH, prostate ca, lymphadenopathy, aneurysm

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44
Q

what biochemistry is seen in intrarenal AKI?

A

urea rise«creat rise
bladder or hydronephrosis not palpable eg Ur 9, Cr 342

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45
Q

what biochemistry is seen in post-renal AKI?

A

urea rise &laquo_space;creat rise
eg Ur 9, Creat 342
bladder or hydronephrosis may be palpable

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46
Q

what are examples of nephrotoxic abx?

A

gentamicin, vancomycin, tetracyclines

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47
Q

how wide should the QRS complex be?

A

<3 small squares

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48
Q

what do wide QRS’s indicate?

A

BBB
-> then do william marrow

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49
Q

what does 1st degree HB look like?

A

prolonged but constant PR interval

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50
Q

what does 2nd degree type 1 HB look like?

A

increasing then missing QRS then increasing again

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51
Q

what does 2nd degree type 2 HB look like?

A

2 or 3 p waves per QRS

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52
Q

what does 3rd degree (complete) HB look like?

A

no relationship between P and QRS

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53
Q

what does st elevation indicate?

A

infarction - st flat and raised in some leads
pericarditis - st convex and raised in all leads

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54
Q

what does st depression indicate?

A

flat and in some leads - infarction or ischaemia - check trop
digoxin - down sloping in all leads

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55
Q

what does tall t waves indicate?

A

more than 2 thirds of QRS height, throughout ecg - hyperkalaemia

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56
Q

what does t wave inversion indicate?

A

normal in aVR and I (top middle two)
other leads - old infarction/LVH

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57
Q

which LFTs are indicators of hepatocyte injury or cholestasis?

A

bilirubin
ALT/AST
alkaline phosphatase

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58
Q

which LFTs are indicators of synthetic function?

A

albumin
vit d dependent clotting factors - II, VII, IX and X (2,7,9,10) - measured via PT and INR

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59
Q

LFT changes in PREhepatic problems?

A

inc bilirubin

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60
Q

LFT changes in INTRAhepatic problems?

A

inc bili and inc AST/ALT

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61
Q

LFT changes in POSThepatic problems?

A

inc bili and inc ALP

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62
Q

prehepatic causes of deranged lfts?

A

haemolysis
gilbert’s and crigler-najjar syndrome

63
Q

intrahepatic causes of deranged lfts?

A

fatty liver
hepatitis
cirrhosis
malignancy
metabolic
heart failure

64
Q

posthepatic causes of deranged lfts?

A

gallstones
drugs causing cholestasis (fluclox, co-amox, nitrofurantoin, steroids, sulfonylurea
tumours, PBC, sclerosing cholangitis
panc cancer, gastric cancer lymph nodes

65
Q

TFT results in primary hypothyroidism?

A

Low t4, raised TSH

66
Q

TFT results in secondary hypothyroidism?

A

low t4 low TSH

67
Q

TFT results in primary hyperthyroidism?

A

raised t4 low tsh

68
Q

TFT results in secondary hyperthyroidism?

A

raised t4 raised tsh

69
Q

what are the causes of primary hypothyroidism?

A

hashimotos thyroiditis, drug induced

70
Q

what are the causes of secondary hypothyroidism?

A

pituitary damage or damage

71
Q

what should be done to thyroxine dose if TSH <0.5?

A

decrease dose

72
Q

what should be done to thyroxine dose if TSH is 0.5-5?

75
Q

what should be done to thyroxine dose if TSH >5?

A

increase dose

77
Q

What are the features of digoxin toxicity?

A

Confusion, nausea, visual halos, arrhythmias

78
Q

What are the early intermediate and late signs of lithium toxicity?

A

Early - tremor
Intermediate - tiredness
Late - arrhythmias, seizures, coma, renal failure, diabetes insipidus

79
Q

What are the features of phenytoin toxicity?

A

Gum hypertrophy, ataxia, nystagmus, peripheral neuropathy, teratogenicity

80
Q

What are the signs of gentamicin toxicity?

A

Ototoxicity and nephrotoxicity

81
Q

What are the signs of vancomycin toxicity?

A

Ototoxicity and nephrotoxicity

82
Q

what is the management for PE?

A

high flow oxygen
morphine + cyclizine IV
LMWH eg tinzaparin 175 units/kg daily (IP)

90
Q

What are the adverse effects of gentamicin and vancomycin?

A

Nephrotoxicity
Ototoxicity

91
Q

What are the common adverse effects of ace-inhibitors?

A

Hypotension
Electrolyte abnormalities
AKI
Dry cough

92
Q

What are the common adverse effects of beta blockers?

A

Hypotension
Bradycardia
Wheeze in asthmatics
Worsens acute HF (helps chronic)

93
Q

What are the common adverse effects of CCBs?

A

Hypotension
Bradycardia
Peripheral oedema
Flushing

94
Q

What are the common adverse effects of diuretics?

A

Hypotension
Electrolyte abnormalities
AKI
Others depending on subclass

95
Q

What are the common adverse effects of heparins?

A

Haemorrhage
Heparin induce thrombocytopenia

96
Q

What are the common adverse effects of warfarin?

A

Haemorrhage

97
Q

What are the common adverse effects of aspirin?

A

Haemorrhage
Peptic ulcers and gastritis
Tinnitus (high dose)

98
Q

What are the common adverse effects of digoxin?

A

Nausea
D + v
Blurred vision
Confusion and drowsiness
Xanthopsia

99
Q

What are the common adverse effects of amiodarone?

A

Interstitial lung disease
Thyroid disease
Skin greying
Corneal deposits

100
Q

What are the common adverse effects of haloperidol?

A

Dyskinesias
Drowsiness

101
Q

What are the common adverse effects of clozapine?

A

Agranulocytosis

102
Q

What are the common adverse effects of dexamethasone and prednisolone?

A

Stomach ulcers
Thin skin
Edema
Right and left HF
Osteoporosis
Infection
Diabetes
Cushing Syndrome

103
Q

What are the common adverse effects of fludrocortisone?

A

Hypertension
Sodium and water retention

104
Q

What are the common adverse effects of ibuprofen?

A

NSAID
No urine
Systolic dysfunction
Asthma
Indigestion
Dyscrasia (clotting dysfunction)

105
Q

What are the common adverse effects of statins?

A

Myalgia
Abdo pain
Inc ALT/AST
Rhabdomyolysis

106
Q

Which statins are highest risk for myalgia?

A

Most>least
Simvastatin > atorvastatin > pravastatin > fluvastatin

107
Q

Which common drugs have narrow therapeutic indexes?

A

Warfarin
Digoxin
Phenytoin
Theophylline

108
Q

Which common drugs require careful dosage control?

A

Antihypertensives
Anti diabetic drugs

109
Q

What are the most common enzyme inhibitors?

A

Ketoconazole
Ciprofloxacin
Erythromycin
GRAPEFRUIT JUICE

110
Q

What drug causes lactic acidosis?

111
Q

What drugs cause hypertensive crises?

A

Monoamine oxidase inhibitors

112
Q

What drugs cause increased anticoagulation?

A

Warfarin with acute alcohol
Chronic alcohol reduces anticoagulant effect

113
Q

Which drugs most commonly cause sedation?

A

Barbiturates
Opioids
Benzodiazepines

114
Q

Which drugs most commonly cause sweating, flushing, nausea and vomiting?

A

Metronidazole
Disulfiram

115
Q

Why should patients taking clozapine seek medical advice if constipation develops?

A

Fatal risk of intestinal obstruction, faecal impaction and paralytic ileus

116
Q

What should be advised to patients taking mirtazapine?

A

Risk of agranulocytosis
- seek medical advise if infective symptoms

117
Q

what precaution should be advised to patients taking amiodarone?

A

phototoxic reactions - avoid direct sunlight and wear suncream

118
Q

which medication should be given to a child with symptoms of meningitis before transfer to hospital?

A

benzylpenicillin IM or IV

119
Q

what should be given to a child with croup who is too unwell to receive oral medications/sig resp distress?

A

nebulised budesonide

120
Q

what is the dose of nebulised salbutamol for a child?

A

2.5mg (-5mg)

121
Q

which medications tend to be given in the morning?

A

diuretics
steroids

122
Q

which medications tend to be given at night?

A

statins
night sedation

123
Q

which medications tend to be given with meals?

A

insulin
creon

124
Q

which medications tend to be given weekly?

A

bisphosphonates (check dose)
methotrexate/folic acid
patches

125
Q

which medications are most likely to cause hypoglycaemia?

A

insulin
sulphonylureas

126
Q

which medications are most likely to cause hyperglycaemia?

A

steroids
antipsychotics
thiazides
beta blockers
tacrolimus

127
Q

which medications are most likely to cause constipation?

A

Opioids, iron, CCBs (amlodipine, verapamil), some diuretics, some antiemetics (ondansetron, metoclopramide), some antiepileptics, some Parkinson’s medications, antacids that contain calcium, anticholinergics (antidepressants, antihistamines, incontinence medications, antipsychotics)

128
Q

which medications are most likely to cause diarrhoea?

A

antibiotics
colchicine
metformin
PPIs
antacids containing magnesium
laxatives

129
Q

which medications are most likely to cause urinary retention?

A

opioids, anticholinergics

130
Q

which medications are most likely to cause urinary incontinence?

A

alpha blockers, diuretics, anticholinesterase inhibitors, clozapine

131
Q

which medications are most likely to cause confusion?

A

opioids
sedatives
anticholinergics

132
Q

which medications are most likely to cause falls?

A

benzos
antidepressants (TCAs and SNRIs)
MAO
antipsychotics
opiates
most antihypertensives
PD meds
antiepileptics
hypoglycaemics

133
Q

which medications are most likely to cause gout?

134
Q

which medications are most likely to cause osteoporosis?

A

steroids
PPIs
LHRH agonists (bureslin, goreslin)

135
Q

which medications are most likely to cause hypertension?

A

NSAIDs, steroids, oral contraceptives, mirabegron

136
Q

which medications are most likely to cause high cholesterol?

A

steroids, thiazides

137
Q

which medications are most likely to cause hypokalaemia?

A

loop diuretics
thiazides
steroids
salbutamol

138
Q

which medications are most likely to cause hyperkalaemia?

A

K sparing diuretics
ACE-is
ARBs
unfractionated heparin/lmwh
blood transfusion

139
Q

which medications are most likely to cause hyponatraemia?

A

SSRIs
TCAs
carbamazepine
opiates
PPIs

140
Q

which medications are most likely to cause hypernatraemia?

A

lithium
demeclocycline

141
Q

which medications should be continued if intercurrent illness?

A

steroids (double)

142
Q

which medications should be stopped if intercurrent illness?

A

metformin
statins
gliflozins

143
Q

which medications should be stopped if trying to conceive?

A

some antiepileptics
some antipsychotics
isotretinoin
methotrexate
warfarin

144
Q

which medications should be stopped prior to surgery?

A

DOACs (48h)
clopidogrel (7d)
warfarin (bridging)

145
Q

which medications are most likely to worsen PD?

A

antipsychotics - haloperidol
antiemetics - metoclopramide
antidepressants

146
Q

which medications are most likely to worsen myasthenia gravis?

A

antibiotics
beta blockers
local anaesthetic
sedating drugs

147
Q

which medications are most likely to worsen psoriasis?

A

beta-blockers
lithium
some antibiotics

148
Q

which medications are most likely to worsen heart failure?

A

NSAIDs
CCBs
thiazolidinediones (pioglitazones)

150
Q

Tablet HRT for uterus intact LMP LESS than 12 mo ago ?

A

Elleste duet 1mg or 2mg

151
Q

Patch HRT for uterus intact and LMP LESS than 12 mo ago?

A

Evorel sequi

Daisy Finals Revision (25 decks)

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