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Year 6 > PSA > Flashcards

PSA Flashcards

1
Q

Following medications may exacerbate heart failure [5]

A
  • thiazolidinediones

pioglitazone is contraindicated as it causes fluid retention

  • verapamil

negative inotropic effect

  • NSAIDs/glucocorticoids

should be used with caution as they cause fluid retention
low-dose aspirin is an exception - many patients will have coexistent cardiovascular disease and the benefits of taking aspirin easily outweigh the risks

  • class I antiarrhythmics

flecainide (negative inotropic and proarrhythmic effect)

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2
Q

Following drugs may worsen seizure control in patients with epilepsy [DAPAN]

A
  • alcohol, cocaine, amphetamines
  • ciprofloxacin, levofloxacin
  • aminophylline, theophylline
  • bupropion
  • methylphenidate (used in ADHD)
  • mefenamic acid

drugs
abx
psych
asthma
NSAID

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3
Q

which antibiotics are contraindicated in pregnancy [5]

A
  • tetracyclines
  • aminoglycosides
    e.g. gentamicin, amikacin, tobramycin, neomycin, and streptomycin
  • sulphonamides
  • trimethoprim
  • quinolones
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4
Q

which drugs are contraindicated in pregnancy (non Abx) [8]

A
  • ACE inhibitors
  • angiotensin II receptor antagonists
  • statins
  • warfarin
  • sulfonylureas
  • retinoids (including topical)
  • cytotoxic agents
  • antiepileptics (risk v benefits decision)
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5
Q

3 drugs to use with caution in asthmatics

A

NSAID
beta blockers
adenosine

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6
Q

what should be used as an alternative for adenosine in the treatment of SVT

A

verapamil

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7
Q

Exacerbating factors of psoriasis

A

drugs
alcohol
trauma
withdrawal of steroids
strep infection

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8
Q

Drugs that can exacerbate psoriasis

A

beta blockers
lithium
antimalarials (chloroquine and hydroxychloroquine)
NSAIDs
ACE inhibitors
infliximab

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9
Q

which anti-diabetic drug is contraindicated in heart failure?

why?

A

pioglitazone

causes fluid retention

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10
Q

which fluid should be avoided in stroke patients? why?

A

5% glucose as there is the risk of cerebral oedema

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11
Q

Maintenance water requirement

A

20-30ml/kg/day

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12
Q

maintenance electrolytes requirement

A

approximately 1 mmol/kg/day of potassium, sodium and chloride

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13
Q

maintenance glucose requirement

A

50-100g/day to limit starvation ketosis

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14
Q

what is the risk with overloading saline

A

hyperchloraemic metabolic acidosis

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15
Q

which patients should Hartmann’s not be given to?

A

hyperkalaemic patients

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16
Q

main adverse effect of carbimazole

A

agranulocytosis

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17
Q

what % is a HbA1c of 48

A

6.5

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18
Q

what % is a HbA1c of 53

A

7.0

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19
Q

what glucose parameter should determine change in diabetic medication

A

HbA1c

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20
Q

endocrine side effects of glucocorticoids [4]

A

impaired glucose regulation
increased appetite/weight gain
hirsutism
hyperlipidaemia

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21
Q

Features of Cushing’s syndrome (side effects of glucocorticoids) [3]

A

moon face
buffalo hump
striae

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22
Q

MSK side effects of glucocorticoids [3]

A

osteoporosis
proximal myopathy
avascular necrosis of the femoral head

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23
Q

immunosuppressive side effects of glucocorticoids [2]

A

increased susceptibility to severe infection
reactivation of tuberculosis

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24
Q

psychiatric side effects of glucocorticoids [4]

A

insomnia
mania
depression
psychosis

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25
Q

GI side effects of glucocorticoids [2]

A

peptic ulceration
acute pancreatitis

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26
Q

ophthalmic side effects of glucocorticoids [2]

A

glaucoma
cataracts

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27
Q

3 other side effects of glucocorticoids

A

suppression of growth in children
intracranial hypertension
neutrophilia

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28
Q

side effects of mineralocorticoids [2]

A

fluid retention
hypertension

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29
Q

why can taking long term steroids precipitate an Addisonian crisis

A

taking exogenous steroids suppresses the production of our own endogenous steroids therefore abrupt withdrawal can lead to Addisonian crisis

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30
Q

BNF suggests gradual withdrawal of systemic corticosteroids if patients have

A

1) received more than 40mg prednisolone daily for more than one week
2) received more than 3 weeks of treatment
3) recently received repeated courses

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31
Q

How should a patient be counselled for taking bisphosphonate

A

1) Take 30 minutes before breakfast i.e. on an empty stomach with plenty of water
2) remain standing or upright for 30 minutes after

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32
Q

main adverse reactions with oral bisphosphonates [5]

A
  • oesophageal issues e.g. ulcer, oesophagi’s
  • osteonecrosis of the jaw
  • hypocalcaemia
  • acute phase response
  • atypical stress fractures
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33
Q

what should be corrected before starting bisphosphonates

A

low calcium/Vitamin D

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34
Q

what should be done 90 minutes after thrombolysis in STEMI?

A

ECG to check for at least 50% ST elevation resolution

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35
Q

main side effects of sulfonylureas e.g. gliclazide [2]

A

hypo and weight gain

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36
Q

rarer adverse effects of sulfonylureas [4]

A

hyponatraemia secondary to syndrome of inappropriate ADH secretion
bone marrow suppression
hepatotoxicity (typically cholestatic)
peripheral neuropathy

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37
Q

breastfeeding and pregnancy advice regarding sulfonylureas

A

AVOID

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38
Q

oxygen therapy for acute unwell COPD patient in hospital

A

Oxygen via a Venturi 24% mask at 2-3 l/min or Venturi 28% mask at a flow rate of 4 l/min or nasal cannula at a flow rate of 1-2 l/min (if a 24% mask is not available)

Aim for an oxygen saturation of 88-92% for patients with risk factors for hypercapnia

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39
Q

two main side effects of insulin therapy

A

hypos and lipodystrophy

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40
Q

Levemir

A

insulin determir

long acting

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41
Q

Lantus

A

insulin glargine

long acting

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42
Q

Humalog

A

insulin lispro

rapid

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43
Q

Novarapid

A

insulin aspart

rapid

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44
Q

ECG sign of digoxin toxicity

A

reverse tick sign (downward sloping ST segment)

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45
Q

what is an FTU

A

amount of medication needed to squeeze a line from finger tip to first crease of an adult finger, provides enough to treat one side of both hands

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46
Q

Enzyme inducers: PC BRAS

A

P-phenytoin
C- Carbamazepine

B- Barbiturates
R- Rifampicin
A- Alcohol chronic
S- Sulphonylureas, St Johns Wort

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47
Q

Enzymes inhibitors: AODEVICES

A

A- Allopurinol, -azoles, amiodarone
O- Omeprazole
D- Disulfiram
E- Erythromycin
V- Valproate
I- Isoniazid
C- Ciprofloxacin, cimetidine
E- Ethanol acute
S- Sulphonamides, SSRIS

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48
Q

Drugs to stop before surgery: I LACK OP

A

I- Insulin

L- Lithium
A- Anticoagulants/antiplatelets
C- COCP/HRT
K- K-sparing diuretics

O- Oral hypoglycaemics
P- Perindopril and other ACEi and ARBs

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49
Q

how long before surgery must COCP be stopped

A

4 weeks before

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50
Q

how long before surgery must lithium be stopped

A

day before

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51
Q

how long before surgery must K+ sparing diuretics and ACEi be stopped

A

day before

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52
Q

Safe routine for prescribing: PReSCRIBER

A

P- Patient detials
Re- Reactions
S- Sign off the front of the chart
C- Contradications
R- Routes
I- IV fluids
B- Blood clot prophylaxis
E- anti Emetics
R- pain Relief

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53
Q

how many pieces of identifying detail must be written on the front of the chart

A

3

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54
Q

which groups of drugs should you know the contraindication of

A

anticoagulants/antiplatelets
steroids
antihypertensives
NSAIDs

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55
Q

contraindications of anticoagulants/antiplatelets

A
  • active bleed
  • suspected bleed
  • risk of bleeding e.g. increased PT secondary to liver disease
  • aware of enzyme inhibitors
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56
Q

contraindications of steroids: STEROIDS

A

S- Stomach Ulcers
T- Thin skin
E- oEdema
R- Right and left heart failure
O- Osteoporosis
I- Infection
D- Diabetes
S- Cushing’s syndrome

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57
Q

contraindications of NSAIDs: NSAID

A

N- No urine
S- Systolic dysfunction i.e. heart failure
A- Asthma
I- Indigestion (any cause)
D- Dyscrasia (clotting abnormality)

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58
Q

Contraindication to general antihypertensives

A

hypotension

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59
Q

two heart related contraindications of hypertensives

A

bradycardia –> beta blockers, CCB

electrolyte disturbances –> ACEi, diuretics

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60
Q

ACEi specific side effect

A

dry cough

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61
Q

Beta blocker specific side effects [2]

A

wheeze in asthmatics
worsening of HF

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62
Q

CCB specific side effects [2]

A

peripheral oedema
flushing

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63
Q

Thiazide specific side effect

A

gout

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64
Q

K+ sparing diuretic specific side effect

A

gynaecomastia

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65
Q

which organ system can diuretics negatively affect

A

renal

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66
Q

All patients should receive 0.9% saline for fluid replacement except which patients [4]

A
  • hypernatraemic
  • hypoglycaemic
  • ascitic
  • haemorrhaging
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67
Q

which replacement fluids should hypernatraemic patients receive

A

5% dextrose

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68
Q

which replacement fluids should hypoglycaemic patients receive

A

5% dextrose

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69
Q

which replacement fluids should ascitic patients receive

A

human albumin solution

(normal saline can worsen ascites)

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70
Q

which replacement fluids should haemorrhaging patients receive

A

blood transfusion

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71
Q

which factors should affect your decision on how much and over how long the replacement fluid should be given? [3]

A

HR
BP
urine output

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72
Q

how much fluid does someone tachycardia or hypotensive receive

what if they had heart failure:

A

500ml bolus

250ml if HF

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73
Q

how much and over how long should fluid be given for someone oliguric for causes other than post-renal

A

1L over 2-4 hours

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74
Q

roughly how fluid deplete is someone with reduced urine output

A

500ml

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75
Q

roughly how fluid deplete is someone with reduced urine output + tachycardia

A

~1L

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76
Q

roughly how fluid deplete is someone with reduced urine output + tachycardia + signs of shock

A

> 2L

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77
Q

what is the maximum fluid you should give to a sick patient

A

no more than 2L of IV fluid

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78
Q

what is the maximum rate IV potassium can be given

A

10mmol/hour

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79
Q

generally, how much fluid do adults require over 24 hours

A

3L

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80
Q

generally, how much fluid do the elderly require over 24 hour

A

2L

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81
Q

which fluids and how much of each provides enough electrolytes over a day

A

1L of 0.9% saline
2L of 5% dextrose

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82
Q

how much potassium replacement should be given for someone with normal potassium

A

40mmol per day

spread over two bags of 20

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83
Q

which fluids can be used to provide potassium

A

saline and dextrose

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84
Q

how often over 24 hours should 3L daily fluid be give

A

8 hourly bags

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85
Q

how often over 24 hours should 2L daily fluid be give

A

12 hourly bags

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86
Q

what three things must you do before prescribing fluids to the patient in terms of pre-assessment

A

1) check their U&Es
2) check for fluid overload
3) check if the bladder is palpable to indicate obstruction

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87
Q

what is contraindicated in those with peripheral arterial disease?

A

compression stockings as it may cause acute limb ischaemia

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88
Q

which two groups of patients should metoclopramide be avoided

A

Parkinsons’ –> worsening symptoms
Young women –> risk of dyskinesia

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89
Q

which antiemetic is good for most reasons except cardiac

what should be used instead

A

cyclizine

not good for cardiac cases as causes fluid retention

metoclopramide for cardiac cases

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90
Q

which drug is indicated in painful diabetic neuropathy

A

duloxetine

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91
Q

daily maximum dose of paracetamol

A

4g

important to check other sources of paracetamol including co-codamol

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92
Q

what is the maximum paracetamol dose in someone <50kg

A

500mg 6 hourly therefore 2g

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93
Q

diuretic drugs that cause hypokalaemia

A

thiazide diuretics
loop diuretics

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94
Q

why is metoclopramide bad for Parkinsons while domiperidone is okay to use?

A

metoclopramide is a dopamine agonist that cross the BBB

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95
Q

drugs that cause hyperkalaemia [6]

A

ACEi
ARBs
K sparing diuretics
Heparin and LMWH
Tolvaptam
Co-trimoxazole

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96
Q

two drugs that cause gastric ulceration

A

NSAIDs
steroids

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97
Q

signs of antimuscarinic toxicity [3]

A

pupillary dilation with loss of accomodation
dry mouth
tachycardia

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98
Q

what must be ensured to be written down when prescribing PRN Medication

A

the maximum dose/frequency

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99
Q

In an active ________ , methotrexate is contraindicated

A

In an active infection , methotrexate is contraindicated

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100
Q

first line thromboprophylaxis/secondary prevention for ischaemic stroke

A

clopidogrel

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101
Q

second line thromboprophylaxis/secondary prevention for ischaemic stroke

A

aspirin + MR dipyridamole

only if clopidogrel is contraindicated

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102
Q

what happens if CCBs are used with beta blockers

A

bradycardia

can become asystole

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103
Q

max dose bisoprolol daily

A

10mg

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104
Q

which insulins are given IV

A

novarapid (rapid) and actrapid (short) sliding scales

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105
Q

how is insulin usually always given

A

S/C

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106
Q

name three drugs contraindicated in asthma

A

beta blockers
NSAIDs
adenosine

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107
Q

4 causes of hypernatraemia

A

dehydration
drips
drugs
diabetes insipidus

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108
Q

3 haematological diseases that lead to microcytic anaemia

A

myeloproliferative
myelodysplastic
multiple myeloma

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109
Q

2 drugs that lead to neutropenia

A

carbimazole
clozapine

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110
Q

which rheumatoid arthritis treatment causes thrombocytopenia

A

penicillamine

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111
Q

which anticoagulant causes thrombocytopenia

A

heparin

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112
Q

3 hypovolaemic causes of hyponatraemia

A

fluid loss diarrhoea or vomiting
diuretics
Addisons’s disease

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113
Q

3 euvolaemic causes of hyponatraemia

A

SIADH
psychogenic polydipsia
hypothyroidism

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114
Q

3 hypervolaemic causes of hyponatraemia

A

heart failure
renal failure
liver failure

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115
Q

causes of SIADH: SIADH

A

S- Small cell lung cancers
I- Infection
A- Abscess
D- Drugs like carbamazepine and antipsychotics
H- Head injury

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116
Q

causes of hypokalaemia: DIRE

A

D- Drugs: loop and thiazide
I- Inadequate intake or intestinal loss
R- Renal tubular acidosis
E- Endocrine: Cushing’s and Conn’s

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117
Q

causes of hyperkalaemic: DREAD

A

D- Drugs: K+ sparing and ACEi
R- Renal failure
E- Endocrine: Addison’s
A- Artefact: clotted sample
D- DKA

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118
Q

what two things can raised urea indicate

A

1) AKI
2) Upper GI bleed

raised urea with normal creatinine and not dehydrated –> check Hb

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119
Q

urea rise and creatinine rise in the 3 types of AKI
- pre renal
- intrinsic
- post renal

A
  • pre renal: urea&raquo_space;creatinine
  • intrinsic: urea &laquo_space;creatinine
  • post renal: urea &laquo_space;creatinine
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120
Q

3 nephrotoxic antibiotics

A

gentamicin
vancomycin
tetracyclines

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121
Q

2 drugs that trigger renal artery stenosis

A

NSAIDs
ACEi

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122
Q

causes of raised ALP: ALKPHOS

A

A- Any fracture
L- Liver damage (post hepatic)
K- Kancer
P- Paget’s disease of the bone and pregnancy
H- Hyperparathyroidism
O- Osteomalacia
S- Surgery

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123
Q

5 drugs that cause cholestasis

A

flucloxacillin
co-amoxiclav
nitrofurantoin
steroids
sulfonylureas

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124
Q

what should guide your change in levothyroxine dose

A

TSH

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125
Q

How can you tell if someone is hypoxic despite being on oxygen and an above normal PaO2

A

FiO2-10 will give you a threshold of kPa for which they are considered, below this level, as hypoxic

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126
Q

3 causes of metabolic alkalosis

A

vomiting
diuretics
Conn’s

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127
Q

in terms of large squares, what is normal PR

A

less than one large square

no heart block

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128
Q

which drug causes ST segment depression in all leads

A

digoxin

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129
Q

name 6 drugs that require monitoring

A

digoxin
theophylline
lithium
phenytoin
gentamicin
vancomycin

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130
Q

when there is an adequate response to a drug, when should a change in drug dose be made?

A

when serum levels are high

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131
Q

which drug require a change in frequency rather than dose if serum levels are too high

A

gentamicin

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132
Q

4 signs of digoxin toxicity

A

confusion
nausea
visual haloes
arrhythmia

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133
Q

early sign of lithium toxicity

A

coarse tremor

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134
Q

intermediate sign of lithium toxicity

A

tiredness

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135
Q

late signs of lithium toxicity [5]

A

arrhythmias
comas
seizures
renal failure
diabetes insipidus

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136
Q

signs of phenytoin toxicity [5]

A

gum hypertrophy
ataxia
nystagmus
peripheral neuropathy
teratogenicity

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137
Q

signs of gentamicin and vancomycin toxicity [2]

A

ototoxicity and nephrotoxicity

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138
Q

3 things to do if there are signs of drug toxicity

A

1) stop the drug, give alternative if needed
2) supportive treatment e.g. fluids
3) give antidote is applicable

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139
Q

what two factors are used in calculating gentamicin dose

A

weight and renal function

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140
Q

which groups of conditions need altered gentamicin dosing [2]

A

renal failure and endocarditis

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141
Q

how do you determine if a patient needs 36 or 48 hour dosing of gentamicin instead of daily

A

serum levels fall above the 24 hour line on the normogram

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142
Q

normal INR target for those on warfarin

A

2.5

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143
Q

normal INR target for those on warfarin with recurrent VTE

A

3.5

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144
Q

treatment of someone with major bleed on warfarin

A

stop warfarin
give IV vitamin K 5-10mg
give prothrombin complex (Beriplex), if not available give FFP which is less effective

nb bleeding always needs IV vit K

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145
Q

if INR is between 5-8 and there is NO bleeding, what must be done with warfarin

A

omit warfarin for 2 days/Withhold 1 or 2 doses of warfarin
reduce subsequent maintenance dose

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146
Q

if INR is between 5-8 and there is bleeding, what must be done with warfarin

A

stop warfarin
give 1-5mg slow IV vit K
Restart warfarin when INR <5.0

147
Q

if INR is >8 and there is NO bleeding, what must be done with warfarin

A

omit warfarin
give 1-5mg PO vit K
(Repeat dose of phytomenadione if INR still too high after 24 hours)
Restart warfarin when INR <5.0

148
Q

if INR is >8 and there is bleeding, what must be done with warfarin

A

stop warfarin
give 1-5mg IV vit K
Repeat dose of phytomenadione if INR still too high after 24 hours)
Restart warfarin when INR <5.0

149
Q

how many milligrams in a gram

A

1000

150
Q

how many micrograms in a milligram

A

1000

151
Q

how many micrograms in a gram

A

1,000,000

152
Q

what is the relationship between dose volume and concentration

A

volume= dose/conc

conc= dose/vol

153
Q

relationship between rate, dose per time and conc

A

rate= dose per time/conc

154
Q

relationship between rate, dose and time

A

rate= dose/time

155
Q

what does % w/v mean

A

x grams in 100ml

156
Q

rhythm control: pharm cardioversion in those with NO structural heart diseasw

A

flecanide

157
Q

rhythm control: pharm cardioversion in those with structural heart diseasw

A

amiodarone

158
Q

CCB used in AF management

A

diltiazem

159
Q

4 contraindications of beta blocker

A

bradycardia
asthma
acute heart failure
hypotension

160
Q

3 contraindications of calcium channel blocker

A

hypotension
bradycardia
peripheral oedema

161
Q

what is the next step in treating angina if failure to treat with 2 anti-anginals

A

urgent revascularisaltion e.g. PCI or CABG

162
Q

4 steps of diabetes management

A

1) education: dietary and exercise advice
2) cardiovascular risk factor management- aspirin and statin
3) monitoring for complications: ACR
4) blood glucose lowering therapy

163
Q

examples of levodopa combined with peripheral decarboxylase inhibitors

A

co-beneldopa and co-careldopa

164
Q

male treatment for myoclonic seizure

A

valproate

165
Q

female treatment for myoclonic seizure

A

levetiracetam

166
Q

male treatment for tonic seizure

A

valproate

167
Q

female treatment for tonic seizure

A

lamotrigine

168
Q

male treatment for generalised TC seizure

A

valproate

169
Q

female treatment for generalised TC seizure

A

lamotrigine

170
Q

treatment for all other focal seizure

A

carbamazepine or lamotrigine

171
Q

treatment for absence seizures [2]

A

ethosuximide or valproate

172
Q

three licensed drugs for treatment of Alzheimers

A

donepezil
rivastigmine
galantamine

173
Q

which enzyme must be tested for before starting azathioprine

what should be done if this enzyme is absent

A

thiopurine S-methyl transferase (TPMT)

use methotrexate for maintenance of Crohn’s remission

174
Q

mild flare of Crohn’s treatment

A

prednisolone

175
Q

severe flare of Crohn’s treatment

A

hydrocortisone

176
Q

maintenance of remission in Crohn’s

A

azathioprine or 6-mercaptopurine

177
Q

side effects of lamotrigine [2]

A

rash
SJS

178
Q

side effects of carbamazepine [5]

A

rash
dysarthria
ataxia
nystagmus
hyponatraemia (secondary to SIADH)

179
Q

side effects of phenytoin [4]

A

ataxia
peripheral neuropathy
gum hyperplasia
hepatotoxicity

180
Q

side effects of sodium valproate [3]

A

tremor
teratogenicity
weight gain

181
Q

side effects of levetiracetam [3]

A

fatigue
mood disorders
agitation

182
Q

contraindication to bulking agents like isphagula husk

A

faecal impaction

183
Q

contraindications to phosphate enema [2]

A

acute abdomen and IBD

184
Q

example of osmotic laxatives [2]

A

phosphate enema
lactulose

185
Q

example of stimulant laxatives [2]

A

Senna and bisacodyl

186
Q

what is the treatment for rheumatoid arthritis if there is failure to respond to 2 DMARDS

A

TNF alpha inhibitors like infliximab

187
Q

when should a laxative never be given

A

in obstruction

188
Q

what is the most first line hypnotic to give for insomnia when all other methods are exhausted

A

zopiclone 7.5mg oral at night in adults
3.75mg in the elderly

189
Q

interaction between tamoxifen and warfarin

A

tamoxifen increases warfarin’s anticoagulant effect

190
Q

effet of calcium salts on bisphosphonates

A

reduces absorption

191
Q

combined HRT or oestrogen only HRT: which has the higher risk of breast cancer

A

combined

192
Q

do vaginal preparation of HRT with low dose oestrogen increase the risk of breast cancer

A

no

193
Q

3 drugs that differ in formulation on salt factor

A

phenytoin
digoxin
sodium fusidate

information on dose equivalence and conversion section.

194
Q

when are ACEi best taken and why?

A

in the evening as they can cause postural hypotension

195
Q

what two drugs can be used in rate control of AF

A

Beta blocker or CCB e.g. diltiazem or verapamil

196
Q

first line drug to decrease potassium in the body

A

short acting insulin with dextrose

10 units act rapid in 100ml of 20% dextrose over 30 minutes IV

197
Q

second line drug to decrease potassium in the body

A

salbutamol

2.5-5mg nebs stat

198
Q

side effect of levetiracetam

A

depression

ideally don’t give in depressed women

199
Q

contraindications of metformin [4]

A

1) chronic kidney disease: NICE recommend that the dose should be reviewed if the creatinine is > 130 µmol/l (or eGFR < 45 ml/min) and stopped if the creatinine is > 150 µmol/l (or eGFR < 30 ml/min)

2) metformin may cause lactic acidosis if taken during a period where there is tissue hypoxia. Examples include a recent myocardial infarction, sepsis, acute kidney injury and severe dehydration

3) Iodine-containing x-ray contrast media: examples include peripheral arterial angiography, coronary angiography, intravenous pyelography (IVP); there is an increasing risk of provoking renal impairment due to contrast nephropathy; metformin should be discontinued on the day of the procedure and for 48 hours thereafter

4) alcohol abuse is a relative contraindication

200
Q

first line anti diabetic drug in overweight people

A

metformin

supresses appetite

201
Q

what creatinine level contraindicates the use of metformin

A

> 150

202
Q

what needs to be checked before starting vancomycin

A

renal function

renally cleared drug

203
Q

what should be measured before starting statins

A

hepatic function

cleared by liver

204
Q

when should CK be checked when starting someone on a statin

A

if they have risk factors for developing myopathy

205
Q

what blood test should be done before starting lithium

A

FBC

206
Q

how does sodium affect lithium in management of mania

A

sodium depletion increases risk of lithium toxicity

207
Q

FBC monitoring in MTX

A

monitor FBC at baseline and every 1-2 weeks until levels are stable, then monitor every 2-3 months

208
Q

when is CXR done during MTX therapy

A

not at baseline

only when pulmonary toxicity is suspected

209
Q

how is MTX excreted

A

predominantly renally

210
Q

what should be measured before starting olanzapine [2]

A

fasting blood glucose

ECG if there is previous CVD or risk factors

211
Q

what imaging is done at baseline before starting amiodarone

A

chest X-ray

212
Q

patients with which electrolyte abnormality must be started with amiodarone with caution

A

hypokalaemia

213
Q

how is gentamicin cleared

A

predominantly renally

214
Q

what should be measured regularly with ACEi

A

U&Es

215
Q

when should plasma digoxin levels be measured

A

if toxicity is suspected

216
Q

what should be monitored during digoxin therapy

A

renal function as it is predominantly renally cleared

217
Q

drugs with a narrow therapeutic window

A

warfarin
phenytoin
digoxin
theophylline

218
Q

which drug causes a hypertensive crisis

A

MAO-I

219
Q

what should be avoided whilst taking metronidazole

A

alcohol –> causes fulminant N&V

220
Q

what co-prescription can worsening renal failure with NSAIDs

A

ACEi

221
Q

what type of drug is amiloride

A

K+ sparing diuretic

222
Q

how much potassium in KCl 0.3% 1L

over how long

A

40mmol

over 4 hours

223
Q

how much potassium in KCl in 0.15% 1L

over how long

A

20mmol

2 hours

224
Q

overhow long should a litre of saline be given if there are no losses/deficits

A

over 8 -12 hours

225
Q

emergency resuscitation in children: fluid bolus given

A

saline 0.9% 10ml/kg over 15 minutes

226
Q

what fluid is given in emergency hypoglycaemia

how much over how long

A

IV 20% glucose 100ml over 15 minutes

227
Q

what fluid is given in emergency hypercalcaemia

how much over how long

A

IV sodium chloride 0.9% 1000ml over 4 hours

228
Q

what fluid is given in emergency hypokalaemia

A

IV sodium chloride 0.9% with 0.3% KCL over 4 hours

229
Q

what fluid is given in maintenance with losses/deficits?

A

replace minimum 30ml/kg/24 hours with required electrolytes over 4-6 hours

230
Q

thromboprophylaxis in renally impaired

A

UFH

231
Q

standard thromboprophylaxis

A

LMWH e.g. enoxaparin, tinzaparin

232
Q

monitoring of UFH

A

aPTT

233
Q

monitoring of LMWH

A

anti factor Xa

234
Q

treatment for hypocalcaemia

A

calcium gluconate 10% IM

235
Q

signs of hypocalcaemia

A

CATS go numb:
C- Convulsions
A- Arrhythmia
T- Tetany
S- signs: trousseau and chvostek

236
Q

where do you find treatment for situations in primary care

A

medical emergencies in the community

237
Q

treatment of migraine with no aura

A

ibuprofen

238
Q

treatment of migraine with aura

A

triptan

239
Q

localised neuropathic pain but can’t take tablets PO

A

lidocaine patch

240
Q

treatment of trigeminal neuralgia

A

carbamazepine

241
Q

anti-emetic: vestibular cause

A

cyclizine

242
Q

anti-emetic: post-op

A

ondansetron

243
Q

anti-emetic: palliative

A

cyclzine
haloperidol
levopromazine

244
Q

anti-emetic: chemo (acute and delayed)

A

acute- ondansetron
delayed- metoclopramide

245
Q

anti-emetic: Parkinson’s

A

domperidone

246
Q

anti-emetic: hyperemesis gravidarum

A

promethazine

247
Q

what BP is a UKMEC 4 for microgynon

A

above 160/100

248
Q

drug for Bell’s Palsy

A

HIGH DOSE prednisolone (50-60mg OD)

249
Q

how often should children with T1DM monitor their BMs

A

at least 5 times a day

250
Q

when should dual therapy for diabetes start

A

when HbA1c hits above 58

251
Q

ADVICE 1

A

when checking monitoring requirements, check for what use of the medication that monitoring requirement is for

252
Q

TFT abnormalities whilst on levothyroxine med changes

A

usually not needed if there is poor compliance, which includes over taking and under taking

253
Q

what three things should you check when checking for serious prescribing errors?

A

dose
frequency/timing
route

254
Q

what drugs can be continued during intercurrent illness

A

steroids

255
Q

what drugs must be stopped during intercurrent illness [3]

A

metformin
statins
gliflozins

256
Q

which drugs can worsen Parkinsons [3]

A

antipsychotics
antiemetics like metoclopramide
antidepressants esp MAO-I

257
Q

which drugs may worsen Myasthenia gravis [4]

A

antibiotics
beta blockers
local anaesthetic
sedating drugs

258
Q

drugs that are usually in micrograms [6]

A

levothyroxine
digoxin
tiotropium,other inhalers
tamsulosin
naloxone
fludrocortisone

259
Q

drugs usually given in the daytime

A

steroids

260
Q

drugs usually given at night [2]

A

statin
sedating drugs

261
Q

which type of insulin is given with meals

A

rapid acting Bolus – e.g. Actrapid or soluble / short-acting insulin

262
Q

how can you check if the insulin type is long acting or rapid

A

scroll to the bottom of BNF

263
Q

which drugs can cause oral thrush [3]

A

steroids
antibiotics
immunosuppressants

treated with nystatin

264
Q

drugs that cause euglycaemic diabetic ketoacidosis

A

glifozins

therefore hold during illness

265
Q

drugs that can increase risk of hypomagnesaemia [3 main ones]

A

Thiazide / thiazide-like diuretics
Loop diuretics
Proton pump inhibitors

Exchange resins (e.g. calcium resonium)
Ciclosporin
IV bisphosphonates (e.g. during treatment of hypercalcaemia)
IV Antifungals
IV Aminoglycosides

266
Q

ADVICE 2

A

if you want to see if a drug should be stopped in CKD, AKI, poor creatinine etc. check renal impairment section

meds may require dose adjustments / cessation with existing reduced renal function
E.g. canagliflozin, metformin, spironolactone
May cause a reduction in renal function
E.g. ACE inhibitors/ARBs, diuretics

267
Q

which drugs can cause acute dystonic reactions [4]

A

Antipsychotic drugs (especially haloperidol)
Metoclopramide
Domperidone
Cyclizine

268
Q

drugs that cause hypokalaemia [5]

A

Diuretics
IV Antifungals (esp. amphotericin)
Cisplatin
Glucocorticoids / mineralocorticoids (typically only if excess)
Beta2-agonists

(Rarely) aminoglycosides such as gentamicin and amikacin

269
Q

how often is a fentanyl patch replaced

A

every 72 hours

270
Q

drugs that can elevate blood pressure [4]

A
  • NSAIDs
  • Glucocorticoids & Mineralocorticoids (but usually as treatment for hypotension/insufficiency)
  • Venlafaxine / tricyclic antidepressants
  • Combined oral contraceptives

Mirabegron
Clozapine
Monoamine oxidase inhibtiors
Selegiline
Cyclosporine / tacrolimus / rapamycin

271
Q

drugs that can cause hypoglycaemia [2 main ones]

A

Insulin
Sulfonylureas

Other anti-diabetic drugs still have the risk, but lower
GLP-1 activators (e.g. exenetide)
SGLT2 inhibitors (e.g. canagiflozin)
DPP4 inhibitors (e.g. sitaglitpin)
Pioglitazone

272
Q

drugs that increase risk of falls [6]

A

Benzodiazepines
Z-drugs
Antidepressants (especially TCAs and SNRIs, less so SSRIs)
Most antipsychotics
Opiates
Most anti-hypertensives (especially alpha-blockers, diuretics, centrally acting)

Some anti-Parkinson’s medications (e.g. selegiline, ropinirole)
(Less commonly) some anti-epileptics (excess dosing / levels)
In theory, those that cause hypoglycaemia

273
Q

drugs that are given weekly [2]

A

methotrexate
bisphosphonates sometimes

274
Q

ADVICE 3

A

if there is a specific brand of that drug, dosage may vary

275
Q

how can you check if heart failure treatment is working

A

exercise tolerance

276
Q

ADVICE 4

A

it is better to alter an existing insulin regime than to add to it

277
Q

ADVICE 5

A

if a method of contraception affects the efficacy of another drug or vice versa, use an alternative method of contraception

278
Q

How do I know if a drug / product needs a prescription or not?

A

BNF  Drug of interest, e.g., ibuprofen  Navigate to Section box: “Medicinal forms”
Many brands & strengths - But for each product listed, the “Legal category” line gives prescription status information

279
Q

ADVICE 6

A

A lot of questions have answers where more than one, or all, options are “true”, You have to select “most important”

Ask yourself: “What happens if the patient does not know this?”

Self-reporting / clinician-monitoring of severe side effects (check safety info)
Sick day rules / peri-operative prescribing
Potential teratogenicity
Missed doses / interactions (i.e. things that make treatment less effective)
Risk of adverse effects if stopping medication suddenly?

280
Q

important info about clozapine

A

Self-reporting
He should report symptoms of infection, especially influenza-like illnesses
He should report new onset (or worsening) constipation – may herald intestinal obstruction

Medications use
He should not stop the medication abruptly

281
Q

what needs to be monitored with clozapine

A

Cholesterol and fasting blood glucose levels
FBC
Prolactin levels
At increased risk of cardiac disease and QTc prolongation

282
Q

important side effects of anti psychotics

A

Blood dyscrasias / agranulocytosis
QT prolongation, arrythmias
Worsening diabetes
Worsening Parkinson’s disease
Neuroleptic malignant syndrome

283
Q

important info about doxycycline

A

avoid exposure to sunlight due to severe photosensitivity reaction

visual side effects are also severe but rare

284
Q

list drugs that cause photosensitivity [5]

A

Isotretinoin
Doxycycline (and other tetracyclines)
Amiodarone
Thiazide diuretics
Topical NSAIDs – on light-exposed skin

285
Q

where can I find drug safety advice

A

cautions
medicincal forms
patient and carer advice

286
Q

Important info regarding insulin

A

stop taking metformin if she develops diarrhoea or vomiting:
To prevent side effects (such as lactic acidosis) when dehydrated.

287
Q

medications to stop on sick days

A

Metformin (not insulin!)
ACEi / ARBs / diuretics
NSAIDs

288
Q

important information for steroids

A

Do not stop steroids abruptly (discuss: fine-tune this advice)
Usually taken in morning (reduce nocturnal side effects)
Take with or just after food
Should carry steroid card

289
Q

ADVICE 7

A

use treatment cessation for advice on how to stop a drug

290
Q

important information about azathioprine

A

Should be warned to report immediately any signs or symptoms of bone marrow suppression e.g. inexplicable bruising or bleeding, infection

There is a risk of hypersensitivity reactions, which calls for immediate withdrawal

291
Q

important information about methotrexate

A

Weekly dosing
Requires folic acid also weekly on a separate day to methotrexate
Should be warned to report immediately any signs or symptoms of bone marrow suppression e.g. bruising or bleeding, infection
Should be warned to report if stomatitis develops (may be first sign of gastro-intestinal toxicity)
Should be warned to report to seek medical attention if dyspnoea, cough or fever (pneumonitis)
Contraception recommended for both women and men for at least 3 months after treatment
Patients should avoid self-medication with over-the-counter aspirin or ibuprofen / NSAIDs – renal toxicity from both; NSAID renal impairment  reduced mtx excretion (mainly excreted unchanged, renally)

292
Q

what can unexpected bruising be a sign off

A

bone marrow toxicity

293
Q

important information about sodium valproate

A

Highly teratogenic - contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met

Advice on how to recognise signs of liver dysfunction or pancreatitis (e.g. persistent vomiting and abdominal pain, anorexia, jaundice) and advised to seek immediate medical attention

294
Q

important information about carbamazepine

A

Advice on how to recognise signs of blood, liver, or skin disorders (e.g. fever, rash, mouth ulcers, bruising, or bleeding) - seek immediate medical attention; CYP enzyme inducer; Teratogenicity reported – specialist referral; Skin: SJ/TEN risk - HLA B*1502 testing before commencing

295
Q

important information about phenytoin

A

Narrow therapeutic index – neurologic toxicity - nystagmus, ataxia, tremor; CYP enzyme inducer – initial dose needs increase to maintain therapeutic level; Teratogenicity reported – specialist referral; Skin toxicity SJS/ TEN

295
Q

important information about lamotrigine

A

Advice to see doctor immediately if rash or symptoms of hypersensitivity (risk of Stevens-Johnson syndrome SJS / toxic epidermal necrolysis TEN); Advice on recognising signs of bone marrow suppression - anaemia, bruising, or infection.

296
Q

important information about anti epileptics in general

A

Often require LFT ± FBC monitoring; Slow up-titration (carbamazepine, phenytoin induce own metabolising CYP enzymes; monitor levels until steady state dose reached); Don’t abruptly withdraw medications; Where appropriate, discuss teratogenic risk of non- valproate agents v epilepsy risks to foetus – specialist neurology;

297
Q

how many nanograms in a microgram

A

1000

298
Q

ADVICE 8

A

check body surface area in children under BNFC

299
Q

what is the guidance around pre dose trough and post dose peaks and gentamicin administration

A

“If the pre-dose (‘trough’) concentration is high, the interval between doses must be increased i.e. made less frequent

If the post-dose (‘peak’) concentration is high, the dose must be decreased”

300
Q

where can I see what do for bleeding whilst on warfarin

A

Oral anticoagulants treatment summary and go to haemorrhage section

301
Q

VTE prophylaxis in the renally impaired

A

LMWH or UFH

302
Q

what Creatine Kinase increases can be tolerated in statins

A

between 1 to 5 times the upper limit of CK can be tolerated, continue the statin but monitor CK., stop if there are muscle symptoms or CK continues to rise

above that , statin needs to be stopped

303
Q

what LFT derangement warrants stopping statins

A

> 3 times the upper limit and recheck LFTs within 4–6weeks to ensure that values settle

304
Q

in terms of non HDL changes with statins, when must you consider an increase in dose

A

when reduction in non-HDL is <=40 %

if more than 40, continue the dose

305
Q

paediatrics dose of adrenaline in anaphylaxis

A

150-300 micrograms

depends on age

306
Q

what bloods may impact choice of DOAC

A

Creatinine and eGFR

307
Q

what duration do you put down for a repeat prescription

A

28/30 days

308
Q

important monitoring requirement for children taking inhaled steroids

A

height and weight

309
Q

what is used to monitor low molecular weight heparin

A

anti factor Xa activity

310
Q

what needs to be monitored with azathioprine for adverse effects

A

FBC

311
Q

what needs to be monitored with azathioprine for beneficial effects in the treatment of Crohns

A

stool frequency

312
Q

typical BMs target whilst on insulin

A

4-10

313
Q

what percentage adjustments are made with insulin dosages

A

10%

314
Q

which type of insulin is given at night

A

Basal – e.g. Lantus, Levemir or insulin glargine

315
Q

when are biphasic insulins dosed

A

Typically dosed at breakfast and evening meal

316
Q

what is used to monitor UFH

A

aPTT

317
Q

which anticoagulants are monitored clincially

A

DOACs and fondaparinux

318
Q

how often must ketones be measured during sick days

A

2-4 hourly

319
Q

which contraception can be continued preoperatively

A

POP

HRT and oestrogen containing contraceptives need to be stopped before major surgery

320
Q

ADVICE 9: checking Abx suitability, check their PMH

A

E.g. Quinolones with long QT, G6PD
E.g. Nitrofurantoin with G6PD, folate deficient (or predisposition)
E.g. Trimethoprim with folate deficiency (or predisposition)
Also, for female, childbearing age, check ask/check re pregnant / breastfeeding

321
Q

where do you find the paracetamol nomogram

A

poisoning treatment

322
Q

when is folate given relative to MTX

A

never on the same day
MTX Mondays Folate Fridays

323
Q

two emergency contraceptive pills

A

levonorgestrel (<72h) and ulipristal acetate (<120h)

324
Q

emergency contraception: extra info for levonorgestrel [4]

A

can be taken straight away if vomiting occurs within 3 hours
double dose if >70kg or BMI >26
double dose if taking an enzyme inducer
can start COCP straightaway

325
Q

emergency contraception: extra info for ulipristal actetate

A

contraindicated in asthma
can start COCP after 5 days

326
Q

COCP cancer risk

A

increases risk of cervical and breast cancer

decreases risk of ovarian and endometrial

327
Q

main side effect of cocp

A

increased risk of VTE

328
Q

main side effect of POP

A

irregular bleeding

329
Q

MoA of COCP

A

inhibits ovulation

330
Q

MoA of POP

A

thickens mucus

331
Q

what drug is cerazette

A

desogestrel

332
Q

what drug is microgynon

A

ethinylestradiol with levonorgestrel

333
Q

perioperative insulin

A

give insulin the day before surgery as normal except is once a day long acting, reduce the dose by 20%

334
Q

metformin and sulfonylureas on the day of surgery

A

continue metformin
hold sulfonylurea

335
Q

threshold for diabetes in pregnancy

A

5678

336
Q

ADVICE 10

A

“antibacterials, use for prophylaxis” for example pre pacemaker insertion

337
Q

examples of triple inhalers for COPD

A

beclometasone with formoterol and glycopyrronium
fluticasone with umeclidinium and vilanterol
mometasone furoate with glycopyrronium bromide and indacaterol

338
Q

ADVICE 11

A

if there is severe hyperkalaemia with no ECG changes, don’t prescribe calcium gluconate yet as there is no benefit if there is no cardiac membrane instability
give insulin (e.g., Actrapid) 10-20units in 50mL of 50% glucose IV over 5-15min would

339
Q

ADVICE 12

A

replacing potassium needs to be done at 10mmol/hr so even if they are hypotensive, no stat dose can’t be given

500ml 0.9% NaCl with 0.15% K+ (10mmol K+ in 500mL) over 1h; or 1L over 2h would be reasonable

not 15 min! and don’t use dextrose as glucose pushes K+ into cell

340
Q

ADVICE 13

A

Diabetes, surgery and medical illness to check for example fluids during surgery

Needs Na / K/ Glu fluid, 1L over 12h ok; 500ml over 6h ok

341
Q

treatment for headlice

A

malathion

342
Q

treatment for threadworm

A

mebendazole

343
Q

croup management

A

Dexamethasone
GP may give oral
in ED, IV maybe given depending on how severe

344
Q

ADVICE 14

A

HRT advice found under “sex hormones”

for someone who doesnt want withdrawal bleeds continuous oestrogen and progestogen is indicated e.g. patch Evorel Conti

345
Q

treatment of scarlet fever

A

phenoxymethylpenicillin

346
Q

if antibiotics and warfarin are interacting, what is changed?

A

warfarin

347
Q

advice regarding methotrexate and conception

A

use effective contraception whilst on MTX and for at least 6 months after stopping

348
Q

treatment of Group B strep in pregnancy

A

benzylpenicillin

Group B is agalactiae

349
Q

loading dose vs prophylaxis in MI

A

300mg v 75mg

one is before PCI

350
Q

fluid deficit formula

A

% dehydration x weight (kg) x 10

351
Q

VTE prophylaxis in a needle phobic pt

A

oral rivaroxaban, apixaban, dabigatran
NOT edoxaban

352
Q

standard VTE thromboprophylaxis

A

LMWH

dalteparin, tinzaparin, enoxaparin

353
Q

what is used for anticoagulation in pregnancy

A

LWMH

DOACS and warfarin are contraindicated

Long-term treatment with heparins in pregnancy require monitoring :
anti-Factor Xa activity (for dosing)
platelets (for heparin-induced thrombocytopenia)

354
Q

fluid to give in someone hypokalaemic (maintenance)

A

1L NaCL 0.9% + 0.3% KCL over 4 hours

355
Q

fluid to give in severe hypercalcaemia

A

1L NaCL 0.9% over 4 hours

356
Q

at what GFR should metformin be stopped and why

A

<30

risk of lactic acidosis

357
Q

treatment of chronic heart failure

A

BASH:
Beta blocker
ACEi
Spirinolactone
Hydralazine + nitrate

358
Q

when should IV insulin be stopped

A

30 minutes after SC infusion

359
Q

drugs that alter the absorption of other drugs

A

antacids, PPIs and H2RAs

360
Q

how long should metoclopramide be prescribed for

A

5 days (short term)

361
Q

contraindications of pioglitazone

A

heart failure
bladder cancer
macroscopic haematuria

362
Q

two anti diabetic drugs that cause weight gain

A

sulfonylureas and GLP-1

363
Q

what does cabergoline need monitoring for

A

fibrotic disease eg. the heart so needs echo

Year 6 (19 decks)

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