PSA Flashcards
what pain relief do you give for neuropathic pain?
- amitriptyline (10 mg oral nightly)
- pregabalin (75 mg oral 12 hourly);
- duloxetine (60 mg oral daily) is indicated in painful diabetic neuropathy.
what is the max dose of paracetamol for adults?
4 g (i.e. 8 tablets of 500 mg each)
patients <50kg the MAXIMUM dose of Paracetamol is 500mg 6-hourly
i.e. 2g a day
what class of drug causes hypokalaemia and hyperkalaemia?
Hypokalaemia : bendroflumethiazide and loop diuretics. Thiazide diuretic. Brand name is Neo-naclex.
Pneumonic : DIRE
Drugs (loop and thiazide)
Inadequate intake or intestinal loss
renal tubular acidosis
endocrine ( Cushing’s and Conns)
ACEinhibitor ( lisinopril) and aldosterone antagonists and potassium sparring diuretics (spironolactone) - causes hyperkalaemia
Pneumonic : DREAD
Drugs ( potassium sparing and ACE inhibitors)
Renal failure
Endocrine (Addisons)
artefact
DKA
which anti-emetic drug should you avoid in Parkinson’s?
metoclopramide - crosses BBB so avoid
domperidone is dopamine agonist also but does not cross BBB so safe to use in Parkinson’s
what is the max IV potassium per hour?
10mmol/hour
what are the side effects of steroids
STEROIDS: Stomach ulcers, Thin skin, oEdema, Right and left heart failure, Osteoporosis, Infection (including Candida), Diabetes (commonly causes hyperglycaemia and uncommonly progresses to diabetes), and Cushing’s Syndrome.
Side effects of anti-inflammatory drugs (NSAIDS)
NSAID: No urine (i.e. renal failure), Systolic dysfunction (i.e. heart failure), Asthma, Indigestion (any cause), and Dyscrasia (clotting abnormality).
what are the side effects of anti-muscarinic drugs?
- oxybutinin
- can cause confusion in the elderly
- antimuscarinic agents commonly cause pupillary dilation, with loss of accommodation, dry mouth, and tachycardia (after a transient bradycardia)
what are the caution for drugs in elderly?
- tramadol, cyclising and benzodiazepines
which drug is an absolute CI for pts taking methotrexate?
trimethoprim : it is a folate antagonist
what are the side effects of CCB like amlodipine?
- flushing, pulmonary oedema
what are the causes of hypernatreamia?
- dehydration
- drips ( too much IV saline)
- drugs
- diabetes insipidus
what are the causes of:
- high neutrophils ( neutrophilia)
- low neutrophils ( neutropenia)
- high lymphocytes ( lymphocytosis)
Neutrophilia:
- bacterial infection, tissue damage and steroids
Neutropenia:
- viral infection, chemotherapy or radiotherapy , clozapine (antipsychotic) and carbimazole (antithyroid)
Lymphocytosis:
- viral infection, lymphoma and CLL
causes of low and high platelets?
Low platelets ( thrombocytopenia):
Reduced production:
- infection
- drugs such as penicillamine ( in RA)
- myelodysplasia, myelofibrosis, myeloma
Increased destruction:
- heparin
-hypersplenism
-DIC
-ITP
-HUS
High platelets:
- bleeding, tissue damage, postsplenectomy
primary:
-myeloproliferative disorders
what are the causes of SIADH?
Pneumonic : SIADH
- small cell lung tumours
- Infection
-abscess - Drugs
- head injury
what are the synethetic function of the liver and mention the clotting factors
▶ albumin
▶ vitamin K-dependent clotting factors (II, VII, IX and X) measured via
prothrombin time (PT)/international normalized ratio (INR).
Causes of high alk phos?
ALKPHOS: Any fracture, Liver damage (posthepatic), K (for kancer), Paget’s disease of bone and Pregnancy, Hyperparathyroidism, Osteomalacia, and Surgery.
what to do with the following TSH levels:
TSH range (mIU/L)
<0.5
0.5–5
>5
TSH range (mIU/L) <0.5 –> Change to thyroxine
0.5–5 –> Decrease dose
>5 –> Nil action – same dose Increase dose
Examples of drugs with narrow therapeutic range?
- digoxin, theophylline, lithium, phenytoin, gentamicin
What are the drug toxicity SE of :
- digoxin
-lithium
-phenytoin
- gentamicin/vancomycin
Digoxin –> Confusion, nausea, visual halos, and arrhythmias
Lithium–>Early: tremor
Intermediate: tiredness
Late: arrhythmias, seizures, coma, renal failure, and diabetes insipidus
Phenytoin –> Gum hypertrophy, ataxia, nystagmus, peripheral neuropathy, and teratogenicity
Gentamicin –> Ototoxicity and nephrotoxicity
Vancomycin –> Ototoxicity and nephrotoxicity
what are the most important ways to interpret C-XRAY?
PRIM:
PA - can interpret heart size
AP - heart will APPEAR bigger
what are the signs of pulmonary oedema?
ABCDE signs of pulmonary oedema:
Alveolar oedema (bat wings)
Kerley B lines (interstitial oedema)
Cardiomegaly
Diversion of blood to upper lobes (where vessels in upper zone are larger than in lower zone), and
pleural Effusions.
what are the vitamin K dependant clotting factors?
2,7,9,10
what to give if a patient is on warfarin and bleeding?
If there is a major bleed (i.e. causing hypotension or bleeding into a confined space
(i.e. brain or eye)):
* stop warfarin
* give 5–10 mg IV vitamin K
* give prothrombin complex (e.g. Beriplex®).
what is the definition of neutropenic sepsis?
and tx?
neutropenia sepsis is neutrophils <1
treatment is : piperacillin with tazobactam and gentamicin
signs of lithium toxicity?
confusion and even seizures, one would expect tremor and diarrhoea too.
what is the risk associated with tamoxifen?
Tamoxifen increases the risk of venous thromboembolism, and a swollen leg could suggest a deep vein thrombosis ==> needs urgent medical attention
what type of drug is gliclazide?
sulphonylurea - risk of hypoglycaemia so avoid missing meals
How often should methotrexate be given?
It should ONLY BE given once a week. More regularly than that increases the risk of neutropenia.
what happens to blood glucose levels when you are unwell
when 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.
what is important about alendronic acid?
The tablet needs to be swallowed with a full glass of water and she should remain upright for 30min afterwards.
( to minimise gastric side effects)
What does 1% mean?
A 1% solution contains 1 g in 100 mL
When to stop aspirin
recent haemorrhagic stroke
when to stop lisinopril?
When there is AKI and hyperkalaemia
When to stop paracetomol?
Already taking co-codamol ( acceptable to withold co-codamol instead)
When to stop ibuprofen
in AKI (stop all NSAIDS)
what is the cheapest LMWH at present and therefore should use
Dalteparin
What is the first line therapy for chronic heart failure?
- ACEi + BB
When should you take ACEi?
In the evening due to the cause of postural hypotension
How to get rate control on AF?
Use rate-limiting CCB (diltiazem or verapamil>) or BB (CI in asthma
what drug to give to lower patients potassium rapidly?
10 units of actrapid in 50ml of 50% dextrose over 30 min IV.
what SE is important to bear in mind for carbamazepine?
can cause SIADH and therefore lower sodium levels.
When to avoid giving levetiracetam?
Someone with depression or very low mood.
Give an example of a biguanide and common SE, and when to use
Metformin
SE : GI upset, lactic acidosis (mainly in liver/renal failure)
Only PO allowed in pregnancy
Use: patient overweight
Give example of a sulfonylurea and its SE
Gliclazide
SE: Hypoglycaemia , weight gain and diarrhoea
CI : ketoacidosis , severe renal impairmenet ( creatinine of >150 mmol/L.
Use if patient normal/underweight
Give an example of a thiazolidinediones
Pioglitazone
SE: weight gain, bone fracture , fluid retention
CI: HF, bladder cancer , ketoacidosis and hepatic impairment
Example of SGLT-2 inhibitors
Dapagliflozin
SE: UTIs, hypoglycaemia, euglycaemic DKA, weight loss
CI: DKA, eGFR <15
Example of DPP4 inhibtior
Sitagliptin
SE: URTI, headache and pancreatitis.
CI: pancreatitis, adjust dose if low GFR.
Example of GLP-1 agonist
exenatide
SE: N+V, weight loss
CI: ketoacidosis.
Who is at most risk of getting statin induce myopathy?
- Personal History or FHx
- previous Hx of muscular toxicity
- high alcohol intake
- renal impairment
- Hypothyroidism
- in the elderly
What should you monitor before giving vancomycin?
Check serum creatinine.
classic SE are nephrotoxicity and ototoxicity.
What to check before giving statin?
Serum ALT
Cautious in pts with a history of liver disease, as they are metabolised by the liver.
so hepatic impairment will increase their levels and risk of myopathy.
CI: if ALT > 3 times the normal range or active liver disease
Check LFTS 3 months and 12 months after starting statin
