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Year 4/5 Revision > psa > Flashcards

psa Flashcards

1
Q

Donepezil (anticholinesterase inhb)

A

Bradycardia

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2
Q

Co-beneldopa (bensarazide hydrochloride and levodopa)

A

Hallucinations
Anxiety
(Rare- leucopenia)

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3
Q

Monitoring for Pramipexole

A

BP - risk of postural hypotension

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4
Q

Serious SE of Lamotrigine

A

Stevens Johnson syndrome - rash within 8 weeks of treatment

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5
Q

Risk factor drugs for SJS

A

Anti-epileptics - Carbamazepine
Allopurinol
Sulfonamides
Anti-fungals- Terbinafine

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6
Q

SE of PPIs

A
  • Low Mg
  • Low Na+
  • Osteoprosis, #risk
  • Microscopic colitis
  • C. diff infections (proliferation of C.diff spores due to reduced gastric acid production)
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7
Q
A
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8
Q

Digoxin toxicity
Can be precipitated by hypokalaemia (doesn’t compete with potassium for ATP-ase pump), but what other factors?
Why does this happen - related to MOA?
* Symptoms/ adverse effects
* Sign on ECG of digoxin induced changes (not necessarily toxicity)?
* Mx

A
  • Digoxin toxicity triggers: electrolyte imbalance, renal failure, age, drugs (amiodarone and ones causing hypokalaemia eg chlortalidone - thiazide like diuretic)
  • MOI: inhibitsNa+/K+ ATPase pump by competing with potassium so lower levels of potassium increase its effect
  • High potassium reduces its efficacy/risk of treatment failure
  • N&V, confusion, yellow-green vision (xanthopsia), drowsiness, diarrhoea
  • Arrythmias - Bradycardia, AV block
  • ECG: backwards tick - ST segment
  • Mx: Digiband, monitor K+, correct arrythmias
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9
Q

Most likely SSRI to cause QT prolongation and torsades de pointes

A

Citalopram

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10
Q

drugs prolonging QT interval (risk of torsades de pointes - polymorphic VT)

A
  • Methadone
  • Odansetron
  • Digoxin
  • Antipsychotics - Haloperidol/Risperidone
  • SSRIs - Fluoexeteine
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11
Q

Mirtazepine:
Class
MOA
Benefit over other antidepressants

A

NaSSA
Noradrenaline and specific serotinergic antidepressant
Increases levels of NA and serotonin in the brain
Helps with insomina, poor appetite, reduced sexual side effects (libido)

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12
Q

Ticagrelor SE

A

Dyspnoea
Dyspepsia
Dizziness
Diarrhoea
Gout

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13
Q

Monitoring:
IV Iron Dextran

A

Blood pressure

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14
Q

Monitoring:
Ethambutol

A

(eye-thambutol)
- Visual acuity

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15
Q

Monitoring for beneficial effects:
Furosemide

A

Weight
(overall loss of potassium with furosemide but not most accurate way to assess diuretic effect/volume loss)

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16
Q

Monitoring for beneficial effects:
Factor XA inhibitors (apixaban)

A

patient reports of bruising

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17
Q

Converting digoxin from IV to oral (via feeding tube)

A

Increase dose by 20-33% due to oral bioavailability

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18
Q

Monitoring requirements for bisphosphonates?
What has to be corrected before starting treatment?

A
  • serum calcium
  • calcium or vitamin d deficiency
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19
Q

treatment of PE: considerations for patients with cancer

A

Dalteparin sodium / Tinzaparin
CANCER - find in “Fragmin single dose syringe” –>
- “in patients with solid tumours”
- by weight categories

Also pregnant patients
note these extra considerations in the question stem!

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20
Q

Hypercalcaemia management

A

Aggressive fluid therapy
if hypotensive - fluid challenge
if not hypotensive:
4-6litres of 0.9 % NaCl over 24 hour period
E.g. 500ml over 2 hours

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21
Q

CYP450 Enzymes
Typical substrates

A

Warfarin
OCP
Statins
SSRI
Amitryptiline, codeine

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22
Q

CYP 450
Inhibitors (risk of toxicity) - SICK FACES

A

Sulfonamides
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alchohol, Amiodarone
Cipro
Erythro
Sodium valproate

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23
Q

CYP 450
Inducers (risk of treatment failure) - CRAP GPS drink grapefruit juice

A

Carbamazepine
Rifampicin
Alcohol (chronic)
Phenytoin
Griseofulvin
Phenobarbitol
St John’s wort, steroids

+ grapefruit juice!

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24
Q

Hydroxychloroquine (DMARD)
main AE

A

(bulls eye) retinopathy
risk of blindness
measure visual acuity/annual screening/need opthal review before

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25
Q

interaction between Azathioprine and what cause bone marrow suppression/agranulocytosis?

A

Allopurinol
Xanthine oxidase inhibitor
Reduces breakdown of 6-mercatopurine (active form of axathioprine) -. builds up in DNA of bone marrow cells

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26
Q

drugs causing hypercalcaemia (3)
common non-drug related causes (3)

A
  • Thiazide diuretics (increase renal absorption of Ca)
  • Lithium
  • calcium containing antacids
  • Primary hyperparathyroidism
  • Malignancy - mets, PTHrP from SCLC
  • granulomatous conditions - sarcoid

Other - dehydration, thyrotoxicosis etc

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27
Q

Drugs causing hypocalcaemia

A
  • PPIs
  • Phenytoin
  • Bisphosphonates (prevent osteoclastic activity)
  • Rifampicin
  • Chemo
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28
Q

PALLIATIVE
- Regimens for starting pain treatment in palliative care
- Dose if no comorbidities
- What should be coprescribed?
- Morphine causes which transient side effects (2) and what persistent?
- By what percentage can opioids be increased by?
- Treatments for metastatic bone pain (3)?
- Treatments for nausea and vomiting?

A
  • MR or IR Morphine + IR Breakthrough dose
  • 20-30mg MR/day + 5mg PRN (2-4hrly)
    • stimulant laxatives (senna or bisacodyl)
  • transient - nausea and drowsiness, persistent - laxative
  • Can increase opioids for next dose by 30-50%
  • NSAIDs, Bisphosphonates, radiotherapy (+/- denosumab)
  • Haloperidol, Cyclizine, Levomepromazine
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29
Q

SIGN Guidelines
* Breakthrough dose
* Choice of opiate in CKD (mild-moderate; severe)

A
  • 1/6 of total daily dose of morphine
  • Oxycodone (mild-mod renal impairment)
  • Alfentanil/Fentanyl/Beprenorphine (severe)
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30
Q

PALLIATIVE
Opioid conversions
1. Between opioids
* Oral codeine –> oral morphine
* Oral tramadol –> oral morphine
* Oral moprhine –> oral oxycodone
2. From oral to subcut
* Oral morphine –> SC morphine
* Oral morphine –> SC diamorphine
* Oral oxycodone –> SC Diamorphine

  1. From oral to transdermal
    BNF gives conversion factors but approx:
    * 30mg oral morphine =? fentanyl (eg change every 7days)
    * And 24mg oral morphine = ?buprenoprhine (OD, eg change every 3 days)
A
  • Oral codeine/tramadol –> morphine: /10
  • Oral morphine –> oral oxycodone: 1.5/2
  • 30mg oral morphine = 12mcg fentanyl.
  • And 24mg oral morphine = 10mcg buprenorphine
  • Oral morphine –> SC morphine = /2
  • Oral morphine –> SC diamorphine = /3
  • Oral oxycodone –> SC Diamorphine /1.5
  • 30mg oral morphine =12mcg fentanyl (eg change every 7days)
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31
Q

Syringe drivers:
Medications are mixed with what for injection (2 options)?
4 common symptoms:
1. Nausea and vomiting
2. Pain
3. Resp secretions and bowel colic
4. Agitation/restlessness

Which drug are there lots of incompatabilities for - e.g. to metoclopramide, sodium chloride 0.9%, hyoscine butylbromide?

A

Indications
- unsafe swallow
- intestinal obstruction
- dysphagia
- nausea
- weakness, coma
Infusion
- Water (majority)
- 0.9% NaCL e.g. for octreotide/odansetron

Commonly used drugs
1. Nausea and vomitng: Cyclizine, Levomepromazine, Haloperidol, Metoclopramide
2. Secretions: Hyoscine butylbromide, hyoscine hydrobromide, glycopyrronium bromide
3. Agitation: Midazolam, Haloperidol, Levomepromazine
4. PAin: diamorphine

NOTE - CYCLIZINE

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32
Q

Non-pharmacological approach for palliative care
- Pain
- N&V
- Low mood/distress

A
  • TENS machine, physio, CBT
  • regular mouth care, acupressure bands, meal alteration
  • Complementary therapies, CBT, talking therapy
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33
Q

Advantage of using hyoscine butylbromide over hydrobromide for secretions?

A

Butyl- less sedative

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34
Q

Amlodipine/dihydropyridines CCBs side effects

A

Ankle swelling
Gum swelling (gingival hyperplasia)
Flushing
Headache

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35
Q

Diclofenac - contraindications

A

IHD, PVD, stroke, heart failure

36
Q

Drug monitoring once established on drug:
* Amiodarone - 6 monthly
* Methotrexate: every 3 months
* Azathioprine: every 3 months
* Lithium: every 6 monthg
* Sodium valproate: periodically in 6 months

A

Amiodarone - LFT, TFT (U&E and CXR prior to treatment)
Azathioprine - FBC, LFT
Methotrexate - FBC, LFT, U&E
Lithium - Lithium level, TFT, U7E
Valpriate - LFT

37
Q

Amiodarone (class3 antiarrythmic)
K+ channel inhibitor (and Na+ channel)
SIDE EFFECTS

A
  • Skin/eyes: slate/grey; photosensitivity, corenal deposits
  • Vessels: thrombophlebitis
  • Heart: prolongs QT, bradycardia
  • Fibrosis: lung, liver
    Lunf fibrosis can also cause fever and raised ESR
  • Thyroid dysfunction - hypo/hyper (amiodarone)
  • Neuro: peripheral neuropathy, myopathy

note amiodaraone typically does NOT cause finger clubbing unlike other causes of pulmonary fibrosis

38
Q

Neonaclex

A

Bendoflumethazide

39
Q

Interractions:
Indapamide (diuretic) and colecalciferol (vitamin d)
risk of

A

hypercalcaemia

40
Q

Metclopramide - dopamine antagonist
- rare adverse effect and treatment

A
  • acute dystonias (EPS)
  • seen in first 1-2 days of treatment
  • Procyclidine (antimuscarinic)
41
Q

Phenothiazine - side effect

A

dry mouth
–>primary polydipsia

42
Q

Drug worsening ischemia in peripheral vascular disease

A

Beta blockers - beta adrenergic antagonist - cause peripheral vasoconstriction
e,g, atenolol

43
Q

Drugs contributing to heart failure

A

corticosteroid - prednisolone
calcium channel blocker

44
Q

Insulin
improving glycaemic control in the afternoon
e.g. on biphasic insulin

A

increase morning dose
(if you increased the evening dose it could cause hypoglycaemia in early morning)

45
Q

interactions with simvastatins - higher risk of myopathy and rhabdomyolysis

A

gemfibrozil - a fibrate for hyper choleserolaemia (increases statin concentration); inhibits CYPP2C8
clarithromycin

46
Q

if statin supsected to be cause of myopathy, CK elevated (5x upper limit of normal) or muscular symptoms are severe …

A

discontinue treatment and reintroduce statin at a lower dose if CK levels return to normal (e.g. from 80mg atorvastatin to 40mg PO nightly)
then - switch to other statij with lower risk of myalgia
Simvastatin ->Atorvastatin –> Prav –> Fluva; or a fibrate

47
Q

Drugs causing hyponatreamia

A

Thiazide diuretics
SSRIs
SNRIs
anti-epileptics

48
Q

Dopamine antagonists
Which is safe in Parkinson’s disease?

A

Haloperidol
Metoclopramide
Domperidone - safe in PD as doesn’t cross blood brain barrier

49
Q

Hyperkalaemia
Typical drugs

A
  • K+ sparing diuretics (Spironalactone, Eplerenone)
  • ACE Inhb/ARB (inhibit aldosterone –> less potassium excretion_)
  • Ciclosporin
50
Q

What increases risk of digoxin toxicity?

A

Hypokalaemia
and hypercalcaemia
- because digoxin competes with potassium at the Na+/K+ATPase (removal of potassium increases effect of digoxin on receptor)

51
Q

Aspirin ADRS

A

Haemorrhage
Peptic ulcers
Gastritis
Tinnitus (large doses)

52
Q

Amiodarone ADRs

A

Grey skin
Corneal deposits
Pulmonary fibrosis
Hypo/hyperthyroid

53
Q

Lithium ADRs

A

Early - tremor
Intemediate - fatigue
Late - arrythmias, coma, renal failure, diabetes insipidus

54
Q

Haloperidol
Clozapine

A

EPSE: dyskinesias (acute dystonias, oculogyric crisis)
Agranulocytosis

55
Q

Corticosteroids (Dexamethasone and Prednisolone) ADRs - STEROIDS

A

S: Stomach ulcers
T: Thin skin
E: Edema
R: R/L heart failure
O: Osteoporosis
I : Infection more likely eg candia
D: Diabetes/hyperglycaemia is commonn bt uncommon toprogress ton DM
S: Syndrome (Cushing’s)

56
Q

Fludrocortisone

A

Sodium and water retention (acts like aldosterone)
Hypertension

57
Q

STATIN adrs

A
  • Myalgia
  • Abdominal pain
  • Increased ALT/AST (mild)
  • Rhabdo (midly increased CK throughout or severe)
58
Q

Trimethoprim
(e.g. cotrimoxazole contains trimethoprim)

A

Neutropenia
e.g. two antifolates (trimethoprim and methotrexate) ccan cause bone marrow suppression, pancytopenia and neutropenic sepsis

59
Q

SURGERY RULES
STOP (4)
Diabetics -convert insulin regimens to what?
keep what drugs?
What might need to be supplemented?

A
  1. Hormonal treatments (OCP)
  2. Anticoagulants (heparin, DOAC)
  3. Antiplatelets (aspirin, ticagrelor)
  4. Metformin - stop day before
  5. Lithium - day before

DM - insulin infusion variable rate
Keep
antihypertensives - particularly beta blockers and calcium channel blockers, if BP lower consider stopping a diuretic instead

supplement iv steroids

60
Q

can aspirin be continued in aki

A

yes
is an nsaid but not c/id

61
Q

Lithium toxicity - if dose has not changed, what drugs could be increasing plasma levels?
Management for mild-moderate
and severe

A

Drugs that reduce renal excretion:
ACE-Inhibitors
Diuretics - thiazides
Nsaids
e.g. stop lithium and the offending drugs causing the toxicity
Mx
Mild/moderate; volume resus with normal saline
Severe: haemodialysis

62
Q

Fluid balance charts

A
  • fluid inputs should equal fluid outputs
  • if hypernatremic 5% glucose solution is a better choice
  • potassium can be corrected with KCl (40mmol/day) and can never exceed 20mmol/hour
  • eg if fluid negative - work out at what rate the patient is losing fluids and prescribe fluids at a rate that matches this
  • eg loss of 6 litres / 24 hours = 1 litre every 4 hours so replace with fluids over 4 hours
63
Q

maintenance fluids
adults req
ederly req
assuming the blood results are normal the maintenance fluids should include (3) in 24hrs

A

generally = 3 L per day (in 8hrly bags)
elderly = 2L (12hrly bags)
regime
2 salty, 1 sweet
2L 0.9% NaCl
1L 5% glucose

64
Q

1st line antidiabetic in ckd

A

gliclazide

65
Q

who requires an ecg for olanzapine

A

if cardiovascular risk factors
eg long term smoker

66
Q

steroid conversion charts

A

search “glucocorticoid therapy”
remember doubek dose during infection/sepsis

67
Q

Laxatives - when to use/avoid
Bulk-forming (isphagula husk)
Stimulant (senna, bisacodyl)
Stimulant and faecal softener (docusate sodium)
Faecal softeners (arachis oil enemea, docusate sodium enema)
Osmotic laxative (lactulose, macrogol 3350)

A
  • bulk forming: short term constipation; avoid in obstruction, colitis and cframps, takes 72 hours to have affect, avoid in opioid-induced consipation
  • stimulant: stools soft but difficult to pass, second line for short-duration constipation
  • faecal softener: can be used in constipation in palliative care
  • osmotic laxative: causes bloating, first line hepatic encephalopathy, use in constipation in palliative care
68
Q

marker of improvement:
aminophylline
antibiotic treatment for pneumonia

A

o2 sats
RR, ABG, O2 sats

69
Q

pre-dose (trough) concentrations for vancomycin

A

1-15mg/l

70
Q

Cause of dyspepsia

A

Steroids- prednisolone
Alendronic acid -
Ibuprofen

71
Q

Cause of peripheral oedema (ankle swelling)

A

Amlodipine / CCBs
Naproxen

72
Q

management for haloperidol-associated parkinsonism (Drug induced epse)

A

procyclidine hydrochloride (anticholinergic)

73
Q

Constipation - treatment options
Bulking agents (isphagula husk)
Stimulant (senna, bisacodyl)
Osmotics (lactulose, phosphate enema, polytethylene glycol “Movicol”)
Stool softener (docusate sodium - also a stimulant at higher doses; arachis oil)

A
  • Bulking agents- contraindicated in fecal impaction/reduced gut motility; can take 72 hours to take effect
  • Stimulants: CId in acute abdomen, may make abdominal cramps worse
  • Osmotics: CId in IBD (enema), may cause bloating
  • Stool softener: good for faecal impaction/ reduced gut motility
74
Q

Constipation first line for children
(no fecal impaction)

A

Osmotic laxatives:
Search “Movicol -
polyethylene glycol 3350 plus electrolytes
1 sachet oral once daily 28 days
or Lactulose - liquid firm
second line is senna

75
Q

Asthma adults

A
  1. Salbutamol
  2. Fluticasone
  3. Montelukast
76
Q

AKI - drugs to stop

A

DAMN - PCL
also codeine (reduced excretion in AKI so more likely to have AEs)

77
Q

Risks of ACE/I/ARBs in Afro-Carribean

A

higher risk angioedema
can happen in CCBs - but less common

78
Q

Drugs causing urinary retention

A

Opiods
TCA - Imipramine
anticholinergics
general anaesthetics
alpha agonists
diazepam
nsaids
ccbs
antihistamines
alcohol

79
Q

drugs causing weight gain

A

antidiabeitcs - pioglitazones, gliclazides
mirtazepine
depot provera injection

80
Q

drugs causing cold peripheries

A

beta blockers
methylphenidate

81
Q

diabetes treatment targets
- diet and lifestyle alone / metformin or one antidiabetic alone
- on a drug associated with hypoglycaemia

if blood sugars aren’t controlled on one and rise to above 58 –> drug treatment should be intesified or add a second
- on two antidiabetics

A

Hba1c <48mmol
<53 mmol
<53 mmol

82
Q

Drugs to stop before surgery

A

ILACKOP
Insulin - INSTEAD variable rate insulin with long acting, omit short acting
Lithiuim
Anticoagulatns/antiplatelets (except aspirin, generally)
COCP/HRT
K+ sparing diuretics
Oral hypoglycaemics - EG nbm
Perindopril/ACE-Inhbs

83
Q

Fluids
Adults
Elderly
Electrolytes - sweet/salty
Potassium

A

Adults: 3L per day (3 x 8hrly bags)
Elderly: 2l (2 x12 hr bags)
Electrolytes: 1 salty, 2 sweet
K+ = 1mmol/kg/day

84
Q

Anti-emetics
- general
-nausea but cardiac failure/risk of cardiac failure

A

Cyclizine 50mg 8hrly
Metoclopramide 10mg 8hrly - avoid in parkison’s disease and young women due to dyskenesia risk
Post-op vomiting - Odansetron

85
Q

never prescribe beta blockers with verapamil due to

A

life threatening bradycardias

Year 4/5 Revision (21 decks)

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