PSA Flashcards
Which medicines can you give for whooping cough in children?
azithromycin
clarithromycin
What is cerazette?
POP
opiate OD treatment
400 mg naloxone IV once only
which common drug gives leg swelling
amlodipine
Which meds for C. difficile infection?
(1st, 2nd and 3rd line/severe)
incl. route & 1st,2nd +3rd (severe) line
1st line: oral vancomycin
2nd line: oral fidaxomicin (dificid)
3rd line/severe: oral vancomycin and IV metronidazole
Which smoking cessation help medication can be given in pregnancy?
nicotine patches
varenicline and bupropion are contraindicated
How long before planned surgery should warfarin be stopped?
5 days
Name examples of aminosalicylates
aminosalicylates = 5-ASA
Examples:
- sulfalazine
- Mesalazine
- Olsalazine
- Balsazide
Considerations before starting azathioprine?
measure thiopurine methyltransferase (TPMT) activity
-> avoid giving azathioprine if TPMT activity is low as this increases toxicity
What does TPMT stand for?
thiopurine methyltransferase
When prescribing vancomycin, baseline levels of what should be checked?
creatinine / U&Es
this is because vancomycin clearance is reduced in patients with renal dysfunciton
is vancomycin nephrotoxic/hepatotoxic?
it is nephrotoxic and ototoxic
not hepatotoxic
what monitoring is needed before starting statin (and after)?
LFTs (check ALT)
if there is active liver disease or transaminases are 3x upper limit of normal, then you should not give/stop if already taking statin.
re-check LFTs at 3 and at 12 months.
Monitoring of phenytoin
you can check if the levels of phenytoin are within the reference range
take clinical picture into account
don’t need post dose levels. phenytoin has a half-life of 24h and if the patient has been on it for a few days/weeks, it is unlikely for diurnal variation to occur.
How long after last dose should lithium levels be checked?
12h
What is the reference range for lithium?
And when do you see toxic effects?
0.4-0.8 mmol/L
-> toxic effects are likely to be seen from 1.5 mmol/L
are lithium levels affected by dietary sodium intake?
yes.
a decrease in sodium intake and sodium depletion are known to increase the risk of lithium toxicity, pts are advised to avoid making dietary changes.
How often should you monitor FBC on long term methotrexate therapy?
every 2-3 months
What dose of oral prednisone would you give in asthma attack and in COPD?
asthma: 40-50mg (high dose)
COPD: 30 mg
What medication can be used in a patient with recurrent calcium oxalate kidney stones?
potassium citrate (for prevention)
What should be tested before starting olanzapine in a patient?
fasting blood glucose
(at baseline and regular intervals)
ECG would only be needed in patients with cardiovascular disease or associated RFs
Mx of acute dystonia
IV procyclidine hydrochloride - once only
IV!!
(5-10 mg)
daily K+ requirement
1 mmol/kg/day
duration of fluids running for 1L in maintenance fluids
over 8-12 h
Common medication to avoid in peripheral vascular disease (e.g. ischaemic ulcer)
b-blockers
(cause peripheral vasoconstriction and worsen ischaemia in PVD)
What medications can worsen HF
e.g.
Steroids
CCB (diltiazem)
What meds can increase risk of vaginal thrush
SYSTEMIC steroids (not inhaled)
abx
Is reducing caloric intake a good option for sugar control in PSA?
not really because unlikely to be sustainable
therefore try to pick an option where there are alterations in the medication regimen
What medication in scarlet fever and duration?
phenoxymethylpenicillin for 10 days
(azithromycin if allergic to penicillin)
does azithromycin affect warfarin?
yes
can reduce its effects so monitor closely
What type of drug is epleronone?
What impact does it have on K+?
- aldosterone antagonist
- it is a K+ sparing diuretic
therefore can increase potassium (check U&E after 1/52)
Methotrexate - how long avoid pregnancy?
Both men and women should avoid conceiving during treatment and 6 months after cessation of methotrexate treatment
Can you give IM glucagon to a hypoglycaemic pt who is anticoagulated?
IV glucose would be preferred
(20% glucose 100 ml once IV)
IM glucagon would not be ideal in a hospital setting if IV is available bot not wrong per se
Person on high dose statin with muscle aches and high CK - what to do?
if >5x ULN -> stop statin, when CK resolves you can consider starting at a lower dose
if <5x ULN -> decrease dose
Is monitoring needed in pts taking sertraline?
No routine monitoring needed
Mx of NMS
- stop antipsychotic
- admit to medical ward (often ITU)
- IV fluids to prevent renal failure
- dantrolene may be useful in selected cases
thought to work by decreasing excitation-contraction coupling in skeletal muscle by binding to the ryanodine receptor, and decreasing the release of calcium from the sarcoplasmic reticulum - bromocriptine, dopamine agonist, may also be used
features of NMS
- pyrexia
- muscle rigidity
- autonomic lability: typical features include hypertension, tachycardia and tachypnoea
- agitated delirium with confusion
- usually occurs within days of starting antipsychotic
- may also occur with dopaminergic drugs (such as levodopa) for Parkinson’s disease, usually when the drug is suddenly stopped or the dose reduced.
Mx of serotonin syndrome
- IV fluids
- benzodiazepines
- more severe cases are managed using serotonin antagonists such as cyproheptadine and chlorpromazine
Mx of acute dystonia
procyclidine hydrochloride
what is procyclidine hydrochloride?
it is a centrally acting anticholinergic drug
What fluid should you give a patient with diabetes who is on fixed rate insulin infusion for surgery
Potassium chloride with glucose and sodium chloride
(see BNF treatment summary of managing diabetes during surgery) -> to avoid hypoglycaemia and hypokalaemia
Does alendronate cause AKI?
alendronate commonly / very commonly causes renal impairment
What route of administration can be used for vincristine?
only IV
cannot be given intrathecal!!!
What are some drugs that are contraindicated in DKA?
- metformin (risk of lactic acidosis)
- SGLT2 inhibitors e.g. dapagliflozin (can cause / contribute to DKA)
- DPP4 inhibitors e.g. sitagliptin (can cause pancreatitis which sometimes caused ketoacidosis in the past)
Where can you find information in prescribing laxatives in pts taking opioids?
treatment summary of constipation
what laxative group should you avoid in opioid induced constipation?
bulk forming laxatives
school exclusion in impetigo
- until lesions are fully healed and crusted over or after 48h of abx therapy
important advice to give to family of child being treated for impetigo
avoid sharing bedding, towels and facecloths
If vomiting occurs in what timeframe does the dose of levonelle need to be repeated?
3h
what should you ctrl+F when looking for interactions of ferrous sulfate with drugs?
'’iron’’
can also try the proper name of the drug but sometimes only found under iron that decreases effect etc.
mx of malignant hyperthermia
dantrolene
What to monitor in long term ceftriaxone?
FBC
What to monitor for beneficial effects of ferrous sulfate?
Hb
tobramycin drug class
aminoglycoside antimicrobial
Management principles of TACO
stop transfusion!
sit patient upright
oxygen
diuretics (e.g. furosemide)
Which common medication reduces the efficacy of clopidogrel?
omeprazole
What to Ctrl+F if looking for hair loss as adverse effect?
'’hair’’ and ‘‘alopecia’’
Can people with TIA/cerebrovascular disease take NSAIDs?
avoid
if then only with caution
certain COX-2 inhibitors like diclofenac are contraindicated
What should you do with LA-insulin the day before surgery?
reduce dose by 20%
continue short acting insulin as normal
Resus fluid prescription in children
bolus of 10 ml/kg over less than 10 minutes
(10 minutes still gives 10 points on the PSA)
HTN in pregnancy - should a woman with BP 151/95 be managed in hospital or in the community?
What is the appropriate monitoring?
in the community with labetalol 1st line (if not asthmatic)
pts with BP 140/90 mmHg and 159/109 mmHg can be managed in the community
it is recommended that BP + urine dip is checked 1-2x/week (also monitor LFTs, U&Es and FBC at presentation and then weekly)
goal is BP 135/85 mmHg or less
What do you need to consider when prescribing dalteparin for a patient with renal disease?
in severe renal impairment, you should reduce the dose by 20%
What are the symptoms of aminophylline toxicity?
agitation
vomiting
tachycardia
hypokalaemia
monitoring and dose changes in aminophylline
- narrow therapeutic index
- monitor plasma theophylline (10-20 mg/L)
- however, also important to monitor for sx of overdose (vomiting, tachycardia, agitation, hypokalaemia)
- if sx but normal range -> withhold the medication
What is aminophylline and what is it used for
- competitive non-selective phosphodiesterase (xanthine) inhibitor -> raises cAMP -> inhibits leukotriene synthesis and causes bronchodilation
- stable mixture of theophylline and ethylenediamine
- used in severe asthma and COPD
What conditions can increase plasma theophylline concentration
heart failure
hepatic failure
viral infection
-> can increase the aminophylline concentration and predispose to SE.
How much NAC do you give in paracetamol OD?
150 mg/kg in 5% glucose over 1h
then 50 mg/kg over 4h (in 500 mL of 5% glucose)
then 100 mg/kg over 16 h (in 1L of 5% glucose)
Which drugs are known to cause SIADH?
sulfonylureas
SSRI
tricyclic antidepressants
carbamazepine
vincristine
cyclophosphamide
which drugs increase the risk of falls?
Benzodiazepines
Antidepressants (particularly TCAs and SNRIs)
Monoamine oxidase inhibitors
Most antipsychotics
Opiates
Most antihypertensives (particularly diuretics and alpha-blockers)
Which drugs increase the risk of fractures?
PPI
steriods
GnRH agonists (buserelin, goserelin etc)
IV mx of hypoglycaemia
15-20g over 15 minutes
using either 10% or 20% glucose infusion IV
What blood test can you use to assess the glycemic control over the 2 previous weeks?
fructosamine
-> useful in pregnancy and in harm conditions with increased RBC turnover
starting dose of levothyroxine rule of thumb
1.6mcg/kg rounded up to the nearest 25mcg
Which drugs cause urinary retention?
- morphine and other opioids (esp. in early post-op period)
- anticholinergics
- general anaesthetics
- alpha agonists
- benzodiazepines
- NSAIDs
- Calcium channel blockers
- antihistamines
- alcohol
Which drugs are likely to cause confusion?
anticholinergics
antipsychotics
antidepressants
anticonvulsants
less commonly:
- histamine H2 receptor antagonists (e.g. famotidine)
- digoxin
- beta blockers
- corticosteroids
- NSAIDs
- antibiotics
Doses of folic acid in pregnancy
low dose is 400 mcg OD
high dose in 5 mg OD
How can you monitor the therapeutic effect of allopurinol?
measure serum urate (should be lowered by allopurinol)
What should you monitor when giving a patient HRT?
BP
-> HRT should be stopped in BP rises above 160 mmHg systolic or 95 mmHg diastolic
Dose adjustments in gentamicin therapy
if peak dose is too high: reduce dose
if trough dose is too high: reduce frequency
if both are too high: reduce both dose and frequency
