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Year 6 > PSA > Flashcards

PSA Flashcards

1
Q

Which medicines can you give for whooping cough in children?

A

azithromycin
clarithromycin

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2
Q

What is cerazette?

A

POP

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3
Q

opiate OD treatment

A

400 mg naloxone IV once only

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4
Q

which common drug gives leg swelling

A

amlodipine

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5
Q

Which meds for C. difficile infection?

(1st, 2nd and 3rd line/severe)

incl. route & 1st,2nd +3rd (severe) line

A

1st line: oral vancomycin
2nd line: oral fidaxomicin (dificid)
3rd line/severe: oral vancomycin and IV metronidazole

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6
Q

Which smoking cessation help medication can be given in pregnancy?

A

nicotine patches

varenicline and bupropion are contraindicated

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7
Q

How long before planned surgery should warfarin be stopped?

A

5 days

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8
Q

Name examples of aminosalicylates

A

aminosalicylates = 5-ASA

Examples:
- sulfalazine
- Mesalazine
- Olsalazine
- Balsazide

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9
Q

Considerations before starting azathioprine?

A

measure thiopurine methyltransferase (TPMT) activity

-> avoid giving azathioprine if TPMT activity is low as this increases toxicity

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10
Q

What does TPMT stand for?

A

thiopurine methyltransferase

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11
Q

When prescribing vancomycin, baseline levels of what should be checked?

A

creatinine / U&Es

this is because vancomycin clearance is reduced in patients with renal dysfunciton

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12
Q

is vancomycin nephrotoxic/hepatotoxic?

A

it is nephrotoxic and ototoxic

not hepatotoxic

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13
Q

what monitoring is needed before starting statin (and after)?

A

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.

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14
Q

Monitoring of phenytoin

A

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.

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15
Q

How long after last dose should lithium levels be checked?

A

12h

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16
Q

What is the reference range for lithium?

And when do you see toxic effects?

A

0.4-0.8 mmol/L

-> toxic effects are likely to be seen from 1.5 mmol/L

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17
Q

are lithium levels affected by dietary sodium intake?

A

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.

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18
Q

How often should you monitor FBC on long term methotrexate therapy?

A

every 2-3 months

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19
Q

What dose of oral prednisone would you give in asthma attack and in COPD?

A

asthma: 40-50mg (high dose)

COPD: 30 mg

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20
Q

What medication can be used in a patient with recurrent calcium oxalate kidney stones?

A

potassium citrate (for prevention)

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21
Q

What should be tested before starting olanzapine in a patient?

A

fasting blood glucose

(at baseline and regular intervals)

ECG would only be needed in patients with cardiovascular disease or associated RFs

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22
Q

Mx of acute dystonia

A

IV procyclidine hydrochloride - once only

IV!!

(5-10 mg)

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23
Q

daily K+ requirement

A

1 mmol/kg/day

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24
Q

duration of fluids running for 1L in maintenance fluids

A

over 8-12 h

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25
Q

Common medication to avoid in peripheral vascular disease (e.g. ischaemic ulcer)

A

b-blockers

(cause peripheral vasoconstriction and worsen ischaemia in PVD)

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26
Q

What medications can worsen HF

A

e.g.

Steroids
CCB (diltiazem)

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27
Q

What meds can increase risk of vaginal thrush

A

SYSTEMIC steroids (not inhaled)

abx

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28
Q

Is reducing caloric intake a good option for sugar control in PSA?

A

not really because unlikely to be sustainable

therefore try to pick an option where there are alterations in the medication regimen

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29
Q

What medication in scarlet fever and duration?

A

phenoxymethylpenicillin for 10 days

(azithromycin if allergic to penicillin)

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30
Q

does azithromycin affect warfarin?

A

yes

can reduce its effects so monitor closely

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31
Q

What type of drug is epleronone?

What impact does it have on K+?

A
  • aldosterone antagonist
  • it is a K+ sparing diuretic

therefore can increase potassium (check U&E after 1/52)

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32
Q

Methotrexate - how long avoid pregnancy?

A

Both men and women should avoid conceiving during treatment and 6 months after cessation of methotrexate treatment

33
Q

Can you give IM glucagon to a hypoglycaemic pt who is anticoagulated?

A

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

34
Q

Person on high dose statin with muscle aches and high CK - what to do?

A

if >5x ULN -> stop statin, when CK resolves you can consider starting at a lower dose

if <5x ULN -> decrease dose

35
Q

Is monitoring needed in pts taking sertraline?

A

No routine monitoring needed

36
Q

Mx of NMS

A
  • 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
37
Q

features of NMS

A
  • 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.
38
Q

Mx of serotonin syndrome

A
  • IV fluids
  • benzodiazepines
  • more severe cases are managed using serotonin antagonists such as cyproheptadine and chlorpromazine
39
Q

Mx of acute dystonia

A

procyclidine hydrochloride

40
Q

what is procyclidine hydrochloride?

A

it is a centrally acting anticholinergic drug

41
Q

What fluid should you give a patient with diabetes who is on fixed rate insulin infusion for surgery

A

Potassium chloride with glucose and sodium chloride

(see BNF treatment summary of managing diabetes during surgery) -> to avoid hypoglycaemia and hypokalaemia

42
Q

Does alendronate cause AKI?

A

alendronate commonly / very commonly causes renal impairment

43
Q

What route of administration can be used for vincristine?

A

only IV

cannot be given intrathecal!!!

44
Q

What are some drugs that are contraindicated in DKA?

A
  • 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)
45
Q

Where can you find information in prescribing laxatives in pts taking opioids?

A

treatment summary of constipation

46
Q

what laxative group should you avoid in opioid induced constipation?

A

bulk forming laxatives

47
Q

school exclusion in impetigo

A
  • until lesions are fully healed and crusted over or after 48h of abx therapy
48
Q

important advice to give to family of child being treated for impetigo

A

avoid sharing bedding, towels and facecloths

49
Q

If vomiting occurs in what timeframe does the dose of levonelle need to be repeated?

A

3h

50
Q

what should you ctrl+F when looking for interactions of ferrous sulfate with drugs?

A

'’iron’’

can also try the proper name of the drug but sometimes only found under iron that decreases effect etc.

51
Q

mx of malignant hyperthermia

A

dantrolene

52
Q

What to monitor in long term ceftriaxone?

A

FBC

53
Q

What to monitor for beneficial effects of ferrous sulfate?

A

Hb

54
Q

tobramycin drug class

A

aminoglycoside antimicrobial

55
Q

Management principles of TACO

A

stop transfusion!

sit patient upright
oxygen
diuretics (e.g. furosemide)

56
Q

Which common medication reduces the efficacy of clopidogrel?

A

omeprazole

57
Q

What to Ctrl+F if looking for hair loss as adverse effect?

A

'’hair’’ and ‘‘alopecia’’

58
Q

Can people with TIA/cerebrovascular disease take NSAIDs?

A

avoid

if then only with caution

certain COX-2 inhibitors like diclofenac are contraindicated

59
Q

What should you do with LA-insulin the day before surgery?

A

reduce dose by 20%

continue short acting insulin as normal

60
Q

Resus fluid prescription in children

A

bolus of 10 ml/kg over less than 10 minutes

(10 minutes still gives 10 points on the PSA)

61
Q

HTN in pregnancy - should a woman with BP 151/95 be managed in hospital or in the community?
What is the appropriate monitoring?

A

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

62
Q

What do you need to consider when prescribing dalteparin for a patient with renal disease?

A

in severe renal impairment, you should reduce the dose by 20%

63
Q

What are the symptoms of aminophylline toxicity?

A

agitation
vomiting
tachycardia
hypokalaemia

64
Q

monitoring and dose changes in aminophylline

A
  • 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
65
Q

What is aminophylline and what is it used for

A
  • 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
66
Q

What conditions can increase plasma theophylline concentration

A

heart failure
hepatic failure
viral infection

-> can increase the aminophylline concentration and predispose to SE.

67
Q

How much NAC do you give in paracetamol OD?

A

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)

68
Q

Which drugs are known to cause SIADH?

A

sulfonylureas
SSRI
tricyclic antidepressants
carbamazepine
vincristine
cyclophosphamide

69
Q

which drugs increase the risk of falls?

A

Benzodiazepines
Antidepressants (particularly TCAs and SNRIs)
Monoamine oxidase inhibitors
Most antipsychotics
Opiates
Most antihypertensives (particularly diuretics and alpha-blockers)

70
Q

Which drugs increase the risk of fractures?

A

PPI
steriods
GnRH agonists (buserelin, goserelin etc)

71
Q

IV mx of hypoglycaemia

A

15-20g over 15 minutes

using either 10% or 20% glucose infusion IV

72
Q

What blood test can you use to assess the glycemic control over the 2 previous weeks?

A

fructosamine

-> useful in pregnancy and in harm conditions with increased RBC turnover

73
Q

starting dose of levothyroxine rule of thumb

A

1.6mcg/kg rounded up to the nearest 25mcg

74
Q

Which drugs cause urinary retention?

A
  • morphine and other opioids (esp. in early post-op period)
  • anticholinergics
  • general anaesthetics
  • alpha agonists
  • benzodiazepines
  • NSAIDs
  • Calcium channel blockers
  • antihistamines
  • alcohol
75
Q

Which drugs are likely to cause confusion?

A

anticholinergics
antipsychotics
antidepressants
anticonvulsants

less commonly:
- histamine H2 receptor antagonists (e.g. famotidine)
- digoxin
- beta blockers
- corticosteroids
- NSAIDs
- antibiotics

76
Q

Doses of folic acid in pregnancy

A

low dose is 400 mcg OD

high dose in 5 mg OD

77
Q

How can you monitor the therapeutic effect of allopurinol?

A

measure serum urate (should be lowered by allopurinol)

78
Q

What should you monitor when giving a patient HRT?

A

BP

-> HRT should be stopped in BP rises above 160 mmHg systolic or 95 mmHg diastolic

79
Q

Dose adjustments in gentamicin therapy

A

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

Year 6 (37 decks)

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