PSA Flashcards
What drugs are enzyme inducers vs enzyme inhibitors?
Inhibitors: cimetidine, chloramphenicol, fluoexetine, sodium valporate, ciprofloxacin
Inducers: rifampicin, carbamezapine, phenytoinm topiramate
What drugs are stopped prior to surgery and when?
- Lithium (1 day before)
- Insulin (variable)
- DOAC (24 hours or 48 hours if high bleeding risk)
- Warfarin (bridging regimen)
- Aspirin (1 week before)
- K+ sparing (day of)
- COCP/HRT (4 weeks before)
Emergency hypoglycaemia treatment in drowsy patient?
Glucose 20% 100ml in 15 minutes
Emergency hypokalaemia treatment?
sodium chloride 0.9% / potassium chloride 0.3% 1000ml in 4 hours
Emergency hypercalcaemia treatment?
sodium chloride 0.9% 1000ml in 4 hours
Maintenance fluids without losses and with losses (maintenance and replacement)?
25-30ml/kg/24h water
1mmol/kg/24h Na and K
50-100g/24h glucose
(aim 1000ml 8-12 hours)
Minimum 30ml/kg/24h water
ensure electrolytes replaced
(aim 1000ml 4-6 hours)
What are the different fluid types?
NaCl 0.9% 1000ml - 150 mmol Na
KCl 0.3% 1000ml - 40 mmol Ka
KCl 0.15% 1000ml - 20 mmol K
Glucose 5% 1000ml - 50g glucose
Side effects - hypoglycaemia and hyperglycaemia
hypoglycaemia: insulin, sulphonylureas
hyperglycaemia: steroids, antipsychotics, thiazides, beta blockers, tacrolimus
side effects - diarrhorea and constipation
diarrhoea - antibiotics, colchicine, metformin, PPIs, alendronic acid
constipation - opioids, CCBs, anticholinergics, some parkinson’s meds, some antiepileptics, nifedipine, ferrous sulphate
side effects - urinary incontinence and urinary retention
retention - opioids, anticholinergics, morphine sulphate, BDZ, NSAIDs, CCB
incontinence - diuretics, clozapine, alpha blockers
side effects - confusion and falls
confusion - opioids, sedatives, anticholinergics, morphine sulphate, metaclopramide
falls - BDZ, antidepressants, opiates
side effects - gout, osteoporosis, hypertension, high cholesterol
gout - diuretics, ticagrelor, aspirin
osteoporosis - steroids, PPIs
hypertension - NSAIDs, steroids, oral COCP
high cholesterol - steroids, thiazides
Which drugs are changed during a period of illness?
steroids - DOUBLED
metformin, statins, - glifozins, methotrexate - WITHHELD
Diabetes - continue insulin and other drugs but stop SGLT-2i
What drugs are given in mcg and grams?
levothyroxine, tamsulosin, digoxin, naloxone, fludrocortisone, inhalers, GTN spray, ipratropium nebs
paracetamol, lithium, calcium carbonate, NAC
VTE prophylaxis and DVT treatment:
therapeutic: DOAC
prophylaxis: LMWH (+ compression stockings) if renal failure then unfractionated heparin
What drugs cause cholestasis?
flucloxacillin, co-amoxiclav
What drugs cause pancreatic cancer?
nitrofurantoin, steroids, sulphonylureas
Reversal drugs in substance misuse?
Opioids (heroin) - methadone hydrochloride or buprenorphine or naloxone
BDZ - flumazenil
Aspirin and TCA - sodium bicarbonate
Treatment for Alzheimer’s?
Donepezil, rivastigmine
Memantime
What is used in constipation?
Stool softener - arachis oil
Bulking agents - isphagula husk
Stimulant laxative - senna
Osmotic laxative - lactulose or phosphate enema
What drugs should/could be prescribed alongside steroids?
bisphosphonate
H2 antagonists - ranitidine
PPI - omeprazole
Side effects of gentamicin, vancomycin and ciprofloxacin?
nephrotoxicity and ototoxicity
tendonitis/achilles tendon rupture
Side effects of ACEi, BB, CCB, diuretics?
ACEi - dry cough, AKI
BB - wheeze in asthmatics, worsens acute HF
CCB - flushing, peripheral oedema
Diuretics - AKI, spironolactone - gynaecomastia
NOTE: check U&Es prior to starting diuretics
Side effects of digoxin and amiodarone?
Digoxin - blurred vision, xanthopsia (disturbed yellow/green visual perception and halo sign
Amiodarone - ILD, skin greying, corneal deposits, hyperthyroidism and hypothyroidism - withhold
NOTE: anti-arrhythmics so monitor using HR
digoxin toxicity from hypokalaemia so check U&Es prior
How to monitor steroids?
LFTs - stop when x3 upper limit of normal
Neutropenic sepsis treatment?
IV tazocin
Warfarin
bleed: stop, IV phytomenadione, PCC, restart when INR <5
no bleed, INR >8: stop, PO phytomenadione, restart when INR <5
no bleed, INR 5-8: withhold 1-2 doses
target INR (2-3): DVT/PE, prosthetic valves
target INR (3-4) recurrent DVT/PE
Day before elective surgery oral phytomenadione given if INR >1.5
UTI treatment?
nitrofurantoin (FOR ALL EXCEPT 3RD TRI)
2nd line: amox or cefalexin
NOTE: nitro contraindicated in renal failure
Neural tube defects?
400mcg folic acid until 12 weeks
5mg folic acid in high risk until birth - SCD, DIABETES, anti-epileptics, child with NTD
5mg till week 12: family history of NTD
ACEi and renal function?
if eGFR <25% or creatinine <30%: recheck in 2 weeks, don’t change ACEi dose
if GFR >25% or creatinine >30%: stop ACEi or reduce to previously tolerable dose
Palliative care management:
- pain relief
- breathlessness
- constipation
- N&V
- restlessness
- secretions
pain relief: use oxycodone rather than morphine if lower eGFR
breathlessness: oxygen -> morphine sulphate IR 1mg PO -> lorazepam 0.5mg PRN SL
constipation: anything apart from bulking agents
N&V: metoclopramide, cyclizine, haloperidol, ondansetron
Restlessness: haloperidol, lorazepam in parkinson’s
Secretions - hyoscine butylbromide
NOTE: all patients prescribed a strong opioid should also be prescribed lactulose
Dysphagia: give dex is tumour and SL GTN if oesophagitis or spasm
Missed pills in COCP and POP?
COCP:
1 missed pill: take it straight away and carry on as normal. If less than 7 pills in pack take back to back. If beginning of pack no and sex no additional contraception
2 missed pills: take most recent pill straight away and protection for 7 days.
If had sex in last 7 days -> emergency contraception
POP:
1 missed pill <3 hours: take it straight away and carry on as normal.
1 missed pill >3 hours: take most recent pill straight away and use condoms for 7 days
Acne treatment:
mild: benzoyl peroxide
moderative: as above and oral abx (doxycycline -> erythromycin)
severe: PO isotretinoin
What to know about rivaroxaban?
take with food
Drugs with EPS?
acute dystonia and parkinsonism - procyclidine
tardive dyskinesia (involuntary movements) - tetrabenazine
akathisia (restlessness) - propanolol
Important equations to know in calculation skills?
concentration = dose/volume
1g = 1ml
1% = 1g in 100ml
infusion rate = dose / concentration
Hypocalcaemia treatment?
calcium gluconate 10% 10ml IV over 10 mins
Meningitis in community?
benpen IM or cefotaxime if allergic
How do you measure blood glucose control in a blood disorder (increases RBC production) or pregnancy?
Frutosamine (2 weeks)
Hyperemesis gravidaram antiemetic?
Promethazine
Oral candidiasis, vaginal candidiasis, BV, trichomoniasis (yellow/green discharge) treatment?
PO nystatin
Clotrimazole and fluconazole if recurrent
Metronidazole
Metronidazole
Otitis media and externa treatment?
media:
self resolve
PO amox
externa:
gentamicin drops and hydrocortisone - otomize
PO flucox and severe then cipro
EAR INFECTIONS
Croup treatment?
PO dex
NEB adrenaline if severe
HRT treatment?
pre-menopause: elleste-duet
post-menpause and uterus: elleste - duet conti
post-menopause and NO uterus: elleste - solo
Cystic fibrosis treatment?
infection:
prophylactic tobramycin in pseudominas
azithromycin
Side effect of tamsulosin?
floppy iris syndrome - stop prior to cataract surgery
What are the choices for emergency contraception?
Levonestregel: <72hr
Ulipristal acetate: <120hr. CONTRAINDICATED IN ASTHMA
Contraceptive treatment?
COCP:
microgynon 30 - ethinylestradiol with levonorgestrel
POP:
cerazette - desogestrel
Whooping cough treatment?
Azithromycin or clarithromycin
Statins - when to take it?
nightly
if QRISK high it is 20mg
What can aspirin cause
IDA picture
Alendronic acid
reduces likelihood of vertebral and non-vertebral fractures
small increased risk of atypical fractures
What is a good marker of correction of dehydration in the short and long term?
BP
Urine output
What is a good monitoring option to assess the adverse effects of HRT?
BP
stop if > 160/95
anti-sickness meds SE?
ondansetron - causes QTc prolongation
metoclopramide - not used in cardiac problems and electrolyte abnormalities
use cyclicine
GP status epilepticus
no IV access so use buccal midazolam or PR diazepamE
When do you take prednisolone?
in morning so can sleep
What drugs increase fracture risk?
PPIs
Steroids
GnrH agonists e.g. goserelin
What is the definition and management for orthostatic hypotension?
OH is defined as a reduction of systolic BP of at least 20 mm Hg or diastolic blood pressure of at least 10 mm Hg within 3 minutes of standing up
treat cause
supportive - fluids, leg crossing
FLUDROCORTISONE
Minor surgery and major surgery insulin in diabetes?
On the day before the surgery, the patient’s usual insulin should be given as normal, other than once daily long-acting insulin analogues, which should be given at a dose reduced by 20 %
Put on variable insulin infusion
Diabetes and surgery
Fluid prescribing in children?
resuscitation:
0.9% NaCl 10ml/kg over 10 minutes or Hartmann’s 10ml/kg over 10 mins
maintenance (>28 days):
100 ml/kg/day for the first 10kg of weight, then 50ml/kg for next 10kg then 20ml
PER 24 HOURS
Cellulitis treatment?
- flucloxacillin
- clarithromycin or erythromycin in pregnancy
SE of zopiclone?
Rebound insomnia after withdrawal following PROLONGED use
Diabetes in pregnancy
Labetalol taken and measured in community twice weekly to aim 135/85.
for women with BP between 140/90 - 159/109
daily every 30 mins if over 159/109
Glucose prescription in DKA?
125ml/hour 10% glucose at 500ml
Wernicke’s treatment?
Pabrinex (vitamin B substances with ascorbic acid)
2-3 pairs
SE of transplant immunosuppressants?
ciclosporin - gingivial hypertrophy
tacrolimus - pancytopenia, peripheral neuropathy
mycophenelate - myelosuppression
What to know about HRT?
vasomotor sx:
1. HRT
2. Clonidine hydrochloride
3. SSRI (off label)
HRT continuous (o+p)
HRT sequential (o + p. last few days)
progesterone adjuncts - utrogestran (micronised) or medroxyprogesterone acete
oestrogel can increase dose from 2 pumps to 4 pumps (3mg)
What fluids are given prior to surgery in a diabetic patient?
as a variable rate insulin infusion has been started, start IV infusion of potassium chloride with glucose and sodium chloride
sodium chloride 0.45%/glucose 5%/potassium chloride 0.15% 1000ml over 12 hours
stepwise hypertension management on dual therapy?
ACEi and CCB -> add thiazide like diuretic
bendroflumethiazide is thiazide diuretic
indapamide and chlortiadone are thiazide-like diuretics, they are preferred
Most important advice when taking lithium carbonate?
drink plenty of water and have a balanced diet
teratogenic but continued if benefits outweigh risk
most important info for emergency contraception levonorgesterol
if vomiting occurs within 3 hours take another
headache is a very common side effect
What is malignant hyperthermia and how do you treat it?
severe reaction to drugs used in anaesthesia
Mx: dantrolene sodium
Insulin adjustment and cbg?
Long acting: influences pre-prandial doses after overnight fast e.g. pre-breakfast reading
Short acting: influence measurements made around daytime meals
VTE prophylaxis
dalteparin sodium 25,000 units/ml
5000 units
GCA treatment?
prednisolone - 60mg
methylprednisolone 1g injection or IV if visual involvement
derm management:
fungal infections (antifungals treatment summary)
1st line is topical antifungal - ketoconazole 2% cream or clotrimazole 1% spray
1 application, topical, daily
oral antifungal 2nd line e.g. fluconazole
Post-MI antiplatelet continued for how long?
after 12 months stop second anticoagulant
continue aspirin lifelong
depression mx
- SSRI (sertraline, fluoxetine)
- another SSRI
- mirtazapine
diabetes mx
- metformin
- not tolerated -> another med
- hba1c >58 despite dual anti hypo treatment
gliclazide (sulphonylurea) cause weight gain
Pioglitazone can’t use in heart failure. and can cause bladder cancer
How do you monitor the effectiveness of addison’s treatment?
resolution of symptoms - malaise and anorexia
weight instead of serum cortisol levels (as can be normal)
monitoring for CAP clear up?
sputum culture
best antibacterial for atypical CAP?
clari/ery/dox
Mx for improving pain in shingles?
pregablin/ amitryptilin
Common prophylactic antibiotics before procedures
Antibacterial, use for prophylaxis
What drugs cause candida?
steroids and antibiotics
Patient on statin has side effects and CK x5 upper limit of normal?
stop statin and if symptoms resolve or CK returns to normal statin should be reintroduced at a lower dose
drugs causing pulmonary oedema?
CCB and NSAIDs
Amiodarone pt gets hyperthyroidism
withhold, at least temporarily
High BP on COCP - what do you do?
stop COCP and start POP
