PSA Flashcards
Drugs that exacerbate psoriasis
beta blockers
lithium
antimalarials (chloroquine and hydroxychloroquine)
NSAIDs
ACE inhibitors
infliximab
Levothyroxine initial starting dose for those with cardiac disease, severe hypothyroidism or patients over 50 years
25mcg od with dose slowly titrated
(other patients should be started on a dose of 50-100mcg od)
When should TFTs be taken following a change in thyroxine dose
After 8-12 weeks
Therapeutic goal TSH value
0.5-2.5 mU/l
Levothyroxine dose increase for women with established hypothyroidism who become pregnant
At least 25-50 micrograms
4 side effects of thyroxine therapy
hyperthyroidism: due to over treatment
reduced bone mineral density
worsening of angina
atrial fibrillation
Thyroxine interactions
iron
calcium carbonate
(give 4 hours apart)
signs of hypoglycaemia
sweating, anxiety, blurred vision, confusion, aggression
drug that reduces hypoglycaemic awareness
Beta blockers
antibiotics C/I in pregnancy
tetracyclines
aminoglycosides
sulphonamides and trimethoprim
quinolones
drugs C/I in pregnancy
ACE inhibitors, angiotensin II receptor antagonists
statins
warfarin
sulfonylureas
retinoids (including topical)
cytotoxic agents
some antibiotics (see card)
BNF advice on how to take oral bisphosphonates
swallowed whole with plenty of water while sitting or standing
to be taken on an empty stomach at least 30 minutes before breakfast (or another oral medicine)
patient should stand or sit upright for at least 30 minutes after taking tablet’.
1st line therapy for chronic heart failure
ACE-inhibitor
Beta-blocker e.g. Bisoprolol, carvedilol, nebivolol
2nd line therapy for chronic heart failure
Aldosterone antagonist e.g. spironolactone and eplerenone
(Monitor potassium)
UKMEC3
more than 35 years old and smoking less than 15 cigarettes/day
BMI > 35 kg/m^2*
family history of thromboembolic disease in first degree relatives < 45 years
controlled hypertension
immobility e.g. wheel chair use
carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
current gallbladder disease
UKMEC 4
more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
diabetes diagnosed > 20 years
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)
Medications contraindicated in heart failure
thiazolidinediones (pioglitazone is contraindicated as it causes fluid retention)
verapamil (negative inotropic effect)
NSAIDs/glucocorticoids (should be used with caution as they cause fluid retention) low-dose aspirin is an exception - many patients will have coexistent cardiovascular disease and the benefits of taking aspirin easily outweigh the risks
class I antiarrhythmics (flecainide has a negative inotropic and proarrhythmic effect)
Croup treatment
single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity
2 adverse affects of gentamicin
Ototoxicity
Nephrotoxicity
Gentamicin C/I condition
Myasthenia gravis
Gentamicin dosing
both peak (1 hour after administration) and trough levels (just before the next dose) are measured
if the trough (pre-dose) level is high the interval between the doses should be increased
if the peak (post-dose) level is high the dose should be decreased
Infective endocarditis: peak 3-5mg/litre, trough < 1mg/litre