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PSA Flashcards

1
Q

what does the p450 enzyme system do?

A

metabolises drugs to INACTIVATE THEM

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1
Q

what are the effects of P450 inducers and inhibitors

A

INDUCERS- induce P450 system resulting in REDUCED rug concentrations

INHIBITORS- inhibit P450 syetm

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2
Q

P450 INDUCERS

A

PC BRAS
phenytoin
carbamezapine
barubiturates
rifampicin
alcohol (chronic)
sulfonylureas

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3
Q

P450 INHIBITORS

A

AODEVICES

allopurinol
omeprazole
disulfaram
erythromycin
valproate
insoniazide
ciprofloxacin
ethanol (acute)
sulphanomides

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4
Q

drugs to stop before surgery

A

I LACK OP

Insulin - variabe
Lithium- day before
Anticoagulants- variable
COCP/HRT- 4 weeks before
K- sparing diuretics/ Acei
Oral hypoglycaemics
Perindopril

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5
Q

key contraindications anticoagulant

A

no platelets/ anticoagulants in patients bleeding, at risk of bleeding or suspected of bleeding

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6
Q

what drug increases the anticoagulant effect of warfarin

A

erythryomycin (P450 inhibitor)

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7
Q

when is sodium chloride contraindicated in fluid replacement?

A
  1. hypernatraemia or hypoglycaemia (5% dextrose)
  2. ascites (human albumin solution)
  3. shocked from bleeding (blood transfusion)
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8
Q

maximum rate of IV K+

A

NEVER MORE than 10mmol/hour

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9
Q

prescribing maintenance fluids adults

A

1L 0.9% NaCl + 40mmol/kg over 8 hours

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10
Q

antiemetics of choice

A

nauseated:
REGULAR cyclizine 50mg 8 hourly IM/IV/ORAL

not nauseated:
PO cyclizine 50mg up to 8 hourly iM/IV/ORAL

nauseated/ not nauseated + heart failure
METOCLOPRAMIDE 10mg up to 8 hourly IM/IV/oral

not cyclizine causes fluid retention

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11
Q

what is the maximum daily dose of paracetamol

A

4g/day

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12
Q

max paracetamol dose in patients <50kg

A

500mg 6 hourly (2g/day)

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13
Q

which 2 drugs when used together can cause AKI

A

ACEi and NSAIDs

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14
Q

give examples of antimuscarinics

A

Atropine (e.g. for bradycardia)
Bronchodilator (e.g. ipratropium bromide, tiotropium)
Urge incontinence (e.g. oxybutynin)

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15
Q

mechanism of action antimuscarinics

A

block acetylcholine binding of nictoninic receptors to SUPPRESS the parasympathetic nervous system

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16
Q

side effects antimuscarinics

A

dry mouth, sore throat
dry eyes, pupillary dilatation
tachucardia
constipation, urinary retention
confusion, disorientation

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17
Q

drugs to consider confusion in the elderly

A
  1. OPIOIDS
  2. cyclizine
  3. diazepam
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18
Q

which drugs increase the risk of methotrexate toxicity

A

NSAIDs

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19
Q

what does co-dydramol 10/500 mean

A

500 mg paracetamol, 10mg codeine

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20
Q

when is methotrexate contraindicated

A
  1. ACTIVE INFECTION
  2. ASCITES
  3. IMMUNODEFICIENCY SYNDROMES
  4. significant pleural effusion
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21
Q

correct route of administration for insulin

A

SC (apart from sliding scales using a short acting insulin- IV)

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22
Q

drugs to continue pre-surgery

A
  • cardiac or anti-hypertensives (except ACEi, ARBs, diuretics)
  • epilepsy + Parkinson’s drugs
  • asthma/ COPD inhalers
  • PPIs
  • Thyroid medication
  • antidepressants
  • regular steroids
  • immunosuppressants + cancer drugs
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23
Q

drugs to stop pre-surgery

A

ACE i

ARBs

diuretics

anticoagulants + antiplatlets

HRT + COCP (stop 4 weeks before)

Lithium

NSAIDs

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24
Q

antidiabetic medications and surgery

A
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25
Q

adult daily fluid requirements

A

1mmol/kg K+/Na+/Cl- daily
50-100g glucose/day
25-30 ml/kg water daily

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26
Q

what important safety information should be given for each of the oral hypoglycaemic agents

A
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27
Q

outline the key information for psychiatric drugs

A
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28
Q

give examples of drugs with a narrow therapeutic index and therefore require monitoring

A

lithium, phenytoin, digoxin, theophylline
abx (gentamicin and vancomycin)

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29
Q

features of digoxin toxicity

A

confusion, nausea, visual halos, arrythmias

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30
Q

features of lithium toxicity

A
  • coarse tremor (a fine tremor is seen in therapeutic levels)
  • hyperreflexia
  • acute confusion
  • polyuria
  • seizure
  • coma
  • arrythmias
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31
Q

how is gentamicin dosed

A

by weight:
typical regime is high dose 5-7mg/kg once daily

if renal failure: divided dosing
1mg/kg 12 hourly

endocarditis: divided dosing
1mg/kg 8 hourly

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32
Q

what is interesting about montiorign gentamicin levels

A

dose is never changed, just the duration between dose

e.g. switch to 36 or 48 hourly dosing, or withhold if VERY high levels

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33
Q

explain the metabolism of paracetamol

A

metabolised by gluthionine in the liver

in overdose, gluthionine is overwhelmed resulting in build up of toxic NAPQI

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34
Q

how does N=-acetylcysteine work

A

replenishes stores of gluthionine in the liver

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35
Q

management paracetamol overdose

A

if presenting <1hour: activated charcoal

give N-acetylcysteine:
- if above treatment line on normogram
- staggered dose
- presentation 8-12 hours post overdose with >150mg/kg ingested
- >24 hours if hepatic dysfunction

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36
Q

warfarin targets

A

general: 2.5
recurrent thromboembolism on warfrin: 3.5

prosthetic mitral valve: 3.5
prosthetic aortic vakve: 3.0

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37
Q

effect of NSAIDs on the kidneys

A

NSAIDs inhibit prostaglandin synthesis

prostaglandins normally cause afferent arteriole dilation, so NSAIDs reduce dulation of afferent arteriole- threfore CONTRAINDICATED IN RENAL ARTERY STENOSIS

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38
Q

List some drugs that affect renal blood flow.

A

ACE inhibitors - reduce efferent arteriolar constriction

NSAIDs - decreased afferent arteriolar constriction

Calcineurin inhibitors - decrease afferent arteriolar constriction

Diuretics - affect tubular funciton and decrease preload

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39
Q

digoxin is contraindicated in

A

BRADYCARDIA

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40
Q

what are the 2 form of available lithium

A

lithium citrate and lithium carbonate= NOT DOSE EQUIVALENT

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41
Q

how should lithium be monitored?

A

12 hours post dose

after dose change:
weekly until levels stabilised. Then every 3 months for first year, every 6 months after that

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42
Q

plasma concentration lithium

A

0.4-1mmol/L

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43
Q

what does lithium monitoring entail once established on tx

A

measure weight, U&Es, Ca, TFTs 6 monthly

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44
Q

ECG finding digoxin toxicity

A

reverse tick phenomenon

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45
Q

when is dogixin tocity made worse

A

in states of hypokalaemia,

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46
Q

when should digoxin levels be checked?

A

6 hours post dose

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47
Q

when should digoxin dose be halved?

A

concurrent use with amiodarone, dronedarone and quinine

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48
Q

switch IV to oral route digoxin

A

dose may beed to be increased by 20-33% to maintain same plasma concentration

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49
Q

what can carbimazole cause

A

ACUTE PANCREATITIS, NEUTROPAENIA, angranulocytosis,

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50
Q

statins and transaminases

A

at 3 month blood test if transaminases are <3X upper limit, no change needs to be made to statin therapy

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51
Q

outline azathioprine monitoring

A

monitor FBC weekly for first 4 weeks, then 3 ,monthly

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52
Q

what limits the use of amiodarone

A

very long half-life (20-100 days). For this reason, loading doses are frequently used
should ideally be given into central veins (causes thrombophlebitis)
has proarrhythmic effects due to lengthening of the QT interval
interacts with drugs commonly used concurrently (p450 inhibitor) e.g. Decreases metabolism of warfarin
numerous long-term adverse effects (see below)

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53
Q

MOA amiodarone

A

class IIII antiarrythmic

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54
Q

monitoring amiodarone

A

TFT, LFT, U&E, CXR prior to treatment
TFT, LFT every 6 months

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55
Q

adverse effects amiodarone

A

thyroid dysfunction: both hypothyroidism and hyper-thyroidism
corneal deposits
pulmonary fibrosis/pneumonitis
liver fibrosis/hepatitis
peripheral neuropathy, myopathy
photosensitivity
‘slate-grey’ appearance
thrombophlebitis and injection site reactions
bradycardia
lengths QT interval

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56
Q

hyponatraemia correction limit

A

no more than 10mmol/L over 24 hours

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57
Q

hyponatraemia medications to hold

A

thiazide
if on PPI switch to famotidine

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58
Q

which drugs require a dose reduction in renal impairment

A

morphine, gabapentin, gliclazide

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59
Q

when should ACEi be given

A

night time (can cause postural hypotension)

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60
Q

when can bisphosphonates be deprescribed?

A

there is no evidence for treatment beyond 10 years; management of these
patients should be on a case-by-case basis with specialist input as appropriate

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61
Q

patient develops HTN on COCP

A

The progesterone-only pill
(mini-pill, POP) is a suitable alternative as it is classified as safe for use in hypertensive patients, or
patients who have developed hypertension secondary to COCP use

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62
Q

main side effect CCB

A

peripheral oedema

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63
Q

side effects cyclizine

A

sedative antihistamien with antimuscarinic effects

64
Q

oxygen prescription for hypercapnic COPD patient

A

Oxygen 28 % Venturi mask continuous

65
Q

at what plasma level is lithium toxicity shown

A

> 1.5 mmol/L

66
Q

what can precipitate lithium toxicity

A
  • dehydration
  • renal failure
  • drugs: diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole
67
Q

when should ramiprim be withheld

A

when a patient is acutely unwell/ with reduced oral intake

68
Q

when should antiplatelet agents be withheld

A

7 days before surgery

69
Q

when should nitrofurantoin be avoided?

A

renal impairment

70
Q

what is the max dose of citalopram in the elderly

A

10mg PO OD

71
Q

which drugs are dosed in micrograms

A

levithyroxine, tamulosin, digoxin, colchicine, naloxone, fludrocortisone, inhalers, GTN spray, ipratropium

72
Q

which drugs are dosed in high 00s (mg)

A

some abx, metformin, some antiepileptics

73
Q

which drugs are dosed in grams

A

paracetamol, lithium, NAC, calcium carbonate

74
Q

outline common drugs and frequencies

A

morning: diuretics and steroids
night: statins, sedatives
activity: parkinson’s
meals: insulin/ creon
weekly: methotrexate, folic acid, patches, bisphosphonates

75
Q

which drugs are taken PR

A

laxatives, diclofenac, diaxepam

76
Q

which drugs are taken SC

A

LMWH and insulin

77
Q

which drugs cause oral candidiasis

A

steroids, abx, immunosuppressants

78
Q

mx orla thrush

A

nyastin drops

79
Q

adults emegrnecy resus fluids

A

0,9% NaCl 500ml over 15 mins

80
Q

emergency hypoglycaemia fluids

A

100ml 20% glucose over 15 mins

81
Q

emrgency hypokalaemia fluids

A

1000 ml NaCL 0.9%/ 0.3% KCl over 4 hours

82
Q

emergency hypercalcaemia fluids

A

1000ml 0.9% NaCl over 4 hours

83
Q

adults maintenance fluids without losses

A

0.9% NaCl/ 0.3% KCl 1L over 8 hours
5% glucose/ 0.15% KCl 1L over 8 hours

84
Q

adults maintenance fluids with losses

A

use upper limit of water replacement (30ml/kg) over 4-6 hours

85
Q

paediatric emergency fluid bolus

A

10ml/kg over 10 mins 0.9% saline

86
Q

paediatric maintenance fluids

A

<10kg: 100ml/kg
<20: 50ml/kg
every kg >20: 20ml/kg

NaCl 0.9%/ 5% glucose

87
Q

rate equations

A

rate (volume-per-time) = dose per time/ concentration

rate = dose/ time

88
Q

drugs needing dose adjustment in CKD

A

abx (gentamicin, vancomycin, cephalosporin, penicillins)
digoxin
atenolol
methotrexate
sulfonylureas
furosemide
opioids

89
Q

drugs to avoid in renal failure

A

NSAIDSs
lithium
abx (nitrofurantoin, tetracycline)
metformin

90
Q

drugs to stop AKI

A

diuretics, aminoglycosides/ ACEi, metformin, NSAIDs

91
Q

examples of COCP and POP

A

COCP- microgynon 30
POP- cerazette (deogestrel)

92
Q

names of emergency contraception

A

evonorgestrel (levonelle)
Ullipristal (EllaOne)

93
Q

antocoagulants and monitoring

A

LMWH: anti factor 10x
unfractionated: aPTT
DOAC: not required
warfarin: INR

94
Q

anticoagulants and reversal agents

A

LMWH/ unfractionated heparin: protamine sulphate
dabigatran- adarucizuman
apixiban/ ribaroxaban- adnexanet alpha
warfarin- vitamin K agonist/ PCC

95
Q

HRT continuous or sequential

A

sequential if amenorrhoeic <1 year
continuous if amenorrhoeic >1 year

96
Q

HRT combined name

A

oestradiol with norethisterone (elleste duet) - tablet

evorelle conti/ evorelle sequi (PATCH)

97
Q

oestrogen only HRT

A

oestradiol (elleste solo)

98
Q

rapid acting insulin

A

novorapid (insulin aspart)

99
Q

short acting insulin

A

actrapid (insulin human)

100
Q

intermediate acting insulin

A

isoform insulin

101
Q

long acting insulin

A

levemir (insulin determir)
lantus (insulin glargine)

102
Q

mixed insulin (biphasic)

A

novomix

103
Q

confusion, falls, gout, osteoporosis, hypertension, high cholesterol drug causes

A
104
Q

electrolyte imbalance causes

A
105
Q

drugs to stop intercurrent illness

A

metformin, statins, gliflozins (SGLT-2)

106
Q

drugs to stop if trying to conceive

A

isotretinoin, methotrexate, warfarin

107
Q

DOACs and surgery

A

48h, clopidogrel 7 days, warfarin (brudging plan)

108
Q

drugs worsening parkinsons, mG, psoriasis, heart failure

A
109
Q

hypo and hyperglycaemia drug causes

A
110
Q

drug causes constipation and diarrhoea

A
111
Q

drug causes urinary retention and incontinence

A
112
Q

what drugs commonly cause dyspepsia

A

steroids and bisphosphontes

113
Q

drugs causing bradycardia

A

bisoprolol and digoxin

114
Q

which drugs cause oedema

A

CCBs and naproxen

115
Q

drugs causing nasal congestion

A

selegiline and prazocin

116
Q

NSAIDs avoided in

A

previous MI

117
Q

common side effect of all insulins

A

oedema

118
Q

fluids on the day of surgery diabetes

A

1000ml over 12 hours of

119
Q

management of opioid induced constipation

A

combination of stimulant and osmotic laxative

120
Q

doxycyclien efficacy reduced by

A

ferrous sulphate

121
Q

drug causes of hypertension

A

steroids
monoamine oxidase inhibitors
the combined oral contraceptive pill
NSAIDs
leflunomide

122
Q

drugs that may worsen osteoporosis

A

SSRIs
antiepileptics
proton pump inhibitors
glitazones
long term heparin therapy
aromatase inhibitors e.g. anastrozole

123
Q

mx opioid induced constipation

A

combination: stimulant + osmotic laxative

124
Q

calcium and ferrous sulphate intake

A

should NOT be taken together: calcium should be taken 1 h before ferrour or 2h after

125
Q

major side effects quinolones

A

TENDON DISORDERS

126
Q

cataract surgery (risk of intra-operative floppy iris syndrome);

A

TAMULOSIN

127
Q

T2DM hba1c target

A

<48

128
Q
A

diabetic meds

129
Q

ROUTE for vaginal pessary

A

PV

130
Q

fluid to start with nariable rate insulin infusion

A
131
Q

dose for creams

A

X applications, topical

132
Q

what drugs can cause hyperuricaemia

A

thiazide diuretics, aspirin, ticagrelor

133
Q

arrythmia + hypotension drug

A

digoxin

134
Q

best SSRI with cardiac comorbidity

A

sertraline

135
Q

directions for administering GTN spray

A

take while sitting down, can cause hypotension

136
Q

fluid deficit children equation

A

Fluid deficit (mL) = % dehydration x weight (kg) x 10

137
Q

cholestatic drugs

A

fluclox
co-amox
nitrofurantoin
steroids
sulphonylureas
fusidic acid

138
Q

relationship between FiO2 and PaO2

A

PaO2 should be Fio2-10

139
Q

tamoxifen and warfarin

A

increases efficacy- HIGH INR

140
Q

statin monitoring

A

rfx: CK baseline
no risk factors: alt

141
Q

STATIN major drug reaction

A

statin + macrolide

142
Q

patient takign lithium develops hypertension, which medicatiin

A

CCB (do not choose ace, arb, thiazides, loop)

143
Q

gentamicin dosing changes

A

high post 1 hour PEAK: reduce dose
high pre-dose (trough): increase interval

144
Q

why is trimethoprim contraindicated with methotrexate use

A

both are FOLATE antagonists

145
Q

what group of patients should DPP4 and GLP-1 agonists be avoided in?

A

those at increased risk of pancreatitis

146
Q

what drugs commonly cause thrombocytopaenia

A

penicillins

147
Q

examples of POP

A

traditional: (missed pill= >3h late)
- micronor, noriday

other: (missed pill >12h late)
- cerazette (desorgestrel)

148
Q

MOA POP

A

traditional: thickens cervical mucus
cerazette: inhibits ovulation

149
Q

colchicine contraindicated in acute gout with patients taking which medication

A

STATINS (increased risk myopathy)

150
Q

oestrogen only contraceptives

A

elleste solo (oral)
evorel (transdermal) - first line if BMI >30

151
Q

PV oestrogen gel

A

sandrena

152
Q

adjunct prohesterones for HRT

A

lNG IUS
medroxyprogesterone acetate

153
Q

1st line oral and transdermal HRT combined

A

sequential:
transdermal: evorel sequi
oral: elleste duel

continuous:
transdermal: evorel conti
oral: kilovance

(oestradiol and norethisterone)

154
Q

contraindications for laxatives

A

stimulant: bowel obstruction
osmotic: bloating
bulk forming: faecal impaction

155
Q

mx of statins in statin myopathy

A

stop statin
remeasure CK
if CK returns to normal, continue at lower dose

156
Q

first line for painful diabetic neuropathy

A

duloxetine

157
Q

diretic to be given if rewuired when patient on lithium

A

furosemide (ACEi/arb, NSAIDs CI with lithium use)

158
Q

prescription for rapid relief of heartburn

A

magesium carbonate

PSA (1 decks)

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