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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

what must be checked on ALL prescriptions

A

Patient details
Reactions (allergies)
Signature
Contraindications
Route
IV fluids
Blood clot prophylaxis
Emetics (antiemetics)
Relief of pain

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6
Q

key contraindications anticoagulant

A

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

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7
Q

what drug increases the anticoagulant effect of warfarin

A

erythryomycin (P450 inhibitor)

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8
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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9
Q

maximum rate of IV K+

A

NEVER MORE than 10mmol/hour

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10
Q

prescribing maintenance fluids adults

A

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

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11
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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12
Q

what is the maximum daily dose of paracetamol

A

4g/day

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13
Q

max paracetamol dose in patients <50kg

A

500mg 6 hourly (2g/day)

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14
Q

which 2 drugs when used together can cause AKI

A

ACEi and NSAIDs

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15
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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16
Q

antimuscarinics should be used with caution in …

A

elderly patients

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17
Q

mechanism of action antimuscarinics

A

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

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18
Q

side effects antimuscarinics

A

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

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19
Q

drugs to consider confusion in the elderly

A
  1. OPIOIDS
  2. cyclizine
  3. diazepam
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20
Q

which drugs increase the risk of methotrexate toxicity

A

NSAIDs

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21
Q

what does co-dydramol 10/500 mean

A

500 mg paracetamol, 10mg codeine

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22
Q

when is methotrexate contraindicated

A
  1. ACTIVE INFECTION
  2. ASCITES
  3. IMMUNODEFICIENCY SYNDROMES
  4. significant pleural effusion
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23
Q

correct route of administration for insulin

A

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

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24
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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25
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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26
Q

antidiabetic medications and surgery

A
27
Q

adult daily fluid requirements

A

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

28
Q

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

A
29
Q

outline the key information for psychiatric drugs

A
30
Q

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

A

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

31
Q

features of digoxin toxicity

A

confusion, nausea, visual halos, arrythmias

32
Q

features of lithium toxicity

A
  • coarse tremor (a fine tremor is seen in therapeutic levels)
  • hyperreflexia
  • acute confusion
  • polyuria
  • seizure
  • coma
  • arrythmias
33
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

34
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

35
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

36
Q

how does N=-acetylcysteine work

A

replenishes stores of gluthionine in the liver

37
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

38
Q

warfarin targets

A

general: 2.5
recurrent thromboembolism on warfrin: 3.5

prostehtic mitral valve: 2.5
prosthetic aortic vakve: 3.5

39
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

40
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

41
Q

digoxin is contraindicated in

A

BRADYCARDIA

42
Q

what are the 2 form of available lithium

A

lithium citrate and lithium carbonate= NOT DOSE EQUIVALENT

43
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

44
Q

plasma concentration lithium

A

0.4-1mmol/L

45
Q

what does lithium monitoring entail once established on tx

A

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

46
Q

ECG finding digoxin toxicity

A

reverse tick phenomenon

47
Q

when is dogixin tocity made worse

A

in states of hypokalaemia,

48
Q

when should digoxin levels be checked?

A

6 hours post dose

49
Q

when should digoxin dose be halved?

A

concurrent use with amiodarone, dronedarone and quinine

50
Q

switch IV to oral route digoxin

A

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

51
Q

what can carbimazole cause

A

ACUTE PANCREATITIS, NEUTROPAENIA, angranulocytosis,

52
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

53
Q

outline azathioprine monitoring

A

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

54
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)

55
Q

MOA amiodarone

A

class IIII antiarrythmic

56
Q

monitoring amiodarone

A

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

57
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

58
Q

hyponatraemia correction limit

A

no more than 10mmol/L over 24 hours

59
Q

hyponatraemia medications to hold

A

thiazide
if on PPI switch to famotidine

60
Q

which drugs require a dose reduction in renal impairment

A

morphine, gabapentin, gliclazide

61
Q

when should ACEi be given

A

night time (can cause postural hypotension)

62
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

63
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

64
Q

main side effect CCB

A

peripheral oedema

65
Q
A

PSA (1 decks)

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