PSA Flashcards
1
Q
daily requirements of water
A
25-30ml / kg/ 24 hr
70kg person needs 1750ml-2100ml per day
2
Q
daily requirement of Na
A
1mmol/kg/24h
70mmol per day
3
Q
daily requirement of K
A
1mmol/kg/24h
70mmol per day
4
Q
daily requirement of glucose per day
A
50-100g / 24h glucose
5
Q
whats important to remember about replacing potassium ?
A
don’t replace it faster than 10mmol/h
6
Q
how many mmol is NaCl 0.9% 1000ml?
A
150mmol
7
Q
how many mmol is KCl 0.3% 1000ml?
A
40mmol
8
Q
how many mmol is KCl 0.15% 1000ml?
A
20mmol
9
Q
how many g is 5% glucose 1000ml?
A
50g
10
Q
emergency resus fluids to prescribe ?
A
NaCl 0.9% solution, 500ml over 15 minutes
11
Q
emergency hypoglycaemia what to prescibe in infusion?
A
glucose 20%, 100ml over 15mins
12
Q
emergency hypercalcaemia fluids to prescribe ?
A
NaCl 0.9%, 1000ml, over 4h
13
Q
emergency hypokalaemia fluid resus
A
NaCl 0.9% / KCl 0.3%, 1000ml, 4h
14
Q
maintenance fluids without defifict or losses
A
25-30ml/kg/24h water
1mmol/kg/24h Na and K
50-100g/24h glucose
(aim 1000ml 9-12h)
15
Q
maintenance fluids with deficits or losses e.g. Na/K
low, vomiting, diarrhoea
A
minimum 30ml/kg/24h water
ensure electrolytes replaced
note aim for 1000ml 4-6h
(quicker replacing time compared to if there were no defiicits)
16
Q
what VTE prophylaxis should you give a medical patient who has a background of CKD ?
A
Not LMWH
Give unfractionated heparin 5000 SC units twice daily
17
Q
how do you monitor a patient on LMWH ?
A
anti-factor Xa
18
Q
how do you monitor a patient on unfractionated heparin ?
A
aPTT
19
Q
how do you monitor a patient on NOAC/DOAC ?
A
clinically
20
Q
How do you monitor a patient on warfarin ?
A
INR
21
Q
what to prescribe for patient with hypocalcaemia
A
calcium gluconate 10%, 10ml over 10min
22
Q
you need to go through HRT prescribing
A
do this
22
Q
if a question says that we’re at the gp where is the best place to look on BNF?
A
Medical emergencies in the community - treatment summary
23
Q
A
24
3 prescribing errors to look for in the prescibring error questions
1. check units
2. frequency / timing
3. Route
25
what time of day do u want to give steroids ?
morning
(they can stop you sleeping)
26
what time of day do you want to give diuretics ?
morning
too much peeing
27
when do you want to give statins ?
at night
This is because the body produces most cholesterol during the night, and statins work by inhibiting HMG-CoA reductase, a key enzyme involved in cholesterol synthesis.
28
what medication is important to give with meals ?
insulin
creon
29
special about giving prednisolone ?
give it in the morning otherwise patient won't be able to sleeep
30
important side effect of PPIs for eldery people
increase fracture risk
31
if a question asks increased risk of falls what side effects do you look for in drugs
drowsiness, postural hypotension, dizziness etc
32
drugs which increase risk of falls (6)
1. Benzodiazepines
2. Antidepressants (particularly TCAs and SNRIs)
3. Monoamine oxidase inhibitors (antidepressants)
4. Most antipsychotics
5. Opiates
6. Most antihypertensives (particularly diuretics and alpha-blockers)
33
drugs which increase risk of fractures (3)
1. PPIs
2. Steroids
3. GnRH agonists
4. (buserelin, goserelin etc)
34
side effects of metformin
Nausea, diarrhoea, MALA (take care if eGFR <45, stop if eGFR <30)
35
side effects of gliclazide
hypoglycaemia
36
side effects of sulfonylurea
hypoglycaemia
37
side effects of pioglitazone
Oedema, heart failure, post-menopausal OP, bladder cancer
38
side effects of sitagliptin
Pancreatitis, nasopharyngitis
39
side effects of acarbose
Bloating, flatulence, diarrhoea
40
side effects of exanatide
Nausea, diarrhoea, pancreatitis
also good for weight loss
41
side effects of SGLT-2i (-gliflozin)
Euglycaemic DKA, genital infections
42
side effects of insulin
Hypoglycaemia, lipodystrophy
43
which diabetic drugs make you gain weight and therefore you would think differently about prescribing for raised BMI?
gliclazide
pioglitazone
insulin
44
what do you monitor if a t1dm patient has their insulin glargine (lantus) changed ?
this is the long acting insulin so you want to see what what happening overnight.
therefore,
You need to monitor the pre-breakfast capillary glucose as this is the long acting insulin that will work to keep her blood glucose levels low overnight and into the next day.
45
when do you measure fructosamine
Fructosamine 2 week diabetic control picture (good in pregnancy, blood disorders increasing RBC turnover etc.)
46
before starting lithium what do you need to check ?
As per the BNF the required things to assess before starting lithium are FBC, U&Es, TFTs and BMI (also ECG if cardiovascular disease or risk factors for it but not needed for this scenario).
47
what are the requirements for monitoring lithium levels ?
Serum-lithium should be checked 12 hours after the dose and be 0.4-1mmol/L
Routine serum-lithium monitoring should be performed weekly after initiation and after each dose change until concentrations are stable, then every 3 months for the first year and every 6 months thereafter
48
where to go if you want to find info on warfarin ?
treatment summaries --> oral anticoagulants --> haemorrhage (even if there is no bleeding)
49
what drugs need to be stopped / withheld before surgery and what are the time frames ?
DOACs (48 hrs)
antiplatelet agents = clopidogrel / aspirin (7 days)
warfarin (bridging plan)
combined hormonal contraceptives
Potassium-sparing diuretics may need to be withheld on the morning of surgery because hyperkalaemia may develop if renal perfusion is impaired or if there is tissue damage
50
common drugs causing hypontraemia
diuretics
SSRIs
haloperidol and phenothiazines
Carbamazepine
51
what happens with peri-operative warfarin - how do you manage these kinds of patients ?
Peri-operative anticoagulation
Warfarin sodium should usually be stopped 5 days before elective surgery; phytomenadione (vitamin K1) by mouth (using the intravenous preparation orally [unlicensed use]) should be given the day before surgery if the INR is ≥1.5. If haemostasis is adequate, warfarin sodium can be resumed at the normal maintenance dose on the evening of surgery or the next day.
Patients stopping warfarin sodium prior to surgery who are considered to be at high risk of thromboembolism (e.g. those with a venous thromboembolic event within the last 3 months, atrial fibrillation with previous stroke or transient ischaemic attack, or mitral mechanical heart valve) may require interim therapy (‘bridging’) with a low molecular weight heparin (using treatment dose). The low molecular weight heparin should be stopped at least 24 hours before surgery; if the surgery carries a high risk of bleeding, the low molecular weight heparin should not be restarted until at least 48 hours after surgery.
Patients on warfarin sodium who require emergency surgery that can be delayed for 6–12 hours can be given intravenous phytomenadione (vitamin K1) to reverse the anticoagulant effect. If surgery cannot be delayed, dried prothrombin complex can be given in addition to intravenous phytomenadione (vitamin K1) and the INR checked before surgery.
52
combined oral contraceptive - what to do in the case of a missed pill / two missed pills
If 1 pill is missed (at any time in the cycle)
take the last pill even if it means taking two pills in one day and then continue taking pills daily, one each day
no additional contraceptive protection needed
If 2 or more pills missed
take the last pill even if it means taking two pills in one day, leave any earlier missed pills and then continue taking pills daily, one each day
the women should use condoms or abstain from sex until she has taken pills for 7 days in a row. FSRH: 'This advice may be overcautious in the second and third weeks, but the advice is a backup in the event that further pills are missed'
if pills are missed in week 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1
if pills are missed in week 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception*
if pills are missed in week 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval
*theoretically women would be protected if they took the COC in a pattern of 7 days on, 7 days off
53
changes to U&Es expected when starting ACE-i
small rise in creatinine (< 20%) is normal
54
how to adjust someones insulin
look at the point when the blood glucose levels start to rise not just when they reach above the threshold level
if they start to rise pre-midday then consider increasing novarapid taken with breakfast
55
what is normal urine output ? per hour and per day
Average urine output should be very minimum approximately 0.5mL/kg/hour
70kg man would be around 35-70 ml/hour
Therefore under 25/30 mL per hour is bad
under 500mL per day is bad
56
patient with AKI what fluid do you prescribe ?
You need to give them a bolus
e.g. NaCl 0.9% 1000mL 15 mins
57
how long to prescribe maintainence fluids for ?
1000mL over 10 hours
it says 8-12 hours but i think maybe stuff doesn't acc get prescribed over 12 hours
58
if post op pain not controlled by weak opiate what should you do ?
step up to strong opiate
e.g. change from
codeine --> morphine
(no point stepping up codeine to tramadol)
59
t1dm patient with high glucose / in hospital sick with pneumonia - how do you appraoch this
This diabetic patient has an elevated capillary blood glucose and is unwell with a pneumonia. His
background insulin has been increased appropriately (Insulin Glargine increased from 18 to 20 units)
but he still needs an increase in his rapid acting insulin alongside his meals.
Ideally an increase to the
same type of insulin that the patient is already taking should be prescribed (in this case Novorapid).
A correction factor (CF) is an estimate of how much 1 unit of rapid acting insulin will lower someone’s
blood glucose. It can be calculated by dividing 100 by the total daily dose (TDD) of insulin.
For this patient the usual TDD is therefore:
18 (18 units of Insulin Glargine once daily) + 21 (7 units of Novorapid three times daily) = 39.
This patient’s CF is therefore 100/39 = ~2.5.
So for every 1 unit of rapid acting insulin, this patient’s blood glucose will fall by approximately 2.5
mmol/L.
This patient therefore requires approximately 4 units of Novorapid to bring their blood glucose
back in to normal range.
60
how to convert someone from lots of immediate release morphine to modified release morphine?
add up all of their immediate release morphine and then make it into 2 doses of modified release
61
what fluids do you give in HHS ?
1L sodium chloride 0.9% over 1 hour
also 500mL over 30 mins
62
person with o2 sats < 85% and you need to give o2 - how will you give this ?
oxygen 15 L/min
non rebreather mask
continuous
63
long term bisphosphonates ?
Alendronic acid
The BNF states that for
bisphosphonates, “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”, therefore this would
be the most appropriate to deprescribe.
Plan to prescribe oral bisphosphonates for at least 5 years, or intravenous bisphosphonates for at least 3 years and then re-assess fracture risk.
64
patient develops hypertension after being started on COCP - what do you do ?
Switch Microgynon (Ethinylestradiol 30 microgram with Levonorgestrel 150 microgram) 1 tablet
PO daily to Cerazette (Desogestrel 75 microgram) 1 tablet PO daily
--> you want to switch to the progesterone only pill
65
max dose amlodipine
10mg daily
66
max dose of bisoprolol daily?
20mg
67
which 3 diabetes drugs cause weight gain ?
pioglitazone
gliclazide (sulphonylureas)
insulin
68
post op patient on variable rate insulin infusion for 12 hours post op, she's now eating and drinking - what is the correct management for her insulin ?
adminster short acting insulin with next meal (insulin lispro) and continue Variable rate insulin for 1 hour agfterwards
cause she's eating and drinkning you want to get her back on track with her normal insulin
69
what does elderly mean on bnf ?
> 65
70
partial improvement in sx following initation of SSRI for depression after 4 weeks - what do you do ?
you can increase the dose - check what max dose is on bnf
71
hba1c targets when you're taking diabetic meds ?
Lifestyle
48 mmol/mol (6.5%)
Lifestyle + metformin
48 mmol/mol (6.5%)
Includes any drug which may cause hypoglycaemia (e.g. lifestyle + sulfonylurea)
53 mmol/mol (7.0%)
72
what does the % mean on a medication ?
grams in 100mL
e.g. 10% MgSO4 solution contains 10g in 100mL
73
how to calculate a child's maintenance fluids ?
The first 10kg of weight replaces fluid at a rate of 100 ml/kg/day.
The second 10kg of weight replaces fluid at a rate of 50 ml/kg/day.
Then any extra kg in weight above 20kg total weight is replaced at a rate of 20 ml/kg/day.
EXAMPLE:
This patient weighs 24kg. Therefore he will need 1000ml for his first 10kg of weight, 500ml for his next 10kg of weight and another 80ml for the last 4kg.
74
what monitoring requirement before starting ullipristal acetate ?
no monitoring requirements since its an emergency contraception
75
what do you monitor before and during taking COCP?
weight
blood pressure
76
patient on metformin 500mg TDS and still have poor glycaemic control (HbA1c = 60) - what do you do ?
Give them max dose metformin (2g per day)
most likely 1g BD
You need to load them up on max dose metformin before you give them another medication
77
important side effect of tamoxifen ?
VTE
78
levothyroxine therapy - initaing treatment and what you're trying to do - explain this ....
initial starting dose of levothyroxine should be lower in elderly patients and those with ischaemic heart disease.
The BNF recommends that for patients with cardiac disease, severe hypothyroidism or patients over 50 years the initial starting dose should be 25mcg od with dose slowly titrated. Other patients should be started on a dose of 50-100mcg od
the therapeutic goal is 'normalisation' of the thyroid stimulating hormone (TSH) level. As the majority of unaffected people have a TSH value 0.5-2.5 mU/l it is now thought preferable to aim for a TSH in this range
79
what do you need to be aware of for NSAID use ?
Crohn's disease; fertility decreased female;
fluid retention; heart failure; hypertension;
increased risk of arterial thromboembolism --> therefore be careful when prescribing in someone with previous stroke/TIA
renal failure (more common in patients with pre-existing renal impairment);
respiratory disorders; respiratory tract reaction
80
common side effect for all insulins
oedema
81
what to do with type 2 diabetes patient on long acting insulin taken in the morning - in the peri-operative period ?
Give 80% of dose and blood glucose to
be checked on admission
82
How should DOACs be taken ?
with food
83
84
85
86
how to manage lower UTI in pregnant woman ?
first-line: nitrofurantoin (should be avoided near term)
second-line: amoxicillin or cefalexin
trimethoprim is teratogenic in the first trimester and should be avoided during pregnancy
87
paeds fluid bolus amount ?
Paediatric fluid bolus is 10mL/kg
a 14/15 year old will most likely be around 45/50kg so you would just give them 500mL
88
how to calculate someone's fluids if they are dehydrated as well
you do:
maintainence + replacement
replacement (fluid deficit mL) = %dehydration x weight (kg) x 10
89
what insulin do you prescribe in DKA ?
e.g. novarapid
0.1units/kg/hour
90
what is furosemide's effect on calcium
increases excretion of calcium into the urine
therefore leading to increased risk of renal stones
91
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