PSA Flashcards
What is a risk factor associated with osteonecrosis of the jaw in patients on bisphosphonates?
poor dental hygiene
What are the adverse effects associated with bisphosphonates?
Oesophageal reactions e.g., oesophagitis, ulcers
Osteonecrosis of the jaw
Increased risk of atypical stress fractures
Hypocalcaemia
How should bisphosphonates be administered?
30 minutes before breakfast, with water on an empty stomach
Prior to bisphosphonate therapy, what should be corrected first?
Correct calcium and vitamin D
Why is pioglitazone contraindicated in heart failure?
Causes fluid retention
Why is verapamil contraindicated in heart failure?
Exerts a negative inotropic effect
Why are NSAIDs not recommended in patients with heart failure?
Causes fluid retention
Lifestyle + Metformin - HbA1c target?
48 mmol/mol
HbA1c target for sulfonylurea
<53 mmol/mol
When should oxygen be delivered in ACS management?
if oxygen saturations are <94%
How is fondaparinux administered?
SC injection
What is the preferred VTE prophylactic drug?
Low molecular weight heparin (LMWH) e.g., enoxaparin
Which type of heparin is indicated as VTE prophylaxis in patients with CKD?
Unfractionated heparin (UFH)
What are the common adverse effects associated with amlodipine?
Diarrhoea, peripheral oedema, headache,
What parameter is used to assess whether the digoxin dose is effective?
Ventricular rate at rest
When should the digoxin level be measured post administration?
at least 6 hours after the last dose
Which drug is used as an alternative to adenosine, in patients with asthma?
Verapamil
Which two investigations are recommended to assess for digoxin toxicity other than digoxin level?
ECG
Urea and electrolytes
Which drugs are usually taken at night?
Statins and amitryptiline
Which anti-emetic is indicated in patients that have a prolonged QT interval?
Cyclizine
Which three anti-emetics are associated with QT prolongation?
Metoclopramide
Ondanestron
Haloperidol
What is the first line drug for the management of shingles?
800 mg acyclovir oral five times daily for 7 days
What is the first line pain management for postherpetic neuralgia?
Simple analgesia e.g., paracetamol
What is the first line management for fluid resuscitation?
IV crystalloids 500 mL bolus over 15 minutes e.g., 0.9% sodium chloride
What effect does ciclosporin have on potassium?
Hyperkalaemia
What is the investigation performed prior to starting statins?
Serum AST/ALT
When should serum ALT be checked once starting statin therapy?
At 3 and 12 months
When should a statin be stopped in reference to serum transaminase level?
3 x UPPER normal limit of AST/ALT
What investigation should be performed prior to starting vancomycin?
Serum creatinine - renal function
What is the normal reference range for lithium?
0.4-0.8
How frequently should lithium levels be measured once stabilised?
Every 3 months
What investigations should be checked at baseline when starting methotrexate?
Baseline FBC and liver function tests
How frequently should FBC be measured in patients first starting methotrexate, until stabilisation?
Every 1-2 weeks
What investigations are performed at baseline in patients starting olanzapine?
Blood lipids, weight and fasting blood glucose
Which investigation is important to perform in patients starting hormonal contraception?
Blood pressure
Which electrolyte should be checked prior to starting amiodarone?
Potassium
What baseline investigations should be performed prior to starting amiodarone?
Baseline X-ray due to pulmonary toxicity
When is the 1-hour peak serum concentration for gentamicin?
3-5 mg/L
What investigation should be performed in regular intervals in patients on ACEi?
Urea and electrolytes
What investigation is performed prior to starting sodium valproate?
Liver function tests at baseline
How frequent should FBC be measured in patients on clozapine?
Weekly for the first 18 weeks due to agranulocytosis risk
What are the two main adverse effects associated with gentamicin and vancomycin?
Ototoxicity
Nephrotoxicity
What visual disturbance is associated with digoxin?
yellow/green visual perception distortion
What are the main adverse effects associated with aspirin?
Peptic ulcers, and gastritis
Tinnitus in large doses
What is the early adverse effect associated with lithium?
Tremor
What are the late adverse effects associated with lithium?
Renal failure
Diabetes insipidus
Seizures
What are the commonest enzyme inhibitors (AO DEVICES)?
Allopurinol
Omeprazole
Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol
Sulphonamides
‘AODDEVICES’
What are the commonest enzyme inducers (PC BRAS)?
Phenytoin
Carbamazepine
Barbituates
Rifampicin
Alcohol
Sulphonylureas
What significant adverse drug reaction is associated with metformin?
Lactic acidosis
What adverse drug reaction is associated with monoamine oxidase inhibitors?
Hypertensive crisis
Which drug is contraindicated in patients taking methotrexate and why?
Trimethoprim - increased risk of bone marrow suppression, pancytopenia and neutropenic sepsis
What class of drug is amiloride?
Potassium-sparing diuretic
What effect does amiloride have on potassium?
Hyperkalaemia
What effect does erythromycin have on INR?
Increases INR - Cytochrome p450 inhibitor
What is the preferred ABx for severe HAP?
IV Tazocin
What is the main adverse effect associated with semaglutide?
Nausea
What investigations should be monitored for short-course prednisolone?
Blood pressure and urinary glucose
What investigation should be performed prior to starting arirpriazole?
Serum prolactin
What investigation is performed to assess for treatment response for statins?
Lipid profile
What parameter is assessed to monitor treatment response in patients with pneumonia?
Respiratory rate
What parameter is assessed to monitor treatment response in patients with acute exacerbation of asthma?
Oxygen saturations
What is measured to assess for the efficiency of furosemide in acute heart failure?
Weight change
Which drugs should be discontinued before surgery?
Antiplatelets (aspirin), anticoagulants (heparin), and the contraceptive pill, lithium
What should happen to short-acting insulin prior to surgery?
Converted to a sliding scale
What is the maximum daily dose of paracetamol?
4 g/day
What dose of alendronic acid is prescribed weekly?
70 mg
What is the daily dose of alendronic acid?
10 mg
What should happen to steroid dose pre-surgery?
Doubled
Which drugs can increase lithium toxicity?
Thiazide like diuretics and ACE inhibitors (reduce lithium renal excretion)
In patients on levothyroxine replacement therapy presenting with low TSH (below reference range), what should be done to the dose?
Reduce levothyroxine dose
What fluids should be prescribed to patients with hypokalaemia?
1 L potassium chloride over 4 hours (20 mmol) with 5% dextrose
Over how many hours is 1L of calcium/potassium replacement delivered?
4 hours
Over how many hours is typical maintenance fluids (e..g, 1 L of 0.9% sodium chloride delivered)?
8 hours
Why should the dose of phenytoin be increased by minimum increments?
Phenytoin has a narrow therapeutic index
Maximum daily dose of potassium?
1 mmol/kg/day
In patients with hyperkalaemia, which investigation should be performed?
ECG
What is the first line diabetic drug in patients with chronic kidney disease?
Gliclazide (sulphonylurea)
What type of analgesia is codeine?
Weak opioid
What is co-codamol?
Paracetamol and codeine
Which anti-emetic is indicated for central causes of nausea and vomiting?
cyclizine
What class of anti-emetic is ondanestron?
5HT3 antagonist
What is the first line drug for patients with congestive acute heart failure?
IV furosemide 80 mg STAT
Emergency fluid resuscitation fluids
0.9% sodium chloride 500 mL 10 minutes
Emergency hypoglycaemia fluids
Glucose 20% 100 mL 15 minutes
Emergency hypokalaemia fluids
Sodium chloride 0.9%/potassium chloride 0.3% 1 L over 4 hours
Emergency hypercalcaemia fluids
Sodium chloride 0.9% 1L over 4 hours
Over how many minutes should 20% glucose 100 mL be administered?
Over 15 minutes
What is the initial fluid equation for children?
10mL/kg 10 minutes
What effect does both omeprazole and alendronic acid have on stools?
Diarrhoea
When should loperamide be taken?
After each loose stool
Time duration for antidepressant effect to take place?
4-6 weeks
Frequency of methotrexate administration
Once a week
What is co-prescribed with methotrexate?
Folic acid
What is the benefit of co-prescription of folic acid with methotrexate?
Reduced methotrexate-induced mucositis and myleosuppression
What should be monitored during methotrexate treatment?
Monitor FBC, renal and liver function (reports of dyscrasias) and liver cirrhosis
How should clozapine be discontinued?
Gradual dose reduction over 1-2 weeks due to risk of rebound psychosis
Contraceptive advice for patients on isotretinoin?
2 complementary user-dependent forms of contraception
What should be monitored in children on steroids?
Height and weight, BP
Which class of antibiotics is contraindicated in patients on insulin?
Macrolides - increased risk of hypoglycaemic episodes
Why are macrolide antibiotics contraindicated in statins?
Cytochrome p450 inhibitors - reduced metabolism = increased myopathy and rhabdomyolysis
What adverse effect is commonly associated with ACE-inhibitors?
Dry cough due to increased bradykinin
What effect does ibuprofen have on kidney perfusion?
Reduces renal artery diameter and blood flow - decreases GFR
What is the maximum daily dose of paracetamol?
4 g
Which is the preferred first-line anti-emetic?
Cyclizine
How frequently should methotrexate be prescribed?
Weekly
What is the maximum dose of citalopram for patients aged >65?
20 mg
What is the haemoglobin cut-off for blood transfusion?
<70 g/L
What are the common adverse effects associated with phenytoin use?
Gum hyperplasia and dysarthria
In the event of ECG changes and hyperkalaemia, what is the first-line management?
10% calcium gluconate 30 mL, 10 minutes
Which drug is indicated for the rate control of fast AF, in the context of known asthma?
Digoxin
What is the reversible warfarin agent in patients with minor bleeding (INR 5-8)?
Slow injection of vitamin K
What is a common adverse effect associated with opioid-based medication - and should be counselled on?
Constipation - advice additional laxatives
Which laxative is contraindicated for opioid-induced constipation?
Bulk-forming laxatives
What anti-androgen adverse effect is associated with spioronolactone?
Gynaecomastia
What is the consequence of failing to rotate insulin injection sites?
Lipodystrophy
What effect does excessive alcohol consumption have on glucose levels in patients with diabetes?
Hypoglycaemia
Which is a common anxiolytic prescribed to pre-operative patients for anxiety?
2 mg diazepam oral (once-only medicine)
What investigation should be performed prior to prescribing sodium valproate?
Liver function tests
What investigation should be monitored during a phenytoin infusion?
ECG (and BP)
What adverse effect does the concomitant use of NSAIDs have with methotrexate use?
Increase thrombocytopenia risk
What adverse effect is associated with the concomitant use of methotrexate with trimethoprim?
Myelosuppression
Frequency of methotrexate administration?
Weekly
1st line drug for the management of an Addisonian crisis?
IV hydrocortisone
Metformin three times a day - surgery rule?
Omit lunchtime dose
Sulfonylurea - surgery dose rule?
Omit morning dose
Which anti-diabetic drug should immediately be discontinued on the day of surgery?
SGLT-2 inhibitors
What is the preferred antimicrobial agent for prophylaxis during the caeserean section?
Cefuroxime
Most common adverse effect associated with methotrexate (concerning)?
Leucopenia
In which form is the risk of ototoxicity highest in patients taking furosemide?
Intravenous
Which four drugs are associated with ototoxicity?
Gentamicin
Furosemide
Bumetanide
Vancomycin
What are the common precipitants of c-difficile diarrhoea?
Omeprazole (PPIs)
Low magnesium
Low sodium
Antibiotics e.g., co-amoxiclav, clindamycin, ciprofloxacin, cephalosporins
What is the antidote to opioid overdose?
Naloxone IM 400 micrograms
Dose units for levothyroxine?
Micrograms
Dose units for digoxin?
Micrograms
What effect does phenytoin have on the combined oral contraceptive pill?
Phenytoin is predicted to decrease the efficacy of Combined hormonal contraceptives
First-line drug for drug-induced Parkinsonism?
Procyclidine hydrochloride
Which drug is indicated for the management of neuroleptic malignant syndrome?
Dantrolene or bromocriptine
What effect do quinolones have on the QT interval?
QT-prolongation
Adverse effect associated with quinolones?
Risk of tendon rupture
Reduce seizure threshold
When should metformin be stopped (eGFR threshold)?
<30
How frequently should blood glucose be checked?
At least every 4 hours (>5 times/day)
When should a double dose of levonestregel be administered for vomiting patients?
If vomiting occurs within 3 hours
What is the main contraindication to ulipristal acetate?
Contraindicated in asthma
What is the reversible agent for benzodiazepines?
Flumazenil
Which drug is associated with floppy iris syndrome?
Tamsulosin
When should lithium be discontinued pre-surgery?
Day before surgery
For how long should COCP be discontinued for prior to surgery?
4 weeks before surgery
When should potassium-sparing diuretics and ACE inhibitors be discontinued for surgery prep?
4 weeks before surgery
How should the gentamicin dose be adjusted if the trough is >2?
Increase dose interval
How should the gentamicin dose be adjusted if the peak is >10?
Decrease the dose
On the day before surgery, what should be done to the long-acting insulin dose?
Dose reduction by 20%
Which drug is indicated in the management of giant-cell arteritis with visual changes?
Intravenous Methylprednisolone 0.5-1g IV daily for 3 days
What is the first-line management for ring-worm?
Clotrimazole 1% cream topical 1- application
What is the first-line anti-emetic for nausea and vomiting during pregnancy?
Promethazine
Which drugs are associated with a tremor?
Haloperidol, salbutamol, theophylline
What effect does nitrofurantoin have on respiratory function?
Hypersensitivity reaction in acute form
Pulmonary fibrosis (long-term)
Which antibiotic increases the risk of seizures in patients on sodium valproate?
Meropenem
