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Phase 4 > PSA > Flashcards

PSA Flashcards

1
Q

What is 1st line management for thromboprophylaxis ?

A
  • A low molecular weight heparin administered for 10 days followed by a low dose aspirin for a further 28 days
  • LMWH for 28 days in combination with anti-embolism stockings
  • Or rivaroxaban
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2
Q

IV management of hypoglycaemia

A
  • Glucose 10 % or 20%
  • 200ml if 10% or 100ml if 20%
  • Over less than 10 mins
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3
Q

What medication should be held in a patient who is unwell and/or has reduced oral intake ?

A
  • ACEi e.g. ramipril
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4
Q

What medications should be withheld until renal function recovers ?

A

-Candesartan cilexetil(ARBs) and ramipril (ACEi) - Allopurinol

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5
Q

Name medications that can contribute to confusion

A
  • Co-codamol
  • Diazepam
  • Prednisolone
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6
Q

In what causes should nitrofurantoin be avoided ?

A
  • eGFR is less than 45
    In which case use trimethoprim or doxycycline
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7
Q

When should patients stop taking warfarin before surgery ?

A
  • 5 days
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8
Q

In what circumstance should patients be given vitamin K before surgery ?

A
  • Having stopped warfarin but INR is still above 1.5
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9
Q

What can be expected with starting lisinopril ?

A
  • A small rise in creatinine (<20%) that does not require investigation or change in prescription
  • Repeat urea and electrolyte measurement after 1 week
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10
Q

What is a potentially dangerous presentation of a patient with a sore throat whom has just started carbimazole ?

A

Agranulocytosis

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11
Q

What should be monitored 3 months after initiating COCP and then annually ?

A
  • Blood pressure
  • Weight
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12
Q

What are serious side effects of ciclosporin ?

A
  • Nephrotoxicity
  • HTN
  • BP and serum ciclosporin should be monitored every 2 weeks
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13
Q

What change in cholesterol should be seen after initiating a statin ?

A
  • > 40% reduction in non-HDL after 3 months
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14
Q

Which drugs should be avoided in renal failure ?

A
  • Antibiotics: tetracycline, nitrofurantoin
  • NSAIDs
  • Lithium
  • Metformin
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15
Q

What medications accumulate in chronic kidney disease and need dose adjustments ?

A
  • Most ABxs including penicillin’s, cephalosporins, vancomycin, gentamicin and streptomycin
  • Digoxin + atenolol
  • Methotrexate
  • Sulphonylureas
  • Furosemide
  • Opioids
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16
Q

What opioid is useful in palliative care ?

A

Oxycodone

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17
Q

Which drugs are relatively safe in kidney failure ?

A
  • ABxs e.g. erythromycin and rifampicin
  • Diazepam
  • Warfarin
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18
Q

What ABx can lower seizure threshold ?

A
  • Ciprofloxacin
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19
Q

Which medicines are P450 inducers ?

A
  • Antiepileptics: phenytoin and carbamazepine
  • Barbiturates: phenobarbitone
  • Rifampicin
  • St John’s Wort
  • Chronic Alcohol Intake
  • Griseofulvin
  • Smoking
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20
Q

Which medications are inhibitors of P450 systems ?

A
  • ABx: ciprofloxacin or erythromycin
  • Isoniazid
  • Cimetidine and omeprazole
  • Amiodarone
  • Allopurinol
  • Imidazoles: fluconazole
  • SSRIs
  • Ritonavir
  • Sodium valproate
  • Acute alcohol intake
  • Quinupristin
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21
Q

The side effect most commonly associated with metformin

A
  • Diarrhoea or nausea
  • Lactic acidosis
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22
Q

The side effect most commonly associated with Glitazones (Pioglitazone)

A
  • Worsening heart failure
  • Weight gain
  • Fluid retention
  • Liver dysfunction
  • Fractures
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23
Q

The side effect most commonly associated with sulfonylureas (gliclazide)

A
  • Hypoglycemia
  • Increased appetite and weight gain
  • SiADH
  • Cholestatic liver dysfunction
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24
Q

Features of salicylate overdose

A
  • Hyperventilation
  • Tinnitus
  • Lethargy
  • Sweating/pyrexia
  • Nausea/vomiting
  • Hyperglycemia and hypoglycemia
  • Seizures
  • Coma
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25
Q

Treatment of salicylate overdose

A
  • ABC + charcoal (if within 1 hour)
  • IV sodium bicarbonate
  • Hemodialysis
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26
Q

Indications for hemodialysis in salicylate overdose

A
  • Serum concentration > 700mg/L
  • Metabolic acidosis resistant to treatment
  • AKI
  • Pulmonary oedema
  • Seizures
  • Coma
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27
Q

Rifampicin side effects

A
  • Potent liver enzyme inducer
  • Hepatitis
  • Orange secretions
  • Flu-like symptoms
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28
Q

Isoniazid side effects

A
  • Peripheral neuropathy (can be prevented with pyridoxine Vit B6)
  • Hepatitis
  • Agranulocytosis
  • Liver enzyme inhibitor
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29
Q

Pyrazinamide side effects

A
  • Hyperuricemia causing gout
  • Arthralgia
  • Myalgia
  • Hepatitis
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30
Q

Ethambutol side effects

A
  • Optic neuritis (check visual activity before and during treatment)
  • Dose needs adjusting in patients with renal impairment
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31
Q

If suspecting digoxin toxicity when should serum concentration be measured ?

A
  • 8-12 hours after last dose
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32
Q

Features of digoxin toxicity

A
  • Lethargy, nausea and vomiting
  • Anorexia
  • Confusion
  • Yellow-green vision
  • Arrhythmias
  • Gynecomastia
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33
Q

Precipitating Factors for digoxin toxicity

A
  • Hypokalemia
  • Increasing age
  • Renal failure
  • Myocardial ischemia
  • Hypomagnesaemia, hypoalbuminemia, hypothermia, hypothyroidism
  • Hypercalcemia, hypernatremia, acidosis
  • Many medications e.g. Amiodarone, quinidine, verapamil
  • Any medication that causes hypokalemia
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34
Q

What drugs can cause digoxin toxicity

A
  • Amiodarone, quinidine, verapamil, diltiazem, spironolactone, ciclosporin
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35
Q
  1. Drugs which cause hypokalemia
A
  • Thiazides e.g. Indapamide or Chlorothiazide
  • Loop diuretics e.g. furosemide
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36
Q

Management of digoxin toxicity

A
  • Digibind
  • Correct arrhythmias
  • Monitor potassium
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37
Q

What should be used to treat DVT in a patient with reduced renal function ?

A
  • Unfractionated heparin
  • Normally it would be a DOAC
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38
Q

What 2 key medications does St John’s Wort Interact with

A
  • Warfarin
  • Ciclosporin
  • St John’s Wort is an inducer !
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39
Q

Drugs which cause lung fibrosis

A
  • Amiodarone
  • Cytotoxic agents: busulphan, bleomycin
  • Anti-RA drugs: methotrexate, sulfasalazine
  • Nitrofurantoin
  • Ergot-derived dopamine receptor agonists: bromocriptine, cabergoline and pergolide
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40
Q

What medications can be given during breastfeeding ?

A
  • ABxs: Penicillin, cephalosporins, trimethoprim
  • Endocrine: glucocorticoids (low dose), levothyroxine
  • Sodium valproate, carbamazepine
  • Asthma: salbutamol, theophyllines
  • Psych drugs: TCA and APs apart from clozapine
  • BBs
  • Warfarin/heparin
  • Digoxin
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41
Q

What drugs should be avoided during breastfeeding ?

A
  • ABxs: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
  • Lithium, benzos
  • Aspirin
  • Carbimazole
  • Methotrexate
  • Sulfonylureas
  • Cytotoxic drugs
  • Amiodarone
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42
Q

Which medications should be avoided in HF ?

A
  • Thiazolidinediones e.g. pioglitazone
  • Verapamil
  • NSAIDs/glucocorticoids
  • Class I antiarrhythmics – flecainide
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43
Q

What type of monitoring do statins require ?

A
  • LFTs at baseline, 3 months and 12 months
  • A rise of under 3 times the upper limit of normal is acceptable
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44
Q

What medications can be given during breastfeeding ?

A
  • ABxs: Penicillin, cephalosporins, trimethoprim
  • Endocrine: glucocorticoids (low dose), levothyroxine
  • Sodium valproate, carbamazepine
  • Asthma: salbutamol, theophyllines
  • Psych drugs: TCA and APs apart from clozapine
  • BBs
  • Warfarin/heparin
  • Digoxin
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45
Q

What drugs should be avoided during breastfeeding ?

A
  • ABxs: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
  • Lithium, benzos
  • Aspirin
  • Carbimazole
  • Methotrexate
  • Sulfonylureas
  • Cytotoxic drugs
  • Amiodarone
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46
Q

Which medications should be avoided in HF ?

A
  • Thiazolidinediones e.g. pioglitazone
  • Verapamil
  • NSAIDs/glucocorticoids
  • Class I antiarrhythmics – flecainide
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47
Q

What type of monitoring do statins require ?

A
  • LFTs at baseline, 3 months and 12 months
48
Q

What type of monitoring do ACEi require ?

A
  • U&E prior to treatment, after increasing dose and at least annually
49
Q

What type of monitoring does amiodarone require ?

A
  • TFT, LFT, U&E and CXR prior to treatment
  • TFT, LFT every 6 months
50
Q

What type of monitoring does methotrexate require ?

A
  • FBC, renal and LFTs before staring treatment and then repeat weekly until therapy stabilized
  • Thereafter every 2-3 months
51
Q

What type of monitoring does azathioprine require ?

A
  • FBC, LFT before treatment
  • FBC weekly for the first 4 weeks
  • FBC, LFT every 3 months
52
Q

What type of monitoring does lithium require ?

A
  • TFT, U&E prior to treatment
  • Lithium levels weekly until stabilized and then every 3 months
  • TFT, U&E every 6 months
53
Q

What type of monitoring does sodium valproate require ?

A
  • LFT, FBC before treatment
  • LFT periodically during first 6 months
54
Q

What type of monitoring does Glitazones require ?

A
  • LFT before treatment
  • LFT regularly during treatment
55
Q

Medications that can cause SIADH

A
  • Sulfonylureas
  • SSRIs, Tricyclics
  • Carbamazepine
  • Vincristine
  • Cyclophosphamide
56
Q

In which condition should HRT be avoided ?

A
  • IHD
57
Q

What are maintenance fluids ?

A
  • 25-30 ml/kg/day of water and
  • Aprox 1 mmol/kg/day of K+, Na+ and Cl+
  • Aprox 50-100 g/day of glucose to limit starvation ketosis
58
Q

How much fluid, K+ and glucose would a 80kg man need ?

A
  • 2L water
  • 80 mmol of K+
  • 50-100g of glucose
59
Q

How would you manage a patient on warfarin with a high INR and an acute haemorrhage ?

A
  • Stop warfarin
  • Give IV vitamin K (IV phytomenadione)
  • Dried prothrombin complex factors (2, 7, 9 and 10)
60
Q

What eGFR level would prompt reduction of a ACE-I dose ?

A
  • 25% or more
61
Q

What are the peak and trough levels of gentamicin ?

A
  • 5-10 peak – change the dose
  • 0-2 trough – change the dose timings
62
Q

How are absence seizures managed in children ?

A
  • Ethosuximide or valproate
63
Q

What is the amount of fluid bolus given for a child ?

A
  • 0.9% NaCl stat (<10 mins)
  • 10ml/kg
64
Q

What are maintenance fluids given for a child ?

A
  • 0.9% NaCl + 5% glucose (over 24 hours)
  • First 10kg 100ml/kg/day
  • Second 10kg = 50ml/kg/day
  • Anything after = 20ml/kg/day
65
Q

In a patient on anti-psychotics with a prolonged QT interval what would be the first line antiemetic of choice ? and what medication should be avoided ?

A
  • 1st line Cyclizine
  • Prochlorperazine – extra-pyramidal side effects
66
Q

How is DKA managed according to BNF treatment summery ?

A
  • IV fluid replacement followed by IV insulin
  • Pts who normally take long acting insulin should continue with their usual dose but should omit sort acting
67
Q

When should loperamide be taken ?

A
  • After each loose stool
68
Q

What is the best way to monitor the beneficial effects of perindopril erbumine when treating HF associated breathlessness ?

A
  • Exercise tolerance
69
Q

How should apixaban be monitored for side effects ?

A
  • Presence of bleeding
70
Q

What would be a good medication option for acute pain with renal failure ?

A
  • Oxycodone
71
Q

How is severe warfarin associated haemorrhage managed ?

A
  • Phytomenadione (Vit K) and dried prothrombin complex
72
Q

What are maintenance fluids ?

A
  • 25-30ml/kg/day
  • Approx 1mmol/kg of K+, Na+ and Cl-
  • Approach 50-100/day glucose
73
Q

How would you prescribe maintenance fluids in a 58kg patient ?

A
  • 1st bag 1000ml NaCl 0.18% (containing 30mmol NaCl) + glucose 4% + potassium 40mmol over 8-12 hours
  • Then a 500ml bag of NaCl 0.18% and 4% glucose and 20mmol of K+ over 6 hours
74
Q

Digoxin is available as a 0.025% preparation. What does this mean ?

A
  • 0.025g in 100ml
75
Q

What fluids should be prescribed in severe hypoglycaemia ?

A
  • Glucose 20% - 100mls – <10 mins
  • Glucose 10% - 150-200mls – <10 mins
76
Q

What is a common side effect of ticagrelor ?

A
  • Dyspnoea
77
Q

First line management of migraines ?

A
  • Aspirin or ibuprofen
78
Q

What conditions should triptans be avoided in ?

A
  • Hypertension
  • CAD
  • History of seizures
79
Q

What is first line for oral thrush treatment ?

A
  • Nystatin oral suspension
80
Q

What fluids should be given in paeds with low BP and in need of rapid rehydration ?

A
  • 10ml/kg
  • Hartmann’s
  • <10 mins
81
Q

What should be first given when treating emergency hypercalcaemia ?

A
  • Sodium chloride 0.9% IV over 4 hours
82
Q

How do SGLT-2 inhibitors work ?

A
  • Increase glucose excretion in the urine
  • Thus a common side effect is increased risk of UTI
83
Q

A new prescription of atorvastatin causes a rise in serum transaminases. How would you proceed depending on serum transaminase level ?

A
  • Continue with current dose if serum transaminase level is less than 3 times the upper limit of normal
84
Q

What is measured in response to finasteride prescription for BPH ?

A
  • Patient symptom score
  • Examinations/investigations are not necessary
85
Q

What should be monitored in LMWH prescription ?

A
  • Platelet count (before and during)
  • Hyperkalemia (in those at risk)
  • Anti-factor Xa (in renal damage or low BMI)
86
Q

How should a postprandial insulin be measured in order to enable titration of dose ?

A
  • Intention is to achieve euglycemia in fasting state not postprandial hyperglycemia
  • Thus the best time and measurement to measure should be a pre-breakfast capillary blood glucose
87
Q

What is the best measurement of response to steroid treatments ?

A
  • Symptom severity
88
Q

What are the oestrogens used in HRT ?

A
  • Estradiol
  • Estrone
89
Q

What are the progesterones used in HRT ?

A
  • Medroxyprogesterone
  • Norethisterone
  • Levonorgestrel
  • Dropirenone
90
Q

Which medications can increase the risk of fractures ?

A
  • Omeprazole (All PPIs)
  • Prednisolone (All PO steroids)
  • GnRH agonists (busereline, goserelin etc.)
91
Q

Medication that can increase the risk of falls

A
  • Amitriptyline (anticholinergic syndrome, drowsiness and hypotension)
  • Ramipril (dizziness, drowsiness and hypotension)
92
Q

Medications that increase risk of falls (types)

A
  • Benzodiazepines
  • Antidepressants (particularly TCAs and SNRI and MAO-i)
  • Antipsychotics
  • Opiates
  • Most antihypertensives (particularly diuretics and alpha blockers)
93
Q

Medications likely to increase risk of pancreatitis ?

A
  • Exenatide (GLP-1 receptor agonist)
  • Sitagliptin (DPP-4-ihibitor)
94
Q

Medications to be stopped during an AKI

A
  • Candesartan
  • Metformin
95
Q

Medications to stop during an AKI

A
  • Diuretics
  • ACEi/ARB
  • Metformin
  • NSAIDs
  • Many antibiotics e.g. amoxicillin
  • Chemo
  • Iodine based contrasts
  • Opioids (not nephrotoxic but can accumulate)
96
Q

What oxygenation device and setting should be used in a patient with low oxygen stats and COPD (and other conditions that would lead to chronically low sats) ?

A
  • 24 or 28% venturi mask and titrate towards 88-92% or level specific to patient
97
Q

Medications that can cause hypokalemia ?

A
  • Loop (furosemide) or thiazide diuretics (indapamide)
98
Q

Medications that can cause hyperkalaemia

A
  • K+ sparing diuretics e.g. spironolactone
  • ACE-I e.g. ramipril
  • ARB e.g. candesartan
  • NSAIDs e.g. ibuprofen
  • BBs e.g. bisoprolol
99
Q

Treatment of hypokalemia

A
  • 0.3% potassium chloride 1000ml over 4h
100
Q

Treatment of hyperkalaemia (short term)

A
  • Initially calcium gluconate 10% 30ml over 10m
  • Then insulin + glucose and salbutamol
101
Q

When should long acting insulin that is taken at night be monitored ?

A
  • Pre-breakfast capillary glucose
102
Q

If a trough or pre-dose medication level is too high what would one do ?

A
  • Increase the duration between doses
103
Q

If a trough or pre-dose medication level is too low what would one do ?

A
  • Decrease the time between doses
104
Q

With what PMHx would NSAIDs be considered sub-optimal in prescribing ?

A
  • NASIDs can cause fluid retention and raise blood pressure and therefore may not be appropriate in conditions such as HTN, CVD or Stroke/TIA
105
Q

What would be an indication for IV antibiotics in cellulitis

A
  • Peripheral vascular disease
  • Severe infection
106
Q

What are guidelines for insulin before surgery ?

A
  • On the day before surgery the patients usual insulin should be given as normal other than once daily long acting insulin analogues which should have a dose reduction of 20%
107
Q

How should modified release morphine tablets be taken ?

A
  • Swallowed whole
  • Chewing or crushing could lead to overdose
108
Q

What should be given in transfusion-associated circulatory overload (TACO) ?

A
  • IV diuretics e.g. furosemide
109
Q

In the BNF how should a complicated UTI be treated ?

A
  • With medications under pyelonephritis
  • E.g. cefalexin
110
Q

Give some examples of a complicated UTI

A
  • Anatomical variation
  • Renal disease or failure
  • Atypical organism
  • Immunocompromised
  • Pregnancy
111
Q

What laxatives are useful in opioid induced constipation ?

A
  • Osmotic laxatives e.g. lactulose
  • Stimulant laxatives e.g. senna
  • Docusate sodium can be used as an adjunct stool softener
112
Q

Under what criteria would you make a dose adjustment in apixaban ?

A
  • 2 of the following
  • Age over 80
  • Weight < 60 kg
  • Serum creatinine > 133
  • Also if CrCl 15-29 mL/min
113
Q

HTN with T2DM (any age or origin) or HTN without T2Dm in aged 55 or below and not of BA or ACB origin

A
  • 1st line – ARB or ACE-I
  • 2nd line add CCB or thiazide like diuretic
  • 3rd line add Thiazide Diuretic or CCB
114
Q

A patient is taking ramipril, amlodipine for HTN with T2DM. What do you add next ?

A
  • Thiazide diuretic
  • E.g. indapamide
115
Q

HTN without T2DM in patients 55 or over or all ages BA or ACB without T2DM

A
  • 1st line CCB
  • 2nd ACE, ARB or thiazide like diuretic
  • 3rd ACE, ARB or thiazide like diuretic
116
Q

What is recommended in the treatment of opioid induced constipation ?

A
  • Combination of an osmotic laxative (e.g. lactulose or macrogol) and a stimulant laxative (e.g. senna or docusate)

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