PSA Flashcards
1
Q
Management for acute oculogyric/dystonic crisis?
A
Procyclidine 10mg
IV superior to IM
2
Q
Management of acute COPD on top of ipratropium and salbutamol?
A
Prednisolone 30mg for 7-14 days
3
Q
Patient on HRT having withdrawal bleeds, wants a patch that won’t cause withdrawal bleeds?
A
Everol Conti self adhesive patch.
1 patch transdermal twice a week.
4
Q
What is contraindicated in peripheral vascular disease?
A
BB’s
They cause vasoconstriction which can worsen ischaemia
5
Q
Two medicines that contribute to biventricular failure?
A
Corticosteroids and CCB’s
6
Q
What renal meds cause hyperkalaemia?
A
ACE inhibitors and aldosterone inhibitors (Spiro)
7
Q
What drugs may contribute to candida?
A
Oral steroids
Antibiotics e.g. amoxicillin and Clarithromycin
8
Q
What should you never do with steroids?
A
Never stop them abruptly, continue them through any illness
9
Q
Maintenance dose of omeprazole for GORD?
A
10-20mg
10
Q
If a patient on biphasic insulin has bad afternoon BM’s, what do we do?
A
Alter her morning dose
11
Q
Signs of early scarlet fever and Mx?
A
Macular red rash, strawberry tongue, red throat, fever >38
If can tolerate oral fluids = oral antibiotics = Phenoxymethylpenicillin 125mg PO QDS for 10 days
No fluids = IV BenPen
12
Q
INR range for mechanical valve?
A
3-4
13
Q
What counts as missing a pill for contraceptive?
A
> 24 hours
14
Q
Rules for missed pill?
A
If miss one anywhere you will be protected. Take the missed pill and todays pill together.
If a woman misses 2 or more pills (especially from the first 7 in a packet), she may not be protected. She should take an active pill as soon as she remembers and then resume normal pill-taking. Use condoms for 7 days. If any of these 7 days fall in the pill free week miss this week.
15
Q
What should you monitor with eplerenone?
A
Potassium (it is a potassium sparing diuretic)
16
Q
Advice for men on methotrexate?
A
Contraception taken during and for at least 3 months after stopping treatment
Same advice for women
17
Q
Side effect of mirtazapine?
A
Abnormal dreams
18
Q
Which diuretics cause hypokalaemia?
A
Thiazide like diuretics e.g. indapamide
19
Q
What interacts with simvastatin to increase severe myopathy risk?
A
Gemfibrozil - potent CYP inhibitor
20
Q
Unconscious hypoglycaemic Mx?
A
1st line = glucose 20% 50-100mL IV, over less than 20 minutes
2nd line = Glucagon
21
Q
How to monitor BB effect in AF?
A
Check heart rate
22
Q
What to monitor electrolyte wise for amiodarone?
A
Potassium - check prior to starting treatment
23
Q
When do you stop the statin in myopathy?
A
If CK is > 5 times the upper normal limit or severe muscular symptoms
24
Q
How does fentanyl convert to oral morphine?
A
25ug/hour of fentanyl = 60mg of morphine
25
What to give to alleviate breathlessness and oedema in heart failure?
Furosemide 40mg IV IV IV
26
Patient needs post-op prophylaxis, scared of needles?
Apixiban can be given orally
Apixiban oral 2.5mg PO BD
27
Treatment for moderate severe acne, having tried topical therapy?
Doxycycline
Lymecycline
28
Standard dose for tacrolimus?
Maintenance dose is commonly 1-2mg BD
29
What electrolyte abnormality do both tacrolimus and Dalteparin cause?
Hyperkalaemia
30
When should anti-platelets be stopped prior to surgery?
7 days
Except if recent vascular stenting
31
What drugs to hold in renal function?
ACEI's, ARBS
Allopurinol is really excreted so BNF advises max daily dose of 100mg in renal failure
32
How can AKI cause confusion?
Decreased clearance of medicines e.g. co-codamol and diazepam
33
How do steroids affect blood sugar levels?
Hyperglycaemia
34
How does citalopram affect electrolytes?
Cause hyponatraemia, due to inappropriate ADH secretion
35
Do you take levothyroxine daily or weekly?
Daily
36
Monitoring furosemide effect in heart failure?
Check weight
37
Alcohol withdrawal Tx?
Chlordiazepoxide hydrochloride 20mg PO TDS
38
If INR >1.5 on the day before surgery what do you give?
Phytomenadione (Vitamin K) 1-5mg orally
39
What should you advise with anti-depressants?
Suicidal idealation may worsen before it gets better / May take 6 weeks to work
40
What should the patient report if on rivoroxaban?
Any abnormal unexplained bruising / bleeding
41
How does topiramate affect progesterone only contraception?
It reduces the efficacy, so you should an alternative contraceptive during the treatment and for at least 4 weeks afterwards
42
Side effect of beta blockers ?
Erectile dysfunction
43
What is an example of a cholestatic drug and who it primarily affects?
Co-amoxicalv
Classically affects men > 65
44
What interacts with dabigatran etexilate to cause increased bleeding risk?
Citalopram
45
What is an acceptable rise in creatinine when starting an ACEI?
<20% is acceptable, if it rises to <20% do not stop, just repeat renal function tests in 1 week
46
Monitoring in carbimazole?
FBC for neutropenia
47
monitoring the affect of ACEI in heart failure?
Excercise tolerance - think NYHA classification is how we grade severity
48
Most serious adverse affect of ciclosporin and monitoring?
Nephrotoxicity
Before starting you must assess renal function
Then check it 2-weekly until stable
49
Whats the usual increase of an insulin dose when the patient goes on glucocorticoids?
10% increase
50
What should non-HDL cholesterol have decreased by once started on statins?
>40% reduction in is the target. If you don't hit this you need to up the dose
51
When should gentamicin levels be measured after the dose?
Within a 6-14 hour window
52
What anti-emetic do you give in patients who are at risk of extra-pyramidal SE's or prolonged QT?
Cyclizine 50mg TDS
53
Management of shingles in a high risk / immunocompromised patient e.g. oncology?
Aciclovir at the higher 800mg 5/day dose. For 7 days
54
How much and how long for a fluid challenge?
ideally 500ml in under 15mins, or 1 litre under 30 minutes
55
Starting dose for metformin?
500mg PO OD
56
Max dose of citalopram in old people?
20mg
57
What drugs cause 'indigestion'?
Steroids, NSAIDS, alendrotnic acid
58
Two common drugs causing diarrhoea?
Alendronic acid and PPI's
59
Other than CCB's, what can cause ankle swelling?
Naproxen
60
Pregnant lady with vaginal candidiasis, whats the Tx?
It has to be prolonged therapy. Clotrimazole pessary / cream
Don't give oral anti-fungals in pregnancy
61
Patient with DKA on short acting insulin (Humulin) and long acting (Lantus). How do we manage her insulin ?
Fixed rate insulin infusion
Stop short acting
Continue long acting
62
Management of pain in post-herpetic neuralgia?
Paracetamol
NSAIDs too but caution if old people with renal risk / ulcer risk
63
Important information to give to people taking loperamide?
Initial dose of 4mg
then take 2mg after each loose stool - MAX 16mg/24 hour period
64
What must we monitor in ciclosporin?
Renal function as it is highly nephrotoxic.
Monitor creatinine every 2 weeks for first 3 months then 3 monthly
65
Is ciclosporin an absolute contra-indication to pregnancy?
No, just not recommended
66
Most likely SE of Liraglutide (GLP1 mimetic)
Vomiting
67
What does tramadol do the given with SSRI's?
Increases risk of serotonin syndrome
68
What TB drug increases metabolism or oestrogen / progestogens?
Rifampicin
69
Mx of anti-psychotic induced Parkinsonism?
Procyclidine 2.5mg oral TDS
70
What does COCP cause short term and how should it be monitored?
BP increase, BP
71
What should you measure prior to initiating azathioprine / mercaptopurine?
TPMT
72
What should be monitored with apixiban?
nothing, just tell patient to report any bleeding / bruising
73
If someone has renal impairment what analgesics should be avoided?
Morphine is metabolised in liver and active metabolite is excreted in the kidneys - so will accumulate in renal impairment
Oxycodone is metabolised to inactive metabolites by the liver, so use this in renal impairment
74
Management of warfarin and bleeding?
>8 = PTC, IV Vit K and stop warfarin
Minor bleeding > 8 IV Vit K and Stop warfarin
minor bleeding 5-8 = Oral Vit K and stop warfarin
5-8 = withhold 2 doses of warfarin
75
If amiodarone causes thyrotoxicosis what should we do?
Stop the amiodarone
76
Drugs contraindicated in heart failure?
Thiazolinediones = Fluid retention
Verapamil = negative inotrope
NSAIDs / glucocorticoids = = Fluid retention (except low dose aspirin)
Class 1 anti-arrhythmics = Flecainide (Don't use in those with structural heart disease)
77
What electrolyte values do people need as maintenance?
25-30ml / kg
1mmol/kg of potassium, sodium and chloride
50-100g/day of glucose
78
What does 0.9% saline have in it?
```
Sodium = 154
Chloride = 154
```
79
What is in Hartmann's?
```
Sodium = 131
Chloride = 111
Potassium = 5
HCO3 = 29
```
80
What laxative do you use in opioid induced constipation?
Osmotic laxative e.g. lactulose
81
What oxygen should be given in critically ill patients?
Resevoir mask 15L/minute
82
What three drugs are contraindicated in asthma?
NSAIDs - increased risk in those with nasal polyps
BB's
Adenosine
83
What type of fluids should you avoid in stroke patients?
5% glucose - increases risk of cerebral oedema
84
Two emergency contraceptions and when you take them?
Levonogesterol - within 72 hours, can be used twice in the cycle
Ulipristal - Within 120 hours, only once within a cycle. Affects other contraception so restart normal stuff after 5 days and use barrier protection in the mean time.
85
what are the CYP450 inducers?
PC BRAS = Enzyme up = drug conc. down
Phenytoin
Carbamazepine
Barbiturates
Rifampicin
Alcohol (CHRONIC EXCESS)
Sulphonylureas
86
CYP450 inhibitors?
AO DEVICES = enzyme down = drug conc. increase
Allopurinol
Omeprazole
```
Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol
Sulphonamides
```
87
Drugs to stop pre-surgery?
LICK OAPS
Lithium = day before
Insulin
COCP = 4 weeks before
K-sparing diuretics = day of
Oral hypoglycaemic
Anticoags / platelets
Perindopril (ACEI's) = Day of
88
Steroid side effects (and loosely the CI's)
STEROIDS
```
Stomach ulcers
Thin skin
Edema
R + LHF
Osteoporosis
Infection (Candida)
Diabetes
Syndrome of Cushings
```
89
When not to use NSAIDs?
Heart failure
Renal failure
Stomach ulcers
Asthma
90
Which diuretic causes gout?
Thiazides
91
Which diuretic causes gynaecomastia?
K Sparing
92
When do you give 5% glucose?
If patient is hypernatraemic
| Hypoglycaemic
93
When do you give gelofusin?
Systolic <90 in trauma etc
94
When shouldn't you use cyclizine as an anti-emetic?
Heart failure as can cause fluid retention
95
When shouldn't you use metoclopramide?
Parkinsons
96
When should you not use COCP?
Migraines
97
What causes hypovolaemic hyponatraemia?
Urine Na < 20 = extra-renal e.g. D&V, fistula, burns
Urine Na > 20 = renal e.g. Diuretics, salt losing nephropathy
98
What causes euvolaemic hyponatraemia?
SIADH, adrenal insufficiency or hypothyroid
99
What causes hypervolaemic hyponatraemia?
Cardiac failure, cirrhosis, and kidney failure
100
What causes hypernatraemia?
Unreplaced losses = GI, DI
101
Causes of hypokalaemia?
1) Renal loss = RTA, thiazides/Gitelmans and Loops/Barters
2) GI loss
3) Excess aldosterone = Conns
4) insulin and salbutamol
102
causes of hyperkalaemia?
1) Renal failure
2) Drugs e.g. NSAIDs, ACEI, ARBs and Spiro
3) Low aldosterone = Addisons
4) Redistribution = Rhabdomyolysis or any acidosis
103
Drugs causing neutropenia?
Carbimazole and Clozapine
104
Drugs causing cholestasis?
```
Flucloxacillin
Co-amoxiclav
Nitrofurantoin
Steroids
Sulphonylureas
```
105
Signs of digoxin toxicity?
Visual halos, yellow-green vision, arrhythmias
106
Lithium toxicity?
```
Early = tremor
Late = Arrhythmias, seizures and DI
```
107
Phenytoin toxicity?
Gum hypertrophy, ataxia, nystagmus and peripheral neuropathy
108
Gent and vancomycin toxicity?
Ototoxic and nephrotoxic
109
Dosing in gentamicin normal vs renal failure?
When do you measure?
Normally high dose = 5mg/kg
Renal failure = 1mg/kg
6-14 hours post dose
110
What interacts with erythromycin to prolong QT?
Domperidone
111
What interacts with fluconazole to cause QT prolongation?
Domperidone and haloperidol
112
Side effects of quinolones?
Convulsions and tendon damage
113
Side effects of barbiturates?
Behavioural disturbances
114
SE's of carbamazepine?
Skin reactions. Asians get Steven Johnsons
115
Management of hyperkalaemia?
10ml 10% calcium gluconate
100ml 20% glucose + 10 units actrapid
Salbutamol 5mg
116
Management of HTN?
1) Under 55 = ACEI / ARB. Over 55 / black = CCB
2) A+C
3) A+C+ diuretic
4) A + C + D + Spiro / alpha blocker / BB / SPECIALIST
117
STEMI and NSTEMI Mx?
GTN, morphine,
STEMI = PCI / thrombolysis. GRACE >3% = Tirofiban.
NSTEMI = LMWH. Angioplasty if GRACE >3% ± PCI. If GRACE>3% = tirofiban.
Long term = Aspirin + clopidogrel, statin, BB and ACEI
118
Anaphylaxis Mx?
0.5ml 1:1000 adrenaline
200mg Hydrocortisone
10mg Chloramphenamine
119
Heart failure Mx?
1st = ACE and BB
2nd line = increase dose
3rd: ARB if mild. Mod to severe = Spiro in whites, hydrazine and isosorbide nitrate in blacks.
120
AF Mx?
Rate if >65 or IHD:
- metoprolol
- asthmatics = diltiazem
- heart failure = Digoxin
Rhythm if 1st time, lone AF, young, secondary precipitant:
<48 hours = cardiovert --> DC, flecainide or amiodarone if structural heart disease
> 48 hours = anticoagulant until INR 2-3, then cardiovert
121
Asthma Mx?
```
1 = SABA PRN
2 = Low dose ICS and SABA
3 = + LRTA
4 = SABA + ICS + LABA ± LRTA if worked
5 = SABA + ICS ±LRTA + MART
6 = ICS to moderate
7 = high dose ICS
```
122
COPD Mx?
1 = SABA / SAMA
2 = FEV > 50% = LABA or LAMA
= FEV < 50% = LABA +ICS, OR LAMA
3 = LABA + LAMA + ICS
123
Diabetes drugs: Metformin MOA and SE's?
Oral
Decreases hepatic neogenesis and increases insulin secretion
SE's = NADL = Nausea, abdo pain, diarrhoea and lactic acidosis
CI = eGFR < 30
124
Diabetes drugs: Sulphonylurea MOA and SE's?
Oral, gliclazide
Increase B cell secretion of insulin
SE's = Hypos, hyponatraemia and weight gain
125
Diabetic drugs: Thiazolinediones MOA and SE's?
Oral, pioglitazone
Activates gamma PPAR receptor = increased adipogenesisand fatty acid uptake = increased peripheral insulin sensitivity
SE's = weight gain and fluid retention
CI's = heart failure and bladder cancer
126
Diabetic drugs: DPP4 / gliptins MOA and SE's?
Oral sildagliptin
Increases incretin levels = inhibits glucagon
SE = pancreatitis
127
Diabetic drugs: SGLT-2 inhibitors MOA and SE's?
Oral
Inhibit glucose reabsorption in the kidney
Get weight loss.... but also UTI's as increased glucose in urine
128
Diabetic drugs: GLP-1 mimetics MOA and SE's?
Subcut, Exanitide
Incretin mimetic
SE's = nausea, vomiting and pancreatitis
129
Common AED SE's?
Lamotrigine = skin hypersensitivity
Valproate = 3T's ==> Teratogenic, tremor and tubby
Phenytoin = Ataxia, peripheral neuropathy and gingival hyperplasia
Carbamazepine = SIADH, nystagmus
130
Alzheimers Mx?
Mild/moderate = AchE inhibitors e.g. donepezil, rivastigmine
Severe = memantine
131
Crohns Mx?
Induction = Prednisolone, then sulfasalazine, then Azathioprine, then infliximab
Maintain = Azathioprine
132
UC Mx?
Induction = Mesalazine, prednisolone then Tac
maintain = Mesalazine, azathioprine then infliximab
133
What do we do with ramipril in pregnancy?
Stop as teratogenic, give labetalol
134
What does tamoxifen increase risk of?
DVT and endometrial cancer
135
How often is methotrexate given, what do you give with it and what do you not give it with?
Once weekly
Folic acid
Trimethoprim / co-trimoxazole
136
If on long term steroids what should you take?
bisphosphonates and PPIs
137
What does 1% for drugs mean?
10mg in 1ml
138
What to monitor in vancomycin?
Kidney function as renal cleared
139
What to monitor in statins?
Baseline LFT's then check at 3 and 12 months
Baseline of creatinine if old / renal disease
140
When do you check phenytoin levels?
Trough at 14 days
141
What is lithium range, when do we monitor?
0.4-0.8, check 12 hours after last dose
Monitor dose weekly after initiation / dose change
3 monthly once stable
142
Methotrexate monitoring?
Monitor 3 monthly FBC's
143
What do you monitor in clozapine?
First 18 weeks FBC weekly
Any agranulocytosis = stop ASAP
144
Sodium valproate monitoring?
Hepatotoxic = LFT's
145
Amiodarone monitoring?
Baseline CXR and do TFT's + LFT's
146
What electrolyte affects digoxin levels?
Potassium
Potassium competes for digoxin binding, so low potassium means digoxin level raised!
147
SE of amiodarone?
Thyroid problems and fibrosis
148
When to use vancomycin in C.Diff vs Metronidazole?
Acute rise in creatinine
Evidence of colitis e.g. fresh bleeding
WCC > 15
149
Anti-emetics in pregnancy?
1st line = cyclizine / promethazine
2nd line = metoclopramide
150
What two cardiac drugs do you not give together as risk pre-syncope?
Verapamil and BB
151
How do drugs cause digoxin toxicity?
By decreasing potassium / magnesium e.g. loop or thiazides
By increasing digoxin plasma conc. e.g. Amiodarone, CCB's and Spiro
152
Big side effect of tamsulosin?
alpha blocker = postural hypotension
153
Side effect of clozapine?
Affect glucose metabolism = metabolic syndrome.
Polyuria, polydipsia and blurred vision
154
What is DRESS syndrome and three common drug precipitants?
Drug Reaction with Eosinophilia and Systemic Symptoms
Allopurinol, anti-epileptics, and sulphonamides (e.g. co-trimoxazole)
155
What do you give in corneal abrasion?
1 week of topical eye drops e.g. chloramphenicol
156
What must you have done monthly on isotrenitoin?
Pregnancy test
157
Common SE of mirtazapine that puts patients off?
Weight gain
158
How to monitor adverse affects of caffeine treatment?
Drug levels
159
Monitoring in venlafaxine?
Regular BP's and ECGs as can prolong QT
160
If you have renal impairment what type of heparin should you use?
Unfractionated.
LMWH is excreted really, so don't use if renal impairment.
161
Post surgery what thromboprophylaxis do you use?
Apixiban, rivaroxiban
162
Pre surgery or for medical patients what VTE prophylaxis?
All surgery LMWH e.g. dalteparin
Renal impairment = unfractionated
163
Which PPI interacts with clopidogrel to reduce its efficacy?
Omeprazole.
Try to use lansoprazole
164
Which anti-epileptic can cause yellow skin, mistaken for jaundice sometimes?
Carbamazepine
165
three common drugs that trigger gout?
Thiazides, aspirin and ACEI
166
When managing AF, what counts as adverse signs meaning we cardiovert?
Heart failure
Shock
MI
Syncope
167
If patient has been on long term Benzo's for anxiety/insomnia what should we do?
Switch to diazepam and taper off
168
What type of rash does lithium exacerbate?
Psoriasis
169
What should you monitor in tenofovir?
Renal function e.g. urinalysis
170
How would you monitor the acute negative effects of aminophylline (i.e. not a theophylline level)?
Cardiac monitoring
171
Quetiapine monitoring?
Annual BMI, lipids, glucose, FBC and ECG
172
What should you avoid if penicillin allergic?
Cephalosporins e.g. ceftriaxones
173
When do you need non-invasive ventilation?
Type 2 respiratory failure
174
When should you not use nitrofurantoin?
If eGFR is <45. Use trimethoprim instead
175
Most likely SE when giving steroids and amoxicillin?
Candidiasis
176
What do you give for urticarial allergic rash, but not full blown anaphylaxis?
Chlorphenamine 4mg PO QDS
177
Mx of thyroid storm?
Carbimazole
178
What to tell pregnant people taking LMWH worried about baby?
It does not cross the placenta
179
What is a patient on a Benzo and nitrate at risk of?
Falls
```
Benzo = confusion
Nitrate = postural hypotension
```
180
What happens when you give buprenorphine with morphine?
Buprenorphine has a partial agonist effects, counteracting the morphine and reducing efficacy
181
How do you treat a PC of gout if the person has heart failure?
Use colchicine
NSAIDs are contraindicated in heart failure, particularly diclofenac
182
Which anti-malarial is contraindicated in pregnancy?
which common medication decreases this drugs absorption?
Doxycycline
Antacids decrease doxycycline absorption - don't prescribe together
