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PSA Flashcards

1
Q

Management for acute oculogyric/dystonic crisis?

A

Procyclidine 10mg

IV superior to IM

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2
Q

Management of acute COPD on top of ipratropium and salbutamol?

A

Prednisolone 30mg for 7-14 days

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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.

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4
Q

What is contraindicated in peripheral vascular disease?

A

BB’s

They cause vasoconstriction which can worsen ischaemia

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5
Q

Two medicines that contribute to biventricular failure?

A

Corticosteroids and CCB’s

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6
Q

What renal meds cause hyperkalaemia?

A

ACE inhibitors and aldosterone inhibitors (Spiro)

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7
Q

What drugs may contribute to candida?

A

Oral steroids

Antibiotics e.g. amoxicillin and Clarithromycin

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8
Q

What should you never do with steroids?

A

Never stop them abruptly, continue them through any illness

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9
Q

Maintenance dose of omeprazole for GORD?

A

10-20mg

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10
Q

If a patient on biphasic insulin has bad afternoon BM’s, what do we do?

A

Alter her morning dose

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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

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12
Q

INR range for mechanical valve?

A

3-4

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13
Q

What counts as missing a pill for contraceptive?

A

> 24 hours

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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.

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15
Q

What should you monitor with eplerenone?

A

Potassium (it is a potassium sparing diuretic)

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16
Q

Advice for men on methotrexate?

A

Contraception taken during and for at least 3 months after stopping treatment

Same advice for women

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17
Q

Side effect of mirtazapine?

A

Abnormal dreams

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18
Q

Which diuretics cause hypokalaemia?

A

Thiazide like diuretics e.g. indapamide

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19
Q

What interacts with simvastatin to increase severe myopathy risk?

A

Gemfibrozil - potent CYP inhibitor

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20
Q

Unconscious hypoglycaemic Mx?

A

1st line = glucose 20% 50-100mL IV, over less than 20 minutes

2nd line = Glucagon

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21
Q

How to monitor BB effect in AF?

A

Check heart rate

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22
Q

What to monitor electrolyte wise for amiodarone?

A

Potassium - check prior to starting treatment

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23
Q

When do you stop the statin in myopathy?

A

If CK is > 5 times the upper normal limit or severe muscular symptoms

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24
Q

How does fentanyl convert to oral morphine?

A

25ug/hour of fentanyl = 60mg of morphine

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25
Q

What to give to alleviate breathlessness and oedema in heart failure?

A

Furosemide 40mg IV IV IV

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26
Q

Patient needs post-op prophylaxis, scared of needles?

A

Apixiban can be given orally

Apixiban oral 2.5mg PO BD

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27
Q

Treatment for moderate severe acne, having tried topical therapy?

A

Doxycycline

Lymecycline

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28
Q

Standard dose for tacrolimus?

A

Maintenance dose is commonly 1-2mg BD

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29
Q

What electrolyte abnormality do both tacrolimus and Dalteparin cause?

A

Hyperkalaemia

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30
Q

When should anti-platelets be stopped prior to surgery?

A

7 days

Except if recent vascular stenting

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31
Q

What drugs to hold in renal function?

A

ACEI’s, ARBS

Allopurinol is really excreted so BNF advises max daily dose of 100mg in renal failure

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32
Q

How can AKI cause confusion?

A

Decreased clearance of medicines e.g. co-codamol and diazepam

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33
Q

How do steroids affect blood sugar levels?

A

Hyperglycaemia

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34
Q

How does citalopram affect electrolytes?

A

Cause hyponatraemia, due to inappropriate ADH secretion

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35
Q

Do you take levothyroxine daily or weekly?

A

Daily

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36
Q

Monitoring furosemide effect in heart failure?

A

Check weight

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37
Q

Alcohol withdrawal Tx?

A

Chlordiazepoxide hydrochloride 20mg PO TDS

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38
Q

If INR >1.5 on the day before surgery what do you give?

A

Phytomenadione (Vitamin K) 1-5mg orally

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39
Q

What should you advise with anti-depressants?

A

Suicidal idealation may worsen before it gets better / May take 6 weeks to work

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40
Q

What should the patient report if on rivoroxaban?

A

Any abnormal unexplained bruising / bleeding

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41
Q

How does topiramate affect progesterone only contraception?

A

It reduces the efficacy, so you should an alternative contraceptive during the treatment and for at least 4 weeks afterwards

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42
Q

Side effect of beta blockers ?

A

Erectile dysfunction

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43
Q

What is an example of a cholestatic drug and who it primarily affects?

A

Co-amoxicalv

Classically affects men > 65

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44
Q

What interacts with dabigatran etexilate to cause increased bleeding risk?

A

Citalopram

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45
Q

What is an acceptable rise in creatinine when starting an ACEI?

A

<20% is acceptable, if it rises to <20% do not stop, just repeat renal function tests in 1 week

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46
Q

Monitoring in carbimazole?

A

FBC for neutropenia

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47
Q

monitoring the affect of ACEI in heart failure?

A

Excercise tolerance - think NYHA classification is how we grade severity

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48
Q

Most serious adverse affect of ciclosporin and monitoring?

A

Nephrotoxicity

Before starting you must assess renal function

Then check it 2-weekly until stable

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49
Q

Whats the usual increase of an insulin dose when the patient goes on glucocorticoids?

A

10% increase

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50
Q

What should non-HDL cholesterol have decreased by once started on statins?

A

> 40% reduction in is the target. If you don’t hit this you need to up the dose

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51
Q

When should gentamicin levels be measured after the dose?

A

Within a 6-14 hour window

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52
Q

What anti-emetic do you give in patients who are at risk of extra-pyramidal SE’s or prolonged QT?

A

Cyclizine 50mg TDS

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53
Q

Management of shingles in a high risk / immunocompromised patient e.g. oncology?

A

Aciclovir at the higher 800mg 5/day dose. For 7 days

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54
Q

How much and how long for a fluid challenge?

A

ideally 500ml in under 15mins, or 1 litre under 30 minutes

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55
Q

Starting dose for metformin?

A

500mg PO OD

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56
Q

Max dose of citalopram in old people?

A

20mg

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57
Q

What drugs cause ‘indigestion’?

A

Steroids, NSAIDS, alendrotnic acid

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58
Q

Two common drugs causing diarrhoea?

A

Alendronic acid and PPI’s

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59
Q

Other than CCB’s, what can cause ankle swelling?

A

Naproxen

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60
Q

Pregnant lady with vaginal candidiasis, whats the Tx?

A

It has to be prolonged therapy. Clotrimazole pessary / cream

Don’t give oral anti-fungals in pregnancy

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61
Q

Patient with DKA on short acting insulin (Humulin) and long acting (Lantus). How do we manage her insulin ?

A

Fixed rate insulin infusion

Stop short acting

Continue long acting

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62
Q

Management of pain in post-herpetic neuralgia?

A

Paracetamol

NSAIDs too but caution if old people with renal risk / ulcer risk

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63
Q

Important information to give to people taking loperamide?

A

Initial dose of 4mg

then take 2mg after each loose stool - MAX 16mg/24 hour period

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64
Q

What must we monitor in ciclosporin?

A

Renal function as it is highly nephrotoxic.

Monitor creatinine every 2 weeks for first 3 months then 3 monthly

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65
Q

Is ciclosporin an absolute contra-indication to pregnancy?

A

No, just not recommended

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66
Q

Most likely SE of Liraglutide (GLP1 mimetic)

A

Vomiting

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67
Q

What does tramadol do the given with SSRI’s?

A

Increases risk of serotonin syndrome

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68
Q

What TB drug increases metabolism or oestrogen / progestogens?

A

Rifampicin

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69
Q

Mx of anti-psychotic induced Parkinsonism?

A

Procyclidine 2.5mg oral TDS

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70
Q

What does COCP cause short term and how should it be monitored?

A

BP increase, BP

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71
Q

What should you measure prior to initiating azathioprine / mercaptopurine?

A

TPMT

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72
Q

What should be monitored with apixiban?

A

nothing, just tell patient to report any bleeding / bruising

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73
Q

If someone has renal impairment what analgesics should be avoided?

A

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
Q

Management of warfarin and bleeding?

A

> 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
Q

If amiodarone causes thyrotoxicosis what should we do?

A

Stop the amiodarone

76
Q

Drugs contraindicated in heart failure?

A

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
Q

What electrolyte values do people need as maintenance?

A

25-30ml / kg

1mmol/kg of potassium, sodium and chloride

50-100g/day of glucose

78
Q

What does 0.9% saline have in it?

A 
Sodium = 154
Chloride = 154
79
Q

What is in Hartmann’s?

A 
Sodium = 131
Chloride = 111
Potassium = 5 
HCO3 = 29
80
Q

What laxative do you use in opioid induced constipation?

A

Osmotic laxative e.g. lactulose

81
Q

What oxygen should be given in critically ill patients?

A

Resevoir mask 15L/minute

82
Q

What three drugs are contraindicated in asthma?

A

NSAIDs - increased risk in those with nasal polyps

BB’s

Adenosine

83
Q

What type of fluids should you avoid in stroke patients?

A

5% glucose - increases risk of cerebral oedema

84
Q

Two emergency contraceptions and when you take them?

A

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
Q

what are the CYP450 inducers?

A

PC BRAS = Enzyme up = drug conc. down

Phenytoin
Carbamazepine

Barbiturates
Rifampicin
Alcohol (CHRONIC EXCESS)
Sulphonylureas

86
Q

CYP450 inhibitors?

A

AO DEVICES = enzyme down = drug conc. increase

Allopurinol
Omeprazole

Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol
Sulphonamides
87
Q

Drugs to stop pre-surgery?

A

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
Q

Steroid side effects (and loosely the CI’s)

A

STEROIDS

Stomach ulcers
Thin skin
Edema
R + LHF
Osteoporosis
Infection (Candida)
Diabetes
Syndrome of Cushings
89
Q

When not to use NSAIDs?

A

Heart failure
Renal failure
Stomach ulcers
Asthma

90
Q

Which diuretic causes gout?

A

Thiazides

91
Q

Which diuretic causes gynaecomastia?

A

K Sparing

92
Q

When do you give 5% glucose?

A

If patient is hypernatraemic

Hypoglycaemic

93
Q

When do you give gelofusin?

A

Systolic <90 in trauma etc

94
Q

When shouldn’t you use cyclizine as an anti-emetic?

A

Heart failure as can cause fluid retention

95
Q

When shouldn’t you use metoclopramide?

A

Parkinsons

96
Q

When should you not use COCP?

A

Migraines

97
Q

What causes hypovolaemic hyponatraemia?

A

Urine Na < 20 = extra-renal e.g. D&V, fistula, burns

Urine Na > 20 = renal e.g. Diuretics, salt losing nephropathy

98
Q

What causes euvolaemic hyponatraemia?

A

SIADH, adrenal insufficiency or hypothyroid

99
Q

What causes hypervolaemic hyponatraemia?

A

Cardiac failure, cirrhosis, and kidney failure

100
Q

What causes hypernatraemia?

A

Unreplaced losses = GI, DI

101
Q

Causes of hypokalaemia?

A

1) Renal loss = RTA, thiazides/Gitelmans and Loops/Barters
2) GI loss
3) Excess aldosterone = Conns
4) insulin and salbutamol

102
Q

causes of hyperkalaemia?

A

1) Renal failure
2) Drugs e.g. NSAIDs, ACEI, ARBs and Spiro
3) Low aldosterone = Addisons
4) Redistribution = Rhabdomyolysis or any acidosis

103
Q

Drugs causing neutropenia?

A

Carbimazole and Clozapine

104
Q

Drugs causing cholestasis?

A 
Flucloxacillin
Co-amoxiclav
Nitrofurantoin
Steroids
Sulphonylureas
105
Q

Signs of digoxin toxicity?

A

Visual halos, yellow-green vision, arrhythmias

106
Q

Lithium toxicity?

A 
Early = tremor
Late = Arrhythmias, seizures and DI
107
Q

Phenytoin toxicity?

A

Gum hypertrophy, ataxia, nystagmus and peripheral neuropathy

108
Q

Gent and vancomycin toxicity?

A

Ototoxic and nephrotoxic

109
Q

Dosing in gentamicin normal vs renal failure?

When do you measure?

A

Normally high dose = 5mg/kg

Renal failure = 1mg/kg

6-14 hours post dose

110
Q

What interacts with erythromycin to prolong QT?

A

Domperidone

111
Q

What interacts with fluconazole to cause QT prolongation?

A

Domperidone and haloperidol

112
Q

Side effects of quinolones?

A

Convulsions and tendon damage

113
Q

Side effects of barbiturates?

A

Behavioural disturbances

114
Q

SE’s of carbamazepine?

A

Skin reactions. Asians get Steven Johnsons

115
Q

Management of hyperkalaemia?

A

10ml 10% calcium gluconate
100ml 20% glucose + 10 units actrapid
Salbutamol 5mg

116
Q

Management of HTN?

A

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
Q

STEMI and NSTEMI Mx?

A

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
Q

Anaphylaxis Mx?

A

0.5ml 1:1000 adrenaline
200mg Hydrocortisone
10mg Chloramphenamine

119
Q

Heart failure Mx?

A

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
Q

AF Mx?

A

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
Q

Asthma Mx?

A 
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
Q

COPD Mx?

A

1 = SABA / SAMA

2 = FEV > 50% = LABA or LAMA
= FEV < 50% = LABA +ICS, OR LAMA

3 = LABA + LAMA + ICS

123
Q

Diabetes drugs: Metformin MOA and SE’s?

A

Oral
Decreases hepatic neogenesis and increases insulin secretion
SE’s = NADL = Nausea, abdo pain, diarrhoea and lactic acidosis

CI = eGFR < 30

124
Q

Diabetes drugs: Sulphonylurea MOA and SE’s?

A

Oral, gliclazide

Increase B cell secretion of insulin

SE’s = Hypos, hyponatraemia and weight gain

125
Q

Diabetic drugs: Thiazolinediones MOA and SE’s?

A

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
Q

Diabetic drugs: DPP4 / gliptins MOA and SE’s?

A

Oral sildagliptin
Increases incretin levels = inhibits glucagon

SE = pancreatitis

127
Q

Diabetic drugs: SGLT-2 inhibitors MOA and SE’s?

A

Oral

Inhibit glucose reabsorption in the kidney

Get weight loss…. but also UTI’s as increased glucose in urine

128
Q

Diabetic drugs: GLP-1 mimetics MOA and SE’s?

A

Subcut, Exanitide

Incretin mimetic

SE’s = nausea, vomiting and pancreatitis

129
Q

Common AED SE’s?

A

Lamotrigine = skin hypersensitivity

Valproate = 3T’s ==> Teratogenic, tremor and tubby

Phenytoin = Ataxia, peripheral neuropathy and gingival hyperplasia

Carbamazepine = SIADH, nystagmus

130
Q

Alzheimers Mx?

A

Mild/moderate = AchE inhibitors e.g. donepezil, rivastigmine

Severe = memantine

131
Q

Crohns Mx?

A

Induction = Prednisolone, then sulfasalazine, then Azathioprine, then infliximab

Maintain = Azathioprine

132
Q

UC Mx?

A

Induction = Mesalazine, prednisolone then Tac

maintain = Mesalazine, azathioprine then infliximab

133
Q

What do we do with ramipril in pregnancy?

A

Stop as teratogenic, give labetalol

134
Q

What does tamoxifen increase risk of?

A

DVT and endometrial cancer

135
Q

How often is methotrexate given, what do you give with it and what do you not give it with?

A

Once weekly

Folic acid

Trimethoprim / co-trimoxazole

136
Q

If on long term steroids what should you take?

A

bisphosphonates and PPIs

137
Q

What does 1% for drugs mean?

A

10mg in 1ml

138
Q

What to monitor in vancomycin?

A

Kidney function as renal cleared

139
Q

What to monitor in statins?

A

Baseline LFT’s then check at 3 and 12 months

Baseline of creatinine if old / renal disease

140
Q

When do you check phenytoin levels?

A

Trough at 14 days

141
Q

What is lithium range, when do we monitor?

A

0.4-0.8, check 12 hours after last dose

Monitor dose weekly after initiation / dose change
3 monthly once stable

142
Q

Methotrexate monitoring?

A

Monitor 3 monthly FBC’s

143
Q

What do you monitor in clozapine?

A

First 18 weeks FBC weekly

Any agranulocytosis = stop ASAP

144
Q

Sodium valproate monitoring?

A

Hepatotoxic = LFT’s

145
Q

Amiodarone monitoring?

A

Baseline CXR and do TFT’s + LFT’s

146
Q

What electrolyte affects digoxin levels?

A

Potassium

Potassium competes for digoxin binding, so low potassium means digoxin level raised!

147
Q

SE of amiodarone?

A

Thyroid problems and fibrosis

148
Q

When to use vancomycin in C.Diff vs Metronidazole?

A

Acute rise in creatinine
Evidence of colitis e.g. fresh bleeding
WCC > 15

149
Q

Anti-emetics in pregnancy?

A

1st line = cyclizine / promethazine

2nd line = metoclopramide

150
Q

What two cardiac drugs do you not give together as risk pre-syncope?

A

Verapamil and BB

151
Q

How do drugs cause digoxin toxicity?

A

By decreasing potassium / magnesium e.g. loop or thiazides

By increasing digoxin plasma conc. e.g. Amiodarone, CCB’s and Spiro

152
Q

Big side effect of tamsulosin?

A

alpha blocker = postural hypotension

153
Q

Side effect of clozapine?

A

Affect glucose metabolism = metabolic syndrome.

Polyuria, polydipsia and blurred vision

154
Q

What is DRESS syndrome and three common drug precipitants?

A

Drug Reaction with Eosinophilia and Systemic Symptoms

Allopurinol, anti-epileptics, and sulphonamides (e.g. co-trimoxazole)

155
Q

What do you give in corneal abrasion?

A

1 week of topical eye drops e.g. chloramphenicol

156
Q

What must you have done monthly on isotrenitoin?

A

Pregnancy test

157
Q

Common SE of mirtazapine that puts patients off?

A

Weight gain

158
Q

How to monitor adverse affects of caffeine treatment?

A

Drug levels

159
Q

Monitoring in venlafaxine?

A

Regular BP’s and ECGs as can prolong QT

160
Q

If you have renal impairment what type of heparin should you use?

A

Unfractionated.

LMWH is excreted really, so don’t use if renal impairment.

161
Q

Post surgery what thromboprophylaxis do you use?

A

Apixiban, rivaroxiban

162
Q

Pre surgery or for medical patients what VTE prophylaxis?

A

All surgery LMWH e.g. dalteparin

Renal impairment = unfractionated

163
Q

Which PPI interacts with clopidogrel to reduce its efficacy?

A

Omeprazole.

Try to use lansoprazole

164
Q

Which anti-epileptic can cause yellow skin, mistaken for jaundice sometimes?

A

Carbamazepine

165
Q

three common drugs that trigger gout?

A

Thiazides, aspirin and ACEI

166
Q

When managing AF, what counts as adverse signs meaning we cardiovert?

A

Heart failure
Shock
MI
Syncope

167
Q

If patient has been on long term Benzo’s for anxiety/insomnia what should we do?

A

Switch to diazepam and taper off

168
Q

What type of rash does lithium exacerbate?

A

Psoriasis

169
Q

What should you monitor in tenofovir?

A

Renal function e.g. urinalysis

170
Q

How would you monitor the acute negative effects of aminophylline (i.e. not a theophylline level)?

A

Cardiac monitoring

171
Q

Quetiapine monitoring?

A

Annual BMI, lipids, glucose, FBC and ECG

172
Q

What should you avoid if penicillin allergic?

A

Cephalosporins e.g. ceftriaxones

173
Q

When do you need non-invasive ventilation?

A

Type 2 respiratory failure

174
Q

When should you not use nitrofurantoin?

A

If eGFR is <45. Use trimethoprim instead

175
Q

Most likely SE when giving steroids and amoxicillin?

A

Candidiasis

176
Q

What do you give for urticarial allergic rash, but not full blown anaphylaxis?

A

Chlorphenamine 4mg PO QDS

177
Q

Mx of thyroid storm?

A

Carbimazole

178
Q

What to tell pregnant people taking LMWH worried about baby?

A

It does not cross the placenta

179
Q

What is a patient on a Benzo and nitrate at risk of?

A

Falls

Benzo = confusion
Nitrate = postural hypotension
180
Q

What happens when you give buprenorphine with morphine?

A

Buprenorphine has a partial agonist effects, counteracting the morphine and reducing efficacy

181
Q

How do you treat a PC of gout if the person has heart failure?

A

Use colchicine

NSAIDs are contraindicated in heart failure, particularly diclofenac

182
Q

Which anti-malarial is contraindicated in pregnancy?

which common medication decreases this drugs absorption?

A

Doxycycline

Antacids decrease doxycycline absorption - don’t prescribe together

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