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Muhesh Final Year from Passmed > PSA > Flashcards

PSA Flashcards

1
Q

Doses in anaphylaxis

Adrenaline

Hydrocortisone

Chlorphenamine

A

<6 months

Adrenaline - 150 mcg

Hydrocortisone - 25 mg

Chlorphenamine - 250 mcg

6months - 6 years

Adrenaline - 150 mcg

Hydrocortisone - 50mg

Chlorphenamine - 2.5 mg

6 - 12 years

Adrenaline - 300mcg

Hydrocortisone - 100mcg

Chlorphenamine - 5mg

>12 years

Adrenaline - 500 mcg (1:1000)

Hydrocortisone - 200mcg

Chlorphenamine - 10mg

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2
Q

Adrenaline

<6 months

6 months - 6 years

6 - 12 years

>12 years

A

<6 months - 150 mcg (0.15 ml 1:1000)

6 months - 6 years - 150 mcg (0.15 ml 1:1000)

6 - 12 years - 300 mcg (0.3 ml 1:1000)

>12 years - 500 mcg (0.5 ml 1:1000)

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3
Q

Which two common medicines are commonly prescribed weekly

A

Alendronate

Methotrexate

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4
Q

Which two medications are commonly taken at night?

A

Amitryptilline

Simvastatin

Ace-i (postural hypotension)

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5
Q

When do you empircally start n-AC in parectomal overdose?

(3)

What is considered overdose?

A

>8 hours since overdose at presentation = start empirically

>153mg/L dose at any time also warrants empiral treatment

staggered dose (tablets taken over a period > 1 hour ) = start empirically

>10 mg is considered overdose

OR

>200 mg/kg

If above nomogram treatment line at >4 hours treat empircally

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6
Q

Medications to avoid In HF

A

Verapamil - negatively inotropic

Thiazolidenidiones - Pioglitazone. Fluid retention

NSAIDs - FLuid Retention

?GCs - fluid retention

Fleicanide (And other Class I VW anti-arrhythmics): Negatively inotropic

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7
Q

Enzyme Inducers and Inhibitors

CRAP GPS

VIP C CEO GFF

A

Inducers - CRAP GPS

Carbamezapine

Rifampicin

Alcohol (Chronic)

Phenytoin

Grieofulvin

Phenobarbitone

Sulphonyulureas

Inhibitors - VIP C CEO GFF

Valproate

Isoniazid

Protease inhibitors

Cimetine

Ciprofloxacin

Erythromycin - macrolides

Omeperazole - PPIs

Grapfruit Juice

Fluoxetine

Flucanazole

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8
Q

Drugs to stop before surgery

A

COCP and HRT - 4 weeks before surgery (if they want to carry on give POP,

Lithium - Day before

Potassium sparing diuretics/ ACE-i - Day of surgery

Anticoagulants / Antiplatelets - variable (5 days before for warfarin) continue bridging with LMWH if high risk of thrombosis

Oral hypoglycaemics - Variable

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9
Q

Paracetomal prescription frequency?

A

6 hourly - NOT four hourly

so 4 times a day NOT 6 times a day

Generally = 1g QDS

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10
Q

Drugs to stop in patients that are bleeding

A

Aspirin / NSAID

Heparin

Warfarin

Enzyme inhibitors (as they will increase warfarin’s infect)

VIP C CEO GFF

Valproate, isoniazid, protease inhibitors, cimetidine, cipro, erythro, omeprazole, grapefruit juice, fluoxetine, flucanazole

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11
Q

Side Effects/ Contrainidcations to

GCs

STEROIDS

A

S - stomach ulcers

T - thin skin

E - oedema

R - right and left heart failure ( due to fluid retention )

O - osteoporosis

I - infection

D - iabetes (hyperglycaemia)

S - Cushing’s syndrome

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12
Q

Side effects / Contraindications

for

NSAID

A

N - No urine (RF)/ Hyperkalaemia

S - Systolic disfunction (fluid retention)

A - Asthma (bronchospasm)

I - Indigestion (any cause)

D - Dyscrasia (Clotting abnormality)

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13
Q

Which replacement fluid if:

Hypernatraemic or hypoglycaemic

In ascites

<90 mmHg

Shocked from bleeding

A

Hypernatraemic or hypoglycaemic - 5% dextrose

In ascites - HAS

<90 mmHg - Colloid

Shocked from bleeding - Blood/colloid

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14
Q

Two salty - one sweet?

A

General rule for prescribing fluids

2 - NS

1 - Dextrose

+ 20 mmol KCL in 2/3 of the bags ( 40-60 mmol KCL per day)

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15
Q

Max rate for potassium transfusion

A

<10 mmol/hour

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16
Q

anti emetic prescribing in:

Cardiac patient

non-cardiac patient

Parkinsonism patients

Young women

A

Cardiac : Metoclopramide 10 mg maximum 8 hourly

non-cardiac: cyclizine 50 mg maximum 8 hourly

Parkinsonism/ young women - not metoclopramide

Cyclizine –> causes fluid retention

Metoclopramide –> worsens parkinson symptoms and causes dyskinesia in young women

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17
Q

Someone on methotrexate with a raised CRP/Possible sepsis?

A

Stop the methotrexate - might be neutropenic sepsis..

Re-assess when the FBC is done

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18
Q

LMWH / heparin thromboprophylaxis post stroke?

A

Not advised until >2 months after the stroke

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19
Q

Drug causes of asthma exacerbations

A

NSAIDs (less so with asthma)

Beta Blockers

Adenosine

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20
Q

Changes to thyroxine dosing?

A

<0.5 - Decrease Dose

0.5-5 - Same Dose

>5 - Increase dose

Always change by the smallest incrament possible

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21
Q

What do with high serum level in the blood of gentamicin?

A

Decrease frequency (i.e. 36 hourlty dosing rather than 24 hourly dosing)

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22
Q

Usual gentamicin dosing?

Measuring levels?

A

5-7 mg/kg OD / divided daily dosing 1 mg/kg for IE

Record when Blood sample taken but usually between 6-14 hours from start of infusion

  • Use a nomogram :

if concentration is <q24></q24>

<p>if concentration is between q24- q36 then <strong>change to 36 hourly dosing</strong></p>

<p>if concentration is between q36-q48 then <strong>change to 48 hourly dosing</strong></p>

<p>if dose is &gt;q48 then <strong>repeat gentamicin levels and only re-dose when gent concentration is &lt;1mg/L</strong></p>

</q24>

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23
Q

paracetomal toxicity mechanism

A

Paracetomal is usually metabolised by glutathione

  • paracetomal overwhelms these stores and leads to accumulation of toxic NAPQI —> liver damage

NAC- replenishes glutathione stores

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24
Q

Bradycardic + on digoxin?

A

Stop digoxin

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25
Q

Fast AF - Pharmacological choices

A

Beta blockers - not if asthmatic or in HF

CCBs - Verapamil/diltiazem —> not if they oedema

Digoxin

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26
Q

Fast AF plus evidence of heart failure (existing)

A

Amiodarone or Digoxin

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27
Q

CHADS VASC

A

Congestive heart failure

Hypertension

Age >75 (2 points)

Diabetes

Stroke or TIA (2 points)

Vascular (PAD or IHD)

Age (65-74)

Sex (female)

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28
Q

Why would you start sulfonylurea instead of metformin?

A

if low/normal weight

creatinine >150 umol/L

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29
Q

AED of choice

A

Valproate for everything apart from:

Absence - Ethosuximide/ valproate

Foxal - CZP/ LTG

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30
Q

Constipation treatment options

Stool softeners (2)

Bulking agents (1)

Stimulant laxatives (2)

Osmotic laxatives (2)

A

Stool softeners (2)

Docusate sodium

Arachis Oil

Bulking agents (1)

Ispaghula Husk

Stimulant laxatives (2)

Senna

Bisacodyl

Osmotic laxatives (2)

Lactulose

Phosphate Enema

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31
Q

Tamoxifen SEs (4)

A

i) Endometrial Ca
ii) Increases efficacy of warfarin
iii) VTE
iv) Hot flushes

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32
Q

Warfarin tablet colour codes

A

White - 0.5mg

Brown - 1mg

Blue - 3mg

Pink - 5mg

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33
Q

What do you do to the insulin dose in illness

A

May need higher doses

Tell them to eat regularly as possible

Check their BMs more frequently

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34
Q

Starting calculations for dose/percentation

A

1% = 1g in 100ml

10mg in 1ml

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35
Q

When should you give ace inhibitors?

A
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36
Q

Focal Seizures - Which drug

A

Lamotrigine

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37
Q

Two classic side effects of vancomycin

Common monitoring of vanc

A

Nephrotoxicity and ototoxicity

Serum creatinine is commonly used to monitor vancomycin/ assess for suitability / dosing

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38
Q

Baseline chest x ray in what drug?

A

Amiodarone

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39
Q

What to regularly monitor in Digoxin?

A

Creatinine

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40
Q

What to measure at baseline and regularly with treatment on valproate?

A

LFTs

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41
Q

What is Warfarin’s MOA?

A

Vitamin K Reductase inhibitor

Reduces production of - 2, 7 , 9, 10 ,Protein C and Protein S

—>

Pro coagulant in the first few days due to protein C and S depletion

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42
Q

Why should ACEis and NSAIDs not be prescribed concurrently

A

NSAIDs- Inhibot prostoglandins. Prostoglandins usually dilate afferent renal vessels

  • NSAIDs therefore prevent the dilation —> reduced afferent flow to kidney

ACEis - Cause smooth muscle relaxation of efferent arterioles. This then causes them to widen.

Combination of reduced calibre afferent vessels + increased calibre efferent vessels = renal hypoperfusion

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43
Q

Warfarin

Bleeding?

No Bleeding:

INR>8

INR 6-8

INR <6

A

Bleeding - IV slow vit K/ FFP/ Prothrombin Complex Conentrate

No Bleeding:

INR>8 - Oral vit k (withold warfarin)

INR 6-8 - omit 1-2 doses

INR <6 - lower dose of warfarin

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44
Q

Dose: Paracetomal

NSAIDs

Co-Codamol

Codeine

A

Paracetomal : 1g QDS

NSAIDs : 300-400 mg TDS (Ibuprofen)

Co-Codamol : 2 x 30/500 QDS

Codeine : 30 - 60 mg QDS

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45
Q

Dose:

Cyclizine

Metoclopramide

Amoxicillin

Clarithromycin

Lansoparazole

Omeprazole

A

Cyclizine - 50 mg TDS

Metoclopramide - 10 mg TDS

Amoxicillin - 500 mg TDS

Clarithromycin - 500 mg BD

Lansoparazole - 15-30 mg OD

Omeprazole - 20-40 mg OD

46
Q

Doses:

Aspirin

Clopidogrel

Simvastatin

Atenolol

Ramipril

Bendroflumethiazide

Frusemide

Amlodipine

A

Aspirin - 75-300mg OD

Clopidogrel - 75-300 mg OD

Simvastatin- 10-80 mg ON

Atenolol - 25-100 mg oD

Ramipril - 1.25-10mg OD

Bendroflumethiazide - 2.5mg OD

Frusemide - 20-80 mg BD

Amlodipine - 5-10mg OD

47
Q

Doses :

Levothyroxine

Metformin

A

Levothyroxine - 25-200mcg OD

Metformin 500 mcg OD- 1g BD

48
Q

Drugs worsening seizure control

A

P450 Inducers

Stimulants - alcohol, cocaine amphetamines

Fluroqunilones

Methylxanthines - ophyllines

Bupropion

Methylphenidate

Mefanamic acid

49
Q
A
50
Q

HB1aC Targets in diabetes

A

<48 mmol/mol TItrate up metformin

-Target for lifestyle / lifestyle + metformin <48 mmol/mol

If Hba1c >53 mmol/mol then add second drug

-Target for any other medicine than metformin <53 mmol/mol

Hba1c shouold be checked every 3-6 months until stable and then six monthly therafter

51
Q

Enzyme induction etc.

Chronic alcohol intake?

Acute alcohol intake?

A

Chronic alcohol intake? - Inducer

Acute alcohol intake? - Inhibitor

52
Q

Aminophylline loading dose

A

5mg/kg

Slow IV over 20 minutes

Attached to cardiac monitor

53
Q

Meningitis when penicillins CI?

A

Chloramphenicol

54
Q

Indications for high dose statin therapy

A

Known CVD

Known history of ischaemic CVA

Known PAD

55
Q

which classification system is used for paracetomal/overdsoe related liver failure.

A

King’s COllege Hospital

ph >7.3

Prothrombin time> >100s

Creatinine >300umol/l

Encephelopathy - Stage III/IV

56
Q

Three things to look for when assessing for digoxin toxicity

A

Digoxin levels

Us and Es

ECG

57
Q

Drugs improving mortality in HF (4)

A 
Beta blockers (although are contraindicated in acute HF)
Ace-i

Aldosterone antagonists

Hydralazine with nitrates

58
Q

two most common side effects of CCB

A

Headache

Anke oedema

59
Q

Conversions:

Codeine/Tramadol to morphine

Morphine to oxycodone

Oral morphine to subcut morphine

Oral morphine to subcut diamorphine

Oral oxycodone to subcut diamorphine

Any oral opioid to its SC form

Oral morphine to transdermal fentanyl

Oral morphint to transdermal buprenorphine

A

Codeine/Tramadol to morphine - 10:1

Morphine to oxycodone - 1.5:1

Oral morphine to subcut morphine : 2:1

Oral morphine to subcut diamorphine: 3:1

Oral morphine to subcut oxycodone: 1.5:1

Any oral opioid to its SC form : 2:1

Oral morphine to transdermal fentanyl: 100:1 (nb look at the units fentanyl will be in mcg)

Oral morphint to transdermal buprenorphine: 75:1

60
Q

metronidazole + warfarin?

A

metronidazole enhances its effect —-> increases INR

61
Q

indications for the need to taper steroid withdrawal?

A

Steroid given for more than 3 weeks

>40mg steroid given for >1 week

Repeated recent courses

62
Q

Drugs to stop when someone has established IHD

A

NSAIDs

Oestrogens

Varenicline

63
Q

BP Targets

<80

>80

A

Clinical/ABPM

< 80

140/90 / 135/85

>80

150/90 / 145/85

64
Q

Monitroring paramaters:

Statin

A

LFTs:

Baseline

3 months

12 months

65
Q

Monitroring paramaters:

ACE-is

A

U&E

prior to starting

when changing dose

at least annually

66
Q

Monitroring paramaters:

Amiodarone

A

TFT, LFT

Prior to treatment - TFT,LFT, U&Es, CXR

Every 6 months - TFT, LFT

67
Q

Monitroring paramaters:

Methotrexate

A

FBC, LFT, U&E

Before starting and weekly until stabilised

2-3 monthly when stabilises

68
Q

Monitroring paramaters:

Azathiaoprine

A

FBC LFT

Before treatmentm,

Weekly for first 4 weeks

Then 3 monthly

69
Q

Monitroring paramaters:

Lithium

A

Lithium level, TFT, U&E

Lithium Level sweekly until stabilised and then 3 monthly

TFT / U&E before starting and then 6 monthly

70
Q

Monitroring paramaters:

Sodium Valproate

A

LFT (FBC)

Before starting - LFT/ FBC

LFT periodically within first 6 months

71
Q

Monitroring paramaters:

Glitazones

A

LFT

Before starting

and regularly throughout

72
Q

Gentamicin

If on a >OD routine what do you do if the trough levels are raised?

If the peak level is high?

A

Trough high = Decrease the frequency

i.e. from TDS —> BD

Peak high = decrease the dose

73
Q

Croup what is the principle drug?

A

Oral dex. 0.15 mg/kg

74
Q

ANtipsychotics monitorin

A

All at baseline then …

Baseline - ECG

Annually - FBC (clozapine more freuqent), LFT, U&Es, Cardiovascular assessment

3 months and then annually - Lipids, wieght

6 months and then annually - FBG, prolactin

frequently - BP

75
Q

Why don’t you give aspirin to women post - partum that are breast feeding ?

A

Risk of reye’s syndrome

76
Q

TSH level to aim for when treating hypothyroidism?

A

0.5-2.5

77
Q

Drugs worsening psoriasis (7)

A

LAABIAN

Lithium

ACE is

Alcohol

Beta blockers

Infliximab

Anti malarials

NSAIDs

78
Q

IF someone has been given to sodium consecutive fluid prescriptions … what hsould the next one be?

A

Glucose ( unless have stroke then think twice )

79
Q

Factors for developing candidiasis infections?

A

DM

SGLT 2 Inhibitors

Antibiotics

Steroids

80
Q

What to do when someone is given a drug that might interact with warfarin?

A

If in therapeutic range then keep at the same dose and re-check freuqnetly

If not in therapeutic range - act appropriately (if warfarin toxicity then withhold meds/treat /// if warfin underdosing then icnrease meds) and re check the INR

81
Q

What is the optimal method of correcting hypoglycaemia in hospital inpatietns that are unconscious

A

Go for IV glucose

IM glucagon is second line and illadvised in people who are anticoagulated

82
Q

If someone is shocked and you’re giving a fluid bolus. How quickly should it be given and how much should you give

A

<15 mins

No evidence of heart failure - 500 ml

Evidene of heart failure -250 ml

83
Q

What insulin do you stop/ continue in DKA?

A

Stop short acting

Continue long acting

84
Q

Amioarone induce:

Hypothyroidism

Hyperthyroidism

A

Hypothyroidism - Don’t stop amiodarone but start thyroxine

Hyperthyroidism - Stop amiodarone

85
Q
A
86
Q

Patient develops renal failure on aspirin what do you do?

Patient is bleeding on aspirin what do you do?

Patient is going for surgery on aspirin what do you do?

A

Patient develops renal failure on aspirin what do you do?

-Carry on

Patient is bleeding on aspirin what do you do?

  • Stop

Patient is going for surgery on aspirin what do you do?

  • Stop
87
Q

First line diabetic med in kidney diseaase?

A

Sulfonylurea

88
Q

Initial response to fluid challenge but BP drops again. (not likely to be a haemorrhaging patient)

A

Likely to be significant ongoing third space losses –think bowel obstruction/ pacnreatitis

Colloid bolus

89
Q

What to do if a patient develops ACE-i related cough

A

Trial of ARBs

candesartan

losartan

etc.

90
Q

Which laxatives to avoid in someone already bloated?

A

Ispaghula Husk

Lactulose

91
Q

Tacrolimus level monitoring?

A

Trough level prior to morning dose

92
Q

FOr PSA questions:

What suggests response to DKA treatment?

A

Serum ketones

  • This is because serum ketones will resolve more slowly than CBG, which likely responds rapidly to rehydration + insulin
93
Q

Measuring effect of oxygen therapy?

A

ABG > O2 sats

(not RR - too non-specific , VBG - better for mreasuring acidosis)

94
Q

Vanco therapuetic range?

When do you measure

A

Measured as a trough dose

10 mg - 20 mg

95
Q

Urticarial drug looking reaction

What do you do ?

A

Chloremphenamine is best

  • Adrenalien is only appropirate if there are clear signs of anaphylaxis - airway compromise, tachycardia, hypovolaemia, wheeze
  • Hydrocortisone will take too long to work
96
Q

Managing drug induced hypoglycaemia?

A

Always as an inpatient

97
Q

When to transfuse for anaemia?

A

Severely symptomatic

HB <7 / <10 in patients with IHD

98
Q

How long do you treat IDA orally for?

A

for 3 months after the Hb is in normal range

99
Q

Why is cardioversion inappropriate if AF has been present >48 hours

A

Due to the risk of thrombombolism

Appraoch should be - Rate control (BB, CCB, Dig)

Then elective cardioversion –> pre treatment with amiodarone and anticoagulants —-> cardiovert —>post treatment with antiocoagulant

100
Q

First line for GAD?

A

Sertralline likely to get you fulll marks?

101
Q

Why do you monitor serum creatinine when prescribiing digoxin?

A

Digoxin is predominantly renally Excreted

102
Q

Assessing for resolution of pneumonia while on the ward

A

REspiratory rate

CXR - chekced after 6 weeks

103
Q

Tacrolimus monitoring

A

Trough level

104
Q

What to monitor for in SSRIs?

A

Rash

Mood assessment (suicidal ideation)

105
Q
A
106
Q

Old people on anti-depressants?

A

The dose is usually a very mild one

If there appears to be a ‘normalish’ looking dose of anti-depressant in an elderly person look it up as it might be a prescribing error

107
Q

Allopurinal in Renal failure?

A

Maximum dose 100 mg!

It accumulates in RF

108
Q

NB on fentanyl patches to morphine conversion

A

Very confusin – Found the BNF treatment summary is available so look for prescribing in palliative care

109
Q

Managing transiently poor glycaemic control due to steroids

A

10% increase in insulin should do the job

110
Q
A

Muhesh Final Year from Passmed (11 decks)

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