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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
**Fast AF - Pharmacological choices**
Beta blockers - not if asthmatic or in HF CCBs - Verapamil/diltiazem ---\> not if they oedema Digoxin
26
Fast AF plus evidence of heart failure (existing)
Amiodarone or Digoxin
27
**CHADS VASC**
Congestive heart failure Hypertension Age \>75 (2 points) Diabetes Stroke or TIA (2 points) Vascular (PAD or IHD) Age (65-74) Sex (female)
28
Why would you start sulfonylurea instead of metformin?
if low/normal weight creatinine \>150 umol/L
29
AED of choice
Valproate for everything apart from: Absence - Ethosuximide/ valproate Foxal - CZP/ LTG
30
**Constipation treatment options** **Stool softeners (2)** **Bulking agents (1)** **Stimulant laxatives (2)** **Osmotic laxatives (2)**
**Stool softeners (2)** Docusate sodium Arachis Oil **Bulking agents (1)** Ispaghula Husk **Stimulant laxatives (2)** Senna Bisacodyl **Osmotic laxatives (2)** Lactulose Phosphate Enema
31
**Tamoxifen SEs (4)**
i) Endometrial Ca ii) Increases efficacy of warfarin iii) VTE iv) Hot flushes
32
**Warfarin tablet colour codes**
White - 0.5mg Brown - 1mg Blue - 3mg Pink - 5mg
33
**What do you do to the insulin dose in illness**
May need higher doses Tell them to eat regularly as possible Check their BMs more frequently
34
**Starting calculations for dose/percentation**
1% = 1g in 100ml 10mg in 1ml
35
**When should you give ace inhibitors?**
36
Focal Seizures - Which drug
Lamotrigine
37
**Two classic side effects of vancomycin** **Common monitoring of vanc**
Nephrotoxicity and ototoxicity Serum creatinine is commonly used to monitor vancomycin/ assess for suitability / dosing
38
Baseline chest x ray in what drug?
Amiodarone
39
What to regularly monitor in Digoxin?
Creatinine
40
What to measure at baseline and regularly with treatment on valproate?
LFTs
41
**What is Warfarin's MOA?**
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
42
**Why should ACEis and NSAIDs not be prescribed concurrently**
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
43
Warfarin Bleeding? No Bleeding: INR\>8 INR 6-8 INR \<6
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
44
**Dose:** Paracetomal NSAIDs Co-Codamol Codeine
Paracetomal : 1g QDS NSAIDs : 300-400 mg TDS (Ibuprofen) Co-Codamol : 2 x 30/500 QDS Codeine : 30 - 60 mg QDS
45
**Dose:** Cyclizine Metoclopramide Amoxicillin Clarithromycin Lansoparazole Omeprazole
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
**Doses:** Aspirin Clopidogrel Simvastatin Atenolol Ramipril Bendroflumethiazide Frusemide Amlodipine
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
Doses : Levothyroxine Metformin
Levothyroxine - 25-200mcg OD Metformin 500 mcg OD- 1g BD
48
**Drugs worsening seizure control**
P450 Inducers Stimulants - alcohol, cocaine amphetamines Fluroqunilones Methylxanthines - ophyllines Bupropion Methylphenidate Mefanamic acid
49
50
**HB1aC Targets in diabetes**
\<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
Enzyme induction etc. Chronic alcohol intake? Acute alcohol intake?
Chronic alcohol intake? - Inducer Acute alcohol intake? - Inhibitor
52
Aminophylline loading dose
5mg/kg Slow IV over 20 minutes Attached to cardiac monitor
53
**Meningitis when penicillins CI?**
Chloramphenicol
54
**Indications for high dose statin therapy**
Known CVD Known history of ischaemic CVA Known PAD
55
**which classification system is used for paracetomal/overdsoe related liver failure.**
King's COllege Hospital ph \>7.3 Prothrombin time\> \>100s Creatinine \>300umol/l Encephelopathy - Stage III/IV
56
**Three things to look for when assessing for digoxin toxicity**
Digoxin levels Us and Es ECG
57
**Drugs improving mortality in HF (4)**
``` Beta blockers (although are contraindicated in acute HF) Ace-i ``` Aldosterone antagonists Hydralazine with nitrates
58
**two most common side effects of CCB**
Headache Anke oedema
59
**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**
**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
**metronidazole + warfarin?**
metronidazole enhances its effect ----\> increases INR
61
**indications for the need to taper steroid withdrawal?**
Steroid given for more than 3 weeks \>40mg steroid given for \>1 week Repeated recent courses
62
**Drugs to stop when someone has established IHD**
NSAIDs Oestrogens Varenicline
63
**BP Targets** **\<80** **\>80**
Clinical/ABPM \< 80 140/90 / 135/85 \>80 150/90 / 145/85
64
**Monitroring paramaters:** Statin
LFTs: Baseline 3 months 12 months
65
**Monitroring paramaters:** **ACE-is**
U&E prior to starting when changing dose at least annually
66
**Monitroring paramaters:** **Amiodarone**
TFT, LFT Prior to treatment - TFT,LFT, U&Es, CXR Every 6 months - TFT, LFT
67
**Monitroring paramaters:** **Methotrexate**
FBC, LFT, U&E Before starting and weekly until stabilised 2-3 monthly when stabilises
68
**Monitroring paramaters:** **Azathiaoprine**
FBC LFT Before treatmentm, Weekly for first 4 weeks Then 3 monthly
69
**Monitroring paramaters:** **Lithium**
Lithium level, TFT, U&E Lithium Level sweekly until stabilised and then 3 monthly TFT / U&E before starting and then 6 monthly
70
**Monitroring paramaters:** **Sodium Valproate**
LFT (FBC) Before starting - LFT/ FBC LFT periodically within first 6 months
71
**Monitroring paramaters:** **Glitazones**
LFT Before starting and regularly throughout
72
**Gentamicin** **If on a \>OD routine what do you do if the trough levels are raised?** **If the peak level is high?**
Trough high = Decrease the frequency i.e. from TDS ---\> BD Peak high = decrease the dose
73
**Croup what is the principle drug?**
Oral dex. 0.15 mg/kg
74
**ANtipsychotics monitorin**
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
Why don't you give aspirin to women post - partum that are breast feeding ?
Risk of reye's syndrome
76
**TSH level to aim for when treating hypothyroidism?**
0.5-2.5
77
**Drugs worsening psoriasis (7)**
**LAABIAN** Lithium ACE is Alcohol Beta blockers Infliximab Anti malarials NSAIDs
78
**IF someone has been given to sodium consecutive fluid prescriptions ... what hsould the next one be?**
Glucose ( unless have stroke then think twice )
79
**Factors for developing candidiasis infections?**
DM SGLT 2 Inhibitors Antibiotics Steroids
80
**What to do when someone is given a drug that might interact with warfarin?**
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
**What is the optimal method of correcting hypoglycaemia in hospital inpatietns that are unconscious**
Go for IV glucose IM glucagon is second line and illadvised in people who are anticoagulated
82
**If someone is shocked and you're giving a fluid bolus. How quickly should it be given** and **how much should you give**
\<15 mins No evidence of heart failure - 500 ml Evidene of heart failure -250 ml
83
**What insulin do you stop/ continue in DKA?**
Stop short acting Continue long acting
84
**Amioarone induce:** **Hypothyroidism** **Hyperthyroidism**
**Hypothyroidism -** Don't stop amiodarone but start thyroxine **Hyperthyroidism -** Stop amiodarone
85
86
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?
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
First line diabetic med in kidney diseaase?
Sulfonylurea
88
**Initial response to fluid challenge but BP drops again. (not likely to be a haemorrhaging patient)**
Likely to be significant ongoing third space losses --think bowel obstruction/ pacnreatitis **Colloid bolus**
89
What to do if a patient develops ACE-i related cough
Trial of ARBs candesartan losartan etc.
90
Which laxatives to avoid in someone already bloated?
Ispaghula Husk Lactulose
91
**Tacrolimus level monitoring?**
Trough level prior to morning dose
92
**FOr PSA questions:** **What suggests response to DKA treatment?**
Serum ketones - This is because serum ketones will resolve more slowly than CBG, which likely responds rapidly to rehydration + insulin
93
Measuring effect of oxygen therapy?
ABG \> O2 sats (not RR - too non-specific , VBG - better for mreasuring acidosis)
94
Vanco therapuetic range? When do you measure
**Measured as a trough dose** **10 mg - 20 mg**
95
**Urticarial drug looking reaction** **What do you do ?**
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
**Managing drug induced hypoglycaemia?**
Always as an inpatient
97
**When to transfuse for anaemia?**
Severely symptomatic HB \<7 / \<10 in patients with IHD
98
How long do you treat IDA orally for?
for 3 months after the Hb is in normal range
99
**Why is cardioversion inappropriate if AF has been present \>48 hours**
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
First line for GAD?
Sertralline likely to get you fulll marks?
101
Why do you monitor serum creatinine when prescribiing digoxin?
Digoxin is predominantly renally Excreted
102
Assessing for resolution of pneumonia while on the ward
REspiratory rate CXR - chekced after 6 weeks
103
Tacrolimus monitoring
Trough level
104
**What to monitor for in SSRIs?**
Rash Mood assessment (suicidal ideation)
105
106
**Old people on anti-depressants?**
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
**Allopurinal in Renal failure?**
Maximum dose 100 mg! It accumulates in RF
108
**NB on fentanyl patches to morphine conversion**
Very confusin -- Found the BNF treatment summary is available so look for prescribing in palliative care
109
Managing transiently poor glycaemic control due to steroids
10% increase in insulin should do the job
110

Muhesh Final Year from Passmed (11 decks)

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