PSA Flashcards
Mx of STEMI
ABC + resus + O2 Aspirin 300mg PO Morphine 5mg IV + metoclop 10mg IV GTN spray Primary PCI or thrombolysis (+ repeat ECG)
Mx of NSTEMI
ABC + resus + O2 Morphine 5mg IV + metoclop 10mg IV GTN spray Aspirin 300mg PO LMWH!!! 1mg/kg SC
Mx of acute pulmonary oedema
ABC + resus + 02 Sit up Morphine 5mg IV metoclop 10mg IV Furosemide 40mg IV If failing --> Isosorbide dinitrate infusion + CPAP
Mx of tachycardia + shock/MI/syncope/LVF
synchronised DC shock 3x
Amiodarone 300mg IV over 10-20 mins
Repeat amiodarone 900mg over 24 hours
Mx of a regular, narrow complex tachycardia?
Vagal manœuvres
Adenosine 6mg IV rapid bolus!
Repeat with 12mg. Repeat with 12mg
Mx of regular, broad complex tachycardia
Amiodarone 300mg IV over 20 mins
Then, amiodarone 900mg IV over 24 hours
Pt on warfarin w major bleed - what do you do?
- STOP warfarin
- Vitamin K 5-10mg IV
- Prothrombin complex
Pt on warfarin w INR 7
Omit warfarin for 2 DAYS
Then, reduce dose
if minor bleed –> also give oral vitamin K
Pt on warfarin w INR 9
Omit warfarin
Vitamin K 1-5mg oral (even if there’s no bleed)
If a pt is stable w acute exacerbation of COPD, how much oxygen should be given?
28% O2 (roughly 2L) –> check ABG 30 mins later
Mx of anaphylaxis
Adrenaline IM 500micrograms
Chlorphenamine IV 10mg
Hydrocortisone IV 200mg
If wheeze - salbutamol nebs
CURB 65?
Confusion (AMTS 8)
Urea (>7.5)
RR (>30)
BP (<90)
> 65yo
Pulmonary embolism: how is LMWH given?
Tinzaparin
175 units/kg SC OD
In a GI bleed, if PT or APTT is >1.5x thermal range, what must you give?
FFP
UNLESS the bleed is due to warfarin, in which case give prothrombin complex
Mx of acute GI bleed
O2
Fluid resus - 0.9% saline 500mL bolus
Catheter to monitor UO
Bloods: clotting, G+S, X-Match 6 units, FBC, LFTs, U+Es
Correct clotting: if prolonged PT/APTT –> FFP
Urgent OGD
Call surgeons
immediate medication given for suspected bacterial meningitis
IM benpen
IV fluids
IV dexamethasone 10mg
Mx of status
Airway - patent?
Recovery position
O2
Bloods: look for precipitating factors (infection, electrolytes, glucose, drugs)
If lasting >5 mins:
-IV LORAZepam/buccal MIDAZolam/IV DIAZepam
- Repeat diazepam after 2 mins
- Inform anaesthetics + ITU + consider phenytoin
Timelimit for thrombolysis in acute ischemic stroke
<4.5hours
Mx of DKA
Airway - patent
Breathing - O2? ABG? order CXR?
Circulation:
- Bloods: FBC, U+Es, ketones, glucose, CRP
1) SBP<90 –> 0.9% saline 500mL bolus
2) Fluids: 0.9% saline 1L over 1 hour, then over 2 hrs, 4 hrs, 8hrs
3) Insulin: 1 unit/1mL of saline. 0.1 units/kg/hr.
4) Replace K if <5.5 –> 40mM of K/1L of saline
Aim for ketones to reduce by 0.5mM/L/hr
Diagnosis of HONK?
Mx of HONK
Glucose >35
Osmolality >340
No ketones
Similar to DKA but half the rate of fluid infusion (500mL over 1 hour, then 2 hours, then 4 hours etc)
+ insulin + K replacement
Mx of hypoglycemia
Eat food
IV glucose 100mL of 20%
Im glucagon 1g
target BP in <80yo?
>80yo?
<80yo: <135/85 at home (140/85 in clinic)
> 80yo: 145/85 at home (150/85 in clinic)
Atrial fibrillation:
in whom would u consider rhythm control?
New onset AF + Haemodynamically unstable –> Electrical cardioversion
Stable + onset <48 hours –> rate or rhythm control (amiodarone 5mg/kg IV)
Stable + onset >48 hours or uncertain –> rate control + anticoagulation for 3 weeks, delay rhythm control
Mx of new onset AF (24 hours ago):
Rate control or rhythm control w
Amiodarone IV 5mg/kg
Rate control in AF?
Propanolol 10mg/6hrs
or
Diltiazem 120mg/day
Mx of stable angina
- GTN spray PRN
- Aspirin
- Statin
- CVS RF control
- one anti-angina drug: beta blocker(asthma!) or CCB (oedema!)
Mx of stable angina in a pt who cannot tolerate B-blockers or CCBs?
GTN spray PRN
Aspirin
Statin
CVS RF modification
Long acting nitrate( isosorbide mononitrate) or K channel activator (nicorandil)
What test is done to check for nephropathy in DM?
Albumin:creatinine ratio
eg of long-acting insulin
GLargine
Indication for oral hypoglycemics in T2DM
HbA1c =>48mM/L (after diet + exercise)
1st line medical mx of T2DM
Metformin 500mg w breakfast
1st line medical mx of T2DM - when might you NOT use metformin?
If pt is low/normal weight, or if their creatinine>150
Gliclazide!
T2DM: if pt is still HbA1c>48 and on metformin + gliclazide… what can you give?
Gliptin (DPP-4 inhibitor)
mediations to avoid in PD patients?
Haloperidol + metoclopramide
Commonly used drug in PD
Co-beneldopa
or co-careldopa
2 drugs used for absence seizure mx?
VPA
ethosuximide
2 drugs used for focal seizure mx? side effects?
VPA - teratogenicity
Lamotrigine - rash
Crohns disease: what drugs are used to treat a flare up?
Mild: oral pred
Moderate/severe: IV hydrocortisone 100mg/6hrly + supportive Mx
Crohns disease: what drugs are used to maintain remission? cautions?
Azathioprine or 6 mercaptopurine
MUST check TPMT activity before starting: if low, there is risk of toxicity. consider MTX in those patients
Maintenance treatment of Rheumatoid arthritis
Methotrexate + another DMARD:
sulfasalazine or hydroxychloroquine
^if poor response to 2 DMARDs –> add anti-TNF
Mx of a flare in RA?
Short term steroids: IM methylpred
Short term NSAIDs: ibuprofen + PPI
Reinstate DMARDs if dose was recently reduced
indications for 5% dextrose (and not NS) in fluid management?
Hypoglycaemic or hypernatremic
Fluid replacement in pt with ascites? why?
Human Albumin Solution (HAS)
- maintains oncotic pressure
General rule for maintenance fluid in adults?
3L a day:
1L of 0.9% saline
2L of 5% dextrose
Add K (guided by U+Es) - approx 40mM/day
Pain relief: for mild pain - regular vs PRN?
Regular: Paracetamol 1g every 6 hours
PRN: Codeine 30mg - max every 6 hours
Pain relief for severe pain - regular vs PRN?
Regular: Co-codamol 30/500, 2 tablets every 6 hours
PRN: Morphine sulphate 10mg, max every 6 hours
Anti-emetics: which are best to use?
Cyclizine UNLESS they have heart failure –> give metoclopramide
Mx of painful diabetic neuropathy
Duloxetine
Stimulant laxative? -ve effect?
Senna
Can worsen abdo cramps
Osmotic laxative? -ve effect?
Phosphate enema or Lactulose
Can worsen bloating
Bulking laxative? -ve aspect?
Isphagula husk - but takes days to take effect
Stool softener laxative?
Docusate
Mx of chronic diarrhoea
Loperamide - 2mg, max every 3 hours or codeine (if painful) - 30mg every 6 hours
Pts with insomnia: what must you consider first?
Appropriate medication?
Are they on corticosteroids?
Consider zopiclone 7.5mg (or 3.75 if elderly!)
Which medication which is used for neuropathic pain, can causeneutropenia?
Carbemazepine
Drugs with antimuscarinic side effects:
Anti-emetic?
Neuropathic pain relief?
cyclizine
amitriptyline
Which 2 drugs are defo best avoided in parkinnsons?
Haloperidol
Metoclopramide
What does 1% lidocaine actually mean
1g of lidocaine in 100mL
General threshold for RBC transfusion
Hb<70g/L
OR
<80g/L in ACS
When NOT to give platelets prophylactically?
ITP
TTP
Heparin induced thrombocytopenia
Chronic BM failure
Indications for FFP?
if APTT or PT are prolonged + pt is bleeding/due surgery
Indication for cryoprecipitate
Low fibrinogen AND bleeding/due surgery