PSA Flashcards
Drugs causing urinary retention
- tricyclic antidepressants
- anticholinergics
- opioids
- NSAIDs
- BENZOS
- Anaesthetics
NSTEMI key difference
No PCI, instead :
Clopi 300mg
LMWH 1mg/kg bd SC
Drugs to stop before surgery
CALIA OP
COCP/HRT (4wks before) Anticoagulants/antiplatelets Lithium (day before) Insulin ACEis (day of) Oral hypoglycaemics Potassium sparing diuretics (day of)
Drugs causing HYPERkalaemia
“K CHAT”
K sparing diuretics Ciclosporin Heparins ACEis Tacrolimus
DKA insulin rules?
Short-acting SC insulin should be stopped, and long-acting insulin should be continued. Patient requires fixed-rate IV insulin alongside fluid resuscitation.
Drugs that worsen heart failure
Diltiazem Prenisolone Thiazolididinoes Verapamil NSAIDs Class I antiarrythmic
COPD infective exacerbation drugs and doses
30mg prednisolone 7-14 days
salbutamol 5mg max every 4h
ipratropium 500 micrograms QDS
24-18% venturi
Hydrocortisone 200mg or oral pred – 30mg – continue for 7 days
4. Amoxicillin 500mg tds ; clarithromycin or doxycycline
5. IV aminophyline
Causes of low neutrophils
Viral infection
Clozapine
Carbimazole
Chemo
Statins
Measure LFTs; lipids at baseline
Measure LFTs at baseline, 3 and 12 months
If INR >1.5 on day of surgery?
Give phytomenadione
drugs that can precipitate serotonin syndrome?
SSRIs
If you combine with opioids, can cause serotonin syndrome
Fondaparinux CIs?
Renal impairment
Active bleeding
Tamoxifen risks
VTE
Treating AF
Beta blocker
if asthmatic, give VERAPAMIL
VTE prophylaxis in needle phobics
“RAD”
RIVAROXABAN
APIXIBAN
DABIGATRAN
Drugs to withhold poor renal function/AKI
Allopurinol (100mg or less until renal recovers)
ACEis
Statins (caution)
ARBs
Ciclosporin
Abx: Tetracycline, Vancomycin, Gentamicin, Nitrofurantoin
Carbamazepine, when not to give?
SIADH
Patients at high risk of VTE who have had to stop warfarin before surgery, what do you give them?
Bridging therapy - LMWH
Stop it 24 hours before surgery though
Mx of irregular narrow complex tachycardia
Probable AF. Control rate with
- beta blocker or diltiazem
- digoxin or amiodarone if contraindications ( asthma or heart failure )
Drugs causing peripheral neuropathy
- amiodarone
- isoniazid
- vincristine
- nitrofurantoin
- metronidazole
“VAIN Me”
Changing doses of thyroxine in response to TSH?
<0.5: decrease dose
0.5-5; do nothing
>5; increase dose
Liver enzyme inducers
PC BRAS
Phenytoin Carbamazepine Barbiturates Rifampicin Alcohol CHRONIC Sulphonylureas
anti emetics first line?
If unknown cause/idiopathic,
CYCLIZINE 50mg 8 hourly IM/IV/oral
however causes fluid retention, so in heart failure,
METOCLOPRAMIDE 10mg 8 hourly IM/IV
(avoid in Parkinson’s, young women -> dystonia)
Clarithomycin and wafarin?
Increases bleeding
Verapamil can’t be combined with which drugs?
Beta blockers
Breakthrough pain, dosing?
1/6th of 24 hour dose every 4 hours as required
Patients on warfarin who need emergency surgery
If can be delayed 6-12 hours, give phytomeniadone
If not, give dried prothrombin complex in addition
Maintenance fluids; which and how much?
30ml/kg/24 hr - approx 3L per 24 hours, 2L in elderly
1 salty 2 sweet (0.9% saline and 5% dextrose)
Approx 100mL per hour, so 500ml every 5/6 hours ash
Tx for DVT
LMWH - Dalteparin
Mx of irregular narrow complex tachycardia
Probable AF. Control rate with
- beta blocker or diltiazem
- digoxin or amiodarone if contraindications ( asthma or heart failure )
Co-amoxiclav can cause hepatitis and jaundice
-
Treating hyperkalaemia
Calcium gluconate does NOT lower potassium
give:
Short acting insulin (Actrapid) and glucose
Salbutamol
ALL THE 5’s: e.g. 5 units of ActRapid in 50ml of 50% glucose over 5 mins IV
Drugs that are dangerous to combine with alcoho
Methotrexate Metronidazole Mao inhibitors NSAIDs Warfarin Opioids/barbs/benzos
ACEis contraindications?
Pregnancy
Renal Artery Stenosis
Kidney failure
Hx of angiodema
Drugs causing HYPOnatraemia
Thiazides
ACEis
SSRIs
Monitoring and co prescribing on methotrexate
folic acid 5mg once weekly should be co-prescribed, taken more than 24 hours after methotrexate dose
FBC, U&E and LFTs need to be regularly monitored
Commonest drugs with major contraindications
Aspirin/heparin/warfarin - Patients bleeding or at risk of bleeding
Steroids - STEROIDS Stomach ulcers Thin skin Edema Right and left heart failure Osteoporosis Infection Diabetes Syndrome Cushings
NSAIDS No urine Systolic dysfunction Asthma Indigestion Dyscrasia (clotting abnormality)
Drugs to increase during surgery
Patients on long term corticosteroids (i.e. Addison’s)
Electrolyte disturbances caused by
ACEIs
Thiazides
ACEIs, K-sparing diuretics: HyperK
Thiazides and Loop diuretics: HypoK
All diuretics - HyperNa
Drugs causing pulmonary fibrosis
BAMENS
Amiodarone Methotrexate Ergo derivatives = bromocriptine, ergolide, pergolide Nitrofurantoin Sulfasalazine drugs Busulphan, bleomycin
Monitoring before starting azathioprine?
thiopurine methyltransferase (TPMT)
How fast to give fluids?
If tachycardia or hypotensive, give 500ml bolus then reassess HR, urine output, BP for next bag
If oliguric (<30ml/hr) (NOT DUE TO OBSTRUCTION) give 1L over 2-4 hours then reassess
Never prescribe more than 2L for a patient
NSTEMI key difference
No PCI, instead :
Clopi 300mg
LMWH 1mg/kg bd SC
Raised urea?
Think dehydration
or if low Hb also, Upper GI bleed
Dangerous side effect of heparin?
Heparin induced thrombocytopenia
Opioids in renal impairment?
Morphine will accumulate in the kidney, so better to give Oxycodone
Liver enzyme inhibitors
AO DEVICES
Allopurinol Omeprazole Disulfuram Erythromycin Valproate Isoniazid Ciprofloxacin Ethanol (ACUTE) Sulphonamides
Starting out on a statin?
Atorvastatin 20mg
Acute dystonia
Procyclidine 10mg IV
Treating hypoglycaemia
Glucose 20% is first line IV treatment of hypoglycaemia. If glucose 20 % is not available, glucose 10% is an alternative.
Volumes delivering between 10–20 g of glucose in 20 minutes are optimal, so 20% glucose in 50-100ml over 20 mins
Prophylactic enoxaparin is contraindicated following acute stroke!
-
When to avoid nitrofurantoin
if eGFR less than 45
Drugs that worsen seizure control
Aminophylline
Ciprofloxacin/levofloxacin
Alcohol and drugs
Mefenamic acid
Gentamicin levels
If trough level high, increase interval
If peak level high, reduce dose
What exacerbates psoriasis?
Lithium Alcohol Beta blockers Anti malarial NSAIDS
