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Final year > PSA > Flashcards

PSA Flashcards

1
Q

Effect of enzyme inducers

A

Increase activity of CYP450s, decreasing effect of drugs broken down by these

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2
Q

Effect of enzyme inhibitors

A

Decrease activity of CYP450s, increasing effect of drugs broken down by these

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3
Q

Interaction between warfarin and CYP inhibitor (e.g erythromycin)

A

Increase in INR due to raised warfarin levels - risk bleeding

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4
Q

Common inducers

A 
PC BRAS
Phenytoin
Carbamazepine
Barbiturates
Rifampicin
Alcohol (chronic excess)
Sulphonureas
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5
Q

Common inhibitors

A 
Ketoconazole, ciprofloxacin, erythromycin and grapefuit juice
AO DEVICES
Allopurinol
Omeprazole
Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol (acute intox)
Sulphonamides
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6
Q

Drugs to stop before surgery

A 
I LACK OP
Insulin
Lithium
Anticoags/platelets
COCP/HRT
K-sparing diuretics
Oral hypoglycaemics
Perindropril (and other ACE-inhibs)
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7
Q

Drugs to increase before surgery

A

Corticosteroids if adreno-supressed - IV steroids at induction of anaesthesia to support adequate stress response to surgery

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8
Q

What does taking metformin risk prior to surgery

A

Lactic acidosis as nill by mouth. Other oral-hypoglycaemics risk hypo

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9
Q

How long before op should COCP/HRT be stopped

A

4 weeks

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10
Q

How long before op should Lithium be stopped

A

Day before

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11
Q

How long before op should potassium-sparing diuretics be stopped

A

Day of op

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12
Q

Max daily dose of paracetemol

A

4g

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13
Q

PReSCRIBER

A 
Patient details
REaction (allerfies plus what happens)
Signing chart
Contraindication for each drug
Route
Iv fluids required?
Thromboprophylaxis required?
(anti)Emetics required?
(pain)Relief required?
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14
Q

Side effects of steroids

A 
STEROIDS mneumonic
Stomach ulcers
Thin skin
Edema
Right/left heart failure
Osteoporosis
Infection (inc. candida)
Diabetes (common cause of hyperglycaemia, uncommonly progresses to diabetes)
Syndome - cushing's
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15
Q

Contraindications to NSAIDs

A 
NSAID mnemonic
No urine (i.e AKI/renal failure)
Systolic dysfunction (i.e heart failure)
Asthma
Indigestion (any cause)
Dyscrasia (clotting abnormality)
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16
Q

Aspirin contraindications

A

Same as NSAIDs except not contra in renal/heart failure or asthma

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17
Q

Effect of beta blockers in asthmatics

A

Wheeze

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18
Q

Unique ACE-inh effects

A

Dry cough and angiooedema

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19
Q

Which antihypertensives cause bradycardia?

A

Beta blockers and rate limiting Ca2+ channel blockers

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20
Q

Side effects of calcium channel blockers

A

Hypotensive effects, peripheral oedema and flushing

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21
Q

Effect of beta blockers on heart failure (acute and chronic)?

A

Worsens acute and beneficial in chronic

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22
Q

Side effects of diuretics

A

Hypotensive effects and renal failure. Other specific effects depend on type. Spironolactone causes gynaecomastia (eplerenone reduces this), Loops cause gout

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23
Q

Which fluid should be used as replacement if patient has ascites?

A

Human albumin solution

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24
Q

What level of fluid loss is indicated by reduced UO? (no tachycardia)

A

500ml

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25
Q

What level of fluid loss is indicated by reduced UO and tachycardia?

A

1L

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26
Q

What level of fluid loss is indicated by shock?

A

2L

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27
Q

Daily potassium requirement

A

40mmol

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28
Q

Max potassium infusion speed

A

10mmol/hour

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29
Q

Signs of fluid overload

A

Increased JVP, peripheral oedema, pulmonary oedema

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30
Q

Contraindications to compression stockings

A

Peripheral arterial disease (absent foot pulses)

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31
Q

Standard anti-emetic post-op

A

PRN if not nauseated, regular if nauseated
Cyclizine 50mg 8-hourly IM/IV/oral
If heart failure then metoclopramide 10mg IM/IV 8-hourly

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32
Q

Patients to avoid metoclopramide in

A

Parkinson’s - exacerbates symptoms

Young women - risk of dyskinesia esp acute dystonia

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33
Q

Neuropathic pain killers

A

Amitriptyline 10mg oral nocte
Pregabalin 75mg oral 12 hourly
If diabetic neuropathy pain duloxetine 60mg oral daily

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34
Q

Major side effect of clozapine

A

Agranularcytosis (at least monthly bloods)

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35
Q

4 categories of hypernatreamia causes

A 
4 d's
Dehydration
Drips (too much IV saline)
Drugs (effervescent tabs and IV preps with high sodium)
Diabetes insipidus
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36
Q

Causes of microcytic anaemia

A

Iron deficiency anaemia is major

Minor are thalassaemia and sideroblastic anaemia

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37
Q

Causes of normocytic anaemia

A

Major causes: Anaemia of chronic disease, acute blood loss

Minor causes: haemolytic anaemia, Chronic renal failure

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38
Q

Causes of macrocytic anaemia

A

Major: B12/folate deficiency, Excess alcohol and liver disease
Minor: Hypothyroid, heam diseases beginning with M (myeloproliferative, myelodysplastic, multiple myeloma)

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39
Q

Causes of high neutrophils

A

Major: bacterial infection
Minor: Tissue damage (inglam/infarct/malignancy) and steroids

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40
Q

Causes of low neutrophils

A

Major: Clozapine, carbimazole, viral infection
Minor: Chemo/radiotherapy

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41
Q

Causes of high lymphocytes

A

Major: Viral infection
Minor: Lymphoma and CLL

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42
Q

Causes of low platelets (reduced production)

A

Penicillamine, infection (usually viral), myelodysplasia, myelofibrosis, myeloma

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43
Q

Causes of low platelets (increased destruction)

A

Heparin, hypersplenism, DIC, idiopathic thrombocytopaenic purpura (ITP), HUS, TTP

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44
Q

High platelets

A

Bleeding, tissue damage (inflamm/infarct/malignancy), post splenectomy and myeloproliferative disorders

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45
Q

Categories of hyponatraemia causes

A

Hypovolaemic, euvoleamic and hypervolaemic

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46
Q

Hypovolaemic causes of hyponatraemia

A

Fluid loss (esp D&V), diuretics and addison’s disease

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47
Q

Euvolaemic causes of hyponatraemia

A

SIADH, psychogenic polydipsia and hypothyroidism (all relatively uncommon)

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48
Q

Hypervolaemic causes of hyponatraemia

A

Major: Heart failure and renal failure
Minor: Liver failure, nutritional failure (hypoalbuminaemia), thyroid failure (hypothyroid-can be be euvolaemic)

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49
Q

Causes of SIADH

A 
SIADH mnemonic
Small cell lung tumour
Infection
Abscess
Drugs (esp carbamezipine and antipsychotics)
Head injury
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50
Q

Causes of hypokalaemia

A 
DIRE mnemonic
Drugs (loop and thiazide diuretics)
Inadequate intake/intestinal loss (D&V)
Renal tubular acidosis
Endocrine (cushing's/conn's)
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51
Q

Causes of hyperkalaemia

A 
DREAD mnemonic
Drugs (esp K+ sparing and thiazide diuretics)
Renal failure
Endocrine (addison's disease)
Artefact (clotted sample)
DKA
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52
Q

Raised urea and normal creatinine in a well hydrated patient may be a sign of what?

A

Upper GI bleed - test Hb levels

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53
Q

Drugs causing AKIs - intrinsic causes

A

Gentamicin, vancomycin and tetracyclines
ACEinh
NSAIDS

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54
Q

How to differentiate prerenal AKI from intrinsic/post-renal causes?

A

Multiply urea by 10 - if it exceeds creatinine then its pre-renal

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55
Q

NOT FULLY COVERED NON-DRUG CAUSES OF AKIs/LFT derrangement NOT BEEN FULLY COVERED

A

…

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56
Q

What does isolated raised billirubin indicate?

A

Pre-hepatic jaundice - usually indicates haemolysis

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57
Q

Lab signs of cholestasis

A

Increased bilirubin and ALP

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58
Q

Drugs causing cholestasis

A

Flucloxacillin, co-amoxiclav, nitrofurantoin, steroids and sulphonureas

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59
Q

Lab signs of hepatitis

A

Increased bilirubin and AST/ALT

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60
Q

Drugs causing hepatitis

A

Paracetemol overdose, statins and rifampicin

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61
Q

Actions to be taken according to TSH in patients taking thyroxine

A

<0.5 decrease dose
0.5-5 no action
>5 increase dose
Always change dose by smallest increment unless unless grossly abnormal

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62
Q

Medication to avoid in people with hypertrophic cardiomyopathy

A

ACE-inh

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63
Q

Causes of raise ALP

A 
ALK PHOS
Any fracture
Liver damage (post hepatic)
K (for kancer)
Pagets disease of bone and Pregnancy
Hyperparathyroidism
Osteomalacia
Surgery
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64
Q

Causes of metabolic alkalosis

A

Vomiting, diuretics and conn’s syndrome

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65
Q

Causes of metabolic acidosis

A

Lactic acidosis, DKA, renal failure, methanol/ethanol/ethylene glycol intoxication and Addison’s disease

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66
Q

CXR signs of pulmonary oedema

A 
ABCDE
Alveolar oedema (bat wings)
kerley B lines (interstitial oedema)
Cardiomegaly
Diversion of blood to upper lobes (vessels bigger in upper lobes than lower lobes)
pleural Effusions
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67
Q

Alteration of gentamicin dose/schedule if levels are too high?

A

Keep dose the same but decrease frequency by 12 hours (e.g. changing every 24 hours to every 36 hours)

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68
Q

Features of digoxin toxicity

A

Confusion, nausea, visual halos and arrythmias

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69
Q

Features of lithium toxicity

A

Early: tremor
Intermediate: tiredness
Late: arrythmias, seizures, coma, renal failure and diabetes insipidus

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70
Q

Features of phenytoin toxicity

A

Gum hypertrophy, ataxia, nystagmus, peripheral neuropathy and teratogenicity

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71
Q

Features of gentamicin toxicity

A

Ototoxicity and nephrotoxicity

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72
Q

Features of vancomycin toxicity

A

Ototoxicity and nephrotoxicity

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73
Q

Typical gentamicin dose

A

5-7mg/kg once daily except renal failure (1mg/kg 12 hourly) and infective endocarditis (1mg/kg 8 hourly)

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74
Q

Methods of genamicin monitoring

A

Hartford nomogram if 7mg/kg or Urban and Craig nomogram if 5mg/kg if dosed once daily
If divided dose use peak (1h post dose; 3-5mg/l in IE, 5-10 everything else) and trough (just before next dose; <1 mg/l in IE, <2 in everything else) levels

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75
Q

Target INR

A

Usually 2.5 (2-3), raised to 3.5 (3-4) if recurrent thromboembolism or metallic heart valve

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76
Q

Treatment of major bleed in warfarin (hypotension or confined space)

A

Stop warfarin, 5-10mg IV vit K and prothrombin complex (beriplex)

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77
Q

Management of warfarin over-anticoagulation

A

INR<6 reduce dose
INR 6-8 omit for 2 days then reduce dose when INR less than 5
INR>8 stop warfarin and give 0.5-1mg IV (minor bleeding) or 5mg PO (no bleeding) vit k

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78
Q

Why do ACE-inh cause AKI in renal artery stenosis?

A

Efferent vessels require angiotensin 2 for constriction so ACEinh cause dilation. Combined with the stenosis in afferent vessel, this results in low renal blood flow

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79
Q

Effect of carbemazepine on sodium

A

Causes hyponatraemia via SIADH

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80
Q

Drugs causing SIADH

A

Carbemazepine and antipsychotics

SSRIs too

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81
Q

Management of STEMI

A

Initial: 12 lead ECG, Bloods (FBC, lipids, U&E’s, glucose, and cardiac enzymes), 300mg aspirin, 10mg IV morphine and anti-emetic (metoclopramide 10mg IV). PCI if possible
Oxygen may be necessary
After: ACEinh, beta blocker and clopidogrel (300mg load followed by 75mg after). Statins too, Keep in for around 5 days. Off work for 2 months,

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82
Q

Management of NSTEMI

A

Admit CCU, aspirin 300mg and clopidogrel/ticagrelor/prasugrel (300mg then 75mg,180mg then 90mg, 50mg then 10mg). 5-10mg IV morphine and anti-emetic (metoclopramide 10mg IV).
Oral beta blocker and fondeparinux
Angiography within 72 hours to identify need for PCI/angioplasty

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83
Q

Management of acute left ventricular failure

A

Sit patient upright, morphine 5-10mg IV + 10mg metoclopramide IV, GTN spray/tablet, furosemide 40-80mg IV. If inadequate response, isosorbide dinitrate infusion +/- CPAP

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84
Q

Management of SVT

A

Vagal manoeuvres followed by 6mg Adenosine rapid IV bolus. Can repeat twice using 12 mg if unsuccessful

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85
Q

Management of SVT

A

Vagal manoeuvres followed by 6mg Adenosine rapid IV bolus. Can repeat twice using 12 mg if unsuccessful. Monitor with continuous ECG.

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86
Q

Management of VT

A

Unstable: Synchronised DC shock (up to 3 times)
Stable: AMiodarone 300mg IV over 20-60mins followed by 900mg over 24 hours

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87
Q

Management of torsade de pointes

A

Give magnesium 2g over 10mins if stable, shock if not.

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88
Q

Management of anaphylaxis adult

A

Secure airway - call anaesthetist if necessary or likely to be
100% oxygen
Remove cause
0.5mg IM adrenaline (0.5ml of 1:1000) - repeat every 5 mins as needed
10mg chlorphenamine IV and 200mg hydrocortisone IV
If wheeze present treat for asthma
If further treatment required (e.g IV adrenaline), admit to ICU
Measure mast cell tryptase 1-6 hours later
If itching 4mg chloramphenamine every 6 hours oral
Admit and monitor with ECG

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89
Q

Management of acute asthma exacerbation

A

15l high flow oxygen non-re-breathe mask, 5mg Salbutomol neb, 100mg hydrocortisone IV (40-50mg oral pred if moderate), 500ug ipratropium bromide neb. Can give theophyline if life threatening

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90
Q

Management of acute COPD exacerbation

A

Start on 28% O2 (high flow if peri-arrest or very sick - review after ABG later). 5mg Salbutomol neb, 100mg hydrocortisone IV (40-50mg oral pred if moderate), 500ug ipratropium bromide neb. Antiobiotics if infective.

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91
Q

Management of pneumothorax

A 
If secondary (patient has lung disease), always treat.  CHest drain if >2cm, patient over 50 or SOB - aspirate if not.
Tension pneumothorax requires emergency aspiration followed by chest drain.
Primary - <2cm and not SOB, discharge and review in 4 weeks. If >2cm, attempt aspiration twice, if unsuccessful then chets drain.
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92
Q

CURB-65 and location of management accordingly

A 
Confusion (AMTS of 8 or less)
Urea >7.5mmol/L
RR>30/min
Blood pressure (systolic) <90mmHg
65 years old or over
1 or 0 can consider home treatment, 2 must be hospitalised, if 3 then consider ICU
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93
Q

PE management

A

High flow oxygen, 5-10mg morphine IV, 10mg metoclopramide IV, LMWH (tinzaparin 175units/kg SC daily)
If low BP: IV gelofusine, noradrenaline and thrombolysis.
Start warfarin. Consider altepase earlier if peri-arrest.

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94
Q

Correcting prolonged PT

A

If over 1.5x normal, give FFP. If platelets <50 then give platelets. If due to warfarin then give give prothrombin complex such as beriplex instead.

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95
Q

GP treatment of suspected bacterial meningitis

A

1.2g benzypenicilline IM (300mg <1y/o, 600mg 1-9y/o)

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96
Q

Hospital management of meningitis

A

High flow oxygen, IV fluid, IV dexamethasone (unless severely immunocomp), LP (+/- CT head), 2g cefotaxime IV (pre LP if likely to be prolonged or CT first). Consider ITU.

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97
Q

Management of seizures lasting over 5 mins

A

2-4mg lorazempam IV, 10mg buccal midazolam or 10mg diazepam IV
If continues, repeat diazepam after 2 mins.
If continues, inform anaesthetist, phenytoin infusion, intubate then propofol.

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98
Q

Acute management of ischaemic stroke

A

<80y/o and onset <4.5 hourse then consider thrombolysis with altepase. Aspirin 300mg oral too.

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99
Q

Fluid management in DKA

A

1L stat, 1L over an hour, then 2 hours, then 4 hours, then 8 hours

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100
Q

Hypoglycaemia management

A

If can eat, then eat sugary snack. If they can’t, but have a cannula in place, 100ml 20% dextrose IV. If no cannula then 1mg glucagon IM.

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101
Q

Management of AKI

A

Address the cause. 500ml STAT then 1L 4-hourly. Catheterise for strict fluid monitoring.

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102
Q

Antidote for benzodiazepine overdose

A

Flumazenil

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103
Q

When do you initiate drug treatment for hypertension?

A

ABPM/HBPM 150/95 or more. Or 135/85 or more plus over 80y + clinic BP >150/90, target organ damage, CVD, renal disease, diabetes or 10 year CVD risk of 10% or more (consider if less than 10% but <60y/o)
If over 180/120 on first clinic visit can start immediately and review if now damage

104
Q

Step 1 hypertension treatment

A

Diabetic - ACEi/ARB
Non-diabetic and <55y - ACEi/ARB
Non-diabetic and >55y - CCB
Non-diabetic and black (any age) - CCB

105
Q

Step 2 and 3 hypertension treatment

A

If already on ACEi/ARB, start CCB or thiazide-like diuretic.
If already on CCB, start ACEi/ARB or thiazide-like diuretic.
For step 3, start whichever of the 3 they are not already on.

106
Q

Step 4 hypertension treatment

A

Confirm with ABPM/HBPM, check for postural hypotension and discuss adherence. Consider specialist referral. If potassium 4.5 or less, sonsider low dose spironolactone, if over 4.5 consider alpha or beta blocker. If this doesn’t work then must refer.

107
Q

BP targets

A

<80y - clinic 140/90, ABPM/HBPM 135/85

Over 80 - clinic <150/90, ABPM/HBPM 145/85

108
Q

Chronic HF management first line

A

Diuretics for congestive symptoms and fluid retention.

If reduced ejection fraction, ACEi and BB, followed by K+ sparing diuretic if symptoms continue.

109
Q

Chronic HF management second line

A

Can swap ACEi/ARB for sacubitril valsartan (monitor U&Es) if ejection fraction <35%. If sinus rhythm and HR >75 and EF<35% can try ivabradine.
Hydralazine and nitrate useful in black patients.
Digoxin can improve symptoms if in sinus rhythm

110
Q

CHA2DS2-VASc

A 
Risk of TE event in non-coagulated patient with non-valvular AF.
Congestive heart failure (or left only)
Hypertension
Age >75y (2 points)
Diabetes mellitus
Stroke or TIA previosuly (2 points)
Vascular disease (PAD or IHD)
Age 65-74
Sex (female)
Score of 0 - aspirin 75mg daily, 1 - aspirin or warfarin, 2 - warfarin
111
Q

When do you rhythm control in atrial fibrillation?

A

If young/symptomatic/first episode/due to a treated precipitant (e.g. sepsis or electrolyte disturbance)

112
Q

How do you pharmacologically cardiovert patients in AF?

A

5mg/kg amiodarone IV over 20-120 mins. Anticoagulation required prior to cardioversion if onset more than 48 hours ago.

113
Q

At what heart rate do you start rate control in AF?

A

90 BPM

114
Q

Rate control drugs in AF

A

Beta blockers eg propanolol 10mg 6 hourly
Rate-limiting calcium channel blockers eg diltiazem 120mg daily.
Do not combine Verapamil and beta blockers due to profound bradycardia (worse than other Ca blockers)
If first line in effective or both contraindicated, digoxin can be used. Load then 62.5-125ug daily.

115
Q

Drugs to treat stable angina

A

Aspirin/statin for secondary prevention and GTN spray as needed
Calcium channel or beta blocker to reduce symptoms
If needed, can add the other one. If contraindicated add isosorbide mononitrate or nicorandil.
If 2 drugs doesn’t work then needs revascularization

116
Q

Contraindications to calcium channel blockers

A

Hypotension, bradycardia and peripheral oedema

117
Q

Contraindications to beta blockers

A

Hypotension, bradycardia, asthma and acute heart failure

118
Q

Chronic asthma management (adults)

A

Step 1 - low dose ICS
Step 2 - LABA and low dose ICS
Step 3 - Increase ICS to medium dose or add LTRA (maybe remove LABA if ineffective)
Step 4 - refer

119
Q

Chronic COPD management

A

Not limited by symptoms / no exacerbations - SAMA/SABA as required
Limited by symptoms/exacerbations - Step 1 is LABA+LAMA if no asthmatic features, LABA+ICS ifthey do
Step 2 - persistent symptoms effecting quality of life or 1 severe/2 moderate exacerbations a year, give triple therapy (review after 3 months if no exacerbations or exacerbations and remove ICS if no improvement)

120
Q

Most common Parkinson’s meds

A

Co-beneldopa and co-careldopa. If very mild may be a dopamine agonist (ropinirole) or MAO-inh (rasagiline)

121
Q

Lamotrigine side effects

A

Rash, rarely Stevens-Johnson syndrome

122
Q

Carbamazepine side effects

A

Rash, dysarthria, ataxia, nystagmus and hyponatraemia

123
Q

Phenytoin side effects

A

Ataxia, peripheral neuropathy, gym hyperolasia, hepatotoxicity

124
Q

Sodium valproate side effects

A

Tremor, teratogenicity, tubby (weight gain)

125
Q

First choice drug in generalised tonic-clonic seizures

A

Sodium valproate (lamotrigine if unsuitable)

126
Q

First choice drug in absence seizures

A

Sodium valproate or ethosuximide

127
Q

First choice drug in myoclonic seizures

A

Sodium valproate (leviteracetam or topiramate)

128
Q

First choice drug in tonic seizures

A

Sodium valproate

129
Q

First choice drug in focal seizures

A

Carbamazepine or lamotrigine

130
Q

Should you give flumazenil in a mixed overdose potentially containing benzodiazepines?

A

NO!!!

131
Q

Alzheimer’s disease treatments

A

Mild/moderate - acetylcholinesterase inhibitors (donepezil, rivistigmine and galantamine)
Moderate/severe - NMDA antagonist (memantine)

132
Q

ACR threshold for prescribing ACEi in diabetics

A

3mg/mmol or more

133
Q

Anti-depressants prolonging QT interval

A

Citalopram and escitalopram

134
Q

Drug treatment of type 2 diabetes

A

Step 1 - metformin 500mg with breakfast, increasing u to max 3x a day (with meals - up to 2g) to achieve acceptable HbA1c. Then add sulphonylurea, DPP-4inh (gliptin), pioglitazone or SGLT-2inh. 3rd step more complicated

135
Q

Contraindications to pioglitazone

A 
Heart failure or history of heart failure
Hepatic impairment
Diabetic ketoacidosis
Current, or a history of, bladder cancer
Uninvestigated macroscopic haematuria.
136
Q

Drug to induce remission in Crohn’s disease

A

Oral prednisolone 30mg daily if mild, 100mg hydrocortisone IV 6-hourly if severe with supportive care. If rectal disease for either can give rectal hydrocortisone too.

137
Q

What must be checked prior to starting azathioprine/6-mercaptopurine?

A

Thiopurine S-methyl transferase (TPMT) levels. Low in 10% population increasing bone marrow and liver toxicity. Use methotrexate instead.

138
Q

First line medication for maintenance in Crohn’s disease

A

Azathioprine or Mercaptopurine. Methotrexate if low levels of TPMT.

139
Q

Alternative medication for severe Crohn’s not responding to conventional therapy

A

Infliximab or adalimumab

140
Q

First line maintenance treatment for rheumatoid arthritis

A

Methotrexate plus another DMARD (usually sulfasalazine or hydroxychloroquine)

141
Q

Medications for RA flare treatment

A

Glucocorticoids such as IM methylprednisolone and NSAIDs with gastro protection

142
Q

Second line RA maintenance treatment

A

If severely active RA that has failed to respond to 2 DMARDs, try TNFa inhibitor infliximab

143
Q

Main contraindication to laxatives

A

Bowel obstruction

144
Q

Chronic, non-infectious diarrhoea treatment

A

Loperamide 2mg oral up to 3 hourly or codeine 30mg up to 6 hourly (good if pain)

145
Q

First line hypnotic and dose

A

Zopiclone 7.5mg oral in adults, 3.5mg in elderly

146
Q

Best laxatives for faecal impaction

A

Stool softeners such as docusate sodium (stimulant at high dose) or rectal arachis oil (not if nut allergy)

147
Q

Laxatives to avoid in faecal impaction and colonic atony

A

Bulking agents such as isphagula husk

148
Q

Stimulant laxatives (examples, contraindications and side effect)

A

Senna and bisacodyl. Bisacodyl contra in acute abdomen. May exacerbate abdo cramps

149
Q

Osmotic laxatives (examples, contraindications and side effect)

A

Lactulose and phosphate enema. Phosphare enema contraindicated in acute abdomen. May exacerbate bloating.

150
Q

Laxatives contra-indicated in acute abdomen

A

Bisacodyl and phosphate enema

151
Q

Indication of inadequate asthma treatment

A

Using SABA more than twice a week or the presence of nocturnal symptoms

152
Q

First line antibiotic for skin infections

A

Flucloxacillin 500mg 6-hourly 7 days

153
Q

Antimuscarinic side effects

A

Dry mouth with difficulty swallowing and thirst
Dilation of the pupils with blurred vision/light sensitivity
Increased intraocular pressure
Hot, flushed, dry skin
Bradycardia followed by tachycardia, palpitations and arrhythmias
Difficulty with micturition - urinary retention
Constipation

154
Q

Drugs causing neutropenia

A

Carbimazole

Carbamazepine

155
Q

Dopamine antagonists

A 
Metoclopramide
Haloperidol
Domperidone (doesn't cross BBB so safe in Parkinson's)
156
Q

Conversion from morphine sulphate to diamorphine

A

2mg morphine = 1mg diamorphine

157
Q

BP meds to avoid during pregnancy

A

ACEi - teratogenic during the first trimester

Diuretics not ideal either

158
Q

At what point in pregancy does blood pressure fall?

A

2nd trimester

159
Q

Side effects/interactions of tamoxifen

A

Increased risk of endometrial cancer
Increases efficacy of warfarin
Increased hot flushes
Increased risk of VTE

160
Q

Important information to tell patients about sulphonureas

A

Hypoglycaemic risk - eat regular meals, don’t miss them and take it with breakfast.

161
Q

Which oral hyoglycaemic risks lactic acidosis?

A

Metformin

162
Q

Methotrexate monitoring

A

Blood tests required 1-2 weekly to monitor FBC. Folic acid should be used alongside to limit myelotoxicity.

163
Q

Effect of alcohol on warfarin

A

Alcohol consumption effects INR (acute inhibits, chronic induces) so should moderate and spread drinking.

164
Q

When should renal function and potassium be monitored after initiating ACEi therapy?

A

1-2 weeks later

165
Q

Important information to tell patients about ACEi

A

Cause cough. Take care if develop D&V as risk AKI - esp elderly.

166
Q

What medications should be prescribed concurrently with long-term steroids?

A

Gastro-protection and bisphosphonate

167
Q

Risks of long-term steroid therapy

A 
Diabetes
Osteoporosis
Gastric/duodenal ulceration
Hypertension
Adrenal suppresion
168
Q

Warfarin monitoring

A

Weekly at first, monthly when stable

169
Q

Antibiotics contraindicated with methotrexate

A

Folate antagonists - trimethoprim and co-trimoxazole

170
Q

Medication used to limit methotrexate toxicity

A

Folic acid - limits myelotoxicity

171
Q

How long does it take for antidepressants to take effect?

A

Up to 6 weeks

172
Q

Medications increasing photosensitivity

A 
Citalopram
Doxycycline
Tetracycline
Amiodarone
Hydrochlorothiazide
Naproxen
Chlorpromazine
173
Q

Symptoms of serotonin syndrome

A 
Agitation or restlessness
Confusion/Hallucinations
Rapid heart rate and high blood pressure
Dilated pupils
Loss of muscle coordination or twitching muscles
Muscle rigidity
Heavy sweating
Diarrhea
Headache
Shivering
Goose bumps
Fever
174
Q

Effect of illness on required insulin dose

A

More insulin required (increase basal dose) as blood glucose rises. However, if oral intake decreases, the opposite may be true.

175
Q

How should alendronic acid be taken?

A

Once weekly. Swallow with a full glass of water and remain upright for 30mins. Avoid eating for the next 2 hours.

176
Q

Can Adcal D3 be taken at then same time as bisphosphonate?

A

No, reduces absorbtion of bisphosphonate.

177
Q

What does 1% mean in g/ml?

A

1g in 100ml

100% = 100g in 100ml

178
Q

Weight to volume ratio units

A

Grams to millilitres

179
Q

Contra-indication to high dose gentamicin

A

Creatinine clearance of <20ml/min

180
Q

What 2 pieces of info do you need to provide if medication prescribed PRN?

A

Indication and max frequency/dose

181
Q

Which blood test is important prior to commencement of Vancomycin?

A

Renal function

182
Q

Main contra-indication to statin therapy

A

Hepatic impairment - measure ALT prior to commencement

183
Q

For assessing phenytoin dose appropriateness, when should blood sample be taken?

A

Pre-dose trough level - should be 40-80umol/L

184
Q

How long after previous dose should lithium levels be sampled?

A

12 hours

185
Q

Normal lithium levels

A

0.4-0.8mmol/L

186
Q

Lithium monitoring regime

A

Weekly until stable, then 3 monthly

187
Q

Frequency of methotrexate monitoring

A

Every 1-2 weeks at first, then every 2-3 months once stabilised

188
Q

Can methotrexate be started if LFTs abnormal

A

No - risks cirrhosis

189
Q

Dose adjustment in methotrexate if clinically significant drop in white cells or platelets

A

Stop immediately!

190
Q

Predominant excretion organ for methotrexate

A

Renal

191
Q

Amiodarone monitoring

A

Baseline CXR, TFTs (T3 T4 and TSH) and LFTs at baseline and every 6 months. Measure serum potassium before use (caution hypokalaemia due to arrythmia risk).

192
Q

Most important Ix in patient taking carbimazole reporting a sore throat

A

Neutrophil count - bone marrow suppression risk

193
Q

Most important parameter to measure during valproate therapy

A

LFTs - esp during first 6 months

194
Q

Primary route of digoxin excretion

A

Renal - take care in impairment. Check U&Es prior to initiation of therapy.

195
Q

Clozapine monitoring

A

WCCs weekly for first 18 weeks, fortnightly for a year and then monthly. Blood lipids, glucose and weight as measured at baseline and then after a few months

196
Q

Nephrotoxic antibiotics

A

Gentamicin and vancomycin

197
Q

Ototoxic antibiotics

A

Gentamicin and vancomycin

198
Q

Antibiotics causing C.Diff

A

All antibiotics - particularly broad specs like cephalosporins and ciprofloxacin

199
Q

ACEi side effects

A

Hypotension, electrolyte abnormalities (hyponatraemia and hyperkalaemia), AKI and dry cough

200
Q

Beta-blocker side effects

A

Hypotension, bradycardia, fatigue, cold extremities, wheeze in asthma and worsens acute HF

201
Q

CCB side effects

A

Hyptension, bradycardia, peripheral oedema and flushing

202
Q

Diuretic side effects

A

Hypotension, electrolyte abnormalities, AKI - subclass dependent effects

203
Q

Heparin side effects

A

Haemorrhage (esp if renal failure or <50kg), heparin induced thrombocytopenia

204
Q

Aspirin side effects

A

Haemorrhage, peptic ulcers and gastritis

Tinnitus in large doses

205
Q

Digoxin side effects

A

Nausea, vomiting and diarrhoes, blurred vision, confusion and drowsiness, xanthopsia (disturbed yellow/green visual perception inc. halo vision)

206
Q

Effect of serum potassium on digoxin

A

Low K+ augments effect, high K+ inhibits effect

207
Q

Amiodarone side effects

A

Interstitial lung disease, hyper/hypothyroid disease, skin greying, hepatoxic and corneal deposits

208
Q

Haloperidol side effects

A

Dyskinesias (such as acute dystonic reactions) and drowsiness

209
Q

Clozapine side effects

A

Agranulocytosis (monitor for)

210
Q

Fludrocortisone side effects

A

Hypertension/sodium and water retention

211
Q

Ibuprofen side effects

A 
NSAID
No urine (renal failure)
Systolic dysfunction (heart failure)
Asthma
Indigestion (any cause)
Dyscrasia (clotting abnormality)
212
Q

Statins side effects

A

Myalgia, abdo pain, Increased ALT/AST (can be mild), rhabdomyolysis (can be just a mildly increased CK)

213
Q

How long should blood be given over?

A

Must be less than 4 so give over 1-3 hours

214
Q

Main drugs causing GI bleeds when with alcohol

A

NSAIDs such as ibuprofen and aspirin

215
Q

Interaction between alcohol and monoamine oxidase inhibitors

A

Hypertensive crisis

216
Q

Interaction between metformin and alcohol

A

Lactic acidosis

217
Q

How long do patients need to be on corticosteroids for weaning to be necessary?

A

3 weeks or 1 week if over 40mg a day. If other causes of adrenal suppression eg excess alohol then further caution.

218
Q

First choice treatment in pericarditis

A

Ibuprofen

219
Q

Effect of lithium on thyroid function

A

5x increase of hypothyroidism

220
Q

Ciclosporin monitoring once stable in transplant patients

A

Monthly LFTs, FBCs and U&Es as well and baseline then periodic lipids

221
Q

Fluids to avoid in cerebral injury

A

Glucose!!!

222
Q

CVD primary prevention dose for atorvastatin

A

20mg nocte

223
Q

Drugs causing urinary retention

A 
Opiods (esp post op)
Anticholinergics (eg, antipsychotic drugs, antidepressant agents, anticholinergic respiratory agents, detrusor relaxants),
General anaesthetics,
Alpha-adrenoceptor agonists,
Benzodiazepines (e.g. diazepam),
Non-steroidal anti-inflammatory drugs (e.g. ibuprofen),
Calcium-channel blockers,
Antihistamines,
Alcohol.
224
Q

Drugs causing confusion

A

Opiods
Metoclopramide
Anticholinergics (eg, antipsychotic drugs, antidepressant agents, anticholinergic respiratory agents, detrusor relaxants),
Antipsychotics,
Antidepressants,
Anticonvulsants.
Less common causes (histamine H2 receptor antagonists, digoxin, beta-blockers, corticosteroids, non-steroidal anti-inflammatory agents and antibiotics.

225
Q

Best method of monitoring during early stages of fluid replacement?

A

Blood pressure

226
Q

When should statins be stopped because of raised liver enzymes?

A

When they are 3x the upper limit

227
Q

Safest diuretics with lithium

A

Loop diuretics

228
Q

Drugs decreasing lithium excretion

A

ACE-i, diuretics (esp. thiazides) and NSAIDs

229
Q

Best way of relieving nausea in bowel obstruction

A

Large bore nasal cannula and de-compression

230
Q

First medication in severe HF decompensation

A

40-80mg furosemide IV stat

231
Q

When should statins be taken?

A

At night (not strictly necessary for atorvastatin)

232
Q

Important sign to look for after starting fluoxetine

A

Skin rash - suggests impending systemic reaction

233
Q

When to adjust enoxaparin dose

A

Weight under 50kg or eGFR<30

234
Q

Contra-indication to nitrofurantoin

A

eGFR<45

235
Q

Ideal INR for surgery

A

<1.5 - if over the day before, give oral vit K (1-5mg)

236
Q

What contraception should be avoided when taking enzymer inducers?

A

Progesterone only

237
Q

What size rise in creatinine is acceptable after commencing ACEi?

A

<20%

238
Q

Which DOAC is licensed for anticoagulation post THR/TKR?

A

Rivaroxaban

239
Q

Infusion time of 20% glucose for hypo

A

100ml in up to 20mins

240
Q

How should rivaroxaban be taken?

A

With food

241
Q

First line treatment for acute dystonia

A

Procyclidine hydrochloride 5-10mg IV/IM

242
Q

What do you do if suspect statin has caused a myopathy and raised CK (>5x upper limit)?

A

Stop statin and if symptoms resolve restart at lower dose

243
Q

Painkiller to avoid with SSRIs

A

Tramadol - risks serotonin syndrome

244
Q

Best PPI in pregnancy

A

Omeprazole over lanzoprazole

245
Q

What blood test is raised in serotonin syndrome?

A

CK

246
Q

Most common drug for reducing portal hypertension and preventing variceal bleeds

A

Propanalol

247
Q

What medication is used to control blood pressure in phaeochromocytoma?

A

Phenoxybenzamine

248
Q

Common side effects of levadopa

A

Nausea, somnolence, dizziness and headache

249
Q

Maximum length of missed clozapine dose at which normal dose can be restarted

A

48 hours - any longer and retitration is required

250
Q

Maximum length of missed clozapine dose at which normal dose can be restarted

A

48 hours - any longer and retitration from 12.5mg is required

251
Q

Fasting glucose cut off for initiating drug management in gestational diabetes

A

7mmol - try exercise and diet for a couple of weeks if uncomplicated pregnancy before adding metformin

252
Q

Contraindication to triptans

A

IHD

253
Q

High risk drugs for falls

A

Antipsychotics, antidopaminergics, anticholinergics and anti-depressants
Also ACEi, diuretics, opiates and antihistamines

254
Q

Nebulised adrenaline dose in croup

A

1 in 1000 400mcg/kg - max 5mg

255
Q

Drugs causing erythema multiforme

A

Anti-convuslants (valproate, phenytoin, lamotrigine and carbamazepine), antibiotics (sulphonamides and penicllins) and aspirin.
Also hydralizine, allopurinol and cimetidine

256
Q

First line diuretic for acites

A

Spironolactone 100mg (plus fluid restriction and low salt diet)

257
Q

Loop and thiazide diuretic effect on bone mass

A

Loop decreases, thiazide protects

Final year (18 decks)

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