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PSA Flashcards

1
Q

Rapid tranquilisation

A

IM lorazepam 2mg IV

or

IM haloperidol with IM promethazine

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2
Q

hypokalaemia treatment

A

treat the cause
oral or IV replacement

oral: SandoK 40-120mmol/day
IV: large vein man 20 mmol/hr

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3
Q

C. Diff treatment

A

1st: metronidazole

2nd/subseq.: vancomycin

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4
Q

arrhythmia stroke prevention

A

warfarin

non valvular: apixaban, dabigatran, edoxaban, rivaroxaban

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5
Q

hypoglycaemia treatment

A

conscious and able to swallow: 15-20g quick acting carb snack

conscious, uncooperative: glucose gel

unconscious: IV glucose

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6
Q

max IV K+

A

10 mmol/hour

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7
Q

adult fluid challenge

A

0.9% NaCl or Hartmann’s
no additives
infused over 10 mins

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8
Q

child fluid challenge

A

20 ml/kg
0.9% NaCl or Hartmanns
no additives

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9
Q

drugs eliminated by kidneys

A

CVS: atenolol, digoxin

neuro: opioids, gabapentin, lithium
infection: penicillins, aminogylcosides
other: LMWH, allopurinol, metformin

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10
Q

nephrotoxic drugs

A

NSAIDs
aminoglycosides
radiographic contrast
trimethoprim

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11
Q

hepatotoxic drugs

A

paracetamol
methotrexate
phenytoin
co-amoxiclav

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12
Q

drugs precipitating encephalopathy

A

sedative effects: opioids, bentos, TCAs
hypokalaemic effects: diuretics
constipating effects: antimuscarinics

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13
Q

drugs prescribed in micrograms

A

digoxin
levothyroxine
tamsulosin
inhaled bronchodilators

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14
Q

drugs prescribed in units

A

insulin

heparins

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15
Q

drugs prescribed weekly

A

bisphosphonates

methotrexate

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16
Q

drugs to stop before surgery

A

COCP and HRT: 4 weeks
lithium: day before
K+ sp. diuretics and ACEi: day of
oral hypoglycaemics: variable

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17
Q

obscure interactions

A

methotrexate and trimethoprim

SSRIs and antiplatelets/NSAIDs

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18
Q

serotonin syndrome signs

A 
confusion
agitation
hyperthermia
hyperreflexia
clonus
hypertonia
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19
Q

serotonin syndorme treament

A

withdraw serotonergic drugs
cooling and supportive care
benzodiazepines and required

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20
Q

drugs causing diarrhoea

A 
antacids
metoclopramide
PPIs
ranitidine
digoxin
metformin (usually transient)
ACEi
antibiotics
SSRIs
colchicine
gliclazide
mesalazine
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21
Q

drugs causing confusion

A

morphine sulphate
anticholinergics
antidepressants
anticonvulsants

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22
Q

drugs causing HYPOKALAEMIA

A 
loop diuretics
thiazide diuretics
insulin
acetazolamide
theophylline
prednisolone
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23
Q

drugs causing HYPERKALAEMIA

A 
heparins
ACEi
tacrolimus
aldosterone antagonists
K+ sparing diuretics
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24
Q

drugs causing urinary retention

A 
morphine sulphate
anticholinergics
general anaesthetics
alpha-adrenoceptor agonists
benzodiazepines
NSAIDs
CCBs
antihistamines
alcohol
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25
drugs that prolong the QTc interval
``` antipsychotics macrolide abx anti fungal drugs anti arrhythmic drugs quinine methadone ```
26
drugs that cause HYPONATRAEMIA
``` loop diuretics thiazide diuretics carbamazepine desmopressin oxytocin SSRIs ```
27
drugs that cause HYPERNATRAEMIA
lots of saline mannitol lithium
28
drugs that cause constipation
antimuscarinics: hyoscine, oxybutynin, tolterodine, TCAs, antipsychotics cations: iron salts, calcium salts, aluminium salts (antacids) CCBs: verapamil OPIOIDS
29
drugs that cause seizures
analgesics: opioids, LA, diclofenac, indomethacin, aspirin Abx: isoniazid, mefloquine, metronidazole, betalactams antidepressants: bupropion, tricyclics antipsychotics: especially clozapine bronchodilators: theophylline, aminophylline nicotine replacement: bupropion, varenicline
30
acute asthma management
O - oxygen driven nebs S - salbutamol 2.5-5mg neb P - Prednisolone 50mg oral (or hydrocortisone if can't have pred) I - ipratropium bromide 500mcg neb T - theophylline M - magnesium sulphate 2g IV over 20 mins E - escalate care (intubation and ventilation)
31
monitoring in acute asthma
pulse oximetry ABG on admission and repeat as necessary peak flow on initial assessment, before and after bronchodilator
32
pulmonary oedema management
IV furosemide 40-80mg bolus followed by infusion at 5-20 mg/hr if needed IV GTN for patients with concomitant myocardial ischaemia, severe hypertension or regurgitant aortic or mitral disease REVIEW MEDICATION: stop CCB and NSAIDs where possible
33
MI acute management
if STEMI on ECH and PCI available within 120 minutes: primary PCI (if no: fibrinolysis transfer to primary PCI centre) M - morphine 5-10 mg in 10ml slow IV O - oxygen only if sats <94% N - sublingual GTN 2 puffs if not hypotensive A - aspirin 300mg PO loading lose then 75mg OD T - ticagrelor 180mg PO loading dose and then 90mg BD
34
MI long term management
modify risk factors: - smoking cessation - treat co-morbidities --> DM, HTN, hyperlipidaemia - cardiac rehab for graded exercise - mental health awareness optimise cardioprotective medications: - anticoagulation: fondaparinux 2.5mg SC OF 3 days post primary PCI - Beta-blockers: bisoprolol 2.5mg OD - ACEi: ramipril 1.25mg - statin: atorvastatin 80mg
35
acute COPD exacerbation management
O - oxygen 24-28% via venturi mask S - salbutamol 2.5-5mg neb (AIR DRIVEN) P - prednisolone PO 40mg daily for 7-14 days I - ipratropium bromide 500mcg neb T - theophylline A - antibiotics: doxycycline PO 200mg STAT then 100mcg OD 5-7 days
36
COPD long term management
1st line: SABA or SAMA if determined as likely to respond to steroids: LABA and ICS if not: add a LABA and LAMA
37
GI bleed management
ABCDE approach platelet transfusion if actively bleeding and plt <50 FFP if actively bleeding and PT or APT >1.5 prothrombin complex to those actively bleeding on warfarin
38
managing variceal bleeding
ABCDE senior help early TERLIPRESSIN 2mg IV followed by 1 or 2 mg every 4-6 hours
39
prophylaxis of variceal bleeding
propranolol: reduced rebreeding and mortality endoscopic variceal band ligation (EVL)
40
ulcerative colitis management
MILD ATTACK: - mesalazine 5-ASA - given PR for distal, PO for more extensive MODERATE ATTACK: - induce remission with oral prednisolone 40mg/d for 1 weeks then taper by 5mg/week over 7 weeks - maintain on 5-ASA SEVERE ATTACK: - if unwell and >6 motions/day, admit for: IV fluids, IV steroids, rectal steroids, VTE prophylaxis - if not improving on day 3: rescue therapy with cyclosporin or infliximab - involve surgery early in shared care
41
crohns management - inducing remission
- 1st presentation or single flare in 12 months: glucocorticosteroids (prednisolone, methylprednisolone, IV hydrocortisone - consider BUDESONIDE in those with more distal disease or can't tolerate conventional glucocorticoids - consider adding AZATHIOPRINE or MERCAPTOPURINE to induce remission if: 2 or more flares in 12 months, steroid dose can't be tapered
42
Crohn's management - maintaining remission
- offer azathioprine or mercaptopurine as mono therapy to maintain remission - consider methotrexate to maintain remission only in people who: needed methotrexate to induce remission or did not tolerate azathioprine or mercaptopurine
43
DKA management
ABCDE Fluids: 1L 0.9% saline over 1h Insulin: infusion at 0.1 unit/kg/hr (add 50 units of HSI to 50ml 0.9% NaCl) Monitoring: check glucose and ketones hourly. check VBG at 2/4/8/12/24 hours Catheter: if not passed urine by 1h. consider NG tube if vomiting or drowsy Avoid hypoglycaemia: when glucose <14 start 10% glucose at 125ml/h to run alongside saline K+ replacement: don't add to first bag. thereafter add according to VBG result ( >5.5=nil, 2.5-5.5=40mmol, <3.5=seek ITU help)
44
UTI in pregnancy
Nitro 50mg QDS immediate release tablets for 7 days avoid nitro in 3rd trimester avoid trimeth in 1st trimester
45
shingles management
start within 72 hours of rash: ACICLOVIR 800mg PO 5 times a day for 7 days immunocompromised: acyclovir 10mg/kg IV 8hrly 5 days
46
CAP management
CURB 0-1: doxycyline 200mg PO STAT then 100mg OD CURB 2-5: benpen 1.2g IV 4 hourly + doxycycline 200mg PO STAT then 100mg OD
47
PE management
offer choice of LMWH or FONDAPARINUX offer warfarin to patients with confirmed PE within 24 hours of diagnosis and continue for 3 months offer warfarin beyond 3 months to patients with an unprovoked PE
48
delirium tremens
S+S: agitation, confusion, paranoia, visual and auditory hallucinations ORAL LORAZEPAM 1st line treatment
49
wernicke's encephalopathy
S+S: confusion, apathy, ocular palsies, nystagmus, ataxia high risk patients: malnourished, decompensated liver disease Mx: IV pabrinex in 50-100ml NaCl or dextrose 5% IV infusion over 30 minutes prophylactic oral thiamine should also be given to harmful or dependent drinkers if they are in acute withdrawal, ro before and during assisted alcohol withdrawal
50
AF management
<48 hours: IV flecainide 1-2mg/kg over 10 mins if HF or cut eischaemia: amiodarone 300mg bolus via large bore cannula >48 hours or uncertain: sort rate control beta-blocker or rate limiting CCB
51
T2DM hyperglycaemia management
1st line: metformin if uncontrolled (HbA1c >58) add: - DPP4 inhibitor - sulphonylurea - SGLT-2 inhibitors - pioglitazone
52
T2DM cardiovascular risk management
control BP - ACEi first line primary prevention: atorvastatin 20mg daily if 10 year CV risk is >10% secondary prevention: atorvastatin 80mg daily, anti platelets
53
acne vulgaris management
1. single topical: topical retinoids, benzoyl peroxide 2. topical combination: topical abx, benzoyl peroxide, topical retinoid 3. oral abc: tetracyclines (DOXYCYCLINE, in pregnancy use erythromycin) 4. oral isotretinoin - SPECIALIST
54
isotretinoin side effects
``` teratogenicity dry skin/eyes/lips raised triglycerides hair thinning nose bleeding intracranial hypertension suicidal ideation photosensitivity ```
55
pt advice about anticoagulation
``` risks of accidental ingestion monitoring alcohol and good interacting drugs - esp NSAIDs tell dentist/doctors dabigatran capsules must be kept whole ```
56
pt advice about strong steroids
``` risks of accidental ingestion dependence and withdrawal symptoms/signs of toxicity MR tablets must be swallowed whole pregnancy and breastfeeding ```
57
pt advice about asthma
``` avoiding or managing triggers preventer vs reliever importance of using preventer signs of poor control asthma action plans ```
58
sick day rules in diabetes
keep taking insulin (adjust doses as needed) keep well hydrated keep eating keep testing sugars check for ketones get help is can't eat/drink anything, vomiting and ketones
59
pt advice about antiepileptics
alcohol, sleep, driving, safety side effects: dizzy, tired, decreased concentration, SJS, agranulocytosis (CBZ) interactions: enzyme effects, drugs that lower seizure threshold brand switching pregnancy and breastfeeding
60
significant SE of allopurinol
DERMATOLOGICAL: severe cutaneous adverse reaction (SCAR) DRESS SJS
61
ciclosporin side effects
``` nephrotoxicity hepatotoxicity fluid retention hypertension hyperkalaemia hypertrickosis gingival hyperplasia tremor impaired glucose tolerance hyperlipidaemia increased susceptibility to severe infection ```
62
adverse effects fo heparins
bleeding thrombocytopenia osteoporosis hyperkalaemia
63
heparin induced thrombocytopenia (HIT)
immune mediated usually develops 5-10 days into treatment prothrombotic condition >50% reduction in platelets, thrombosis and skin allergy treatment: alternative anticoagulants such as lepirudin and danaparoid
64
macrolide examples
erythromycin, clarithromycin, azithromycin
65
adverse effects of macrolides
GI upset cholestatic jaundice P450 inhibitors
66
adverse effects of metformin
GI upset: nausea, anorexia, diarrhoea reduced B12 absorption lactic acidosis
67
metformin contraindications
CKD tissue hypoxia eg MI, sepsis, AKI, severe dehydration iodine containing X-ray contrast media alcohol abuse (relative CI)
68
tamoxifen adverse effects
``` menstrual disturbance hot flushes VTE endometrial cancer osteoporosis ```
69
quinolone examples
ciprofloxacin | levofloxacin
70
quinolone adverse effects
``` lower seizure threshold tendon damage (risk increased if also taking steroids) cartilage damage (avoid in children) lengthens QT interval ```
71
drugs that CAN be given in breastfeeding
``` ABX: penicillin, cephalosporins, trimethoprim Endo: glucocorticoids, levothyroxine Epilepsy: sodium valproate, carbamazepine asthma: salbutamol, theophylline psych: TCAs HTN: BB, hydralazine anticoagulant:warfarin, heparin digoxin ```
72
drugs to AVOID in breastfeeding
``` ABX: cipro, tetracyclines, chloramphenicol, sulphonamides psych: lithium, benzos, clozapine aspirin carbimazole methotrexate sulfonylureas cytotoxic drugs amiodarone isotretinoin ```
73
psoriasis exacerbating factors
trauma alcohol drugs: BB, antimalarials, NSAIDs, ACEi, infliximab withdrawal of systemic steroids
74
volume required equation
(dose req / stock dose) x stock volume
75
rate (ml/hr) equation
(rate (mg/hr) / stock dose mg) x stock volume ml
76
P450 inducers
decrease the effects of warfarin ``` PC BRAS Phenytoin Carbamazepine Barbituates Rifampicin Alcohol (chronic) Sulphonylureas ```
77
P450 inhibitors
increase the effects of warfarin ``` ODEVICES Omeprazole Disulfiram Erythromycin Valproate Isoniazid Cimetidine and Ciprofloxacin Ethanol (acutely) Sulphonamides ```
78
major bleeding on warfarin management
dried prothrombin complex phytomenadione (vit K) 5mg IV and withhold warfarin
79
minor bleeding on warfarin management
phytomenadione (vit K) 1-3mg IB withhold warfarin
80
INR >8 on warfarin management
phytomenadione (vit K) 1-5mg oral withhold warfarin
81
INR 5-8 on warfarin management
withhold warfarin only
82
drugs that cause impaired glucose tolerance
``` thiazides / furosemide steroids tacrolimus / ciclosporin interferon alpha nicotinic acid antipsychotics ```
83
drugs that cause urinary retention
``` morphine sulphate anticholinergics general anaesthesia alpha adrenoceptor agonists benzos NSAIDs CCBs antihistamines alcohol ```
84
drugs that cause lung fibrosis
``` amiodarone cytotoxic agents: busulphan, bleomycin anti rheumatoid drugs: methotrexate, sulfasalazine nitrofurantoin bromocriptine / cabergoline / pergolide ```
85
TB drug side effects
RIFANPICIN: P450 inducer, hepatits, orange secretions, flu like symptoms ISONIAZID: P450 inhibitor, peripheral neuropathy, hepatitis, agranulocytosis PYRAZINAMIDE: hyperuricaemia (gout), arthralgia, myalgia, hepatitis ETHAMBUTOL: optic neuritis
86
drug levels routinely measured
ahminoglycosides (gentamicin, amikacin) vancomycin tacrolimus and ciclosporin lithium
87
statins safety monitoring
liver enzymes at baseline, 3m and 12m can accept LFTs 3x upper normal check TFTs before starting
88
methotrexate safety monitoring
before: FBC, LFT, U+E - then 1-2 weekly and then 2-3 monthly avoid in pregnancy CI in severe renal impairment can cause hepatotoxicity
89
amiodarone safety monitoring
TFTs before and 6 monthly LFTs before and 6 monthly K+ before CXR before IV use: ECG monitoring and resus available
90
low platelets causes
reduced production: infection, pencillamine, myelodysplasia, myelofibrosis, myeloma increased destruction: heparin, hypersplenism, DIC, ITP, H|US, TTP
91
high platelets causes
reactive: bleeding, tissue damage (infection, inflammation, malignancy), post-splenectomy primary: myeloproliferative disorders
92
high neutrophils causes
bacterial infection tissue damage steroids
93
low neutrophils causes
viral infection chemo or radio therapy clozapine carbimazole
94
high lymphocyte causes
viral infection lymphoma CLL
95
SIADH
large amount of ADH secreted into the body even when there is a decrease in plasma osmolality, causes an increase in aquaporin channels more water reabsorbed back into the blood and sodium becomes more diluted urine therefore more concentrated and high urine osmolality (>100)
96
causes of SIADH
``` 'SIADH' small cell lung tumours infection abscess drugs: carbamazepine, antipsychotics head injury ```
97
hyperkalaemia causes
``` drugs: K+ sp diuretics, ACEi, spironolactone renal fialure Addisons disease artefact (clotted sample) DKA rhabdomyolysis massive blood transfusion ```
98
hypokalaemia causes
drugs: loop and thiazide diuretics inadequate intake/intestinal loss (D+V) renal tubular acidosis endocrine: cushings and conns
99
loop diuretics
eg furosemide, bumetanide ascending LoH SE: hyponatraemia, hypokalaemia, hearing loss, tinnitus
100
thiazide diuretics
eg bendroflumethiazide, indapamide cotransporter of DCT SE: hyponatraemia, hypokalaemia, impotence, worsens gout
101
K+ sparing diuretics
eg amiloride, triamterene DCT not given with K+ supplements of ACEi or ARBs
102
aldosterone antagonists
eg spironolacotone, epleronone DCT SE: hyperkalaemia, gynaecomastia, liver impairment, jaundice, SJS
103
elective hip VTE prophylaxis
LMWH 10 days then aspirin (75 or 150) 18 days OR LMWH 28 days combined with strockings
104
elective knee VTE prophylaxis
aspirin 75 or 150mg 14 days or LMWH 14 days with stocking
105
fragility fractures of pelvis/hip/proximal femur VTE prophylaxis
LMWH or fondaparinux
106
HRT contraindications
``` oestrogen dependent cancer past PE undiagnosed PV bleeding abnormal LFTs pregnancy breastfeeding ```
107
HRT side effects
``` fluid retention bloating breast tenderness nausea headaches leg cramps dyspepsia mood swings depression acne backache ```
108
benefits of HRT
reduction of vasomotor symptoms improvement in GU symptoms osteoporotic fractures reduced reduced risk of colorectal cancer (around 1/3)
109
risks of HRT
breast cancer risk increased by around 2.3% per year (returns to normal after 5 years off) - highest risk on combined unopposed oestrogen increase risk of endometrial cancer more than doubles VTE risk - most likely in first year and increases with age
110
TCA (amitriptyline) toxicity presentation
``` altered consciousness tachycardia dilated pupils dry mouth hot dry skin urinary retention ``` long PR/QRS/QTc heart block changes to ST and T wave
111
management of TCA OD
activated charcoal within 1h reduces absorption IV Lorazepam for convulsions sodium bicarbonate if QRS >120 ms (3 small squares)
112
digoxin toxicity features
``` generally unwell lethargy N+V anorexia confusion yellow green vision arrhythmia: AV block, bradycardia ```
113
precipitating factors of digoxin toxicity
``` HYPOKALAEMIA increasing age renal fialure myocardial ischaemia hypomagnesaemia, hypercalcaemia, hypernatraemia acidosis hypoalbuminaemia hypothermia hypothyroidism ``` drugs: amiodarone, quinidine, verapamil, diltiazem, spironolactone, ciclosporin
114
lithium toxicity precipitating factors
dehydration renal fialure drugs: diuretics, ACEi, ARBs, NSAIDs, metronidazole
115
features of lithium toxicity
``` D+V ataxia dysarthria muscle twitching tremor seizure acute confusion ```
116
management of lithium toxicity
mild-mod: volume resus with NaCl | severe: haemodialysis
117
features of opioid overdose
``` drowsiness confusion hallucinations myoclonic jerks respiratory depression (RR<8) ```
118
opioid overdose management
stop the opioid and obs monitoring ABCDE NALOXONE IV 100-200mcg every 2-3 mins until rousable and rest drive returns expect to see improvement after 3-4 doses
119
CO poisoning features
``` headache nausea irritable dizziness respiratory failure confusion ```
120
management of CO poisoning
measure carboxyhaemoglobin and ABG give OXYGEN at max conc ± IPPV treat metabolic acidosis with O2, AVOID sodium bicarb anticipate cerebral oedema - if necessary give mannitol 1g/kg discuss hyperbaric oxygen therapy if: - unconscious at any time since exposure - carboxyhaemoglobin >20% - any neuro/psych symptoms - CVS complications - pregnancy
121
paracetamol OD management
WITHIN 4 HRS: - <1hr activated charcoal if >150mg/kg ingested - NAC if above treatment line 4-8 HOURS: - measure plasma conc at presentation - use graph to decide on NAC 8-15 HOURS: - urgent blood conc - start NAC immediately if >150 mg/kg ingested - stop NAC if level below treatment line 15-24 HOURS OR STAGGERED: - urgent blood measurement - start NAC immediately
122
aspirin over dose S+S
hyperventilation respiratory alkalosis then metabolic acidosis tinnitus (level >400)
123
aspirin over dose management
ABCDE activated charcoal if <1hour consider gastric lavage in adults within 1hr of potentially life threatening over dose providing can protect airway urinary alkalinisation: IV sodium bicarbonate haemodialysis: renal failure, CHF, hypoxia, coma, convulsions, CNS effects not resolved by correction of acidosis, persistently high salicylate levels unresponsive to urinary alkalinisation
124
insulin SEs
hypoglycaemia weight gain lipodystrophy
125
metformin SE
GI upset | lactic acidosis
126
sulphonylureas/gliclazide SEs
hypoglycaemia GI upset weight gain hyponatraemia
127
thiazolidinediones SEs
``` weight gain anaemia small increase in bladder cancer increased fractures in women fluid retention ```
128
DPP4 inhibitors (gliptins) SEs
generally well tolerated | increased risk of pancreatitis
129
SGLT2 inhibitors (glifozins) SEs
UTI | weight loss
130
GLP1 agonists (-tides) SEs
N+V pancreatitis weight loss
131
examples of rapid acting insulins
insulin aspart = NovoRapid | insulin lispro = Humalog
132
examples of short acting insulins
Actrapid | Humulin S
133
examples of intermediate acting insulins
isophane insulin
134
examples of long acting insulins
``` insulin determine (Levemir): OD or BD insulin glargine (Lantus): OD ```
135
palliative care analgesia for bone metastases
bisphosphonates
136
palliative care analgesia for neuropathic pain
pregabalin or gabapentin
137
breakthrough pain dosages
1/10 to 1/6 of the regular 24 hour dose repeated every 2-4 hours as required review pain management if rescue analgesia is needed 2x daily or more
138
palliative care pain relief for patients who can't tolerate morphine
oxycodone
139
opioids oral vs parenteral (SC/IM/IV)
parenteral about half the oral dose
140
palliative care: anorexia management
prednisolone | dexamethasone
141
palliative care: bowel colic and resp secretions management
hyoscine hydrobromide or glycopyrronium bromide generally given every 4hours SC
142
palliative care: constipation management
regular laxatives: faecal softener with a peristaltic stimulant or lactulose solution with a Senna preparation should be used
143
palliative care: convulsions management
prophylactic treatment with phenytoin or carbamazepine
144
palliative care: dry mouth management
artificial saliva, sucking ice dry mouth due to candidiasis: nystatin
145
palliative care: dyspnoea management
orla morphine
146
palliative care: N+V management
metoclopramide: associated with gastritis, gastric states, functional bowel obtruction haloperidol: most metabolic causes (eg hypercalcaemia, renal failure) cyclizine: mechanical bowel obstruction, raised ICP, motion sickness
147
levodopa (PD) SEs
motor fluctuations | dyskinesias
148
dopamine agonists (PD) SEs
sedation | impulse control disorder
149
MAO-B inhibitor (PD) SEs
generally well tolerated
150
COMT inhibitor (PD) SEs
diarrhoea
151
anticholinergic medication (PD) SEs
confusion dry eyes and mouth constipation urinary retention
152
amantadine (PD) SEs
diarrhoea | confusion

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