PSA Flashcards
treatment of wheeze in acute asthma
5mg salbutamol nebulised
DVT treatment
12500 units dalteparin (25000units/ml)
daily potassium requirement
1mmol/kg/dau
rate for 0.9% sodium chloride/0.15% potassium chloride
500 ml over 4 hours
hypercholesterolaemia
simvastatin
drugs causing impaired renal function
ibuprofen
ACEi
ARBs
drugs to stop in AKI
DAMN Diuretics ACEi/ARBs Metformin NSAIDs
aspirin adverse effect FBC
iron deficiency anaemia
urinary retention drugs
morphine anti-cholinergics (anti-psychotics, antidepressants, detrusor relaxants) alpha adrenoceptor agonists benzos NSAIDs CCBs Antihistamines Alcohol
drugs causing confusion
metaclopramide
morphine
corticosteroids
DKA management
insulin 50 units in 500ml 0.9% saline IV 0.1 units/kg/hour
dehydration early monitoring
blood pressure
HRT monitoring for adverse effects
blood pressure
lithium monitoring for toxicity
U&Es
simvastatin + slightly raised ALT
don’t stop simvastatin
potassium max rate
10mmol/hour
enzyme inducers
PC BRAS Phenytoin Carbamazepine Barbiturates Rifampacin Alcohol (chronic excess) sulphonylureas
other enzyme inducers
topiramate
St. John’s Wort
Smoking
Enzyme inhibitors
AO DEVICES Allopurinol Omeprazole Disulfiram Erythromycin Valproate Isoniazid Ciprofloxacin Ethanol (acute intoxication) Sulphonamides
other enzyme inhibitors
grapefruit juice
amiodarone
SSRIs
anaphylaxis treatment
1:1000 adrenaline 500 mcg IM (0.5ml)
chlorphenamine 10mg IM/slow IV
hydrocortisone 200mg IM/slow IV
ACEi side effects
cough
hyperkalaemia
amlodipine side effect
oedema
amiodarone side effects
pulmonary fibrosis
thyroid dysfunction
carbamazepine side effects
hyponotraemia
clozapine side effects
agranulocytosis
gliclazide side effects
agranulocytosis
metformin side effects
lactic acidosis
statin side effects
myalgia
major bleeding on warfarin
stop warfarin
give phytomenadione (Vit. K)
give prothrombin complex (or FFP)
INR > 8.0 + minor bleeding
stop warfarin
give phytomenadione (Vit. K) & repeat in 24 hours if INR still too high
restart warfarin when INR < 5.0
INR > 8.0 + no bleeding
stop warfarin
give phytomenadione (Vit. K)
restart warfarin when INR < 5.0
INR 5.0-8.0 + minor bleeding
stop warfarin
give phytomenadione (Vit. K)
restart warfarin when INR < 5.0
INR 5.0-8.0 + no bleeding
withhold 1 or 2 doses
reduce subsequent maintenance dose
stop warfarin when before elective surgery
5 days
if INR >/= 1.5 give phytomenadione (Vit. K) by mouth
emergency surgery, patient on warfarin can delay 6-12 hours
give phytomenadione (Vit. K)
emergency surgery, patient on warfarin, cannot delay
give phytomenadione (Vit. K) + prothrombin complex
co-amoxiclav adverse effect
cholestatic jaundice
creatinine rise when starting ACEi
< 20% ok
effective furosemide treatment measurement
weight
effective perindopril erbumine in heart failure treatment measurement
exercise tolerance
INR target 2.5 in
DVT/PE treatment AF cardioversion (3 weeks before) dilated cardiomyopathy mitral stenosis/regurgitation MI
INR target 3.5 in
recurrent DVT/PE
warfarin treatment length for isolated calf DVT
6 weeks
warfarin treatment length for provoked VTE
3 months
warfarin treatment length for unprovoked VTE
at least 3 months
combined pill improves
acne
combined pill reduces risk of
ovarian, uterine and colon cancer
combine pill increases risk of
VTE, breast cancer and cervical cancer
contra-indications to combined pill
pregnant smoking + >35years >35 years + stopped smoking < 1 year ago BMI . 35 migraine with aura breastfeeding up to 6 weeks CVS/VTE risk factors family history of breast cancer
one missed combined pill
take missed pill straight away and continue with rest of pack
no extra contraception
two or more missed combined pills
take most recent pill straight away
condoms/avoid sex for 7 days
sec in previous 7 days -> emergency contraception
7+ combined pills in pack after two missed
finish pack and have 7 day break
<7 combined pills in pack after two missed
finish pack but no break
tacrolimus units
mg
hyperkalaemia causes
dalteparin ramipril tacrolimus ciclosporin eplerenone
breakthrough for someone on >25mcg transdermal fentanyl patch
nasal fentanyl spray 50mcg into one nostril, repeat once if necessary
acute alcohol withdrawal treatment
chlordiazepoxide 20mg PO 6 hourly
advice for rivaroxaban
take with food
beta blocker side effect
erectile dysfunction
progesterone only pill increases risk of
ovarian cysts and breast cancer
contraindications to progesterone only pill
pregnant
breast cancer
severe cirrhosis
liver tumours
one missed progesterone only pill > 3 hours late
take missed pill
take next pill at usual time
condoms for next 2 days
recent sex may need emergency contraception
one missed pill < 3 hours late (12 hours for desogesterel)
take pill as soon as remembered
take next pill at usual time
rapid anticoagulation with warfarin
5mg or 10mg OD for 2 days
INR check on day 3
lower rapid anticoagulation with warfarin dose if
elderly
low body weight
liver disease
heart failure
slow initiation starting dose warfarin
1-2mg
contraindications to warfarin
haemorrhagic stroke clinically significant bleeding within 72 hours of major surgery within 48 hours postpartum pregnancy (teratogenicity) bleeding disorder
1 mcg =
0.001 mg
1% =
1g in 100 ml
0.1% =
0.1g (100mg) in 100ml
1:1000 =
1mg per ml
1:10000 =
1mg per 10 ml
rivaroxaban contraindications
eGFR < 15 active bleeding GI ulcer (current.recurrent) oesophageal varices recent brain/spine injury recent brain/spine/eye surgery malignant neoplasm vascular aneurysm prosthetic heart valve liver disease with coagulopathy
resuscitation fluid
500ml bolus of 0.9% saline or Hartmann’s over less than 15 mins then reassess
daily water requirement
25-20ml/kg/day
20-25 ml/kg/day in elderly, renal/heart failure, malnourished
daily sodium requirement
1mmol/kg/day
daily chloride requirement
1mmol/kg/day
daily glucose requirement
50-100g/day
0.9% saline tonicity
isotonic
resuscitation/maintenance
0.9% saline constituents
154 mmol/L Na+
154 mmol/L Cl-
Hartmann’s tonicity
isotonic
resuscitation/maintenance
Hartmann’s constituents
131 mmol/L Na+
5 mmol/L K+
111 mmol/L Cl-
29 mmol/L HCO-3
NaCl 0.18%/glucose 4% tonicity
hypotonic
maintenance
NaCl 0.18%/glucose 4% constituents
30 mmol/L Na+
30 mmol/L Cl-
40g/L glucose
5% dextrose tonicity
hypotonic
maintenance
5% dextrose constituents
50g/L
pulmonary oedema treatment
IV 20mg-50mg of Furosemide 10mg/ml
DVT prophylaxis for total hip replacement/total knee replacement patients
rivaroxaban 10mg PO
hypoglycaemia treatment
IV glucose 20% 75-100ml over 10 mins
contraindications to HRT (current)
undiagnosed PV bleeding Pregnancy/breastfeeding oestrogen dependant cancer acute liver disease uncontrolled hypertension
contraindications to HRT (history)
history of breast cancer
history of VTE
recent stroke/MI/angina
risks of HRT
VTE (no risk with transdermal) stroke breast cancer (combined HRT) ovarian cancer (if used >5 years) endometrial cancer (if no progesterone)
oestrogen HRT side effects
breast tenderness
leg cramps
nausea
progesterone HRT side effects
pre-menstrual symptoms
progesterone phase of cyclical HRT side effect
PV bleeding
no uterus + need HRT
oestrogen only (oral or transdermal)
users + peri-menopausal
cyclical HRT
monthly cyclical HRT
oestrogen every day but + progesterone 12-14 days to cause bleed at end of every menstrual cycle
use if still having regular periods
3 monthly cyclical HRT
oestrogen every day but + progesterone every 13 weeks
use if having irregular periods
post-menopausal
no periods for >1 year or been on cyclical HRT >1 year
post-menopausal + need HRT
continuous HRT
continuous HRT
combined oestrogen + progesterone
no bleeds
urogenital menopausal symptoms only
low dose vaginal oestrogen
beta blockers contraindication
peripheral vascular disease
drugs exacerbating heart failure
CCBs
steroids
methotrexate teratogenicity
effects both men & women
avoid conception for 3 months after stopping too
mirtazipine S/E
abnormal dreams
simvastatin + gemifibrozil
severe myopathy and rhabdomyolysis
before starting amiodarone check
potassium (causes hypokalaemia)
sertraline monitoring
no routine blood monitoring
symptoms + very raised CK (e.g. 5 x upper limit)
stop statin
if symptoms resolve, reduce dose and reintroduce
nasal steroids + gets nosebleeds
stop taking
carbamazepine s/e
dizziness drowsiness dry mouth weight gain hyponotraemia leucopenia low platelets
amitriptyline side effects
dry eyes (+ blurry vision) dry mouth GI upset drowsiness QT prolongation
post-op nausea & vomiting
ondansatron
ondansetron contraindications
prolonged QT
ondansetron alternative for PONV
cyclizine
shingles in immunosuppressed
Aciclovir 800mg PO 5 x a day
lansoprazole side effects
diarrhoea
naproxen side effects
ankle oedema
pregnant + thrush
prolonged therapy (7 days) e.g. clotrimoxazole pessary 100mg PV daily for 7 days
first line acute pain in elderly
paracetamol
ciclosporin monitoring
U&Es
what to check before starting azathiprine
thiopurine methyltransferase (TPMT)
how to check over coagulation for NOAC
patient reporting bruising
morphine in renal impairment
swap to oxycodone
Verapamil S/E
heart failure constipation hypotension bradycardia flushing
Diltiazem S/E
hypotension
heart failure
bradycardia
ankle swelling
nifedipine, amlodipine, felodipine S/E
flushing
headache
ankle swelling
drugs to improve long term prognosis of heart failure
ACEi
beta-blocker
Diabetic drugs causing low sodium
sulfonylureas (cause SIADH)
drugs which may worsen epilepsy control
alcohol, cocaine, amphetamines
ciprofloxacin, levofloxacin
aminophylline, theophylline
bupropion
methylphenidate (used in ADHD)
mefenamic acidbarking cough
= croup
croup
give sterids
worsens psoriasis
beta blockers lithium antimalarials (chloroquine and hydroxychloroquine) NSAIDs ACE inhibitors infliximab withdrawal of systemic steroids
beta blockers in diabetes
reduce hypoglycaemic awareness
long term steroids + sick
double the steroids
drugs to stop before surgery
I LACK OP Insulin Lithium Anticoagulants/Antiplatelets COCP/HRT K-sparing diuretics Oral hypoglycaemics Perindopril and other ACEi
furosemide
gout
spironolactone
gynaecomastia
