PSA Flashcards by Richard Wu

All diuretics

· Hyponatremia
	• Although when they contribute to dehydration, the sodium can increase too.
· Hypotension
· AKI
· Give in mornings – subsequent diuresis

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Thiazide (Bendroflumethiazide)

+ Loop diuretic (Furosemide)

· Hypokalaemia

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ACEi (Lisinopril)

· Hyperkalaemia
· Dry cough
• (accumulation of bradykinin via reduced degradation by ACE)
· Reduces AT-2 production necessary for preserving GFR when the renal blood flow is reduced
· CI in pregnancy (teratogenic) – convert to Labetolol before conception
· Postural hypotension – given in evenings [except Perindopril: in AM]

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K+ sparing diuretics (aldosterone antagonists)(Amiloride)

· Hyperkalaemia

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CCB (Amlodipine)

· Peripheral oedema (ankle swelling)
	• E.g. normal EF/echo i.e. no HF
· Hypotension
· Bradycardia
· Flushing

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βblockers

Bisoprolol 10mg daily

· Bronchospasm in asthmatics
· Hypotension
· Bradycardia
· Cold extremities
· Fatigue

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SABA (Salbutamol, Terbutaline)

· Tremor

· Tachycardia

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NSAID (Ibuprofen, Diclofenac, Naproxen)

NSAIDs: No urine (renal failure), Systolic dysfunction (HF), Asthma, Indigestion (any cause), Dyscrasia (clotting abnormality)
· Indigestion
o (inhibits PG synthesis needed for gastric mucosal protection from acid – thus @ risk of influencing inflammation + ulceration)
· Renal failure
o (inhibits PG synthesis which reduces renal artery diameter (+ blood flow) and thus reducing kidney perfusion and function)
· Bronchoconstriction – asthmatics

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Aspirin

Cardioprotective dose = 75mg daily ACS/stroke dose = 300mg orally

· Despite being NSAID, aspirin rarely worsens asthma and is commonly (cautiously) used
· Haemorrhage
· Peptic ulcers + gastritis
· Tinnitus in large doses

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Warfarin

· Haemorrhage

• Remember Heparin should be prescribed alongside Warfarin (pro-coag effects first) and continued until INR >2

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Heparin

· Haemorrhage (esp if renal failure or <50kg)

· HIT

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Steroids (Prednisolone)

· Oral steroids inhibit gastric epithelial renewal thus predisposing to ulceration
STEROIDS: Stomach ulcers, Thin skin, Edema, Right + Left HF, Osteoporosis,
Infection (incl Candida), Diabetes,

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Antibiotics (most commonly broad- spectrum e.g.Cephalosporins/Cipro)

· Clostridium Difficile colitis

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Gentamicin/Vancomycin

· Nephrotoxicity, ototoxicity

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Trimethoprim

· Risk of bone marrow toxicity (pancytopenia/neutropenic sepsis)
• Folate antagonist thus CI if on Methotrexate (another folate antagonist)

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Methotrexate

· If patient on Methotrexate has sepsis, this medication is withheld pending exclusion of neutropenic sepsis.
· Do not start if abnormal LFTs (risk of liver cirrhosis)
· Fatal blood dyscrasias
· Pulmonary fibrosis

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Cyclizine

· Sedating antihistamine

· Anti-muscarinic effects

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TCA (Amitryptiline)

· Also has anti-muscarinic SEs (seeing double, dry mouth)

• Used at lower doses in the tx of neuropathic pain (10mg), higher doses in tx as antidepressant (20mg)

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SSRI (Citalopram)

· Dry mouth
· Serotonin syndrome (temperatures, agitation, hallucinations)
· Photosensitive

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COCP (Microgynon)

· CI in migraine with aura as significantly incr risk of stroke

Tamoxifen

· DVT
· Hot flushes
· Incr risk of endometrial carcinoma
· Increases efficacy of Warfarin and thus incr susceptibility to high INR readings

Carbimazole

· Drug-induced neutropenia

· –> seek help if signs of infection (e.g. sore throat)

Metformin

· Risk of lactic acidosis

Carbamazepine
(alternative to gabapentin for tx of
neuropathic pain)

· Neutropenia

· SIADH

Sodium Valproate

· Hepatotoxicity · Pancreatitis · OP risk?

Lithium

· Early – tremor · Intermediate – tiredness · Late – arrhythmias, seizures, coma, renal failure, DI

Haloperidol

· Dyskinesias e.g. acute dystonic rxns, drowsiness

Clozapine

· Agranulocytosis (req intensive FBC monitoring)

Statin

``` · Caution if liver disease o CI if active disease/ALT or AST is > 3x the normal range · If RFs present, @ risk of myopathy o Common SE: myalgia o Dangerouse SE: rhabdomyolysis · Abdo pain ```

Amiodarone (anti- arrhythmic)

· ILD (pulmonary fibrosis) · Thyroid disease (both hypo- and hyperthyroidism are reported; it is structurally related to iodine) · Skin greying · Corneal deposits

Digoxin (anti-arrhythmic)

``` · HypoK increases risk of toxicity · N&V · Diarrhoea · Blurred vision · Confusion + drowsiness · Xanthopsia (disturbed green/yellow visual perception including ‘halo’ vision) ```

Most Antibiotic courses duration

5 days

Regular mild pain

Paracetamol 1g up to 6-hourly oral

Regular severe pain

Co-codamol 30/500, 2 tablets 6-hourly oral

PRN mild pain

Codeine 30mg up to 6-hourly oral

PRN severe pain

Morphine Sulphate (Oral --> SC --> IV)*(1) Oramorph 10mg/5ml up to 6-hourly (2) SC Morphine sulphate (3) IV Morphine sulphate

PRN no pain

Paracetamol 1g up to 6-hourly oral

Regular no pain

Nil

Calculate PRN dose of Morphine sulphate

*PRN doses of Morphine Sulphate (e.g. Oramorph) = 1/6 of the total daily dose given up to every 4-6 hrs

Generally, which fluid to give

GENERAL RULE: Give all patients 0.9% Sodium Chloride

Which fluid to give in hypernatraemia

give 5% Dextrose

Which fluid to give in hypoglycaemia

give 5% Dextrose

Which fluid to give in ascites

give Human-Albumin Solution (HAS)Albumin maintains oncotic pressure, higher Na content in saline worsens ascites

Which fluid to give in shock with sBP < 90

give Gelofusine (a colloid)Has a high osmotic content so stays intravascularly thus maintain BP for longer

Which fluid to give in shock due to bleeding

give blood transfusion but a colloid 1st if no blood available

Generally, 1st line anti-emetic

Cyclizine 50mg 8-hourly MOA: anti-histamine Good 1st line tx for almost all cases C/I: Cardiac failure (can worsen fluid retention)

Anti-emetic in heart failure

Metoclopramide 10mg 8-hourly C/I: Parkinson's disease

Anti-emetic in PD

Domperidone: safer to use b/c does not cross BBB