PSA Flashcards
What drugs should be stopped before surgery
I LACK OP
Insulin
Lithium
Anticoagulants
COCP/HRT
K-Sparing diuretics
Oral hypoglycaemics
Perindopril and other ACE-is
when should the COCP be stopped before surgery
4 weeks before
when should lithium be stopped before surgery
day before
when should potassium sparing diuretics and ace-inhibitors be stopped before surgery
day of surgery
Py450 enzyme inducers
PC BRAS
Phenytoin
Carbamazemine
Barbituates
Rifampicin
Alcohol (chronic excess)
Sulphonylureas
py450 enzyme inhibitors
AODEVICES
allopurinol
omeprazole
disulfiram
erythromycin
valproate
isoniazid
ciprofloxacin
ethanol (acute intoxication)
sulphonamides (trimethoprim)
what should be stopped in a patient with haemoptysis
any anticoagulant/antiplatelet
Mnemonic for prescribing
PReSCRIBER
Patient details
Reaction (allergy)
Sign the front of the chart
Contraindications - check contraindications for each drug
IV Fluids - consider
Blood clot prophylaxis (consider)
antiEmetic (consider)
painRelief (consider)
side effects of chronic steroids
STEROIDS
Stomach Ulcers
Thin skin
oEdema
Right and left heart failure
Osteoporosis
Infection
Diabetes
cushings Syndrome
NSAIDS contraindications
NSAID
No urine - renal dysfunction
Systolic dysfunction (heart failure)
Asthma
Indigestion
Dyscrasia (clotting abnormality)
how much fluid should be given in an oliguric patient
1L over 2-4 hours then reassess
how much fluid loss does oliguria indicate
500ml
how much fluid loss does oliguria plus tachycardia indicate
1L
how much fluid depletion does oliguria + tachycardia + hypotension indicate
2L
max infusion rate for potassium
10mmol/hour
CI for compression stockings
peripheral arterial disease
antiemetic for persistent nausea
cyclizine 50mg 8 hourly IM/IV/Oral
antiemetic for persistent nausea in heart failure
metoclopramide 10mg 8 hourly IM/IV
CI for metoclopramde
parkinsons
young women (risk of dyskinesea)
first line treatment neuropathic pain
amitriptyaline 10mg ON
Pregabalin 75mg oral 12 hourly
first line treatment painful diabetic neuropathy
duloxetine 60mg PO
main side effect calcium channel blockers
peripheral oedema
dosage of paracetamol in cocodamol
500mg in 1 tablet of 30/500
what route is most insulin given and whats the rule for when it isn’t
SC , if it is a rapid acting one (novorapid/actrapid) it may be given as an IV infusion
what is the rule around enoxaparin and strokes
prophylactic enoxaparin is contraindicated for 2 months post stroke
causes of microcytic anaemia
IDA
Thalassaemia
Sideroblastic anaemia
causes of normocytic anaemia
anaemia of chronic disease
acute blood loss
haemolytic anaemia
renal failure (chronic)
causes of macrocytic anaemia
B12/folate deficiency
excess alcohol
liver disease
hypothyroidism
myeloproliferative disorders
myelodysplasia
multiple myeloma
causes of euvolaemic hyponatraemia
SIADH
psychogenic polydipsia
hypothyroidism
causes of hypervolaemic hyponatremia
heart failure renal failure liver failure nutritional failure thyroid failure
signs of pulmonary oedema on CXR
ABCDE
Alveolar Oedema (bat wings)
kerley B lines
Cardiomegaly
Diversion of blood to upper lobes
pleural Effusions
drugs with narrow therapeutic index
digoxin
lithium
theophylline
phenytoin
gentamicin/vancomycin
signs of digoxin toxcicity
confusion
nausea
bradycardia + dizziness
visual halos
arrythmias
signs of lithium toxcicity
early: tremor
intermediate: tiredness
late: arrythmias, seizures, coma, renal failure diabetes
signs of phenytoin toxcicity
gum hypertrophy, ataxia nystagmus, peripheral toxcicity and teratogenicity
signs of gentamicin/vancomycin toxcicity
ototoxicity and nephrotoxicity
gentamicin dosing guidelines
peak: 3-5 mg/L in endocarditis/renal failure , 5-10 everything else
trough: <1 endocarditis/renal failure, <2
management of warfarin overdose if INR is <6 (no bleed)
reduce warfarin dose
management of warfarin overdose if INR is 6-8 (no bleed)
omit warfarin for 2 days then reduce dose
management of warfarin overdose if INR is >8
omit warfarin and give 1-5mg oral vit K
management of warfarin overdose if INR >5 and minor bleeding
IV vit K + omit warfarin
management of warfarin overdose if there is a major bleed
stop warfarin
5-10mg IV vit K
prothrombin complex
what counts as a major bleed in warfarin overdose
hypotension
bleeding into a confined space
target INR for warfain
2-3, unless they have a mechanical valve/recurrent thromboembolism then its 3-4
causes for SIADH
SIADH
small cell lung tumours
Infection
Abscess
Drugs - carbamazepine and antipsychotics
Head injury
what antibiotic is contraindicated in early pregnancy
trimethoprim
what is a contraindication to the use of calcium channel blockers
peripheral oedema
what CCB is used in AF
diltiazem
Tx for PE
high flow oxygen
ECG if not done (looking for RH strain)
morphine 5-10mg IV
metoclopramide 10mg IV
LMWH/DOAC
low BP = thrombolysis
how many units of blood should you crossmatch in a GI bleed
6
tx for GI bleed
cannula (2x large bore)
catheter and strict fluid monitoring
fluids
cross match 6 units blood
correct any clotting abnormalities
endoscopy
stop anticoagulants and NSAIDS
surgical referral if severe
Tx bacterial meningitis
ABC
High flow o2
IV Fluids
Dexamethasone IV (unless severely immunocompromised)
LP +/- CT Head
2g CefotaximeIV STAT
consider ITU
Tx heart failure
- ACE-i + BB
- increase dose if inadequate
- mild-moderate disease = ARB
moderate-severe disease (afrocaribbean patients) = hydralazine 25mg tds + isorbide mononitrate 20mg tds
moderate-severe (non afrocaribbean) = spironlactone 25mg
Tx angina
- GTN + secondary prevention (aspirin statin)
- BB or CCB
- increase dose as tolerated
- add other one of BB or CCB, or if CI add isorbide mononitrate or nicorandil
- if uncontrolled on 2 antianginal drugs = PCI or CABg
COPD Tx
- SABA/SAMA as required
- FEV <50% = LABA or LAMA (discontinue SAMA)
FEV >50% = LABA + ICS (if steroid responsive) or LAMA - LABA –> LABA + ICS or LABA + LAMA
LAMA —> LAMA + LABA + ICS
LABA + ICS –> LAMA + LABA + ICS
LAMA —> LAMA + LABA + ICS
features of COPD for LTOT
very severe airflow obstruction (FEV1 < 30% predicted). Assessment should be ‘considered’ for patients with severe airflow obstruction (FEV1 30-49% predicted)
cyanosis
polycythaemia
peripheral oedema
raised jugular venous pressure
oxygen saturations less than or equal to 92% on room air
what hypnotic should be chosen if you have to prescribe one
zopiclone 7.5mg PO O.N (3.75mg in elderly)
Tx crohn’s flare
IV hydrocortisone 100mg 6 hourly IV + IV fluids, NBM +/-antibiotics
what is the first pain relief medication used for all acute coronary syndrome
GTN spray sublingual
`what blood pressure medication should ACE-is or CCBs be changed to in pre-conception
labetalol
when is a renal function test done post commencement of Ace-inhibitors (esp in renally impaired patients)
1-2 weeks post-initiation
what does 1:1000 concentration refer to
1mg/ml
if you’re plotting a dose on a gentamicin dosing graph,if the serum concentration falls between two dosing interval lines, what should you do
pick the largest interval
what time of the day should ace inhibitors be prescribed for + why
nightly - can cause postural hypotension
what is the most important thing to check before commencing vancomycin
renal function
what concentration of lithium is likely to manifest in toxic effects
1.5 mmol/L
what monitoring is always indicated when prescribing olanzipine
fasting blood glucose
what monitoring is essential in digoxin therapy
renal
what kind of drug is amiloride
potassium sparing diuretic
Indication for stopping diazepam
drowsiness
CI for bendroflumethiazide
gout
when stopping drugs to lower blood pressure what should be chosen first preferably
any diuretics over the cardioactive drugs like beta blockers
.
.
single best Tx for bowel obstruction
NG tube and IV infusion
non pharmalogical option for pain relief (esp lower back pain)
TENS machine
after salbutamol what is the next best thing to give in an exacerbation of COPD
ipratropium bromide
max O2 % in COPD (CO2 retainers)
28% venturi
what drugs are best for immediate relief of symptoms of dyspepsia/GORD
alginates/aluminium hydroxide
what should every antibiotic prescription have
start date and review/stop date
best laxative for post operative ileus + what dose
stimulant laxative like senna (15-30mg)
how long does consolidation take to clear on an X ray
6 weeks
best monitoring for resolution of a DKA
serum ketones
optimal pre trough dose concentration for vancomycin
10-15mg/L
what side effects does cyclizine have
anti-muscarinic ones - blurry vision, dry mouth etc
what are appropriate treatments for mild hypoglycaemia
orange juice or biscuits
where should cases of drug induced hypoglycaemia be treated
hospital
what time of the day are thiazides contraindicated
evening - will cause excessive nocturesis
indications for stopping codeine/co-codamol
constipation
drowsiness
respiratory sedation
max dose of citalopram for younger and older people
20mg if >60
40mg otherwise - but start low
what does a leucocytosis with a normal CRP usually indicate
non infectious causes - potentially chronic steroid use or bone marrow issues or hyposplenism
what what should you do with someone taking phenytoin with signs of toxicity but normal serum levels
decrease dose
rate control of AF in asthmatics
digoxin
what should be checked 2 weeks after starting fluoxetine
development of a rash
dosage for IV furosemide for acute relief of pulmonary Oedema
20-50mg
what IV solution is the initial solution of choice for hypoglycaemia and what is an alternative
50-100ml 20% glucose , or glucose 100-200ml 10% if not available
first line systemic therapy for acne not responding to topical therapy
oral tetracycline 500mg PO BD (1g total)
what medications are likely to cause hyperkalaemia
ACE-is ARBs heparins tacrolimus K+ sparing diuretics NSAIDS
what should be done to allopurinol in renal impairment
hold/reduce dose to 100mg
can glucocorticoids cause confusion
yes
can fentanyl be used for breakthrough pain
yes
what should be done if someones INR is >1.5 on the day of surgery
give vit K 1-5mg PO (using IV preparations)
most important advice for patients taking rivaroxaban
take with food
whats the advice around contraception when taking topiramate (or any other enzyme inducer)
change to an alternate form if the patient is on the progesterone-only pill until at least 4 weeks after cessation of topiramate therapy
what should you do if there is a small (<20%) rise in creatinine 1 week after taking an ace-inhibiter
nothing, up to 20% rise is acceptable and nothing needs changing
what is the best indicator for effectiveness of furosemide administration?
weight loss
when prescribing maintenance fluids , how should a glucose/dextrose + 20mmol KCL bag appear
Glucose/Dextrose 5%/0.3% potassium chloride over 9-12 hours
what commonly cause vaginal candidiasis
antibiotics
SGTL-1is
systemic steroids (not inhaled)
what should you do with regular prescription systemic steroids in acute illness
continue them - they may have adrenal suppression
max dose of omeprazole for GORD
80mg
when adjusting insulin regimes, whats the principle for increasing glycaemic control at certain times of the day
avoid adding in new insulin preparations and try increasing doses of existing ones first
if an INR target is 3.5 what is the acceptable range
3-4 (e.g. if someones target is 3.5 and they’re at 3.3 its ok but monitor if on any CYP450 medications)
for someone on the COCP what is the rule about missing doses
for 1-2 days full dose or 1 day reduced dose: take both pills the next day and resume the normal cycle - no additional contraceptives required
any more than this = start again and use condoms for 7 days
what are the rules around missed doses for progesterone only pills
if the dose is missed >3 hours outside the usual time another should be taken immediately and condoms should be used for 2 days
do males need contraception when taking methotrexate
yes
what is a common side effect of mirtazipine
abnormal dreams
what kind of medication is indapamide
thiazide-like diuretic
what is more likely to interact with statins - ezemitibe or gemfibrozil
gemfibrozil
when treating hypothyroidism what is the best measure for adherence to medication
TSH
when treating hypothyroidism, if TSH is raised and adherence is in question do you need to increase the dose
no just encourage adherence
BP threshold for shock
<90 syst or <60 diast
common medical causes of ankle oedema
naproxen
amlodipine
first-line treatment for more than 1 episode of c.difficile
oral vancomycin
first line treatment for first presentation of c diff
metronidazole
what should be done when someone requiring opiate s has renal impairment causing toxicity
switch to oral oxycodone (or fentanyl if appropriate concentration)
what should you do if there is thyrotoxicosis with amiodarone
hold it
new guidelines for DVT Tx
DOAC (apixaban or rivaroxiban)
What fluids are contraindicated in acute brian injuries (such as acute ischaemic strokes)
glucose as it is hypotonic and may exacerbate cerebral oedema
what should you do if the gentamicin dose levels are too high
trough dose too high: increase treatment interval (TDS to BD)
Peak Dose too high : decrease dose
what antibiotics should be avoided in patients with epilepsy
Ciprofloxacin
Levofloxacin
what antibiotics are ok for breastfeeding women
penicillins, cephalosporins, trimethoprim
