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PSA Flashcards

1
Q

What drugs should be stopped before surgery

A

I LACK OP

Insulin

Lithium

Anticoagulants

COCP/HRT

K-Sparing diuretics

Oral hypoglycaemics

Perindopril and other ACE-is

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2
Q

when should the COCP be stopped before surgery

A

4 weeks before

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3
Q

when should lithium be stopped before surgery

A

day before

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4
Q

when should potassium sparing diuretics and ace-inhibitors be stopped before surgery

A

day of surgery

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5
Q

Py450 enzyme inducers

A

PC BRAS

Phenytoin

Carbamazemine

Barbituates

Rifampicin

Alcohol (chronic excess)

Sulphonylureas

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6
Q

py450 enzyme inhibitors

A

AODEVICES

allopurinol

omeprazole

disulfiram

erythromycin

valproate

isoniazid

ciprofloxacin

ethanol (acute intoxication)

sulphonamides (trimethoprim)

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7
Q

what should be stopped in a patient with haemoptysis

A

any anticoagulant/antiplatelet

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8
Q

Mnemonic for prescribing

A

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)

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9
Q

side effects of chronic steroids

A

STEROIDS

Stomach Ulcers

Thin skin

oEdema

Right and left heart failure

Osteoporosis

Infection

Diabetes

cushings Syndrome

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10
Q

NSAIDS contraindications

A

NSAID

No urine - renal dysfunction

Systolic dysfunction (heart failure)

Asthma

Indigestion

Dyscrasia (clotting abnormality)

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11
Q

how much fluid should be given in an oliguric patient

A

1L over 2-4 hours then reassess

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12
Q

how much fluid loss does oliguria indicate

A

500ml

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13
Q

how much fluid loss does oliguria plus tachycardia indicate

A

1L

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14
Q

how much fluid depletion does oliguria + tachycardia + hypotension indicate

A

2L

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15
Q

max infusion rate for potassium

A

10mmol/hour

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16
Q

CI for compression stockings

A

peripheral arterial disease

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17
Q

antiemetic for persistent nausea

A

cyclizine 50mg 8 hourly IM/IV/Oral

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18
Q

antiemetic for persistent nausea in heart failure

A

metoclopramide 10mg 8 hourly IM/IV

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19
Q

CI for metoclopramde

A

parkinsons

young women (risk of dyskinesea)

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20
Q

first line treatment neuropathic pain

A

amitriptyaline 10mg ON

Pregabalin 75mg oral 12 hourly

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21
Q

first line treatment painful diabetic neuropathy

A

duloxetine 60mg PO

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22
Q

main side effect calcium channel blockers

A

peripheral oedema

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23
Q

dosage of paracetamol in cocodamol

A

500mg in 1 tablet of 30/500

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24
Q

what route is most insulin given and whats the rule for when it isn’t

A

SC , if it is a rapid acting one (novorapid/actrapid) it may be given as an IV infusion

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25
Q

what is the rule around enoxaparin and strokes

A

prophylactic enoxaparin is contraindicated for 2 months post stroke

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26
Q

causes of microcytic anaemia

A

IDA

Thalassaemia

Sideroblastic anaemia

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27
Q

causes of normocytic anaemia

A

anaemia of chronic disease

acute blood loss

haemolytic anaemia

renal failure (chronic)

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28
Q

causes of macrocytic anaemia

A

B12/folate deficiency

excess alcohol

liver disease

hypothyroidism

myeloproliferative disorders

myelodysplasia

multiple myeloma

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29
Q

causes of euvolaemic hyponatraemia

A

SIADH
psychogenic polydipsia
hypothyroidism

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30
Q

causes of hypervolaemic hyponatremia

A 
heart failure
renal failure
liver failure
nutritional failure
thyroid failure
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31
Q

signs of pulmonary oedema on CXR

A

ABCDE

Alveolar Oedema (bat wings)

kerley B lines

Cardiomegaly

Diversion of blood to upper lobes

pleural Effusions

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32
Q

drugs with narrow therapeutic index

A

digoxin

lithium

theophylline

phenytoin

gentamicin/vancomycin

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33
Q

signs of digoxin toxcicity

A

confusion

nausea

bradycardia + dizziness

visual halos

arrythmias

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34
Q

signs of lithium toxcicity

A

early: tremor
intermediate: tiredness
late: arrythmias, seizures, coma, renal failure diabetes

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35
Q

signs of phenytoin toxcicity

A

gum hypertrophy, ataxia nystagmus, peripheral toxcicity and teratogenicity

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36
Q

signs of gentamicin/vancomycin toxcicity

A

ototoxicity and nephrotoxicity

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37
Q

gentamicin dosing guidelines

A

peak: 3-5 mg/L in endocarditis/renal failure , 5-10 everything else
trough: <1 endocarditis/renal failure, <2

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38
Q

management of warfarin overdose if INR is <6 (no bleed)

A

reduce warfarin dose

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39
Q

management of warfarin overdose if INR is 6-8 (no bleed)

A

omit warfarin for 2 days then reduce dose

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40
Q

management of warfarin overdose if INR is >8

A

omit warfarin and give 1-5mg oral vit K

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41
Q

management of warfarin overdose if INR >5 and minor bleeding

A

IV vit K + omit warfarin

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42
Q

management of warfarin overdose if there is a major bleed

A

stop warfarin
5-10mg IV vit K
prothrombin complex

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43
Q

what counts as a major bleed in warfarin overdose

A

hypotension

bleeding into a confined space

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44
Q

target INR for warfain

A

2-3, unless they have a mechanical valve/recurrent thromboembolism then its 3-4

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45
Q

causes for SIADH

A

SIADH

small cell lung tumours

Infection

Abscess

Drugs - carbamazepine and antipsychotics

Head injury

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46
Q

what antibiotic is contraindicated in early pregnancy

A

trimethoprim

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47
Q

what is a contraindication to the use of calcium channel blockers

A

peripheral oedema

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48
Q

what CCB is used in AF

A

diltiazem

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49
Q

Tx for PE

A

high flow oxygen

ECG if not done (looking for RH strain)

morphine 5-10mg IV

metoclopramide 10mg IV

LMWH/DOAC

low BP = thrombolysis

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50
Q

how many units of blood should you crossmatch in a GI bleed

A

6

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51
Q

tx for GI bleed

A

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

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52
Q

Tx bacterial meningitis

A

ABC

High flow o2

IV Fluids

Dexamethasone IV (unless severely immunocompromised)

LP +/- CT Head

2g CefotaximeIV STAT

consider ITU

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53
Q

Tx heart failure

A
  1. ACE-i + BB
  2. increase dose if inadequate
  3. mild-moderate disease = ARB
    moderate-severe disease (afrocaribbean patients) = hydralazine 25mg tds + isorbide mononitrate 20mg tds
    moderate-severe (non afrocaribbean) = spironlactone 25mg
54
Q

Tx angina

A
  1. GTN + secondary prevention (aspirin statin)
  2. BB or CCB
  3. increase dose as tolerated
  4. add other one of BB or CCB, or if CI add isorbide mononitrate or nicorandil
  5. if uncontrolled on 2 antianginal drugs = PCI or CABg
55
Q

COPD Tx

A
  1. SABA/SAMA as required
  2. FEV <50% = LABA or LAMA (discontinue SAMA)
    FEV >50% = LABA + ICS (if steroid responsive) or LAMA
  3. LABA –> LABA + ICS or LABA + LAMA
    LAMA —> LAMA + LABA + ICS
    LABA + ICS –> LAMA + LABA + ICS
    LAMA —> LAMA + LABA + ICS
56
Q

features of COPD for LTOT

A

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

57
Q

what hypnotic should be chosen if you have to prescribe one

A

zopiclone 7.5mg PO O.N (3.75mg in elderly)

58
Q

Tx crohn’s flare

A

IV hydrocortisone 100mg 6 hourly IV + IV fluids, NBM +/-antibiotics

59
Q

what is the first pain relief medication used for all acute coronary syndrome

A

GTN spray sublingual

60
Q

`what blood pressure medication should ACE-is or CCBs be changed to in pre-conception

A

labetalol

61
Q

when is a renal function test done post commencement of Ace-inhibitors (esp in renally impaired patients)

A

1-2 weeks post-initiation

62
Q

what does 1:1000 concentration refer to

A

1mg/ml

63
Q

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

A

pick the largest interval

64
Q

what time of the day should ace inhibitors be prescribed for + why

A

nightly - can cause postural hypotension

65
Q

what is the most important thing to check before commencing vancomycin

A

renal function

66
Q

what concentration of lithium is likely to manifest in toxic effects

A

1.5 mmol/L

67
Q

what monitoring is always indicated when prescribing olanzipine

A

fasting blood glucose

68
Q

what monitoring is essential in digoxin therapy

A

renal

69
Q

what kind of drug is amiloride

A

potassium sparing diuretic

70
Q

Indication for stopping diazepam

A

drowsiness

71
Q

CI for bendroflumethiazide

A

gout

72
Q

when stopping drugs to lower blood pressure what should be chosen first preferably

A

any diuretics over the cardioactive drugs like beta blockers

73
Q

.

A

.

74
Q

single best Tx for bowel obstruction

A

NG tube and IV infusion

75
Q

non pharmalogical option for pain relief (esp lower back pain)

A

TENS machine

76
Q

after salbutamol what is the next best thing to give in an exacerbation of COPD

A

ipratropium bromide

77
Q

max O2 % in COPD (CO2 retainers)

A

28% venturi

78
Q

what drugs are best for immediate relief of symptoms of dyspepsia/GORD

A

alginates/aluminium hydroxide

79
Q

what should every antibiotic prescription have

A

start date and review/stop date

80
Q

best laxative for post operative ileus + what dose

A

stimulant laxative like senna (15-30mg)

81
Q

how long does consolidation take to clear on an X ray

A

6 weeks

82
Q

best monitoring for resolution of a DKA

A

serum ketones

83
Q

optimal pre trough dose concentration for vancomycin

A

10-15mg/L

84
Q

what side effects does cyclizine have

A

anti-muscarinic ones - blurry vision, dry mouth etc

85
Q

what are appropriate treatments for mild hypoglycaemia

A

orange juice or biscuits

86
Q

where should cases of drug induced hypoglycaemia be treated

A

hospital

87
Q

what time of the day are thiazides contraindicated

A

evening - will cause excessive nocturesis

88
Q

indications for stopping codeine/co-codamol

A

constipation

drowsiness

respiratory sedation

89
Q

max dose of citalopram for younger and older people

A

20mg if >60

40mg otherwise - but start low

90
Q

what does a leucocytosis with a normal CRP usually indicate

A

non infectious causes - potentially chronic steroid use or bone marrow issues or hyposplenism

91
Q

what what should you do with someone taking phenytoin with signs of toxicity but normal serum levels

A

decrease dose

92
Q

rate control of AF in asthmatics

A

digoxin

93
Q

what should be checked 2 weeks after starting fluoxetine

A

development of a rash

94
Q

dosage for IV furosemide for acute relief of pulmonary Oedema

A

20-50mg

95
Q

what IV solution is the initial solution of choice for hypoglycaemia and what is an alternative

A

50-100ml 20% glucose , or glucose 100-200ml 10% if not available

96
Q

first line systemic therapy for acne not responding to topical therapy

A

oral tetracycline 500mg PO BD (1g total)

97
Q

what medications are likely to cause hyperkalaemia

A 
ACE-is 
ARBs
heparins 
tacrolimus 
K+ sparing diuretics 
NSAIDS
98
Q

what should be done to allopurinol in renal impairment

A

hold/reduce dose to 100mg

99
Q

can glucocorticoids cause confusion

A

yes

100
Q

can fentanyl be used for breakthrough pain

A

yes

101
Q

what should be done if someones INR is >1.5 on the day of surgery

A

give vit K 1-5mg PO (using IV preparations)

102
Q

most important advice for patients taking rivaroxaban

A

take with food

103
Q

whats the advice around contraception when taking topiramate (or any other enzyme inducer)

A

change to an alternate form if the patient is on the progesterone-only pill until at least 4 weeks after cessation of topiramate therapy

104
Q

what should you do if there is a small (<20%) rise in creatinine 1 week after taking an ace-inhibiter

A

nothing, up to 20% rise is acceptable and nothing needs changing

105
Q

what is the best indicator for effectiveness of furosemide administration?

A

weight loss

106
Q

when prescribing maintenance fluids , how should a glucose/dextrose + 20mmol KCL bag appear

A

Glucose/Dextrose 5%/0.3% potassium chloride over 9-12 hours

107
Q

what commonly cause vaginal candidiasis

A

antibiotics
SGTL-1is
systemic steroids (not inhaled)

108
Q

what should you do with regular prescription systemic steroids in acute illness

A

continue them - they may have adrenal suppression

109
Q

max dose of omeprazole for GORD

A

80mg

110
Q

when adjusting insulin regimes, whats the principle for increasing glycaemic control at certain times of the day

A

avoid adding in new insulin preparations and try increasing doses of existing ones first

111
Q

if an INR target is 3.5 what is the acceptable range

A

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)

112
Q

for someone on the COCP what is the rule about missing doses

A

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

113
Q

what are the rules around missed doses for progesterone only pills

A

if the dose is missed >3 hours outside the usual time another should be taken immediately and condoms should be used for 2 days

114
Q

do males need contraception when taking methotrexate

A

yes

115
Q

what is a common side effect of mirtazipine

A

abnormal dreams

116
Q

what kind of medication is indapamide

A

thiazide-like diuretic

117
Q

what is more likely to interact with statins - ezemitibe or gemfibrozil

A

gemfibrozil

118
Q

when treating hypothyroidism what is the best measure for adherence to medication

A

TSH

119
Q

when treating hypothyroidism, if TSH is raised and adherence is in question do you need to increase the dose

A

no just encourage adherence

120
Q

BP threshold for shock

A

<90 syst or <60 diast

121
Q

common medical causes of ankle oedema

A

naproxen

amlodipine

122
Q

first-line treatment for more than 1 episode of c.difficile

A

oral vancomycin

123
Q

first line treatment for first presentation of c diff

A

metronidazole

124
Q

what should be done when someone requiring opiate s has renal impairment causing toxicity

A

switch to oral oxycodone (or fentanyl if appropriate concentration)

125
Q

what should you do if there is thyrotoxicosis with amiodarone

A

hold it

126
Q

new guidelines for DVT Tx

A

DOAC (apixaban or rivaroxiban)

127
Q

What fluids are contraindicated in acute brian injuries (such as acute ischaemic strokes)

A

glucose as it is hypotonic and may exacerbate cerebral oedema

128
Q

what should you do if the gentamicin dose levels are too high

A

trough dose too high: increase treatment interval (TDS to BD)

Peak Dose too high : decrease dose

129
Q

what antibiotics should be avoided in patients with epilepsy

A

Ciprofloxacin

Levofloxacin

130
Q

what antibiotics are ok for breastfeeding women

A

penicillins, cephalosporins, trimethoprim

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