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Chloe's PSA revision > PSA > Flashcards

PSA Flashcards

1
Q

How do you treat a hypo if the patient has an unsafe swallow

A

75ml 20% glucose over 15 minutes

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2
Q

How do you treat a hypo in an alcoholic

A

As normal but they also need thiamine

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3
Q

Which groups of patients is IM glucagon not effective in for treating a hypo

A

prolonged fasting
Alcohol induced hypo
Adrenal insufficiency
Sulphonylurea induced hypo

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4
Q

How do you manage HHS

A

1L 0.9% saline over 1 hour

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5
Q

How do you manage DKA

A

0.1unit/kg/hour insulin (50 units actrapid in 50ml saline)
500ml fluid bolus if BP<90 (maintenance fluids if not)
10% glucose once glucose <14

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6
Q

What two drug used in the treatment of hyperkalaemia need to be given via different access points

A

calcium and sodium bicarb form an insoluble precipitate if given through the same port

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7
Q

Allergic ADR to ACE-i

A

angioedema - this can occur months down the line

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8
Q

what other abx should be prescibed with caution in penicillin allergic patients

A

cephalopsorines - cefalexin, cefuroxime, ceftriaxone

carbopenems - meropenem

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9
Q

can fentanyl be prescribed to a morphine allergic patient?

A

yes and vice versa

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10
Q

what drugs are prescribed in micrograms

A

levothyroxine

digoxin

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11
Q

ADR of acetylcystine and what to do about it

A

bronchospasm and rash
give chlorphenamine and salbutamol
restart acetylcystine at a slower rate

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12
Q

ECG changes in TCA OD

A

long QT

wide QRS

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13
Q

Presentation of a TCA OD

A

hot, red, dry, blind, mad
hypokalaemia
respiratory depression

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14
Q

estimate of a child’s weight

A

(age +4) x2

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15
Q

do you dose gentamicin according to the patients actual or ideal body weight

A

ideal if they are obese

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16
Q

how do you treat AKI + sepsis + metabolic acidosis

A

sodium bicarbonate 1.26%

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17
Q

how does dabigatran effect PT/INR, APTT and thrombin time

A

prolonged APTT and thrombin time

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18
Q

how does rivaroxaban effect PT/INR, APTT and thrombin time

A

prolonged PT/INR

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19
Q

how does apixaban effect PT/INR, APTT and thrombin time

A

It doesn’t. Measure anti-Xa assay

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20
Q

How would you start someone on a DOAC

A

riv/apix don’t require LMWH

dab/edox require 5 days LMWH then stop LMWH and start doac i.e. NO bridging.

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21
Q

What common medications are cautioned in DOAC patients

A

CI: aspirin and clopidogrel (unless ACS)
caution: SSRIs

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22
Q

How do you manage a bleeding patient on a DOAC

A

TXA, FFP

dabigatran has a reversal agent

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23
Q

when can you restart a DOAC following surgery

A

12-48 hours depending on operation

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24
Q

How does LMWH effect coagulation tests

A

it doesn’t. Measure anti-xa assay

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25
Q

What common medications are cautioned in LMWH patients

A

NSAIDs

ACE-i and diuretics as risk of hyperkalaemia

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26
Q

How is unfractionated heparin monitored

A

APTT

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27
Q

how do you reverse unfractionated heparin

A

protamine

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28
Q

what analgesia should you avoid in pregnancy

A

NSAIDs and opioids

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29
Q

How long and what dose of folic acid is required in patients on antiepileptics

A

12 weeks of 5mg

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30
Q

emergency contraception in a patient on antiepileptic

A

copper IUD

double dose of levonorgestrel

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31
Q

Diabetes management in pregnancy

A

metformin is the only oral agent allowed

switch to insulin

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32
Q

Cardiovascular management in pregnancy

A

STOP: ACE-i, ARB, statins
START: labetalol, nifedipine, methyldopa

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33
Q

thyroid management in pregnancy

A

requirements are increased

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34
Q

drugs that lower the seizure threshold/provoke seizures

A

NSAIDS and tramadol
SSRIs, haloperidol, clozapine, benzos
ciprofloxacin
cyclizine

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35
Q

what contraception is acceptable in a patient on antiepileptics

A

IUD, IUS, depot

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36
Q

how would you start someone on morphine

A

IR morphine sulphate PRN up to 4 hourly. Once stable switch to MR preparation BD.
generally 10mg BD and 5mg PRN

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37
Q

If someones pain isn’t controlled how much would you increase their morphine by

A

30%

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38
Q

Name some indications and contraindications for specific oral diabetes medications

A

pioglitazone contraindicated in HF and hepatic impairment

CKD patient: generally gliclazide first instead of metformin

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39
Q

generally how much insulin would you start someone on

A
  1. 5 units/kg for adults

0. 3 units/kg for elderly

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40
Q

ADR of dapaglifozine (SGL2 inhibitor)

A

DKA

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41
Q

how would you set up a VRII

A

49.5ml saline + 0.5ml 50 units insulin into a syringe to get 1 unit/ml

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42
Q

What fluids are given alongside a VRII

A

0.45% NaCl, 5% dextrose, 0.15% K (20mmol)

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43
Q

How do you convert from VRII back to normal regime

A

insulin/oral agent given
meal
wait 30 minutes
remove VRII

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44
Q

How do you alter long acting insulin regimes before surgery

A

drop to 80% of the normal the day before and day of

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45
Q

How do you alter steroid regimes prior to surgery

A

give 25mg IV hydrocortisone at induction

give 100mg IV hydrocortisone over following 24 hours

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46
Q

what shouldn’t be co-prescribed with verapamil

A

b-blockers (including ocular preparations such as timilol)

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47
Q

2 ototoxic drugs that shouldn’t be co-prescribed

A

aminoglycosides and loop diuretics

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48
Q

which drug can cause lithium toxicity

A

ACE-i (reduce GFR so reduced excretion)

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49
Q

Which drugs can cause digoxin toxicity

A

verapamil
statins
amiodarone
liquorice (due to causing hypokalaemia)

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50
Q

ADR/interactions with St John Wart

A

reduced effect of warfarin and COCP
SSRIs = serotonin syndrome
MAOIs = hypertensive crisis

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51
Q

drugs/classes you should use with caution in liver impairment and why

A

risk of encephalopathy: constipating (opioids), electrolyte disturbance (diuretics), agitation and sedation (benzos/antipsychotics)

clotting abnormalities: anticoag/antiplatelets, thrombocytopenia (valproate)

Varices/haemorrhage: NSAIDs

Ascites: fluids retention (NSAIDs, steroids), fluids

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52
Q

contraception in over 40’s

A

POP
implant
IUS

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53
Q

contraception alongside HRT

A

IUS can protect endometrium if oestrogen only regime

POP in combined HRT

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54
Q

postpartum contraception

A

nothing for 21 days
COCP not <6 weeks and breastfeeding
IUS and IUD either <48 hours or >4 weeks
POP anytime

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55
Q

Things to remember about POP

A

irregular bleeding

effected by enzyme inducing drugs

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56
Q

Things to remember about implant

A

Any BMI (if obese replace early in 3rd year)
irregular bleeding
effected by enzyme inducing drugs

57
Q

Things to remember about depot injection

A

takes a year for fertility to return

CI in adolescents as risk of osteoporosis

58
Q

Things to remember about IUS

A

good for heavy bleeding

59
Q

Things to remember about IUD

A

effective immediately

60
Q

postpartum emergency contraception

A

day 21-28: EllaOne

>28 days: EllaOne or IUD

61
Q

ACE-i are cautioned in who

A

PVD
atherosclerosis
asthmatics (not on BNF)
warn diabetics about risk of hypo’s

62
Q

who needs a statin for primary prevention

A

10 year risk >10%

T2DM for >10 years OR >40 OR nephropathy

63
Q

statins are contraindicated in who and interact with what?

A

pregnancy and intracerebral haemorrhage

erythromycin and clarithromycin - STOP the statin whilst on abx

64
Q

ADR of loop and thiazide

A 
loop = gout and alkalosis
thiazide = gynaecomastia and impotence
65
Q

what electrolyte abnormalities can cause digoxin toxicity

A 
hypokalaemia
hypomagnesaemia 
hypernatremia
hypercalcaemia 
acidosis
66
Q

maximum paracetamol dose

A

1g 6 hourly

67
Q

what electrolyte abnormality can bisphosphonates lead to

A

hypocalcaemia

68
Q

when can bisphosphonates be stopped

A

after 5 years if…
age <75
T score >-2.5
low FRAX risk

69
Q

drugs causing hyponatraemia

A 
SSRI
TCA
carbamezapine
sulphonylureas 
vincristine 
cyclophosphamide
70
Q

pre-surgery when do you stop ACE-I and K sparing diuretics

A

day of

71
Q

where in the BNF do you find where to convert different steroid therapies

A

“glucocorticoid therapy”

72
Q

common drugs CI with methotrexate

A

trimethoprim
co-trimoxazole
aspirin

73
Q

management of methotrexate toxicity

A

folinic acid

74
Q

how do you prescribe blood

A

1 unit at a time on 1 line
“packed red cells”
1 unit over 2 hours

75
Q

ADR of citalopram

A

prolonged QT

SIADH

76
Q

indication for fluoxetine or sertraline over citalopram

A

fluoxetine - teenagers

sertraline- post MI

77
Q

a patient is on warfarin and needs an anti-depressant, what do you prescribe

A

NOT SSRI

Give mirtazapine

78
Q

a patient is on an SSRI and needs ibuprofen for joint pain, what do you need to remember

A

PPI as increased bleeding risk

79
Q

how do you go about stopping an SSRI

A

6 months of symptoms resolution then reduce dose over 4 weeks

80
Q

Causes of lithium toxicity

A

hyponatremia
renal failure, dehydration, ACE-I/ARB, thiazides
NSAIDs
metronidazole

81
Q

how do you manage lithium toxicity

A

rehydrate

dialysis

82
Q

important bits about clozapine

A 
needs dose adjustment according to smoking status
agranulocytosis
lowers seizure threshold 
constipation
myocarditis
83
Q

how to find antipsychotics in the BNF

A

“psychoses”

84
Q

ADR of antipsychotics

A 
extrapyramidal: tardive dyskinesia, dystonia, akathisia, parkinsonism
impaired glucose tolerance 
prolonged QT
stroke and VTE risk in elderly 
NMS
reduced seizure threshold
sedation and weight gain
antimuscarinic - pee, see, spit, shit
postural hypo
impotence
85
Q

how do you treat neuroleptic malignant syndrome

A

dantrolene

bromocriptine

86
Q

which patients would you not use pioglitazone in

A

HF

87
Q

which patients would you use a sulphonylurea first over metformin

A

normal/low weight

raised creatinine

88
Q

what regime is used for DKA

A

Fixed rate of 0.1 unit/kg/hr
You use a 50 unit/50ml syringe typically
therefore rate is 0.1ml/kg/hr

89
Q

complications of DKA management

A

hypokalaemia

cerebral oedema - monitor GCS

90
Q

metformin is CI when creatinine reaches. Why

A

150

risk of lactic acidosis

91
Q

what blood result would indicate diabetic nephropathy and therefore what needs monitoring

A

microalbuminaemia

albumin-creatinine ratio

92
Q

how do you step down benzo’s and where in the BNF do you find this info

A

change to equivalent dose of diazepam then reduce this to zero
“anxiolytics and hypnotics”

93
Q

Outline how you go from morphine to fentanyl

A

you can add equivalent patches together. So for 90mg morphine
30mg = 12 patch
60mg = 25 patch
therefore give 37 patch

94
Q

Which hospital patients would you not give dalteparin to?

A

Ischaemic stroke patients - they can bleed into the stroke

95
Q

when would you give FFP

A

if PT/APTT >1.5x normal

96
Q

when would you give platelets

A

count <50

97
Q

what contraception should a patient on enzyme inducing drugs avoid

A

Progesterone

98
Q

what oestrogen is used for COCP and HRT

A 
COCP = ethinylestradiol
HRT = estradiol
99
Q

in the BNF how would you look up information on the ring or patch contraception

A 
ring = nuvaring
patch = Evra
100
Q

how do you avoid getting a bleed whilst on COCP

A

use a continuous regime i.e. taking packets back to back

101
Q

describe cyclical and continuous HRT

A

cyclical: progesterone taken for last 14 days of each cycle
continuous: progesterone taken constantly

102
Q

in which women is a continuous HRT regime not suitable

A

if <12 months since last bleed as causes irregular bleeding

103
Q

How is the VTE risk of HRT minimsed

A

patch instead of oral

104
Q

Risks associated with HRT

A 
breast cancer
endometrial cancer
ovarian cancer
Stroke and VTE
IHD
105
Q

progesterone HRT increases the risk of which HRT risks

A 
breast cancer (especially if continuous regime) 
VTE
106
Q

When do you stop HRT before surgery

A

4-6 weeks

107
Q

How would you look up endometriosis and dysmenorrhoea treatment in the BNF

A

“sex hormones”

108
Q

how do you manage vasomotor symptoms of menopause

A

fluoxetine or citalopram

109
Q

how do you manage vaginal dryness in menopause

A

estriol - vaginal lubricant

110
Q

What drugs should you be wary of in myasthenia?

A

Loads so check the BNF if they have a history of MG. Particularly careful with aminoglycoside abx, other abx, b-blockers, neuro/psych drugs

111
Q

what drugs should you be wary of in epilepsy?

A 
ciprofloxacin 
amino/theophylline 
mefenamic acid
methylphenidate 
amphetamines
112
Q

What drugs should you be wary of in HF

A

pioglitazone
NSAIDs and steroids
flecainide
verapamil

113
Q

what should you do if a HYPOthyroid patient presents with…
TSH<0.5
TSH>5

A

<0.5: reduce dose of levothyroxine as you’ve overtreated

>5: increase dose

114
Q

management of hyperkalaemia

A

10 units of actrapid in 100ml of 20% dex over 30 minutes

115
Q

causes of hyponatraemia

A

diuretics
carbamezapine
citalopram

116
Q

causes of neutropenia

A

clozapine

carbimazole

117
Q

causes of thrombocytopenia

A

heparin

penicillamine

118
Q

starting dose of statins for primary prevention

A

20mg (BNF says 20mg so remember this one!)

119
Q

how can aspirin affect the blood

A

iron deficiency anaemia

120
Q

drugs that cause urinary retention

A

NSAIDs and opioids
Benzodiazepines
anticholinergics and antihistamines
CCBs

121
Q

drugs that cause confusion

A 
opioids
metoclopramide
antidepressants and psychotics
anticonvulsants
anticholinergics
(steroids, NSAIDs, B-blockers, digoxin)
122
Q

what drugs can worsen statin induced myalgia

A

enzyme inhibitors

123
Q

drugs that cause anaphylaxis

A

NSAIDs
Abx
IV iron infusion
morphine

124
Q

what is an indication for stopping HRT

A

BP rise >160/95

125
Q

What Hb level would indicate a need for transfusion

A

> 70

or <80 in ACS

126
Q

maximum K infusion rate

A

10mmol/hr

127
Q

in hyperkalaemia if there are still ECG changes after a first dose of calcium chloride what can you do

A

repeat every 15 minutes up to 50ml i.e. 5x

128
Q

presentation of lithium toxicity

A

muscle weakness

polyuria and polydypsia

129
Q

when would you consider stepping down asthma treatment

A

symptoms controlled for 3 months

130
Q

what are the BP targets in HTN

A

<140/90

unless age >80 then it’s <150/90

131
Q

what anti–hypertensives do diabetics start on

A

ACE-i regardless of age or ethnicity

132
Q

first line POP

A

desogestrel (long pill free period in case of missed pill)

133
Q

what fluids should you prescribe to a stroke patient

A

not glucose (risk of cerebral oedema)

134
Q

where would you find info on sepsis in children

A

“blood infection”

135
Q

what drugs should be stopped in PVD

A

CI: b-blockers
caution: ACE-I

136
Q

blood glucose levels diagnostic of diabetes

A

fasting >7
random >11
HbA1C >48 (6.5%)

137
Q

post-op fluids

A

often omit K unless it is low (K released from cell lysis in surgery so likely to be raised)

138
Q

what may be causing low BP and urine output in a HF patient

A

dehydration

overload + LVF

139
Q

which fluids should you use in liver failure

A

5% dextrose

saline worsens ascites

Chloe's PSA revision (1 decks)

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