PSA Flashcards
Prescribe the most appropriate drug to rapidly relieve bronchospasm (COPD/asthma).
Salbutamol 1 mg/mL OR 2.5 mg/mL nebuliser liquid
Dose = 2.5-5 mg
Route = nebulised/inhaled
Frequency = PRN, up to 4 times daily
Treatment of confirmed DVT/PE
Factor Xa inhibitors:
Apixaban 10 mg PO BD
Rivaroxaban 15 mg PO BD
When is LMWH contra-indicated?
- Current or history of heparin-induced thrombocytopaenia
- Conditions that put the patient at high risk of bleeding complications (acute GI bleed, cerebral haemorrhage, serious coagulation disorders, recent stroke)
What is the treatment dose of LMWH for DVT/PE?
1.5 mg/kg every 24 hours until oral anticoagulation established
INITIAL TREATMENT of dehydration (no cardiac failure)
Sodium chloride 0.9% + Potassium chloride 0.3%/0.15
500 mL over 4-6 hours or 1 L over 8-12 hours
How quickly should potassium be replaced on the ward?
Max 10 mmol/hour
Primary prevention of cardiovascular disease
QRisk score >10% = atorvastatin 20 mg OD at night
QRisk score <10% = simvastatin 20 mg OD at night
What is the QRisk3 score?
Calculates a person’s risk of developing a heart attack or stroke over the next 10 years
What are the important dose-related adverse effects of statins?
Myalgia (rarely risk of myopathy, myositis, and rhabdomyolysis) Disturbed liver function GI disturbance Sleep disturbance Headache
How do NSAIDs work?
Inhibit COX2 enzyme and production of prostaglandins which protect the gastric mucosa against acid-related erosion and ulceration.
How does ibuprofen effect the kdneys?
Ibuprofen inhibits prostaglandin synthesis in the kidney so reduces cortical blood flow and renal function.
What is the significance of renal function and ramipril?
Ramipril is an ACE inhibitor which blocks intrarenal production of angiotensin 2. Angiotensin 2 is important for protecting GFR when renal blood flow is reduced.
Why are U&Es checked 1-2 weeks after starting ramipril?
If the patient has undiagnosed renal artery stenosis, then the kidney function will be significantly impaired.
Which two drugs (anti-hypertensive and NSAID) and taken together are bad for kidneys?
Ramipril and ibuprofen
What kind of drug is bendroflumethiazide and where does it work?
Thiazide diuretic - acts on the sodium/chloride-co-transporter in the distal convoluted tubule.
Causes excess sodium and water loss.
What kind of drug is spironolactone and where does it work?
Potassium-sparing diuretic - aldosterone agonist which inhibits aldosterone-dependent sodium-potassium-exchange channels in the DCT.
What is atenolol, what is it used for and how would it be prescribed?
Cardio-selective beta-blocker
Used to treat hypertension, angina, and arrhythmias
Normal range of dose = 25-50 mg for hypertension and 100 mg for angina
Absolute contra-indications for beta-blockers
History of asthma/bronchospasm Severe: Heart failure Bradycardia Heart failure Hypotension Peripheral arterial disease
What common drugs should be held in renal impairment?
Ramipril - reduced effectiveness of renin-angiotensin system means renal blood flow will not be correctly maintained and potassium is not excreted enough
Metformin - contraindicated in significant renal impairment and acutely unwell patients
What kind of drug is pioglitazone and what is one adverse effect?
Thiazolidinedione
Higher risk of hypoglycaemia episodes
What drugs can cause urinary retention?
Morphine + other opioid analgesics Anticholinergics (antipsychotics, detrusor relaxants, antidepressants) General anaesthetics Benzodiazepines NSAIDs CCBs Alcohol
What drugs can cause disorientation/confusion?
Metoclopramide Morphine Antipsychotics Antidepressants Anticonvulsants
Treatment of Wernicke’s encephalopathy?
Vitamin B substances with ascorbic acid (Pabrinex IV high potency)
IV infusion over 30 minutes 8-hourly
Management of DKA
Soluble short-acting insulin:
50 units in 50 mL 0.9% sodium chloride by IV infusion at a rate of 0.1 units/kg/hour