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Year 6 - PSA > PSA: Capsule > Flashcards

PSA: Capsule Flashcards

1
Q

What are the proven benefits of HRT?

A

Control of menopausal sx & protection from osteoporosis

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2
Q

What are the proven risks of HRT?

A

Inc incidence of endometrial ca, breast ca & VTE

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3
Q

List CIs to HRT

A

Undx vaginal bleeding, severe liver disease, pregnancy, venous thrombosis pmhx, breast ca pmhx & incomplete tx of endometrial ca

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4
Q

Which red flag sx require urgent cessation of the OCP?

A

Elevated BP, new onset headache/neuro sex, acute chest pain/SOB

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5
Q

Which agents inc OCP metabolism?

A

Rifampicin, carbamazepine, phenytoin

Therefore inc risk of pregnancy

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6
Q

Which agents do oestrogens antagonise?

A

Warfarin & steroids

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7
Q

Which two routes can oxytocin be administered?

A

IV & IM

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8
Q

The SEs of oxytocin

A

Uterine hyperstimulation & water intoxication and hyponatraemia as it has a similar structure to vasopressin

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9
Q

Which drug can correct uterine hyperstimulation secondary to oxytocin?

A

Terbutaline

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10
Q

MOA of mifepristone

A

Antiprogestogen & sensitises the myometrium to prostaglandin induced contractions

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11
Q

MOA of misoprostol

A

Prostaglandin used in medical mx of miscarriage & after 48h from mifepristone in TOP

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12
Q

What is the most common chronic condition in pregnancy?

A

Asthma, can be made worse by acid reflux, pts should use both reliever and preventer

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13
Q

How is pulmonary function altered during N pregnancy?

A

A widened subcostal angle inc transverse diameter of the chest to oppose the effect of inc abdo volume & progesterone has a bronchodilator effect so forced spirometry generally remains unchanged

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14
Q

Risks of asthma during pregnancy

A

PET, IUGR, PTB

Therefore continuous fetal monitoring is recommended

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15
Q

Why are asthmatics at an inc risk of IUGR babies?

A

If uncontrolled the FEV1 is red

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16
Q

When are antenatal steroids given?

A

A single course b/w 24 and 34 weeks of gestation who are at risk of preterm birth within 7 days to red morbidity and mortality of hyaline membrane disease

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17
Q

What are the benefits of breastfeeding?

A

Transfer of IgA abs, red risk of infant D&V, if <6m LAM contraception

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18
Q

Anti-HTN

A

Labetalol (asthma), nifedipine (rebound headaches), methyldopa (post natal depression), IV hydralazine

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19
Q

Safest anti-epileptic to use in pregnancy

A

Lamotrigine

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20
Q

How does acute dystonia usually px

A

Oculogyric crisis & torticollis

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21
Q

How does tardive dyskinesia usually px

A

Orofacial dyskinesias such as lip smacking

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22
Q

Tx for acute dystonia

A

Procyclidine

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23
Q

Tx for tardive dyskinesia

A

Tetrabenazine

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24
Q

How long do you need to wait for local prostate damage following catheterisation to pass before measuring the PSA?

A

2w

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25
Q

List two mood stabilising meds

A

Lithium & Sodium Valproate (only used in women of child-bearing age if on contraception)

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26
Q

Tx of paracetamol OD

A

N-acetylcysteine

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27
Q

Tx of opiate OD

A

Naloxone

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28
Q

Tx of benzo & zopiclone ODs

A

Flumazenil

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29
Q

Lithium toxicity >1.2, fatal >1.5, urgent tx >2.0

A

Early - N&V and tremor

Intermediate - tiredness

Late - irreversible nephrogenic DI, hypothyroidism, arrhythmias, seizures, delirium, coma, death

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30
Q

Meds a/w depression

A

Oral contraceptives, antihypertensives, statins, ranitidine & corticosteroids

Therefore important to ask about recent drug hx when diagnosing depression

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31
Q

How long is needed at an effective dose before deciding pt has failed to respond to antidepressant?

A

4w

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32
Q

After remission how long should antidepressants be continued for?

A

First ep 6m & second ep 2y

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33
Q

Duloxetine MOA

A

SNRI

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34
Q

Venlafaxine MOA

A

SNRI

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35
Q

Mirtazapine MOA

A

NaSSA

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36
Q

Reboxetine MOA

A

NARI

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37
Q

Uses of amitriptyline

A

Neuropathic pain e.g. herpetic neuralgia and phantom limb pain & migraine prophylaxis

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38
Q

Common SEs of amitriptyline

A 
Dry mouth
Sedation
Blurred vision
Constipation
Postural hypotension
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39
Q

Rare SEs of amitriptyline

A 
Urinary retention
Hyponatremia
Convulsions
Weight gain
Precipitation of glaucoma
Hepatic impairment
Cardiac dysrhythmias
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40
Q

CIs to prescribing amitriptyline

A

Known allergy, cardiac arrhythmias, complete heart block, immediately post MI, severe liver disease & acute porphyria

Think heart & liver

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41
Q

Which drug class should never be co-prescribed w TCAs?

A

MAOIs as the risk of serotonin syndrome is too high

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42
Q

What inc risk of ventricular arrhythmias w TCAs?

A

Beta-blockers & GA

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43
Q

Benzo withdrawal @ anytime up to 3w

A

Complaints: insomnia, anxiety, loss of appetite, wt loss, tremor, perspiration, tinnitus & perceptual disturbances

Physical signs: hyperthermia, HR >100bpm, RR >20bpm, variable BP, dilated pupils, palpitations, tremors, spasms, ataxia +/- dyskinesia & inc deep tendon reflexes

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44
Q

Normal therapeutic range for lithium

A

0.4-0.8mmol/L @12hrs post dose

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45
Q

Sodium valproate SEs

A

N&D&V, wt gain, hair loss w curly re-growth, tremor, ataxia

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46
Q

Sodium valproate OD

A

Hypotonia, hyporeflexia, met acidosis, impaired resp function, constricted pupils, CNS depression & coma

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47
Q

Outline the monitoring of lithium

A

If indicated ht, wt, FBC, ECG at initiation then once stable therapeutic levels every 3m & U&Es/TFTs every 6m

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48
Q

Carbamazepine SEs

A

Constipation & aplastic anaemia

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49
Q

Phenelzine MOA

A

Non-Selective Irreversible MAOI

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50
Q

Which foods can cause a hypertensive crisis w MAOIs?

A

Cheese & marmite

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51
Q

Sx of SSRI discontinuation syndrome following sudden cessation

A

Flu-like sx, dizziness, insomnia, N&V, sweating, agitation, electric shock sensations, tinnitus, headaches & irritability

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52
Q

SSRI SEs

A

N&V, diarrhoea, constipation, dyspepsia, hyponatraemia, insomnia & suicidal behaviour

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53
Q

Citalopram MOA

A

SSRI

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54
Q

Lofepramine MOA

A

Tricyclic Antidepressant

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55
Q

Trazadone MOA

A

Tricyclic Related Antidepressant

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56
Q

Moclobemide MOA

A

Selective Reversible MAOI

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57
Q

Outline a typical course of ECT

A

Twice a week for 3-6w

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58
Q

ECT SEs

A

Headache, memory problems, muscle aches

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59
Q

Meds that reduce renal excretion of lithium

A

ACEi, NSAIDS, diuretics particularly thiazides

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60
Q

What should be checked before starting atypical antipsychotic drugs?

A

Fasting blood glucose

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61
Q

Dose of sertraline

A

50mg OD then slowly inc up to 200mg OD

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62
Q

Sertraline MOA

A

SSRI

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63
Q

List three asthma tx that cause hypoK

A

Salbutamol, theophylline, prednisolone

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64
Q

Which electrolyte imbalance does SIADH cause?

A

HypoNa

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65
Q

Which asthma tx can potentially sig interact?

A

Salbutamol w theophylline, salbutamol w prednisolone, theophylline w prednisolone

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66
Q

List drugs where an inc dose of theophylline may be required

A

Carbamazepine, rifampicin, cigarettes

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67
Q

List drugs where an decr dose of theophylline may be required

A

Allopurinol, cimetidine, ciprofloxacin, erythromycin, propranolol, COCP

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68
Q

Ipratropium bromide SEs

A

Dry mouth, urinary retention, constipation, acute glaucoma

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69
Q

Salbutamol MOA

A

Selective short-acting beta-2 agonist

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70
Q

What can IV MgSO4 tx?

A

PET, acute severe asthma, severe diarrhoea w hypokalaemia & torsades de pointes ventricular tachycardia

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71
Q

Steroids + Cardiac Glycosides/Amphotericin

A

HypoK

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72
Q

Steroids + Phenytoin/Carbamazepine

A

Requires inc steroid dose

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73
Q

Which drugs do steroids antagonise?

A

ACEi, CCBs, nitrates, methyldopa

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74
Q

Asthma mod exacerbation BTS

A

PEF 50-75% best or predicted, inc sx, no features of severe asthma

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75
Q

Asthma severe exacerbation BTS

A

PEF 33-50% best or predicted, RR >25, HR >110, inability to complete sentences in one breath

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76
Q

Asthma life-threatening exacerbation BTS

A

PEF <33% best or predicted, SO2 <92% on air, paO2 <8kPa, silent chest, cyanosis, feeble respiratory effort, bradycardia, arrhythmia, hypotension, exhaustion, confusion, coma

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77
Q

Asthma near fatal BTS

A

Raised pCO2 >6.0kPa +/or requiring mechanical ventilation w raised inflation pressures

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78
Q

Tx of chronic asthma BTS

A

Step 1: inhaled SABA as required

Step 2: add ICS 200-800 micrograms per day

Step 3: add LABA, if no response stop and inc ICS dose, if benefit but not enough continue and inc ICS dose

Step 4: consider trial of other therapy - leukotrine receptor antagonists, theophylline, long-acting muscarinic receptor antagonists

Step 5: refer patient to specialist care - is always indicated if there has been a recent >/= severe exacerbation

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79
Q

Define sufficient control of asthma

A

Normal lung function (FEV1 +/or PEF >80% best or predicted) w minimal SEs and no daytime sx, night time awakening, rescue medication, exacerbations, daytime limitations inc exercise

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80
Q

What should you do before drug escalation in chronic asthma tx?

A

Check inhaler technique and concordance w tx regime

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81
Q

First line tx for allergic rhinitis

A

Daily oral antihistamines & nasal steroid spray

82
Q

H1 and H2 Antags

A

H1 - second gen antihistamines

H2 - suppress gastric acid production

83
Q

First and second gen antihistamines

A

First - chlorphenamine - 4-6h duration

Second - loratadine - 24h duration

84
Q

First gen antihistamines MOA

A

Anti-muscarinic action

85
Q

First gen antihistamines SEs

A

Blurred vision, dry mouth, constipation, urinary retention (particularly in elderly), sedation (can cross BBB)

86
Q

List three ICS other than beclomethasone

A

Fluticasone, budesonide, mometasone

87
Q

Advice for asthma control during pregnancy

A

Continue w current tx doses of SABA and ICS and emphasise importance of good control

88
Q

How does theophylline toxicity manifest?

A

Serious arrhythmias & convulsions

89
Q

What does tazocin contain?

A

Piperacillin and tazobactam

90
Q

What does timentin contain?

A

Ticaricillin and clavulanic acid

91
Q

What is aminophylline made up of?

A

Stable mixture of theophylline and ethylenediamine

92
Q

When do you check serum theophylline levels?

A

18hrs after commencing tx w a target of 10-20mg/L

93
Q

List some common drugs w narrow therapeutic indexes

A

Warfarin
Digoxin
Phenytoin
Theophylline

94
Q

What do you monitor when giving IV aminophylline?

A

Oxygen sats (measure of therapeutic effect)

ECG (as it can precipitate cardiac arrhythmias)

95
Q

Steroid in AECOPD

A

Prednisolone 30mg OD for 5d

96
Q

Which infections does ciprofloxacin tx?

A

Salmonella, shigella, campylobacter

97
Q

List indications for metronidazole tx

A

Anaerobic bacteria and giardia infections, part of H. pylori eradication therapy, rosacea, pseudomembranous colitis

98
Q

When should quinolones be used w caution?

A

Children, pts over 60yo, in pregnancy, pts w epilepsy

99
Q

What are quinolones a/w?

A

Tendon damage (esp in elderly, renal impairment, taking steroids) & aortic aneurysm/dissection

100
Q

Loperamide CIs

A

High temp, bloody diarrhoea, abx associated colitis

101
Q

What are the three main classes of parasites?

A

Protozoa, helminths, ectoparasites

102
Q

Which class does ciprofloxicin belong to?

A

Quinolones

103
Q

Which class does metronidazole belong to?

A

Nitroimidazoles

104
Q

Which abx should you NOT drink alcohol whilst taking?

A

Metronidazole, tinidazole, sulfamethoxazole, trimethoprim

105
Q

What happens if you drink alcohol whist taking metronidazole (or up to 3d after stopping)?

A

A disulfiram-like effect inc flushing, abdo pain and hypotension

106
Q

Which conditions are grouped under dyspepsia?

A

Functional dyspepsia, drug-induced dyspepsia, PUD and GORD

107
Q

What does a dx of functional dyspepsia require?

A

Sx w no abnormal structural/pathological findings

108
Q

What sx would be alarming of underlying pathology?

A

Dysphagia, persistent vomiting, upper abdo mass, evidence of GI blood loss, unexplained wt loss

109
Q

Which meds commonly cause upper GI sx?

A

Amlodipine, atorvastatin, oral corticosteroids

110
Q

Tx of dyspepsia

A

Avoid drugs potentially causing sx, advise wt loss, avoidance of common precipitants and to raise head of the bed, antacid therapy as required, empirical PPI for 1m

If sx return after stopping PPI test for H. pylori, if pos tx, if neg offer low dose PPI and discuss using PPI on an as required basis

If there’s ever a concerning feature refer for 2w wait endoscopy

111
Q

Antiemetics MOAs

A

Cyclizine - H1 antag first gen antihistamine

Prochlorperazine - DA antag in CTZ

Metoclopramide - DA2 antag in GI tract

Ondasetron - 5HT3 antag interacts w SSRIs and MAOIs

112
Q

When is metoclopramide particularly useful?

A

N&V a/w gastroduodenal, hepatic and biliary disease

113
Q

When must metoclopramide NOT be used?

A

Parkinsons pts & GI obstruction, perforation or haemorrhage as it inc gut motility

114
Q

Metoclopramide SEs

A

Acute dystonic reactions esp in young women & QTc prolongation

115
Q

Prochloperazine SEs

A

Tardive dyskinesia and akathisia

116
Q

When is ondansetron particularly useful?

A

N&V post-op and that secondary to cytotoxic therapy

117
Q

Ondansetron SEs

A

Constipation, headaches, flushing, bradycardia and chest pain

118
Q

When is cyclizine particularly useful?

A

N&V as a result of underlying conditions

119
Q

Tx of morning sickness

A
  1. Cyclizine/Prochloperazine

2. Metoclopramide

120
Q

When must cyclizine NOT be used?

A

HF pts

121
Q

Def of constipation

A

The passage of hard stools less frequently than the patient’s own normal pattern

122
Q

Laxative MOAs

A

OSMOTIC
Lactulose - semisynthetic disaccharide of fructose and galactose - gut bacteria break it down, it ferments to lactic and acetic acid, keeps fluid within bowel

Movicol - inert polymer of ethylene glycol - sequesters fluid within the bowel accelerating the transfer of gut contents

STIMULANT
Senna - anthracene derivatives - stimulates myenteric plexuses and thus peristalsis

Picolax - mg citrate w na picosulfate - powerful laxative but will not shift impacted stool

BULK-FORMING
Fybogel - ispaghula husk – inc faecal mass thereby stimulating peristalsis

POO-SOFTENER
Docusate - surface active compound - primarily a faecal softener but has a weak stimulant effect

123
Q

Movicol SEs

A

Nausea, abdo distension, colicky pain

124
Q

Lactulose SEs

A

Flatulence, cramps, diarrhoea and occasional electrolyte disturbances

125
Q

When to use lactulose?

A

Anal fissures and hepatic encephalopathy

126
Q

When would an enema or manual evacuation be appropriate?

A

Low faecal impaction

127
Q

Laxative CIs

A

Bowel obstrc, known or suspected perforation, severe IBD +/- comps

128
Q

Stimulant laxatives

A

Senna, sodium picosulfate, bisacodyl

129
Q

Osmotic laxatives

A

Lactulose, movicol, miralax, milk of magnesia

130
Q

Bulk forming laxatives

A

Fybogel and methylcellulose

131
Q

Stool softener laxatives

A

Docusate na and arachis oil

132
Q

Senna SEs

A

Cramping and colicky pain

133
Q

Fybogel SEs

A

Flatulence and abdo distension

134
Q

Pt w neuro problems, constipation, rectum full of hard stools

A

Combination of movicol and phosphate enemata, if unsuccessful manual evacuation, regular oral laxatives to prevent recurrence

135
Q

Phosphate enema SE

A

Rectal irritation

136
Q

Speed of onset for picolax, senna, fybogel

A

Picolax - 3h

Senna - 8-12h

Fybogel - days

137
Q

Picolax SEs

A

N&V, abdo pain, distention, headaches, dizziness

138
Q

What must pts on picolax be advised to do?

A

Drink plenty

139
Q

When to use picolax?

A

Bowel prep prior to surgery

140
Q

Lactulose CI

A

Bloating

141
Q

Senna CIs

A

Cramps and colitis

142
Q

Dose of loperamide

A

4mg followed by 2mg after each loose stool up to max of 16mg/24hrs

143
Q

Two organisms that cause cellulitis

A

Group A Strept Pyogenes & Staph Aureus

144
Q

Abx to tx cellulitis w dose

A

Benzylpenicillin 1.2g IV QDS or flucloxacillin 1g IV QDS

145
Q

Which oral abx can you switch pts onto?

A

Phenoxymethylpenicllin or flucloxacillin

146
Q

Which abx do you use if they’re penicillin allergic?

A

Erythromycin

147
Q

When would you reduce penicillin doses?

A

Mod-severe renal impairment

148
Q

When would you reduce clindamycin doses?

A

Any hepatic impairment

149
Q

What is morphine metabolised to by the liver?

A

Inactive morphine 3 glucuronide and active morphine 6 glucuronide

Inactive 3 & active 6

150
Q

What is a standard dose of morphine sulphate solution?

A

2.5-5mg four hrly as required

151
Q

What affect does renal impairment have on opioids?

A

Inc and prolonged effect & inc cerebral sensitivity

152
Q

What should you monitor in these pts?

A

RR & conscious level

153
Q

List five drugs excreted by the kidneys that require dose reduction in renal impairment

A

Gliclazide, Gabapentin, Morphine, Digoxin, Gentamicin

154
Q

What is the risk of gliclazide in pts w renal impairment?

A

Hypoglycaemia

155
Q

Which drug can you switch morphine to if eGFR falls <30mls/min?

A

Oxycodone

156
Q

What should you consider when the pt fails to respond to abx?

A

Wrong abx, wrong dx, not penetrating infected site, immunosuppressed, development of severe sepsis syndrome

157
Q

List four causes of visible haematuria

A

UTI, stones, urothelial malignancy, IgA vasculitis

158
Q

How would you remove large stones?

A

Percutaneous lithotripsy or surgically

159
Q

What is the IgA disease rule of thirds?

A

1/3 asx just urine dip abnormalities

1/3 plus chronic kidney disease

1/3 progressive resulting in dialysis, transplantation, death

160
Q

Tx of vasculitis

A

Watch and wait, immunosuppressive agents, ACEi to red proteinuria

161
Q

Glucocorticoid SEs

A

Hyperglycaemia and diabetes, wasting and weakness, osteoporosis, fat redistribution, inc susceptibility to infection, peptic ulceration, cataracts, glaucoma, psychosis

162
Q

Drugs that cause hyperK

A

ACEi & Spironolactone

163
Q

Uses of spironolactone

A

Liver disease w ascites, hyperaldosteronism, severe HF

164
Q

Which synthetic glucocorticoids have no salt retaining actions?

A

Betametasone and dexamethasone

165
Q

Mineralocorticoid SEs

A

Fluid retention, hypokalaemia and hypertension

166
Q

Adcal D3

A

Calcium 600mg + Cholecalciferol 10mcg

167
Q

Calcichew D3

A

Calcium 500mg + Cholecalciferol 5mcg

168
Q

List two egs of bisphosphonates

A

Alendronic Acid and Risedronate

169
Q

What would you co-prescribe w long term steroid therapy esp in elderly?

A

Bisphosphonate, calcium carbonate, cholecalciferol

170
Q

What should all pts on pong term steroid tx carry?

A

A steroid tx card

171
Q

The three zones of the adrenal cortex

A

Zona glomerulosa - mineralocorticoids

Zona fasciculata - glucocorticoids

Zona reticularis - androgens

172
Q

How should long term prednisolone dose be changed in pts who are acutely unwell?

A

x2

173
Q

How do migraines typically px?

A

Unilateral, pulsating, mod to severe, building up in minutes to hours, a/w nausea and light sensitivity

174
Q

If the headache is aggravated by physical activity which direction does this point

A

Migraines > Tension Type

175
Q

How do tension type headaches typically px?

A

Bilateral, tightening, mild to mod, cranial tenderness, no nausea

176
Q

What is a chronic headache?

A

> 15 days/mnth for >3 mnths

177
Q

Tension type tx

A

Acute - paracetamol or aspirin

Prophylaxis - amitriptyline

178
Q

Migraine tx

A

Acute - ibuprofen, aspirin or triptan

Prophylaxis - propranolol

179
Q

Headache red flags

A

New onset in pt over 50yo, thunderclap, wakes pt up, changes w posture, precipitated by physical exertion, abnormal neuro sx

PLUS promptly ix pts w signs of infection and history of HIV/cancer

180
Q

What are bisphosphonates an analogue of?

A

Pyrophosphate

181
Q

How do bisphosphonates work?

A

They are incorporated into the bony matrix, red bone resorption by promoting the apoptosis of osteoClasts, dec progression of bony mets

182
Q

Routes of bisphosphonates

A

Oral + IV

183
Q

Risks of bisphosphonates

A

Lifelong risk as long half life of untreatable and painful osteonecrosis

PLUS oesophagitis, peptic ulcers, fracture SEs

184
Q

Uses of bisphosphonates

A

Osteoporosis, Pagets disease, bony mets, hyperCa of malignant disease

185
Q

Sinister causes of a headache

A

VIVID

Vascular
Infection
Vision Threatening
Intracranial Pressure
Dissection
186
Q

Systems affected in lidocaine OD

A

CNS & CVS

187
Q

Sx of lidocaine OD

A

CNS - light headedness, perioral paraesthesia, dizziness, drowsiness, convulsions

CVS - myocardial depression, peripheral vasodilatation, hypotension, bradycardia

Plus central resp depression & allergic reactions (urticaria-anaphylaxis)

Does NOT affect gut motility

NB: draw back to ensure you’re not infecting into a vessel

188
Q

Lidocaine MOA

A

Amide based LA, penetrates interior of axon, reversibly blocks Na channels, metabolised in liver & excreted in urine

189
Q

What are the benefits of using using vasoconstrictors w LA?

A

Provide relatively bloodless field in which to work & prolongs the LA affect

190
Q

List the nerve fibre order of sensitivity to lidocaine

Hint: based on fibre diameter

A

Pain, autonomic fibres, coarse touch, motor

Smaller C fibres - pain & temp

Larger A fibres - touch & power

191
Q

What is paronychia?

A

Skin infection around the nail requiring LA ring block at the base of the finger before draining

192
Q

Where must you NOT use LA w adrenaline?

A

Digits because of the risk of ischaemia

193
Q

Why is toxicity more likely if lidocaine is infected into inflamed soft tissue?

A

Inc absorption

194
Q

Which arrhythmia can IV lidocaine be used in tx?

A

Ventricular Tachycardia

195
Q

Which heart conditions are contraindications to lidocaine tx?

A

SSS & AV block

196
Q

Before injecting lidocaine

A

Brief hx for CIs, xray if possible radioopaque object still in wound, neurovascular exam of affected limb above and below level of injury

197
Q

Name another LA that has a slower onset and longer duration than lidocaine

A

Bupivicaine

198
Q

What method of pain relief should NOT be used in open wounds?

A

A cold spray

199
Q

The onset and duration of lidocaine

A

Few mins & 1-2hrs

200
Q

List ways to minimise the pain of LA infection

A

Allow LA to warm to room temp, infect slowly through small needle, use max dose, add adrenaline where possible to cause local vasoconstriction

201
Q

How does rapid infection cause pain?

A

Inc hydrostatic pressure

Year 6 - PSA (4 decks)

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