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PSA > PSA condensed > Flashcards

PSA condensed Flashcards

1
Q

what are 6 cytochrome P450 inducers?

A

PC BRAS

Phenytoin
Carbamazepine

Barbiturates
Rifampicin
Alcohol (chronic use)
Sulphonylureas/St john’s wart

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2
Q

what are 9 cytochrome P450 inhibitors?

A

AO DEVICES

Allopurinol
Omeprazole

Disulfram
Erythromycin
Valporate
Isoniazid
Ciprofloxacin
Ethanol (acute intoxication)
Sulphonamides

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3
Q

what are 7 side effects of steroids?

A

STEROIDS

Stomach ulcers
Thin skin
Edema
Right (+L) heart failure
Osteoporosis
Infection
Diabetes
Syndrome, Cushings

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4
Q

what are 5 contraindications to NSAIDS?

A

NSAIDS

No urine
Systolic dysfunction (HF)
Asthma
Indigestion
Dyscrasia - clotting dysfunction

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5
Q

what is one side effect of loop diuretics?

A

gout

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6
Q

what is one side effect of potassium sparing diuretics?

A

gynaecomastia

spironolactone

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7
Q

what is a good general antiemetic to prescribe?

A

Cyclizine 50mg 8 hourly IM/IV/PO

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8
Q

what is one important side effect of cyclizine?

A

fluid retention
contra-indicated in heart failure

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9
Q

what is a good all round antiemetic to use in heart failure?

A

metoclopramide 10mg 8 hourly IM/IV

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10
Q

when can metoclopramide not be used?

A

PARKINSONS

or lewy body dementia

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11
Q

what is the normal range for sodium?

A

135 - 145 mmol/L

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12
Q

what are 4 causes of hypernatraemia

A

Ds

Dehydration
Drips - too much NaCl
Drugs - effervesants/IVs with lots of sodium
Diabetes insipidus

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13
Q

what are 3 causes of hypovolaemic hyponatraemia?

A

Fluid losses
Addisons
Diuretics

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14
Q

what are 3 causes of euvolaemic hyponatraemia?

A

SIADH
Psychogenic polydipsia
Hypothyroid

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15
Q

what are 5 causes of SIADH?

A

SIADH

Small cell lung cancer
Infection
Abscess
Drugs - carbamezapine, antipsychotics
Head injury

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16
Q

what are 5 causes of hypervolaemic hypernatraemia?

A

Heart failure
Renal failure
Liver failure - hypoalbuminaemia
Nutritional deficiency - hypoalbuminaemia
Thyroid failure

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17
Q

what is the normal range of potassium?

A

3.5-5.0

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18
Q

what are 4 causes of hypokalaemia?

A

DIRE

Drugs - loop and thiazide diuretics
Inadequate intake/intestinal losses
Renal tubular acidosis
Endocrine - cushings, conns

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19
Q

what are 5 causes of hyperkalaemia?

A

DREAD

Drugs - ACEI, potassium sparing diuretics
Renal failure
Endocrine - Addisons
Artefact
DKA

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20
Q

what are 2 medications that can cause thrombocytopenia?

A

Penicillamine
Heparin

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21
Q

what are 3 nephrotoxic antibiotics?

A

gentamicin
vancomycin
tetracyclines

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22
Q

what are 9 intrinsic causes of AKI?

A

INTRINSIC

Ischaemia - causing acute tubular necrosis
Nephrotoxic antibiotic
Tablets - NSAIDs, ACEI
Radiological contrast
Injury - Rhabdo
Negatively bifringent crystals (gout)
Syndromes - glomerulonephritises
Inflammation - vasculitises
Cholesterol Emboli

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23
Q

what are 5 medications that can causes cholestasis (and therefore raised Alk Phos)?

A

Flocloxacillin
Coamoxiclav
Nitrofurantoin
Steroids
Sulphonylureas

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24
Q

How is thyroxine dosing changed based off TSH?

A

TSH < 0.5 => decrease thyroxine dose
TSH 0.5-5 - no change
TSH >5 => Increase thyroxine dose

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25
Q

How do you assess the quality of an x-ray?

A

RIPE

Rotation
Inspiration - 7th anterior rib should transect diaphram
Projection
Exposure - all fields visible, vertebrae visible behind heart

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26
Q

How do you calculate expected PaO2 of a patient on O2 on an ABG?

A

FiO2 minus 10

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27
Q

what are 6 medications with a narrow therapeutic range than require serum monitoring?

A

Digoxin
Theophylline
Lithium
Phenytoin
Gentamicin
Vancomycin

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28
Q

what are 4 features of digoxin toxicity?

A

Confusion
Nausea
Visual Halos/yellowing of vision
Arrhythmias

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29
Q

what are 8 features of lithium toxicity?

A

Early - tremor
Intermediate - tiredness
Late -
Arrythmias
seizures
coma
renal failure
diabetes insipidus

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30
Q

what are 2 features of gentamicin and vancomycin toxicity?

A

ototoxicity
nephrotoxicity

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31
Q

what are 5 features of lithium toxicity?

A

Nausea + Diarrhoea
confusion/drowsiness
blurred vision
Polyuria and polydipsia
shaking, muscle weakness, spasms - coarse tremor
difficulty speaking

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32
Q

what happens if dose >48h section on gentimicin normogram?

A

repeat gent level and do not redose till <1 mg/L

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33
Q

what is the usual INR target ?

A

2.5

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34
Q

what is the INR target for metallic heart valves or recurrent VTE on warfarin?

A

3.5

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35
Q

what is the management of INR >8 and major bleed?

A

Stop warfarin
Vitamin K (phytomenadione)
Prothombin complex

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36
Q

what is the management of INR >8 minor bleed?

A

Stop Warfarin
Vitamin K (phytomenadione)

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37
Q

what is the management of INR >8 no bleed?

A

Stop warfarin
Vitamin K (phytomenadione)

Repeat Vitamin K (phytomenadione) if still high after 24h

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38
Q

what is the management of INR 5-8 with minor bleed?

A

Stop warfarin
Vitamin K (phytomenadione)

restart warfarin when INR <5

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39
Q

what is the managment of INR 5-8 no bleed?

A

Withhold 1/2 doses of warfarin
Reduce subsequent doses

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40
Q

How many mmol of sodium are there in 1L 0.9% NaCl?

A

150 mmol (also quoted at 154)

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41
Q

How many mmol of potassium are there in 1L of 0.3% KCl?

A

40 mmol

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42
Q

How many mmol of potassium are there in 1L of 0.15% KCl?

A

20 mmol

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43
Q

How many grams of glucose are in 1L of 5% glucose?

A

50g

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44
Q

How quickly can potassium solutions be given?

A

10 mmol/h

0.3% KCl - 4 hours min
0.15% KCl - 2 hours min

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45
Q

what are daily water requirements?

A

25-30 ml/Kg/day

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46
Q

what are daily sodium, potassium and chloride requirements?

A

1 mmol/kg/day

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47
Q

what are daily glucose requirements?

A

50-100g/24h

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48
Q

what are adult resus fluids?

A

NaCl 0.9%
500ml
10 mins

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49
Q

what is the management of emergency hypoglycaemia? (fluid)

A

Glucose 20%
100ml
15 mins

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50
Q

what is the management of emergency hypokalaemia?

A

NaCl 0.9%/KCl 0.3%
1000ml
4h

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51
Q

what is the management of emergency Hypercalcaemia?

A

NaCL 0.9%
1000ml
4h

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52
Q

what is maintenance fluids in someone without deficits or losses?

A

25-30ml/kg/day water
1 mmol/kg/day Na + K
50-100g glucose

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53
Q

what maintenance fluids are needed with deficits and losses?

A

30ml/kg/day water min
ensure electrolyte replacement

1000ml every 4-6 hours

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54
Q

what are resus fluids in children?

A

NaCl 0.9%
10 ml/kg
10 minutes

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55
Q

what is maintenance fluids for children?

A

100 ml/Kg <10kg
50 ml/kg 10-20kg
20ml/kg >20kg

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56
Q

what are 2 diabetes medications that may cause weight gain?

A

Thiazolidinedione - pioglitazone
Slufonylureas - Gliclazide

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57
Q

what is the MOA of Metformin (biguanides)?

A

improves insulin sensitivity in liver/muscles and helps suppress hepatic gluconeogenesis

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58
Q

what is the MOA of DDP4 inhibitors (-gliptins)?

A

incretin effect - makes body produce more insulin

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59
Q

what is the MOA of sulfonylureas (gliclazide)

A

enhances insulin secretion

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60
Q

what is the MOA of thiazolidinediones (pioglitazone)

A

improves insulin sensitivity in liver/muscles and helps suppress hepatic gluconeogenesis

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61
Q

what is the MOA of SGLT2 inhibitors (-gliflozens)?

A

reduce renal glucose reabsorption

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62
Q

what is the MOA of GLP-1 analogues (eventide, semaglutide)?

A

incretin effect

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63
Q

what is the MOA of alpha-glucosidase inhibitors (acarbose)?

A

reduce intestinal glucose absorption

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64
Q

what are 3 side effects of metformin?

A

Nausea
diarrhoea
metformin associated lactic acidosis - caution in eGFR <45, stop <30

No effect on weight

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65
Q

what are 2 side effects of DDP4 inhibitors (linagliptin)?

A

pancreatitis
nasopharyngitis

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66
Q

what are 5 side effects of thiazolidinediones (pioglitazone)?

A

oedema
heart failure
post-menopausal osteoporosis
bladder cancer
weight gain

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67
Q

what are 3 side effects of sulfonylureas (gliclazide)?

A

hypoglycaemia
Cholestasis
weight gain

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68
Q

what are 2 side effects of SGLT2 inhibitors?

A

Euglycaemic ketoacidosis
Genital infections

69
Q

what are 3 side effects of GLP-1 analogues (semaglutide)?

A

nausea
diarrhoea
pancreatitis
weight loss

70
Q

what are 3 side effects of alpha-glucosidase inhibitors (acarbose)?

A

bloating
flatulence
diarrhoea

71
Q

what diabetes measurement needs to be done in people with high RBC turn over?

A

frutosamine

72
Q

what are 6 presentations of hypocalcaemia?

A

CATs go Numb

Convulsions
Arrythmias
Tetany
Numbness

Trousseaus sign
Chvostek’s sign
Long QT

73
Q

what is the management of hypocalcaemia?

A

Calcium gluconate 10%
10-20ml
10 mins

74
Q

what is the management of hyperkalaemia?

A

Calcium gluconate 10%
30ml
10mins

75
Q

what is the 1st line management of addisonaian crisis?

A

Hydrocortisone 100mg
IM/IV

76
Q

what is the management of meningococcal septicaemia in community?

A

Benzylpenicillin IM

77
Q

what is the management of meningococcal septicaemia in community in someone with pen allergy?

A

2g cefotaxime IM

78
Q

How much insulin should be given if blood glucose >15?

A

4 units of novorapid

79
Q

what is the management of insulins for surgery?

A

reduce long acting by 20%

stop all other insulin

80
Q

what antiemetic should be used for vertigo, motion sickness and vestibular disorders?

81
Q

what antiemetic should be used post-operatively?

A

ondansetron

82
Q

what antiemetic should be used for acute chemo nausea?

A

ondansetron

83
Q

what antiemetic should be used for delayed chemo nausea?

A

metoclopramide

84
Q

what antiemetics should be used in palliative care?

A

cyclizine
haloperidol
levopromazine

85
Q

what antiemetic should be used in Parkinson’s?

A

domperidone

86
Q

what antiemetic is used in hyperemesis gravidum?

A

promethazine

87
Q

what is one immunosuppressant that can cause hyperkalaemia?

A

Tacrolimus

88
Q

How long before surgery should antiplatelets be stopped?

A

7 days

Including high dose aspirin

89
Q

what is the 1st line management of acute alcohol withdrawl?

A

1 - Chlordiazepoxide 20mg PO 6 hourly

thiamine is SECOND

90
Q

what is the preferred benzo in alcohol withdrawal in hepatic failure?

91
Q

How long before surgery should warfarin be stopped?

92
Q

what INR is required before surgery?

93
Q

what antibiotic can cause jaundice?

A

Flucloxacillin

More common in elderly and in Men

94
Q

what rise in creatinine is acceptable when starting an ACEI?

95
Q

How much should a statin have reduced LDL after 3 months of treatment?

A

> 40% in any non-HDL cholesterol

96
Q

How long after dose should digoxin levels be taken?

A

minimum 6 hours post dose

97
Q

what is the monitoring requirement for statin safety?

A

LFTs

Baseline
3 months
12 months

98
Q

what safety monitoring is required for ACEIs?

A

U+E

Prior to treatment
Dose change
Annually

99
Q

what safety monitoring is required for amiodarone?

A

TFTs, LFTs, U+E, CXR - before initiation

TFTs + LFTs 6monthly

100
Q

what safety monitoring is required for methotrexate?

A

LFT, U+E, FBC weekly till stabilised then 3 monthly

101
Q

what safety monitoring is required for azathioprine?

A

FBC + LFT pre treatment

FBCs weekly first 4 weeks

FBC + LFT 3 monthly

102
Q

what safety monitoring is required for lithium?

A

TFT + U+E - baseline

Lithium levels - weekly till stable

TFT + U+E - 6 monthly

103
Q

when are lithium levels taken?

A

12 hours after dose

104
Q

what safety monitoring is required for sodium valporate?

A

FBC + LFT - baseline

LFTs - periodically for 1st 6 months

105
Q

what monitoring is required for pioglitazone?

A

LFTs baseline and regularly

106
Q

what non MONA drug should be prescribed in STEMI/NSTEMI?

A

Metoclopramide for sickness 10mg IV

107
Q

what is one contraindication to pioglitazone?

A

heart failure

108
Q

what are 3 medications that are contraindicated in asthma?

A

beta blockers
NSAIDs
Adenosine

109
Q

what medication is used in SVT in asthmatics?

A

Verapamil - adenosine is contraindicated

110
Q

what common analgesia cannot be given in heart failure?

A

NSAIDs - may cause fluid retention - use with caution

111
Q

what is the management of narrow complex regular tachyarrhythmia?

A

SVT (QRS <0.12s)

1 - vagal manoeuvres

2 - Adenosine 6mg (then 12mg, then 12mg again)

if does not resolve ?atrial flutter and rate control

112
Q

what is the management of narrow complex irregular tachyarrhythmia?

A

Atrial fibrillation (QRS >0.12s)

1 - Rate control - B blocker OR diltiazem/verapamil

If Heart failure - consider digoxin or amiodarone

113
Q

what is the management of broad complex regular tachyarrythmia?

A

VT (QRS >0.12s)

1 - amiodarone 300mg IV over 20-60 mins then 900mg over 24h

IF prev SVT w/ BBB then give ADENOSINE and treat as SVT

114
Q

what are 3 differentials of broad complex irregular tachyarrhythmias?

A

AF with BBB - Tx with rate control
Pe-excitation AF - Amiodarone
Polymorphic VT (torsades) - magnesium 2g over 10 mins

115
Q

what is the adult dose (>12 years) of adrenalin in anaphylaxis?

A

500 micrograms (0.5 ml)
1 in 1000
IM

116
Q

what are 2 other medications that can be given along side adrenalin in anaphylaxis?

A

Antihistamines - chlorphenamine or non-sedating
Hydrocortisone

Also IV fluids

117
Q

what is the dose of adrenalin in anaphylaxis <6 months?

A

100-150 micrograms (0.1-0.15ml)
1 in 1000
IM

118
Q

what is the dose of adrenalin in anaphylaxis 6 months - 6 years?

A

150 micrograms (0.15ml)
1 in 1000
IM

119
Q

what is the dose of adrenalin in anaphylaxis 6 -12 years?

A

300 micrograms (0.3ml)
1 in 1000
IM

120
Q

what is the management of acute asthma in an adult?

A

1 - Salbutamol Nebs 2.5-5mg
2 - Ipratropium bromide - 500 micrograms
3 - mag sulphate/aminophyllin

Oral pred - 40mg OD 5 days
IV hydrocortisone if unable to take oral

121
Q

what is the management of acute COPD?

A

1 - Salbutamol Nebs 2.5-5mg
2 - Ipratropium bromide - 500 micrograms
3 - Aminophyllin

Oral pred - 30mg OD 5 days
IV hydrocortisone if unable to take oralw

122
Q

what antihypertensive is 1st line in diabetes?

123
Q

what antihypertensive is first line <55 years?

124
Q

what antihypertensive is 1st line in black people?

125
Q

what antihypertensive is 1st line >55 years?

126
Q

what is the stepwise management of asthma in adults?

A

1 - Salbutamol
2 - Low dose ICS
3 - Montelukast
4 - LABA
5 - MART

127
Q

when should chronic asthma management be escalated?

A

use salbutamol >3x per week
OR
wake with asthma symptoms more than once a week

128
Q

how often should HbA1c levels be monitored in diabetes?

129
Q

what is the stepwise management of T2DM?

A

1 - Metformin - titrate up to max dose
2 - DPP-4 inhibitor OR pioglitazone OR sulfonylurea
3 - triple therapy/insulin

SGLT-2 inhibitor can be added if sulfonylureas are unacceptable

130
Q

what antidiabetic medication should be added in patients with both diabetes and cardiovascular disease?

A

SGLT-2 inhibitors

131
Q

what is HbA1c target on metformin?

132
Q

when should secondary antidiabetic be added?

A

if HbA1c >58 mmol/L

133
Q

what is the HbA1c target on an antidiabetic which can induce hypos?

134
Q

what is the 1st line management of parkinsons?

A

Levodopa PLUS
Co-careldopa OR Co-beneldopa

135
Q

what is the 1st line management of mild/moderate alzheimers?

A

acetylcholinesterase inhibitors

Rivastigimine
Donepezil
galantamine

136
Q

what is the 1st line management of severe alzheimers?

A

NMDA antagonist - memantine

137
Q

what is the first line management of intrapartum GBS infection?

A

1 - Benzylpenicillin

Pen allergy - Cefotaxime/Vancomycin

138
Q

what are 8 medications that are prescribed in MICROgrams?

A

levothyroxine
tamsulosin
digoxin
naloxone
fludrocortisone
Inhalers
GTN spray
Ipratropium nebs

also vitamins

139
Q

what are 5 medications that are prescribed in grams?

A

paracetamol
lithium
calcium carbonate
NAC

140
Q

what are 2 medications that should be taken in the morning?

A

diuretics
steroids

141
Q

what are 2 medications that should be taken at night?

A

statins
night sedation

142
Q

what are 2 medications to be taken with meals?

A

Insulin
Creon

143
Q

what are 3 medications to be taken weekly?

A

Methotrexate
Folic acid (for RhA)
Bisphosphonates (check dose)

144
Q

what TYPE and DOSE of insulin is required in an insulin infusion for DKA?

A

Fast acting (actrapid, novorapid, humalin S)

0.1 units/kg/h

145
Q

How should long acting insulin doses be adjusted?

A

by 10-20% if need increasing/decreasing

146
Q

How long after surgery should a variable rate insulin be stopped and short acting insulin be recommenced?

A

Once patient can eat and drink at next meal give SC short acting insulin and discontinue VRI 30 mins after

147
Q

when should glucose be commenced in DKA?

A

when serum glucose <14 mmol/L

148
Q

what dose of glucose should be prescribed in DKA once BMs <14?

A

10% glucose
1000 ml

over 8 hours

In addition to saline regime

149
Q

what is the management of hypernatraemia?

A

5% glucose
1000 ml
IV
6-8 hours

150
Q

what increments is levothyroxine adjusted in?

A

25 micrograms

151
Q

what class of ABx can causes tendonitis and tendon rupture?

A

quinolones - ciprofloxacin

152
Q

what diuretic is used in ascites secondary to liver cirrhosis?

A

spironolactone

153
Q

what is the management of hyponatraemia?

A

0.9% NaCl
1000 ml
IV
12 hours

154
Q

what is the brand name of one combined HRT for >12 months post menopause?

A

Evorel conti

Elleste-duet conti

155
Q

what is the name of one combined HRT for <12 months post finishing mentruation?

A

Evorel sequi

Elleste-duet

clinorette

156
Q

what is the preferred 3rd line antihypertensive agent?

A

INDAPAMIDE (specifically over other thiazide like diuretics)

157
Q

what are 6 medications that increase falls risk?

A

benzodiazepines
antidepressants - Tricyclics and SNRIs specifically
Atipsychotics
opiates
antihypertensives - diuretics and alpha blockers

158
Q

what are 3 medications that increase fracture risk?

A

PPIs
Steroids
GnRH analogues

159
Q

what drugs should be stopped in AKI?

A

stop the DAMN drugs

DAMN

Diuretic
ACEi/ARB
Metformin
NSAIDs

160
Q

what what blood glucose level should ketones be checked?

A

> 15 mmol/l

161
Q

what is the name of an ICS + LABA inhaler (suitable for MART)?

A

FOSTAIR - beclometasone with formoterol

suitable for both asthma and COPD with asthmatic features

162
Q

what is the stepwise management of COPD without asthmatic features?

A

1 - SABA/SAMA

2 - LABA + LAMA combo

3 - + ICS - triple therapy

163
Q

what is the stepwise management of COPD with asthmatic features?

A

1 - SABA/SAMA

2 - LABA + ICS

3 - + LAMA - triple therapy

164
Q

what is the name of a LABA + LAMA combo inhaler?

A

GENUAIR - aclidinium bromide with formoterol

for tx of COPD without asthmatic features

165
Q

what triple therapy inhaler can be used in both COPD and Asthma?

A

TRIMBOW - beclometasone with formoterol and glycopyronium

166
Q

what is the maximum change in serum sodium in one day?

A

+/- 10 mmol

167
Q

how long before surgery should the COCP be stopped?

168
Q

when before surgery should lithium be stopped?

A

Day before surgery

169
Q

what are the criteria for resus fluids in adults?

A

BP <100
HR >90
CRT >2s /cold peripheries
RR >20
NEWS >5

PSA (9 decks)

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