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FINALS REVISION > PSA conditions treatment > Flashcards

PSA conditions treatment Flashcards

1
Q

what treatment for STEMI

A

MONAT

Morphine (5-10mg)
Oxygen only if desaturing
Nitrates (GTN 2 puffs sublingual)
Aspirin 300mg
Ticagrelor 180mg /clopidogrel 300mg
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2
Q

what should you give if stemi pt undergoing PCI

A

Prasugrel

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3
Q

what treatment if no PCI in stemi patient?

A

fondaparinux

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4
Q

what treatment for nstemi/unstable angina

A

MONAT

Morphine 5-10g
Oxygen if indicated
Nitrates (2 puffs sublingual GTN)
Aspirin 300mg
Ticagrelor 180 or clopidogrel 300mg
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5
Q

what long term treatment for ACS

A

CRABS

Clopidogrel 75mg
Ramipril
Aspirin
Beta blocker
Statin
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6
Q

what treatment for chronic heart failure - specify drug in each class

A

ACEi - ARB if intolerated

Beta blocker - bisoprolol

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7
Q

in heart failure, if ARB and ACEi not tolerated, what to prescribe

A

hydralazine and nitrate

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8
Q

if symptoms of chronic HF continue despite treatment with ACEi and BB, what to prescribe

A

spironolactone/amiloride

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9
Q

how to treat ACUTE heart failure

A

UNLOAD FAST - diuretics

Upright position
Nitrates
Loop diuretic
Oxygen
ACEi
Digoxin

Fluids (decrease)
Afterload (decrease)
Sodium restrict
Test (Digoxin level, ABG, potassium level)

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10
Q

how to treat angina

A

GTN

BB
CCB if no BB (verapamil/diltiazem)

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11
Q

how to treat angina if CCB+BB combo not enough

A

ivabradine

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12
Q

what secondary prevention for stable angina

A

statin
aspirin
ACEi if patient has diabetes

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13
Q

describe treatment pathway for HTN if under 55

A
  1. A
  2. A + C or A+D
  3. A + C + D
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14
Q

describe treatment pathway for HTN if diabetic of any age

A
  1. A
  2. A + C or A+D
  3. A + C + D
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15
Q

describe treatment pathway for >55 or afro-caribbean

A
  1. C
  2. C + A or C + D
  3. A + C + D
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16
Q

If patient still hypertensive after triple treatment, what to give if low potassium

A

k-sparing diuretic if less than 4.5mmol

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17
Q

if patient still hypertensive after triple treatment with HIGH potassium, what to give

A

alpha or beta blocker

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18
Q

how to treat AF - rate control

A

Beta blocker or rate limiting CCB (verapamil or diltiazem)

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19
Q

if AF rate not controlled with one drug, what to give

A

two of three:

  1. beta blocker
  2. diltiazem
  3. digoxin
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20
Q

when to start rhythm control in AF

A

if less than 48 hours, can start with amiodarone or flecainide
if more than 48 hours, anticoagulate first

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21
Q

what investigations needed before amiodarone

A

CXR - amiodarone can cause interstitial lung disease
TFT
LFT
U&E

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22
Q

what anticoagulant for AF

A

warfarin

DOAC - apixaban, rivaroxiban, dabigatran

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23
Q

supraventricular tachy - immediate treatment

A

IV adenosine 6mg bolus

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24
Q

SVT treatment in asthmatic

A

no adenosine, use verapamil instead

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25
Q

treatment for ventricular tachy

A

amiodarone via central line
lidocaine
procainamide

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26
Q

treatment for pericarditis

A

nsaid and colchicine

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27
Q

treatment for anaphylaxis in adult

A

IM adrenaline 500mcg

then oral cetirizine or IV chlorphenamine

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28
Q

treatment for anaphylaxis in child 6-12

A

IM adrenaline 300mcg

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29
Q

treatment for anaphylaxis in 6m-6y

A

IM adrenaline 150mcg

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30
Q

treatment for patent ductus arteriosus to close the duct

A

indomethacin or ibuprofen

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31
Q

treatment to keep PDA duct open

A

prostaglandin E1 (alprostadil)

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32
Q

What are the short-acting forms of insulin?

A

soluble insulin, Actrapid

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33
Q

What are the intermediate forms of insulin?

A

Insulatard

Isophane insulin

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34
Q

How often are intermediate forms of insulin administered?

A

Usually twice a day

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35
Q

What are the long-acting forms of insulin?

A

Insulin glargine

Lantus

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36
Q

How often are the long-acting forms of insulin administered?

A

Once or twice daily, doesn’t need to be administered with food

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37
Q

What route is gentamicin usually administered?

A

IV

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38
Q

What condition is gentamicin contra-indicated in?

A

myasthenia gravis

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39
Q

Impairment of which organ can cause gentamicin toxicity?

A

Renal

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40
Q

What route of vancomycin for C. Diff

A

oral

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41
Q

How often is vancomycin concentration monitored?

A

trough levels between 3rd and 6th dose

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42
Q

IV infusions of vancomycin need to be administered over how long

A

at least 60 mins

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43
Q

What thromboprophylaxis in surgical patients

A

enoxaparin

if high risk (eg orthopaedic surgery) different dose 40mg every day and 12 hours before surgery

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44
Q

What is the first line IV treatment of hypoglycaemia

A

glucose 20%, 50ml given over 20minutes

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45
Q

What treatment for acne unresponsive to topical treatment?

A

tetracycline 500mg PO twice daily

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46
Q

When must you be cautious when prescribing nitrofurantoin

A

low eGFR/poor renal function

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47
Q

First line management of alcohol withdrawal

A

chlordiazepoxide 20mg QDS PO

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48
Q

if INR > 1.5 on day of surgery, what to give

A

Phytomenadione 1-5mg PO

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49
Q

How should patients take rivaroxaban

A

with food

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50
Q

What is the effect of topiramate on contraceptives

A

topiramate is enzyme inducer, reduces effectiveness of contraceptive
use additional contraceptive for at least 4 weeks after

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51
Q

what is a side effect of beta blockers

A

erectile dysfunction

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52
Q

what sort of jaundice does co-amox cause

A

cholestatic jaundice

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53
Q

By what percentage is the creatinine expect to rise after starting ACEi

A

up to 20% - no need for investigation or withdrawal of ACEi

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54
Q

What is the most effective measure of furosemide efficacy?

A

weight

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55
Q

What is the most effective measure of ACEi efficacy in treatment of HF

A

exercise tolerance after a month

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56
Q

What must be monitored with ciclosporin after 2 weeks

A

renal function (creatinine)

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57
Q

What is the first line treatment of COPD

A

SABA or SAMA (ipratropium)

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58
Q

What is the second line treatment of COPD if no asthma features

A

SABA PRN and

LABA + LAMA

eg. salbutamol + salmeterol + tiotropium

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59
Q

What is the second line treatment of COPD if asthmatic features

A

SABA PRN and

LABA (salmeterol) + ICS (beclometasone)

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60
Q

What is third line treatment in all COPD patients?

A

SABA PRN and

LABA + LAMA + ICS

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61
Q 
Give an example of each of the following:
SAMA
LABA
LAMA
ICS
A 
SAMA = ipratropium
LABA = Salmeterol
LAMA = tiotropium
ICS = beclometasone
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62
Q

How to treat infective exacerbation of COPD

A

pred 30mg for 5 days

antibiotics only if purulent sputum

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63
Q

what antibiotics in copd exacerbation

A

amoxicillin
doxycycline
clarithromycin

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64
Q

what antibiotics in copd infection prophylaxis

A

azithromycin

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65
Q

what must be checked before prescribing azithromycin

A

LFTs and ECG

azithromycin can prolong QT interval

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66
Q

Stepwise asthma management in adults

A
  1. SABA
  2. SABA + ICS
  3. SABA + ICS + LTRA
  4. SABA + ICS + LABA, keep LTRA if needed
  5. SABA + MART
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67
Q

what is MART in asthma treatment

A

form of combined ICS and LABA (seretide - salmeterol and fluticasone)

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68
Q

Emergency asthma treatment

A
  1. O2
  2. Salbutamol 5mg nebulised
  3. Pred 40mg PO
  4. Ipratropium bromide
  5. Theophylline
  6. Mag sulf
  7. Escalate
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69
Q

How is aminophylline prescribed

A

loading dose of 5mg/kg given over at least 20 minutes then 500–700mcg/kg/hr based on plasma concentration

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70
Q

What is PE treatment

A

First line: apixaban or rivaroxaban

second line: enoxaparin

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71
Q

What is VTE prophylaxis

A

enoxaparin

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72
Q

How to treat massive PE?

A

alteplase or streptokinase

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73
Q

What drug for TB prophylaxis

A

isoniazid and rifampicin

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74
Q

What is the curb65 criteria

A

Confusion (AMT <8/10)
Urea >8
Respiratory Rate >30
Blood pressure <90/60

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75
Q

If CURB65 is 0, what to prescribe

A

amoxicillin

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76
Q

what mucolytic in CF

A

dornase alfa

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77
Q

what pancreatic replacement in CF

A

pancreatin/creon

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78
Q

what antibiotic for pseudomonas

A

aztreonam

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79
Q

what antibiotic for burkholderia

A

co-trimoxazole

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80
Q

how to treat dyspnoea in pleural effusion

A

opioids

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81
Q

what treatment for pulmonary hypertension

A 
IV prostanoids (e.g. epoprostenol)
Endothelin receptor antagonists (e.g. macitentan)
Phosphodiesterase-5 inhibitors (e.g. sildenafil)
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82
Q

what should be measured before starting azathioprine

A

TPMT - myelosuppression if low levels

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83
Q

what is used to induce remission in crohns

A

steroids

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84
Q

what is used to induce remission in ulcerative colitis

A

mesalazine (PR)

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85
Q

how to treat diarrhoea in IBS

A

loperamide

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86
Q

which antispasmodic in IBS

A

mebeverine

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87
Q

what laxative to avoid in IBS

A

lactulose

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88
Q

what treatment for gord

A

PPI

famotidine/cimetidine. not ranitidine

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89
Q

h pylori eradication

A

PPI + Amoxicillin + Clarithromycin or Metronidazole

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90
Q

h pylori eradication if penicillin allergic

A

PPI + Clarithromycin + Metronidazole

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91
Q

what treatment for primary biliary cirrhosis

A

ursodeoxycholic acid

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92
Q

what treatment for ascites

A

low sodium

spironolactone

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93
Q

what antibiotic to prevent SBP in ascites

A

ciprofloxacin

94
Q

what is prophylaxis for variceal bleeding

A

propranolol

95
Q

what treatment for c.diff

A

oral vancomycin FOR 10 DAYS

96
Q

what treatment for life threatening c. diff

A

oral vancomycin and IV metronidazole

97
Q

What is the effect of diltiazem on heart failure

A

exacerbates biventricular failure

98
Q

what is the effect of prednisolone on heart failure

A

exacerbates heart failure

99
Q

How long is treatment for scarlet fever

A

10 days phenoxymethylpenicillin

100
Q

what is the effect of PPIs on stool consistency

A

loose stools

101
Q

What is the effect of alendronic acid on stool consistency

A

loose stools

102
Q

Which electrolyte abnormality can exacerbate lithium toxicity?

A

hyponatraemia

103
Q

What medication can exacerbate glaucoma

A

tricyclic antidepressants (antimuscarinic side effects)

104
Q

What are some side-effects of anti-muscarinics (TCAs and antispasmodics)?

A
  • Memory loss
  • Urinary retention
  • Constipation
  • Exacerbation of glaucoma
105
Q

What are some side-effects of hypnotics/anxiolytics?

A

Falls
Confusion
Postural hypotension

106
Q

What are some side effects of NSAIDs

A

GI bleeding

Fluid retention

107
Q

What are some side effects of opioids?

A

Respiratory depression
Constipation
Drowsiness
Falls

108
Q

What dose of rivaroxaban to prescribe for AF in patient with renal impairment

109
Q

How much is 100mg PO carbamazepine equivalent to PR?

A

125mg - dose equivalence and conversion

110
Q

How to treat HTN in phaeochromocytoma

A

phenoxybenzamine

111
Q

What treatment for chlamydia

A

doxycycline - not in preg
erythromycin
amoxicillin
azithromycin - not in preg

112
Q

what treatment for chlamydia in pregnancy

A

erythromycin

amoxicillin

113
Q

What effect can carbamazepine have on electrolytes

A

can cause hyponatraemia due to SIADH effect

114
Q

What is first line antiemetic in pregq

A

cyclizine - IV if no oral intake

115
Q

what medication to prevent sickle crises

A

hydroxycarbamide

116
Q

what drug to stop variceal haemorrhage

A

IV terlipressin

117
Q

what medication to delay labour (tocolytic)

A

nifedipine

118
Q

which opioid in renal impairment

119
Q

What is the interaction between metformin and contrast dye

A

lactic acidosis

120
Q

how does metformin affect weight

A

causes weight loss

121
Q

what infection do PPIs increase the risk of

122
Q

fluid resus in heart failure

A

250ml over 30 minutes

123
Q

what must patients be warned of with SSRIs

A

can cause GI bleeding

124
Q

what happens to phosphate levels in CKD

A

hyperphosphataemia

125
Q

how to treat hyperphosphataemia and hypocalcaemia

A

calcium carbonate

126
Q

in pneumonia if pt allergic to penicillin, what to prescribe

A

clarithromycin

127
Q

which diuretic can cause hypercalcaemia

A

bendroflumethiazide

128
Q

what treatment for wilsons disease

A

penicillamine or trientene

129
Q

what must be monitored with methotrexate

A

FBC - myelosuppression

LFT - cirrhosis

130
Q

what can methotrexate do to the lungs

A

pneumonitis

131
Q

what must be monitored with hydroxychloroquine?

A

retinopathy

132
Q

what must be checked before starting a patient on infliximab and biologics

A

TB status - tuberculin skin test

133
Q

what is the main side effect of colchicine

134
Q

what treatment for acute gout if colchicine/nsaids contraindicated

A

oral pred 15mg or intra-articular steroids

135
Q

do you continue allopurinol in acute flares of gout

136
Q

which drugs can precipitate gout

A

thiazides - stop in flares

137
Q

which drug can be used to control HTN in gout

138
Q

what treatment for pseudogout

A

NSAIDs, intra-articular steroids, joint aspiration

139
Q

what treatment for osteoporosis/fractures

A

bisphosphonates - alendronate

long acting once monthly = ibandronate

140
Q

what biologic for osteoporosis?

141
Q

what is first line treatment of ankylosing spondylitis

A

nsaids and physio

second line - anti-TNF (infliximab)

142
Q

what treatment for reactive arthritis

A

nsaids
intra-articular steroids
sulfasalazine or methotrexate for persistent disease

143
Q

what antibiotic for septic arthritis and for how long

A

fluclox or clindamycin if pen allergic

for 6 WEEKS

144
Q

What treatment for lupus

A

hydroxychloroquine - monitor for retinopathy

145
Q

how is osteomalacia treated

A

vit D supplements - loading dose required

calcium supplements if dietary not sufficient

146
Q

what treatment for GCA

A

pred, higher dose if visual symptoms

147
Q

what treatment for GCA with visual symptoms

A

IV Methylpred according to passmed, not on BNF

148
Q

what treatment for kawasaki disease

149
Q

how to differentiate kawasaki disease from scarlet fever

A

scarlet fever responds to antipyretics

scarlet fever is PAINFUL lymphadenopathy

150
Q

what to treat coronary vasospasm with in kawasaki

A

nifedipine

151
Q

what treatment for pagets disease of bone

A

risedronate oral

152
Q

How does pagets disease bone present

A

usually older male with bone pain and isolated raised ALP

153
Q

what causes hypercalciuria leading to kidney stones

A

thiazide diuretics (bendroflumethiazide)

154
Q

what drugs can precipitate AKI

A 
NSAID
ACEi
ARB
Diuretics
Aminoglycoside antibiotics
iodinated contrast agents
155
Q

Give examples of aminoglycosides causing AKI

A

gentamicin
tobramicin
streptomycin
neomycin

156
Q

which drugs to stop in AKI as they can be toxic

A

metformin
digoxin
lithium

157
Q

how is hyperkalaemia in AKI treated

A

IV calcium gluconate to stabilise cardiac membrane

Nebulised salbutamol
Insulin and dextrose infusion

To remove the excess potassium from body:

  • Calcium resonium (PO or PR)
  • Loop diuretics
  • Dialysis
158
Q

How is excess potassium removed from body in AKI

A

Calcium resonium (PO or PR)
Loop diuretics
Dialysis

159
Q

how to treat vit D deficiency in CKD

A

alfacalcidol or calcitriol

160
Q

how is proteinuria managed in ckd

A

ACEi or ARB

161
Q

how to treat anaemia in ckd

A

EPO/darbepoetin

162
Q

how to treat HTN in CKD

A

ACEi and furosemide

163
Q

how to treat BPH

A

tamsulosin first line

finasteride second line

164
Q

what are the side effects of tamsulosin/alpha blockers

A

dizziness
postural hypotension
dry mouth
depression

165
Q

which drug slows down progression of BPH

A

finasteride

166
Q

if there is a mixture of storage and voiding problems in BPH what to give

A

tolterodine or darifenacin

167
Q

what treatment for minimal change disease

A

steroids/cyclophosphamide

168
Q

what treatment for ADPKD

169
Q

what thrombolysis for stroke

170
Q

what antiplatelet for stroke

A

aspirin (+PPI)

171
Q

If AF and stroke, what to prescribe

A

Aspirin for 2 weeks, then anticoagulation

172
Q

what is long term management of stroke

A

clopidogrel + statin + antihypertensive

173
Q

what long term management of stroke if AF

A

warfarin/doac + statin + antihypertensive

174
Q

if pt with AF has stroke, what to give

A

warfarin or apixaban or rivaroxaban AFTER 2 WEEKS

175
Q

TIA immediate treatment

A

aspirin 300mg

176
Q

TIA secondary prevention

A

clopidogrel
If AF - anticoag with DOAC/warfarin
Statin
anti-hypertensive

177
Q

what treatment for generalised seizures

178
Q

what treatment for focal

A

carbamazepine

179
Q

what are the side effects of valproate

A

P450 inhibitor
ataxia
hepatitis - avoid in hepatic impairment

180
Q

what are the side effects of carbamazepine

A

p450 inducer
SIADH - hyponatraemia
visual disturbances - diplopia

181
Q

what are the side effects of lamotrigine

A

Stevens-Johnson syndrome

182
Q

what treatment for parkinsons if the symptoms are affecting QoL

A

co-careldopa

183
Q

what treatment for postural hypotension in parkinsons

184
Q

what treatment for hypersalivation in parkinsons

A

glycopyrronium

185
Q

what treatment for parkinsons if not affecting QoL

A 
co-careldopa
dopamine receptor agonists (ropinirole)
MAOB inhibitors (rasagiline)
186
Q

what must be checked before starting a patient on cabergoline/bromocriptine

A

Can cause pulm/cardiac fibrosis - CXR, echo, ESR, and creatinine

187
Q

which class of parkinsons drugs cause impulse control disorders

A

dopamine agonists - ropinirole/cabergoline/bromocriptine - patients should be warned of these effects

188
Q

what class of drug is seligiline?

A

MAOB inhibitor

189
Q

what class of drug is entecapone

A

COMT (Catechol-O-Methyl Transferase) inhibitors

190
Q

what treatment for parkinsonism drug induced

A

antimuscarinics - procyclidine, benztropine

191
Q

what prophylaxis for migraine

A

propranolol or topiramate

192
Q

what prophylaxis for migraine if perimenstrual

A

frovatriptan

193
Q

what treatment for acute migraine

A

oral triptan and NSAID/paracetamol

194
Q

what treatment for acute migraine in 12-17

A

nasal preparation of triptan

195
Q

what treatment for acute cluster

A

100% Oxygen and subcut triptan

196
Q

what prophylaxis for cluster headache

197
Q

how to shorten acute flare of MS

A

high dose iv methylpred

198
Q

how to treat fatigue in MS

A

amantadine

199
Q

how to treat spasticity in MS

A

baclofen and gabapentin

200
Q

how to treat urinary retention in MS

A

intermittent self-catheterisation

201
Q

how to treat MS bladder symptoms if no significant residual volume

A

anticholinergics - oxybutynin?

202
Q

how to treat oscillopsia in MS

A

Gabapentin

203
Q

how to treat mnd

A

riluzole and NIV - BIPAP

204
Q

how to treat meningitis in hospital in children and adults up to 50y

A

cefotaxime

205
Q

how to treat meningitis in neonates up to 3m, and adults after 50y

A

cefotaxime + amoxicillin

206
Q

how to treat encephalitis

A

IV acyclovir

207
Q

how to treat oedema in brain tumour

A

dexamethasone

208
Q

what treatment of myasthenia gravis

A

pyrodostigmine

209
Q

which drugs can cause peripheral neuropathy

A 
amiodarone
isoniazid
vincristine
nitrofurantoin
metronidazole
210
Q

first line treatment for neuropathic pain

A

amitryptiline
gabapentin
pregabalin
duloxetine

211
Q

treatment for trigeminal neuralgia

A

carbamazepine

212
Q

treatment for status epilepticus

A

lorazepam (PR in community, IV in hospital)

213
Q

what drugs cause myopathy

214
Q

how is croup treated in children

A

0.15mg/kg dexamethasone
nebulised adrenaline
high flow O2

215
Q

how is viral wheeze treated in children

A

salbutamol
montelukast
fluticasone`

216
Q

how is bronchiolitis treated

A

humidified oxygen

217
Q

how is epiglottitis treated

A

intubation, iv abx

218
Q

how is otitis media treated

A

amoxicillin

219
Q

how is otitis externa treated

A

flucloxacillin

220
Q

how is suspected cyanotic heart disease treated

A

keep duct open with alprostadil

221
Q

how is rheumatic fever treated

A

phenoxymethylpenicillin

222
Q

how is constipation treated in children

A

MACROGOL/movicol
senna
lactulose

223
Q

how is minimal change disease treated

A

steroids/cyclophosphamide

224
Q

what treatment for hayfever

A

Azelastine hydrochloride intranasal

225
Q

how is whooping cough treated

A

erythromycin/clarithromycin/ macrolides

226
Q

what is treatment for sickle cell disease

A

hydroxycarbamide

227
Q

how is impetigo treated

A

hydrogen peroxide 1% cream first line or topical fusidic acid
oral fluclox/clari if extensive disease

228
Q

how to treat nipple candidiasis for mother and baby

A

miconazole cream for mother, nystatin for baby

229
Q

what treatment for scarlet fever

A

phenoxymethylpenicillin for 10 days

230
Q

what treatment for ADHD

A

methylphenidate

231
Q

how is von Willebrand disease treated

A

tranexamic acid for mild bleeding,

desmopressin for severe

FINALS REVISION (17 decks)

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