PSA Incorrect Qs Flashcards

1
Q

Hypoglycaemia fluid treatment
% and volume of dextrose? over how long?

A

10% dextrose (100-200mL) over 15 minutes (up to 20 mins)

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2
Q

Tacrolimus dose: (prevent kidney rejection)

  • Initial dose post-transplant =
  • Maintenance dose =
A

Initial dose post-transplant = 200 - 300 micrograms/kg (70kg male 10mg every 12 hours)
- Maintenance dose = 1-2mg 12 hourly

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3
Q

Drugs which can contribute to hyperkalaemia

A

ACEi
Dalteparin Sodium (rare)
Tacrolimus (in preg?)

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4
Q

Withhold allopurinol until renal function recovers

A
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5
Q

Antiplatelets should be stopped how long before surgery?

Clopidogrel should be stopped 7 days before surgery

ILACKOP

A
  • 7 days

I- insulin (to VIII)
L- lithium (day before)
A- Antiplatelts/ anticoag
C - COCP/ HRT
K- K+ sparing diuretics
O - oral hypoglycaemics (not strictly metformin but can be so choose that if no other better option)
P - Prils - ACEi (day of)

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6
Q

common drugs which can cause hyponatramia (2)

A

SSRI
Thiazide diuretics

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7
Q

common b blocker side effect?

A

Fatigue (NOT SEDATION)
Erectile dysfunction

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8
Q

flucloxacillin can cause what side effect?

A

Cholestatic jaundice

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9
Q

when starting an ACEi a small rise in Cr can be expected as and continued as long as its less than….

A

< 20% rise

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10
Q

check benefits of ACEi in Heart failure by monitoring…. (as an outpatient)

A

exercise tolerance!

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11
Q

what investigation should you use 2 weeks after starting ciclosporin?

A

U+E and serum Cr - it is nephrotoxic

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12
Q

increase long term insulin by 10%! especially if blood glucose rises when steroid is increased

A
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13
Q

No change in statin is needed if after 3 months of treatment >40% in non-HDL cholesterol has occurred

A
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14
Q

paid pain relief give NASAL fentanyl 50 micrograms one spray to one nostril and can be repeated after 10 mins - a minimum of 4 hours between treatment of each pain episode

A
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15
Q

Nitrofurantoin should be avoided in who? (investigation)

A

eGFR < 45
can be used with caution if eGFR 30 - 44

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16
Q

stopping warfarin 5 days before elective surgery

you dont need formal anticoag unless … (2)

If not then give…

A

AF or Stroke/ TIA hx.

Phytomenadione (Vit K) 2mg PO

BNF guidance says if INR > 1.5 on the day before surgery then give Vit K 1-5mg PO using IV preperation

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17
Q

Rivaroxaban should be given…

A

with food!

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18
Q

Prescribe ACEi in the evening/ at night why?

A

Postural hypotension

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19
Q

When prescribing GTN it naturally comes in 400micrograms spray so in the dose section put 2 sprays or 2 tablets

A
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20
Q

What to prescribe in hyperkalaemia to LOWER K+ with ecg changes?

Drug:
Dose: ____ and its dissolved in what?
given over how long?
Route:

General hyperkalaemia Mx:
1. give…
2. give…
3. give…
4.+/-

A

Drug: ACTRAPID or NOVORAPID
Dose: 10 Units in 100ml of 20% dextrose over 30 mins
Route: IV

General hyperkalaemia Mx:
1. Calcium gluconate (30ml 10%) or calcium chloride (10mL in 10%) to stabilise cardiac membrane
2. give… ACTRAPID or NOVORAPID 10 Units in 100ml of 20% dextrose IV infusion (20g of glucose) to shift K+ intracellularly
3. give… Calcium rosonim (K+ binder)
4. +/- Dialysis

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21
Q

types of seizure and med you should prescribe

Focal seizures: 2 drugs and reason why you should/ should not prescribe
1. first line- good because
2. second line - bad because

Tonic clonic generalised
1. male -
2. female (2)

Absence
1. first line =
2. second line; male = female = (2)

A

Focal:
Lamotrigine - safe in preg
Carbemazipine - can cause SIADH (hypoatraemia)

Tonic clonic generalised
1. male - sodium valproate
2. female- lamotrigine or levatricitam

Absence
1. first line = ethosuximide
2. second line: male = sodium valp female = lamotrigine or levatricitam

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22
Q

metformin should be stopped day before surgery - lactic acidosis

aspirin should also be stopped but not 75mg dose?

A
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23
Q

long term steroids should be AMENDED for surgery - why?

A

If its adrenal insuff. then they might not be able to amount a stress response - therefore anaesthetist might have to increase!

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24
Q

ALWAYS CHECK THE UNITS!!!!

A
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25
Q

lithium toxicity
stop ACEi and Diuretics - they stop excretion

if you do need a diuretic then use furosemide

A
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26
Q

Best way to monitor tacrolimus levels?

A

Trough level prior to morning dose

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27
Q

Monitoring DKA has resolved by what? (2)

A

Ketones < 0.6mmol/L
Bicarbonate > 15

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28
Q

Vancomycin

What should be the pre-dose trough level?

Look at BNF!

A

10-15mg/L

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29
Q

Amlodipine side effects

A
  • facial flushing
  • peripheral oedema
  • hypotension
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30
Q

Opioids but also what other common drug can cause constipation?

A

Cyclizine

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31
Q

INR too high and they’re bleeding, what should you do?

A

Give Vit K by slow IV infusion

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32
Q

If someone’s having an allergic reaction mild (pruritis and macular rash) with NO SIGNS of anaphylaxis give what?

A

Oral chlorphenanine (anti-histamine)

  • IM adrenaline or IV hydrocortisone not needed
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33
Q

Hypoglycaemia

Conscious give =
Unconscious give =

Why is 50%. IV Glucose not advised?

A

Conscious give = oral glucose 10-20g this can include tablet, orange juice, biscuit
Unconscious give = IM/IV/S/C glucagon if no IV access for glucose

High risk of extravasating injury

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34
Q

don’t take bendrofluthiazide at night- why?

A

up all night pissing!

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35
Q

cyclize and metroclopramide should be given what hourly?

A

8 hourly?

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36
Q

elderly dose for citalopram (>65yo) is max …

A

elderly 20mg

adult can go up to 40mg

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37
Q

how long ferrous sulfate given for in iron def anaemia?

A

Until Hb is normal and then for 3 months after

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38
Q

maintenance fluids - in elderly patients give how much?

A

2L instead of the standard 3L (2 bags instead of 3)

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39
Q

UC more than 6 bowel movement is considered a severe flair therefore give what

A

IV hydrocortisone 100mg 6 hourly

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40
Q

life threatening hypogylcaemia advice to tell a T1DM in young adults?

A

Alcohol excess can cause severe hypoglycaemia

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41
Q

how do you choose between weak opioids tramadol and codeine?

tramadol =
codeine =

A

Tramadol avoided in elderly becuase can cause agitation, hallucinations

constipation more constipating

42
Q

first line med for GAD?

A

citalopram or sertraline

43
Q

when should you assess plasma-digoxin levels?

A

at least 6 hours after dose

44
Q

before starting sodium valproate check what?

A

LFTs

45
Q

signs to check for aminophylline toxicty?

A

check serum levels

check 18 hours after giving and should be between 10-20 mg/L

46
Q

a new rash on fluoxetine could show signs of impending system reaction so check at 2 weeks!

A
47
Q

Managing impetigo

systemically well
1. first line =
2. if not suitable already tried =
3. Third line =

systemically unwell
1.

If MRSA
1.

A

systemically well
1. first line = 1% hydrogen peroxide
2. if not suitable (around eyes) already tried = Fusidic acid
3. Third line = Fluclox (If allergic erythromycin or clarithromycin)

systemically unwell
1. oral abx

If MRSA
1. mupirocin

48
Q

dose of insulin given to adult in DKA

dose of insulin given to child in DKA

A

Actrapid 0.1Units/kg/hour IV

49
Q

Bacterial meningitis inpatient what abx do you give?

A

Cetriaxone

can give Cefotaxime

50
Q

whcih drugs can cause sleeping distrubances?

A

B-blocker
Pramipexole (dopamine agonsit for P.D)

51
Q

common drugs which cause diarrhoea

A
  • omeprazole
  • co-amoxiclav
52
Q

whats the most common side effect of donepezil (first line for mild to mod dementia reversible cholinesterase inhibitor)

other info
- NSIADs use with caution
- Don’t drink alcohol on it
- should not be chewed and just dissolved under the tongue

A

diarrhoea

53
Q

dalitparin sodium is very commonly associated with immune-mediated drug induced thrombocytopenia

A
54
Q

When starting warfarin its important to tell patients to report any new bruising as a method of monitoring if the dose is too high etc.

A
55
Q

anti-emetic contraindications

cyclizine = HF
prochloroperazine = Parkinson’s
Metochlopramide = pro-kinetic so anything blocking or affecting the bowel (gastrectomy)

therefore give ondansetron

A
56
Q

paeds chronic constipation with no signs of impaction give movicol or macrogol, 1 sachet for 28 DAYS!!!!

A
57
Q

drug induced dystonia from anti-psychotic - what to give to treat

A
  1. first line = procyclidine IV
  2. second line = benzo IV (diazepam)
58
Q

drug contraindicated in ischaemic leg ulcers

A

B-blockers

ACEi are also cautioned in PVD and critical limb ischaemia

59
Q

of CCB and steroids worsen?

A

Heart failure

60
Q

what two classes of drug should you think of when candida is present?

A

antibiotics
steroids

61
Q

eplerenone is a K+ sparing diuretic a GP should check….

A

serum K+ in 1 weeks time

62
Q

mirtazepine common/ v common side effect?

A

sleep disturbances (abnormal dreams)

63
Q

before starting amioderone check 3 things (+1 extra)

A
  1. CXR
  2. Serum K+
  3. LFTs
  4. TFTs too?
64
Q

SSRIs don’t require any formal monitoring - just be weary of hyponatraemia in elderly

A
65
Q

statin dosage if you get a big rise in CK

A

If statin is suspected to be the cause of myopathy and CK increases ( > 5x normal upper limit) or if muscular symptoms are severe then:
1. discontinue treatment
2. if CK drops or symptoms resolve then reintroduce at lower dose

66
Q

naproxen can cause ankle swelling

A
67
Q

clotrimazole is given for vaginal candida in preg - it can be given on a PESSARY and usually given longer dose of 7 days

fluclonazole is not safe to give in preg

A
68
Q

when a T1 Diabetic presents with a DKA you obviously put them on a fixed rate insulin regimen of 0.1 Units/kg/hour but you KEEP THEIR LONG ACTING INSULIN

A
69
Q

herpes zoster (shingles) pai relief

A

start with paracetamol - especially in the flared up stage

Amitriptyline is given for post-herpetic neuralgia

70
Q

loperamide should be given after every loose stool

A
71
Q

Ciclosporin
- regular kidney monitoring is required

A
72
Q

most common side effect of liraglutide is vomiting

A
73
Q

peptic ulcer diease (H.pylorinegative)

  1. first line is PPI (omeprazole)
  2. Second line is H2 antagonist - rinitidine or famotidine

H.pylori infection ( triple therapy) = 7 days
1. PPI
2. Amoxicillin
3. Metronidozole or clarithromycin

pencillin allergy
PPI, Metro, Clarithro

A
74
Q

Giving emergency contraception (Ellaone) in frequency say review in 4 weeks

A
75
Q

Streptococcus agalactiae in preg think….

and treat them with…

A

Group B step

Benzylpencillin 3g IV once only

76
Q

omeprazole and carbemazepine cause hyonatraemia (as well as SSRIs)

A
77
Q

Allopurinol can be prescribed up to 900mg a day but it must be done in divided doses ie. TDS

Max that can be given in one dose is 300mg

A
78
Q

co-careldopa can cause excessive day time sleepiness - information giving on working heavy machinery and driving etc.

A
79
Q

sit down when taking GTN spray

  • causes dizziness
  • also headaches!
A
80
Q

Allendronic acid can cause dizziness - especially when interacting with oxybutinin

A
81
Q

monitoring lithium levels- take sample when?

A

12 hours post last dose

82
Q

STEPPING DOWN THE PAIN LADDER:
- start with strongest pain relief first
- stop the regular one first
- Keep strong PRN
- Then stop weak opioid
- Then NSAID
- Then paracetamol

A
83
Q

Started a statin and LFTs are raised - what should you do?

LFTs are checked at 3 months after initiation

A
  • Transaminase are raised more than 3 times upper limit of normal - stop the statin and repeat LFT in 1 month
  • Transaminase raised but NOT 3 times upper limit of normal continue statin at same dose and repeat LFTs in 1 month
84
Q

If ‘CHECK ADHERENCE’ is one of the answers- always consider this and re-read the question

A
85
Q

long term steroids in children
specifically oral prednisolone

  • obviously check height and weight
  • but also check for blood pressure and urinary glucose!
A
86
Q

simaglutide - nausea

A
87
Q

aripiprazole - check serum prolactin before and when monitoring

A
88
Q

methotrexate monitoring - U+Es, LFT, FBC every 1-2 weeks until stabilised

A
89
Q

Lithium monitoring prior:
ECG, U+Es and TFTs

A
90
Q

UTIs with renal impairment

Nitrofurantoin - don’t use if eGFR < 45. caution is 30-45.

Trimethoprim
If eGFR < 30 = dose reduction to half of normal dose after 3 days

If eGFR < 15 = dose reduction to half

A
91
Q

on max dose of metformin, what to do next?

1 of 3 possibilites to add
- Sulfonylurea (Gliclizide)
- DPP4 inhib (saxagliptin)
- GLP-1 (liraglutide)

DPP4s and GLP-1s are contraindicated in pancreatitis

A
92
Q

Drugs which can kick off a c.diffe infection

  • Clindamycin
  • ## PPIs
A
93
Q

c.diffe management

A

First line = Oral vancomycin
second line = Oral fidoxamicin

further episode
Oral fidoximicin

Life-threatening
Oral vancomycin AND IV metronidazole

94
Q

Inpatient treatment of meningitis

  • ceftriaxone give 2g BD or 4mg OD (even though it says 2-4g daily on the BNF just be on the safe side)
A
95
Q

constipation is common with all bisphosphinates

A
96
Q

check dosages of salbutamol
200 micrograms is the max dose that can be given- not 200 mg

A
97
Q

Drugs which commonly interact with lithium
- thiazide diuretics
- ACEi
- Ibuprofen (NSAIDs)

A
98
Q

Remember Tazocin is a trade name for Pip=Taz and this means if you have an allergy to this you have a penicillin allergy

A
99
Q

benzo overdose presents with Nystagmus and dysarthria and severe cases respiratory depression - pupils PEARL

A
100
Q

Tranylcypromine is a monoamine oxidase B inhibitor (MAO-Inhib)

THEY CAN INCREASE RISK OF OPIOD TOXICITY

A
101
Q

Stopping anticoags before surgery

warfarin =
DOACs (apix, rivarox, edox) =
Dibigatran =
Acenocoumarol =

antiplatelets
clopidogrel =
aspirin 75mg =

A

warfarin = 5 days before
DOACs (apix, rivarox, edox) = 1-3 days before
Dibigatran = 1-4 days before
Acenocoumarol = 3 days before

clopidogrel = 7 days
aspirin 75mg = continue as normal

102
Q

bulk forming laxative given anal fissures constipation

A