PSA Incorrect Qs Flashcards
Hypoglycaemia fluid treatment
% and volume of dextrose? over how long?
10% dextrose (100-200mL) over 15 minutes (up to 20 mins)
Tacrolimus dose: (prevent kidney rejection)
- Initial dose post-transplant =
- Maintenance dose =
Initial dose post-transplant = 200 - 300 micrograms/kg (70kg male 10mg every 12 hours)
- Maintenance dose = 1-2mg 12 hourly
Drugs which can contribute to hyperkalaemia
ACEi
Dalteparin Sodium (rare)
Tacrolimus (in preg?)
Withhold allopurinol until renal function recovers
Antiplatelets should be stopped how long before surgery?
Clopidogrel should be stopped 7 days before surgery
ILACKOP
- 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)
common drugs which can cause hyponatramia (2)
SSRI
Thiazide diuretics
common b blocker side effect?
Fatigue (NOT SEDATION)
Erectile dysfunction
flucloxacillin can cause what side effect?
Cholestatic jaundice
when starting an ACEi a small rise in Cr can be expected as and continued as long as its less than….
< 20% rise
check benefits of ACEi in Heart failure by monitoring…. (as an outpatient)
exercise tolerance!
what investigation should you use 2 weeks after starting ciclosporin?
U+E and serum Cr - it is nephrotoxic
increase long term insulin by 10%! especially if blood glucose rises when steroid is increased
No change in statin is needed if after 3 months of treatment >40% in non-HDL cholesterol has occurred
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
Nitrofurantoin should be avoided in who? (investigation)
eGFR < 45
can be used with caution if eGFR 30 - 44
stopping warfarin 5 days before elective surgery
you dont need formal anticoag unless … (2)
If not then give…
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
Rivaroxaban should be given…
with food!
Prescribe ACEi in the evening/ at night why?
Postural hypotension
When prescribing GTN it naturally comes in 400micrograms spray so in the dose section put 2 sprays or 2 tablets
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.+/-
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
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)
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
metformin should be stopped day before surgery - lactic acidosis
aspirin should also be stopped but not 75mg dose?
long term steroids should be AMENDED for surgery - why?
If its adrenal insuff. then they might not be able to amount a stress response - therefore anaesthetist might have to increase!
ALWAYS CHECK THE UNITS!!!!
lithium toxicity
stop ACEi and Diuretics - they stop excretion
if you do need a diuretic then use furosemide
Best way to monitor tacrolimus levels?
Trough level prior to morning dose
Monitoring DKA has resolved by what? (2)
Ketones < 0.6mmol/L
Bicarbonate > 15
Vancomycin
What should be the pre-dose trough level?
Look at BNF!
10-15mg/L
Amlodipine side effects
- facial flushing
- peripheral oedema
- hypotension
Opioids but also what other common drug can cause constipation?
Cyclizine
INR too high and they’re bleeding, what should you do?
Give Vit K by slow IV infusion
If someone’s having an allergic reaction mild (pruritis and macular rash) with NO SIGNS of anaphylaxis give what?
Oral chlorphenanine (anti-histamine)
- IM adrenaline or IV hydrocortisone not needed
Hypoglycaemia
Conscious give =
Unconscious give =
Why is 50%. IV Glucose not advised?
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
don’t take bendrofluthiazide at night- why?
up all night pissing!
cyclize and metroclopramide should be given what hourly?
8 hourly?
elderly dose for citalopram (>65yo) is max …
elderly 20mg
adult can go up to 40mg
how long ferrous sulfate given for in iron def anaemia?
Until Hb is normal and then for 3 months after
maintenance fluids - in elderly patients give how much?
2L instead of the standard 3L (2 bags instead of 3)
UC more than 6 bowel movement is considered a severe flair therefore give what
IV hydrocortisone 100mg 6 hourly
life threatening hypogylcaemia advice to tell a T1DM in young adults?
Alcohol excess can cause severe hypoglycaemia