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
how do you choose between weak opioids tramadol and codeine?
tramadol =
codeine =
Tramadol avoided in elderly becuase can cause agitation, hallucinations
constipation more constipating
first line med for GAD?
citalopram or sertraline
when should you assess plasma-digoxin levels?
at least 6 hours after dose
before starting sodium valproate check what?
LFTs
signs to check for aminophylline toxicty?
check serum levels
check 18 hours after giving and should be between 10-20 mg/L
a new rash on fluoxetine could show signs of impending system reaction so check at 2 weeks!
Managing impetigo
systemically well
1. first line =
2. if not suitable already tried =
3. Third line =
systemically unwell
1.
If MRSA
1.
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
dose of insulin given to adult in DKA
dose of insulin given to child in DKA
Actrapid 0.1Units/kg/hour IV
Bacterial meningitis inpatient what abx do you give?
Cetriaxone
can give Cefotaxime
whcih drugs can cause sleeping distrubances?
B-blocker
Pramipexole (dopamine agonsit for P.D)
common drugs which cause diarrhoea
- omeprazole
- co-amoxiclav
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
diarrhoea
dalitparin sodium is very commonly associated with immune-mediated drug induced thrombocytopenia
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.
anti-emetic contraindications
cyclizine = HF
prochloroperazine = Parkinson’s
Metochlopramide = pro-kinetic so anything blocking or affecting the bowel (gastrectomy)
therefore give ondansetron
paeds chronic constipation with no signs of impaction give movicol or macrogol, 1 sachet for 28 DAYS!!!!
drug induced dystonia from anti-psychotic - what to give to treat
- first line = procyclidine IV
- second line = benzo IV (diazepam)
drug contraindicated in ischaemic leg ulcers
B-blockers
ACEi are also cautioned in PVD and critical limb ischaemia
of CCB and steroids worsen?
Heart failure
what two classes of drug should you think of when candida is present?
antibiotics
steroids
eplerenone is a K+ sparing diuretic a GP should check….
serum K+ in 1 weeks time
mirtazepine common/ v common side effect?
sleep disturbances (abnormal dreams)
before starting amioderone check 3 things (+1 extra)
- CXR
- Serum K+
- LFTs
- TFTs too?
SSRIs don’t require any formal monitoring - just be weary of hyponatraemia in elderly
statin dosage if you get a big rise in CK
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
naproxen can cause ankle swelling
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
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
herpes zoster (shingles) pai relief
start with paracetamol - especially in the flared up stage
Amitriptyline is given for post-herpetic neuralgia
loperamide should be given after every loose stool
Ciclosporin
- regular kidney monitoring is required
most common side effect of liraglutide is vomiting
peptic ulcer diease (H.pylorinegative)
- first line is PPI (omeprazole)
- 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
Giving emergency contraception (Ellaone) in frequency say review in 4 weeks
Streptococcus agalactiae in preg think….
and treat them with…
Group B step
Benzylpencillin 3g IV once only
omeprazole and carbemazepine cause hyonatraemia (as well as SSRIs)
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
co-careldopa can cause excessive day time sleepiness - information giving on working heavy machinery and driving etc.
sit down when taking GTN spray
- causes dizziness
- also headaches!
Allendronic acid can cause dizziness - especially when interacting with oxybutinin
monitoring lithium levels- take sample when?
12 hours post last dose
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
Started a statin and LFTs are raised - what should you do?
LFTs are checked at 3 months after initiation
- 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
If ‘CHECK ADHERENCE’ is one of the answers- always consider this and re-read the question
long term steroids in children
specifically oral prednisolone
- obviously check height and weight
- but also check for blood pressure and urinary glucose!
simaglutide - nausea
aripiprazole - check serum prolactin before and when monitoring
methotrexate monitoring - U+Es, LFT, FBC every 1-2 weeks until stabilised
Lithium monitoring prior:
ECG, U+Es and TFTs
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
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
Drugs which can kick off a c.diffe infection
- Clindamycin
- ## PPIs
c.diffe management
First line = Oral vancomycin
second line = Oral fidoxamicin
further episode
Oral fidoximicin
Life-threatening
Oral vancomycin AND IV metronidazole
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)
constipation is common with all bisphosphinates
check dosages of salbutamol
200 micrograms is the max dose that can be given- not 200 mg
Drugs which commonly interact with lithium
- thiazide diuretics
- ACEi
- Ibuprofen (NSAIDs)
Remember Tazocin is a trade name for Pip=Taz and this means if you have an allergy to this you have a penicillin allergy
benzo overdose presents with Nystagmus and dysarthria and severe cases respiratory depression - pupils PEARL
Tranylcypromine is a monoamine oxidase B inhibitor (MAO-Inhib)
THEY CAN INCREASE RISK OF OPIOD TOXICITY
Stopping anticoags before surgery
warfarin =
DOACs (apix, rivarox, edox) =
Dibigatran =
Acenocoumarol =
antiplatelets
clopidogrel =
aspirin 75mg =
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
bulk forming laxative given anal fissures constipation
