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4 - Med > PSA misc > Flashcards

PSA misc Flashcards

1
Q

what blood thinners to be avoided in pregnancy ?

A

DOACs
(apixiban, edoxiban)

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2
Q

what drug combination makes up tazocin ? so keep in mind if patient has what allergy ?

A
  • piperacillin with tazobactam
    (so beware if patient has penicillin allergy)
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3
Q

what opiates to be used in renal dysfunction ? (3)

A

Fentanyl, alfentanil and buprenorphine

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4
Q

name a contraindication to tramadol ?

A

epilepsy (lowers seizure threshold)

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5
Q

what antibiotics is contraindicated with methotrexate use ?

A

Trimethoprim, co-trimoxazole
- Potentially fatal interaction (due to severe bone marrow suppression) between MTX and trimethoprim. Interaction also applies to co-trimoxazole

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6
Q

how often is methotrexate prescribed ? what is prescribed alongside it ?

A

methotrexate is always taken weekly
- folic acid taken on a different day

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7
Q

what are the 6 rights of medicine administration ?

A
  • right patient
  • right medicine
  • right route
  • right dose
  • right time
  • right to refuse
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8
Q

when is a second check required for drug administration ?

A
  • controlled drugs
  • injectables (the prep of drugs for parenteral administration should be double checked)
  • medicine given under section 62 of MHA
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9
Q

when should an SSRi be administered ?

A

in the morning
- not at night as can affect sleep

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10
Q

when should aledronic acid be taken ?

A
  • Take alendronic acid first thing in the morning, before you have anything to eat or drink and before you take any other medicines.
  • Stay sitting or standing for 30 minutes so the medicine does not irritate your food pipe
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11
Q

when should levothyroxine be taken ?

A

once a day in the morning, ideally at least 30 minutes before having breakfast or a drink containing caffeine, like tea or coffee

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12
Q

when should a statin be taken ?

A

before going to bed

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13
Q

name some medications where timing of administration is important ? (4)

A
  • antimicrobials
  • insulin
  • nitrates (need to have at least 8 hrs nitrate free)
  • meds for Parkinson’s disease
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14
Q

where in the bnf can you find info for what dilutant should be used for an IV drug

A

directions for administration

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15
Q

name some indications for the use of warfarin ?

A
  • after prosthetic heart valve insertion
  • prophylaxis of embolisation in RHD and AF
  • prophylaxis and treatment of VTE + PE when DOAC not appropriate
  • TIA
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16
Q

what is target INR for DVT and AF ?

A

2-3 (2.5)

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17
Q

name some warfarin inducers (reduced warfarin effect)

A
  • carbamazepine
  • rifampicin
  • phenytoin
  • azathioprine
  • st johns wort
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18
Q

give some examples of warfarin inhibitors (warfarin increased effect)

A
  • amiodarone
  • clarythromycein
  • SSRI
  • fluconazole
  • omeprazole
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19
Q

what type of drug is warfarin ?

A

Vitamin K antagonist
(Inhibits vitamin K dependent clotting factors II, VII, IX,X)

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20
Q

what type of drug is apixiban ?

A

Direct factor Xa inhibitor

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21
Q

why type of drug is Dabigatran ?

A

thrombin inhibitor

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22
Q

what type of drug is morhpine ?

A

mu opioid receptor agonist

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23
Q

how is morphine excreted ?

A

really excreted - can accumulate in renal impairment
- need to know renal function and weight

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24
Q

in what presentations are opioids contraindicated ? (3)

A
  • acute abdomen
  • respiratory depression
  • head injury
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25
Q

morphine 10 mg = how much oxycodone

A

morphine 10 mg = 5 mg oxycodone
(oxycodone is good in renal impairment)

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26
Q

what is normal blood glucose range ?

A

6 – 10mmol/L (acceptable range = 4-12mmol/L)

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27
Q

what are the four key components of pharmacokinetics ?

A
  • absorption
  • distribution
  • metabolism
  • excretion
    (ADME)
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28
Q

name the enteral routes ? (4)

A
  • oral
  • sublingual
  • buccal
  • rectal
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29
Q

name the parenteral routes ? (3)

A
  • SC
  • IM
  • IV
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30
Q

to which cardiac rhythms should you administer DC shocks ? (2)

A
  • ventricular fibrillation
  • pulseless ventricular tachycardia
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31
Q

in cardiac arrest, how often do you repeat adrenaline doses ?

A

3-5 mins

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32
Q

if IV route is not feasible in cardiac arrest, what other route could be trie d?

A

intraosseous

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33
Q

CPR. what is the rate of chest compressions to breaths ? what depth of compressions ? what rate ?

A

30:2
5-6cm
100-120 bpm
(delivered on lower half of sternum)

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34
Q

what are the non-sociable rhythms in cardiac arrest ?

A
  • systole
  • pulseless electrical activity (PEA)
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35
Q

how often should you check the cardiac rhythm during a cardiac arrest ?

A

every 2 mins

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36
Q

patient has had cardiac arrest. Was in VT. what do you do after 3 shocks ?

A
  • give IV dose of adrenaline 1mg
  • give single dose of IV amiodarone 300mg
  • repeat doses of adrenaline every 3-5 mins
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37
Q

what do you do when non shockable rhythm is detected during cardiac arrest ?

A
  • give 1mg IV adrenaline
  • give 2 ins CPR before next rhythm check
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38
Q

causes of cardiac arrest
what are the 4Hs and 4Ts ?

A
  • Hypoxia
  • Hypovolaemia
  • Hypo/hyperkalaemia
  • Hypothermia
  • Tamponade
  • Thromboembolism
  • Toxins
  • Tension pneumothorax
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39
Q

what is given for managment of hyperkalaemia ?

A
  • calcium gluconate
  • insulin + dextrose
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40
Q

which medications can cause cardiac arrest ?

A
  • opioids
  • benzodiazepines
  • TCAs (amitriptyline)
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41
Q

what’s an important ADR reaction of carbimazole ?

A

bone marrow suppression

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42
Q

what do you search on bnf to find info about steroids ?

A

glucocorticoid therapy

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43
Q

what is the action of methotrexate ?

A

antagonist of folic acid

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44
Q

DOAC ADR ? (3)

A
  • bleeding
  • anaemia
  • Nausea
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45
Q

what things does a patient taking amiodarone need to be counselled about ?

A
  • sunscreen
  • breathing problems
  • vision problems
  • liver toxicity
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46
Q

methotrexate ADR ?

A
  • stomatitis
  • SJS
  • TEN
  • interstitial pneumonitis
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47
Q

ACEI ADR ?

A
  • cough
  • low BP
  • renal impairment
  • hyperkalaemia
  • angioedema (can occur after years of being on the drug all ok)
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48
Q

name some rate limiting CCB ?

A
  • diltiazem
  • verapamil
    (the other ones are called Dihydropyridine CCB - amlodipine)
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49
Q

CCB ADR ? (4)

A
  • abdo pain
  • flushing
  • headache
  • peripheral oedema
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50
Q

what dose of statin for secondary prevention of cardiovascular events ?

A

80 mg
(this is the max statin dose)

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51
Q

Name some SABAs (2)

A
  • salbutamol
  • terbutaline
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52
Q

name some LABAs (4). what do they end in ?

A

end in -rol
- olodaterol
- formoterol
- salmetarol
- indaceterol

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53
Q

name some ICS (5) what do they end in ?

A

end in -asone/-onide
- beclametasone
- budesonide
- mometasone
- cicelsondie
- fluticasone

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54
Q

name some LAMA (4). what do they end in ?

A

end in -ium
- tiotropium
- Umeclidindium
- Glycopyronium
- Aclidinium

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55
Q

what route are patches administered ?

A

transdermal (not topical)

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56
Q

what are the 3 options for emergency contraception ?

A
  • copper IUD
  • levonorgestrel
  • ulipristal
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57
Q

ulipristal contraindications

A
  • breast/ovarian/cervical/uterine cancer
  • severe asthma controlled by oral glucocorticoids
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58
Q

is parenterally or oral administration associated with worse anaphylaxis ?

A

parenteral is generally more severe
- with median cardiac arrest time from first symptom onset only 5 mins

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59
Q

common causes of allergic drug reactions ? (6)

A
  • penicillins + other beta lactams
  • NSAIDs
  • muscle relaxants
  • chlorhexidine
  • opioid analgesics
  • radio contrast media
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60
Q

what should be administered for a mild-mod drug allergy ?

A

fast acting oral antihistamine (chlorphenamine)

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61
Q

what is the adrenaline dose for an adult in anaphylaxis ?

A

500micrograms IM
- 0.5mL of 1mg/mL (1:1000)

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62
Q

when can IV route be used for adrenaline ?

A

should only be prescribed and administered by specialist physicians. pulse oximetry and ECG monitoring throughout
- may cause life-threatening arrhythmias and hypertension

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63
Q

what drug class and example can be used to help treat the skin symptoms of allergic drug reactions ?

A

non-sedating antihistamine (cetirizine)

64
Q

what drugs should be prescribed following resolution of severe anaphylactic reaction ?

A
  • prednisolone for up to 3 days
  • non-sedating antihistamine for up to 3 days
  • ensure allergy is documented
  • yellow card scheme
65
Q

when should you take timed blood test sample after an anaphlacit reaction ? what are you looking for ?

A

mast cell try-take as soon as possible after emergency treatment has started AND 1-2 hours after the onset of symptoms (but no later than 4)

66
Q

if a patient has received treatment for anaphylaxis, how long should they be observed for ?

A

6-12 hours

67
Q

in what time frame is activated charcoal useful ?

A

it binds may poison in the GI tract, helping to reduce absorption
- only likely to be useful if given within one hour of ingestion

68
Q

what is is used in Mx of paracetamol poisoning ? what route ? what time frame ?

A

IV acetylocysteine (within 8 hours of paracetamol ingestion)

69
Q

what is is used in Mx of iron poisoning ?

A

Desferrioxamine
(you can get lucid interval in iron overdose)

70
Q

what is is used in Mx of benzodiazepine poisoning ?

A

Flumazenil

71
Q

what is is used in Mx of methanol and ethylene glycol poisoning ?

A

fomepizole

72
Q

what is is used in Mx of BB toxicity ?

A

glucagon

73
Q

what is is used in Mx of warfarin poisoning ?

A

phytomenadione (vit K)

74
Q

when take plasma-paracetamol conc in suspected paracetamol overdose ?

A

take a sample between 4 and 15 hours post-ingestions
- gives indication of severity of poisoning and the degree of liver toxicity

75
Q

when can acetyl cysteine be commenced before the palms-paracetamol concentration is known ?

A
  • more than 8 hrs elapsed since overdose
  • staggered overdose
  • doubt over the time of paracetamol ingestion
76
Q

what does 1% lidocaine mean. for calculation purposes

A

1g per 100mL

77
Q

what are the two main fluid compartments ? what can this be further divided into ?

A
  • intracellular
  • extracellular
    • interstitial
    • intravascular
78
Q

difference between crystalloids and colloids

A
  • crystalloids are essentially solutions of mineral salts
  • Colloids contain larger water-insoluble molecules
79
Q

what amount of K, Na and Cl mmol/kg/day

A

1 mmol/kg/day of potassium
1 mmol/kg/day of sodium
1 mmol/kg/day of chloride

80
Q

approximately what % of total body weight in adults is made from water ?

A

50-60%

81
Q

of a 70kg man: how much today body water ? how much in inctracellular? how much interstitial ? how much intravascular ?

A

42 litres total body water
- intracellular (65% TBW): 28L
- interstitial (35% x 75%): 10.5L
- intravascular (35% x 25%): 3.5L

82
Q

what vol of water is approximate to insensible fluid losses

A

800 mL per day

83
Q

how much water needed per day ?

A

25-30 ml/kg/day of water
(around 2 - 2.5 litres per day)
20-25ml/kg/day for elderly, renal impairment, malnourished
so go with 25 !

84
Q

how much glucose required per day ?

A

50-100 g/day of glucose to limit starvation ketosis

85
Q

what counts as red flag sepsis ?

A
  • NEWS2 score > 7
  • NEWS2 score 5 or 6, plus: lactate >2, other organ failure (AKI), patient looks very unwell, patient is actively deteriorating
86
Q

what counts as amber flag sepsis ?

A
  • NEWS2 score 5 or 6
  • NEWS2 score 1 - 4 , plus: lactate >2, other organ failure (AKI), patient looks very unwell, patient is actively deteriorating
87
Q

what is cryptic shock

A

patients present with a high lactate concentration in the presence of a normal blood pressure

88
Q

what do you search bnf for to find things about the pill and HRT ?

A

conracep
(the pill, HRT, emergency contraception)

89
Q

what do you need to know about in a patient who you are prescribing the patch for contraception ?

A

their weight
>90kg it is not as effective

90
Q

when should you start the COCP ?

A

start on day 1 of menstrual cycle

91
Q

what are the withdrawal bleeds on the COCP ?

A
  • withdrawal bleeds occur during hormone free interval, not menstruation
  • withdrawal bleeds can still occur during pregnancy (cannot rely on this for pregnancy status)
92
Q

what are rules for COCP and POP before surgery ?

A
  • COCP needs to be held for 4 weeks before major surgery
  • POP does not need tube held prior to surgery
93
Q

emergency contraception: levonorgestrel.
what time window ?
how many times per cycle ?
how BMI effect ?

A
  • 72 hour window (3 days)
  • more than once per cycle is allowed, but increase SE risk
  • double dose required in high BMI
94
Q

emergency contraception: ulipristal.
what time window ?
how many times per cycle ?
how BMI effect ?
contraindications ?

A
  • 120 hr time window (5 days)
  • more than once per cycle is allowed
  • can be used in high BMI
  • CI: breast/ovarian/cervical/uterine cancers, severe asthmas controlled by oral glucocorticoids
95
Q

which is more effective: ulipristal or levonorgestrel ?

A

ulipristal

96
Q

what is HRT ? what hormone ?

A

a small dose of oestrogen for alleviating the symptoms of menopause given if premenopausal or postmenopausal
- given with progesterone if the woman has a uterus

97
Q

when cyclical or continuous progesterone for HRT ?

A

continuous not to be used in perimenopause or within 12 months of last period
- progesterone free period causes withdrawal bleeds
(so usually initial: oestrogen plus cyclical progesterone)

98
Q

HRT comes in many formulations. what a good one to remember with lots of formulations ?

A

estradiol with norethisterone
- tablets, cyclical patch, continuous patch

99
Q

name some crystalloids ?

A
  • sodium chloride
  • Hartmans
  • dextrose 5%
    (NaCl, Hartmans can be used for resus)
100
Q

what pads rhesus fluids ?

A

sodium chloride 0.9% 10Ml/kg over <10 mins

101
Q

what is maximum infusion rate of potassium ?

A

10mmol/hr

102
Q

what does potassium 0.3 % mean ?

A

potassium 0.3 means there is 40mmol potassium in 1 litre, or 20mmol potassium in 500ml

(0.15% is the paediatric value)

103
Q

adult hypoglycaemia mx ?

A

150ml glucose 10% in less than 15 minutes

(glucose 10% x 15 mins = 150mls)

104
Q

what info do you need to submit a yellow card ?

A
  • identifiable patient
  • identifiable reporter
  • a suspect reaction
  • a suspect drug
105
Q

what is type A drug reaction ? (4)

A

dose-related
common, predictable
related to the pharmacology
unlikely to be fatal
(like digoxin toxicity, or constipation with opioid analgesics)

106
Q

what is type B ADR ?

A

type b (bizzarre)
- not dose related (within therapeutic dose range)
- uncommon, unpredictable
- not related to the pharmacology
- often fatal

107
Q

what is the yellow card scheme ?

A

the yellow card scheme in the UK collects spontaneous reports of suspected ADRs

108
Q

mx of conscious person with diabetes ?

A

mild hypo can be reversed in about 10 mins with 15 - 20g of a quick acting carbohydrate
- then check blood glucose after 10 - 15 mins
- if still remains <4 mmol/litre after 3 cycles, then administer IM glucagon

109
Q

mx of conscious confused person with hypo ?

A

same as mild but give 2 tubes of 40% glucose gel (squeeze into the mouth between the teeth and gums)

110
Q

tamoxifen SE ?

A
  • increase risk of blood clots
  • hot flushes
111
Q

what are the sick day rules for steroids ?

A

double steroid doses to avoid adrenal insufficiency

112
Q

when does the BNF suggest gradual withdrawal of systemic corticosteroids for patients ?

A
  • received more than 40mg prep daily for more than one week
  • received more than 3 weeks treatment
  • recently received repeated courses
113
Q

what fluids should be avoided in patients who have had a stroke ? why ?

A

5% glucose should be avoided due to the increased risk of cerebral oedema

114
Q

what route of oxygen should be administered in patients who are critically ill (anaphylaxis, shock) ?

A

oxygen should initially be given via a reservoir mask at 15l/min
(hypoxia kills)

115
Q

describe the oxygen managment for COPD patients ? prior to blood gas ? then what ?

A
  • prior to blood gases, use a 28% Venturi mask at 4 l/min and aim for an oxygen saturation of 88-92%
  • adjust target range to 94-98% if the pOC2 is normal
116
Q

how many mmol of sodium in one litre bag of 0.9% normal saline ?

A

154 mmol

117
Q

if large vols of saline are used, what blood gas is there risk of ?

A

increased risk of hyperchloraemic metabolic acidosis

118
Q

what is the maximum concentration of potassium chloride that can be administered via peripheral route ?

A

40 mmol/litre
(infusions exceeding this should be given vie central IV route

119
Q

what is the max rate of infusion of potassium per hour - normally ? in emergency ?

A
  • shouldn’t no normally exceed 10 mmol/hour
  • up to 20 mmol/hour in an emergency situation
120
Q

what is given to protect the heart in hyperkalaemia ?

A

10 ml of calcium gluconate 10 % solution, by slow IV injection over 3-5 minutes

121
Q

what impact does renal function have on gentamicin ?

A

any impairment in renal function can cause reduced elimination of gentamicin form the body and a high serum-gentamicin concentration as a result.

122
Q

how quickly should gentamicin infusions be done ?

A

via IV infusion over at least 60 mins

123
Q

what is used to calculate doses of gentamicin ?

A
  • calculated using the actual body weight
  • unless patients weight is 20% heavier than IBW or has BMI more than 30
124
Q

when should you measure vancomycin levels ?

A

measure levels after 36-72 hours (3-6 doses)

125
Q
A
125
Q

how often should HbA1c levels be monitored in T1DM ?

A

every 3 - 6 months

126
Q

which drugs may exacerbate heart failure ?

A
  • thiazolidinediones (Pioglitazone)
  • verapamil (negative inotropic effect)
  • NSAIDs/glucocorticoids (can cause fluid retention)
  • flecanide
127
Q

what is the therapeutic range of lithium ? when should you take this measurement ?

A

range = 0.4 - 1.0 mmol/l
take 12 hours post-dose

128
Q

what drug can be given to reverse the effects of warfarin ?

A

phytomenadione

129
Q

how is digoxin excreted ?

A

renal excretion
(digoxin has long half-life of 20-50 hours which can extend to 100 hours in renal dysfunction)

130
Q

what is the form of lithium that is oral tablets ?

A

lithium carbonate
(lithium citrate is oral liquid)

130
Q

what electrolyte imbalance exacerbates lithium toxicity ?

A

sodium depleted

131
Q

what is the general rule with antidepressants and breast milk ?

A

if a medicine enters the CNS (antidepressant) it will enter the milk

132
Q

describer aspects of a drug that are associated with reduced passage into breast milk ?

A
  • high molecular weight
  • high protein binding
  • low lipid solubility
  • Lower pH
133
Q

what can be given to stop milk supply

A

cabergoline 1 mg

134
Q

which analgesics are safe during breast feeding ?

A
  • paracetamol
  • NSAIDs
  • NOT Opioids (only prescribe for short time)
135
Q

what is the first line treatment of depression in breast feeding mothers ?

A

SSRIs (sertraline)

136
Q

how to you adjust the gentamicin dose when the trough levels are too high ?

A

the interval between the doses should be increases if the trough levels are raised ? (switch from QDS to BD)

137
Q

which medications are usually prescribed weekly in the UK ?

A
  • bisphosphonates
  • methotrexate
138
Q

if large volumes of 0.9% saline are used, what is there risk of ? what acid/alkalosis ?

A

hyperchloraemic metabolic acidosis ?

139
Q

therapeutic drug monitoring. when do you test ciclosproin levels ?

A

trough levels immediately before dose

140
Q

therapeutic drug monitoring. the do you test digoxin levels ?

A

at least 6 hrs post-dose (so often immediately before next dose is given)

141
Q

how to you adjust peak and trough levels when too high ?

A
  • if the trough (pre-dose) level is high the interval between the doses should be increased
  • if the peak (post-dose) level is high the dose should be decreased
142
Q

what drugs are contraindicated in severe liver disease ?

A
  • NSAIDs
  • ACEI
  • paracetamol
  • co-amoxiclav, flucloxacillin
  • methotrexate
  • amiodarone
143
Q

what dose of acutely ingested paracetamol can lead to lever damage ? in what time frame ?

A

150 mg/kg in less than one hour

144
Q

a decrease in first-pass metabolism has what effect on the oral bioavailability ?

A

increase the oral bioavailability of some drugs (even to 100% - same as IV)

145
Q

describe how to calculate maintenance fluids over 24 hrs in kids. by weight

A

100ml/kg for the first 10 kg
50 ml/kg for the next 10kg
20 ml/kg for every remaining kg

146
Q

how should bisphosphnoates be taken ?

A

tablets should be swallowed whole with plenty of water while sitting or standing, to be taken on an empty stomach at least 30 minutes before breakfast

146
Q

how to you calculate fluid deficit in children ?

A

deficit = % dehydration x weight (kg) x 10

147
Q

which drugs should be used with caution in patients with ischaemic heart disease ? (3)

A
  • NSAIDs
  • oestrogens (COCP, HRT)
  • varenicline
148
Q

which drug is licensed for use in milk to moderate Parkinson’s disease dementia ?

A

rivastigmine

149
Q

what mode stabilisers recommended for med naive patients for mania or hypomania ?

A
  • haloperidol
  • olanzapine
  • quetiapine
  • risperidone
150
Q

1st 2nd 3rd line for bipolar

A
  • 1st: lithium
  • 2nd: valproate, olanzapine
  • 3rd: carbamazepine, lamotrigine
151
Q

how long until lithium is effective ?

A

can take 10 - 14 days to be effective
(take 4 - 7 days to reach steady state)

152
Q

what effect on kidneys do ACEI have on?

A

inhibit vasoconstriction of efferent arterioles

4 - Med (16 decks)

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