PSA: Mocks Flashcards
List the drugs you stop prior to surgery (7)
I LACK OP
Insulin Lithium Anticoag/pl COCP/HRT K-Sparing Diuretics Oral Hypoglycaemics Perindopril/ACEi
Why do you stop metformin before surgery?
The NBM predisposes to lactic acidosis
What should you do with pts on insulin prior to surgery?
Sliding Scale
How long before surgery do you stop COCP/HRT?
4w
How long should you wait before starting the COCP again after surgery?
2wks after full mobilisation
How long before surgery do you stop aspirin?
7d
How long before surgery do you stop lithium?
Day Before
How long before surgery do you stop K-Sparing Diuretics and ACEi?
Day of Surgery
What drugs should you NOT stop before surgery?
Antiepileptics Antiparkinsonian Antipsychotics Anxiolytics Cardiovascular Bronchodilators Immunosuppressants Drugs of Dependence Thyroid/Antithyroid Glaucoma
When do you start insulin in NBM pts who were on metformin?
If metformin is more than OD or BM >12 on two consecutive occasions
When do you recommence metformin following surgery?
The pt is eating/drinking and has normal renal function
How can you maximise the absorption of rivaroxaban?
Take w food at the same time each day
Tx of Hypoglycaemia
Conscious - Glucotabs x5 PO STAT
No IV Access - Glucagon 1mg IM STAT
Yes IV Access - 10% Dextrose 150mL IV over 15mins
Why is 50% dextrose NOT recommended for use anymore?
Risk of extravasation injury and the viscosity makes administration difficult
What is the most common SE of furosemide?
Dizziness
What are the UKMEC4 for CHC?
Age >=35 AND smoking >=15 cigarettes/day
Postpartum: other VTE RF b/w 0-3wks OR breast feeding b/w 0-6wks
Others: >=160/100 BP, vascular disease, IHD, stroke, AF, VTE, known thrombogenic mutation, positive antiphospholipid abs, major surgery w prolonged immobilisation, migraine w aura, current breast cancer, HCA/HCC, decompensated liver cirrhosis
What should you check before prescribing an OCP?
The UKMEC criteria for CHC vs POP
MOA of Salbutamol vs Ipratropium
B2 Agonist + Anti-Muscarinic
What is the dose of adrenaline for anaphylaxis in children?
150mcg: 1m-5y
300mcg: 6y-11y
500mcg: 12y-17y
How do you write out the dose for adrenaline in anaphylaxis and cardiac arrest in adults?
Make sure you specify if 1:1,000 or 1:10,000
Anaphylaxis - IM
0.5mg (0.5mL of 1:1,000)
Cardiac Arrest - IV
1mg (10mL of 1:10,000)
Where is IM adrenaline administered?
Into the anterolateral aspect of the middle third of the thigh
What should you offer pts <=84yrs if their QRISK is >=10%?
PO Atorvastatin 20mg ON
Which vaccines are pregnant women advised to have?
Whooping Cough + Flu
Which vaccines are CI in pregnancy?
Live: MMR, chicken pox, yellow fever, BCG, typhoid
What are the common DOACs?
Apixaban
Rivaroxaban
Dabigatran
What are the common LMWH’s?
Enoxaparin
Dalteparin
Tinzaparin
What are the indications for enoxaparin?
Prophylaxis of DVT/PE: mod-sev surgical + medical pts
Tx of DVT/PE: uncomplicated w low risk of reoccurrence, RFs, pregnancy
Tx of MI: acute STEMI +/- PCI, NSTEMI, unstable angina
When is LMWH taken around surgery?
At 12hrs pre-op and then every 24hrs following
What is now the first line tx for suspected PE?
An anticoag that can be continued once the PE is confirmed: apixaban/rivaroxaban
At which HbA1c is dual therapy advised?
> 58 despite max doses of metformin
What is given as fluid resus?
0.9% Sodium Chloride 500mL IV over 15mins
When can you give 250mL fluid bolus for resus?
Pt w HF to avoid precipitating pulmonary oedema but even then it’s unlikely not to give 500mL
Abx in Pregnancy
Safe: penicillin, cefalexin, erythromycin
Avoid: other macrolides, tetracyclines, fluoroquinolones, nitroimidazoles (late preg), trimethoprim (early preg)
Tramadol SEs
Agitation + Hallucinations
When should alendronic acid be taken?
On an EMPTY stomach ie >30mins before breakfast or another oral medicine and sit upright during this time
Which drugs cause mydriasis?
MDMA
Cocaine
Amphetamines
What is used to assess the effectiveness of prednisolone for PMR?
The severity of muscle pains
How is the dose of prednisolone reduced for PMR?
Start at 15mg OD until sx are fully controlled then 12.5mg 3wks, 10mg 4-6wks and thereafter a reduction of 1mg every 4-8wks until stopped
What should PMR pts seek urgent medical attention?
Any sx of temporal arteritis ie unilateral headache, scalp tenderness, jaw claudication, visual disturbance
Adenosine SEs
Chest Tightness + Hypotension
Sx of Lithium Toxicity
Diarrhoea Vomiting Drowsiness Tremor Thirst Urination Weakness Confusion Ataxia
How do ACEi cause hyperK?
Dec Angiotensin II
Dec Aldosterone
Dec Na + Inc K
HyperK ECG
- Peaked T Waves
- Small P Waves
- Inc PR Interval
- Broad QRS
What should you add to maintenance fluids?
KCl
What are the normal daily fluid and electrolyte requirements?
25-30 ml/kg/d H2O
1 mmol/kg/d Na, K, Cl
50-100 g/day Glucose
What is the best way to specify the type of preparation of miconazole?
Prescribe ‘Miconazole Gel/Cream/Spray’
When should pts on carbimazole seek immediate medical advice?
Any fevers/sore throat to check for agranulocytosis
Precipitates Hyperglycaemia
Glucocorticoids
Precipitates Hyperlipidaemia
Thiazide Diuretics
Aminoglycosides
Gentamicin Amikacin Tobramycin Streptomycin Neomycin
Fluoroquinolones
Ciprofloxacin
Levofloxacin
Moxifloxacin
What is used to assess the effectiveness of abx for CAP?
CRP: changes more rapidly than ESR/WCC
Tx of Status Epilepticus
Once only of either:
Diazepam 10mg Rectal
Midazolam 10mg Buccal
Lorazepam 4mg Intravenous
Repeat @ 10-20mins if no response
IV Paracetamol Dosing
<50kg: 15mg/kg every 4-6hrs over 15mins w max 60mg/kg/d
> =50kg: 1g every 4-6hrs over 15mins w max 4g/d
What is the first line tx of HTN in pregnancy w/o asthma?
Labetalol
Analgesia + Alcoholic Liver Disease
Avoid NSAIDs (risk of bleeding) and opioids (hepatic encephalopathy)
RFs for Drug-Induced Psoriasis
Obesity Diabetes Hypertension Dyslipidaemia Smoking
What is the acceptable range of blood glucose for a type 1 diabetic pre-op?
4-12mmol/L
What is the general guide to giving supplementary doses of insulin?
If you can’t ask the pt use 100/TDD or that one unit will roughly drop blood glucose by 3mmol/L
What would be the indication to postpone surgery in a pt w T1DM?
Blood Glucose >=12mmol/L
And: capillary blood ketones >3 or urinary ketones >+++
Tx of HyperCa
0.9% Sodium Chloride 1L IVI over 1hr + then recheck the calcium after
Morning Sickness vs Hyperemesis
None of: >5% wt loss, dehydration, electrolyte imbalances
Tx of Hyperemesis in Early Preg
Antiemetics +/- Fluids
- Oral/IM Antihistamine eg Cyclizine/Promethazine
- Oral Metoclopramide/Ondansetron
What is the usual dose of atenolol for HTN/angina?
25-100mg
Precipitates Hypoglycaemia
Thiazolidinedione eg Pioglitazone/Rosiglitazone
Statins + Warfarin
Inc INR by competitive inhibition of CYP-450 metabolism
Monitor: Simvastatin/Atrovastatin
Avoid: Fluvastatin/Rosuvastatin
List the abx that should NOT be mixed with alcohol (4)
Metronidazole
Tinidazole
Sulfamethoxazole
Trimethoprim
When would a dose of 5mg > 400mcg folic acid by required during first 12wks of pregnancy?
If at high risk of conceiving a child with a neural tube defect: prev infant w defect, on anti-epileptics, has diabetics/sickle cell disease
Antihistamines: Sedating vs Non-Sedating
Sedating: chlorphenamine, hydroxyzine, promethazine
Non-Sedating: cetirizine, fexofenadine, loratadine
Tx of Uncomplicated Chlamydia
- PO Doxycyline 100mg BD 7d
2. PO Azithromycin 1g x1
Tx of Uncomplicated Gonorrhoea
- IM Ceftriaxone 1g x1
2. PO Ciprofloxacin 500mg x1
Tx of Scabies
- Apply topical permethrin 5% cream given as two applications 7d apart and washed off after 8-12 hrs
- Add oral ivermectin 200mcg/kg if hyperkeratotic or failure to respond to first line topical tx alone
Tx of Reflux in Infants
Breastfed:
- Breastfeeding Assessment
- Trial 1-2wk Gaviscon Infant
Formula:
- Review Feeding Hx
- Trial Dec Amount Inc Freq
- Trial Thickened Formula
- Trial 1-2wk Gaviscon Infant
Medical:
Trial 4wk Omeprazole/Ramitidine
Sugical:
Nissen Fundoplication
Tx of OAB
Oxybutynin Hydrochloride Immediate-Release
What should you specify when prescribing oramorph PRN?
Set a time limit eg 4hrly
What should you put as the dose for permethrin 5% cream?
‘1 application topical once a week’
SSRI + Triptans
Serotonin Syndrome
Which class of oral hypoglycaemics inc risk of UTI?
Gliflozins
CCB SE
Leg Swelling
Px of Impetigo
Child w several pustulated areas on the face which form a yellow crusted lesion when they burst
Tx of Impetigo
All one application to the skin three times a day for 5d:
- Topical Hydrogen Peroxide 1% Cream
- Topical Fusidic Acid 2% Cream
- Topical Mupirocin 2% Cream
When do you use oral vs IV rehydration in children?
Preferable to use ORS even if hypernatremic unless:
- Shock (different parameters inc HR/RR and dec BP than adults)
- Red Flags (sunken eyes, red skin turgor, unresponsive)
- Persistently vomits the ORS
When do you half the starting dose of allopurinol? (2)
Elderly or Hepatic Impairment
Clozapine SE
Agranulocytosis
How do you monitor clozapine?
Differential WBC wkly for 18wks - fortnightly for 1yr
How do you monitor NOACs?
Not routinely as unreliable BUT for active bleeding
Tx of Mastitis
If infected nipple fissure, sx not improving after 12hrs despite effective milk removal, pos culture:
- Flucloxacillin 500mg Oral QDS
- Erythromycin 500mg Oral QDS
What should be monitored prior to and then annually after commencing the COCP?
BP + BMI
Tx of Variceal Upper GI Bleeding: Before Endoscopy
A-E + IV Terlipressin 2mg every 4hrs
Tx of Non-Variceal Upper GI Bleeding: After Endoscopy
A-E + IV Omeprazole 80mg over 1hr
When should you NOT prescribe hypnotics?
Routinely they’re for the acutely distressed
Elderly/Pregnant/Breastfeeding
How do you induce a withdrawal bleed in a woman w prolonged amenorrhea ie less than one period every 3m?
Prescribe a cyclical progestogen and refer for a TVUS to assess endometrial thickness: medroxyprogesterone acetate 10mg oral once a day
Tx of IDA
- Ferrous Sulphate 200mg TDS
2. Ferrous Gluconate 300mg QDS
Tx of Opioid Dependence
- Buprenorphine 4mg SL OD
2. Methadone 10mg PO OD
What are the different types of laxatives?
Osmotic: Lactulose + Movicol
Stimulant: Senna + Picolax
Bulk Agents: Ispaghula Husk + Methylcellulose
Stool Softeners: Docusate Sodium + Arachis Oil
Which type of laxative should be used in pts w anal fissures?
Lactulose
Which type of laxative should be used in pts w haemorrhoids?
Ispaghula Husk
When should alendronic acid be stopped?
After 10yrs where mx should be taken on a case-by-case basis
Tx of Hyperthyroidism
- Propranolol
2. Carbimazole (or propylthiouracil if pregnant)
COCP
Microgynon 30 One Tablet PO Daily
POP
Cerazette 75mcg PO Daily
Tx of Bell’s Palsy
If px within 72h give pred
Which heparin should you give to renal failure pts?
Unfractionated
Tx for Chemotherapy Related N+V
Low risk of sx then metoclopramide vs high risk of sx then ondansetron
When would you seek expert help during fluid resus?
> 2000mL given OR pt is in shock
When are NG fluids or enteral feeding preferred?
When maintenance needs are more than 3 days
When would you consider prescribing less maintenance fluids i.e. 20-25mL/kg/day?
Older/frail, cardiac failure, renal impairment, malnourished, risk of refeeding syndrome
How do you quickly navigate the BNF and CKS?
BNF - click on the prefill dropbox do NOT type the drug in full and press return
CKS - pick the letter and control F do NOT search for the condition
Which type of monitoring qs can you find in the BNF?
Only drug toxicity NOT efficacy
Why shouldn’t you go on prescribing information in CKS?
The info we’ll need for the qs requiring CKS will be in mx
What are the CIs to all penicillins?
If it’s a LT infection give penicillin unless prev anaphylaxis
But for all other infections use an alternative if there’s any hx of a rash
Which other class of abx may a pt w penicillin allergy react to?
Cephalosporins
Tx of Meningitis
GP: IM Benzyl Penicillin
Hosp: IV Co-Trimoxazole
What should you do if you’d advise more than one option?
Pick the life saving one
When would pioglitazone or gliclazide NOT be appropriate?
Pioglitazone: high risk of bladder cancer
Gliclazide: elevated BMI
Tx of Chronic Asthma
- SABA
- SABA + Low ICS
- SABA + Low ICS + LTRA
- SABA + Low ICS + LABA +/- LTRA
- SABA + Low MART +/- LTRA
- SABA + Med MART +/- LTRA
- Inc MART Dose or Add Aminophylline
Tx of Long-Term COPD
- SABA + SAMA
- If signs of asthma or good steroid response: no add LABA+LAMA OR yes add LABA+ICS
- SABA + LABA + LAMA + ICS
Tx of Chronic HTN
<55yrs / T2DM: ACEi/ARB
> 55yrs / Afro-Caribbean: CCB
Then add the other one/thiazide on before taking all three
Tx of Renal Calculus
Diclofenac
Topical Corticosteroids
Mild: hydrocortisone 0.1-2.5% cream
Mod: clobetasone butyrate 0.05% cream
Potent: diflucortolone valerate 0.1% cream
V Potent: clobetasol propionate 0.5% cream
Prophylaxis/Tx of Infected Dog/Cat Bite
Co-Amoxiclav
Tx of PCP
Co-Trimoxazole
Tx of Acute Otitis Media
Paracetamol
Ibuprofen
Amoxicillin
Tx of Pityriasis Versicolor
Ketoconazole
Tx of Strep Pneumoniae CAP
Tazocin + Meropenem
Tx of Lyme Disease
Oral doxycycline unless CNS involvement therefore IV ceftriaxone is used
Tx of BV
- PO Metronidazole
2. Topical Clindamycin
Tx of AD
- Donepezil
2. Memantine
Who is at high risk of refeeding syndrome?
Lost >15% BW within the last 3-6m
Little/no nutritional intake for >5d
What is the most important abnormality to correct in refeeding syndrome?
Phosphate Polyfusor 50mL IV Over 12hrs
Which anaemia can aspirin cause?
IDA
Urinary Retention
Anticholinergics Alpha Agonists Antihistamines Alcohol Benzos CCBs NSAIDs GA
What is HRT a/w?
Inc risk of breast cancer
Why is oestrogen only hrt NOT given to women with an intact uterus?
Inc risk of endometrial cancer
When should you stop HRT?
> 160/95 BP
At which level of serum transaminases should prompt the discontinuation of statin therapy?
> 3x Upper Limit
At what fentanyl level can pts use nasal for breakthrough pain?
25mcg
Nasal Fentanyl Spray
Max 50mcg into one nostril, repeat in 10mins, wait another 4hrs
