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Medicine and Surgery Mushkies > PSA Mushkies > Flashcards

PSA Mushkies Flashcards

1
Q

PRN drug 2 instructions?

A
  1. Indication

2. Maximum frequency

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2
Q

Abx 2 instructions?

A
  1. Indication

2. Stop/review date

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3
Q

Enzyme inducers?

A

PC BRASSS

  1. Phenytoin
  2. Carbamazepine
  3. Barbiturates
  4. Rifampicin
  5. Alcohol (Chronic)
  6. Sulfonylureas
  7. St Johns Wort
  8. Smoking
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4
Q

Enzyme inhibitors?

A

AO DEVICES GR

  1. Allopurinol, antifungals, amiodarone
  2. Omeprazole
  3. Disulfiram
  4. Erythromycin
  5. Valproate
  6. Isoniazid
  7. Clarithromycin, ciprofloxacin
  8. Ethanol (acute)
  9. Sulphonamides, SSRIs
  10. Grapefruit juice
  11. Ritonavir
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5
Q

Drugs to stop before surgery?

A

I LACK OP

  1. Insulin
  2. Lithium
  3. Anticoagulants/antiplatelets
  4. COCP/HRT
  5. K-sparing diuretics
  6. Oral hypoglycaemics
  7. Perindopril and other ACEi
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6
Q

When to stop COCP/HRT before surgery?

A

4 weeks before surgery

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7
Q

When to stop lithium before surgery?

A

Day before surgery

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8
Q

When to stop K-sparing diuretics and ACEi before surgery?

A

Day of surgery

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9
Q

When to stop anticoagulants and antiplatelets before surgery?

A

Variable

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10
Q

When to stop oral hypoglycaemics before surgery?

A

Variable

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11
Q

New drug chart, what must be on front?

A

3 pieces of patient-identifying information

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12
Q

Prescription review?

A

PReSCRIBER

  1. Pt details
  2. Reaction (allergy + rxn)
  3. Sign front of chart
  4. Contraindications for each drug (check)
  5. Route for each drug (check)
  6. IV fluids if needed
  7. Blood clot prophylaxis if needed
  8. anti-Emetic if needed
  9. pain Relief if needed
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13
Q

3 drugs that increase bleeding?

A
  1. Aspirin
  2. Heparin
  3. Warfarin
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14
Q

Why is prophylactic heparin contraindicated in acute ischaemic stroke for at least 2 months?

A

Due to risk of bleeding into stroke

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15
Q

S/e of steroids?

A

STEROIDS

  1. Stomach ulcers
  2. Think skin
  3. oEdema
  4. Right and left HF
  5. Osteoporosis
  6. Infection (Candida)
  7. Diabetes (Hyperglycaemia)
  8. Syndrome (Cushings)
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16
Q

S/e of NSAIDs?

A

NSAID

  1. No urine e.g. AKI
  2. Systolic dysfunction = HF
  3. Asthma
  4. Indigestion
  5. Dyscrasia (clotting abnormality)
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17
Q

3 main s/es of antihypertensives?

A
  1. All = Hypotension
  2. Mechanistic Categories –> Bradycardia = BBs + CCBs, Electrolyte disturbance = ACEi + diuretics
  3. Specific drug classes
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18
Q

ACEi specific s/e?

A

Dry cough

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19
Q

BB specific s/e?

A

Wheeze in asthmatics, worsening of acute AF (but helps chronic HF)

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20
Q

CCBs specific s/e?

A

Peripheral oedema and flushing

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21
Q

Diuretics specific s/e?

A

Renail failure

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22
Q

Loop diuretics specific s/e?

A

Gout

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23
Q

How should anti-emetics be given if pt is vomiting?

A

Non-orally, same dose regardless of route for common anti-emetics

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24
Q

Cyclizine dose?

A
  1. 50mg 8 hourly IM/IV/orally

2. Good 1st line tx for almost all cases except cardiac cases (can worsen fluid retention)

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25
Q

Metoclopramide dose?

A
  1. 10 mg IM/IV 8 hourly

2. If pt has heart failure

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26
Q

When should metoclopramide be avoided?

A

DA antagonist so avoid if:

  1. Parkinsons (use Domperidone instead, safer to use as doesnt cross BBB)
  2. Young women = risk of acute dystonia
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27
Q

Hypernatraemia or hypoglycaemia pt fluids?

A

5% dextrose

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28
Q

Ascitic pt flulids?

A

Human Albumin Solution (HAS)

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29
Q

Shocked with SBP <90mmHg fluid?

A

Give Gelofusine (a colloid)

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30
Q

Shocked from bleeding fluids?

A

Blood transfusion but colloid if no blood available

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31
Q

How to determine how much and how fast to give fluid?

A

Assess HR, BP and UO

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32
Q

Tachycardiac/hypotensive fluid amount and speed?

A

500ml bolus STAT

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33
Q

Tachycardic/hypotensive HF pt fluid amount and speed?

A

250ml then reassess

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34
Q

Oliguric pt (not due to obstruction) fluid amount and speed?

A

1L over 2-4hrs then reassess

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35
Q

Oliguria defn?

A

<30ml/hr

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36
Q

Anuric defn?

A

0ml/hr

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37
Q

Reduced UO fluid depletion amount?

A

500ml

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38
Q

Reduced UO + tachycardia fluid depletion amount?

A

1L

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39
Q

Reduced UO + tachy + shock fluid depletion amount?

A

2L

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40
Q

Maintenance fluid volume?

A
  1. Adults = 3L IV fluids per day

2. Elderly = 2L

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41
Q

Classic maintenance fluid regime?

A

1 salty, 2 sweet

  1. 1L 0.9% Normal saline
  2. 2L 5% dextrose
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42
Q

How much K required per day?

A

40mmol KCl per day –> put 20mmol KCl in 2 bags

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43
Q

IV potassium maximum rate?

A

10mmol/hour

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44
Q

Blood clot prophylaxis?

A

Dalteparin 5000 Units daily SC + Compression Stockings

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45
Q

Maximum paracetamol prescription?

A
  1. Paracetamol 1g 6 hrly

2. 2 x Co-codamol 30/500 tablets 6 hrly

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46
Q

What is in co-codamol 30/500?

A

30mg Codeine + 500mg paracetamol

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47
Q

No pain prescription?

A

None

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48
Q

No pain PRN prescription?

A

Paracetamol 1g up to 6 hourly oral

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49
Q

Mild pain regular prescription?

A

Paracetamol 1g up to 6 hourly oral

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50
Q

Mild pain PRN prescription?

A

Codeine 30mg up to 6 hourly oral

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51
Q

Severe pain regular prescription?

A

Co-codamol 30/500, 2 tablets 6 hourly oral

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52
Q

Severe pain PRN prescription?

A

Morphine sulphate 10mg up to 6 hourly oral

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53
Q

Order of morphine sulphate effectiveness?

A

Oramorph –> SC –> IV

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54
Q

Morphine sulphate (oramorph) dose?

A

1/6th of total daily dose, given up to every 4-6 hours

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55
Q

Duration of most Abx courses?

A

5 days

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56
Q

Once clinically improving, Abx route change?

A

IV to oral

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57
Q

Infections that require weeks of Abx?

A
  1. Bone = septic arthritis/osteomyelitis

2. Endocarditis

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58
Q

Thiazide s/e?

A

Hypokalaemia

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59
Q

Loop diuretics s/e?

A

Hypokalaemia

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60
Q

All diuretics s/e?

A
  1. Hyponatraemia
  2. Hypotension
  3. AKI
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61
Q

When should diuretics be given?

A

In the morning

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62
Q

ACEi s/e?

A
  1. Hyperkalaemia
  2. Dry cough
  3. Postural hypotension
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63
Q

When are ACEi given?

A

In the evening (to prevent postural hypotension), except perindopril which is given in the AM

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64
Q

K+ sparing diuretic s/e?

A

Hyperkalaemia

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65
Q

BB s/e?

A
  1. Bronchospasm in asthmatics
  2. Hypotension
  3. Bradycardia
  4. Fatigue
  5. Cold extremities
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66
Q

Bisoprolol dose?

A

10mg OD

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67
Q

CCB s/e?

A
  1. Peripheral oedema
  2. Hypotension
  3. Bradycardia
  4. Flushing
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68
Q

SABA s/e?

A
  1. Tremor

2. Tachycardia

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69
Q

2 SABA examples?

A

Salbutamol, Terbinafine

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70
Q

3 NSAID examples?

A

Ibuprofen, Diclofenac, Naproxen

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71
Q

How do NSAIDs cause indigestion?

A

Inhibits PG synthesis needed for gastric mucosal protection from acid, thus at risk of influencing inflammation and ulceration

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72
Q

How do NSAIDs cause renal failure?

A

Inhibits PG synthesis which reduces renal artery diameter (and blood flow) and thus reducing kidney perfusion and function

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73
Q

What should be prescribed alongside Warfarin and continued until INR > 2?

A

Heparin, due to initial pro-coagulant effects of Warfarin

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74
Q

Heparin s/e?

A
  1. Haemorrhage

2. Heparin-induced thrombocytopenia

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75
Q

Aspirin cardioprotective dose?

A

75mg OD

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76
Q

Aspirin ACS/stroke dose?

A

300mg OD

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77
Q

Aspirin s/e?

A
  1. Haemorrhage
  2. Peptic ulcers + gastritis
  3. Tinnitus in large doses
  4. Despite being an NSAID, rarely worsens asthma
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78
Q

How does prednisolone cause ulceration?

A

Steroids inhibit gastric epithelial renewal

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79
Q

Gentamicin/vancomycin s/e?

A

Nephrotoxicity and ototoxicity

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80
Q

Trimethoprim s/e?

A

Risk of bone marrow toxicity (pancytopenia/neutropenic sepsis)

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81
Q

Cyclizine s/e?

A

Is a sedating antihistamine, and is known to have anti-muscarinic effects

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82
Q

Amitryptiline (TCA) s/e?

A

Anti-muscarinic e.g. double vision, dry mouth

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83
Q

Neuropathic pain drugs?

A
  1. Amitryptiline 10mg oral nightly
  2. Pregabalin 75mg oral 12-hourly
  3. Duloxetine 60mg oral daily (Diabetic)
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84
Q

Amitryptiline anti-depressant dose?

A

20mg oral nightly

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85
Q

SSRI s/e?

A
  1. Dry mouth
  2. Photosensitive
  3. Serotonin syndrome (temperature, agitation, hallucinations)
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86
Q

COCP C/I?

A

Migraine with aura due to increased risk of stroke

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87
Q

Tamoxifen s/e?

A
  1. DVT
  2. Hot flushes
  3. Endometrial Ca
  4. Increases efficacy of Warfarin and thus increases susceptibility to high INR readings
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88
Q

Carbimazole s/e?

A

Drug-induced neutropenia

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89
Q

Metformin risk?

A

Lactic acidosis

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90
Q

Carbamazepine s/e?

A
  1. Neutropenia
  2. SIADH
  3. Hyponatraemia
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91
Q

Sodium valproate s/e?

A
  1. Hepatotoxicity

2. Pancreatitis

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92
Q

Lithium s/e?

A
  1. Early = tremor
  2. Immediate = tiredness
  3. Late = arrhythmias, seizures, coma, renal failure, DI
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93
Q

Haloperidol s/e?

A

Dyskinesias

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94
Q

Clozapine s/e?

A

Agranulocytosis

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95
Q

Statins s/e?

A
  1. Caution of liver disease
  2. Myopathy = myalgia, rhabdo
  3. Abdo pain
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96
Q

When are statins c/i w/ regards to liver disease?

A

If active disease, or if ALT/AST is >3x the normal range

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97
Q

Amiodarone s/e?

A
  1. ILD = pulmonary fibrosis
  2. Thyroid disease = hypo and hyperthyroidism
  3. Grey skin
  4. Corneal deposit
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98
Q

Digoxin s/e?

A
  1. N&V
  2. Diarrhoea
  3. Blurred vision
  4. Confusion and drowsiness
  5. Xanthopsia (disturbed green/yellow visual perception including ‘halo’ vision)
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99
Q

What increases the risk of digoxin toxicity?

A

Hypokalaemia

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100
Q

Constipated pt, what should be stopped?

A

Opiate-derived drugs e.g. Codeine and co-codamol

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101
Q

What should be stopped if pt is already on maximum dose of paracetamol?

A

Stop PRN prescription

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102
Q

Warfarin + bleeding with any INR Mx?

A

IV Vitamin K

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103
Q

Warfarin with INR >8 but not bleeding?

A

Oral Vitamin K

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104
Q

Ibuprofen causing AKI mx?

A

Stop ibuprofen and ACEi even if on that too

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105
Q

All insulin is SC, except?

A

Sliding scales using short acting insulin (ActRapid/Novorapid) = IV infusion

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106
Q

Acute asthma –> how much salbutamol can be given?

A

Back to back (only limited by s/e?

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107
Q

Acute asthma –> how much ipratropium can be given?

A

x4-6/day

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108
Q

Mx of neutropenic sepsis?

A

Piperacillin with Tazobactam IV (Tazocin) + Gentamicin IV

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109
Q

What should be withheld in slow AF?

A

Digoxin

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110
Q

Fast AF w/o adverse effects Mx?

A

BB (avoid in asthmatic), Diltiazem (avoid in peripheral oedema) or Digoxin

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111
Q

Postherpetic neuralgia Mx?

A

Topical lidocaine patch 5%

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112
Q

Drug for arrhythmia and hypotension?

A

Digoxin

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113
Q

What is clindamycin typically used for?

A

Bone infections

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114
Q

What is metronidazole typically used for?

A

GI infections (good effects on anaerobes which colonise the gut)

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115
Q

B12 deficiency Mx?

A

Hydroxycobalamin 1m IM alternate days for 2 weeks

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116
Q

Best AED for pregnancy?

A

Lamotrigine 25mg OD

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117
Q

Causes of microcytic anaemia?

A
  1. Thalassaemia
  2. ACD
  3. IDA
  4. Lead poisoning
  5. Sideroblastic anaemia
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118
Q

Causes of normocytic anaemia?

A
  1. ACD
  2. Acute blood loss
  3. Haemolytic anaemia
  4. CKD
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119
Q

Causes of macrocytic anaemia?

A
  1. Megaloblastic = Vit B12/folate deficiency
  2. Non-megaloblastic = alcohol, liver disease, hypothyroidism, haemotological (Ms = myeloproliferative, myelodysplastic, multiple myeloma)
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120
Q

Causes of thrombocytopenia?

A
  1. Reduced production

2. Increased destruction

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121
Q

Reduced production thrombocytopenia?

A
  1. Infection = viral
  2. Drugs = e.g. Penicillamine in RhA
  3. Myelodysplasia, myelofibrosis, myeloma
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122
Q

Increased production thrombocytopenia?

A
  1. Heparin
  2. Hypersplenism
  3. DIC
  4. ITP
  5. HUS/TTP
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123
Q

Causes of thrombocytosis?

A
  1. Reactive = bleeding, tissue damage (infection, inflammation, malignancy), post-splenectomy
  2. Primary = myeloproliferative disorders
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124
Q

Neutrophilia causes?

A
  1. Bacterial infection
  2. Inflammation
  3. Infarction
  4. Malignancy
  5. Steroids
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125
Q

Neutropenia causes?

A
  1. Viral infection
  2. Chemotherapy/radiotherapy
  3. Clozapine
  4. Carbimazole
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126
Q

Lymphocytosis causes?

A
  1. Viral infection
  2. Lymphoma
  3. CLL
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127
Q

Causes of a raised urea?

A
  1. AKI
  2. UGI haemorrhage
  3. Large steak
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128
Q

Raised urea with normal creatinine in a pt who is not dehydrated Ix?

A

Look at Hb (if dropped, probably a UGI bleed)

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129
Q

Causes of hypernatraemia?

A

4 Ds

  1. Dehydration
  2. Drips = too much IV saline
  3. Diabetes Insipidus
  4. Drugs = effervescent/IV preparations with high Na content
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130
Q

Causes of hyponatraemia?

A
  1. Hypovolaemia
  2. Euvolaemic
  3. Hypervolaemia
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131
Q

Hypovolaemic hyponatraemia causes?

A

FAD

  1. Fluid loss = D&V
  2. Addisons
  3. Diuretics (any type)
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132
Q

Euvolaemic hyponatraemia causes?

A
  1. SIADH
  2. Psychogenic polydipsia
  3. Hypothyroidism
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133
Q

Hypervolaemic hyponatraemia causes?

A
  1. Heart failure
  2. Renal failure
  3. Liver failure = hypoalbuminaemia
  4. Nutritional failure = hypoalbuminaemia
  5. Thyroid failure = hypothyroidism, often euvolaemic
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134
Q

Causes of hypokalaemia?

A

DIRE

  1. Drugs = loop and thiazide diuretics
  2. Inadequate intake/intestinal loss = D&V
  3. Renal tubular acidosis
  4. Endocrine = Cushings/Conns
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135
Q

Causes of hyperkalaemia?

A

DREAD

  1. Drugs = K+ sparing, ACEi, heparins, Tacrolimus
  2. Renal failure
  3. Endocrine = Addisons
  4. Artefact
  5. DKA
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136
Q

Pre-renal AKI urea and creatinine?

A

Urea rise > Creatinine rise

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137
Q

Intrinsic renal AKI urea and creatinine?

A

Urea rise &laquo_space;Creatinine rise

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138
Q

Post-renal AKU urea and creatinine?

A

Urea rise &laquo_space;Creatinine rise

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139
Q

Pre-renal AKI causes?

A
  1. Dehydration/shock

2. RAS = often triggered by ACEi or NSAIDs

140
Q

Intrinsic renal AKI causes?

A

INTRINSIC

  1. Ischaemic = ATN
  2. Nephrotoxic Abx = Gentamicin, Vancomycin, Tetracyclines
  3. Tablets = ACEi, NSAIDs
  4. Radiological contrast
  5. Injury = rhabdo
  6. Negatively birefringent crystals = gout
  7. Syndromes = glomerulonephritis
  8. Inflammation = vasculitis
  9. Cholesterol emboli
141
Q

Post-renal AKI causes?

A
  1. In lumen = stone or hydronephrosis
  2. In wall = tumour (renal cell, transitional cell), fibrosis
  3. External pressure = BPH, prostate ca, lymphadenopathy, aneurysm
142
Q

How to differentiate rise in creatinine that can be seen in severe prerenal AKI from intrinsic and obstructive AKI?

A

Multiply urea by 10; if it exceeds Creatinine, then this suggests a prerenal aetiology

143
Q

Hepatocyte injury markers?

A
  1. Bilirubin
  2. ALT and AST
  3. ALP
144
Q

Synthetic function of liver?

A
  1. Albumin

2. Vit K dependent clotting factors (2,7,9,10)

145
Q

Causes of raised ALP?

A

ALKPHOS

  1. Any fracture
  2. Liver damage (post-hepatic)
  3. Kancer
  4. Paget’s disease of bone/pregnancy
  5. HyperPTH
  6. Osteomalacia
  7. Surgery
146
Q

Pre-hepatic high Br?

A
  1. Haemolysis
  2. Gilbert’s
  3. Criggler-Najjar syndrome
147
Q

3 drugs that can cause liver cirrhosis?

A
  1. Paracetamol OD
  2. Statins
  3. Rifampicin
148
Q

Drugs that cause cholestasis?

A
  1. Flucloxacillin
  2. Co-amoxicalv
  3. Nitrofurantoin
  4. Steroids
  5. Sulphonylureas
149
Q

Obstructive jaundice causes?

A
  1. In lumen = gallstones, drugs
  2. In wall = cholangiocarcinoma, PBC, PSC
  3. Extrinsic pressure = pancreatic or gastric cancer, Lymph nodes
150
Q

Target TSH range?

A

0.5-5mIU/L, try and change by the smallest increment offered in the exam (unless grossly hypo/hyperthyroid)

151
Q

Primary hypothyroidism TFTs and cause?

A
  1. Low T4, High TSH

2. Hashimoto’s thyroiditis, drug-induced hypothyroidism

152
Q

Secondary hypothyroidism TFTs and cause?

A
  1. Low T4, Low TSH

2. Pituitary tumour or damage

153
Q

Primary hyperthyroidism TFTs and cause?

A
  1. High T4, Low TSH

2. Graves, toxic nodular goitre, drug-induced

154
Q

Secondary hyperthyroidism TFTs and cause?

A
  1. High T4, High TSH

2. Pituitary tumour

155
Q

V1-V4 ST depression could indicate?

A

Anterior ischaemia OR posterior infarction (add leads V7-V9 posteriorly to confirm STEMI for the latter)

156
Q

FiO2 and hypoxia rules?

A

Subtract 10 from FiO2 and if PaO2

  1. Exceeds this number = pt is not hypoxic
  2. Is lower = pt is hypoxic
157
Q

Type I respiratory failure causes?

A

Anything that damages heart/lungs that causes SOB

1. Low or normal PaCO2 i.e. fast/normal breathing

158
Q

Type II respiratory failure causes?

A

COPD blue bloaters, neuromuscular failure, restrictive disease
1. High PaCO2 i.e. fast/normal breathing

159
Q

Drugs with narrow therapeutic index that requires monitoring?

A
  1. Digoxin
  2. Theophylline
  3. Lithium
  4. Phenytoin
  5. Abx e.g. gentamicin and vancomycin
160
Q

Drug that shows zero-order kinetics?

161
Q

High gentamicin level Mx?

A

Decrease in frequency rather than dose e.g. change from every 24hr to every 36 hrs

162
Q

Gentamicin toxicity?

A

Ototoxicity and nephrotoxicity

163
Q

Vancomycin toxicity?

A

Ototoxicity and nephrotoxicity

164
Q

Phenytoin toxicity?

A
  1. Gum hypertrophy
  2. Ataxia
  3. Nystagmus
  4. Peripheral neuropathy
  5. Teratogenicity
165
Q

Lithium toxicity?

A
  1. Early = tremor
  2. Intermediate = tiredness
  3. Late = arrhythmias, seizures, coma, renal failure, DI
166
Q

How is gentamicin dose calculated?

A

According to pts weight and renal function

167
Q

Usual gentamicin tx?

A

High dose regimen of 5-7mg/kg OD

168
Q

Gentamicin for pts with severe renal failure or endocarditis?

A

May receive divided daily dosing at 1mg/kg

  1. Renal failure = 12 hourly
  2. Endocarditis = 8 hourly
169
Q

How to determine if gentamicin level is too high?

A

Use nomogram, measure gentamicin levels at particular times e.g. 6-14 hours after the last Gentamicin infusion is started

  1. If falls in q36h area, change to 36h dosing
  2. If falls in q48h area, change to 48hr dosing
  3. If point rests above q48h area, repeat gentamicin level and only re-dose when the conc. is <1mg/L
170
Q

Mx of any drug toxicity principles?

A
  1. Stop drug +/- alternatives if available
  2. Supportive measures, usually IV fluids
  3. Give antidote if one is available
171
Q

Pathophysiology of paracetamol overdose?

A
  1. Paracetamol is usually metabolised by the liver in a process reliant on the antioxidant glutathione. In paracetamol OD, the limited hepatic stores of glutathione are quickly depleted, leading to accumulation of NAPQI. Accumulation of NAPQI = cause of acute liver damage.
  2. NAC (N-acetyl cysteine) replenishes the stores of glutathione and so reduces the formation of NAPQI, therefore protecting against liver damage.
172
Q

What may INR be viewed as?

A

The ratio of a patient’s PT compared to the normal population

173
Q

Normal INR?

174
Q

Warfarin inhibits synthesis of?

A

Vit K dependent clotting factors = 2,7,9,10 –> prolongs PT (from which INR is derived)

175
Q

When is PT used instead of INR for monitoring Warfarin?

A

Pts with liver disease or DIC

176
Q

Target INR for most warfarin pts?

177
Q

Target INR for recurrent VTE or metal replacement heart valves?

178
Q

Major bleed on warfarin Mx?

A
  1. Reduce warfarin dose
  2. Give 5-10mg IV Vitamin K
  3. Give prothrombin complex concentrate e.g. Beriplex
179
Q

INR <6 no bleed?

A

Reduce warfarin dose

180
Q

INR 6-8 no bleed?

A

Omit warfarin for 2 days then reduce

181
Q

INR >8 no bleed?

A

Omit warfarin and give 1-5mg oral Vitamin K

182
Q

MI aspirin or clopidgrel dose?

A

300mg oral

183
Q

MI morphine dose?

184
Q

MI metoclopramide dose?

185
Q

MI BB dose?

A

Atenolol 5mg oral (Use BB in ACS unless LVF/asthma)

186
Q

When would you not use BB in ACS?

A

LVF and asthma

187
Q

Cardiac furosemide dose?

A

Furosemide 40-80mg IV –> if inadequate response to LVF –> Isosorbide dinitrate infusion +/- CPAP

188
Q

VT drug and dose?

A

Amiodarone 300mg IV over 20-60mins and then 900mg over 24hrs

189
Q

Polymorphic VT drug and dose?

A

Magnesium sulphate 2g IV over 10 mins

190
Q

SVT drug and dose?

A

Adenosine 6mg IV –> 12mg IV –> 12mg IV

191
Q

Causes of Irregular broad QRS?

A
  1. AF with BBB
  2. Pre-excited AF
  3. Polymorphic VT
192
Q

Causes of regular broad QRS?

A
  1. VT

2. SVT with BBB

193
Q

Anaphylaxis drugs and doses?

A
  1. Adrenaline 500micrograms of 1:1000 IM
  2. Chlorphenamine 10mg IV
  3. Hydrocortisone 200mg IV
  4. Asthma tx if wheeze
194
Q

Acute exacerbation of asthma/COPD drugs and doses?

A
  1. Salbutamol 5mg NEB
  2. Hydrocortisone 100mg IV or Prednisolone 40mg oral
  3. Ipratropium 0.5mg NEB
  4. Theophylline if life threatening
  5. 28% O2 if COPD known
  6. Abx if infective
195
Q

PE drugs and doses?

A
  1. Morphine 5-10mg IV
  2. Metoclopramide 10mg IV
  3. Tinzaparin 175 units/kg SC daily
  4. Low BP –> IV Gelofusin –> NA –> Thrombolysis
196
Q

GI bleeding drug management?

A
  1. Crystalloid/colloid
  2. X-match 6 units of blood
  3. Correct clotting abnormalities
  4. Stop culprit drugs = NSAIDs, Aspirin, Heparin, Warfarin
197
Q

Correction of clotting abnormalities in GI haemorrhage?

A
  1. If PT/aPTT > 1.5x INR –> Give FFP (unless due to Warfarin then give PCC)
  2. If plts <50 and actively bleeding –> platelet transfusion
198
Q

Bacterial meningitis Drug Mx?

A
  1. Dexamethasone 10mg IV
  2. 2g Cefotaxime IV
  3. IV fluids
  4. LP +/- CT head
199
Q

Seizure >5 mins drugs?

A
  1. Lorazepam 2-4mg OR
  2. IV Diazepam 10mg OR
  3. Buccal Midazolam 10mg
200
Q

Still fitting after 2 mins on initial drugs?

A
  1. Phenytoin infusion

2. Intubate + Propofol

201
Q

DKA Dx?

A
  1. Hyperglycaemia = BM>11
  2. Ketones = >3 or significant ketonuria
  3. Acidaemia = pH < 7.3
202
Q

DKA Mx?

A
  1. IV fluids = 1L over 1hr, then over 2hr, then 4hr, then 8hr (if SBP <90 then give 500ml STAT then re-assess)
  2. 50 Units human soluble insulin to 50 ml 0.9% Saline, infuse continuously at 0.1units/kg/hr OR sliding scale insulin
  3. Monitor BM, K, pH
  4. Aim for fall in blood ketones at 0.5mmol/L
  5. When glucose <14mmol/L –> Start 10% glucose to run alongside saline
  6. Continue fixed rate insulin until = Ketones < 0.6mmol/L, Venous pH > 7.3, venous bicarb >15mmol/L
203
Q

HHS Dx?

A

Marked dehydration in T2DM pts with glucose >30mmol/L, hyperosmolar (osmolality >340mmol/L), non-acidotic and non-ketotic

204
Q

HHS Mx?

A

Similar to DKA but 1/2 the rate of fluids required

  1. Rehydrate slowly with 0.9% Saline IVI over 48 hours
  2. Replace K+ when urine starts to flow
  3. Only use insulin if BM not falling by 5mmol/L with rehydration or if ketonaemia
  4. Keep blood glucose at least 10-15mmol/L for first 24 hours to avoid cerebral oedema
205
Q

AKI fluids?

A
  1. Strict fluid monitoring
  2. IV fluid = 500ml STAT then 1L 4hrly
  3. Check drug chart for nephrotoxic medications
206
Q

How to reduce absorption in acute poisoning <1hr?

A
  1. Gastric lavage
  2. Whole bowel irrigation (if lithium/iron)
  3. Charcoal (dx-dependent)
207
Q

HTN Dx?

A

NICE now recommends ambulatory/home BP monitoring to minimise white coat HTN

208
Q

When to treat HTN?

A
  1. BP > 150/95mmHg OR

2. BP > 135/85mmHg + any of IHD/stroke/PVD/HTN organ damage

209
Q

HTN algorithm?

A
  1. A or C
  2. A+C
  3. A+C+D
  4. A+C+D+ further diuretic/AB/BB
210
Q

CHADSVASC score?

A
  1. Congestive HF
  2. HTN
  3. Age > 75 x 2
  4. Diabetes
  5. Stroke/TIA x 2
  6. Vascular disease
  7. Age 65-74
  8. Sex category

Offer Warfarin/DOC of >=2 for Women, >=1 for Men

211
Q

When to rhythm control for AF?

A
  1. Young
  2. Symptomatic AF
  3. 1st episode
  4. AF due to precipitant e.g. sepsis/e- disturbance
212
Q

Rhythm control AF options?

A

Cardioversion

  1. Electrical
  2. Pharmacological = Amiodarone 5mg/kg IV over 20-120mins, pt will require anticoagulation if more than 48 hours since onset
213
Q

When to rate control for AF?

A

Everyone else with HR >90bpm

214
Q

Rate control AF options?

A
  1. BB = Propranolol 10mg 6 hrly
  2. Rate-limiting CCB = Verapamil 40mg-120mg TDS or Diltiazem 120mg daily using a modified release preparation
  3. Digoxin if needed = load then start 62.5-125 micrograms daily
215
Q

Stable angina Mx?

A
  1. GTN spray PRN
  2. Secondary prevention = Aspirin, Statin
  3. One anti-anginal drug = BB e.g. atenolol OR CCB e.g. amlodipine/diltiazem
  4. If still experiencing Sx –> increase dose of BB/CCB
  5. If still experiencing Sx –> add other option
  6. If C/I –> add isosorbide mononitrate/Nicorandil
  7. If uncontrolled on 2 anti-anginal drugs = refer for urgent PCI/CABG
216
Q

Diabetes Mx?

A
  1. Education + dietary advice/exercise
  2. CV RF Mx = Aspirin 75mg OD, Simvastatin 20-40mg OD
  3. Annual review of complications = check albumin-creatinine ratio as an early indicator of diabetic nephropathy and predictor of CVD, e.g. microalbuminuria (ACR >=3mg/mmol) indicates need for ACEi
  4. Blood glucose lowering therapy
217
Q

Blood glucose lowering therapy in T1DM?

218
Q

Blood glucose lowering therapy in T2DM?

A

If HbA1c >=48mmol/l after trial of diet and exercise, use the following steps:

  1. Metformin 500mg with breakfast orally, however if low/normal weight or Cr >150micromol/L, use sulphonylurea instead (Gliclazide 40mg with breakfast orally)
  2. If HbA1c >= 48 increase drug dose to maximum as tolerated
  3. If HbA1c >=48 still with Metformin –> sulphonylurea, with Sulphonylurea –> add Gliptin (DPP4 inhibitor) e.g. Sitagliptin
  4. If HbA1c still >= 48 then add insulin
219
Q

Most commonly used regimen for Parkinsons?

A
  1. Co-Beneldopa or Co-Careldopa (i.e. levodopa combined with peripheral dopa decarboxylase inhibitor - Benserazide or carbidopa respectively)
220
Q

Patient with mild PD who is worried about the finite period of benefit from Levodopa?

A
  1. DA agonist (ropinorole) or

2. MAOi (rasagiline)

221
Q

Drugs to avoid in parkinsons?

A

Metoclopramide and Haloperidol

222
Q

More appropriate antiemetic for parkinsons?

A

Domperidone

223
Q

Generalised tonic clonic seizures drug?

A

Sodium valproate

224
Q

Absence seizures drug?

A

Sodium valproate or Ethosuximide

225
Q

Myoclonic seizures drug?

A

Sodium valproate

226
Q

Tonic seizures drug?

A

Sodium valproate

227
Q

Focal seizures drug?

A

Carbamazepine or Lamotrigine

228
Q

Lamotrigine s/e?

A

RASH, rarely SJS

229
Q

Carbamazepine s/e?

A
  1. Rash
  2. Dysarthria
  3. Ataxia
  4. Nystagmus
  5. Hyponatraemia
230
Q

Phenytoin s/e?

A
  1. Ataxia
  2. Peripheral neuropathy
  3. Gum hyperplasia
  4. Hepatotoxicity
231
Q

Sodium valproate s/e?

A

3 Ts

  1. Tremor
  2. Teratogenicity
  3. Tubby (weight gain)
232
Q

3 licensed drugs for mild/moderatee Alzheimers?

A

Acetylcholinesterase inhibitors

  1. Donepezil (Initially 5 mg once daily, then increased in steps of 5 mg every week; usual maintenance 20 mg daily)
  2. Rivastigmine
  3. Galantamine
233
Q

Drug for moderate/severe Alzheimers?

A

NMDA antagonist (Memantine = Initially 5 mg once daily for one month, then increased if necessary up to 10 mg daily, doses to be given at bedtime)

234
Q

Crohns mild flare?

A

Prednisolone 30mg OD orally

235
Q

Crohns severe flare?

A

Hydrocortisone 100mg 6hrly IV + supportive care

236
Q

Crohns rectal disease?

A

Rectal hydrocortisone

237
Q

Crohns remission maintenance?

A

Azathioprine or Mercaptopurine

238
Q

What should be checked before starting on Azathioprine or 6-mercaptopurine?

A

TPMT levels

239
Q

Why do TPMT levels need to be measured?

A

In 10% of the population, there is congenitally low activity of TPMT which would lead to abnormal accumulation of 6-mercaptopurine when azathioprine is given in normal doses –> increase risk of liver and BM toxicity

240
Q

What should be prescribed instead if TPMT levels are low?

A

Methotrextae

241
Q

RhA Mx?

A

Methotrexate + one other DMARD e.g.

  1. Sulfasalazine
  2. HCQ
242
Q

RhA flare Mx?

A
  1. Glucocorticoids = IM Methylprednisolone 80mg
  2. NSAIDs = Ibuprofen 400mg 8hrly + gastroprotection
  3. Re-instate DMARDS if dose previously reduced
243
Q

Failure to respond to 2 DMARDs in RHA?

A

TFNa inhibitors e.g. Infliximab

244
Q

Constipation treatment options?

A
  1. Stool softener
  2. Bulking agents
  3. Stimulant laxatives
  4. Osmotic laxatives
245
Q

Stool softeners?

A
  1. Docusate sodium

2. Arachis oil (rectal)

246
Q

Bulking agents?

A

Ispaghula husk

247
Q

Stimulant laxatives?

A
  1. Senna

2. Bisacodyl

248
Q

Osmotic laxatives?

A
  1. Lactulose

2. Phosphate enema

249
Q

C/I for bisacodyl?

A

Acute abdomen

250
Q

C/I for phosphate enema?

A

Acute abdomen

251
Q

Good laxative for faecal impaction?

A

Docusate sodium

252
Q

What laxative may exacerbate abdominal cramps?

A

Stimulant laxatives

253
Q

What laxative may exacerbate bloating?

A

Osmotic laxatives

254
Q

Mx of fever?

A
  1. Tx underlying cause

2. Paracetamol as antipyretic

255
Q

Mx of constipation?

A
  1. Tx underlying cause

2. Laxative depending on cause, e.g. not if evidence of obstruction

256
Q

Mx of diarrhoea?

A
  1. GI infection = do not tx with quick removal

2. Chronic e.g. non-infectious with negative stool cultures

257
Q

Chronic diarrhoea mx?

A
  1. Loperamide 2mg oral up to 3 hrly OR

2. Codeine 30mg oral up to 6 hrly (also provides pain relief)

258
Q

Insomnia Mx?

A
  1. May be on drugs that prevent sleep e.g. corticosteroids

2. Zopiclone 7.5mg oral nightly in adults

259
Q

When are corticosteroids given and why?

A

In the AM as it affects sleep

260
Q

Zopiclone dose in elderly?

A

3.75mg nightly in elderly

261
Q

Beclomethasone example dose?

A

200micrograms, 1 puff BD inhaled

262
Q

Flucloxacillin example dose?

A

500mg, 6 hourly for 7D

263
Q

Omeprazole example dose?

A

20mg, oral daily

264
Q

Enoxaparin example dose for prophylaxis?

A

40mg OR 4000 units, SC daily

265
Q

Dalteparin example dose for treatment?

A

15,000 units SC daily (therapeutic dose if weight 72kg)

266
Q

Levothyroxine example dose?

A

75micrograms oral daily

267
Q

Citalopram example dose?

268
Q

Ferrous sulphate example dose?

269
Q

Amlodipine example dose?

270
Q

Co-careldopa example dose?

A

125mg, oral 8hrly

271
Q

5mg IV diamorphine equivalent in IV morphine?

A

10mg IV morphine

272
Q

What shouldnt be prescribed alongside methotrexate?

A

Folate antagonists e.g. Trimethoprim and Co-trimoxazole

273
Q

Acute alcohol and CYP450?

274
Q

Chronic alcohol and CYP450?

275
Q

Warfarin monitoring?

A

It is essential that the INR be determined daily or on alternate days in early days of treatment, then at longer intervals (depending on response), then up to every 12 weeks.

276
Q

Citalopram s/e?

A

Photosensitivity

277
Q

Why does insulin dose need to be increased when pt unwell?

A

As blood glucose increases when unwell

278
Q

How should alendronic acid be taken?

A

Tablets should be swallowed whole and oral solution should be swallowed as a single 100 mL dose. Doses should be taken with plenty of water while sitting or standing, on an empty stomach at least 30 minutes before breakfast (or another oral medicine); patient should stand or sit upright for at least 30 minutes after administration.

279
Q

1g in mg?

280
Q

1mg in micrograms?

A

1000 micrograms

281
Q

What can 1% drug mean?

A
  1. 1g in 100ml OR

2. 1g in 100g

282
Q

Dalteparin treatment dose?

A

15,000 Units SC once daily

283
Q

Enoxaparin treatment dose?

A

120mg or 12,000 Units SC once daily

284
Q

Tinzaparin treatment dose?

A

14,000 Units SC once daily

285
Q

Enalapril and Lisinopril starting dose for HF?

286
Q

Peindopril starting dose for HF?

287
Q

Ramipril starting dose for HF?

288
Q

Spironolactone dose for HF?

A

25mg oral daily (should be given in morning)

289
Q

How to write GTN prescription?

A

GTN SPRAY, 2 Sprays, Sublingual

290
Q

How much GTN is in one metered dose

A

400 micrograms

291
Q

GTN tablet dose?

A

0.3-1mg sublingual

292
Q

Hyperkalaemia, 1st drug to lower K+?

A

Actrapid 10 units in 100ml of 20% dextrose over 30 minutes IV

293
Q

2nd line drug to lower K+?

A

Salbutamol 5mg nebulised STAT

294
Q

Gliclazide dose?

A
  1. 40mg oral daily with first meal OR

2. 80mg oral daily with first meal

295
Q

What creatinine should preclude prescribing metformin?

A

> 150 umol/L

296
Q

Simvastatin monitoring?

A
  1. A CK level should be sought at baseline in pts with RFs for myopathy = personal/FHx of muscular disorders, prev. history of muscular toxicity, high alcohol intake, renal impairment, hypothyroidism, in the elderly
  2. If no RFs –> baseline CK check not needed, serum ALT should be sought instead
297
Q

What should be checked before prescribing Vancomycin?

A

Serum creatinine

298
Q

Normal lithium range?

A

0.4-0.8mmol/L

299
Q

Recommended sampling time for Lithium?

A

12 hours after last dose

300
Q

Lithium monitoring?

A
  1. Weekly after initiation
  2. After each dose change until concentrations are stable
  3. Ever 3m therafter
301
Q

What increases the risk of lithium toxicity?

A

Sodium depletion (pts advised to avoid making changes in their diet that would lead to increased/decreased sodium intake)

302
Q

Lithium reference range?

A

0.4-0.8mmol/L

303
Q

At what lithium level do toxic effects typically occur?

A

> 1.5mmol/L

304
Q

FBC monitoring for methotrexate?

A

Every 2-3m

305
Q

What needs to be checked before olanzapine is prescribed?

A

Fasting blood glucose

306
Q

What must be checked before starting COCP?

307
Q

What must be checked before prescribing amiodarone?

A
  1. Baseline CXR

2. TSH, T3+4

308
Q

One hour peak serum concentration of gentamicin?

A

3-5mg/litre

309
Q

Pre-dose trough concentration of gentamicin?

A

<1mg/litre

310
Q

When should serum gentamicin concentrations be measured?

A
  1. After 3 or 4 doses
  2. Then At least every 3 days
  3. Then after a dose change
311
Q

What should be measured during digoxin tx?

A

Serum creatinine, as it is predominantly renally excreted

312
Q

When should digoxin levels be measured?

A

Not measured unless toxicity, non-compliance or inadequate effect are suspected

313
Q

What should be measured before commencing sodium valproate?

314
Q

Apart from hepatic effects, what is a s/e of sodium valproate?

A

Pancreatitis

315
Q

What must be monitored during clozapine tx?

A
  1. FBC must be checked weekly for the 1st 18 weeks

2. Registration with a clozapine monitoring service is required for all patients

316
Q

When must clozapine be stopped?

A

If leukocyte count drops <3000/mm^3 or neutrophil count drops <1500mm^3

317
Q

Type A adverse drug reaction?

A

Common, predictable, dose related

318
Q

Type B adverse drug reaction?

A

Idiosyncratic, bizarre, unexpected, related to gene/host/environment interactions

319
Q

4 drugs with a narrow therapeutic index?

A
  1. Warfarin
  2. Digoxin
  3. Theophylline
  4. Phenytoin
320
Q

2 drugs that require careful titration of dose according to effect?

A

Antihypertensives, anti-diabetic drugs

321
Q

How long does enzyme induction take to establish?

A

Days to weeks

322
Q

How long does enzyme inhibition take to establish?

A

Hours to days

323
Q

What should ACEis not be co-prescribed with, especially in the elderly?

324
Q

What shouldnt you do on metronidazole?

A

Drink alcohol –> fulminant N&V

325
Q

How do NSAIDs affect kidneys?

A

Inhibit PGs which constrict afferent vessels

326
Q

How do ACEis affect kidneys?

A

Dilate efferent renal vessels

327
Q

2 situations IV fluid is prescribed?

A
  1. As replacement

2. As maintenance

328
Q

What pt should not be prescribed compression stockings?

A

Those with peripheral arterial disease

329
Q

Usual oramorph strength?

330
Q

Sail sign on CXR?

A

Triangle behind heart, suggests LLL collapse

331
Q

Downward sloping ST segment in all leads?

332
Q

Normal gentamicin peak dosage?

333
Q

Normal gentamicin trough dosage?

334
Q

Endocarditis gentamicin peak dosage?

335
Q

Endocarditis gentamicin trough dosage?

336
Q

Action if gentamicin out of peak range?

A

Adjust dose

337
Q

Action if gentamicin out of trough range?

A

Adjust dose interval

338
Q

Only commonly used CCB in AF?

339
Q

Drowsy pt with hypoglycaemia?

A

100ml 20% glucose

340
Q

What drug class can docusate sodium act as at higher doses?

A

Stimulant laxative

341
Q

Carbimazole dose?

A

20mg orally 12 hourly

342
Q

Warfarin tablet colours?

A
  1. White = 0.5mg
  2. Brown = 1mg
  3. Blue = 3mg
  4. Pink = 5mg
343
Q

Alteplase dose?

A

10mg IV over 1-2 minutes

344
Q

Enalapril dose for HTN?

345
Q

Lisinopril dose for HTN?

346
Q

Ramipril dose for HTN?

A

1.25mg ON or 2.5mg ON

347
Q

Conscious hypoglycaemic pt management?

A

10-20G glucose orally

Medicine and Surgery Mushkies (52 decks)

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