PSA Mushkies Flashcards
1
Q
PRN drug 2 instructions?
A
- Indication
2. Maximum frequency
2
Q
Abx 2 instructions?
A
- Indication
2. Stop/review date
3
Q
Enzyme inducers?
A
PC BRASSS
- Phenytoin
- Carbamazepine
- Barbiturates
- Rifampicin
- Alcohol (Chronic)
- Sulfonylureas
- St Johns Wort
- Smoking
4
Q
Enzyme inhibitors?
A
AO DEVICES GR
- Allopurinol, antifungals, amiodarone
- Omeprazole
- Disulfiram
- Erythromycin
- Valproate
- Isoniazid
- Clarithromycin, ciprofloxacin
- Ethanol (acute)
- Sulphonamides, SSRIs
- Grapefruit juice
- Ritonavir
5
Q
Drugs to stop before surgery?
A
I LACK OP
- Insulin
- Lithium
- Anticoagulants/antiplatelets
- COCP/HRT
- K-sparing diuretics
- Oral hypoglycaemics
- Perindopril and other ACEi
6
Q
When to stop COCP/HRT before surgery?
A
4 weeks before surgery
7
Q
When to stop lithium before surgery?
A
Day before surgery
8
Q
When to stop K-sparing diuretics and ACEi before surgery?
A
Day of surgery
9
Q
When to stop anticoagulants and antiplatelets before surgery?
A
Variable
10
Q
When to stop oral hypoglycaemics before surgery?
A
Variable
11
Q
New drug chart, what must be on front?
A
3 pieces of patient-identifying information
12
Q
Prescription review?
A
PReSCRIBER
- Pt details
- Reaction (allergy + rxn)
- Sign front of chart
- Contraindications for each drug (check)
- Route for each drug (check)
- IV fluids if needed
- Blood clot prophylaxis if needed
- anti-Emetic if needed
- pain Relief if needed
13
Q
3 drugs that increase bleeding?
A
- Aspirin
- Heparin
- Warfarin
14
Q
Why is prophylactic heparin contraindicated in acute ischaemic stroke for at least 2 months?
A
Due to risk of bleeding into stroke
15
Q
S/e of steroids?
A
STEROIDS
- Stomach ulcers
- Think skin
- oEdema
- Right and left HF
- Osteoporosis
- Infection (Candida)
- Diabetes (Hyperglycaemia)
- Syndrome (Cushings)
16
Q
S/e of NSAIDs?
A
NSAID
- No urine e.g. AKI
- Systolic dysfunction = HF
- Asthma
- Indigestion
- Dyscrasia (clotting abnormality)
17
Q
3 main s/es of antihypertensives?
A
- All = Hypotension
- Mechanistic Categories –> Bradycardia = BBs + CCBs, Electrolyte disturbance = ACEi + diuretics
- Specific drug classes
18
Q
ACEi specific s/e?
A
Dry cough
19
Q
BB specific s/e?
A
Wheeze in asthmatics, worsening of acute AF (but helps chronic HF)
20
Q
CCBs specific s/e?
A
Peripheral oedema and flushing
21
Q
Diuretics specific s/e?
A
Renail failure
22
Q
Loop diuretics specific s/e?
A
Gout
23
Q
How should anti-emetics be given if pt is vomiting?
A
Non-orally, same dose regardless of route for common anti-emetics
24
Q
Cyclizine dose?
A
- 50mg 8 hourly IM/IV/orally
2. Good 1st line tx for almost all cases except cardiac cases (can worsen fluid retention)
25
Metoclopramide dose?
1. 10 mg IM/IV 8 hourly
| 2. If pt has heart failure
26
When should metoclopramide be avoided?
DA antagonist so avoid if:
1. Parkinsons (use Domperidone instead, safer to use as doesnt cross BBB)
2. Young women = risk of acute dystonia
27
Hypernatraemia or hypoglycaemia pt fluids?
5% dextrose
28
Ascitic pt flulids?
Human Albumin Solution (HAS)
29
Shocked with SBP <90mmHg fluid?
Give Gelofusine (a colloid)
30
Shocked from bleeding fluids?
Blood transfusion but colloid if no blood available
31
How to determine how much and how fast to give fluid?
Assess HR, BP and UO
32
Tachycardiac/hypotensive fluid amount and speed?
500ml bolus STAT
33
Tachycardic/hypotensive HF pt fluid amount and speed?
250ml then reassess
34
Oliguric pt (not due to obstruction) fluid amount and speed?
1L over 2-4hrs then reassess
35
Oliguria defn?
<30ml/hr
36
Anuric defn?
0ml/hr
37
Reduced UO fluid depletion amount?
500ml
38
Reduced UO + tachycardia fluid depletion amount?
1L
39
Reduced UO + tachy + shock fluid depletion amount?
2L
40
Maintenance fluid volume?
1. Adults = 3L IV fluids per day
| 2. Elderly = 2L
41
Classic maintenance fluid regime?
1 salty, 2 sweet
1. 1L 0.9% Normal saline
2. 2L 5% dextrose
42
How much K required per day?
40mmol KCl per day --> put 20mmol KCl in 2 bags
43
IV potassium maximum rate?
10mmol/hour
44
Blood clot prophylaxis?
Dalteparin 5000 Units daily SC + Compression Stockings
45
Maximum paracetamol prescription?
1. Paracetamol 1g 6 hrly
| 2. 2 x Co-codamol 30/500 tablets 6 hrly
46
What is in co-codamol 30/500?
30mg Codeine + 500mg paracetamol
47
No pain prescription?
None
48
No pain PRN prescription?
Paracetamol 1g up to 6 hourly oral
49
Mild pain regular prescription?
Paracetamol 1g up to 6 hourly oral
50
Mild pain PRN prescription?
Codeine 30mg up to 6 hourly oral
51
Severe pain regular prescription?
Co-codamol 30/500, 2 tablets 6 hourly oral
52
Severe pain PRN prescription?
Morphine sulphate 10mg up to 6 hourly oral
53
Order of morphine sulphate effectiveness?
Oramorph --> SC --> IV
54
Morphine sulphate (oramorph) dose?
1/6th of total daily dose, given up to every 4-6 hours
55
Duration of most Abx courses?
5 days
56
Once clinically improving, Abx route change?
IV to oral
57
Infections that require weeks of Abx?
1. Bone = septic arthritis/osteomyelitis
| 2. Endocarditis
58
Thiazide s/e?
Hypokalaemia
59
Loop diuretics s/e?
Hypokalaemia
60
All diuretics s/e?
1. Hyponatraemia
2. Hypotension
3. AKI
61
When should diuretics be given?
In the morning
62
ACEi s/e?
1. Hyperkalaemia
2. Dry cough
3. Postural hypotension
63
When are ACEi given?
In the evening (to prevent postural hypotension), except perindopril which is given in the AM
64
K+ sparing diuretic s/e?
Hyperkalaemia
65
BB s/e?
1. Bronchospasm in asthmatics
2. Hypotension
3. Bradycardia
4. Fatigue
5. Cold extremities
66
Bisoprolol dose?
10mg OD
67
CCB s/e?
1. Peripheral oedema
2. Hypotension
3. Bradycardia
4. Flushing
68
SABA s/e?
1. Tremor
| 2. Tachycardia
69
2 SABA examples?
Salbutamol, Terbinafine
70
3 NSAID examples?
Ibuprofen, Diclofenac, Naproxen
71
How do NSAIDs cause indigestion?
Inhibits PG synthesis needed for gastric mucosal protection from acid, thus at risk of influencing inflammation and ulceration
72
How do NSAIDs cause renal failure?
Inhibits PG synthesis which reduces renal artery diameter (and blood flow) and thus reducing kidney perfusion and function
73
What should be prescribed alongside Warfarin and continued until INR > 2?
Heparin, due to initial pro-coagulant effects of Warfarin
74
Heparin s/e?
1. Haemorrhage
| 2. Heparin-induced thrombocytopenia
75
Aspirin cardioprotective dose?
75mg OD
76
Aspirin ACS/stroke dose?
300mg OD
77
Aspirin s/e?
1. Haemorrhage
2. Peptic ulcers + gastritis
3. Tinnitus in large doses
4. Despite being an NSAID, rarely worsens asthma
78
How does prednisolone cause ulceration?
Steroids inhibit gastric epithelial renewal
79
Gentamicin/vancomycin s/e?
Nephrotoxicity and ototoxicity
80
Trimethoprim s/e?
Risk of bone marrow toxicity (pancytopenia/neutropenic sepsis)
81
Cyclizine s/e?
Is a sedating antihistamine, and is known to have anti-muscarinic effects
82
Amitryptiline (TCA) s/e?
Anti-muscarinic e.g. double vision, dry mouth
83
Neuropathic pain drugs?
1. Amitryptiline 10mg oral nightly
2. Pregabalin 75mg oral 12-hourly
3. Duloxetine 60mg oral daily (Diabetic)
84
Amitryptiline anti-depressant dose?
20mg oral nightly
85
SSRI s/e?
1. Dry mouth
2. Photosensitive
3. Serotonin syndrome (temperature, agitation, hallucinations)
86
COCP C/I?
Migraine with aura due to increased risk of stroke
87
Tamoxifen s/e?
1. DVT
2. Hot flushes
3. Endometrial Ca
4. Increases efficacy of Warfarin and thus increases susceptibility to high INR readings
88
Carbimazole s/e?
Drug-induced neutropenia
89
Metformin risk?
Lactic acidosis
90
Carbamazepine s/e?
1. Neutropenia
2. SIADH
3. Hyponatraemia
91
Sodium valproate s/e?
1. Hepatotoxicity
| 2. Pancreatitis
92
Lithium s/e?
1. Early = tremor
2. Immediate = tiredness
3. Late = arrhythmias, seizures, coma, renal failure, DI
93
Haloperidol s/e?
Dyskinesias
94
Clozapine s/e?
Agranulocytosis
95
Statins s/e?
1. Caution of liver disease
2. Myopathy = myalgia, rhabdo
3. Abdo pain
96
When are statins c/i w/ regards to liver disease?
If active disease, or if ALT/AST is >3x the normal range
97
Amiodarone s/e?
1. ILD = pulmonary fibrosis
2. Thyroid disease = hypo and hyperthyroidism
3. Grey skin
4. Corneal deposit
98
Digoxin s/e?
1. N&V
2. Diarrhoea
3. Blurred vision
4. Confusion and drowsiness
5. Xanthopsia (disturbed green/yellow visual perception including 'halo' vision)
99
What increases the risk of digoxin toxicity?
Hypokalaemia
100
Constipated pt, what should be stopped?
Opiate-derived drugs e.g. Codeine and co-codamol
101
What should be stopped if pt is already on maximum dose of paracetamol?
Stop PRN prescription
102
Warfarin + bleeding with any INR Mx?
IV Vitamin K
103
Warfarin with INR >8 but not bleeding?
Oral Vitamin K
104
Ibuprofen causing AKI mx?
Stop ibuprofen and ACEi even if on that too
105
All insulin is SC, except?
Sliding scales using short acting insulin (ActRapid/Novorapid) = IV infusion
106
Acute asthma --> how much salbutamol can be given?
Back to back (only limited by s/e?
107
Acute asthma --> how much ipratropium can be given?
x4-6/day
108
Mx of neutropenic sepsis?
Piperacillin with Tazobactam IV (Tazocin) + Gentamicin IV
109
What should be withheld in slow AF?
Digoxin
110
Fast AF w/o adverse effects Mx?
BB (avoid in asthmatic), Diltiazem (avoid in peripheral oedema) or Digoxin
111
Postherpetic neuralgia Mx?
Topical lidocaine patch 5%
112
Drug for arrhythmia and hypotension?
Digoxin
113
What is clindamycin typically used for?
Bone infections
114
What is metronidazole typically used for?
GI infections (good effects on anaerobes which colonise the gut)
115
B12 deficiency Mx?
Hydroxycobalamin 1m IM alternate days for 2 weeks
116
Best AED for pregnancy?
Lamotrigine 25mg OD
117
Causes of microcytic anaemia?
1. Thalassaemia
2. ACD
3. IDA
4. Lead poisoning
5. Sideroblastic anaemia
118
Causes of normocytic anaemia?
1. ACD
2. Acute blood loss
3. Haemolytic anaemia
4. CKD
119
Causes of macrocytic anaemia?
1. Megaloblastic = Vit B12/folate deficiency
2. Non-megaloblastic = alcohol, liver disease, hypothyroidism, haemotological (Ms = myeloproliferative, myelodysplastic, multiple myeloma)
120
Causes of thrombocytopenia?
1. Reduced production
| 2. Increased destruction
121
Reduced production thrombocytopenia?
1. Infection = viral
2. Drugs = e.g. Penicillamine in RhA
3. Myelodysplasia, myelofibrosis, myeloma
122
Increased production thrombocytopenia?
1. Heparin
2. Hypersplenism
3. DIC
4. ITP
5. HUS/TTP
123
Causes of thrombocytosis?
1. Reactive = bleeding, tissue damage (infection, inflammation, malignancy), post-splenectomy
2. Primary = myeloproliferative disorders
124
Neutrophilia causes?
1. Bacterial infection
2. Inflammation
3. Infarction
4. Malignancy
5. Steroids
125
Neutropenia causes?
1. Viral infection
2. Chemotherapy/radiotherapy
3. Clozapine
4. Carbimazole
126
Lymphocytosis causes?
1. Viral infection
2. Lymphoma
3. CLL
127
Causes of a raised urea?
1. AKI
2. UGI haemorrhage
3. Large steak
128
Raised urea with normal creatinine in a pt who is not dehydrated Ix?
Look at Hb (if dropped, probably a UGI bleed)
129
Causes of hypernatraemia?
4 Ds
1. Dehydration
2. Drips = too much IV saline
3. Diabetes Insipidus
4. Drugs = effervescent/IV preparations with high Na content
130
Causes of hyponatraemia?
1. Hypovolaemia
2. Euvolaemic
3. Hypervolaemia
131
Hypovolaemic hyponatraemia causes?
FAD
1. Fluid loss = D&V
2. Addisons
3. Diuretics (any type)
132
Euvolaemic hyponatraemia causes?
1. SIADH
2. Psychogenic polydipsia
3. Hypothyroidism
133
Hypervolaemic hyponatraemia causes?
1. Heart failure
2. Renal failure
3. Liver failure = hypoalbuminaemia
4. Nutritional failure = hypoalbuminaemia
5. Thyroid failure = hypothyroidism, often euvolaemic
134
Causes of hypokalaemia?
DIRE
1. Drugs = loop and thiazide diuretics
2. Inadequate intake/intestinal loss = D&V
3. Renal tubular acidosis
4. Endocrine = Cushings/Conns
135
Causes of hyperkalaemia?
DREAD
1. Drugs = K+ sparing, ACEi, heparins, Tacrolimus
2. Renal failure
3. Endocrine = Addisons
4. Artefact
5. DKA
136
Pre-renal AKI urea and creatinine?
Urea rise > Creatinine rise
137
Intrinsic renal AKI urea and creatinine?
Urea rise << Creatinine rise
138
Post-renal AKU urea and creatinine?
Urea rise << Creatinine rise
139
Pre-renal AKI causes?
1. Dehydration/shock
| 2. RAS = often triggered by ACEi or NSAIDs
140
Intrinsic renal AKI causes?
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
Post-renal AKI causes?
1. In lumen = stone or hydronephrosis
2. In wall = tumour (renal cell, transitional cell), fibrosis
3. External pressure = BPH, prostate ca, lymphadenopathy, aneurysm
142
How to differentiate rise in creatinine that can be seen in severe prerenal AKI from intrinsic and obstructive AKI?
Multiply urea by 10; if it exceeds Creatinine, then this suggests a prerenal aetiology
143
Hepatocyte injury markers?
1. Bilirubin
2. ALT and AST
3. ALP
144
Synthetic function of liver?
1. Albumin
| 2. Vit K dependent clotting factors (2,7,9,10)
145
Causes of raised ALP?
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
Pre-hepatic high Br?
1. Haemolysis
2. Gilbert's
3. Criggler-Najjar syndrome
147
3 drugs that can cause liver cirrhosis?
1. Paracetamol OD
2. Statins
3. Rifampicin
148
Drugs that cause cholestasis?
1. Flucloxacillin
2. Co-amoxicalv
3. Nitrofurantoin
4. Steroids
5. Sulphonylureas
149
Obstructive jaundice causes?
1. In lumen = gallstones, drugs
2. In wall = cholangiocarcinoma, PBC, PSC
3. Extrinsic pressure = pancreatic or gastric cancer, Lymph nodes
150
Target TSH range?
0.5-5mIU/L, try and change by the smallest increment offered in the exam (unless grossly hypo/hyperthyroid)
151
Primary hypothyroidism TFTs and cause?
1. Low T4, High TSH
| 2. Hashimoto's thyroiditis, drug-induced hypothyroidism
152
Secondary hypothyroidism TFTs and cause?
1. Low T4, Low TSH
| 2. Pituitary tumour or damage
153
Primary hyperthyroidism TFTs and cause?
1. High T4, Low TSH
| 2. Graves, toxic nodular goitre, drug-induced
154
Secondary hyperthyroidism TFTs and cause?
1. High T4, High TSH
| 2. Pituitary tumour
155
V1-V4 ST depression could indicate?
Anterior ischaemia OR posterior infarction (add leads V7-V9 posteriorly to confirm STEMI for the latter)
156
FiO2 and hypoxia rules?
Subtract 10 from FiO2 and if PaO2
1. Exceeds this number = pt is not hypoxic
2. Is lower = pt is hypoxic
157
Type I respiratory failure causes?
Anything that damages heart/lungs that causes SOB
| 1. Low or normal PaCO2 i.e. fast/normal breathing
158
Type II respiratory failure causes?
COPD blue bloaters, neuromuscular failure, restrictive disease
1. High PaCO2 i.e. fast/normal breathing
159
Drugs with narrow therapeutic index that requires monitoring?
1. Digoxin
2. Theophylline
3. Lithium
4. Phenytoin
5. Abx e.g. gentamicin and vancomycin
160
Drug that shows zero-order kinetics?
Phenytoin
161
High gentamicin level Mx?
Decrease in frequency rather than dose e.g. change from every 24hr to every 36 hrs
162
Gentamicin toxicity?
Ototoxicity and nephrotoxicity
163
Vancomycin toxicity?
Ototoxicity and nephrotoxicity
164
Phenytoin toxicity?
1. Gum hypertrophy
2. Ataxia
3. Nystagmus
4. Peripheral neuropathy
5. Teratogenicity
165
Lithium toxicity?
1. Early = tremor
2. Intermediate = tiredness
3. Late = arrhythmias, seizures, coma, renal failure, DI
166
How is gentamicin dose calculated?
According to pts weight and renal function
167
Usual gentamicin tx?
High dose regimen of 5-7mg/kg OD
168
Gentamicin for pts with severe renal failure or endocarditis?
May receive divided daily dosing at 1mg/kg
1. Renal failure = 12 hourly
2. Endocarditis = 8 hourly
169
How to determine if gentamicin level is too high?
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
Mx of any drug toxicity principles?
1. Stop drug +/- alternatives if available
2. Supportive measures, usually IV fluids
3. Give antidote if one is available
171
Pathophysiology of paracetamol overdose?
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
What may INR be viewed as?
The ratio of a patient's PT compared to the normal population
173
Normal INR?
1
174
Warfarin inhibits synthesis of?
Vit K dependent clotting factors = 2,7,9,10 --> prolongs PT (from which INR is derived)
175
When is PT used instead of INR for monitoring Warfarin?
Pts with liver disease or DIC
176
Target INR for most warfarin pts?
2.5
177
Target INR for recurrent VTE or metal replacement heart valves?
3.5
178
Major bleed on warfarin Mx?
1. Reduce warfarin dose
2. Give 5-10mg IV Vitamin K
3. Give prothrombin complex concentrate e.g. Beriplex
179
INR <6 no bleed?
Reduce warfarin dose
180
INR 6-8 no bleed?
Omit warfarin for 2 days then reduce
181
INR >8 no bleed?
Omit warfarin and give 1-5mg oral Vitamin K
182
MI aspirin or clopidgrel dose?
300mg oral
183
MI morphine dose?
5-10mg IV
184
MI metoclopramide dose?
10mg IV
185
MI BB dose?
Atenolol 5mg oral (Use BB in ACS unless LVF/asthma)
186
When would you not use BB in ACS?
LVF and asthma
187
Cardiac furosemide dose?
Furosemide 40-80mg IV --> if inadequate response to LVF --> Isosorbide dinitrate infusion +/- CPAP
188
VT drug and dose?
Amiodarone 300mg IV over 20-60mins and then 900mg over 24hrs
189
Polymorphic VT drug and dose?
Magnesium sulphate 2g IV over 10 mins
190
SVT drug and dose?
Adenosine 6mg IV --> 12mg IV --> 12mg IV
191
Causes of Irregular broad QRS?
1. AF with BBB
2. Pre-excited AF
3. Polymorphic VT
192
Causes of regular broad QRS?
1. VT
| 2. SVT with BBB
193
Anaphylaxis drugs and doses?
1. Adrenaline 500micrograms of 1:1000 IM
2. Chlorphenamine 10mg IV
3. Hydrocortisone 200mg IV
4. Asthma tx if wheeze
194
Acute exacerbation of asthma/COPD drugs and doses?
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
PE drugs and doses?
1. Morphine 5-10mg IV
2. Metoclopramide 10mg IV
3. Tinzaparin 175 units/kg SC daily
4. Low BP --> IV Gelofusin --> NA --> Thrombolysis
196
GI bleeding drug management?
1. Crystalloid/colloid
2. X-match 6 units of blood
3. Correct clotting abnormalities
4. Stop culprit drugs = NSAIDs, Aspirin, Heparin, Warfarin
197
Correction of clotting abnormalities in GI haemorrhage?
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
Bacterial meningitis Drug Mx?
1. Dexamethasone 10mg IV
2. 2g Cefotaxime IV
3. IV fluids
4. LP +/- CT head
199
Seizure >5 mins drugs?
1. Lorazepam 2-4mg OR
2. IV Diazepam 10mg OR
3. Buccal Midazolam 10mg
200
Still fitting after 2 mins on initial drugs?
1. Phenytoin infusion
| 2. Intubate + Propofol
201
DKA Dx?
1. Hyperglycaemia = BM>11
2. Ketones = >3 or significant ketonuria
3. Acidaemia = pH < 7.3
202
DKA Mx?
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
HHS Dx?
Marked dehydration in T2DM pts with glucose >30mmol/L, hyperosmolar (osmolality >340mmol/L), non-acidotic and non-ketotic
204
HHS Mx?
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
AKI fluids?
1. Strict fluid monitoring
2. IV fluid = 500ml STAT then 1L 4hrly
3. Check drug chart for nephrotoxic medications
206
How to reduce absorption in acute poisoning <1hr?
1. Gastric lavage
2. Whole bowel irrigation (if lithium/iron)
3. Charcoal (dx-dependent)
207
HTN Dx?
NICE now recommends ambulatory/home BP monitoring to minimise white coat HTN
208
When to treat HTN?
1. BP > 150/95mmHg OR
| 2. BP > 135/85mmHg + any of IHD/stroke/PVD/HTN organ damage
209
HTN algorithm?
1. A or C
2. A+C
3. A+C+D
4. A+C+D+ further diuretic/AB/BB
210
CHADSVASC score?
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
When to rhythm control for AF?
1. Young
2. Symptomatic AF
3. 1st episode
4. AF due to precipitant e.g. sepsis/e- disturbance
212
Rhythm control AF options?
Cardioversion
1. Electrical
2. Pharmacological = Amiodarone 5mg/kg IV over 20-120mins, pt will require anticoagulation if more than 48 hours since onset
213
When to rate control for AF?
Everyone else with HR >90bpm
214
Rate control AF options?
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
Stable angina Mx?
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
Diabetes Mx?
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
Blood glucose lowering therapy in T1DM?
Insulin
218
Blood glucose lowering therapy in T2DM?
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
Most commonly used regimen for Parkinsons?
1. Co-Beneldopa or Co-Careldopa (i.e. levodopa combined with peripheral dopa decarboxylase inhibitor - Benserazide or carbidopa respectively)
220
Patient with mild PD who is worried about the finite period of benefit from Levodopa?
1. DA agonist (ropinorole) or
| 2. MAOi (rasagiline)
221
Drugs to avoid in parkinsons?
Metoclopramide and Haloperidol
222
More appropriate antiemetic for parkinsons?
Domperidone
223
Generalised tonic clonic seizures drug?
Sodium valproate
224
Absence seizures drug?
Sodium valproate or Ethosuximide
225
Myoclonic seizures drug?
Sodium valproate
226
Tonic seizures drug?
Sodium valproate
227
Focal seizures drug?
Carbamazepine or Lamotrigine
228
Lamotrigine s/e?
RASH, rarely SJS
229
Carbamazepine s/e?
1. Rash
2. Dysarthria
3. Ataxia
4. Nystagmus
5. Hyponatraemia
230
Phenytoin s/e?
1. Ataxia
2. Peripheral neuropathy
3. Gum hyperplasia
4. Hepatotoxicity
231
Sodium valproate s/e?
3 Ts
1. Tremor
2. Teratogenicity
3. Tubby (weight gain)
232
3 licensed drugs for mild/moderatee Alzheimers?
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
Drug for moderate/severe Alzheimers?
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
Crohns mild flare?
Prednisolone 30mg OD orally
235
Crohns severe flare?
Hydrocortisone 100mg 6hrly IV + supportive care
236
Crohns rectal disease?
Rectal hydrocortisone
237
Crohns remission maintenance?
Azathioprine or Mercaptopurine
238
What should be checked before starting on Azathioprine or 6-mercaptopurine?
TPMT levels
239
Why do TPMT levels need to be measured?
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
What should be prescribed instead if TPMT levels are low?
Methotrextae
241
RhA Mx?
Methotrexate + one other DMARD e.g.
1. Sulfasalazine
2. HCQ
242
RhA flare Mx?
1. Glucocorticoids = IM Methylprednisolone 80mg
2. NSAIDs = Ibuprofen 400mg 8hrly + gastroprotection
3. Re-instate DMARDS if dose previously reduced
243
Failure to respond to 2 DMARDs in RHA?
TFNa inhibitors e.g. Infliximab
244
Constipation treatment options?
1. Stool softener
2. Bulking agents
3. Stimulant laxatives
4. Osmotic laxatives
245
Stool softeners?
1. Docusate sodium
| 2. Arachis oil (rectal)
246
Bulking agents?
Ispaghula husk
247
Stimulant laxatives?
1. Senna
| 2. Bisacodyl
248
Osmotic laxatives?
1. Lactulose
| 2. Phosphate enema
249
C/I for bisacodyl?
Acute abdomen
250
C/I for phosphate enema?
Acute abdomen
251
Good laxative for faecal impaction?
Docusate sodium
252
What laxative may exacerbate abdominal cramps?
Stimulant laxatives
253
What laxative may exacerbate bloating?
Osmotic laxatives
254
Mx of fever?
1. Tx underlying cause
| 2. Paracetamol as antipyretic
255
Mx of constipation?
1. Tx underlying cause
| 2. Laxative depending on cause, e.g. not if evidence of obstruction
256
Mx of diarrhoea?
1. GI infection = do not tx with quick removal
| 2. Chronic e.g. non-infectious with negative stool cultures
257
Chronic diarrhoea mx?
1. Loperamide 2mg oral up to 3 hrly OR
| 2. Codeine 30mg oral up to 6 hrly (also provides pain relief)
258
Insomnia Mx?
1. May be on drugs that prevent sleep e.g. corticosteroids
| 2. Zopiclone 7.5mg oral nightly in adults
259
When are corticosteroids given and why?
In the AM as it affects sleep
260
Zopiclone dose in elderly?
3.75mg nightly in elderly
261
Beclomethasone example dose?
200micrograms, 1 puff BD inhaled
262
Flucloxacillin example dose?
500mg, 6 hourly for 7D
263
Omeprazole example dose?
20mg, oral daily
264
Enoxaparin example dose for prophylaxis?
40mg OR 4000 units, SC daily
265
Dalteparin example dose for treatment?
15,000 units SC daily (therapeutic dose if weight 72kg)
266
Levothyroxine example dose?
75micrograms oral daily
267
Citalopram example dose?
20mg OD
268
Ferrous sulphate example dose?
200mg OD
269
Amlodipine example dose?
5mg OD
270
Co-careldopa example dose?
125mg, oral 8hrly
271
5mg IV diamorphine equivalent in IV morphine?
10mg IV morphine
272
What shouldnt be prescribed alongside methotrexate?
Folate antagonists e.g. Trimethoprim and Co-trimoxazole
273
Acute alcohol and CYP450?
Inhibitor
274
Chronic alcohol and CYP450?
Inducer
275
Warfarin monitoring?
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
Citalopram s/e?
Photosensitivity
277
Why does insulin dose need to be increased when pt unwell?
As blood glucose increases when unwell
278
How should alendronic acid be taken?
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
1g in mg?
1000
280
1mg in micrograms?
1000 micrograms
281
What can 1% drug mean?
1. 1g in 100ml OR
| 2. 1g in 100g
282
Dalteparin treatment dose?
15,000 Units SC once daily
283
Enoxaparin treatment dose?
120mg or 12,000 Units SC once daily
284
Tinzaparin treatment dose?
14,000 Units SC once daily
285
Enalapril and Lisinopril starting dose for HF?
2.5mg ON
286
Peindopril starting dose for HF?
2mg OD
287
Ramipril starting dose for HF?
1.25mg ON
288
Spironolactone dose for HF?
25mg oral daily (should be given in morning)
289
How to write GTN prescription?
GTN SPRAY, 2 Sprays, Sublingual
290
How much GTN is in one metered dose
400 micrograms
291
GTN tablet dose?
0.3-1mg sublingual
292
Hyperkalaemia, 1st drug to lower K+?
Actrapid 10 units in 100ml of 20% dextrose over 30 minutes IV
293
2nd line drug to lower K+?
Salbutamol 5mg nebulised STAT
294
Gliclazide dose?
1. 40mg oral daily with first meal OR
| 2. 80mg oral daily with first meal
295
What creatinine should preclude prescribing metformin?
>150 umol/L
296
Simvastatin monitoring?
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
What should be checked before prescribing Vancomycin?
Serum creatinine
298
Normal lithium range?
0.4-0.8mmol/L
299
Recommended sampling time for Lithium?
12 hours after last dose
300
Lithium monitoring?
1. Weekly after initiation
2. After each dose change until concentrations are stable
3. Ever 3m therafter
301
What increases the risk of lithium toxicity?
Sodium depletion (pts advised to avoid making changes in their diet that would lead to increased/decreased sodium intake)
302
Lithium reference range?
0.4-0.8mmol/L
303
At what lithium level do toxic effects typically occur?
>1.5mmol/L
304
FBC monitoring for methotrexate?
Every 2-3m
305
What needs to be checked before olanzapine is prescribed?
Fasting blood glucose
306
What must be checked before starting COCP?
BP
307
What must be checked before prescribing amiodarone?
1. Baseline CXR
| 2. TSH, T3+4
308
One hour peak serum concentration of gentamicin?
3-5mg/litre
309
Pre-dose trough concentration of gentamicin?
<1mg/litre
310
When should serum gentamicin concentrations be measured?
1. After 3 or 4 doses
2. Then At least every 3 days
3. Then after a dose change
311
What should be measured during digoxin tx?
Serum creatinine, as it is predominantly renally excreted
312
When should digoxin levels be measured?
Not measured unless toxicity, non-compliance or inadequate effect are suspected
313
What should be measured before commencing sodium valproate?
ALT
314
Apart from hepatic effects, what is a s/e of sodium valproate?
Pancreatitis
315
What must be monitored during clozapine tx?
1. FBC must be checked weekly for the 1st 18 weeks
| 2. Registration with a clozapine monitoring service is required for all patients
316
When must clozapine be stopped?
If leukocyte count drops <3000/mm^3 or neutrophil count drops <1500mm^3
317
Type A adverse drug reaction?
Common, predictable, dose related
318
Type B adverse drug reaction?
Idiosyncratic, bizarre, unexpected, related to gene/host/environment interactions
319
4 drugs with a narrow therapeutic index?
1. Warfarin
2. Digoxin
3. Theophylline
4. Phenytoin
320
2 drugs that require careful titration of dose according to effect?
Antihypertensives, anti-diabetic drugs
321
How long does enzyme induction take to establish?
Days to weeks
322
How long does enzyme inhibition take to establish?
Hours to days
323
What should ACEis not be co-prescribed with, especially in the elderly?
NSAIDs
324
What shouldnt you do on metronidazole?
Drink alcohol --> fulminant N&V
325
How do NSAIDs affect kidneys?
Inhibit PGs which constrict afferent vessels
326
How do ACEis affect kidneys?
Dilate efferent renal vessels
327
2 situations IV fluid is prescribed?
1. As replacement
| 2. As maintenance
328
What pt should not be prescribed compression stockings?
Those with peripheral arterial disease
329
Usual oramorph strength?
10mg/5ml
330
Sail sign on CXR?
Triangle behind heart, suggests LLL collapse
331
Downward sloping ST segment in all leads?
Digoxin
332
Normal gentamicin peak dosage?
5-10mg/L
333
Normal gentamicin trough dosage?
<2mg/L
334
Endocarditis gentamicin peak dosage?
2-5mg/L
335
Endocarditis gentamicin trough dosage?
<1mg/L
336
Action if gentamicin out of peak range?
Adjust dose
337
Action if gentamicin out of trough range?
Adjust dose interval
338
Only commonly used CCB in AF?
Diltiazem
339
Drowsy pt with hypoglycaemia?
100ml 20% glucose
340
What drug class can docusate sodium act as at higher doses?
Stimulant laxative
341
Carbimazole dose?
20mg orally 12 hourly
342
Warfarin tablet colours?
1. White = 0.5mg
2. Brown = 1mg
3. Blue = 3mg
4. Pink = 5mg
343
Alteplase dose?
10mg IV over 1-2 minutes
344
Enalapril dose for HTN?
5mg ON
345
Lisinopril dose for HTN?
10mg ON
346
Ramipril dose for HTN?
1.25mg ON or 2.5mg ON
347
Conscious hypoglycaemic pt management?
10-20G glucose orally
