PSA notes Flashcards
1
Q
Hack for searching for one side effect within multiple drugs
A
side effect AND (drug1 OR drug2 OR drug3)
2
Q
How to find HRT in treatment summaries
A
Search sex hormones
3
Q
How to find opioid dose equivalent tables
A
Search prescribing in palliative care
4
Q
How to find glucocorticoid dose equivalence tables
A
Search corticosteroid
5
Q
How to find information on overdoses?
A
Poisoning section
6
Q
How to find information on how to manage a high INR
A
oral anticoagulants treatment summary
7
Q
How to find conversions eg lb to Kg
A
search approximate conversions and units
8
Q
what does PRESCRIBER stand for
A
to remember what to do when you get a full paper prescription
Patient details
Reactions
Signature
Contraindications
Route
IV fluids if needed
Blood clot prophylaxis if needed
Emetic prophylaxis if needed
Relief of pain if needed
9
Q
Drugs causing prolonged QT
A
Amiodarone
Chlorpromazine
Citalopram (SSRI)
Clarithromycin
Clomipramine
Domperidone
Erythromycin
Escitalopram
Flecainide
Fluconazole
Haloperidol
Levomepromazine
Lithium
Methadone
Metocloperamide
Ondansetron
Quinine
Risperidone
Sildenafil
Tolterodine
Tricyclic antidepressants
10
Q
Antibiotics to avoid in renal failure
A
Nitrofurantoin and tetracyclines
11
Q
Drugs likely to accumulate in renal failure
A
Digoxin
Furosemide
Atenolol
Allopurinol
Opioids
Methotrexate
Metformin
Sulphonylureas
12
Q
Drugs to avoid in pregnancy
A
Rotton wet dogs smell so stinky
Ramipril
Warfarin
Doxycycline
Sulphonylureas - gliclazide
Statins
Sodium Valproate
13
Q
Drugs which cause hyperkalaemia
A
Dalteparin sodium
Ramipril
Tacrolimus (oral immunosuppressant)
14
Q
things to include if prescribing an ‘as required’ medication
A
give an indication and maximum frequency
15
Q
things to include if prescribing an antibiotic
A
give an indication and a stop or review date
16
Q
remember to include what when prescribing tacrolimus
A
trade name
17
Q
can you write a prescription for tazocin?
A
No it needs to be written as piperacillin with tazobactam
18
Q
when is diclofenac contraindicated
A
peripheral arterial disease, vascular disease, and congestive heart failure due to increased risk of CVD
19
Q
which drugs may exacerbate heart failure
A
Thiazolidinediones due to fluid retention.
Verapamil.
NSAIDS
Glucocorticoids.
CLASS one antiarrhythmics such flecainide.
20
Q
Cp450 inducers
A
BS CRAP GPS
Barbiturates
St johns wart / Smoking
Carbamazepine
Rifampicin
Alcohol (chronic)
Phenytoin
Griseofulvin
Phenobarbitones
Sulphonylureas
21
Q
Cp450 inhibitors
A
SICKFACESS.COM
Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol (acute)
Chloramphenicol
Erythromycin/
Clarithromycin
Sulphonamides
SSRIs (sertraline & fluoxetine)
Ciprofloxacin
Omeprazole
Metronidazole
22
Q
what is 1 Fingertip unit
A
Amount of medication to squeeze a line from tip of adult finger to first crease. This will be enough to treat one side of both hands
23
Q
If someone is on long term steroids, what do you do at induction of anaesthesia
A
Give IV steroids
24
Q
Drugs to stop before surgery
A
HIA LACK
Hypoglycemics (oral)
Insulin
Anticoagulants/antiplatelets
Lithium - day before
ACEi - day of
COCP - 4 weeks before
K sparing – day of
25
Maximum dose of paracetamol
4g / day (8 X 500mg tablets)
(2g per day if <50kg)
26
why should you not give prophylactic heparin in acute ischaemic stroke
bleeding risk
27
Side effects of steroids
Stomach ulcers,
Thin skin,
Edema,
Right and left heart failure,
Osteoporosis,
Infection,
Diabetes,
Syndrome of cushings.
28
Side effects of NSAIDS
No urine (renal failure),
Systolic dysfunction (heart failure),
Asthma,
Indigestion,
Dodgy clotting (or Dyscrasia)
29
ACEi side effects
dry cough due to bradykinin accumulation
30
beta blocker side effects
wheeze in asthmatics,
worsening acute HF but help chronic.
31
CCB side effects
Peripheral oedema and flushing
32
side effects of K+ sparing diuretics
gynaecomastia
33
When to stop NSAIDS in asthma
when wheezy
34
do you still give oral medications including prior to surgery if NBM?
yes
35
when to give 5% dextrose as replacement fluid
if Hypernatraemic or hypoglycaemia
36
when to give human albumin solution (HAS) as replacement fluid
If they have ascites
37
how much fluid to give in bolus if heart failure
250ml
38
what is the maximum speed to give IV potassium?
don't give faster than 10mmol/hour
39
what volume maintenance fluid should be given?
25-30 ml/kg/day (around 3L per day IV for adults and 2L per day for elderly)
40
when should you NOT prescribe compression stockings or B blockers
in PAD due to risk of acute limb ischaemia
41
when to avoid metoclopramide
In Parkinson’s and in young women due to risk of unwanted movements eg acute dystonia.
41
when to avoid metoclopramide
In Parkinson’s and in young women due to risk of unwanted movements eg acute dystonia.
42
How to change between anti-emetics
common antiemetics have the same dose regardless of the route taken.
43
what anti-emetic should be used in heart failure
metocloperamide. Cyclizine causes fluid retention
44
first line anti-emetic
cyclizine as long as no cardiac problems
45
Maximum dose of ibuprofen
400mg 8 hourly
46
First line for neuropathic pain
* amitriptyline 10mg oral nightly
* OR pregabalin 75mg oral BD
47
first line for diabetic neuropathy
duloxetine 60mg oral daily
48
How to manage pain
NO PAIN –
PRN paracetamol 1g up to 6 hrly ORAL
MILD PAIN –
Regular paracetamol 1g up to 6 hrly ORAL
PRN Codeine 30mg up to 6 hrly ORAL (OR TRAMADOL)
SEVERE PAIN –
Regular co-codamol 30/500, 2 tablets 6 hrly ORAL
PRN Morphine sulphate (10mg/5ml) 10mg up to 6 hrly ORAL.
49
what does co-codamol 30/500 mean
30mg of codeine and 500mg of paracetamol
50
what is NEO-NACLEX
thiazide diuretic
51
what is oxybutynin and what are the side effects
= antimuscarinic causing confusion in the elderly. Pupil dilation, loss of accommodation, dry mouth and tachycardia.
52
tramadol in elderly
opioid, causes confusion and should be avoided unless completely necessary
53
cyclizine in elderly
can cause drowsiness and confusion. Reduce dose in elderly.
54
diazepam in elderly
use with extreme caution and only for short courses.
55
why is trimethoprim contraindicated with methotrexate?
methotrexate is a folate antagonist and so is trimethoprim which can cause pancytopenia and neutropenic sepsis.
56
what to avoid prescribing with methotrexate due to nephrotoxic risk
ibuprofen and other NSAIDs
57
what to do with methotrexate in active infection?
stop methotrexate. it has a long half-life so shouldn’t affect the control of RA
58
what to do with methotrexate in active infection?
stop methotrexate. it has a long half-life so shouldn’t affect the control of RA
59
monitoring of methotrexate
1-2 weekly FBC, U&E, LFTs until stable, monitored 2-3 months after.
60
Inpatients with INR >2
should not be given prophylactic heparin as it increases the risk of unnecessary bleeding
61
dose of aspirin
75mg cardioprotective. 300mg in ACS
62
bisoprolol dose
10mg/ day
63
i
64
urea and creatinine in different types of AKI
Pre-renal - Urea rises more than creatinine. (Urea X10) > creatinine
Renal - Creatinine rises more than urea
(Urea X10) < creatinine
Post-renal - Creatinine rises more than urea
(Urea X10) < creatinine
65
isolated raised bilirubin
pre hepatic hepatitis due to haemolytic.
66
drugs which cause cholestasis
flucloxacillin, co-amoxiclav, nitrofurantoin, steroids, Sulphonylureas, COCP
67
drugs requiring monitoring of levels
Digoxin – confusion, nausea, visual halos, arrythmias. Check digoxin 8-10days later.
Theophylline
Lithium - tremor, tiredness, arrythmia, seizure, coma, renal failure, insipidus.
Phenytoin – gum hypertrophy, ataxia, nystagmus, peripheral neuropathy, teratogenicity.
Antibiotics – gentamycin and vancomycin – ototoxic and nephrotoxic
68
if high serum level of a drug what do you do?
= decrease dose
Except gentamycin where a high level = reduce frequency by 12hrs.
69
gentamicin monitoring
If high serum level and toxicity = omit for few days.
If plotted point is above the every 48 hour area = repeat gentamicin level and only give another dose when <1mg/L
12 hours after last infusion is started (troph measurement)
70
when might someone taking gentamicin receive reduced and divided doses
renal failure or endocarditis
71
INR and warfarin
INR 5-8
NO BLEEDING = withheld 1-2 doses and reduce subsequent dose
MINOR BLEEDING = stop warfarin, IV VITAMIN K, restart when INR <5.
INR >8
NO BLEEDING = stop warfarin. Oral vitamin K. restart when INR <5.
MINOR BLEEDING = stop warfarin. IV vitamin K. restart when INR <5.
Any major bleeding = stop warfarin. IV vitamin K. Prothrombin complex concentrate / FFP if unavailable
72
management of neutropenic sepsis
= piperacillin with tazobactam and gentamicin IV
73
electrolytes and carbemazepine
hyponatraemia
74
Digoxin and HR
stop digoxin if bradycardic
75
Salbutamol inhaler during acute attack
Withold salbutamol inhaler while using nebulisers
76
acute HF drug management
furosemide 20-50mg IV.
77
lanoxin
trade name for diltiazem
78
side effects of lamotrigine
rash, rarely SJS
79
side effects of carbamazepine
rash, dysarthria, ataxia, nystagmus, hyponatraemia
80
side effects of phenytoin
ataxia, peripheral neuropathy, gum hyperplasia, hepatotoxicity.
81
side effects of levetiracetam
fatigue mood disorders and agitation
82
flecanide is contraindicated when?
structural heart disease
83
Diabetes – managing cardiovascular risk factors
Aspirin 75mg if CV risk factors or >50yo in T2DM
Stating 20mg daily if CV risk factors >40yo in T2DM
84
Annual review in diabetes –
Albumin creatinine ratio
indicates diabetic nephropathy early. ACR >3= ACEi.
85
alzheimers drug management
treatment may only be started by specialist doctors
* there are three licenced drugs: donepezil, rivastigmine and galantamine.
* If moderate/severe dementia, then treat with NMDA antagonist (memantine
86
Crohns disease management
Inducing remission
Mild – 20-40mg pred oral daily
Severe – 100-500mg IV hydrocortisone
Maintaining remission
Azathioprine (check TPMT activity before starting as a deficiency can increase the risks of liver and bone marrow toxicity)
87
when to start TNF-alpha inhibitors in RA
If fail to respond to 2 DMARDS then severely active RA may be managed with TNF-alpha inhibitors like infliximab
88
when to give steroids
Steroids can cause insomnia so give in the morning.
89
Carbimazole and carbamazepine can cause
neutropenia
90
what to prescribe if Cardiac chest pain and allergic to opiates
sublingual GTN 2 puffs. Can do infusion if this doesn’t work.
91
examples of LMWH
enoxaparin, tinzaparin or dalteparin.
92
If a contraception is 30/75 it tells you
you it is combined straight away without having to check
93
carbamazepine and oral contraception
COCP and POP should be avoided if taking carbamazepine (enzyme inducers)
94
Sayana press and depo-provera are
injectable contraceptives
95
ramipril and pregnancy
Ramipril is teratogenic in the first trimester. Stop before conception and start labetalol
96
tamoxifen and warfarin
Tamoxifen increases the efficacy of warfarin = bleeds.
97
Warfarin colour tablets
we bite big penises
white (0.5 mg), brown (1 mg), blue (3 mg), and pink (5 mg).
98
warfarin monitoring
When first on warfarin weekly blood tests required. Monthly when stable.
99
when to check renal function with ramipril
1-2 weeks after starting
100
when to take bisphosphonates with steroids
if taking steroids more than 3 months
101
citalopram side effects
suicidal and salivate a lot
102
instructions for taking bisphonates
swallow with full glass of water and remain upright for 30 min. Taken once weekly. Don’t eat for 2 hours after
103
Breast cancer risk after stopping HRT
Although the risk of breast cancer is lower after stopping HRT than it is during current use, the excess risk persists for more than 10 years after stopping compared with women who have never used HRT.
104
calculation questions for weight/volume or weight/weight
1%= 10mg/ml 1% = 1g/100g
105
how much oral phenytoin = a 100mg phenytoin capsule
92mg
106
when to give ACE inhibitors
in evening as they can cause postural hypotension
107
how to prescribe GTN spray
write the dose in the drug name GTN spray (400 micrograms/metered dose) and write 2 sprays in the dose
108
For guidance on electrolytes what do you search
fluid and electrolytes section on treatment summary
109
what to prescribe hyperkalaemia
Short-acting insulin (actrapid) with glucose.
10 units of actrapid in 50 ml of 50% dextrose over 15 min IV
110
when not to prescribe levetiracetam
Levetiracetam can worsen low mood so don’t give if depressed!
111
gliclazide and low BMI
Gliclazide can be used if underweight.
112
when to check CK on simvastatin
should be checked at baseline if at risk of myopathy i.e. a personal or family history of muscular disorders, previous history of muscular toxicity, a high alcohol intake, renal impairment, hypothyroidism, and in the elderly.
If no risk factors then measure serum ALT.
113
before prescribing vancomycin check what?
creatine for renal function
114
Vancomycin may cause what after a week of therapy
neutropenia
115
– recommended sampling time for lithium
is 12 hours after last dose. Weekly serum lithium after initiation and after each dose change until stable then every 3 month.
116
lithium
Likely to have toxic symptoms above 1.5 mmol/L.
117
methotrexate if liver function tests are abnormal
should not be started
118
monitoring in methotrexate
FBC every 2-3 month. In clinically significant drop in WCC or platelets, methotrexate should be stopped.
119
monitoring olanzapine
– fasting blood glucose should be measured at baseline, at 4-6 month and then yearly. Baseline ECG is only required if risk factors
120
amiodarone monitoring
baseline chest xray prior to amiodarone. T3 TSH and T4 must all be checked. LFT should be checked at baseline and at regular intervals. Caution in hypokalaemia.
121
carbimazole and sore throat
Neutropenia so do a FBC
122
sodium valproate monitoring
liver function should be measured at baseline as well as at regular intervals.
123
clozapine monitoring
FBC weekly for 18weeks, fortnightly for 1 year and monthly after due to agranulocytosis. Registration with a clozapine monitoring service is required for all patients.
124
side effects of ciprofloxacin
lowers seizure threshold and causes tendonitis
125
BB and heart failure
worsens acute heart failure (but helps chronic heart failure)
126
heparins are a higher risk of bleeding when?
in renal failure or <50kg
127
why should heparin be prescribed alongside warfarin at first
warfarin has a procoagulant effect initially, as well as taking a few days to become an anticoagulant; thus heparin should be prescribed alongside warfarin and continued until the INR exceeds 2
128
side effects of aspirin
Haemorrhage, peptic ulcers and gastritis, tinnitus in large doses
129
side effects of amiodarone
Interstitial lung disease (pulmonary fibrosis), thyroid disease (both hypo- and hyperthyroidism are reported; it is structurally related to iodine, hence its name amIODarone), skin greying, corneal deposits.
130
side effects of fludrocortisone
Hypertension/sodium and water retention
131
side effects of simvastatin
Myalgia∗, abdominal pain, increased ALT/AST (can be mild), rhabdomyolysis (can be just mildly increased creatine kinase though)
132
management of statin induced myalgia
exclude rhabdomyolysis (with creatine kinase (CK) level and urine dip). Otherwise, if symptoms unacceptable or CK very high (>2,000): (i) ensure needs statin, then (ii) reduce the dose; then (iii) switch to other statin with lower risk of myalgia (risk of myalgias: simvastatin > atorvastatin > pravastatin > fluvastatin).
133
low GCS and metformin
lactic acidosis
134
monoamine oxidase inhibitors can do what to BP
cause hypertensive crisis
135
ACEi and NSAIDS ok?
should not be co-prescribed due to renal function
136
amiloride drug class
potassium sparing diuretic
137
metformin and contrast
Discontinue metformin from day of procedure to 48 hours after CT with contrast. Review if eGFR <45 and stop if <30.
138
Antidotes to drugs -
B- blocker =
Lithium =
TCA =
Benzodiazepines =
CO =
Methanol =
Iron =
Heparin =
Ethylene glycol (antifreeze) =
Digoxin =
B- blocker = atropine
Lithium = IV NaCl
TCA = IV sodium bicarb
Benzodiazepines = flumazenil
CO = 100% oxygen
Methanol = Fomepizole / ethanol
Iron = desferrioxamine
Heparin = Protamine sulphate
Ethylene glycol (antifreeze) = fomepizole / ethanol
Digoxin = digiband
139
daily requirement of glucose
50-100g
140
Drugs causing pulmonary fibrosis
AMEN
Amiodarone
Methotrexate, Sulfasalazine
Ergot derived dopamine EG bromocriptine, cabergoline, pergolide
Nitrofurantoin
Cytotoxic agent (bleomycin)
141
drugs causing urinary retention
TCA’s (eg amitriptyline)
Anticholinergics
Opioids
NSAIDs
142
VTE prophylaxis enoxaparin dose
Write in MG and Units (1mg = 100units)
20mg every 24 hours if moderate risk surgical
40 mg every 24 hours if high risk surgical (eg orthopaedic)
143
what to prescribe FIRST for suspected meningitis in GP and in hospital
Prescribe benzylpenicillin in GP
Prescribe Ceftriaxone (2g IV) / cefotaxime in hospital
144
Glucose for reduced GCS hypoglycaemic
Glucose 20% solution IV 50-100ml over 15min.
or
Glucose 10% solution IV 150ml over 15min
145
what antibiotic is used for acne in children
doxycycline
146
when to stop anti-platelets before surgery
1 week prior to surgery eg aspirin.
147
what to use for breakthrough pain in fentanyl patch users
fentanyl nasal spray 50micrograms into one nostril.
148
avoid nitrofurantoin if renal function is what level
<45
149
can you give trimethoprim if folate deficient
yes Can give a short course of trimethoprim even if folate deficient.
150
INR for surgery
INR needs to be <1.5 for surgery. Give Phytomenadione (vitamin K) if it is not.
1-5mg PO.
151
rivaroxaban administration instructions
Rivaroxaban should be taken with food to improve absorbtion
152
topiramate and oral contraceptives
Topiramate makes oral contraceptives not as effective. So should change to alternative method of contraception until 4 weeks after stopping taking topiramate.
153
citalopram and dabigatran interaction
Citalopram can increase bleeding. Especially when paired with dabigatran and increases GI haemorrhage
154
What rise in creatinine is acceptable after starting an ACEi?
<20%
155
How should the beneficial effect of furosemide be monitored?
weight reduction
156
ACEi measuring adverse effects and beneficial effects of therapy
Measure serum creatinine for adverse effects of therapy
Measure exercise tolerance to monitor beneficial effects of ACEi.
157
Most serious side effects of ciclosporin
nephrotoxicity and hypertension
Before treatment assess renal function and every 2 weeks until stable. Also monitor BP.
158
how to manage A rise in glucose after starting steroids on T1DM
increase insulin by 10%.
159
How do you know if statin dose is effective?
>40% reduction in non-HDL cholesterol
160
What is given for all exacerbations of COPD?
30mg prednisolone PO daily for 5 days
161
after 2L NaCL 0.9% in 24hrs glucose is required, how is it given
Glucose 5%/potassium chloride 0.3%.
162
After stroke it is recommended to maintain glucose between
5 and 15.
163
HRT patch dosing
Estradiol 50 microgram per 24 hour, Levonorgestrel 7 microgram per 24 hour in a transdermal patch once weekly.
164
CCB (diltiazem) and prednisolone can contribute to
biventricular failure
165
Usual dose of citalopram is
is 10-20mg PO daily (max 20mg daily)
166
If glycaemic control needs to be improved on insulin in the afternoon then
increase breakfast novomix dose.
167
Scarlet fever abx treatment
phenoxymethylpenicillin 125mg PO 6 hourly for 10 days
168
clarithromycin and INR
Clarithromycin increases INR.
169
missing 1st pill of pack after break COCP
Starting a pack one day late is not an issue. Take 2 pills in once day.
A missed pill is more than 24 hours late with COCP.
170
What should be monitored when starting K+ sparing diuretic? and when?
Serum potassium 1 week after starting.
171
Mirtazapine can cause
sleep disturbance and abnormal dreams
172
Monitoring beneficial effects of B-blockers using ..
Heart rate.
173
Before starting amiodarone need to check
serum potassium as hypokalaemia is a caution and needs to be corrected prior to starting treatment.
174
Sertraline monitoring
no routine blood monitoring needed.
175
Hepatic impairment and sertraline
doses may need to be reduced
176
CK markedly raised at what level on statins?
5X the upper limit of normal.
177
what to do if Statin causing raised CK
stop statin, when symptoms resolve and CK reduces to normal then restart at a lower dose.
178
Ondansetron is contraindicated if ? what to use instead
prolonged QT interval. Cyclizine is preferred.
179
1st and 2nd line for PONV?
Ondansetron and cyclizine
180
ciclosporin caues what electrolyte abnormality
hyperkalaemia
181
Epleronone is
potassium sparing diuretic
182
Drugs causing dyspepsia
prednisolone, nsaids and alendronic acid
183
Drugs causing diarrhoea
PPIs and alendronic acid.
184
Drugs that can cause ankle oedema
Amlodipine and naproxen
185
How long should a clotrimazole pessary be given for thrush in pregnancy
= 7 days
186
first line analgesic for pain in shingles
Paracetamol
187
when to use loperamide
after each loose stool up to 16mg per day
188
monitoring on cyclosporin
kidney function must be monitored every 2 weeks for first 3 months
189
tramadol can cause what complication
serotonin syndrome
190
Rifampicin can effect and reduce effectiveness of what
oral contraceptives
191
COCP should be stopped if BP is what?
>160/95
192
What should be checked before starting azathioprine?
TPMT activity.
193
How to check for adverse effects of apixaban?
Patients reporting of bleeding or bruising
194
what to do if amiodarone has caused thyroid issues
In hyperthyroidism (thyrotoxicosis) stop amiodarone at least temporarily to achieve control
In hypothyroidism continue amiodarone and replace thyroxine.
195
Dose of salbutamol neb
2.5mg
196
Why don’t you give IV glucose straight after a stroke if normal glucose level?
Can exacerbate cerebral injury
197
ching for sodium chloride fluids with potassium
type in potassium chloride with sodium chloride and go to medicinal forms
198
For sodium chloride 0.9% with Potassium chloride 0.3% how many mmol of potassium in 500ml
20mmol
199
For sodium chloride 0.9% with Potassium chloride 0.15% how many mmol of potassium in 500ml
10mmol
200
IV potassium should not be given faster than
10mmol/hour.
201
What is the indication in the BNF for a statin due to high QRISK?
Primary prevention of cardiovascular events
202
Aspirin can cause what deficiency
Iron deficiency anemia
203
Can Pioglitazone cause hypoglycaemia
Yes
204
how do opiates reduce urine output
Opiates can cause urinary retention
205
Morphine and metoclopramide can both cause
disorientation and confusion
206
When is IV sedation with a benzodiazepine contraindicated?
In a patient who is confused and disorientated.
207
Mx for FH of spina bifida in pregnancy?
5mg folic acid to 12 weeks
208
Pregnancy and no RF for neural tube defect?
400 micrograms folic acid
209
Oestrogen + progesterone HRT reduces what risk?
Risk of endometrial cancer
210
Oestrogen + progesterone HRT increases what risk?
Risk of breast cancer
211
Very common blood result in methotrexate use?
Leucopenia (low WCC)
212
How to assess the beneficial effects of allopurinol?
Serum urate
213
When to stop statin based on LFT?
If ALT >3X upper limit. If not then can continue statin.
214
If the thyroxine dose needs to be increased then increase it by up to ...
50%.
215
Thyroxine can exacerbate which condition?
Angina. (not contraindicated)
216
Gentamycin - If high peak concentration post-dose
reduce the dose
217
Gentamycin - If high trough concentration
= increase the interval between dose
