PSA NOTES Flashcards by Raunak Chandiramani

Anti-emetic choice for migraines

Prochlorperazine or Metoclopramide

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Drugs that can cause upper GI bleed

Prenisolone
Aspirin
Bisphosphonates

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Drug for prevention of diabetic nephropathy

ACEi

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Patient on amiodarone develops hypothyroidism. Next steps?

Continue amiodarone and start thyroid replacement tx

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1st line mucolytic for CF

Dornase Alfa

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What electrolyte abnormality can omeprazole cause?

Low magnesium

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Monitoring requirements for furosemide

U&Es - check for hypokalaemia

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Carbimazole monitoring requirements

Thyroid function tests should be performed every six weeks until the thyroid-stimulating hormone (TSH) is in the reference range according to NICE guidance.

Full blood count should be performed if there is clinical suspicion of infection due to the risk of agranulocytosis. Carbimazole should be stopped if there is any evidence of neutropenia and patients should report any clinical features of infection.

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Carbimazole monitoring requirements

Thyroid function tests should be performed every six weeks until the thyroid-stimulating hormone (TSH) is in the reference range according to NICE guidance.

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1% solution

1 g in 100ml

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Folic acid requirements in pregnancy for SCD patients

5mg folic acid until the end of pregnancy

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Statin monitoring

Liver function tests should be repeated within 3 months of starting treatment and again at 12 months according to NICE guidelines.

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Management of Raynaud’s phenomenon

Nifedipine

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Management of dehydration with hypernatraemia

1000ml of 5% glucose over 8-12 hrs

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Why do ibuprofen and prednisolone cause indigestion?

Ibuprofen inhibits prostaglandin synthesis needed for gastric mucosal protection from acid: there is therefore a risk of inflammation and ulceration.

Oral steroids inhibit gastric epithelial renewal, thus predisposing to ulceration.

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When should bendroflumethiazode be taken?

Daytime (NOT evening)

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Max paracetamol in one day

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How often should cyclizine and metoclopramide be given?

8 hrly

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How often should methotrexate be given?

once a week

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Aspirin dose for primary and secondary prevention

75mg

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Max citalopram dose for patient aged over 65 yrs

20mg

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How much are maintenance fluids (24 hrs)?

3 L (i.e. 8-hourly bags) for most adults, except the elderly or those with low body weight when 2 L per 24 h (i.e. 12-hourly bags) are needed.

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Side effects of phenytoin

dysarthria and gum hyperplasia

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Severe flare up of UC mx

IV hydrocortisone 100mg 6 hrly

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What can excessive alcohol do to glucose levels?

Hypoglycaemia

What can excessive alcohol do to glucose levels?

Hypoglycaemia

What condition should oxybutynin be avoided in?

MG - ACh receptors not functional

How can we manage urge incontinence in MG?

Duloxetine

Marker for pneumonia resolution

ABG ideally. RR is also good.

What should you check for 2 weeks after starting fluoxetine?

Presence of rash - any rash should prompt consideration of discontinuing fluoxetine as it may be a sign of an impending serious systemic reaction.

Patients under 50 kg - special considerations.

Enoxaparin is dose-adjusted in low eGFRs (<30 mL/min) but also in adults under 50 kg to prevent excessive anticoagulation. Note that patients under 50 kg should also have lower dose paracetamol (as prescribed here) to prevent hepatotoxicity.

Hypoglycaemia IV management

20% Glucose (50-100ml) 10% Glucose (100-200ml) within 20 min

Drugs to stop prior to surgery

**I LACK OP** * Insulin - *variable* * Lithium - *stop day before* * Antiplatelets/Anticoagulants - *variable* * COCP/HRT - *stop 4 weeks before* * K-sparing drugs - *stop on day* * Oral hypoglycaemics - *variable* * Perindopril + other drugs - *stop on day*

UTI management in patient with eGFR< 45 ml/min/1.73 m2

Trimethoprim preferred over nitrofurantoin

Patient stopped warfarin sodium 5 days before surgery. INR is 1.6 (Target 2.5). What should he be given?

Vitamin K BNF recommends that if INR > 1.5 on the day before surgery, Vit K 1-5 mg PO using the IV prep is indicated

Information to give about Rivaroxaban tx

Take with food

How to look for pain relief conversions on BNF

Prescribing in palliative care

Who should not be given 0.9% saline

- Hypernatraemia or hypoglycaemia (5% glucose) - ascites (human albumin solution) - shocked from bleeding (blood transfusion)

Fluids for: High HR or low BP

0.9% NaCl stat If hx of HF given 250ml

Fluids for: Olyguric

1L 0.9% NaCl over 2-4 hrs

Max rate potassium can be given at

10 mmol/hr

Maintenance fluid and electrolytes (24hrs)

3 L (i.e. 8-hourly bags) for most adults, except the elderly or those with low body weight when 2 L per 24 h (i.e. 12-hourly bags) are needed. 1 L of NaCl 0.9% 2 L of dextose 5% Potassium 1mmol per Kg

Drugs that can exacerbate HF

CCB and corticosteroids

Mirtazapine SE not really stated on BNF

Abnormal dreams

Elevated CK levels (>5x upper limit) in a pt on a statin, next steps?

Stop atorvastatin and restart at lower dose if symptoms resolve

Mastitis management

Flucloxacillin 500mg for 10-14 days If allergy: Erythromycin 250mg-500mg QDS for 10-14 days

What causes tendon rupture

Ciprofloxacin (fluoroquinolone). Most commonly within 48hrs of commencing tx or if combined with a corticosteroid.

What should be done if a patient on statin has3x upper limit of normal serum transaminases?

Discontinue statin and consider ezetimibe

Not on BNF: Olanzapine monitoring

Can cause prolonged QTc particularly if CV RFs therefore need ECGs (baseline, one week after start)

BNF navigating. oral pred to IM

Glucocoritcoid therapy treatment summaries. Hydrocortisone or methylpred can be given IM

1st line for reducing constipation

Isphagula hulk

GCA with visual loss

Methylprednisolone 1g IV daily for 3 days

Patient started on VRII, NBM, what fluids should be prescribed?

Sodium chloride 0.45%/Glucose 5%/Potassium chloride 0.15% solution 500ml over 4-6hrs

Bolus in children in dehydration

20x weight over less than 10 min.

Medications that can cause tremor

- Salbutamol - Haloperidol - Theophylline

Medications that can cause gout/hyperuricaemia

-Aspirin - Bumetanide (diuretics) - Ticagrelor

Medications that increase CK levels

- Statin - Haloperidol

What should patients on gentamicin be told?

To report any hearing loss

What are the first signs of lidocaine toxicity?

Circumoral tingling

Monitoring efficacy of thyroxine replacement therapt

TSH

Most appropriate option to monitor for benefical effects of dalteparin sodium prescription after 72 hrs of tx

Peak anti-Xa conc.

How to monitor for beneficial effects of donepezil?

Validated cognitive assessment score

How to monitor beneficial effects of cortisol in adrenal insufficiency

Weight