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Year 5/6 > PSA: PassMedicine > Flashcards

PSA: PassMedicine Flashcards

1
Q

Which drugs cause impaired glucose tolerance?

A

Steroids
Thiazides
Tacrolimus
Ciclosporin

Plus: interferon-alpha, nicotinic acid, antipsychotics, beta-blockers

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2
Q

Which drugs cause urinary retention?

A

TCAs + Anticholinergics

Plus: opioids, NSAIDs, disopyramide

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3
Q

Which drugs cause lung fibrosis?

A

Amiodarone
Nitrofurantoin

Busulphan
Bleomycin

Methotrexate
Sulfasalazine

Bromocriptine
Cabergoline

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4
Q

Rifampicin SEs

A

Orange Secretions

Plus: hepatitis, flu-like sx, liver enzyme inducer

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5
Q

Isoniazid SEs

A

Peripheral Neuropathy

Plus: hepatitis, agranulocytosis, liver enzyme inhibitor

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6
Q

Pyrazinamide SEs

A

Hyperuricaemia

Plus: hepatitis, arthralgia, myalgia

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7
Q

Ethambutol SEs

A

Optic Neuritis

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8
Q

What must be checked before/during starting ethambutol?

A

Visual Acuity

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9
Q

Lithium SEs

A

Early: tremor

Intrm: tiredness

Late: arrhythmia, seizure, coma, renal failure, diabetes insipidus

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10
Q

What class of drugs is known for causing a hypertensive crisis w alcohol?

A

MAOIs

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11
Q

How do you initiate allopurinol prophylaxis of gout?

A

Wait until the pt is pain free before discussing ULT

Start at 100mg OD unless red eGFR and titrate until serum uric acid <300μmol/L

Use colchicine/NSAIDs as cover ~6m

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12
Q

What are the indication to stop allopurinol immediately?

A

Development of a rash: SCAR, DRESS, SJS

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13
Q

What should pts at high risk of severe cutaneous ADR be screened for before starting allopurinol?

A

HLA-B *5801 Allele

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14
Q

What can allopurinol react with? (3)

A

Azathioprine
Cyclophosphamide
Theophylline

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15
Q

What can aspirin potentiate? (3)

A

Oral Hypoglycaemics
Warfarin
Steroids

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16
Q

Why should aspirin not be used in <16yo and what’s the exception?

A

Risk of Reye’s syndrome however in Kawasaki disease benefits>risks

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17
Q

What is first line tx for HTN in pts <55yrs or T2DM?

A

ACEi/ARB

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18
Q

What is first line tx for HTN in pts >55yrs or Afro-Caribbean?

A

CCB

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19
Q

What determines step four in the HTN tx ladder?

A

If K <=4.5 add low dose spironolactone

If K >4.5 add an alpha/beta blocker

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20
Q

Verapamil SEs

A 
HF
Bradycardia
Hypotension
Constipation
Flushing
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21
Q

Diltiazem SEs

A

HF
Bradycardia
Hypotension
Ankle Swelling

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22
Q

Dihydropyridine SEs

A

Flushing
Ankle Swelling
Headache

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23
Q

What are the indications for ciclosporin?

A

Transplantation

Plus; RA, UC, psoriasis, pure red cell aplasia

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24
Q

Ciclosporin SEs

A

Nephrotoxic + Hepatotoxic

Plus everything is inc: fluid retention, hypertension, hyperkalaemia, hypertrichosis, gingival hyperplasia, tremor, impaired glucose tolerance, hyperlipidaemia, susceptibility to infection

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25
Gentamicin SEs
Ototoxic + Nephrotoxic
26
What is the CI for starting gentamicin?
Myasthenia Gravis
27
How do you give gentamicin?
It’s poorly lipid-soluble therefore: parentally for IE and topically for otitis externa
28
How is standard heparin administered?
IV w short duration of action
29
When does HIT develop?
After 5-10d of tx
30
What can be used to reverse heparin OD?
Protamine Sulphate
31
Macrolide Egs
Erythromycin Clarithromycin Azithromycin
32
Macrolide SEs
Prolonged QT Gastrointestinal Cholestatic Jaundice Plus: azithromycin is a/w hearing loss and tinnitus
33
What should you stop whilst taking a course of macrolides?
Statins: myopathy + rhabdomyolysis
34
When is metformin used? (3)
T2DM PCOS NAFLD
35
Metformin CIs
CKD Tissue Hypoxia Iodine Contrast Media
36
At what Cr and eGFR should the dose of metformin be reviewed or stopped?
Review: Cr >130 or eGFR <45 Stop: Cr >150 or eGFR <30
37
Octreotide SE
GS 2° to Biliary Stasis
38
Mx of Salicylate OD
IV Bicarbonate + Haemodialysis
39
Mx of TCA OD
IV Bicarbonate
40
Mx of Ethylene Glycol Poisoning
Fomepizole Ethanol Haemodilaysis
41
Mx of Lead Poisoning
IV Dimercaprol or Calcium Edetate
42
Mx of Cyanide Poisoning
Hydroxocobalamin or Amyl Nitrite/Sodium Nitrite/Sodium Thiosulfate
43
Mx of Methanol Poisioning
Fomepizole Ethanol Haemodilaysis
44
List the P450 inhibitors
SICK FFAAACES Dot COM Group Sodium Valproate Isoniazid Cimetidine Ketoconazole ``` Fluconazole Fluoxetine Alcohol (Acute) Allopurinol Amiodarone Chloramphenicol Erythromycin Sulphonamides ``` ``` Disulfiram Ciprofloxacin Omeprazole Metronidazole Grapefruit ```
45
List the P450 inducers
PCC SSBAR Phenytoin Carbamazepine Cigarettes ``` St Johns Wort Sulphonylureas Barbiturates Alcohol (Chronic) Rifampicin ```
46
How long is NAC infused over?
1hr
47
What constitutes a staggered paracetamol OD?
If all the tablets were not taken within 1hr
48
What are the King’s College Hospital criteria for liver transplantation following a paracetamol OD?
Arterial pH <7.3 @ 24hrs after ingestion or all of: PT >100s, Cr >300μmol/L, grade III/IV encephalopathy
49
PDE5i Egs
Sildenafil Tadalafil Vardenafil
50
PDE5i CIs
Nitrates Nicorandil Hypotension Stroke/MI <6m
51
Sildenafil SEs
Blue Discolouration + Flushing
52
K-Sparing Diuretic Egs
Amiloride Triamterene Spironolactone Eplerenone
53
ACEi + K-Sparing Diuretic
HyperK
54
Which drugs should be used w caution in asthmatic pts?
NSAIDs Adenosine Beta-Blockers
55
Which drugs should be used w caution in IHD pts?
NSAIDs Oestrogen Varenicline
56
Which drugs are teratogenic?
``` Thalidomide Epileptic Retinoid ACEi/ARB Third Element OCP/Hormones Warfarin Alcohol ``` Plus: abx, statins, sulfonylureas
57
Quinolone SEs
Dec Seizure Threshold Tendon Damage Prolonged QT
58
Quinolone CIs
Pregnant Breastfeeding G6PD Deficiency
59
Tamoxifen SEs
VTE + Endometrial Cancer Plus: hot flushes, vaginal bleeding, amenorrhoea
60
Which drugs should be used w caution in HF pts?
``` NSAIDs Glucocorticoids Thiazolidinediones Verapamil Flecainide ```
61
Which drugs should be used w caution in epileptic pts?
``` Alcohol Cocaine Amphetamines Ciprofloxacin Levofloxacin Aminophylline Theophylline Bupropion Methylphenidate Mefenamic Acid ```
62
How long is tamoxifen typically used for following tumour removal?
5yrs
63
Tx HTN Pregnant Asthmatic
PET: labetalol (CI in asthma), nifedipine (CI at term), methyldopa 250mg BD/TDS
64
Tx of Acute Herpes
Maternal: oral aciclovir 400mg TDS Neonate: IV aciclovir for 14d if SEM disease or 21d if CNS/disseminated
65
Tx of Post-Immunisation Pyrexia in Infants
If distressed give paracetamol and if unsuitable ibuprofen
66
What medication can cause hair thinning?
Isotretinoin
67
5HT3 Antagonists
Ondansetron + Granisetron SEs: constipation + prolonged QT interval
68
When should specialist advice be sought before starting ACEi?
K >= 5.0 mmol/L
69
What enhances and blocks adenosine?
Enhanced by dipyridamole and blocked by theophyllines
70
HypoK Causes: DIRE
Drugs ie loop and thiazide diuretics Inadequate intake or intestinal loss Renal tubular acidosis Endocrine ie Cushings and Conns
71
HyperK Causes: DREAD
Drugs ie K-sparing diuretics, ACEi, heparin Renal failure Endocrine ie Addisons Artefact DKA
72
How are the doses of gentamicin calculated?
According to pts wt and renal function: 5-7mg/kg OD or divide the daily dose into 1mg/kg if creatinine clearance <20mL/min (12hrly) and endocarditis (8hrly)
73
What is the target INR for pts on warfarin?
Usually 2.5 unless recurrent VTE or metal valve then inc to 3.5
74
How do you tx a major bleed when the pt is on warfarin?
Stop Warfarin Give 5-10mg Slow IV Vitamin K Give 25-50units/kg IV Dried Prothrombin Complex
75
What should you do if the INR if above the target?
If >5 w minor bleeding stop warfarin and give 1-3mg Slow IV Vitamin K <6: reduce warfarin dose 6-8: omit warfarin for 2d then reduce dose >8: omit warfarin, give 1-5mg oral vitamin K, start warfarin when INR<5
76
What is vitamin K on the bnf?
Phytomenadione
77
What are the target gentamicin concentrations for pts w IE?
Peak 3-5mg/L | Trough <1mg/L
78
What is the CI to gentamicin?
MG
79
What are the usual target gentamicin concentrations?
Peak 5-10mg/L Trough <2mg/L Where peak is taken 1hr after administration and trough is taken just before the next dose If the peak is too high dec the dose If the trough is too high inc the interval If both the peak and trough are too high do both
80
What is the paracetamol tx line?
100mg/L@4h - 15mg/L@15h
81
How long is the NAC infusion given for paracetamol OD?
1hr
82
When can you measure paracetamol blood levels?
>=4hrs
83
Tx of Paracetamol OD
Admit and establish exact time taken: If <1hr give activated charcoal If 4-8hrs measure serum paracetamol, plot on nomogram and if over tx line commence NAC infusion If >8hrs commence NAC infusion, measure serum paracetamol and ALT, if over tx line or raised ALT continue
84
What can a raised urea indicate aside from kidney injury?
Upper GI Bleed: a raised urea w normal creatinine in a pt who is not dehydrated look at hb
85
Adenosine MOA
Agonist of the A1 receptor in the AV node which inhibits adenylyl cyclase thus red cAMP and causing hyperpolarisation
86
What is the dosing of aminophylline?
Loading: 5mg/kg given by slow IV over 20mins Maintenance: 500-700mcg/kg/hr, if elderly red to 300, 1g of aminophylline is added to 1L of 0.9% sodium chloride giving 1mg/mL
87
Sulphasalazine SEs
``` Rashes Oligospermia Headache Heinz Body Anaemia Megaloblastic Anaemia Lung Fibrosis ```
88
Mesalazine SEs
``` GI Upset Headache Agranulocytosis Pancreatitis Interstitial Nephritis ```
89
What is the key investigation in unwell pts taking aminosalicylates?
FBC - Agranulocytosis
90
Where should amiodarone be administered?
Central Vein - Thrombophlebitis
91
How is amiodarone monitored?
Prior: TFT LFT U+E CXR Every 6m: TFT LFT
92
Amiodarone SEs
``` Hypothyroidism Hyperthyroidism Corneal Deposits Pulmonary Fibrosis Liver Fibrosis Peripheral Neuropathy Photosensitivity Slate Grey Appearance Bradycardia Long QT ```
93
Which diabetic drug can cause hypoglycaemia?
Gliclazide
94
Mx of Acne Rosacea
Mild sx - topical metronidazole Flushing - topical brimonidine Telangiectasia - laser therapy Severe sx - oxytetracycline Rhinophyma - refer to dermatology
95
Mx of Acne Vulgaris
1. Single Topical 2. Combo Topical 3. Antibiotics 4. COCP 5. Isotretinoin
96
Typical Antipsychotic SEs
Acute Dystonia Tardive Dyskinesia Parkinsonism Akathisia
97
Atypical Antipsychotic SEs
Wt Gain Sedation Dyslipidaemia Hyperprolactinaemia
98
Acute Dystonia Tx
Procyclidine
99
Tardive Dyskinesia Tx
Tetrabenazine
100
Which antipsychotic classically causes a prolonged QT interval?
Haloperidol
101
What are the paediatric ICS doses?
Low: <200 mcg Mod: 200-400 mcg High: >400 mcg
102
How do you withdraw benzodiazepine?
1/8th daily dose every fortnight
103
MOA of Benzodiazipines
Inc freq of chloride channels
104
MOA of Barbiturates
Inc duration of chloride channel opening
105
Can anticoagulants and antiplatelets be used whilst breastfeeding?
Safe: heparin + warfarin Avoid: aspirin
106
Dose of Amoxicillin
500mg TDS
107
Dose of Clarithromycin
500mg BD
108
Dose of Ibuprofen
200-400mg TDS
109
Dose of Codeine
30-60mg QDS
110
Tx of Croup
Single dose of oral dexamethasone 0.15mg/kg If emerg: high flow oxygen + adrenaline nebs
111
CXR of Croup - PA View
‘Steeple Sign’
112
CXR of Epiglottitis - Lateral View
‘Thumb Sign’
113
Mx of Fungal Nail Infections
Confirm dx by microbiology If dermatophyte: 1. oral terbinafine 2. oral itraconazole - fingernails 6w-3m and toenails 3m-6m If candida: 1. topical amorolfine - fingernails 6m and toenails 12m 2. oral itraconazole 12w
114
What is the first line SSRI for tx of GAD?
1. Sertraline 2. SNRI 3. Pregabalin
115
Blotting Techniques
SNoW DRoP Southern - DNA Northern - RNA Western - Proteins
116
When do you refer pts with molluscum contagiosum?
If HIV positive and extensive lesions, eyelid margin/ocular lesions and red eye, anogenital lesions
117
Which drugs exacerbate psoriasis?
``` NSAIDs Chloroquine Lithium Beta Blockers ACEi Alcohol ```
118
Who should you avoid giving citalopram/escitalopram?
Congenital LQTS, known preexisting QT interval prolongation or in combo w other medicines that prolong QT
119
What is the max dose of citalopram?
40mg - Adults 20mg - Elderly/Hepatic Impairment
120
When should you F/U pts after commencing antidepressants?
By 2wks but red to 1wk if <30yo or at inc risk of suicide
121
How long over should you stop SSRIs?
4wks
122
TCA SEs
``` Dry Mouth Urinary Retention Blurred Vision Constipation Drowsiness ```
123
TCAs: More vs Less Sedative
More: amitriptyline, clomipramine, dosulepin Less: lofepramine, imipramine, nortriptyline
124
Mx of Urge vs Stress Incontinence
Urge: bladder retraining, immediate release oxybutynin, mirabegron Stress: pelvic floor training, retropubic mid-urethral tape, duloxetine
125
Anticoag/pl in Breastfeeding
Safe: warfarin + heparin Avoid: aspirin
126
What is the concentration of aminophylline?
25mg/mL
127
Statins
LFT: baseline, 3m, 12m
128
ACEi
U+E: prior to tx, after dose inc, annually - inc of 30% in serum Cr and up to 5.5 K are acceptable changes
129
Amiodarone
TFT/LFT: prior to tx w U+E/CXR and every 6m
130
Methotrexate
FBC/LFT/U+E: wkly until stabilised and every 3m thereafter
131
Azathioprine
FBC/LFT: prior to tx, FBC wkly for first 4w, both every 3m
132
Lithium
Li/TFT/U+E: prior to tx, Li wkly until stabilised then every 3m, TFT/U+E every 6m
133
Sodium Valproate
FBC/LFT: prior to tx then LFT periodically during first 6m
134
Glitazones
LFT: prior to tx then regularly
135
When are digoxin concentrations measured?
If toxicity is suspected measure within 8-12h of the last dose
136
What are the features of digoxin toxicity?
``` Gynaecomastia Arrhythmias Xanthopsia Confusion Anorexia ```
137
What classically precipitates digoxin toxicity?
HypoK
138
Mx of Digoxin Toxicity
Digibind, correct arrhythmias, monitor potassium
139
When do you monitor gentamicin plasma conc?
Both trough and peak levels: if pre-dose trough is high inc dose interval and if post-dose peak is high dec dose
140
When should you check phenytoin trough levels?
If you detect non-adherence, suspect toxicity, dose adjustment
141
What is the range of lithium?
0.4-1.0 mmol/L
142
What precipitates lithium toxicity?
Drugs Dehydration Renal Failure
143
Which drugs precipitate lithium toxicity?
Diuretics ACEi/ARB NSAIDs Metronidazole
144
What are the features of lithium toxicity?
``` Coarse Tremor Hyperreflexia Confusion Polyuria Seizure Coma ```
145
Mx of Li Toxicity
Fluid Resus + Haemodialysis
146
Antipsychotics
Start of therapy/annually: FBC, U+E, LFT, lipids/wt (at 3m), fasting bm/prolactin (at 6m) Plus: baseline BP/ECG and annual cardiovascular risk assessment
147
When should you review a pt on HRT?
At 3m after starting or following a change then annually thereafter
148
What is the therapeutic index of digoxin?
0.5-2.0mcg/L
149
Which other class of abx can pts w penicillin allergy also be allergic to?
Cephalosporins: 0.5-6.5% of pts
150
What is Augmentin?
Co-Amoxiclav: Amoxicillin + Clavulanic Acid
151
What is Magnapen?
Co-Fluampicil: Flucloxacillin + Ampicillin
152
What is Tazocin?
Piperacillin + Tazobactam
153
What is Timentin?
Ticarcillin + Clavulanic Acid
154
What are common prescribing errors wrt frequency?
Wkly: Alendronic Acid + Methotrexate
155
What are common prescribing errors wrt timing of medication?
At Night: Statins + Amitriptyline
156
Carbimazole vs Carbmazepine
Carbimazole: Antithyroid Carbmazepine: Antiepileptic
157
Chlorphenamine vs Chlorpromazine
Chlorphenamine: Antihistamine Chlorpromazine: Antipsychotic

Year 5/6 (20 decks)

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