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Year 6 - PSA > 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
Q

Gentamicin SEs

A

Ototoxic + Nephrotoxic

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26
Q

What is the CI for starting gentamicin?

A

Myasthenia Gravis

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27
Q

How do you give gentamicin?

A

It’s poorly lipid-soluble therefore: parentally for IE and topically for otitis externa

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28
Q

How is standard heparin administered?

A

IV w short duration of action

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29
Q

When does HIT develop?

A

After 5-10d of tx

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30
Q

What can be used to reverse heparin OD?

A

Protamine Sulphate

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31
Q

Macrolide Egs

A

Erythromycin
Clarithromycin
Azithromycin

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32
Q

Macrolide SEs

A

Prolonged QT
Gastrointestinal
Cholestatic Jaundice

Plus: azithromycin is a/w hearing loss and tinnitus

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33
Q

What should you stop whilst taking a course of macrolides?

A

Statins: myopathy + rhabdomyolysis

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34
Q

When is metformin used? (3)

A

T2DM
PCOS
NAFLD

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35
Q

Metformin CIs

A

CKD
Tissue Hypoxia
Iodine Contrast Media

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36
Q

At what Cr and eGFR should the dose of metformin be reviewed or stopped?

A

Review: Cr >130 or eGFR <45

Stop: Cr >150 or eGFR <30

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37
Q

Octreotide SE

A

GS 2° to Biliary Stasis

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38
Q

Mx of Salicylate OD

A

IV Bicarbonate + Haemodialysis

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39
Q

Mx of TCA OD

A

IV Bicarbonate

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40
Q

Mx of Ethylene Glycol Poisoning

A

Fomepizole
Ethanol
Haemodilaysis

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41
Q

Mx of Lead Poisoning

A

IV Dimercaprol or Calcium Edetate

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42
Q

Mx of Cyanide Poisoning

A

Hydroxocobalamin or Amyl Nitrite/Sodium Nitrite/Sodium Thiosulfate

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43
Q

Mx of Methanol Poisioning

A

Fomepizole
Ethanol
Haemodilaysis

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44
Q

List the P450 inhibitors

A

SICK FFAAACES Dot COM Group

Sodium Valproate
Isoniazid
Cimetidine
Ketoconazole

Fluconazole
Fluoxetine
Alcohol (Acute)
Allopurinol
Amiodarone
Chloramphenicol
Erythromycin
Sulphonamides
Disulfiram
Ciprofloxacin
Omeprazole
Metronidazole
Grapefruit
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45
Q

List the P450 inducers

A

PCC SSBAR

Phenytoin
Carbamazepine
Cigarettes

St Johns Wort
Sulphonylureas
Barbiturates
Alcohol (Chronic)
Rifampicin
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46
Q

How long is NAC infused over?

A

1hr

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47
Q

What constitutes a staggered paracetamol OD?

A

If all the tablets were not taken within 1hr

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48
Q

What are the King’s College Hospital criteria for liver transplantation following a paracetamol OD?

A

Arterial pH <7.3 @ 24hrs after ingestion or all of: PT >100s, Cr >300μmol/L, grade III/IV encephalopathy

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49
Q

PDE5i Egs

A

Sildenafil
Tadalafil
Vardenafil

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50
Q

PDE5i CIs

A

Nitrates
Nicorandil
Hypotension
Stroke/MI <6m

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51
Q

Sildenafil SEs

A

Blue Discolouration + Flushing

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52
Q

K-Sparing Diuretic Egs

A

Amiloride
Triamterene
Spironolactone
Eplerenone

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53
Q

ACEi + K-Sparing Diuretic

A

HyperK

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54
Q

Which drugs should be used w caution in asthmatic pts?

A

NSAIDs
Adenosine
Beta-Blockers

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55
Q

Which drugs should be used w caution in IHD pts?

A

NSAIDs
Oestrogen
Varenicline

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56
Q

Which drugs are teratogenic?

A 
Thalidomide
Epileptic
Retinoid
ACEi/ARB
Third Element
OCP/Hormones
Warfarin
Alcohol

Plus: abx, statins, sulfonylureas

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57
Q

Quinolone SEs

A

Dec Seizure Threshold
Tendon Damage
Prolonged QT

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58
Q

Quinolone CIs

A

Pregnant
Breastfeeding
G6PD Deficiency

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59
Q

Tamoxifen SEs

A

VTE + Endometrial Cancer

Plus: hot flushes, vaginal bleeding, amenorrhoea

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60
Q

Which drugs should be used w caution in HF pts?

A 
NSAIDs
Glucocorticoids
Thiazolidinediones
Verapamil
Flecainide
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61
Q

Which drugs should be used w caution in epileptic pts?

A 
Alcohol
Cocaine
Amphetamines
Ciprofloxacin
Levofloxacin
Aminophylline
Theophylline
Bupropion
Methylphenidate
Mefenamic Acid
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62
Q

How long is tamoxifen typically used for following tumour removal?

A

5yrs

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63
Q

Tx HTN Pregnant Asthmatic

A

PET: labetalol (CI in asthma), nifedipine (CI at term), methyldopa 250mg BD/TDS

64
Q

Tx of Acute Herpes

A

Maternal: oral aciclovir 400mg TDS

Neonate: IV aciclovir for 14d if SEM disease or 21d if CNS/disseminated

65
Q

Tx of Post-Immunisation Pyrexia in Infants

A

If distressed give paracetamol and if unsuitable ibuprofen

66
Q

What medication can cause hair thinning?

A

Isotretinoin

67
Q

5HT3 Antagonists

A

Ondansetron + Granisetron

SEs: constipation + prolonged QT interval

68
Q

When should specialist advice be sought before starting ACEi?

A

K >= 5.0 mmol/L

69
Q

What enhances and blocks adenosine?

A

Enhanced by dipyridamole and blocked by theophyllines

70
Q

HypoK Causes: DIRE

A

Drugs ie loop and thiazide diuretics

Inadequate intake or intestinal loss

Renal tubular acidosis

Endocrine ie Cushings and Conns

71
Q

HyperK Causes: DREAD

A

Drugs ie K-sparing diuretics, ACEi, heparin

Renal failure

Endocrine ie Addisons

Artefact

DKA

72
Q

How are the doses of gentamicin calculated?

A

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
Q

What is the target INR for pts on warfarin?

A

Usually 2.5 unless recurrent VTE or metal valve then inc to 3.5

74
Q

How do you tx a major bleed when the pt is on warfarin?

A

Stop Warfarin

Give 5-10mg Slow IV Vitamin K

Give 25-50units/kg IV Dried Prothrombin Complex

75
Q

What should you do if the INR if above the target?

A

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
Q

What is vitamin K on the bnf?

A

Phytomenadione

77
Q

What are the target gentamicin concentrations for pts w IE?

A

Peak 3-5mg/L

Trough <1mg/L

78
Q

What is the CI to gentamicin?

A

MG

79
Q

What are the usual target gentamicin concentrations?

A

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
Q

What is the paracetamol tx line?

A

100mg/L@4h - 15mg/L@15h

81
Q

How long is the NAC infusion given for paracetamol OD?

A

1hr

82
Q

When can you measure paracetamol blood levels?

A

> =4hrs

83
Q

Tx of Paracetamol OD

A

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
Q

What can a raised urea indicate aside from kidney injury?

A

Upper GI Bleed: a raised urea w normal creatinine in a pt who is not dehydrated look at hb

85
Q

Adenosine MOA

A

Agonist of the A1 receptor in the AV node which inhibits adenylyl cyclase thus red cAMP and causing hyperpolarisation

86
Q

What is the dosing of aminophylline?

A

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
Q

Sulphasalazine SEs

A 
Rashes
Oligospermia
Headache
Heinz Body Anaemia
Megaloblastic Anaemia
Lung Fibrosis
88
Q

Mesalazine SEs

A 
GI Upset
Headache
Agranulocytosis
Pancreatitis
Interstitial Nephritis
89
Q

What is the key investigation in unwell pts taking aminosalicylates?

A

FBC - Agranulocytosis

90
Q

Where should amiodarone be administered?

A

Central Vein - Thrombophlebitis

91
Q

How is amiodarone monitored?

A

Prior: TFT LFT U+E CXR

Every 6m: TFT LFT

92
Q

Amiodarone SEs

A 
Hypothyroidism
Hyperthyroidism
Corneal Deposits
Pulmonary Fibrosis
Liver Fibrosis
Peripheral Neuropathy
Photosensitivity
Slate Grey Appearance
Bradycardia
Long QT
93
Q

Which diabetic drug can cause hypoglycaemia?

A

Gliclazide

94
Q

Mx of Acne Rosacea

A

Mild sx - topical metronidazole

Flushing - topical brimonidine

Telangiectasia - laser therapy

Severe sx - oxytetracycline

Rhinophyma - refer to dermatology

95
Q

Mx of Acne Vulgaris

A
  1. Single Topical
  2. Combo Topical
  3. Antibiotics
  4. COCP
  5. Isotretinoin
96
Q

Typical Antipsychotic SEs

A

Acute Dystonia
Tardive Dyskinesia
Parkinsonism
Akathisia

97
Q

Atypical Antipsychotic SEs

A

Wt Gain
Sedation
Dyslipidaemia
Hyperprolactinaemia

98
Q

Acute Dystonia Tx

A

Procyclidine

99
Q

Tardive Dyskinesia Tx

A

Tetrabenazine

100
Q

Which antipsychotic classically causes a prolonged QT interval?

A

Haloperidol

101
Q

What are the paediatric ICS doses?

A

Low: <200 mcg

Mod: 200-400 mcg

High: >400 mcg

102
Q

How do you withdraw benzodiazepine?

A

1/8th daily dose every fortnight

103
Q

MOA of Benzodiazipines

A

Inc freq of chloride channels

104
Q

MOA of Barbiturates

A

Inc duration of chloride channel opening

105
Q

Can anticoagulants and antiplatelets be used whilst breastfeeding?

A

Safe: heparin + warfarin

Avoid: aspirin

106
Q

Dose of Amoxicillin

A

500mg TDS

107
Q

Dose of Clarithromycin

A

500mg BD

108
Q

Dose of Ibuprofen

A

200-400mg TDS

109
Q

Dose of Codeine

A

30-60mg QDS

110
Q

Tx of Croup

A

Single dose of oral dexamethasone 0.15mg/kg

If emerg: high flow oxygen + adrenaline nebs

111
Q

CXR of Croup - PA View

A

‘Steeple Sign’

112
Q

CXR of Epiglottitis - Lateral View

A

‘Thumb Sign’

113
Q

Mx of Fungal Nail Infections

A

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
Q

What is the first line SSRI for tx of GAD?

A
  1. Sertraline
  2. SNRI
  3. Pregabalin
115
Q

Blotting Techniques

A

SNoW
DRoP

Southern - DNA
Northern - RNA
Western - Proteins

116
Q

When do you refer pts with molluscum contagiosum?

A

If HIV positive and extensive lesions, eyelid margin/ocular lesions and red eye, anogenital lesions

117
Q

Which drugs exacerbate psoriasis?

A 
NSAIDs
Chloroquine
Lithium
Beta Blockers
ACEi
Alcohol
118
Q

Who should you avoid giving citalopram/escitalopram?

A

Congenital LQTS, known preexisting QT interval prolongation or in combo w other medicines that prolong QT

119
Q

What is the max dose of citalopram?

A

40mg - Adults

20mg - Elderly/Hepatic Impairment

120
Q

When should you F/U pts after commencing antidepressants?

A

By 2wks but red to 1wk if <30yo or at inc risk of suicide

121
Q

How long over should you stop SSRIs?

A

4wks

122
Q

TCA SEs

A 
Dry Mouth
Urinary Retention
Blurred Vision
Constipation
Drowsiness
123
Q

TCAs: More vs Less Sedative

A

More: amitriptyline, clomipramine, dosulepin

Less: lofepramine, imipramine, nortriptyline

124
Q

Mx of Urge vs Stress Incontinence

A

Urge: bladder retraining, immediate release oxybutynin, mirabegron

Stress: pelvic floor training, retropubic mid-urethral tape, duloxetine

125
Q

Anticoag/pl in Breastfeeding

A

Safe: warfarin + heparin

Avoid: aspirin

126
Q

What is the concentration of aminophylline?

A

25mg/mL

127
Q

Statins

A

LFT: baseline, 3m, 12m

128
Q

ACEi

A

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
Q

Amiodarone

A

TFT/LFT: prior to tx w U+E/CXR and every 6m

130
Q

Methotrexate

A

FBC/LFT/U+E: wkly until stabilised and every 3m thereafter

131
Q

Azathioprine

A

FBC/LFT: prior to tx, FBC wkly for first 4w, both every 3m

132
Q

Lithium

A

Li/TFT/U+E: prior to tx, Li wkly until stabilised then every 3m, TFT/U+E every 6m

133
Q

Sodium Valproate

A

FBC/LFT: prior to tx then LFT periodically during first 6m

134
Q

Glitazones

A

LFT: prior to tx then regularly

135
Q

When are digoxin concentrations measured?

A

If toxicity is suspected measure within 8-12h of the last dose

136
Q

What are the features of digoxin toxicity?

A 
Gynaecomastia
Arrhythmias
Xanthopsia
Confusion
Anorexia
137
Q

What classically precipitates digoxin toxicity?

A

HypoK

138
Q

Mx of Digoxin Toxicity

A

Digibind, correct arrhythmias, monitor potassium

139
Q

When do you monitor gentamicin plasma conc?

A

Both trough and peak levels: if pre-dose trough is high inc dose interval and if post-dose peak is high dec dose

140
Q

When should you check phenytoin trough levels?

A

If you detect non-adherence, suspect toxicity, dose adjustment

141
Q

What is the range of lithium?

A

0.4-1.0 mmol/L

142
Q

What precipitates lithium toxicity?

A

Drugs
Dehydration
Renal Failure

143
Q

Which drugs precipitate lithium toxicity?

A

Diuretics
ACEi/ARB
NSAIDs
Metronidazole

144
Q

What are the features of lithium toxicity?

A 
Coarse Tremor
Hyperreflexia
Confusion
Polyuria
Seizure
Coma
145
Q

Mx of Li Toxicity

A

Fluid Resus + Haemodialysis

146
Q

Antipsychotics

A

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
Q

When should you review a pt on HRT?

A

At 3m after starting or following a change then annually thereafter

148
Q

What is the therapeutic index of digoxin?

A

0.5-2.0mcg/L

149
Q

Which other class of abx can pts w penicillin allergy also be allergic to?

A

Cephalosporins: 0.5-6.5% of pts

150
Q

What is Augmentin?

A

Co-Amoxiclav: Amoxicillin + Clavulanic Acid

151
Q

What is Magnapen?

A

Co-Fluampicil: Flucloxacillin + Ampicillin

152
Q

What is Tazocin?

A

Piperacillin + Tazobactam

153
Q

What is Timentin?

A

Ticarcillin + Clavulanic Acid

154
Q

What are common prescribing errors wrt frequency?

A

Wkly: Alendronic Acid + Methotrexate

155
Q

What are common prescribing errors wrt timing of medication?

A

At Night: Statins + Amitriptyline

156
Q

Carbimazole vs Carbmazepine

A

Carbimazole: Antithyroid

Carbmazepine: Antiepileptic

157
Q

Chlorphenamine vs Chlorpromazine

A

Chlorphenamine: Antihistamine

Chlorpromazine: Antipsychotic

Year 6 - PSA (4 decks)

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