PSA Past Papers Flashcards
1
Q
Max. dose of citalopram for patients over 65?
A
20mg
2
Q
When you have a volume of medicine and the dilutant, what do you need to do to calculate the infusion rate?
A
Make sure to add the volume of medicine to the volume of dilutant
3
Q
CI in asthmatics
A
Beta blockers and NSAIDS
4
Q
What are common combos of death?
A
NSAIDS and ACEi (renal failure)
Stating and macrolides (myopathy)
Mtx and trimethoprim (folate deficiency)
Citalopram and Dabigatran (increased risk of GI bleed in >65 yr olds)
Simvastatin and Gemfibrozil (severe myopathy and rhabdo risk)
5
Q
Common SE of ACEi?
A
Dry cough
6
Q
What do you need to know about ciclosporin?
A
Watch kidney function and it causes hyperkalaemia
7
Q
What drugs cause hyperkalaemia?
A
Potassium-sparing diuretics (eg, spironolactone, triamterene, amiloride) NSAIDs. ACE inhibitors. Angiotensin-receptor blockers (ARBs) Cyclosporine or tacrolimus. Pentamidine. Trimethoprim-sulfamethoxazole. Heparin. (daltepatin)
Mycophenolate mofetiL?
8
Q
How long should iron supplementation be done?
A
Until iron levels are good again and then another 3 months
9
Q
Which fluids do normotensive patients get?
A
Normotensive patients get crystalloids as colloids have the slight risk of an anaphylactic reaction as well as staying in the intravascular space for longer
10
Q
How much fluid do we replace for maintenance?
A
3L (8 hourly bags) normally, 2L per 24hr (12 hrly bags) for the elderly and those with low body weight
11
Q
What causes leucocytosis?
A
Leucocytosis can be caused by steroids
12
Q
WHat to do in mild phenytoin toxicyt?
A
Not necessarily the plasma levels will be reflective but the clinical features -> lower the dose
13
Q
Metformin or weight loss?
A
Always try weight loss first
14
Q
Hypoglycaemic patient with IV access unresponsive?
A
Use 100ml 20% glucose first and IM glucagon second line
15
Q
How often should calcium gluconate be given in ECG changes hyperkalamaei?
A
Every 15 minutes. Calcium resonium is given if hyperkalameia persists despite treatment (only acts after a couple of days)
16
Q
How do you treat asthmatics with fast AF?
A
Not beta blockers, go second line DIGOXIN
17
Q
warfaring and bleeding?
A
No bleeding:
5-8 - dose withdrawal
>8 - oral vit K
Minor bleeding:
5-8 - IV vit K
>8 - Repeated IV vit K doses
Major bleeding:
PCC
18
Q
What are additional side effects of bendroflumethiazide?
A
It can raise blood sugar levels and make gout worse
19
Q
What is first line in epiglottitis?
A
Ceftriaxone
20
Q
First line in generalised anxiety disorder?
A
Sertraline is most cost-effective, second line escitalopram
21
Q
What do you test for prior to administration of phenytoin and the during the infusion?
A
ECG due to risk of cardiac arrhythmias during IV infusion
22
Q
Tazocin for CAP - what do you check to confirm its gettings better?
A
Resp rate
23
Q
Checking for aminophylline toxicity?
A
check for THEOphyilline serum levels
24
Q
If you do not know the treatment for a conmdition, where do you check?
A
BNF
25
How many weeks until efficacy of an SSRI can be tested?
4 weeks
26
Meningtis Tx?
Ceftriaxone
27
Tinea corporis tx?
cotrimazole cream?
28
Fluids in resus?
Standrad 0.9% over 10 mins
29
Which drug causes a high risk of stroke?
Risperidone
30
Immediate mx of high calcium?
Fluids
31
UC severity indications?
Rising CRP
32
ECG showing hypercalcaemia, first tx?
Calcium gluconate
33
Gout and CKD - CI?
Avoid colchicine
34
guy has sinusitis for 3 days, what do you do?
Analgesia and rest
35
how do you know patient responding to C diff tx?
Symptoms
36
When do you stop aspirin prior to a surgery>
1 week before
37
What do you stop in renal impairment?
ACEi, ARB, Allopurinol, NSAIDS
38
What can confusion in AKI patients be caused by?
Increased codeine, diazepam retention, glucocoritoicoid?
39
Which drugs cause hyponatraemia?
```
Angiotensin-converting enzyme inhibitors (ACE inhibitors)
Heparin
Diuretics
Antidepressants
Antipsychotics
Carbamazepine
Eslicarbazepine
Oxcarbazepine
Atovaquone
Amphotericin
Sulphonylureas
Desmopressin
Cyclophosphamide
Acetazolamide
```
40
When do you avoid nitrofurantoin?
When eGFR <45
41
What do you give prior to surgery if INR still high?
Phytomenadione 5mg orally (vit K)
42
What do you have to advise when starting topiramate?
Change to an alternative method of contraception until 4 weeks after ceasing to take topiramate (it's an enzyme inducer)
43
What occurs frequently following tx with co-amoxiclav?
Chiolestatic jaundice
44
What should you expect when starting ACEi or ARB
Expect a small rise in Cr (<20%) -> does not require ix or change in prescription
45
What do you aim with atorvastatin treatment?
40% reduction in non-HDL
46
What occurs frequently following tx with co-amoxiclav?
Cholestatic jaundice
other drugs: Fluclox, Co-amoxi, nitrofurantoin, steroids, SU's
47
Acute dystonia?
10mg IV procyclidine
48
Exacerbation of COPD steroids req?
Prednisolone 30mg
49
Fluid replacement rules
3L (8 hourly bags) normally, 2L per 24hr (12 hrly bags) for the elderly and those with low body weight
Make sure one bag is sweet and also that 1mmol/kg KCL per day
50
Cotinuous HRT
Conti rather than Sequi product
51
Cotinuous HRT
Conti rather than Sequi product
| Progesterone is required if a uterus is still present
52
Fluid replacement rules
3L (8 hourly bags) normally, 2L per 24hr (12 hrly bags) for the elderly and those with low body weight
Make sure one bag is sweet and also that 1mmol/kg KCL per day
GLucose containing fluids have a risk of exacerbating cerebral injury
Replace fluids in dehydration at a rate of 100ml/hr
53
Where are ACEi contraindicated?
Severe PVD
54
Drugs tha can cause confusion?
Opioids, benzo's
55
What can exacerbate biventricular failure?
Corticosteroids
Diltiazem
NSAIDS
56
Drugs tha can cause confusion?
* Anticholinergics (eg, antipsychotic drugs, antidepressant agents, anticholinergic respiratory agents, detrusor relaxants),
* Antipsychotics,
* Antidepressants,
* Anticonvulsants.
* Less common causes (Histamine H2 receptor antagonists, digoxin, beta-blockers, corticosteroids, non-steroidal anti-inflammatory agents and antibiotics.
57
What should you do if you miss a pill?
If 1 pill is missed (at any time in the cycle)
take the last pill even if it means taking two pills in one day and then continue taking pills daily, one each day
- no additional contraceptive protection needed
If 2 or more pills missed
-take the last pill even if it means taking two pills in one day, leave any earlier missed pills and then continue taking pills daily, one each day
-the women should use condoms or abstain from sex until she has taken pills for 7 days in a row. FSRH: 'This advice may be overcautious in the second and third weeks, but the advice is a backup in the event that further pills are missed'
if pills are missed in week 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1
if pills are missed in week 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception*
if pills are missed in week 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval
58
What do you need to keep in mind regards to MTX and conception?
Both MEN AND WOMEN should avoid conception while taking it and for 3m after
59
ADR of mirtazapine?
Abnormal dreams
60
What do you do when you suspect a statin to have cause myopathy?
Suspected to be cause of myopathy + CK markedly elevated (x5>upper limit) -> discontinue tx
Once Sx resolve and CK levels return ot normal, the statin should be reintroduced at a lower rate
61
Treatment of shingles pain?
First paracetamol and only after do you use amitryptilline
62
What do you do when you suspect a statin to have cause myopathy?
Suspected to be cause of myopathy + CK markedly elevated (x5>upper limit) -> discontinue tx
Once Sx resolve and CK levels return ot normal, the statin should be reintroduced at a lower rate
Only discontinue statins ever is serum transaminases are 3x the upper limit
63
Amitryptilline uses?
2nd line post-herpetic neuralgia, depression
64
Duloxetine uses?
Depression, DM neuropathy and urinary incontinence
65
Carbamezepine uses?
Trigeminal neuralgia, DM neuropathy, seizures (particularly focal)
66
What do you need to measure before starting allopurinol?
TPMT levels
67
Contraindications to dalteparin?
HIT, high risk bleeders, recent stroke (last 3mo)
68
Which drugs cause hypoglycaemia?
Thiazolidinediones and Suplohnylureas
GLP-1, e.g. liraglutide, can causes GI upset
69
Which drugs cause urinary retention?
Morphine and other opioid analgesics (esp. post-op), anticholinergics (APs, ADs), G.A, alpha agonist, benzos, NSAIDS, CCBs, anti-H2s, alcohol
70
How do you monitor beneficial effect of allopurinol?
Sodium Urate
71
Which drugs cause urinary retention?
1. tricyclic antidepressants
2. anticholinergics
3. opioids
4. NSAIDs
5. BENZOS
6. Anaesthetics
72
AKI - which drugs do you stop?
ACEi and ARBs
NSAIDs
Metformin
Nephrotoxic drugs
Statins no- but use with caution or reduce the dose in CKD
Allopurinol can accumulate in renal dysfunction and the BNF advises a max daily dose of 100 mg (or less if more severe renal injury) until renal function improves.
73
Asthma emergency treatment
5mg salbutamol NEB
ipratropium 500mcg NBE qds
prednisolone 40mg for 5 days
Beta agonists cause hypokalemia – monitor K, tremor, tachycardia
Salbutamol – lactic acidosis 5mg
Ipratropium 500mcg
Hydrocortisone 100mg or pred 40mg (give for 5 days)
MgSO4 IV given to adults (neb MgSO4 NOT given) but give IV 1.2-2g over 20mins
Theophylline/aminophylline
Frustratingly, the definitions of what constitutes a low, moderate or high-dose ICS have also changed. For adults:
* <= 400 micrograms budesonide or equivalent = low dose
* 400 micrograms - 800 micrograms budesonide or equivalent = moderate dose
* > 800 micrograms budesonide or equivalent= high dose.
74
COPD IE Tx
1. Salbutamol NEB 5mg + ipratropium 500mcg (qds) in AIR
2. Controlled oxygen 88-92% - start venture 24-28%
3. Hydrocortisone 200mg or oral pred – 30mg – continue for 7 days
4. Amoxicillin 500mg tds ; clarithromycin or doxycycline
5. IV aminophyline
```
Repeat ABG 1h after every change in oxygen therapy
Physio
NIPV - BiPAP
• RR >30
• pH <7.35-7.25
• rising PaCo2
• doxapram 1.5mg only short-term
```
Intubation if
• pH <7.25
• PaCO2 rising despite BiPAP
75
What should you do when HIT happens?
the heparin should be stopped and an alternative anticoagulant, such as danaparoid, should be given. Ensure platelet counts return to normal range in those who require warfarin.
76
What do you do with insulin in DKA?
Never stop the long acting insulin
77
Drugs that cause lung fibrosis
1. Amiodarone
2. Methotrexate
3. Busulphan, bleomycin
4. Nitrofurantoin
5. Sulfasalazine drugs
6. Ergo derivatives = bromocriptine, ergolide, pergolide
78
Which drugs cause diarrhoea?
Lansoprazole (and all proton pump inhibitors) can cause loose stools and diarrhoea.
Alendronic acid can also cause diarrhoea.
Colchicine can cause diarrhoea
Loperamide should be taken after every loose stool. Take one dose to start with and then take one dose after every loose stool
Loperamide hydrochloride should be taken as an initial dose of 4 mg followed by 2 mg after each loose stool up to a maximum of 16 mg/24 h. Advice on use would be the most important piece of information in this instance
79
What do you have to do with kindey contrast agents?
Contrast media nephrotoxicity may be defined as a 25% increase in creatinine occurring within 3 days of the intravascular administration of contrast media.
Prehydrate with saline 12h pre and 12h post at a rate of 1 mL/kg/hour
80
Which drugs cause diarrhoea?
Lansoprazole (and all proton pump inhibitors) can cause loose stools and diarrhoea.
Alendronic acid can also cause diarrhoea.
- Colchicine can cause diarrhoea
Loperamide should be taken after every loose stool. Take one dose to start with and then take one dose after every loose stool
Loperamide hydrochloride should be taken as an initial dose of 4 mg followed by 2 mg after each loose stool up to a maximum of 16 mg/24 h. Advice on use would be the most important piece of information in this instance
81
Used in VTE prophylaxis for patients afraid of needles?
Rivaroxaban
82
Which drugs cause peripheral neuropathy?
* amiodarone
* isoniazid
* vincristine
* nitrofurantoin
* metronidazole
83
Which opioid do you use in AKI?
so in AKI and post-op => convert morphine to OXYCODONE
84
When do you use codeine and when tramadol?
Diarrhoea -> Codeine (as has constipating effect)
Constipation -> Tramadol (can give diarrhoea)
85
Which opioid do you use in AKI?
so in AKI and post-op => convert morphine to OXYCODONE
Oral morphine to oxycodone Divide by 1.5-2**
86
How to transfer morphine to fentanyl patches?
morphine salt 30 mg daily ≡ fentanyl '12' patch
morphine salt 60 mg daily ≡ fentanyl '25' patch
morphine salt 120 mg daily ≡ fentanyl '50' patch
morphine salt 180 mg daily ≡ fentanyl '75' patch
morphine salt 240 mg daily ≡ fentanyl '100' patch
87
How should you treat breakthrough pain?
Breakthrough pain should be given at 1/6 of the 24 hour dose every 4 hours as required.
88
What are the morphine conversions?
Oral morphine Subcutaneous morphine Divide by 2
Oral morphine Subcutaneous diamorphine Divide by 3
Oral oxycodone Subcutaneous diamorphine Divide by 1.5
Oral codeine Oral morphine Divide by 10
Oral tramadol Oral morphine Divide by 10**
89
Contraindication contraceptive pill
Examples of UKMEC 3 conditions include
• more than 35 years old and smoking less than 15 cigarettes/day
• BMI > 35 kg/m^2*
• family history of thromboembolic disease in first degree relatives < 45 years
• controlled hypertension
• immobility e.g. wheel chair use
• carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
Examples of UKMEC 4 conditions include
1. more than 35 years old and smoking more than 15 cigarettes/day
2. migraine with aura
3. history of thromboembolic disease or thrombogenic mutation
4. history of stroke or ischaemic heart disease
5. breast feeding < 6 weeks post-partum
6. uncontrolled hypertension 160/95
7. current breast cancer
8. major surgery with prolonged immobilisation
90
Do you need additional contraception when you start the COCP?
• if the COC is started within the first 5 days of the cycle then there is no need for additional contraception. If it is started at any other point in the cycle then alternative contraception should be used (e.g. condoms) for the first 7 days
91
What emergency contraception is licensed in the UK?
3 TYPES OF EC licensed in the UK (from most effective to least effective)
1. COPPER IUD – most effective
2. PO ELLAONE = 30mg ULIPRISTAL ACETATE – 5 days
3. PO LEVONELLE = 1.5 mg LEVONORGESTREL – least effective - 3 days
Ellaone avoid in asthma with steroids, severe epilepsy, enzyme inducers, previous 5 /7 days contraception hormonal
Levonelle double dose if enzyme inducers, >70kg or BMI >26
92
What to keep in mind about HRT?
HRT NOT CONTRACEPTION
Need contraception for 2 yrs after stopping periods if <50yrs; 1yr after stopping periods if >50yrs
Cyclical HRT if periods stopped recently or are just stopping; continuous if stopped periods before
Prog + oestrogen if they have a uterus; only oestrogen if they don’t have a uterus
93
Metformin and CKD?
chronic kidney disease: NICE recommend that the dose should be reviewed if the creatinine is > 130 µmol/l (or eGFR < 45 ml/min) and stopped if the creatinine is > 150 µmol/l (or eGFR < 30 ml/min)
94
Nitrofurantoin and CKD?
Nitro 100mg BD (50mg QDS) 3 days female; 7 days male; do not give if eGFR <45, do not give in G6PD (sulfa drugs & dapsone also t be avoided, so co-trimoxazole is a no no but trimetophrim is a yes!)
95
When do you aim for INR 3.5 rather than 2.5
1. recurrent deep-vein thrombosis or pulmonary embolism in patients currently receiving anticoagulation and with an INR above 2
2. some mechanical prosthetic heart valves:
• the recommended target INR depends on the type and location of the valve, and patient-related risk factors
• consider increasing the INR target or adding an antiplatelet drug, if an embolic event occurs whilst anticoagulated at the target INR.
96
What do you give in neutropaenic sepsis?
Tazocin + Gent
97
Fast AF
Beta blocker
Diltiazem (avoin in peripheral oedema)
Digoxin if asthmatic?
98
Postherpetic neuralgia on body?
Paracetamol first, then consider topical lidocaine patch 5%
99
How do you treat Alzheimer's?
Donepezil, Rivastigmine, galantamine for mild/moderate
NMDA antagonist memantine for moderate/severe
100
What laxatives are there?
Stool softener -> docusate sodium
Bulking agent -> psphagula husk
Stimulant laxative -> senna
Osmotic laxative -> lactulose
101
How do you treat insomnia?
In exams start with 7.5mg zopiclone (half that dose in the elderly)
102
When do you prescribe 5mg folica acid in preganancy?
Any risk factor presence, even when first degree relative had spina bifida
103
Which statin should you always prescribe?
Just go for atorvastatin since simvastatin is taken at bedtime
104
What should you not forget to add to maintenance fluids?
KCL
105
What should you measure after commencing HRT?
BP
106
What do you monitor in HF?
Exercise tolerance
107
How much furosemide do you give in hd-stable pulm oedema?
start with 20mg
108
In ciclosporin monitoring?
Most important in first two week is renal function
109
What may a high TSH indicate?
Poor adherence rather than actual underdosing
