PSA/Pharm Flashcards
What does 1% conc w/v mean
1g in 100 mL
Eznyme inhibitors
AODEVICES
Allopurinol Omeprazole Disulfiram Erythromycin Valproate Isoniazid Criprofloxacin Ethanol(acute intoxication) Sulphonamides
Enzyme inducers
PC BRAS
Phenytoin Carbamazepine Barbiturates Rifampicin Alcohol(chronic excess) Sulphonylureas
Which drug is important to increase during surgery
Patients on long-term corticosteroids(they commonly have adrenal atrophy; they are therefore unable to mount an adequate physiological stress response to surgery) –> profound hypotension
Drugs to stop before surgery
COCP and HRT Lithium Potassium-sparing diuretics and ACE-i Anticoagulants Oral hypoglycaemic drugs and insulin
Key side effects of steroids
STEROIDS Stomach ulcers Thin skin oEdema Right and left heart failure Osteoporosis Infection(candida) Diabetes cushing's Syndrome
NSAIDs cautions and contraindications
NSAID
No urine(renal failure) Systolic dysfunction(heart failure) Asthma Indigestion Dyscrasia(clotting abnormality)
What type of fluid should be given in ascites
Human-albumin solution - albumin maintains oncotic pressure; furthermore, the higher sodium content of 0.9% saline will worsen ascites
Max rate for IV potassium
Not more than 10 mmol/hr
In which patients should metoclopramide be avoided in
Patients with Parkinson’s disease due to the risk of
exacerbating symptoms.
Young women due to the risk of dyskinesia, i.e. unwanted
movements especially acute dystonia.
Gastric stasis
General analgesic choice for mild pain
Regular paracetamol 1g 6-hourly oral
Codeine 30mg up to 6 hourly oral as required
General analgesic choice for severe pain
Co-codamol 30/500, 2 tablets 6-hourly oral - regular
Morphine sulphate 10 mg up to 6hourly oral - as required
Medication causes of hypokalaemia
Diuretics(thiazide-like and loop) Laxatives(large doses) Sympathomimetic drugs(beta-adrenergic bronchodilators) Theophylline Glucocorticoids Insulin(not significant)
Medication causes of hyperkalaemia
ACE inhibitors/ARBs
Beta blockers
NSAIDs
Spironolactone
Medication causes of dyspepsia
Corticosteroids Aspirin Beta-blockers NSAIDs TCAs Alpha-blockers
Medication causes of constipation
Opioids
Anticholinergics(tricyclics, phenothiazines)
Iron
Key contraindication of trimethoprim
Trimethoprim is a folate antagonist, and is a direct contraindication to patients taking methotrexate (another folate
antagonist) due to the risk of bone marrow toxicity.
This can lead to pancytopenia and neutropenic sepsis.
UKMEC 4 conditions for COCP
more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
Which meds are usually prescribed once a week
Bisphosphonates
Methotrexate
Causes of low MCV
IDA
Thalassaemia
Sideroblastic anaemia
Causes of normocytic anaemia
Anaemia of chronic disease
Acute blood loss
Haemolytic anaemia
Renal failure(chronic)
Causes of macrocytic MCV
B12/folate def Excess alcohol Liver disease Hypothyroidism MDS/multiple myeloma
Causes of neutrophilia
Bacterial infection
Tissue damage(inflammation/infarct/malignancy)
Steroids
Causes of lymphocytosis
Viral infection
Lymphoma
Chronic lymphocytic leukaemia
Causes of neutropenia
Viral infection
Chemotherapy or radiotherapy
Clozapine
Carbimazole
Causes of thrombocytopenia linked to reduced production
Infection(usually viral)
Drugs
MDS/Myelofibrosis
Myeloma
Causes of thrombocytopenia linked to increased destruction
Heparin Hypersplenism DIC ITP HUS
Causes of thrombocytosis
Bleeding Tissue damage(infection/inflammation/malignancy/post-splenectomy)
Myeloproliferative disorders
Which drug specifically is associated with thrombocytopenia
Penicillamine
General causes of hypokalaemia
DIRE
Drugs
Inadequate intake or intestinal loss(diarrhoea/vomiting)
Renal tubular acidosis
Endocrine(cushing’s and conn’s syndrome)
General causes of hyperkalaemia
DREAD
Drugs Renal failure Endocrine(Addison's) Artefact(common due to clotted sample) DKA
Biochemical disturbance pattern in prerenal AKI
Urea rise»_space; creatinine rise
Biochemical disturbance pattern in intrinsic AKI
Urea rise «_space;creatinine rise
Biochemical disturbance pattern in post renal AKI
Urea rise «_space;creatinine rise
Bladder or hydronephrosis may be palpable
What does a raised bilirubin on its own indicate
Prehepatic jaundice - usually haemolytic
Common causes of raised ALP
ALKPHOS
Any fracture Liver damage K (Cancer) Paget's disease of bone and pregnancy Hyperparathyroidism Osteomalacia Surgery
Prehepatic causes of LFT derangement
Haemolysis
Gilbert’s
Intrahepatic causes of deranged LFTs
Fatty liver Hepatitis Cirrhosis Malignancy Metabolic(Wilson's)
Posthepatic causes of deranged LFTs
Gallstones Cholangiocarcinoma PBC PSC Pancreatic or gastric cancer
Which drugs can cause cholestasis
Paracetamol overdose
Statins
Rifampicin
Which drugs may worsen seizure control in patients with epilepsy
Alcohol Ciproflox, levoflox Aminophylline Buproprion Methophenidate
How can liver disease increase a patient’s PT and INR
Liver disease can impair the synthesis of vitamin K and hence increase a patients prothrombin time and INR
Preferred opioid in renal impairment in palliative prescribing
Oxycodone is preferred to morphine
Breakthrough pain dosage for morphine
1/6th of dose
Advice when increasing opioid dosage
When increasing the dose of opioids the next dose should be increased by 30-50%.
Which meds may exacerbate heart failure
thiazolidinediones
verapamil
NSAIDs/glucocorticoids flecainide
Which meds should be avoided in IHD
NSAIDs
oestrogens: e.g. combined oral contraceptive pill, hormone replacement therapy
varenicline
Drugs which can cause hepatocellular picture in jaundice
Paracetamol Sodium valproate, phenytoin MAOIs Anti-TB meds Statins Alcohol Amiodarone Methyldopa Nitrofurantoin
Drugs which can cause cholestasis
COCP Fluclox,co-amox, erythromycin Analbolic steroids Chlorpromazine Sulphonylureas Fibrates
Which antibiotics should be avoided in CKD
Tetracyclines
Nitrofurantoin
Criteria for liver transplantation in paracetamol overdose
arterial pH<7.3
24 hours after ingestion or:
PT>100 secs
creatinine>300umol/l
grade III or IV encephalopathy
TB meds side effects
RIPE ONGO
Rifampicin: Orange secretions
Isoniazid: Neuropathy
Pyrazinamide: Gout
Ethambutol: Optic Neuritis
Indications for HRT
Vasomotor symptoms
Premature menopause
How long should HRT be continued for for premature menopause
Should be continued until the age of 50 years
Types of HRT
Oestrogens
Progestogens
Tibolone
When is transdermal HRT preferred
If at risk of VTE
Adverse effects of heparins
Bleeding
Thrombocytopenia
Osteoporosis and an increased risk of fractures
hyperkalaemia(inhibition of aldosterone secretion)
Monitoring for standard heparin
APTT
Monitoring for LMWH
Anti-factor Xa(routine monitoring not required)
Drugs which can cause low magnesium
Diuretics
PPIs
General causes of hypomagnesaemia
Drugs TPN Diarrhea Alcohol Hypokalaemia Hypercalcaemia
Features of hypomagnesaemia
paraesthesia tetany seizures arrhythmias exacerbates digoxin toxicity
Mx of hypomagnesaemia if <0.4 mmol/L
<0.4 mmol/L or tetany, arrhythmias, or seizures
intravenous magnesium replacement is commonly given.
an example regime would be 40 mmol of magnesium sulphate over 24 hours
Mx of hypomagnesaemia if > 0.4mmol/l
oral magnesium salts (10-20 mmol orally per day in divided doses)
diarrhoea can occur with oral magnesium salts
