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Finals COPY (FdCi) > PSA/Pharm > Flashcards

PSA/Pharm Flashcards

1
Q

what is the treatment for acute dystonia/oligouric crisis?

A

procyclidine 10 mg iv STAT

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2
Q

what cardiovascular medications are contraindicated in peripheral vascular disease?

A

all - beta-blockers because they reduce peripheral limb perfusion through action on the adrenergic system

severe PVD - also avoid ACE-I

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3
Q

what are some commonly used mediations that worsen congestive heart failure?

A
  • calcium-channel blockers
  • NSAIDs
  • DPP-4 inhibitors (sitagliptin)
  • alpha-blockers (doxazosin)
  • anti-arrhythmics (sotalol, flecanide, disopyramide)
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4
Q

name the commonly used thiazides and thiazide-like diuretics

A
  • bendroflumethiazide
  • hydrochlorothiazide
  • indapamide
  • chlorthalidone
  • metolazone
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5
Q

name the common used cardioselective calcium channel blockers

A
  • verapamil
  • diltiazem
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6
Q

name the common peripherally acting calcium channel blockers

A
  • amlodipine
  • nifedipine
  • nimodipine
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7
Q

which antibiotics should be avoided when a patient is on methotrexate?

A

trimethoprim and fluroquinolones

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8
Q

what medication seriously increased the risk of myotoxicity when given in combination with a statin?

A

gemfibrozil

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9
Q

what should be checked before starting a patient on spironolactone or eplerenone?

A

serum potassium

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10
Q

what should be told to patients on methotrexate?

A
  • blood disorders (infections, bleeding, anaemia, ulcers)
  • liver toxicity (dark urine, nausea and vomiting)
  • respiratory effects (shortness of breath)
  • NSAIDs - should be avoided, but not absolutely CI
  • teratogenicity - both men and women should be on contraception for the duration of treatment and 3 months after stopping
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11
Q

which NSAIDs have the highest and lowest CV risk associated?

A

highest - coxibs and diclofenac

lowest - naproxen

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12
Q

what is the mechanism of action of thiazide diuretics?

what are the common side effects of thiazide diuretics?

A

inhibiting sodium reabsorption in the distal convoluted tubule through the Na-Cl symporter. potassium is lost as a result of more Na reaching the DCT and collecting ducts

common:

  • dehydration & postural hypotension
  • hyponatraemia, hypokalaemia, hypercalcaemia
  • gout
  • impotence

rare:

  • photosensitive rash
  • thrombocytopenia
  • agranulocytosis
  • pancreatitis
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13
Q

what are the main serious side effects of NSAIDs?

A
  • worsening of asthma
  • increased risk of thromboembolic (MI or CVA) events
  • increased risk of GI-ulceraiton and haemorrhage
    • worsened if drinking alcohol in moderate quantities concurrently
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14
Q

what are the fluid and electrolyte requirements for an adult in 1 day?

what is the minimum urine output target?

A

fluid - 40 mL/kg

Na+ - 2 mmol/kg

K+ - 1 mmol/kg

0.5 mL/kg/hour

…do not exceed an infusion rate of 10 mmol/hr K+

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15
Q

what a suitable dose of any LMWH for treatment of VTE?

what are the treatment doses of rivaroxaban and apixaban for VTE?

A

enoxaparin - 1.5 mg/kg OD s/c every day until adequate oral anticoagulation is established

rivaroxaban - 15 mg BD for 21 days taken with food

apixaban - 10 mg BD for 7 days, then 5 mg BD

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16
Q

what medication can lead to gingival hyperplasia?

A

ciclosporin

phenytoin

CCBs

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17
Q

what are the starting and monitoring requirements for warfarin?

what finding would be a contraindication to starting warfarin?

A

measure PT and baseline LFTs, do not hold off the first dose while waiting for PT to come back from the lab
measure the PT and calculate the INR

PT > 5 x ULN then do not use warfarin

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18
Q

what are the monitoring requirements for methotrexate?

what are the side effects?

what is the conception advice?

what drugs should be avoided while on methotrexate?

A
  • low-dose = LFTs
  • high-dose = LFTs and FBC and U&E

myelosupression, liver cirrhosis, pulmonary fibrosis, pneumonitis, mucositis

  • *women**: avoid pregnancy for at least 3 months following MTX therapy
  • *men:** use effective contraception for at least 3 months following MTX therapy

trimethoprim and co-trimoxazole (TMP/SMX)

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19
Q

what are the monitoring requirements for lithium?

what are the target and acceptable levels?

A

lithium levels - check every 3 months, taken 12 hours after last dose (trough)

TFTs and U&E checked every 6 months

  • *target**: 0.8-1.0
  • *acceptable:** 0.4-1.2
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20
Q

what blood test is used to monitor 5-aminosalycylic acids (5-ASAs)?

A

U&Es

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21
Q

what are the side effects common to sulfa drugs?

A
  • rashes
  • oligospermia
  • headache
  • Heinz body anaemia
  • megaloblastic anaemia
  • lung fibrosis
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22
Q

what are the side effects common to 5-ASA drugs?

A
  • GI disturbance
  • agranulocytosis
  • pancreatitis
    • mesalazine >>> sulphasalazine
  • interstitial nephritis
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23
Q

what are the adverse affects of amiodarone?

what are the monitoring requirements?

A
  • slate-grey appearance
  • thyroid dysfunction
  • corneal deposits
  • pulmonary fibrosis/pneumonitis
  • liver fibrosis (ALT > AST)
  • photosensitivity
  • thrombocytopenia at injection sites
  • bradycardia
  • *prior to treatment:** TFTs, LFTs, U&E, CXR
  • *every 6 months:** TFTs and LFTs
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24
Q

what is the impact of NSAIDs on heart failure?

A

NSAIDs worsen heart failure by causing fluid retention, increasing blood pressure and increasing the afterload on an already strained heart

heart failure worsened by NSAIDs

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25
Q

why should 5% glucose not be given to an alcoholic at risk of wernicke’s encephalopathy immediately?

A

when malnourished, all the glucose in the body is diverted to the brain for energy. thiamine is a co-factor for OxPhos.

introducing systemic glucose increases the whole body demand for thiamine, so it is diverted away from the brain, leading decreased cerebral oxidative phosphorylation.

fill the patient up with thiamine (Pabrinex) first, then give glucose

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26
Q

what are the starting and monitoring requirements of statin medications?

A

get lipid profile (obviously) and LFT before starting

LFTs at 3 and 12 months after starting

AST/ALT is more than 3x ULN, stop and restart at a lower dose

transaminase rise of less than 3x ULN - do not stop medication

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27
Q

what is the rare but serious liver side effect of statins?

A

cholestatic hepatitis (raised ALP and liver damage)

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28
Q

which diuretic worsens gout?

A

thiazides

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29
Q

which antibiotics increase the chances of statin-induced myopathy?

A

macrolides - erythromycin/clarithromycin

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30
Q

what proportion of patients will not tolerate AZA therapy?

what are the common side effects?

what is the uncommon and serious side effect of AZA?

what medication should you try next in a patient with IBD?

A

33% of patients will not tolerate AZA

GI side effects, hair loss and skin rash

red cell aplasia, pancytopenia

6-mercaptopurine

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31
Q

what is the side effect of AZA that is more likely to occur in patients with low TMPT levels/deficiency?

A

myelosupression

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32
Q

which tests are needed if you suspect digoxin toxicity?

A

ECG and renal function (looking for raised creatinine or hypokalaemia)

digoxin level
though there is no absolute number for this. the likelihood of toxicity increases as concentrations rise, but toxicity is indicated by the degree of hypokalaemia

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33
Q

which drugs are directly hepatotoxic?

i.e. give raise transaminases without ALP rise

A

paracetamol overdose

statins

rifamipicin

34
Q

which drugs give a cholestatic hepatitis?

A

co-amoxiclav and flucloxacillin

nitrofurantoin

steroids

sulfonylureas

35
Q

what is the rule for calculating the expected PaO2 from the FiO2?

A

[FiO2 - 10] = expected PiO2

36
Q

what medication can result in a downward-sloping ST segment depression in all leads?

A

digoxin

37
Q

what are the main ototoxic drugs?

A
  • aminoglycosides
  • loop diuretics
  • platinum-based chemotherapy
38
Q

which medication should be avoided in myasthenia gravis?

A

anti-cholinergics..

i.e. oxybutynin for urinary incontinence

39
Q

when should thiazides be taken?

A

in the morning

if you prescribe at night then the patient will wake up having to pee

40
Q

what is the dosing schedule for common anti-emetics?

A

metoclopramide and cyclizine

given TDS/8-hourly

41
Q

which is the anti-emetic dopamine blocker than can be used in parkinson’s disease?

A

domperidone, as it does not cross the BBB

metaclopramide should not be used in Parkinson’s

42
Q

what are the common drugs that precipitate bronchospasm in asthmatics?

A

beta-blockers, NSIADs and adenosine

note: 10-20% of asthmatics are sensitive
if they’ve been on it before without a problem then they can stay on NSAIDs
risk is increased in patients who are middle-aged or those with nasal polyps

43
Q

what is the definition and treatment of a severe flare of UC?

A

opening bowels >6 times/day and systemically unwell

IV hydrocortisone 100 mg QDS/6-hourly

44
Q

what is the definition of a major bleed on warfarin?

i.e. requiring PCC

A

bleeding causing hypotension or into a confined space (skull)

45
Q

what are the sick day rules for T1DM patients with regards to insulin?

A

needs to increase the dose of insulin, otherwise will run a higher risk of DKA

46
Q

after how many days should you review the antibiotic therapy for acute otitis media?

A

5 days

47
Q

after how many days should you review the antibiotic therapy for acute epiglottitis?

A

3 days

48
Q

what is first line treatment for GAD?

A

citalopram/escitalopram/fluoxetine

49
Q

what is the first line treatment for depression in adults?

A

citalopram/escitalopram/fluoxetine/fluvoxamine/paroxetine

50
Q

what is the monitoring requirement before you start valproate?

A

liver function tests

51
Q

what is the monitoring requirement for clozapine?

A

FBC checked weekly for at least the first 18 weeks

52
Q

what is the monitoring for phenytoin?

A

ECG and blood pressure

53
Q

what is the best marker to monitor the response of a pneumonia to antibiotic therapy?

A

respiratory rate

return to normal indicates that the respiratory failure is resolved.

ABG would be preferable, but is invasive so RR is often easiest

54
Q

which diuretic is associated with hyponatraemia?

A

thiazides

55
Q

dose for paracetamol?

A

1g qds

56
Q

dose for ibuprofen?

A

200-400 mg tds

57
Q

dose for codeine?

A

30-60 mg qds

58
Q

dose for co-codamol?

A

8/500 mg qds

30/500 qds

or ‘co-codamol 8/500 mg 2 tablets qds’

59
Q

dose for cyclizine?

A

50 mg tds

60
Q

dose for metaclopramide?

A

total 30-100

typically 10 mg tds

61
Q

amoxicillin

A

500 mg tds

62
Q

dose for clarithromycin

A

500 mg bd

63
Q

dose for lansoprazole

A

15-30 mg od

64
Q

dose for omeprazole

A

20-40 mg od

65
Q

dose for aspirin

A

secondary prevention

75 mg od

treatment 300 mg od

66
Q

dose for clopidogrel

A

75 mg od secondary prevention

300 mg od treatment

67
Q

dose for simvastatin

A

10-80 mg ON

start at 40 mg ON if the patient has diabetes or established atherosclerotic cardiovascular disease

68
Q

dose for atenolol

A

25-100 mg od

69
Q

dose for ramipril

A

1.25-10 mg od

70
Q

dose for bendroflumethiazide

A

2.5 mg od

give in the morning!

71
Q

dose for furosemide

A

20 mg od - 80 mg bd

can be much higher for renal patients

72
Q

dose for amlodipine

A

5-10 mg od

73
Q

dose for levothyroxine?

A

25-200 mcg od

74
Q

dose for metformin?

A

500 mg od - 1 g bd

75
Q

which drugs worsen seizure control in patients with epilepsy?

A
  • alcohol, cocaine, amphetamines
  • cirpfloxacin, levofloxacin
  • aminophylline, theophylline
  • bupropion
  • methylphenidate
  • mefenamic acid
76
Q

what is the rule for dose of oral morphine for breakthrough pain in palliative care?

A

take 1/6th of daily oral morphine dose for breakthrough pain

77
Q

which opioids are best used in renal impairment?

A

fentanyl or oxycodone

78
Q

what is the effect of ciclosporin on electrolytes?

A

hyperkalaemia

hyperglycaemia and hyperuricaemia

79
Q

how do you treat vulvovaginal candidiasis?

what is the difference in pregnancy?

A

topical/PV clotrimazole

must be prolonged treatment… 7 days usually rather than a single dose

80
Q

T1DM in DKA

usually on a basal-bolus

what do you do with their regular insulin? is the treatment with fixed-rate or variable-rate insulin for the DKA?

A

stop the short acting

keep the long-acting insulin as normal

start them on fixed-rate insulin of 0.1 U/kg/hr

81
Q

what is the advice for patients when treating with loperamide for acute diarrhoea?

A

loperamide should be taken after each loose stool

care not to exceed the maximum dose (16 mg/24 hrs)

82
Q

what is the dose adjustment of insulin when a T1DM patient starts taking steroids for treatment of another disease?

A

increase the dose by 10%

Finals COPY (FdCi) (10 decks)

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