PSA questions Flashcards
Hyperkalaemia stages
Mild
Moderate
Severe
Mild 5.5-5.9 mmol/L
Moderate 6-6.4 mmol/L
Severe > 6.5 mmol/L
Emergency treatment for hyperkalaemia?
If severe ie >6.5 mmol/L or ECG changes- tall T waves, loss of P waves, broad QRS
Iv calcium gluconate- to stabilise myocardium
Insulin dextrose infusion- shifts K+ from ECF to ICF
Nebulised salbutamol
Extra: stop drugs e.g. ACEi
treat cause
Lower total K+: calcium resonium, loop diuretics, dialysis
1st line mx in T2DM
Metformin
Metformin giving patient GI side effects, change to what?
Modified release metformin
Metformin MOA?
Inhibits hepatic gluconeogenesis
Inhibits glucagon function
When would you add a SGLT-2 inhibitor to metformin in 1st line treatment?
If patient has
- high risk (QRISK >10%) or established CVD
- chronic HF
If metformin is contraindicated
(Also as a 2nd line option if Hba1c >58 despite 1st line)
If metformin is contraindicated, what would you give as a first line tx for T2DM?
If CI due to CVD or HF, give SGLT-2 inhibitor
Otherwise 1 of:
- DPP-4 inhibitor (gliptans)
- pioglitazone
- sulfonylurea e.g. glicazide
- SGLT-2 inhibitor e.g. dapaglifozin
When would you start a 2nd line medication in T2DM?
If Hba1c is >58mmol/mol despite 1st line
What would you give as 2nd line tx for T2DM?
Metformin + (one of below)
- DPP-4 inhibitor (gliptans)
- pioglitazone
- sulfonylurea
- SGLT-2 inhibitor
What would you give as 3rd line treatment for T2DM?
Add another of 2nd line options
E.g metformin + DPP-4 inhibitor + sulfonylurea
Or
Insulin therapy
MOA of metformin?
Inhibits hepatic gluconeogenesis
Inhibits glucagon function
MOA of SGLT-2 inhibitors?
And contraindication?
Reduced glucose reabsorption in kidneys
—> more excreted in urine
SGLT-2 is the main transport protein of glucose (90%)
CI: severe renal failure
Examples of SGLT-2 inhibitors? (4)
SGLT-2 abbreviated from?
Dapaglifozin
Canaglifozin
Empaglifozin
Ertuglifozin
Sodium glucose Co-transporter-2
DPP-4 inhibitor MOA?
Inhibits DPP-4 enzyme, an enzyme that destroys the hormone incretin. Incretin:
- encourages insulin release from b cells
- inhibits release of glucagon from a cells
So, less DPP-4 enzyme —> more incretin —> more insulin and less glucagon —> less glucose in blood
Side effects and contraindications of GPP-4 inhibitors?
SEs: GI problems
CIs: pancreatitis hx, hypoglycaemia, angioedema
Examples of DPP-4 inhibitors?
Sitagliptin
Vildagliptin
Alogliptin
Lingagliptin
Main thiazolidinedione used?
Pioglitazone
MOA of pioglitazone
A thiazolidinedione
Binds to receptors in adipocytes —> promotes adipogenesis and fatty acid uptake —> reduces circulating fatty acid conc —> improves insulin sensitivity
But, can therefore lead to weight gain
MOA of sulfonylureas?
Directly stimulate B cells to release insulin
Therefore can only be used if there is some B cell function I.e should not be used in type 1 diabetes
Examples of sulfonylurea? (4)
Glicazide
Glipizide
Glimepiride
Tolbutamide
MOA of GLP-1 receptor agonist?
Stimulates release of insulin from B cells
GLP-1 = glucagon like peptide
Examples of GLP-1 receptor agonists?
Liraglutide
Lixisenatide
Dulaglutide
Semaglutide
All injections, some OD, some once weekly. Should only be commenced by a specialist
‘GL’ “glutides”
When are GLP-1 mimetic (receptor agonist) indicated
If control not achieved or tolerated (Hba1c >58 mmol/mol) on triple therapy.
Used if
- BMI over 35
- insulin therapy not concordant with lifestyle
*only continue if Hba1c reduces by 11 mmol/mol AND body weight decreases by 8%
Normal Na range?
135-145 mmol/L
Normal K+ range?
3.5-5.0 mmol/L
Normal bicarb level?
22-29 mmol/L
Normal magnesium level?
0.7-1.0 mmol/L
Urea normal blood level?
2.0-7.0 mmol/L
Blood creatinine normal level?
55-120 umol/L
Fasting glucose tolerance test normal level
Normal glucose level (not fasted)?
Fasted- <5.6 mmol/L
Normal- <7.8 mmol/L
5.6 7.8
“5678”
Treatment for hypomagnesaemia?
Hypo is below 0.7 mmol/l
Severe is below 0.4
<0.4 mmol/L, arrhythmia or seizure
- IV magnesium e.g. 40 mmol magnesium sulphate over 24 hrs
> 0.4 mmol/l
- oral magnesium salts e.g. 10-20 mmol oral OD, SE diarrhoea
Sitagliptin is an example of which type of diabetic drug?
A DPP- 4 inhibitor
‘Dipeptidyl peptidase-4 inhibitor’
“Gliptins”
They inhibit breakdown of incretin enzyme
So, more insulin and less glucagon in blood
Pharmacokinetic vs pharmacodynamic?
Pharmacokinetic- two drugs affect on eachother e.g. inhibitory or synergistic. Alters the length or strength of drugs rather than the type of effect.
Pharmacodynamic- alters the body’s responsiveness or sensitivity to a drug
What type of pain relief medications should be avoided with oral anticoagulants including warfarin?
NSAIDS
Common interactions with St Johns Wort?
An unlicensed herbal medicine often used for it’s antidepressants effects
A common CYP system inducer
Often interacts in by inducing the effects of:
- Antidepressants- can lead to serotonin syndrome
- MAOIs- can cause a hypertensive crisis
- Warfarin- induces metabolism —> reduces INR
- Redcuced conc of oestrogen and progesterone
Common CYP system inhibitors?
Common CYP inducers?
Most common CYP enzyme?
CYP3A4 is our main enzyme that metabolises most drugs
Most common enzyme inducers?
Increase enzyme activity —> so reduce drug conc
“PC BRAS”
Phenytoin
Carbamazepine
Barbiturates
Rifampicin
Alcohol- chronic excess
Sulphonylureas
Most common enzyme inhibitors?
Decrease enzyme activity —> so drug conc rises
“AODEVICES”
Allopurinol
Omeprazole
Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol (alcohol intoxication)
Sulphonamides
Are enzyme inducers or inhibitors more likely to lead to toxicity of a drug?
Inhibitors
Because they inhibit the enzymes that break down the drug
Which hypertensives drugs should (nearly) always be carried on during surgery?
Calcium channel blockers
Beta blockers
What long term drugs should be increased during surgery?
Long term steroids e.g. prednisolone
Patients on steroids commonly will have adrenal atrophy so can’t naturally respond to the physiological stress of surgery so should have there steroid doses doubled to prevent a hypotensive crisis.
Similar to ‘sick day rules’ when a patient on steroids come into hospital or are acutely ill
Drugs that should be stopped prior to surgery?
I LACK OP
Insulin
Lithium
Anticoagulants/anti platelets
COCP/HRT
K-sparing diuretics e.g. spironolactone
Oral hypoglycaemics
Perindopil and ACE inhibitors
How long before surgery should COCP or HRT be stopped prior to surgery?
4 weeks
How long before surgery should lithium be stopped?
1 day before
How long before surgery should K-sparing diuretics and ACE inhibitors be stopped?
Day of surgery
4 key things that you should consider prescribing for a patient coming into hospital?
IV fluids
Pain relief
Thromboprophylaxis
Anti-emetics
PReSCRIBER mneumonic for remembering what to ensure is done when prescribing?
Patients details
Reaction ie allergies + reaction?
Sign
Contraindications?
Route?
Iv fluids needed?
Blood clot prophylaxis?
anti-Emetic?
pain Relief?
Which two antibiotics have penicillin in them but don’t have the -cillin in the name?
Tazocin
Co-amoxiclav
What antibiotic should be avoided with a high INR?
Erythromycin- enzyme inhibitor
Which drugs should are contraindicated in patients that are bleeding or at risk of bleeding e.g. prolonged PT due to liver disease
Drugs that increase bleeding
Aspirin
Heparin
Warfarin
Contraindications for steroids?
‘STEROIDS’
Stomach ulcers
Thin skin
oEdema
Right and left HF
Osteoporosis
Infection- including candida
Diabetes- can cause hyperglycaemia
cushing’s Syndrome
NSAID cautions and contraindications.
‘NSAIDS’
No urine ie renal failure
Systolic dysfunction ie HF
Asthma
Indigestion- any cause
Dyscrasia- clotting abnormality
Main side effect if ACE inhibitors?
Dry cough
Main side effects of calcium channel blockers?
Peripheral oedema
Flushing
General diuretics main side effect?
Renal failure
Loop diuretic main side effect?
Loop diuretic example?
Gout
Renal failure- generic
Furosemide
K sparing diuretic specific side effect?
Gynaecomastia
Generic- renal failure
Hyperkalaemia
For fluid replacement, all patients should have 0.9% saline unless….
If hypernatraemic?
If hypoglycaemic?
Has ascites?
If shocked with systolic <90?
If shocked from bleeding?
Hypernatraemic- 5% dextrose
Hypoglycaemic- 5% dextrose
Ascites- human-albumin solution
If shocked with systolic <90 -give gelofusine- has a high osmotic content so stays intravascularly longer
Shocked from bleeding? Give blood transfusion, give colloid if blood not available
If tachycardic or hypotensive, what vol of fluid bolus?
If oliguric?
500ml bolus
In HF, give 250ml
1L over 2-4hr then reassess
As a general rule, what vol of fluid do adults and elderly require per 24 hours?
Adults- 3L IV fluid per 24 hours
Elderly- 2L Iv fluid per 24 hours
Max rate if IV potassium infusion?
IV potassium Max 10 mmol/hour
Antiemetic choice and dose for patient with nausea?
Cyclizine 50mg 8 hourly IM/IV/oral
- can cause fluid retention
If HF, metoclopramide 10mg 8 hourly IM/IV
Can be given ‘as required’
What is the most common go to antiemetic?
Cyclizine
50mg TDS
Unless cardiac cause, then give Metoclopramide 10mg TDS
When would you avoid using metoclopramide?
What is its MOA?
MOA- dopamine antagonist
Avoid in
- Parkinson’s as can exacerbate symptoms
- young women- risk of dyskinesia
Daily max of paracetamol?
4g
First line for neuropathic pain?
Painful diabetic neuropathy 1st line?
Amitriptyline- 10mg oral nightly
Pregabalin- 75mg oral 12hrly
For painful diabetic neuropathy- Duloxetine 60mg OD
What analgesic should be avoided in asthmatics?
NSAIDS
Can cause bronchoconstriction so should be avoided unless strictly necessary and under close supervision
What abx should be avoided when using methotrexate?
Trimethoprim- ABSOLUTE contraindication as both are folate antagonists due to risk of bone marrow toxicity, can lead to pancytopenia and neutropenic sepsis
What rheumatological drug should be withheld until neutropenic sepsis is ruled out?
Methotrexate
Why should verapamil not be given concomitantly with beta blockers?
(Verapamil is a calcium Chanel blocker)
Concomitant use of these can cause bradycardia and hypotension, and even asystole
What can cause a high neutrophil count?
Bacterial infection
Tissue damage —> inflammation/infarct/malignancy
Steroids
What can cause a low neutrophil count?
Viral infection
Chemo or radiotherapy
Clozapine- antipsychotic
Carbimazole- anti thyroid
*patients undergoing chemo or radiotherapy can have a low neutrophil count in response to a bacterial infection. Urgent IV broad spec abx needed
What can cause a high lymphocyte count?
Viral infection
Lymphoma
Chronic lymphocytic leukaemia
Define thrombocytopenia and thrombocytosis
Thrombocytopenia- low plateletS
Thrombocytosis- high platelets
Thrombocytopenia can be caused by reduced production or increased destruction. What are causes of both?
Reduced production:
- infection (viral)
- drugs esp rheum drug penicillamine
- myelodysplasia, myelofibrosis, myeloma
Increased destruction
- heparin
- hypersplenism
- DIC
- ITP
- haemolytic uraemia syndrome/ TTP
What can cause thrombocytosis?
Reactive or primary
Reactive:
- bleeding
- Tissue damage - infection/inflammation/malignancy
- post splenectomy
Primary
- myeloproliferative disorders
Three generic groupings of the causes of hyponatraemia?
Hypovolaemic
Euvolaemic
Hypervolaemic
Hypovolaemic causes of hyponatraemia?
Fluid loss- d&v
Addison’s disease
Diuretics
Euvolaemic causes of hyponatraemia?
SIADH
Psychogenic polydipsia
Hypothyroidism
Hypervolaemic causes of hyponatraemia?
Heart failure
Renal failure
Liver failure- causing hypoalbuminaemia
Nutritional failure- causing hypoalbuminaemia
Thyroid failure- can be Euvolaemic too
Causes of SIADH?
Mneumonic ‘SIADH’
Small cell lung cancer
Infection
Abscess
Drugs- esp carbamazepine and antipsychotics
Head injury
Raised urea can indicate an AKI or what else?
A bleed e.g. upper GI bleed
Haemoglobin is broken down into urea by gastric acid then absorbed into the blood.
So, if raised urea with normal creatinine, look at haemoglobin
*also could have a raised urea from a bloody steak
Causes for raised alk phos (ALP)?
Mneumonic ALKPHOS
Any fracture
Liver damage- post hepatic
Kancer
Paget’s disease of bone
+Pregnancy
Hyperparathyroidism
Osteomalacia
Surgery
*a raised alk phos doesn’t necessarily indicate a posthepatic jaundice
Sometimes asked to change a Levothyroxine dose for patients with hypothyroidism. What is the target range for TSH?
~0.5- 5 mIU/L
How would you change a thyroxine dose depending on the TSH results below?
TSH 0.2
TSH 3
TSH 4.9
TSH 9
TSH 0.2 decrease dose
TSH 3 same dose
TSH 4.9 same dose
TSH 9 increase dose
So,
<0.5 decrease
0.5-5 keep the same
>5 increase dose
Drugs that can cause cholestasis?
Flucloxacillin
Co-amoxiclav
Nitrofurantoin
Steroids
Sulphoylureas
What would the T4 and TSH levels be in
Primary hypothyroidism
Secondary hypothyroidism
Primary hyperthyroidism
Secondary hyperthyroidism
1’ hypo- ⬆️TSH ⬇️T4 -Problem in thyroid gland
2’ hypo- ⬇️TSH ⬇️T4. - problem in pituitary gland
1’ hyper- ⬇️TSH ⬆️T4
2’ hyper- ⬆️TSH ⬆️T4
Warfarin management
If patient is asymptomatic, what would you do with the following INRs?
<6
6-8
>8
Normal is 1
Aim is usually 2.5
Metallic valve is usually 3.5
<6 reduce warfarin dose
6-8 omit warfarin for 2 days then reduce dose
>8 omit warfarin and give 1-5mg oral vit K
If minor bleeding with an INR >5, give IV vit K 1-3mg (instead of oral)
What is the management plan if a patient is on warfarin and they have a major bleed e.g. causing hypotension or bleeding into a confided space like brain or eye.
Stop warfarin
Give 5-10mg IV vit K
Give prothrombin complex
When would it be indicated to give Vitamin K?
When INR is >8 with no bleeding
Or bleeding
*if major bleeding, prothrombin complex should be given too e.g. Beriplex
Most common antibiotic regime for patients with neutropenic sepsis?
Neutropenic sepsis is a cause of sepsis e.g. pneumonia or UTI with neutrophils <1
Management
IV ABX
Piperacillin with tazobactam and gentamicin
LMWH examples?
Dalteparin
Enoxaparin- easier to prescribe in PSA. 100mg/ml
Tinzaparin
DOAC examples?
Apixaban
Rivaroxiban - use this in PSA (I think)
Edoxaban
Dabigatran
Betrixaban
What score would you use if a you wanted to assess the risk of stroke in a patient with AF?
CHA2DS2-VASc
What are the points scored in the CHA2DS2-VASc score?
What to the pints scored indicate for treatment?
Used to assess stroke risk in an AF patient
Congestive heart failure
Hypertension >140/90
Age >75 (2)
Diabetic T2
Stroke or TIA previously (2)
Vascular disease e.g. peripheral artery disease or IHD
Age 65-74
Sex- female
0- consider 75mg OD
1- aspirin or warfarin w aim INR 2.5
2+ - warfarin w aim 2.5
When would you give rhythm control treatment to patients with AF and when would you use rate control?
Rhythm control if:
- young
- symptomatic AF
- first episode of AF
- AF due to treated cause e.g. sepsis or electrolyte disturbance
Rate control
- everyone else with a heart rate >90bpm
You choose to treat a patient with AF with rhythm control treatment. How would you treat them?
Cardio version
Either electrical or pharmacological
Pharmacological- Amiodarone 5mg/kg over 20-120mins
*if over 48hours from onset, will need anticoagulation prior- for 3 weeks(?)
What treatment options are available for patients requiring rate control for AF?
Options of
- Beta blocker e.g. propranolol
- rate limiting calcium channel blocker e.g. diltiazem. Could also use verapamil (but not with a beta blocker)
- Digoxin- if also required, or 1st line if others are CI
3 1st line management drugs for stable angina?
- GTN spray
- 2’ prevention: consider aspirin, statin and CVD risk mod
- anti-anginal drug: beta blocker, CCB
Contraindications of beta blockers?
Hypotension
Bradycardia
Asthma
Acute heart failure
+ don’t prescibe with verapamil or NSAIDs
Contraindications of CCBs?
Hypotension
Bradycardia
Peripheral oedema
Asthma management ladder?
Inhaled SABA e.g. salbutamol
Inhaled preventor- steroid
Inhaled LABA, if no response, increase steroid
Either increase steroid or 4th drug from:
-leukotriene receptor antagonist (Montelukast)
- theophylline
- oral B2 agonist e.g. carbuterol
Oral steroid
High dose inhaled
Referral to specialist
Most seizure types have what as their first line tx?
Focal seizures have a different first line, what is this?
And when are they’re most significant CIs?
Sodium valporate
Focal seizures- carbamazepine or lamotragine
Sodium valproate is teratogenic
Lamotragine can cause a rash
Parkinson’s (most likely) treatment 1st line?
What would you use if trying to limit the use of this medication due to its finite period of effectiveness.
Co-beneldopa
Or
Co-careldopa
*these are both levodopa with a peripheral dopa decarboxylase inhibitor
If avoiding levodopa:
- Dopamine agonist e.g. ropinole
- MAO-inhibitor e.g. rasagiline
Common side effects of lamotragine?
Rash
Rarely- Stevens-Johnson’s syndrome
Common side effects of carbamazepine?
Rash
Dysarthria
Ataxia
Nystagmus
Reduced sodium
Common side effects of phenytoin?
Ataxia
Peripheral neuropathy
Gym hyperplasia
Hepatotoxicity
Sodium valproate common side effects?
3Ts
Tremor
Teratogenic
Tubby- weight gain
Type and example of 1st line drugs for Alzheimer’s?
Only started by a specialist
Acetylcholinesterase (AChE) inhibitors:
- donepezil
- rivastigmine
- galantamine
1st line tx for Crohn’s flare
-mild
-severe
Mild- 30mg prednisolone OD
Severe- Hydrocortisone 100mg 6 hourly IV
If rectal disease- rectal hydrocortisone
Maintaining remission in Crohn’s?
Azathioprine
Or
6- mercaptopurine*
*in 10% population, this is poorly metabolised so can accumulated, causing liver and bone marrow toxicity, should consider methotrexate instead
When would vancomycin be used orally?
To treat C.difficile in the gut
Max vancomycin infusion rate
10mg/ min
What’s gentamicin used for?
Bacterial endocarditis
Surgical prophylaxis
Neutropenic sepsis
Adult dose of gentamicin
5-7mg/kg/day
Via IV over >60mins
Women’s and men’s ideal body weight calculation?
Womens
[ (height (cm) - 154) x 0.9 ] + 45.5
Mens
[ (height (cm) -154) x 0.9 ] + 50
Insulin blood glucose targets before meals and after meals?
Before: 4-7mmol/l
After: <9mmol/l
How much NaCl is in 0.9% NaCl in 1ml
0.9g in 100ml
900mg in 100ml
1ml has 9mg NaCl
How much glucose is in 1ml of 5% glucose solution?
5g in 100ml
5000mg in 100ml
50mg in 1ml
MgSO4 20% solution. How much MgSO4 is in 1ml of solution?
20g in 100ml
20,000mg in 100 ml
200mg in 1ml
What do the following ratios mean practically?
1:1000
1:10000
1:1000 = 1g in 1000ml
1:10000= 1g in 10000ml
What does the adrenaline 1 in 1000 mean in doses?
1 in 1000 = 1g in 1000ml
You’ve got adrenaline 1 in 200000. How much adrenaline is in 1ml?
1:200000
= 1g in 200000ml
= 1000mg in 200000
= 1mg in 200ml
= 1000 mcg in 200ml
/ 200
= 5mcg in 1ml
What type of laxative is
Senna
Lactulose
Senna- stimulant
Lactulose- osmotic
First line abx in skin infections?
Flucloxacillin
What is hydroxycobalamin used to treat?
Vit B12 deficiency
What drugs should be avoided in Parkinson’s disease?
Which dopamine antagonist can be used in Parkinson’s patients and why?
Haloperidol
Metoclopramide
As they’re both dopamine antagonists. Can precipitate parkinsonian symptoms in patients without Parkinson’s too
Domperidone is a dopamine antagonist but doesn’t cross the blood brain barrier so is alright to use
Young female on ace inhibitor wants to get pregnant. Do you need to alter medications? If yes, how?
ACEi teratogenic in first trimester
Should swap to labetolol before conception
Colour coding of warfarin tablets?
White 0.5mg
Brown 1mg
Blue 3mg
Pink 5mg
What would 1% mean (regarding concentrations of solutions)?
1g in 100ml
What does 1 in 1000 mean?
What does 1 in 10000 mean?
Units are same as percentage
1g in 1000ml
1g in 10000ml
When is 1 in 1000 adrenaline used and when is 1 in 10000 used?
1 in 1000 is used in the IM format e.g. in an epipen
1in 10000 is used IV in ALS (ALS trained)
First line medical treatment for heart failure?
‘ABAL’
ACEi e.g. ramipril
Beta blocker e.g. bisoprolol
Aldosterone antagonist, if not controlled on A and B e.g. spironolactone
Loop diuretic improves sx e.g. furosemide
Rate control options for AF?
1’ Beta blocker
2’ CCB
3’ Digoxin- only in sedentary, needs monitoring
1st drug given in sever hyperkalaemia?
Short acting insulin WITH glucose
E.g. actrapid or novorapid
Dose: 10 units
In 100ml of dextrose
30 min IV
Most appropriate drug for (most types of) epilepsy in pregnancy?
Lamotragine
When is metformin NOT used first line for T2DM?
And what would you use instead 1st line?
Causes appetite suppression so not used in underweight or normal.
Avoid if creatinine >150 as can cause lactic acidosis
Would use a sulphonylurea instead for normal and underweight e.g.
- Glicazide
- Tolbutanide
- Glipizide
What parameter should be checked prior to initiating vancomycin?
Serum creatinine
Renally excreted so dysfunction can lead to toxicity
2 most common side effects of vancomycin?
Nephrotoxicity
Ototoxicity
What parameter should be checked before prescribing statin? And when after starting them?
When are statins contraindicated?
Liver function
Contraindicated in active liver disease or if AST or ALT are raised more than 3x normal range- or should be stopped if on them
LFTs should be check 3 and 12 months after starting a statin
What should be measured before starting antipsychotics, particularly olanzapine?
Fasting blood glucose. At baseline and regularly thereafter
Antipsychotics can cause hyperglycaemia T2DM
What should be checked prior to starting ACEi? And why?
U&Es should be checked before starting and after every dose change
Can cause hyperkalaemia, hyponatraemia and AKI
What parameter should be measured when using digoxin?
Serum creatinine
Would measure serum digoxin level if suspecting toxicity or inadequate effect suspected
What should you check prior to starting sodium valporate?
LFTs - should be measured at baseline and at regular intervals
Can cause hepatotoxicity
What should be measured when a patient is taking clozapine?
FBC for 1st 18weeks
High risk of neutropenia and agranulocytosis
What should you avoid prescribing alongside ACEi?
NSAIDS- can worsen kidney function considerably
What are the standard requirements per day of Na, Cl and K?
1 mmol/kg/day
What is the standard glucose requirement per day?
50-100g glucose per day
When would you avoid giving glucose IV?
Obvs if hyperglycaemic
Avoid within 24hrs of an ischaemic stroke or head trauma
Max potassium infusion rate?
10 mmol / hour
NEVER use in resus bag
Use the 0.3% conc to meet K requirements
What would you prescibe to a severly hypoglycaemic patients?
10% or 20% glucose, not stronger as can cause thromboembolus
Fluid requirements /kg/day?
25-30ml /kg/day
If changing insulin dose, how much do you change it by?
~10%. Avoid complicating, keep on same medications and just adjust doses if needed
What is the breakdown of short to long acting insulin in Novomix 30
30% short acting
70% long acting
Which NSAID does not cause renal failure?
Aspirin
How long does it take for aspirins effect to wear off?
Approx 7-10 days
Irreversible inhibitor of COX enzyme. So last the life of the platelets (which is 7-10 days)
What medication should you avoid in patients with gout?
Thiazide like diuretics e.g. Bendroflumethazide
Lithium excretion is significantly reduced by what medications?
ACEi
Diuretics- particularly thiazides
NSAIDs
When patients are treated and recovering from dehydration, they can sometimes overcompensate and have a polyuric phase where output is considerably higher than input. What point would you consider this ‘polyuric’ phenomanon?
If urine output exceeds 200ml/hr
KCl requirements per day? in mmol
40-60mmol /day
Maintenence fluids. What is meant by the term ‘2 salty, 1 sweet’?
2L NaCl 0.9%
1L 5% dextrose w 40-60 mmol KCl
This gives the 3L a day. With the adequate amount of Na, Cl and K
If a patient is improving clinically and their bloods come back with a significantly raised potassium, what would you do?
Recheck - likely artefactually abnormal if everything else normal and patient seems well
True hyperkalcaemia:
- 10ml 10% IV calcium gluconate
- 10 units actrapid insulin in..
- 100 ml 20% IV dextrose
- Nebulized salbutamol
Metformin is contraindicated in chronic kidney failure below what eGFR?
Contraindicated below 30
Cautionary use below 45
What diabetic drug is 1st line in patients with CKD?
A sulphoylurea e.g. glicazide
What antiemetic is inappropriate in bowel obstruction?
Metoclopramide
and CI in few days post abdo surgery
If started on clarithromycin, what common regular drug should be stopped?
Statins.
Clari is a CYP3A4 inhibitor meaning the enzymes metabolising statins activity is reduced leading to a build up leading to increased toxicity and SEs
Rapid antacid?
Gaviscon- alginate
Magnesium carbonate
Aluminium hydroxide
Co-magaldrox
Hospital acquired pneumonia 1’ tx?
Piperacillin w/ Tazobactam
When would you check tacrolimus levels to check normal range?
Measure trough levels prior to morning dose
Should be between 6-10ng/ml
Non-sedating antihistamines?
Fexofenadine
Loratidine (these 2 are the least sedating)
Acrivastine
Cetirizine
Non
Sedating antihistamines?
Chlorphenamine
Promethazine
Cinnarizine
Anion gap formula?
Serum osmolality formula?
Anion gap
(Na + K) - (bicarb + Cl)
Serum osmolality
2(Na) + glucose + urea
