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PSA revision Flashcards

1
Q

which antiemetic should you never use in parkinsons patients

A

metoclopramide

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2
Q

which drugs should you never use in parkinsons

A

haloperidol and other antipsychotics for agitation bc dopamine antagonists

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3
Q

best antiemetic to use in parkinsons

A

domperidone

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4
Q

management of pain in acute MI

A
  • morphine
  • paracetomol can be used but not as fast acting
  • GTN spray 2 puffs very fast acting to relieve pain by dilating coronary arteries
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5
Q

management of hypertension in pregnancy -

which drug should you switch to

A

switch to labetaolol bc other antihypertensives all teratogenic

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6
Q

which diabetes drug is associated with lactic acidosis

A

metformin

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7
Q

oral diabetic drugs advice

A

eat regular meals to avoid hypoglycaemia

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8
Q

name 3 SSRI’s

A

citalopram
sertraline
fluoxetine
paroxetine

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9
Q

name a SNRI

A

venlafaxine

duloxteine

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10
Q

name a TCA

A

amitryptiline

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11
Q

name a norad serotinin specific antidepressant (NASSA)

A

mirtazepine

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12
Q

name a noradrenaline reuptake inhibitor NARI

A

reboxetine

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13
Q

which antidepressant is safest in the elderly

A

SSRI’s

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14
Q

which drugs should you avoid prescribing alongside SSRI’s

A

warfarin
doacs
heparin
NSAIDS

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15
Q

which antidepressants are safest to use during pregnancy

A

sertraline and fluoxetine

give a lower dose

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16
Q

what does a cytochrome p450 inducer do

A

induces the p450 enzymes, so increases clearance of the drug, so decrease bioavailability

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17
Q

name 4 examples of p450 inducers

A 
phenytoin
rifampicin
phenobarbital
alcohol
sulphonylureas
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18
Q

name 6 exmaples of p450 inhibitors

A 
sodium valproate
fluconazole
grapefruit juice
alcohol
chloramfenicol
erythromycin
ciprofloxacin
omeprazole
metronidazole
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19
Q

what does a p450 inhibitor do

A

inhibits p450 enzymes so less breakdown of the drug so increased bioavailability (ie increased risk of toxicity, more effects)

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20
Q

name 2 drugs that cause ototoxicity

A 
vancomycin
gentamicin
furosemide in high doses
NSAIDS
aspirin in large doses
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21
Q

what food should be avoided with warfarin

A

vitamin k rich food - antagonises warfarin

stuff like kale, spinach, cranberry juice

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22
Q

which 5 antibiotics cause C. diff infection

A 
clindamycin
cephalosporins (cefalexin, cefuroxime, cefotaxime, ceftriaxone)
ciprofloxacin
co-amoxiclav
carbapenams (meropenam)
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23
Q

management of c.diff infection

A
  1. oral vancomycin
  2. oral fidaxomycin
  3. if severe presentation / not treated with the above use IV metronidazole and PO vancomycin
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24
Q

which antiemetics are contraindicated in patients with a prolonged QT interval

A

ondansetron (5 ht receptor antagonist)

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25
Q

1st line antiemetic in post op nausea and vomiting

A

ondansetron

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26
Q

which antiemetics should you avoid in patients on antipsychotics

A

metoclopramide (dopamine antagonist) - increased risk of extrapyramidal side effects

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27
Q

1st line management of shingles

A

aciclovir

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28
Q

patient with t2 diabetes with a high hba1c 1st line management

A

metformin

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29
Q

common drugs that cause hyperkalaemia

A 
ace inhibitors
ARBS - candesartan 
fluconazole
beta blockers
digoxin
ciclosporin
eplerenone (type of k sparing diuretic)
spironolactone
NSAIDS
tacrolimus
trimethoprim
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30
Q

drugs that can cause dyspepsia

A 
alendronic acid
prednisolone
NSAIDS
CCB's eg amlodipine
TCA's
beta blockers
antimuscarinics eg oxybutinin, tolterodine
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31
Q

drugs that can cause ankle oedema

A

amlodipine
naproxen
corticosteroids
pioglitazone

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32
Q

treatment of thrush in pregnancy

A

clotrimazole pessary bc oral fluconazole is contraindicated

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33
Q

management of c.diff infection

A
  1. oral vancomycin
  2. fedaxomicin
  3. oral vancomycin + IV metronidazole
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34
Q

when should loperamide be taken

A

after each loose stool

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35
Q

medications that can cause serotonin syndrome

A

SSRI’s

tramadol –> a serotonin inducing drug

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36
Q

which drugs can lower the contraceptive effects of COCP

A

carbamezapine
rifampicin
phenytoin
topiramate

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37
Q

management of neuroleptic malignant syndrome

A

procyclidine

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38
Q

monitoring effects of COCP

A

blood pressure - 6 monthly

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39
Q

monitoring therapeutic effects of diuretics

A

daily weights

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40
Q

what side effects should patients on DOACs be warned about

A

bleeding and bruising - go to gp

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41
Q

what should you switch to when patients arent tolerating morphine

A

oxycodone

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42
Q

management of too high INR on warfarin

A
  1. if severe eg UGIB or intracranial haemorrhage and INR >5 give beriplex (dried prothrombin concentrate) + vitamin K
  2. major bleeding - give FFP + vitamin K
  3. INR > 8 but no bleeding or minor bleeding - vitamin K, restart warfarin when INR reaches <5
  4. INR 6-8 - stop warfarin and restart when less than 5
  5. INR <6 - reduce dose of warfarin
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43
Q

pt develops hyperthyroid on amiodarone - management

A

stop amiodarone

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44
Q

pt develops hypothyroid on amiodarone

A

can continue amiodarone and replace with levothyroxine

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45
Q

what should you monitor on amiodarone

A

TFT’s - hypo or hyper thyroid

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46
Q

when should you monitor lithium levels

A

12 hours after the lithium dose

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47
Q

which electrolyte abnormality increases the risk of lithium toxicity

A

hyponatraemia

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48
Q

which fluid should you prescribe alongside potassium when treating hypokalaemia

A

0.9% saline

cant give 5% dextrose because the glucose would cause a shift of the potassium into the cells

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49
Q

what is the maximum rate of infusion of potassium

A

10mmol per hour

so can give 40mmol over 4 hours, 20 mmol over 2 etc

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50
Q

signs and symptoms of hypokalaemia

A

can be asymptomatic

muscle cramps, weakness, fatigue, constipation, arrythmia

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51
Q

name as many causes of hypokalaemia as you can

A 
excessive laxative use
steroids eg pred
insulin
furosemide
salbutamol
bendroflumethiazine
theophylline
vomiting/diarrhoea
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52
Q

which electrolyte should you always check in a patient with hypokalaemia

A

magnesium - low magnesium can make low potassium resistant to treatment so must treat and correct both

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53
Q

management of hyperkalaemia

A

protect the heart - IV calcium gluconate 10% over 3-5 mins
drive potassium into cells -
use IV actrapid insulin 5-10 units with 50ml 50% glucose over 5-15 mins
can give nebulised salbutamol to help

excrete excess potassium - oral calcium resonium

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54
Q

in which condition is gentamicin always contraindicated in

A

myasthenia gravis

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55
Q

side effects of gentamicin

A

ototoxicity

nephrotoxic

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56
Q

what should you monitor when treating a pt with gentamicin

A

peak and trough gent levels

renal function before and during treatment

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57
Q

what should you monitor when treating a pt with gentamicin

A

peak and trough (6-14 hours after dose) gent levels

renal function before and during treatment

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58
Q

which pain relief medications are appropriate to use in CKD

A

paracetamol
coedine phophate
co-codamol
fentanyl

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59
Q

which pain relief medications should you avoid in CKD

A

strong opioids if possible (bc metabolites are renally excreted)
NSAIDs - nephrotoxic

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60
Q

what deprescribing / prescribing should you consider in patients with acute AKI

A
  1. prescribe things to correct hypovolaemia eg fluids
  2. stop nephrotoxics
  3. stop or reduce drugs that are renally excreted to prevent build up in the circulation
  4. consider stopping drugs that may be reducing renal perfusion
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61
Q

which diuretics should you avoid prescribing in ckd

A

potassium sparing eg spironolactone

elperenone

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62
Q

which diuretic can you use in CKD but should be withheld in aki

A

furosemide

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63
Q

can you use ace inhibitors and spironolactone together in ckd

A

not usually due to risk of hyperkalaemia, but can do it under specialist advice only

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64
Q

when should you avoid ace inhibitors in ckd

A

in patients with bilateral renal artery stenosis

or in patients with 1 functioning kidney and renal artery stenosis

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65
Q

what should you look at when considering prescribing ACEi / ARB to patients with CKD

A

whether they have diabetes
whether they have HTN
albumin creatinine ratio

if they have diabetes and ACR of 3 or more then prescribe
if they have HTN and ACR of over 30 then prescribe
or an ACR of over 70 always prescribe

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66
Q

what bloods should you check when prescribing ACEi/ARB to patients with CKD

A

check potassium before prescribing, and again after 7 days

dont start treatment if K is upper limit of normal eg 5.0
re check in 7 days after every dose change

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67
Q

name a side effect of calcium channel blockers

A

oedema! easily gets confused with fluid overload so be careful
this oedema is resistant to diuretics

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68
Q

when is verapamil contraindicated for SVT / rate control

A

when patient is on a beta blocker - increases the risk of heart block

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69
Q

drug of choice for Fast AF in a patient with heart failure and a reduced ejection fraction

70
Q

when should dc cardioversion be avoided

A

when the onset of new fast af is unknown, there is a risk of clots firing off so patient needs anticoagulating before cardioversion

if haemodynamically stable, anticoagulate for 3 weeks before cardioversion
if unstable anticoagulate asap and cardiovert

71
Q

why should you stop metformin in acidotic patients with reduced renal function

A

increased risk of lactic acidosis

72
Q

patient with renal disease and heart failure presents with fluid overload, already on indapamide

what would you do

A

switch indapamide to furosemide (best diuretic for removing excess fluid without causing CKD to worsen / aki)

73
Q

name 3 side effects of metformin

A

GI upset eg diarrhoea, vomiting, abdo pain (most common)
reduced appetite - good for weight loss
lactic acidosis risk when unwell

74
Q

1st line t2dm management

75
Q

name 3 contraindications to metformin

A
  1. severe renal impariment
  2. ketoacidosis
  3. low BMI (bc causes weight loss)
76
Q

explain how metformin works

A

increases your bodies response to insulin so it is able to take up more glucose from your blood and reduces gluconeogenesis by liver

77
Q

normal starting dose of metformin

78
Q

maximum dose of metformin

79
Q

what to do when patient isn’t tolerating metformin

A
  1. switch from IR to MR
  2. offer an alternative…
    - can offer a gliptin eg sitagliptin / linagliptin
    - sulphonylureas eg gliclazide, glipizide, tolbutamide
    - pioglitazone
80
Q

give an example of a DPP-4 inhibitor

A

GLIPTINS
sitagliptin
linagliptin

81
Q

give 3 examples of sulphonylureas

A

gliclazide
glipizide
tolbutamide

82
Q

when is pioglitazone contraindicated

A 
heart failure
hepatic impairment
history of current or past bladder cancer
uninvestigated macroscopic haematuria
DKA
83
Q

what is a benefit of using a dpp-4 inhibitor (eg sitagliptin) over a sulphonylurea

A

less risk of hypoglycaemia

84
Q

give 2 examples of sodium glucose co transporter inhibitors

A

canagliflozin

empagliflozin

85
Q

benefits of sodium glucose co transporter inhibitors

A

good to use in patients with established cardiovascular risk either when metformin not tolerated or in addition to metformin

86
Q

give examples of glucagon like peptide - 1 inhibitors

A

exenatide

liraglutide

87
Q

describe the escalation approach for managing T2dm with oral hypoglycaemics

A
  1. metformin
  2. dual therapy (add a gliptin, sulphonylurea or pioglitazone)
  3. triple therapy
88
Q

when are sodium glucose co transporter inhibitors eg canagliflozin used

A

in step up therapy in addition to metformin but only if sulphonylureas and other options aren’t tolerated / cotraindicated

89
Q

when are sodium glucose co transporter inhibitors eg canagliflozin used

A

in step up therapy in addition to metformin but only if sulphonylureas and other options aren’t tolerated / cotraindicated eg metformin + GLP-1 inhibitor + sulphonylurea

90
Q

side effects of sodium glucose co transporter -4 inhibitors

A

significant weight loss so can only be used in patients with a BMI >35

91
Q

when should you consider insulin therapy in T2dm

A

when hba1c is not controlled on dual therapy, triple therapy then you can consider insulin therapy

92
Q

at what hba1c level should you consider intensifying treatment in t2dm

A

when it raises above 58mmol (7.5%)

93
Q

name 5 actions of insulin

A 
inhibits glycogenolysis
inhibits gluconeogenesis
increased production of glycogen from glucose to store
inhibits lipolysis (stops fat breakdown)
increases potassium uptake by cells
decreases fatty acid synthesis
94
Q

what type of insulin regimen would you offer to patients with T2dm whos triple therapy has failed

A

usually offer a once daily regimen with a basal / long acting insulin

95
Q

give 2 examples of long acting insulin

A

insulin detemir

insulin garglene

96
Q

describe a twice daily insulin regimen

A

given once on a morning, once on an evening
usually done with a pre mixed mixture of short (regular human) and intermediate insulins

examples of the pre mixed include:
Humulin 70/30 on a morning, Humulin 50/50 on an evening
usually want to give higher in the morning and less on night bc more at risk of hypo’s over night bc not eating

others: Novolog 70/30, Novolin 70/30, humulin 75/25

97
Q

what type of insulin regimen would you offer to patients with T2dm whos triple therapy has failed

A

usually offer a once daily regimen with a basal / long acting insulin

eg 10 units in a morning

98
Q

describe a basal bolus insulin regimen

A

long acting insulin in the morning eg levemir, lantus
then a rapid acting insulin (eg novolog, humulog ) before breakfast lunch and dinner to manage post pradial hyperglycaemia

99
Q

describe a once daily insulin regimen

A

usually 10 units of a long acting basal insulin given on a morning eg lantus, levemir

often used in pts with t2dm alongside on oral hypoglycaemic who have failed to control with oral hypoglycaemics alone

100
Q

what is the doseage for patients on a twice daily insulin regimen (eg pts on the pre mixed)

A

0.5 units per kg is the total daily dose
they should get 2/3 of this in the morning dose
and 1/3 in the evening dose

eg pt weighs 60kg = 30 units daily total
so 20 units on a morning (2/3)
10 units on an evening

101
Q

what is the dosage for patients on a basal bolus insulin regimen

A

10 units of long acting on a morning

then 0.1-0.3 units of rapid acting around 15 minutes before meals

102
Q

give 3 examples of rapid acting insulin

A

insulin aspart - novorapid
insulin lispro - humulog
insulin glulisine - apidra

103
Q

which class of antibiotics can precipitate torsades des pointes

A

azithromycin, erythromycin (macrolides)

104
Q

how many mls of fluid does the average adult need daily

A

25-30 mls / kg

105
Q

daily requirement for glucose when nil by mouth

A

50-100g per day

106
Q

where do loop diurects act in the kidney

A

ascending limb of loop of henle on the NA/K/2Cl co transporter
they inhibit this transporter so none of these are moved from the tubular lumen into the epithelial cell for reabsorption therefore no water follows by osmosis so you get electrolyte and water loss out of kidneys

107
Q

which receptor / transporter does furosemide / bumetanide work on

A

Na/K/2cl co transporter on ascending limb of loop of henle

108
Q

name 4 complications of loop diuretics

A 
ototoxicity
hypokalaemia
hyponatraemia
dehydration
worsening hepatic encephalopathy
precipitates gout
metabolic alkalosis
109
Q

name 3 side effects of loop diuretics

A 
deafness
tinnitus
dizziness
headache
fatigue
muscle spasms
110
Q

which drug should you never give with iv furosemide + why

A

gentamicin - both ototoxic

111
Q

why do loop diuretics precipitate / worsen gout

A

because they 1. can cause dehydration so a more concentrated blood 2. inhibit excretion of uric acid so increase blood uric acid levels = gout

112
Q

which drugs should you be careful prescribing furosemide or bumetanide with

A
  1. lithium = increased risk of lithium toxicity bc reduced excretion by kidneys whilst on furosemide
  2. digoxin toxicity may occur if loop diuretic causes hypokalaemia (makes digoxin toxicity worse)
113
Q

usual dose of furosemide

A

40mg to start, 20mg maintenance dose

114
Q

which drug should you never prescribe in addisons disease

A

spironolactone or elperenone

because they are aldosterone antagonists, and people with addisons are deficient in aldosterone so makes it worse

115
Q

how does spironolactone / eplerenone work

A

aldosterone antagonists
so competitively binds to aldosterone receptors in the distal tubules
aldosterone usually increases sodium reabsorption via ENac channels in distual tubule, dragging water with it, in exchange for potassium which is then excreted
if you inhibit aldosterone you therefore get sodium and water excretion but also potassium reabsorption = hyperkalaemia risk

116
Q

monitoring of spironolactone

117
Q

monitoring of furosemide

A

symptomatic improvement, daily weights

118
Q

what type of drug is indapamide

A

thiazide like diuretic

119
Q

what is indapamide used for

A

hypertension

120
Q

name a thiazide like diuretic

A

indapamide

121
Q

name a thiazide diuretic

A

bendroflumethiazide

122
Q

how do thiazides work

A

inhibit the Na/cl transporter in the distal tubule so prevents sodium reabsorption, water always follows sodium so if sodium is excreted so is water = diuretic

can also cause hypokalaemia because this means there is more sodium than normal travelling to the other side of the distal tubule where the Na+/K+ channels are where it is exchanged for potassium meaning there is also excess potassium loss

123
Q

name 2 side effects of thiazide diuretics

A

hypokalaemia
hyponatraemia
dehydration
gout

124
Q

which types of diuretics can precipitate a gout attack

A

thiazide diuretics and loop diuretics

125
Q

standard dose of spironolactone

A

100-200mg per day, max 400mg

126
Q

standard dose of indapamide

A

1.5-2.5mg per day

127
Q

standard dose of bendroflumethiazide

A

5-10mg daily

128
Q

which types of diuretics act in the distal tubule

A

aldosterone antagonists and thiazides

129
Q

which type of diuretic works in the ascending loop of henle

A

loop diuretics eg furosemide bumetenide

130
Q

how does amiodarone work

A

works by blocking Na+ K+ and Ca2+ channels in the heart and also beta and alpha adrenergic receptors to reduce spontaneous depolarisations, increase av node refraction, and slow conduction velocity. this is helpful in reducing ventricular rate in AF and flutter and also reduces ventricular rate in VT /VF

131
Q

side effects of amiodarone (6)

A

contains iodine so can cause thyroid disease (both hypo and hyper for some reason)
pneumonitis
brady cardia
av block
hepatitis
can also make the skin more photosensitive and can cause a grey discolouration

132
Q

what 3 conditions should you avoid amiodarone in

A
  1. active thyroid disease
  2. Av block
  3. severe hypotension
133
Q

counsel a patient on side effects of amiodarone

A
  1. look out for signs and symptoms of hepatitis so go to GP if develops jaundice (yellowing of skin and eyes), RUQ pain
  2. thyroid symptoms - fatigue, weight loss/gain, abnormal periods, change in bowel habit, palpitations
  3. pneumonitis - SOB, persistent cough
  4. avoid grapefruit juice bc increases risk of side effects
  5. avoid direct sunlight and wear suncream bc increases risk of burn
134
Q

name 2 indications for amiodarone

A

rate control in acute fast AF
ventricular tachycardia
ventricular fibrillation
atrial flutter

135
Q

name 3 indications for adrenaline

A

anaphylaxis
cardiac arrest
local anaesthetic for vasoconstriction
to stop bleeding in endoscopy (inject into mucosa)

136
Q

what dose of adrenaline is given in anaphylaxis and when can it be repeated

A

0.5ML (so 0.5mg) of 1:100 (1mg in 1ml)

137
Q

what dose of adrenaline is given in cardiac arrest

A

10ml (whole thing) of 1:10,000 (1mg in 10ml) adrenaline IV

always follow with a flush of 10ml 0.9% saline

138
Q

how does adrenaline work

A

agonist to alpha 1 + 2 and B1 and B2 receptors so causes …
sympathetic effects!! (fight or flight)
vascoconstricts vessels in skin and mucosa and gut
increases force of heart contraction
increases heart rate
vasodilates coronary arteries (helps redistribute blood to heart where needed in emergencies)
bronchodilation
suppresses inflammatory marker release from mast cells

139
Q

side effects of adrenaline

A 
post injection hypertension
tremor
anxiety
headache
palpitations
arrhythmia
140
Q

what is doxazosin used for

A

step 4 treatment for hypertension in pts with a potassium on the higher side when you would want to avoid spironolactone

141
Q

what type of drug is doxazosin

A

alpha blocker

142
Q

name 3 alpha blockers

A

doxazocin - used in HTN
tamsulosin - used in BPH
alfuzosin

143
Q

name 4 contraindications to anticoagulants

A

acute ischaemic stroke - risk of bleeding into stroke
bleeding disorders
liver disease with coagulopathy - if PT raised dont prescribe anti coag

144
Q

name 2 common side effects of calcium channel blockers

A

flushing
peripheral oedema
bradycardia

145
Q

how do statins work

A

inhibit HMG-CoA reductase which is the rate limiting enzyme in hepatic synthesis of cholesterol

146
Q

which statin is first line

A

atorvastatin - proven to be more effective than simvastatin in recent studies to reduce cholesterol

147
Q

which weight should you use for obese patients when prescribing gentamicin

A

ideal body weight

148
Q

which weight would you use for underweight patients when prescribing gentamicin

A

actual body weight

149
Q

common side effect of statins

150
Q

which drug can mask symptoms of hypo’s in diabetes

A

bisoprolol

151
Q

side effect of carbamezapine

A

lowers sodium - hyponatraemia

152
Q

monitoring of amiodarone

A

LFT’s before treatment and ev 6 months
TFT’s before and ev 6 months
HR - can cause bradycardia
CXR before starting bc can cause pulmonary fibrosis

153
Q

why should bisoprolol and dilitazem / verapamil never be prescribed together

A

can cause AV block = bradycardia

154
Q

what 3 drugs should be avoided in pregnancy

A

ace inhibitors
statins
warfarin

155
Q

why should statins be avoided in pregnancy

A

decrease in cholesterol synthesis can be harmful to foetal development

156
Q

first line management of febrile seizure in a child

A

buccal midazolam

157
Q

management of acute gout

A

colchicine

158
Q

prophylaxis of gout

A

allopurinol

159
Q

first line management of depression in a child

A

fluoxetine

160
Q

name 2 side effects of tacrolimus

A

pancytopenia

pulmonary fibrosis

161
Q

why should you withold co-codamol in aki

A

not because it is nephrotoxic but because in lowered renal function it can accumulate

162
Q

first line treatment for bacterial tonsillitis

A

penicillin V aka phenoxymethylpenicillin

163
Q

when giving levonogestrel as emergency contraception what is the dose

164
Q

when should you give double the dose of levonogestrel for emergency contraception (3mg instead of standard 1.5mg)

A

obese patients

or patients taking an enzyme inducer eg carbamezapine, phenytoin

165
Q

advice to give to patients on inhaled steroid

A

rinse mouth after use to prevent candidiasis

166
Q

management of eclampsia

A

IV magnesium + labetalol

167
Q

when should you stop a patient taking a statin

A

when LFT’s increase by more than 3 times the upper limit - small increases are fine and you can keep pt on them

168
Q

what should you do if the patients morning blood glucose reading is high

A

increase their evening insulin by 10-20 %

169
Q

when is cyclizine contraindicated

A

heart failure

170
Q

what is the amount of glucose and how long do you give it over in hypoglycaemia

A

10% glucose 150ml over 15 mins

or 20% glucose

finals (18 decks)

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