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PSA Revision Flashcards

1
Q

CYP450 enzyme inducers

A

PC BRAS-> phenytoin, carbamazepine, barbituates, rifampicin, alcohol (chronic), sulphonylureas

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2
Q

CYP450 enzyme inducers’ effect

A

Increased enzyme activity-> drugs metabolised more-> drug less effective

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3
Q

CYP450 enzyme inhibitors

A

AODEVICES-> allopurinol, omeprazole, disulfiram, erythromycin, valproate, isonazid, ciprofloxacin, ethanol (acute), sulphonamides

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4
Q

CYP450 enzyme inhibitors’ effect

A

Decreased enzyme activity-> drugs metabolised less-> drug more effective

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5
Q

What drugs should be changed pre-surgery?

A

I LACK OP-> insulin, lithium, antiplatelets + anticoagulants (inc heparin and aspirin), COCP/HRT, K=sparing diuretics, oral hypoglycaemics (eg metformin), perindopril (+ other ACE-i’s)

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6
Q

When should you stop the COCP pre-surgery?

A

4 weeks before

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7
Q

When should you stop lithium pre-op?

A

The day before

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8
Q

When should you stop potassium sparing diuretics pre-op?

A

On the day of surgery

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9
Q

When should you stop Ace-inhibitors pre-op?

A

On the day of surgery

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10
Q

Why shouldn’t you stop long-term steroids pre-op?

A

Likely some adrenal atrophy-> won’t be able to respond to stress of surgery-> hypotension

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11
Q

What should you check on a patient’s drug chart? (PReSCRIBER)

A

Patient details, Reactions, Sign, Contraindications, Route, IV fluids, Blood clot prophylaxis, Emetic (anti), Relief of pain

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12
Q

When shouldn’t prophylactic heparin be used?

A

Recent ischaemic stroke (bleeding risk)

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13
Q

Side effects of steroids?

A

STEROIDS-> Stomach ulcers, Thin skin, Edema, Right and left heart failure, Osteoporosis, Infection, Diabetes (hyperglycaemia), Cushing’s syndrome

Others-> hirsutism, psychosis, glaucoma, cataracts, growth suppression in kids, insomnia, proximal myopathy, weight gain, hyperlipidaemia

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14
Q

When should you be careful about using NSAIDS?`

A

NSAIDs-> No urine (renal failure), Systolic dysfunction (HF), Asthma, Indigestion, Dyscrasias (clotting abnormalities)

Also in 3rd trimester of pregnancy

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15
Q

ACE-i side effects?

A
  • Cough, hyperkalaemia, hypotension

- Can worsen critical ischaemia + severe PVD

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16
Q

Beta blocker side effects?

A

Bradycardia, worsening of asthma, hypotension, lethargy/drowsiness, sexual/erectile dysfunction, worsening of awareness of hypoglycaemia

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17
Q

Calcium channel blocker side effects?

A

Peripheral oedema, flushing (especially facial), bradycardia (some), headache

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18
Q

Diuretic side effects (in general)?

A

-General-> hypotension, electrolyte disturbance, renal failure

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19
Q

What should you prescribe for maintenance fluids?

A

0.9% saline, unless hypernatraemic/hypoglycaemic, then opt for dextrose 5%

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20
Q

What is the maximum rate at which a potassium infusion should be given?

A

20mmol/hour

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21
Q

What maintenance fluids should patients receive?

A
  • 3L per 24 hours (2L in elderly)
  • 1 salty 2 sweet ie 1L 0.9% saline + 2L 5% dextrose
  • K+ requirement 1mmol/kg/day
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22
Q

Contraindications to compression stockings?

A

Peripheral artery disease, absent foot pulses

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23
Q

What is a good antiemetic option in most cases?

A
  • Cyclizine 50mg, up to 8 hourly, IM/IV/oral

- Unless cardiac cause for nausea-> can worsen fluid retention

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24
Q

Contraindications to metoclopramide?

A
  • Parkinson’s-> dopamine agonist so can exacerbate symptoms

- Young women-> high risk of dyskinesia (eg acute dystonias)

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25
Q

When should you be cautious of a paracetamol prescription?

A
  • Patient weighs <50kg

- Patient already prescribed co-codamol

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26
Q

Causes of microcytic anaemia?

A

Iron deficiency, thalassaemia, sideroblastic

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27
Q

Normocytic anaemia causes?

A

Blood loss, anaemia of chronic disease, haemolytic, renal failure

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28
Q

Causes of macrocytic anaemia?

A

B12/folate deficiency (megaloblastic), alcohol excess, liver disease, hypothyroidism, haem disorders

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29
Q

Causes of neutrophilia?

A

Bacterial infection, tissue damage, steroids

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30
Q

Causes of neutropaenia?

A

Viral infection, clozapine, carbimazole, chemotherapy

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31
Q

Causes of lymphocytosis (high lymphocytes)?

A

Viral infection, lymphoma, CLL

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32
Q

Causes of low platelets?

A
  • Low production-> infection, drugs, myeloma

- Increased destruction-> heparin-induced, hypersplenism, DIC, HUS, TTP

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33
Q

Causes of thrombocytosis (high platelets)?

A
  • Reactive-> bleeding, tissue damage, post-splenectomy

- Primary-> myeloproliferative disorders

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34
Q

Causes of hypernatraemia?

A

Dehydration, drugs, drips, diabetes insipidus

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35
Q

Causes of hyponatraemia?

A
  • Hypovolaemic-> fluid loss from D+V, diuretics, Addison’s
  • Euvolaemic-> SIADH, psychogenic polydipsia, hypothyroid
  • Hypervolaemic-> HF, renal failure, liver failure, nutrition, hypoalbuminaemia, hypothyroid
  • Drugs-> diuretics, SSRIs
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36
Q

Causes of hypokalaemia (<3.5mmol/L)?

A

DIRE-> Drugs (loop + thiazide diuretics), Inadequate intake, Intestinal loss (D+V), Renal tubular acidosis, Endocrine (Cushing’s, Conns)

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37
Q

Causes of hyperkalaemia (>5mmol/L)?

A

DREAD->

  • Drugs (K+ sparing diuretics, ACE-i’s, heparins, tacrolimus)
  • Renal Failure
  • Endocrine (Addison’s)
  • Artefact (eg clotting of sample)
  • DKA
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38
Q

Causes of Syndrome of Inappropriate Anti Diuretic Hormone secretion (SIADH)?

A

SIADH-> Small cell lung tumours, Infection, Abscess, Drugs (carbamazepine, antipsychotics), Head injury

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39
Q

What might a raised urea + normal creatinine indicate?

A

Upper GI bleed

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40
Q

What bloods might show a pre-renal AKI?

A

Urea>creatinine rise

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41
Q

What bloods might show an intrinsic cause of AKI?

A

Urea

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42
Q

What bloods might show a post-renal AKI?

A

Urea

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43
Q

Pre-renal causes of AKI?

A

Dehydration, sepsis, renal artery stenosis

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44
Q

Intrinsic causes of AKI?

A

INTRINSIC-> Ischaemia (due to prerenal)

  • Nephrototic antibiotics (gentamicin, vancomycin, tetracyclines)
  • Tablets (ACE-is, NSAIDs),
  • Radiological contrast
  • Injury (eg rhabdomyolysis),
  • Negative birefringent crystals (gout)
  • Syndromes (glumerulonephritis etc)
  • Inflammation (vasculitis)
  • Cholesterol emboli
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45
Q

Post-renal causes of AKI?

A
  • Lumen (stones, slough)
  • Wall (tumour, fibrosis)
  • External pressure (BPH, cancer, lymphadenopathy, aneurysm)
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46
Q

What blood results would you expect for a prehepatic cause of deranged LFTs?

A

Increased bilirubin

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47
Q

What blood results would you expect for an intrahepatic cause of deranged LFTs?

A

Increased bilirubin and AST/ALT

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48
Q

What blood results would you expect for a posthepatic cause of deranged LFTs?

A

Increased bilirubin and ALP

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49
Q

Prehepatic causes of deranged LFTs?

A

Haemolysis, Gilbert’s

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50
Q

Intrahepatic causes of deranged LFTs?

A

Hepatitis, cirrhosis, malignancy, fatty liver, metabolic (eg Wilson’s or haemochromatosis), HF (congestion)

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51
Q

Posthepatic causes of deranged LFTs?

A

-Obstructive-> lumen (stone, cholestasis, drugs), tumour, PBC, PSC, extrinsic pressure (cancer, lymph nodes)

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52
Q

Causes of hepatitis + cirrhosis?

A

Alcohol, viruses (Hep A-E, CMV, EBV), drugs (paracetamol, statins, rifampicin)

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53
Q

Drugs that can cause cholestasis?

A

Flucloxacillin, co-amoxiclav, nitrofurantoin, sulphonylureas

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54
Q

Primary hypothyroidism- bloods and causes?

A
  • Low T4, high TSH

- Hashimoto’s, drug induced

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55
Q

Secondary hypothyroidism- bloods and causes?

A
  • Low T4, low TSH

- Pituitary tumour or damage

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56
Q

Primary hyperthyroidism- bloods and causes?

A
  • High T4, low TSH

- Grave’s disease, toxic nodular goitre, drug induced

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57
Q

Secondary hyperthyroidism- bloods and causes?

A
  • High T4, high TSH

- Pituitary tumour

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58
Q

What to look at on a CXR?

A
  • Film quality-> projection, rotation, inspiration, markings
  • Structures-> heart, lungs, trachea, mediastinum, bones
  • Difficult areas-> costophrenic angles, air under diaphragm, sail sign, clear apices
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59
Q

How many ribs should you be able to see (at least) on a CXR?

A

7

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60
Q

How wide should the heart be on a CXR?

A

<50% width of the lung fields

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61
Q

What does tracheal deviation going away from the problem indicate on a CXR?

A

Pneumothorax pushes it away

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62
Q

What does tracheal deviation going towards the problem indicate on a CXR?

A

Lung collapse (come ‘ere!)

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63
Q

What could a widened mediastinum on a CXR indicate?

A

Right upper lobe collapse or aortic dissection

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64
Q

What does a sail sign on a CXR indicate?

A

Triangle shape behind heart indicating left lower lobe collapse

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65
Q

Causes of respiratory alkalosis?

A

Rapid breathing, anxiety, PE

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66
Q

Causes of respiratory acidosis?

A

Slow or shallow breathing, ‘blue bloaters’ in COPD, neuromuscular failure, restriction to chest wall movements

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67
Q

Causes of metabolic alkalosis?

A

Vomiting, diuretics, Conn’s

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68
Q

Causes of metabolic acidosis?

A

Lactic acidosis, DKA, ethanol

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69
Q

What drugs require their serum concentration to be monitored?

A

Theophylline + aminophylline, lithium, phenytoin, gentamicin, vancomycin, digoxin

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70
Q

When should a paracetamol and nomogram be performed in a patient with potential paracetamol OD?

A

4 hours after ingestion

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71
Q

How does N-acetyl-cysteine work in the treatment of paracetamol OD?

A
  • Paracetamol usually metabolised by the liver using glutathione
  • OD-> limited glutathione stores are used up rapidly + causes accumulation of NAPQI toxin
  • NAPQI causes acute liver damage
  • NAC-> replenishes glutathione stores so reduced NAPQI formation + damage
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72
Q

Why should gentamicin serum levels be monitored?

A

High risk of ototoxicity and nephrotoxicity

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73
Q

When should gentamicin serum levels be measured?

A

6-14 hours after the last infusion

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74
Q

What are the normal ranges of serum gentamicin levels (peak)?

A

5-10mg/L (1 hour post-dose)

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75
Q

What are the normal ranges of serum gentamicin levels (trough)?

A

<2mg/L (just before next dose)

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76
Q

What is a normal INR level and what does it mean?

A

1-> a patient’s INR is compared to the ‘normal’ ie the general population

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77
Q

Treatment for major bleed on warfarin?

A

Stop warfarin
Give 5-10mg Vitamin K IV
Give PT complex (eg Beriplex)

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78
Q

Treatment for minor bleed and INR 8+ on warfarin?

A

Stop warfarin + give 1-5mg IV Vit K

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79
Q

Treatment for minor bleed and INR 5-8 on warfarin?

A

Stop warfarin + give 1-5mg IV Vit K

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80
Q

Treatment for no bleeding but INR 8+ on warfarin?

A

Omit warfarin and give 1-5mg Vit K (oral)

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81
Q

Treatment for no bleeding but INR 5-8 on warfarin?

A

Omit warfarin for 2 days then reduce maintenance dose

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82
Q

Immediate management of STEMI?

A
  • Aspirin 300mg PO
  • Morphine 5-10mg IV
  • GTN spray/tablet
  • Cyclizine 50mg IV
  • Primary PCI within 120 mins (if could have given fibrinolysis)
  • Give unfractionated heparin when PCI with radial access
  • Fibrinolysis-> within 12 hours when PCI can’t be done (give ticagrelor after)
  • Beta blocker?
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83
Q

Immediate management of NSTEMI?

A
  • Aspirin 300mg PO
  • Clopidogrel 300mg PO (or ticagrelor or prasugrel)
  • Fondaparinux 2.5mg OD SC
  • Morphine 5-10mg IV
  • Cyclizine 50mg IV
  • GTN spray/tablet
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84
Q

Management of acute LVF?

A
  • ABCDE + Oxygen (15L non-rebreathe)
  • Sit patient up
  • Furosemide 20-50mg (BNF) or 40-80mg (PTP) IV + repeat if needed
  • Morphine 5-10mg IV
  • Cyclizine 50mg IV
  • Inadequate response-> isosorbide dinitrate +/- CPAP
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85
Q

Treatment of regular narrow complex tachycardia?

A
  • Vagal manoeuvres
  • Adenosine 6mg rapid IV bolus (give 12mg up to 2x more if unsuccessful)
  • Restored (re-entry paroxysmal SVT)-> monitor
  • Not restored (atrial flutter)-> beta blocker
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86
Q

Treatment of irregular narrow complex tachycardia?

A
  • Beta blocker or diltiazem (rate control)

- In HF-> digoxin or amiodarone

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87
Q

Treatment of irregular broad complex tachycardia?

A
  • Could be AF or BBB
  • Pre-excited AF-> amiodarone
  • Polymorphic VT-> magnesium 2g over 10 mins
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88
Q

Treatment of broad complex tachycardia (when SVT or BBB previously confirmed)

A

-Adenosine 6mg rapid IV bolus + give 12 up to 2x more if unsuccessful

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89
Q

Treatment of VT or uncertain broad QRS tachycardia?

A

-Amiodarone 300mg IV over 20-60 mins then 900mg over 24 hours

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90
Q

Treatment of unstable tachycardia?

A
  • Synchronised DC shock (up to 3)

- Amiodarone 300mg IV over 10-20 mins + repeat shock, then 900mg over 24 hours

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91
Q

Treatment of anaphylaxis (adult)?

A
  • Oxygen 15L non-rebreathe
  • Adrenaline 500mcg of 1:1000
  • Chloramphenamine 10mg IV
  • Hydrocortisone 200mg
  • May need salbutamol nebs if asthma/wheeze
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92
Q

Treatment for primary PTX with <2cm rim?

A

Discharge + 4-week follow up

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93
Q

Treatment for primary PTX with >2cm rim?

A
  • Aspirate x2

- Unsuccessful-> chest drain

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94
Q

Treatment for secondary PTX?

A
  • Aspirate (when <2cm)

- Chest drain (when >2cm, SOB or 50+ years)

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95
Q

Treatment for tension PTX?

A

-Emergency aspiration + chest drain

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96
Q

Treatment for PE?

A
  • High flow O2 + ABCDE
  • LMWH eg tinzaparin 175u/kg SC daily
  • Morphine 5-10mg IV
  • Cyclizine 50mg IV
  • IV fluid bolus if hypotensive
  • Consider thrombolysis
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97
Q

Treatment for GI bleed (hint- 8Cs)?

A
  • Cannulae (2 large bore)
  • Catheter + fluid monitoring
  • Crystalloid bolus
  • Cross match 6 units
  • Correct clotting abnorms-> FFP, Beriplex (eg if warfarin), platelet transfusion
  • Camera (endoscopy)
  • Culprits ie stop aspirin, warfarin, heparin, NSAIDs, bisphosphonates
  • Call surgeons if need
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98
Q

Treatment for bacterial meningitis?

A
  • Benzylpenicillin 1.2g IM in primary care
  • Admission-> high flow O2, IV fluids, LP +/- CT head
  • Dexamethosone 4-10mg IV (not in septicaemia or immunocompromised)
  • Cefotaxime 2g IV 6 hourly
  • Add ampicillin or amoxicillin when immunocompromised or 55+
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99
Q

Treatment for seizure lasting over 5 minutes?

A
  • ABCDE + recovery position
  • Lorazepam 2-4 mg IV OR diazepam IV 10mg OR midazolam 10mg buccal + repeat in 5 mins if needed
  • Still fitting-> phenytoin 15-20mg/kg IV + anaesthetist
  • Still fitting-> propofol + intubation
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100
Q

Treatment for ischaemic stroke?

A
  • Aspirin 300mg (oral or rectal)
  • Thrombolysis with alteplase (when <4.5h onset)
  • Thrombectomy (when <24 hours onset)
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101
Q

Treatment of DKA?

A
  • IV fluids-> 1L saline stat, then 1L over 1 hour, then 2/4/8 hours
  • Fixed rate insulin-> eg 50 units actarapid in 50ml 0.9% saline at 0.1 units/kg/hour
  • K+-> add 20mmol if 4-5.5mmol/L, add 40mmol if <4mmol/L
  • Dextrose 10% at 125ml/hour-> when BMs <14mmol/L to prevent hypo
  • Long acting insulin-> should continue as normal
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102
Q

Treatment aims in DKA?

A
  • Decrease blood ketones by 0.5mmol/L/hour
  • Increase venous bicarb by >3mmol/L/hour
  • Increase insulin rate by 1U/hour
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103
Q

Treatment of hyperosmolar hyperglycaemic state?

A

Same as DKA but lower insulin rates + slower rehydration

  • If on biphasic insulin-> increase dose by 10%
  • Consider causative drugs-> steroids
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104
Q

Treatment of hypoglycaemia (<3mmol/L)?

A
  • If can eat-> orange juice + biscuits (10-20g glucose)
  • Drowsy/vomiting-> IV glucose eg 100ml 20% (over 20 minutes ish)
  • If no IV access-> glucagon 1mg IM
  • Reduce normal insulin by 10%
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105
Q

Treatment of poisoning?

A
  • General-> catheter, fluid balance, correct electrolytes
  • Reduce absorption-> gastric lavage (eg stomach pump) within 1 hour, whole bowel irrigation, charcoal
  • Increase elimination-> IV fluids, NAC, naloxone, flumazenil (benzos)
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106
Q

Which drugs might predispose a patient to developing gastric ulcers?

A
  • NSAIDs
  • Steroids
  • Anticoagulants-> increase bleeding risk
  • SSRIs
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107
Q

What drugs might reduce the excretion of lithium and should be stopped in toxicity?

A

ACE inhibitors, diuretics

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108
Q

What might indicate that a patient’s hyperkalaemia is due to artefact (incorrect blood result)?

A

The patient is well-> usually unwell with hyperkalaemia

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109
Q

Contraindications to metformin?

A
  • eGFR <30
  • Lactic acidosis (eg acutely unwell)
  • DKA
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110
Q

Treatment of acute COPD exacerbation?

A
  • Salbutamol nebs 5mg INH
  • Ipratropium bromide nebs 500mcg PRN (max 2g/day)
  • 24% O2 + titrated with ABG results
  • Prednisolone 30 mg daily for 7–14 days
  • May use aminophylline or NIV
  • If infective may need amoxicillin, tetracycline or clarithromycin
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111
Q

Monitoring requirements of ACE-inhibitors?

A
  • U+Es baseline + 1-2 weeks after starting
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112
Q

What foods and drugs should be avoided when taking statins and why?

A
  • Grapefruit juice and clarithromycin-> both CYP3A4 inhibitors
  • Fibrates (eg gemfibrozil)-> increased risk of rhabdomyolysis
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113
Q

What should a patient do if they develop muscle cramps whilst taking statins?

A

-Stop taking them immediately and seek medical advice (myositis risk)

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114
Q

What additional drugs should be considered for patients taking long-term steroids?

A
  • Gastroprotection eg PPI

- Calcium +/- bisphosphonate (for osteoporosis risk)

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115
Q

When should statins be taken and why?

A

At night as this is when cholesterol metabolism takes place

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116
Q

Monitoring requirements for olanzapine?

A
  • Check ECG 1 week after commencing-> QT prolongation risk
  • Lipids + weight-> baseline, every 3 months for one year then yearly
  • Fasting blood glucose-> baseline, at one month, then every 4-6 months
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117
Q

What does a 1% solution mean?

A

1g of substance in 100ml of liquid

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118
Q

Monitoring requirements for antipsychotics?

A
  • Prolactin-> baseline, at 6 months then yearly
  • Lipids + weight-> baseline, 3 months then yearly
  • -Fasting blood glucose-> baseline, at 4-6 months, then yearly
  • Physical health check once yearly
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119
Q

What is bisacodyl and when shouldn’t it be prescribed?

A
  • Stimulant laxative

- CI in colitis and cramps

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120
Q

Immediate treatment of dyspepsia?

A
  • Magnesium carbonate 10ml oral

- Aluminium hydroxide 1 capsule oral

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121
Q

When should serum aminophylline/theophylline levels be measured?

A
  • 4-6 hours after starting treatment (IV)

- 4-6 hours for modified release + 5 days for othe roral preparations

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122
Q

What is the ideal theophylline serum level?

A

10-20mg/l

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123
Q

What are the best ways to monitor treatment effectiveness in pneumonia?

A
  • Resp rate, oxygen sats, ABG
  • CXR-> can take 6 weeks+ to resolve
  • Crepitations-> can take few days to resolve
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124
Q

Side effects of SSRIs?

A
  • Hyponatraemia

- Can cause increased suicidal ideation in first few weeks

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125
Q

How do NSAIDs cause AKI?

A
  • Reduce renal perfusion

- Acute interstitial nephritis

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126
Q

Why can opioids be useful in treating diarrhoea?

A

Slow transit through bowel-> increased time for water absorption

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127
Q

What’s the best way to monitor treatment response in DKA and why?

A
  • Serum ketones

- Glucose unreliable as may be normal when ketosis/acidosis not resolved

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128
Q

Side effects of cyclizine?

A
  • Antimuscarinic-> dry mouth + skin, blurred vision, flushing
  • Worsen fluid retention
  • Palpitations and arrhythmias
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129
Q

Treatment for mild allergic reaction (eg pruritus but breathing OK)?

A

-Antihistamine eg chlorphenamine

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130
Q

Treatment for mild-moderate acne?

A
  • Benzoyl peroxide

- Clindamycin

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131
Q

Treatment for moderate-severe acne?

A
  • Benzoyl peroxide
  • Doxycycline 100mg OD PO
  • Lymecycline
  • Tetracycline
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132
Q

Treatment for severe and resistant acne?

A

-Oral isotretinoin

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133
Q

What drugs should be stopped in AKI?

A
  • ACE-i’s
  • ARBs
  • NSAIDs
  • Allopurinol
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134
Q

What should be prescribed for a patient using fentanyl patches (over 25mcg/hour) to help with breakthrough pain?

A

-Fentanyl nasal spray-> absorbed rapidly so good for acute pain

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135
Q

Contraindications for nitrofurantoin?

A

eGFR <45

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136
Q

What should be done if a patient’s INR is >1.5 on the day before surgery?

A

Give oral vitamin K (2mg)

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137
Q

What should a patient’s INR be the day before surgery?

A

<1.5

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138
Q

Administration instructions for rivaroxaban?

A

Should be taken with food to increase absorption

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139
Q

If a patient starts taking topiramate or other enzyme inducers, what should they do about their contraception (if on OCP)?

A
  • Change to alternate contraception until 4 weeks after stopped topiramate/drug
  • OCP efficacy reduced with these drugs
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140
Q

Co-amoxiclav side effects?

A

-Jaundice-> cholestatic, during or shortly after treatment, higher risk if man or 65+

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141
Q

What drug can interact with dabigatran and cause a bleed?

A

-Citalopram-> especially in over 65’s

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142
Q

What blood test finding would you expect to see after starting ACE-i’s that doesn’t warrant a change to the medication?

A
  • May see a small rise in creatinine (<20%)-> normal

- Should recheck in 1 week

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143
Q

How can the effectiveness of furosemide therapy in acute HF be assessed?

A

-Measure weight after a few days-> should lose some

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144
Q

Side effects of carbimazole?

A

-Neutropaenia-> sore throat etc warning sign

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145
Q

How can the effectiveness of ACE-i’s be assessed when used in heart failure?

A

Increased exercise tolerance

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146
Q

Side effects and monitoring of ciclosporin?

A
  • Can cause nephrotoxicity and hypertension (vasoconstriction)
  • Hyperkalaemia
  • Impaired glucose tolerance
  • Measure renal function and BP at baseline and every 2 weeks for 3 months then monthly
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147
Q

Treatment for acute dystonic reactions (eg due to antipsychotics)?

A

-Procyclidine 5mg/ml injection, 5-10mg IV/IM

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148
Q

What HRT regime(s) should be used to prevent withdrawal bleeds?

A
  • Oestrogen and progesterone combination-> for symptoms + endometrial cancer protection
  • Avoid sequential-> same dose + continuous better
  • Examples-> levonorgestrel 7mcg/estradiol 50mcg/24hours transdermal patch
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149
Q

Contraindications to beta blockers?

A
  • Peripheral arterial disease-> worsen ischaemia + cause peripheral vasodilation
  • Asthma
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150
Q

What drugs can contribute to/worsen HF?

A

Corticosteroids, CCBs

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151
Q

What drugs can predispose someone to candida infections?

A
  • Antibiotics-> amoxicillin, clarithromycin

- Steroids (oral>inhaled)

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152
Q

Treatment for scarlet fever?

A

Phenoxymethylpenicillin (penV) 125mg PO 6 hourly for 10 days

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153
Q

What should a patient do if they miss one pill (COCP), ie they are 24+ hours late?

A
  • Take 2 pills when remember + no need for emergency contraception-> should still be protected
  • At any point in cycle
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154
Q

What advice should a patient on methotrexate be given about pregnancy?

A

All patients should avoid pregnancy/conception when taking and for 6 months after stopping treatment

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155
Q

Side effects of mirtazapine?

A

Sleep disturbances, abnormal dreams

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156
Q

Side effects of and monitoring requirements for amiodarone?

A
  • Pulmonary fibrosis
  • Grey skin
  • Corneal deposits
  • Lengthen QT interval
  • Liver fibrosis/hepatitis
  • Photosensitivity
  • Measure potassium before treatment (hypokalaemia is cautioned)
  • Thyrotoxicosis-> should withhold if symptoms
  • Check TFTs + LFTs every 6 months
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157
Q

What should be done when a patient’s CK level is raised and they are taking statins?

A
  • Discontinue

- Restart at lower dose when symptoms + CK have resolved

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158
Q

When is cyclizine a good choice of anti-emetics in particular?

A

-High risk of extra-pyramidal side effects or QT prolongation

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159
Q

Treatment for shingles?

A
  • Aciclovir 800mg PO 5 times daily for 7 days

- Alternatives-> valaciclovir, famciclovir

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160
Q

Drugs that can cause diarrhoea?

A
  • Lanzoprazole and PPIs

- Alendronic acid

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161
Q

Side effects of digoxin?

A
  • Bradycardia
  • Nausea and vomiting
  • Diarrhoea
  • Confusion + drowsiness
  • Xanthopsia-> yellow/green visual perception + halo vision + blurred vision
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162
Q

Treatment for candida infection in pregnancy?

A

Clotrimazole pessary (PV) 100mg daily for 7 days (prolonged course)

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163
Q

Treatment for C.diff?

A
  • 1st episode-> Vancomycin 125mg PO 6 hourly

- Multiple episodes-> oral fidaxomicin

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164
Q

Antibiotics that can cause/precipitate C.diff?

A

Clindamycin, cephalosporins, fluoroquinolones, broad-spectrum penicillins

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165
Q

When should loperamide be taken?

A

After each loose stool

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166
Q

Side effects of GLP1 analogues (eg liraglutide)?

A

Nausea and vomiting, acute pancreatitis

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167
Q

What drugs can cause/exacerbate serotonin syndrome?

A
  • SSRIs
  • Other types of antidepressant
  • Tramadol
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168
Q

At what BP level should the COCP be stopped?

A

> 160/95

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169
Q

What should be measured before starting azathioprine and why?

A
  • Thiopurine methyltransferase (TPMT)-> can cause accumulation of drug + bone marrow toxicity
  • Will need lower dose or MTX alternative if deficiency
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170
Q

Why should stopping morphine be considered in AKI?

A
  • Morphine is metabolised by the liver but morphine-6-glucuronide (metabolite) is active, potent and renally excreted
  • Can accumulate in AKI + cause opiate overdose
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171
Q

If morphine is stopped in AKI, what should be started instead and why?

A

-Oxycodone as is metabolised by the liver to inactive metabolites

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172
Q

Side effects of ARBs?

A

Hyperkalaemia

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173
Q

When should bendroflumethiazide be taken?

A

At night to prevent patients from needing the toilet during the night

174
Q

Side effects of ferrous sulphate?

A

Constipation, black stools

175
Q

How long should ferrous sulphate be taken for?

A

-Until Hb levels are normal then 3 months after that

176
Q

Signs of phenytoin toxicity?

A

Dysarthria, gum hyperplasia

177
Q

Treatment for severe UC flare (6+ bowel movements/day + unwell)?

A
  • IV hydrocortisone 100mg 6 hourly

- Can use biological drugs

178
Q

Treatment for mild to moderate UC flare (<6 bowel movements/day + well)?

A
  • Topical aminosalicylates (eg sulphasalazine)
  • Can add oral aminosalicylates if persistent
  • Prednisolone
179
Q

Treatment of hyperkalaemia?

A
  • Calcium gluconate 10mL of 10% solution IV + can repeat every 15 minutes (up to 50ml)-> prevent arrhythmias
  • Soluble insulin (5-10 units) in 50ml glucose 50% over 5-15 minutes
  • Salbutamol nebulisers
  • Sodium bicarb-> when acidosis
180
Q

Treatment for haemodynamically stable fast AF?

A
  • 1st line-> bisoprolol 5mg oral

- 2nd line-> digoxin 500mcg IV loading dose then 62.5-125mcg maintenance

181
Q

Side effects of opiates?

A

Pruritis, constipation, respiratory depression, drowsiness (may need to warn about driving/machinery), urinary retention

182
Q

Contraindications of ACE-i’s?

A

Aortic stenosis

Caution in known CKD

183
Q

What effect can alcohol binges have on a diabetic patient?

A

Severe hypoglycaemia

184
Q

What should be given in urge incontinence if antimuscarinics are contraindicated (eg in myasthenia gravis)?

A

Duloxetine 40mg PO BD

185
Q

Treatment if short term and severe anxiety?

A
  • Diazepam 2mg PO once only

- Others-> lorazepam, chlordiazepoxide

186
Q

When should digoxin levels be taken?

A

6 hours post dose

187
Q

What can predispose someone to digoxin toxicity?

A

Hypokalaemia-> competes with digoxin at myocyte Na+/K+ ATPase so low level means digoxin effect increased

188
Q

Side effects and monitoring requirements of sodium valproate?

A
  • Teratogenic, tremor, weight gain, pancreatitis, alopecia

- Check ALT before starting + at regular intervals-> can cause hepatotoxicity

189
Q

Clozapine monitoring requirements?

A

FBCs-> weekly for 1st 18 weeks (risk of neutropaenia + agranulocytosis)

190
Q

When should hypertension be treated for a patient aged 80+?

A

Clinic BP reading of >150/95

191
Q

When should hypertension be treated for a patient aged <80?

A
  • BP >135/85

- Target organ damage, CVD or CVD risk of 10%+

192
Q

When should hypertension be treated for a patient aged <60?

A
  • BP >135/85

- CVD risk 10%+

193
Q

Step 1 management for HTN when <55years or T2 diabetic (not of black African/Afro-Carribean origin)?

A

ACE-i or ARB

194
Q

Step 2 management for HTN when <55years or T2 diabetic (not of black African/Afro-Carribean origin)?

A
  • Will already be on ACE-i or ARB

- Add CCB or thiazide-like diuretic

195
Q

Step 3 management for HTN when <55years or T2 diabetic (not of black African/Afro-Carribean origin)?

A
  • Will already be on ACE-i or ARB + CCB or TLD
  • Add what hasn’t already been added
  • ACEi/ARB + CCB + TLD
196
Q

Step 4 management for HTN when <55years or T2 diabetic (not of black African/Afro-Carribean origin)?

  • When not controlled on -ACEi/ARB + CCB + TLD?
  • When K+ level <4.5mmol/l?
A

Add low dose spironolactone

197
Q

Step 4 management for HTN when <55years or T2 diabetic (not of black African/Afro-Carribean origin)?

  • When not controlled on -ACEi/ARB + CCB + TLD?
  • When K+ level >4.5mmol/l?
A

Add alpha-blocker or beta-blocker

198
Q

Step 1 management of HTN when aged 55+ or black African/Afro-Caribbean origin?

A

Calcium channel blocker

199
Q

Step 2 management of HTN when aged 55+ or black African/Afro-Caribbean origin?

A
  • Already on CCB

- Add ARB (preferably) or ACE-i or TLD

200
Q

Step 3 management of HTN when aged 55+ or black African/Afro-Caribbean origin?

A
  • Already on CCB + ARB (preferably) or ACE-i or TLD
  • Add what hasn’t been added
  • CCB + ARB/ACEi + TLD
201
Q

Step 4 management of HTN when aged 55+ or black African/Afro-Caribbean origin?

  • Already on CCB + ARB/ACEi + TLD?
  • When K+ level <4.5mmol/l?
A

Add low dose spironolactone

202
Q

Step 4 management of HTN when aged 55+ or black African/Afro-Caribbean origin?

  • Already on CCB + ARB/ACEi + TLD?
  • When K+ level >4.5mmol/l?
A

Add alpha-blocker or beta-blocker

203
Q

1st line management of chronic heart failure?

A
  • ACEi eg lisinopril 2.5mg OD
  • Beta-blocker eg bisoprolol 1.25mg OD

-If intolerant of ACEis-> ARB (eg cancesartan 4mg OD) or hydralazine or nitrate

204
Q

Other ways of managing chronic heart failure if 1st line options (ACE-is, beta blockers etc) inadequate?

A
  • Digoxin
  • Sacubitril valsartan
  • Ivabradine
  • Resynchronisation therapy
205
Q

When should anticoagulation by considered in AF?

A
  • Men-> CHA2DS2-VASc score of 1+

- Women-> CHA2DS2-VASc score of 2+

206
Q

What is the CHA2DS2-VASc scoring system?

A
  • Risk of stroke/TIA in AF

- CHF, HTN, Age 75+ (2), Stroke/TIA (2), Vasc disease, Age 65-74, Sex female

207
Q

What is the HASBLED scoring system?

A
  • Risk of bleeding on anticoagulation
  • HTN, Abnormal renal func or liver func, Stroke, Bleeding tendency/disposition, Labile INR, Elderly (65+), Drugs (alcohol/NSAIDs)
208
Q

What are the different risk levels after calculating a HASBLED score and what do they mean?

A
  • Low risk + consider anticoagulation (score 0)
  • Low-mod risk (score 1-2)
  • High risk + consider alternative treatment (3+)
209
Q

What drugs are used for reducing stroke risk in AF?

A

Apixaban, dabigatran etexilate, rivaroxaban, warfarin

210
Q

What is used for rhythm control in AF and when is this appropriate to use?

A
  • Patient presents within 48 hours of AF starting
  • Patient is young, symptomatic or this is their 1st episode
  • Cardioversion-> electrical or pharmacological (eg flecainide)
211
Q

What is used for rate control in AF and when is this appropriate to use?

A
  • Patient presents more than 48 hours after AF started
  • Give beta-blocker (eg bisoprolol 2.5mg OD) or CCB (eg diltiazem 120mg OD)
  • Can use digoxin monotherapy or combination with b-blocker/CCB
212
Q

1st line treatments for stable angina?

A
  • GTN spray PRN
  • Anti-anginal drug-> beta blocker or rate limiting CCB (verapamil/diltiazem)
  • Secondary prevention-> aspirin, statin, CV risk modifications

-If can’t tolerate b-blocker or CCB-> nitrates eg ivabridine

213
Q

Treatments for stable angina when 1st line (beta-blocker, CCB, nitrates or combination) are inadequate?

A
  • Add long acting nitrate eg isosorbide mononitrate
  • Add K+ channel activator (eg nicorandil)
  • If still uncontrolled on 2+ drugs-> PCI or CABG
214
Q

Step 1 management for asthma (adult)?

A

Add SABA PRN

215
Q

Step 2 management for asthma (adult)?

A

Add low dose ICS

216
Q

Step 3 management for asthma (adult uncontrolled on SABA + ICS)?

A
  • NICE-> add LRTA

- SIGN-> add LABA fixed dose or MART

217
Q

Step 4 management for asthma (adult uncontrolled on SABA + ICS + LRTA/LABA/MART)?

A
  • NICE-> add LABA and take LTRA away if indicated

- SIGN-> increase ICS to medium dose or add LRTA

218
Q

Step 5 management for asthma?

Adult uncontrolled on SABA + ICS + LRTA (SIGN) or LABA (NICE)?

A
  • May change ICS +/- LRTA to MART if not tried (NICE)

- Refer to specialist (SIGN)

219
Q

Step 1 for management of COPD?

A

-SABA or SAMA (eg ipratropium) PRN

220
Q

Step 2 for management of COPD + no asthma/steroid responsive features?

A

Add LABA + LAMA (eg tiotroptium)

221
Q

Step 2 for management of COPD + asthma/steroid responsive features?

A

Add LABA + ICS

222
Q

Step 3 for management of COPD + no asthma/steroid responsive features?

A
  • 3 month trial of LABA + LAMA + ICS

- Permanent regime if 1 severe or 2 moderate exacerbations in 1 year

223
Q

Step 3 for management of COPD + asthma/steroid responsive features?

A

LABA + LAMA + ICS-> when day symptoms or 1 severe/2 moderate exacerbations in a year

224
Q

General management and advice in diabetes?

A
  • CV risk factor management-> aspirin 75mg OD, atorvastatin 20mg OD
  • -Annual complications review-> albumin:creatinine (nephropathy + CVD risk)
225
Q

Side effects/risks of pioglitazone?

A
  • Increases risk of heart failure, bladder cancer, fractures
  • Weight gain
  • Liver impairment
  • Fluid retention
  • Can cause hypoglycaemia
226
Q

When should GLP1 inhibitors be continued when used in diabetes?

A
  • Loss of 11mmol/mol (1%) HbA1C over 6 months

- Loss of 3% total body weight in 6 months

227
Q

Step 1 management in T2 diabetes (can take metformin)?

A

Standard release metformin-> 500mg OD and can increase as needed

228
Q

Step 2 management in T2 diabetes (can take metformin)?

A
  • When HbA1c >58mmol/mol
  • Add pioglitazone, DPP-4i, SU, or SGLT-2i
  • Aim for <53mmol/mol
229
Q

Step 3 management in T2 diabetes (can take metformin + dual therapy failed)?

A
  • Triple therapy with one of following->
  • Metformin + pioglitazone + SU
  • Metformin + SU + DPP-4i
  • Metformin + pioglitazone or SU + SGLT-2i
230
Q

Step 3 management in T2 diabetes (can take metformin + dual therapy failed + BMI >35)?

A

-Metformin + SU + GLP-1 mimetic

231
Q

Management of T2 diabetes when can’t take metformin?

A
  • Start with monotherapy-> pioglitazone or SU or DPP-4i

- Then dual therapies

232
Q

1st line management options of Parkinson’s disease?

A
  • Co-beneldopa
  • Co-careldopa

These are levodopa + dopa-decarboxylase inhibitors

233
Q

Management option for Parkinson’s disease when mild or concerned about finite benefit of 1st line options?

A
  • -Dopamine agonists-> ropinirole, bromocriptine, cabergoline
  • Rasagiline-> MAO inhibitor
234
Q

Treatment of generalised tonic-clonic seizures?

A
  • Sodium valproate

- Lamotrigine

235
Q

Treatment of absence seizures?

A
  • Sodium valproate

- Ethosuximide

236
Q

Treatment of myoclonic seizures?

A
  • Sodium valproate

- Levetiracetam

237
Q

Treatment of tonic seizures?

A
  • Sodium valproate

- Lamotrigine

238
Q

Treatment of focal seizures?

A
  • Carbamazepine

- Lamotrigine

239
Q

When is it OK to use sodium valproate in girls/women?

A
  • Alternatives are unsuitable

- They meet the criteria set out by the pregnancy prevention programme

240
Q

Side effects of lamotrigine?

A
  • Rash

- Steven-Johnson syndrome

241
Q

Side effects of phenytoin?

A

Ataxia, peripheral neuropathy, gum hyperplasia, hepatotoxicity, nystagmus

242
Q

Side effects of levetiracetam?

A

Fatigue, mood disorders, agitation

243
Q

Treatment of mild-to-moderate Alzheimer’s?

A

Acetylcholinesterase inhibitors-> donepezil, rivastigmine, galantamine

244
Q

Treatment of moderate-severe Alzheimer’s?

A

NMDA antagonists-> memantine

245
Q

Treatment for inducing remissions in Crohn’s flare (mild)?

A

Prednisolone 20-40mg oral daily

246
Q

Treatment for inducing remission in Crohn’s flare (severe)?

A

Hydrocortisone 100-500mg TDS-QDS IV + supportive care

247
Q

Treatment for inducing remission in Crohn’s flare (rectal disease)?

A

-Rectal hydrocortisone

248
Q

Treatment for maintaining remission in Crohn’s disease?

A
  • Azathioprine or 6-meraptopurine

- If low TPMT levels-> methotrexate

249
Q

Treatment for flare in rheumatoid arthritis?

A
  • Short term methylprednisolone (eg 80mg IM)
  • NSAIDS + PPI
  • Re-instate DMARDs if previously reduced
250
Q

Treatment for rheumatoid arthritis (long-term)?

A
  • DMARDs-> methotrexate, sulfasalazine, leflunomide
  • Consider short-term bridging with steroids when first start-> can take 2-3 months to take effect
  • Failure to respond to 2 DMARDs-> try TNF-alpha inhibitors (eg infliximab)
251
Q

When is it inappropriate to prescribe laxatives?

A

Obstruction

252
Q

What should be used in constipation caused by faecal impaction +/- reduced motility?

A

Stool softeners-> docusate sodium, movicol, lactulose, arachis oil

253
Q

Examples of stool softeners for constipation?

A

Docusate sodium, movicol, lactulose, arachis oil

254
Q

Examples of bulking agents for constipation?

A

Isphagula husk-> can take days to take effect

255
Q

Examples of stimulant laxatives?

A

Senna, bisacodyl

256
Q

Examples of osmotic laxatives?

A

Lactulose, macrogol, phosphate enemas

257
Q

Contraindications of bulking agents (laxatives)?

A
  • Faecal impaction
  • Colonic atony (ie reduced motility)
  • Obstruction
258
Q

Contraindications of bisacodyl?

A

Acute abdomen

259
Q

Contraindications of osmotic laxatives?

A
  • IBD

- Acute abdomen

260
Q

Treatment of chronic and non-infectious diarrhoea?

A
  • Loperamide 2mg oral up to TDS (taken after loose stool)

- Codeine 30mg oral up to 6 hourly

261
Q

Heparin side effects?

A
  • Haemorrhage
  • Heparin-induced thrombocytopaenia
  • Osteoporosis
262
Q

Effect of chronic alcohol use on anticoagulation + INR?

A
  • Enzyme inducer-> reduced anticoagulant effect

- Lower INR

263
Q

Effect of acute alcohol use on anticoagulation + INR?

A
  • Enzyme inhibitor-> increased anticoagulant effect

- Higher INR

264
Q

Side effects of aspirin?

A

Haemorrhage, peptic ulcers, gastritis, tinnitus (at high doses), Reye’s syndrome (kids)

265
Q

Side effects of lithium?

A
  • Early-> tremor
  • Intermediate-> tiredness
  • Late-> arrhythmias, seizures, coma, renal failure, diabetes insipidus
266
Q

Side effects of statins?

A
  • Myalgia
  • Abdominal pain
  • Deranged LFTs (AST/ALT)
  • Rhabdomyolysis
267
Q

Side effects of metronidazole?

A

Sweating, flushing, nausea and vomiting

268
Q

Why does digoxin cause bradycardia?

A
  • They compete with K+ at myocyte Na+/K+ ATPase so limit influx of Na+
  • Ca2+ relies on this mechanism to leave the cell so accumulates in cell
  • Lengthens AP + slows HR
269
Q

Fludrocortisone side effects?

A

Hypertension, hypernatraemia, oedema

270
Q

What risks are associated with iodinated contrast media?

A
  • Renal impairment
  • May increase risk of AKI if taking ACEis
  • May increase risk of metformin-induced lactic acidosis
271
Q

Where are the CYP450 enzymes mostly found in the body?

A
  • Mostly liver

- Duodenum-> modify toxins before absorbed in the gut (some foods can affect)

272
Q

Long-term management of ischaemic stroke (no drug allergies)?

A

-Clopidogrel 75mg OD

273
Q

Long term management of ischaemic stroke (when clopidogrel contraindicated)?

A

Aspirin (75mg OD) + dipyramidole (200mg BD)

274
Q

Secondary prevention after ACS?

A
  • Dual antiplatelets-> aspirin (lifelong) + clopidogrel/tigacrelor (12 months)
  • Add ACE-i, B-blocker (or CCB) and statin
275
Q

Side effects of adenosine?

A

Chest pain, bronchospasm, flushing

276
Q

Side effects of methotrexate?

A

Loss of appetite, nausea and vomiting, diarrhoea, headaches, tired/drowsy, hair loss, mucositis, pulmonary fibrosis, jaundice, infection, leucopaenia, Steven-Johnson syndrome

277
Q

Side effects of carbamazepine?

A

Dizziness, ataxia, drowsiness, headache, diplopia, agranulocytosis, hyponatraemia (SIADH), Steven-Johnson syndrome

278
Q

What should be taken alongside methotrexate?

A

Folic acid 5mg once weekly, on a different day to MTX

279
Q

Are NSAIDs safe to use in pregnancy?

A

Not ideal and shouldn’t be used in 3rd trimester (risk of early closure of PDA)

280
Q

Is trimethoprim safe to use in pregnancy?

A

No- it is a folate antagonist and is contraindicated in the first trimester

281
Q

Side effects of the COCP?

A

Weight gain, irritability, headaches, hypertension

-Increased risk of VTE, stroke/TIA, breast cancer and cervical cancer

282
Q

Side effects of azathioprine?

A

Bone marrow depression, nausea + vomiting, pancreatitis, myelosuppression/agranulocytosis

283
Q

Side effects of loop diuretics?

A

Hypokalaemia, hypocalcaemia

284
Q

Side effects of thiazide-like diuretics (eg bendroflumethiazide)?

A

Gout, hypokalaemia, hyponatraemia, hypercalcaemia, dehydration, impaired glucose tolerance, impotence

285
Q

Side effects of potassium-sparing diuretics?

A

Hyperkalaemia, gynaecomastia, dehydration

286
Q

Side effects of sulphonylureas (eg gliclazide)?

A

Hypoglycaemia, weight gain, hyponatraemia (SIADH), hepatotoxicity, peripheral neuropathy

287
Q

Side effects of antipsychotics?

A
  • Anticholinergic-> blurred vision, urinary retention, dry mouth, constipation
  • Extrapyramidal-> resting tremor, acute dystonias, dyskinesia, akathisia, tardive dyskinesia
  • Antihisamine-> sedation, weight gain
  • Antiadrenergic-> sedation, postural hypotension, ejaculation problems
  • Inreased prolactin-> galactorrhoea, amenorrhoea
  • QT prolongation
  • Lower seizure threshold
  • Neuroleptic malignant syndrome
  • Increased risk of TIA/stroke in elderly
288
Q

Side effects most commonly seen in first-generation antipsychotics (eg haloperidol)?

A

Extrapyramidal, galactorrhoea, amenorrhoea

289
Q

Side effects most commonly seen in second-generation antipsychotics (eg olanzapine)?

A

Metabolic syndromes eg diabetes, hypertension, blood dyscrasias

290
Q

Symptoms of neuroleptic malignant syndrome?

A

Antipsychotic use, hyperthermia, LOC, altered mental state, autonomic dysfunction, rigidity, inflammation and high WCC

291
Q

Secondary prevention after TIA?

A
  • Clopidogrel (lifelong)

- If CI’d-> aspirin + dipyramidole (lifelong)

292
Q

Secondary prevention after stroke?

A
  • Clopidogrel (lifelong)

- If CI’d-> aspirin + dipyramidole (lifelong)

293
Q

What long-term treatment should be given in peripheral arterial disease?

A
  • Clopidogrel (lifelong)

- If CI’d-> Aspirin (lifelong)

294
Q

Side effects of levodopa?

A

Dyskinesias, dry mouth, anorexia, palpitations, postural hypotension, psychosis, drowsy

295
Q

Side effects of nitrates (eg isosorbide mononitrate)?

A

Tachycardia, hypotension, headaches, flushing

296
Q

Which drugs might exacerbate psoriasis?

A

Alcohol, beta blockers, lithium, NSAIDs, ACE-i’s, antimalarials (eg chloroquine), infliximab

297
Q

Side effects of quinolones (eg ciprofloxacin)?

A
  • Lowers seizure threshold
  • Tendon damage + rupture
  • Lengthens QT interval
298
Q

Treatment for hypercalcaemia?

A

IV NaCL (0.9%) + high dose disodium pamidronate

299
Q

When is oral/IV bicarbonate used?

A
  • Oral-> chronic acidotic states (eg renal tubular acidosis)

- IV-> severe metabolic acidosis

300
Q

Side effects of bicarbonate?

A

Hypertension, fluid retention, pulmonary oedema, hypokalaemia

301
Q

1st line VTE prophylaxis (surgical patients)?

A
  • LMWH usually
  • Renal impairment-> unfractionated heparin
  • May be slightly different in hip + knee replacements
302
Q

1st line VTE prophylaxis (medical patients)?

A

-LMWH or fondaparinux

303
Q

1st line VTE treatment in provoked DVT/PE?

A
  • Apixaban or rivaroxaban

- 3 months

304
Q

1st line VTE treatment in unprovoked DVT/PE?

A
  • Apixaban or rivaroxaban

- 3-6 months

305
Q

1st line treatment in DVT/PE (patient has active cancer)?

A
  • Apixaban or rivaroxaban

- 6 months (longer if unprovoked)

306
Q

What considerations need to be taken into account when choosing VTE treatment and dosage?

A
  • Extremes of BMI
  • Active cancer
  • Triple positive antiphospholipid syndrome
  • Haemodynamic instability
307
Q

1st line treatment for PE/DVT in pregnancy?

A
  • LMWH

- If high haemorrhage risk-> IV unfractionated heparin

308
Q

What reversal agent can be used in heparin overdose?

A

Protamine sulfate

309
Q

How long do Vitamin K antagonists take to take effect and what can be done to rectify this?

A
  • 48-72 hours

- Bridge with LMWH or unfractionated heparin

310
Q

What is the usual INR target in AF?

311
Q

What is the INR target for recurrent DVT/PE?

312
Q

What changes should be made to warfarin therapy when INR above target range but no symptoms?

A

Omit dose + check INR again the next day

313
Q

When should warfariin be stopped pre-op?

A

5 days before op

314
Q

When should warfarin be resumed post-op?

A
  • Evening of or day after surgery

- Bridge with LMWH if high risk of VTE

315
Q

What can be used as a reversal agent for dabigatran?

A

Idarucizumab

316
Q

What can be used as a reversal agent for apixaban or rivaroxaban?

A

Andexanet alfa

317
Q

What should be given in pregnancy when the patient is at high risk of pre-eclampsia?

A

Daily aspirin from week 12 till birth

318
Q

1st line treatment in hypertension in pregnancy?

A
  • Labetalol hydrochloride

- If CI’d-> nifedipine or methyldopa

319
Q

Treatment for severe hypertension or pre-eclampsia in pregnancy?

A

IV magnesium sulphate

320
Q

What drugs are contraindicated in pregnancy?

A
  • Antihypertensives-> ACE-i’s, ARBs, TLDs
  • Trimethoprim
  • Sodium valproate
321
Q

What hypertensive drugs are safe to use in pregnancy?

A
  • Enalapril maleate
  • Nifedipine
  • Amlodipine
322
Q

Treatment pathway for acute asthma (adults)?

A
  • High flow oxygen-> aim for 94-98%
  • Salbutamol nebs back to back
  • Oral prednisolone (+continue steroid inhalers) or IV hydrocortisone
  • Irpatropium bromide nebs-> when poor initial response to salbutamol
  • Magnesium sulphate IV-> severe
  • Aminophylline IV-> when near-fatal
323
Q

Treatment pathway for acute asthma (kids)?

A
  • High flow O2
  • Salbutamol nebs
  • Oral prednisolone-> 3 days usually, can give IV steroids
  • Ipratropium bromide nebs-> when poor response
  • HDU-> when frequent nebs + steroids
  • IV-> magnesium sulphate, IV salbutamol, aminophylline
324
Q

Treatment of asthma for under 5’s (when not controlled with SABA)?

A
  • 8 week trial of moderate dose ICS
  • Consider alternative diagnosis if doesn’t resolve
  • Repeat trial if recurs
325
Q

What medications used for asthma are safe in pregnancy?

A

Most except LTRAs (but just limited evidence rather than dangerous)

326
Q

What prophylactic antibiotics can be used in COPD and what are the criteria for this treatment?

A
  • Azithromycin (unlicensed)

- Criteria-> non-smoker, optimised other treatments, 4+ exacerbations in a year

327
Q

When is an urgent endoscopy indicated in dyspepsia?

A
  • Dysphagia
  • Acute GI bleed
  • 55+ and unexplained weight loss and symptoms
328
Q

Drugs that can cause/exacerbate dyspepsia?

A

Alpha-blockers, antimuscarinics, aspirin, benzodiazepines, beta-blockers, bisphosphonates, CCBs, steroids, nitrates, NSAIDs, theophyllines, TCAs

329
Q

Treatment for H.pylori infection?

A
  • Triple eradication-> 7 days PPI + amoxicillin + clarithromycin or metronizadole
  • 2nd line-> whichever wasn’t used
330
Q

Treatment for maintaining remission in UC?

A
  • Rectal or oral aminosalicylates (eg sulphasalazine)
  • Alternatives-> azathioprine/mercaptopurine
  • NOT steroids or MTX
331
Q

What are some examples of antihistamine antiemetics?

A

Cyclizine and promethiazine-> act on H1 receptors

332
Q

What are some examples of phenothiazine antiemetics?

A

Chlorpromazine and prochlorperazine-> DA antagonists + act on chemoreceptor trigger zone

333
Q

What are some examples of 5HT3-receptor antagonist antiemetics?

A

Ondansetron and granisetron

334
Q

What is the mechanism of action of cyclizine?

A

Antihistamine-> acts on H1 receptors

335
Q

What is the mechanism of action of ondansetron?

A

5HT3-receptor antagonist

336
Q

Side effects of ondansetron?

A

Constipation, headache, flushing, involuntary movements, QT prolongation

337
Q

Side effects of chlorpromazine?

A

Extrapyramidal, anti-muscarinic, postural hypotension, QT prolongation, dystonic reactions

338
Q

Mechanism of action of dexamethasone?

A

Corticosteroid

339
Q

Mechanism of action of metoclopramide?

A

Prokinetic + acts on D2 receptors as well as on smooth muscle cells to stimulate gastric emptying

340
Q

Side effects of metoclopramide?

A

Extra-pyramidal, diarrhoea, hyperprolactinaemia, worsening of Parkinson’s, oculogyric crisis, tardive dyskinesia

341
Q

Mechanism of action of domperidone?

A

D2 receptor antagonist + acts on chemoreceptor trigger zone

342
Q

Side effects of domperidone?

A
  • QT prolongation, dry mouth, malaise

- Less likely to cause cetral effects than metoclopramide (sedation + extrapyramidal)

343
Q

Why is domperidone safe to use in Parkinson’s?

A

It doesn’t cross the blood brain barrier

344
Q

What antiemetics are safe to use during pregnancy?

A

Chlorpromazine, cyclizine, metoclopramide, prochlorperazine, promethazine, ondansetron

345
Q

Side effects of laxatives (most/in general)?

A
  • Hypokalaemia

- Abdominal cramps + bloating

346
Q

Which laxatives are first line in pregnancy?

A

Bulk forming laxatives or lactulose

347
Q

First line treatment for constipation in children?

A

Paediatric movicol + dietary changes + behaviour management

348
Q

Second line options for constipation in children (when paediatric movicol failed)?

A
  • Add or change to stimulant (senna or bisacodyl)

- If hard stool-> lactulose or docusate

349
Q

What is a basal-bolus insulin regime?

A
  • Multiple injections of intermediate or long acting (basal) insulin
  • Multiple injections of short acting insulin (before meals)
350
Q

What is a mixed/biphasic insulin regime?

A
  • 1/2/3 injections a day of a mix of short and intermediate acting insulins
  • Premixed or mixed by the patient
351
Q

What is an example of a basal-bolus insulin regime?

A
  • Insulin detemir (Levemir) BD-> long acting

- Insulin aspart (eg Novorapid) at mealtimes (short acting)

352
Q

What are some examples of short-acting insulins?

A
  • Insulin aspart (eg Novorapid)
  • Insulin lispro (Humalog)
  • Insulin glulisine (Apidra)
353
Q

What are some examples of long-acting insulins?

A
  • Insulin detemir (Levemir)
  • Insulin glargine (Lantus)
  • Insulin degludec (Tresiba)
354
Q

When might a person on insulin therapy need to decrease their dose?

A

Physical activity, intercurrent illness, reduced food intake, impaired renal function, endocrine disorders

355
Q

When might a person on insulin therapy need to increase their dose?

A

Infection, stress, trauma

356
Q

What cancers can the COCP be protective against?

A

Ovarian, endometrial and colorectal cancers

357
Q

What are some of the contraindications/cautions for the depot contraception?

A
  • Under 18’s and over 50’s, people with risk factors for osteoporosis
  • Due to bone loss side effect
358
Q

How often is the depot contraception administered?

A

Once every 13 weeks?

359
Q

How long does it take for fertility to return to normal after being on the depot contraception?

A

Up to 1 year

360
Q

Maintenance fluids when nil by mouth + raised glucose?

A
  • Sodium chloride 0.9% with potassium chloride 0.3% solution

- 1L every 8-12 hours

361
Q

Why is using glucose solution as maintenance fluids not a good idea in some circumstances?

A
  • May worsen hyperglycaemia if present

- May exacerbate cerebral injury

362
Q

Drug of choice for primary prevention of CV events in hypercholesterolaemia?

A

-Atorvastatin 20mg PO daily

363
Q

When should atorvastatin be offered?

A

More than 10% risk of CVD in the next 10 years

364
Q

Side effects of aspirin?

A

Iron deficiency anaemia, bronchospasm, dyspepsia, haemorrhage

365
Q

What drugs can contribute to iron deficiency anaemia?

366
Q

Drugs that can cause urinary retention?

A
  • Anti-cholinergics-> antipsychotics, antidepressants, detrusor relaxants
  • General anaesthetics
  • Alpha-adrenoreceptor agonists
  • Benzodiazepines
  • NSAIDs
  • CCBs
  • Antihistamines
  • Alcohol
  • Opioids
367
Q

Drugs that can cause confusion?

A
  • Anticholinergics-> antipsychotics, antidepressants, detrusor relaxants
  • Anticonvulsants
  • Opiates
  • Metaclopramide
368
Q

Treatment for Wernicke’s encephalopahy (or patients at risk of developing this)?

A

-Pabrinex (vitamin B substances with ascorbic acid) 2 pairs (10mL) IV over 30 mins 8-hourly

369
Q

What fixed rate of insulin should be infused in DKA?

A

0.1 units/kg/hour

370
Q

What should be given in pregnancy to prevent neural tube defects (low risk)?

A

Folic acid 400 mcg daily-> from before conception until 12 weeks of pregnancy

371
Q

What should be given in pregnancy to prevent neural tube defects (high risk)?

A

Folic acid 5mg daily-> from conception until week 12 of pregnancy

372
Q

Why should progesterone be given alongside oestrogen in HRT regimes?

A

To reduce the risk of endometrial cancer

373
Q

Monitoring requirements for methotrexate?

A
  • FBCs-> every 1-2 weeks until therapy stabilised (then every 2-3 months)
  • LFTs-> every 1-2 weeks until therapy stabilised (then every 2-3 months)
  • Report signs of infection (eg sore throat)
374
Q

Which drugs commonly cause anaphylaxis?

A

Beta-lactam antibiotics (eg penicillin + cephalosporins), aspirin, NSAIDs, chemo, vaccines, iron injections, herbal preps

375
Q

How to monitor the therapeutic effect of allopurinol?

A

Measure serum urate-> primary therapeutic effect

376
Q

Best way to measure therapeutic effect of rehydration with sodium chloride solution?

A
  • Blood pressure

- Urine output is less reliable in early stages

377
Q

Monitoring requirements for HRT?

A

Blood pressure-> can cause sodium + fluid retention hence rise in BP

378
Q

At what BP should HRT be stopped?

A

160/95 or higher

379
Q

What should happen when a person taking a statin has a raised ALT level (<3x limit of normal)?

A

Continue statin

380
Q

What should happen when a person taking a statin has a raised ALT level (>3x limit of normal)?

A

Stop statin

381
Q

What should happen if the peak concentration of gentamicin is outside the normal range?

A

Change the dose

382
Q

What should happen if the trough concentration of gentamicin is outside the normal range?

A

Change the dose interval (ie time between each dose)

383
Q

Antibiotics used in exacerbation of chronic bronchitis?

A

amoxicillin, tetracycline or clarithromycin

384
Q

Antibiotics used in uncomplicated CAP?

A
  • Amoxicillin
  • Doxycycline or clarithromycin in allergy
  • Add flucloxacillin if staph suspected
385
Q

Antibiotics used in pneumonia caused by atypical pathogens?

A

Clarithromycin

386
Q

Antibiotics used in hospital-acquired pneumonia?

A
  • Within 5 days of admission-> co-amoxiclav or cefuroxime

- 5+ days after admission-> piperacillin + tazobactam or broad spectrum cephalosporin or quinolone (eg ciprofloxacin)

387
Q

Antibiotics used in lower UTI?

A
  • Nitrofurantoin
  • Trimethoprim
  • Amoxicillin
  • Cephalosporins
388
Q

Antibiotics used in acute pyelonephritis?

A
  • Broad-spectrum cephalosporin

- Quinolones (eg ciprofloxacin

389
Q

Antibiotics used in acute prostatitis?

A
  • Trimethoprim

- Quinolone (eg ciprofloxacin)

390
Q

Treatment and antibiotics used in impetigo?

A
  • Topical hydrogen peroxide
  • Oral flucloxacillin
  • Erythromycin
391
Q

Antibiotics used in cellulitis (not near eyes or nose)?

A
  • Flucloxacillin

- If allergic-> clarithromycin, erythromycin or doxycycline

392
Q

Antibiotics used in cellulitis (near the eyes or nose)?

A
  • Co-amoxiclav

- Allergy-> clarythromycin, metronizadole

393
Q

Antibiotics used in erysipelas?

A
  • Flucloxacillin

- If allergic-> clarithromycin, erythromycin or doxycycline

394
Q

Antibiotics used in animal or human bite?

A
  • Co-amoxiclav

- Allergic-> doxycycline + metronidazole

395
Q

Antibiotics used in mastitis during breast feeding?

A

Flucloxacillin

396
Q

Antibiotics used in throat infections?

A
  • Phenoxymethylpenicillin (Pen V)

- Allergic-> erythromycin

397
Q

Antibiotics used in sinusitis?

A

-Phenoxymethylpenicillin (Pen V)

398
Q

Antibiotics used in otitis media?

A
  • Amoxicillin

- Allergic-> erythromycin

399
Q

Antibiotics used in otitis externa?

A
  • Flucloxacillin

- Allergic-> erythromycin

400
Q

Antibiotics used in periapical or periodontal abscess?

A

Amoxicillin

401
Q

Antibiotics used in gingivitis (acute, necrotising, ulcerative)?

A

Metronidazole

402
Q

Antibiotics used in gonorrhoea?

A

Intramuscular ceftrixone

403
Q

Antibiotics used in chlamydia?

A

Doxycyline or azithromycin

404
Q

Antibiotics used in pelvic inflammatory disease?

A
  • Oral ofloxacin + metronidazole

- IM ceftriaxone + oral doxycycline + oral metronidazole

405
Q

Antibiotics used in syphilis?

A
  • Benzathine benzylpenicillin
  • Doxycycline
  • Erythromycin
406
Q

Antibiotics used in bacterial vaginosis?

A
  • Oral or topical metronidazole

- Topical clindamycin

407
Q

Antibiotics used in campylobacter enteritis?

A

Clarithromycin

408
Q

Antibiotics used in salmonella (non-typhoid)?

A

Ciprofloxacin

409
Q

Antibiotics used in shigellosis?

A

Ciprofloxacin

410
Q

Contraindications to adenosine?

A
  • Asthma

- COPD

411
Q

Monitoring requirements of lithium?

A
  • Serum lithium level-> every 3 months for 1 year then 6 monthly after
  • Body weight/BMI, TFTs, U+Es, eGFR-> every 6 months
412
Q

When should lithium levels be monitored?

A

12 hours post-dose

413
Q

Side effects of tamoxifen?

A
  • Increased risk of VTE
  • Hot flushes
  • Menstrual disturbance-> bleeding + amenorrhoea
  • Endometrial cancer
414
Q

Daily electrolyte requirements in maintenance fluids?

A
  • 25-30ml/kg/day of water
  • 1mmol/kg/day of potassium, sodium and chloride
  • 50-100g/day of glucose
415
Q

Which drugs are contraindicated in heart failure?

A
  • Pioglitazone-> fluid retention
  • Verapamil-> negative inotropic effect
  • Flecainide
  • NSAIDs + glucocorticoids should be used with caution
416
Q

What should not be co-prescribed with a beta-blocker and why?

A

Verapamil-> can cause life-threatening arrhythmias

417
Q

Which drugs should be avoided when breastfeeding?

A
  • Antibiotics-> ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
  • Lithium
  • Benzodiazepines
  • Aspirin
  • Carbimazole
  • Methotrexate
  • Sulphonylureas
  • Cytotoxic drugs
  • Amiodarone
418
Q

What electrolyte imbalance can tacrolimus cause?

A

Hyperkalaemia

419
Q

First line treatment for alcohol withdrawal?

A

Chlordiazepoxide hydrochloride

420
Q

Most important piece of information to tell someone who is starting an SSRI?

A

Suicidal ideation may worsen in the first 4 weeks of therapy

421
Q

When should stopping steroid treatment be tapered and not sudden?

A
  • If the patient has more than 40mg prednisolone daily for 1+ week
  • Received 3+ weeks of treatment
  • Recently received repeat courses
422
Q

When should amitriptyline be taken?

423
Q

Dose of atorvastatin in established CVD?

424
Q

Signs of digoxin toxicity?

A
  • Generally unwell-> N+V, confusion, yellow-green vision, lethargy
  • Arrhythmias-> AV block, bradycardia
  • Gynaecomastia
425
Q

Monitoring requirements in suspected digoxin toxicity?

426
Q

What can reduce the risk of contrast-induced nephropathy in CKD?

A

IV NaCl 0.9%

427
Q

Why should NSAIDs be avoided in heart failure?

A

They may worsen fluid retention

428
Q

Which drugs can be given to patients who are breastfeeding?

A
  • Antibiotics-> penicillins, cephalosporins, trimethoprim
  • Glucocorticoids
  • Levothyroxine
  • Sodium valproate
  • Carbamazepine
  • Salbutamol
  • Theophyllines
  • Tricyclic antidepressants
  • Antipsychotics (except clozapine)
  • Beta blockers
  • Hydralazine
  • Warfarin
  • Heparin
  • Digoxin
429
Q

What effect does rifampicin have on INR?

A

Decreases it

430
Q

What are the normal ranges of serum gentamicin levels (peak) during treatment of endocarditis?

431
Q

What are the normal ranges of serum gentamicin levels (trough) during treatment of endocarditis?

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