PSA Revision Flashcards
1
Q
CYP450 enzyme inducers
A
PC BRAS-> phenytoin, carbamazepine, barbituates, rifampicin, alcohol (chronic), sulphonylureas
2
Q
CYP450 enzyme inducers’ effect
A
Increased enzyme activity-> drugs metabolised more-> drug less effective
3
Q
CYP450 enzyme inhibitors
A
AODEVICES-> allopurinol, omeprazole, disulfiram, erythromycin, valproate, isonazid, ciprofloxacin, ethanol (acute), sulphonamides
4
Q
CYP450 enzyme inhibitors’ effect
A
Decreased enzyme activity-> drugs metabolised less-> drug more effective
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)
6
Q
When should you stop the COCP pre-surgery?
A
4 weeks before
7
Q
When should you stop lithium pre-op?
A
The day before
8
Q
When should you stop potassium sparing diuretics pre-op?
A
On the day of surgery
9
Q
When should you stop Ace-inhibitors pre-op?
A
On the day of surgery
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
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
12
Q
When shouldn’t prophylactic heparin be used?
A
Recent ischaemic stroke (bleeding risk)
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
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
15
Q
ACE-i side effects?
A
- Cough, hyperkalaemia, hypotension
- Can worsen critical ischaemia + severe PVD
16
Q
Beta blocker side effects?
A
Bradycardia, worsening of asthma, hypotension, lethargy/drowsiness, sexual/erectile dysfunction, worsening of awareness of hypoglycaemia
17
Q
Calcium channel blocker side effects?
A
Peripheral oedema, flushing (especially facial), bradycardia (some), headache
18
Q
Diuretic side effects (in general)?
A
-General-> hypotension, electrolyte disturbance, renal failure
19
Q
What should you prescribe for maintenance fluids?
A
0.9% saline, unless hypernatraemic/hypoglycaemic, then opt for dextrose 5%
20
Q
What is the maximum rate at which a potassium infusion should be given?
A
20mmol/hour
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
22
Q
Contraindications to compression stockings?
A
Peripheral artery disease, absent foot pulses
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
24
Q
Contraindications to metoclopramide?
A
- Parkinson’s-> dopamine agonist so can exacerbate symptoms
- Young women-> high risk of dyskinesia (eg acute dystonias)
25
When should you be cautious of a paracetamol prescription?
- Patient weighs <50kg
| - Patient already prescribed co-codamol
26
Causes of microcytic anaemia?
Iron deficiency, thalassaemia, sideroblastic
27
Normocytic anaemia causes?
Blood loss, anaemia of chronic disease, haemolytic, renal failure
28
Causes of macrocytic anaemia?
B12/folate deficiency (megaloblastic), alcohol excess, liver disease, hypothyroidism, haem disorders
29
Causes of neutrophilia?
Bacterial infection, tissue damage, steroids
30
Causes of neutropaenia?
Viral infection, clozapine, carbimazole, chemotherapy
31
Causes of lymphocytosis (high lymphocytes)?
Viral infection, lymphoma, CLL
32
Causes of low platelets?
- Low production-> infection, drugs, myeloma
| - Increased destruction-> heparin-induced, hypersplenism, DIC, HUS, TTP
33
Causes of thrombocytosis (high platelets)?
- Reactive-> bleeding, tissue damage, post-splenectomy
| - Primary-> myeloproliferative disorders
34
Causes of hypernatraemia?
Dehydration, drugs, drips, diabetes insipidus
35
Causes of hyponatraemia?
- 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
36
Causes of hypokalaemia (<3.5mmol/L)?
DIRE-> Drugs (loop + thiazide diuretics), Inadequate intake, Intestinal loss (D+V), Renal tubular acidosis, Endocrine (Cushing's, Conns)
37
Causes of hyperkalaemia (>5mmol/L)?
DREAD->
- Drugs (K+ sparing diuretics, ACE-i's, heparins, tacrolimus)
- Renal Failure
- Endocrine (Addison's)
- Artefact (eg clotting of sample)
- DKA
38
Causes of Syndrome of Inappropriate Anti Diuretic Hormone secretion (SIADH)?
SIADH-> Small cell lung tumours, Infection, Abscess, Drugs (carbamazepine, antipsychotics), Head injury
39
What might a raised urea + normal creatinine indicate?
Upper GI bleed
40
What bloods might show a pre-renal AKI?
Urea>creatinine rise
41
What bloods might show an intrinsic cause of AKI?
Urea
42
What bloods might show a post-renal AKI?
Urea
43
Pre-renal causes of AKI?
Dehydration, sepsis, renal artery stenosis
44
Intrinsic causes of AKI?
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
45
Post-renal causes of AKI?
- Lumen (stones, slough)
- Wall (tumour, fibrosis)
- External pressure (BPH, cancer, lymphadenopathy, aneurysm)
46
What blood results would you expect for a prehepatic cause of deranged LFTs?
Increased bilirubin
47
What blood results would you expect for an intrahepatic cause of deranged LFTs?
Increased bilirubin and AST/ALT
48
What blood results would you expect for a posthepatic cause of deranged LFTs?
Increased bilirubin and ALP
49
Prehepatic causes of deranged LFTs?
Haemolysis, Gilbert's
50
Intrahepatic causes of deranged LFTs?
Hepatitis, cirrhosis, malignancy, fatty liver, metabolic (eg Wilson's or haemochromatosis), HF (congestion)
51
Posthepatic causes of deranged LFTs?
-Obstructive-> lumen (stone, cholestasis, drugs), tumour, PBC, PSC, extrinsic pressure (cancer, lymph nodes)
52
Causes of hepatitis + cirrhosis?
Alcohol, viruses (Hep A-E, CMV, EBV), drugs (paracetamol, statins, rifampicin)
53
Drugs that can cause cholestasis?
Flucloxacillin, co-amoxiclav, nitrofurantoin, sulphonylureas
54
Primary hypothyroidism- bloods and causes?
- Low T4, high TSH
| - Hashimoto's, drug induced
55
Secondary hypothyroidism- bloods and causes?
- Low T4, low TSH
| - Pituitary tumour or damage
56
Primary hyperthyroidism- bloods and causes?
- High T4, low TSH
| - Grave's disease, toxic nodular goitre, drug induced
57
Secondary hyperthyroidism- bloods and causes?
- High T4, high TSH
| - Pituitary tumour
58
What to look at on a CXR?
- Film quality-> projection, rotation, inspiration, markings
- Structures-> heart, lungs, trachea, mediastinum, bones
- Difficult areas-> costophrenic angles, air under diaphragm, sail sign, clear apices
59
How many ribs should you be able to see (at least) on a CXR?
7
60
How wide should the heart be on a CXR?
<50% width of the lung fields
61
What does tracheal deviation going away from the problem indicate on a CXR?
Pneumothorax pushes it away
62
What does tracheal deviation going towards the problem indicate on a CXR?
Lung collapse (come 'ere!)
63
What could a widened mediastinum on a CXR indicate?
Right upper lobe collapse or aortic dissection
64
What does a sail sign on a CXR indicate?
Triangle shape behind heart indicating left lower lobe collapse
65
Causes of respiratory alkalosis?
Rapid breathing, anxiety, PE
66
Causes of respiratory acidosis?
Slow or shallow breathing, 'blue bloaters' in COPD, neuromuscular failure, restriction to chest wall movements
67
Causes of metabolic alkalosis?
Vomiting, diuretics, Conn's
68
Causes of metabolic acidosis?
Lactic acidosis, DKA, ethanol
69
What drugs require their serum concentration to be monitored?
Theophylline + aminophylline, lithium, phenytoin, gentamicin, vancomycin, digoxin
70
When should a paracetamol and nomogram be performed in a patient with potential paracetamol OD?
4 hours after ingestion
71
How does N-acetyl-cysteine work in the treatment of paracetamol OD?
- 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
72
Why should gentamicin serum levels be monitored?
High risk of ototoxicity and nephrotoxicity
73
When should gentamicin serum levels be measured?
6-14 hours after the last infusion
74
What are the normal ranges of serum gentamicin levels (peak)?
5-10mg/L (1 hour post-dose)
75
What are the normal ranges of serum gentamicin levels (trough)?
<2mg/L (just before next dose)
76
What is a normal INR level and what does it mean?
1-> a patient's INR is compared to the 'normal' ie the general population
77
Treatment for major bleed on warfarin?
Stop warfarin
Give 5-10mg Vitamin K IV
Give PT complex (eg Beriplex)
78
Treatment for minor bleed and INR 8+ on warfarin?
Stop warfarin + give 1-5mg IV Vit K
79
Treatment for minor bleed and INR 5-8 on warfarin?
Stop warfarin + give 1-5mg IV Vit K
80
Treatment for no bleeding but INR 8+ on warfarin?
Omit warfarin and give 1-5mg Vit K (oral)
81
Treatment for no bleeding but INR 5-8 on warfarin?
Omit warfarin for 2 days then reduce maintenance dose
82
Immediate management of STEMI?
- 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?
83
Immediate management of NSTEMI?
- 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
84
Management of acute LVF?
- 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
85
Treatment of regular narrow complex tachycardia?
- 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
86
Treatment of irregular narrow complex tachycardia?
- Beta blocker or diltiazem (rate control)
| - In HF-> digoxin or amiodarone
87
Treatment of irregular broad complex tachycardia?
- Could be AF or BBB
- Pre-excited AF-> amiodarone
- Polymorphic VT-> magnesium 2g over 10 mins
88
Treatment of broad complex tachycardia (when SVT or BBB previously confirmed)
-Adenosine 6mg rapid IV bolus + give 12 up to 2x more if unsuccessful
89
Treatment of VT or uncertain broad QRS tachycardia?
-Amiodarone 300mg IV over 20-60 mins then 900mg over 24 hours
90
Treatment of unstable tachycardia?
- Synchronised DC shock (up to 3)
| - Amiodarone 300mg IV over 10-20 mins + repeat shock, then 900mg over 24 hours
91
Treatment of anaphylaxis (adult)?
- Oxygen 15L non-rebreathe
- Adrenaline 500mcg of 1:1000
- Chloramphenamine 10mg IV
- Hydrocortisone 200mg
- May need salbutamol nebs if asthma/wheeze
92
Treatment for primary PTX with <2cm rim?
Discharge + 4-week follow up
93
Treatment for primary PTX with >2cm rim?
- Aspirate x2
| - Unsuccessful-> chest drain
94
Treatment for secondary PTX?
- Aspirate (when <2cm)
| - Chest drain (when >2cm, SOB or 50+ years)
95
Treatment for tension PTX?
-Emergency aspiration + chest drain
96
Treatment for PE?
- 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
97
Treatment for GI bleed (hint- 8Cs)?
- 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
98
Treatment for bacterial meningitis?
- 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+
99
Treatment for seizure lasting over 5 minutes?
- 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
100
Treatment for ischaemic stroke?
- Aspirin 300mg (oral or rectal)
- Thrombolysis with alteplase (when <4.5h onset)
- Thrombectomy (when <24 hours onset)
101
Treatment of DKA?
- 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
102
Treatment aims in DKA?
- Decrease blood ketones by 0.5mmol/L/hour
- Increase venous bicarb by >3mmol/L/hour
- Increase insulin rate by 1U/hour
103
Treatment of hyperosmolar hyperglycaemic state?
Same as DKA but lower insulin rates + slower rehydration
- If on biphasic insulin-> increase dose by 10%
- Consider causative drugs-> steroids
104
Treatment of hypoglycaemia (<3mmol/L)?
- 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%
105
Treatment of poisoning?
- 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)
106
Which drugs might predispose a patient to developing gastric ulcers?
- NSAIDs
- Steroids
- Anticoagulants-> increase bleeding risk
- SSRIs
107
What drugs might reduce the excretion of lithium and should be stopped in toxicity?
ACE inhibitors, diuretics
108
What might indicate that a patient's hyperkalaemia is due to artefact (incorrect blood result)?
The patient is well-> usually unwell with hyperkalaemia
109
Contraindications to metformin?
- eGFR <30
- Lactic acidosis (eg acutely unwell)
- DKA
110
Treatment of acute COPD exacerbation?
- 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
111
Monitoring requirements of ACE-inhibitors?
- U+Es baseline + 1-2 weeks after starting
112
What foods and drugs should be avoided when taking statins and why?
- Grapefruit juice and clarithromycin-> both CYP3A4 inhibitors
- Fibrates (eg gemfibrozil)-> increased risk of rhabdomyolysis
113
What should a patient do if they develop muscle cramps whilst taking statins?
-Stop taking them immediately and seek medical advice (myositis risk)
114
What additional drugs should be considered for patients taking long-term steroids?
- Gastroprotection eg PPI
| - Calcium +/- bisphosphonate (for osteoporosis risk)
115
When should statins be taken and why?
At night as this is when cholesterol metabolism takes place
116
Monitoring requirements for olanzapine?
- 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
117
What does a 1% solution mean?
1g of substance in 100ml of liquid
118
Monitoring requirements for antipsychotics?
- 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
119
What is bisacodyl and when shouldn't it be prescribed?
- Stimulant laxative
| - CI in colitis and cramps
120
Immediate treatment of dyspepsia?
- Magnesium carbonate 10ml oral
| - Aluminium hydroxide 1 capsule oral
121
When should serum aminophylline/theophylline levels be measured?
- 4-6 hours after starting treatment (IV)
| - 4-6 hours for modified release + 5 days for othe roral preparations
122
What is the ideal theophylline serum level?
10-20mg/l
123
What are the best ways to monitor treatment effectiveness in pneumonia?
- Resp rate, oxygen sats, ABG
- CXR-> can take 6 weeks+ to resolve
- Crepitations-> can take few days to resolve
124
Side effects of SSRIs?
- Hyponatraemia
| - Can cause increased suicidal ideation in first few weeks
125
How do NSAIDs cause AKI?
- Reduce renal perfusion
| - Acute interstitial nephritis
126
Why can opioids be useful in treating diarrhoea?
Slow transit through bowel-> increased time for water absorption
127
What's the best way to monitor treatment response in DKA and why?
- Serum ketones
| - Glucose unreliable as may be normal when ketosis/acidosis not resolved
128
Side effects of cyclizine?
- Antimuscarinic-> dry mouth + skin, blurred vision, flushing
- Worsen fluid retention
- Palpitations and arrhythmias
129
Treatment for mild allergic reaction (eg pruritus but breathing OK)?
-Antihistamine eg chlorphenamine
130
Treatment for mild-moderate acne?
- Benzoyl peroxide
| - Clindamycin
131
Treatment for moderate-severe acne?
- Benzoyl peroxide
- Doxycycline 100mg OD PO
- Lymecycline
- Tetracycline
132
Treatment for severe and resistant acne?
-Oral isotretinoin
133
What drugs should be stopped in AKI?
- ACE-i's
- ARBs
- NSAIDs
- Allopurinol
134
What should be prescribed for a patient using fentanyl patches (over 25mcg/hour) to help with breakthrough pain?
-Fentanyl nasal spray-> absorbed rapidly so good for acute pain
135
Contraindications for nitrofurantoin?
eGFR <45
136
What should be done if a patient's INR is >1.5 on the day before surgery?
Give oral vitamin K (2mg)
137
What should a patient's INR be the day before surgery?
<1.5
138
Administration instructions for rivaroxaban?
Should be taken with food to increase absorption
139
If a patient starts taking topiramate or other enzyme inducers, what should they do about their contraception (if on OCP)?
- Change to alternate contraception until 4 weeks after stopped topiramate/drug
- OCP efficacy reduced with these drugs
140
Co-amoxiclav side effects?
-Jaundice-> cholestatic, during or shortly after treatment, higher risk if man or 65+
141
What drug can interact with dabigatran and cause a bleed?
-Citalopram-> especially in over 65's
142
What blood test finding would you expect to see after starting ACE-i's that doesn't warrant a change to the medication?
- May see a small rise in creatinine (<20%)-> normal
| - Should recheck in 1 week
143
How can the effectiveness of furosemide therapy in acute HF be assessed?
-Measure weight after a few days-> should lose some
144
Side effects of carbimazole?
-Neutropaenia-> sore throat etc warning sign
145
How can the effectiveness of ACE-i's be assessed when used in heart failure?
Increased exercise tolerance
146
Side effects and monitoring of ciclosporin?
- 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
147
Treatment for acute dystonic reactions (eg due to antipsychotics)?
-Procyclidine 5mg/ml injection, 5-10mg IV/IM
148
What HRT regime(s) should be used to prevent withdrawal bleeds?
- Oestrogen and progesterone combination-> for symptoms + endometrial cancer protection
- Avoid sequential-> same dose + continuous better
- Examples-> levonorgestrel 7mcg/estradiol 50mcg/24hours transdermal patch
149
Contraindications to beta blockers?
- Peripheral arterial disease-> worsen ischaemia + cause peripheral vasodilation
- Asthma
150
What drugs can contribute to/worsen HF?
Corticosteroids, CCBs
151
What drugs can predispose someone to candida infections?
- Antibiotics-> amoxicillin, clarithromycin
| - Steroids (oral>inhaled)
152
Treatment for scarlet fever?
Phenoxymethylpenicillin (penV) 125mg PO 6 hourly for 10 days
153
What should a patient do if they miss one pill (COCP), ie they are 24+ hours late?
- Take 2 pills when remember + no need for emergency contraception-> should still be protected
- At any point in cycle
154
What advice should a patient on methotrexate be given about pregnancy?
All patients should avoid pregnancy/conception when taking and for 6 months after stopping treatment
155
Side effects of mirtazapine?
Sleep disturbances, abnormal dreams
156
Side effects of and monitoring requirements for amiodarone?
- 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
157
What should be done when a patient's CK level is raised and they are taking statins?
- Discontinue
| - Restart at lower dose when symptoms + CK have resolved
158
When is cyclizine a good choice of anti-emetics in particular?
-High risk of extra-pyramidal side effects or QT prolongation
159
Treatment for shingles?
- Aciclovir 800mg PO 5 times daily for 7 days
| - Alternatives-> valaciclovir, famciclovir
160
Drugs that can cause diarrhoea?
- Lanzoprazole and PPIs
| - Alendronic acid
161
Side effects of digoxin?
- Bradycardia
- Nausea and vomiting
- Diarrhoea
- Confusion + drowsiness
- Xanthopsia-> yellow/green visual perception + halo vision + blurred vision
162
Treatment for candida infection in pregnancy?
Clotrimazole pessary (PV) 100mg daily for 7 days (prolonged course)
163
Treatment for C.diff?
- 1st episode-> Vancomycin 125mg PO 6 hourly
| - Multiple episodes-> oral fidaxomicin
164
Antibiotics that can cause/precipitate C.diff?
Clindamycin, cephalosporins, fluoroquinolones, broad-spectrum penicillins
165
When should loperamide be taken?
After each loose stool
166
Side effects of GLP1 analogues (eg liraglutide)?
Nausea and vomiting, acute pancreatitis
167
What drugs can cause/exacerbate serotonin syndrome?
- SSRIs
- Other types of antidepressant
- Tramadol
168
At what BP level should the COCP be stopped?
>160/95
169
What should be measured before starting azathioprine and why?
- Thiopurine methyltransferase (TPMT)-> can cause accumulation of drug + bone marrow toxicity
- Will need lower dose or MTX alternative if deficiency
170
Why should stopping morphine be considered in AKI?
- Morphine is metabolised by the liver but morphine-6-glucuronide (metabolite) is active, potent and renally excreted
- Can accumulate in AKI + cause opiate overdose
171
If morphine is stopped in AKI, what should be started instead and why?
-Oxycodone as is metabolised by the liver to inactive metabolites
172
Side effects of ARBs?
Hyperkalaemia
173
When should bendroflumethiazide be taken?
At night to prevent patients from needing the toilet during the night
174
Side effects of ferrous sulphate?
Constipation, black stools
175
How long should ferrous sulphate be taken for?
-Until Hb levels are normal then 3 months after that
176
Signs of phenytoin toxicity?
Dysarthria, gum hyperplasia
177
Treatment for severe UC flare (6+ bowel movements/day + unwell)?
- IV hydrocortisone 100mg 6 hourly
| - Can use biological drugs
178
Treatment for mild to moderate UC flare (<6 bowel movements/day + well)?
- Topical aminosalicylates (eg sulphasalazine)
- Can add oral aminosalicylates if persistent
- Prednisolone
179
Treatment of hyperkalaemia?
- 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
Treatment for haemodynamically stable fast AF?
- 1st line-> bisoprolol 5mg oral
| - 2nd line-> digoxin 500mcg IV loading dose then 62.5-125mcg maintenance
181
Side effects of opiates?
Pruritis, constipation, respiratory depression, drowsiness (may need to warn about driving/machinery), urinary retention
182
Contraindications of ACE-i's?
Aortic stenosis
| Caution in known CKD
183
What effect can alcohol binges have on a diabetic patient?
Severe hypoglycaemia
184
What should be given in urge incontinence if antimuscarinics are contraindicated (eg in myasthenia gravis)?
Duloxetine 40mg PO BD
185
Treatment if short term and severe anxiety?
- Diazepam 2mg PO once only
| - Others-> lorazepam, chlordiazepoxide
186
When should digoxin levels be taken?
6 hours post dose
187
What can predispose someone to digoxin toxicity?
Hypokalaemia-> competes with digoxin at myocyte Na+/K+ ATPase so low level means digoxin effect increased
188
Side effects and monitoring requirements of sodium valproate?
- Teratogenic, tremor, weight gain, pancreatitis, alopecia
| - Check ALT before starting + at regular intervals-> can cause hepatotoxicity
189
Clozapine monitoring requirements?
FBCs-> weekly for 1st 18 weeks (risk of neutropaenia + agranulocytosis)
190
When should hypertension be treated for a patient aged 80+?
Clinic BP reading of >150/95
191
When should hypertension be treated for a patient aged <80?
- BP >135/85
| - Target organ damage, CVD or CVD risk of 10%+
192
When should hypertension be treated for a patient aged <60?
- BP >135/85
| - CVD risk 10%+
193
Step 1 management for HTN when <55years or T2 diabetic (not of black African/Afro-Carribean origin)?
ACE-i or ARB
194
Step 2 management for HTN when <55years or T2 diabetic (not of black African/Afro-Carribean origin)?
- Will already be on ACE-i or ARB
| - Add CCB or thiazide-like diuretic
195
Step 3 management for HTN when <55years or T2 diabetic (not of black African/Afro-Carribean origin)?
- Will already be on ACE-i or ARB + CCB or TLD
- Add what hasn't already been added
- ACEi/ARB + CCB + TLD
196
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?
Add low dose spironolactone
197
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?
Add alpha-blocker or beta-blocker
198
Step 1 management of HTN when aged 55+ or black African/Afro-Caribbean origin?
Calcium channel blocker
199
Step 2 management of HTN when aged 55+ or black African/Afro-Caribbean origin?
- Already on CCB
| - Add ARB (preferably) or ACE-i or TLD
200
Step 3 management of HTN when aged 55+ or black African/Afro-Caribbean origin?
- Already on CCB + ARB (preferably) or ACE-i or TLD
- Add what hasn't been added
- CCB + ARB/ACEi + TLD
201
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?
Add low dose spironolactone
202
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?
Add alpha-blocker or beta-blocker
203
1st line management of chronic heart failure?
- 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
Other ways of managing chronic heart failure if 1st line options (ACE-is, beta blockers etc) inadequate?
- Digoxin
- Sacubitril valsartan
- Ivabradine
- Resynchronisation therapy
205
When should anticoagulation by considered in AF?
- Men-> CHA2DS2-VASc score of 1+
| - Women-> CHA2DS2-VASc score of 2+
206
What is the CHA2DS2-VASc scoring system?
- Risk of stroke/TIA in AF
| - CHF, HTN, Age 75+ (2), Stroke/TIA (2), Vasc disease, Age 65-74, Sex female
207
What is the HASBLED scoring system?
- Risk of bleeding on anticoagulation
- HTN, Abnormal renal func or liver func, Stroke, Bleeding tendency/disposition, Labile INR, Elderly (65+), Drugs (alcohol/NSAIDs)
208
What are the different risk levels after calculating a HASBLED score and what do they mean?
- Low risk + consider anticoagulation (score 0)
- Low-mod risk (score 1-2)
- High risk + consider alternative treatment (3+)
209
What drugs are used for reducing stroke risk in AF?
Apixaban, dabigatran etexilate, rivaroxaban, warfarin
210
What is used for rhythm control in AF and when is this appropriate to use?
- 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
What is used for rate control in AF and when is this appropriate to use?
- 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
1st line treatments for stable angina?
- 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
Treatments for stable angina when 1st line (beta-blocker, CCB, nitrates or combination) are inadequate?
- Add long acting nitrate eg isosorbide mononitrate
- Add K+ channel activator (eg nicorandil)
- If still uncontrolled on 2+ drugs-> PCI or CABG
214
Step 1 management for asthma (adult)?
Add SABA PRN
215
Step 2 management for asthma (adult)?
Add low dose ICS
216
Step 3 management for asthma (adult uncontrolled on SABA + ICS)?
- NICE-> add LRTA
| - SIGN-> add LABA fixed dose or MART
217
Step 4 management for asthma (adult uncontrolled on SABA + ICS + LRTA/LABA/MART)?
- NICE-> add LABA and take LTRA away if indicated
| - SIGN-> increase ICS to medium dose or add LRTA
218
Step 5 management for asthma?
| Adult uncontrolled on SABA + ICS + LRTA (SIGN) or LABA (NICE)?
- May change ICS +/- LRTA to MART if not tried (NICE)
| - Refer to specialist (SIGN)
219
Step 1 for management of COPD?
-SABA or SAMA (eg ipratropium) PRN
220
Step 2 for management of COPD + no asthma/steroid responsive features?
Add LABA + LAMA (eg tiotroptium)
221
Step 2 for management of COPD + asthma/steroid responsive features?
Add LABA + ICS
222
Step 3 for management of COPD + no asthma/steroid responsive features?
- 3 month trial of LABA + LAMA + ICS
| - Permanent regime if 1 severe or 2 moderate exacerbations in 1 year
223
Step 3 for management of COPD + asthma/steroid responsive features?
LABA + LAMA + ICS-> when day symptoms or 1 severe/2 moderate exacerbations in a year
224
General management and advice in diabetes?
- CV risk factor management-> aspirin 75mg OD, atorvastatin 20mg OD
- -Annual complications review-> albumin:creatinine (nephropathy + CVD risk)
225
Side effects/risks of pioglitazone?
- Increases risk of heart failure, bladder cancer, fractures
- Weight gain
- Liver impairment
- Fluid retention
- Can cause hypoglycaemia
226
When should GLP1 inhibitors be continued when used in diabetes?
- Loss of 11mmol/mol (1%) HbA1C over 6 months
| - Loss of 3% total body weight in 6 months
227
Step 1 management in T2 diabetes (can take metformin)?
Standard release metformin-> 500mg OD and can increase as needed
228
Step 2 management in T2 diabetes (can take metformin)?
- When HbA1c >58mmol/mol
- Add pioglitazone, DPP-4i, SU, or SGLT-2i
- Aim for <53mmol/mol
229
Step 3 management in T2 diabetes (can take metformin + dual therapy failed)?
- Triple therapy with one of following->
- Metformin + pioglitazone + SU
- Metformin + SU + DPP-4i
- Metformin + pioglitazone or SU + SGLT-2i
230
Step 3 management in T2 diabetes (can take metformin + dual therapy failed + BMI >35)?
-Metformin + SU + GLP-1 mimetic
231
Management of T2 diabetes when can't take metformin?
- Start with monotherapy-> pioglitazone or SU or DPP-4i
| - Then dual therapies
232
1st line management options of Parkinson's disease?
- Co-beneldopa
- Co-careldopa
These are levodopa + dopa-decarboxylase inhibitors
233
Management option for Parkinson's disease when mild or concerned about finite benefit of 1st line options?
- -Dopamine agonists-> ropinirole, bromocriptine, cabergoline
- Rasagiline-> MAO inhibitor
234
Treatment of generalised tonic-clonic seizures?
- Sodium valproate
| - Lamotrigine
235
Treatment of absence seizures?
- Sodium valproate
| - Ethosuximide
236
Treatment of myoclonic seizures?
- Sodium valproate
| - Levetiracetam
237
Treatment of tonic seizures?
- Sodium valproate
| - Lamotrigine
238
Treatment of focal seizures?
- Carbamazepine
| - Lamotrigine
239
When is it OK to use sodium valproate in girls/women?
- Alternatives are unsuitable
| - They meet the criteria set out by the pregnancy prevention programme
240
Side effects of lamotrigine?
- Rash
| - Steven-Johnson syndrome
241
Side effects of phenytoin?
Ataxia, peripheral neuropathy, gum hyperplasia, hepatotoxicity, nystagmus
242
Side effects of levetiracetam?
Fatigue, mood disorders, agitation
243
Treatment of mild-to-moderate Alzheimer's?
Acetylcholinesterase inhibitors-> donepezil, rivastigmine, galantamine
244
Treatment of moderate-severe Alzheimer's?
NMDA antagonists-> memantine
245
Treatment for inducing remissions in Crohn's flare (mild)?
Prednisolone 20-40mg oral daily
246
Treatment for inducing remission in Crohn's flare (severe)?
Hydrocortisone 100-500mg TDS-QDS IV + supportive care
247
Treatment for inducing remission in Crohn's flare (rectal disease)?
-Rectal hydrocortisone
248
Treatment for maintaining remission in Crohn's disease?
- Azathioprine or 6-meraptopurine
| - If low TPMT levels-> methotrexate
249
Treatment for flare in rheumatoid arthritis?
- Short term methylprednisolone (eg 80mg IM)
- NSAIDS + PPI
- Re-instate DMARDs if previously reduced
250
Treatment for rheumatoid arthritis (long-term)?
- 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
When is it inappropriate to prescribe laxatives?
Obstruction
252
What should be used in constipation caused by faecal impaction +/- reduced motility?
Stool softeners-> docusate sodium, movicol, lactulose, arachis oil
253
Examples of stool softeners for constipation?
Docusate sodium, movicol, lactulose, arachis oil
254
Examples of bulking agents for constipation?
Isphagula husk-> can take days to take effect
255
Examples of stimulant laxatives?
Senna, bisacodyl
256
Examples of osmotic laxatives?
Lactulose, macrogol, phosphate enemas
257
Contraindications of bulking agents (laxatives)?
- Faecal impaction
- Colonic atony (ie reduced motility)
- Obstruction
258
Contraindications of bisacodyl?
Acute abdomen
259
Contraindications of osmotic laxatives?
- IBD
| - Acute abdomen
260
Treatment of chronic and non-infectious diarrhoea?
- Loperamide 2mg oral up to TDS (taken after loose stool)
| - Codeine 30mg oral up to 6 hourly
261
Heparin side effects?
- Haemorrhage
- Heparin-induced thrombocytopaenia
- Osteoporosis
262
Effect of chronic alcohol use on anticoagulation + INR?
- Enzyme inducer-> reduced anticoagulant effect
| - Lower INR
263
Effect of acute alcohol use on anticoagulation + INR?
- Enzyme inhibitor-> increased anticoagulant effect
| - Higher INR
264
Side effects of aspirin?
Haemorrhage, peptic ulcers, gastritis, tinnitus (at high doses), Reye's syndrome (kids)
265
Side effects of lithium?
- Early-> tremor
- Intermediate-> tiredness
- Late-> arrhythmias, seizures, coma, renal failure, diabetes insipidus
266
Side effects of statins?
- Myalgia
- Abdominal pain
- Deranged LFTs (AST/ALT)
- Rhabdomyolysis
267
Side effects of metronidazole?
Sweating, flushing, nausea and vomiting
268
Why does digoxin cause bradycardia?
- 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
Fludrocortisone side effects?
Hypertension, hypernatraemia, oedema
270
What risks are associated with iodinated contrast media?
- Renal impairment
- May increase risk of AKI if taking ACEis
- May increase risk of metformin-induced lactic acidosis
271
Where are the CYP450 enzymes mostly found in the body?
- Mostly liver
| - Duodenum-> modify toxins before absorbed in the gut (some foods can affect)
272
Long-term management of ischaemic stroke (no drug allergies)?
-Clopidogrel 75mg OD
273
Long term management of ischaemic stroke (when clopidogrel contraindicated)?
Aspirin (75mg OD) + dipyramidole (200mg BD)
274
Secondary prevention after ACS?
- Dual antiplatelets-> aspirin (lifelong) + clopidogrel/tigacrelor (12 months)
- Add ACE-i, B-blocker (or CCB) and statin
275
Side effects of adenosine?
Chest pain, bronchospasm, flushing
276
Side effects of methotrexate?
Loss of appetite, nausea and vomiting, diarrhoea, headaches, tired/drowsy, hair loss, mucositis, pulmonary fibrosis, jaundice, infection, leucopaenia, Steven-Johnson syndrome
277
Side effects of carbamazepine?
Dizziness, ataxia, drowsiness, headache, diplopia, agranulocytosis, hyponatraemia (SIADH), Steven-Johnson syndrome
278
What should be taken alongside methotrexate?
Folic acid 5mg once weekly, on a different day to MTX
279
Are NSAIDs safe to use in pregnancy?
Not ideal and shouldn't be used in 3rd trimester (risk of early closure of PDA)
280
Is trimethoprim safe to use in pregnancy?
No- it is a folate antagonist and is contraindicated in the first trimester
281
Side effects of the COCP?
Weight gain, irritability, headaches, hypertension
| -Increased risk of VTE, stroke/TIA, breast cancer and cervical cancer
282
Side effects of azathioprine?
Bone marrow depression, nausea + vomiting, pancreatitis, myelosuppression/agranulocytosis
283
Side effects of loop diuretics?
Hypokalaemia, hypocalcaemia
284
Side effects of thiazide-like diuretics (eg bendroflumethiazide)?
Gout, hypokalaemia, hyponatraemia, hypercalcaemia, dehydration, impaired glucose tolerance, impotence
285
Side effects of potassium-sparing diuretics?
Hyperkalaemia, gynaecomastia, dehydration
286
Side effects of sulphonylureas (eg gliclazide)?
Hypoglycaemia, weight gain, hyponatraemia (SIADH), hepatotoxicity, peripheral neuropathy
287
Side effects of antipsychotics?
- 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
Side effects most commonly seen in first-generation antipsychotics (eg haloperidol)?
Extrapyramidal, galactorrhoea, amenorrhoea
289
Side effects most commonly seen in second-generation antipsychotics (eg olanzapine)?
Metabolic syndromes eg diabetes, hypertension, blood dyscrasias
290
Symptoms of neuroleptic malignant syndrome?
Antipsychotic use, hyperthermia, LOC, altered mental state, autonomic dysfunction, rigidity, inflammation and high WCC
291
Secondary prevention after TIA?
- Clopidogrel (lifelong)
| - If CI'd-> aspirin + dipyramidole (lifelong)
292
Secondary prevention after stroke?
- Clopidogrel (lifelong)
| - If CI'd-> aspirin + dipyramidole (lifelong)
293
What long-term treatment should be given in peripheral arterial disease?
- Clopidogrel (lifelong)
| - If CI'd-> Aspirin (lifelong)
294
Side effects of levodopa?
Dyskinesias, dry mouth, anorexia, palpitations, postural hypotension, psychosis, drowsy
295
Side effects of nitrates (eg isosorbide mononitrate)?
Tachycardia, hypotension, headaches, flushing
296
Which drugs might exacerbate psoriasis?
Alcohol, beta blockers, lithium, NSAIDs, ACE-i's, antimalarials (eg chloroquine), infliximab
297
Side effects of quinolones (eg ciprofloxacin)?
- Lowers seizure threshold
- Tendon damage + rupture
- Lengthens QT interval
298
Treatment for hypercalcaemia?
IV NaCL (0.9%) + high dose disodium pamidronate
299
When is oral/IV bicarbonate used?
- Oral-> chronic acidotic states (eg renal tubular acidosis)
| - IV-> severe metabolic acidosis
300
Side effects of bicarbonate?
Hypertension, fluid retention, pulmonary oedema, hypokalaemia
301
1st line VTE prophylaxis (surgical patients)?
- LMWH usually
- Renal impairment-> unfractionated heparin
- May be slightly different in hip + knee replacements
302
1st line VTE prophylaxis (medical patients)?
-LMWH or fondaparinux
303
1st line VTE treatment in provoked DVT/PE?
- Apixaban or rivaroxaban
| - 3 months
304
1st line VTE treatment in unprovoked DVT/PE?
- Apixaban or rivaroxaban
| - 3-6 months
305
1st line treatment in DVT/PE (patient has active cancer)?
- Apixaban or rivaroxaban
| - 6 months (longer if unprovoked)
306
What considerations need to be taken into account when choosing VTE treatment and dosage?
- Extremes of BMI
- Active cancer
- Triple positive antiphospholipid syndrome
- Haemodynamic instability
307
1st line treatment for PE/DVT in pregnancy?
- LMWH
| - If high haemorrhage risk-> IV unfractionated heparin
308
What reversal agent can be used in heparin overdose?
Protamine sulfate
309
How long do Vitamin K antagonists take to take effect and what can be done to rectify this?
- 48-72 hours
| - Bridge with LMWH or unfractionated heparin
310
What is the usual INR target in AF?
2.5 (2-3)
311
What is the INR target for recurrent DVT/PE?
3.5 (3-4)
312
What changes should be made to warfarin therapy when INR above target range but no symptoms?
Omit dose + check INR again the next day
313
When should warfariin be stopped pre-op?
5 days before op
314
When should warfarin be resumed post-op?
- Evening of or day after surgery
| - Bridge with LMWH if high risk of VTE
315
What can be used as a reversal agent for dabigatran?
Idarucizumab
316
What can be used as a reversal agent for apixaban or rivaroxaban?
Andexanet alfa
317
What should be given in pregnancy when the patient is at high risk of pre-eclampsia?
Daily aspirin from week 12 till birth
318
1st line treatment in hypertension in pregnancy?
- Labetalol hydrochloride
| - If CI'd-> nifedipine or methyldopa
319
Treatment for severe hypertension or pre-eclampsia in pregnancy?
IV magnesium sulphate
320
What drugs are contraindicated in pregnancy?
- Antihypertensives-> ACE-i's, ARBs, TLDs
- Trimethoprim
- Sodium valproate
321
What hypertensive drugs are safe to use in pregnancy?
- Enalapril maleate
- Nifedipine
- Amlodipine
322
Treatment pathway for acute asthma (adults)?
- 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
Treatment pathway for acute asthma (kids)?
- 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
Treatment of asthma for under 5's (when not controlled with SABA)?
- 8 week trial of moderate dose ICS
- Consider alternative diagnosis if doesn't resolve
- Repeat trial if recurs
325
What medications used for asthma are safe in pregnancy?
Most except LTRAs (but just limited evidence rather than dangerous)
326
What prophylactic antibiotics can be used in COPD and what are the criteria for this treatment?
- Azithromycin (unlicensed)
| - Criteria-> non-smoker, optimised other treatments, 4+ exacerbations in a year
327
When is an urgent endoscopy indicated in dyspepsia?
- Dysphagia
- Acute GI bleed
- 55+ and unexplained weight loss and symptoms
328
Drugs that can cause/exacerbate dyspepsia?
Alpha-blockers, antimuscarinics, aspirin, benzodiazepines, beta-blockers, bisphosphonates, CCBs, steroids, nitrates, NSAIDs, theophyllines, TCAs
329
Treatment for H.pylori infection?
- Triple eradication-> 7 days PPI + amoxicillin + clarithromycin or metronizadole
- 2nd line-> whichever wasn't used
330
Treatment for maintaining remission in UC?
- Rectal or oral aminosalicylates (eg sulphasalazine)
- Alternatives-> azathioprine/mercaptopurine
- NOT steroids or MTX
331
What are some examples of antihistamine antiemetics?
Cyclizine and promethiazine-> act on H1 receptors
332
What are some examples of phenothiazine antiemetics?
Chlorpromazine and prochlorperazine-> DA antagonists + act on chemoreceptor trigger zone
333
What are some examples of 5HT3-receptor antagonist antiemetics?
Ondansetron and granisetron
334
What is the mechanism of action of cyclizine?
Antihistamine-> acts on H1 receptors
335
What is the mechanism of action of ondansetron?
5HT3-receptor antagonist
336
Side effects of ondansetron?
Constipation, headache, flushing, involuntary movements, QT prolongation
337
Side effects of chlorpromazine?
Extrapyramidal, anti-muscarinic, postural hypotension, QT prolongation, dystonic reactions
338
Mechanism of action of dexamethasone?
Corticosteroid
339
Mechanism of action of metoclopramide?
Prokinetic + acts on D2 receptors as well as on smooth muscle cells to stimulate gastric emptying
340
Side effects of metoclopramide?
Extra-pyramidal, diarrhoea, hyperprolactinaemia, worsening of Parkinson's, oculogyric crisis, tardive dyskinesia
341
Mechanism of action of domperidone?
D2 receptor antagonist + acts on chemoreceptor trigger zone
342
Side effects of domperidone?
- QT prolongation, dry mouth, malaise
| - Less likely to cause cetral effects than metoclopramide (sedation + extrapyramidal)
343
Why is domperidone safe to use in Parkinson's?
It doesn't cross the blood brain barrier
344
What antiemetics are safe to use during pregnancy?
Chlorpromazine, cyclizine, metoclopramide, prochlorperazine, promethazine, ondansetron
345
Side effects of laxatives (most/in general)?
- Hypokalaemia
| - Abdominal cramps + bloating
346
Which laxatives are first line in pregnancy?
Bulk forming laxatives or lactulose
347
First line treatment for constipation in children?
Paediatric movicol + dietary changes + behaviour management
348
Second line options for constipation in children (when paediatric movicol failed)?
- Add or change to stimulant (senna or bisacodyl)
| - If hard stool-> lactulose or docusate
349
What is a basal-bolus insulin regime?
- Multiple injections of intermediate or long acting (basal) insulin
- Multiple injections of short acting insulin (before meals)
350
What is a mixed/biphasic insulin regime?
- 1/2/3 injections a day of a mix of short and intermediate acting insulins
- Premixed or mixed by the patient
351
What is an example of a basal-bolus insulin regime?
- Insulin detemir (Levemir) BD-> long acting
| - Insulin aspart (eg Novorapid) at mealtimes (short acting)
352
What are some examples of short-acting insulins?
- Insulin aspart (eg Novorapid)
- Insulin lispro (Humalog)
- Insulin glulisine (Apidra)
353
What are some examples of long-acting insulins?
- Insulin detemir (Levemir)
- Insulin glargine (Lantus)
- Insulin degludec (Tresiba)
354
When might a person on insulin therapy need to decrease their dose?
Physical activity, intercurrent illness, reduced food intake, impaired renal function, endocrine disorders
355
When might a person on insulin therapy need to increase their dose?
Infection, stress, trauma
356
What cancers can the COCP be protective against?
Ovarian, endometrial and colorectal cancers
357
What are some of the contraindications/cautions for the depot contraception?
- Under 18's and over 50's, people with risk factors for osteoporosis
- Due to bone loss side effect
358
How often is the depot contraception administered?
Once every 13 weeks?
359
How long does it take for fertility to return to normal after being on the depot contraception?
Up to 1 year
360
Maintenance fluids when nil by mouth + raised glucose?
- Sodium chloride 0.9% with potassium chloride 0.3% solution
| - 1L every 8-12 hours
361
Why is using glucose solution as maintenance fluids not a good idea in some circumstances?
- May worsen hyperglycaemia if present
| - May exacerbate cerebral injury
362
Drug of choice for primary prevention of CV events in hypercholesterolaemia?
-Atorvastatin 20mg PO daily
363
When should atorvastatin be offered?
More than 10% risk of CVD in the next 10 years
364
Side effects of aspirin?
Iron deficiency anaemia, bronchospasm, dyspepsia, haemorrhage
365
What drugs can contribute to iron deficiency anaemia?
Aspirin
366
Drugs that can cause urinary retention?
- Anti-cholinergics-> antipsychotics, antidepressants, detrusor relaxants
- General anaesthetics
- Alpha-adrenoreceptor agonists
- Benzodiazepines
- NSAIDs
- CCBs
- Antihistamines
- Alcohol
- Opioids
367
Drugs that can cause confusion?
- Anticholinergics-> antipsychotics, antidepressants, detrusor relaxants
- Anticonvulsants
- Opiates
- Metaclopramide
368
Treatment for Wernicke's encephalopahy (or patients at risk of developing this)?
-Pabrinex (vitamin B substances with ascorbic acid) 2 pairs (10mL) IV over 30 mins 8-hourly
369
What fixed rate of insulin should be infused in DKA?
0.1 units/kg/hour
370
What should be given in pregnancy to prevent neural tube defects (low risk)?
Folic acid 400 mcg daily-> from before conception until 12 weeks of pregnancy
371
What should be given in pregnancy to prevent neural tube defects (high risk)?
Folic acid 5mg daily-> from conception until week 12 of pregnancy
372
Why should progesterone be given alongside oestrogen in HRT regimes?
To reduce the risk of endometrial cancer
373
Monitoring requirements for methotrexate?
- 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
Which drugs commonly cause anaphylaxis?
Beta-lactam antibiotics (eg penicillin + cephalosporins), aspirin, NSAIDs, chemo, vaccines, iron injections, herbal preps
375
How to monitor the therapeutic effect of allopurinol?
Measure serum urate-> primary therapeutic effect
376
Best way to measure therapeutic effect of rehydration with sodium chloride solution?
- Blood pressure
| - Urine output is less reliable in early stages
377
Monitoring requirements for HRT?
Blood pressure-> can cause sodium + fluid retention hence rise in BP
378
At what BP should HRT be stopped?
160/95 or higher
379
What should happen when a person taking a statin has a raised ALT level (<3x limit of normal)?
Continue statin
380
What should happen when a person taking a statin has a raised ALT level (>3x limit of normal)?
Stop statin
381
What should happen if the peak concentration of gentamicin is outside the normal range?
Change the dose
382
What should happen if the trough concentration of gentamicin is outside the normal range?
Change the dose interval (ie time between each dose)
383
Antibiotics used in exacerbation of chronic bronchitis?
amoxicillin, tetracycline or clarithromycin
384
Antibiotics used in uncomplicated CAP?
- Amoxicillin
- Doxycycline or clarithromycin in allergy
- Add flucloxacillin if staph suspected
385
Antibiotics used in pneumonia caused by atypical pathogens?
Clarithromycin
386
Antibiotics used in hospital-acquired pneumonia?
- Within 5 days of admission-> co-amoxiclav or cefuroxime
| - 5+ days after admission-> piperacillin + tazobactam or broad spectrum cephalosporin or quinolone (eg ciprofloxacin)
387
Antibiotics used in lower UTI?
- Nitrofurantoin
- Trimethoprim
- Amoxicillin
- Cephalosporins
388
Antibiotics used in acute pyelonephritis?
- Broad-spectrum cephalosporin
| - Quinolones (eg ciprofloxacin
389
Antibiotics used in acute prostatitis?
- Trimethoprim
| - Quinolone (eg ciprofloxacin)
390
Treatment and antibiotics used in impetigo?
- Topical hydrogen peroxide
- Oral flucloxacillin
- Erythromycin
391
Antibiotics used in cellulitis (not near eyes or nose)?
- Flucloxacillin
| - If allergic-> clarithromycin, erythromycin or doxycycline
392
Antibiotics used in cellulitis (near the eyes or nose)?
- Co-amoxiclav
| - Allergy-> clarythromycin, metronizadole
393
Antibiotics used in erysipelas?
- Flucloxacillin
| - If allergic-> clarithromycin, erythromycin or doxycycline
394
Antibiotics used in animal or human bite?
- Co-amoxiclav
| - Allergic-> doxycycline + metronidazole
395
Antibiotics used in mastitis during breast feeding?
Flucloxacillin
396
Antibiotics used in throat infections?
- Phenoxymethylpenicillin (Pen V)
| - Allergic-> erythromycin
397
Antibiotics used in sinusitis?
-Phenoxymethylpenicillin (Pen V)
398
Antibiotics used in otitis media?
- Amoxicillin
| - Allergic-> erythromycin
399
Antibiotics used in otitis externa?
- Flucloxacillin
| - Allergic-> erythromycin
400
Antibiotics used in periapical or periodontal abscess?
Amoxicillin
401
Antibiotics used in gingivitis (acute, necrotising, ulcerative)?
Metronidazole
402
Antibiotics used in gonorrhoea?
Intramuscular ceftrixone
403
Antibiotics used in chlamydia?
Doxycyline or azithromycin
404
Antibiotics used in pelvic inflammatory disease?
- Oral ofloxacin + metronidazole
| - IM ceftriaxone + oral doxycycline + oral metronidazole
405
Antibiotics used in syphilis?
- Benzathine benzylpenicillin
- Doxycycline
- Erythromycin
406
Antibiotics used in bacterial vaginosis?
- Oral or topical metronidazole
| - Topical clindamycin
407
Antibiotics used in campylobacter enteritis?
Clarithromycin
408
Antibiotics used in salmonella (non-typhoid)?
Ciprofloxacin
409
Antibiotics used in shigellosis?
Ciprofloxacin
410
Contraindications to adenosine?
- Asthma
| - COPD
411
Monitoring requirements of lithium?
- Serum lithium level-> every 3 months for 1 year then 6 monthly after
- Body weight/BMI, TFTs, U+Es, eGFR-> every 6 months
412
When should lithium levels be monitored?
12 hours post-dose
413
Side effects of tamoxifen?
- Increased risk of VTE
- Hot flushes
- Menstrual disturbance-> bleeding + amenorrhoea
- Endometrial cancer
414
Daily electrolyte requirements in maintenance fluids?
- 25-30ml/kg/day of water
- 1mmol/kg/day of potassium, sodium and chloride
- 50-100g/day of glucose
415
Which drugs are contraindicated in heart failure?
- Pioglitazone-> fluid retention
- Verapamil-> negative inotropic effect
- Flecainide
- NSAIDs + glucocorticoids should be used with caution
416
What should not be co-prescribed with a beta-blocker and why?
Verapamil-> can cause life-threatening arrhythmias
417
Which drugs should be avoided when breastfeeding?
- Antibiotics-> ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
- Lithium
- Benzodiazepines
- Aspirin
- Carbimazole
- Methotrexate
- Sulphonylureas
- Cytotoxic drugs
- Amiodarone
418
What electrolyte imbalance can tacrolimus cause?
Hyperkalaemia
419
First line treatment for alcohol withdrawal?
Chlordiazepoxide hydrochloride
420
Most important piece of information to tell someone who is starting an SSRI?
Suicidal ideation may worsen in the first 4 weeks of therapy
421
When should stopping steroid treatment be tapered and not sudden?
- If the patient has more than 40mg prednisolone daily for 1+ week
- Received 3+ weeks of treatment
- Recently received repeat courses
422
When should amitriptyline be taken?
At night
423
Dose of atorvastatin in established CVD?
80mg OD
424
Signs of digoxin toxicity?
- Generally unwell-> N+V, confusion, yellow-green vision, lethargy
- Arrhythmias-> AV block, bradycardia
- Gynaecomastia
425
Monitoring requirements in suspected digoxin toxicity?
ECG, U+Es
426
What can reduce the risk of contrast-induced nephropathy in CKD?
IV NaCl 0.9%
427
Why should NSAIDs be avoided in heart failure?
They may worsen fluid retention
428
Which drugs can be given to patients who are breastfeeding?
- Antibiotics-> penicillins, cephalosporins, trimethoprim
- Glucocorticoids
- Levothyroxine
- Sodium valproate
- Carbamazepine
- Salbutamol
- Theophyllines
- Tricyclic antidepressants
- Antipsychotics (except clozapine)
- Beta blockers
- Hydralazine
- Warfarin
- Heparin
- Digoxin
429
What effect does rifampicin have on INR?
Decreases it
430
What are the normal ranges of serum gentamicin levels (peak) during treatment of endocarditis?
3-5mg/L
431
What are the normal ranges of serum gentamicin levels (trough) during treatment of endocarditis?
<1mg/L
