PSA Revision

Question 1

What broad spectrum antibiotics can be used for sepsis?

Answer 1

Tazocin, co-amoxiclav

Question 2

Which classes of medication are time dependent?

Answer 2

Antibiotics, anti-Parkinson’s, anti-diabetic, anti-epileptic

Question 4

How is hypoklaemia above 3.0 managed?

Answer 4

Sando K: 1-2 tablets TDS for 3 days
(most people get 2 tablets, only 1 tablet in very small/frail people)

Question 5

How is hypokalaemia <3.0 managed?

Answer 5

IV 20mmol KCl in 1L 0.9% saline NaCl

Question 6

What are the rules of prescribing IV KCl?

Answer 6

• Rate of administration shouldn’t exceed 10 mmol/hour (higher rates need cardiac monitoring)
• Concentration shouldn’t exceed 40mmol/L via peripheral line (higher can cause phlebitis and pain and should be given via a central line)

Question 7

What is important in hyperkalaemia to protect the myocardium?

Answer 7

Protect the myocardium: 10ml calcium chloride 10% or 30ml calcium gluconate 10% - give over 5-10 minutes

Question 8

What is important in hyperkalaemia to drive the potassium into cells?

Answer 8

Drive the potassium back: Insulin (actrapid) 10 units in 50ml of 50% glucose IV over 15 minutes plus salbutamol nebs 5mg inhaled given back to back

Question 9

What is important in hyperkalaemia to remove K+ from the body?

Answer 9

Remove potassium frmo the body: calcium risonium 15g QDS orally, or sodium zirconium cyclosilicate

Question 10

How is hypomagnesmia treated PO?

Answer 10

Oral magnesium aspartate sachet, one BD for 5 days (need to give 20mmol/day)

Other types of magnesium are available in different hospitals

Question 11

How is hypomagnesmia treated IV?

Answer 11

IV infusion of magnesium sulphate 10-20mmol in 100ml 0.9% NaCl over 1 hour

Question 12

How can mild hypocalcaemia be managed?

Answer 12

Can be treated with calcichem 2 tablets BD for 5-7 days

Question 13

How is more severe hypocalcemia <1.9 managed?

Answer 13

10ml calcium gluconate 10% in 100ml 0.9% NaCl over 15 minutes (bolus) - ECG monitoring for people with arrhythmias or cardiac history

Then

100ml calcium gluconate 10% in 1L 0.9% saline at 50ml/hour - adjust rate according to response and monitor calcium levels every 4-6 hours

Question 14

How is hypercalcaemia managed?

Answer 14

IV fluids - 4-6L over 24 hours - will dilute the blood and hydrate the patient

If Ca2+ still >2.8mmol/symptomatic, give zolendronic acid 4mg IV in 0.9% saline over 15 minutes

Question 15

How should major bleeding be reversed in patients on warfarin?

Answer 15

Stop the warfarin, give IV vitamin K 5mg and prothrombin complex concentrate (acts more quickly)