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PSA > PSA Revision > Flashcards

PSA Revision Flashcards

1
Q

Common Enzyme Inducers (↑ Enzyme Activity→ ↓ Drug Concentration)

A 
PC BRAS:
Phenytoin
Carbamazepine
Babiturates
Rifampicin
Alcohol (chronic excess)
Sulphonylureas
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2
Q

Common Enzyme Inhibitors

↓ Enzyme Activity→ ↑ Drug Concentration

A 
AODEVICES:
Allopurinol
Omeprazole
Disufiram (antibuse)
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol (acute intoxication)
Sulphonamides
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3
Q

Drugs to stop before surgery

A 
I LACK OP:
Insulin
Lithium
Anticoagulants/antiplatelets
COCP/HRT
K-sparing diuretics
Oral hypoglycaemics
Perindopril and other ACE-Inhhibitors
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4
Q

Drugs to stop if patient bleeding/suspected of bleeding/at risk of bleeding (ex haemoptysis)

A

Aspirin
LMWH/Heparin
Warfarin

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5
Q

Drugs to stop in hyperkalaemia

A

ACE-I (contributes to renal failure/decrease renal excretion of K+)

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6
Q

Antibiotics containing penicillin

A

Tazocin

Co-amoxiclav

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7
Q

Interaction between warfarin and enzyme inhibitor (eg. erythromycin)

A

Increase warfarin’s effect –> increased PT and INR.

Consider in patient with excess anticoagulation

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8
Q

Side Effects - Steroids

A 
STEROIDS:
Stomach ulcers
Thin skin
oEdema
Right and Left heart failure
Osteoporosis
Infection (inc. Candida)
Diabetes/Hyperglyceamia (!!!)
Cushing's syndrome
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9
Q

NSAIDs - cautions and contraindications

A

NSAID:

  • No urine (renal failure)
  • systolic dysfunction (heart failure)
  • asthma
  • indigestion
  • dyscrasia (clotting abnormality)
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10
Q

Side effects of antihypertensives

A
  • Hypotension
  • Bradycardia (beta blockers/calcium channel blockers)
  • Electrolyte disturbance/hyperkalaemia (ACE-I/diuretics)
  • Dry cough (ACE-I)
  • Wheeze/worsening heart failure (beta blockers)
  • Peripheral oedema/flushing (Calcium-channel blockers)
  • Renal failure (diuretics)
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11
Q

Antiemetics

A

Cyclizine 50mg 8-hourly IM/IV - causes fluid retention so avoid if cardiac problems
Metoclopramide 10mg 8-hourly IM/IV - use in heart failure/avoid in Parkinsons

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12
Q

Loop Diuretics/Thiazide Diuretics

A

Cause hypokalaemia –> increase potassium extraction by the kidney

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13
Q

Clozapine: Side-effect

A

Agranulocytosis causing neurtopenia (low neutrophils); patients require at least monthly monitoring blood tests.

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14
Q

Causes of Microcytic Anaemia

A

Low MCV:

  • Iron deficiency anaemia
  • Thalassaemia
  • Sideroblastic anaemia (unable to make Hb from iron - iron accumulates in mitochondria of RBC)
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15
Q

Causes of Normocytic Anaemia

A

Normal MCV:

  • Anaemia of chronic disease
  • Acute blood loss
  • Haemolytic anaemia (RBC destroyed faster than they are made)
  • Renal failure (chronic) - kidneys not making enough EPO
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16
Q

Causes of Macrocytic Anaemia

A

High MCV:

  • B12/folate deficiency
  • Excess alcohol
  • Liver disease
  • Hypothyroidism
  • Haematological diseases beginning with ‘M’: myeloproliferative, myelodysplatic, multiple myeloma
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17
Q

High/Low White Blood Cells

A 
High neutrophils (neutrophilia): Bacterial infections/tissue damage - inflammation, infarction, malignancy/Steroids
Low neutrophils (neutopenia): Viral infection/chemo or radiotherapy/clozapine (antipsychotic)/carbimazole (antithryoid)
High lymphocytes (lymphocytosis): Viral infection/lymphoma/chronic lymphocytic leukaemia
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18
Q

Causes of Hyponatraemia

A

Hypovolaemic: Fluid loss/Addison’s disease/Diuretics
Euvolaemic: SIADH/Hypothyroidism/Psychogenic polydipsia
Hypervolaemic: Heart/renal failure/liver failure/thyroid failure

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19
Q

Causes of SIADH - Syndrome of inappropriate antidiurtetic hormone

A
  • Small cell lung tumours
  • Infection
  • Abscess
  • Drugs (carbamazepine/antipsychotics)
  • Head Injury
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20
Q

Causes of Hypokalaemia

A

DIRE:

  • Drugs (loop and thiazide diuretics)
  • Inadequete intake/intestinal loss
  • Renal tubular acidosis
  • Endocrine (Cushing’s/Conn’s)
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21
Q

Causes of Hyperkalaemia

A

DREAD:

  • Drugs (potassium-sparing diuretics and ACE-Inhibitors)
  • Renal failure
  • Endocrine (Addison’s)
  • Artefact (ie. clotted sample)
  • DKA - but be aware when DKA treated with insulin the K+ drops requiring hourly monitoring and replacement if required
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22
Q

Acute Kidney Injury (AKI)

A

↑ urea = AKI or upper GI haemorrhage

  • ↑urea (breakdown product of amino acids in Hb) + normal creatinine = upper GI haemorrhage
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23
Q

Causes of AKI:

A

Prerenal: Dehydration/shock of any cause/Renal artery stenosis
Intrinsic: Ischaemia/Nephrotoxic antibiotics (gentamicin/vancomycin/tetracyclines)/Tablets (ACEI/NSAIDs)/Radiological contrast/Rhabdomyolysis/Gout (negatively birefringent crystals/Glomerulonephritis/Vasculitis/Choleterol
Postrenal: Stones/tumours/fibrosis/BPH/lymphadenopathy/aneurysm

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24
Q

Liver Function Tests

A

Markers of hepatocyte injury/cholestasis:
- Bilirubin
- ALT/AST
- ALP
Markers of synthetic function:
- Albumin
- Vitamin-K dependent clotting factors (II, VII, IX, X) measured by PT/INR

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25
Q

Deranged Liver Function Causes

A

Prehepatic (↑Bilirubin): Haemolysis/Gilbert/Crigler-Najjar syndromes
Intrahepatic (↑Bilirubin/AST/ALT): Fatty Liver/Hepatitis/Cirrhosis/Malignancy/Wilson’s disease/haemochromatosis/Heart failure - hepatic congestion
Posthepatic (↑Bilirubin/ALP): Gallstones/Drugs causing cholestasis/Primary biliary cirrhosis/Sclerosing cholangitis/Pancreatic/gastric cancer/lymph nodes

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26
Q

Adjusting Thyroxine dose

A

TSH <0.5: decrease dose
TSH = 0.5-5: same doese
TSH >5: increase dose

Change dose by the smallest increment offered

27
Q

Abnormal Thyroid Function Tests

A

Primary hypothyroidism (↓T4 causing ↑TSH)
- Hashimoto’s/drug-induced hypothyroidism
Secondary hypothyroidism (↓TSH causing ↓T4)
- Pituitary tumour/damage
Primary hyperthyroidism (↑T4 causing ↓TSH):
- Grave’s/Toxic nodular goitre/drug-induced hyperthyroidism
Secondary hyperthyroidism (↑TSH causing ↑T4)
- Pituitary tumour

28
Q

CXR Signs of Pulmonary Oedema

A 
ABCDE:
Alveolar oedema
Kerley B lines
Cardiomegaly
Diversion of blood to upper lobes
Plueral effusions
29
Q

Reversal of Warfarin

A

On Warfarin with any minor/major Bleeding (with any raised INR) = give IV Vitamin K (allows synthesis of Factors 2, 7, 9, 10)

INR>8 = give oral Vitamin K

Major bleeding = give Beriplex (prothrombin complex)

30
Q

Neutropenic sepsis

A

Any case of sepsis with neutrophils <1

Tx: IV piperacillin with tazobactam and gentamicin

31
Q

Addison’s Disease

A

Steroid dose must be increased when patients are sick

32
Q

Treatment of Acute Heart Failure

A

Signs of right-sided (raised JVP + peripheral oedema) and left-sided (bilateral creps and breathlessness) heart failure = congestive cardiac failure

Furosemide: main treatment for acute heart failure - in acute setting give IV

33
Q

PRN dose of Morphine Sulphate

A

Calculated as 1/6th of total daily dose of morphine

34
Q

Management of STEMI

A
  1. ABC and O2 (15L) non-rebreathe mask
  2. Hx, Ex, Ix
  3. Aspirin 300mg oral
  4. Morphine 5-10mg IV with metoclopramide 10mg IV
  5. GTN spray/tablet
  6. Primary PCI or thrombolysis
  7. Beta-blocker (atenolol 5mg unless LVF/asthma)
  8. Transfer to CCU
35
Q

Management of NSTEMI

A
  1. ABC and O2 (15L) non-rebreathe mask
  2. Hx, Ex, Ix
  3. Aspirin 300mg oral
  4. Morphine 5-10mg IV with metoclopramide 10mg IV
  5. GTN spray/tablet
  6. Clopidogrel 300mg and LMW heparin (enoxaparin 1mg/kg BD SC)
  7. Beta-blocker (atenolol 5mg unless LVF/asthma)
  8. Transfer CCU
36
Q

Management of Left ventricular failure (LVF)

A
  1. ABC and O2 (15L) non-rebreathe mask
  2. Hx, Ex, Ix
  3. Sit patient up
  4. Morphine 5-10mg IV with metoclopramide 10mg IV
  5. GTN spray/tablet
  6. Furosemide 40-80mg IV
  7. If inadequate response: isosorbide dinitrate infusion +- CPAP
  8. Transfer CCU
37
Q

Management of Anaphylaxis

A
  1. ABC and O2 (15L) for non-rebreathe mask
  2. Hx, Ex, Ix
  3. Remove cause ASAP
  4. Adrenaline 0.5mg of 1:1000 IM
  5. Chlorphenamine 10mg IV
  6. Hydrocortisone 200mg IV
  7. Asthma Tx if wheeze
  8. Amend drug chart allergies
38
Q

Management of Asthma ** check this one

A
  1. ABCDE
  2. Hx, Ex, Ix
  3. 100% O2 non-rebreathe mask
  4. Salbutamol (5mg NEB)
  5. Hydrocortisone 100mg IV or prednisolone 40-50mg (if mild)
  6. Ipratropium nebs
  7. Theophylline (only if life threatening)
39
Q

Community-acquired pneumonia severity

A 
CURB 65
Confusion
Urea >7.5mmol/L
Respiratory Rate >30/min
Blood Pressure (systolic) <90mmHg
Age 65years +

2+: Hospital Treatment with oral/IV antibiotics

40
Q

DKA: Diagnostic Criteria

A
  1. Diabetic (hyperglycaemia: BM>30 mmol/L)
  2. Keto (check urine/blood levels)
  3. Acidosis (also look for ↑K+)
41
Q

Hyperglycaemic HONK coma: Diagnostic Criteria

A
  1. Hyperglycaemia (>35mmol/L)
  2. Hyperosmolar (osmolality >340mmol/L)
  3. No ketones in urine/blood
42
Q

Hypertension Management

A

Step 1:
Under 55 years: ACEI/ARB
Over 55 years/Afro-Caribbean: Calcium-channel blocker (CCB)
Step 2: ACEI/ARB + CCB
Step 3: ACEI/ARB + CCB + Thiazide-diuretic
Step 4: Resistant - expert advice

43
Q

Atrial Fibrillation: Stroke Prevention

A

Stroke Prevention: Use CHADS2-VASC to determine require anticoagulation
Score 0 = Aspirin 75mg OD
Score 1 = Aspiring/Warfarin (target INR 2.5)
Score 2 = Warfarin (INR 2.5)

44
Q

Atrial Fibrillation: Rate/Rhythm Control

A

Rhythm control - young/symptomatic AF/caused by precipitant
Tx: cardioversion - electrical or pharmacological (amiodarone)

Rate control: anyone with HR>90bpm
Tx: Beta-blocker (propranolol) or calcium-channel blocker (diltiazem) then add Digoxin (or use if beta-blockers/CCB contraindicated)

45
Q

Management of Asthma (Chronic)

A
  1. Inhaled short-acting B2 agonist (salbutamol)
  2. Add inhaled steroid
  3. Add LABA (salmeterol)/Increase steroid if required
  4. Luekotriene receptor antagonist
  5. Refer to specialist
46
Q

Management of Type 1/2 Diabetes

A
  1. Patient education (diet/exercise)
  2. CV risk factor modification - aspirin 75mg if CV risk factors (or age 50+ with T2DM)
    - simvastatin if CV risk (or age 40+ with T2DM)
  3. Check albumin-creatinine ratio - indicator of diabetic neuropathy/cardio disease - AR>3 then ACEI
  4. Blood glucose lowering therapy
47
Q

Epilepsy Treatment

A 
Generalised tonic-clonic: Na+ Valproate (TERATOGENIC!)
Absence: Na+ valproate/ethoxsuximide
Myoclonic: Na+ valproate
Tonic: Na+ valproate
Focal: carbamazepine/lamotrigine (RASH!)
48
Q

Laxatives

A

Stool softener: Docusate sodium (good for faecal impaction)
Bulking agents: Isphagula husk (contraindicated in faecal impaction)
Stimulants: Senna
Osmotic: Lactulose

49
Q

Anti-muscarinic side effects

A
  • Dry mouth
  • Dilated pupils - difficulty accomodating to light/possible double vision
  • Dry skin
  • Constipation
  • Bradycardia
50
Q

Drugs that cause neutropenia

A

Carbimazole

Carbamazepine

51
Q

Drugs with Parkinsonian S/E

A

Metoclopramide and haloperidol - dopamine agonists (make parkinson’s symps worse!)

Domperiodone: dopamine antagonist safe to use as anti-emetic in Parkinsonian patients

52
Q

ACEI in Pregnancy

A

Teratogenic esp in 1st trimester - advice to convert to labetalol pre-conception

53
Q

Methotrexate

A
  • 1-2 weekly blood tests required to monitor FBC
  • Should be taken once/week
  • Higher risk of infection
  • Folate antagonists (trimethoprim/co-trimoxazole) should NEVER be used as increases effect
  • Folic acid given everyday (except methotrexate day) to limit toxicity to bone marrow
54
Q

Warfarin

A

-significant risk of bleeding

-

55
Q

Anti-platelets prior to surgery

A

Stop anti-platelets 7 days before surgery. Ie. aspirin 75mg/clopidogrel

56
Q

Breakthrough Pain - Fentanyl Patch

A

Patients on at least 25microgram patch can use nasal fentanyl - 50 micrograms per nostril (repeat once after 10 mins as required)

57
Q

INR (Day before surgery)

A

If INR>1.5 on day before surgery - phytomenadione (Vitamin K) 1-5mg PO given

58
Q

Changes in Creatinine when starting ACEI

A

Small rise (<20%) in creatinine to be expected when starting an ACEI - doesn’t require investigation or prescription change

59
Q

Adverse Effects Ciclosporin

A

Nephrotoxicity and hypertension - check baseline renal function before begin treatment and monitor every 2 weeks until results stable

60
Q

Statins

A

Expect to see a >40% reduction in non-HDL cholesterol after 3 months of treatment

Stop statin if myopathy severe and creatine kinase is 5x normal –> reintroduce at lower dose

Give at Night!

61
Q

Vancomycin

A

Reduced clearance in patients with renal dysfuncuon - check renal func with serum creatinine.

S/E: ototoxicty and nephrotoxicity

62
Q

Renally eliminated

A

Check renal function - serum creatinine

63
Q

Fluid Requirements (Electrolyte Abnormalities)

A

1L 0.9% NaCl = 154 mmol Na/Cl
For 80kg man daily requirements:
Na/Cl: 80mmol
K+: 80mmol

  • Can use 5% dextrose to maintain hydration if blood glucose okay

2000-2400mL per day for 80kg man

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