PSA Revision Flashcards
NSAID contraindications
Asthma
Renal Impairment
GI bleed/ulcer Hx
Parkinson’s contraindications
Metoclopramide and Haloperidol
Aspirin and Children
Should not be used in <3y due to Reyes syndrome
Asthma Drug CIs
NSAIDs
BBs
Renal Impairment drugs - Peri-Operative Prescribing
Gentamicin
ACEi
Metformin
NSAIDs
Pre- Surgery - When to hold ACEi
1 day before
Pre-Surgery - When to hold Metformin
2 days before and 2 days after surgery
Pre-Surgery - NSAIDs
Limit use pre and post operative
Pre-Surgery - Gentamicin
AVOID completely if possible
Bleeding drugs - Peri-Operative Prescribing
Clopidogrel
DOAC/Warfarin
Pre-Surgery - When to hold Clopidogrel
7 days before
Pre-Surgery - When to stop Warfarin/DOAC
Warfarin = stop 5 days before
Bleeding risk drug which is safe to continue throughout surgery
Aspirin
VTE Prophylaxis
SC 5000U Dalteparin
VTE Prophylaxis <50kg or renal impairment
SC 2500U Dalteparin
Paracetamol prescription
1g QDS (max 4g/day)
Paracetamol prescription if <50kg or liver dysfunction
500mg QDS (max 2g/day)
NSAID prescription
Ibuprofen 400mg TDS
Naproxen 250mg QDS
Morphine and renal impairment
Morphine is renally excreted.
AVOID in renal impairment.
Morphine alternative in renal impairment
Oxycodone
Oral morphine (Oramorph) -> Oxycodone
Divide by 2
PRN dose of morphine calculation
Divide total daily dose of morphine by 6
Morphine side effects
Itch
Nausea
Constipation
Drowsinesss
Anticholinergic drugs to avoid prescribing together in elderly
Antidepressants Antiemetics Antipsychotics Antihistamines BZDs
Drugs which can cause confusion and falls
Anticholinergic Drugs
Zopliclone, BZDs
Steroids
Anti-hypertensives (Diuretics)
HYPONATREMIA
Salt Can Displace Tequila Oh!
SSRIs Carbamazepine Diuretics Trimethoprim Omeprazole
Causes of low salt and dehydration
Diarrhoea/Vomiting
Diuretics
Causes of low salt and euvolaemia
Hypothyroidism
Addison’s
SIADH
Drugs:
Omeprazole
Carbamazepine
Citalopram (SSRI)
Causes of low salt and excess fluid
Liver failure
Renal failure
Heart failure
HYPERKALAEMIA
Tequila Always Makes Nurses Smile
Trimethoprim ACEis/ARBs Mefenamic Acid/Metformin NSAIDs Spironolactone
Gentamicin
Angiotensin II
- > Aldosterone release from Zona Glomerulosa in adrenal cortex
- > DCT = sodium reabsorption, potassium excretion.
Hypocalcaemia drugs
Loop diuretics
Bisphosphonates
Phenytoin
Hypercalcaemia drugs
Thiazide diuretics
Hyperglycaemia Drugs
Steroids Olanzapine Tacrolimus BBs Thiazide Diuretics
Normal male QTc
<440
Normal female QTc
<470
Prolonged QT interval - drugs which affect neurotransmitters
Antipsychotics
Antidepressants
Antiemetics
Prolonged QT interval - drugs which affect cardiac conduction
BBs
Sodium channel blockers e.g. flecainide
Potassium channel blockers e.g. amiodarone
Prolonged QT interval - Abx
Ciprofloxacin
Erythromycin
Low INR
Clotting
High INR
Bleeding
ACEi ADRs
Dry cough
Renal Failure
Hyperkalaemia
Postural hypotension
BBs ADRs
Erectile Dysfunction
Bradycardia
Fatigue
Cold extremities
CCBs ADRs
Flushing
Headache
Ankle swelling
Spironolactone ADRs
Hyperkalaemia
Gynaecomastia
PHenytoin ADRs
Gum hypertrophy
Hirsutism
Carbamazepine ADRs
Rash
Dry mouth
Hyponatremia
Sodium Valproate ADRs
Teratogenic
Tremor
Weight gain
Lamotrogine ADRs
Rash (SJS)
Induces CP450
SSRIs ADRs
Sick (nausea)
SIADH (hyponatremia)
Reduced libido
Insomnia
TCAs ADRs
Anticholinergic (confusion, agitation)
MAOi ADRs
HTN
Jaundice
Hyperthermia
Sulfasalazine ADRs
Myelosuppression
Oligospermia
Rash
Renal failure
Hepatitis
Gold ADRs
GN
Myelosuppression
Erythroderma
Thrombocytopenia
Pencillamine ADRs
GN
Myasthenia
Lupus
Taste disturbance
Chloroquine ADRs
Retinopathy
Tinnitus
Methotrexate ADRs
Myelosuppression
Hepatotoxicity
Pneumonitis
Anti-TNF ADRs
Reactivation of TB infection
Cyclophosphamide ADRs
Haemorrhagic Cystitis
Azathioprine ADRs
Myelosuppression
Cyclosporin ADRs
Tremor Nephritis Hirsutism Gum hyperplasia Burning hands/feet
Typical Antipsychotics e.g. Haloperidol
ADRs
Dystonic reactions
QTc prolongation
Atypical Antipyschotics e.g. Olanzapine, Risperidone
ADRs
Metabolic syndrome
Amiodarone ADRs
Thryoiditis Pulmonary fibrosis Slate grey skin Metallic taste Hepatitis
Peripheral neuropathy
Myopathy
Adenosine ADRs
Flushing
Sense of impending doom
Lithium (Overdose)
Hypothyroidism
Nephrongenic DI
Nausea/diarrhoea
Tremor Ataxia Dysarthria Coma Convulsions
Gentamicin ADRs
Renal Failure
Tinnitus
C.Diff Risk Abx
Clindamycin Clarithromycin Co-amoxiclav Ciprofloxacin Cephalosporins
Statins and Macrolides/Grapefruit
= Myopathy
NSAIDs and ACEi
= AKI
ACEi and Spironolactone
= Hyperkalaemia
Major Bleeding management
Stop Warfarin
Vitamin K
Prothrombin Complex Concentrate
INR >8 and Minor Bleed management
Stop Warfarin
Vitamin K
Give further Vitamin K if INR high after 24 hrs
Restart Warfarin when INR >5
INR 5-8 and Minor Bleed
Stop Warfarin
Vitamin K
Restart Warfarin when INR <5
INR 5-8 and No bleed
Withhold 1 or 2 doses
Reduce subsequent maintenance dose
When to measure peak drug
To measure effectiveness
Time taken varies
When to measure trough drug
To avoid toxicity
Taken pre dose
Hyperkalaemia causes - DREAD
Drugs - Tequila Always Makes Nurses Smile Renal Failure Endocrine (Addison's) Artefact (Haemolysed Sample) DKA
Hypokalaemia causes - DIRE
Drugs - Don’t Cut Banana’s
Inadequate intake/loss
Renal Tubular Acidosis
Endocrine (Cushing’s, Conn’s)