PSA study Flashcards
1
Q
what are common P450 enzyme inducers? CRAP GPS induce anger
A
carbamazepine
rifampicin
alcohol (chronic)
Phenytoin
Griseofulvin
Phenobarbitol
Sulphonylureas/St Johns Wort
2
Q
what are common P450 enzyme inhibitors? Google SICKFACES.COM
A
Grapefruit juice
Sulphonamides
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol (acute)
Chloramphenicol
Erythromycin
Sodium valproate
Ciprofloxacin
Omeprazole
Metronidazole
3
Q
which medication should be increased during surgery?
A
steroids if patient on long-term, similar to sick day rules
4
Q
what drugs should be stopped before surgery? (I LACK OP)
A
insulin, lithium, anticoag/antiplatelets, COCP/HRT, K-sparing diuretics, Oral hypoglycaemics, perindopril (and other ACEis)
5
Q
when should a patient stop taking their COCP or HRT before surgery?
A
4 weeks before surgery
6
Q
when should a patient stop taking their lithium before surgery?
A
one day before
7
Q
when should a patient stop taking their potassium sparing diuretic or ACEi priorto surgery?
A
the day of surgery
8
Q
what are things to look through when assessing a prescription chart? PReSCRIBER
A
patient details
reaction (allergies)
signed chart
contraindications
route of drugs
does the patient need: IV fluids, VTE prophylaxis, anti-emetic or pain relief
9
Q
what are the side effects of corticosteroids?
A
Stomach ulcers, Thin skin, oEdema, heaRt failure, Osteoporosis, Infection, Diabetes
10
Q
what are contraindications of NSAIDs?
A
No urine (renal impairment/AKI), Systolic dysfunction (heart failure), Asthma, Indigestion, Dyscrasia (clotting abnormality)
11
Q
which drug that is technically an NSAID is not contraindicated in renal impairment or asthma?
A
aspirin
12
Q
dry cough is a common side effect of which anti-hypertensives?
A
ACE inhibitors
13
Q
which anti-hypertensives can cause a wheeze in asthmatics and worsening of acute heart failure (but helps chronic heart failure)?
A
beta blockers
14
Q
peripheral oedema and flushing are side effects commonly seen with which anti-hypertensives?
A
calcium channel blockers
15
Q
gynaecomastia is associated with which type of anti-hypertensive?
A
potassium sparing diuretics (e.g spirinolactone)
16
Q
gout is associated with which diuretic?
A
loop diuretics like furosemide
17
Q
if a patient is hypernatraemic or hypoglycaemic which fluid is preferred for maintenance compared to the usual normal saline?
A
5% dextrose
18
Q
what fluid may be considered in patients with ascites?
A
human albumin solution
19
Q
how much fluid would we stimate a patient is depleted if:
- they are oliguric <30ml/hr?
- reduced urine output and tachycardic?
- reduced urine output, tachycardic and shocked?
A
- 500ml
- 1 litre
- over 2 litres
20
Q
IV potassium should not be given at a rate of greater than what?
A
10mmol per hour
21
Q
what should you check before prescribing a patient fluids?
A
their U+Es, fluid status (ensure not overloaded), palpate bladder to ensure if reduced urine is not from obstruction
22
Q
which patients shouldn’t be given compression stockings?
A
patients with peripheral arterial disease as may lead to acute limb ischaemia
23
Q
who should not be given metaclopramide?
A
parkinson patients- as dopamine antagonist
young women- risk of dyskinesia
24
Q
how much paracetamol should be prescribed?
A
1g QDS or 6 hourly
25
when would you not use a stimulant laxative?
contraindicated with bowel obstruction
26
when might you consider not using an osmotic laxative?
if patient already feels bloated or at risk of dehydration
27
what are two examples of stimulant laxatives?
senna and bisacodyl
28
what are two examples of osmotic laxatives?
macrogol and lactulose
29
why might ispagula husk not be an appropriate laxative for a patient?
patioent already feels bloated, havent opened bowels in long time as ispagula husk takes around 72 hours to work
30
what are side effects of bulking agents?
bloating, flatulence and cramping. fluid intake needs to be maintained to reduce risk of obstruction
31
what patient would benefit most from ispagula husk?
patient with small hard stool that can't increase dietary fibre
32
how do glycerol suppositories work?
they act as lubricant and rectal stimulant by mildly irritating the rectum
33
why is lactulose helpful in the treatment of hepatic encephalopathy?
it discourages the proliferation of ammonia-producing organisms in the gut
34
what laxative should be considered if stools are soft but difficult to pass or the person complains of inadequate emptying?
stimulant laxative
35
which laxatives should be avoided in opioid induced constipation?
bulk forming
36
how do we treat opioid induced constipation?
with a osmotic and stimulant laxative (e.g docusate or two individual drugs)
37
what analgesic is most commonly used for neuropathic pain seen in diabetic neuropathy?
gabapentin
38
what medication is best to give for musculoskeletal pain?
NSAID usually topical ibuprofen to start
39
what are two things to do when considering oral NSAIDs for a patient?
check renal function and co-prescribe a PPI
40
what is the post-operative pain ladder?
paracetamol -> codeine/dihydrocodeine -> PRN morphine sulphate (modified release) -> PRN morphine (immediate release)
41
what are the usual daily requirements needed from fluids?
water 25-30ml per day
potassium/chloride and sodium 1mmol/kg/day
glucose 50-100g per day
42
how many grams of glucose is in 1Litre of 5% dextrose?
50g
43
how many grams pf glucose is in a 500ml bag of 5% dextrose?
25g
44
which anti-emetic can cause addiction and withdrawal when given IV?
cyclizine
45
what are important interactions to remember with methotrexate?
NSAIDs- low platelets
Trimethoprim- bone marrow suppression
PPIs- increase level of methotrexate
46
what are common drugs related to ototoxicity?
gentamicin, bumetanide, IV furosemide if patient has renal impairment, vancomycin, carbo/cisplatin
47
which drugs are most likely to lead to C.Dif infection? (4Cs)
Clindamycin
Co-amoxiclav
Ciprofloxacin
Cephalosporins (ceftriazone, cefotaxime, cefalexin)
48
what is the opioid toxidrome and its treatment?
pinpoint pupils, respiratory depression, reduced consciousness/altered mental state
treatment: 400 micrograms IM naloxone every 2-3 mins
49
under what treatment summary can you find treatment for overdoses?
poisoning treatment summary
50
what is the treatment of anti-psychotic induced parkinsonism and acute dystonia?
procyclidine
51
what are features of serotonin syndrome?
abrupt onset of neuromuscular hyperactivity (such as tremor, hyperreflexia, clonus, myoclonus, rigidity), autonomic dysfunction (tachycardia, blood pressure changes, hyperthermia, diaphoresis, shivering, diarrhoea), and altered mental state (agitation, confusion, mania).
52
how does onset differ between serotonin syndrome and neuroleptic malignant syndrome?
onset is more abrupt in serotonin syndrome whereas it is more gradual in neuroleptic malignant syndrome
53
how do the neuromuscular findings differ between serotonin syndrome and neuroleptic malignant syndrome?
serotonin: increases reflexes, tremor and myoclonus
NMS: reduced reflexes, diffuse rigidity
54
how do pupils differ between serotonin syndrome and neuroleptic malignant syndrome?
serotonin: mydriasis (dilated)
NMS: normal
55
what drugs can be used for treatment of neuroleptic syndrome aswell as conservative measures?
bromocriptine and dantrolene
56
what are side effects associated with quinolones?
tendon rupture, prolong QT interval, reduce seizure threshold
57
what drugs when taken with ciprofloxacin further increase tendon rupture risk?
steroids
58
what are side effects associated with SGLT-2 inhibitors?
UTIs, fourniers gangrene, euglycaemic DKA
59
where would you look in the BNF for guidance on warfarin reversal?
go to oral anticoagulants section then to the vitamin K antagonist sub section under the heading haemorrhage
60
what are some adverse effects of metaclopramide?
extrapyramidal effects (acute dystonia), hyperprolactinaemia, tardive dyskinesia
61
what anti-platelet therapy is started following an acute coronary syndrome?
aspirin lifelong and ticagrelor for 12 months
62
what anti-platelet therapy is started following a TIA or ischaemic stroke?
clopidogrel lifelong
63
what drugs can cause a tremor?
lithium, sodium valproate, ciclosporin, salbutamol
64
what are adverse effects of heparin?
bleeding, thrombocytopenia, osteoporosis, hyperkalaemia
65
how long after starting heparin treatment does heparin induced thrombocytopenia develop?
5-10 days
66
what are common symptoms associated with the RIPE drugs for TB treatment?
rifampicin: orange secretions, hepatitis
Isoniazid: peripheral neuropathy, agranulocytosis, hepatitis
Pyrazinamide: hyperuricaemia (gout), arthralgia, hepatitis
Ethambutol: optic neuritis
67
The use of amiodarone is limited by which factors?
very long half life, should ideally be delivered into central veins, interacts with manydrugs (p450 inhibitor)
68
what monitoring is required for patients taking amiodarone?
prior to treatment: TFT, LFT, U+Es, CXR
every 6 months: TFT, LFT
69
What are adverse effects of amiodarone?
thyroid dysfunction, pulmonary fibrosis, liver fibrosis, photo-sensitivity, slate-grey appearance, lengthens QT interval
70
which drugs can cause gingival hypertrophy?
phenytoin and ciclosporin
71
what is the time frame for primary PCI to be delivered?
within 12 hours of symptom onset and within 120 minutes of time when fibrinolysis could have been given
72
what treatment summary gives information about treating heart attacks?
acute coronary syndromes
73
What is given in an acute asthma attack?
supplementary oxygen to keep sat between 94-98%
salbutamol - 5mg nebs every 15-30 mins
ipratropium bromide- 500 microgram nebs
prednisolone oral or IV hydrocortisone
74
what lifestyle measures can be advised for a patient suffering with dyspepsia?
eat smaller meals, avoid trigger foods (spicy, fatty, acidic), don't eat 3-4 hours before bed, sleep with head raised, smoking cessation, reduce alcohol and weight loss
75
In which patients would urgent endoscopy be required?
those with dysphagia, significant acute GI bleeding, over 55 with unexplained weight loss and symptoms of abdo pain/reflux/dyspepsia
76
how long would pharmacological prophylaxis of VTE be continued following general surgery?
7 days post op or until sufficient mobilisation
77
how long would pharmacological prophylaxis of VTE be continued following major abdominal cancer surgery?
28 days
78
where can you look in BNF for duration of VTE prophylaxis following elective hip and knee surgeries?
venous thromboembolism treatment summary and control F 'knee replacement' 'hip replacement'
79
how does fondaparinux act?
it inhibits activated factor X
80
how does dabigatran work?
a reversible inhibitor of free thrombin and thrombin-induced platelet aggregation
81
how does apixaban work?
direct inhibitor of factor Xa (activated factor X)
82
what is the reversal agent of apixaban and rivaroxaban?
andexanet alfa
83
what is the reversal agent of dabigatran?
idarucizumab
84
what can be used to reverse the effects of warfarin?
oral or IV vitamin K, prothrombin complex concentrate
85
what treatment is given for gonorrhoea?
IM ceftriaxone
86
what treatment is given for chlamydia?
doxycycline
87
what treatment is given for syphilis?
IM benzathine benzyl penicillin
88
what treatment is given for vaginal candidiasis?
topical clotrimazole or 1 day oral fluconazole (oral antifungals avoided in pregnancy)
89
what are examples of aminoglycosides?
streptomycin, gentamicin
90
what are adverse effects of aminoglycosides like gentamicin?
nephrotoxicity, ototoxicity, neuromuscular blockade (caution in patients with myasthenia)
91
which common drug do macrolides increase the concentration of by preventing breakdown?
statins- increasing risk of myopathy and rhabdomyolysis
92
what is an adverse effect associated with metronidazole?
disulfiram like reaction with alcohol
93
what are some adverse effects of nitrofurantoin?
pulmonary fibrosis, deranged LFTs, eosinophilia, can cause peripheral neuropathy
94
what's an example of a quinolone?
ciprofloxacin
95
what are adverse effects of ciprofloxacin?
tendon damage (particularly achilles), low seizure threshold, lengthens QT
96
why are quinolones avoided in patients with G6PD deficiency?
can lead to acute haemolytic anaemia
97
what are tetracyclines indicated for?
acne, lyme disease, chlamydia
98
why are tetracycline not given to women who are pregnant or breastfeeding?
risk of teeth discolouration of the infant
99
what are adverse effects of tetracyclines?
photosensitivity, angioedema, black hairy tongue, discolouration of teeth (not used in kids under 12)
100
what are some adverse effects of vancomycin?
nephrotoxicity, ototoxicity, thrombophlebitis, red man syndrome (on rapid infusion)
101
when prescribing an anti-emetic what things should you look out for as contraindications in a question?
severe heart failure- contraindicated for cyclizine
parkinsons- metoclopramide and prochlorperazine contraindicated
102
which anti-depressant is preferred in younger patients and what is its half-life like?
fluoxetine- has a long half life
103
what medication is given to treat high blood pressure in pre-eclampsia?
labetalol (nifedipine if asthmatic)
104
what is first line for paediatric constipation?
movicol
105
for an adult already on salbutamol and fluticasone inhalers for asthma what is their next step in management?
LTRA e.g montelukast
106
what is commonest cause of hypothyroidism in UK and what test supports this diagnosis?
hashimotos- thyroid peroxidase antibody (anti-TPO) positive
107
how long will a patient need to be on levothyroxine?
life-long
108
What medications should be stopped/reviewed when patient has AKI?
109
what is the maximum daily haloperidol dose given to psychiatric patients?
20mg daily
110
what drugs are most commonly associated with angioedema?
ACEi, tetracycline, calcium channel blockers (not as common)
111
what is the maximum dose of bisoprolol given for hypertension?
20mg daily
112
why are ACEi stopped in AKI?
they inhibit efferent renal arteriolar vasoconstriction- lowering the glomerular filtration pressure
113
which diabetes drugs have weight gain as a side effect?
sulfonylureas (e.g gliclazide)
PPAR-y (e.g piaglitazone)
114
what side effects of mirtazapine can be helpful as an antidepressant?
weight gain and sedation
115
what drugs can cause cold peripheries?
beta blockers, methylphenidate
116
what drugs commonly cause constipation?
opioids, PPIs, statins, ACE inhibitors, iron supplements
117
is tamsulosin usually 400 mg or 400 micrograms?
micrograms
118
what mistakes can be made with paracetamol prescription?
prescribing 1mg instead of 1g
or 4 hourly over QDS
119
how should you restart a patients short acting insulin after being on variable rate insulin infusion?
administer their usual short acting with their next meal and continue VRII for one hour afterwards
120
how long are patients required to take contraception with isotretinoin?
while on treatment and for a month after stopping
121
what drug toxicity should be considered if a patient complains of xanthopsia (yellow vision)?
digoxin
122
cholestatic jaundice can be seen with which antibiotics?
penicillins
123
what is the immediate action to do when a patient on clozapine has agranulocytosis (with WWC <3 and neutrophils <1.5)?
stop clozapine immediately
124
what drugs can be given alongside GTN to help with stable angina?
beta blockers or calcium channel blockers
125
what would you give in addition to GTN spray to help a patient with stable angina who is asthmatic?
a calcium channel blocker- normally could also give a beta blocker but these are contraindicated in asthmatics
126
which anti-hypertensives would you not give to a patient on propanolol for migraines?
non-dihydropyridine calcium channel blocker
127
what two features would make you start a patient on an ACEi for hypertension over a CCB?
diabetic or under 55
128
what two features would make you start a patient on a CCB for hypertension over an ACEi?
over 55, black ethnic origin
129
before prescribing a drug what should you always check?
patient allergies
130
if a patient is allergic to PPIs what other form of medication can you use for dyspepsia?
H2 antagonists like ranitidine
131
what is the treatment of Group B strep positive mum during labour?
IV benzylpenicillin
132
what's a common drug that causes fluid retention?
steroids
133
are digoxin doses usually in milligrams or micrograms?
micrograms- this may be a prescribing error to pick up on
134
what are some drugs that commonly cause hyponatraemia?
PPIs, SSRIs, carbamazepine
135
a diabetic patient with signs of nephropathy with increased urine protein and A:CR should be started on what drug?
a renoprotective agent like an ACEi (e.g lisinopril)
136
what antibiotic would you give for UTI in a pregnant lady and for how long?
nitrofurantoin for 7 days
137
what would you warn drivers or patients who work with machinery about before starting co-careldopa?
it can lead to excessive daytime sleepiness and sudden onset of sleep
138
how long should a woman have stopped taking their methotrexate before becoming pregnant, how long for a man?
6 months for both men and women
139
what us an important symptom that needs reporting if you're taking carbimazole?
sore throat and any signs of infection- carbimazole can cause bone marrow suppression and neutropenia
140
if a patient on carbimazole is found to be neutropenic on FBC what should be done?
stop their carbimazole immediately
141
how should a patient taken GTN spray?
take it sat down (so don't fall if become dizzy) and administer under the tongue
142
what is the tetrad that characterises neuroleptic malignant syndrome?
hyperthermia, changed mental status, muscle rigidity and autonomic instability
143
why should metformin be held in AKI?
risk of lactic acidosis
144
what common side effect of alendronic acid is seen more in women over 60 who have been taking the drug for less than a month?
dizziness
145
how long after a dose are digoxin levels taken?
levels are taken 6 hours after the last dose
146
what investigation if any would you do before starting a patient on donepezil (anticholinesterase inhibitor)?
ECG
- contraindicated in patients with heart block of symptomatic bradycardia
147
when would you take a lithium level?
12 hours after the last dose
148
what is used to monitor for adverse effects of ACEi treatment?
renal function tests prior to and during treatment
149
what is an effective way of measuring the effectiveness of furosemide treatment?
daily weights
150
what level would transaminase need to be to warrant stopping someones statins?
if they are raised more than 3 times the upper limit of normal
151
how would you manage a patients COCP if their blood pressure was found to be systolic >160 or diastolic >100?
stop COCP as contraindicated
152
if a question asks which drug should be stopped before surgery, where can this info be found on the BNF?
under surgery and long term medication section
153
would you stop a patients long term steroid if they are going for surgery?
no they could go into adrenal insufficiency and have a really big drop in BP
154
what drugs should be stopped before surgery?
COCPs, ACEi and ARBs, diuretics, lithium, anticoagulants, antiplatelets
155
how long would you stop taking COCP before surgery?
4 weeks
156
most diabetic drugs are taken as normal during surgery which would you omit or taken differently?
SGLT-2 inhibitors should be omitted the day of surgery
gliclazide- omit morning dose
metformin- don't have midday dose if taking TDS
157
what are cyp450 inhibitors? SICK FACES
Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol/grapefruit juice
Chloramphenicol
Erythromycin
Sulphonamides
158
what arecyp450 inducers? SCRAP GP
Sulphonylurea
Carbimazapine
Rimfampicin
Alcohol
Phenobarbitone
Griseofulvin
Phenytoin
159
before prescribing paracetamol what do you need to check?
weight, as dose needs to be lowered if below 50kg
160
what should be done with a patient's methotrexate if they are septic?
withhold the methotrexate until neutropenic sepsis excluded
161
what antibiotic should not be given with methotrexate and why?
trimethoprim- both folate antagonists and increase risk of pancytopenia and neutropenic sepsis
162
how do different diuretics affect potassium levels?
increase potassium: potassium sparing and ACEi
decrease potassium: thiazide and loop diuretics
163
when seeing a beta blocker prescribed, what else should you check on the chart?
if patient has asthma, if they also have a calcium channel blocker like verapamil prescribed
164
what is something to check other than dosing on insulin prescription?
route- all insulin is given SC unless sliding scale
165
where in the BNF would you find which drugs to not use in G6PD deficiency?
Anaemias section- G6PD heading
166
what are usual dosings of atorvastatin?
10mg once daily; increased up to 80mg (increased at intervals of at least 4 weeks)
167
what doses of atorvastatin are given for primary and secondary prevention of cardiovascular events?
20mg primary
80 mg secondary
168
when taken with what other drugs can atorvastatin not exceed 10 mg a day?
ciclosporin
169
what are monitoring requirements for statins?
lipids, TSH and renal function before treatment
LFTs repeated at 3 and 12 months after starting treatment
170
what are common side effects of statins?
joint and muscle aches, GI upset, sleep disorders, thrombocytopenia
171
when would you consider stopping an elderly patients ACEi?
hyperkalaemia, persistent postural hypotension
172
what are common side effects of ACEi?
dry cough, angioedema, dizziness, GI upset, hyperkalaemia
173
what is antiplatelet treatment following TIA or ischaemic stroke?
aspirin and clopidogrel, followed my clopidogrel monotherapy
174
what dose of codeine is given for acute moderate pain?
30-60mg every 6 hours for a max of three days
175
why might opioids be avoided in patients with head injury?
they can interfere with pupillary responses vital for neuro assessment
176
what are some side effects of opioids?
constipation, dizziness, drowsiness, hypotension, miosis, nausea, respiratory depression, urinary retention, withdrawal
177
what are the steps to managing mild-moderate pain?
1. paracetamol
2. ibuprofen or weak opioid
3. add paracetamol to last one
4. paracetamol plus alternative NSAID like naproxen
5. weak opioid + paracetamol +/- NSAID
178
why would you probably not use fixed dose analgesics with low dose opioids?
e.g codeine 8mg plus paracetamol 500mg are no more effective than paracetamol by itself but can cause opioid adverse effects
179
what are the most common side effects of GLP-1 analogues (e.g semaglutide)?
nausea and vomiting
180
what tests would be most appropriate to monitor for adverse effects of oral steroids in children?
blood pressure and urinary glucose weekly
181
what blood test is done before starting on aripiprazole?
serum prolactin
182
what is the appropriate monitoring of a patient starting methotrexate?
FBC, U+Es and LFTs every 1-2 weeks until stabilised
183
what tests should a patient undergo before starting lithium?
thyroid test, renal function test and ECG if cardio risk factors
184
what routine monitoring do DOAcs require?
they dint require any routine monitoring
185
if a diabetic patient is hyperglycaemic in the mornings, how should their evening insulin be changed?
increase evening dose by 10-20%
186
which diabetic drugs are best avoided in patient with a background of pancreatitis?
GLP-1 analogues and DPP4 inhibitor
187
what non-antibiotic medication increases c diff risk?
PPIs
188
what dose of insulin is given in DKA and what insulin type is given?
0.1 unit/kg/hour
IV short acting insulin e.g novorapid or humalog
189
what antibiotic is given for suspected bacterial meningitis?
ceftriaxone
(pre-hospital give benzyl penicillin)
190
does omeprazole commonly cause diarrhoea?
yes
191
does penicillin commonly cause thrombocytopenia?
yes
192
is constipation common with bisphosphonates?
yes
193
in constipation common with amlodipine?
yes
194
what drugs increase lithium concentration?
ACEi, NSAIDs, and thiazide like diuretics
195
what is first line to treat lactational mastitis?
flucloxacillin
196
what is given for alcohol withdrawal?
chlordiazepoxide
197
why would it be necessary for patients to inform doctor about diet changes if on warfarin?
foods containing lots of vitamin K can interfere with warfarin, examples of high Vit K foods are green leafy vegetables and liver
198
what important advice is given with GTN spray for angina?
seek medical help if symptoms not resolved after 3 consecutive doses, sit down when using it
199
what are 3 main complications of unfractionated heparin therapy?
haemorrhage, hyperkalaemia, thrombocytopenia
200
why do loop diuretics increase risk of renal stones?
block NaCl transporter so more calcium in urine
201
how do thiazide like diuretics affect serum calcium?
increase it- causing hypercalcaemia
202
what percentage of people who are allergic to penicillin are allergic to cephalosporins?
0.5-6.5%
203
what meds are usually taken at night?
statins and amitriptyline
204
which anti hypertensive is contraindicated in heart failure?
non-dihydropyridine CCB like verapamil
205
which anti-arrhythmic should not be used in patients with structural heart disease?
flecainide
206
what medications may exacerbate heart failure?
pioglitazone (fluid retention), verapamil (negative ionotropic effects), NSAIDs and glucocorticoids (fluid retention), flecainide
207
how should gentamicin dosing be adjusted if trough levels are raised?
increase the interval between doses
208
how should gentamicin dosing be adjusted if peak levels are raised?
reduce gentamicin dose
209
if suspecting digoxin toxicity why is important to check U+Es?
toxicity may occur at normal concentration if hypokalaemia is present
210
what is one common and one important side effect of tamoxifen to mention to patients?
hot flushes are common
increased risk of blood clots
211
when is acetylcysteine given for paracetamol overdose?
4-8 hours with levels over treatment line
staggered overdose
after 8 hours more than 150mg/kg taken
over 24 hours with jaundice, hepatic tenderness or raised ALT
212
what are some drugs that cause low neutrophils?
clozapine, carbimazole, chemo/radiotherapy
213
what are some drugs that cause thrombocytopenia?
heparin, penicillamine (used in RA treatment)
214
what drugs can cause low sodium?
all diuretics, SSRIs, NSAIDs, carbamazepine...
215
what are causes of SIADH? (using mneumonic siadh)
small cell lung tumours
infection
abscess
drugs (especially carbamazepine and antipsychotics)
head injury
216
what are causes of intrinsic AKI? (INTRINSIC mneumonic)
I- Ischaemia (ATN)
N- nephrotoxic antibiotics
T- tablets like NSAIDs,ACEi
R- radiological contrast
I-injury (rhabdo)
N- negatively bifringent crystals (gout)
S- syndromes (glomerulonephritis)
I- inflammation (vasculitis)
C- cholesterol emboli
217
what drugs cause cholestasis?
flucloxacillin, co-amoxiclav, nitrofurantoin, steroids and sulphonylureas
218
what are features of digoxin toxicity?
confusion, nausea, visual halos and arrhythmias
219
what are early and late features of lithium toxicity?
early: tremor and tiredness
late: arrhythmias, seizures, coma, renal failure and diabetes insipidus
220
what are features of phenytoin toxicity?
gum hypertrophy, ataxia, nystagmus, peripheral neuropathy
221
what are features of toxicity with gentamicin and vancomycin?
ototoxicity and nephrotoxicity
222
what is the CURB65 score?
confusion
Urea >7
Resp rate > 30
BP <90 sys or <60 dias
age >65
223
what antibiotic is given for meningitis in hospital?
2g Cefotaxime IV
224
what is given to a seizing patient after 5 minutes?
IV lorazepam 4mg
225
Can calcium channel blockers be used in heart failure?
only amlodipine as the rest (e.g verapamil, nifedipine) reduce heart contractility so should be avoided in patients who have heart failure with reduced ejection fraction
226
what is a side effect of stimulant laxatives?
may worsen abdominal cramping
227
who can't have the COCP?
smoking and over 35, breastfeeding, BMI >35, migraine with aura, hypertension, prev. VTE (in themselves or family), active breast cancer or BRCA carrier
228
what are features of lithium toxicity?
agitation, restlessness, vomiting, diarrhoea, tremor and muscle fasiculations
229
what annual monitoring is required for hydroxychloroquine and why?
fundus autofluorescence and OCT
adverse effects of keratinopathy and retinopathy
230
what reaction is seen with statins and macrolides?
macrolides increase statin concentration increasing risk of muscle aches and rhabdo
231
what are features of acute intermittent porphyria?
adbo pain, hallucinations, polyneuropathy and urine discolouration
232
how does lamotrigine interact with hormonal contraception?
COCP decreases exposure to lamotrigine
lamotrigine decreases effects of desogestrel
233
234
what electrolyte abnormality is advised to be monitored with prolonged PPI treatment?
magnesium
235
why would ACEi be held when patient is unwell or has reduced oral intake?
increased risk of AKI
236
which women will will take 5mg folic acid in pregnancy over the typical 400micrograms?
those at high risk of neural tube defects:
had prev. baby with neural tube defect, on anti epileptic drugs or have diabetes
237
what is first line treatment for arthritis?
topical ibuprofen
238
what medication is given prophylactically for raynauds?
nifedipine
239
what analgesia would you give in someone with ACS?
IV morphine 5-10mg at a rate of 1-2mg/minute
240
what drug reduces parathyroid hormone levels, therefore reducing calcium?
Cinacalcet
241
what pain med is good for severe biliary colic?
IM diclofenac
242
which drugs can be used for agitation in palliative care, when would you use both?
haloperidol- agitation related to delirium
midazolam- agitation related to anxiety
243
what is given for gonorrhoea before sensititvites are back?
1g IM ceftriaxone
244
what considerations need to be had in a patient who is obese with severe asthma wanting emergency hormonal contraception?
obese- levnorgestrel needs higher dose of 3mg or ulipristal acetate
severe asthma- ulipristal acetate contraindicated
245
what is used for atrophic vaginitis?
estradiol cream
246
why would you not give metronidazole to a patient with alcohol dependence?
metronidazole gives a disulfiram like reaction with alcohol
247
what medicine is used to help with flushing and vasomotor conditions associated with menopause?
clonidine
248
what drugs can cause hyperprolactinaemia?
dopamine antagonists (e.g antipsychotics, metoclopromide) and rarely SSRIs
249
what drugs commonly cause constipation?
opioids, anticholinergics
250
what drugs commonly cause confusion?
anticholinergics, opioids, benzos
251
what drugs commonly cause diarrhoea?
PPIs, allopurinol, antibiotics, colchicine, metformin, SSRIs
252
what drugs commonly cause dyspepsia?
steroids, NSAIDs, alendronic acid, metformin
253
what drugs commonly cause falls/dizziness?
antihypertensives, CNS supressant drugs (opioids, benzos, antidepressants, antipsychotics), diuretics
254
what drugs commonly cause hearing loss?
aminoglycosides, loop diuretics
255
what drugs commonly cause tremor?
salbutamol, cyclosporin, levothyroxine, lithium, nicotine
256
what are commonly contraindicated drugs with peptic ulcer disease?
aspirin and other NSAIDs
257
what are commonly contraindicated drugs with CKD?
NSAIDs, ACE inhibitors, gentamicin, digoxin
258
what are commonly contraindicated drugs with chronic heart failure?
CCBs, flecainide, TCAs, NSAIDs, corticosteroids
259
what are commonly contraindicated drugs with asthma?
beta blockers and NSAIDs
260
what are commonly contraindicated drugs with parkinsons?
antipsychotics and metoclopramide
261
what drugs commonly cause impaired liver function?
amiodarone, antiepileptics, anti-TB drugs, paracetamol and statins
262
what drugs reduce respiratory rate?
benzos, opioids, gabapentin/pregabalin
263
