Random Flashcards by Zuzanna Łoboda

Patient on HRT having withdrawal bleeds, wants a patch that won’t cause withdrawal bleeds?

Everol Conti self adhesive patch.

1 patch transdermal twice a week.

How well did you know this?

Not at all

Perfectly

Scarlet fever management?

Phenoxymethylpenicillin 10days QDS PO (125mg)

How well did you know this?

Not at all

Perfectly

INR range for bioprosthetic mitral valve?

2.5 (within 0.5 is always acceptable)

How well did you know this?

Not at all

Perfectly

Missed pill advice for COCP?

9 completed days of HFI (hormone free interval) - consider emergency pill if UPSI

48 and <72hrs since last pill in week 1 - emergency pill not required if consistent pill taking in lass 7 days

If 2-7 pills missed - take the last missed pill ASAP then use barrier contraception for 7 days but emergency contraception not needed if there was consistent pill taking 7 days prior (backup for subsequent incorrect use)

If 2 or more missed pills in week prior to HFI then do not take the HFI

Qlaira pills
- 12hr margin but management depends on which day it was missed.

How well did you know this?

Not at all

Perfectly

Missed pill advice for mini pill?

Most have a 3hr window

For desogestrel the window is 12hrs and drospirenone is 24rs.

If more than one pill has been missed only one should be taken. But if one has been missed you can take 2 in a 24hr period.

Use additional contraception for 2 days (or 7 days for drospirenone)

https://cks.nice.org.uk/topics/contraception-progestogen-only-methods/management/progestogen-only-pill/#missed-pill

How well did you know this?

Not at all

Perfectly

Methotrexate contraception?

Contraception during and for at least 6 months after treatment in men and women.

How well did you know this?

Not at all

Perfectly

Gemfibrozil interaction with common medication?

Simvastatin - increases risk of myopathy as gemfibrozil is a CYP inhibitor

How well did you know this?

Not at all

Perfectly

When do you stop statin in myopathy?

If CK >5 times upper limit of normal or severe symptoms

How well did you know this?

Not at all

Perfectly

How does fentanyl convert to oral morphine?

25mcg/hr patch of fentanyl = 60-90 MST

How well did you know this?

Not at all

Perfectly

Treatment for moderate severe acne, having tried topical therapy?

Doxycycline

Lymecycline

How well did you know this?

Not at all

Perfectly

Standard dose for tacrolimus?

Maintenance dose is commonly 1-2mg BD

How well did you know this?

Not at all

Perfectly

Tacrolimus and dalteparin combination effect?

Hyperkalaemia

How well did you know this?

Not at all

Perfectly

When do you stop antiplatelets before surgery?

7 days prior - exceptions are if there was recent vascular stenting

How well did you know this?

Not at all

Perfectly

Allopurinol in AKI?

Need to be held - renally excreted and max dose is 100mg in renal failure

How well did you know this?

Not at all

Perfectly

Reversal of high INR no bleeding?

Phytomenadione (vitamin K) 1-5mg orally

How well did you know this?

Not at all

Perfectly

Does topiramate affect COCP/POP?

Yes reduces their efficacy so need to use alternative contraception

How well did you know this?

Not at all

Perfectly

How can dabigatran interact with an antidepressant?

Increased risk of bleeding if used with citalopram for example

How well did you know this?

Not at all

Perfectly

What is an acceptable rise in creatinine when starting an ACEI?

<30% is acceptable, if it rises to <30% do not stop, just repeat renal function tests in 1 week

How well did you know this?

Not at all

Perfectly

Monitoring the affect of ACEI in heart failure?

Exercise tolerance - think NYHA classification is how we grade severity

How well did you know this?

Not at all

Perfectly

Whats the usual increase of an insulin dose when the patient goes on glucocorticoids?

10% increase

How well did you know this?

Not at all

Perfectly

What should non-HDL cholesterol have decreased by once started on statins?

> 40%

How well did you know this?

Not at all

Perfectly

What is a normal INR?

0.8-1.2

How well did you know this?

Not at all

Perfectly

Target INR in metallic valves?

3-4

What to do in case of high INR +/- bleeding?

Major bleed - stop warfarin, give vit K1 by slow IV, give dried PCC (alt: FFP)

INR 5-8 no bleed - withhold 1-2 doses warfarin and reduce subsequent maintenance

INR 5-8 minor bleed - stop warfarin and give VitK by slow IV

INR >8 no bleed- stop warfarin, give vit K by MOUTH using IV preparation, repeat after 24hrs if still too high, restart warfarin when INR <5

INR >8 + minor bleed - stop, give Vit K, repeat vit K after 24hrs if needed, restart warfarin when INR <5

Drugs that increase risk of bleeding even if INR in range?

NSAIDs steroids aspirin, clopidogrel

Monitoring when starting someone on warfarin?

INR daily, or alternate days, until 2-3 on two consecutive occasions (a meaningful INR can only be obtained 3–4 days after starting Tx) Then, twice weekly for 1–2 weeks (this should be continued if HT, RF or bleed risk) Then, weekly measurements until > two INR measurements are 2-3 Thereafter, longer intervals (for example, < 12 weeks, if agreed locally) Once stable, changes seldom required.

When to stop warfarin before surgery?

5 days before (converted to tinzaparin/LMWH) Restart evening of surgery/next day INR before surgery needs to be <1.5

What to consider when prescribing DOACs?

eGFR

If a pt on warfarin with INR in range is being Tx with clarithromycin?

continue warfarin at normal dose and re-check INR in 48 hours

Enoxaparin/dalteparin/tinzaparin are contraindicated in?

with current (or history of) heparin-induced thrombocytopenia high risk of bleeding (e.g. acute gastroduodenal ulcer, cerebral haemorrhage, conditions causing a predisposition to bleed, serious coagulation disorders) within 3 months stroke (unless due to emboli)

Dose of tinzaparin for 60kg patient in DVT Tx?

When calculating note that it can only be given in 1000unit increments tinzaparin sodium 20000 units/mL injection 175 units/kg SC daily 60*175 = 10500 but can only be given in increments of 0.05ml which is 1000 units therefore 11 000 units is practical for administration

MOA of fondaparinux?

Synthetic pentasaccharide that inhibits activated factor X

Treatment of heparin OD?

protamine sulfate

Tamoxifen effect on INR?

If on warfarin then INR will increase on tamoxifen treatment

What should you not prescribe on methotrexate?

Trimethoprim Co-trimoxazole

Effect of acute alcohol on warfarin?

Increases INR as it inhibits enzyme Chronic alcohol intake will induce enzymes and reduce INR

Name some side effects of citalopram?

Photosensitivity Excess salivation

Instructions for taking bisphosphonate tablet?

Weekly Do not take within 2hrs of AdCal Avoid food for 2hrs post dose Take with full glass of water and stay upright for 30mins

How to prevent alcohol relapse?

Acamprosate

When would you Tx paracetamol OD with NAC before waiting for blood results?

1. if taken >150 mg/kg 2. staggered overdose 3. if doubt over dose Otherwise if plasma concentration on or above the treatment line (100mg/L at 4hrs) NB: to avoid underestimating the potentially toxic paracetamol dose ingested by obese patients who weigh more than 110 kg, use a body-weight of 110 kg (rather than their actual body-weight) when calculating the total dose of paracetamol ingested (in mg/kg).

King’s College Hospital criteria for liver transplantation (paracetamol liver failure)?

Arterial pH < 7.3, 24 hours after ingestion or all of the following: prothrombin time > 100 seconds creatinine > 300 µmol/l grade III or IV encephalopathy

Over how long do you infuse NAC?

Over 1hr

Causes of hypernatraemia?

All Ds dehydration drips drugs diabetes insipidus

Causes of low potassium?

DIRE Drugs (loop i.e. furosemide + thiazide diuretics) Inadequate intake/intestinal loss (D+V) Renal tubular acidosis Endocrine (Cushing’s + Conn’s syndromes)

Causes of high potassium?

DREAD Drugs (K+ sparing diuretics and ACEi) Renal failure Endocrine (Addison’s) Artefact (very common, due to clotted sample) DKA (NB when insulin is given the K+ drops requiring regular (hourly) monitoring +/− replacement)

How to differentiate pre-renal from obstructive/intrinsic AKI using urea and creatinine?

Creatinine can rise with severe prerenal AKI but urea>creatinine rise usually To differentiate this from intrinsic and obstructive AKI, multiply the urea by 10; if it exceeds the creatinine then this suggests a prerenal aetiology Postrenal and intrinsic AKI has creatinine > urea

Nephrotoxic abx?

gentamicin vancomycin tetracyclines

Cause of high urea with normal creatinine?

If low Hb -> GI bleed

When to alter thyroxine dosing according to TSH?

TSH < 0.5 - lower dose 0.5-5 - keep dose > 5 - increase dose

What ABG abnormality can diuretics cause?

Metabolic alkalosis with thiazide diuretics esp at higher doses

Does aspirin need to be stopped in AKI?

No - NSAID but doesn't cause renal failure

Which antibiotics do steroids interact with to cause Achilles tendon rupture?

Fluoroquinolones e.g. ciprofloxacin or moxifloxacin

Abx used to treat bone infection with S/E of abx colitis?

clindamycin

What Abx is contraindicated in MG?

Gentamicin - aminoglycosides may impair neuromuscular transmission

Verapamil and BB interaction'?

Severe bradycardia