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- Y6 PSA > Random 2 > Flashcards

Random 2 Flashcards

1
Q

Diuretics effect on Na?

A

Hypo Na

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2
Q

What to avoid in PD?

A

metoclopramide
haloperidol
prochloperazine
(use domperidone instead because it doesn’t cross BBB)

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3
Q

Interactions of MAOis?

A

SSRIs, SNRIs, TCA, buproprion

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4
Q

What CVD should you avoid NSAIDs in?

A

Systolic dysfunction

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5
Q

Medications that need to be STOPPED before surgery?

A

I LACK OP

Insulin - not long-acting
Lithium - 1day pre
Anticoagulants/ antiplatelets
COCP/HRT
K sparing diuretics
Oral hypoglycaemics - metformin 1 day pre
Perindopril/ACEi

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6
Q

Which antidepressants can interact with anaesthetic drugs?

A

MAOIs and TCAs

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7
Q

Diabetes meds before surgery?

A

stop metformin
give short as normal
give 80% of long as normal
place on sliding scale with dextrose, insulin, K+

After surgery stop the sliding scale 30-60mins after the first meal time.

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8
Q

What drugs should you increase for surgery?

A

Steroids

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9
Q

2 drugs to prescribe when on steroids?

A

PPI
Bisphosphonates

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10
Q

5mg pred is how much hydrocort?

A

20mg

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11
Q

Should a patient that is NBM still receive their oral medication?

A

yes! including prior to surgery

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12
Q

Fluid replacement if only ↓ urine output?
(solely oliguria)

A

1 litre over 2-4 hrs

reassess HR, BP, urine output

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13
Q

What does symbol ° mean?

A

Number of hours over which a bag of fluid should be given, e.g. 0.9% saline 1 L 2° means 1 L of 0.9% saline over 2 h

in PSA write “2 hours” or “2-hourly” or “2-hrly”

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14
Q

What is the daily potassium requirement IV?

A

Approximately 1 mmol/kg/day of potassium, sodium and chloride

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15
Q

Fluid requirement by weight?

A

25-30ml/kg per day e.g. 70kg adult would be 1750 but round up

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16
Q

Max rate of K+ infusion?

A

10mmol/hr

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17
Q

Severe hyperkalaemia?

A

> 6.5mmol/L and ECG changes

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18
Q

Tx of severe hyperkal?

A

1) 10-20ml calcium gluconate 10% by slow IV injection (cardioprotective)
2) 10 units actrapid IV - prescribed as “10 units Actrapid in 100ml of 20% dextrose, over 30 min”

3) 100ml of 20% IV dextrose
4) nebulised salbutamol 10mg

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19
Q

how long to give oral Fe for ↓Hb?

A

until Hb is normal
then 3 months thereafter

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20
Q

effect of LMWH on K+?

A

Dalteparin (and all heparins) can contribute to hyperkalaemia

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21
Q

Normoglycaemic patient admitted after acute stroke, unable to swallow and does not tolerate insertion of a nasogastric tube. ONE IV fluid that is most appropriate for the patient at this stage?

A

NaCl 0.9% with K 0.15% will provide all the electrolytes needed

Patient will require some nutritional support (glucose) in the first 24 hrs.
BUT, glucose-containing fluids have the potential to EXACERBATE cerebral injury

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22
Q

Why not cyclizine in HF?

A

Causes fluid retention

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23
Q

What antiemetic in HF?

A

metoclopramide

24
Q

Acute vs chronic diabetic neuropathy?

A

Acute : paracetamol
Chronic: duloxetine (licensed) , venlafaxine/TCA (unlicensed)

https://bnf.nice.org.uk/treatment-summaries/diabetic-complications/#diabetic-nephropathy

25
Q

NSAIDs contraindications?

“NSAID” mnemonic

A

No urine (AKI)
Systolic dysfunction (HF!)
Asthma
Indigestion
Dyscrasia (abnormal platelets)

26
Q

Max percentage increase of baseline morphine per day?

A

30-50%

27
Q

What to give instead of morphine in AKI?

A

Oxycodone (liver metabolism)

28
Q

What is the route of sliding scale insulin?

A

IV infusion

29
Q

What kind of insulin is Novomix 30?

A

Short and medium combo

30
Q

Use of antidiabetic medication during surgery?

A

Generally if there is more than 1 skipped meal then meds have to be adjusted and restarted once earing and drinking normally.

If insulin infusion started - stop acarbose, metformin, pioglitazone, DPP4/gliptins, SGLT2i. GLP1 can be continued as normal.

During perioperative period:

Continued as normal = Pioglitazone, DPP4i, GLP1

Omitted on day of surgery = SGLT2i and sulfonylureas (SGLT2 not restarted until patient stable; sulfonylureas restarted when eating and drinking)

Metformin - if GFR >60 and low risk of AKI associated then continue, only miss one dose if skipping one meal.

If contrast will be required and GFR <60 then omit day before surgery and for 48hrs after.

31
Q

If Cr >150 what T2DM tx 1st line?

A

Gliclazide

32
Q

Glucose target in surgery diabetes?

A

6mmol - if below give 20% glucose

33
Q

When to start dextrose in DKA?

A

If glucose <14

34
Q

How do you calculate osmolarity?

A

osmolarity = 2 (Na+) + 2 (K+) + Glucose + Urea

35
Q

How do you calculate anion gap?

A

Na⁺ + K⁺ – (Cl⁻ + HCO₃⁻)

36
Q

Weight loss antihyperglycaemics?

A

Metformin
GLP1
SGLT2

37
Q

Weight gain antihyperglycaemics?

A

Insulin
Sulfonylureas
Thiazolidinediones

38
Q

What type of insulin is Humulin?

A

Biphasic

39
Q

BB in diabetes?

A

Reduce hypoglycaemic awareness

40
Q

What reduces levothyroxine effects?

A

Iron and Calcium reduce absorption so wait 4 hours after or 2hrs before

41
Q

What type of insulin is Humalog?

A

Rapid acting

42
Q

Name 2 basal insulins.

A

Isophane
Determir/levermir
Glargine/Lantus

43
Q

EPSEs?

A
  1. parkinsonian (tremor, appears gradually)
  2. acute dystonia + dyskinesia (young ppl, after few doses)
  3. akathisia (restlessness) after large initial doses
  4. tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw), normally w/ long-term therapy
44
Q

Most serious EPSE?

A

Tardive dyskinesia -may be irreversible

45
Q

Best antipsychotic to avoid EPSE, ↑ QT interval, sexual dysfunction, ↑ glucose?

A

aripiprazole

46
Q

Tx of Alzheimer’s?

A

1st line - donepezil or rivastigmine or galantamine
2nd line - memantine (NMDA antagonist)

47
Q

Tx of anti-psychotic induced parkinsonism?

A

Procyclidine (anti-cholinergic)

48
Q

4 drugs with narrow therapeutic window?

A

digoxin
theophylline
lithium
phenytoin
Abx (gentamicin and vancomycin)

NOT clozapine - monitoring is for FBC

49
Q

Lithium target levels?

A

0.4–1 12hrs post-dose

50
Q

Phenytoin toxicity?

A

Gum hypertrophy
Ataxia
Nystagmus
Peripheral neuropathy

51
Q

Vanc/genta toxicity?

A

Ototoxicity
Nephrotoxicity

52
Q

What is measured in aminophylline THERAPEUTIC monitoring?

A

O2 sats

Toxicity moitoring: serum levels

53
Q

What should you do if significant WCC drop with methotrexate?

A

Manufacturer advises a clinically significant drop in white cell count or platelet count calls for immediate withdrawal of methotrexate and introduction of supportive therapy

54
Q

Before starting amiodarone?

A

CXR and K
TFTs and LFTs

55
Q

Theophylline monitoring?

A

Serum level 5 days after starting

- Y6 PSA (8 decks)

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