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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
NSAIDs contraindications? “NSAID” mnemonic
No urine (AKI) Systolic dysfunction (HF!) Asthma Indigestion Dyscrasia (abnormal platelets)
26
Max percentage increase of baseline morphine per day?
30-50%
27
What to give instead of morphine in AKI?
Oxycodone (liver metabolism)
28
What is the route of sliding scale insulin?
IV infusion
29
What kind of insulin is Novomix 30?
Short and medium combo
30
Use of antidiabetic medication during surgery?
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
If Cr >150 what T2DM tx 1st line?
Gliclazide
32
Glucose target in surgery diabetes?
6mmol - if below give 20% glucose
33
When to start dextrose in DKA?
If glucose <14
34
How do you calculate osmolarity?
osmolarity = 2 (Na+) + 2 (K+) + Glucose + Urea
35
How do you calculate anion gap?
Na⁺ + K⁺ – (Cl⁻ + HCO₃⁻)
36
Weight loss antihyperglycaemics?
Metformin GLP1 SGLT2
37
Weight gain antihyperglycaemics?
Insulin Sulfonylureas Thiazolidinediones
38
What type of insulin is Humulin?
Biphasic
39
BB in diabetes?
Reduce hypoglycaemic awareness
40
What reduces levothyroxine effects?
Iron and Calcium reduce absorption so wait 4 hours after or 2hrs before
41
What type of insulin is Humalog?
Rapid acting
42
Name 2 basal insulins.
Isophane Determir/levermir Glargine/Lantus
43
EPSEs?
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
Most serious EPSE?
Tardive dyskinesia -may be irreversible
45
Best antipsychotic to avoid EPSE, ↑ QT interval, sexual dysfunction, ↑ glucose?
aripiprazole
46
Tx of Alzheimer's?
1st line - donepezil or rivastigmine or galantamine 2nd line - memantine (NMDA antagonist)
47
Tx of anti-psychotic induced parkinsonism?
Procyclidine (anti-cholinergic)
48
4 drugs with narrow therapeutic window?
digoxin theophylline lithium phenytoin Abx (gentamicin and vancomycin) NOT clozapine - monitoring is for FBC
49
Lithium target levels?
0.4–1 12hrs post-dose
50
Phenytoin toxicity?
Gum hypertrophy Ataxia Nystagmus Peripheral neuropathy
51
Vanc/genta toxicity?
Ototoxicity Nephrotoxicity
52
What is measured in aminophylline THERAPEUTIC monitoring?
O2 sats Toxicity moitoring: serum levels
53
What should you do if significant WCC drop with methotrexate?
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
Before starting amiodarone?
CXR and K TFTs and LFTs
55
Theophylline monitoring?
Serum level 5 days after starting

- Y6 PSA (8 decks)

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