Random 2 Flashcards
Adrenally suppressed patients undergoing minor surgery should be managed how, in terms of their steroids?
Take normal steroid dose the morning of surgery, additional steroids not required
Adrenally suppressed patients undergoing moderate or major surgery should be managed how, in terms of their steroids?
Take usual steroid dose AND 25-50mg hydrocortisone IV on induction
25-50mg hydro IV tds for moderate surgery for 24 hours and 48-72 hours if major
How should OHA be managed the morning of surgery?
RUH tend to omit all OHA
How long is post-op VTE prophylaxis usually continued for?
If patients are high risk (i.e. they have one or more risk factors) then should give them LMWH prophylactic dose until mobility restored - consider to hip and knee replacements etc. that extended prophylaxis will be needed.
What weak opioid is preferred post surgery?
Dihydrocodeine (PLUS paracetamol as baseline)
codine - non metabolisers and tramadol now a CD
Your patient has been prescribed metoclopramide for PONV, when should this be given??
IT SHOULDNT BE - metoclopramide is ineffective for the management of PONV.
Switch patient to dexametasone or ondansetron and give 20-30mins before the end of surgery (therefore given IV)
Are antibiotics needed for clean procedures?
NO
A patient has AF, no bleeding and an INR of 8.0 - what do you do?
Stop warfarin and restart when INR <5
True or False, ACEi increased life expectancy in patients with CHF?
True
What are the preferred diuretics for the management of symptoms in CHF?
Loop diuretics
TCAs have anticholinergic side effects, give examples
Heart block, urinary retention, constipation, dry eyes
SSRIs in combination with MOAI can cause what/?
Serotonin syndrome
What is the target TC in patients with ACS started on atorvastatin?
No target
True or false - COPD is commonly associated with symptoms at night
False - asthma is though
When should alteplase be given in ischemic stroke? What does it target?
4.5 hours - activates tPa
What drug is the most frequently implicated in drug induced parkinsons?
Prochlorperazine
Why is prochlorperazine a concern in the elderly?
often prescribed for dizziness but can caused PD
Warfarin is associated with an increased risk of falls. True or false?
False - warfarin is often witheld (when it should be prescirbed!) because of the risk of falls, we should manage the falls risk instead
Dopaminergic drugs, such as co-beneldopa in PD can often have what side effects that are of concern in the elderly?
Can cause sudden excessive daytime sleepiness - careful dose titration required to avoid inducing confusion.
What is the ‘active’ thyroid hormone?
T3 (T4 converted to T3 in the peripheries)
What does the hypothalamus secrete in terms of thyorid hormone regulation?
TRH
Hypo or hyperthyroidism?: Bradycardia
Hypo
Hypo or hyperthyroidism?: warm, sweaty skin
Hyper
Hypo or hyperthyroidism?: constipation
Hypo
Hypo or hyperthyroidism?: weight gain
Hypo
Hypo or hyperthyroidism?: AF
Hyper
Why are anti-embolic stockings not used routinely in stroke patients?
Ineffective in reducing risk of DVT and increased risk of skin damage. Use intermittent pneumatic stockings instead
A blood pressure of 140/80 scores what (in terms of ponts) in the CHA2DSVasc scoring?
0 - BP of >140/90 is considered risk of stroke
True or False - Hallucinations is NOT a typical sign of dementia
False - patients with dementia experience hallucinations, agitatation, short term memory loss and often have poor self-care.
Why is it important to identify factors that can alter the plasma theophyline concentration (e.g. illness, smoking)
Very narrow therapeutic range
TIA management - acute and long term
- Aspirin 300mg STAT - oral or rectal
- SALT assessment and confirmation of diagnosis
- Clopidogrel 300mg loading dose
- 75mg clopidogrel thereafter
- Atorvastatin 80mg
- Manage hypertension - target is 130/80
Ischemic stroke management
- Aspirin 300mg STAT
- SALT assessment and diagnosis
- clopidogrel 75mg
- Atorvasatin 80mg as soon as patient can swallow
- Antihypertensive if needed target = 130/80
ABCD2 score, is used for what? What does it stand for?
Used to assess someone’s risk of future stroke following a TIA
A- age >60 years
B - blood pressure 140/90
C- clinical symptoms - unilateral weakness (2), speech disturbance and no weakness (1), other symptoms (0)
D - diabetes (1)
or duration of symptoms >59mins (2), 10-59 (1) and <10 is 0.
Blood pressure target in pregnancy?
150/90 or 140/90 is diabetic or has CKD
Diabetes BP target?
140/90
lower 130/80 if target organ damage
BP target following TIA/Stroke?
130/80
Outline some of the issues associated with a person taking long-term steroids (think short and long term)
Immunosuppresion Osteoporosis Adrenal suppresion Cushings syndrome Depression
