Random Flashcards by alice Sawka

Fibromyalgia- first line med

Amitriptyline
Avoid opioid analgesia
Rreassurance and regular aerobic exercise

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Does the lancet think in acute back pain there is difference between panadol and placebo?

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Compare terms hyperaesthesia, dysaesthesia, paraesthesia, hyperalgesia, allodynia, hyperpathia

hyperaesthesia is increased sensation to stimulus (subgroups hyperalgesia, allodynia, hyperpathia)

parasthesia not unpleasant abnormal
dysaesthesia unpleasant abnormal

hyperalgesia- painful stimulus but extra pain
allodynia- pain from non painful stimulus
hyperpathia - pain from reped stimulus

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Describe codeine metabolism

Codeine is metabolised to morpine via CYP 2D6
May be absent in 10% caucasians
Can be uptrarapid metaboliser with +++ effect

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What is the effect of tramadol?

serotonin and noradrenaline reuptake inhibitor and mu opioid agonist

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How does tapentadol work/compare?

Mu opioid but weaker than morphine
NA reuptake inhibition
Better GI tolerability than oxxy
Cannot give with MAOi

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What is NNT for targin and constipation

NNT if already opiod const = 4

NNT otherwise = 14

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What is a 25 mcg/hr fent patch in morphine per day

90mg/day morphine

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Gabapentin target and pregabalin target?

alpha-2-delta subunit of calcium channels in brain and dorsal horn

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trigeminal neuralgia first line

carbamazepine

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painful diabetic neuropathy first line

duloxetine

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Post herpetic neuralgia first line

pregab or gabapentin or TCA

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Secondary causes of increased LDL

hypothyroidism
nephrotic syndrome
cholestasis
anorexia

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Causes of increase TAG AND HDLs

Oestrogen use

Alcohol

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Causes of increase TAG and HDL decrease

type 2 DM
obesity
renal imp
smoking

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Effect of fish oil on lipid profile

reduce TAG

no change LDL

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First line in LDL predominant

statin

ezetimibe second line

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Effect bile acid binding resin on TAG

increase

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What is the risk of statin plus nicotinic acid?

Increase risk rhabdo

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Which fibrate should you not combine with a statin?

Gemfibrozil

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TAG increase- first lineq

Fenofibrate or gemfibrozil
Or fish oil
NOT ok to use statin monotherapy

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What do you use first line if both LDL and TAG are up?

If TAG under 4 total then use statin

If over 4 then use fibrate first line

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What should your CK cutoff be?

tolerate up to 5 times ULN, mild muscle sx
Tolerate up to 3 x ALT LN

Also if asympt and up, should repeat after 7 exercise free days.

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If CK stays up after stop a statin, what should you do?

Consider hypothyroidism or NM disease

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Does statin cause diabetes

can impair glucose metabolism | sort of 1 in 1000

Fibrate effect on kidney

increase creatinine but no kidney effect; ok up to 30mmol or 30%

What is the MOA of oxybutynin?

Inhibits M2 and M3 receptors in bladder to stop muscarinic ACh action -->antispasmodic No antinicotinic effects Avoid in GI obst, narrow angle glaucoma, GORD

Which type of incontinence can you use oxybutynin?

Urge incontinence

What are the other types of antispasmodics, and how are they classified

There are nonselective antimuscarinics which act on M2 and M3 receptors eg oxybutynin and tolterodine. Can cross BBB to lead to less dizziness and cog symptoms There are M3 selective eg solifenacin. Cannot easily cross BBB- M3 selective, increase risk dry mouth at higher dose. Safer if over 65

If person who is 30 has spleen out, how to pneumovax 23 them?

Give 30, 35 and then at 65

If person who is 66 has spleen out, how to pneumovax?

Give at 66, then 71

If completely healthy caucasian 65 year old, how to pneumovaz?

Single dose at 65

How do ATSI rules differ for pneumovax?

The same except age 50 cutoff and revaccinate everyone twice

Are obesity, down sydrome and alcoholism considered Flu refundable?

EEG in delirium?

Background slowing

What is thought to be the brain imbalance in delirium?

Cholinergic deficiency and dopaminergic excess

Leading RF for delirium?

Dementia

what is tricky about DLB and dlirium

Both have fluctuating cognition and visual hallucinations

What is the drug of choice in delirium short term?

Haloperidol -be aware of extrapyramidal effects, long QT Quetiapine associated with increased death rates among dementia Benzos- worsen delirium

What stroke can present as a delirium?

Right parietal and medial dorsal thalamus

paget's most common location

pelvis >femur>lumabr>skull>tibia

What is the mutation in 5-10% sporadic paget's?

SQSTM1 mutation- encodes p62 which regulates osteoclass

What is the biochemical finding in paget's?

Increase ALP | hypercalcaemia if immobilised

Skull pagets can lead to...

deafness

Radiograph of pagets

focal osteolysis with coarse trabecular pattern, bone expansion, cortical thickening cotton wool appearance of skull RADIONUCLEOTIDE BONE SCAN MOST USEFUL

Do you treat pagets?

If pain-->antiresorptive If no pain-->no indication to treat If pain at pseudofracture site--> surgery

If you cannot use bisphosphonates in pagets due to renal impairment, what could you use?

Calcitonin

Aboriginal with paget's?

No! They don't get it!

Complications of paget's?

Sarcoma rare pain and deformity spinal cord stenosis patholgical fracture nerve root compression CN- ophthalmoplegia, facial and bulbar palsy, trigeminal neuralgia hearing loss from temporal bone involvement

Increase Ca and increase ALP vs Decrease Ca and increase ALP

mets, HPT osteomalacia, renal failure

Which is worse for falls risk? Psychoactive or antihypertensive?

Psychoactive Also 4 or more medications

How many times a year to fall to prevent one warfarin serious bleed?

300

What effect does delay to theatre have on hip fracture?

Double mortality with operative delay over 2 days

Hip fracture patients - how many never get home?

20% never get home 30% dead at one year

Most common form of incontinence in the elderly?

Urge and mixed urge/stress

Effect of anticholinergics on voiding

Reduced flow rate and increased residual colume

Cholinergics effect on incontinence

Cholinergics may precipitate or worsen urge symptoms and incontinence

What do calcium channel blockers do to your gut?

constipating (smooth muscle)

First line for stress incontinence?

Pelvic floor exervises Topical oestrogens can help with urethral atrophy NOT HRT Mid urethral sling last line- may make it worse so need urodynamics to rule out detrusor instability

Treatment for urge incontinence in cognitively intact?

Antimuscarinic (oxybutynin, solifenacin, tolteridone, darifenacin) - but peripheral anticholinergic effects

What is material risk?

Telling the patient about a risk that would change the PATIENT's mind about an intervention

Can you refuse palliative treatment as next of kin?

No Can refuse medical care but not palliative care Palliative treatment includes reasonable provision of food and water but PEG feeding is medical treatment