Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Diploma exam > Random > Flashcards

Random Flashcards

You may prefer our related Brainscape-certified flashcards:
WSET® Level 4 Wine flashcards
1
Q

Which troponins are specific to cardiac muscle?

A

Troponin T and Troponin I

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

A troponin level should be taken when? What level is considered significant?

A

Levels should be taken on arrival, then at 30 minutes and 1 hour. A normal level is <30
If above 100 = strongly indicative of myocardial damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Why is creatinine kinase not measured routinely in patients with suspected MI?

A

Not selective for myocardial damage as also found in skeletal muscle. Exercise can cause levels to raise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Outline initial management of ACS

A 
Aspirin 300mg STAT
Morphine IV for pain
Metoclopramide
PO betabocker
Tight glucose control
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Duration of DAPT in patient with bare metal stent?

A

1 month only

if patient has had an MI event, then DAPT automatically defaults to 1 year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Duration of DAPT in patient with drug eluting stent?

A

12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How to beta blockers work?

A

B1/B2 adrenoreceptor antagonists
Reduces the sympathetic stimulation on the heart and cardiovascular system
Reducing myocardial contractility and oxygen demand, this reduces the stress on the myocardium and prevents further ischemic damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Name the cardioselective beta blockers

A

Atenolol, bisoprolol or metoprolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why might eplenerone be preferred in men (instead of spironolactone)?

A

Spironolactone can cause breast tenderness and swelling. Doesn’t occur with eplenerone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When are aldosterone antagonists recommended post MI?

A

Recommended by NICE for patients with evidence of heart failure (EF<40%) POST mi
Start within 3-14 days of event
Eplenerone is a licensed for this indication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is paroxysmal AF?

A

Episodes lasting longer than 30 seconds but less than 7 days, they are self-terminating and recurrent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is persistent AF?

A

AF episodes lasting longer than 7 days require pharmacological or electrical cardioversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is permanent AF?

A

AF that failure to terminate using cardioversion, or relapses within 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Causes of AF

A

Hypertension, coronary artery disease and myocardial infarction
Congestive heart failure, rheumatic valvular disease
Acute infection, electrolyte depletion, cancer, pulmonary embolism, diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

HASBLED

A 
Hypertension
Abnormal liver/renal function
Stroke
Bleeding 
Labile INR
Elderly - over 65 years
Drugs (antiplatelet agents or NSAIDs)
Harmful alcohol consumption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Beta blocker adverse effects

A

Bradycardia, bronchospasm, cold extremities, conduction disorders, dizziness, fatigue, sleep disturbances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which beta blocker is less likely to cause sleep disturbances?

A

Water soluble beta blocker - atenolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Diltiazem side effects?

A

Dizziness, GI disorders, fatigue, flushing, headaches, ankle swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Verapamil side effects?

A

Constipation, nausea, vomiting, dizziness, fatigue, flushing, headaches, ankle swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Digoxin therapeutic range

A

0.7ng/ml -2ng/ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When should digoxin levels be taken?

A

At least 6 hours post dose

Ideally 8-12 hours afterwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Amiodarone baseline monitoring

A 
Thyroid function tests 
LFTs
Potassium 
Chest x-ray 
ECG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Amiodarone adverse effects

A

Pulmonary toxicity inc. pneumonitis and fibrosis
Thyroid dysfunction (hypo or hyperthyroidism)
Visual disorders (corneal microdeposits)
Photosensitivity reactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Amiodarone + colestyramine interaction

A

Colestyramine reduces amiodarone levels buy 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Amiodarone + digoxin interaction

A

Amiodarone may increase plasma levels of digoxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Amiodarone + simvastatin interaction

A

Increases simvastatin levels, max recommended dose is 20mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Amiodarone + warfarin interaction

A

Amiodarone increases the anticoagulant effects of warfarin. Monitor INR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

NYHA Class I definition

A

No limitation on physical activity. Ordinary physical activity does not cause undue fatigue, breathlessness or palpitations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

NYHA Class II definition

A

Slight limitation of physical activity. Comfortable at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

NYHA Class III definition

A

Marked limitation of physical activity, less than ordinary physical activity results in undue breathlessness etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

NYHA Class IV definition

A

Unable to carry out any physical activity without discomfort, symptoms at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Outline initial heart failure management

A 
Loop diuretics
Start ACEi and BB
Consider anti-platelet
Prescribe statin
Refer to exercise based rehab programme
Offer annual flu vaccine and once only pneumococcal vaccine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Patient heart failure advice

A 
Monitor weight at home
Max salt consumption 6g/day avoid LoSalt products
Fluid restriction to 1.5-2L/day
Sick day rules regarding ACEi and ARBs
Smoking cessation 
Alcohol consumption 
Physical activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Which beta blockers are licensed in heart failure?

A

Bisoprolol, carvediolol and nebivolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

When should beta blockers be started in heart failure?

A

Should only be started once a person is stable - without fluid overload or hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Outline potassium monitoring after starting ACEi/ARB

A

Monitor baseline potassium - do not initiate treatment if K+ >5mmol/L
Recheck in 1-2 weeks - stop if K+ is above 5.5mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Stage 1 hypertension

A

clinic bp 140/90mmHg

and ABPM 135/85mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Stage 2 hypertension

A

clinic BP 160/100mmHg or ABPM 150/95mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Stage 3 hypertension

A

180>mmHg or diastolic BP >120mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Step 1 antihypertensive treatment

A

< 55 years - ACEi or an ARB

or >55 years or black african/caribbean offer a CCB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Step 2 antihypertensive treatment

A

ACEi/ARB +CCB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Step 3 antihypertensive treatment

A

ACEi + CCB + thiazide like diuretic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Step 4 antihypertensive treatment

A

ACEi + CCB + thiazide-like diuretic
If K+ <4.5 consider low-dose spironolactone
If K+ >4.5 consider an alpha or beta blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Management of angina attack

A

Stop what they are doing and rest
Use GTN spray/tablets
Take a second dose after 5 minutes if pain has not eased
Call 999 if pain has not eased 5 minutes after the second dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

First line treatment for angina

A

Beta blocker or a rate limiting calcium channel blockers
aspirin 75mg OD
Statin
Treat hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

When should asthma treatment be stepped up from a SABA?

A

Patient has used an inhaled SABA three times a week or more, have asthma symptoms 3 times a week or more, are woken up at night by asthma symptoms once or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Patient on SABA PRN + low dose ICS. What is the next step of treatment?

A

Consider LTRA

Offer LABA in combination with ICS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

How to decrease asthma maintenance therapy?

A

Consider decreasing therapy if asthma has been controlled for at least 3 months
Decrease dose by 25-50% each time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Prednisolone dose for acute asthma exacerbation

A

40-50mg for 5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Baseline monitoring before starting theophylline therapy

A

Urea and electrolytes - particularly K+

Liver function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Target theophylline concentration

A

10-20mg/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Examples of factors that increase theophylline half life

A

Fever, heart failure, elderly and hepatic impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

COPD diagnosis

A

Symptoms and spirometry (post bronchodilator FEV1/FVC less than 0.7)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is cor pulmonale?

A

Right sided heart failure secondary to lung disease - caused by pulmonary hypertension as a consequence of hypopoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

When is a VRIII indicated peri-operatively?

A

If starvation period >one meal and usually on insulin
OR
If usually non-insulin managed only use VRIII if BMs>12 for >2 hours and pt is NBM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

How should a VRIII be prescribed?

A

Humuan soluble insulin 50 units in 50mL
Always continue long acting insulin
Run with glucose 5%
Run with potassium in fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Outline warfarin management peri-operatively

A

Stop 5 days pre-op

If bridging required (MVR, recurrent DVT/PE, high risk AF) then switch to treatment dose LMWH on day 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Average daily fluid requirements

A

25-30ml/kg/day

For obese patients adjust to IBW

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

How often should children have their BMs checked?

A

5 times a day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

How often should type 1 diabetics monitor their BMs?

A

At least 4 times a day, monitor more frequently during periods of illness, stress etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

How often should type 2 diabetes monitor their BMs?

A

Not routinely required - only necessary if patient on insulin or there is evidence of hypoglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

When should ketones be tested in diabetes?

A

Urine ketone testing is not recommended as it is imprecise and cumbersome
Ketones are not routinely checked but are considered part of sick day rules -
Ketones should be checked when BG levels >14mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Management of suspected TIA

A

Give aspirin 300mg immediately and continue until diagnosis established

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

When should anticoagulants be started following an AF-related stroke?

A

Patients should receive aspirin 300mg for 2 weeks before being considered for anticoagulant treatment
Patients already receiving anticoagulation are at significant risk of haemorrhagic transformation and should have their anticoagulant treatment stopped for 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Should you treat hypertension in acute phase of stroke?

A

Treatment of hypertension in the acute phase can result in reduced cerebral perfusion and should therefore only be instituted in the event of a hypertensive emergency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Secondary prevention following ischeamic stroke or TIA

A

Long term clopidogrel
if clopidogrel C/I prescribe M/R dipyridamole in combination with aspirin
High intensity statin 48 hours after stroke onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Blood pressure target following the acute phase of ischaemic stroke?

A

Target BP <130/80mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

How does aspirin work as an antiplatelet?

A

Irreversibly inhibits cyclo-oxygenase and blocks the production of thromboxane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

How does clopidogrel and ticagrelor work?

A

Thienopyridines
They inhibit the binding of adenosine into erythrocytes, platelets and endothelial cells, resulting in an increased extracellular concentration of adenosine, which is a potent inhibitor of platelet activation and aggregation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is parkinsons disease?

A

PD is a chronic, progressive neurodegenerative condition resulting from the loss of the dopamine containing cells of the substantia niagra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Why should ergot derived dopamine agonists not be used first line?

A

Risk of cardiac fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Dopamine receptor side effects

A

Excessive sleepiness, hallucinations and impulse control disorders are more likely to occur with dopamine-receptor agonists then with levodopa
Risk of postural hypotension - monitor blood pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What type of drug is selegiline?

A

Monoamine oxidase B inhibitor

74
Q

How should entacapone be prescribed?

A

Prevents the breakdown of levodopa by inhibiting catechol-O-methyltransferase should be prescribed in adjunct to levodopa for patients with ‘end-of-dose’ motor fluctuations

75
Q

First line treatment for status epilepticus?

A

Benzodiazepine- IV lorazepam

or buccal midazolam or rectal diazepam solution

76
Q

2nd line treatment for status epilepticus?

A

Phenytoin or phenobarbitol

77
Q

Which antipsychotics are most commonly associated with extrapyramidal symptoms?

A

Fluphenazine, prochlorperazine, haloperidol

78
Q

Which antipsychotics might be preferred in a patient not wanting side effects from hyperprolactinaemia (sexual dysfunction, breast enlargement)

A

Aripiprazole (partial dopamine agonist)

79
Q

Which antipsychotics are most commonly associated with sexual dysfunction? Why does sexual dysfunction occur?

A

Risperidone
Haloperidol
Occurs due to reduced dopamine transmission and hyperprolactinaemia

80
Q

Which antipsychotics commonly cause weight gain?

A

Clozapine

Olanzapine

81
Q

Which class of antipsychotics might be preferred to treat negative symptoms of schizophrenia?

A

Second generation (atypical) antipsychotics

82
Q

Antipsychotics with a reduced tendency to prolong QT interval

A 
Aripiprazole
Amisulphride
Clozapine
Fluphenazine
Olanzapine
83
Q

How is clozapine dose titrated?

A

12.5mg 1-2 times a day on day 1, 25-50mg day 2, then increased in steps of 25-50mg daily. Max dose 900mg
If doses are missed for more than 48 hours then will need to be retitrated

84
Q

Clozapine monitoring

A

Weekly FBC for 18 weeks
Then at least every 2 weeks for 1 year.
After 1 year - if stable can reduce to 4 weekly monitoring
Blood lipids and weight should be measured at baseline, at 3 months and then yearly
Fasting blood glucose baseline, at 4-6 months and then yearly

85
Q

Treatment of variceal haemorrhage

A

Terlipressin IV

Prophylactic beta blocker such as propranolol

86
Q

What causes ascites?

A 
Portal hypertension (results in an increased circulating volume) 
Decreased metabolism of aldosterone encourages sodium and water retention 
Decreases albumin synthesis reduces the oncotic pressure which results in fluid accumulating in tissues
87
Q

Management of ascites

A

Sodium restriction

Spironolactone - aim for weight loss of 0.5kg/day (or 1kg/day if peripheral oedema is present)

88
Q

How is spontaneous bacterial peritonitis (SPB) diagnosed and treated?

A

Ascitic neutrophil count >250 cells/mm3
Rx antibitoics - ceftriaxone 2g IB BD or ciprofloxacin
May need albumin infusion

89
Q

What causes hepatorenal syndrome?

A

portal hypertension leads to peripheral vasodilation
This drop in blood pressure activates the renin-angiotensin pathway
Results in renal vasoconstriction and AKI

90
Q

Management of coagulopathy

A

IV vitamin K 10mg for up to 3 days
Do not give PO as absorption is impaired in cholestasis
IM not recommended due to risk of haematoma

91
Q

Azathiopurine and allopurinol interaction

A

Allopurinol increases levels - reduce azathiopurine dose to one-quarter of usual dose

92
Q

MRSA treatment options

A

Resistant to flucloxacillin
Glycopeptides e.g. vancomycin
Clindamycin
Linezolid in combination with other antibacterials

93
Q

Signs and symptoms of hyperthyroidism

A

TSH low
T3/4 high
Increased irritability, sweating, tremor, lethargy, tachycardia, palpitations, arrythmia

94
Q

Signs and symptoms of hypothyroidism

A

Low T3/4
TSH high
Lethargy, pale skin, slow speech, constipation, bradycardia, cold intolerance, weight gain

95
Q

How is urea produced?

A

Break down to amino acids

96
Q

What factors can increase urea levels?

A

Impaired renal function, dehydration, GI bleed, increased protein breakdown (post-op, trauma, infection), high protein diet, starvation-> increased catabolism

97
Q

What factors can decrease urea levels?

A

Malnutrition, liver disease, pregnancy

98
Q

Why does dehydration increase urea levels?

A

Urea is an osmotic diuretic, and so is reabsorbed in dehydrated states.
Therefore can be used to interpret someones fluid status - if urea raised but creatinine isn’t then pt is likely dehydrated

99
Q

Management of hyperkalemia

A

1) IV calcium gluconate 10% - stabilises myocardial membrane, has no effect on K+ levels. Do not give if Ca>3mmol/L or if pt has digoxin toxicity
2) Insulin-glucose infusion - 10 units of actrapid in 50mL of glucose 5%. Shifts potassium into cells
3) Salbutamol 10mg via nebuliser. Shifts potassium into cells

100
Q

Why is sodium chloride the preferred diluent for IV potassium replacement?

A

If replace with glucose 5% then this stimulates insulin production and further reduces potassium levels

101
Q

When might high concentration potassium be appropriate? i.e. 40mmol in 500mL

A

Patients with fluid restriction - should be given via central vein. Not to be used for rapid K+ replacement

102
Q

Signs of hypernatremia

A

extreme thirst, headache, confusion, nausea and vomiting, lethargy, seizures, nystagmus, loss of consciouness

103
Q

Causes of hypernatremia

A

Most common cause if water depletion - either inadequate intake or excessive loss
Diabetes insipidus
Low fluid intake commonly in elderly/dementia

104
Q

Causes of hyponatremia <130mmol/l

A

renal losses such as diuretics, hypoadrenalism
diarrhoea, vomiting, burns
SIADH
Oedematous states - cirrhosis, congestive heart failure

105
Q

Signs and symptoms of low Mg (<0.75mmol/L)

A

Cramps, tetany, paraesthesia (pins and needles), convulsions, arrythmias and ECG changes

106
Q

Causes of high mg (>1.5mmol/L)

A

Renal failure or Mg administration

107
Q

Signs of high Mg

A

K+ level >1.5mmol/L

Nausea, flushing, headache, lethargy, drowsiness, hypotension, respiratory failure

108
Q

Management of raised calcium levels

A

Rehydrate with NaCl 0.9%

Zolendronic acid 4mg over 15 minutes

109
Q

Limitations of the cockcroft-gault equation

A

Does not account of differences in race
Does not account for muscle mass
Calculations are based on steady state - less useful in acute renal failure
Inaccurate at extremes of body weight - may need to use adjusted body weight

110
Q

What causes acidosis in CKD? How is it treated?

A

In CKD the kidneys are less able to excrete H+ and re-absorb HCO3-
Rx PO sodium, bicarbonate 1g TDS
Give IV in acute setting
Caution as increased Na levels will cause fluid retention.

111
Q

Prothrombin time reference range

A

10-14 seconds

112
Q

Describe the different types of enteral feeding tubes

A
  1. Nasogastric (NG) - Inserted through the nose into the stomach. For short term use only, up to 4 weeks. Long fine bored tubes which can block easily
  2. Percutaneous endoscopic gastrostomy (PEG) - inserted directly through the abdominal wall. For long term feeding, shorter with a wider bore
  3. Percutaneous endoscopy jejunostomy (PEJ)
113
Q

Standard questions to ask when asked about administration of medications

A

Why can’t the medications be given orally
Why type of enteral tube does the patient have?
How long will the patient be NBM?
What the doses of the drugs and their indications?
Does the patient have IV access?
Is there any reason why alternative routes would be inappropriate e.g. ongoing diarrhoea and PR

114
Q

Define type A ADR reaction

A

A = augmented
Result from an exaggeration of a drugs normal physiological actions when given at the usual therapeutic dose and are normally dose dependent
Examples: opioids and respiratory depression, warfarin and bleeding, dry mouth and TCAs

115
Q

Define type B ADR reaction

A

B = bizarre
Novel responses that are not expected from the known pharmacological actions of the drug
These are less common, so may only be discovered for the first time after a drug has already been made available for general use

116
Q

Define type C ADR

A

C = continuing

Reactions which persist for a relatively long time e.g. osteonecrosis of the jaw and bisphosphonates

117
Q

Define type D ADR

A

D = delayed
become apparent sometime after the use of a medicines
The timing of these make them more difficult to detect
e.g. leucopenia can occur up to six weeks after a dose of lomustine

118
Q

Define type E reactions

A

E = end of use

Reactions associated with the withdrawal of a medicine

119
Q

What adverse drug reactions should be reported via the yellow card scheme?

A

New medications under the black triangle scheme (usually for 5 years)
All reactions that a serious/medically significant/result in harm
Medications taken during pregnancy
Medications used in children

120
Q

What factors should be considered when predicting the compatibility of two injectable medications?

A
  1. pH - is the pH similar? Drugs with very different pH values are less likely to be compatible
  2. Are chemically similar drugs compatible?
  3. Do the injections have a similar formation? aqeuous vs lipid
  4. Are any of the injections new products? may have limited data
  5. What concentrations are being used?
  6. What diluents are being used?
121
Q

What are the four different types of RRT?

A
  1. Haemodialysis
  2. Haemofiltration
  3. Haemodiaflitration
  4. Peritoneal dialysis
122
Q

Outline haemodialysis

A

Dialyser is composed of thousands of hollow synthetic fibres which acts as a semi-permeable membrane
Water, waste products and excessive electrolytes move from the blood into the dialysis solution via DIFFUSION
Essential nutrients from the dialysis solution enter the blood via diffusion

123
Q

Outline haemofiltration

A

Similar to HD. The blood is pumper through a dialyser, however a negative pressure is applied to the dialysate, causing solutes to move across a pressure gradient, as opposed to diffusion
More aggressive than HD

124
Q

Outline peritoneal dialysis

A

In PD the inside lining of the peritoneum acts as a natural filter
A catheter is placed in the abdomen surgically
Sterile dialysate is then put into the peritoneum
waste diffuses into the dialyslate

125
Q

What are the principles of homeopathy?

A
  1. Like cures like - a patients symptoms are treated with a substance that could cause the same symptoms, but only a tiny dose is used
  2. The more dilute a preparation is, the more potent it is
126
Q

Chloroquine is contraindicated in which patients?

A

Patients with epilepsy

Patients taking amiodarone (increased risk of ventricular arrhythmias)

127
Q

Mefloquine is contraindicated in which patients?

A

People with current or previous hx of depression
Generalised anxiety disorder, psychosis
Epilepsy

128
Q

Mefloquine monitoring

A

More LFTs and eye assessments for visual disorders

129
Q

Can patients be administered more than one vaccine at a time?

A

Yellow fever and MMR - a four week minimum interval period should be observed between administration. Should not be administered on the same day as can lead to a sub-optimal antibody response
Varicella and MMR - can either be administered on the same day, or requires a 4 week interval

No other restrictions

130
Q

Which guide outlines travel vaccine advice?

A

The green book

131
Q

The presence of post void residual volume greater than 30mL indicates what?

A

Obstruction and post-renal AKI

132
Q

Why can sepsis result in AKI?

A

Leads to diversion of the blood to the peripheries away from essential organs

133
Q

Linezolid monitoring requirements

A

Weekly FBC

134
Q

Daptomycin monitoring requirements

A

Monitor creatine phosphokinase before treatment and then at least weekly
Monitor more frequently in patients at higher risk of developing myopathy e.g. renal impairment, taking statins
Monitor renal function

135
Q

Chloramphenicol monitoring requirements

A

Monitor plasma concentrations in elderly and children <4 years
FBC before and during treatment

136
Q

What is the difference between gram positive and negative bacteria?

A

Gram +ive bacteria have thick peptidoglycan layer, non outer membrane

Gram -ive outer membrane is present

137
Q

When would you expect to use the IV route for antimicrobial therapy?

A

For patients who are strictly NBM
Patients with a non-functional GI tract or malabsorption
For life threatening infections or severe sepsis
For patients with serious deep seated infections

138
Q

Amoxicillin might sometimes be attributed to the development of a rash in patients with what specific infection?

A

Glandular fever (Epistein-barr virus)

139
Q

List the sepsis 6

A
  1. Give fluids
  2. Give oxygen
  3. Give broad spectrum iv abx
  4. Take blood
  5. Check lactate
  6. Urine output measurement
140
Q

What is defined daily dose? or ddd?

A

The DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults. Gives a rough estimate of consumption

141
Q

Can nitrofurantoin be given in pregnancy?

A

Yes with caution - avoid in third trimester (specifically after 37 weeks) due to risk of neonatal haemolysis

142
Q

Can nitrofurantoin be given for pyelonephritis?

A

Not recommended as does not reach therapeutic concentrations in the upper urinary tract

143
Q

How should tazocin be administered?

A

Over at least 30 minute infusion

bolus injection is not appropriate

144
Q

What is the only treatment that slows progression of copd?

A

Smoking cessation

145
Q

Oxygen target saturations in COPD?

A

88-92%

146
Q

Dose and duration of prednisolone to treat COPD exacerbation

A

30mg 7-14 days

147
Q

What is roflumilast? When is it indicated?

A

Phosphodiesterase inhibitor with anti-inflammatory properties
May be used in severe COPD - pt with post bronchodilator FEV <0.5 and more than 2 exacerbations in last 12 months despite triple inhaler therapy

148
Q

Suggested first line antidepressant in adolescents

A

Fluoxetine (as licensed)

149
Q

Suggested first line antidepressant in hepatic disease

A

Paroxetine (short half life)

150
Q

Suggested first line antidepressant in cardiac disease

A

Sertrlaine

Avoid citalopram and escitalopram
Avoid TCAs

151
Q

Examples of drugs implicated in serotonin syndrome

A

SSRIs, SNRIs, sumatriptan, MAOIs, linezolid, tramadol, St Johns Wort, amphetamines

152
Q

Signs and symptoms of serotonin syndrome

A

Changes in mental state - feeling confused, agitated and/or restless
Physical symptoms - sweating, diarrhoea fever, tachycardia
Seizures and fits

153
Q

Which medication might be a suitable option for a patient with depression complaining of sexual dysfunction?

A

Mirtazipine

154
Q

What foods should be avoided with phenelzine?

A

Phenelzine = MAOI

Avoid matured foods e.g. cheese, wine, marmite

155
Q

Which hypnotic might be useful for someone with insomnia who has to work the next morning?

A

Zolpidem - has shortest half life

156
Q

After how many missed days should lamotrigine therapy be retitrated?

A

Retitrate is more than 3 days missed

157
Q

Prochlorperazine MOA?

A

Dopamine D2 antagonist

158
Q

Max rate of IV potassium chloride when administered peripherally?

A

10mmol/hr

159
Q

Max concentration of IV potassium chloride that can be administered via peripheral line?

A

The concentration of potassium for intravenous administration via a peripheral line should not exceed 40mmol/L, as higher strengths can cause phlebitis and pain.

160
Q

Dalteparin mechanism of action

A

Binds to antithrombin III

Antithrombin III usually activates factor Xa and thrombin, therefore LMWH causes inactivation of Xa

161
Q

Apixaban mechanism of action

A

Direct Xa inhibitor
This prevents conversion of prothrombin to thrombin
Prevents conversion of fibrinogen to fibrin

162
Q

Candesartan mechanism of action

A

Angiotensin II receptor blocker
Stops binding to Angiotensin II to AT1 receptor - this prevents vasoconstriction and inhibits the release of aldosterone –> therefore reduces sodium retention

163
Q

Aspirin mechanism of action

A

Inhibits COX-1 enzyme

COX-1 usually converts arachidonic acid to prostagradlin H2 and thromboxane A2

164
Q

NICE Asthma guidance - adults

A 
Step 1 - SABA
Step 2 - SABA + low dose ICS
Step 3 - consider LTRA
Step 4 - ICS/LABA +/- LTRA
Step 5 - Switch to MART regimen 
Step 6 - increase to moderate dose ICS
165
Q

NICE asthma guidance in children 5-16 years

A

Step 1. SABA
Step 2. Low dose ICS
Step 3. ICS + LTRA
Step 4. ICS/LABA + LTRA

166
Q

Advise nurse on how to administer IV phenytoin

A

Dilute in 50-100mL of saline (do not mix with glucose as precipitates)
Max conc in 10mg/ml
Administer slowly through large vien - max rate is 50mg/min, using an inline filter of 0.22-0.50microns
Monitor ECG and blood pressure
Check infusion site of complications and monitor for phlebitis
Flush line before and after administration

167
Q

ACE inhibitor and renal function advice

A

If serum creatinine levels rises by more than 20%
or eGFR decreases by 15% remeasure in 2 weeks

If serum creatinine increases by 30-50% OR to over 200 or eGFR decreases by 30% then this should prompt dose reduction/stopping

If serum creatinine increases by more than 100% or to greater than 310umol stop ACEi

168
Q

Lifestyle advice for GORD

A 
Weight loss
Avoid trigger foods - spicy/fatty foods
Eating smaller meals, eat last meal 3-4 hours before bed
Stop smoking
Reduce alcohol consumption 
Sleep with head of bed raised - put bricks under bed
Assess for stress and anxiety 
Review medications that might cause 
Prescribe PPI
169
Q

What factors should be considered when reviewing if a medication is safe to give while breastfeeding?

A
  1. Maternal systemic exposure i.e. PO vancomycin is not absorbed systemically
  2. Lipophillicity - lipophillic drugs can cross the epilethium
  3. Neonatal clearance - renal/liver is not fully matured, medications with short t 1/2 is preffered
  4. Neonatal toxicity - avoid known toxic drugs
  5. Acid-base balance - breast milk is slightly acidic, this ionises weak bases, makes them water soluble so unable to pass back into blood stream and accumulates in the breast milk
  6. Protein binding - highly protein bound drugs are less likely to pass intro breastmilk
  7. Consider whether drugs inhibit lactation
170
Q

Severe COPD is defined as?

A

FEV1% predicted <30%

171
Q

Most common causative organisms of cellulitis

A

Staph. aurea

Strep pyogenes

172
Q

How do NSAIDs work?

A

Inhibit COX-1 and COX-2 enzymes to reduce prostaglandins

COX-1 inhibitors e.g. low dose aspirin, are associated with highest risk of bleeding

COX-2 inhibitors e.g. celecoxib results in cardiac side effects

173
Q

How does naloxone work?

A

It is a semi synthetic opioid antagonist that acts competitively at opioid receptors. It has a very high affinity for opioid receptor sites so displaces agonist and partial agonists.

174
Q

How does buprenorphine work?

A

Partial opioid agonist
Acting at mu opioid receptor
Also a kappa receptor weak antagonist

175
Q

How does tramadol work/?

A

Mu opioid receptor agonist

weak inhibition of the uptake of serotonin and noradrenaline

176
Q

How does moxifloxacin work?

A

Inhibits topoisomerase II (DNA gyrase) and topoisomerase IV. Enzymes are essential for DNA replication, repair

177
Q

How does cefalexin work? What type of antibiotic is it?

A

First generation cephalosporin
Bind to penicillin binding proteins to prevent cell wall formation
(Gram positive bacteria have thick cell wall. Less effective against gram negative because they have an outer membrane surrounding the cell wall)

178
Q

How does simvastatin work?

A

Inhibits HMG-COA reductase in the liver
Results in reduced production of mevalonate - rate limiting step in cholesterol biosynthesis. Leads to reduced cholesterol
Decreased hepatic cholesterol concentrations leads to upregulation of LDL receptors which increases uptake of LDL

179
Q

How does spironolactone work?

A

Competitively inhibits aldosterone dependent sodium=potassium exchange in the distal convoluted tubule to promote Na and water excretion and K+ retention.

180
Q

How does warfarin work?

A

Warfarin is a vitamin K antagonist
It inhibits the production of vitamin K by vitamin K epoxide reductase
The reduced form of vitamin K is usually involved in the carboxylation of coagulation factors 2, 7, 9 and 10
Uncarboxylated factors are inactive

181
Q

How does fluphenazine work?

A

First generation antipsychotic

Blocks dopamine D1 and D2 in the mesolimbic pathway

182
Q

How does metformin work?

A
  1. Decreases hepatic glucose production - gluconeogenesis
  2. Decreased intestinal absorption of glucose
  3. Increased insulin sensitivity by increasing peripheral glucose uptake

Diploma exam (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions