Random Tidbits Flashcards
Hepatic Encephalitis
Lactulose
Oral contraception for a smoker?
Desogestrel (POP = progesterone only pill)
Asthma management in children?
- SABA
- SABA + ICS (low dose)
- SABA + (low dose) ICS + LRTA
- SABA + (low dose) ICS + LABA
- Start the MARTs…
Low dose ICS = < 200 micrograms budesonide
LRTA = montelukast
Drug to give 9 hours after a stroke?
Aspirin 300mg
(Alteplase < 4.5 hours)
C Difficile management?
CKS - ‘Diarrhoea - antibiotic associated’
Paracetamol overdose?
- Measure @ 8 hours
- < 4 hours and > 150 mg = charcoal
- Treat according to graph
- 8-16 hours and > 75mg/kg start NAC while awaiting results
Statin interaction causing myopathy?
Clarithromycin
Drugs that cause diarrhoea?
- Alendronic Acid
- Lansoprazole
Maintenance fluids?
- 8-hourly bags (3L) BUT elderly/underweight = 12-hourly bags (2L)
- Add the potassium (divide by the 3 bags)
- 25-30 ml/kg/day of water
- 1 mmol/kg/day of potassium, sodium and chloride
- 50-100 g/day of glucose to limit starvation ketosis
- Adults generally require 3L IV maintenance fluids per day (8 hourly bags); 40-60 mmol KCL per day when NBM; 2 salt (saline) and 1 sweet (dextrose) every 24 hours
Hypoglycemic diabetic?
20% glucose 100 ml 20 minutes
Relieving oedema?
IV furosemide 40mg
Drug that causes flushing?
CCBs
What is normal urine output?
Average urine output should be approximately 0.5mL/kg/hour
Glycaemic control in stroke patients?
Tight glycaemic control has not been shown to improve outcome in stroke and current recommendations suggest maintaining plasma glucose in the range 5 to 15 mmol/L
Surgery and medication?
‘Surgery and long-term medication’ in treatment summary
Converting units?
Approximate Conversions and Units
Breakthrough pain?
- Palliative = treatment summaries
- Breakthrough pain = 1/6 of 24 hour dose given 4-hourly as required
Antidotes
‘Poisoning, emergency treatment’ on BNF
HRT
ESTRADIOL WITH NORETHISTERONE
COCP monitoring?
Blood Pressure
Transient rise in blood glucose caused by corticosteroids?
An increase in the usual insulin dose of 10% would be an appropriate way to manage a transient rise in blood glucose caused by corticosteroids
When is no change in Statin dose the appropriate management?
No change in dose is required, as after 3 months of treatment a > 40% reduction in non-HDL cholesterol has occurred
When should ACEi be taken?
Can give postural hypotension = best given in the evening
Hyperkalaemia management?
- Found in ‘treatment summary’ for ‘fluids and electrolytes’
- An intravenous injection of soluble insulin (5–10 units) with 50 mL glucose 50% given over 5-15 minutes
- E.g. Actrapid or Novorapid
Epilepsy treatment differences?
- Lamotrigine = in pregnancy
- Carbamazepine = causes SIADH
Initial drug therapy in T2DM?
Vomiting medications?
‘Nausea and labyrinth disorders’
LMWH contra-indications?
- Prophylactic heparin CIed in acute ischaemic stroke due to risk of bleeding into stroke (for at least 2 months)
- @ Risk of bleeding/recent ischaemic stroke/if patient has PAD (absent foot pulses) = no compression stockings – can cause acute limb ischaemia
Vancomycin side effects?
Ototoxicity + Nephrotoxicity
Statins management?
- LFTs checked before treatment, 3 months & 12 months
- CI if 3 x normal ALT/AST
- CI if 5 x normal CK
- CK monitoring only if risk factors
Adverse Drug Reactions: Low GCS or Acidotic?
Look for Metformin!
Which 2 drugs should NEVER be co-prescribed?
ACEi and NSAIDs
Neuropathic pain in an elderly person?
Paracetamol > Amitryptiline initially for neuropathic pain
Conversions?
- 1000 micrograms = 1 mg
- 1 microgram = 1000 nanograms
- 0.1% = 0.1 g per 100 mL = 100 mg per 100 mL = 1 mg in 1 ml
- 1% = 1g in 100ml (100g) = 10 mg in 1 ml
- 1 in 1000 = 1g in 1000ml
Severe lithium toxicity?
- Stop Lithium (severe toxicity = arrhythmia, seizure, renal failure)
- Stop Thiazide diuretics and ACEi and NSAIDs (= can cause decreased excretion via kidneys)
KCL maximum?
20mmol/hour
Levothyroxin dose changes?
Change levothyroxine doses in 25-50 microgram increments
Anaphylaxis treatment?
0.5mg of 1:1000; high flow oxygen FIRST (ABC); Chlorphenamine = 10mg IV
Which drug is CI in indigestion?
NSAIDs
COPD exacerbation managment?
1) Salbutamol nebs
2) Ipratropium bromide nebs 500mg
3) Prednisolone 30mg.
4) Non-threatening OBS + ABG = 24% Oxygen
BiPAP = Type 2 Respiratory Failure
CPAP = Type 1 Respiratory Failure
5) Aminophylline only if all other treatments failed = senior colleague observation required
Human Albumin Solution
Liver Failure (low-sodium content required)
Cough w ACEi. Management?
Change to a trial of an ARB
Monitoring of ACEi?
- After initiating ACEi: renal function and potassium should be checked 1-2 weeks later
- Creatinine baseline
- N.B. renal impairment can present as general malaise and fatigue
Abrupt cessation of steroids?
- Addisonian Crisis
- Prescribe a calcium tablet, and sometimes a bisphosphonate, as osteoporosis prophylaxis with steroids
Methotrexate monitoring?
Every 3-4 weeks (FBC, LFT, U&E) → neutropenia
Considerations w Statins?
- Avoid grapefruit juice when taking a statin
- Take statin at night
- Do not use statins in active liver disease
- Stop statins when a macrolide is prescribed.
Steroids prescription when ill?
STEROID PRESCRIPTIONS ARE DOUBLED during sepsis/illness → ‘sick day rules’
When should methotrexate be stopped?
Methotrexate should be stopped during active infection
Initial relief of indigestion?
Antacid (e.g. Magnesium Carbonate) for INITIAL RELIEF
Weak Opioids?
Codeine and Tramadol
What should you monitor w Aminophylline?
Monitor OXYGEN → improvement in saturations (asthma)
How to know if antibiotics are working in pneumonia?
Response to antibiotics = oxygen saturations, ABG, respiratory rate
- consolidation can take 6 weeks to clear
- crepitations take days to resolve
Tacrolium monitoring?
Trough
Fluoxetine monitoring?
- Hyponatremia
- First 2 weeks = check for suicidal ideation
- Assess for efficacy = 4 weeks
DKA monitoring?
serum ketones > serum glucose
Oxygenation in COPD?
- 88-92%
- Monitor w pulse oximetry
