RPS Flashcards
When to wean corticosteroid doses
Taken more than 40 mg oral prednisolone daily or equivalent for more than 1 week.
Taken repeated evening doses of corticosteroids.
Received more than 3 weeks of corticosteroid treatment.
Recently received repeated courses of corticosteroids (especially if taken for longer than 3 weeks), such as short courses repeatedly prescribed for the treatment of acute exacerbations of asthma.
A history of previous long-term therapy (months or years).
Other possible causes of adrenal suppression, such as excessive alcohol consumption or stress.
Antibiotics for COPD exacerbation
Amoxicillin, Doxycycline, Clarithromycin
COPD exacerbation
Treatment duration: 5 days
Prednisolone in COPD vs Asthma exacerbations
COPD: 30mg OD for 5 days
Asthma: 40mg OD for 5 days
Theophylline-smoking
When patient quits smoking, their theophylline conc will rise.
Signs of theophylline toxicity
Vomiting Agitation Restlessness Arrhythmias Convulsions
Theophylline range
10-20mg/L or 55-110 micromol/L
When to measure plasma theophylline concentration after starting treatment
5 days after initiating
After initiating, take levels 4-6 hours after last dose
What electrolyte disturbance can be caused by aminophylline/theophylline?
Hypokalaemia, particularly in conjunction with salbutamol and steroids
Monitoring for aminophylline/theophylline
Plasma theophylline levels
Liver function
Potassium levels
Symptoms of an ulcer
Pain in stomach/back/neck- usually starts after eating Indigestion Heartburn/dyspepsia Loss of appetite Nausea and vomiting Weight loss
Symptoms of GI bleed
Vomiting blood
Black sticky stools (malaena)
Sharp stomach pain
Symptoms of anaemia- fatigue/fainting/breathless/palpitations
Endoscopy GI bleed
Do not give PPIs prior to endoscopy for patients with suspected non-variceal upper GI bleeding
Phenytoin conversion
100mg phenytoin sodium (tablets) approx equivalent to 92mg phenytoin base (liquid)
No dose switch needed between capsules to IV but IV has a shorter half life (300mg ON= 100mg IV TDS)
Risk of PPI use
Gastric cancer
GI infections
Fractures
Osteoporosis
