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SCRIPT modules Flashcards

1
Q

what drug causes ‘red man syndrome’

A

vancomycin when injected as bolus (too rapid)

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2
Q

what drugs are assoc w worsening gouts?

A

thiazides (hyperuric)

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3
Q

which drugs can exacerbate existing urticaria?

A

NSAIDs

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4
Q

someone gets angio-oedema on a longstanding ACEi. what can you switch them to?

A

ARB

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5
Q

give an example of a first gen cephalosporin

A

cefalexin

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6
Q

give two examples of third gen cephalosporins

A

cefotaxime

ceftriaxone

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7
Q

which kind of cephalosporins are worse at cross reacting with penicillin ?

A

first generation (e.g. cefalexin)

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8
Q

in penicillin allergy, which drugs are CONTRAINDICATED?

A

Penicillin and first gen cephalosporins

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9
Q

in pen allergy, which drugs are CAUTIONED?

A

third gen cephalosporins, monobactams, carbapenems

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10
Q

how long should anaphylaxis pts be observed before discharge?

A

6-12hrs

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11
Q

what reduces risk of radiocontrast reaction?

A

pre-dosing w corticosteroids and anti-histamine

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12
Q

what drug can you give for mild/mod allergic reactions?

A

chlorphenamine 4mg

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13
Q

500mcg IM adrenaline for adult with anaphylaxis. what about a child <12? <6?

A

<12: 300mcg

<6: 150mcg

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14
Q

whats the dose of IM chlophenamine in anaphylaxis?

A

10mg IM chlorphenamine

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15
Q

whats the dose of IM hydrocortisone in anaphylaxis?

A

200mg IM hydrocortisone

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16
Q

name 3 big CYP inducers

A

rifampicin
st johns wort
phenytoin/phenobarbital/carbamazepine

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17
Q

what does rifampicin do to the conc of drug in blood

A

decreases plasma concs.

its a CYP inducer

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18
Q

what does carbamazepine do the conc of drug in plasma

A

decreases plasma concs.

its a CYP inducer

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19
Q

what does TOBACCO do conc of drugs in plasma

A

decreases plasma concs.

its a CYP inducer

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20
Q

name 2 drugs that are CYP inhibitors

A

azole antifungals

erythromycin

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21
Q

name 2 foods that are CYP inibitors

A

grapefruit

cranberry juice

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22
Q

what does fluconazole do to conc of drug in plasma?

A

increases plasma concs.

its a CYP inhibitor

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23
Q

what does erythromycin do to conc of drug in plasma?

A

increases plasma conc.

its a CYP inhibitor

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24
Q

rifampicin and COCP?

A

decreases effectiveness of pill

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25
Q

carbamazepine and morning after pill?

A

you need to double the dose

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26
Q

grapefruit juice effects which drugs?

A

statins, CCBs, anti-arryhtmics

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27
Q

what minimum urine output should you aim for on fluids?

A

0.5ml/kg/hr

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28
Q

what is a normal urine output/?

A

1.5-2.5 litres

1ml/kg/hr

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29
Q

what is the only time you could give vancomycin orally?

A

to treat C diff

its not absorbed in GI tract

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30
Q

when should levothyroxine be given?

A

in morn before breakfast

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31
Q

what is the half life of morphine sulfate?

A

4hrs

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32
Q

how often do timolol eye drops for glaucoma need to be administered?

A

12hrly

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33
Q

what can aid absorption of iron salts?

A

vit C

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34
Q

what is the antidote to iron overdose?

A

IV desferrioxamine

gives you red wee

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35
Q

what is posh name for vit K?

A

phytomenadione

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36
Q

what is the half life of naloxone?

A

20-40 mins

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37
Q

what metabolic disturbance does salicylate overdose cause?

A

metabolic acidosis

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38
Q

venlafaxine does what to ECG

A

increase QT interval

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39
Q

autonomic instability, hyperthermia, sweating, rhabdomyolysis, diarrhoea, tremor, and altered mental state are all features of…

A

serotonin syndrome

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40
Q

two types of stimulant

A

cocaine
amfetamines
(MDMA and ecstasy are types of amfetamine)

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41
Q

which illicit drug causes INTENSE vasoconcstriction which can lead to MI, stroke, aortic dissection?

A

cocaine

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42
Q

effects of chronic cocaine use/?

A

perforation of nasal septum
CSF rhinorrhoea (thin cribriform plate)
myocardial fibrosis

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43
Q

should you leave trailing zeros?

A

no. and avoid decimal points where poss.

e. g. write 500mcg instead of 0.5 mg

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44
Q

what 3 pieces of info do you need to include when prescribing PRN?

A
  • max dose
  • minimum dose interval
  • the indication
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45
Q

what does medicine reconciliation involve?

A

verification - check the durg Hx correct

clarification - check it against current list of meds prescribed in hosp

reconciliation - document any discrepancies

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46
Q

levothyroxine is stopped. can you just bang it back onto its original dose?

A

have to titrate back up again gradually. otherwise can precipitate angina, palpitations and HF

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47
Q

do ACEis need titrating back up if theyre stopped?

A

yes

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48
Q

is garlic anticoagulant?

A

yes

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49
Q

what can you look at in a pts back of drugs to give you a good idea of adherence?

A

dispensing date

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50
Q

what kind of drugs wont the nomad include?

A

variable doses (e.g. warfarin), PRNs, liquids

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51
Q

what is a good source of info for a pt on warfarin?

A

yellow oral anticoagulation book

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52
Q

what dose is the brown tab of warfarin?

A

1mg

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53
Q

what dose is the blue tab of warfarin ?

A

3mg

54
Q

what’s the liquid lithium?

A

lithium citrate

55
Q

what the tablet lithium?

A

lithium carbonate

56
Q

are lithium citrate and lithium carbonate equivalent?

A

NO

57
Q

why do you have to prescribe lithium by brand name?

A

the bioavailability varies

58
Q

0.4-1 mmol/L is the range for

A

serum lithium concentration

59
Q

when do you measure serum lithium concentation?

A

week after initiation
every week until stabilised
every 3 months on maintenance

60
Q

what tests should be monitored on lithium? (5)

A 
ECG
TFT
U&E
Ca
BMI
61
Q

how often should ECG, TFT, U&E, Ca and BMI be monitored on lithium?

A

every 6 months

62
Q

why do you need to check TFTs on lithium?

A

hypothyroidism

63
Q

why do you need to check BMI on lithium?

A

weight gain

64
Q

why do you need to check U&Es on lithium?

A

can impair renal function

is also renally excreted so ishew

65
Q

why do you need to check Ca on lithium?

A

hypercalcaemia

66
Q

what does NPIS stand for (contact them for advice)?

A

national poisons information service

67
Q

name three drugs that lithium interacts with.

A

ACE-is
NSAIDs
diuretics

–> affect renal excretion - toxicity

68
Q

how much folic acid do you need to take with methotrexate?

A

5mg once weekly

not on same day as methotrexate!

69
Q

what needs monitoring w methotrexate?

A

FBC
LFT
U&E

also - CXR

70
Q

when do you monitor FBC, U&E and LFT on methotrexate?

A

baseline, every 1-2wks until stabilised, every 3 months after

71
Q

why do you do CXR with methotrexate?

A

pulm toxicity (pneumonitis)

basline and then repeat if symptoms emerge

72
Q

give me 3 signs of methotrexate toxicity

A

lymphopena
thrmbocytopenia (abnormal bruising)
GI bleed

73
Q

patients who are folate deficient, and who are co-prescribed NSAIDs, are at increased risk of….

A

methotrexate toxicity

74
Q

give me 3 drugs that interact w methotrexate

A

trimethoprim!
aspirin and NSAIDs
ciprofloxacin and penicillins

also corticosteroids

75
Q

what drug, prescribed alongside methotrexate, increases the risk of agranulocytosis?

A

clozapine

76
Q

do you omit methotrexate in acute infection?

A

yes

77
Q

name two antibiotics that warfarin interacts with

A

erythromycin and clarithromycin
CYP inhibitors
(increase the anticoag effect)

78
Q

maintenance doses of warfarin vary considerably. can be anything from

A

1-15mg!

79
Q

what is the starting dose for SLOW LOADING regimen of warfarin

A

3mg

80
Q

what is the starting dose for the RAPID LOADING regimen of warfarin

A

5-10mg

81
Q

when is the peak pharmacological effect of warfarin?

A

2-3days

82
Q

once stable dose and INR achieved, monitoring can be how often?

A

every 3 months

83
Q

name three CONTRAINDICATIONS to warfarin

A

pregnancy
haemorrhagic stroke
severe liver/renal disease

84
Q

name five CAUTIONS to warfarin

A 
frequent fallers
recent ischaemic stroke
hx GI bleed /peptic ulcer
breastfeeders
recent surgery
85
Q

how does amiodarone interact w warfarin

A

increases anticoag

86
Q

how does ibuprofen interact w warfarin

A

increase GI bleed risk (and increases anticoag)

87
Q

how does fluconazole interact w warfarin

A

increases anticoag

88
Q

how does simvastatin interact w warfarin

A

increases anticoag

89
Q

how does omeprazole interact w warfarin

A

increases anticoag

90
Q

if someone is ALCOHOL DEPENDANT how does it affect warfarin

A

decreases anticoag

91
Q

name 3 things that DECREASE the anticoag effect of warfarin

A

green leafy veg
alcohol dependence
st john’s wort

92
Q

the greater the INR, the greater risk of

A

bleeding and bruising

93
Q

which drug increases the force of contraction whilst slowing the heart down?

A

digoxin

94
Q

what are the indications for digoxin?

A

HF

AF (supraventricular arrhythmias)

95
Q

what organ excretes digoxin?

A

kidneys

so renal function influences dosing/ toxicity risk

96
Q

the concentration of which drug should be 0.8 - 2

A

digoxin

97
Q

you monitor the U&E on digoxin. for what two reasons is this super important?

A

hypokalaemia (increases risk of toxicity / myocardial instability)
eGFR - renally excreted

98
Q

what bloods do you monitor on digoxin?

A

U&E

99
Q

name 3 long acting insulins

A

Levemir
Lantus
Tresiba

100
Q

in t2dm, NICE recommends starting insulin when?

A

if HbA1c elevated consistently above 75

101
Q

Name two rapid acting insulins

A

NovoRapid

Humalog

102
Q

when do you take rapid acting insulin?

A

just before or WITH a meal

103
Q

when do you take short acting insulin?

A

20 mins before meal

104
Q

name two short acting insulins

A

Actrapid

Humulin S

105
Q

Actrapid and Humulin S are what kind of insulins?

A

short acting

106
Q

NovoRapid and Humalog are what kind of insulins?

A

rapid acting

107
Q

Insulatard and Humulin I are what kind of insulin?

A

medium acting

108
Q

what kind of insulin is Humulin M3?

A

mixed medium acting - biphasic (short acting and long acting)

109
Q

do you ever give mixed insulins at bedtime?

A

no never

110
Q

how often do you give long acting insulin?

A

once daily.

consistent delivery throughout with no peak

111
Q

name two medium acting insulins

A

insulatard and humulin I

112
Q

name a mixed medium acting biphasic insulin

A

Humulin M3

113
Q

what is target HbA1c for elderly pts at risk of hypos

A

<58

114
Q

what is the basal bolus regimen?

A

intermediate or long acting once or twice a day
PLUS
bolus injections of short/rapid before meals

115
Q

what is the once daily regimen?

A

one long acting insulin in morn

or one intermed at night
depending when u get spikes

116
Q

what is the twice daily regimen?

A

biphasic mixed insulin twice a day before breakfast and evening meal

117
Q

who is continuous subcut insulin infusion for?

A

type 1s if get loads of hypos or sugars uncontrolled

and theresa may

118
Q

risk of insulin pump?

A

DKA rapidly if pump fails

119
Q

what pt education programmes are there for type 1s?

A

DAFNE

BGAT (bm awareness)

120
Q

what pt education programmes are there for type 2s?

A

DESMOND

121
Q

what is the optimal blood glucose reading ?

A

4-7mmol/L

122
Q

in the UK, what is strength of most insulins?

A

100 units / mL

123
Q

what two aspects cause symptoms of hypo?

A

adrenergic and neuroglycopenic

124
Q

pt’s bm is 2. they are co-operating. rx?

A

glucotab / lucozade

125
Q

pt’s bm is 2. they are conscious but unable to co-operate. rx?

A

glucogel in mouth. repeat until two tubes finished.

126
Q

pt’s bm is 2. they are unconscious. you have IV access. rx?

A

IV 20% glucose 100ml over 20 mins

127
Q

pt’s bm is 2. they are unconscious. you don’t have IV access. rx?

A

IM glucagen 1mg

128
Q

you’re treating DKA. the bm has come down and is now <14. what do you give as well as insulin?

A

IV 10% glucose and Kcl 20mmol

129
Q

how often should BMs be monitored on IV insulin?

A

hourly

130
Q

when do you use IV insulin (3)?

A

DKA
during surgery
when cant eat / drink if vom

Prescribing (5 decks)

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