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SGTs Complex Px Flashcards

1
Q

SGT Complex Px 1

Metformin drug class

A

biguanide

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2
Q

Gliclazide drug class

A

sulfonylurea

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3
Q

Sitagliptin drug class

A

DPP4 inhibitor

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4
Q

Thirsty, weight loss, blurred vision, frequent urination symptoms cause

A

uncontrolled diabetes

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5
Q

which meal of the day should gliclazide be taken with

A

breakfast

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6
Q

what is the usual hba1c range for diabetes patients

A

48-59 (want below 48 ideally)

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7
Q

egfr should be above 90ml/min/1.73m2, if it is at 59, what level of ckd is present

A

3

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8
Q

total serum cholesterol should be below 5 mmol/l for normal people and below what level for people with increased risk

A

4

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9
Q

it is important that bp isnt managed too well in elderly patients to the point where it becomes too reduced due to the risk of what

A

risk of falls

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10
Q

symptoms of hyperglycaemia

A

passing more urine at night
thirst
tiredness
thrush
bladder or skin conditions
feeling sick
blurred vision
weight loss

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11
Q

why might metformin not have been titrated to the highest dose (2g a day)

A

GI disturbance, size of tablets, pill burden

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12
Q

why might you not want to optimise the dose of gliclazide in obese patients

A

causes weight gain

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13
Q

metformin and sitagliptin associated with weight gain?

A

yes

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14
Q

new guidelines recommend that sglt2 inhibitors are used earlier in treatment, name one which has cardioprotective effects

A

dapagliflozin

give w metformin dose for anyone at risk of HF

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15
Q

give one con of using dapagliflozin

A

high risk of DKA

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16
Q

give some symptoms that would be indicative of DKA

A

ketones
fruity breath
deep and fast breathing
confusion

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17
Q

what actions should be taken for patients wit T2DM with a hba1c not controlled by a single drug and higher than 58mmol/l

A

reinforce diet and lifestyle advice, adherence, support person for aim of 53, intensity treatment

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18
Q

how do statins prevent strokes, clot, embolism and dvt

A

stabilise cholesterol plaques

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19
Q

what are the maximum strengths of treatment in mg for ramipril and bisoprolol

A

10mg

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20
Q

give some symptoms that without their presence you would be inclined to rule out the possibility of a uti in men

A

blood in urine, pain when passing urine, pain, temp, dipstick

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21
Q

what is the risk of taking abx if there is no bacterial pathology

A

increases risk of resistance

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22
Q

aim of PCI: percutaneous coronary intervention

A

Restore blood flow in narrow/ blocked blood vessel.

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23
Q

what to monitor with ACEi?

A
  • BP. Initiation and follow up few weeks check not dropping too much
  • kidney function AKI possible.
  • POTASSIUM LEVELS
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24
Q

SGT Complex Px 2

Felodipine drug class

A

CCB

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25
Q

bendroflumethiazide drug class

A

thiazide diuretic

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26
Q

normal serum triglycerides range? below X mmol/l

A

1.7

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27
Q

what could breathlessness, palpitations when coupled with leg swelling be indicative of

A

HF

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28
Q

what drug and class could you link swollen ankles to

A

CCB felodipine

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29
Q

list some different differentials for swollen ankles

A

endocarditis, pneumonia, asthma, copd, heart failure

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30
Q

symptoms of HF (fatigue, breathlessness, swollen ankles, palpitations) must be explored but also contextualise with what

A

risk: in older man w HTN, more likely

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31
Q

breathlessness can be a sign of HF, what is it important to establish for these people

A

triggers and alleviators

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32
Q

what would be the rationale behind doing a peak flow measurement for someone that is experiencing breathlessness

A

establish asthma, need for salbutamol reliver inhaler and indication of respiratory function

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33
Q

what procedure can be used to investigate the cause of palpitations, check for the development of AF/HF, and check cardiac rate, rhythm and tachycardia

A

12 lead ecg

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34
Q

respiratory symptoms tests to do

A

Chest Xray, spirometry, assess lung function

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35
Q

what would be the rationale behind a cxr for a patient that is experiencing breathlessness/ what pathology could it reveal

A

check fluid in lungs
enlargement of heart
visual presentation

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36
Q

t/f hypertensive meds may cause oedema?

A

true
SE of CCB and ibuprofen
fluid overload

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37
Q

ejection fraction is the % of blood that the ventricles are pumping out compared to the total that enters, what procedure can be used to measure it

A

echocardiogram

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38
Q

true or false, post MI it is common for patients to have cardiac failure

A

true

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39
Q

what levels to assess w statin no matter how small dose is

A

cholesterol

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40
Q

how can you check quickly if a patient has a normal pulse rate or not

A

quick 30s pulse rate

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41
Q

levels of what in the blood will rise in patients with acute heart failure

A

bnp

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42
Q

what equipment can be used to check patients blood pressure goes up or down over a period of 24 hrs to establish htn and the need for antihypertensive therapy

A

abpm

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43
Q

why is furosemide not wanted for HTN?

A

Lose volume and pressure BUT
o Want to lower BP consistently, drop over 24 hours
o Furosemide drops quick and short half life. Quick drop, lasts about 6 hours.
o Only used for resistant HTN. Poor choice.
o Lose lot of fluid then BP rises
o Thiazide like diuretics work in distal tubule and long half life better choice

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44
Q

in a fbc what information can you get from white blood cells

A

infection

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45
Q

what 3 things can be measured in the blood to identify any anaemia if present

A

iron, b12, folate

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46
Q

what 2 measurements can be taken to establish and investigate for diabetes

A

hba1c and fasting plasma glucose

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47
Q

what is the rationale behind investigating egfr and u&e

A

kidney function

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48
Q

would you expect urea and creatinine to be high or low in poor kidney function/ dysfunction

A

high

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49
Q

lungs can be physically checked and you can listen to breathing sounds to see if there is x in the lungs

A

fluid

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50
Q

the base of the lung picks up crackles whereas higher up the lung you can hear x sounds

A

heart

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51
Q

does renal function need to be reviewed prior to starting an acei in renal failure as it is contraindicated

A

yes

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52
Q

true or false, acei are renoprotective to a degree in patients with diabetes

A

true

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53
Q

how should kidney function be measured with acei

A

when starting and titrating dose measure kidney function 2-4 weeks later, once stabilised can be longer periods

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54
Q

possible risk of overtreating high bp

A

falls

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55
Q

is a thiazide or loop diuretic more appropriate for severe water retention

A

loop

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56
Q

bendroflumethiazide is linked to reductions in cholesterol, if this is not needed what different drugs can it be changed to, to treat water retention

A

indapamide or chlortalidone

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57
Q

would 3 classes of drugs would you expect to see patients on in heart failure

A

acei
bb
statin

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58
Q

why should nsaids be avoided in ckd

A

can cause cardiac events

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59
Q

if increasing doses of cocodamol to the point of constipation risk what 2 things should be reinforced to the px counselling points

A

diet and hydration

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60
Q

if a patient at max dose of cocodamol what other analgesic drug could you add on a regular basis to manage pain

A

paracetamol

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61
Q

if px experiencing anxiety what 2 things can patients be referred to if they feel comfortable to it and would benefit from it

A

cbt and talking therapy

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62
Q

differentials in elderly men for needing to urinate often, difficulty in starting to pee and feeling that the bladder is full

A

constipation
weight
uti due to kidney stones
bladder stones
caffeine intake
enlarged prostate

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63
Q

what test detects the levels of a certain protein in the blood as an indicator for prostate cancer

A

PSA prostate specific antigen

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64
Q

what informed choice programme exists with the aim of providing healthy men aged over 50 who ask GPs about PSA testing

A

prostate cancer risk management

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65
Q

what are the cons of PSA testing

A

can give false positives and show slow growing cancers that will never shorten life or cause issues

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66
Q

what further tests could occur after identifying a raised PSA

A

MRI
digital rectal examination
biopsy

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67
Q

true or false, PSA is an indicator of cancer

A

false. not always

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68
Q

why can stopping smoking help to treat urinary incontinence

A

smoking causes coughing that puts strain on the pelvic floor muscles

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69
Q

true or false, alcohol has a diuretic effect

A

true

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70
Q

how is BPH benign prostatic hyperplasia managed?

A

tamsulosin, finasteride
Diff:
Look at how each work
Openers phincer etc. sphincter

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71
Q

SGT Complex Px 3+4

what is BPH/ benign prostatic hyperplasia

A

non cancerous enlargement of prostate gland

72
Q

what drug can be used to treat hyperplasia to shrink the gland and reduce the side effect of urinary urgency

A

Finasteride : 5a reductase inhibitor

73
Q

Rivastigmine drug class

A

centrally acting anticholinesterase

74
Q

how does rivastigmine work in dementia patients

A

prevents breaking down of ach and increases neurotransmitter transmission

75
Q

what is phenytoin commonly used to treat

A

seizures epilepsy

76
Q

what type of laxative is senna

A

stimulant

77
Q

what assessment can be carried out for establishing swallowing difficulties and communication issues

A

SALT

78
Q

for SALT px normally made to swallow or drink foods of different thickness, give some different options

A

water, soft piece, pudding, fruit

79
Q

if a patient has swallowing issues and is given water where will it sit

A

tip of tongue

80
Q

what can be used as a tracer to follow a persons swallow through the gut to get a visual picture
radiopharmacy

A

barium tracer

81
Q

what procedure can use a fibre optic camera to see the back of the nose or throat and see if there are any strictures or pathology

A

nasoendoscopy

82
Q

SALT therapists can guide patients through exercises that train muscles used for swallowing and and adjust posture to prevent the risk of x and improve y

A

aspiration and swallowing

83
Q

what volume of water can aspirin be dissolved in to administered via ng tube

A

10ml

84
Q

what is required in terms of flushing with regards to aspirin

A

before, after and in between admin different drugs

85
Q

finasteride can be dispersed in 10ml of water, what is the appearance of the liquid that you can then use via ng tube

A

milky liquid

86
Q

why should women esp those who are pregnant not handle finasteride directly but can when wearing gloves

A

causes risk to male fetus

87
Q

how should finasteride tablets be dissolved

A

in a closed system, draw it up and let it dissolve in syringe so less risk

88
Q

rivastigmine can be switched from tablets to the oral liquid for ng tube admin, does the enteral feed need to be stopped before yes or no

A

yes

89
Q

when giving rivastigmine via ng tube it should be flushed and given a break for x hrs

A

1

90
Q

if a patient is on 6mg of rivastigmine, how many mls of a 2mg/ml oral solution should be given to the patient

A

3ml

91
Q

rivastigmine can be given as a patch, however why might oral liquid be preferred

A

complicated regimen and skin condition

92
Q

phenytoin is a NTR drug and tabs and caps can be switched for oral liquid , when should enteral feeds be stopped and restarted before and after admin

A

2 hrs

93
Q

if single daily dosing of phenytoin is possible how should the drug be given

A

suspend feed between 10pm and 6am and give dose at midnight so it has 6h to absorb

94
Q

true or false, for phenytoin conversions between formulations, it must first be converted to base

A

true

95
Q

what volume of water should phenytoin be mixed with

A

equal amount

96
Q

phenytoin is 90% protein bound
Only free drug working and active
… what does this mean for px w low albumin levels?

A

low albumin levels, more phenytoin about and greater effect and less stuck, more active = have TO CORRECT!
Critical care px get toxic? On phenytoin.
ADJUST LEVELS

97
Q

senna comes as an oral solution and the same dose can be given via ng tube, what must be done before and after admin however

A

flush

98
Q

true or false, for ng admin liquids should be used where they exist

A

true

99
Q

what provisions may need to be made for more viscous liquids in the ng tube

A

flushing or wider tube

100
Q

if crushing tablets why should they be dissolved separately

A

different solubilities

101
Q

why should oral syringes be used when doing mixing of crushed tablets

A

avoid IV admin

102
Q

monitoring needed w NG tube

A
  • Coughing
  • Dyspnea
  • Oxygen sat levels
  • Vomiting
  • Swallowing function
  • Tolerance to NG tube feeding
  • Check for aspiration pneumonia signs
103
Q

what would a budesonide/formeterol inhaler be used to treat

A

COPD

104
Q

is formeterol along or short acting beta 2 agonist

A

long

105
Q

tiotropium capsules can be taken daily for the maintenance of copd, how does it work

A

antimuscarinic, blocks receptors in airways, bronchodilation, reduces sputum thickness

106
Q

what would be indicative of patients having taken too much salbutamol

A

shaking

107
Q

what is FENO test used for

A

nitrous oxide test to differentiate asthma/ COPD

108
Q

what procedure measures lung function by measuring a volume of air out in a second and a volume of air forced out in a second

A

spirometry

109
Q

how is spirometry done

A

with no meds and then salbutamol

110
Q

with spirometry should you see an improvement in bronchodilation in asthma or copd

A

asthma

111
Q

why are you unlikely to see a change in the volume of air forced out via spirometry in patients with copd

A

damage to lungs

112
Q

what advice can you give patients with regards to meds 24 hrs before spirometry

A

avoid taking bronchodilators and smoking 24h before and avoid alcohol and a heavy meal a few hrs before

113
Q

is coughing due to asthma or copd more common at night and early morning

A

asthma

114
Q

is sputum more likely in asthma or copd

A

copd

115
Q

what visual presentations can indicate copd in patients

A

barrel chest and weight loss

116
Q

what grades different levels of breathlessness

A

mrc

117
Q

why could a feno test indicate asthma

A

high levels suggest inflammed airways

118
Q

are coarse lung crepitations associated with bronchiectasis or hf

A

bronchiectasis

119
Q

are fine lung crepitations associated with bronchiectasis or hf

A

hf

120
Q

would differential would the following suggest?

consistent cough
haemoptysis
weight loss
persistent coarse voice

A

lung cancer

121
Q

what diagnostics can be used to see upper airway obstruction such as tracheal tumours

A

xray/ ct

122
Q

copd symptoms usually have an onset above what age

A

35

123
Q

true or false, hf will present with breathlessness when lying flat

A

true

124
Q

what are 3 different abx that can be used firstline for the treatment of exacerbation of copd

A

amoxicillin, doxycycline and clarithromycin

125
Q

discuss use of lozenges and gum vs patch for NRT

A

Depend hm cigarettes use a day
Fast, short acting gum and lozenges
Driven by fast highs and lows – especially social circumstances like feeling of holding something – patch not best. But good to give baseline nicotine level and discreet. But no quick hit

Nicotine inhalator (cartridge) good and better than vapes

126
Q

SGT Complex Px 5

Cisplatin drug class

A

alkylating agent

127
Q

Capecitabine drug class

A

antimetabolite

128
Q

what genetic testing is done before giving patients capecitabine or 5fu

A

DPYD for DPD enzyme

129
Q

majority of people have normal dpd enzyme, what do carriers of polymorphism have

A

impaired ability to metabolise drug so can cause tox

130
Q

what actions may have to be taken if a patient has dpd polymorphism

A

dose adjustments or avoid drug

131
Q

list some of the potential side effects of capecitabine

A

tiredness, fatigue, loss of appetite, diarrhoea, mouth sores and ulcers, feeling or being sick, hand and foot syndrome, anaemia, neutropenia, thrombocytopenia

132
Q

what advice would you give a patient on capecitabine if they have tiredness, weakness or fatigue

A

rest

133
Q

what low dose steroid can you give someone that is on capecitabine and experiencing loss of appetite

A

dexamethasone

134
Q

how can diarrhoea in capecitabine patients be managed

A

loperamide, octreotide, supportive management for loss of fluids

135
Q

what can be done to prevent mouth sores and ulcers in patients that are taking capecitabine

A

sucking ice cubes or chips to constrict small blood vessels in the mouth

136
Q

name a 5ht3 antagonist drug that can be used for nausea and vomiting

A

ondansetron

137
Q

name some different dopamine antagonists that can be used for nausea and vomiting

A

metoclopramide, domperidone, haloperidol

138
Q

name an atypical antipsychotic drug that can be used for nausea and vomiting

A

olanzapine

139
Q

name an antihistamine that can be used for nausea and vomiting

A

cyclizine

140
Q

name a steroid that can be used to treat nausea and vomiting

A

dexamethasone

141
Q

what can be done for patients that experience hand and foot syndrome whilst on capecitabine

A

urea based creams, reduce dose, vitamin b6, avoid hot baths, loose fitting footwear

142
Q

list some different symptoms of hand foot syndrome

A

soreness, redness, peeling on palms and soles of feet

143
Q

how can anaemia in patients that are taking capecitabine be treated

A

iron, b12, folate, epo

144
Q

what can be given for patients that have neutropenia while on capecitabine

A

G-CSF

145
Q

what can be given for thrombocytopenia in patients that are on capecitabine

A

platelets

146
Q

name two things that can be used for mucositis

A

diflam, corsodyl

147
Q

name a family of chemo drugs where cardiotox is common

A

anthracyclines eg doxorubicin

148
Q

true or false, doxorubicin is associated with cardiotox

A

true

149
Q

true or false, acute cardiotox can occur with capecitabine or 5fu

A

true

150
Q

what dose adjustment would you make to cisplatin in the case of mild renal impairment

A

lower

151
Q

why would a raised bilirubin not necessitate a dose reduction of cisplatin

A

it is not metabolically metabolised

152
Q

why is cisplatin able to be used in the case of mild cardiac failure

A

does not have cardiac effects

153
Q

cisplatin comes in 1mg/mL sterile concentrate and would usually be diluted in what volume of fluid

A

1l

154
Q

true or false, lots of fluids would be given before and after cisplatin infusions

A

true, Concern: fluid overload not eliminated properly.

good hydration will also help prevent nephrotox

155
Q

what diluent can be used to dilute cisplatin for iv infusion

A

0.9% sodium chloride

156
Q

what can be given alongside cisplatin iv infusions so that patients dont experience fluid overload

A

mannitol infusion or shot of furosemide

157
Q

what is the most important side effect of cisplatin that patients should be made aware of

A

nausea and vomiting
… also ototox as w gentamicin

158
Q

what is an appropriate rate and duration for a cisplatin iv infusion

A

200ml/10h

159
Q

extra fluids and mannitol prevent damage to what organ in patients that are on cisplatin

A

kidney

160
Q

the risk of ototox exists with cisplatin, however, it can cannot be prevented. what should patients be aware of reporting if it develops

A

tinnitus or hearing loss

161
Q

how can nephrotoxicity when on cisplatin be prevented

A

good hydration and ensuring good kidney function at start

162
Q

there is not much that can be done about neurotoxicity in patients that are on cisplatin, however what warning signs should be reported by patients

A

numbness in fingertips, hands or feet

163
Q

why is a fbc necessary for cisplatin
what parameters are important

A

wbc, rbc risk of anaemia, neutropenia and thrombocytopenia

164
Q

why is it important to check electrolytes for cisplatin

A

hypokalemia common with chemo drugs, hypercalcaemia of malignancy

165
Q

what drug class causes SIADH: syndrome of inappropriate ADH

A

vinca alkaloids

166
Q

why might uric acid levels be raised in haematological cancers especially

A

risk of tumour lysis syndrome TLS

167
Q

what is extravasation

A

drugs leak outside of vein and damage surrounding tissue

168
Q

true or false, vessicants cause the most damage if extravasated

A

true

169
Q

if the drug that extravasates is a vesicant what should the next steps be

A

stop drug and leave cannula in place

170
Q

why would you initially leave the cannula in place in case of extravasation

A

aspirate as much drug as possible

171
Q

what should be marked on the patient after extravasation

A

area of damage

172
Q

what specific antidote may be given for anthracyclines that extravasate

A

dexrazoxane
chemo drug, free radical scavenger

173
Q

for anthracyclines would you use a warm or cold pack

A

cold

174
Q

why would a cold pack be used for anthracyclines

A

want to localise drug and prevent it spreading

175
Q

would vinca alkaloid extravasation require a warm or cold pack

A

warm

176
Q

why would vinca alkaloids require a warm pack

A

no antidote so want to disperse through the tissue

177
Q

what drug can be used to break down sc tissue matrix so that it helps treat extravasation

A

hyaluronidase

Finals (29 decks)

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