SGTs Complex Px Flashcards
SGT Complex Px 1
Metformin drug class
biguanide
Gliclazide drug class
sulfonylurea
Sitagliptin drug class
DPP4 inhibitor
Thirsty, weight loss, blurred vision, frequent urination symptoms cause
uncontrolled diabetes
which meal of the day should gliclazide be taken with
breakfast
what is the usual hba1c range for diabetes patients
48-59 (want below 48 ideally)
egfr should be above 90ml/min/1.73m2, if it is at 59, what level of ckd is present
3
total serum cholesterol should be below 5 mmol/l for normal people and below what level for people with increased risk
4
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
risk of falls
symptoms of hyperglycaemia
passing more urine at night
thirst
tiredness
thrush
bladder or skin conditions
feeling sick
blurred vision
weight loss
why might metformin not have been titrated to the highest dose (2g a day)
GI disturbance, size of tablets, pill burden
why might you not want to optimise the dose of gliclazide in obese patients
causes weight gain
metformin and sitagliptin associated with weight gain?
yes
new guidelines recommend that sglt2 inhibitors are used earlier in treatment, name one which has cardioprotective effects
dapagliflozin
give w metformin dose for anyone at risk of HF
give one con of using dapagliflozin
high risk of DKA
give some symptoms that would be indicative of DKA
ketones
fruity breath
deep and fast breathing
confusion
what actions should be taken for patients wit T2DM with a hba1c not controlled by a single drug and higher than 58mmol/l
reinforce diet and lifestyle advice, adherence, support person for aim of 53, intensity treatment
how do statins prevent strokes, clot, embolism and dvt
stabilise cholesterol plaques
what are the maximum strengths of treatment in mg for ramipril and bisoprolol
10mg
give some symptoms that without their presence you would be inclined to rule out the possibility of a uti in men
blood in urine, pain when passing urine, pain, temp, dipstick
what is the risk of taking abx if there is no bacterial pathology
increases risk of resistance
aim of PCI: percutaneous coronary intervention
Restore blood flow in narrow/ blocked blood vessel.
what to monitor with ACEi?
- BP. Initiation and follow up few weeks check not dropping too much
- kidney function AKI possible.
- POTASSIUM LEVELS
SGT Complex Px 2
Felodipine drug class
CCB
bendroflumethiazide drug class
thiazide diuretic
normal serum triglycerides range? below X mmol/l
1.7
what could breathlessness, palpitations when coupled with leg swelling be indicative of
HF
what drug and class could you link swollen ankles to
CCB felodipine
list some different differentials for swollen ankles
endocarditis, pneumonia, asthma, copd, heart failure
symptoms of HF (fatigue, breathlessness, swollen ankles, palpitations) must be explored but also contextualise with what
risk: in older man w HTN, more likely
breathlessness can be a sign of HF, what is it important to establish for these people
triggers and alleviators
what would be the rationale behind doing a peak flow measurement for someone that is experiencing breathlessness
establish asthma, need for salbutamol reliver inhaler and indication of respiratory function
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
12 lead ecg
respiratory symptoms tests to do
Chest Xray, spirometry, assess lung function
what would be the rationale behind a cxr for a patient that is experiencing breathlessness/ what pathology could it reveal
check fluid in lungs
enlargement of heart
visual presentation
t/f hypertensive meds may cause oedema?
true
SE of CCB and ibuprofen
fluid overload
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
echocardiogram
true or false, post MI it is common for patients to have cardiac failure
true
what levels to assess w statin no matter how small dose is
cholesterol
how can you check quickly if a patient has a normal pulse rate or not
quick 30s pulse rate
levels of what in the blood will rise in patients with acute heart failure
bnp
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
abpm
why is furosemide not wanted for HTN?
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
in a fbc what information can you get from white blood cells
infection
what 3 things can be measured in the blood to identify any anaemia if present
iron, b12, folate
what 2 measurements can be taken to establish and investigate for diabetes
hba1c and fasting plasma glucose
what is the rationale behind investigating egfr and u&e
kidney function
would you expect urea and creatinine to be high or low in poor kidney function/ dysfunction
high
lungs can be physically checked and you can listen to breathing sounds to see if there is x in the lungs
fluid
the base of the lung picks up crackles whereas higher up the lung you can hear x sounds
heart
does renal function need to be reviewed prior to starting an acei in renal failure as it is contraindicated
yes
true or false, acei are renoprotective to a degree in patients with diabetes
true
how should kidney function be measured with acei
when starting and titrating dose measure kidney function 2-4 weeks later, once stabilised can be longer periods
possible risk of overtreating high bp
falls
is a thiazide or loop diuretic more appropriate for severe water retention
loop
bendroflumethiazide is linked to reductions in cholesterol, if this is not needed what different drugs can it be changed to, to treat water retention
indapamide or chlortalidone
would 3 classes of drugs would you expect to see patients on in heart failure
acei
bb
statin
why should nsaids be avoided in ckd
can cause cardiac events
if increasing doses of cocodamol to the point of constipation risk what 2 things should be reinforced to the px counselling points
diet and hydration
if a patient at max dose of cocodamol what other analgesic drug could you add on a regular basis to manage pain
paracetamol
if px experiencing anxiety what 2 things can patients be referred to if they feel comfortable to it and would benefit from it
cbt and talking therapy
differentials in elderly men for needing to urinate often, difficulty in starting to pee and feeling that the bladder is full
constipation
weight
uti due to kidney stones
bladder stones
caffeine intake
enlarged prostate
what test detects the levels of a certain protein in the blood as an indicator for prostate cancer
PSA prostate specific antigen
what informed choice programme exists with the aim of providing healthy men aged over 50 who ask GPs about PSA testing
prostate cancer risk management
what are the cons of PSA testing
can give false positives and show slow growing cancers that will never shorten life or cause issues
what further tests could occur after identifying a raised PSA
MRI
digital rectal examination
biopsy
true or false, PSA is an indicator of cancer
false. not always
why can stopping smoking help to treat urinary incontinence
smoking causes coughing that puts strain on the pelvic floor muscles
true or false, alcohol has a diuretic effect
true
how is BPH benign prostatic hyperplasia managed?
tamsulosin, finasteride
Diff:
Look at how each work
Openers phincer etc. sphincter
SGT Complex Px 3+4
what is BPH/ benign prostatic hyperplasia
non cancerous enlargement of prostate gland
what drug can be used to treat hyperplasia to shrink the gland and reduce the side effect of urinary urgency
Finasteride : 5a reductase inhibitor
Rivastigmine drug class
centrally acting anticholinesterase
how does rivastigmine work in dementia patients
prevents breaking down of ach and increases neurotransmitter transmission
what is phenytoin commonly used to treat
seizures epilepsy
what type of laxative is senna
stimulant
what assessment can be carried out for establishing swallowing difficulties and communication issues
SALT
for SALT px normally made to swallow or drink foods of different thickness, give some different options
water, soft piece, pudding, fruit
if a patient has swallowing issues and is given water where will it sit
tip of tongue
what can be used as a tracer to follow a persons swallow through the gut to get a visual picture
radiopharmacy
barium tracer
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
nasoendoscopy
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
aspiration and swallowing
what volume of water can aspirin be dissolved in to administered via ng tube
10ml
what is required in terms of flushing with regards to aspirin
before, after and in between admin different drugs
finasteride can be dispersed in 10ml of water, what is the appearance of the liquid that you can then use via ng tube
milky liquid
why should women esp those who are pregnant not handle finasteride directly but can when wearing gloves
causes risk to male fetus
how should finasteride tablets be dissolved
in a closed system, draw it up and let it dissolve in syringe so less risk
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
yes
when giving rivastigmine via ng tube it should be flushed and given a break for x hrs
1
if a patient is on 6mg of rivastigmine, how many mls of a 2mg/ml oral solution should be given to the patient
3ml
rivastigmine can be given as a patch, however why might oral liquid be preferred
complicated regimen and skin condition
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
2 hrs
if single daily dosing of phenytoin is possible how should the drug be given
suspend feed between 10pm and 6am and give dose at midnight so it has 6h to absorb
true or false, for phenytoin conversions between formulations, it must first be converted to base
true
what volume of water should phenytoin be mixed with
equal amount
phenytoin is 90% protein bound
Only free drug working and active
… what does this mean for px w low albumin levels?
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
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
flush
true or false, for ng admin liquids should be used where they exist
true
what provisions may need to be made for more viscous liquids in the ng tube
flushing or wider tube
if crushing tablets why should they be dissolved separately
different solubilities
why should oral syringes be used when doing mixing of crushed tablets
avoid IV admin
monitoring needed w NG tube
- Coughing
- Dyspnea
- Oxygen sat levels
- Vomiting
- Swallowing function
- Tolerance to NG tube feeding
- Check for aspiration pneumonia signs
what would a budesonide/formeterol inhaler be used to treat
COPD
is formeterol along or short acting beta 2 agonist
long
tiotropium capsules can be taken daily for the maintenance of copd, how does it work
antimuscarinic, blocks receptors in airways, bronchodilation, reduces sputum thickness
what would be indicative of patients having taken too much salbutamol
shaking
what is FENO test used for
nitrous oxide test to differentiate asthma/ COPD
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
spirometry
how is spirometry done
with no meds and then salbutamol
with spirometry should you see an improvement in bronchodilation in asthma or copd
asthma
why are you unlikely to see a change in the volume of air forced out via spirometry in patients with copd
damage to lungs
what advice can you give patients with regards to meds 24 hrs before spirometry
avoid taking bronchodilators and smoking 24h before and avoid alcohol and a heavy meal a few hrs before
is coughing due to asthma or copd more common at night and early morning
asthma
is sputum more likely in asthma or copd
copd
what visual presentations can indicate copd in patients
barrel chest and weight loss
what grades different levels of breathlessness
mrc
why could a feno test indicate asthma
high levels suggest inflammed airways
are coarse lung crepitations associated with bronchiectasis or hf
bronchiectasis
are fine lung crepitations associated with bronchiectasis or hf
hf
would differential would the following suggest?
consistent cough
haemoptysis
weight loss
persistent coarse voice
lung cancer
what diagnostics can be used to see upper airway obstruction such as tracheal tumours
xray/ ct
copd symptoms usually have an onset above what age
35
true or false, hf will present with breathlessness when lying flat
true
what are 3 different abx that can be used firstline for the treatment of exacerbation of copd
amoxicillin, doxycycline and clarithromycin
discuss use of lozenges and gum vs patch for NRT
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
SGT Complex Px 5
Cisplatin drug class
alkylating agent
Capecitabine drug class
antimetabolite
what genetic testing is done before giving patients capecitabine or 5fu
DPYD for DPD enzyme
majority of people have normal dpd enzyme, what do carriers of polymorphism have
impaired ability to metabolise drug so can cause tox
what actions may have to be taken if a patient has dpd polymorphism
dose adjustments or avoid drug
list some of the potential side effects of capecitabine
tiredness, fatigue, loss of appetite, diarrhoea, mouth sores and ulcers, feeling or being sick, hand and foot syndrome, anaemia, neutropenia, thrombocytopenia
what advice would you give a patient on capecitabine if they have tiredness, weakness or fatigue
rest
what low dose steroid can you give someone that is on capecitabine and experiencing loss of appetite
dexamethasone
how can diarrhoea in capecitabine patients be managed
loperamide, octreotide, supportive management for loss of fluids
what can be done to prevent mouth sores and ulcers in patients that are taking capecitabine
sucking ice cubes or chips to constrict small blood vessels in the mouth
name a 5ht3 antagonist drug that can be used for nausea and vomiting
ondansetron
name some different dopamine antagonists that can be used for nausea and vomiting
metoclopramide, domperidone, haloperidol
name an atypical antipsychotic drug that can be used for nausea and vomiting
olanzapine
name an antihistamine that can be used for nausea and vomiting
cyclizine
name a steroid that can be used to treat nausea and vomiting
dexamethasone
what can be done for patients that experience hand and foot syndrome whilst on capecitabine
urea based creams, reduce dose, vitamin b6, avoid hot baths, loose fitting footwear
list some different symptoms of hand foot syndrome
soreness, redness, peeling on palms and soles of feet
how can anaemia in patients that are taking capecitabine be treated
iron, b12, folate, epo
what can be given for patients that have neutropenia while on capecitabine
G-CSF
what can be given for thrombocytopenia in patients that are on capecitabine
platelets
name two things that can be used for mucositis
diflam, corsodyl
name a family of chemo drugs where cardiotox is common
anthracyclines eg doxorubicin
true or false, doxorubicin is associated with cardiotox
true
true or false, acute cardiotox can occur with capecitabine or 5fu
true
what dose adjustment would you make to cisplatin in the case of mild renal impairment
lower
why would a raised bilirubin not necessitate a dose reduction of cisplatin
it is not metabolically metabolised
why is cisplatin able to be used in the case of mild cardiac failure
does not have cardiac effects
cisplatin comes in 1mg/mL sterile concentrate and would usually be diluted in what volume of fluid
1l
true or false, lots of fluids would be given before and after cisplatin infusions
true, Concern: fluid overload not eliminated properly.
good hydration will also help prevent nephrotox
what diluent can be used to dilute cisplatin for iv infusion
0.9% sodium chloride
what can be given alongside cisplatin iv infusions so that patients dont experience fluid overload
mannitol infusion or shot of furosemide
what is the most important side effect of cisplatin that patients should be made aware of
nausea and vomiting
… also ototox as w gentamicin
what is an appropriate rate and duration for a cisplatin iv infusion
200ml/10h
extra fluids and mannitol prevent damage to what organ in patients that are on cisplatin
kidney
the risk of ototox exists with cisplatin, however, it can cannot be prevented. what should patients be aware of reporting if it develops
tinnitus or hearing loss
how can nephrotoxicity when on cisplatin be prevented
good hydration and ensuring good kidney function at start
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
numbness in fingertips, hands or feet
why is a fbc necessary for cisplatin
what parameters are important
wbc, rbc risk of anaemia, neutropenia and thrombocytopenia
why is it important to check electrolytes for cisplatin
hypokalemia common with chemo drugs, hypercalcaemia of malignancy
what drug class causes SIADH: syndrome of inappropriate ADH
vinca alkaloids
why might uric acid levels be raised in haematological cancers especially
risk of tumour lysis syndrome TLS
what is extravasation
drugs leak outside of vein and damage surrounding tissue
true or false, vessicants cause the most damage if extravasated
true
if the drug that extravasates is a vesicant what should the next steps be
stop drug and leave cannula in place
why would you initially leave the cannula in place in case of extravasation
aspirate as much drug as possible
what should be marked on the patient after extravasation
area of damage
what specific antidote may be given for anthracyclines that extravasate
dexrazoxane
chemo drug, free radical scavenger
for anthracyclines would you use a warm or cold pack
cold
why would a cold pack be used for anthracyclines
want to localise drug and prevent it spreading
would vinca alkaloid extravasation require a warm or cold pack
warm
why would vinca alkaloids require a warm pack
no antidote so want to disperse through the tissue
what drug can be used to break down sc tissue matrix so that it helps treat extravasation
hyaluronidase
