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Yr3 Revision > Specialities > Flashcards

Specialities Flashcards

1
Q

How does aging affect Absorption of drugs?

A

Decreases Rate of absorption but doesn’t affect extent of absorption

Notable Exception – Levodopa (less dopa-decarboxylase –> Increased rate and peak serum level)

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2
Q

How does aging affect Distribution of drugs?

A

More fat = Higher Vd for fat soluble drugs and longer lifespan

Less muscle = lower Vd & higher serum conc for Water soluble drugs

Less albumin = Less protein binding and so higher serum conc of acidic drugs

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3
Q

How does aging affect metabolism and excretion of drugs?

A

Decreases hepatic metabolism –> Some drugs stronger and some prodrugs weaker

REnal excretion decreases –> Toxicity of some drugs

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4
Q

How does aging affect pharmacodynamics of drugs?

A

Changes in receptor number, size and effect –> Increased sensitivity to some drugs e.g. diazepam and warfarin

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5
Q

What can trigger delirium?

A 
Infection
Environment or social change
Dehydration
Pain
Meds (Anti-cholinergics & Sedatives)
Sleep Disturbance
Brain injury / hypoxia
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6
Q

How would you assess delirium?

A

4AT to screen

Full History/exam

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7
Q

How can you manage delirium?

A

TIME bundle

IF you have to:
- Quetiapine (an atypical antipsychotic that has some sedative effect)

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8
Q

What can cause reversible dementia?

A 
NPH
B12 deficiency
Hypothyroid
Hypercalcaemia
Intracerebral tumour
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9
Q

What gene type is mutated in HNPCC?

A

Mismatch repair gene

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10
Q

What gene is mutated in NF1?

A

17q Tumour suppressor gene

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11
Q

Difference between NF1 & 2?

A

NF1 –> Neurofibromas in extremities and skin

NF2 –> CNS, Cord and cranial nerve tumours e.g. acoustic neuroma

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12
Q

How do you diagnose NF1?

A

2+ of:

  • 6+ Café au lait spots
  • 2+ Neurofibromas
  • Axillary Freckling
  • Lisch nodules (iris)
  • Optic Glioma
  • FH
  • Thinning of long bone cortex
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13
Q

How do you manage NF1?

A

Annual reviews of BP, educational assessment, spine & vision

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14
Q

What gene is involved in tuberal sclerosis?

A

TSC 1 & 2

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15
Q

What does tuberal sclerosis do and how do we diagnose?

A 
Causes benign tumours to form in the 
Brain!
Skin!
Eyes
Lungs
Kidney
Heart
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16
Q

What mutation is involved in myotonic dystrophy?

A

CGT repeat (like huntington’s)

Also shows anticipation

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17
Q

How do you spot myotonic dystrophy?

A 
Progressively worsening proximal muscle weakness, stiffness
Bilateral late cataracts
DM
Heart block
Bowel problems
18
Q

What drugs contribute to each part of the triad of anaesthesia?

A

Hypnosis – GA! + opiates
Analgesia – Opiates! + GA/LA
Relaxation – Muscle Relaxants + GA/LA

19
Q

How do General anaesthetics work? (both inhalational and IV)

A

Open neuronal ion channels –> Hyperpolarisation

Inhalational by being absorped into the membrane
IV by binding to GABA receptors

20
Q

Whats the major functional difference between inhalational and IV GAs?

A

Inhalational are slow to induce but easier to maintain

IV are quick in and quick out

21
Q

How do we rates Inhalational GAs and what are they?

A

on the MAC (inverse of potency)

Halogenated Hydrocarbons

22
Q

How do we control IV GAs and give 2 examples?

A

TCI - Target Controlled Infusion pump

Propafol & Thiopentone

23
Q

How does LA affect respiration?

A

Tend not to affect insp muscles due to high spinal output

Some can cause loss of cough reflex by hitting lower down exp muscle nerves

24
Q

what factors determine LA toxicity?

A

Site (by rate of absorption)
Dose
Drug
Patient Wt

25
Q

What are the methods of airway maintenance?

A

Triple Airway Maneuvre
Face mask
Guedel Airway
Laryngeal Mask Airway

26
Q

Define airway protection and 1 method?

A

Maintence - airway open and unobstructed
Protected - Free from contamination

Endotracheal Intubation with laryngoscope, muscle relaxants and “sniffing the air” position

27
Q

When would you intubate a surgical patient?

A

1) Using muscle relaxants (e.g. surgery through muscles or requiring stillness)
2) Emergency and can’t fast (protect from gastric aspiration)
3) High risk of aspiration e.g. tonsillectomy
4) Restricted airway access e.g. Maxfax surgery
5) Tightly control blood gasses e.g. neurosurgery

28
Q

How do we grade patients prior to surgery? (think physical status and tolerance?)

A

ASA physical status classification:

  • 1–>6 based on physical health
  • 1 (otherwise health), 2 (mild/mod systemic upset), 3 (SEvere systemic upset), 4 (Life-threatening), 5 (Moribund) & 6 (Organ retrieval)

METS - Measure of Exercise Tolerance pre-Surgery
1->9 based on ability to do tasks without SOB
E.g. 3 = walking around house
E.g. 5 = Walk up a hill or a flight of stairs
E.g. 8 = run a short distance
(15% drop in mortality for every METS point you go up)

29
Q

What receptors are affected by vasopressors and inotropes?

A

Vasopressors – Alpha 1 agonists

Inotropes – Beta 1 agonists

30
Q

Whats the daily requirement for Na, K, Glc & fluid?

A 
Na = 1-2mmol/Kg/day
K = 0.5-1mmol/Kg/day
Glc = 50-100g
Fluid = 25-30ml/Kg/Day
31
Q

How could you rate pain?

A 
Numerical
Verbal
Visual Analogue scale
Faces
Abbey pain scale (confused patients)
32
Q

How do you treat nociceptive vs neuropathic pain?

A

Nociceptive – WHO Pain ladder

Neuropathic – Start non-pharmacologically (TENS, RICE, psychological) Then Alternative analgesics e.g. Gabapentin, Amitriptyline or Duloxetine

33
Q

Who licenses UK drugs and in what ways?

A

MHRA

  • Clinical Trial Authorisation
  • Marketing Authorisation
  • Wholesale Dealer’s or Manufacturer’s License
34
Q

Who licenses Scottish drugs and in what way?

A

SMC

Take into account cost-benefit and comparison to existing meds

35
Q

What’s a Kardex called?

A

Prescription & Administration Record (PAR)

36
Q

What formulaires are there?

A

BNF

NHS Grampian Joint Formulary

37
Q

What are the different categories of licensed drugs. And use?

A

OTC - GSL or Pharmacy only

Prescription Only (POM)

Off label = has a Marketing Authorisation but not for this use
Unlicensed = Has no Marketing Authorisation

38
Q

How do we prescribe combination meds, combination inhalers and drugs in solution?

A

Combination Meds – “CO-AMILOFRUSE 2.5mg:20mg” (so drug and strength) in the medication box on PAR

Combination inhalers – “SERATIDE 100” (So drug & steroid strength) in the medication box & the formulation e.g. “dry powder accuhaler” in the additional instructions box

DRugs in solution – “PARACETAMOL 120mg/5ml” (So drug, amount and per volume) in the medication box

39
Q

What is dextrose used for vs Crystalloids?

A

Dextrose can move out the ECF so used for chronic dehydration and in hypernatraemic patients

Crystalloids e.g. Saline are used in acute dehydration, AKI and resus as they stay in the ECF

40
Q

Difference between a mole and an osmole? Also osmolarity and osmolality?

A 
Mole = 6.02x10^23 molecules
Osmole = 6.02x10^23 differnentiated particles
Osmolarity = Osmoles / 1L of solution
Osmolality = Osmoles / 1Kg of Solvent

Yr3 Revision (9 decks)

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