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Clinical - Rosie > Third year revision > Flashcards

Third year revision Flashcards

1
Q

What is the blood pressure target in pregnancy?

A

150/90

or 140/90 if they have diabetes, CKD etc.

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2
Q

What is the BP target in elderly?

A

150/90

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3
Q

What is the BP target in diabetes?

A

130/80

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4
Q

What is stage 2 hypertension defined as?

A

160/100

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5
Q

What antihypertensives are suitable in pregnancy?

A

Labetolol, methyl dopa and nifedipine

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6
Q

What is the target cholesterol level?

A

Total cholesterol <5mmol/L

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7
Q

Are statins appropriate for use in pregnancy?

A

NO

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8
Q

Outline the secondary prevention of angina

A

75mg Aspirin
80mg Atorvastain
ACEI
Short-acting nitrate (GTN spray) and BB/CCB

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9
Q

What is the difference between acute and chronic pain?

A

Chronic pain lasts over 3-6 months

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10
Q

How can we assess pain?

A

Verbal rating scale, numeric rating scale (1-10), visual

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11
Q

Outline the WHO analgesic ladder

A

Step 1. - NSAIDs, Paracetamol, Aspirin
Step 2 - weak opioids (codeine, oxycodone, tramadol)
Step 3- strong opioids (morphine, fentanyl)

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12
Q

If NSAIDs are CI then what is a suitable alternative?

A

Weak opioid

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13
Q

What dose of morphine should an opioid naieve patient be initiated on?

A

20-30mg

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14
Q

What dose of morphine should a non opoid naive patient be started on?

A

30-40mg

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15
Q

If a patient cannot tolerate morphine, what should be given instead?

A

Consider giving oxycodone

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16
Q

How should break through pain be managed?

A

Give 1/10th to 1/6th of the total daily dose

17
Q

How should morphine doses be titrated?

A

Increments of morphine should not exceed 1/3 to 1/2 of the total daily dose every 24 hours.

18
Q

How can VTE risk be reduced in a patient taking COC with planned surgery?

A

NICE advises stopping oestrogen containing pill 4 weeks before elective surgery.

19
Q

What EHC is best for patients overweight?

A

If oral then Ulipristal is more efficacous. However IUD is most effective

20
Q

Who can we not use the cockcroft gault equation for?

A

Should not be used in patients with extensive burns of those with fluid overload - HEART FAILURE

21
Q

If a patient is taking an ACEi and they are vomiting/diarrhoea what advice would you give them?

A

Stop taking ACEI until better, need to maintain hydration

22
Q

What is ACR test?

A

Albumin:creatine ratio - used to test for proteinurea and therefore kidney failure

If ACR is >3mg/mmol then it is regarded as clinically important.

23
Q

What ACR value is regarded as clinically important in terms of kidney failure?

A

ACR >3mg/mmol

24
Q

How should pain be managed in someone with liver impairment?

A

Paracetamol is preferred

NSAIDs increase bleeding risk
Opioids increase sedation and constipation so can worsen encephalopathy

25
Q

PPI and broad spec antibiotics increase the risk of what?

A

C.diff

26
Q

How should C.diff be managed?

A

Important to stop all unnecessary antibiotcs
Fluid and electrolyte replacemnet
Metronidazole or vancomycin

27
Q

What pharmacogical agents can be used to manage diabetes in pregnancy?

A

Metformin and insulin.

All other oral agents should be stopped.

28
Q

What dose of folic acid is advised in pregnant diabetics?

A

Should have the higher dose - 5mg.

29
Q

Are BB safe for the management of symptom control in hyperthyroidism if the patient is diabetic?

A

Safe for short term use

30
Q

What anti asthmatic drug should not be started in pregnancy?

A

Leukotriene antagonists.

If patient is already taking and it is considered essential then they can continue.

31
Q

Opioid induced constipation should be treated with what?

A

Avoid bulk forming laxatives. Treat using stimulant or osmotic.

32
Q

Constipation that has failed to be treated with diet and lifestyle should be treated with what type of laxative?

A

1st line - bulk forming (unless opioid induced) e.g. isphagula husk
2nd line - Osmotic, macrogels and then lactulose
3rd - stimulant e.g. senna, docusate

Clinical - Rosie (16 decks)

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