Transition Block Flashcards
Monitoring Requirements for Methotrexate
Every 1-2 weeks whilst dose is being adjusted, every 2-3 months once on stable dose
FBC - can cause bone marrow suppression
Any drop in WBC or platelets should withdraw drug
LFTs - if abnormal, withdraw the drug until abnormalities return to normal and recommence drug
My Structure for Review History Taking
Clarify - condition, how long for, symptoms presenting with/currently have
Last Seen - how have you been since then, who saw you
Management - current regimen, medications/any supplements/any OTC, any monitoring requirements, sick day rules
Systemic Enquiry - check for red flags
Social History - alcohol, smoking, occupation, impact of condition/ICE
Framework for Alcohol Brief Intervention
Raising the issue of alcohol
Screening and giving feedback
Listening for readiness to change
Selecting an approach
Alcohol Recommendations
Not to drink >14 units per week and best to spread evenly over 3 days or more (ensuring have some alcohol free days
Side effect of PPIs
Hyponatraemia
Consider switching to ranitidine
Blood Draw Order
Light Blue Red Dark Blue Yellow Dark Green Green Purple Pink Grey
Light Blue Blood Draw
INR aPTT PT Fibrinogen D-dimer
Red Blood Draw
Platelet AB screen
Dark Blue Blood Draw
Trace elements
Yellow Blood Draw
Biomedical tests
B12
Folate
Serology
Dark Green Blood Draw
EPO
Green Blood Draw
Fast track biomedical tests
Purple Blood Draw
FBC
PV
HbA1c
Renin
Pink Blood Draw
Cross match
Group and hold
Coombs
Grey Blood Draw
Glucose
Lactate
Ethanol
What test to do before performing an ABG?
Allen’s Test
= occlude radial and ulnar artery, ask patient to form tight fist then release hand flat
Continue to occlude radial artery, to check the circulation of the ulnar artery
Recommendations around breast feeding
Exclusively for the first 6 months then for up to 2 years/preference alongside solids
Vitamin D supplement guidance for breast feeding infants
Given a daily vitamin D supplement from birth
From 6 months if <500ml formula supplement vitamin A, C and D
What is the marker for a child being overweight?
Over the 91st weight centile
Management of cow’s milk allergy
2-4 weeks cows milk diet exclusion trail using extensively hydrolysed infant formula
What % weight loss is recommended for risk reduction from co-morbidities in BMI 25-35?
5-10%
Criteria for diabetes risk assessment
- Age 40 or over
- Age 25 or over and South Asian/Chinese, Black African, Afro-Carribbean
- Those with risk factors
How does fibre decrease colon cancer risk?
It encourages fibre fermentation which has an anti-proliferative effect
Use of nutrition to induce Crohn’s Disease remission
Exclusive enteral nutrition cam induce remission in Crohn’s
Intestinal biopsy preparation Coeliac Disease
Need to have gluten for at least one meal per day at least 6 weeks prior to testing
Examples of enteral access
Nasogastric tube
Gastrostomy e.g. PEG
Jejunostomy
Parenteral access
Indications
Refers to the delivery of calories and nutrition into a vein
Indications = bowel obstruction, short bowel syndrome, Crohn’s disease, ulcerative colitis
Contents of saline
Positives/negatives
Na+ and Cl-
Good for resus and maintenance
Can cause hypernatraemia and acidosis in large quantities
Contents of glucose 5%
Positives/negatives
Contains no electrolytes, glucose is metabolised by the liver leaving water
Good for pure dehydration
Bad for resuscitation
Contents of Hartmans
Positives/negatives
Na+, Cl- and K+
Closer to normal plasma than saline
Good for resuscitation and maintenance
Contents of gelofusine/colloids
Positives/negatives
Contains 0.9% saline and big molecules (to exert oncotic pressure)
Can draw in water in from ECF = volume expanders
Management of DVT
1st - dalteparin
Also used in prophylaxis of DVT, consider heparin in situations where risk of bleeding (easily reversed)
Can also use rivaroxaban for treatment of uncomplicated DVT
Limb Lead Placement
Ride Your Green Bike Right Arm - Red Left Arm - Yellow Left Leg - Green Right Leg - Black
Combination results in increased risk of GI bleed
Warfarin and Naproxen
Three antibiotics not used in pregnancy
Ciprofloxacin
Trimethoprim - 1st and 2nd semester
Nitrofurantoin - avoid at term, can cause haemolysis
Three drugs to avoid in hepatic impairment/monitor closely
Diazepam
ACE inhibitors
Amlodipine
ACE inhibitor safe to use in hepatic impairment
Lisinopril
Centor Criteria
What for?
= tonsillar exudate, tender anterior cervical lymph nodes, absence of cough, history of fever
3/4 indicates potential group B strep infection, patient may benefit from antibiotic treatment
Treating pain and shortness of breath at end of life
Use morphine
Treating distress at end of life
Midazolam
Treating nausea at end of life
Levopromazine
Treating respiratory secretions at end of life
Buscopan
Going from oral to SC morphine
Need to half the 24 hour dose
Going from codeine to morphine
Divide codeine dose by 10 to give 24 hour morphine dose
Calculating morphine breakthrough dose
1/6th of 24 hour dose
Anaemia threshold for blood transfusion
Hb <70g/L
<80g/L if significant co-morbidity e.g. ischaemic heart disease
Who requires irradiated blood?
Any history of Hodgkins lymphoma
Any history of purine analogue chemptherapy
Immunosuppressed
Examples of purine analogue chemotherapy
Fludarabine Azathioprine Cladribine Pentostatin Clofarabine Nelarabine
Who requires CMV negative blood?
Pregnant women
Neonates
Not required at delivery, CMV takes a couple of days to transfer across the placenta so risk to foetus in delivery is small
Mild Transfusion Reaction
Presentation
Management
P: isolated temperature rise (>38 or 1-2 above baseline) or rash only
Mx: slow the rate of transfusion, give paracetamol/piriton, observe closely
Moderate Transfusion Reaction
Presentation
Management
P: temperature rise (>39) and other symptoms
e.g. rigors, chills, rash, flushing, collapse, pain
Mx: stop transfusion, report to transfusion laboratory
