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Y6 PSA > Difficult prescriptions > Flashcards

Difficult prescriptions Flashcards

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1
Q

How do you adjust insulin

A

TOTAL DAILY DOSE = long acting + short acting
100/TDD = correction factor

the correction factor is how much 1U of insulin decreases blood glucose by

THEN: (actual glucose - target glucose)/ correction factor

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2
Q

what is target glycaemic index during the day

A

5-7

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3
Q

how do you change insulin if patient is sick

A

YOU DONT

Continue normal insulin but with more monitoring

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4
Q

What do you do if patient is NBM to insulin

A

continue basal insulin

omit bolus insulin

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5
Q

Name of oestrogen HRT you can prescribe (oral / transdermal / gel)

A

Estradiol
Oral: Elleste solo
Transdermal: Evorel
PV gel: sandrena

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6
Q

what adjunct progesterone can you gve for HRT

A

IUS (Mirena)

PO (Provera)

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7
Q

what formulation of HRT do you need to give if peri-menopausal / wants period

A

OESTROGEN + PROGESTERONE (cyclical / sequential commbined)

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8
Q

name of oral HRT to give if peri-menopausal / wants period

A

Estradiol with norethisterone

Elleste duet ORAL

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9
Q

name of transdermal HRT to give if peri-menopausal / wants period

A

Evonorel sequi

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10
Q

what anti contipation meds can you give

A
  • OSMOTIC
    STIMULAANT
    BULKING
    PROKINETI
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11
Q

What is the front line stimulant algorithm to give

A
  1. Osmotic

2. Add Stimulant

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12
Q

give examples of ossmotic laxative

A

lactulose, movicol, phosphate enema

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13
Q

how does an osmotic laxative work

A

it draws water intto stool > softtens stool

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14
Q

containdication of osmotic laxatve

A

bloating

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15
Q

give examples of stimulants

A

senna

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16
Q

how do stimulants work

A

stimulate GI nerves > stimulate movement of bowel

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17
Q

contraindications of sttimulants

A

colitis
cramps
bowel obstruction
colostomy

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18
Q

which laxative is good for patients on opioids

A

stimulant laxative

because they counteract the slowing down of gut movement caused by opioid

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19
Q

what anti-diarrhoeal meds can you give (NOT if INFECTIVE=

A

Loperamide – take after each loose movement

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20
Q

What is the steroid ladder?

A

Help Carol Beat Medicine

Hydrocortisone
Clobetasone
Betamethhasone
Mometasone

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21
Q

when do you need to weane a patient off steroids (rather than stopping abruptlu)

A

> 40mg pred for 1 week
3 weeks of treatment
repeated course

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22
Q

what situation is it okay to abruptly withdraw steroids

A

if giiven for emergency (COPD/asthma)

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23
Q

What time of day should you take simvastatin

Study These Flashcards
A

in the evening (as cholesterol metabolism is in the evening)

24
Q

commonest side effect of statins

25
when should you stop statins following LFTT monitoring=
stop statins if AST/ALT >3 x ULN continue statin otherwise
26
when must you stop statins in muscle myopathy
if CK elevated (>5ULN) or severe muscular sx > STOP STATIN resume at lower dose once CK has returned to normal
27
Why is warfarin and statins a concernign combination
because they will lead to a high INR | due to competitive inhibition of CYP by statin
28
Outline WHO pain ladder
1. Non opioid (NSAID, paracetamol) 2. Weak opioid 3. Strong opioid
29
list some weak opioids
codeine tramadol morphine (oromorph PO, modiphied release morphine)
30
what are strong opioids
morphine diamorphine fentanyl oxycodone
31
How do you convert codeine / tramadol to oral morphine=
DIVIDE by 10
32
How do you convert oral morphine to subcut morphine
DIVIDE by 2 (subcut is STRONGER than oral)
33
convert oral morphone to oxycodone
DIVIDE by 2 (oxycodone is stronger than morphine)
34
which opioids can you give in. CKD
Oxycodone (GFR >30) | Fentanyl, alfentanyl, buprenorphinie (GFR<30)
35
how does warfarin work
inhibits vit K epoxide reductase > reduces levels of 2, 7, 9. 10
36
what is INR target for AF, cardioversion, MI
2-3
37
what is INF target for mechanical heart valve
3-4
38
what does 1% mean in terms of mg in mL
10mg in 1mL
39
how do you change / adapt COCP if surgery?
stop COCP 4 weeks beforee surgery restart COCP 2 weeks post surgery consider POP in interim
40
what kinds of laxatves are good for HAEMORRHOIDS?
bulk forming laxative
41
give examples of bulk formming laxative
ispaghula hysk | methylcellulose
42
when can biphosphonates be deprescrbed
when taken for more than 10 years | as there is no evidence that they still work
43
what unit can you use for topical meds
fingertip units (FTU)
44
is aspirin technically an NSAID? what must you keep in mind
yes it is technically an NSAID | but because it exists at a much lower dose, it is not necessarily subject to same level of caution
45
what is the only situation when cyclizine is contraindicated
``` if HF (as it worsens fluid retention) give metoclopramide instead ```
46
what is the max dose of paracetamool they can take
4g a day
47
how much paracetamol does one tablet cocodamol 30/500 contain
500mg
48
which drug type causes HYPOkalaemia
THIAZIDE diuretic
49
give an example of a THIAZIDE diuretic
bendroflumethazide
50
give an example of a THIAZIDE LIKE diuretic
indapamie
51
how do THIAZIDE diuretics work
INHIBIT sodium and chloride resorption > low Na, Cl | + increase calcium reabsorption> high CA
52
how doo THIAZIDES cause HYPOKALAEMIA
later in the nephron transporters attempt to resorb sodium in doiong this they excrete pootassium
53
which diuretics cause hypokalaemia
loop and thiazie
54
which diuretics cause HYPERkalaemia
aldosterone antagoniists ACEi ARB
55
what is the action of NSAIDs on the kidneys
cause renal artery constriction> reduce renal perfusion
56
what must you give for extrapyramidal sx e.g. dystonia
procyclidine
57
what must you do if discontinuing statin due to muscle pains / raised CK?
wait until muscle pains stop | then re start at lower dose

Y6 PSA (10 decks)

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