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medicine emergency > Monitoring > Flashcards

Monitoring Flashcards

1
Q

What risk are statins associated with?

A

Myopathy

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2
Q

What are the classic side effects of vancomycin?

A

Ototoxicity and nephrotoxicity

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3
Q

What is a rare side effect of vancomycin?

A

Thrombocytopenia and neutropenia

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4
Q

What do you check before starting statins in patients with risk factors for myopathy

A

Creatinine kinase

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5
Q

What do you check before starting statins for patients with no risk factors for myopathy? Why?

A

Statins are metabolised by the liver, so contraindicated in liver disease or 3x normal transaminases (ALT and AST)

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6
Q

How often should LFTs be checked after starting statins?

A

At 3 months, then 12 months

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7
Q

What longterm complication is methotrexate associated with?

A

Liver cirrhosis

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8
Q

How is methotrexate excreted?

A

Renally

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9
Q

How does sodium depletion affect lithium?

A

Increases risk of toxicity

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10
Q

What can carbimazole cause?

A

Acute pancreatitis

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11
Q

What should be measured in a thyroid assessment for patients on amiodarone?

A

T3, TSH and T4

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12
Q

What is a known side effect of amiodarone?

A

Raised serum transaminases and acute liver dysfunction

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13
Q

How is gentamicin excreted?

A

Renally so monitoring is required

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14
Q

How does hypokalaemia affect digoxin?

A

Increases the risk of toxicity

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15
Q

What can valproate cause?

A

Pancreatitis

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16
Q

What is sodium valproate associated with?

A

Hepatotoxicity

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17
Q

How should FBC be monitored for clozapine?

A

Weekly for first 18 weeks, then fortnightly for up to one year, and then monthly

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18
Q

What are the causes of microcytic anaemia?

A

Iron deficiency
Thalassaemia
Sideroblastic anaemia

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19
Q

What are the causes of normocytic anaemia?

A

Anaemia of chronic disease
Acute blood loss
Haemolytic anaemia
Renal failure (chronic)

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20
Q

Causes of macrocytic anaemia

A 
B12/folate deficiency
Excess alcohol
Liver disease
Hypothyrodism
Myleloproliferative, myelodysplastic, multiple myeloma
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21
Q

What are the causes of high neutrophils?

A

Bacterial infection
Tissue damage
Steroids

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22
Q

Causes of low neutrophils

A

Viral infection
Chemotherapy or radiotherapy
Clozapine
Carbimazole

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23
Q

Causes of high lymphocytes

A

Viral infection
Lymphoma
Chronic lymphocytic leukemia

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24
Q

Causes of thrombocytopenia

A 
Reduced production:
infection
drugs (penicillamine)
myelodysplasia, myelofibrosis
myeloma
Increased destruction:
Heparin
Hypersplenism
DIC
ITP
Haemolytic uraemic syndrome / thrombotic thrombocytopenic purpura
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25
Q

Causes of thrombocytosis

A 
Reactive: 
bleeding
tissue damage
Primary:
myeloproliferative disorders
26
Q

When would you discontinue statins in someone with no myalgia risk factors?

A

serum transaminases can be raised by up to 3x the upper limit of normal before statins should be discontinued

27
Q

Causes of hypovolaemic hyponatraemia

A

Fluid loss
Addison’s disease
Diuretics

28
Q

Causes of euvolaemic hyponatraemia

A

SIADH
Psychogenic polydipsia
Hypothyrodism

29
Q

Causes of hypervolaemic hyponatraemia

A 
Heart failure
Renal failure
Liver failure
Nutritional failure
Thyroid failure
30
Q

Causes of SIADH?

A

Remember SIADH!!

Small cell lung tumours
Infection
Abscess
Drugs (carbamazepine and antipsychotics)
Head injury
31
Q

Causes of hypokalaemic

A

DIRE

Drugs (loop and thiazide diuretics)
Inadequate intake or intestinal loss (diarrhoea/vomiting)
Renal tubular acidosis
Endocrine (Cushing’s and Conn’s syndromes)

32
Q

Causes of hyperkalaemic

A

DREAD

Drugs (potassium sparing diuretics and K sparing diuretics)
Endocrine (Addison’s disease)
Artefact (clotted samples)
DKA (however, this drops when given insulin so requires hourly monitoring)

33
Q

What does raised urea indicate?

A

Kidney injury or upper GI haemorrhage.

(Urea is a product of amino acid breakdown). If patient is not dehydrated and creatinine is normal, suspect upper GI bleed and check Hb)

34
Q

Causes of prerenal AKI

A

Dehydration
Renal artery stenosis

Indicated by urea rise&raquo_space; creatinine rise

35
Q

Causes of intrinsic renal AKI

A

INTRINSIC

Ischaemic (due to prerenal AKI causing acute tubular necrosis) 
Nephrotoxic antibiotics
Tablets (ACEi, NSAIDS)
Radiological contrast
Injury (rhabdomyolisis)
Negatively bifringent crystals (gout)
Syndromes (glomerulonephridities)
Inflammation (vasculitis)
Cholesterol emboli

Urea rise &laquo_space;creatinine rise
Bladder or hydronephrosis not palpable

36
Q

Post-renal AKI

A

In lumen: stone or sloughed papilla
In wall: tumour (renal cell, transitional cell), fibrosis
External pressure: BPH, prostate cancer, lymphadenopathy, aneurysm.

Urea rise &laquo_space;creatinine rise.

Bladder or hydronephrosis may be palpable

37
Q

What does raised urea alone indicate?

A

Pre-renal AKI or upper GI bleed

38
Q

What does raised bilirubin alone indicate?

A

Pre-hepatic dysfunction

Haemolysis or gilberts or crigler-najjar syndrome

39
Q

What does raised bilirubin and AST/ALT indicate?

A

Intrahepatic problem

Fatty liver
hepatitis
cirrhosis
malignancy
wilson's disease or haemochromatosis
Heart failure causing hepatic congestion
40
Q

What does high bilirubin and ALP indicate?

A

Posthepatic (obstructive) picture.
In lumen: stone (gallstone) or drugs causing cholestasis
In wall: tumour (cholangiocarcinoma), primary biliary cirrhosis, schlerosing cholangitis
Extrinsic pressure: pancreatic or gastric cancer, lymph node

41
Q

What can cause hepatitis or cirrhosis?

A

Alcohol
Viruses (Hep A-E, CMV and EBV)
Drugs (paracetamol overdose, statins, rifampicin)
Autoimmune (primary biliary cirrhosis, primary schlerosing cholangitis, and autoimmune hepatitis)

42
Q

What drugs cause cholestasis?

A

Flucloxacillin, co-amoxiclav, nitrofurantoin, steroids, and sulphonyureas

43
Q

What are common causes of a high ALP?

A

ALK PHOS

Any fracture
Liver damage (posthepatic)
Kancer
Pagets disease of bone and Pregnancy
Hyperparathyrodism
Osteomalacia
Surgery
44
Q

What is the target range for TSH?

A

0.5 - 5

45
Q

What are causes of primary hypothyrodism?

A

Hashimoto’s thyroditis

Drug-induced hypothyrodism

46
Q

What are causes of secondary hypothyrodism?

A

Pituitary damage or tumour

47
Q

What are causes of primary hyperthyrodism?

A

Grave’s disease
Toxic multi-nodular goitre
Drug-induced

48
Q

What are the causes of secondary hyperthyrodism?

A

Pituitary tumour

49
Q

What are the most common drugs with narrow therapeutic indexes?

A

Phenytoin, gentamicin, warfarin, lithium, theophylline, digoxin, vancomycin.

50
Q

What are the signs of digoxin toxicity?

A

Confusion, nausea, visual halos, and arrythmias

51
Q

What are the signs of lithium toxicity?

A

Early: tremour
Intermediate: tiredness
Late: arrythmias, seizures, coma, renal failure, and diabetes insipidus

52
Q

What are the signs of phenytoin toxicity?

A

Gum hypertrophy, ataxia, nystamus, peripheral neuropathy, and teratogenicity

53
Q

What are the signs of vancoymcin and gentamicin toxicity?

A

Ototoxicity and nephrotoxicity

54
Q

What is the normal range for genamicin (not in infective endocarditis)

A

Peak: 5-10
Trough: <2

55
Q

What is the normal range for gentamicin in infective endocarditis?

A

Peak: 3-5mg
Trough: <1

56
Q

What do you do if peak gentamicin is out of range?

A

Adjust dose

57
Q

What do you do if trough gentamicin is out of range?

A

Adjust dose interval

58
Q

What do you do for a major bleed on warfarin?

A

Stop warfarin
Give 5-10mg vitamin K
Give prothrombin complex

59
Q

What do you do if the INR is 5-8?

A

If not bleeding, omit warfarin for 2 days then reduce dose.

If bleeding, omit warfarin and give vitamin K IV

60
Q

What do you do if INR is over 8?

A

Omit warfarin and give PO vitamin K if not bleeding

medicine emergency (3 decks)

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