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Final Med > Passing the PSA > Flashcards

Passing the PSA Flashcards

1
Q

Drugs to stop before surgery

A 
I LACK OP 
insulin 
lithium 
anticoagulants,
antiplatelets
COCP/HRT 
K sparing diuretics 
oral hypoglycaemics 
perindopril 
and ACE inhibitors
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2
Q

When do you need to stop the OCP and HRT before surgery?

A

4 weeks

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3
Q

before surgery: when do you stop lithium?

A

day before

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4
Q

When do you stop potassium sparing diuretics and ACE inhibitors before surgery?

A

day of surgery

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5
Q

What are the 9 things we have to think about for safe prescribing?

A
  1. Is it the correct patient?
  2. Do they have any allergies?
  3. Did you sign the front of the chart
  4. Consider any contraindications for the drug I am prescribing
  5. consider the route
  6. consider the need for IV fluids
  7. consider the need for thromboprophylaxis
  8. need for antiemetic
  9. consider the need for pain relief
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6
Q

What does the mnemonic PReSCRIBER stand for?

A 
Patient details 
Reaction (allergies)
Sign the front of chart
check for Contraindications to each drug
check Route for each drug
prescribe IV fluids if needed
prescribe Blood clot prophylaxis if needed 
prescribe antiEmetics if needed 
prescribe pain Relief if needed
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7
Q

What two commonly prescribed drugs both have penicillin in them?

A

co-amoxiclav and Tazocin

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8
Q

What are the four classes of drugs you must know the contraindications for?

A
  1. drugs that increase the bleeding risk
  2. for steriods
  3. NSAIDS
  4. antihypertensives
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9
Q

What are the contraindications for anticoagulation?

A

bleeding
suspicion that they could be bleeding
ischemic stroke (because could bleed into stroke)
Erythromycin (enzyme inducer) increase the PT and INR

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10
Q

What are the SE of steroids?

A

eyes= cataracts, glaucoma
face- moon like facies cushingoid appearance
cardiovascular- heart failure
skin and bones- osteoporosis and skin thinning and infection
endocrine= diabetes

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11
Q

NSAID contraindications

A 
No urine 
Systolic dysfunction 
Asthma 
indigestion 
Dyscrasia clotting abnormality
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12
Q

What are the SE of ACE inhibitors

A

dry cough, hyperkalemia,

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13
Q

SE of Beta blockers and CA channel blockers

A

hypotension

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14
Q

Should Beta blockers be prescribed in asthmatics?

A

nope

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15
Q

SE of calcium channel blockers

A

perpheral oedema and flushing

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16
Q

diuretics can cause?

A

renal failure

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17
Q

What two drugs can cuase gout

A

thiazide diuretics and frusemide

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18
Q

Spirolactatone can cause

A

cause gyncomastia

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19
Q

Iv potassium what is the maximum infusion rate?

A

10 mmol/hour

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20
Q

What are the two situations fluids are prescribed?

A

replacement

maintenance

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21
Q

Which fluid are you going to give patients?

A

0.9% normal saline

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22
Q

when would you give 5% dextrose to a patient

A

hypernatremic or hypoglycemia

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23
Q

What would you give your patient for fluid resus if the patient has ascites?

A

human albumin solution

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24
Q

In fluid resuscitation how do you know how much fluid to give?

A

HR, BP, urine output
500 ml bolus 0.9%
if heart failure 250 ml

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25
Q

If the patient is only oligouric how do you give the fluid?

A

give 1 litre over 2-4 hours than reassess the patient

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26
Q

How can you predict the fluid deficit?

A

reduced urine output will be decreased
500ml
reduced UO plus tachycardia 1 litre of fluid

plus shock- greater than 2 L fluid depletion

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27
Q

How do you prescribe maintenance fluids?

A

general rule: elderly 2 L

normal 3L

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28
Q

What do you give for daily maintenance?

A

1 salty 2 sweet

1 litre normal saline and 2 litres of 5% dex

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29
Q

With a normal potassium level what is the daily requirement for the patient K?

A

40mmol per day (20 mmol per bag)

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30
Q

How fast can you give maintenance fluids?

A

So to calculate this all you have to do is take the
amount of fluid you need to give and divide from 24 hours.
So if the patient is elderly then you are going to give 2L over 24 hours therefore 1 bag every 12 hours

if needing to give three litres than it is 24 divided by 3 is 8 hourly

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31
Q

What should you do before prescribing fluids?

A

check the patient’s U&Es
check that the patient is not fluid overloaded
check that the patient’s bladder is not palpable.

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32
Q

Most patients will be prescribed low molecular weight heparin why wouldn’t you?

A

bleeding or risk of bleeding

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33
Q

When should compression stockings not be prescribed?

A

in PVD, in celulitis
in skin grafting
mixed arterial and venous disease
acute stroke

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34
Q

If the patient is nauseated what do you prescribe?

A

cyclizine 50mg 8 hourly IV

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35
Q

What is the adverse Se of cyclizine?

A

fluid retention

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36
Q

When would you not rep scribe cyclizine?

A

in heart failure so metoclopramide 10 mg 8 hourly

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37
Q

If the patient is not nauseated what anti-emetic would you use?

A

PRN anti-emetic
cyclizine 50mg every 8 hours
metoclopramide 50 mg to 8 hourly

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38
Q

when would you aviod metclopromide?

A

patients with parkinson’s

young women—-> dyskinesia - acute systolic reaction

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39
Q

If the patient is in no pain, but the nurse asks you to prescribe paracetamol

A

PRN 1 g up to 6 hourly oral

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40
Q

mild pain chart up dose of paracetamol?

A

regular meds
1 g 6 hourly

PRN
codeine 30 mg up to 6 hourly

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41
Q

severe pain prescribe analgesia

A

co-codamol 30/500 2 tablets every 6 hours

PRN morphine sulphate 10 mg up to 6 hourly oral

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42
Q

What is the first line treatment for neuropathic pain?

A

amitriptyline (10 mg oral nightly)

pregabalin 75 mg 12 hourly

duloxetine 60 mg OD

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43
Q

Remember what does co-codamol have in it?

A

30/500
30 mg codeine
500 mg paracetamol

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44
Q

What is the max daily dose of paracetamol?

A

4 g

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45
Q

What antibiotic should not be given with methotrexate?

A

trimethoprim as it is also a folic acid antagonist

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46
Q

What antihypertensive can cause peripheral oedema?

A

calcium channel blocker

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47
Q

If you have a normal ejection fraction and peripheral oedema what do you need to consider before putting the patient on frusemide?

A

drug induced by calcium channel blocker

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48
Q

What are the causes for hyponatremia

A

dehydration
drips
drugs
diabetes insipidus

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49
Q

what are the causes of neutrophillia?

A

bacterial infection
tissue damage (inflammation, infarct, malignancy)
steriods

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50
Q

what are the causes of low neutrophils

A

viral infection
chemotherapy
clozapine
carbimazole (antithyroid)

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51
Q

what a re the causes fro thrombocytopenia?

A 
reduced production: 
infection 
drugs (penicillamine- RA) 
myeloma myelodysplasia, myelofibrosis 
increased destruction: 
heparin 
hypersplenism 
DIC 
ITP 
heamolytic uremic syndrome 
TTP
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52
Q

high platelets

A 
reactive: 
bleeding 
tissue damage (infection/inflammation/ malignancy) 
post-splenectomy 
primary: 
myeloproliferative disorders
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53
Q

If the patient is hypovolemic what are the causes of hyponatremia?

A

fluid loss (D&V)
addisons
diuretics

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54
Q

What is the patient is euvolemic what are the causes of hyponatremia?

A

SIADH
psychogenic polydipsia
hypothyriodism

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55
Q

hypervolemic but hyponatremic what is the cause?

A 
heart failure 
liver failure 
renal failure 
nutritional failure 
thyriod failure (hypothyriodism)
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56
Q

What are the cause of syndrome of inappropriate ADH secretion?

A

small cell lung ca
infection
abcess
drugs

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57
Q

what are the cause of hypokalaemia?

A

drugs (loop or thiazides)
inadequate intake or intestinal loss
renal tubular acidosis
endocrine (sunshine’s and conns)

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58
Q

What are the causes of hyperkalemia?

A

drugs potassium sparing diuretics and ACE inh
renal failure
artefactual
diabetic ketoacidosis

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59
Q

What does raised urea indicate?

A

kidney injury or upper GI heamorrhage

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60
Q

What are the cause of AKI?

A

prerenal- dehydration, shock, sepsis, blood loss, renal artery stenosis

intrinsic- ischemia (acute tubular necrosis) nephrotoxic antibiotics gent vanc, tetracyclines 
contrast 
gout 
glomerulonephritis 
cholesterol emboli 
post renal 
lumen- stone or slough papilla 
wall tumour or fibrosis 
external - BPH, lymphadenopathy, aneurysm
61
Q

If you want to determine whether or not the cause fo the renal injury is pre or post what can you do?

A

multiply the urea by 10 if it exceeds the creatinine than it is prerenal

62
Q

If the patient has a raised creatinine but a relatively normal urea what can you do to differentiate between intrinsic renal and postrenal?

A

intrinsic renal
bladder and hydronephrosis not palpable

post renal may be

63
Q

What do you look at in the LFTs to determine hepatocyte injury?

A

bilirubin
ALT
AST ALP

64
Q

What do you look at in the LFTs to determine synthetic function?

A

albumin

coagulation profile

65
Q

What can also raise the ALP

A 
fracture 
liver damage 
cancer 
pagers disease
pregnancy 
osteomalacia 
surgery
66
Q

How do you interpret and change levothyroxine depending on the results on the tests?

A

TSH less than .5 decrease dose
if it is in the sweet spot of .5-5 then stay the same
if TSH is greater than 5 ask about complicance and then increase dose

67
Q

what are the cause of pre hepatic LFT derangement

A

heamolysis

gilbert and crigler najjar

68
Q

intrahepatic

A 
fatty liver 
hepatitis
cirrhosis 
malignancy 
metabolic wilson/ hemochromatosis 
heart failure
69
Q

post hepatic failure

A

lumen: gallstone,
wall tumour
extrinsic pressure pancreatic or gastric ca

70
Q

What are some drugs that can cause post hepatic obstruction?

A

flucloxacillin co amoxiclav
nitrofurantoin
steroids
sulphonylureas

71
Q

primary hypothyriodism TFT look like?

A

T4 down

TSH up

72
Q

secondary hypothyroid

A

T4 down

TSH down

73
Q

primary hyperthyroidism

A

t4 up TSH down

74
Q

secondary hyperthyroidism TFT

A

T4 up

TSH up

75
Q

What are the causes of primary hypothyroidism

A

hashimotos

drug induced

76
Q

causes of secondary hypothyroidism

A

pituitary tumour or damage

77
Q

primary hyperthyroidism

A

graves’ disease
toxic nodular goitre
drug induced

78
Q

secondary hyperparathryoidism

A

pit tumour

79
Q

What a re the ABCDE signs of pulmonary oedema?

A 
alveolar oedema 
kerley B lines 
cardiomegaly 
Diversion of blood to the upper lobes 
pleural effusion
80
Q

When interpreting blood gases it is important to follow this routine?

A

check the inspired oxygen concentration

approximate the FIO2 take % oxygen minus 10 this should be at least the patients PaO2

check for respiratory failure type 1 type 2

check the acid base status
think about the causes

81
Q

What is the causes of respiratory alkalosis

A

rapid breathing- disease or anxiety

82
Q

respiratory acidosis causes

A

slow or shallow breathing

COPD and less commonly nueromuscular failure or restrictive wall abnormalities

83
Q

What are the causes of metabolic acidosis

A

lactic acidosis
DKa
renal failure
ethanol methanol glycol intoxication

84
Q

What are the causes of metabolic alkalosis

A

vomiting diuretics and conns syndromes

85
Q

What are the most common drugs prescribed that have a narrow therapeutic index?

A 
digoxin 
theophylline 
lithium 
phenytoin 
and vancomycin and gentamicin
86
Q

What are the features of toxicity for digoxin?

A

confusion nausea and vomiting and visual halos and arrhythmias

87
Q

lithium toxicity

A 
early tremor 
tiredness 
arrhythmias 
seizures 
coma 
renal failure 
diabetes insipidus
88
Q

Phenytoin toxicity

A 
gum hyperplasia 
ataxia 
nystagmus 
peripheral neuropathy 
teratogenicity
89
Q

gentamicin

A

ototoxicity and nephrotoxicity

90
Q

vancomycin toxicity

A

ototoxicty and nephrotoxicity

91
Q

What is paracetamol normally metabolisms by?

A

liver

92
Q

How does paracetamol overdosing happen

A

limited hepatic stores of glutathione are quickly depleted
there is a toxic accumulation of NAPQI
causes acute liver damage

93
Q

What is the protocol for Warfarin based on INR

A

less than 6 reduce dose
6-8 omit warfarin for 2 days then reduce
greater than 8 omit and give 1-5 mg oral warfarin

94
Q

Target INR for most patients

target for heart valves

A
  1. 5 INR

3. 5 INR heart valves

95
Q

What do you do for a major bleed if the patient is on warfarin

A

stop warfarin
give 5-10 mg IV vitamin K
give prothrombin complex

96
Q

How does Ibuprophen contribute to renal injury?

A

it decreases blood flow to the kidneys by inhibiting prostaglandin (vasodilator) mimics pre renal failure causing increase in urea and creatinine and potassium

97
Q

What antihypertensive drug can cause hyperkalemia?

A

ACE inh

98
Q

What commonly prescribed antibiotic can cause warfarin levels in the blood to increase?

A

erythromyocin

99
Q

Treatment for neutropenic sepsis

A

pip taz with gent

100
Q

What antihypertensive drug class can cause hyponatremia?

A

ca channel blocker

101
Q

What medication commonly given in uti should not be given in pregnancy?

A

trimethoprim

102
Q

in an acute setting what should you give for CCF

A

furosemide 40 mg iv

103
Q

name another loop diuretic besides frusemide

A

bumetanide

104
Q

what is the commonly used ca channel blocker in af

A

diltiazem

105
Q

what drug is good for neuropathic pain relief?

A

amitriptyline 10 mg nightly

106
Q

What is the management plan for STEMI

A 
ABC and O2 
aspirin 300mg 
morphine 5-10 mg IV with metoclopramide 10 mg IV
GTN spray 
primary PCI or thrombolysis 
Beta blocker atenolol 5 mg
107
Q

Non- ST elevation MI

A

ABC and O2
aspirin 300 mg
morphine 5-10 mg IV with metoclopromide 10 mg IV
GTN spray
clopidogrel 300 mg and LMWH
Beta blocker atenolol 5 mg (unless LVF or asthma)

108
Q

Left ventricular failure

A 
ABCs and o2 
sit the patient up 
morphine 5-10 mg IV with metclopromide 10 mg IV 
GTN spray 
frusemide 40-80 mg IV
109
Q

What are the elements that are needed to managing a STEMI?

A

ABC and resus
history examination investigations confirming dx
aspirin dose 300mg oral
morphine 5-10mg IV with meclopramide 10 mg IV
GTN spray
primary PCI or thrombolysis
B blocker * atenolol 5 mg oral

110
Q

What are the elements of treating a NSTEMI?

A 
ABCS and resus 
dx NSTEMI 
asprin 300 mg oral 
morphine 5-10 mg IV with metclopromide 10 mg IV 
GTN 
clopidogrel 300 mg oral and LMWH 
enoxaparin 1 mg/kg BD SC
111
Q

WHat are your management steps with acute left ventricular failure?

A

ABCs and resus
confirm the dx
sit the patient
morphine 5 mg IV with metoclopramide 10 mg IV
GTN spray *only if the patient’s bp is greater than 100 systolic
furosemide 40-80 mg IV
if inaquete response isosorbide dinitrate infusion.
plus or minus ?CPAP= pulmonary oedema

112
Q

The patient is tachycardic what is your plan?

A 
first determine sick or unsick? shock syncope myocardial infarction heart failure 
if so DC shock 3 times 
amiodarone 300 gm IV over 10-20 min
r/p amiodarone 900 mg over 24 hours 
————-
stable qrs 
narrow regular 
vagal adenosine 6 mg then 12 
not workin sh atrial flutter? b block 
if irregular 
control rate with block or diltiazem 
hf? digoxin 
—————
wide qrs 
irregular sh 
regular—- amiodarone 300 mg iv
113
Q

Anaphylaxis pathway

A 
ABCs and resus 
confirm and focused hx and exam 
remove cause ASAP
iv access bloods fbc u&e mast cell tryptase immed after, 1 harm 6-24 h later 
adrenaline 500 micrograms of 1:1000 IM 
chlorphenamine 10 mg slow iv 
hydrocortisone 200 mg IV 
asthma treat wheeze 5 mg salbutamol
114
Q

Asthma pathway

A 
ABC 
100% O2 
salbutamol 5 mg NEB
Hydrocortisone 100 mg IV (if severe) 
or Prednisalone 40-50 mg if moderate 
Ipratropium bromide 500 micrograms NEB 
theophylline (life threatening)
115
Q

Treatment for pneumonia

A 
ABCs 
high flow O2 
antibiotics according to the CURB 65 score and if onset was in or out of hospital 
paracetamol for pain relief 
if low BP or tachycardic fluid resus
116
Q

treatment for pulmonary embolism

A 
ABCs
sit up unless low BP
high flow O2 
Morphine 5-10 mg IV 
metoclopromide 10 mg IV 
LMWH tinzaparin 175 units per kg SC daily 
if low BP IV gelofusine 
noradrenaline 
thrombolysis
117
Q

What is the management for a GI bleed?

A 
ABCS 
cannula 
catheter (fluid monitoring) 
crystalloid 
cross match 6 units 
correct clotting abnormalities
endoscopy  
stop culprit drugs like NSAIDS aspirin warfarin and heparin 
call the surgeons if severe
118
Q

What are you looking for the in the clotting screen if a patient is bleeding? When would you replace?

A

platelets if less than 50 x 10^9

PT/APPT greater than 1.5 times the upper limit of normal

119
Q

What is the treatment of bacterial meningitis?

A

ABCs
high flow O2
IV fluid
dexamethasone IV unless sevely immunocompromised
LP (plus or minus CT head)
2 g cefotaxime IV plus Vanc (using GAPP)
consider ITU

120
Q

What is the treatment pathway for status epilepticus?

A

ABCs
put patient into the left lateral decubitus position with O2
check the glucose
take blood s and establish IV access
5-20 minutes:
lorazepam 4 mg IV over 2 min repeat at 10 minutes if no effect
inform the anaesthesist
Phenytoin infusion 20 mg/ kg IV at less than 50 mg per minute
intubation with propofol

121
Q

Management of stroke

A

ABCs
blood glucose and CT head to exclude heamorrhage
if aged less than 80 and onset is less than 4.5 hrs thrombolysis
Aspirin 300 mg Oral for 14 days
transfer to the stroke unit

122
Q

What is the treatment for hyperglycemia

A 
ABCs 
IV fluids 
1 L stat then 1 L over 1 hours 
then 2 hours then 4 hours then 8 hours 
sliding scale insulin 
hunt for trigger (infection, MI, missed insulin) 
monitor BM K and pH
123
Q

What is he management of AKI

A 
ABCs
cannula and catheter fluid monitoring 
IV fluids and 500 ml stat then 1 L hourly 
hunt for cause and complications 
monitor U&Es and fluid compliance
124
Q

what is the mgx for acute poisoning?

A

Abcs
cannula and catheter strict fluid balance
supportive measures
correct E- disturbance
reduce absorption (less than 1 hour- gastric lavage or charcoal)
increase elimination
psychiatric management

125
Q

What medication do you give for paracetamol overdose?

A

N acetyl cysteine (paracetamol level at 4 hours is over the line on treatment)

126
Q

What do you take for opiate poisoning?

A

Naloxone

127
Q

What so you take for benzo overdose?

A

Flumazenil

128
Q

Treatment for Heart failure

A 
treat the underlying cause 
smoking cessation 
cardiac rehab 
B blockers and ACE inh 
EF less than 35% can add aldosterone anatongonist
129
Q

What is the treatment for Parkinson Disease

A

levodopa and carbidopa
life style effecting
non lifestyle affecting
dopamine agonists (ropinirole)
monoamine oxidase inhibitors (selegiline)
On and off effect may need to add MAO B inh COMT inh, and dopamine agonists

130
Q

Epilepsy management

A 
generalised- Na valproate 
absence- Na valproate 
myoclonic - Na val
tonic NA val 
focal- Carbamazepine or lamotrigine
131
Q

What are the SE of lamotrigine

A

rash, rarely steven johnson syndrome

132
Q

What is the SE of carbamazepine

A

rash, dysarthria, ataxia, nystagmus, hyponatremia

133
Q

What are the SE of phenytoin?

A

ataxia, P neuropathy, gum hyperplasia hepatotoxicty

134
Q

Na valproate

A

tremor teratogencity weight gain

135
Q

When do you not give a laxative?

A

When there are evidence of obstruction
absolute constipation no flatus
abdominal distension

136
Q

What is one of the side effects of Carbimazole?

A

neutropenia

137
Q

What are the SE of carbamazepine?

A

This is a treatment for neuropathic pain. can cause neutropenia

138
Q

What is Donepezil licensed for?

A

mild to moderate Alzheimer’s disease

139
Q

What is me mantiene licensed for?

A

severe alzheimer disease

140
Q

What are two drugs not to be prescribed in Parkinson’s

A

metoclopromide and Haloperidol because they are dopamine agonists

141
Q

Should you prescribe an ACE inhibitor in pregnancy?

A

No it is tetratogenic especially in the first trimester

switc to labetalol

142
Q

What are some common SE of tamoxifen?

A

increased risk of endometrial ca
messes with Warfarin leading to increased INR
hot flushes
increased risk of VTE

143
Q

What time of the day should Gliclazide should be taken?

A

morning with breakfast

144
Q

What medications should never be used with Methotrexate?

A

folate antagonists such as trimethoprim (which is also the reason this drug should not be used in pregnancy)
and co-trimoxazole

145
Q

how do you look after patients on Warfarin?

A

initially weekly blood tests and then once stable blood tests monthly

146
Q

What are the side effects of ACE inh

A

hyperkalemia
cough
monitor for CKI every 1-2 weeks do U&Es

147
Q

What SE of SSRIs do you need to warn the patient of?

A

dry mouth
suicidal ideation
photosentivity
symptoms of serotonin syndrome agaitation, temperature, hallucinations

148
Q

What is the weird thing you have to tell patients on bisphosphonates?

A

Tablet needs to be swallowed with a full glass of water and remain upright for 30 minutes afterwards.
Bisphosphonates are a once weekly preparation.

149
Q

What creatinine clearance is deemed unsafe for patients who are going to be put on Gent?

A

less than 20 ml/min

Final Med (35 decks)

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