eScript 3 Flashcards
1
Q
What is an electrolyte abnormality caused by spironolactone?
A
hyperkalaemia
2
Q
are ACE inhibitors contraindicated in severe liver disease?
A
yes
In severe liver disease, the patient relies in part on activation of the renin-angiotensin system to maintain peripheral vascular resistance. Administration of an ACE inhibitor can lead to a rapid drop in blood pressure and the development of renal failure.
3
Q
signs on examination of chronic liver disease?
A
Spider naevi Clubbing Jaundice Loss of secondary sexual hair Gynaecomastia Ascites Splenomegaly Peripheral oedema
4
Q
tests to evaluate hepatic function?
A
Albumin, prothrombin time, bilirubin
USS
5
Q
what is child pugh score?
A
The Child Pugh score was developed to evaluate operative risk in patients with liver cirrhosis, but it remains one of the easiest bedside scores to calculate. It considers five variables; the severity of ascites and of encephalopathy, serum bilirubin, serum albumin and clotting time. It stages patients as Child class A, B or C, with class C patients having the most severe liver dysfunction.
6
Q
what liver complications can flucloxacillin cause?
A
hepatitis and cholestatic jaundice
the onset may be delayed for up to 2 months
7
Q
name some commonly prescribed drugs that can cause acute liver injury?
A
Paracetamol causes a dose-dependent acute liver injury that can lead to acute liver failure.
Co-amoxiclav and flucloxacillin can cause cholestatic hepatitis that resolves in most cases after withdrawal of the drug.
NSAIDs (e.g. ibuprofen, naproxen, diclofenac) can cause an ideosyncratic hepatitis that resolves in most cases after withdrawal of the drug. Aspirin can also cause hepatitis but it tends to be dose related.Ibuprofen classically causes a cholestatic hepatitis.
Antituberculosis drugs (e.g. rifampicin) can cause liver injury.
Methotrexate can cause severe fibrosis and cirrhosis if not adequately monitored.
Amiodarone can cause a steato hepatitis.
8
Q
how does paracetamol OD cause toxicity?
A
Paracetamol is primarily metabolised in the liver and metabolism of paracetamol is required prior to hepatotoxicity. Liver injury does not occur until glutathione is depleted. After this, the reactive metabolites of paracetamol bind to cellular macromolecules, causing lethal damage to the hepatocyte.
9
Q
when is NAC treatment commenced?
A
Treatment should be commenced if a patient has taken more than 150 mg/kg in any 24-hour period, unless:
The plasma-paracetamol concentration is undetectable
The patient is asymptomatic
LFTs, serum creatinine and INR are all normal
10
Q
what happens if a patient presents after 8 hours who has taken potentially toxic amounts of paracetamol, even if plasma concs are not available?
A
given NAC
11
Q
what are the 2 phases of drug metabolism?
A
Phase 1 - The cytochrome P450 group of enzymes is responsible for the majority of Phase 1 reactions. In cirrhosis, the activity of these enzymes can be markedly reduced.
Phase 2 - conjugation, which results in a water soluble compound that is usually inactive and more easily excreted in the urine or bile.
12
Q
what is first pass metabolism?
A
They will pass through the liver and be partially or wholly metabolised before reaching the systemic circulation, reducing oral bioavailability.
If the blood flow through the liver is slowed, a drug may be subject to increased metabolism, as it may stay in the liver for longer.
However, patients with cirrhosis often develop collaterals, enabling the blood to bypass the liver, resulting in a decrease in first-pass metabolism
13
Q
adverse effects of liver disease?
A
encephalopathy
clotting abnormalities
gastric and oesophageal varices, secondary to portal hypertension
ascites
14
Q
what medication can be prescribed for hepatic encephalopathy?
A
lactulose
15
Q
why are NSAIDs contraindicated in chronic liver disease?
A
The risk of bleeding is increased. NSAIDs can irritate the gastrointestinal tract, which may increase the risk of bleeding from GI varices. NSAIDs may also increase fluid retention in ascites. Patients with liver failure may depend on renal prostaglandins to maintain blood flow. NSAIDs inhibit prostaglandin production, reducing renal perfusion and can therefore precipitate renal impairment.
16
Q
how does body composition change with age?
A
Decrease in lean body mass.
Decrease in body water.
Increase in body fat in relation to total body weight.
Decrease in bone mass.
17
Q
what is the effect on distribution of drugs in elderly people for water-soluble and lipid-soluble drugs?
A
The distribution of lipid-soluble drugs (e.g. diazepam) may increase, resulting in a prolonged action or a ‘hangover effect’.
The distribution of water-soluble drugs (e.g. paracetamol, digoxin, ethanol) may decrease resulting in a higher initial plasma concentration for any dose based on body weight.
18
Q
what is the clinical relevance in decrease in lean body mass?
A
doses may need to be reduced e.g. digoxin
19
Q
what are the changes to drug metabolism as you get older?
A
decrease in hepatic function
decline in hepatic blood flow
20
Q
name some drugs that can cause toxicity due to a decline in renal function with age?
A
Aminoglycosides (e.g. gentamicin) Digoxin Lithium salts Metformin Thiazide diuretics
21
Q
What should be calculated to estimate a decline in renal function in elderly people with extremes of weight?
A
creatinine clearance- eGFR not accurate
22
Q
what drugs can cause hypothermia in older people?
A
- sedatives- benzos, opioid analgesics, TCAs
- impair awareness of temp- chlorpromazine
- decrease motility- antipsychotics, antiparkinsonian drugs
- cause vasodilation- e.g. amlodipine
23
Q
what drugs can cause peripheral oedema resistant to diuretics?
A
calcium channel blockers e.g. amlodipine
24
Q
drugs that can cause confusion and affect cognition?
A
Anticholinergics Antihistamines Beta-blockers Hypnotics Opioid analgesics Tricyclic antidepressants
25
when can benzodiazepines be contraindicated?
they can cause respiratory depression
26
when is haloperidol contraindicated?
in the presence of long QT
Haloperidol is a ‘typical’ antipsychotic, which can cause extrapyramidal side-effects such as tremor and restlessness (akathesia).
27
ADRs of anti-muscarinics e.g. TCAs and anti-spasmodics?
Memory loss
Urinary retention
Constipation
Exacerbation of glaucoma
28
ADRs of hypnotics/anxiolytics e.g. diazepam, zopiclone?
Falls
Confusion
Postural hypotension
29
ADRs of opioid analgesics such as codeine, dihydrocodeine and morphine sulfate?
Constipation
Drowsiness
Falls
30
why can amiodarone cause low mood and fatigue?
it can cause hypothyroidism
31
what is the criteria for a possible covid-19 case?
Requiring admission to hospital (i.e. hospital practitioner decided that admission to hospital is required with expected stay at least one night) AND
Have either clinical or radiological evidence of: - Pneumonia; OR
- Acute respiratory distress syndrome; OR
- Influenza like illness (fever ≥ 37.8oC and ≥ one acute
respiratory symptom: persistent cough (with or without
sputum), hoarseness, nasal discharge or congestion,
shortness of breath, sore throat, wheezing, sneezing)
Patients admitted who have symptoms that meet the above criteria should be tested, irrespective of contact or travel history.
32
Ix for covid-19?
Urea and electrolytes (calculate the patient's CURB-65 score)
Other biochemistry
Full blood count
Clotting - Prothrombin time (PT) or INR, D-dimers, Fibrinogen (DIC)
Liver function tests
Arterial blood gases (if O2 saturations < 92% on air)
Blood cultures and other microbiology, as per standard practice and indications
Imaging: Chest X-ray +/- CT thorax
Coronavirus swabs
33
abnormal blood test results on covid-19?
U&E’s: ↑ creatinine
Other biochemistry: ↑CRP, ↑Ferritin, ↑LDH, ↑troponin
Full blood count: Lymphocytopaenia, ↓Platelets
Clotting: ↑ Prothrombin time (PT) or INR, ↑D-dimers, Fibrinogen (DIC)
Liver function tests: ↑Bili, ↑ALT/AST
Arterial blood gases: hypoxia, ↑Lactate
34
CXR findings of covid-19?
May appear clear / unchanged
Local consolidation
Ground-glass opacity
Bilateral pulmonary infiltrate (basal / peripheral)
35
moderate features of deterioration in covid-19?
Oxygen requirement of more than 4 litres/min or inspired oxygen > 28% to maintain target saturations
36
severe features of deterioration in covid-19?
Unable to maintain target saturations (92–96% or 88–92% in type 2 respiratory failure risk group)
Inspired oxygen ≥ 50% to maintain target saturations
Respiratory Rate > 30 despite oxygen
pH < 7.2
Systolic BP < 90 mmHg
Other organ failure (e.g. liver/kidney/heart/brain)
Decreased conscious state
37
other complications of covid-19?
There is emerging evidence that COVID-19 can cause acute myocarditis and heart failure, as the Middle East Respiratory Syndrome (MERS) did. Activation of coagulation pathways, can lead to blood clots, leading to ischaemia and multi-organ failure.
38
what is stage 1 AKI?
Creatinine rise of 26 micromol/litre or more within 48 hours; or
Creatinine rise of ≥ x 1.5 from baseline in 7 days ; or
Reduced urine output of < 0.5 ml/kg/hour for more than 6 hours.
39
what is stage 2 AKI?
Creatinine rise of ≥ x 2 from baseline; or
| Reduced urine output of < 0.5 ml/kg/hour for 12 hours or more
40
what is stage 3 AKI?
Creatinine rise of ≥ x 3 from baseline within 7 days
OR
Creatinine rise to ≥ 354 micromol/litre with either:
Acute rise in creatinine of ≥ 26 micromol/litre within 48 hours or
≥ 50% rise from baseline within 7 days
OR
Urine output of < 0.3 ml/kg/hour for 24 hours
OR
Anuria for 12 hours
OR
Any requirement for renal replacement therapy.
41
common drugs causing nephrotoxicity?
Aminoglycosides: are directly nephrotoxic, causing acute tubular necrosis.
Amphotericin: is directly nephrotoxic. The use of newer liposomal formulations can still result in nephrotoxicity.
Cytotoxic chemotherapy: e.g. cisplatin, which has been associated with renal tubular damage.
Diuretics: can lead to volume depletion.
Immunosuppressants: ciclosporin and tacrolimus cause renal vasoconstriction producing ischaemia.
Lithium salts: can cause tubulo-interstitial damage and chronic kidney disease with long-term use.
NSAIDs/COX-2 inhibitors: renal blood flow often relies on prostaglandins. NSAIDs and cyclooxygenase-2 inhibitors reduce prostaglandin synthesis, and cause renal hypoperfusion, and AKI.
Radiocontrast media: a high ionic load can produce renal vasoconstriction leading to ischaemia.
Other nephrotoxic agents: Synthetic agents: insecticides, herbicides. Naturally occurring agents: alkaloids from plants/fungi, reptile venoms (all rare), cocaine.
42
what are some pathological states that are nephrotoxic?
Hypoperfusion: reduces oxygen and nutrient supply to the kidney.
Sepsis: endotoxins and inflammatory mediators from infection can damage the renal vascular endothelium resulting in thrombosis.
Rhabdomyolysis: myoglobin released from damaged muscles precipitates in renal tubules and also reduces blood flow in the outer medulla.
Hepatorenal syndrome: patients with end-stage liver disease often have renal vasoconstriction.
43
when should creatinine clearance be used for estimating eGFR?
Estimating renal function or calculating drug doses in patients with renal impairment
Older adults
Patients at extremes of muscle mass
Patients on a medicine with a low therapeutic index
44
what is the role of prostaglandins and angiotensin II in renal dysfunction?
Prostaglandins produced within the kidney maintain renal blood flow and GFR, especially under conditions of reduced effective circulating volume (e.g. dehydration, cardiac failure, cirrhosis).
Angiotensin-II is produced by the renin-angiotensin system in response to hypovolaemia or reduced renal perfusion (e.g. with reno-vascular disease). It causes efferent arteriolar vasoconstriction.
45
what parameters are used to measure fluid balance in AKI?
Pulse - supine and upright (where possible). You may need to sit the patient up in bed if they are unable to stand.
Blood pressure - supine and upright.
Arterial oxygen saturation.
Look for signs of pulmonary oedema - examine for tachypnoea, fine bilateral basal inspiratory crackles, chest X-ray signs.
Fluid overload - check for pitting ankle and sacral oedema. Check the patient's weight daily (rising daily weights are a very useful indicator of fluid overload).
46
what fluids are prescribed in AKI?
Sodium chloride 0.9% is an appropriate intravenous fluid in AKI. Sodium bicarbonate 1.26% is a good alternative if the patient has AKI with hypovolaemia and a metabolic acidosis (a serum bicarbonate of less than 20 mmol/litre)
47
why is hartmann's unsuitable for AKI?
it has a high potassium content
48
what 2 parameters are CKD classified on?
eGFR and Albumin: Creatinine ratio (ACR)
49
diuretics in CKD?
Loop diuretics (usually furosemide) may reduce fluid overload and hyperkalaemia in CKD. Only consider diuretic therapy in fluid overload and/or hyperkalaemia or hypertension
For severe fluid overload requiring urgent treatment:
Use an infusion of a loop diuretic (e.g. up to 250 mg of furosemide given neat via a syringe driver over 1 hour, at a rate not exceeding 4 mg/minute).
Do not give bolus injections of loop diuretics. Higher infusion rates can cause deafness.
50
When should you not use ACEi or ARBs in CKD?
Bilateral renal artery stenosis,
Renal artery stenosis in a patient with a single functioning kidney, or
Known widespread vascular disease ("vasculopaths") as renovascular disease is likely to be present compromising blood flow.
Blocking angiotensin-II (through ACEi or ARB use) will lead to dilatation in efferent arterioles, loss of 'back pressure' and failure of filtration.
51
what is the target blood pressure in CKD and CKD/diabetes?
In patients with CKD, the target blood pressure is below 140/90 mmHg.
In patients with CKD and diabetes mellitus, and also in those with an ACR of > 70 mg/mmol, the target blood pressure is below 130/80 mmHg.
52
when should ACE/ARBs should be offered to patients with CKD?
diabetes mellitus and an ACR of 3 mg/mmol or more (ACR A2 or A3).
hypertension and an ACR of 30 mg/mmol or more (ACR A3).
an ACR of 70 mg/mmol or more, irrespective of whether the patient is hypertensive or has cardiovascular disease.
53
when should potassium be measured when starting ACEi in CKD patients?
Check the potassium concentration and eGFR before commencing treatment and again about 7 days later; re-check after 7 days if a dose increase is made
Do not start treatment if the potassium is above the upper limit of normal (> 5.0 mmol/litre).
54
can CCBs be used in CKD and hypertension?
These agents are very useful in CKD and hypertension. They can produce oedema, which is resistant to diuretics and can be confused with volume overload.
55
can diuretics be used in CKD and hypertension?
Their use is crucial for blood pressure control in patients with salt and volume overload, particularly in CKD stage G4/5, and/or when oedematous (see diuretics in CKD).
56
when can BBs and alpha-blockers be used in CKD and hypertension?
Beta-blockers have a limited role in hypertension management. They are now mainly used in resistant hypertension (4th line), hypertension accompanied by ischaemic heart disease, or hypertension with heart failure (uncommon). In CKD, use beta-blockers that have significant non-renal elimination, such as bisoprolol or metoprolol
Selective alpha-blockers e.g. doxazosin are used fourth-line in resistant hypertension.
57
what is the drug of choice in the presence of heart failure with reduced ejection fraction?
digoxin
58
name some drugs that can cause hyperkalaemia?
```
ACE inhibitors
Angiotensin-2 receptor blockers
Spironolactone
Potassium sparing diuretics (amiloride, triamterene)
Potassium supplements (Sando-K, Slow-K)
```
59
how to rid the body of excess potassium?
stop any drugs that might be promoting hyperkalaemia
correct metabolic acidosis- In CKD, correct acidosis with oral sodium bicarbonate 1-6 g/day in divided doses.
In AKI, correct acidosis with 50-100 mmol of intravenous bicarbonate ions. Dialysis.
Restrict dietary potassium.
60
signs of hyperkalaemia on ECG?
Loss of P wave can be seen with hyperkalaemia.
As the hyperkalaemia worsens the QRS widens, eventually becoming a 'sine' wave appearance before cardiac arrest.
The PR interval is prolonged in hyperkalaemia.
T waves become peaked.
61
how long should anti-platelets be stopped prior to surgery?
7 days
the main exemption from this would be a patient who had received recent vascular stenting, in which case surgery is usually held off until the crucial antiplatelet period has finished as they are high risk for stent thrombosis if antiplatelet agents are stopped too early.
62
what common drugs need to be stopped in an AKI?
```
allopurinol
ACEi/ARBs
NSAIDs
HIV meds
gentamicin
```
63
why can steroids cause hyperglycaemia?
Synthetic glucocorticoids, such as prednisolone, mimic the effect of endogenous steroids. They can modulate carbohydrate metabolism resulting in hyperglycaemia.
64
what can a patient of fentanyl patches use for breakthrough pain?
fentanyl nasal sprays
65
why is trimethoprim teratogenic?
blocks folate metabolism
66
what is the first line drug in alcohol withdrawal?
benzodiazepines e.g. chlordiazepoxide
67
what drug is given if INR >1.5 the day before surgery?
BNF guidance recommends that if INR > 1.5 on the day before surgery, phytomenadione (vitamin K) 1–5 mg PO, using the IV preparation, is indicated.
68
what antibiotic can cause cholestatic jaundice?
co-amoxiclav
69
what monitoring is required for carbimazole?
FBC- neutropenia
70
what are the most serious adverse effects of ciclosporin and what needs to be measured?
The most serious adverse effects of ciclosporin are nephrotoxicity and hypertension which are thought to be mediated by vasoconstrictive effects on renal arterioles. Before initiation of treatment, a baseline assessment of renal function should be established and it is recommended that renal function is monitored every 2 weeks until results are stable. Blood pressure should also be monitored on a regular basis.
71
what change in insulin dose is an appropriate way to manage a transient rise in blood glucose caused by corticosteroids?
a 10% increase in dose
| normal fasting glucose <5.5
72
mx of acute dystonic reactions?
procyclidine hydrochloride 5 mg/mL injection
| Antimuscarinic drugs are first line in treating acute dystonic reactions.
73
name a med that is contraindicated in PVD?
beta blockers and ACE i
74
meds that can exacerbate heart failure?
CCB
| Prednisolone
75
signs and treatment of scarlet fever?
macular red rash, strawberry tongue, red throat, fever >38.3°C
phenoxymethylpenicillin 125 mg PO 6-hrly for 10 days
76
what electrolyte abnormality can thiazide-like diuretics, including indapamide cause?
hypokalaemia
77
what is the first line anti-emetic for PONV?
ondansetron- 5-HT3 antagonists
78
what is the side effect of onsansetron?
can prolong the QT interval
| if this is the case use cyclizine instead in PONV
79
prescription for a patient who is shocked and dehydrated?
If patients need IV fluid resuscitation, use crystalloids that contain sodium in the range 130–154 mmol/l, with a bolus of 500 ml over less than 15 minutes.
PlasmaLyte water is a balanced crystalloid, and is a reasonable choice for fluid resuscitation or hartmanns
80
common side effect of alendronic acid?
irritant to the upper GI tract causing dyspepsia
81
GI side effects of PPI?
diarrhoea
82
drugs that can cause ankle swelling?
naproxen
| amlodipine
83
drugs to avoid in renal failure?
antibiotics: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin
84
drugs that can accumulate in chronic kidney disease?
```
most antibiotics including penicillins, cephalosporins, vancomycin, gentamicin, streptomycin
digoxin, atenolol
methotrexate
sulphonylureas
furosemide
opioids
```
85
drugs that are considered safe in CKD
antibiotics: erythromycin, rifampicin
diazepam
warfarin
86
How many millimoles of sodium in 0.9% saline?
154
| 131 in hartmanns- closer to plasma amounts of 135-145
87
plasma potassium millimoles?
3.5-5
| hartmanns has 5 millimoles
88
drugs that improve prognosis in heart failure?
ACIi, beta-blocker first line- 1.25mg OD both
spironolactone
hydralazine with nitrates
if symptoms persist cardiac resynchronisation therapy or digoxin** should be considered. An alternative supported by NICE in 2012 is ivabradine. The criteria for ivabradine include that the patient is already on suitable therapy (ACE-inhibitor, beta-blocker + aldosterone antagonist), has a heart rate > 75/min and a left ventricular fraction < 35%
diuretics should be given for fluid overload
offer annual influenza vaccine
offer one-off*** pneumococcal vaccine
89
name some medications that may exacerbate heart failure?
thiazolidinediones
pioglitazone is contraindicated as it causes fluid retention
verapamil- negative inotropic effect
NSAIDs/glucocorticoids- should be used with caution as they cause fluid retention
class I antiarrhythmics
flecainide (negative inotropic and proarrhythmic effect)
90
what drug can reduce hypoglycaemic awareness?
beta blockers
91
drugs that can decrease potassium?
Thiazide diuretics
Loop diuretics
Acetazolamide
92
what drugs should be used in caution in a patient with asthma?
NSAIDs
beta-blockers
adenosine
93
dose of IM adrenaline, hydrocortisone and chlorphenamine in anaphylaxis?
500 micrograms (0.5ml 1 in 1,000)
H- 200mg
C-100mg
94
meds for angina?
statin for everyone, aspirin/clopidogrel if stroke/PAD
either CCB or BB
BB 1st line unless asthma
95
convert morphine of oxycodone?
divide by 1.5
96
primary prevention of CV disease using a statin vs secondary prevention?
atorvastatin 20mg OD primary prevention
atorvastatin 80mg OD secondary prevention (IHD/PAD/CVD)
97
```
common drug doses: analgesia
paracetamol
ibuprofen
codeine
co-codamol
```
```
Paracetamol 1g qds
Ibuprofen 200-400mg tds
Codeine 30-60mg qds
Co-codamol 8/500 2 tabs QDS
Co-codamol 30/500 2 tabs qds
```
98
common drug doses: antiemetics
cyclizine
metoclopramide
Antiemetics
Cyclizine 50mg tds
Metoclopramide 10mg tds
99
common drug doses: antibiotics
amoxicillin
clarithromycin
Amoxicillin 500mg tds
| Clarithromycin 500mg bd
100
common drug doses:Gastric acid reducing drugs
lansoprazole
omeprazole
Lansoprazole 15-30mg od
| Omeprazole 20-40mg od
101
```
common drug doses:cardiovascular drugs
aspirin
clopidogrel
simvastatin
atenolol
ramipril
bendroflumethiazide
furosemide
amlodipine
```
```
Aspirin 75-300mg od
Clopidogrel 75-300mg od
Simvastatin 10-80mg on
Atenolol 25-100mg od
Ramipril 1.25-10mg od
Bendroflumethiazide* 2.5mg od
Furosemide 20mg od - 80mg bd**
Amlodipine 5-10mg od
```
102
common drug doses:endocrine drugs
levothyroxine
metformin
Levothyroxine 25-200mcg od
| Metformin 500mg od - 1g bd
103
when is adenosine contraindicated in SVT and what is given instead?
asthmatics
| verapamil is given
104
what antihypertensive is teratogenic?
ACE inhibitors
| also statins
105
when should NAC be given immediately?
- if there is a staggered overdose* or there is doubt over the time of paracetamol ingestion, or the plasma paracetamol concentration is on or above a single treatment line
- or >150mg/kg
106
King's College Hospital criteria for liver transplantation (paracetamol liver failure)?
Arterial pH < 7.3, 24 hours after ingestion
or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy
107
how does digoxin work?
decreases conduction through the atrioventricular node which slows the ventricular rate in atrial fibrillation and flutter
increases the force of cardiac muscle contraction due to inhibition of the Na+/K+ ATPase pump. Also stimulates vagus nerve
digoxin has a narrow therapeutic index
108
what is digoxin used for?
Digoxin is a cardiac glycoside now mainly used for rate control in the management of atrial fibrillation. As it has positive inotropic properties it is sometimes used for improving symptoms (but not mortality) in patients with heart failure.
109
main precipitating factor of digoxin toxicity?
classically: hypokalaemia
digoxin normally binds to the ATPase pump on the same site as potassium. Hypokalaemia → digoxin more easily bind to the ATPase pump → increased inhibitory effects
110
mx of digoxin toxicity?
Digibind
correct arrhythmias
monitor potassium
111
what to do for gentamicin levels if
a) peak levels are too high
b) trough levels are too high
peak levels- decrease dose,same interval
| trough levels- decrease interval, same dose
112
when should glucose be avoided giving as a fluid?
in a stroke due to risk cerebral oedema
113
what is the aim for routine maintenance fluids?
When prescribing for routine maintenance alone, consider using 25-30 ml/kg/day sodium chloride 0.18% in 4% glucose with 27 mmol/l potassium on day 1
other regimes can achieve thia
114
Ix of meningitis?
```
full blood count
CRP
coagulation screen
blood culture
whole-blood PCR
blood glucose
blood gas
```
Lumbar puncture if no signs of raised intracranial pressure
115
mx of meningitis?
IV cefotaxime
benpen for outside hospital or confirmed meningococcal meningitis
add amoxicillin of <3 months or >50 years
116
what are women taking warfarin who become pregnant switched to?
LMWH
117
common causes of SIADH?
SCLC
stroke/SAH
drugs- sulfonylureas*, SSRIs, tricyclics, carbamazepine, vincristine, cyclophosphamide
118
why do ACE inhibitors cause hyperkalaemia?
reduced aldosterone secretion, and thus reduced potassium excretion
119
why can ibuprofen cause stomach ulceration?
Ibuprofen inhibits prostaglandin synthesis needed for gastric mucosal protection from acid
