EXTRA REVISION NOTES Flashcards

(61 cards)

1
Q

Normal Serum Potassium levels:

A

3.5 - 5.3 mmol/L

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2
Q

6 DRUGS CAUSING HYPOKALEAMIA -

A
A - AMINOPHYLLINE/THEOPHYLLINE
B - BETA AGONISTS E.G. Salbutamol
C - CORTICOSTEROIDS
D - DIURETICS - LOOP + THIAZIDE
E - ERYTHROMYCIN & MACROLIDES
I - INSULIN

Imbalance causes cardiac SE e.g.
palpitations, arrhythmias

Hypokaleamia predisposes patients
taking to digoxin toxicity

TREATMENT
-Mild-moderate: Oral replacement
therapy (Sando-K tabs)
-Severe: IV Potassium (KCL) in Nacl

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3
Q

6 DRUGS CAUSING HYPERKALEMIA

A
T - TRIMETHOPRIM
H - HEPARINS
A - ACE/ARBS
N - NSAIDS
Ks - K+ SPARRING DIURETICS e.g.
spironolactone, amiloride
B - BETA BLOCKERS
TREATMENT -
Acute Severe Hyperkaleamia
(>6.5mmol/L)
- Urgent Hospital treatment
- IV Cacl /Calcium gluconate
- IV soluble insuling with glucose
- Salbutamol (nebulisation or slow
IV injection)

Mild to moderate -
- Ion exchange resins to remove
excess potassium (calcium
resonium)

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4
Q

Normal Serum Sodium levels:

A

133-146 mmol/L

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5
Q

4 DRUGS CAUSING HYPONATREMIA

A

★ SSRIs
★ DIURETICS
★ DESMOPRESSIN/ VASOPRESSIN
★ CARBAMAZEPINE

Lithium - hyponatremia predisposes to
lithium toxicity
Effects - headache, confusion, seizures

TREATMENT -
● Mild to moderate - Oral supplements
(sodium chloride/bicarbonate)
● Severe - IV NACL

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6
Q

4 DRUGS CAUSING HYPERNATREMIA

A
❖ Sodium bicarbonate / chloride
❖ Corticosteroids
❖ Effervescent formulations
❖ Androgens + Oestrogens
Effects - Thirst, fatigue, confusion
Reduce dietary sodium intake
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7
Q

Normal Serum Calcium levels:

A

2.20 - 2.60 mmol/L

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8
Q

DRUGS CAUSING HYPOCALCEMIA

A
❖ Rifampin
❖ Phenytoin
❖ Phenobarbital
❖ Alendronate, risedronate,
zoledronic acid

Mild-moderate hypocalceamia -
oral calcium supplements often given with
Vit D

Severe Hypocalceamia - IV slow calcium
gluconate 10% (to prevent arrhythmias) with
ECG monitoring

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9
Q

DRUGS CAUSING HYPERCALCEAMIA

A
❖ Hydrochlorothiazide and other
thiazide diuretics
❖ Lithium
❖ Excessive intake of vitamin D, A,
calcium
TREATMENT -
- Correct dehydration with IV NaCl
- Bisphosphonates and pamidronate
used
- Discontinue drugs causing
hypercalceamia
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10
Q

Normal Serum Magnesium levels:

A

0.6 - 1.00 mmol/L

PPIs can cause HYPOMAGNESIA

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11
Q
DRUGS WHICH PROLONG
QT-INTERVAL
(Extended interval between the heart
contracting and relaxing + can increase
risk of abnormal heart rhythms and
sudden cardiac arrest)

Clue - 7 ANTI drug classes + 1 ABX + I NTD

A

❖ Lithium

❖ Macrolide antibiotics - erythromcyin

❖ Anti-psychotics - Haloperidol,
Quinine, Chlorpromazine

❖ Antihistamines - hydroxyzine

❖ Antidepressants - Venlafaxine,
SSRIs, TCAs

❖ Antiarrhythmics - Amiodarone,
flecainide, sotalol

❖ Anti-emetics - Domperidone,
Ondansetron

❖ Anti-fungals - Fluconazole,
ketoconazole

❖ Anti-malarials - Chloroquine,
Mefloquine

❖ Sildenafil
❖ Methadone

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12
Q

PHOTOXIC DRUGS - Increases sensitivity of the skin to sunlight

A
➔ Quinine
➔ Amiodarone
➔ Retinoids
➔ Tetracyclines e.g. Doxycyline
➔ Sulfasalzine
➔ Hydrochlorothiazide
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13
Q

DRUGS THAT IMPACT EYESIGHT

A
  • LINEZOLID
  • ETHAMBUTOL
  • ISOTRETINION ( DRUY EYES)
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14
Q

OVERDOSE ANTIDOTES !!!!

A
★ Opioids - Naloxone
★ Benzodiazepines - Flumazenil
★ Iron - Desferrioxamine
★ Paracetamol - Acetylcysteine
★ Warfarin - Phytomenadione
★ Unfractionated Heparin -
Protamine
★ Apixaban/edoxaban/rivaroxoban -
Andexanet Alfa
★ Dabigatran - Idarucuzimab
★ Methotrexate - Folinic acid
★ Copper - Penicillamine
★ Digoxin - DigiFab
★ BB + CCB - Glucagon
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15
Q

NEPHROTOXICITY SIGNS+SYMPTOM

A
➢ Nausea / Vomiting
➢ Diarrhoea
➢ Dehydration
➢ Reduced urination
➢ Confusion
➢ Drowsiness
Monitor CrCl or eGFR
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16
Q

NEPHROTOXIC DRUGS

A

NEPHROTOXIC DRUGS -

Cardiovascular drugs:

  • ACE-Inhibitors
  • ARBs
  • Diuretics

Antibiotics:

  • Aminoglycosides (e.g.Gentamicin)
  • Gylcopeptides (e.g. Vancomycin)
  • Nirofurantoin (Avoid if eGFR<45ml/m)
  • Trimethoprim / Tetracyclines

Immunosuppressants:

  • Ciclosporin
  • Tacrolimus
  • Methotrexate

Lithium / NSAIDs / Metformin

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17
Q

DRUGS EXACERBATING AKI - DAMN

A

D - Diuretics
A - ACE Inhibitors
M - Metformin
N - NSAIDS

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18
Q

HEPATOXICITY SIGNS+SYMPTOMS

A
➢ Jaundice - yellowing of skin + eye
➢ Itching (Pruritis)
➢ Abdominal pain in the upper right
quadrant
➢ Fatigue / Loss of appetite
➢ N+V / Rash / Fever / Weight loss
➢ Dark or tea colored urine

Monitor LFTs, Creatinine Kinase, Serum
Transaminases

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19
Q

HEPATOTOXIC DRUGS -

A

Anti-epileptics: Sodium Valproate,
Carbamazepine, Phenytoin

Anti-fungals: Fluconazole, Ketoconazole

Antibiotics: Isoniazid, Rifampicin,
tetracyclines

***Risk of cholestatic jaundice and
hepatitis with:
- Flucloxacillin
- Co-amoxiclav

Antipsychotics, sotalol, Amiodarone, labetolol, methotrexate,
paracetamol, pioglitazone

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20
Q

ANTI-MUSCARINIC DRUGS -

A
❖ Antimuscarinics -
Tiotropium, umeclidinium, glycopyronium,
Atropine, Scopolamine, Ipratropium,
oxybutynin, hyoscine, tolterodine,
solifenacin

CI (systemic) - Angle-closure glaucoma,
Severe UC, urinary retention

❖ Anti-histamines -
Sedating - Chlorphenamine, hydroxyzine,
promethazine, cyclizine

❖ Antipsychotics
1st Generation: Chlorpromazine,
prochlorperazine, haloperidol
2nd Generation: Clozapine

❖ Tricyclic antidepressants
Amitriptyline, clomipramine

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21
Q

ANTIMUSCARINIC EFFECTS

A
➢ Dry mouth
➢ Constipation
➢ Blurred vision
➢ Drowsiness
➢ Nausea OR vomiting
➢ Urinary Retention
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22
Q

SEDATING ANTIHISTAMINES

A
SEDATING ANTIHISTAMINES
Causes sedation as they are highly lipid
soluble and readily cross the BBB:
➔ Sedative activity used where
sleep maybe disturbed due to
pruritus
➔ Sedating antihistamines also
have significant antimuscarinic
activity
Examples of sedating antihistamines:
● Chlorphenamine (e.g. Piriton)
● Hydroxyzine
● Ketotifen
● Promethazine (E.g. Phenergan)
● Diphenhydramine (E.g. benadryl)

** Performance of skilled tasks such as
operating machinery or driving maybe
affected ***

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23
Q

NON-SEDATING ANTIHISTAMINES

A

Penetrate the blood-brain barrier only to
a slight extent - less sedative effects

1st line choice -
★ Cetirizine (e.g. Piriteze)
★ Loratadine (e.g. Claritin)
★ Fexofenadine (e.g. Allegra)

Other non-sedating antihistamines -
● Acrivastine
● Desloratadine

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24
Q

MHRA MEDICATION RECALL

CLASSES →

A

Class 1 - Defect presents a
life-threatening or serious risk to health
** Requires Immediate action **

Class 2 - Defect may cause
mistreatment or harm to patient but is
not life-threatening or serious
** Action recall within 48hrs **

Class 3 - Defect is unlikely to cause
harm to patient
** Action recall within 5 days **

Class 4 - No threat to patient
** Advise caution with use **

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25
4 ANTIFOLATE DRUGS - (Concomitant use will lead to teratogenicity + blood dysrcasias):
❖ Phenytoin ❖ Methotrexate ❖ Trimethoprim ❖ Co-Trimoxazole
26
GI BLEED SIGNS + SYMPTOMS
``` ★ Vomiting bright red blood ★ Vomiting coffee-like material ★ Passing Black tarry stools ★ Rectal bleeding ★ Lightheadedness ★ Shortness of breath ★ Abdominal Pain *Risk minimized by co-prescribing PPI to suppress stomach acid production ```
27
DRUGS THAT INCREASE THE RISK OF | GI BLEED -
``` ● Corticosteroids ● Carbocisteine ● DOAC e.g Rivaroxaban ● Anti-platelets e.g. Aspirin ● Warfarin ● NSAIDs ● SSRIs ```
28
4 ANTIPSYCHOTICS THAT INDUCE | HYPERGLYCEMIA - CiROQ
C - Clozapine R - Risperidone O - Olanzapine Q - Quetiapine
29
DRUGS THAT COLOUR URINE -
``` ● Senna – red/yellow ● Dantron containing preparations e.g. co-danthramer, co-danthrusate – red ● Sulfasalazine – yellow-orange ● Phenindione – pink/orange ● Triamterene containing preparations e.g. co-triamterzide, Frusene – blue in some lights ● Levodopa containing preparations e.g. co-beneldopa, co-careldopa – reddish/darker in colour ● Entacapone – reddish-brown ● Nefopam – pink ● Clofazimine – red ● Nitrofurantoin – yellow/brown ● Rifabutin – orange-red ● Rifampicin – orange-red ● Deferiprone – reddish-brown ```
30
DRUGS CAUSING RESPIRATORY | DEPRESSION (RD)
``` ➔ Pregabalin / Gabapentin ➔ Opioids - morphine, tramadol, heroin, or fentanyl ➔ Benzodiazepines - tamazepam ➔ Alcohol ➔ Barbiturates - phenobarbital ```
31
SIGNS + SYMPTOMS OF RESPIRATORY DEPRESSION
``` ● Fatigue ● Confusion ● Headache / Dizziness ● Nausea and/or vomiting ● Fluctuations in BP ● Abnormal breathing sounds e.g. whistling or crackling sound ● Apnea (abnormally long pauses in between breaths followed by a long sigh) ● Bluish or grayish skin ● Rapid heart rate ```
32
MORPHINE SIDE EFFECTS -
``` M - Myosis O - Out of it (Sedation) R - Respiratory Depression P - Pneumonia (Aspiration) H - Hypotension I - Infrequency (Constipation) N - Nausea E - Emesis ```
33
DRUGS THAT CAUSE WEIGHT GAIN -
``` ● Insulin ● Sulphonylureas ● Steroids ● Antipsychotics ● Carbamazepine ```
34
DRUGS WHICH LOWER SEIZURE | THRESHOLD -
❖ Antidepressants ❖ Antipsychotics ❖ Opioids - especially tramadol ❖ Quinolones e.g. ciprofloxacin + NSAID combo
35
``` CYP 450 ENZYME INDUCERS These will induce the enzyme to clear substrates, leading to a decreased concentration SCRAP GPS ``` ``` 3 ANTI-EPILEPTICS 1 HERBAL 1 ABX 1 ANTIDIABETIC MED 1 ANTIFUNGAL ```
``` S - ST.JOHN’S WORT C - CARBAMAZEPINE R - RIFAMPICIN / RIFABUTIN A - ALCOHOL (CHRONIC) P - PHENYTOIN ``` G - GRISEOFULVIN P - PHENOBARBITAL S - SULPHONYLUREAS
36
CYP 450 ENZYME INHIBITORS These will inhibit the enzyme from clearing substrates leading to an increased concentration SICKFACES.COM GAVID
``` S - SODIUM VALPROATE I - ISONIAZID C - CIMETIDINE K - KETOCONAZOLE F - FLUCONAZOLE A - ALCOHOL (BINGE) C - CHLORAMPHENICOL E - ERYTHROMYCIN (macrolides) S - SULFANAMIDE -TRIMETHOPRIM . C - CIPROFLOXACIN O - OMEPRAZOLE M - METRONIDAZOLE ``` ``` G - GRAPEFRUIT A - AMIODARONE V - VERAPAMIL I - ITRACONAZOLE D - DILTIAZEM ```
37
CYP 450 ENZYME SUBSTRATES - INHIBITORS WILL INCREASE THEIR CONC - INDUCERS WILL REDUCE THEIR CONC
``` ➔ STATINS ➔ WARFARIN ➔ ORAL CONTRACEPTIVES ➔ TRICYCLIC ANTIDEPRESSANTS ```
38
SEPSIS
``` SEPSIS - ★ Sepsis is a life-threatening reaction to an infection. It happens when your immune system overreacts to an infection and starts to damage your body's own tissues and organs. ★ If not treated immediately, sepsis can result in organ failure and death. Yet with early diagnosis, it can be treated with antibiotics. HOW TO SPOT SEPSIS IN ADULTS - ❖ Slurred speech or confusion ❖ Extreme shivering or muscle pain ❖ Passing no urine (in a day) ❖ Severe breathlessness ❖ It feels like you’re going to die ❖ Skin mottled or discoloured high temperature (fever) or low body temp, a fast heartbeat, fast breathing ``` ``` HOW TO SPOT SEPSIS IN CHILDREN 1. Is breathing very fast 2. Has a ‘fit’ or convulsion 3. Looks mottled, bluish, or pale 4. Has a rash that does not fade when you press it 5. Is very lethargic or difficult to wake 6. Feels abnormally cold to touch If you spot any of these signs, call 999 or go straight to A&E ``` ``` A child under 5 may have sepsis if he or she: 1. Is not feeding 2. Is vomiting repeatedly 3. Has not passed urine for 12 hours ```
39
SHOCK
``` SHOCK - A serious life threatening condition where vital organs in the body are not getting enough blood flow resulting n organ failure ``` Causes: Bleeding, cardiac event, loosing bodily fluids e.g. severe vomiting, allergic rct Signs of shock: - Cold clammy skin - Sweating - Rapid shallow breathing - Weakness + dizziness - Nausea or vomiting - Thirst - Yawning SEPTIC SHOCK - Life-threatening condition that happens when your blood pressure drops to a dangerously low level after an infection
40
ANAPHYLAXIS: Anaphylaxis is a severe, life-threatening, hypersensitivity reaction. Signs & Symptoms ?
``` ★ Feeling lightheaded or faint ★ breathing difficulties: fast / shallow breathing ★ a fast heartbeat ★ clammy skin ★ confusion and anxiety ★ collapsing or losing consciousness ★ other allergy symptoms: an itchy, raised rash (hives), angioedema ```
41
ANAPHYLAXIS TREATMENT
``` TREATMENT - ★ Start cardiopulmonary resuscitation (CPR) immediately. ★ Call 999 for an ambulance 999 ★ Begin initial treatment for anaphylaxis: ``` Intramuscular adrenaline /epinephrine should be given as 1st line treatment for anaphylaxis. ``` A repeat dose of intramuscular adrenaline/epinephrine (1mg/ml) should be given after a 5-minute interval if there is no improvement in the patient’s condition. ``` ADRENALINE DOSES: ➔ 5 years or below: 150 mcg ➔ 6-11 years: 300 mcg ➔ 12+ years: 500 mcg
42
MUMPS
MUMPS Contagious viral infection ``` SYMPTOMS - ● painful swellings in the side of the face under the ears (the parotid glands) ● Headaches ● Joint pain ● a high temperature ``` ``` TREATMENT - No cure ● Plenty of rest and fluids ● Painkillers e.g. Paracetamol ● Warm or cool compress to the swollen glands to help relieve pain ```
43
MEASLES
``` MEASLES Usually starts with cold-like symptoms, followed by a rash a few days later. Some people may also get small spots in their mouth. The first symptoms of measles include: ● a high temperature ● a runny or blocked nose ● sneezing ● a cough ● red, sore, watery eyes Small white spots (KOPLIK spots) may appear inside the cheeks and on the back of the lips a few days later. ``` ``` Measles rash - (Not itchy) & Red/brown ❖ Starts on the face and behind the ears before spreading to the rest of the body. ❖ The spots of the measles rash are sometimes raised and join together to form blotchy patches ```
44
RUBELLA “German Measles”
``` RUBELLA “German Measles” A red or pink spotty rash that feels rough. - swollen glands in your neck, aching fingers, wrists, or knees and a high temperature. MMR Vaccine - 2 doses can give lifelong protection against measles, mumps, and rubella. ```
45
MENINGITIS
MENINGITIS An infection of the protective membranes that surround the brain and spinal cord (meninges). ``` Symptoms of meningitis develop suddenly and can include: ● a high temperature ● cold hands and feet ● vomiting ● confusion ● breathing quickly ● muscle and joint pain ● pale, mottled or blotchy skin ● spots or a rash ● headache ● a stiff neck ● a dislike of bright lights ● being very sleepy or difficult to wake ● fits (seizures) Babies may also: ● refuse feeds / be irritable ● have a high-pitched cry ● stiff body/ floppy or unresponsive ● have a bulging soft spot on the top of their head (Fontanele) Meningitis rash starts as small, red pinpricks before spreading quickly into red or purple blotches. ``` ``` The meningitis glass test - ● Press the side of a clear glass firmly against the skin ● Spots/rash may fade at first ● Keep checking ● Fever with spots/rash that do not fade under pressure is a medical emergency ``` Call 999 for an ambulance or go to your nearest A&E if you think you or your child might be seriously ill.
46
SCARLET FEVER
``` SCARLET FEVER The first signs can be flu-like symptoms, including a high temperature, a sore throat and swollen neck glands (a large lump on the side of your neck). ``` A blanching rash usually develops on the trunk 12–48 hours after initial symptoms, before spreading to the rest of the body and flexures. the rash is red/pink and makes your skin feel rough, like sandpaper. White coating on tongue aka - strawberry tongue Refer to GP for Treatment with antibiotics e.g. phenoxymethylpenicillin
47
IMPETIGO
IMPETIGO Highly contagious skin infection that often starts with sores or blisters on the face or hands that burst and leave crusty, golden-brown patches. They can look a bit like cornflakes stuck to your skin. Treatment - - topical fusidic acid - if widespread oral flucloxacillin
48
GLANDULAR FEVER
Glandular fever Mostly affects teenagers and young adults. It gets better without treatment, but it can make you feel very ill and last for weeks. ``` SYMPTOMS: ● a very high temperature or you feel hot and shivery ● a severe sore throat ● swelling either side of your neck – swollen glands ● extreme tiredness or exhaustion ● tonsillitis that is not getting better ``` Don't treat sore throat with ABX e.g. amoxicillin as it can cause maculopapular rash if glandular fever
49
PARACETAMOL MAX DOSAGE
``` PARACETAMOL MAX DOSAGE ● 3-5 Months - 60mg ● 6-23 Months - 120mg ● 2-3 Years - 180 mg ● 4-5 years - 240 mg ● 6-7 years - 250 mg ● 8-9 years - 375 mg ● 10-11 years - 500 mg ● 12-15 years - 750 mg ● 16+ years - 1000mg ``` Maximum of 4 times a day
50
IBUPROFEN MAX DOSAGE
``` IBUPROFEN MAX DOSAGE ● 3-5 months: 50mg TDS (150 mg) ● 6-11 months: 50mg QDS (200 mg) ● 1-3 years: 100mg TDS (300 mg) ● 4-6 years: 150mg TDS (450 mg) ● 7-9 years: 200mg TDS (600 mg) ● 10-11 years: 300mg TDS (900 mg) ● 12-17 years: 400mg QDS (1200mg) ```
51
Montelukast
MHRA - risk of neuropsychiatric reactions Be alert of speech impairment and ocd symptoms, hallucinations, sleep disorders and suicidal behaviour
52
Adrenaline doses
1 month - 5 yrs = 150mcg 6-11yrs = 300mcg 12+ = 500mcg Repeat adrenaline after 5 min interval if necessary
53
Urinalysis antispasmodics
Solifenacin or tolterodine
54
Ulcerative colitis acute flare up to avoid
Loperamide or codeine die to paralytic ileus as it increases risk of toxic mega colon
55
Ulcerative colitis inflammation location
Rectum and colon
56
Proctitis treatment
Inflammation of rectum Give suppositories 1st line aminosalicyclate (rectal) mesalazine or sulfasalazine
57
Extensive colitis treatment
Oral treatment High dose oral aminosalicylate
58
Left sided colitis
Enemas
59
Proctosigmoditis
Foam preparation
60
Crohns disease location
Inflammation of GI tract from mouth to anus
61
PPI cautions
Lansoprazole - take 30-60 mins before food PPI cautions - - mask symptoms of gastric cancer - increased risk of fractures and osteoporosis - increased risk of GI infections e.g C. difficile - hypomagnesia