Final notes Flashcards by Laura Lazzari

what do you do with metformin before surgery?

CONTINUE if 1 or less than 1 missed meal, GFR >60, low risk AKI/ischaemia

STOP if 2+ meals missed, T1DM, poor diabetic control

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risk of methotrexate

NEUTROPOENIC SEPSIS

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monitoring for methotrex

1-2 weekly blood tests

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what is the effect of hypo/hyperkalaemia on digoxin

HYPOkalaemia = enhances digoxin effect 
HYPERkalaemia = reduces digoxin effect

(becuase digoxin acts at sodium/potassium channel, so high potassium means digoxin is used up faster)

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what drug is STRONGLY CONTRAINDICATED with methotrexate

TRIMETHOPRIM

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what is rule of thumb when adjusting insulin in hyperglycaemic T1DM patient

adjust by minimum dose available

so 10 / 20% increase

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for what blood glucose /ketones must you delay surgery in diabetic

for BG >12, ket> 3 or urinary ketones +++

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Name the three types of ORAL HRT:

just oestrogen
cyclical oestrogen + progesterone
continuous oestrogen + progesterone

oestrogen = elleste solo 
cyclical = elleste duet 
continuous = kliovance

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name the three types of TRANSDERMAL HRT:

just oestrogen
cyclical oestrogen + progesterone
continuous oestrogen + progesterone

oestrogen = evonorel 
cyclical = evonorel sequi 
Continuous = evonorel conti

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how and when do you stop HRT

stop after menopause symptoms (few years)

stop GRADUALLY

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what must yopu monitor with HRT

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for what BP must you stop HRT/COCP

if BP >160/95

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what other drugs can you give for vasomotor sx as alternative for HRT

Fluoxetine

2. Citalopram, venlaxafine

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what drugs can you give for vaginal dryness as replacement for HRT

lubricants

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what drugs can you give for osteoporosis as replacement for HRT

biphosphonates

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when is conttraceptio required until if menopausal

Until amenorrhoeic for more than 1 YEAR if OVER 50

Until amenorrhoeic for more than 2 YEARS if UNDER 50

what are indications for cyclizine, promethazine

pre and post op
hyperemesis
motion sickness
labirinth disorders

what must you type in to find anti emetics

“Nausea and Labirynth disorders”

indications for metoclopramide and domperidone

GI Motility disorders
Uraemia
Radiatgion sickness
Cancer chemo

indication for hyoscine

PROPHYLACTIC antiemetic pre-op

indication for ondansetron

chemo / radiotherapy sickness

post op

example of pro-kinetic laxative

metoclop

when is pro kinetic laxative contrainigncated

in bowel obstruction> may cause perforation

what time should corticosteroids be given and why

give in MORNING , NOT at night

because they can cause insomnia

how do you manage aggression

1. oral de escalation 2. oral loraz 3. IM loraz

what do you give with aggression due to delirium instead of lorazepam

give haloperidol

what drugs must you AVOID ALCOHOL with

``` Metronidazole, doxy fluoxetine statins benzos disulfiram warfarin ```

what is the effect of liver disease on INR and PT , and why

liver disease will INCREASE INR | because it impairs vit K sythesis > increases PT and INR

what is the effect of alcohol as an enzyme inducer / inhibitor?

ACUTE alcohol use = INHIBITOR | CHRONIC alcohol use = INDUCER

CCB for HTN first line

AMLODIPINE

beta blocker for angina first line

LABETALOL

most powerful steroid option

Clobetasol propionate - "proprio potente" | Clobetasol butyrate is weaker

what must you type in for guidance for skin infection antibacterial therapy INCL ANIMAL BITES

Skin infections, antibacterial therapy

most appropriate measure of initial rehydration

BP (not urine output)

what are EPSE

Parkinsonism Dystonia (uncontrollable muscle contraction) Akathisia (restlessness) Tardive dyskinesa (chewing, smacking lips _ continue even after you stop medication)

How do you treat EPSEs

procyclidine IM

what other antibiotic should patients allergic to penicillin NOT receive

cephalosporin (cefixime, cefotaxime, ceftazidime, ceftriaxone, or cefuroxime)

what is TAZOCIN made up of

piperacillin with tazobactam