Final notes Flashcards
(76 cards)
1
Q
what do you do with metformin before surgery?
A
CONTINUE if 1 or less than 1 missed meal, GFR >60, low risk AKI/ischaemia
STOP if 2+ meals missed, T1DM, poor diabetic control
2
Q
risk of methotrexate
A
NEUTROPOENIC SEPSIS
3
Q
monitoring for methotrex
A
1-2 weekly blood tests
4
Q
what is the effect of hypo/hyperkalaemia on digoxin
A
HYPOkalaemia = enhances digoxin effect HYPERkalaemia = reduces digoxin effect
(becuase digoxin acts at sodium/potassium channel, so high potassium means digoxin is used up faster)
5
Q
what drug is STRONGLY CONTRAINDICATED with methotrexate
A
TRIMETHOPRIM
6
Q
what is rule of thumb when adjusting insulin in hyperglycaemic T1DM patient
A
adjust by minimum dose available
so 10 / 20% increase
7
Q
for what blood glucose /ketones must you delay surgery in diabetic
A
for BG >12, ket> 3 or urinary ketones +++
8
Q
Name the three types of ORAL HRT:
- just oestrogen
- cyclical oestrogen + progesterone
- continuous oestrogen + progesterone
A
oestrogen = elleste solo cyclical = elleste duet continuous = kliovance
9
Q
name the three types of TRANSDERMAL HRT:
- just oestrogen
- cyclical oestrogen + progesterone
- continuous oestrogen + progesterone
A
oestrogen = Evonorel cyclical = Evorel sequi Continuous = Evorel conti
10
Q
how and when do you stop HRT
A
stop after menopause symptoms (few years)
stop GRADUALLY
11
Q
what must yopu monitor with HRT
A
BP
12
Q
for what BP must you stop HRT/COCP
A
if BP >160/95
13
Q
what other drugs can you give for vasomotor sx as alternative for HRT
A
- Fluoxetine
2. Citalopram, venlaxafine
14
Q
what drugs can you give for vaginal dryness as replacement for HRT
A
lubricants
15
Q
what drugs can you give for osteoporosis as replacement for HRT
A
biphosphonates
16
Q
when is conttraceptio required until if menopausal
A
Until amenorrhoeic for more than 1 YEAR if OVER 50
Until amenorrhoeic for more than 2 YEARS if UNDER 50
17
Q
what are indications for cyclizine, promethazine
A
pre and post op
hyperemesis
motion sickness
labirinth disorders
18
Q
what must you type in to find anti emetics
A
“Nausea and Labirynth disorders”
19
Q
indications for metoclopramide and domperidone
A
GI Motility disorders
Uraemia
Radiatgion sickness
Cancer chemo
20
Q
indication for hyoscine
A
PROPHYLACTIC antiemetic pre-op
21
Q
indication for ondansetron
A
chemo / radiotherapy sickness
post op
22
Q
example of pro-kinetic laxative
A
metoclop
23
Q
when is pro kinetic laxative contrainigncated
A
in bowel obstruction> may cause perforation
24
Q
what time should corticosteroids be given and why
A
give in MORNING , NOT at night
because they can cause insomnia
25
how do you manage aggression
1. oral de escalation
2. oral loraz
3. IM loraz
26
what do you give with aggression due to delirium instead of lorazepam
give haloperidol
27
what drugs must you AVOID ALCOHOL with
```
Metronidazole, doxy
fluoxetine
statins
benzos
disulfiram
warfarin
```
28
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
29
what is the effect of alcohol as an enzyme inducer / inhibitor?
ACUTE alcohol use = INHIBITOR
| CHRONIC alcohol use = INDUCER
30
CCB for HTN first line
AMLODIPINE
31
beta blocker for angina first line
LABETALOL
32
most powerful steroid option
Clobetasol propionate - "proprio potente"
| Clobetasol butyrate is weaker
33
what must you type in for guidance for skin infection antibacterial therapy INCL ANIMAL BITES
Skin infections, antibacterial therapy
34
most appropriate measure of initial rehydration
BP (not urine output)
35
what are EPSE
Parkinsonism
Dystonia (uncontrollable muscle contraction)
Akathisia (restlessness)
Tardive dyskinesa (chewing, smacking lips _ continue even after you stop medication)
36
How do you treat EPSEs
procyclidine IM
37
what other antibiotic should patients allergic to penicillin NOT receive
cephalosporin (cefixime, cefotaxime, ceftazidime, ceftriaxone, or cefuroxime)
38
what is TAZOCIN made up of
piperacillin with tazobactam
39
What is the first-line treatment for unconcisous patients/ drowsy patients with hypoglycaemia?
10-15g Glucose IV administered with 10 or 20% Glucose **over 15 minutes**
* **150-200ml of 10% Glucose OR**
* 75-100ml of 20% glucose
40
What are the different options for thromboprophylaxis in patients undergoing total hip replacements?
1. Low-molecular weight heparin 10 days, followed by 28days of aspirin
2. Or LMWH for 28days and stockings until discharge **(High risk surgers - usually Enoxaparin Sodium 40mg SC OD) **
41
What are the most common drugs causing hyperkalaemia?
NSAIDS
ACEi
ARB
Diuretics - in particular
All Heparins
And more
42
Name and example of a drug that is commonly presribed under the brand name and why?
tacrolimus
Becuause different forms micht alter concentration and affect toxicity/
43
What are common Enzyme inducers?
**PC BRAS: **
**P** henytoin
**C **arbamazepine
**B** arbiturates
**R** ifampicin
**A** lcohol (chronic excess)
**S** ulphonylureas
Induce enzyme therefore reduce concentration of drugs
44
What are common Enyzme inhibitors?
AODEVICES
**A** llopurinol
**O** meprazole
**D** isulfiram
**E** rythromycin
**V** alproate
**I** soniazid
**C** iprofloxacin
**E** thanol (acute intoxication)
**S** ulphonamides
Increase drug concentration
45
When should you avoid metoclopramide?
Is a dopamine antagonist
1. Patient with Parkinson's
2. Young women due to risk of dyskinesia
46
What is a good first-line prescription for anti-emetic? When should it be avoided?
Cyclizine 50mg 8hrl (IM/ IV oral)
--> avoided in cardiac cases as it might cause fluid-retention (metaclopromide 10mg (hrl) is safer)
47
What is the maximum dose of paracetamol per day?
1g 6-hourly (4g) for adults
But
if < 50 kg: 500mg 6-hourly (2g)
48
What are the main causes of thrombocytopenia?
1. Reduced production
Infection
**Drugs (especially penicillamine** (e.g. for RA))
myelodysplasia, myelofibrosis
2. Increased destruction
**Heparin **
hyperspenism
DIC + ITP
HHS/ HUS
49
How can you biochemically differentiate between prerenal, intrinsic renal and postrenal AKIs?
Urea: creatinine rations migh be different
Pre-renal Urea >> creatinine
Intrinsic renal Urea << creatinine no palpable bladder
Post-renal Urea<< creatinine with clinical signs of obstruction
50
Which drugs can commonly cause cholestasis?
Bilirubin with increase in ALP
Flucloxacillin
Co-amixiclav
nitrofurantoin
steroids
sulphonylureas
51
Which drugs can commonly cause hepatitis?
Paracetamol overdose
statins
rifampicin
52
If in a drug with monitored theapeutic window adequate response with high serum drug level is achieved, how should the drug administration be changed?
Name one example
Usually omitting the dose for a few days
Exept: gentamicin: reduce frequency of admission by 12h (e.g. change from 24h to 36h)
53
When should gentamicin blood levels be taken? What do they show?
2 samples
1. Peak (1h post dose) - adjust dose if out of range
2. Through (just before next dose) (adjust dose if out of range
Otherwise monitoring sample time will be at particular times 6-14h after infusion started (use graph to determine frequency of administration)
54
What are definitions for a major bleed?
1. Causing hypotension
2. Bleeding into a confined space (brain or eye)
55
What is the emergency management for a major bleed on warfarin?
Stop warfarin
give 5-10mg Vitamin K IV
give prothrombin complex
56
What should be done in patients on warfarin with increased INR but no bleeding
INR 5-8 omit warfarin for 2 days then reduce dose
INR >8 omit warfarin and give 1-5mg PO Vitamin K
57
What should be done for patients with increased INR and minor bleeding
INR >5: omit warfarina nd give 1-5mg Vitamin K
58
Which drug classes commonly cause SIADH?
sulfonylureas* (e.g. Glimepiride)
SSRIs, tricyclics
carbamazepine
vincristine
cyclophosphamide
59
Which diuretics have to be avoided with Lithium? Why?
Should avoid ACEi and diuretics, in particular thiazide (because can reduce lithium excretion)
If diuretics are prescribed: aim for loop diuretics
60
What dietary modifications should be done in patiets taking statins?
Patients should avoid Grapefruits and Grapefruit juice due to risk of statin toxicity (due to inhibition of CYP3A4
--> Also not taken in conjunction with other enzyme inhibitors (e.g. clarithromycin - statins should be stopped)
61
How does active liver disease influence the use of statins?
Statins should be avoided in patients with active liver disease due to risk of change in metabolism
62
What drugs have severe interactions with Methotrexate and should be avoided?
Other folate antagonists, in particular
* trimethoprim and
* co-trimoxazole
Due to riks of bone marrow supression and neutropenic sepsis
63
What monitoring is required with Olanzapine?
1. ECG (before and shortly after 1w initiation of treatnment for long-QT syndrome)
2. Lipids and BP and weight every 3 months for first year, then annually
64
How are tacrolimus usually monitored?
With the through level (before morning or evening dose) --> aim for 6-10ng/mL
65
How should alcohol withdrawal with delirium be treated?
If signs of delirium tremens: Lorazepam or Diazepam (oral first, then IV)
Then ADD an antipsychotic if not improving
(The rest would be e.g. adding phenylbarbitone etc. but should only be considered if no improvement and secondary care involvement is started)
66
What is the treatment for alcohol withdrawal seizure?
Give intravenous lorazepam as a single dose. Give a second dose after 10 minutes if seizures continue. Always follow your local protocol.
67
What is the managment of patients with alcohol withdrawal without signs of delirium/ hepatic imparment etc?
chlordiazepoxide (long-acting benzodiazepine) (20mg PO 6hrl)
+ supportive care (aka glucose + thiamine, correct electrolyte imbalances)
68
What should often be communicated when prescribin rivaroxaban?
Doses of 15-20mg should be taken with food - otherwise risk of ineffectiveness
69
What is the treatment target when starting statins?
A reduction of >40% in** non-HDL cholesterol **
70
What are the most common drugs to cause confusion in the elderly?
Benzodiazepines
Anticholinergics (e.g. oxybutinin)
Drugs to treat insomnia
Steroids
Opioids
(Sedating) antihistamines
Be careful with
SSRIs/ antidepressants
71
Which drugs should be witheld in a patient with AKI due to risk of exacerbating the AKI?
* Contrast media
* ACE Inhibitor
* NSAIDs
* Diuretics (only some, can consider continuing loop diuretics e.g.)
* Angiotensin receptor blocker
72
Which common drugs are renally excreted and might therefore be stopped or reduced during an AKI?
1. Opioids
2. Aciclovir and many Antibiotics
3. Allopurinol
4. Lithium
5. Colchicine
6. Methotrexate
7. Metformin if eGFR < 30
8. Phenytoin, Gapapentin+ Pregabalin, Leviteracetam
## Footnote
https://www.thinkkidneys.nhs.uk/aki/wp-content/uploads/sites/2/2016/07/Medicines-optimisation-toolkit-for-AKI-MAY17.pdf
73
Which medication should be stopped in a patient undergoing routine contrast-CT studies?
Metformin (also ensure adequate hydration to prevent AKI)
f a patient at high risk for contrast-induced AKI (CI-AKI) is taking a metformin-containing medication, it should be discontinued for a minimum of 48 hours after the procedure and, if AKI develops, not reinstated until the kidney function has improved
74
How is serum osmolality calculated?
Serum osmolality is 2 x(Na) + Urea + glucose
(Normal Range 275 to 295)
75
How is anion gap calculated?
What is a normal range?
(Na+ + K+) – (Cl- + HCO3-) = Anion Gap
NR: 4 to 12 (16) mmol/L
76
What is usually the choice of antibiotic for serious MRSA infections?
Vancomycin
(can be others aswell, but usually they are a bit overkill)
