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IK6 - PSA and prescribing > From Questions > Flashcards

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1
Q

In haemodynamically stable SVT what medication is used 1st line in asthmatics after vagal manoeuvres?

A

Verapamil

Adenosine is contraindicated in asthmatics

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2
Q

conversion of PO codeine → PO morphine

A

divide by 10

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3
Q

conversion of PO tramadol → PO morphine

A

divide by 10

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4
Q

conversion of PO morphine → PO oxycodone

A

divided by 1.5 - 2

*BNF says 1.5

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5
Q

conversion of PO morphine → SC morphine

A

divide by 2

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6
Q

conversion of PO morphine → SC diamorphine

A

divided by 3

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7
Q

PO oxycodone → SC diamorphine

A

divide by 1.5

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8
Q

drugs CI in peptic ulcer disease

A
  • aspirin
  • NSAIDS
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9
Q

drugs CI in CKD

A
  • NSAIDS
  • ACEi
  • drug clearance of many is slowed e.g. gentamicin, digoxin
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10
Q

drugs CI in chronic heart failure

A
  • CCB
  • negative inotropies e.g. flecainide
  • TCA
  • NSAIDs
  • corticosteroids
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11
Q

drugs CI in heart block

A
  • verapamil
  • digoxin
  • beta-blockers
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12
Q

antiplatelet for ACS (medically treatment)

A
  1. aspirin lifelong + ticagrelor 12 months
  2. if aspirin CI then clopidogrel lifelong
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13
Q

anti-platelet after PCI ACS

A
  1. aspirin (lifelong) + prasurgrel/ticagrelor (12 months)
  2. if aspiring CI then clopidogrel lifelong
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14
Q

anti-platelet for TIA and ischaemic stroke

A
  1. clopidogrel (lifelong)
  2. aspirin + dipyridamole (lifelong)
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15
Q

antiplatelet for peripheral arterial disease

A
  1. clopidogrel lifelong
  2. aspirin lifelong
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16
Q

types of rapid acting insulin

A

NovoRapid

Humalog

Actrapid

Humilin S

when prescribing must write name of specific type

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17
Q

what electrolyte abnormality is associated with heparins?

A

hyperkalaemia

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18
Q

what is target INR for day before surgery? If not what to do?

A

aim for 1.5

can give vitamin K (phytomenadione) iV or oral depending

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19
Q

what is the target when starting statin treatment?

A

aim for a > 40% reduction in non-HDL cholesterol 3/12 after starting

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20
Q

what drugs cause gynaecomastia?

A

DISCO

digoxin

isoniazid

Spironolactone

Cimetidine

Omeprazole

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21
Q

contraindications for sildenafil ?

A

nitrates

nicorandil related drugs

hypotension

recent stroke or MI (last 6/12)

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22
Q

what electrolyte imbalance precipitates digoxin toxicity?

A

low potassium

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23
Q

what electrolyte imbalance caused by digoxin?

A

high potassium

24
Q

when do you not need to stop metformin for surgery?

A
  • < 1 meal missed
  • eGFR > 60
  • low risk AKI
25
what should metformin be stopped for surgery?
* \> 1 meal missed * AKI risk
26
warfarin and surgery (pre-op)
* aim INR 1.5 * elective - stop 5.7 before, INR _\>_ 1.5 PO vitamin K * emergency, can delay 6-12 hrs → IV vitamin K * emergency no delay → IV vitamin K + prothrombin complex
27
what anti-emetic should be avoided in PD? which to be used?
avoid metoclopromaide because crosses BBB use domperidone as doesn't cross
28
when shouldn't you prescribe cyclizine? what to give instead?
fluid retention use metoclopramide
29
what antibiotic to be cautious of with warfarin?
clarithromycin and erythromycin
30
what medication used if hypotensive + arrhythmia?
digoxin CCB and beta-blocker can worsen hypotension
31
what drugs can cause a low neutrophil count?
clozapine carbimazole
32
how to differentiate types of AKI?
* pre renal - urea \> creatinine * renal urea - urea \< creatinine * post-renal - urean \< creatinine
33
causes of intrinsive renal failure?
INTRINSIC * ischaemia (pre-renal → ATN) * nephrotoxic Abx - gent, vanc, tetracyclines * tablets - NSAIDS, ACei * radiological contrast * injury → rhabdo * negatively birefringent (gout) * syndromes (glomerulonephritis) * inflammation (vasculitis) * cholesterol emboli
34
what ratio of AST to ALT in alcoholic hepatitis?
AST \> ALT
35
what are cholestatic drugs?
* flucloxacillin * co-amoxiclav * nitrofurantoin * steroids * sulphonylureas
36
INR target for warfarin
* 2-3 → AF, DVT, cardioversion, cardiomyopathy, MI * 3-4 → recurrent VTE on warfarin, mechanical valve
37
counselling for ACEi
* teratogenic * raised potassium * caution with D+V
38
counselling tamoxifen
* Increases risk of endometrial cancer * Increases efficacy of warfarin à high INR * **Side effects**: hot flushes, VTE risk
39
when do steroid patient need bone protection?
> more than 3/12 of treatment
40
monitoring for statins
* Risk factors → CK * **No** risk factors → ALT * * Check LFTs at 3 and 12 months * * **Stop** if taking a _macrolide_ * Caution in CYP-i
41
how to adjust basal/bolus insulin regiments?
* High/low before _breakfast_ / _at night_ → increase/decrease **_evening**_ _**long**_ _**acting_** * High/low before _lunch_ / _dinner_ / _bed_ → increase/decrease **_rapid**_ _**acting**_ in _**meal before_**
42
adjusting BD pre-mixed regimens
* High/low _before bed_ **AND** _before breakfast_ → increase/decrease **_evening_** insulin * High/low _before lunch_ **AND** _before evening meal_ → increase/decrease **_morning_** insulin
43
how to mix solution for insulin infusions?
50 units actrapid insulin in 50mL of 0.9% sodium chloride
44
what are the steroid strengths?
G - glucocorticoid, M - mineralocorticoid * hydrocortisone - G1, m1 * prednisolone - G4, M 0.8 * fludrocortisone - G15, M150 * aldosterone - G0, M500 * dexamethasone - G40, M0
45
what is the topical steroid ladder?
Help Every (eumovate) Busy (betnovate) Dermatologist (dermovate) * _low potency -_ hydrocortisone + clobetasone * _medium potency_ - betamthasone * _high_ - mometasone, clobetasol
46
what abx should you hold statins with?
macrolide e.g. clarithromycin and erythromycin
47
how many mmol for: 0. 3% potassium in 1L 0. 15% potassium in 1L
0. 3 = 40 mmol 0. 15 = 20 mmol
48
what drugs can predispose to candida infections?
amoxicillin clarithromycin prednisolone SGLT2 potentially
49
1st line for eczema topical (after emollient)
1% hydrocortisone cream
50
management of short term constipation (Adult)
1. bulk forming laxative (ispaghula husk) 2. add/swap to osmotic laxative (lactulose) 3. stimulant if soft stool but complaining of hard to pass (bisacodyl, senna)
51
management of opioid induced constipation (adults)
1. osmotic laxative + stimulant (lactulose + biscodyl/senna) 2. naloxegol if no response DON'T give bulk forming
52
management of faecal impaction (adults)
1. high dose oral macrogol if hard stool 2. stimulant added (senna) - if soft or no response to 1 3. no response to oral - soft stool PR bisacodyl, hard stool PR glycerol
53
management of constipation in children
1. conservative + behavioural measures 2. macrogol 1st line 3. add stimulant if unresponsive
54
who can't have ondansetron as 1st line post-op N&V?
* long QTc * drugs that prolong QTc e.g. anti-psychotics
55
what is the anti-emetic of choice for pt at risk of EPSE _+_ QT prolongation?
cyclizine

IK6 - PSA and prescribing (11 decks)

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