Gold Notes Flashcards
(84 cards)
1
Q
Fluid prescription
A
- 2 sweet 1 salty – 2L 5% dextrose and 1L 0.9% saline
- 3L a day if usually & 2L if elderly
- 40mmol KCl a day
- If oliguric <30mL per day then 1L over 2-4 hrs
2
Q
Renal excreted drugs
A
Diuretics (stop in poor kidney function)
ACEi & ARBs
Allopurinol
Digoxin
Abx – tetracycline, nitrofurantoin
Lithium
Metformin
3
Q
Hepatic excreted drugs
A
Statins
4
Q
When do you take rivaroxaban?
A
With breakfast
5
Q
When do you take ACEi?
A
night
6
Q
When do you take TCAs?
A
Night
6
Q
When do you take furosemide and diuretics?
A
Morning
7
Q
When do you take metformin?
A
With meal or immediately after
8
Q
When do you take levothyroxine?
A
Before breakfast
9
Q
When do you take loperamide?
A
After loose stool
10
Q
When do you take bisphosphonates?
A
Take at least 30 minutes before food
Be upright for 30 minutes after swallowing
Take with full glass of water
11
Q
Surgery & drugs:
Insulin
Long term corticosteroids
Lithium
Anti-coagulants/Anti platelets
COCP
K sparing diuretics
Oral hypoglycaemics
Perindopril & ACEi
A
Insulin - variable infusion
Long term corticosteroids - change to high dose hydrocortisone
Lithium - day before
Anti-coagulants/Anti platelets:
Aspirin = 7 days before
DOAC = 24hr prior in minor & 48 hrs major
Unfractionated Hep = 4 hrs prior
Warfarin = Stop 5 day prior – prescribe LMWH in interim
COCP - stop 4 week prior and start 2 week after
K sparing diuretics - day of op
Oral hypoglycaemics - day of op
Perindopril & ACEi - day of op
12
Q
What drugs cause GI bleeds?
A
NSAIDs
13
Q
Hypotension drug cause
A
Ca channel blockers i.e. Diltiazem Verapamil
Beta blockers
Alpha blockers
Isosorbide nitrate
Amiodarone
Bromocriptine
14
Q
Bradycardia drug cause
A
Diltiazem
Ivabradine
Verapamil
Amiodarone
Digoxin
15
Q
Hyperkalaemia drug cause
A
Digoxin
Renal failure
Endocrine – Addison’s
ACEi + ARBs
DKA
Heparin
Aspirin + NSAIDs
Trimethoprim
Ciclosporin
K+ sparing diuretics
16
Q
Hypokalaemia drug causes
A
Thiazide & loop diuretics
PPIs
Penicillin
Verapamil
V+D
17
Q
Hyponatraemia drug causes
A
SSRIs
ACEi + ARBs
Amiodarone
Diuretics – loop & thiazide
Carbamazepine
Amitriptyline
Antipsychotics
PPIs
Sulfonylureas – Gliclazide
MDMA
18
Q
Thrush drug causes
A
ABX
Steroids
19
Q
Sedation drug causes
A
Opioids, barbs, bentos
20
Q
Ototoxicity & nephrotoxicity
A
Gentamicin
Vancomycin
21
Q
C.diff cause
A
Broad spec ABX - cephalosporin or ciprofloxacin
22
Q
Gynaecomastia cause
A
Spironolactone, digoxin, Cannabis, Oestrogen, GnRH
23
Q
Lung fibrosis causes
A
Amiodarone, cytotoxic drugs, Methotrexate, sulfasalazine, bromocriptine, cabergoline, nitrofurantoin
24
Stevens Johnson syndrome causes
Allopurinol
25
Urticaria causes
Aspirin
Penicillin
NSAIDs
opiates
26
Impaired glucose tolerance
Steroids, thiazide diuretics, furosemide, antipsychotics
27
Urinary retention causes
TCAs (amitriptyline), anticholinergics, opioids, NSAIDs
28
Thrombocytopenia causes
Quinine, NSAIDs, furosemide, Penicillin, carbamazepine, valproate, heparin
29
Increase QT interval - MADE CAT
Macrolides – clarithromycin, erythromycin, azithromycin
Anti-psychotics & Anti-depressants
Digoxin
Electrolyte: hypocalcaemia, hypokalaemia, hypomagnesaemia
Ciprofloxacin
Anti-arrhythmics: amiodarone, sotalol,
TCA
Myocarditis
Hypothermia
Subarachnoid haemorrhage
30
Cause diarrhoea
Lansoprazole
Alendronic acid
31
Cause dyspepsia
Alendronic acid
Prednisolone
32
Cause ankle swelling
Ca2+ channel blockers
Naproxen
33
Anti-muscurinic Sx
Cyclizine
Amitriptylline
34
ACE-i side-effects
Cough
Hyperkalaemia
Caution with V+D = risk of AKI
CI in pregnancy
35
Thiazide-like diuretics side effects
Gout
Hypokalaemia
Hyponatraemia
Impaired glucose tolerance
Hypercalcaemia
Impotence
Dehydration
36
Calcium channel blocker side-effects
Headache
Flushing
Ankle oedema
Bradycardia
37
Beta-blocker side effects
Bronchospasm (especially in asthmatics)
Fatigue
Cold peripheries
Bradycardia
Sleep disturbances
ED
Beta-blockers reduce hypoglycaemic awareness
38
Alpha blockers side effects
Postural hypotension
39
Loop diuretics side effect
Hypokalaemia
Fatigue
Headache
Metabolic alkalosis
Muscle spasms
40
Amiodarone side effects
Bradycardia
Hyper/hypothyroidism
Pulmonary fibrosis/pneumonitis
Liver fibrosis/hepatitis
Jaundice
Taste disturbance
Persistent slate grey skin discolouration
Raised serum transaminases
Nausea
Constipation (particularly at the start of treatment)
Increases QT interval
41
Amoxicillin side effects
Rash with infectious mono
42
Co-amoxiclav and flucloxacillin side-effects
Cholestasis
43
Erythromycin side-effects
GI upset
Prolongs QT
44
Ciprofloxacin side effects
Lowers seizure threshold
Tendonitis
Prolongs QT
45
Doxycycline side effects
Photosensitivity
46
Trimethoprim side-effects
Rashes, including photosensitivity
Pruritus
Suppression of haematopoiesis
47
Metform side-effects
GI upset
Lactic acidosis
48
Sulphonylureas side effects
Hypoglycaemic episodes
Increased appetite and weight gain
Syndrome of inappropriate ADH secretion
Liver dysfunction (cholestatic)
49
Glitazones side effects
Weight gain
Fluid retention
Liver dysfunction
Fractures
50
Gliptins side effect
Pancreatitis
51
Glucocorticoid side-effects (STEROIDS)
Stomach ulcers, acute pancreatitis
Thin skin
Edema
Right & L HF
Osteoporosis & Ophthalmic (cataracts, glaucoma)
Immunosuppression, Neutrophilia
Diabetes - impaired glucose regulation - increased appetite/weight gain, hirsutism, hyperlipidaemia
Syndrome Cushing’s - moon face, buffalo hump, striae
Psychiatric: insomnia, mania, depression, psychosis
Give bisphosphonates for osteoporosis protection if >3month course
NEVER STOP STEROIDS ABRUPTLY
52
Carbamezapine side-effects
Neutropenia!!
Lethargy
Drowsiness
53
Mineralocorticoid side-effects
Fluid retention
Hypertension
54
TCA side-effects
Dizzy
Hallucinations
Vision problems
Agranulocytosis
Anti-muscarinic SEs (dry mouth, brady then tachycardia with palpitations, constipation, red, blurred vision, pupillary dilation)
55
Neutropenic sepsis Mx
Piperacillin with tazobactam
56
Bacterial meningitis pre-hospital and hospital Mx
Benpenicillin 600mg IM
Cefotaxime 8g IM/IV divided by 4 = 2g QDS
57
Tonsilitis Mx
Phenoxymethylpenicillin 500mg QDS 5-10 days
o 250mg if <12yrs
Clarithromycin 250mg-500mg BD 5 days
58
Skin infection Mx
Flucloxacillin 500mg QDS
59
Pulmonary oedema Mx
IV furosemide 20-50mg
60
Asthma Mx (OHSHITME)
* Oxygen
* Salbutamol 2.5-5mg NEB
* Hydrocortisone IV 100mg or pred 40mg PO
* Ipratropium bromide 500 micrograms
* Theophylline
* MgSO4 2g IV
* Escalate
61
VTE prophylaxis
Enoxaparin
o 40mg SC OD – surgical high risk, orthro surg, med pt.
o 20mg SC OD – surg mod risk
Dalteparin
o 5000u SC OD
- Remember TEDs – CI is PAD
62
PT or DVT Mx
PE if haemodynamically unstable
PE or DVT Tx
DOAC – Rivaroxaban PO
o 15mg PO for 21days
Or apixaban
o 10mg BD PO
If Antiphospholipid syndrome = LMWH i.e. dalteparin
PE haemodynamically unstable
- UFH infusion
- Thrombolytic therapy – alteplase
63
Nause MX
Cyclizine
o 50mg 8 hrly IM/IV/Oral
o Be aware can cause fluid retention
Metoclopramide
o 10mg 8 hrly IV/IM in HF
Ondansetron
o 4mg or 8mg 8hrly IV/oral
64
Pain Mx
Paracetamol
o 1g 6 hrly
o Mild pain
Codeine
o 30mg 6hrly Oral
o Mild pain
Co codamol
o 30/500 2 tablets 6 hrly oral
o Severe pain
65
Hypoglycaemia Mx
Conscious: PO glucose
o 10-20g child
o 15-20g adult
Unconscious: IM glucagon
o 1mg
Severe: IV glucose
o 10% Child 5mL/kg
o 10% Adult 200mL over 15 mins
o 20% 100mL over 15mins
66
Hypercalcaemia Mx
- Emergency 1L 0.9% NaCl over 4-6 hrs (aim for 1-3L over 24 hrs)
IV Bisphosphonate: Zoledronic acid (Pamidronate 2nd line)
Admit and monitor
Symptomatic control: Laxatives, Anti-emetics
- Others: Calcitonin, Furosemide, Dialysis
67
Hypothyroidism Mx
Levothyroxine
o 50-100mcg OD morning
o 25mcg PO - elderly, ischemic heart disease or severe hypothyroidism starting dose
o Pregnancy increase dose by at least 25-50 micrograms due to the increased demands of pregnancy.
o Thyroid function tests should be checked after 8-12 weeks
68
Hyperkalaemia Mx
Acute severe
o 1st = calcium gluconate 10% over slow IV injection
Not severe
o 10 units of actrapid in 50ml of 50% dextrose IV over 10-15mins
o Salbutamol NEB 5mg
69
Crohns Mx
ACUTE
o Mild - mod:
- PO mesalasine or budesonide
- Mod - severe flare: Predinosolone PO
- If severe extensive disease = IV corticosteroids
* 1st = PO pred or IV hydrocortisone
budesonide (if above not suitable/CI)
* 2nd = sulfasalazine (↓effective, but ↓SE)
Add on (if ≥2 inflammatory exacerbations in 12m or steroid dose can’t be reduced) = azathioprine
If unsuitable/CI: Methotrexate w corticosteroid
MAINTANENCE: (NO steroids)
o 1st = Azathioprine
o 2nd = MXT
* If fistulising Crohn’s: metro / ciprofloxacin & Azathioprine (AZT)
70
UC Mx
ACUTE
- Mild - mod
Distal disease: topical Mesalazine (preferable PO aminosalicylate)
More extensive: PO mesalazine.
Failed = PO corticosteroid
o Severe flare: (>6 bowel motions/day and systemically unwell)
IV corticosteroids
If can’t tolerate: IV ciclosporin
MAINTENANCE:
o PO aminosalicylate (mesalasine) → if not, sulfasalazine
o Frequent relapse, give azathioprine
71
Drugs which may worsen seizure control in epilepsy
* Alcohol, cocaine, amphetamines
* Ciprofloxacin, levofloxacin
* Aminophylline, theophylline
* Bupropion
* Methylphenidate (used in ADHD)
* Mefenamic acid
72
Mx of epilepsy
Focal seizures
- Carbamazepine or lamotrigine
All other seizures
- 1st LINE: Sodium valproate
o NEVER GIVE SODIUM VALPORATE TO WOMEN – JUST DON’T. EVER.
- 2nd LINE: Lamotrigine or carbamazepine
o GIVE THE WOMEN LAMOTRIGINE
73
C.Diff management
- 1st line mild/mod/severe = vancomycin PO 125 mg every 6hours/QDS for 10 days
- Life threating = vancomycin 500mg PO QDS with metronidazole 500mg IV TDS 10days
74
Palliative care meds
* Change frequent injections to a syringe driver
* Pain: morphine sulphate 10mg/ 24hr
* Nausea: Cyclizine 150mg / 24hrs
* Secretions: Hyoscine butylbromide 60mg / 24hrs or Hyoscine hydrobromide 1.2 / 24hrs
* Agitation: Midazolam 10-20mg / 24hrs
75
Anti-emetic for:
1. post operative nausea
2. Palliative care
3. Vertigo/motion sickness/vestibular disorders
4. Chemotherapy
5. PD
6. Opioid induced
1. post operative nausea - ondansetron
2. Palliative care - cyclizine, haloperidol, levopromazine
3. Vertigo/motion sickness/vestibular disorders - cyclising
4. Chemotherapy
Acute: Ondansetron
Chronic: Metoclopramide
Dexamethasone
5. PD - dompeidone
6. Opioid induced - haloperidol, metoclopramide
76
Bulk forming laxatives:
examples
mechanism
pros
cons
Ispahgula
(Fybogel®)
MOA: Works like dietary fibre by adding bulk to stool so increases faecal mass and stimulates peristalsis
Pros: Widely available
More convenient than increasing dietary fibre for many
Cons: Takes 2-3 days to work
Adequate fluid intake necessary
77
Osmotic laxatives:
examples
mechanism
pros
cons
Macrogol (Movicol)
Lactulose
MOA: Increases fluid in large bowel by trapping water
Pros: Produces soft stools with large volume
Macrogol acts quick
(4-6hrs)
Cons: Abdo cramps, flatulence
Lactulose: CI - bloating, long to act (1-3d)
78
Stool softeners:
examples
mechanism
pros
cons
Sodium docusate
Reduces surface tension of stool, allowing water to penetrate and soften
Pros: Does not require large fluid intake
Cons: SE: cramps, diarrhoea
CI: already soft stools
79
Stimulant laxatives:
examples
mechanism
pros
cons
Senna
Bisacodyl 15-30mg oral nightly
MOA: Causes peristalsis by stimulating the myenteric plexus
Pros: rapid effect (6-12)
Cons: Avoid in bowel obstruction
SE: abdo cramps, diarrhoea
80
Fluid therapy
For maintenance fluids:
- 25-30 ml/kg/day of water and
- 1 mmol/kg/day of potassium, sodium and chloride and
- 50-100 g/day of glucose to limit starvation ketosis
0.9% saline
* If large volumes are used there is an increased risk of hyperchloraemic metabolic acidosis
Hartmann's
* Contains potassium and therefore should not be used in patients with hyperkalaemia
81
Inducers of P450
PCBRASS
Phenytoin
Carbamazepine
Barbiturates
Rifampicin
Alcohol (Chronic)
Sulfonylureas – Gliclazide
Smoking
St Johns Wort
82
Inhibitors of P450 (INR increases)
GOAA DEVICES
Grapefruit & Cranberry juice
Omeprazole
Allopurinol
Anti-fungal – FLUCONAZOLE
Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol (acute intoxication)
Sulphonamides
= higher bleeding risk
83
