Important Things to Remember Flashcards
(31 cards)
How long before surgery should the COCP/HRT be stopped?
4 weeks
How long before surgery should Lithium be stopped?
Day before
How long before surgery should potassium-sparing diuretics be stopped?
Day of surgery
How long before surgery should ACE-inhibitors be stopped?
Day of surgery
How long before surgery should antiplatelets and anticoagulants be stopped?
Variable between hospitals (some continued throughout surgery)
How long before surgery should oral hypoglycaemics and insulin be stopped?
Variable
- Metformin stopped due to risk of lactic acidosis
- Insulin and other oral hypoglycaemics will cause hypoglycaemia unless stopped
- Start sliding scale with hourly blood glucose monitoring and adjust insulin accordingly
What are the three common side effects of antihypertensives?
- Hypotension (ALL - inc. postural hypotension)
- Bradycardia (β-blockers + some CCBs)
- Electrolyte disturbance (ACE-i + diuretics)
What is the most common side effect of ACE-i?
Dry cough
What are the two most common side effects of Β-blockers?
- Wheeze in asthmatics
- Worsening of acute heart failure (helps with chronic heart failure)
What are the two most common side effects of CCBs?
- Peripheral oedema
- Flushing
What are the common side effects of diuretics?
- Renal failure (ALL)
- Gout (thiazide-sparing diuretics)
- Gynaecomastia (potassium-sparing diuretics)
What are the contraindications to giving saline as a fluid replacement and the alternative fluids given?
- Hypernatraemia/hypoglycaemia (5% dextrose)
- Ascitic (human-albumin solution (HAS))
- Shock from bleeding (blood transfusion/crystalloid if blood unavailable)
What is the maximum rate of prescribing IV potassium?
10mmol/hour
What are the two contraindications for prescribing metoclopramide?
- Parkinson’s disease (exacerbates symptoms)
- Young women (dyskinesia - especially acute dystonia)
What is the maximum daily dose of paracetamol?
4g daily
- If pt <50kg = 500mg 6-hourly
What are some causes of hypernatraemia?
Dehydration
Drips
Drugs
Diabetes Insipidus
What are some causes of a prehepatic (isolated rise in bilirubin) jaundice?
Haemolysis
Gilbert’s + Crigler-Najjar syndromes
What are some causes of an intrahepatic (raised bilirubuin + raised ALT/AST) jaundice?
Fatty liver
Hepatitis
Cirrhosis
Malignancy
Metabolic (Wilson’s disease/haemachromatosis)
Heart failure (causing hepatic congestion)
What are some causes of a posthepatic/obstructive (raised bilirubin + raised ALP) jaundice?
Stones (gallstones)
Drugs causing cholestasis (flucloxacillin, co-amoxiclav, nitrofurantoin, steroids, sulphonylureas)
Cholangiocarcinoma
Primary biliary cirrhosis
Sclerosing cholangitis
Pancreatic/gastric cancer
Lymph node
What are the features of Digoxin toxicity?
Confusion
Nausea
Visual halos
Arrhythmias
What are the features of lithium toxicity?
Early: Tremor
Intermediate: Tiredness
Late: Arrhythmias, seizures, coma, renal failure, diabetes insipidus
What are the features of phenytoin toxicity?
Gum hypertrophy
Ataxia
Nystagmus
Peripheral neuropathy
Teratogenicity
What are the features of gentamicin toxicity?
Ototoxicity
Nephrotoxicity
What are the features of vancomycin toxicity?
Ototoxicity
Nephrotoxicity
