more Flashcards
(196 cards)
1
Q
Hypokalaemia causing drugs
A
Bendroflumethazide (thiazides) and loop
2
Q
Hyperkalaemia causing drugs
A
ACEin, potassium sparing diuretics, tacrolimus, heparin
3
Q
Max Iv potassium rate
A
10mmol/hr
4
Q
Antiemetic options
A
cyclizine 50mg 8-hrly IV/IM/oral
Metoclopramide 10mg 8hrly IV/IM (heart failure)
5
Q
Metoclopramide ci
A
parkinsons, young women (dyskinesia, acute dystonia)
6
Q
Paracetamol max/day
A
4g/day (8x500mg) Co-codamol.
7
Q
Steroid side effects
A
Stomach ulcers, thin skin, edema, right and left heart failure, osteoporosis, infection (inc candida), diabetes, cushings syndrome
8
Q
NSAIDS/ibuprofen side effects
A
No urine systolic dysfunction- Heart failure asthma Indigestion dyscrasia
9
Q
pre operative drug changes
A
I LACK OP INsulin Lithium anticoag/plt COCP/HRT K-sparing diuretics oral hypoglycaemics peridonopril (+ other acein)
10
Q
when to stop COCP for surgery
A
4 weeks before
11
Q
when to stop litihium for surgery
A
day before
12
Q
ACEin/K sparing stop for surgery
A
day of surgery
13
Q
anticoag when stop for surgery
A
warfarin 5 days before
anti platelets day before
heparin day before
14
Q
insulin when stop for surgery
A
variable
15
Q
cough as se- what is the medication?
A
ace in
16
Q
indigestion causes
A
steroids, nsaids
17
Q
constipation causes
A
cocodamol, codeine
18
Q
methotrexate cautions
A
give weekly, no trimethoprim or co-trimoxazole- folate antagonists. Give folic acid alongside to reduce BM toxicity.
19
Q
peripheral oedema cause
A
CCB e.g. amlodipine
20
Q
post stroke caution
A
no heparin 2 months e.g. enoxaparin
21
Q
CCB caution
A
not with beta blockers- bradycardia
e.g. verampil
22
Q
asthma cautions
A
beta blockers, nsaids, aspirin (can use with caution)
23
Q
COCP ci
A
migraine with aura
24
Q
insulin route
A
S/c unless sliding scale IV actrapid and novarapid
25
agranulocytosis which drug
clozapine. immediately cease and refer to haem
26
Neutrophilia which drug
steroids
27
Neutropenia which drug
chemo or radiotherapy. clozapine, carbimazole. carbamazepine.
28
thrombocytopaenia which drug
penicilliamine (RF) reduced production
Heparin increased destruction
29
SIADH- low na which drug cause
carbamezepine, antipscyh
30
intrinsic renal failure which drug
gentamicin, vancomycin, tetracycline, (ACEin), NSAIDS, contrast, lithium
31
TSH ranges with levothyroxine
<0.5 decrease dose
0.5-5 nill action
>5 increase dose
32
cholestasis drugs
flucloxacillin, coamoxiclav, nitrofuratoin, steroids, sulphonylreas
33
hepatitis drugs
paracetamol od, statins, rifampicin.
34
digoxin tox sx
Confusion, nausea, visual halos and arrhythmias
35
lithium tox sx
Early: tremor
Intermediate: tiredness
Late: arrhythmias, seizures, coma, renal failure and diabetes insipidus
36
phenytoin tox sx
Gum hypertrophy, ataxia, nystagmus, peripheral neuropathy and teratogenicity
37
Gentamicin/vancomycin se
Ototoxicity and nephrotoxicity
38
Gentamicin monitoring
IE: peak- 3-5
trough <1
Everything else: 5-10 peak
<2 trough
peak adjust dose, trough adjust interval
39
gentamicin dose
5-7mg/kg OD
| renal failure or IE: 1mg/kg 12 hourly- divided daily dosing.
40
Warfarin INR too high
<6 reduce dose
6-8 omit 2 days then reduce
>8 (and no bleeding) omit warfarin and give 1-5mg oral vit k
if minor bleed with INR >5 give 1-2mg vit k phytomenadione IV NOT ORAL!
41
neutropenic sepsis tx
IV piperacillin with tazobactam and gentamicin
42
UTI in preg mx
no trimethoprin- folate antagonist
43
Addisons caution
Increase hydrocortisone with infection or illness
44
HF acute mx
40mg IV furosemide
45
AF caution
can use diltazem but worsens fluid retention as CCB
46
Neuropathic pain
amitriptylline TCA. i.e. 10mg nightly
47
STEMI MX
```
ABC. O2 if sats <94%
Aspirin 300mg oral
Morphine 10mg IV with metoclopramide 10mg IV
GTN spray
Primary PCI
Atenolol 5mg Oral
```
48
NSTEMI mx
ABC. O2 if sats <94%
Aspirin 300mg oral
Morphine 10mg IV with metoclopramide 10mg IV
GTN spray
Clopidogrel 300mg, enoxaprin 1mg//kg bD SC
Atenolol 5mg Oral
49
LVF mx acute
```
ABC and o2
Sit patient up
Morphoine 5-10mg IV with metoclopramide 10mg IV
GTN spary
Furosemide 40-80mg IV
CPAP
```
50
Unstable arrthymia mx
Synchronised DC shock (3 attempts)
| amiodarone 300mg IV 10-20 min and repeat shock then amiodarone 900mg over 24 hours.
51
Anaphylaxis mx
```
ABC, o2
Remove cause
Adrenaline 500mcg of 1:1000 IM
Chlorphenamine 10mg IV
Hydrocortisone 200mg IV
Astham tx with wheeze
amend drug allergys box on chart
```
52
Acute asthma mx
ABC
100% o2 via non-rebreather
salbutamol 5mg neb (20-30 mins repeat with oxygen driven)
Hydrocortisone 100mg IV (6hrly) or pred 40-50mg oral
Magnesium sulphate 1.2-2g over 20 mins
Ipratropiium 500 mcg neb]
Theophylline.
53
Pneumonia tx
```
ABC
High flow o2
antibioitics: amoxicillin or co-amoxiclav,
paracetamol
IV fluids
```
54
Pulmonary Embolism tx
High flow O2, morphine 5-10mg IV with metoclopramide 10mg IV
| Rivaroxaban- Initially 15 mg twice daily for 21 days, then maintenance 20 mg once daily
55
GI bleeding mx
```
ABC with o2 non breather
2 large bore cannulae
catheter with strict fluid monitoring
cross match 6 units
correct clotting abn
endoscopy
stop nsaids, aspirin, warfarin, heparin
```
56
Bacterial meningitis mx
ABC, high flow o2, iv fluids, dexamethasone iv unless immmunocompr. LP with CT head
2g cefotaxime QDS/cephtriaxone (2-4g) min 10 days (if over 50 add amoxicillin)
57
epileptic seizure mx
ABC, recovery position with o2
58
Status epilepticus mx
```
ABC, recovery position with o2
Lorazepam 2-4mg IV or diazepam/midazolam buccal 10mg
repeat diazepam after 2 mins
inform anaesthetist
phenytoin
intubate then propofol.
```
59
Stroke mx
ABC CT head to exclude haemmorage
if <80 and <4.5 hrs ago thrombolysis
aspirin 300mg oral
transfer to stroke
60
Hyperglycaemia mx
ABC,
IV fluid 1L stat then 1L over 1 hour then 2, 4, 8.
Fixed dose insulin. 1 unit/mL; with 0.9% saline infuse at a fixed rate of 0.1 units/kg/hour.
Monitor Bm, K, pH and ketones.
CONTINUE WITH LONG ACTING
61
AKI tx
```
ABC
cannula and catheter with strict fluid monitoring
IV fluid 500ml stat then 1L 4 hrly.
Monitor U&E and fluid balance
treat cuase.
```
Stop allopuriol, acein, arbs, nsaids, metformin, acculumating drugs.
62
Acute poisoning mx
ABC
Cannulae catheter strict fluid balance
supportive IV fluids and analgesia
Correct electrolyte abn
Reduce absorption if <1hr: gastric lavage (unless caustic), whole bowel irrigation (iron/lithium), charcoal (dose dependent)
N-acetyl cysteine if paracetamol at 4 hours above line on normogram
Naloxone )opiates in slow breathing or low GCS
Flumazenil benzo
63
Lamotrigine se
Rash, rarely Stevens–Johnson syndrome
64
Carbamazepine se
Rash, dysarthria, ataxia, nystagmus, ⇓Na, neutropenic sepsis
65
Phenytoin se
Ataxia, peripheral neuropathy, gum hyperplasia, hepatotoxicity
66
Sodium Valporate se
Tremor, teratogenicity, tubby (weight gain
67
COPD tx
smoking cessation, inhaled therapy
68
Alzheimers tx
Acetylcholinesterease inhibitors. Donezepil, rivastigmine, galantamine.
NMDA antagonist- memantine
69
Crohns mx
Induce remission with pred 30mg daily oral
Severe: hydrocortisone 100mg 6hrly IV.
Rectal hydrocortisone if rectal disease.
Maintaining remission with azathioprine or 6-mercaptopurine. (check TPMT)
70
Rheumatoid arthritis mx
methotrexate with DMARD (sulfasalazine or hydroxychloroquine)
Flare: Im methlypred 80mg
Short term nsaids ibuprofen with lansoprazole.
if failure to respond to two DMARDS- infliximab.
71
Fever mx
Tx cause. 4g paracetamol
72
Constipation mx
Stool softener: Docusate sodium. Good for impactino
Bulking agents: isphagula husk (CI in impaction and colonic atony) takes days to work
Stimulant laxatives: senns, bisacodyl (not in acute abdo), exacerbate cramps
osmotic: lactulose/phosphate enema: exacerbate bloating.
73
HTN when to treat
Treat if >150/95 or >135/85 with existing or high risk of vascular disease, hypertensve organ damage.
74
HTN target BP
<80yrs <140/85 in clinic and <135/85 for ambulatory or home.
if over 80 then add 10.
75
HTN Treatment
Under 55/t2dm: Acein or ARB
then add CCB or thiazide
then add the other out of CCB and thiazide
>55 or black: CCB
then add ACei or ARB or thiazide
then CCB + thiazide + acein or arb
refer if uncontrolled on max dose of 4 drugs.
76
Heart failure mx
Acein-lisinopril 2.5m g daily plus beta blocker e.g. bisoprolol 1.25mg daily.
if mild: add arb
if moderate/black: add hydralazine 25mg 8hrly and isosorbide mononitrate 20mg 8 hrly
mod-sev: spironolactone 25mg daily.
77
CHADVASC
```
congetive heart failure (or LHF)
Hypertension
Age >75 2 points
DM
Stroke or TIA (2 points)
Vascular disease (peripheral or IHD)
Age 65-74
Sex (female)
```
0= aspirin 75mg daily
1 aspirin or warfarin with INR 2.5 target
Score >2 warfarin with inr target 2.5
78
DM mx
education, dietary and exercise advice.
CV risk mx: aspirin 75mg daily if any significant risk or over 50 with t2dm
simvastatin 20-40mg daily if any significant rf or over 40 in t2dm
Annual rv: ACR (diabetic nephropathy), >3mg/mmol- ace in
blood glucose lowering therapy.
79
Glucose lowering therapy
if Hba1c >48: metformin 500mg with breakfast oral. if low or normal weight or high creatinine use sulphonylurea instead gliclazide 40mg with breakfast oral.
then increase dose to max tolerated
then add sulphonylurea (gliclazide)
if already gliclazide add gliptin (dpp4 inhibitor e.g. sitagliptin
if still over 48 add insulin.
80
Skin infection mx
flucloxacillin 500mg 6 houly for 7 days.
81
domperidone caution
safe for use in parkisons as does not cross bbb
82
Parkinsons meds to avoid
metoclopramide, haloperiodol.
83
HTN in pregnancy caution
avoid ramipril as teratogenic. Use labetalol
84
HTN in pregnancy tx
Labetolol 100 mg BD, dose to be increased at intervals of 14 days; usual dose 200 mg BD, increased if necessary up to 800 mg daily in 2 divided doses, to be taken with food, higher doses to be given in 3–4 divided doses; maximum 2.4 g per day.
85
Tamoxifen cautions
Increases endometrial cancer risk, increases warfarin efficacy high INR, increases VTE risk.
86
Metformin Caution
causes lactic acidosis
87
Gliclazide se
risk of hypoglycaemia. sulphonylurea. taken in morning.
88
Methotrexate monitoring
have full blood count and renal and liver function tests repeated every 1–2 weeks until therapy stabilised, thereafter patients should be monitored every 2–3 months.
be advised to report all symptoms and signs suggestive of infection, especially sore throat
89
Warfarin cautions
significant bleeding risk, alcohol enzyme inhibition. chronic excess enzyme induction.
90
Warfarin colours
White 0.5mg
Brown 1mg
Blue 3mg
Pink 5mg
91
Target INR
2.5- af, dvt, pe
| recurrent vte or mechanical valve- 3.5
92
Warfarin monitoring
initially weekly then monthly INR
93
ACEin caution
dehydration, D&V. AKI risk. do not prescribe with NSAIDs. do not use in aortic stenosis.
94
ACEin monitoring
check renal function and potassium 1-2 weeks after initiation. and after each dose change.
95
Steroids co-prescribe
bisphosphonate (e.g. alendronic acid). Ranitidine or PPI (omeprazole) if at risk. DOnt stop suddenly. Monitor for HTN and DM.
96
Citalopram
Photosensitivity, increased suicidality, dry mouth.
97
Serotonin syndrome
agitation, temperatures, hallucinations.
98
Alendronic acid
Weekly. not with calcium salts or food. swallowed with full glass of water and remain upright for 30 mins afterwards.
99
1%
1g in 100ml or 10mg in 1ml
100
ACEin
give in evening to avoid postural hypotension.
101
GTN
glyceryl trinitrate. 2 sprays sublingual
102
Vancomycin
Renal dysfuncton changes the dosage. Measure renal function before treatmetn
103
Statins
Should check liver function as is metabolised by the liver. increases myopathy risk check ALT/AST before. CI if >3x normal range. Check at 3 and 12 months.
Check CK is patient at increased risk of myopathy.
104
Phenytoin
Reference range (40-80micromols/L) measured at trough. COnsider seizure control also.
105
Lithium
Sample 12 hours after last dose. 0.4-0.8mmol/L. Tox at >1.5mmol/L
Routine serum lithium conc weekly after initiation and after each dose change until stable. then 3 monthly after.
Low sodium increases lithium toxicity so dietary changes.
106
Methotrexate
Must monitor FBC once stabilised every 2-3months.
Can do xray chest as baseline.
Dont start with abn liver function
renally excreted.
107
Olanzapine
Check fasting blood glucose at baseline, at 4-6 months then yearly.
108
Psych
ECG if CVS history.
109
OCP
check BP prior to prescribing.
110
amiodarone monitoring
```
T3/4 and TSh must be checked.
Baseline chest xray.
Can cause abn LFTs.
Renal function not applicable.
Caution in hypokalaemia due to increased arrythmia risk.
```
111
Carbimazole
Check neutrophil count if sore throat- agranulocytosis. FBC.
Associated with hepatic disorders.
112
Digoxin monitoring
renally excreted so monitor digoxin levels in renal impairment. Also measure if tox suspected, non-compliance or inadequate effect.
Monitor renal function and electrolytes. Hypokalaemia increases risk of tox.
113
Sodium valproate monitoring
Monitor liver function before therapy and during first 6 months (especially in patients most at risk)
Measure full blood count and ensure no undue potential for bleeding before starting and before surgery.
No need to measure plasma conc.
114
Sodium valproate cautions
Can cause pancreatitis.
Consider vit d supplementation if pt at risk of osteoporosis.
Change dose based on monitoring in renal impairment.
115
Clozapine monitoring
Monitor FBC. weekly for 18 weeks. then fortnightly up to 1 year. then monthly. Monitor for 4 weeks after discontinuation also. Stop permanantly if leukocytes <3000/mm3, or neutrophils <1500/mm3.
Blood conc measured in certain situations.
Observe during initiation (hypotension and convulsions)
Lipids and weight at baseline, at frequent intervals in first 3 months, then 3monthly for 1st year. then yearly. (other psychotics is just baseline, frequently in 1st 3 months then, yearly.
fasting blood glucose tested at baseline, after one months’ treatment, then every 4–6 months.
Patient, prescriber, and supplying pharmacist must be registered with the appropriate Patient Monitoring Service.
116
Anti-psychotics monitoring
Lipids and weight at baseline, frequently in 1st 3 months then, yearly.
Fasting blood glucose at baseline, 4-6 months and then yearly.
monitor prolactin at the start of therapy, at 6 months, and then yearly.
Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year.
117
c.diff
broad-spec esp cephalosporins or ciprofloxacin.
118
ACEin Side effects
hypotension, electrolyte abn (hyperkalaemia), AKI, dry cough. hyponatraemia.
119
Beta blocker side effects
Hypotension, bradycardia, wheeze in asthmatics, worsens acute heart failure (helps chronic). Cold extremities. Fatigue.
120
CCB side effects
hypotension, bradycardia, peripheral oedema, flushing
121
Diuretic side effects
hypotension, electrolyte abn, AKI, subclass dependent effects.
122
Heparin side effects
Haemorrhage (esp in renal failure or <50kg), heparin-induced thrombocytopaenia.
123
Warfarin side effects
Haemorrhage, pro-coagulant in first few days (co-prescribe heparin until INR >2)
124
Aspirin side effects
Haemorrhage, peptic ulcers and gastritis, tinnitus in large doses.
125
Digoxin side effects
N&V, blurred vision, confusion, drowsiness, xanthopsia (yellow green vision). Low K augments effect. high levels limit effect.
126
Amiodarone side effects
pulmonary fibrosis, thyroid disease (hypo and hyper), skin greying, corneal deposits.
127
Lithium side effects
early- tremor
Intermediate- fatigue
Late- arrythmias, seizures, coma, renal failure, diabetes insipidus.
128
Haloperidol side effects
dyskinesias (acute dystonic reactions), drowsiness.
129
Fludrocortisone side effects
hypertension, sodium and water retention
130
Statin side effects
Myalgia, abdominal pain, increased ALT/AST (mild), rhabdomyolysis (mildly raised CK).
131
Drugs with narrow therapeutic index
warfarin, digoxin, phenytoin
132
Drugs that need careful titration of dose to effect
Antihypertensives, antidiabetic
133
Low GCS/acidosis
metformin
134
Enzyme inducers
```
PC BRAS:
Phenytoin
Carbamazepine
Barbituates
Rifampicin
Alcohol chronic
Sulphonylureas
```
135
Enzyme inhibitors
```
ketoconazole, ciprofloxacin, erythromycin, grapefruit juice.
AODEVICES:
Allopurinol
Omeprazole
Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol (acute)
Sulphonamides.
```
136
Interactions with alcohol
GI bleeding- NSAIDS
Lactic acidosis- metformin
Increased anticoagulation: warfarin (acute alcohol- enzyme inhibition)
Reduced anticoagulation: warfarin (chronic alcohol- enzyme induction).
Hypertensive crisis: Monoamine oxidase inhibitors
Sweating, flushing, N&V: metronidazole and disulfiram.
Sedation: barbituates, opiods and benzodiazepines.
137
Augmentin
Co-amoxiclav
138
hypoglycaemia management
If conscious- sugar rich snack 10-20g glucose.
Glucagon 1mg IM/SC/IV - if unconscious or unsafe swallow and no IV access.
IV glucose 20% 100ml = 20g of glucose or glucose 10% 100ml = 10g of glucose
give 10-20g. 15-20 mins
139
Bendroflumethaizide
increases gout
140
Give potassium max rate
20mmol/hour
141
Hyperkalaemia
```
DREAD
Drugs
Renal failure
Endocrine (addisons)
Artefact (repeat bloods)
DKA (blood sugar)
```
142
Hyperkalaemia treatment
10ml 10% IV calcium gluconate and 10 Units actrapid insulin with 100ml 20% IV dextrose and nebulised salbutamol.
143
Anaphlaxis
15L/min Oxygen via non-rebreather mask
500 micrograms (0.5mg) of 1:1000 adrenaline IM.
10mg Chlorphenamine IV
200mg Hydrocortisone IV stat
144
T2DM with renal impairment
```
Not metformin if GFR <30.
Give gliclazide (sulphonylurea).
```
145
Metoclopramide
10mg IV prokinetic antiemetic
| cannot use in bowel obstruction or first few days post abdo surgery.
146
Clarithromycin
Avoid statins CYP3a4 inhibitor increase tox and se.
147
Statins
Take at night, avoid grapefruit, not in liver disease, avoid clarithromycin, myositis stop medication.
148
Angio-oedema
ACEin, months later due to accumulation of bradykinin
149
Sick day rules
2x normal dose. During sepsis.
150
dyspepsia
magnesium carbonate 10ml oral
151
Dalteparin dose
5000 units S/c OD - prophylactic dose
152
Enoxaparin dose
40mg/4000 units s/c od - prophylactic dose
153
Paracetamol dose
500mg 4 hourly oral. WITH INDICATION and FREQUENCY. on as required chart.
154
IV abx r/v
3 days as often can be stepped down to oral
155
when to give laxatives
before bed. oral nightly
156
Monitoring of chest infection
O2 sats or ABG- more accurate and specific. Otherwise RR.
157
Tacrolimus monitoring
trough level before morning or evening dose. 6-10ng/ml post transplant
158
Vancomycin monitoring
trough 10-15mg/l. renally excreted.
159
Steroids
Hypokalaemia
160
Bumetanide
Hypokalaemia
161
Elderly
>65yrs
162
Chloramphenicol
increases phenytoin level
163
Mild UC
<6 stools a day and no other symptoms
| Oral 30mg prednisolone OD
164
Severe UC
>6 stools a day and systemically unwell.
| Hydrocortisone 100mg IV 6 hourly.
165
Hyperkalaemia with ECG changes
10ml 10% calcium gluconate IV repeated every 15 mins until ECG normalises (max 50ml).
166
Digoxin loading dose
500mcg IV. Maintenance is 62.5-125 mcg daily.
167
pruritis
codeine se
168
Spironolactone
hyperkalaemia, diuretic, aldosterone antagonist. potassium retention, gynaecomastia.
169
Converting phenytoin
normal dose x 0.92 = new dose with capsules or whatever it is
170
1st line medical management for GAD
Sertraline or paroxetine
171
DVT
Rivaroxaban, apixaban
172
IV phenytoin
ECG as cardiac arrythmias
173
SSRI cx
rash- side effect indicattive of potential serious systemic reaction
takes 6 weeks
174
Patients <50kg
dose-adjustmentt e.g. enoxaparin. also lower dose paracetamol to avoid hepatotoxicity
175
Confusion
Morphine, metoclopramide, anticholinergics, antipsychotics, antidepressants, anticonvulsants, histamine H2 receptor antagonists, digoxin, beta blockers, corticosteroids, NSAIDS, abx.
176
Alcohol withdrawl
vitamin b substances with ascorbic acid (pabrinex Iv high potency 2 pairs 10ml by iv infusion over 30 mins 8 hourly.
177
DKA
soluble insulin 50 units in sodium chloride 0.9% 50ml by iv infusion at a rate of 0.1units/kg/hr.
178
Folic acid
low risk 400mcg before conception and up to week 12 of pregnancy.
high risk i.e. family history of neural tube defects. 5mg daily. until week 12 of pregnancy.
179
Adrenaline
IM 0.5ml of 1 in 1000 = 500mcg.
180
HRT
can increase BP, stop if >160/95. sodium and fluid retention.
181
Statins and liver function
3x upper limit with transaminases discontinue.
182
phytomenadione vit k 2mg po
if inr >1.5 on the day before surgery, use phytomenadione vit k 1-5mg PO using iv preparation.
183
Statins
looking for a >40% reduction in non-HDL cholesterol.
184
Digoxin
bradycardia
185
for second episode of c.diff
oral vancomycin
186
COCP
monitor bp
187
opioids in renal impairment
not renal excreted so can use in renal impairment
188
Hyponaturaemia
thiazides ssri siadh spirinolactone
189
Breakthrough pain
keep same drug, dose is 1/6 of 24 hour dose,
190
INR surgery day
if <1.5 give oral vit k 1-5mg phytomenadione
191
Rivaroxaban
give with food
192
evening hyperglycaemia
increase morning insulin by 10%
193
Tardive dyskinesthia
stop drug and give terbutaline
194
Dystonia (olyguric crisis or extra-pyramidal)
procyclidine
195
Peripheral vascular disease
dont give beta adrenoceptor blockesr e.g. atenolol
196
CK >5 times upper limit discontinue
If resolve then restart at lower level
