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1
Q

How much K does a patient need in a day?

A

1 mmol / kg / day

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2
Q

What does the rate of infusion of K cannot exceed?

A

> 10 mmol / hr

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3
Q

Max dose of paracetomal in a day

A

1g QDS

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4
Q

What do enzyme inducers do?

A

Increase the metabolism of drugs thus leading to a decreased effect

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5
Q

Enzyme inducers

A 
Phenytoin
Carbamazepine
Barbituates 
Rifampicin 
Chronic alcohol excess 
Sulphonyureas 
St Johns wort
Smoking
Topiramate
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6
Q

What do enzyme inhibitors do?

A

Increase metabolism of drugs and therefore more of the drug in the body

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7
Q

Enzyme inhibitors

A 
Allopurinol 
Omeprazole
Disulfiram 
Ciprofloxacin 
Acute alcohol excess 
Sulphonamines 
Grapefruit juice
Amoidarone
SSRIs
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8
Q

How much can transaminases be raised before statins have to be discontinued?

A

3x the upper limit of normal

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9
Q

Examples of drugs prescribed in micrograms

A

Digoxin

Levothyroxine

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10
Q

Paracetomal and what drug together often mean too much of the drug?

A

Co-codamol

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11
Q

What does 1% mean?

A

1g in 100ml

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12
Q

Prescribed name as tazocin

A

Piperacillin with tazobactam

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13
Q

How long before surgery does the COCP have to be stopped?

A

4 weeks before

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14
Q

How long before the surgery does lithium have to be stopped?

A

1 day

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15
Q

How long before surgery should potassium sparing diuretics and ACEIs be stopped?

A

Day of

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16
Q

How long before surgery should anticoagulants be stopped?

A

7 days

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17
Q

Examples of anticoagulants

A

Warfarin

Heparin

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18
Q

Examples of antiplatelets

A

Aspirin
Clopidogrel
Dipyramidole

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19
Q

Should metformin be stopped before surgery?

A

Yes, as NBM -> lactic acidosis

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20
Q

What should be done to insulin when having surgery?

A

A sliding scale should be started

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21
Q

What should be stopped if a patient is bleeding?

A

Any antiplatelets etc or prophylactic anticoagulation

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22
Q

What do ACEIs contribute to?

A

Renal failure

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23
Q

How many hourly is 3x daily?

A

8 hourly

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24
Q

How many hourly is 4x daily?

A

6 hourly

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25
Does co amoxiclav contain penicillin?
Yes
26
Does amoxicillin contain penicillin?
Yes
27
Does tazocin contain penicillin?
Yes
28
What is a specific condition that prophylactic heparin is contraindicated in?
Acute ischemic stroke (as risk of bleeding into the stroke)
29
What would an enzyme inhibitor e.g. erythromycin do to INR?
Increase warfarins effect i.e. Increase INR
30
S/Es steriods
``` Stomach ulcers Thin skin Confusion Oedema Right and left HF Osteoporosis Infection (including candida) Hyperglycaemia Cushings ```
31
What are NSAIDs contraindicated in?
Heart failure Renal failure Asthma
32
S/Es NSAIDs
``` Renal failure Systolic dysfunction Indigestion Clotting abnormalities Ulceration ```
33
S/Es antihypertensives
Hypotension
34
S/Es BBs
Bradycardia Wheeze in asthmatics Worsening of acute HF
35
S/Es of CCBs
Bradycardia Peripheral oedema Flushing
36
S/Es of loop diuretics
Renal failure Hypokalaemia Gout
37
S/Es K+ sparing diuretics
Hyperkalaemia | Gynaecomastia
38
S/Es TTD
Hypokalaemia
39
S/Es ACEIs
Hyperkalaemia | Dry cough
40
S/Es ARBs
Hyperkalaemia
41
If a patient is vomiting, how should antiemetics be given?
Non oral routes i.e. IM/IV/SC
42
Should a patient who is NBM still receive their medication?
Yes
43
As a general rule, never prescribe more than how many Litres of fluid for a sick patient?
2 litres
44
How much fluid does a patient need for maintenance fluids as a general rule?
3L adult per 24 hrs | 2L elderly per 24 hrs
45
What is a saying for maintenance fluids in 24 hours?
2 sweet and 1 salt - 2L 5% dextrose - 1L 0.9% saline
46
Rough amount of K needed in an adult per day
40 mmol
47
So if giving 3 litres per day for maintenance, how many bags do you need to give over what time?
3x 1L bags 8 hourly
48
So if giving 2 Litres per day for maintenance, how many bags do you need to give over what time?
2x 1L bags 12 hourly
49
What is the prophylactic DVT dose for LMWH?
5000 units dalteparin OD S/C
50
When should a patient not wear compression stockings in DVT prophylaxis?
Peripheral artery disease as may cause acute limb ischaemia
51
What can cyclizine cause?
Peripheral oedema
52
Who should metaclopramide be avoided in?
``` PD (exacerbates symptoms) Young women (risk of dyskinesia) Bowel obstruction ```
53
Pain relief prescription for someone in no pain
No regular painkillers | PRN paracetomal 1g up to 6 hourly oral
54
Pain relief prescription for someone in mild pain
Regular paracetomal QDS 1g | As required codeine 30mg up to 6 hrs or tramadol
55
Pain relief prescription for someone in severe pain
Regular co codamol 30/500 2 tablets 6 hourly | As required morphine sulphate 10mg up to 6 hourly oral
56
What is oromorph and what is the dose?
Liquid morphine sulphate | 10mg/5ml
57
What is the maximum dose of ibruprofen?
400 mg 8 hrly
58
1st line Tx for neuropathic pain
Amitriptyline 10mg oral at night OR | Pregabalin 75 mg oral BD
59
Treatment of painful diabetic neuropathy
Duloxetine 60 mg oral OD
60
What does co codamol contain?
30mg codeine | 500mg paracetomal
61
What is the antiemetic of choice in parkinsons disease and why?
Domperidone | Does not cross the BBB
62
What kind of drugs are metoclopramide and domperidone?
Anti sickness - dopamine antagonists
63
What kind of drug is cyclizine?
Anti-histamine anti-emetic
64
If a patient is constipated, what drugs should be withheld?
All opiate derived drugs
65
What is trimethoprim contraindicated with?
Methotrexate
66
Why is trimethoprim contraindicated with methotrexate?
Risk of bone marrow toxicity - leading to pancytopenia and neutropenic sepsis
67
All diuretics can cause what?
Hyponatraemia | However when they contribute to dehydration then can get hypernatremia too
68
How long should patients who have suffered from acute strokes NOT take thromboprophylaxis for?
2 months (duration varies)
69
What is INR?
Standardized version of prothrombin time
70
What are the PT and INR a measure of?
Overall clotting factor synthesis or consumption
71
Normal INR
1
72
What does a high INR mean?
Higher risk of bleeding
73
Target INR on warfarin
2 - 3
74
Should patients already on warfarin be put on thromboprophylaxis?
No
75
What should CCBs be not used with and why?
Beta blockers | Due to risk of bradycardia (at worst asystole) and hypotension
76
Cardioprotective aspirin dose
75 mg
77
Treatment dose aspirin
300 mg
78
Give an example of something the COCP is contraindicated with
Migraine with aura (increased risk of stroke)
79
What type of insulin is novomix?
Short and medium term insulins
80
What route is all insulin?
Subcut (except for sliding scale insulins = infusion)
81
S/E clozapine
agranulocytosis - resulting in neutropenia
82
K+ monitoring when treating DKA
When insulin is given, the K+ drops requiring regular (hourly) monitoring +/- replacement
83
What does a raised urea indicate?
Upper GI bleed | AKI/dry
84
What to look at is there is a raised urea with a normal creatinine in someone who is euvolaemic?
Hb
85
How is the synthetic function of the liver assessed?
Albumin | PT/INR
86
Isolated bilirubin rise means what?
Haemolysis
87
Drugs causing hepatitis
Paracetomal Statins Rifampicin
88
Drugs causing cholestasis
``` Flucloxacillin Co amoxiclav Nitrofurnatoin Steriods Sulphonyureas ```
89
Common drugs requiring monitoring
``` Digoxin Theophylline Lithium Phenytoin Gentamicin Vancomycin ```
90
Presentation of digoxin toxicity
Confusion Nausea Visual halos Arrythmias
91
Presentation of lithium toxicity
``` Tremor Fatigue Arrythmias Seizures Coma Renal failure Diabetes insipidus ```
92
Presentation of phenytoin toxicity
``` Gym hyperplasia Ataxia Nystagmus Peripheral neuropathy Teratogenicity ```
93
Presentation of gentamicin toxicity
Ototoxicity | Nephrotoxicity
94
Presentation of vancomycin toxicity
Ototoxicity | Nephrotoxicity
95
What happens on a gent chart when the concentration lies above the 48 hour line?
Repeat the gentamicin level and only redose when the conc. < 1 mg/L
96
Treatment of paracetomal overdose
At least 4 hours after ingestion -> if the paracetomal level is below the line, the patient DOES NOT require NAC If staggered overdose was taken or time of ingestion is unknown, treatment with NAC is advised
97
Target INR if on warfarin with recurrent TE or metal replacement heart valves
3.5
98
What to do if a patient has a major bleed and a patient is on warfarin?
1. Stop warfarin 2. Give 5 - 10 mg IV Vitamin K 3. Give prothrombin complex (e.g. beriplex)
99
How to manage warfarin is INR <6
Reduce warfarin dose
100
How to manage warfarin if INR 6 - 8
Omit warfarin for 2 days then reduce dose
101
How to manage warfarin if INR > 8
Omit warfarin and give 1 - 5 mg oral vit K
102
Treatment of neutropenic sepsis
IV tazocin (piperacillin with tazobactam) + gentamicin
103
S/E carbamazepine
Hyponatraemia (through SiADH)
104
What is the adequate choice to treat a seizure lasting longer than 5 minutes?
Lorazepam
105
If a patient has addisons disease and becomes unwell, what must be done?
Increase steriod dose
106
What does right sided heart failure result in?
Peripheral oedema and raised JVP
107
What does left sided heart failure result in?
Bilateral creps and SOB
108
What is the mainstay of treatment in acute heart failure?
Furosemide
109
What is bumetanide and what is it used for?
A loop diuretic reserved for patients resistance to furosemide
110
Tx AF if rate < 100 bpm
Not termed fast AF and does NOT require rate control
111
When is DC Cardioversion not required in the acute setting of AF?
Abscence of adverse features e.g. chest pain, heart failure, hypotension/syncope
112
Tx PE
Treatment dose LMWH
113
What are the LMWH?
Enoxaparin Dalteparin Tineaparin
114
Regular morphine vs PRN morphine dose
1/6 of total daily dose given 4 - 6 hourly
115
If a patient with chronic pain is requiring higher doses of PRN, what does this mean?
The regular dose requires adjustment
116
Tx STEMI
``` 02 Aspirin 300mg Morphine 5-10mg IV Metoclopramide 10mg IV GTN PCI or thrombolysis BB (unless CId) ```
117
Tx NSTEMI
All the same as STEMI except instead of PCI, clopidogrel 300mg oral + enoxaparin 1mg/kg S/C
118
Tx acute HF
``` O2 Sit patient up Morphine and metoclopramide GTN Furosemide 40 - 80mg If no response -> isosorbide dinitrate infusion +/- CPAP ```
119
Tx of MI in shockable rhythm
1. Synchronised DC shock up to 3x 2. Amoidarone 300mg IV over 10 - 20 mins + repeat shock 3. Amoidarone 900mg over 24 hrs
120
What is an irregular narrow complex tachycardia probably?
AF
121
Tx polymorphic VT (torsades de pointes)
2mg Mg over 10 mins
122
Tx SVT
Adenosine
123
Tx anaphylaxis
``` O2 Adrenaline 500mg of 1:1000 IM Repeat if no effect IV adrenaline Chlorphenamine 10mg IV Hydrocortisone 200mg IV ```
124
Tx acute asthma
``` 02 Salbutamol 5mg Neb Hydrocortisone 100mg IV or prednisolone 40 - 50 mg oral Ipratropium 500mcg neb Theophylline ```
125
Oxygen in acute COPD
28% O2 safe starter then ABG 30 mins later
126
Tx suspected bacterial meningitis in primary care
1.2g BenPen IM
127
Tx suspected bacterial meningitis in secondary care
``` 02 Fluids IV dexamethasone LP +/- CT head 2g ceftoaxmine IV ```
128
Tx seizure
Lorazepam 2 - 4mg IV or diazepam IV or midazolam buccal Repeat if still fitting after 2 mins Phenytoin infusion Intubate then propofol
129
Tx Stroke
If CT shows haemorrhage DO NOT GIVE thrombolysis or aspirin If < 80 + onset < 4 - 5 hours = thrombolysis Aspirin 300 mg oral
130
Tx hyperglycaemia
IV fluids; stat then over 1 hour then 2, 4 + 8 hours | Sliding scale insulin
131
HONK vs DKA Tx
Same Tx however in HONK 1/2 the rate of fluids
132
Tx opoiod toxicity
Naloxone
133
Tx benzos overdose
Flumazenil
134
Tx Chronic heart failure
``` ACEI BB If isnt working add - ARB - hydralazine and IMN - spironolactone ```
135
Tx HTN < 55
ACEI
136
Tx HTN > 55
CCB
137
Tx HTN black people
CCB
138
CHADSVASC Score and Tx
0 = aspirin 75mg 1 = either aspirin or warfarin (INR aim 2.5) 2 or more = warfarin (INR aim 2.5)
139
Rate control AF
1. Beta blocker or diltiazem | 2. Digoxin
140
Cardioversion AF
Electrical Pharmacological (amoidarone 5mg/kg IV over 20 - 120 min) Will require anticoagulation if > 48 hours onset
141
Tx Angina
GTN PRN 2ndry prevention BB or CCB
142
Tx Asthma
``` SABA ICS LABA LTRA / theophylline Oral steriods ```
143
Tx smoking cessation
Nicotine replacement therapy Bupropion Varenciline
144
Tx T2DM
Metformin Gliclazide Sitagliptin Insulin
145
Tx COPD
SAMA or SABA PRN LABA or LAMA (stop SAMA) LABA + LAMA + ICS
146
Tx PD
Co-benledopa or co-carledopa Mild / younger - ropinirole (dopamine agonist) - rasagiline (MOA-inhibitor)
147
Tx generalised epilepsy
Sodium valproate
148
Tx absence seizures
Sodium valproate or ethosuximide
149
Tx myoclonic seizures
Sodium valproate
150
Tx tonic seizures
Sodium valproate
151
Tx focal seziures
Carbamazepine or lamotrigine
152
S/E lamotrigine
SJS/rash
153
S/E carbamazepine
``` Rash Dysarthria Ataxia SIADH Nystagmus Hyponatraemia ```
154
S/E phenytoin
Gym hyperplasia Ataxia Peripheral neuropathy Hepatotoxicity
155
S.E valproate
Tremor Teratogenicity Weight gain
156
Tx Alzheimers
``` Mild/moderate - Ach inhibitors - donepezil - Rivastigmine - galantamine Mod - severe NMDA antagonist - memantine ```
157
Tx CD (inducing remission)
Mild flare 30 mg prednisolone oral | severe flare 100mg hydrocortisone QDS and can use rectal if rectal involvement
158
Maintaining remission of CD
Azathioprine or 6-metcaptopurine
159
Tx RA (maintaining remission)
1. Methotrexate and DMARD (e.g. sulphazalaine or hydroxychloroquine) 2. Biologic Tx
160
Tx flare RA
Short term steriods | NSAIDs
161
What has to be checked before starting azathioprine?
TMPT level
162
Tx pyrexia
Paracetomal
163
If there is evidence of obstruction, what should not be given?
Metoclopramide | Laxatives
164
Tx chronic diarrhoea
Loperamide 2mg oral up to 3 hourly | Codeine 30mg oral 6 hourly
165
Tx insomnia
Zopiclone 7.5 mg (3.75 mg elderly)
166
What is the stool softener laxative and what is it good for?
Docusate | Good for faecal impaction
167
What is the stimulant laxative and what may it worsen?
Senna | Cramps
168
What are the osmotic laxatives and what may they exacerbate?
Phosphate enema Lactulose May exacerbate bloating
169
What contraindicated in the acute abdomen?
Laxatives
170
What infections is metronidazole good for and why?
GI infections | Because of its good effects on anaerobes which colonise the gut
171
1st line antibiotic for skin infections
Flucloxacillin
172
S/Es antimuscarinic drugs
Dry mouth Constipation Visual disturbance
173
Tx vit B12 deficiency
Hydroxocobalamin
174
Examples of drugs that can precipitate parkinsonian symptoms even in patients without PD
Metoclopramide | Haloperidol
175
What is the anti emetic of choice in PD and why?
Domperidone | Does not cross the BBB
176
What does the treatment dose of dalteparin depend on?
Weight
177
Is ramipiril teratogenic and when?
Yes, 1st trimester
178
S/Es tamoxifen
Increased risk of endometrial cancer Increased efficacy of warfarin leading to increased INR Increased risk of DVT
179
S/E metformin
Lactic acidosis
180
S/E sulphonyureas
Hypos
181
How often is methotrexate taken?
Weekly
182
What can ACEIs do in the elderly?
Increases risk of AKI if unwell
183
How long can SSRIs take to work?
Up to 6 weeks
184
What is serotonin syndrome and what is the Px?
Life threatning complication of SSRIs | Agitation, fever, hallucinations
185
HbA1c aim in diabetic pts
48
186
How many months is HbA1c over?
3 months
187
When unwell, how do you adjust the dose of insulin?
When unwell your blood glucose increases and therefore your dose of insulin required also increases. However, if oral intake decreases if you are unwell, insulin may also need to be decreased
188
How should biphosphonates be taken?
With a full glass of water | Remain upright for 30 mins after
189
How often are bisphosphonates taken?
Weekly
190
Food and alendronic acid
Food should be avoided 2 hours after alendronic acid as it decreases absorption
191
1% = ?
1 g in 100ml
192
1 g = ? mg
1000 mg (3 DPs)
193
1 g = ? mcg
1000,000 (6DPs)
194
Gent and low egfr
Egfr < 20 - high doses of gentamicin are not recommended
195
On a gentamicin chart if the point falls on the boundary line between the two intervals, what dosing interval should be chosen?
Longer dosing interval
196
If a patient in the scenario has pain, make sure they have what prescribed?
Regular painkillers as well as PRN
197
When should ACEIs be given and why?
At night | Cause postural hypotension
198
Tx Hyperkalaemia
1. Short acting insulin (e.g. 10 units actarapid) in 100ml of 20% dextrose over 30 min IV 2. Salbutamol 2.5 - 5mg stat 3. Calcium resonium (takes few days to work) 4. Dialysis Calcium gluconate stabilizes cardiac membrane
199
What is the safest anti-epileptic in pregnancy?
Lamotrigine
200
What hyperglycemic medication should not be used when renal impairemnt?
Metformin
201
Monitoring requirements statin
Creatinine kinase level at baseline | LFTs (3 + 12 months)
202
What scenarios are statins contraindicated in?
Active liver disease | Serum transaminases > 3x normal
203
Monitoring requirements phenytoin
Trough level taken on day 14 If no seizures (i.e. a therapeutic level of the dose) - then the dose dosent need increased If S/Es despite a normal trough level then decrease the dose if seizure control adequate
204
Serum concs of lithium > ? are likely to manifest with toxic effects
1.5 mmol / L
205
Sampling time for lithium
12 hours after last dose
206
Are FBCs routinely done for patients on lithium?
No
207
Lithium monitoring requirmenets
Weekly Then after each dose change Every 3 months thereafter
208
Lithium and diet
Patients advised to avoid making changes to their diet as increased Na in their diet can increase the risk of lithium toxicity
209
Methotrexate and LFTs
Should not be started if LFTs are abnormal as there is a risk of cirrhosis
210
Monitoring methotrexate
FBC one stable every 2 - 3 months Renal function LFTs
211
How is methotrexate predominately excreted?
Renally
212
Monitoring requirements olanzapine
Fasting BMs at baseline and regular intervals -> hyperglycaemia and DM can occur
213
Pts starting on an antipsychotic - who needs an ECG?
Patients with CVS disease or assosiated RFs
214
Monitoring requirements OCP
BP
215
What is needed when starting amoidarone and why?
CXR | Risk of pulmonary toxicity
216
Monitoring requirements amoidarone
Baseline CXR T4 T3 + TSH Serum transaminase K+ (hypokalaemia caution)
217
What should patients be advised of when starting carbimazole and why?
Sore throat Carbimazole induced bone marrow suppression and agranulocytosis FBC and neutrophil count required
218
What should be checked for a multiple daily dose regimen of gentamicin?
Both pre and post dose levels at regular intervals
219
Monitoring requirements ACEIs
U + Es at baseline and after every dose change
220
When do you measure plasma digoxin concentration?
Not unless toxicity, non compliance or inadequate effect
221
How is digoxin predominatelty excreted?
Renally excreted and pts at risk of renal dysfunction have increased risk of toxicity
222
Monitoring of valproate
LFTs at baseline and regular intervals
223
Does valproate cause renal toxicity?
NO
224
Monitoring clozapine
FBC checked for first 18 weeks then more spaced out intervals
225
Monitoring warfarin
INR daily / alternative days at start then longer intervals then every 12 weeks
226
What should be fixed before starting a bisphosphonate and what should be monitored during?
Ca + vit D
227
When starting warfarin, what can be prescribed alongside to stablilise the dose and why?
Heparin | As it has a pro coagulant effect initially
228
S/E aspirin
PUD Gastritis Tinintus Haemorrhage
229
S/E digoxin
``` Nausea and vomiting Diarrhoea Blurred vision Confusion Drowsiness Xanthopsia ```
230
S/E Amoidarone
Pulmonary fibrosis Thyroid disease Skin greying Corneal deposit
231
S/E lithium
``` Tremor Tiredness Arrythmias Seizures Coma Renal failure Diabetes insipidus ```
232
S/E haloperidol
Dyskinesias
233
S/E fludrocortisone
HTN / Na + H20 retention
234
S/E statins
Myalgia Abdominal pain LFTs abnormal Rhabdomyolysis
235
Drugs with a narrow therapeutic index
Warfarin Digoxin Phenytoin
236
Drugs which require careful dosage control
Anti HTNs | Anti diabetic drugs
237
Acute alcohol effect on warfarin
Increases its effects
238
Chronic alcohol effect on warfarin
Decreases its effects
239
What should NSAIDs not be co prescribed with, especially in the elderly who already have a history of renal impairment?
ACEIs
240
What is the brand name for co amoxiclav?
Augmentin
241
What reverses the effects of heparin?
Protamine
242
Tx hypoglycaemia
If conscious - sugar rich snack If unconscious/cant swallow - IV 20% glucose (or 10%) over 15 - 20 mins Glucagon
243
S/Es opiods
Constipation Resp depression Drowsiness
244
What is lithium excretion significantly decreased by?
ACEIs Diuretics NSAIDs
245
What titration increments should thyroxine be done in?
25 - 50 mcg doses
246
What may happen to patients when recovering from renal failure?
May enter a 'polyuric phase' in which their urine output increases and fluid input may not be in keeping of this pace
247
What should never happen to anti epileptic drugs?
Should never be stopped abruptly unless patient is toxic and in the hospital where emergency treatment of seizures can be instigated
248
How much maintenance fluids does an adult generally require per day?
3 litres (8 hourly)
249
How much maintenance fluids does an elderly person generally require per day?
2 litres (12 hourly)
250
How much K does a patient require in a day if NBM?
40 - 60 mmol
251
What odd S/E can BB have?
Fatigue | Erectile dysfunction
252
Tx of acute manifestation of COPD
Salbutamol | Ipratropium bromide
253
What types of NIV exist?
BPAP | CPAP
254
What resp failure requires CPAP?
Type 1
255
What resp failure requires BPAP?
Type 2
256
In a diabetic patient, what can excessive alcohol lead to?
Life threatning hypoglycaemia
257
What are patients on steriods at risk of?
HTN
258
Statins should be stopped when taking what drug?
Clarithromycin
259
Tx immediate relief of dyspepsia
Magnesium carbonate Aluminium hydroxide Co-magaldrox
260
When should senna not be given?
If colitis or cramps
261
What is the beneficial monitoring of aminothyline done by?
O2 sats
262
How long can consolidation on a CXR due to pneumonia take to clear?
Up to 6 weeks
263
Monitoring tacrolimus
Trough level before the dose
264
What is an increased resp drive triggered by?
Hypoxia | Hypercapnia
265
How to assess response to DKA Tx?
Serum ketones | Serum glucose normalizes rapidly after commencing insulin sliding scale
266
What can the only presentation of renal impairment be?
Malaise
267
What does co-dydramol contain?
Dihydrocoedine
268
When can vit K be given by mouth?
If no active bleeding
269
When should diuretics not be given and why?
Shouldnt be given at night as will be up all night peeing
270
How often are metoclopramide and cyclzine given?
6 hourly
271
When should a patient have a blood transfusion?
< 70 g/L | < 100 in ischaemic heart disease
272
How long should oral iron replacement be given for?
Until Hb is in normal range and then for a further 3 months to replenish stores
273
Can dextrose be used for fluid resus?
No
274
Can you give 1L stat in resuscitation?
Yes
275
What is flecanide contraindicated in?
Structural heart disease
276
What is a serious complication of statins?
Myositis (presents as cramps)
277
What heart condition should ACEI be avoided in?
Aortic stenosis
278
First line treatment for acute otitis media
Amoxicillin
279
What drugs should be avoided in myasthenia gravis?
Antimuscarinics/anticholinergics
280
Treatment of epiglottitis
Cefotaxime
281
What is the mainstay of treatment of severe anxiety?
Benzodiazepines e.g. diazepam
282
If start on floxetine, what is a rare S/E to look for?
Rash
283
When should an efficacy assessement be done for depression treatment?
4 weeks after starting treatment
284
When is enoxaparin dose altered?
``` Low egfrs (< 30) Adults < 50kg ```
285
What drugs should be prescribed at a lower dose if an adult is < 50 kg?
Paracetomal | Enoxaparin
286
What is a common S/E of all heparins?
Hyperkalaemia
287
How long before surgery are antiplatelets stopped?
7 days
288
Are ARBs nephrotoxic?
Yes
289
What can allopurinol accumulate in?
Renal dysfunction
290
What can steriods cause particularly in the elderly?
Confusion
291
How do citalopram and other SSRIs cause hyponatraemia?
Through innapropriate ADH secretion
292
What is important general pain relief advice?
Same drug is used for regular and breakthrough pain relief
293
When should nitrofurantoin be avoided?
Pregnancy | eGFR < 45
294
What INR is needed for surgery?
1.5 or under
295
What should be done if the INR > 1.5 the day before surgery?
Vitamin K 1-5mg IV
296
What should rivaroxaban be taken with?
Food
297
1 nanogram = ? mcg
Move 3 DPs to get to mcg
298
What drug can cause cholestatic jaundice?
Co amoxiclav
299
Citalopram and gabigatran together cause what?
Increased risk of bleeding
300
When ACEIs are started, what should be expected?
A small rise in creatinine (<20%)
301
How is the treatment efficacy of furosemide mointored?
Weight reduction
302
How is the treatment efficacy of treatment of congestive heart failure moinotred?
Exercise tolerance
303
How much insulin should be added to manage a tranisent rise in BM caused by steriods?
Increase in usual insulin dose by 10%
304
Statins ideal effects after 3 months
> 40% reduction in non-HDL cholesterol
305
Treatment of acute dystonic reactions
Anti muscarinics 1st line | Benzodiazepines
306
Anti muscarinic drugs
TCAs BBs Ipratropium bromide SSRIs
307
What condition are BB contraindicated in?
Asthma | Peripheral vascular disease
308
What drugs can worsen acute heart failure?
Corticosteriods | CCBs
309
Steriods and intercurrent illness
Steriods must be continued through intercurrent illness as they may have chronic adrenal suppression and therefore steriods should not be stopped abruptly
310
What may an increased dose of insulin in the evening lead to?
More hypos in the early morning
311
What happens when miss one COCP?
The patient can still be protected from pregnancy. They should take the missed pill and todays pill even if taking 2 pills in one day. Does not need extra contraception.
312
Methotrexate and conception
Both men and women should avoid conception while taking it and for 6 months after stopping it
313
Beneficial monitoring of antibiotic treatment
If symptoms resolve
314
Statins and muscular Cx
If muscular symptoms or CK elevated over 5x normal, then treatment should be discontinued If symptoms resolve and CK returns to normal, then the statin should be reintroduced at a lower dose.
315
1st line Tx for HTN patients who have DM
Regardless of age / race - 1st line Tx is ACEI/ARB
316
When should simvastatin be used cautionally in renal impairment?
Used in caution if > 10 mg /day with an eGFR low
317
What should sertraline be used with caution in?
Renal impairment
318
What can diclofenac worsen and how?
Heart failure It causes renal hypoperfusion which has deleterious effects on the heart function due to the release of vasoconstrictive mediators
319
1st line Tx HTN in pregnancy
Labetolol
320
Which anti emetic is of choice in a patient who is at risk of extrapyramidal S/Es and QT prolongation?
Cyclizine
321
What is recommended for initial fluid resuscitation?
Fluid bolus 500ml NaCl 0.9% or plasmalyte over 15 mins is recommended
322
S/Es ciclosporin
Hyperkalaemia | Nephrotoxicity
323
When looking for dosing errors, what is important to look at?
Check if the patient is elderly
324
What can all PPIs cause?
Loose stools and diarrhoea
325
What can alendronic acid cause?
Diarrhoea
326
What can naproxen cause?
Ankle oedema
327
Tx of thrush during pregnancy
Prolonged therapy required | Systemic therapy not recommended
328
Tx C diff
Metronidazole | Vancomycin - repeated infections / metronidazole no effect
329
Insulin changes in DKA
1. Fluid resus 2. Short acting insulin S/C should be STOPPED 3. Long acting insulin should be CONTINUED 4. Fixed rate IV insulin
330
What is the simplest Tx of acute pain in an elderly person?
Paracetomal
331
When should loperamide be taken?
After each loose stool
332
Dose of loperamide
2mg / dose
333
SSRIs + what can precipitate serotonin syndrome?
Serotonin inducing drugs (e.g. tramadol)
334
Tx of antipsychotic induced parkinsonism (particularly tremor)
Procyclidine hydrochloride (anti-cholinergic drugs)
335
What should be checked before starting azathioprine?
TPMT levels
336
What should patients starting treatment with apixaban be told to look out for?
Any bruising or signs of bleeding
337
Are fentanyl patches appropriate for acute pain?
No
338
What is the painkiller which is appropriate where strong analgesia is needed in the context of renal impairment? Why?
Oxycodone - it is metabolized by the liver
339
What can morphine cause?
Urinary retention
340
Max dose of loperamide in a day
16 mg
341
What can cyclizine exacerbate?
Heart failure
342
What is topiramate contraindicated with?
COCP
343
Tx alcohol withdrawal
Chlordiazepoxide hydrochloride
344
Why is BB contrainidcated in PVD?
It worsens ischemia
345
S/E of TTD
Hyponatraemia
346
What can prednisolone worsen?
Heart failure
347
S/E tacrolimus
Hyperkalaemia
348
What is the dosing of allopurinol?
300 mg PO OD | Reduced to 100 mg whilst renal function is poor
349
What can SSRIs cause an increase in?
Bleeding
350
Blood glucose and nicotine replacement therapy
Monitoring of BMs should be carried out when commencing nicotine replacement therapy. Especially if have diabetes as they may require less insulin or need to reduce the amount of nicotine replacement
351
What is the first choice treatment in a pt with confirmed DVT or PE?
Apixaban or rivoroxaban | LWMH if unsuitable
352
When should you not used maintenance fluids containing glucose?
After cerebral injury (excessive glucose containing fluids have the potential to exacerbate cerebral injury)
353
Who should statins be offered to?
Pts with CV risk > 10%
354
What is the starting dose of statins for primary prevention?
20mg
355
Who is metformin contraindicated in?
Pts with significant renal impairment Who are acutely unwell Tissue hypoxia likely
356
What is aspirin a cause of?
Iron deficiency anaemia
357
What does pioglitazone have the potential to cause?
Hypoglycaemia
358
Drugs that may cause urinary retention
``` Morphine and other opiod analgesics (esp in elderly post op period) Anticholinergics Anaesthetics A-adrenoceptor agonists Benzodiazepines NSAIDs CCBs Antihistamines Alcohol ```
359
Drugs that can cause confusion
``` Anticholinergics Opiods Benzodiazepines Metoclopramide Antipsychotics Antidepressants Anticonvulsants ``` Uncommon - digoxin - BB - prednisolone - NSAIDs - Antibiotics
360
What is indicated in a patient with a long history of alcohol abuse and disorientation who may have or are at risk of wernickes encephalopathy?
IV vit B (pabrinex)
361
What is the insulin rate in DKA Tx?
Fixed rate insulin 0.1 units / kg / hr
362
What is recommended for the prevention of neural tube defects? When is it taken until?
Folic acid - 5mg in high risk parents - 400 mcg in lower risk parents From conception until 12 weeks pregnancy
363
What does alendronic acid reduce?
Fractures
364
What is used for HRT in a women with an intact uterus?
Oestrogen is combined with progesterone which decreases the risk of endometrial carcinoma assosiated with unopposed oestrogen
365
Presentation of anaphylaxis
``` Vasodilation Hypotension Tachycardia Bronchospasm Interstitial pneumonitis urticaria Angioedema Bronchospasm Tissue oedema ```
366
Drugs that may cause anaphylaxis
``` NSAIDs / aspirin B lactam antibiotics Chemo Vaccines Parenteral iron injections Herbal preparations ```
367
How is allopurinol's therapeutic effect monitored?
Serum urate
368
What is used to assess the beneficial effect of IV fluids when dehydrated?
BP
369
How is HRT monitored and when must it be stopped in relation to this?
BP | Stop if systolic > 160 or diastolic > 95
370
If you are on a statin and transaminases are > 3x upper limit of normal, what do you do?
Discontinue

PSA Notes (1 decks)

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