Pass the PSA Flashcards by Kelvin Sunn Yap

TSH 0.3, what should you do to levothyroxine dose?

Decrease it

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TSH 5.2, what should you do to levothyroxine dose?

Increase it

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Cause of secondary hypothyroidism

Pituitary damage
Reduced TSH causing reduced TH

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Secondary cause of hyperthyroidism

Pituitary tumour

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1st line treatment of diabetic neuropathy

Duloxetine (SNRI)

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Treatment of opioid overdose (low RR, drowsy)

Naloxone

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Which pain killer can lower seizure threshold?

Tramadol

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Which pain killer is good in renal failure because it isn’t really excreted?

Tramadol

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Which drug do you give for first-line T2DM in BMI 18, creatinine 172?

Sulphonyurea e.g. gliclazide

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First-line treatment of focal epilepsy

Lamotrigine

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1st prescription for hyperkalaemia

10U actrapid with 100ml of 20% dextrose over 30 minutes

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What interacts with warfarin to increase INR?

Erythromycin

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Drugs to stop before surgery

I LACK OP
Insulin
Lithium
Aspirin
COCP
K+ sparing diuretics
Oral hypoglycaemics
Perinopril (ACEi)

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When should you ideally stop COCP before surgery?

4-6weeks!

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What should you stop in haemoptysis and any bleeding?

Anticoagulants e.g. aspirin and enoxaparin

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CYP450 inducers

PC BRAS
Phenytoin
Carbamazepine
Barbiturates
Rifampicin
Alcohol (chronic excess)
Sulphonyureas

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CYP450 inhibitors

AODEVICE
Allopurinol
Omeprazole
Dislfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol (acute)

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When should you stop ACEi and K+ sparing diuretics before surgery?

The day of

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Causes of hyperkalaemia

DREAD
Diuretics (K+ sparing) and ACEi and dalteparin (LMWH)
Renal failure
Endocrine (Addison’s)
Artefact
DKA!

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Steroid side effects

Stomach ulcers
Thin skin
Edema
Right heart failure
Osteoporosis
Infection
Diabetes!!!!!
Cushing’s syndrome

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NSAID contraindications

Clotting issues
Heart failure
Asthma
Indigestion
Renal failure

CHAIR

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NSAID contraindications

Clotting issues
Indigestion
Renal failure
Asthma!
Heart failure

CHAIR

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How much paracetamol in 30/500 tablet of co-codamol?

500mg

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Typical maintenance fluid prescription in healthy individual

2 salty 1 sweet
1L bag of dextrose (8hr)
2L saline (8hr each)

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Typical prophylactic LMWH for prophylaxis of blood clots in hospital

S/C 5000U dalteparin

Drug for nausea in heart failure

Metoclopramide

Drug for nausea in a normal patient

Cyclizine

Who shouldn't get metoclopramide?

Parkinson's patients

Drug causes of hypokalaemia

Loop diuretics Thiazide diuretics

Side effects of ACEi

Cough Worsen renal failure Can trigger renal failure in renal artery stenosis Hyperkalaemia

Rheumatoid pt on methotrexate, got a UTI and given trimethoprim, what should you do?

Stop the methotrexate (current infection) Change trimethoprim because too much folate antagonism

Furosemide can lead to which electrolyte abnormalities?

Hyponatraemia Hypokalaemia

Drugs to stop in hyperkalaemia

ACEi Thiazide diuretics e.g. eplerone

Drug causes of neutropaenia

Clozapine Carbimazole

Causes of microcytic anaemia

Iron deficiency Thalassaemia Sideroblastic

Causes of normocytic anaemia

Anaemia of chronic disease Blood loss

Causes of macrocytic anaemia

Folate deficiency Alcohol B12 deficiency

Drug cause of HIGH neutrophils

STEROIDS

Causes of thrombocytopaenia

Heparin induced! Always do baseline and post treatment FBC DIC HUS Hypersplenism

Causes of SIADH

Any serious illness Head injury Lung cancer Anti-psychotics Carbamazepine (used in schizophrenia)

Causes of raised urea

Renal failure Gastric bleed Chemotherapy

Causes of hyponatraemia, hypovolaemia

Dehydration Addisons Diuretics

Causes of hyponatraemia euvolaemia

SIADH Psychogenic polydipsia

Causes of hyponatraemia hypervolaemia

Renal failure Heart failure

Causes of intrinsic renal failure

Pre-renal Nephrotoxic drugs Rhabdomyolysis Contrast

Causes of raised ALP

Fracture Paget's disease Post-hepatic jaundice

How do you calculate rate on ECG?

Divide 300 by squares between QRS complexes

Cause of sloping ST depression

Digoxin toxicity

Normal to find T wave inverstion in which leads?

V1 and aVR

T wave inversion can imply

Old infarct NSTEMI

INR target in recurrent thromboembolism

3-4

What to do if major bleed on warfarin

Stop warfarin 10mg Vit K IV Prothrombin complex

Drug to reduce bleeding in surgery

Tranexamic acid!

How does N-acetylcysteine work?

It replenishes glutathione stores to remove toxic metabolites

Why should you stop ibuprofen in renal failure?

Reduces prostaglandin synthesis so reduces GFR Can contribute to renal failure

Drug causes of agranulocytosis

Carbamazepine Clozapine Lithium

What's in seratide?

LABA and ICS

Cut off for doing something about rate in AF

100bpm

Treatment of anaphylaxis

ABCDE IM adrenaline IV hydrocortisone IV chlorphenamine

Treatment of asthma attack

5mg nebulised salbutamol Nebulised ipratropium bromide

Management of stable angina

GTN spray Aspirin, statin B blocker/CCB ?Long-acting nitrate RF modification

Management of focal seizures

Lamotrigine

Management of seizures other than focal

Sodium valproate

Management of T2DM

1. Education and dietary/exercise advice 2. Cardiovascular RF Mx = consider 75mg aspirin & 20mg simvastatin 3. Annual review of complications = ophthalmology and albumin:creatinine ratio (indicator of diabetic nephropathy) 4. Blood glucose lowering therapy if HbA1c > 48mmol after these measures

Whats an early indication of diabetic neuropathy?

Albumin:creatinine ratio

Mx of mild, early parkinsons

Ropinerole

Mx of flare of rheumatoid?

Short course of glucocorticoid

How often can you use a salbutamol inhaler each week?

What should you do if asthma pt using salbutamol inhaler 6x per week

Counsel about usage and add an ICS

Signs of congestive heart failure

RHF and LHF RHF = raised JVP and peripheral oedema LHF = pulmonary oedema

What is the treatment dose enoxaparin?

15000U

What does tamoxifen increase your risk of?

PE and DVT Endometrial cancer

HTN Mx drug in pregnancy

Labetalol

Side effect of gliclazide

Hypoglycaemia

Whats the risk of ramipril when you are unwell?

Increased risk of AKI Take precautions when vomiting/ill

Unwell on insulin? What should you do with the dose?

Increase it

What should you do with the rotation site with SC insulin?

Rotate it to avoid lipodystrophy

Recommendations for alendronic acid

Oesophagitis and indigestion So, take it standing upright for 30 mins Avoid food for 2 hours after

1g = how many mg?

1000

What ix should you do before commencing amiodarone?

Chest x-ray because pulmonary fibrosis

Lithium therapeutic range

0.4-0.8

What should you check before commencing statins?

ALT (liver function)

What should you check before commencing vancomycin?

Creatinine (renal function)

What should you check before starting anti-psychotics e.g. olanzapine?

Glucose levels (risk of diabetes)

What should you measure with carbimazole and general illness?

FBC (white cell count)

Treatment of infective endocarditis with streptococcus viridans

Penicillin and gentamicin

Treatment of infective endocarditis with s.aureus

Could be fluclox, most likely vancomycin

What should you check weekly for 18w for in clozapine treatment?

FBC Risk of agranulocytosis

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