Pass The PSA Flashcards
(39 cards)
Drugs to Stop Before Surgery
I LACK OP
Insulin - variable
Lithium - 1d
Anticoagulants/ antiplatelets - variable
COCP/ HRT - 4wks
K-sparing diuretics - day of
Oral hypoglycaemics - variable
-Prils (ACEi) - day of
PReSCRIBER
Patient details
Reaction (+ allergen)
Sign
Contra
Route
?
IV fluids
Blood clot proph
antiEmetic
pain Relief
STEROIDS Side Effects
Stomach ulcers
Thin skin
Edema
Right and left HF
Osteoporosis
Infection incl. candida
Diabetes/ hyperglycaemia
Cushing’s
NSAIDs Considerations
No urine
Systolic dysfunction
Asthma
Indigestion
Dysfunctional clotting
Pain Relief
Regular
paracetamol 1g 6hrly
co-codamol 30/500 2 tablets 6hrly
PRN
paracetamol 1g up to 6hrly
codeine 30mg up to 6hrly
morphine sulphate (10mg/5ml) 10mg up to 6hrly
Replacement Fluid
0.9% normal saline
UNLESS
- ^Na or v glucose (use 5% dextrose)
- ascites (HAS)
- bleeding and shocked (ideally transfuse)
Replacement: Speed
500ml bolus (250ml if HF) and then reassess
IV Potassium Speed
No more than 10mmol/hr
Maintenance Fluids
Most require 3L per 24hrs (2L elderly)
1 salty 2 sweets for electrolytes
add 2x 20mmol KCL to these
Metoclopramide: Caution
Parkinson’s
Young women (risk of dyskinesia e.g., acute dystonia)
Confusion in Elderly
Antimuscarinic e.g., oxybutynin
- confusion, pupil dilation, v accom, dry mouth, tachy
Tramadol
Opioid
Cyclizine
Benzos
Amitriptyline
Steroids
Methotrexate
STOP in active infection
Contra - trimethoprim (folate ant, bone marrow suppression)
FBC, U&E, LFTs 1-2wkly until stable (then 2-3mthly)
Hypernatraemia Causes
Dehydration
Dips
Drugs
Diabetes insipidus
WCC
^Neut
= bacteria, inflam, steroids
v Neut
= virus, chemo/ radio, clozapine, carbimazole
PLT
High
= bleeding, infection, inflam, cancer, post-splenectomy, myeloproliferative disorders
Low
= virus, penicillamine, heparin, hypersplenism, DIC, ITP, HUS
Hypokalaemia DIRE
Diuretics (loop, thiazide)
Intake/ intestinal loss
RTA
Endocrine (Cushing’s, Conns)
Hyperkalaemia DREAD
Drugs (K-sparing diuretic, ACEi)
Renal failure
Endocrine (Addison’s)
Artefact
DKA
SIADH Causes
Small cell lung cancer
Infection
Abscess
Drugs (carbamazepine, antipsych)
Head injury
Thyroxine Dose Change
TSH
<0.5 = decrease dose
0.5-5 = no change
>5 = increase dose
Phenytoin Toxicity
Zero order kinetics
Small dose increase = large clinical effect
SE: gum hypertrophy, ataxia, nystagmus, peripheral neuropathy, teratogen
Total plasma-phenytoin concentration for optimum response is 10–20 mg/litre (or 40–80 micromol/ litre).
Lithium Toxicity
SE: tremor, fatigue, arrhythmia, seizure, coma, renal failure, diabetes insipidus
Gentamicin
Measure 6-14hr after last infusion was started
For multiple daily dose regimen in endocarditis
- one-hour (‘peak’) serum conc should be 3–5 mg/L
- pre-dose (‘trough’) conc should be <1 mg/L
Serum-gentamicin concentration should be measured after 3 or 4 doses, then at least every 3 days and after a dose change (more frequently in renal impairment)
Salbutamol
Stop inhaler if having nebs
AF Rate Control
- b-clocker (not if asthma)
- CCB (not if oedema esp. dilt)
? 3. digoxin
