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Pass the PSA Flashcards

1
Q

Effect of erythromycin on warfarin

A

can increase warfarin effect

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2
Q

Steroid Side effects

A
  1. stomach ulcers
  2. thin skin
  3. oedema
  4. right and left heart failure
  5. osteoporosis
  6. infection
  7. diabetes
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3
Q

common side effect of ACEi

A

dry cough

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4
Q

common side effects of beta blockers

A
  • can increase wheeze in asthmatics

also beware of NSAID use in asthmatics

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5
Q

common side effects of calcium channel blockers

A
  • peripheral oedema
  • flushing
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6
Q

common side effects of potassium sparing diuretics

A

gynaecomastia

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7
Q

Avoid metoclopramide in which patietns

A
  1. Parkinsons –> risk of exacerbating symptoms
  2. Young women –> risk of dyskinesia
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8
Q

Anti-emetic choices

A

Nauseated patients
1. cyclizine 50mg 8 hourly (causes fluid retention)
2. metoclopramide 10mg 8 hourly (if heart failure)
3. ondansetron 4mg or 8mg 8-hourly

Non-nauseated (as-required)
1. cyclizine 50mg 8 houlry
2. metoclopramide 10mg 8 hourly

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9
Q

Analgesic choices:
no pain
mild pain
severe pain

A

No pain
1. No regular
2. As required : 1g paracetamol 6hourly (max dose 4g)

Mild pain
1. Paracetamol 1g 6 hourly oral
2. As required: up to 30mg codeine 6 hourly (or tramadol)

Severe pain
1. co-codamol 30/500, 2 tablets 6 hourly oral
2. as required: morphine sulphate 10mg/5ml (10mg up to 6 hourly)

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10
Q

Analgesic choice: neuropathic pain

A

1st line: amitriptylline (10mg oral nightly)

or

Pregabalin 5mg oral 12 hourly

If painful diabetic neuropathy
–> duloxetine 60mg oral daily

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11
Q

side effects of antimuscarinic drugs

A

e.g. oxybutynin

  1. pupilary dilatation
  2. dry mouth
  3. loss of accomodation reflex
  4. tachycardia (after transient bradycardia)
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12
Q

common drugs that may worsen confusion in the elderly

A
  1. tramadol (avoid)
  2. cyclizine (can cause drowsiness)
  3. benzodiazepines
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13
Q

which antiocoagulant should not be given post stroke

A

enoxaparin due to risk of haemorrhagic transformation

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14
Q

causes of neutrophilia

A

high neutrophils

  • bacterial infection
  • tissue damage (inflammation / infarct etc)
  • steroids
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15
Q

causes of neutropenia

A

viral infection

chemotherapy

clozapine (anti-psychotics)

carbimazole (anti-thyroid)

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16
Q

how to interpret and change levothyroxine dose following tft (TSH) results

A

< 0.5 then reduce dose

0.5-5 nil action , same dose

> 5 then increase dose

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17
Q

Confusion, nausea, visual halos and arrhytmias is associated with what toxicity

A

digoxin

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18
Q

Features of lithium toxicity

A

early: tremor
Intermediate: tiredness
late: arrhytmias, seizures, coma, renal failure and diabetes insipidus

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19
Q

Features of phenytoin toxicity

A
  • gum hypertrophy
  • ataxia
  • nystagmus
  • peripheral neuropathy
  • teratogenecitiy
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20
Q

Ototoxicty and nephrotixicity is associated with which two drugs

A
  • gentamicin
  • vancomycin
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21
Q

gentamicin monitoring for divided faily dosing regimes

A

1 hour post dose (PEAK)

Normal range in infective endocarditis (3-5)

Normal range in everything else (5-10)

If out of range adjust dose

Trough: before next dose

Normal range in infective endocarditis (<1)

Normal range in everything else (<2)

Action if out of range: adjust dose interval

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22
Q

Warfarin management: major bleed

A
  1. stop warfarin
  2. give 5-10mg IV vitamin K
  3. give prothrombin complex

INR 5-8
No bleeding: omit warfarin for 2 days then reduce dose
Minor bleeding: omit warfarin and give 1-5mg IV vitamin K

INR >8
No bleeding: omit warfarin and give 1-5mg PO vitamin K
Minor bleeding: omit warfarin and give 1-5mg IV vitamin K

23
Q

treatment of neutropenic sepsis

A

Piperacillin with tazobactam IV, gentamicin IV and paracetamol (if pyrexic) .

24
Q

some drug causes of hyponatraemia

A

furosemide

carbamazepine

25
which is the only calcium channel blocker used for treatment of AF
- DILTIAZEM avoid if presence of peripheral oedema as CCB can worsen fluid retention
26
AF treatment
Any adverse features: chest pain, heart failure, crepitations, oedema / raised JVP, or syncope If adverse features: DC CARDIOVERT (not if symptoms more than 48 hours, then need to anticoagulation for 4 weeks first) BB contraindicated in asthmatics Digoxin
27
Narrow complex regular tachycardia management
1. vagal manouvers 2. adenosine 6mg rapid IV bolus 3. if unsuccessful give 12mg 4. then further 12 mg
28
irregular narrow complex tachycardia management
1. BB or diltiazem If heart failure - digoxin or amiodarone
29
Ventricular tachycardia mx
amiodarone 300mg IV over 20-60 mins then 900mg over 24hrs
30
Anaphylaxis mx
ABCDE Adrenaline 500 micrograms of 1:1000 IM Chlorphenamine 10mg IV Hydrocortisone 200mg IV
31
bacterial meningitis in the community treatment
1.2g benzylpenicillin
32
what is given in benzodiazepine overdose
flumazenil
33
ramipril and pregnancy
ACEi teratogenic in pregnancy should be avoided
34
lamotrigine side effects
rash rarely: steven johnson syndrome
35
carbamazepine side effects
rash dysarthria ataxia nystagmus reduced sodium
36
phenytoin side effects
ataxia peripheral neuropathy gum hyperplasia hepatotoxicity
37
sodium valproate side effects
tremor teratogenicity weight gain
38
levetiracetam side effects
- fatigue - mood disorders - agitation
39
treatment option for PE
confirmed PE LMWH : dalteparin or LMWH followed by oral anticoagulant (dabigatran or edoxaban)
40
chronic heart failure management
1. BB (bisoprolol) or ACEi (ramipril) ARBs --> candesartan if ACEi not tolerated If not tolerated then add spironolactone Note - when initiating ACEi, ARB: monitor sodium, potassium, BP and renal function 1-2 weeks following treatment. Avoid CCB in CHF w/ reduced ejection fraction as can reduce cardiac contractility.
41
ACEi best prescribed at what time of day
- in the evening due to postural hypotension
42
recap hypertension guidelines
43
asthma acute treatment summary
1. salbutamol nebs 2. If severe or life threatening then add ipratropium bromide 3. magnesium sulphate prednisolone should be prescribed but won't help acute breathlessness
44
Atrial fibrillation management
if within 48hours: DC cardioversion more than 48hours: - rate control: BB or CCB Add digoxin if not controlled w/ monotherapy
45
hyperkalaemia management
To stabilise membrane : calcium gluconate reduce potassium 1. 10 units of actrapid in 100mls of 20% dextrose over 30 mins IV 2. salbutamol 3. calcium resonium
46
diabetes management
1. lifestyle first 2. metformin (if overweight) 3. sulphonylurea (if normal or underweight ) --> gliclazide
47
when prescribing a statin what MIGHT NEED TO be checked
baseline ck if increased risk of myopathy if not then serum ALT will suffice as statins are metabolised in the liver --> 3 and 12 months post starting treatment
48
what serum concentration of lithium is likely to manifest with toxic effects
serum concentration above 1.5 therapeutic reference range 0.4-0.8
49
when taking olanzapine what measurement must be taken:
fasting blood glucose hyperglycaemia and diabetes can occur in patients prescribed antipsychotic drugs
50
monitoring for a patient on amiodarone
Liver function tests required before treatment and then every 6 months. Serum potassium concentration should be measured before treatment. Chest x-ray required before treatment.
51
Recap STEMI management
52
Recap NSTEMI management
53
Write a prescription for one drug that is most appropriate as maintenance treatment for coronary artery spasm
Prinzmetal or variant angina associated with coronary artery vasospasm. Tx: isosorbide mononitrate or calcium channel blocker Do not use BB!! may aggravate coronary artery spasm. e.g. felodipine 5mg m/r PO daily
54

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