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Pass the PSA Flashcards

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1
Q

What are the commonest enzyme inducers?

A

PC BRAS

Phenytoin
Carbamazepine
Barbituates
Rifampicin
Alcohol (chronic excess)
Sulphonylureas
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2
Q

What are the most common enzyme inhibitors?

A

AO DEVICES

Allopurinol
Omeprazole
Disulfaram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol (acute)
Sulphonamides
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3
Q

Which long term drug should be increased in surgery?

A

Steroids

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4
Q

Which drugs should be stopped before surgery?

A

I LACK OP

Insulin
Lithium
Anticoagulants
COCP
K sparing diuretics
Oral hypoglycaemic
Perindopril and other ACEis
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5
Q

What are the contraindications to drugs which increase bleeding?

A

Those who are bleeding
Those who might be bleeding
Those who are at risk of bleeding (e.g. liver failure)

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6
Q

Should prophylactic heparin be given to an acute ischaemic stroke patient?

A

No - because it risks bleeding into the stroke causing haemorrhagic transformation

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7
Q

What are the contraindications to steroid use?

A

Remember the side effects - STEROIDS

Stomach ulcers
Thin skin
oEdema
Right and left heart failure
Osteoporosis 
Infection
Diabetes
Syndrome of Cushing..
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8
Q

What are the contraindications to NSAID use?

A

NSAID

No urine (i.e. renal failure) 
Systolic dysfunction (heart failure)
Asthma
Indigestion
Dysgrasia (abnormal clotting)
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9
Q

What are the contraindications to antihypertensive use?

A

Hypotension
Bradycardia if beta blockers and CCB
Electrolyte disturbances if ACEi and diuretics

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10
Q

What are the side effects of ABCD antihypertensives?

A

ACEi - dry cough, angioedema
Beta blockers - wheeze, worsens acute HF
CCB - peripheral oedema, flushing
Diuretics - renal failure, (loop -> gout, K sparers -> gynaecomastia)

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11
Q

What is the maximum rate at which IV potassium can be delivered?

A

10mmol/hr

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12
Q

When might you give 5% dextrose over 0.9% saline?

A

Hypernatraemia

Hypoglycaemia

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13
Q

When would you give gelofusine over 0.9% saline?

A

If systolic BP <90

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14
Q

Which three parameters should be assessed to determine fluid response and future dosing?

A

BP
HR
Urine output

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15
Q

What is the definition of oliguria and what does it mean for the patient’s fluid balance?

A

<30ml/hr

Means they are 500ml dry

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16
Q

What fluid prescription should be given fro someone who is dehydrated with tachycardia or hypotension?

A

500ml bolus or 250 in HF

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17
Q

How much maintenance fluids do adults need?

A

3L/24hrs - 8 hourly bags

2L/24hrs if elderly - 12 hourly bags

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18
Q

How much potassium should be given daily for maintenance?

A

Provided not in renal failure
We need 40mmol/day
Therefore put 20mmol in 2 bags each day

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19
Q

What are the common antiemetic doses?

A

Cyclizine - 50mg 8 hourly IM/IV/PO
Metoclopramide - 10mg 8 hourly IM/IV/PO

Use metoclopromide over cyclizine in HF as the latter causes fluid retention

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20
Q

When should you not use metoclopramide?

A

Parkinson’s patients

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21
Q

What is a typical codeine dose for mild/moderate pain?

A

30mg up to 6 hourly oral

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22
Q

What is a typical co-codamol dose for severe pain?

A

Co-codamol 30/500, 2 tablets 6 hourly PO

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23
Q

What is the prescription for neuropathic pain?

A

Amitryptiline 10mg PO ON
Pregabalin 75mg PO 12hrly
Duloxetine 60mg PO OD

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24
Q

What effect do thiazide diuretics have on potassium levels?

A

Causes hypokalaemia

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25
Other than anti-emesis, what property does cyclizine have?
Anti-histamine
26
What should be done for a patient on methotrexate with a UTI?
Withold the methotrexate (if septic) and prescribe nitrofurantoin (NOT trimethoprim)
27
Which antihypertensive commonly causes peripheral oedema?
CCBs
28
How would you manage a patient with bradycardia and peripheral oedema on verapamil and bisoprolol? And why?
Stop the verapamil: 1) NEVER give verapamil to a patient already on beta blockers 2) CCBs cause peripheral oedema, so stop verapamil rather than adding furosemide 3) Don't stop 2 rate controllers at the same time as it would likely cause a rebound tachy
29
What is Novomix and by which route is it administered?
A mixture of short and medium acting insulin given SC
30
For how long following stroke should prophylactic enoxaparin be held?
2 months
31
What is a typical dose of bisoprolol?
10mg OD PO
32
What are the causes of hypernatraemia?
Dehydration Drip - excess saline? Drugs - particularly effervescent/iv preparations
33
Which drugs might cause a thrombocytopenia?
Penicillamine | Heparin
34
What are causes of hypokalaemia?
DIRE Drugs - Thiazides, loops Inadequate intake/excess loss Renal tubular acidosis Endo - Cushings and Conns
35
What are the causes of hyperkalaemia?
DREAD ``` Drugs - ACEi, ARBs Renal failure Endocrine - Addison's Artefact DKA ```
36
In which type of AKI is urea raised more than creatinine is?
Pre-renal
37
When and how should Vitamin K be given to a warfarin patient?
Give as oral if INR>8 without bleeding | Give IV if any major or minor bleeding alongside PCC
38
What type of drug is Bumetanide and when is it used?
A loop diuretic used in patients resistant to furosemide
39
Which drugs are used for rate control in fast AF, and when would you not use each of them?
Bisoprolol - asthmatics Diltiazem - fluid overload Digoxin
40
Management of STEMI?
``` Abcde O2 aiming for 94-98% 300mg aspirin 5mg IV morphine 10mg IV metoclopramide GTN spray/tablet Beta blockers unless brady/asthmatic/CCF Primary PCI or Alteplase Transfer to CCU ```
41
NSTEMI management?
``` Abcde O2 aiming 94-98% 300mg aspirin 5mg IV morphine 10mg IV metoclopramide GTN Clopidogrel 300mg and LMWH Beta blocker unless CI CCU transfer ```
42
Acute heart failure management?
``` ABCDE Sit up O2 aiming 94-98% 5mg IV morphine 10mg IV metoclopramide GTN spray/tablet Furosemide 40mg IV Isosorbide infusion if furosemide ineffective CPAP if above fails CCU transfer ```
43
Anaphylaxis management?
``` ABCDE O2 high flow Remove the cause ASAP Adrenaline 500mcg of 1:1000 10mg IV Chlorphenamine 200mg IV Hydrocortisone Asthma Rx if wheezy ```
44
Acute asthma management?
``` ABCDE 100% O2 Salbutamol 5mg NEB Hydrocortisone 100mg IV (if severe/LT), 50mg PO pred if moderate Ipratropium 500mcg NEB Theophyline if LT ```
45
PE management?
``` ABCDE High flow O2 5mg morph 10mg meto IV LMWH e.g. Tinzaparin SC (Rx dose) If hypotensive -> IV gelofusine -> noradrenaline -> thrombolysis ```
46
GI bleed management?
``` ABCDE 15L O2 2 large bore cannulae Catheter Fluids (crystalloid) Cross match 6 units Correct clotting abnormalities (FFP or PTC if on warfarin) Endoscopy + terlipressin + banding Stop aspirin, warfarin etc Call surgeons if needed ```
47
Bacterial meningitis management?
``` A-E O2 IV fluids Dexamethasone IV CT head -> LP 2g cefotaxime Conider ITU ```
48
Status epileptics management?
``` A-E O2 Recovery position Lorazepam IV/buccal midazolam Repeat after 5 mins Call anaesthetics Phenytoin/phenobarbitone infusion Rapid sequence induction (propofol/sodium thiopental) ```
49
Acute ischaemic stroke management?
``` A-E Investigations - glucose, CT head 300mg Aspirin once haemorrhage excluded Thrombolysis if <4.5hrs Thrombectomy if <6 hours Stroke unit transfer ```
50
DKA management?
A-E IV fluid replacement (generally bolus ->maintenance) with KCl unless anuric Insulin IV 0.1U/kg/hr Monitor everything Once BM<14 - start 10% dextrose at 125ml/hr + NaCl Continue IV insulin till patient able to eat/drink, bridge with SC insulin for 1 hour before stopping infusion
51
AKI management?
``` A-E Cannulate and catheterise Fluid monitoring 500ml bolus STAT 1L 4 hourly Investigate cause and comps ```
52
What are the components of the CHA2DS2-VASc score?
``` Congestive heart failure Hypertension Age >75 (2pts) Diabetes Stroke/TIA (2pts) Vascular disease Age 65-74 Sex (female) ``` 0 - 75 aspirin OD 1 - aspirin or warfarin 2 or more - Warfarin (target INR 2.5)
53
Chronic asthma mangagement protocol?
1. SABA PRN 2. Add 400mcg steroid INH 3. Add LABA, assess response and adjust dose, if no response -> stop and up steroid dose 4. Consider LTRA or upping steroid dose further 5. Steroid tablets
54
Name one of each of the following: Stool softener Bulking agent Stimulant laxative Osmotic laxative
Stool softener - Docusate sodium Bulking agent - Isphagula husk Stimulant laxative - Senna, Bisacodyl Osmotic laxative - Lactulose, phosphate enema
55
What is the first line management of PD?
Co-careldopa (Levodopa + dopa decarboxylase inhibitor
56
What might be used instead of co-careldopa in first line management of mild PD?
Dopamine agonist e.g. Ropinirole | MAO-A inhibitors - Rasgiline
57
What are the side effects of Lamotrigine?
Rash | Sometimes SJS
58
What are the side effects of Carbamazepine?
``` Rash Hyponatraemia Dyarthria Ataxia Nystagmus ```
59
What are the side effects of Phenytoin?
Peripheral neuropathy Gum hypertrophy Hepatotoxicity Ataxia
60
What ar the side effects of valproate?
Tremor Teratogenicity Weight gain
61
How would you induce remission in a mild and severe Crohns flare?
Mild - 30mg PO Prednisolone | Severe - 100mg IV Hydrocortisone
62
How would you maintain remission in Crohns?
Azathioprine or 6-mercaptopurine | Check TPMT first
63
What is the management of rheumatoid arthritis?
Start Methotrexate and a DMARD (sulfasalazine/hydroxychloroquine) ASAP During a flare: Short term IM methylpred Short term Ibuprofen with lansoprasole
64
Aside from being a sedating antihistamine used as an antiemetic, what other side effects might cyclizine cause?
Anti-muscarinics (urine retention, constipation, dry mouth etc)
65
What is hydroxycobalamin used for?
B12 deficiency
66
Which two anti-emetics are not safe for use in PD?
Metoclopramide | Haloperidol
67
Which antiemetic does not cross the BBB, and is those particularly safe in PD?
Domperidone
68
Which anti-diabetic drug confers risk of lactic acidosis?
Metformin
69
Do sulphonylureas (e.g. gliclazide) confer risk of hypoglycaemic episodes?
Yes
70
How frequently is methotrexate taken by RA patients?
Weekly
71
What medication should be co-prescribed with methotrexate?
Folic acid
72
What should be done on commencement of steroid therapy in someone likely to be on the medication for more than 3 months?
Co-prescribe bisphosphonates due to osteoporosis risk
73
How much of a drug in 1% solution is in: 100ml 1ml
``` 100ml = 1g 1ml = 10mg ```
74
What is the treatment dose of Dalteparin and Enoxaparin?
``` Dalteparin = 15000 units Enoxaparin = 12000 units ```
75
What is the starting dose of Ramipril for symptomatic HF?
1.25mg
76
What time of day should ACEi be taken?
18:00 (ON)
77
What is the prescription for insulin in hyperkalaemia?
Actrapid IV 10 units in 100ml of 5% dextrose over 30 mins
78
What must you measure before starting a patient on vancomycin and why?
UnE (Cr clearance) - as vancomycin is renally excreted
79
Which blood test should be done before starting a patient on a statin?
LFT - statins are metabolised by the liver.
80
What blood tests must be done before starting methotrexate?
FBC LFT UnE HcG
81
WHat is a contraindication to methotrexate use (other than pregnancy)
Deranged LFTs due to risk of cirrhosis
82
What effect does sodium depletion have on lithium levels?
Causes them to rise.
83
What should be monitored in patients on digoxin?
UnEs/serum Creatinine
84
Common ADRs to Gentamicin and Vancomycin?
Nephrotoxicity | Ototoxicity
85
Common ADRs to all antibiotics?
C dif colitis
86
Common ADRs to ACEis>
Hyperkalaemia Dry cough Hypotension
87
Common ADRs to B blockers
Bradycardia Wheeze in asthmatics Worsens acute heart failure Fatigue
88
Common ADRs to CCBs?
Peripheral oedema FLushing Bradycardia
89
Common ADRs to heparin?
Haemorrhage | Thrombocytopaenia
90
Common ADRs to warfarin?
Haemorrhage
91
Common ADRs to aspirin?
Haemorrhage | Gastritis/PUD
92
Common ADRs to digoxin?
N/V/D | Blurred vision
93
Common ADRs to amiodarone?
Interstitial lung disease Thyroid disease Grey skin Thrombophlebitis
94
Common ADRs to Lithium?
Early tremor Intermediate tiredness Late arrhythmias, seizures, coma, renal failure, DI
95
Common ADRs to haloperidol?
Dyskinesia
96
Common ADRs to Dex and Pred?
STEROIDS ``` Stomach ulcers Thin skin Edema Right and left HF Osteoporosis Infection Diabetes Syndrome of Cushing ```
97
Common ADRs to statins?
Myalgia Abdo pain LFT derangement Rhabdomyolysis
98
What class of drug is amiloride, and what biochemical side effect does it commonly have?
Potassium sparing diuretic commonly associated with Hyperkalaemia
99
What should be given to a conscious and alert patient who is hypoglycaemic?
10-20g of glucose
100
Which of the following drugs should be stopped before surgery? ``` Metformin Microgynon Enoxaparin Aspirin Bisoprolol Novomix 30 Paracetamol Lansoprazole ```
``` Metformin Microgynon Enoxaparin Aspirin Novomix ```
101
By how much should steroids be increased in long term users who are acutely unwell?
Double the dose
102
What drug would you give for the immediate relief of dyspepsia?
10ml PO Magnesium carbonate (antacid)
103
What is the main contraindication to lactulose use?
Bloating
104
What is the first line management of GAD?
Citalopram NOT Propranolol

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