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- Y6 PSA > Pre-exam things > Flashcards

Pre-exam things Flashcards

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1
Q

Drugs which cause urinary retention?

A

Alpha agonists e.g. phenelzine
Benzodiazepines
NSAIDs
CCBs
Antihistamines
Alcohol
Anticholinergics
General anaesthetics

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2
Q

Drugs which cause confusion?

A

Uncommon:
- H2 antagonists
- digoxin
- BB
- steroids
- NSAIDS
- antibiotics

Common: antidepressants, anticholinergics, antipsychotics, anticonvulsants.

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3
Q

Folic acid timing in pregnancy?

A

Before conceiving and until 12 weeks gestation

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4
Q

When do you offer 5mg folic acid instead of 400mcg?

A

FH or personal history of NTD in either partner
Antiepileptics
Coeliac disease
Diabetes
Thalassemia trait
Obese >30kg/m2

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5
Q

Effect of grapefruit juice on statins?

A

Inhibits CYP3A4 so increases statin toxicity

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6
Q

Effect of clarithromycin on statin?

A

Inhibits CYP34A so increases statin so predisposes to toxicity

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7
Q

Why can HRT cause hypertension?

A

Causes sodium and fluid retention

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8
Q

What biochemistry suggests stopping statins?

A

ALT 3x upper limit of normal

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9
Q

Alternative to metoclopramide in opioid induced nausea?

A

Cyclizine

NB: metoclopramide can cause QT prolongation and EPSEs are a common side effect. This is a problem in someone already taking antipscyhotics for example.

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10
Q

When should you give IV over IM?

A

When the person already has a cannula

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11
Q

Colecalciferol diarrhoea and dyspepsia?

A

No - they are very uncommon side effects. More likely to cause GI discomfort.

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12
Q

How is loperamide taken?

A

Max 16mg/day

First dose is 4mg then 2mg after each loose stool.

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13
Q

What % of patients respond to any one drug in depression?

A

50%

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14
Q

Most common SE of GLP1?

A

Vomiting

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15
Q

Postpartum antihypertensives?

A

1st enalapril
2nd nifedipine/amlodipine (if AfroCar)

Consider combination of both or trial of labetalol (!asthma!)

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16
Q

How do drugs increase digoxin toxicity ?

A

Promoting hypokalaemia or hypomagnasaemia e.g.
- loop
- thiazide

Increasing plasma concentration of digoxin e.g.
- amiodarone
- amlodipine + CCBs
- K sparing diuretic spironolactone
- quinine

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17
Q

3 causes of hypernatraemia.

A

Thiazides
Loops
Lithium (DI)

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18
Q

3 drugs that prolong QT

A

Citalopram
Venlafaxine
Amiodarone

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19
Q

Causes of DRESS?

A

fever, lymphadenopathy, eodinophilia (type IV reaction)

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20
Q

citalopram + NSAID =

A

increased risk of GI bleeding

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21
Q

Hepatic encephalopathy,how to monitor response to lactose?

A

Stool chart - constipation means ammonia gets absorbed more from stools which may precipitate encephalopathy

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22
Q

Ramipril or amlodipine more likely to cause postural hypotension?

A

Ramipril

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23
Q

Venlafaxine monitoring?

A

ECG and BP - higher risk of QT prolongation in those with pre-existing CVD

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24
Q

Omeprazole and clopidogrel?

A

Reduced efficacy of clopidogrel

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25
Gout precipitants?
Aspirin is an NSAID and can precipitate gout attacks. Ramipril is an ACE-1 inhibitor and can also trigger gout. Thiazide diuretics can also precipitate gout.
26
Causes of dry eyes?
- bisoprolol - amitriptyline - chlorpheniamine This occurs through inhibition of aqueous production, either directly or via an anti-muscarinic effect
27
Tenofovir 3-6 monthly monitoring of...?
URINALYSIS - associated with renal impairment due to damage sustained to the proximal tubule which can progress to Fanconi syndrome so BHIVA recommend 3-6monthly urinalysis for blood or protein
28
How is rivaroxaban taken?
With food
29
When to use trimethoprim over nitrofurantoin?
When eGFR is <45 you should avoid nitrofurantoin
30
Post-elective hip replacement anticoagulants?
Rivaroxaban OR enoxaparin (amongst others but these are the main ones)
31
Intranasal prescription for breakthrough pain?
Fentanyl 50mcg/actuation nasal spray 1 spray to one nostril Repeated once after 10mins if required
32
Instructions for COCP taken with enzyme inducing drugs?
Switch to alternative method After stopping the enzyme inducer use alternative contraception for 4 weeks before returning to the oral contraceptive.
33
How much prednisolone for bell's palsy?
60mg OD
34
Which anticoagulants DOACs need parenteral LMWH in the first few days?
Dabigatran Edoxaban Both need 5 days parenteral LMWH prior to initiation
35
What should tacrolimus not be coprescribed with?
Clarithromycin, erythromycin could cause AKI as they inhibit metabolism of tacrolimus
36
Inducers and Inhibitors stories.
Enzyme inducers: St John was a Barber (barbiturate/phenobarbitone) chronically smoking phenytoin and drinking alcohol, and eating carbz (carbamazepine) with his red (rifampicin) fun grizzly bear (griseofulvin) Enzyme inhibitors; Sarah was depressed (fluoxetine, sertraline) and having seizures (valproate). She sometimes binged alcohol so had to take omeprazole and often got gout (allopurinol). She panicked which gave her tachycardia(amiodarone) so went to hospital. Unluckily she saw on the XR that she also got miliary TB (iSawniazid) from her HIV(ritonavir) She had to be admitted and got a pneumonia (ciprofloxacin, erythromycin) followed by thrush (fluconazole) from abx.
37
What should simvastatin be carefully prescribed with?
CCBs - they all increase levels of simvastatin so increase risk of rhabdo Max dose of simvastatin you can give is 20mg if taking it with CCBs ALSO: all statins should not be prescribed with clarithromycin.
38
Which abx should you be cautious with in penicillin allergic pt?
Cefalexin Meropenem/aztreonam
39
Pt on warfarin, which drugs alter levels?
Daily INR if taking: Warfarin AND.... antibiotics - penicillins and clari tramadol fluconazole omeprazole amiodarone corticosteroids at high dose
40
Constipating medications?
o antacids (aluminium and calcium salts), o anticholinergics (e.g. oxybutynin or hyoscine), o antidepressants (e.g. TCAs, SSRIs), o muscle relaxants (e.g. baclofen), o iron supplements, o opioids and derivatives.
41
Calcium affects absorption of which 4 drugs?
o Quinolones (e.g. norfloxacin) or tetracyclines (e.g. doxycyclines) o Bisphosphonates (e.g. alendronic acid) o Iron tablets o Levothyroxine
42
Lactulose and movicol together?
No - both osmotic laxatives
43
Tramacet contains?
PARACETAMOL and tramadol
43
Agitation in PD?
Lorazepam 500 micrograms PO stat
44
Severe asthma respiratory rate in adults vs children?
Adult severe asthma is RR >25 But in child it is >40 (2-5yrs) or >30 (>5yrs)
45
Lithium + triptan risk?
Serotonin syndrome
46
Mild jaundice from HRT, what do you do?
Stop the HRT Other reasons for stopping: chest pain, breathlessness, DVT-like, stomach pain, neuro effects, hepatitis, jaundice, hepatomegaly, BP 165/95, immobility, new RF.
47
Epiglottitis tx?
Cefotaxime or ceftriaxone 2nd line: chloramphenicol if there is a penicillin allergy.
48
Side effects of MMR vaccine?
Rash one week after Febrile seizures 6-11 days after Parotid swelling in 1% IPT within 6 weeks very rarely More common SE with first dose rather than second
49
Lithium and ACEi?
Risk of lithium toxicity as excretion is reduced
50
Drugs which may worsen seizure control in epilepsy?
alcohol, cocaine, amphetamines ciprofloxacin, levofloxacin aminophylline, theophylline bupropion methylphenidate (used in ADHD) mefenamic acid
51
When to taper steroids?
received more than 40mg prednisolone daily for more than one week received more than 3 weeks treatment recently received repeated courses
52
2 things to check 6 monthly on lithium?
U&Es TFTs
53
Drug causes of SIADH (and hyponatraemia)?
sulfonylureas* - some SSRIs, tricyclics carbamazepine vincristine cyclophosphamide
54
X % of patients who are allergic to penicillin are also allergy to cephalosporins
0.5-6.5% of patients who are allergic to penicillin are also allergy to cephalosporins
55
Third line HF drugs and when to recommend each?
Hydralazine - Afro-Caribbean Digoxin - coexistent AF ARNI sacubitril-valsartan - HFrEF <35% Ivabradine - >75bpm and HFrEF
56
PPH medications?
1. IV oxytocin – injection then infusion 2. Ergometrine slow IV or IM 3. Carboprost IM 4. Misoprostol sublingual Found under "obstetrics"
57
ITU drug for serotonin syndrome?
cyproheptadine
58
Tx for severe neuroleptic malignant syndrome?
Dantrolene Bromocriptine
59
Drugs that cause retention.
General anaesthetics Alpha-adrenoceptor agonists Benzodiazepines NSAIDs CCBs Alcohol Antihistamines Obvious ones: Anticholinergics (e.g. antipsychotics, antidepressants, detrusor relaxants) Opioids
60
Drugs causing confusion.
Anticonvulsants H2 receptor antagonists Digoxin Beta-blockers NSAIDs Obvious: Anticholinergics (e.g. antipsychotics, antidepressants, detrusor relaxants) Antipsychotics Antidepressants Corticosteroids
61
Causes of cholestasis.
Flucloxacillin Co-amoxiclav Nitrofurantoin Steroids Sulphonylureas OCP
62
Causes of thrombocytopenia.
Penicillamine Heparin Valproate Salicylates Chloroquine
63
Causes of neutropenia.
Clozapine Carbimazole Cytotoxics e.g. Methotrexate Chloramphenicol Carbamazapine

- Y6 PSA (8 decks)

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