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Prescribing Flashcards

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1
Q

Fluid management: Emergency resus?

A

500ml 0.9% NaCl over 15 m

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2
Q

Fluid management: Emergency hypoglycaemia

A

20% glucose 100ml over 15 mins

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3
Q

Fluid mx: emergency hypoK

A

1L 0.9% NaCl/ 0.3% KCL over 4 hours

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4
Q

Fluid mx: emergency hyperCa

A

1L 0.9% NaCl over 4 hours

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5
Q

Fluid management: maintenance fluids without loss

A

25-30ml/kg/day H2O
1mmol/kg/day Na/k/cl
50-100g glucose per day

over 8 hours = adult
over 12 hours = elderly

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6
Q

Fluid mx: maintenance with deficits of loss eg: Na or K low/ d&V

A

Minimum 30ml /kg/ day water

1L

over 4-6 hours

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7
Q

emergency resus CHILD?

A

10ml/kg 0.9% Nacl over 15 mins

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8
Q

maintenance fluids without deficits of loss in PAEDS?

A

100ml/kg/day first 10 kg

50ml/kg/day next 10-20kg

20ml/kg/day > 20 kg

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9
Q

ecg change in hyperCa

A

short QT

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10
Q

ECG changes in hypoK + symptoms

A

sx: metabolic aklaosis, arrhythmias, muscle weakness, reduced reflexes, constiatpion

In hypoK U have no Pot or no T but a long PR and long QT

  • no u waves
  • no t waves
  • long qt
  • long PR
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11
Q

maximum speed to replace K?

How fast to replace
0.3% KCL
0.15% KCL

A

10mmol/ hour

0.3 % (40 mmol)= 4 hours

0.15% (20mmol) = 2 hours

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12
Q

volume and rate of maintenance and replacement?

A

1L over 4-6 hours

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13
Q

volume and rate of maintenance only?

A

1L over 8-12 hours

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14
Q

Prescribing ONCE ONLY:

Acute pain MI?

A

5-10mg morphine IV

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15
Q

Prescribing ONCE ONLY: acute asthma

A

5mg salbutamol nebulised

0.5mg ipatropium bromide nebs

40-50mg prednisolone oral

100mg IV hydrocortisone

others:
MgSo4, aminophyilline, IV salbutamol

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16
Q

Prescribing ONCE ONLY: Acute heart failure

A

IV 40mg furosemide

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17
Q

Prescribing ONCE ONLY: Acute anaphylaxis

A

500mcg (0.5mg) IM 1:1000 adrenaline

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18
Q

Prescribing ONCE ONLY: AF onset < 48 hours

Rate?
- contraindications?

Rhythm?
- contraindications?

A

Rate:
- BB = asthma
- Verampil / diltiazam = heart failure
- digoxin = if above unsuitable / CCF

Rhythm
- Flecainide = no IHD / structural heart disease
- Amiodarone = IHD

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19
Q

Prescribing ONCE ONLY: SVT?

Second line if contraindicated? what is the contraindication?

A

IV adenosine 6mg -12mg -12mg

ASTHMA => veramapil

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20
Q

Prescribing ONCE ONLY: bradycardia?

A

IV atropine

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21
Q

Prescribing ONCE ONLY: VT stable

A

IV amiodarone

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22
Q

Prescribing ONCE ONLY: Torsades de pointes?

A

IV MgSo4

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23
Q

Prescribing REGULAR hospital medications: VTE

A

LWMH eg: enoxaparin, dalteparin, tinz

UFH if renal failure

Fondaparinux

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24
Q

Prescribing REGULAR hospital medications: IECOPD

A

salbutamol
ipatropium
hydrocortisone / pred
abx
aminophylline
NIV

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25
Prescribing REGULAR hospital medications: reflux oesphagitis
lansoprazole ompeprazole
26
Prescribing REGULAR hospital medications: On going pain (ladder) Neuropathic pain?Prescribing REGULAR hospital medications:
1. paracetamol ± nsaids (ppi) 2. weak opioid eg: - codeine - tramadol - co codamol 3. strong opioid - morphine - oxycodone = renal impairement preferred - diamorhpine - fentanyl - buprenorphine Neuropathic pain: - amitrypillin - pregablin - gabapentin
27
Medication for trigeminal neuralgia pain?
carbamezapine
28
Prescribing REGULAR hospital medications: Anti-emetics 1. Vertigo/ motion sickness 2. Post op (contraindications? 3. palliative care 4. Chemo induce - acute - delayed 5. parkinsons 6. hyperemesis gravidarum
1. cyclizine 2. ondasetron (long qt) 3. Cyclizine, haloperidole, levopromazine 4. chemo acute = ondansetron, delayed= metoclopramide 5. PD = domperidone 6. HG = promethazine
29
Prescribing REGULAR hospital medications: Laxatives 1. bulk forming 1 2. stimulants 2 3. softeners 1 4. osmotic 2
bulk: - isphagula husk stimulants: - senna - bisacodyl softener: - bisacodyl osmotic - lactulose - macrogol
30
what to type into BNF to find pain mangement
chronic pain / neuropathic pain
31
what to type into bnf to find anti-emetics
nausea TS
32
what to type into bnf for laxatives
constipation TS
33
HTN medication in pregnancy
labetalol nifedipine methylodopa
34
Prescribing in GP: gout acute and chronic
acute: - NSAIDS = avoid in PUD - colchichine - intraarticular steroid injection chronic - allopurinol = start 2-4 weeks after attack
35
electrolyte disturbance with SSRI?
hypoNa
36
What to search in bnf for depression + anxiety mx?
treatment summary: antidepressant drugs
37
mx of acute anxiety in hospital ?
benzodiazepines eg: - diazepam / lorazempan
38
medications to avoid in children?
opiates & aspirin
39
adverse effects of anticholinergics 6
1. dry mouth 2. dry eyes and blurred vision 3. constiopation 4. urinary retention 5. orthostatic 6. hypotension sedation
40
Drugs with potential teratogenic effects/ avoid in child bearing age 11
1. ACEi/ ARB 2. carbimazole 3. warfarin 4. statins 5. phenytoin 6. na valproate 7. trimethoprime 8. COCP 9. MTX 10. isotretinooin 11. lithium
40
drugs that should be prescribed at lower doses in the elderly
1. aminoglycosides = aki 2. hypoglycaemics 3. anticholingerics 4. anticoagulants 5. antipyschotics = tardive dyskinesia 6. bb = hypotension 7. opioids 8. sedation
41
contraindicated drugs in PUD? 2
NSAIDS aspirin
42
contraindicated drugs in CKD? 3
NSAIDS ACEi slower clearance of drugs eg: digoxin / gent
43
contraindicated drugs in chronic heart failure 5
1. calcium channel bockers eg: verampil / diltizaime 2. iontopes eg: flecainide 3. TCA 4. NSAIDS 5. steroids
43
drugs contraindicsted in asthma 2
nsaids beta blockers
43
drugs contraindicated in parkinsons disease 2
metoclopramide haloperidol
43
drugs contraindicated in heart block 3
beta blockers digoxin verampil
44
drug interaction with amiodarone? why?
grapefruit juice - inhibition of metabolism systems => cardiac arrhythmias due to prolonged QT
44
drug interaction with warfarin + effect
clarithromycin => increase INR / anticoagulation (inhibitor)
45
drug interaction with phenytoin + effect
miconazole => phenytoin toxicity
46
drug interaction with haloperidol + effect?
fluoextine = haloperidol toxicity
47
drug interaction with azathioprine + effect
allopurinol > aza toxicity
48
drug interaction with adrenaline / NA + effect
MAOS => HTN crisis
49
drug interaction with ciclosporin + effect
st johns wort => enzyme induction + loss of immunosupression
50
drug interaction with lithium + effect
diuretics / nsaids => reduced renal function = lithium toxicity
51
drug interaction with MTX + effect
NSAIDS = reduced renal clearance and toxicity (neutropneia and deranged LFT) trimethoprim = folate antagonism
52
drug interaction with salbutamol + effect
BB => both target receptor bronchodilator effect
53
drug interaction with ACEi due to similar mechanism?
NSAIDS = reduced renal
54
drug interaction with warfarin due to similar mechanism
nsaids / aspirin = bleeding
55
drug interaction with diuretics due to similar action
ACEI = volume depletion
56
drugs to avoid in bradycardia 3
BB CCB digxoin
57
drugs to avoid in hypotension 6
nitrates bb ccb alpha blockers TCA sedatives
58
drugs to avoid in HTN 3
oestrogen nsaids venlfexaine
59
what drugs exacerbate anaemia (low Hb) and should be stopped?
anticoagulatns nsaids
60
treatment of low Hb? 3
ferrous sulphate folic acid hydroxycolamin b12
61
drugs that are contraindicated / prescribed with caution in renal failure? 12
1. diuretics (loops/ potassium sparing) 2. ACEi/ ARB 3. Nsaids 4. aminoglycisdes eg: gent 5. digoxin 6. lithium 7. abx eg: cipro / cephalosproin 8. MTX 9. opoiods 10. metformin 11. sulfonylureas 12. insulin
62
drugs that should be prescribed with caution / contraindicated in impaired liver function 5
benzodiazepines metformin nsaids statins warfarin
63
drugs contraindicated with poor left ventricular function? 5
nsaids metformin pioglitazones class 1 antiarrthymics eg: flecainde CCB
64
mx of IBS?
antispasmodic eg: mebeverine loperamide = if diarrhoea main concern laxative (Avoid lactulose!)
65
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