PSA Flashcards
(103 cards)
1
Q
Resus fluids
A
500ml bolus over 15 mins
Reassess
Following fast bolus, adjust dose accordingly (250-500ml)
2
Q
Replacement fluids needed in tachycardia and low BP
A
- tachycardia = usually 1-2L fluid depleted
- BP only starts going with more than 2L
3
Q
maintenance fluid requirements
A
3 L over 24 hrs
1 salty, 2 sweet (1L normal saline, 2L 5% dextrose)
K+ (40-60mmol/24hrs)
4
Q
K infusion rate and concentration
A
Rate <10 mmol/hr
Infusion concentration <40 mmol/L
5
Q
Enzyme inducers
A
PC BRAS
Phenytoin
Carbamazepine
Barbiturates
Rifampicin
Alcohol (chronic)
Sulphonlyurea
6
Q
Enzyme inhibitors
A
AO DEVICES
Allopurinol
Omeprazole
Disulfuram
Valproate
Isoniazid
Ciprofloxacin
Ethanol (acute intoxication)
Sulphonamides
7
Q
interactions of paracetamol
A
- alcohol = hepatotoxic
- flucloxacillin = metabolic acidosis
- warfarin = inc INR
8
Q
interactions of NSAIDs
A
- SSRIs/warfarin/DOAC/steroids = inc bleeding risk
- ACEi = hyperkalaemia
- Diuretics = AKIi
9
Q
interactions of opioids
A
- alcohol = CNS depressant
- SSRI/ St John Wart/ Sumitriptan = serotonin syndrome
10
Q
interactions of steroids
A
- aspirin = GI bleeding
- digoxin = dig toxicity
- erythromycin/citalopram = hypokalaemia
- antifungals = inc exposure of steroids
11
Q
disulfram reactions
A
ketoconazole
metronidazole
12
Q
where to find opioid conversations
A
prescribing palliative care
13
Q
where to find benzo dose conversions
A
hypontoics and anxiolytics
14
Q
how to find treating hyperkalaemia
A
fluids and electrolytes
15
Q
how to find menorrhagia
A
heavy menstrual bleeding
16
Q
where to find vaccination schedule
A
immunisation schedule
17
Q
where to find vaccination schedule
A
immunization schedule
18
Q
where to find what drugs to stop before surgery
A
surgery and long term medication
19
Q
where to find what drugs to stop before surgery
A
surgery and long term medication
20
Q
where to find overdoses and poisoning
A
poisoning, emergency treatments
21
Q
where to find overdoses and poisoning
A
poisoning, emergency treatments
22
Q
GP stuff/hypoglycaemia
A
medical emergencies in community
23
Q
diabetes, surgery, medical illness
A
surgery in diabetic patients
24
Q
where to find pneumonia management?
A
respiratory system infection, antibacterial therapy
25
where to find infective endocarditis management?
cardiovascular system infections, antibacterial
26
where to find DI management?
posterior pituitary hormones and anatagonists
27
calculating concentration
mass of solute (g) / volume of solution (mL) x 100
in g/mL
28
1:100
1g in 100mL
1000mg in 100mL
10mg in 1mL
= 1%
28
1:100
1g in 100mL
1000mg in 100mL
10mg in 1mL
= 1%
29
1:1000
1g in 1000mL
1000mg in 1000mL
1mg in 1mL
= 0.1%
29
1:1000
1g in 1000mL
1000mg in 1000mL
1mg in 1mL
= 0.1%
30
1:10,000
1g in 10,000mL
1000mg in 10,000mL
0.1mg in 1mL
= 0.01%
31
kg to mcg
kg to g (x1000)
g to mg (x1000)
mg to mcg (x1000)
32
key opioid conversations
codeine PO to morphine PO (divide by 10)
morphine PO to morphine IM/IV/SC (divide by 2)
33
important to remember when prescribe morphine sulphate
prepared as 2.5mg aliquots
round to nearest
better to over dose
34
Fentanyl patch prescription
1 application
topical
35
rattling breath sound tx
hyoscine hydrobromide
Glycopyronnium bromide
36
pain and breathlessness tx
morphine
37
agitation tx
midazolam
38
nausea tx
haloperidol
39
POP prescription
noethisterone
levonorgestrel
desogestrel
40
prescribing COCP e.g. microgynon
ethinylestradiol 30mcg/ levonorgestrel 50mcg
monophasic 21-day tablets
41
COCP 1 missed pill
take missed pill straight away
continue rest of pack as normal
42
COCP 2+ pills missed
take most recent missed pill
abstain/use condoms for 7 days
if recent intercourse in 7 days = emergency contraception
43
if < 7 pills left in pack after missed pill
start next pack back to back
no rest or withdrawal bleed
44
POP patient info
take within 3 hours (or 12 if desogestrel)
need 48hrs to re-establish
44
POP patient info
take within 3 hours (or 12 if desogestrel)
need 48hrs to re-establish
44
POP patient info
take within 3 hours (or 12 if desogestrel)
need 48hrs to re-establish
44
POP patient info
take within 3 hours (or 12 if desogestrel)
need 48hrs to re-establish
45
POP patient info
take within 3 hours (or 12 if desogestrel)
need 48hrs to re-establish
46
POP patient info
take within 3 hours (or 12 if desogestrel)
need 48hrs to re-establish
47
vomiting patient info with pill
if sick within 2 hours of taking pill, take another
48
diarrhoea patient info with pill
if severe lasting >24 hours, act as if missed pill
49
COCP risks
inc risk of VTE/MI/stroke
inc risk of breast and cervical Ca
50
POP risk
inc risk of ovarian cysts and breast Ca
51
HRT risks
VTE
ischaemic stroke
breast and endometrial Ca
52
hint about finding contraception on BNF
type brand name in = will give you prescription drug equivalent
53
prescribing COC patch
estradiol 50mcg per 24 hours, levongestrel 7mcg per 24 hours
transdermal patch
1 application
once a week
54
prescribing COC vaginal ring
search vaginal ring
ethenylestradiol with etonogestrel
1 unit
once a month, for 7 days
55
prescribing POC implant
etonogestrel
1 implant
subdermal
once only
56
1st line management of T2DM
diet, exercise, weight loss for 6-8 weeks
57
when is second line diabetic treatment started?
when HbA1c > 53 even after 1st line treatment
58
SGLT-2 inhibitor SE
weight loss
euglycaemic ketoacidosis
59
DPP-4 inhibitor examples
who to prescribe
sitagliptin, linagliptin
elderly and obese
60
GLP-1 inhibitor examples
important info
semaglutide, exenatide
weight loss, SC injfection
61
contraindications of thiazdinediones
HF
bladder Ca
Hx of DKA
62
when is insulin therapy started in T2DM
if HbA1c > 58 mmol/mol despite max non-insulin treatment
63
insulin regimes
1. Basal: long acting insulin given OD/BD
2. Biphasic: LA and SA insulin given BD with meds
3. Basal-bolus: basal + SA bolus doses with meds
64
names of long acting insulins
Humulin
Glargine (Lantus)
Detemir
65
hypoglycaemia treatment
alert: juice, oral glucose
unconscious: 100ml 20% glucose, 200ml 10% glucose, glucagon 1mg IM
66
when can't you use glucagon
in malnourished, fasting, liver disease, on sulphonlyurea
67
how to monitor after hypoglycaemia?
recheck every 10-15 minutes until >4 mmol/mol
once alert give long acting carbs
68
what to do if hypoglycaemia is due to basal insulin?
reduce dose by 10-20%
69
what to do if hypoglycaemia is due to bolus insulin?
reduce dose by 2-4 units
70
what to do if hypoglycaemia is due to sulphonylurea?
reduce dose e.g. gliclazide down by 40mg
71
if have hyperglycaemia and metformin, what do to?
increase by 500mg
72
if have hyperglycaemia and on insulin, what to do?
if fasting BMs are high = inc LA insulin by 10%
73
where to find important diabetes treatment summary?
Diabetes, Surgery and Medical Illness
74
what to do with warfarin if major bleed?
stop warfarin
give phytomenadione IV
give PCC
75
what to do with warfarin and minor bleed (no matter what INR)?
stop warfarin
give phytomenadione IV
restart warfarin when INR < 5
76
what to do with warfarin is INR > 8.0 but no bleed?
stop warfarin
give phytomenadione PO
restart warfarin when INR < 5
77
what to do with warfarin if INR 5-8 but no bleed?
withhold 1-2 doses
reduce maintenance dose
78
what does PCC contain?
2, 7, 9, 10
79
neural tube prevention in sickle cell
folic acid 5mg PO OD until birth
80
what happens if eGFR drops by <25% or creatinine increases by < 30% on ACEi?
do not modify dose
re-check levels in 2 weeks
81
what happens if eGFR drops by >25% or creatinine increases by > 30% on ACEi?
investigate other causes e.g. volume depletion
consider drugs which may contribute
stop ACEi
OR
reduce dose to previosuly tolerable dose and re-check in 5 days
82
what does FFP contain?
all clotting factors, slower admin
83
what does cryo contain?
factors 8, 13, fibrinogen, vWF
84
what is the indication for cryo?
fibrinogen deficiency
dysfibrinogenaemia
85
important points to remember about U&Es
eGFR trend
pre-renal AKI: urea rises more
post/intrinsic: creatinine rises more
86
what is the vancomycin dose calculated on?
creatinine clearence
87
what is trough level of vancomycin?
10-20
88
if vancomycin trough is 21-25, what to do?
reduce dose by 25%
repeat pre-dose level after 48 hrs
89
if vancomycin trough is >25, what to do?
do not administer further vancomycin until trough <20
90
example maintenance fluid regime
1. Saline 0.9% + 20mmol KCL (/8 hrs)
2. Dextrose 5% + 20mmol KCL (/8 hrs)
3. Dextrose 5% + 20mmol KCL (/8 hrs)
91
Rapid acting insulin
- effect
- duration
- examples
- start after 10 mins
- last ~4 hours
- e.g. novorapid
92
Short acting insulin
- effect
- duration
- examples
- start after 30 mins
- last ~ 8 hours
- e.g. Actrapid
93
Immediate acting insulin
- effect
- duration
- examples
- start after 1 hour
- last ~16 hours
- e.g. Humulin I
94
Long acting insulin
- effect
- duration
- examples
- start after 1 hour
- last ~ 24 hours
- e.g. Lantus
95
gentamicin toxicities and CI
ototoxic, nephrotoxic
CI: MG
96
peak and trough of gentamicin
peak (1 hour after admin)
trough (just before next dose)
97
what to do if trough (pre-dose) is high?
increase interval between doses
98
what to do if peak (post-trough) is high?
dose should be decreased
