PSA Flashcards
(244 cards)
1
Q
how to enzyme inducers work
A
increases P450 enzyme activity -> hastening metabolism of other drugs -> therefore they have a reduced effect and may need an increased dose
2
Q
how do enzyme inhibotors work
A
reduced P450 enzyme activity->increased level of other drugs thefore may need doses reducing
3
Q
common enzyme inducers
A
PC BRAS
phenytoin
carbamazepine
barbiturates
rifampicin
alcohol (chronic excess)
sulphonylureas
4
Q
common enzyme inhibitors
A
AODEVICES
allopurinol
omeprazole
disulfiram
erythromycin
valproate
isoniazid
ciprofloxacin
ethanol (acute intoxication)
sulphonamides
5
Q
drugs to increase during surgery
A
if on long term steroids need an IV dose on induction anaesthesia
6
Q
drugs to stop before surgery
A
I LACK OP
inuslin
lithium
anticoagulants/antiplatelets
COCP/HRT
K sparing diuretics
oral hypoglycaemics
perindopril and other ACEi
7
Q
when to stop COCP and HRT before surgery
A
4w
8
Q
when to stop lithium before surgery
A
day before
9
Q
when to stop potassium sparing diuretics before surgery
A
day of
10
Q
when to stop ACEi before surgery
A
day of
11
Q
how does erythromycin effect warfarin
A
increase its effect and PT/INR
12
Q
how do enzyme inhibitors affect warfarin
A
increase its effect and PT/INR
13
Q
when is prophylactic heparin CI
A
acute ischaemic stroke due to risk of bleeding
14
Q
SE/CI steroids
A
stomach ulcers
thin skin
oedema
R and L heart failure
osteoporosis
infection - candida
diabetes
cushings syndrome
15
Q
cautions/CI NSAIDs
A
no urine - renal failure
systolic dysfunction - HF
asthma
indigestion
dyscrasia - clotting abnormality
16
Q
SE anti hypertensives
A
hypotension
bradycardia with BB and some CCB
electrolyte disturbances with ACEi and diuretics
17
Q
SE ACE i
A
dry cough
18
Q
SE BB
A
wheeze in asthmatics
worsen acute HF
19
Q
SE CCB
A
periheral oedema
flushing
20
Q
SE diuretics
A
renal failure
loop diuretics (furosemide)=gout
postassium sparign diuretics (spironolactone)=gynaecomastia
21
Q
what fluid to give as a replacement
A
0.9% saline
22
Q
what fluid replacement to give if patient hypernatraemic or hypoglycaemic
A
5% dextrose
23
Q
what fluid replacement to give if patient has ascites
A
human albumin solution
24
Q
what fluid replacement to give if a patient bleedint
A
blood
25
how much fluid replacement to give
tachyacrdia cand hypotensive: 500ml bolus (250ml if HF) and assess response
if only oliguric: 1L over 2-4h and reassess
26
what maintenance fluids to give
general = 3L/d, elderly=2L
1L 0.9% saline and 2L 5% dextrose
if normal potassium level add 20mmol KCl to 2 of the bags
if giving 3L give bags 8 hourly
27
VTE prophylaxis
LMWH e.g. dalteparin 5000 units SC and compression stocks
dont give LMWH if leeding or ishcaemic stroke
no compression stockings in PAD
28
what antiemetic to prescribe if nauseated
REGULAR
-cyclizine 50mg 8 hourly IM/IV oral UNLESS FLUID RETENTION
- metoclopramide 10mg 8 hrly if HF
29
antiemetic to prescribe if not nauseated
AS REQUIRED
- -cyclizine 50mg up to 8 hourly IM/IV oral UNLESS FLUID RETENTION
- metoclopramide 10mg up to 8 hrly if HF
30
when to avoid metoclopramide
patients with parkinsons - may exacerbate sx
young women as risk dyskinesia
31
what to prescribe in non pain
non regular
PRN: paracetamol 1g up to 6hrly oral
+/- NSAID
32
what to prescribe in mild pain
regular: paracetamol 1g 6 hrly oral
PRN: codeine 30mg up to 6 hrly oral (can use tramadol)
+/- NSAID
33
what to prescribe in severe pain
regular: co-codamol 30/500 2 tablets 6hrly oral
PRN: morphine sulphate 10mg up to 6 hrly oral
+/- NSAID
34
1st line mx neuropathic pain
amitryptiline (at night)
pregabalin 12 hrly
duloxetine in painful diabetic neuropathy
35
causes of microcytic anaemia
iron deficiency
thalassaemia
sideroblastic anaemia
36
causes normocytic anaemia
anaemia of chronic disease
acute blood loss
haemolytic anaemia
renal failure - chronic
37
causes macrocytic anaemia
B12/folate deficiency
excess alcohol
liver disease
hypothyroid
haem: myeloproliferative, myelodysplastic, multiple myeloma
38
causes hypernatraemia
dehydration
too much IV saline
drugs:
diabetes insipidus
39
causes high neutrophils (neutrophilia)
bacterial infection
tissue damage: inflammation/infarct/malignancy
steroids
40
causes low neutrophils (neutropenia)
viral infection
chemo/radio
CLOZAPINE
CARBIMAZOLE
41
causes high lymphocytes (lymphosytosis)
viral infection
lymphoma
chronic lymphocytic leukaemia
42
causes low platelets (thrombocytopenia)
REDUCED PRODUCTION
infection - viral
drugs: penicillamine
myelodysplasia, myelofibrosis, myeloma
INCREASED DESTRUCTION
heparin
hypersplenism
DIC
ITP
HUS/thrombotic thrombocytopenic purpura
43
causes high platelets (thrombocytosis)
REACTIVE
bleeding
tissue damage: infection, inflamamtion, malignancy
post-splenectomy
PRIMARY
myeloproliferative disorders
44
causes hypovolaemic hyponatraemia
fluid loss: D+V
addisons disease
diuretics
45
causes euvolaemic hyponatraemia
SIADH
psychogenic polydipsia
hypothyroid
46
causes hypervolaemic hyponatraemia
HF
renal failure
liver failure
nutritional failure
hypothyroid
47
causes SIADH
small cell lung tumours
infection
abscess
drugs: CARBAMAZEPINE, ANTIPSYCH
HI
48
causes hypokalaemia
loop and thiazide diuretics
inadequate intake or intestinal loss (D+V)
renal tubular acidosis
endocrine: cushings, conns
49
causes hyperkalaemia
drugs: potassium sparing diuretics and ACEi
renal failure
addisons disease
artefact - clotted sample
DKA
50
what can cause raised urea
kidney injury
upper GI haemorrhage
big/raw steak
51
causes pre-renal AKI
dehydration - sepsis, blood loss, renal artery stenosis
52
causes renal/intrinsic AKI
ischaemia
nephrotoxic abx: gentamicin, vancomycin, tetracyclines
ACEi
NSAIDs
radiological contrast
rhabdomyolysis
gout
glomerulonephritides
vasculitis
cholesterol emboli
53
post renal AKI causes
in lumen: stone
wall: tumour, fibrosis
external pressure: BPH, prostate ca, lymphadenopathy, aneurysm
54
causes increased ALP
fracture
liver damage
cancer
pagets disease
pregnancy
hyperparathyroidism
osteomalacia
surgery
55
how to alter levothyroxien based off TSH
<0.5 = decrease dose
0.5-5 = leave as is
>5 = increase dose
56
causes raised bilirubin only
haemolysis
gilberts and crigler-najjar syndromes
57
causes increased bilirubin and AST/ALT
fatty liver
hepatitis
cirrhosis
malignancy
metabolic: wilsons, haemochromatosis
HF
58
causes increased bilirubin and ALP
gallstone
flucloxacillin, coamox, nitrofurantoin, steroids, sulfonylureas
cholangiocarcinoma
primary biliary cirrhosis, sclerosing cholangitis
pancreatic or gastric ca
lymph node
59
features digoxin toxicity
confusion
nausea
visual halos
arrhythmias
60
sx lithium toxicity
early: tremor
intermediate: tired
late: arrhythmas, seizures, coma, renal failure, diabetes insipidus
61
sx phenytoin toxicity
gum hypertrophy
ataxia
nystagmus
peripheral neurpathy
teratogenicity
62
sx gentamicin toxicity
ototoxic
nephrotoxic
63
sx vancomycin toxicity
ototoxic
nephrotoxic
64
how is once daily gentamicin dosing monitored
measure level 6-14h after last infusion started
use a nomogram to look whether need to alter frequency of the dose
65
how is divided daily gentamicin dosing monitored
take a peak level (1h before dose) and a trough level (just before dose). if peak outside range adjust dose, if trough outside range adjust dose interval
66
mx major bleed inpatient on warfarin
stop warfarin
5-10mg IV vit k
prothrombin compelx
67
mx INR <6
reduce warfarin dose
68
mx INR 6-8
omit warfarin for 2d then reduced dose
69
mx INR >8
omit warfarin and give 1-5mg oral vit K
70
mx INR >5 and minor bleeding
IV vit K 1-3mg
71
STEMI mx
ABC and 15L oxygen non-rebreather mask
aspirin 300mg oral
morphine 5-10mg IV with metoclompramide
GTN spray/tablet
primary PCI or thrombolysis
B blocker (atenolol 5mg) unlesss LVF/asthma
transfer CCU
72
NSTEMI mx
ABC and 15L oxygen non-rebreather mask
aspirin 300mg oral
morphine 5-10mg IV with metoclompramide
GTN spray/tablet
clopidogrel 300mg oral and LMWH e.g. enoxaparin
B blocker (atenolol 5mg) unlesss LVF/asthma
transfer CCU
73
acute LVF max
ABC and 15L oxygen non-rebreather mask
sit patient up
morphine 5-10mg IV with metoclompramide
GTN spray/tablet
furosemide 40-80mg IV
if inadequate response, isosorbide dinitrate infusion +/- CPAP
transfer CCU
74
adverse features in arrhythmia
shock
syncope
myocardial ischaemia
HF
75
mx arrhythmia with adverse feartures
synchronised DC shock up to 3 attempts
76
mx broad QRS, regular tachyarrhytmia (likely VT)
amiodarone 300mg IV over 20-60m
77
mx SVT with BBB
adenosine 6mg, then 12mg, then 12mg
78
mx tachyarrhythmia with narrow regular QRS
vagal manoevres
adenosine 6mg rapid IV bolus, then 12mg, then 12mg
79
mx tachycarrhythmia with narrow QRS but irregular
likely AF
rate control=BB
digoxin or amiodarone if HF
80
anaphylaxis acute mx
A-E and 15L O2 non rebreath mask
remove cause
adrenaline 500mcg 1:1000 IM
chlorphenamine 10mg IV
hydrocortisone 200mg IV
asthma tx if wheeze
amend drug chart allergies
81
mx acute exacerbation asthma
A-E
100% oxygen via non rebreath mask
salbutamol 5mg neb
hydrocortisone 100mg IV if sev, 40-50mg oral pred if mod
ipratropium 500mcg neb
theophylline if life threatening
82
mx acute exacerbation COPD
A-E
100% oxygen via non rebreath mask - however ABG ASAP as may need to reduce
salbutamol 5mg neb
hydrocortisone 100mg IV if sev, 40-50mg oral pred if mod
ipratropium 500mcg neb
theophylline if life threatening
abx if infective exacerbation
83
CURB 65 criteria
confusion (AMT<8)
urea >7.5
RR >30
BP <90
age >65
84
CURB 65 interpretation
0/1 = at home
>/= 2 = at hospital
>/= 3 = consider ITU
85
pneumonia mx
A-E
high flow oxygen
abx : amoxicillin or coamox
paracetamol
IV fluids
86
PE mx
A-E
high flow oxygen
morphine 5-10mg IV and metoclopramide 10mg IV
LMWH
87
GI bleeding mx
A-E and oxygen 15L non-rebreath mask
2 large bore cannulae
catheter
crystalloid or colloid
cross match 6 units
correct clotting abnormalities
endoscopy
stop cause: nsaids, aspirin, warfarin, heparin
cal surgeons if sev
88
mx bacterial meningitis
A-E
high flow oxygen
IF fluids
dexamethasone IV
LP +/- CT head
cefotaxime IV
consider ITU
89
max seizures
A-E
recover position
oxygeb
90
mx status epilepiticus
A-E
recovery position
oxygen
lorazepam 2-4mg IV or diazepam 10mg IV or buccal midazolam IV
repeat loraz after 2m x 2
inform anaesthetist
phenytoin
intubate and propofol
91
mx acute stroke
A-E
CT head to exclude haemorrhage
consider thrombolysis
aspirin 300mg
transfer to stroke unit
92
mx hypoglycaemua (BM <3)
eat sugary snack
IV glucose 100ml 20%
if no cannular IM glucagon 1mg
93
mx hhyperglycaemia
A-E
IV fluid: 1L stat, 1L over 1hr, 1L over 2h, 1L over 4h, 1L over 8h,
sliding scale insulin
look for trigger: infection, MI, missed insulin, monitor BM/K/pH
94
mx AKI
A-E
cannula, catheter, monitor fluids
IV fluid: 500ml stat then 1L every 4h
look for cause and complications
monitor U+E and fluid balance
95
mx chronic HF
ACE i
BB
if inadequate: candesartan, isosorbide mononitrate, spironolactone
96
mx HTN
1. <55= ACEi
>55 or afrocaribean=CCB
2. ACEi and CCB
3. add indapamide
97
AF rhytm control
if young/sx/first episode/due to precipitant
cardiovery: electrical or amiodarone, need anticoag first if >48h since onset
98
AF rate control
if HR>90
BB - propanolol or rate limiting CCB - diltiazep. then add digoxin
99
anticoag AF
1=consider DOAC
2=DOAC
100
mx stable angina
GTN spray for sx
secondary prevention: aspirin, statin, reduced CV risks
anti0anginal: BB, CCB
101
mx parkinsosn
co-beneldopa or co-careldopa
unless v mild: dopamine agonist (ropinerole) or MAO i (rasagiline)
102
SE lamotrigine
rashs
SJS
103
SE carbamazepine
rash
dysarthria
ataxia
nystagmus
low Na
104
SE phenytoin
ataxia
peripheral neuropathy
gum hyperplasia
hepatotoxicity
105
SE sodium valproate
tremor
teratogenicity
wt gain
106
mx alzheimers
mild/mod= acetylcholinersterase i - donepezil
mod/sev = NMDA antagnoist - memantine
107
inducing remission in crohns
mild= oral pred
sev=hydrocortisone IV
rectal disease=rectal hydrocortisone
108
maintaining remission crohns
azathioprine
109
mx RA
methotrexate + another DMARD (sulfasalazine)
flare=Im methylpred, nsaids,
not responding to 2 DMARDS= TNF a inhibitords - infliximab
110
stool softeners
docusat sodium
used for faecal impaction
111
bulking agents
isphagula husk
takes days to work
CI=faecal impaction, colonic atony
112
stimulant laxatives
senna, bisacodyl
may exacerbate abdo cramps
CI=acute abdo
113
osmotic laxatives
lactulose, phosphate enema
may exacerbate bloating
CI enema in acute abdo
114
ramipril in pregnancy
ramipril is teratogenic on first trimester
convert to labetalol first line
115
how to take oral bisphosphonates
THE TABLET NEEDS TO BE SWALLOWED WITH A FULL GLASS OF WATER AND SHE
SHOULD REMAIN UPRIGHT FOR 30 MIN AFTERWARDS
116
insulin doses when unwell
unwell, blood glucose increases therefore higher basal doses are required. Failing to do so will
increase the risk of diabetic ketoacidosis. Conversely, if patients reduce their oral intake (which many will when
ill) there is a risk of hypoglycaemia if the insulin intake is not decreased.
117
steroids and bone density
steroids increase the risk of osteoporosis, particularly in the elderly. If a patient is predicted to take
steroid therapy for greater than 3 months (as is typical in polymyalgia rheumatica), prophylactic treatment with a
bisphosphonate (e.g. alendronic acid) is an option.
118
what does 1% mean
1 g in 100mL (or 10mg in 1mL) for weight/volume (w/v)
calculations; or
1 g in 100 g for weight/weight (w/w) calculations.
119
important units to write out in full
micrograms
units / international units
120
prescriber pnuemonic
P – patient details
Re – reaction (allergy plus the reaction)
S – sign the front of the chart
C – check contraindications to each drug
R – check route for each drug
I – prescribe intravenous fluids if needed
B – prescribe blood clot prophylaxis if needed
E – prescribe antiemetic if needed
R – prescribe pain relief if needed.
121
ADR gentamicin
Nephrotoxicity, ototoxicity
122
ADR vancomycin
Nephrotoxicity, ototoxicity
123
ADR cephalosporins, ciprofloxacin (or most broad spectrum abx)
Clostridium difficile colitis
124
ADR ACE-inhibitors, e.g. lisinopril
Hypotension, electrolyte abnormalities, acute kidney injury, dry cough
125
125
ADR Beta-blockers, e.g. bisoprolol
Hypotension, bradycardia, wheeze in asthmatics, worsens acute heart
failure (but helps chronic heart failure)
126
ADR Calcium-channel blockers, e.g.
diltiazem
Hypotension, bradycardia, peripheral oedema, flushing
127
ADR Diuretics, e.g. furosemide,
bendroflumethiazide, spironolactone
Hypotension, electrolyte abnormalities, acute kidney injury, subclass-
dependent effects
128
ADR heparins
Haemorrhage (especially if renal failure or <50 kg), heparin-induced
thrombocytopaenia
129
ADR warfarin
Haemorrhage (note that ironically warfarin has a pro-coagulant effect
initially as well as taking a few days to become an anti-coagulant; thus
heparin should be prescribed alongside warfarin and continued until the
INR exceeds 2.
130
ADR aspirin
Haemorrhage, peptic ulcers and gastritis, tinnitus in large doses
131
ADR digoxin
Nausea, vomiting and diarrhoea, blurred vision, confusion and drowsiness, xanthopsia (disturbed yellow/green visual perception including ‘halo’ vision)
changes in serum K+ at the receptor can compete with digoxin; low K+ augments digoxin effect. High levels limit the effect
132
ADR amiodarone
-Hyperthyroid
-Hypothyroid
-Pulmonary toxicity
-Raised serum transaminases
-Persistent -slate grey skin
-Phototoxicity - need to wear suncream
-Corneal microdeposits:causes glare
133
ADR lithium
Early – tremor
Intermediate – tiredness
Late – arrhythmias, seizures, coma, renal failure, diabetes insipidus
-electrolyte imbalance: particularly sodium (reduced salt intake can cause increase lithium level)
-EPSE
-hyperthyroid
-hypothyroid
-QT interval prolongation
-wt gain
134
ADR haloperidol
Dyskinesias, e.g. acute dystonic reactions, drowsiness
135
ADR clozaapine
Agranulocytosis (requires intensive monitoring of full blood count)
136
ADR dexamethasone and pred
ASSOCIATED WITH LONG TERM USE - consider secondary prevention to reduce
-GI discomfort
-cataracts
-impaired healing
-Immunosuppression
-Mood changes
-Candidiasis
-Cushings
-Increased cholesterol
-Osteoporosis
-Hyperglycaemia
-Reduced K
-Sodium retention
137
ADR fludrocortisone
Hypertension/sodium and water retention
138
ADR NSAIDs (ibuprofen)
NSAID: No urine (renal failure), Systolic dysfunction (heart failure),
Asthma, Indigestion (any cause), Dyscrasia (clotting abnormality)
139
ADR simvastatin
Myalgia, abdominal pain, increased ALT/AST (can be mild),
rhabdomyolysis (can be just mildly increased creatine kinase though)
140
drugs with a narrow therapeutic window
warfarin
digoxin
phenytoin
theophylline
141
drugs requiring careful dosage control
antiHTN
antidiabetic
142
alcohol and drugs causing GI bleed?
nonsteroidal anti-inflammatory drugs,
including aspirin and ibuprofen
143
what does alcohol and metfotmin cause
lactic acidosis
144
alcohol and which drugs increase anticaog
warfarin (with acute alcohol due to
enzyme inhibition); chronic alcohol causes
enzyme induction and thus reduces
anticoagulant effect
145
what drug interacts woth alcohol causing hypertensive crisis
monoamine oxidase
inhibitors
146
how do metronidazole and disuliram react with alcohol
Sweating, flushing, nausea and
vomiting
147
alcohol and which drugs cause sedation
barbiturates,
opioids and
benzodiazepines
148
where are opioid conversions
Prescribing in palliative care
149
prescribing warfarin
WILL NOT GET ASKED TO PRESCRIBE WARFARIN IN AN EXAM - OTHER THAN THE DAY 1 DOSE (the only thing shown in BNF=10mg)
150
best parenteral anticoag to use in PSA
enoxaparin as less options
151
best DOAC to use in PSA
rivaroxaban
152
breahtrhough dose pain relief
1/10 TO A ⅙ TOTAL 24HR DOSE)
153
how often is modified release tablet morphine given
BD
154
preventing constipaiton opiooids
movicol laxative
155
PRN morphine
can give 2-4 hourly = max doses per day
156
when is oxycodone good
renal impairment
157
CI oxycodone
resp depression, HI, chronic constipation, cor pulmonale, delayed gastric emptying, acute abdo
158
where to find insulin types
search insulin and treatment summary
159
how to approach biphasic insulin changes
Biphasic insulin changes: wherever problem is need to adjust dose 12h before. E.g. if hypo in morning need to reduce evening dose, if hyperglycaemic in evening need to increase morning dose. Usually change by approx 10%
160
SE aminophylline/theophylline
hypokalaemia
161
sx aminophylline/theophylline toxicity
N+V, agitation, restlessness, dilated pupils
162
what effects aminophylline/theophylline clearance
Clearance increased by: smoking,
Clearance reduced by: HF, liver failure, viral infections
163
where to find conversion table of steroids
SEARCH GLUCOCORTICOID IN BNF
164
how is methotrexate taken
weekly
do not take folic acid on same day
165
which abx does atorvastatin interact with
clarithromycin
withold the statin while on
166
monitoring DOAC
-Renal funct
-Baseline clotting, FBC, LFT
-?wt (for Cr clearance)
-Factor Xa - if extremes of bw or clotted on a doac
167
counselling advice DOAC
-Indication
-Dose info- explain loading regime
-Duration
-Interacting medications
-Over the counter meds to avoid-ibuprofen and aspirin
-To inform healthcare professionals - dentist
168
monitoring amiodarone
-TFT and LFT baseline and then 6m
-CXR baseline
169
counselling amiodarone
-Sunscreen
-Breathing problems
-Vision problems
-Liver toxicity- know signs
170
ADR carbimazole
-rash
-pruritus
-agranulocytosis
-bone marrow suppression
-jaundice
-acute pancreatitis
171
monitorign carbimazole
-TFT/WBC
172
counselling carbimazole
-how to recognise signs bone marrow suppression
-Effective contraception as teratogenic
-Signs acute pancreatitis
173
monitoring corticosteroids
-BP
-Wt
-Glucose
-Potassium
-triglycerides
174
counselling corticosteroids
-need a steroid emergency card: says what to do if unwell and informs medical professionals
-not to abruptly stop if: had 40mg or more pred daily for 1wk, repeat doses in evening, more than 3w tx, recently received repeated courses (especially if taken for more than 3w), short course within a yr of stopping long term
175
ADR methotrexate
-stomatitis
-stevens johnsons syndrome
-toxic epidermal necrolysis
-blood disorders
-hepatotoxicity
-interstitial pneumonitis
176
monitoring methotrexate
-FBC/LFT/U+E/eGFR/TFT: every 2w when start then every 6mly
-CXR
-pregnancy/breastfeeding as need to avoid
177
counselling methotrexate
-reduced fertility while taking
-weekly: how to take
-immediately report features of blood disorders, liver toxicity, resp effects
-avoid OTC NSAID: aspirin and ibuprofen
-alert card
-take folic acid once weekly alongside it but on a different day
178
monitoring ramipril/ACEi
-U+E
-eGFR
-BP
179
monitoring lithium
-eGFR/TFT/cardiac function
(renally excreted)
180
monitoring digoxin
-eGFR, U+E
-Dont need to routinely check serum level
181
ADR phenytoin
-gingival hypertrophy
-hirsutism
-tremor
-leukopenia
-aplastic anaemia
-blood disorders
-dyskinesia
-hepatotoxicity
-stevens johnson syndrome
-pneumonitis
182
monitoring phenytoin
-LFTs/FBC
183
ADR atorvastatin
-hepatitis
-jaundice
-interstitial lung disease
-rhabdomyolysis
184
monitoring atorvastatin
-TFT/LFT/lipid profile/eGFR
-LFT within 3m and then at 12m
185
ADR theophylline
-hypokalaemia
-N+V
-tremor
-palpitations
186
monitoring theophylline
-level after 5-7d
-U+E, LFT
-smoking
-increased monitoring if HF, alcoholics, or liver dysfunction
187
counselling theophylline
-smokers need a high dose (smoking 20-40/d), if stop need a dose reduction 20-33%
188
ADR sodium valproate
-anaemia
-hyponatraemia
-SIADH
-bone marrow failure
-pancreatitis
189
monitoring sodium valproate
-LFTs: repeat 1st within 6m
190
counselling sodium valproate
-if female need to be on a pregnancy prevention programme, however if get pregnant on it dont stop taking
-advise signs pancreatitis/liver/blood disorders
191
features hypokalaemia
muscle weakness/hypotonia/hyporeflexia/cramps/tetany, cardiac palpitations/arrhythmias
192
features hyperkalaemia
asx, muscle weakness/fatigue, cardiac palpitations/arrhythmias
193
features hyponatraemia
mild anorexia, headache, muscle cramp, irritability, seizures, confusion, reduced GCS, coma
194
features hypernatraemia
thirst, tired, confusion, irritability, seizures, coma
195
causes hypernatraemia
sodium bicarb
Steroids
Oestrogens
Sodium chloride
Androgens
liquorice
196
drugs increasing risk GI bleed
Nsaids
SSRIs
Antiplatelet: aspirin, clopidogrel
Anticoag: warfarin
Corticosteroids: pred
Bisphosphonates: alendronate, risedronate
Doxycycline
197
drugs causing wt gain
Lithium
Antipsychotics: olanzapine one of the worse
Corticosteroids
SSRIs
Sulphonylureas
Amitriptyline
Sodium valproate
insulin
198
features hypovolaemia
HR>90, systolic BP<100, non visible JVP, decreased GCS, fluid loss (bleeding/burns)
199
resus fluids adult
500ml sodium chloride 0.9% over less than 15m
200
resus fluids paeds
children= 20ml/kg less than 10mins
neonate=10-20ml/kg over less than 10m
CAN USE FOR NEONATES AND CHILDREN: 0.9% SODIUM CHLORIDE 20ML/KG OVER LESS THAN 10M
201
vol maintenance fluids adult
25-30ml/kg/d unless elderly, renal impairment, cardiac patient, malnourised at risk of refeeding syndrome when use 20-25ml/kg/d
202
electrolyte requirements adults
1mmol sodium, potassium and chloride
50-100 g /d glucose (gluc 5% contains 5g/100ml) - 1-2L day gluc 5% will fulfill needs
giv e potassium even if K currently normal, only dont if hyperkalaemic. K max 10mmol/hr. 0.15% =20mmol, 0.3%=40mol. FLUIDS AND ELECTROLYTES TX SUMMARY. Give 40mmol/L
203
caution with 5% glucose
Patients with ischaemic stroke
Severe traumatic brain injury
Impaired glucose tolerance
204
mx hypoglycaemia adults
ADULTS = Glucose 10% 150ml in 15 minutes (THINK 10% X 15MINS =150ML)
(if cant swallow
205
phosphate replacement
search phosphate and look at hypohophataemia guidance
=9mmol in 90ml!! (worked out using the above info)
206
fluids and meds considerations
If NBM consider they will be having meds IV - consider med diluents - account for this in maintenance e.g. 1g paracetamol in 100ml. IV tazocin
IV meds may contain high sodium: fosfomycin, paracetamol, benzyl penicillin
Oral effervescent tabs contain high sodium
207
mx acute dystonic rxn
procyclidine
208
how much K per day
1mmol/Kg
209
when are BB CI
PVD
210
when are ACEi CI
critical ischaemia
211
what worsens biventricular failure
corticosteroids
CCB
212
what can cause thrush
oral corticosteroids
abx
213
what to not stop abruptly
steroids as can cause adrenal crisis
214
mx scarlett fever
phenoxymethylpenicllin 10d
215
methotrexate and contraception
M nd F need during tx and for 6m after stopping
216
checking response to BB in AF
HR
217
monitoring sertraline
no bloods
218
how to manage a statin causing myopathy
if CK increased over 5x norm or sev sx then stop
if sx resolve start again at a lower dose
219
anti-emetics in post op N+V
ondansetron 1st line but can prolong QT therefore use cyclizine if risk
220
mx shingles
aciclovir
221
shingles sx
painful
well demarcated vesicular rash in dermatomal distribution
222
causes ankle oedema
amlodipine
naproxen
223
mx c diff
oral vancomycin
224
mx DKA in T1DM
stop short acting insulin
continue long actin insulin
fixed rate IV insulin
fluid resus
225
when to take loperamide
after each loose stool
226
advice starting apixaban
report bruising or other sings bleeding immediately
227
analgesia in renal impairment
oxycodone
228
mx bleeding and shock on warfarin
prothrombin complex or fresh frozen plasma
229
SE amiodarone
thyrotoxicosis - temporarily suspend amiodarone
230
common causes hyperkalaemia
dalteparin
ramipril
tacrolimus
231
when to stop aspirin before surgery
1wk before
232
stop in AKI
ACEi
ARB
allopurinol
233
SE pred
hyperglycameia
confusion
234
how to answer dosing error qs
check freq drugs
then units
then dose
235
UTI and poor renal funct
dont give nitrofurantoin in poor renal funct as it doesnt work
236
INR and surgery
if INR >1.5 on day of surgery need vit K
237
how to take rivaroxaban
with food to improve absorption
238
topiramate and hormones
progesterone only preparations are reeduced by topiramate
239
what can fluclox cause (liver)
cholestatic jaundice
240
Cr increase and ACEi
small increase (20%) normal when start
241
how to monitor furosemide tx
wt
242
monitoring carbimazole
FBC - can cause neutropenia
243
monitoring HF sx
exercise tolerance
