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Daisy Finals Revision > PSA > Flashcards

PSA Flashcards

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1
Q

what is the mnemonic for drugs that need to be stopped pre surgery?

A

I LACK OP
Insulin
Lithium
Anticoagulants
COCP/HRT
K-sparing diuretics
Oral hypoglycaemic agents
Perindopril (ACE-is)

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2
Q

what does the PReSCRIBER mnemonic stand for?

A

Patient details
Reactions
Sign the front of the chart
Contraindications
Route
IV fluids
Blood clot prophylaxis
antiEmetics
pain Relief

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3
Q

when should anti-platelets and anticoagulants not be given?

A

patients who are bleeding, suspected of bleeding, or at risk of bleeding

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4
Q

when should prophylactic heparin not be given in the IP setting?

A

(generally) it shouldn’t be given in acute ischaemic stroke

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5
Q

which drugs are enzyme inducers?

A

PC BRAS
Phenytoin
Carbamazepine
Barbituates
Rifampicin
Alcohol (chronic)
Sulfonylureas

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6
Q

what is the effect of enzyme inducers on other drugs?

A

inc enzyme activity
-> dec drug concentration

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7
Q

which drugs are enzyme inhibitors?

A

AO DEVICES
Allopurinol
Omeprazole
Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol (acute)
Sulphonamides

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8
Q

what is the effect of enzyme inhibitors on other drugs?

A

dec enzyme activity
-> inc drug conc

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9
Q

what are the side effects of steroids?

A

STEROIDS
Stomach ulcers
Thin skin
oEdema
Right and left heart failure
Osteoporosis
Infection
Diabetes(hyperglycaemia)
Syndrome - cushings

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10
Q

what safety considerations should be remembered for NSAIDS?

A

NSAID
No urine (renal failure)
Systolic dysfunction (heart failure)
Asthma
Indigestion
Dyscrasia (clotting abnormality)

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11
Q

what are the 3 categories of side effects of antihypertensives?

A

a. hypotension (all)
b. 2 mechanisms:
1. BBs/CCBs can cause bradycardia
2. ACE-is and diuretics can cause electrolyte disturbance
c. individual classes have specific s/es:
ACE-is eg ramipril - dry cough
BBs - wheeze in asthmatics, worsening of acute HF
CCBs eg amlodipine - peripheral oedema
diuretics - renal failure
thiazides Ds - gout
K-sparing Ds eg spiro - gynaecomastia

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12
Q

what fluid should be given in most patients for fluid replacement?

A

0.9% saline

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13
Q

what fluid should be given in hypernatraemic or hypoglycaemic patients for replacement?

A

5% dextrose

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14
Q

what fluid should be given in patients with ascites for replacement?

A

HAS

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15
Q

what fluid should be given in patients shocked from bleeding (replacement)?

A

blood transfusion
crystalloid first if no blood available

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16
Q

how much fluid should be given to a tachycardic or hypotensive patient?

A

500ml bolus (250 if hx of HF)
then reassess

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17
Q

how much fluid should be given to a patient who is not tachy/hypotensive but is oliguric?

A

1L over 2-4h then reassess

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18
Q

how can fluid depletion be estimated clinically?

A

reduced urine output - 500ml fluid depletion
reduced urine output plus tachy - 1L fluid depletion
red UO plus tachy plus shocked - 2L +

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19
Q

what is the maximum rate that IV potassium should be given?

A

10mmol/hour

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20
Q

how much fluid should be given as maintenance?

A

3L most adults, 2L /day elderly
3L - give 8hourly bags, 2L - give 12 hourly bags

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21
Q

when should a patient not be prescribed anti-embolic stockings?

A

peripheral arterial disease

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22
Q

when should metoclopramide be avoided?

A

parkinsons disease - exacerbation of sx
young women - risk of dyskinesia

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23
Q

what should be prescribed for a nauseated pt?

A

regular antiemetic
cyclizine 50mg 8 hourly IM/IV/PO - avoid in HF
metoclopramide 10mg 8 hourly IM/IV if HF
ondansetron 4mg or 8mg 8 hourly IV/PO

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24
Q

what should be prescribed for a patient who is not nauseated?

A

PRN antiemetic
cyclizine 50mg up to 8 hourly IM/IV/PO - avoid in HF
metoclopramide 10mg up to 8H IM/IV if HF

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25
what pain relief should be prescribed for a patient with no pain?
PRN paracetamol 1g 6h PO
26
what pain relief should be prescribed for a patient with mild pain?
regular paracetamol 1g 6H PRN codeine 30mg up to 6h PO
27
what pain relief should be prescribed for a patient with severe pain?
co-codamol 30/500 2 tablets 6h PO PRN morphine 10mg/5ml, 10mg up to 6H PO (then SC then IV if needed)
28
what to be aware of with paracetamol
ensure they aren't on it 4hourly (max dose is 4g/day) ensure they arent on both paracetamol and co-codamol
29
what is the max dose of paracetamol in patients <50kg?
500mg 6hourly
30
why might cyclizine need to be reviewed in a confused elderly patient?
anticholinergic effects -> can cause confusion and drowsiness
31
what are the most important results of an FBC?
Hb, WCC, plt
32
what are the main causes of hypernatraemia?
Ds dehydration drips drugs diabetes insipidus (opposite of siadh)
33
causes of hyponatraemia: hypovolaemic
fluid loss (D+V) addisons diuretics
34
causes of hyponatraemia: euvolaemic
SIADH psychogenic polydipsia hypothyroidism
35
causes of hyponatraemia: hypervolaemic
HF renal failure liver failure (hypoalbuminaemia) nutritional failure (hypoalbumin) nutritional failure thyroid failure
36
what are the causes of SIADH?
SIADH Small cell lung tumours Infection Abscess Drugs (esp carbamazepine and antipsychotics) Head injury
37
what are the causes of hypokalaemia?
DIRE Drugs (loop and thiazide diuretics) Inadequate intake or intestinal loss Renal tubular acidosis Endocrine (cushings and conns)
38
what are the causes of hyperkalaemia?
DREAD Drugs (potassium sparing diuretics and ACE-is) Renal failure Endocrine (addisons) Artefact DKA (insulin given - drops K, need replacement)
39
what are the 3 types of AKI?
pre-renal (70%) intra/intrinsic renal (10%) post-renal (20%)
40
what are the causes of pre-renal AKI?
dehydration/shock - sepsis, blood loss renal artery stenosis
41
what biochemistry is seen in pre-renal AKI?
urea rise >> creat rise eg Ur 19, Creat 110
42
what are the causes of intra renal AKI?
INTRINSIC Ischaemia (due to prerenal aki - causing ATN) Nephrotoxic abx Tablets (ACEI, NSAIDs) Radiological contrast Injury (rhabdomyolysis) Negatively birefringent crystals (gout) Syndromes (glomerulonephritis) Inflammation (vasculitis) Cholesterol emboli
43
What are the causes of postrenal AKI?
lumen - stone or sloughed papilla wall - tumour, fibrosis external pressure: BPH, prostate ca, lymphadenopathy, aneurysm
44
what biochemistry is seen in intrarenal AKI?
urea rise<
45
what biochemistry is seen in post-renal AKI?
urea rise << creat rise eg Ur 9, Creat 342 bladder or hydronephrosis may be palpable
46
what are examples of nephrotoxic abx?
gentamicin, vancomycin, tetracyclines
47
how wide should the QRS complex be?
<3 small squares
48
what do wide QRS's indicate?
BBB -> then do william marrow
49
what does 1st degree HB look like?
prolonged but constant PR interval
50
what does 2nd degree type 1 HB look like?
increasing then missing QRS then increasing again
51
what does 2nd degree type 2 HB look like?
2 or 3 p waves per QRS
52
what does 3rd degree (complete) HB look like?
no relationship between P and QRS
53
what does st elevation indicate?
infarction - st flat and raised in some leads pericarditis - st convex and raised in all leads
54
what does st depression indicate?
flat and in some leads - infarction or ischaemia - check trop digoxin - down sloping in all leads
55
what does tall t waves indicate?
more than 2 thirds of QRS height, throughout ecg - hyperkalaemia
56
what does t wave inversion indicate?
normal in aVR and I (top middle two) other leads - old infarction/LVH
57
which LFTs are indicators of hepatocyte injury or cholestasis?
bilirubin ALT/AST alkaline phosphatase
58
which LFTs are indicators of synthetic function?
albumin vit d dependent clotting factors - II, VII, IX and X (2,7,9,10) - measured via PT and INR
59
LFT changes in PREhepatic problems?
inc bilirubin
60
LFT changes in INTRAhepatic problems?
inc bili and inc AST/ALT
61
LFT changes in POSThepatic problems?
inc bili and inc ALP
62
prehepatic causes of deranged lfts?
haemolysis gilbert's and crigler-najjar syndrome
63
intrahepatic causes of deranged lfts?
fatty liver hepatitis cirrhosis malignancy metabolic heart failure
64
posthepatic causes of deranged lfts?
gallstones drugs causing cholestasis (fluclox, co-amox, nitrofurantoin, steroids, sulfonylurea tumours, PBC, sclerosing cholangitis panc cancer, gastric cancer lymph nodes
65
TFT results in primary hypothyroidism?
Low t4, raised TSH
66
TFT results in secondary hypothyroidism?
low t4 low TSH
67
TFT results in primary hyperthyroidism?
raised t4 low tsh
68
TFT results in secondary hyperthyroidism?
raised t4 raised tsh
69
what are the causes of primary hypothyroidism?
hashimotos thyroiditis, drug induced
70
what are the causes of secondary hypothyroidism?
pituitary damage or damage
71
what should be done to thyroxine dose if TSH <0.5?
decrease dose
72
what should be done to thyroxine dose if TSH is 0.5-5?
nothing
73
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75
what should be done to thyroxine dose if TSH >5?
increase dose
76
77
What are the features of digoxin toxicity?
Confusion, nausea, visual halos, arrhythmias
78
What are the early intermediate and late signs of lithium toxicity?
Early - tremor Intermediate - tiredness Late - arrhythmias, seizures, coma, renal failure, diabetes insipidus
79
What are the features of phenytoin toxicity?
Gum hypertrophy, ataxia, nystagmus, peripheral neuropathy, teratogenicity
80
What are the signs of gentamicin toxicity?
Ototoxicity and nephrotoxicity
81
What are the signs of vancomycin toxicity?
Ototoxicity and nephrotoxicity
82
what is the management for PE?
high flow oxygen morphine + cyclizine IV LMWH eg tinzaparin 175 units/kg daily (IP)
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90
What are the adverse effects of gentamicin and vancomycin?
Nephrotoxicity Ototoxicity
91
What are the common adverse effects of ace-inhibitors?
Hypotension Electrolyte abnormalities AKI Dry cough
92
What are the common adverse effects of beta blockers?
Hypotension Bradycardia Wheeze in asthmatics Worsens acute HF (helps chronic)
93
What are the common adverse effects of CCBs?
Hypotension Bradycardia Peripheral oedema Flushing
94
What are the common adverse effects of diuretics?
Hypotension Electrolyte abnormalities AKI Others depending on subclass
95
What are the common adverse effects of heparins?
Haemorrhage Heparin induce thrombocytopenia
96
What are the common adverse effects of warfarin?
Haemorrhage
97
What are the common adverse effects of aspirin?
Haemorrhage Peptic ulcers and gastritis Tinnitus (high dose)
98
What are the common adverse effects of digoxin?
Nausea D + v Blurred vision Confusion and drowsiness Xanthopsia
99
What are the common adverse effects of amiodarone?
Interstitial lung disease Thyroid disease Skin greying Corneal deposits
100
What are the common adverse effects of haloperidol?
Dyskinesias Drowsiness
101
What are the common adverse effects of clozapine?
Agranulocytosis
102
What are the common adverse effects of dexamethasone and prednisolone?
Stomach ulcers Thin skin Edema Right and left HF Osteoporosis Infection Diabetes Cushing Syndrome
103
What are the common adverse effects of fludrocortisone?
Hypertension Sodium and water retention
104
What are the common adverse effects of ibuprofen?
NSAID No urine Systolic dysfunction Asthma Indigestion Dyscrasia (clotting dysfunction)
105
What are the common adverse effects of statins?
Myalgia Abdo pain Inc ALT/AST Rhabdomyolysis
106
Which statins are highest risk for myalgia?
Most>least Simvastatin > atorvastatin > pravastatin > fluvastatin
107
Which common drugs have narrow therapeutic indexes?
Warfarin Digoxin Phenytoin Theophylline
108
Which common drugs require careful dosage control?
Antihypertensives Anti diabetic drugs
109
What are the most common enzyme inhibitors?
Ketoconazole Ciprofloxacin Erythromycin GRAPEFRUIT JUICE
110
What drug causes lactic acidosis?
Metformin
111
What drugs cause hypertensive crises?
Monoamine oxidase inhibitors
112
What drugs cause increased anticoagulation?
Warfarin with acute alcohol Chronic alcohol reduces anticoagulant effect
113
Which drugs most commonly cause sedation?
Barbiturates Opioids Benzodiazepines
114
Which drugs most commonly cause sweating, flushing, nausea and vomiting?
Metronidazole Disulfiram
115
Why should patients taking clozapine seek medical advice if constipation develops?
Fatal risk of intestinal obstruction, faecal impaction and paralytic ileus
116
What should be advised to patients taking mirtazapine?
Risk of agranulocytosis - seek medical advise if infective symptoms
117
what precaution should be advised to patients taking amiodarone?
phototoxic reactions - avoid direct sunlight and wear suncream
118
which medication should be given to a child with symptoms of meningitis before transfer to hospital?
benzylpenicillin IM or IV
119
what should be given to a child with croup who is too unwell to receive oral medications/sig resp distress?
nebulised budesonide
120
what is the dose of nebulised salbutamol for a child?
2.5mg (-5mg)
121
which medications tend to be given in the morning?
diuretics steroids
122
which medications tend to be given at night?
statins night sedation
123
which medications tend to be given with meals?
insulin creon
124
which medications tend to be given weekly?
bisphosphonates (check dose) methotrexate/folic acid patches
125
which medications are most likely to cause hypoglycaemia?
insulin sulphonylureas
126
which medications are most likely to cause hyperglycaemia?
steroids antipsychotics thiazides beta blockers tacrolimus
127
which medications are most likely to cause constipation?
Opioids, iron, CCBs (amlodipine, verapamil), some diuretics, some antiemetics (ondansetron, metoclopramide), some antiepileptics, some Parkinson’s medications, antacids that contain calcium, anticholinergics (antidepressants, antihistamines, incontinence medications, antipsychotics)
128
which medications are most likely to cause diarrhoea?
antibiotics colchicine metformin PPIs antacids containing magnesium laxatives
129
which medications are most likely to cause urinary retention?
opioids, anticholinergics
130
which medications are most likely to cause urinary incontinence?
alpha blockers, diuretics, anticholinesterase inhibitors, clozapine
131
which medications are most likely to cause confusion?
opioids sedatives anticholinergics
132
which medications are most likely to cause falls?
benzos antidepressants (TCAs and SNRIs) MAO antipsychotics opiates most antihypertensives PD meds antiepileptics hypoglycaemics
133
which medications are most likely to cause gout?
diuretics
134
which medications are most likely to cause osteoporosis?
steroids PPIs LHRH agonists (bureslin, goreslin)
135
which medications are most likely to cause hypertension?
NSAIDs, steroids, oral contraceptives, mirabegron
136
which medications are most likely to cause high cholesterol?
steroids, thiazides
137
which medications are most likely to cause hypokalaemia?
loop diuretics thiazides steroids salbutamol
138
which medications are most likely to cause hyperkalaemia?
K sparing diuretics ACE-is ARBs unfractionated heparin/lmwh blood transfusion
139
which medications are most likely to cause hyponatraemia?
SSRIs TCAs carbamazepine opiates PPIs
140
which medications are most likely to cause hypernatraemia?
lithium demeclocycline
141
which medications should be continued if intercurrent illness?
steroids (double)
142
which medications should be stopped if intercurrent illness?
metformin statins gliflozins
143
which medications should be stopped if trying to conceive?
some antiepileptics some antipsychotics isotretinoin methotrexate warfarin
144
which medications should be stopped prior to surgery?
DOACs (48h) clopidogrel (7d) warfarin (bridging)
145
which medications are most likely to worsen PD?
antipsychotics - haloperidol antiemetics - metoclopramide antidepressants
146
which medications are most likely to worsen myasthenia gravis?
antibiotics beta blockers local anaesthetic sedating drugs
147
which medications are most likely to worsen psoriasis?
beta-blockers lithium some antibiotics
148
which medications are most likely to worsen heart failure?
NSAIDs CCBs thiazolidinediones (pioglitazones)
149
150
Tablet HRT for uterus intact LMP LESS than 12 mo ago ?
Elleste duet 1mg or 2mg
151
Patch HRT for uterus intact and LMP LESS than 12 mo ago?
Evorel sequi

Daisy Finals Revision (25 decks)

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