PSA

Question 1

mnemonic for review

Answer 1

P - patient details
Re - reactions/allergies
S - sign
C - contraindications
R - route
I - IV fluids?
B - blood clot proph
E - emetic (anti)
R - relief (pain)

Question 2

what drugs need to be stopped before surgery and when

Answer 2

I LACK OP
insulin - variable
lithium - day before
antiplatelets/coagulants - variable
COCP/HRT - 4 weeks before
K sparing antidiuretics - day of

oral hypoglycaemics
Perindopril + ACEi

Question 3

name some enzyme inducers = drugs conc decrease

Answer 3

PC BRAS
phenytoin
carbamezapine
barbituates
rifampicin
alcohol chronic
sulphonylureas

Question 4

name some enzyme inhibitors = drug conc increase

Answer 4

AO DEVICES
allopurinol
omeprazole
disulfuram
erythromycin
valproate
isoniazid
ciprofloxacin
ethanol
sulphonamides

Question 5

what 4 groups of drugs are commonly contraindicated and why

Answer 5

1. anticoagulants in active bleeding
2. steroids
   Stomach ulcers
   Thin skin
   Edema
   Right/left HF
   Osteoporosis
   Infection
   Diabetes
   Syndrome Cushings
   3.NSAIDS
   No urine
   Systolic dysfunction
   Asthma
   Indigestion
   Dyscrasia
3. antihypertensives

Question 6

describe the common side effects of antihypertensives

Answer 6

1. bradycardias (BB, CCB)
2. electrolyte disturbances (ACEi/diuretics)
3. specific SEs

Question 7

when should IV normal saline NOT be given

Answer 7

hypernatraemic or hypoglycaemic
= give 5% dextrose

ascites = give human albumin sollution

shock from haemorrhage = give blood

Question 8

what rate should IV potassium be given

Answer 8

no more than 10mmol/hour

Question 9

how much fluids and potassium do adults generally need

Answer 9

3L per 24hrs
elderly 2L per 24hrs
40mmol KCl per dayw

Question 10

what antiemetics to give a nauseated patient

Answer 10

cyclizine 50mg 8 hourly (causes fluid retention)
metoclopromide 10mg 8 hrly
ondansetron 4mg 8 hourly

Question 11

what antiemetics to give a NON nauseated patient

Answer 11

cyclizine 50mg 8 hrly
metoclopromide 10mg 8 hrly

Question 12

who should NOT get metoclopramide

Answer 12

pt with parkinsons
young women
= dyskinesia

Question 13

what analgesic is first line in neuropathic pain

Answer 13

amitriptyline or pregabalin

Question 14

what antihypertensives cause hypERkalaemia + other causes

Answer 14

ARBs and ACEi
renal failure
addisons
DKA

Question 15

what antihypertensives cause hypOkalaemia + other causes

Answer 15

thiazide diuretics
loop diuretics
D+V
renal tubular acidosis
conns/cushings

Question 16

what drugs can cause renal impairment

Answer 16

NSAIDs
ACEi
lithium
immunosuppressants

Question 17

what drugs should you be careful of in the elderly - confusion etc

Answer 17

oxybutinin
opioids
cyclizine
benzodiazepines

Question 18

what drugs need to be stopped in infection

Answer 18

methotrexate

Question 19

causes of normocytic anaemia

Answer 19

chronic disease
acute blood loss
haemolytic anaemia
renal failure

Question 20

causes of macrocytic anaemia

Answer 20

B12/folate def anaemia
excess alcohol
liver disease

Question 21

causes of low neutrophils

Answer 21

viral infection
clozapine
carbimazole

Question 22

causes of SIADH

Answer 22

small cell lung tumours
infection
abscess
drugs - carbamezapine and antipsychotics
head injury

Question 23

name 3 nephrotoxic antibiotics

Answer 23

gentamycin
vancomycin
tetracyclines

Question 24

what does it indicate if there is a urea rise&raquo_space; creatinine risk

Answer 24

pre-renal AKI

Question 25

what does it indicate if there is a urea rise << creatinine rise

Answer 25

intrinsic renal AKI postrenal

Question 26

what does a raised urea but normal creatinine indicate

Answer 26

upper GI bleed !!

Question 27

what does a raised bilirubin but normal LFTs suggest

Answer 27

prehepatic = haemolysis

Question 28

what does a raised bilirubin + raised AST/ALT suggest

Answer 28

intrahepatic = hepatitis = cirrhosis = malignancies

Question 29

what does a raised bilirubin and raised ALP suggest

Answer 29

posthepatic = stones = tumours

Question 30

what is the target TSH level

Answer 30

0.5 -5

Question 31

things to check when looking at ABG

Answer 31

FiO2 - if patient on O2 - 10 from % PaO2 should be higher if not pt = hypoxic

Question 32

what drugs have a narrow therapeutic index so need close monitoring

Answer 32

digoxin theophylline lithium phenytoin gentamycin/vancomycin

Question 33

what drugs can affect sleep

Answer 33

corticosteroids = give in morning

Question 34

how to prescribe for short term insomnia

Answer 34

good sleep hygiene CBT hypnotics = lowest dose for shortest time zopiclone 7.5mg once daily at bedtime (half dose in elderly)

Question 35

what is: femodette zoely katya 30/75 microgynon 30 ED

Answer 35

COCP

Question 36

what is climanor

Answer 36

progesterone only contraceptive

Question 37

what contraceptives can NOT be used if taking carbamezapine

Answer 37

COCP because oral = enzyme inducers will affect it take sayana press instead = parenteral route

Question 38

management of HTN in pregnancy

Answer 38

stop ACEi before pregnancy labetalol is first line

Question 39

what to be communicated about tamoxifen

Answer 39

VTE risk, look out for signs

Question 40

what to communicate about gliclazides

Answer 40

take in the morning with breakfast dont miss meals = risk of hypos

Question 41

what to communicate about methotrexate

Answer 41

take once a week 1-2 weekly blood tests for FBC take folic acid to limit toxicity

Question 42

describe warfarin tablets

Answer 42

0.5mg = white 1mg = brown 3mg = blue 5mg = pink

Question 43

what to communicate about ACEi

Answer 43

1-2 weeks after starting = U+Es caution taken when vomiting or diarrhoea = risk of AKI

Question 44

what to communicate about steroids

Answer 44

increases risk of hyperglycaemia increase risk of OP = need bisphosph increased risk of gastric irritation never stop suddenly = addisonian crisis increased risk of HTN

Question 45

what to communicate about SSRIs

Answer 45

citalopram = more sensitive to sunlight caution about suicidal ideation fever, agitation and hallucinations = seratonin syndrome

Question 46

can alendronic acid and calcium be taken at the same time

Answer 46

no calcium reduces the uptake of bisphosphonates

Question 47

what to communicate about HRT

Answer 47

increased risk relates to duration of use risk returns to non HRT levels after 5 years of stopping