PSA Flashcards
(174 cards)
1
Q
What are the 2 emergency contraception tablets?
A
Levonorgestrel
Ulipristal
2
Q
How to calculate morphine breakthrough dose?
A
1/6
3
Q
What electrolyte imbalance is seen in SIADH?
A
Hyponatraemia
4
Q
What medications can cause SIADH? (6)
A
Sulfonylureas
SSRIs
Tricyclics
Carbamazepine
Vincristine
Cyclophosphamide
5
Q
What measurements should be done at the yearly review for oral contraceptives?
A
Body mass index and blood pressure
6
Q
What classes of medication is oral thrush commonly seen?
A
Steroids
Antibiotics
7
Q
What are the approximate requirements for maintenance IV fluids?
A
25-30 ml/kg/day of water
~ 1mmol/kg/day of K, Na and Cl
~50-100g/day of glucose
8
Q
What is the first step in hypertension management for someone <55 years old, or who has T2DM?
A
An ACEI or an ARB
9
Q
What is the first step in hypertension management for someone >55 and no T2DM, or someone of afro-Caribbean ethnicity?
A
A CCB
10
Q
Why does gentamicin require close monitoring?
A
As it is ototoxic and nephrotoxic
11
Q
What gentamicin levels are measured?
A
Peak level - 1 hour after administration
Trough level - taken just before the next dose
12
Q
What should be done in gentamicin management, if the trough measurement is high?
A
Trough is taken pre-dose
If high then the interval between doses should be increases
13
Q
What should be done in gentamicin management if the peak measurement is high?
A
Peak is taken 1 hour after a dose is given
If the level is high the dose should be decreased
14
Q
What medications are taken at night? (2)
A
Statins
Amitriptyline
15
Q
What is the conversion for oral morphine to oral oxycodone?
A
divide by 1.5
16
Q
What is the conversion for oral codeine to oral morphine?
A
Divide by 10
17
Q
What is the conversion for oral tramadol to oral morphine?
A
Divide by 10
18
Q
What is the conversion for oral morphine to subcut morphine?
A
Divide by 2
19
Q
What is the conversion for oral morphine to subcut diamorphine?
A
Divide by 3
20
Q
What is the conversion for oral oxycodone to subcut diamorphine?
A
Divide by 1.5
21
Q
How to convert micrograms to milligrams?
A
Divide by 1000
e.g. 150mcg = 0.15mg
22
Q
If a patient presents with a paracetamol OD 8-24 hours after ingestion with an OD of BLANK, give NAC even if plasma concentration is not available yet
Fill in the BLANK
A
150mg/kg
23
Q
If a patient on long-term steriods becomes ill, what should happen to their steriod dose?
A
It should be doubled
24
Q
What is INR?
A
International Normalised Ratio
A measure of how long it takes for blood to clot
25
What dose an increased INR mean?
It takes longer for blood to clot
26
What do inhibitors of the P450 system do to INR and warfarin?
P450 inhibitors increases INR
This potentiates the action of warfarin and leads to an increase in its anticoagulant effect
27
What are some factors that potentiate warfarin? (5)
Liver disease
P450 enzyme inhibitors
Cranberry juice
Drugs that displace warfarin from the plasma albumin e.g. NSAIDs
Drugs that inhibit platelet function e.g. NSAIDs
28
What is the frist line drug for SVT?
Adenosine
29
What is the first line drug for someone with asthma in SVT?
Verapamil
30
DAMN AKI
Drugs that should be stopped in AKI
Diuretics
ACEIs/ARBs
Metformin
NSAIDs
31
In critically ill patients, at what rate should oxygen be give?
15 litres Via a resovior mask
32
If the question stem doesn't give a concentration of a drug for a calculation, where is this information found?
BNF > Medicinal forms
33
Where in the BNF can information regarding insulin preperations be found (e.g. long acting, short acting insulin examples)
BNF > Treatment summaries > Insulin
34
Prior to the avalibility of blood gases, what is the dose of oxygen used in oxygen therapy in someone with COPD
28% venturi mask at 4l/min
Aim for sats of 88-92% if there are risk factors for hypercapnia
Adjust for sats of 94-98% if PCO2 normal
35
When prescribing insulin, how should it be written on a drug chart?
Always write UNITS, never just put u
36
What drugs should be prescribed in Angina?
1. Statin and aspirin if no contraindications
2. GTN spray for angina attacks
3. Beta blockers or CCB first line
37
What drugs are contraindicated in heart failure? (4)
- Thiazolidinediones (pioglitazone can cause fluid retention)
- Verapamil - has a negative inotropic effect
- NSAIDs/Glucocorticoids - can cause fluid retention, low dose aspirin is exception
- Class I anti-arrythmics e.g. flecanide
38
What drug should be used in VTE prophylaxis for someone with renal failure?
Unfractioned heparin
39
What drugs can be given for VTE prophylaxis?
LMWHs
Dabigatran
Rivoroxaban
Apixaban
Fondaparinux
Unfractioned heparin
40
What are some examples of LMWH?
Enoxaparin
Dalteparin
41
What opiod is a good option in patients with CKD?
Fentanyl
42
Where in the BNF can you find opiod conversion rates?
BNF > Medicines guidence > Prescribing in palliative care
43
What drugs should be used with caution in COPD and asthma? (3)
NSAIDs
Beta-blockers
Adenosine
44
How long prior to surgery are antiplatelet drugs (e.g. aspirin) stopped?
7 days prior to surgery
45
What max dose does the BNF recommend for allopurinol in renal dysfunction?
As allopurinol can accumulate in renal dysfunction, the BNF recommends a max daily dose of 100mg until function improves
46
What antibiotic for UTIs should be avoided, where the eGFR is <45mil/min?
Nitrofurantoin
47
What antibiotic is preferred for a UTI if there is renal impairment?
Trimethoprim
48
What drugs can be given to manage alcohol dependence?
Long-acting benzodiazepine
Chlorodiazepoxide hydrochloride or diazepam
49
How many days before elective surgery should warfarin be stopped?
5 days
50
In warfarin patients who have stopped their medication prior to elective surgery, what should be given if the INR is >1.5?
Phytomenadione (vitamin K)
51
What kind of diuretics are spironolactone and eplerenone?
Potassium sparing
K+ should be monitored at initiation of drug especially at risk groups e.g. elderly, CKD, DM
52
What should be monitored in patients taking beta blockers for AF?
HR should be measured to assess response to treatment
The primary aim of a beta blocker therapy in AF is rate control
53
If there is any clinical evidence of infection in a patient taking carbimazole, what should be done?
A FBC
Carbimazole can cause neutropenia
54
How is renal function monitored in patients taking a ciclosporin?
Serum creatinine
Blood pressure
Serum ciclosporin
55
How are nanograms converted to micrograms?
Divide by 1000
1 nanogram = 0.001 micrograms
56
What is a drug that can be used to treat obesity?
Orlistat - a lipase inhibitor that reduces the absorption of dietary fat
57
What is the reversal agent for benzodiazepines?
Flumazenil
58
What is the medication of choice for migraine prophylaxis?
Propranolol
2nd line = amitriptyline, topiramate, sodium valproate
59
What is the first line treatment for myasthenia gravis?
Pyridostigmine - and AChE inhibitor
60
What is an alternative to dex in croup if IV access is difficult?
Nebulised budesonide
61
What is the treatment of acute otitis media?
First line = amoxicillin
Second line = erythromycin or clarithromycin
62
What is the first line treatment for hypoglucaemia?
1mg Glucagon IM
63
In what scenarios might IM glucagon be ineffective?
If liver glycogen is depleted e.g. prolonged fasting, chronic hypoglycaemia, alcohol induced hypoglycaemia
Less effective if patient is taking sulfonylureas e.g. gliclazide
64
Why is glucose 50% infusion not recomended?
It is hypertonic and viscous which makes administering the drug difficult - causes irritation
65
What is the management of a tension headache?
Simple analgesia e.g. paracetamol
66
What is the treatment of acute pulmonary oedema?
High dose IV diuretics
e.g. IV Furosemide 40mg STAT
67
What is the treatment for suspected bacterial meningitis/ meningococcal sepsis in a child < 3 months?
IV cefotaxime and IV amoxicillin
68
What is the treatment for suspected bacterial meningitis/ meningococcal sepsis in a child > 3 months?
IV ceftriaxone
69
What should be given as chickenpox PEP in pregnant people?
Oral aciclovir
Give from day 7-14 post exposure prophylaxis
70
What is the most important piece of safety information for patients taking Ciprofloxacin?
Seek medical attention if ankle or calf pain develops
Cipro can cause tendonitis and tendon rupture
71
What is the treatment for fungal nail infection where topical treatments have failed?
oral Terbinafine
72
What is the treatment for an acute relapse of MS?
Methylprednisolone
73
What are some examples of PPIs?
Lansoprazole
Omeprazole
74
What is the antibiotic treatment for C.Diff?
1st line = Vancomycin
2nd line = Fidaxomicin
75
What can be prescribed to treat breathlessness at the end of life?
Morphine
76
What can be used to treat breathlessness at the end of life if there is associated anxiety?
Diazepam
77
What is the treatment for bacterial vaginosis?
Metronidazole
78
What is an antiplatelet used prior to PCI?
Prasugrel
79
What should be checked before staring a patient on indapamide?
Potassium level
Is a thiazide like diuretic and can cause hypokalaemia
80
Why is oxycodone a good alternative for pain relief in renal impairment?
Metabolised by the liver into inactive metabolites which makes it appropriate in renal impairment
81
How are the effects of warfarin reversed?
Phytomenadione (Vit K)
Dried prothrombin complex
82
What anti-emetic is contraindicated in QT-interval prolongation?
Ondansetron
83
What should be given and at what rate if a patient needs IV fluid resus?
A crystalloid that contains Na (130-154mmol/l) with a bolus of 500ml
Give STAT (15 mins or less)
84
What are some crystalloid fluids used in fluid resus?
NaCl 0.9%
Plasma-lyte 148
Ringer's solution
Hartmann's
85
What antibiotic is given in life-threatening C.Diff infection?
Metronidazole IV
86
Why is IV vancomycin not given in C.Diff?
It doesn't pass into the gut
87
What is the treatment of DKA?
Fixed rate insulin infusion
Fluid resus
Continue long-acting insulin
88
What is the treatment for scarlet fever?
Phenoxymethylpenicillin
89
What drugs are used to treat extrapyramidal side effects (e.g. oculogyric crisis) and anti-psychotic induced parkinsonism?
Anticholinergic drugs e.g. Procyclidine
90
What advice should be given if 1 pill is missed in someone taking the COCP at any time in the cycle?
Take the missed pill now, even if that means taking 2 pills in a day, and then carry on taking pills as normal
No additional contraception needed
91
Whats the advice for someone who misses 2+ COCPs in days 1-7 of the pack?
Take the last pill, even if it means 2 pills in 1 day, leave any earlier missed pills, then continue as normal 1 each day
Condoms or abstain from sex until taken pill for 7 days in a row
Consider emergency contraception if had unprotected sex in the pill free interval or during week 1
92
Whats the advice for someone who misses 2+ COCPs in days 8-14 of the pack?
Take the last pill, even if it means 2 pills in 1 day, leave any earlier missed pills, then continue as normal 1 each day
Condoms or abstain from sex until taken pill for 7 days in a row
After 7 consecutive days of taking the pill there is no need for any emergency contraception
93
Whats the advice for someone who misses 2+ COCPs in days 15-21 of the pack?
Take the last pill, even if it means 2 pills in 1 day, leave any earlier missed pills, then continue as normal 1 each day
Condoms or abstain from sex until taken pill for 7 days in a row
Finish pills in current pack, the run on next pack, omitting the pill free interval
94
0.5-6.5% of penicillin allergic patients are also allergic to what other antibiotic class?
Cephalosporins
95
What class are the following antibiotics - cefixime, cefotaxime
Cephalosporins
Note the cef prefix
96
What class do the following brand named antibiotics belong to?
Augmentin
Magnapen
Tazocin
Timentin
Penicillins
97
Sulphonylureas such as gliclazide can have what effect on blood sugar levels?
Hypoglycaemia
98
What is the medical treatment for urge incontinence?
Oxybutynin
Tolterodine
Darifenacin
99
In a frail older women with urge incontinence, what treatment should be avoided?
Oxybutynin
100
In frail elderly patients with urge incontinence, what treatment can be used if there are concerns about anticholinergic side effects?
A Beta-3 agonist such as Mirabegron
101
What is the medical treatment for stress incontinence?
Duloxetine
102
What can be searched for to determine which drugs may have acid reflux as a side effect?
Dyspepsia
Reflux
Gastro
103
What does 3% solution mean?
3g in 100ml
3000mg in 100ml
30mg in 1ml
104
What does 2% solution mean?
2g in 100ml
2000mg in 100ml
20mg in 1ml
105
What adrenaline dose is given in a cardiac arrest?
1mg - 1 in 10000 IV
(100 micrograms/ml)
106
What dose of adrenaline is given in anaphylaxis?
500 micrograms - 1 in 1000 IM (1mg/ml)
107
What are the 3 broad categories of fluids?
Resus
Replacement
Routine (maintenance)
108
What are resus fluids?
Fluids needed urgently to correct hypovolaemia
109
What are replacement fluids?
Given in electrolyte derangement or dehydration
Prescribed to patients with difficult-to-estimate requirements due to pre-existing losses or electrolyte abnormalities or ongoing losses or complex current issues (e.g. heart failure)
110
What are routine fluids?
Fluids given to meet the daily requirements of water and electrolytes
111
How much glucose is in a glucose 5% bag?
5g of glucose per 100ml
112
What fluid bags can potassium be added to?
Added separately to dextrose and NaCl
113
How much NaCl is in a bag of sodium chloride 0.9%?
154 mmol of NaCl
114
What type of fluid is 0.9% NaCl and what are its typical indications?
Isotonic
Resus or Maintenance
115
Are hypotonic fluids more or less hydrating than isotonic?
Less
116
What type of fluid is Hartmann's and what are its typical indications?
Isotonic
Resus and maintenance
117
What type of fluid is 5% dextrose and what are its typical indications?
Hypotonic
HYPERnatraemia
HYPOglycaemia
118
What type of fluid is 3% saline and what are its indications?
Hypertonic
Severe Hyponatraemia
119
What is the maximum dose of potassium per litre of fluid?
Cannot be prescribed >40mmol/litre
e.g. if you are giving a 500ml bag of fluid, the max dose of potassium that can be added is 20mmol
120
What is the maximum rate that potassium can be infused at?
Cannot exceed a rate more than 10mmol/hour
E.g. If giving 40mmol of K (1 litre bag of fluids) this must be infused over 4 hours
121
How much potassium is in a litre of Hartmann's?
5mmol
122
What electrolytes should be checked before giving fluids with glucose?
Sodium
Can cause/worsen hyponatraemia
123
In an emergency, how fast should resus fluids be given?
15 mins/ STAT
124
Over how long should maintenance fluids be given?
8-12 hourly
125
In patients who are dehydrated/ AKI/ HYPOkalaemic, over how long should fluids be given?
4-6 hourly
126
In frail/elderly patients, or patients at risk of overload, over how long should fluids be given?
1 litre bag, 10-12 hourly
127
What is given for the prevention of pre-eclampsia in at-risk women?
Aspirin (75-150mg PO daily)
128
What is given for agitation/delirium in palliative patients?
Haloperidol
129
What is given for the treatment of impetigo?
Topical hydrogen peroxide cream 1%
130
What are 2 medications that are typically prescribed weekly?
Bisphosphonates e.g. Alendronate
Methotrexate
131
What 2 drug types are prescribed in heart failure that improve prognosis?
ACE inhibitor
Beta blocker
132
What can be given in patients with renal failure to prevent contrast induced nephropathy?
IV sodium chloride 0/9%
Give at a rate of 1ml/kg/hour for 12 hours pre- and post-procedure
133
What are the target O2 sats for acutely ill patients?
94-98%
134
What are the target O2 sats for patients at risk of hypercapnia?
88-92%
135
What class of antibiotics is used to treat whopping cough and give some examples?
Macrolides
- Clarithromycin
- Erythromycin
- Azithromycin
136
What is the treatment for head lice?
Dimeticone
Malathion
137
What is the treatment for scabies?
Permethrin 5% cream
Treatment summaries > Skin infections
138
What does asthenia mean?
Generalised weakness
139
Why should Lamotrigine and the COCP not be prescribed together?
Lamotrigine decreases the efficacy of the COCP meaning additional methods of contraception are required
The COCP also decreases the efficacy of Lamotrigine, increasing the likelihood of seizures occurring
140
True or False?
Changing the preparation of lithium (e.g. from tablets to liquid) requires a dose change?
TRUE
Different preparations have different bio-availabilities
141
What is the treatment of choice for a C.Diff infections that occurs within 12 weeks of symptom resolution of a previous C.Diff infection (relapse)?
Fidaxomicin
142
What is the treatment of choice for a C.Diff infection that occurs more than 12 weeks after symptom resolution of a previous C.Diff infection (resolution)?
Vancomycin
2nd line = fidaxomicin
143
What PPI should be prescribed in someone with GORD who is on clopidogrel?
Lansoprazole
(Omeprazole can reduce efficacy of clopidogrel)
144
What medications should be started in a diabetic patient with confirmed nephropathy (ACR of >3mg/mmol) even if BP is normal?
An ACEI or an ARB
Ramipril
Lisinopril
Losartan
145
What is clomifene?
A selective oestrogen receptor modulator that induce ovulation in people with anovulatory cycles
146
In what doses can alendronic acid be prescribed?
10mg daily
70mg weekly
147
What is the management of blepharitis if symptoms are not controlled by eyelid hygiene alone?
Chloramphenicol ointment
148
What is the main aim of beta blockers in the treatment of atrial fibrillation?
Rate control
Measuring heart rate will assess response to treatment
149
What dose the BNF recommend to treat breathlessness and oedema associated with CHF?
Furosemide
Bumetanide
Torasemide
150
What is the 1st line treatment for gonorrhoea?
Ceftriaxone IM
151
What should be monitored throughout insulin-glucose infusion?
Capillary blood glucose
Risk of hypoglycaemia
152
What is co-prescribed with isoniazid to prevent peripheral neuropathy?
Pyridoxine - Vitamin B6
153
What is the 1st line treatment for bites?
Co-Amoxiclav
154
What ECG change may be seen in patients taking ondansetron?
QT prolongation
155
What can be prescribed to treat nausea and vomiting in patients with Parkinsons?
Domperidone
156
What anti-emetics should be avoided in patients with Parkinsons?
Anti-dopaminergic anti-emetics such as metoclopramide
Anti-histamines such as cyclizine
157
What is the antibiotic treatment for mastitis?
1st line = Flucloxacillin 10-14 days
2nd line = Erythromycin 10-14 days
158
What should be used in the rapid tranquilisation in acute delirium in a patient with Parkinsons?
Lorazepam 1mg IM STAT
159
What can be prescribed to reduce respiratory secretions in palliative care?
Hyoscine Butylbromide
160
What can excessive alcohol intake do to blood sugars that people with diabetes should be aware of?
Excessive alcohol intake can cause life-threatening hypoglycaemia by reducing hepatic gluconeogenesis
161
What is the treatment for a DVT or PE?
Apixaban or Rivaroxaban
162
How is neutropenic sepsis treated?
Piperacillin with tazobactam (Tazocin)
Or if pen allergic - ceftazidime
163
What is a typical maintenance fluid given to paediatric patients?
An isotonic crystalloid with 5% glucose
e.g. 0.9% saline with 5% glucose
164
What is the Holliday-Segar formula, used to calculate rates of infusion in paediatrics?
100ml/kg/day for the first 10kg
50ml/kg/day for the next 10kg
20ml/kg/day for any remaining weight
E.g. a 25kg child requires 1000ml + 500ml + 100ml = 1600ml
165
What electrolyte change can aldosterone antagonists such as spironolactone and eplerenone, cause?
Hyperkalaemia
166
Where can I check if a drug dose needs to be changed according to renal function?
Go to renal impairment and then dose adjustments
167
Where in the BNF can I find guidance on INR levels and anticoagulants?
Treatment summaries > oral anticoagulants
168
What is the classic toxidrome of opioid toxicity?
Pin-point pupils
Respiratory depression
Loss of consciousness
169
What is the antibiotic treatment for tonsilitis?
1st line = phenoxymethylpenicillin
2nd line = clarithromycin
170
What is the first line treatment for warts?
Salicylic acid
171
What beta blockers can be used to improve mortality in HF?
Bisoprolol
Carvedilol
Nebivolol
172
What is the treatment for oral thrush?
Fluconazole (preferred in immunocompromised)
Miconazole gel
Nystatin
173
What is the first line treatment choice for BPH with bothersome symptoms?
Tamsulosin Hydrochloride
174
What dose a 0.025% solution mean?
25mg per 100ml of active ingredient
250mg per 1000ml
