PSA Flashcards
(162 cards)
1
Q
Example of drug where trade name is acceptable?
A
tacrolimus- different preparations may lead to toxicity if used interchangeably
2
Q
What enzyme system metabolizes majority of drugs in the liver?
A
Cytochrome P450 enzyme system in liver
3
Q
What effect do enzyme inducers have on cytochrome P450 and consequently on drug effect?
A
Enzyme induces increase metabolism by P450 leading to reduced effect of drugs
4
Q
What effect do enzyme inhibitors have?
A
Enzyme induces reduce metabolism by P450 leading to increased effect of drugs
5
Q
PC BRAS mnemonic for enzyme inducers?
A
Phenytoin, carbamazepine, barbituates, rifampicin, alcohol (chronic excess), sulphonylureas
6
Q
AODEVICES mnemonic for enzyme inhibitors?
A
Allopurinol, Omeprazole, Disulfiram, Erythromycin, Valproate, Isoniazid, Ciprofloxacin, Ethanol (acute intoxication), Sulphonamides
7
Q
I LACK OP mnemonic for drugs to stop pre-op?
A
Insulin, Lithium, Anti-coagulants/antiplatelets, COCP/HRT, K-sparing diuretics, Oral hypoglycaemics, Perndropil and other ACEi
8
Q
Why should patients on long-term steroids have increased dose pre-op?
A
Long term steroids lead to adrenal atrophy- unable to mount adequate stress response leading to HYPOTENSION
9
Q
Should beta blockers or CCBs be stopped pre-op?
A
No, may be detrimental
10
Q
PReSCRIBER menominc for preventing pitfalls in prescribing?
A
Patient details, REaction, Sign front of chart, check for Contraindications, check Route for each drug, prescribe IV fluids if needed, prescribe Blood clot prophylaxis if needed, prescribe antiEmetic if needed, prescribe pain Relief if needed
11
Q
How do you ensure patient details are correct?
A
Write 3 pieces of info (name, DOB, hospital number), or use addressograph sticker. If amending chart, make sure it is the write patients’
12
Q
How to ensure you are aware of reactions?
A
Fill in allergy/reaction box on front of chart. If ammending- check box before prescribing
13
Q
4 groups of drugs need to be aware of contraindications for?
A
drugs that increase bleeding, steroids, NSAIDs, antihypertensives
14
Q
Drugs that increase bleeding include?
A
antiplatelets (e.g. aspirin), anticoagulant (e.g. warfarin, heparin)
15
Q
What are drugs that increas bleeding contraindicated for?
A
pts who are bleeding, suspected of bleeding or at risk of bleeding (e.g. prolonged PT in liver disease)
16
Q
STEROIDS mnemonic for steroid side-effects/contraindications?
A
Stomach ulcers, Thin skin, oEdema, Right and left heart failure, Osteoporosis, Infection incl. candida, Diabetes, Cushing’s Syndrome
17
Q
NSAID mnemonic for contraindications of NSAIDs?
A
No urine (renal failure), Systolic dysfunction i.e. heart failure, Asthma, Indigestion (any cause), and Dyscrasia (clotting abnormality)
18
Q
Which NSAID is not contraindicated for heart failure, renal failure or asthma?
A
aspirin
19
Q
Side-effect of all antihypertensives?
A
hypotension incl. postural
20
Q
Which antihypertensives can cause bradycardia?
A
beta blockers
21
Q
Which antihypertensives can cause electrolyte disturbance?
A
ACEi, diuretics
22
Q
Which antihypertensive class causes dry cough?
A
ACEi
23
Q
Which antihypertensive class causes wheeze in asthmatic/worsening of acute HF?
A
beta blockers
24
Q
Which antihypertensive class causes peripheral oedema and flushing?
A
CCBs
25
Which antihypertensive class can cause renal failure?
diuretics
26
Which specific type of diuretic can cause gout?
loop diuretics
27
Which specific type of diuretic can cause gynaecomastia?
K-sparing diuretics
28
If patient is vomiting, what route shoudl anti-emetics be given by?
not oral e.g. IV, SC, IM
29
If patient is vomiting should route of other oral drugs be changed?
no should continue as can be complicated to change everything
30
Should patients NBM still recieve oral medication?
yes including pre-op
31
Two situations in which fluid prescription is necessary?
REPLACEMENT (for dehydrated/acutely unwell patient), MAINTENANCE (patient who is NBM)
32
Which fluid is given as replacement normally?
saline 0.9%
33
If hypernatraemic/hypoglycaemic which fluid is used for replacement insead?
dextrose 5%
34
If pt has ascites what fluid is given instead?
human-albumin solution. Albumin maintains oncotic pressure- saline would worsen it
35
If shocked with systolic BP<90 which fluid is given?
gelofusine- a colloid with high osmotic content so stays intravascularly
36
If shocked from bleeding but no blood available which fluid given for replacement?
give blood transfusion but if no blood available give colloid first
37
What measures are useful for assessing how fast fluid needs to be replaced?
BP, HR, urine output
38
If tachycardic or hypotensive, what fluid needs to be given immediately?
500ml bolus (250ml if HF), then reassess pt esp. HR, BP and urine output to assess response and speed of next bag
39
If only oliguric how should fluid be given?
1L over 2-4h then reassess patient esp. HR, BP and urine output to assess response and speed of next bag
40
How much fluid loss would reduced urine output (oliguria<30mL/H, anuria) indicate?
500ml
41
How much fluid loss would reduced urine output and tachycardia indicate?
1L depletion
42
How much fluid loss would reduced UO, tachycardia and shock indicate?
2L depletion
43
As a general rule how much fluid do adults require per 24 hours for maintenance?
3L IV fluid
44
AS a general rule how much fluid do elderly require per 24 hours for maintenance?
2L IV fluid
45
What different fluids are used for maintenance to ensure adequate electrolytes?
1L 0.9% saline, 2L 5% dextrose
46
How much potassium do patients require per day?
40mmol per day e.g. 20mmol in two bags
47
What is the max rate of IV potassium delivery?
10mmol/hour
48
If giving 3L per day how fast do you give for maintenance?
8 hourly bags
49
If giving 2L per day how fast do you give for maintenance?
12 hourly bags
50
What should you monitor to check what to give patients for maintenance?
U&Es
51
How do you check the patient isn't fluid overloaded?
JVP, peripheral/pulmonary oedema
52
Why do you need to check if patient's bladder is palpable before prescribing fluids?
signifies urinary obstruction as cause of reduced urine output,
53
What sort of blood clot prophylaxis do most patients recieve in hospital?
compression stockings, LMWH (e.g. dalteparin)
54
Which patients should not be prescribed warfarin or heparin?
if patient is bleeding or at risk of bleeding- incl. recent ischaemic stroke
55
Which patients should not recieve compression stockings?
those with peripheral artery disease- can cause acute limb ischaemia
56
What antiemetics are usually given?
metoclopramide, cyclizine
57
Which patients should you avoid metoclopramide in?
a dopamine antagonist, avoid patients with Parkinson's disease due to risk of exacerbation, young women due to risk of dyskinesia i.e. unwanted movements especially due to dystonia
58
How do thiazide diuretics cause hypokalaemia?
increase K excretion in kidneys
59
What kind drug is bendroflumethiazide?
thiazide diuretic
60
How can lisinopril affect potassium?
can cause hyperkalaemia
61
What class of drugs do metoclopramide and domperidone belong to?
dopamine antagonists
62
Why is domperidone safer than metoclopramide for Parkinsons
domperidone can't cross the BBB
63
What class of drug is cyclizine?
anti-histamine antiemetic
64
How do ACEi lead to dry cough?
increased accumulation of bradyinin as less is degraded by ACE
65
How do ACEi lead to hyperkalaemia?
reduced aldosterone production->reduced K excretion in kidneys
66
How does ibuprofen cause stomach problems?
inhibits prostaglandin synthesis needed for gastric mucosal protection from acid.
67
How do oral steroids cause stomach problems?
inhibit gastric epithelial renewal thus predisposing to ulceration
68
How does ibuprofen affect kidneys?
inhibits prostaglandin synthesis which reduces renal artery diameter (and blood flow), thereby reducing kidney perfusion and function.
69
How does ramipril affect kidneys?
ACEi so reduces angiotensin II production necessary for glomerular filtration when renal blood flow is reduced
70
Causes of microcytic anaemia?
IDA, thalassaemia, sideroblastic
71
Causes of normocytic anaemia?
ACD, acute blood loss, haemolytic, renal failure
72
Causes of macrocytic anaemia?
B12/folate deficiency, excess alcohol, liver disease, hypothyroidism, myeloproliferative/myelodysplastic/multiple myeloma
73
Causes of high neutrophils?
BACTERIAL INFECTION, tissue damage (inflammation/infarct/malignancy), steroids
74
Causes of low neutrophils?
VIRAL INFECTION, CLOZAPINE, CARBIMAZOLE, chemotherapy or radiotherapy
75
Causes of high lymphocytes?
VIRAL INFECTION, lymphoma, CLL
76
Causes of low platelets due to reduced production?
infection (usually viral), DRUGS (esp. penicillamine e.g. rheumatoid arthritis treatment), myelodysplasia/myeloma/myelofibrosis
77
Causes of low platelets due to increased destruction?
HEPARIN, hypersplenism, DIC, ITP, HUS/TTP
78
Reactive causes of high platelets?
bleeding, tissue damage, post-splenectomy
79
Primary causes of high platelets?
myeloproliferative disorders
80
Causes of hypovolaemic hyponatraemia?
fluid loss esp. DIARRHOEA/VOMITING, Addison's, DIURETICS
81
Causes of euvolaemic hyponatraemia?
SIADH, psychogenic polydipsia, hypothyroidism
82
Causes of hypervolaemic hyponatraemia?
HEART FAILURE, RENAL FAILURE, liver failure (causing hypoalbuminaemia), nutritional failure (causing hypoalbuminaemia), thyroid failure (hypothyroidism can be euvolaemic too)
83
Causes of hypernatraemia?
dehydration, drips (i.e. too much saline), drugs (e.g. effervescent tablet prep or IV prep with high Na content), diabetes insipidus
84
DIRE mnemonic for hypokalaemia?
DRUGS (loop and thiazide diuretics), Inadequate intake or intestinal loss, Renal tubular acidosis, Endocrine (Cushing's/Conn's)
85
DREAD mnemonic for hyperkalaemia?
DRUGS (K-sparing diuretics and ACEi), RENAL FAILURE, ENDOCRINE (Addison's), ARTEFACT (very common due to clotted sample), DKA
86
What does raised urea indicate other than renal failure?
upper GI bleed- protein like haem is broken down to urea by gastric acid
87
How can you distinguish the above cause from renal failure?
If normal creatinine and raised urea ina patient who isn't dehydrated, look at Hb-> if this has dropped then probably an upper GI bleed
88
Cause of prerenal AKI?
dehydration (or if severe, shock) of any cause e.g. sepsis, blood loss, renal artery stenosis
89
Cause of intrinsic AKI? mnemonic- INTRINSIC
Ischaemia (due to prerenal AKI causing acute tubular necrosis), Nephrotoxic Abx (esp. gentamicin, vancomycin and tetracyclines), Tablets (ACEi, NSAIDs), Radiological contrast, Injury (rhabdomyolysis), Negatively birefringent crystals (gout), Syndromes (glomerulonephritides), Inflammation (vasculitis), Cholesterol emboli
90
Posterenal causes of AKI?
In lumen: stone or sloughed papilla. In wall: tumour (renal transitional cell), fibrosis. External pressure: BPH, prostate cancer, lymphadenopathy, aneurysm
91
How can you distinguish prerenal AKI from Intrinsic/postrenal AKI?
Urea rise is much higher than creatinine rise in prerenal.
92
LFT markers of hepatocyte injury/cholestasis?
bilirubin, ALT, AST, ALP
93
LFT markers of synthetic function?
albumin, vit K dependent clotting factors (II, VII, IX and X) measured via PT/INR
94
Prehepatic LFT derangement pattern? causes?
raised bilirubin. Caused by HAEMOLYSIS, also Gilbert's and Crigler-Najjar syndromes
95
Intrahepatic LFT derangement pattern? causes?
raised bilirubin and AST/ALT.. Fatty liver, HEPATITIS, CIRRHOSIS, MALIGNANCY, metabolic (Wilson's haemochromatosis), Heart failure (causing hepatic congestion)
96
Posthepatic LFT derangement pattern? causes?
Raised bilirubin and ALP. In lumne: gallstone, drugs causing cholestasis. In wall: tumour, PBC, PSC. Extrinsic pressure: pancreatic/gastric cancer, lymph node
97
Drugs causing cholestasis?
flucloxacillin, coamoxiclav, nitrofuratoin, steroids and sulphonylureas
98
What % width of the lungs should the heart be if cardiomegaly present on CXR?
more than 50%
99
How does effusion appear on CXR?
white area solid and unilateral
100
How does pneumonia appear on CXR?
unilateral and fluffy white
101
How does oedema appean on CXR?
bilateral and fluff whiteness
102
How does fibrosis appear on CXR?
bilateral and honeycomb white
103
What direction does trachea move in collapse? pneumothorax?
towards collapse, away from pneumothorax
104
What does widened mediastinum indicate? how do you differentiate?
right upper lobe collapse or aortic dissection. RUL collapse will have tracheal deviation
105
What do lytic lesions in bones indicate?
metastasis
106
What does not sharp costophrenic angles on CXR indicate?
pleural effusion
107
What does air under the right hemidiaphragm indicate?
bowel perforation or recent surgery
108
What does a triangle behing heart (sail sign) indicate?
left lower lobe collapse
109
What would non-clear apices on CXR indicate?
TB or apical tumour
110
ABCDE signs of pulmonary oedema?
Alveolar oedema (bat wings), Kerley B lines (interstitial oedema), Cardiomegaly, Diversion of blood to upper lobes, and pleural Effusinos
111
How can one approximately calculate PaO2 from FiO2?
minus 10
112
What is PaCO2 in Type 1 and Type 2 resp failures?
low or normal in Type 1, high in type 2
113
Causes of Type 1 resp failure?
anything damaging heart or lungs causing SOB
114
Causes of type 2 resp failure?
blue-bloaters subtype of COPD, less commonly neuromuscular failure or reactive chest wall abnormalities
115
Cause of resp alkalosis?
rapid breathing, due to disease or anxiety
116
Cause of resp acidosis?
type 2 resp failure
117
Cause of metabolic alkalosis?
vomiting, diuretics, and Conn's
118
Causes of metabolic acidosis?
lactic acidosis, DKA, renal failurem ethanol/methanol/ethylene glycol intoxication.
119
If sinus rhythm but PR interval is constant and over 1 large square what kind of HB?
1st degree
120
IF PR interval is increasing then missing QRS what kind of HB?
second degree HB type 1
121
If 2/3 P waves for every QRS what kind of heart block?
second degree HB type 2
122
If no relation between P wave and QRS complex, what kind of HB?
third degree
123
If QRS complex is more than 3 squares what does this suggest?
BBB
124
What does an elevated ST segment indicate?
infarction or pericarditis
125
What does a depressed ST segment indicate?
ischaemia, digoxin
126
What do tented T waves signify?
hyperkalaemia
127
Which leads is T wave inversion normal in?
aVR and I
128
What does T wave inversion in other leads incidcate?
old infarction/LVH
129
Common drugs requiring monitoring?
digoxin, theophylline, lithium, phenytoin, certain Abx (e.g. gentamicin, vancomycin)
130
If inadequate response to the drug and low serum drug level...?
increase dose
131
If adequate response to the drug and normal/low serum drug level?
no change required, if clinical response is adequate then aiming for therapeutic range is unnecessary
132
If adequate response to the drug and normal/low serum drug level?
decrease dose - omit drug for a few days if appropriate
133
What is zero order kinetics?
when rate of reaction/elimination is not proportional to concentration of drug e.g. phenytoin. Need to be especially care when increasing dose for drugs with this
134
3 treatments for toxicity?
stop drug, supportive measures, give antidote
135
Features of digoxin toxicity?
confusion, nausea, visual halos, arrhythmias
136
Features of lithium toxicity (early)?
tremor
137
Features of lithium toxicity (intermediate)?
tiredness
138
Features of lithium toxicity (late)?
arrhythmias, seizures, coma, renal failure, and diabetes insipidus
139
Features of phenytoin toxicity?
gum hypertrophy, ataxia, nystagmus, peripheral neuropathy, and teratogenicity
140
Features of gentamicin/vancomycin toxicity?
otooxicity and nephrotoxicity
141
Treatment of paracetamol overdose?
specfic management (NAC) and supportive management (IV fluids)
142
Where is paracetamol metabolized, what antioxidant is this reliant on?
liver reliant on glutathione
143
What toxic metabolite accumulates in paracetamol overdose causing liver damage?
NAPQI
144
What class of drugs does bumetanide belong to?
loop diuretic
145
Dose for oedema in young adults?
1mg in the moring then another dose 6-8hrs later if required
146
Dose for oedema in elderly?
500mcg daily
147
Dose for SEVERE oedema?
5mg daily
148
Contraindications for bumetanide?
anuria, comatose/precomatose states associated with liver cirrhosis, renal failure, severe hyponatraemia/hypokalaemia
149
What is lithium indicated for?
Mood stabilising drug for bipolar disorder, and refractory depression
150
What may precipitate lithium toxicity?
dehydration, renal failure, drugs (diuretics, ACEi/ARB, NSAIDs, metranidazole)
151
Features of lithium toxicity?
coarse tremor, hyperreflexia, acute confusion, seizure, coma, hypothyroidism
152
Therapeutic range of lithium?
04-1.0 mmol/litre
153
Drugs that may worsen epilepsy?
alcohol, cocaine, amphetamines, ciprofloxacin, levofloxacin, aminophylline, theophylline, bupropion, methylphenidate, mefenamic acid
154
Drugs which decrease serum potassium?
thiazide diuretics, loop diuretics, acetazolamide
155
Drugs which increase serum potassium?
ACEi, ARBs, spironolactone, K sparing diuretics, K supplements
156
Adverse effects of carbimazole?
agranulocytosis, crosses the placenta but may be used in low doses during pregnancy
157
Why do you avoid 5% glucose fluid in stroke patients?
Can cause cerebral oedema
158
How much water, potassium/sodium/chloride, and glucose do people need a day?
water: 25-30 ml/kg/day. K/Na/Cl 1mmol/kg/day. glucose: 50-100 g/day
159
When should Hartmann's not be used?
if hyperkalaemic
160
Starting dose of levothyroxine?
25mcg od
161
Side effects of thyroxine therapy?
hyperthyyroidism, reduced bone mineral density, worsening of angina, AF
162
Safe Abx in pregnancy?
penicillins, cephalosporins, trimethoprim
