PSA Flashcards
(139 cards)
1
Q
How do you treat a hypo if the patient has an unsafe swallow
A
75ml 20% glucose over 15 minutes
2
Q
How do you treat a hypo in an alcoholic
A
As normal but they also need thiamine
3
Q
Which groups of patients is IM glucagon not effective in for treating a hypo
A
prolonged fasting
Alcohol induced hypo
Adrenal insufficiency
Sulphonylurea induced hypo
4
Q
How do you manage HHS
A
1L 0.9% saline over 1 hour
5
Q
How do you manage DKA
A
0.1unit/kg/hour insulin (50 units actrapid in 50ml saline)
500ml fluid bolus if BP<90 (maintenance fluids if not)
10% glucose once glucose <14
6
Q
What two drug used in the treatment of hyperkalaemia need to be given via different access points
A
calcium and sodium bicarb form an insoluble precipitate if given through the same port
7
Q
Allergic ADR to ACE-i
A
angioedema - this can occur months down the line
8
Q
what other abx should be prescibed with caution in penicillin allergic patients
A
cephalopsorines - cefalexin, cefuroxime, ceftriaxone
carbopenems - meropenem
9
Q
can fentanyl be prescribed to a morphine allergic patient?
A
yes and vice versa
10
Q
what drugs are prescribed in micrograms
A
levothyroxine
digoxin
11
Q
ADR of acetylcystine and what to do about it
A
bronchospasm and rash
give chlorphenamine and salbutamol
restart acetylcystine at a slower rate
12
Q
ECG changes in TCA OD
A
long QT
wide QRS
13
Q
Presentation of a TCA OD
A
hot, red, dry, blind, mad
hypokalaemia
respiratory depression
14
Q
estimate of a child’s weight
A
(age +4) x2
15
Q
do you dose gentamicin according to the patients actual or ideal body weight
A
ideal if they are obese
16
Q
how do you treat AKI + sepsis + metabolic acidosis
A
sodium bicarbonate 1.26%
17
Q
how does dabigatran effect PT/INR, APTT and thrombin time
A
prolonged APTT and thrombin time
18
Q
how does rivaroxaban effect PT/INR, APTT and thrombin time
A
prolonged PT/INR
19
Q
how does apixaban effect PT/INR, APTT and thrombin time
A
It doesn’t. Measure anti-Xa assay
20
Q
How would you start someone on a DOAC
A
riv/apix don’t require LMWH
dab/edox require 5 days LMWH then stop LMWH and start doac i.e. NO bridging.
21
Q
What common medications are cautioned in DOAC patients
A
CI: aspirin and clopidogrel (unless ACS)
caution: SSRIs
22
Q
How do you manage a bleeding patient on a DOAC
A
TXA, FFP
dabigatran has a reversal agent
23
Q
when can you restart a DOAC following surgery
A
12-48 hours depending on operation
24
Q
How does LMWH effect coagulation tests
A
it doesn’t. Measure anti-xa assay
25
What common medications are cautioned in LMWH patients
NSAIDs
| ACE-i and diuretics as risk of hyperkalaemia
26
How is unfractionated heparin monitored
APTT
27
how do you reverse unfractionated heparin
protamine
28
what analgesia should you avoid in pregnancy
NSAIDs and opioids
29
How long and what dose of folic acid is required in patients on antiepileptics
12 weeks of 5mg
30
emergency contraception in a patient on antiepileptic
copper IUD
| double dose of levonorgestrel
31
Diabetes management in pregnancy
metformin is the only oral agent allowed
| switch to insulin
32
Cardiovascular management in pregnancy
STOP: ACE-i, ARB, statins
START: labetalol, nifedipine, methyldopa
33
thyroid management in pregnancy
requirements are increased
34
drugs that lower the seizure threshold/provoke seizures
NSAIDS and tramadol
SSRIs, haloperidol, clozapine, benzos
ciprofloxacin
cyclizine
35
what contraception is acceptable in a patient on antiepileptics
IUD, IUS, depot
36
how would you start someone on morphine
IR morphine sulphate PRN up to 4 hourly. Once stable switch to MR preparation BD.
generally 10mg BD and 5mg PRN
37
If someones pain isn't controlled how much would you increase their morphine by
30%
38
Name some indications and contraindications for specific oral diabetes medications
pioglitazone contraindicated in HF and hepatic impairment
| CKD patient: generally gliclazide first instead of metformin
39
generally how much insulin would you start someone on
0. 5 units/kg for adults
| 0. 3 units/kg for elderly
40
ADR of dapaglifozine (SGL2 inhibitor)
DKA
41
how would you set up a VRII
49.5ml saline + 0.5ml 50 units insulin into a syringe to get 1 unit/ml
42
What fluids are given alongside a VRII
0.45% NaCl, 5% dextrose, 0.15% K (20mmol)
43
How do you convert from VRII back to normal regime
insulin/oral agent given
meal
wait 30 minutes
remove VRII
44
How do you alter long acting insulin regimes before surgery
drop to 80% of the normal the day before and day of
45
How do you alter steroid regimes prior to surgery
give 25mg IV hydrocortisone at induction
| give 100mg IV hydrocortisone over following 24 hours
46
what shouldn't be co-prescribed with verapamil
b-blockers (including ocular preparations such as timilol)
47
2 ototoxic drugs that shouldn't be co-prescribed
aminoglycosides and loop diuretics
48
which drug can cause lithium toxicity
ACE-i (reduce GFR so reduced excretion)
49
Which drugs can cause digoxin toxicity
verapamil
statins
amiodarone
liquorice (due to causing hypokalaemia)
50
ADR/interactions with St John Wart
reduced effect of warfarin and COCP
SSRIs = serotonin syndrome
MAOIs = hypertensive crisis
51
drugs/classes you should use with caution in liver impairment and why
risk of encephalopathy: constipating (opioids), electrolyte disturbance (diuretics), agitation and sedation (benzos/antipsychotics)
clotting abnormalities: anticoag/antiplatelets, thrombocytopenia (valproate)
Varices/haemorrhage: NSAIDs
Ascites: fluids retention (NSAIDs, steroids), fluids
52
contraception in over 40's
POP
implant
IUS
53
contraception alongside HRT
IUS can protect endometrium if oestrogen only regime
| POP in combined HRT
54
postpartum contraception
nothing for 21 days
COCP not <6 weeks and breastfeeding
IUS and IUD either <48 hours or >4 weeks
POP anytime
55
Things to remember about POP
irregular bleeding
| effected by enzyme inducing drugs
56
Things to remember about implant
Any BMI (if obese replace early in 3rd year)
irregular bleeding
effected by enzyme inducing drugs
57
Things to remember about depot injection
takes a year for fertility to return
| CI in adolescents as risk of osteoporosis
58
Things to remember about IUS
good for heavy bleeding
59
Things to remember about IUD
effective immediately
60
postpartum emergency contraception
day 21-28: EllaOne
| >28 days: EllaOne or IUD
61
ACE-i are cautioned in who
PVD
atherosclerosis
asthmatics (not on BNF)
warn diabetics about risk of hypo's
62
who needs a statin for primary prevention
10 year risk >10%
| T2DM for >10 years OR >40 OR nephropathy
63
statins are contraindicated in who and interact with what?
pregnancy and intracerebral haemorrhage
| erythromycin and clarithromycin - STOP the statin whilst on abx
64
ADR of loop and thiazide
```
loop = gout and alkalosis
thiazide = gynaecomastia and impotence
```
65
what electrolyte abnormalities can cause digoxin toxicity
```
hypokalaemia
hypomagnesaemia
hypernatremia
hypercalcaemia
acidosis
```
66
maximum paracetamol dose
1g 6 hourly
67
what electrolyte abnormality can bisphosphonates lead to
hypocalcaemia
68
when can bisphosphonates be stopped
after 5 years if...
age <75
T score >-2.5
low FRAX risk
69
drugs causing hyponatraemia
```
SSRI
TCA
carbamezapine
sulphonylureas
vincristine
cyclophosphamide
```
70
pre-surgery when do you stop ACE-I and K sparing diuretics
day of
71
where in the BNF do you find where to convert different steroid therapies
"glucocorticoid therapy"
72
common drugs CI with methotrexate
trimethoprim
co-trimoxazole
aspirin
73
management of methotrexate toxicity
folinic acid
74
how do you prescribe blood
1 unit at a time on 1 line
"packed red cells"
1 unit over 2 hours
75
ADR of citalopram
prolonged QT
| SIADH
76
indication for fluoxetine or sertraline over citalopram
fluoxetine - teenagers
| sertraline- post MI
77
a patient is on warfarin and needs an anti-depressant, what do you prescribe
NOT SSRI
| Give mirtazapine
78
a patient is on an SSRI and needs ibuprofen for joint pain, what do you need to remember
PPI as increased bleeding risk
79
how do you go about stopping an SSRI
6 months of symptoms resolution then reduce dose over 4 weeks
80
Causes of lithium toxicity
hyponatremia
renal failure, dehydration, ACE-I/ARB, thiazides
NSAIDs
metronidazole
81
how do you manage lithium toxicity
rehydrate
| dialysis
82
important bits about clozapine
```
needs dose adjustment according to smoking status
agranulocytosis
lowers seizure threshold
constipation
myocarditis
```
83
how to find antipsychotics in the BNF
"psychoses"
84
ADR of antipsychotics
```
extrapyramidal: tardive dyskinesia, dystonia, akathisia, parkinsonism
impaired glucose tolerance
prolonged QT
stroke and VTE risk in elderly
NMS
reduced seizure threshold
sedation and weight gain
antimuscarinic - pee, see, spit, shit
postural hypo
impotence
```
85
how do you treat neuroleptic malignant syndrome
dantrolene
| bromocriptine
86
which patients would you not use pioglitazone in
HF
87
which patients would you use a sulphonylurea first over metformin
normal/low weight
| raised creatinine
88
what regime is used for DKA
Fixed rate of 0.1 unit/kg/hr
You use a 50 unit/50ml syringe typically
therefore rate is 0.1ml/kg/hr
89
complications of DKA management
hypokalaemia
| cerebral oedema - monitor GCS
90
metformin is CI when creatinine reaches. Why
150
| risk of lactic acidosis
91
what blood result would indicate diabetic nephropathy and therefore what needs monitoring
microalbuminaemia
| albumin-creatinine ratio
92
how do you step down benzo's and where in the BNF do you find this info
change to equivalent dose of diazepam then reduce this to zero
"anxiolytics and hypnotics"
93
Outline how you go from morphine to fentanyl
you can add equivalent patches together. So for 90mg morphine
30mg = 12 patch
60mg = 25 patch
therefore give 37 patch
94
Which hospital patients would you not give dalteparin to?
Ischaemic stroke patients - they can bleed into the stroke
95
when would you give FFP
if PT/APTT >1.5x normal
96
when would you give platelets
count <50
97
what contraception should a patient on enzyme inducing drugs avoid
Progesterone
98
what oestrogen is used for COCP and HRT
```
COCP = ethinylestradiol
HRT = estradiol
```
99
in the BNF how would you look up information on the ring or patch contraception
```
ring = nuvaring
patch = Evra
```
100
how do you avoid getting a bleed whilst on COCP
use a continuous regime i.e. taking packets back to back
101
describe cyclical and continuous HRT
cyclical: progesterone taken for last 14 days of each cycle
continuous: progesterone taken constantly
102
in which women is a continuous HRT regime not suitable
if <12 months since last bleed as causes irregular bleeding
103
How is the VTE risk of HRT minimsed
patch instead of oral
104
Risks associated with HRT
```
breast cancer
endometrial cancer
ovarian cancer
Stroke and VTE
IHD
```
105
progesterone HRT increases the risk of which HRT risks
```
breast cancer (especially if continuous regime)
VTE
```
106
When do you stop HRT before surgery
4-6 weeks
107
How would you look up endometriosis and dysmenorrhoea treatment in the BNF
"sex hormones"
108
how do you manage vasomotor symptoms of menopause
fluoxetine or citalopram
109
how do you manage vaginal dryness in menopause
estriol - vaginal lubricant
110
What drugs should you be wary of in myasthenia?
Loads so check the BNF if they have a history of MG. Particularly careful with aminoglycoside abx, other abx, b-blockers, neuro/psych drugs
111
what drugs should you be wary of in epilepsy?
```
ciprofloxacin
amino/theophylline
mefenamic acid
methylphenidate
amphetamines
```
112
What drugs should you be wary of in HF
pioglitazone
NSAIDs and steroids
flecainide
verapamil
113
what should you do if a HYPOthyroid patient presents with...
TSH<0.5
TSH>5
<0.5: reduce dose of levothyroxine as you've overtreated
| >5: increase dose
114
management of hyperkalaemia
10 units of actrapid in 100ml of 20% dex over 30 minutes
115
causes of hyponatraemia
diuretics
carbamezapine
citalopram
116
causes of neutropenia
clozapine
| carbimazole
117
causes of thrombocytopenia
heparin
| penicillamine
118
starting dose of statins for primary prevention
20mg (BNF says 20mg so remember this one!)
119
how can aspirin affect the blood
iron deficiency anaemia
120
drugs that cause urinary retention
NSAIDs and opioids
Benzodiazepines
anticholinergics and antihistamines
CCBs
121
drugs that cause confusion
```
opioids
metoclopramide
antidepressants and psychotics
anticonvulsants
anticholinergics
(steroids, NSAIDs, B-blockers, digoxin)
```
122
what drugs can worsen statin induced myalgia
enzyme inhibitors
123
drugs that cause anaphylaxis
NSAIDs
Abx
IV iron infusion
morphine
124
what is an indication for stopping HRT
BP rise >160/95
125
What Hb level would indicate a need for transfusion
>70
| or <80 in ACS
126
maximum K infusion rate
10mmol/hr
127
in hyperkalaemia if there are still ECG changes after a first dose of calcium chloride what can you do
repeat every 15 minutes up to 50ml i.e. 5x
128
presentation of lithium toxicity
muscle weakness
| polyuria and polydypsia
129
when would you consider stepping down asthma treatment
symptoms controlled for 3 months
130
what are the BP targets in HTN
<140/90
| unless age >80 then it's <150/90
131
what anti--hypertensives do diabetics start on
ACE-i regardless of age or ethnicity
132
first line POP
desogestrel (long pill free period in case of missed pill)
133
what fluids should you prescribe to a stroke patient
not glucose (risk of cerebral oedema)
134
where would you find info on sepsis in children
"blood infection"
135
what drugs should be stopped in PVD
CI: b-blockers
caution: ACE-I
136
blood glucose levels diagnostic of diabetes
fasting >7
random >11
HbA1C >48 (6.5%)
137
post-op fluids
often omit K unless it is low (K released from cell lysis in surgery so likely to be raised)
138
what may be causing low BP and urine output in a HF patient
dehydration
| overload + LVF
139
which fluids should you use in liver failure
5% dextrose
| saline worsens ascites
