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PSA condensed Flashcards

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1
Q

what are 6 cytochrome P450 inducers?

A

PC BRAS

Phenytoin
Carbamazepine

Barbiturates
Rifampicin
Alcohol (chronic use)
Sulphonylureas/St john’s wart

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2
Q

what are 9 cytochrome P450 inhibitors?

A

AO DEVICES

Allopurinol
Omeprazole

Disulfram
Erythromycin
Valporate
Isoniazid
Ciprofloxacin
Ethanol (acute intoxication)
Sulphonamides

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3
Q

what are 7 side effects of steroids?

A

STEROIDS

Stomach ulcers
Thin skin
Edema
Right (+L) heart failure
Osteoporosis
Infection
Diabetes
Syndrome, Cushings

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4
Q

what are 5 contraindications to NSAIDS?

A

NSAIDS

No urine
Systolic dysfunction (HF)
Asthma
Indigestion
Dyscrasia - clotting dysfunction

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5
Q

what is one side effect of loop diuretics?

A

gout

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6
Q

what is one side effect of potassium sparing diuretics?

A

gynaecomastia

spironolactone

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7
Q

what is a good general antiemetic to prescribe?

A

Cyclizine 50mg 8 hourly IM/IV/PO

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8
Q

what is one important side effect of cyclizine?

A

fluid retention
contra-indicated in heart failure

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9
Q

what is a good all round antiemetic to use in heart failure?

A

metoclopramide 10mg 8 hourly IM/IV

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10
Q

when can metoclopramide not be used?

A

PARKINSONS

or lewy body dementia

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11
Q

what is the normal range for sodium?

A

135 - 145 mmol/L

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12
Q

what are 4 causes of hypernatraemia

A

Ds

Dehydration
Drips - too much NaCl
Drugs - effervesants/IVs with lots of sodium
Diabetes insipidus

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13
Q

what are 3 causes of hypovolaemic hyponatraemia?

A

Fluid losses
Addisons
Diuretics

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14
Q

what are 3 causes of euvolaemic hyponatraemia?

A

SIADH
Psychogenic polydipsia
Hypothyroid

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15
Q

what are 5 causes of SIADH?

A

SIADH

Small cell lung cancer
Infection
Abscess
Drugs - carbamezapine, antipsychotics
Head injury

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16
Q

what are 5 causes of hypervolaemic hypernatraemia?

A

Heart failure
Renal failure
Liver failure - hypoalbuminaemia
Nutritional deficiency - hypoalbuminaemia
Thyroid failure

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17
Q

what is the normal range of potassium?

A

3.5-5.0

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18
Q

what are 4 causes of hypokalaemia?

A

DIRE

Drugs - loop and thiazide diuretics
Inadequate intake/intestinal losses
Renal tubular acidosis
Endocrine - cushings, conns

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19
Q

what are 5 causes of hyperkalaemia?

A

DREAD

Drugs - ACEI, potassium sparing diuretics
Renal failure
Endocrine - Addisons
Artefact
DKA

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20
Q

what are 2 medications that can cause thrombocytopenia?

A

Penicillamine
Heparin

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21
Q

what are 3 nephrotoxic antibiotics?

A

gentamicin
vancomycin
tetracyclines

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22
Q

what are 9 intrinsic causes of AKI?

A

INTRINSIC

Ischaemia - causing acute tubular necrosis
Nephrotoxic antibiotic
Tablets - NSAIDs, ACEI
Radiological contrast
Injury - Rhabdo
Negatively bifringent crystals (gout)
Syndromes - glomerulonephritises
Inflammation - vasculitises
Cholesterol Emboli

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23
Q

what are 5 medications that can causes cholestasis (and therefore raised Alk Phos)?

A

Flocloxacillin
Coamoxiclav
Nitrofurantoin
Steroids
Sulphonylureas

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24
Q

How is thyroxine dosing changed based off TSH?

A

TSH < 0.5 => decrease thyroxine dose
TSH 0.5-5 - no change
TSH >5 => Increase thyroxine dose

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25
How do you assess the quality of an x-ray?
RIPE Rotation Inspiration - 7th anterior rib should transect diaphram Projection Exposure - all fields visible, vertebrae visible behind heart
26
How do you calculate expected PaO2 of a patient on O2 on an ABG?
FiO2 minus 10
27
what are 6 medications with a narrow therapeutic range than require serum monitoring?
Digoxin Theophylline Lithium Phenytoin Gentamicin Vancomycin
28
what are 4 features of digoxin toxicity?
Confusion Nausea Visual Halos/yellowing of vision Arrhythmias
29
what are 8 features of lithium toxicity?
Early - tremor Intermediate - tiredness Late - Arrythmias seizures coma renal failure diabetes insipidus
30
what are 2 features of gentamicin and vancomycin toxicity?
ototoxicity nephrotoxicity
31
what are 5 features of lithium toxicity?
Nausea + Diarrhoea confusion/drowsiness blurred vision Polyuria and polydipsia shaking, muscle weakness, spasms - coarse tremor difficulty speaking
32
what happens if dose >48h section on gentimicin normogram?
repeat gent level and do not redose till <1 mg/L
33
what is the usual INR target ?
2.5
34
what is the INR target for metallic heart valves or recurrent VTE on warfarin?
3.5
35
what is the management of INR >8 and major bleed?
Stop warfarin Vitamin K (phytomenadione) Prothombin complex
36
what is the management of INR >8 minor bleed?
Stop Warfarin Vitamin K (phytomenadione)
37
what is the management of INR >8 no bleed?
Stop warfarin Vitamin K (phytomenadione) Repeat Vitamin K (phytomenadione) if still high after 24h
38
what is the management of INR 5-8 with minor bleed?
Stop warfarin Vitamin K (phytomenadione) restart warfarin when INR <5
39
what is the managment of INR 5-8 no bleed?
Withhold 1/2 doses of warfarin Reduce subsequent doses
40
How many mmol of sodium are there in 1L 0.9% NaCl?
150 mmol (also quoted at 154)
41
How many mmol of potassium are there in 1L of 0.3% KCl?
40 mmol
42
How many mmol of potassium are there in 1L of 0.15% KCl?
20 mmol
43
How many grams of glucose are in 1L of 5% glucose?
50g
44
How quickly can potassium solutions be given?
10 mmol/h 0.3% KCl - 4 hours min 0.15% KCl - 2 hours min
45
what are daily water requirements?
25-30 ml/Kg/day
46
what are daily sodium, potassium and chloride requirements?
1 mmol/kg/day
47
what are daily glucose requirements?
50-100g/24h
48
what are adult resus fluids?
NaCl 0.9% 500ml 10 mins
49
what is the management of emergency hypoglycaemia? (fluid)
Glucose 20% 100ml 15 mins
50
what is the management of emergency hypokalaemia?
NaCl 0.9%/KCl 0.3% 1000ml 4h
51
what is the management of emergency Hypercalcaemia?
NaCL 0.9% 1000ml 4h
52
what is maintenance fluids in someone without deficits or losses?
25-30ml/kg/day water 1 mmol/kg/day Na + K 50-100g glucose
53
what maintenance fluids are needed with deficits and losses?
30ml/kg/day water min ensure electrolyte replacement 1000ml every 4-6 hours
54
what are resus fluids in children?
NaCl 0.9% 10 ml/kg 10 minutes
55
what is maintenance fluids for children?
100 ml/Kg <10kg 50 ml/kg 10-20kg 20ml/kg >20kg
56
what are 2 diabetes medications that may cause weight gain?
Thiazolidinedione - pioglitazone Slufonylureas - Gliclazide
57
what is the MOA of Metformin (biguanides)?
improves insulin sensitivity in liver/muscles and helps suppress hepatic gluconeogenesis
58
what is the MOA of DDP4 inhibitors (-gliptins)?
incretin effect - makes body produce more insulin
59
what is the MOA of sulfonylureas (gliclazide)
enhances insulin secretion
60
what is the MOA of thiazolidinediones (pioglitazone)
improves insulin sensitivity in liver/muscles and helps suppress hepatic gluconeogenesis
61
what is the MOA of SGLT2 inhibitors (-gliflozens)?
reduce renal glucose reabsorption
62
what is the MOA of GLP-1 analogues (eventide, semaglutide)?
incretin effect
63
what is the MOA of alpha-glucosidase inhibitors (acarbose)?
reduce intestinal glucose absorption
64
what are 3 side effects of metformin?
Nausea diarrhoea metformin associated lactic acidosis - caution in eGFR <45, stop <30 No effect on weight
65
what are 2 side effects of DDP4 inhibitors (linagliptin)?
pancreatitis nasopharyngitis
66
what are 5 side effects of thiazolidinediones (pioglitazone)?
oedema heart failure post-menopausal osteoporosis bladder cancer weight gain
67
what are 3 side effects of sulfonylureas (gliclazide)?
hypoglycaemia Cholestasis weight gain
68
what are 2 side effects of SGLT2 inhibitors?
Euglycaemic ketoacidosis Genital infections
69
what are 3 side effects of GLP-1 analogues (semaglutide)?
nausea diarrhoea pancreatitis weight loss
70
what are 3 side effects of alpha-glucosidase inhibitors (acarbose)?
bloating flatulence diarrhoea
71
what diabetes measurement needs to be done in people with high RBC turn over?
frutosamine
72
what are 6 presentations of hypocalcaemia?
CATs go Numb Convulsions Arrythmias Tetany Numbness Trousseaus sign Chvostek's sign Long QT
73
what is the management of hypocalcaemia?
Calcium gluconate 10% 10-20ml 10 mins
74
what is the management of hyperkalaemia?
Calcium gluconate 10% 30ml 10mins
75
what is the 1st line management of addisonaian crisis?
Hydrocortisone 100mg IM/IV
76
what is the management of meningococcal septicaemia in community?
Benzylpenicillin IM
77
what is the management of meningococcal septicaemia in community in someone with pen allergy?
2g cefotaxime IM
78
How much insulin should be given if blood glucose >15?
4 units of novorapid
79
what is the management of insulins for surgery?
reduce long acting by 20% stop all other insulin
80
what antiemetic should be used for vertigo, motion sickness and vestibular disorders?
Cyclizine
81
what antiemetic should be used post-operatively?
ondansetron
82
what antiemetic should be used for acute chemo nausea?
ondansetron
83
what antiemetic should be used for delayed chemo nausea?
metoclopramide
84
what antiemetics should be used in palliative care?
cyclizine haloperidol levopromazine
85
what antiemetic should be used in Parkinson's?
domperidone
86
what antiemetic is used in hyperemesis gravidum?
promethazine
87
what is one immunosuppressant that can cause hyperkalaemia?
Tacrolimus
88
How long before surgery should antiplatelets be stopped?
7 days Including high dose aspirin
89
what is the 1st line management of acute alcohol withdrawl?
1 - Chlordiazepoxide 20mg PO 6 hourly thiamine is SECOND
90
what is the preferred benzo in alcohol withdrawal in hepatic failure?
lorazepam
91
How long before surgery should warfarin be stopped?
5 days
92
what INR is required before surgery?
INR <1.5
93
what antibiotic can cause jaundice?
Flucloxacillin More common in elderly and in Men
94
what rise in creatinine is acceptable when starting an ACEI?
< 20%
95
How much should a statin have reduced LDL after 3 months of treatment?
>40% in any non-HDL cholesterol
96
How long after dose should digoxin levels be taken?
minimum 6 hours post dose
97
what is the monitoring requirement for statin safety?
LFTs Baseline 3 months 12 months
98
what safety monitoring is required for ACEIs?
U+E Prior to treatment Dose change Annually
99
what safety monitoring is required for amiodarone?
TFTs, LFTs, U+E, CXR - before initiation TFTs + LFTs 6monthly
100
what safety monitoring is required for methotrexate?
LFT, U+E, FBC weekly till stabilised then 3 monthly
101
what safety monitoring is required for azathioprine?
FBC + LFT pre treatment FBCs weekly first 4 weeks FBC + LFT 3 monthly
102
what safety monitoring is required for lithium?
TFT + U+E - baseline Lithium levels - weekly till stable TFT + U+E - 6 monthly
103
when are lithium levels taken?
12 hours after dose
104
what safety monitoring is required for sodium valporate?
FBC + LFT - baseline LFTs - periodically for 1st 6 months
105
what monitoring is required for pioglitazone?
LFTs baseline and regularly
106
what non MONA drug should be prescribed in STEMI/NSTEMI?
Metoclopramide for sickness 10mg IV
107
what is one contraindication to pioglitazone?
heart failure
108
what are 3 medications that are contraindicated in asthma?
beta blockers NSAIDs Adenosine
109
what medication is used in SVT in asthmatics?
Verapamil - adenosine is contraindicated
110
what common analgesia cannot be given in heart failure?
NSAIDs - may cause fluid retention - use with caution
111
what is the management of narrow complex regular tachyarrhythmia?
SVT (QRS <0.12s) 1 - vagal manoeuvres 2 - Adenosine 6mg (then 12mg, then 12mg again) if does not resolve ?atrial flutter and rate control
112
what is the management of narrow complex irregular tachyarrhythmia?
Atrial fibrillation (QRS >0.12s) 1 - Rate control - B blocker OR diltiazem/verapamil If Heart failure - consider digoxin or amiodarone
113
what is the management of broad complex regular tachyarrythmia?
VT (QRS >0.12s) 1 - amiodarone 300mg IV over 20-60 mins then 900mg over 24h IF prev SVT w/ BBB then give ADENOSINE and treat as SVT
114
what are 3 differentials of broad complex irregular tachyarrhythmias?
AF with BBB - Tx with rate control Pe-excitation AF - Amiodarone Polymorphic VT (torsades) - magnesium 2g over 10 mins
115
what is the adult dose (>12 years) of adrenalin in anaphylaxis?
500 micrograms (0.5 ml) 1 in 1000 IM
116
what are 2 other medications that can be given along side adrenalin in anaphylaxis?
Antihistamines - chlorphenamine or non-sedating Hydrocortisone Also IV fluids
117
what is the dose of adrenalin in anaphylaxis <6 months?
100-150 micrograms (0.1-0.15ml) 1 in 1000 IM
118
what is the dose of adrenalin in anaphylaxis 6 months - 6 years?
150 micrograms (0.15ml) 1 in 1000 IM
119
what is the dose of adrenalin in anaphylaxis 6 -12 years?
300 micrograms (0.3ml) 1 in 1000 IM
120
what is the management of acute asthma in an adult?
1 - Salbutamol Nebs 2.5-5mg 2 - Ipratropium bromide - 500 micrograms 3 - mag sulphate/aminophyllin Oral pred - 40mg OD 5 days IV hydrocortisone if unable to take oral
121
what is the management of acute COPD?
1 - Salbutamol Nebs 2.5-5mg 2 - Ipratropium bromide - 500 micrograms 3 - Aminophyllin Oral pred - 30mg OD 5 days IV hydrocortisone if unable to take oralw
122
what antihypertensive is 1st line in diabetes?
ACEI
123
what antihypertensive is first line <55 years?
ACEI
124
what antihypertensive is 1st line in black people?
CCB
125
what antihypertensive is 1st line >55 years?
CCB
126
what is the stepwise management of asthma in adults?
1 - Salbutamol 2 - Low dose ICS 3 - Montelukast 4 - LABA 5 - MART
127
when should chronic asthma management be escalated?
use salbutamol >3x per week OR wake with asthma symptoms more than once a week
128
how often should HbA1c levels be monitored in diabetes?
3 monthly
129
what is the stepwise management of T2DM?
1 - Metformin - titrate up to max dose 2 - DPP-4 inhibitor OR pioglitazone OR sulfonylurea 3 - triple therapy/insulin SGLT-2 inhibitor can be added if sulfonylureas are unacceptable
130
what antidiabetic medication should be added in patients with both diabetes and cardiovascular disease?
SGLT-2 inhibitors
131
what is HbA1c target on metformin?
48 mmol/L
132
when should secondary antidiabetic be added?
if HbA1c >58 mmol/L
133
what is the HbA1c target on an antidiabetic which can induce hypos?
53 mmol/L
134
what is the 1st line management of parkinsons?
Levodopa PLUS Co-careldopa OR Co-beneldopa
135
what is the 1st line management of mild/moderate alzheimers?
acetylcholinesterase inhibitors Rivastigimine Donepezil galantamine
136
what is the 1st line management of severe alzheimers?
NMDA antagonist - memantine
137
what is the first line management of intrapartum GBS infection?
1 - Benzylpenicillin Pen allergy - Cefotaxime/Vancomycin
138
what are 8 medications that are prescribed in MICROgrams?
levothyroxine tamsulosin digoxin naloxone fludrocortisone Inhalers GTN spray Ipratropium nebs also vitamins
139
what are 5 medications that are prescribed in grams?
paracetamol lithium calcium carbonate NAC
140
what are 2 medications that should be taken in the morning?
diuretics steroids
141
what are 2 medications that should be taken at night?
statins night sedation
142
what are 2 medications to be taken with meals?
Insulin Creon
143
what are 3 medications to be taken weekly?
Methotrexate Folic acid (for RhA) Bisphosphonates (check dose)
144
what TYPE and DOSE of insulin is required in an insulin infusion for DKA?
Fast acting (actrapid, novorapid, humalin S) 0.1 units/kg/h
145
How should long acting insulin doses be adjusted?
by 10-20% if need increasing/decreasing
146
How long after surgery should a variable rate insulin be stopped and short acting insulin be recommenced?
Once patient can eat and drink at next meal give SC short acting insulin and discontinue VRI 30 mins after
147
when should glucose be commenced in DKA?
when serum glucose <14 mmol/L
148
what dose of glucose should be prescribed in DKA once BMs <14?
10% glucose 1000 ml over 8 hours In addition to saline regime
149
what is the management of hypernatraemia?
5% glucose 1000 ml IV 6-8 hours
150
what increments is levothyroxine adjusted in?
25 micrograms
151
what class of ABx can causes tendonitis and tendon rupture?
quinolones - ciprofloxacin
152
what diuretic is used in ascites secondary to liver cirrhosis?
spironolactone
153
what is the management of hyponatraemia?
0.9% NaCl 1000 ml IV 12 hours
154
what is the brand name of one combined HRT for >12 months post menopause?
Evorel conti Elleste-duet conti
155
what is the name of one combined HRT for <12 months post finishing mentruation?
Evorel sequi Elleste-duet clinorette
156
what is the preferred 3rd line antihypertensive agent?
INDAPAMIDE (specifically over other thiazide like diuretics)
157
what are 6 medications that increase falls risk?
benzodiazepines antidepressants - Tricyclics and SNRIs specifically Atipsychotics opiates antihypertensives - diuretics and alpha blockers
158
what are 3 medications that increase fracture risk?
PPIs Steroids GnRH analogues
159
what drugs should be stopped in AKI?
stop the DAMN drugs DAMN Diuretic ACEi/ARB Metformin NSAIDs
160
what what blood glucose level should ketones be checked?
>15 mmol/l
161
what is the name of an ICS + LABA inhaler (suitable for MART)?
FOSTAIR - beclometasone with formoterol suitable for both asthma and COPD with asthmatic features
162
what is the stepwise management of COPD without asthmatic features?
1 - SABA/SAMA 2 - LABA + LAMA combo 3 - + ICS - triple therapy
163
what is the stepwise management of COPD with asthmatic features?
1 - SABA/SAMA 2 - LABA + ICS 3 - + LAMA - triple therapy
164
what is the name of a LABA + LAMA combo inhaler?
GENUAIR - aclidinium bromide with formoterol for tx of COPD without asthmatic features
165
what triple therapy inhaler can be used in both COPD and Asthma?
TRIMBOW - beclometasone with formoterol and glycopyronium
166
what is the maximum change in serum sodium in one day?
+/- 10 mmol
167
how long before surgery should the COCP be stopped?
4 weeks
168
when before surgery should lithium be stopped?
Day before surgery
169
what are the criteria for resus fluids in adults?
BP <100 HR >90 CRT >2s /cold peripheries RR >20 NEWS >5

PSA (9 decks)

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