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PSA conditions treatment Flashcards

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1
Q

what treatment for STEMI

A

MONAT

Morphine (5-10mg)
Oxygen only if desaturing
Nitrates (GTN 2 puffs sublingual)
Aspirin 300mg
Ticagrelor 180mg /clopidogrel 300mg
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2
Q

what should you give if stemi pt undergoing PCI

A

Prasugrel

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3
Q

what treatment if no PCI in stemi patient?

A

fondaparinux

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4
Q

what treatment for nstemi/unstable angina

A

MONAT

Morphine 5-10g
Oxygen if indicated
Nitrates (2 puffs sublingual GTN)
Aspirin 300mg
Ticagrelor 180 or clopidogrel 300mg
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5
Q

what long term treatment for ACS

A

CRABS

Clopidogrel 75mg
Ramipril
Aspirin
Beta blocker
Statin
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6
Q

what treatment for chronic heart failure - specify drug in each class

A

ACEi - ARB if intolerated

Beta blocker - bisoprolol

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7
Q

in heart failure, if ARB and ACEi not tolerated, what to prescribe

A

hydralazine and nitrate

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8
Q

if symptoms of chronic HF continue despite treatment with ACEi and BB, what to prescribe

A

spironolactone/amiloride

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9
Q

how to treat ACUTE heart failure

A

UNLOAD FAST - diuretics

Upright position
Nitrates
Loop diuretic
Oxygen
ACEi
Digoxin

Fluids (decrease)
Afterload (decrease)
Sodium restrict
Test (Digoxin level, ABG, potassium level)

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10
Q

how to treat angina

A

GTN

BB
CCB if no BB (verapamil/diltiazem)

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11
Q

how to treat angina if CCB+BB combo not enough

A

ivabradine

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12
Q

what secondary prevention for stable angina

A

statin
aspirin
ACEi if patient has diabetes

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13
Q

describe treatment pathway for HTN if under 55

A
  1. A
  2. A + C or A+D
  3. A + C + D
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14
Q

describe treatment pathway for HTN if diabetic of any age

A
  1. A
  2. A + C or A+D
  3. A + C + D
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15
Q

describe treatment pathway for >55 or afro-caribbean

A
  1. C
  2. C + A or C + D
  3. A + C + D
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16
Q

If patient still hypertensive after triple treatment, what to give if low potassium

A

k-sparing diuretic if less than 4.5mmol

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17
Q

if patient still hypertensive after triple treatment with HIGH potassium, what to give

A

alpha or beta blocker

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18
Q

how to treat AF - rate control

A

Beta blocker or rate limiting CCB (verapamil or diltiazem)

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19
Q

if AF rate not controlled with one drug, what to give

A

two of three:

  1. beta blocker
  2. diltiazem
  3. digoxin
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20
Q

when to start rhythm control in AF

A

if less than 48 hours, can start with amiodarone or flecainide
if more than 48 hours, anticoagulate first

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21
Q

what investigations needed before amiodarone

A

CXR - amiodarone can cause interstitial lung disease
TFT
LFT
U&E

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22
Q

what anticoagulant for AF

A

warfarin

DOAC - apixaban, rivaroxiban, dabigatran

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23
Q

supraventricular tachy - immediate treatment

A

IV adenosine 6mg bolus

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24
Q

SVT treatment in asthmatic

A

no adenosine, use verapamil instead

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25
treatment for ventricular tachy
amiodarone via central line lidocaine procainamide
26
treatment for pericarditis
nsaid and colchicine
27
treatment for anaphylaxis in adult
IM adrenaline 500mcg | then oral cetirizine or IV chlorphenamine
28
treatment for anaphylaxis in child 6-12
IM adrenaline 300mcg
29
treatment for anaphylaxis in 6m-6y
IM adrenaline 150mcg
30
treatment for patent ductus arteriosus to close the duct
indomethacin or ibuprofen
31
treatment to keep PDA duct open
prostaglandin E1 (alprostadil)
32
What are the short-acting forms of insulin?
soluble insulin, Actrapid
33
What are the intermediate forms of insulin?
Insulatard | Isophane insulin
34
How often are intermediate forms of insulin administered?
Usually twice a day
35
What are the long-acting forms of insulin?
Insulin glargine | Lantus
36
How often are the long-acting forms of insulin administered?
Once or twice daily, doesn't need to be administered with food
37
What route is gentamicin usually administered?
IV
38
What condition is gentamicin contra-indicated in?
myasthenia gravis
39
Impairment of which organ can cause gentamicin toxicity?
Renal
40
What route of vancomycin for C. Diff
oral
41
How often is vancomycin concentration monitored?
trough levels between 3rd and 6th dose
42
IV infusions of vancomycin need to be administered over how long
at least 60 mins
43
What thromboprophylaxis in surgical patients
enoxaparin | if high risk (eg orthopaedic surgery) different dose 40mg every day and 12 hours before surgery
44
What is the first line IV treatment of hypoglycaemia
glucose 20%, 50ml given over 20minutes
45
What treatment for acne unresponsive to topical treatment?
tetracycline 500mg PO twice daily
46
When must you be cautious when prescribing nitrofurantoin
low eGFR/poor renal function
47
First line management of alcohol withdrawal
chlordiazepoxide 20mg QDS PO
48
if INR > 1.5 on day of surgery, what to give
Phytomenadione 1-5mg PO
49
How should patients take rivaroxaban
with food
50
What is the effect of topiramate on contraceptives
topiramate is enzyme inducer, reduces effectiveness of contraceptive use additional contraceptive for at least 4 weeks after
51
what is a side effect of beta blockers
erectile dysfunction
52
what sort of jaundice does co-amox cause
cholestatic jaundice
53
By what percentage is the creatinine expect to rise after starting ACEi
up to 20% - no need for investigation or withdrawal of ACEi
54
What is the most effective measure of furosemide efficacy?
weight
55
What is the most effective measure of ACEi efficacy in treatment of HF
exercise tolerance after a month
56
What must be monitored with ciclosporin after 2 weeks
renal function (creatinine)
57
What is the first line treatment of COPD
SABA or SAMA (ipratropium)
58
What is the second line treatment of COPD if no asthma features
SABA PRN and LABA + LAMA eg. salbutamol + salmeterol + tiotropium
59
What is the second line treatment of COPD if asthmatic features
SABA PRN and LABA (salmeterol) + ICS (beclometasone)
60
What is third line treatment in all COPD patients?
SABA PRN and LABA + LAMA + ICS
61
``` Give an example of each of the following: SAMA LABA LAMA ICS ```
``` SAMA = ipratropium LABA = Salmeterol LAMA = tiotropium ICS = beclometasone ```
62
How to treat infective exacerbation of COPD
pred 30mg for 5 days | antibiotics only if purulent sputum
63
what antibiotics in copd exacerbation
amoxicillin doxycycline clarithromycin
64
what antibiotics in copd infection prophylaxis
azithromycin
65
what must be checked before prescribing azithromycin
LFTs and ECG | azithromycin can prolong QT interval
66
Stepwise asthma management in adults
1. SABA 2. SABA + ICS 3. SABA + ICS + LTRA 4. SABA + ICS + LABA, keep LTRA if needed 5. SABA + MART
67
what is MART in asthma treatment
form of combined ICS and LABA (seretide - salmeterol and fluticasone)
68
Emergency asthma treatment
1. O2 2. Salbutamol 5mg nebulised 3. Pred 40mg PO 4. Ipratropium bromide 5. Theophylline 6. Mag sulf 7. Escalate
69
How is aminophylline prescribed
loading dose of 5mg/kg given over at least 20 minutes then 500–700mcg/kg/hr based on plasma concentration
70
What is PE treatment
First line: apixaban or rivaroxaban | second line: enoxaparin
71
What is VTE prophylaxis
enoxaparin
72
How to treat massive PE?
alteplase or streptokinase
73
What drug for TB prophylaxis
isoniazid and rifampicin
74
What is the curb65 criteria
Confusion (AMT <8/10) Urea >8 Respiratory Rate >30 Blood pressure <90/60
75
If CURB65 is 0, what to prescribe
amoxicillin
76
what mucolytic in CF
dornase alfa
77
what pancreatic replacement in CF
pancreatin/creon
78
what antibiotic for pseudomonas
aztreonam
79
what antibiotic for burkholderia
co-trimoxazole
80
how to treat dyspnoea in pleural effusion
opioids
81
what treatment for pulmonary hypertension
``` IV prostanoids (e.g. epoprostenol) Endothelin receptor antagonists (e.g. macitentan) Phosphodiesterase-5 inhibitors (e.g. sildenafil) ```
82
what should be measured before starting azathioprine
TPMT - myelosuppression if low levels
83
what is used to induce remission in crohns
steroids
84
what is used to induce remission in ulcerative colitis
mesalazine (PR)
85
how to treat diarrhoea in IBS
loperamide
86
which antispasmodic in IBS
mebeverine
87
what laxative to avoid in IBS
lactulose
88
what treatment for gord
PPI | famotidine/cimetidine. not ranitidine
89
h pylori eradication
PPI + Amoxicillin + Clarithromycin or Metronidazole
90
h pylori eradication if penicillin allergic
PPI + Clarithromycin + Metronidazole
91
what treatment for primary biliary cirrhosis
ursodeoxycholic acid
92
what treatment for ascites
low sodium | spironolactone
93
what antibiotic to prevent SBP in ascites
ciprofloxacin
94
what is prophylaxis for variceal bleeding
propranolol
95
what treatment for c.diff
oral vancomycin FOR 10 DAYS
96
what treatment for life threatening c. diff
oral vancomycin and IV metronidazole
97
What is the effect of diltiazem on heart failure
exacerbates biventricular failure
98
what is the effect of prednisolone on heart failure
exacerbates heart failure
99
How long is treatment for scarlet fever
10 days phenoxymethylpenicillin
100
what is the effect of PPIs on stool consistency
loose stools
101
What is the effect of alendronic acid on stool consistency
loose stools
102
Which electrolyte abnormality can exacerbate lithium toxicity?
hyponatraemia
103
What medication can exacerbate glaucoma
tricyclic antidepressants (antimuscarinic side effects)
104
What are some side-effects of anti-muscarinics (TCAs and antispasmodics)?
- Memory loss - Urinary retention - Constipation - Exacerbation of glaucoma
105
What are some side-effects of hypnotics/anxiolytics?
Falls Confusion Postural hypotension
106
What are some side effects of NSAIDs
GI bleeding | Fluid retention
107
What are some side effects of opioids?
Respiratory depression Constipation Drowsiness Falls
108
What dose of rivaroxaban to prescribe for AF in patient with renal impairment
15mg
109
How much is 100mg PO carbamazepine equivalent to PR?
125mg - dose equivalence and conversion
110
How to treat HTN in phaeochromocytoma
phenoxybenzamine
111
What treatment for chlamydia
doxycycline - not in preg erythromycin amoxicillin azithromycin - not in preg
112
what treatment for chlamydia in pregnancy
erythromycin | amoxicillin
113
What effect can carbamazepine have on electrolytes
can cause hyponatraemia due to SIADH effect
114
What is first line antiemetic in pregq
cyclizine - IV if no oral intake
115
what medication to prevent sickle crises
hydroxycarbamide
116
what drug to stop variceal haemorrhage
IV terlipressin
117
what medication to delay labour (tocolytic)
nifedipine
118
which opioid in renal impairment
oxycodone
119
What is the interaction between metformin and contrast dye
lactic acidosis
120
how does metformin affect weight
causes weight loss
121
what infection do PPIs increase the risk of
c. diff
122
fluid resus in heart failure
250ml over 30 minutes
123
what must patients be warned of with SSRIs
can cause GI bleeding
124
what happens to phosphate levels in CKD
hyperphosphataemia
125
how to treat hyperphosphataemia and hypocalcaemia
calcium carbonate
126
in pneumonia if pt allergic to penicillin, what to prescribe
clarithromycin
127
which diuretic can cause hypercalcaemia
bendroflumethiazide
128
what treatment for wilsons disease
penicillamine or trientene
129
what must be monitored with methotrexate
FBC - myelosuppression | LFT - cirrhosis
130
what can methotrexate do to the lungs
pneumonitis
131
what must be monitored with hydroxychloroquine?
retinopathy
132
what must be checked before starting a patient on infliximab and biologics
TB status - tuberculin skin test
133
what is the main side effect of colchicine
diarrhoea
134
what treatment for acute gout if colchicine/nsaids contraindicated
oral pred 15mg or intra-articular steroids
135
do you continue allopurinol in acute flares of gout
yes
136
which drugs can precipitate gout
thiazides - stop in flares
137
which drug can be used to control HTN in gout
losartan
138
what treatment for pseudogout
NSAIDs, intra-articular steroids, joint aspiration
139
what treatment for osteoporosis/fractures
bisphosphonates - alendronate | long acting once monthly = ibandronate
140
what biologic for osteoporosis?
denosumab
141
what is first line treatment of ankylosing spondylitis
nsaids and physio | second line - anti-TNF (infliximab)
142
what treatment for reactive arthritis
nsaids intra-articular steroids sulfasalazine or methotrexate for persistent disease
143
what antibiotic for septic arthritis and for how long
fluclox or clindamycin if pen allergic for 6 WEEKS
144
What treatment for lupus
hydroxychloroquine - monitor for retinopathy
145
how is osteomalacia treated
vit D supplements - loading dose required calcium supplements if dietary not sufficient
146
what treatment for GCA
pred, higher dose if visual symptoms
147
what treatment for GCA with visual symptoms
IV Methylpred according to passmed, not on BNF
148
what treatment for kawasaki disease
aspirin
149
how to differentiate kawasaki disease from scarlet fever
scarlet fever responds to antipyretics | scarlet fever is PAINFUL lymphadenopathy
150
what to treat coronary vasospasm with in kawasaki
nifedipine
151
what treatment for pagets disease of bone
risedronate oral
152
How does pagets disease bone present
usually older male with bone pain and isolated raised ALP
153
what causes hypercalciuria leading to kidney stones
thiazide diuretics (bendroflumethiazide)
154
what drugs can precipitate AKI
``` NSAID ACEi ARB Diuretics Aminoglycoside antibiotics iodinated contrast agents ```
155
Give examples of aminoglycosides causing AKI
gentamicin tobramicin streptomycin neomycin
156
which drugs to stop in AKI as they can be toxic
metformin digoxin lithium
157
how is hyperkalaemia in AKI treated
IV calcium gluconate to stabilise cardiac membrane Nebulised salbutamol Insulin and dextrose infusion To remove the excess potassium from body: - Calcium resonium (PO or PR) - Loop diuretics - Dialysis
158
How is excess potassium removed from body in AKI
Calcium resonium (PO or PR) Loop diuretics Dialysis
159
how to treat vit D deficiency in CKD
alfacalcidol or calcitriol
160
how is proteinuria managed in ckd
ACEi or ARB
161
how to treat anaemia in ckd
EPO/darbepoetin
162
how to treat HTN in CKD
ACEi and furosemide
163
how to treat BPH
tamsulosin first line | finasteride second line
164
what are the side effects of tamsulosin/alpha blockers
dizziness postural hypotension dry mouth depression
165
which drug slows down progression of BPH
finasteride
166
if there is a mixture of storage and voiding problems in BPH what to give
tolterodine or darifenacin
167
what treatment for minimal change disease
steroids/cyclophosphamide
168
what treatment for ADPKD
tolvaptan
169
what thrombolysis for stroke
alteplase
170
what antiplatelet for stroke
aspirin (+PPI)
171
If AF and stroke, what to prescribe
Aspirin for 2 weeks, then anticoagulation
172
what is long term management of stroke
clopidogrel + statin + antihypertensive
173
what long term management of stroke if AF
warfarin/doac + statin + antihypertensive
174
if pt with AF has stroke, what to give
warfarin or apixaban or rivaroxaban AFTER 2 WEEKS
175
TIA immediate treatment
aspirin 300mg
176
TIA secondary prevention
clopidogrel If AF - anticoag with DOAC/warfarin Statin anti-hypertensive
177
what treatment for generalised seizures
valproate
178
what treatment for focal
carbamazepine
179
what are the side effects of valproate
P450 inhibitor ataxia hepatitis - avoid in hepatic impairment
180
what are the side effects of carbamazepine
p450 inducer SIADH - hyponatraemia visual disturbances - diplopia
181
what are the side effects of lamotrigine
Stevens-Johnson syndrome
182
what treatment for parkinsons if the symptoms are affecting QoL
co-careldopa
183
what treatment for postural hypotension in parkinsons
midodrine
184
what treatment for hypersalivation in parkinsons
glycopyrronium
185
what treatment for parkinsons if not affecting QoL
``` co-careldopa dopamine receptor agonists (ropinirole) MAOB inhibitors (rasagiline) ```
186
what must be checked before starting a patient on cabergoline/bromocriptine
Can cause pulm/cardiac fibrosis - CXR, echo, ESR, and creatinine
187
which class of parkinsons drugs cause impulse control disorders
dopamine agonists - ropinirole/cabergoline/bromocriptine - patients should be warned of these effects
188
what class of drug is seligiline?
MAOB inhibitor
189
what class of drug is entecapone
COMT (Catechol-O-Methyl Transferase) inhibitors
190
what treatment for parkinsonism drug induced
antimuscarinics - procyclidine, benztropine
191
what prophylaxis for migraine
propranolol or topiramate
192
what prophylaxis for migraine if perimenstrual
frovatriptan
193
what treatment for acute migraine
oral triptan and NSAID/paracetamol
194
what treatment for acute migraine in 12-17
nasal preparation of triptan
195
what treatment for acute cluster
100% Oxygen and subcut triptan
196
what prophylaxis for cluster headache
verapamil
197
how to shorten acute flare of MS
high dose iv methylpred
198
how to treat fatigue in MS
amantadine
199
how to treat spasticity in MS
baclofen and gabapentin
200
how to treat urinary retention in MS
intermittent self-catheterisation
201
how to treat MS bladder symptoms if no significant residual volume
anticholinergics - oxybutynin?
202
how to treat oscillopsia in MS
Gabapentin
203
how to treat mnd
riluzole and NIV - BIPAP
204
how to treat meningitis in hospital in children and adults up to 50y
cefotaxime
205
how to treat meningitis in neonates up to 3m, and adults after 50y
cefotaxime + amoxicillin
206
how to treat encephalitis
IV acyclovir
207
how to treat oedema in brain tumour
dexamethasone
208
what treatment of myasthenia gravis
pyrodostigmine
209
which drugs can cause peripheral neuropathy
``` amiodarone isoniazid vincristine nitrofurantoin metronidazole ```
210
first line treatment for neuropathic pain
amitryptiline gabapentin pregabalin duloxetine
211
treatment for trigeminal neuralgia
carbamazepine
212
treatment for status epilepticus
lorazepam (PR in community, IV in hospital)
213
what drugs cause myopathy
steroids
214
how is croup treated in children
0.15mg/kg dexamethasone nebulised adrenaline high flow O2
215
how is viral wheeze treated in children
salbutamol montelukast fluticasone`
216
how is bronchiolitis treated
humidified oxygen
217
how is epiglottitis treated
intubation, iv abx
218
how is otitis media treated
amoxicillin
219
how is otitis externa treated
flucloxacillin
220
how is suspected cyanotic heart disease treated
keep duct open with alprostadil
221
how is rheumatic fever treated
phenoxymethylpenicillin
222
how is constipation treated in children
MACROGOL/movicol senna lactulose
223
how is minimal change disease treated
steroids/cyclophosphamide
224
what treatment for hayfever
Azelastine hydrochloride intranasal
225
how is whooping cough treated
erythromycin/clarithromycin/ macrolides
226
what is treatment for sickle cell disease
hydroxycarbamide
227
how is impetigo treated
hydrogen peroxide 1% cream first line or topical fusidic acid oral fluclox/clari if extensive disease
228
how to treat nipple candidiasis for mother and baby
miconazole cream for mother, nystatin for baby
229
what treatment for scarlet fever
phenoxymethylpenicillin for 10 days
230
what treatment for ADHD
methylphenidate
231
how is von Willebrand disease treated
tranexamic acid for mild bleeding, | desmopressin for severe

FINALS REVISION (17 decks)

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