PSA Incorrect Qs Flashcards by Laurence Patterson

Hypoglycaemia fluid treatment
% and volume of dextrose? over how long?

10% dextrose (100-200mL) over 15 minutes (up to 20 mins)

How well did you know this?

Not at all

Perfectly

Tacrolimus dose: (prevent kidney rejection)

Initial dose post-transplant =
Maintenance dose =

Initial dose post-transplant = 200 - 300 micrograms/kg (70kg male 10mg every 12 hours)
- Maintenance dose = 1-2mg 12 hourly

How well did you know this?

Not at all

Perfectly

Drugs which can contribute to hyperkalaemia

ACEi
Dalteparin Sodium (rare)
Tacrolimus (in preg?)

How well did you know this?

Not at all

Perfectly

Withhold allopurinol until renal function recovers

How well did you know this?

Not at all

Perfectly

Antiplatelets should be stopped how long before surgery?

Clopidogrel should be stopped 7 days before surgery

ILACKOP

7 days

I- insulin (to VIII)
L- lithium (day before)
A- Antiplatelts/ anticoag
C - COCP/ HRT
K- K+ sparing diuretics
O - oral hypoglycaemics (not strictly metformin but can be so choose that if no other better option)
P - Prils - ACEi (day of)

How well did you know this?

Not at all

Perfectly

common drugs which can cause hyponatramia (2)

SSRI
Thiazide diuretics

How well did you know this?

Not at all

Perfectly

common b blocker side effect?

Fatigue (NOT SEDATION)
Erectile dysfunction

How well did you know this?

Not at all

Perfectly

flucloxacillin can cause what side effect?

Cholestatic jaundice

How well did you know this?

Not at all

Perfectly

when starting an ACEi a small rise in Cr can be expected as and continued as long as its less than….

< 20% rise

How well did you know this?

Not at all

Perfectly

check benefits of ACEi in Heart failure by monitoring…. (as an outpatient)

exercise tolerance!

How well did you know this?

Not at all

Perfectly

what investigation should you use 2 weeks after starting ciclosporin?

U+E and serum Cr - it is nephrotoxic

How well did you know this?

Not at all

Perfectly

increase long term insulin by 10%! especially if blood glucose rises when steroid is increased

How well did you know this?

Not at all

Perfectly

No change in statin is needed if after 3 months of treatment >40% in non-HDL cholesterol has occurred

How well did you know this?

Not at all

Perfectly

paid pain relief give NASAL fentanyl 50 micrograms one spray to one nostril and can be repeated after 10 mins - a minimum of 4 hours between treatment of each pain episode

How well did you know this?

Not at all

Perfectly

Nitrofurantoin should be avoided in who? (investigation)

eGFR < 45
can be used with caution if eGFR 30 - 44

How well did you know this?

Not at all

Perfectly

stopping warfarin 5 days before elective surgery

you dont need formal anticoag unless … (2)

If not then give…

AF or Stroke/ TIA hx.

Phytomenadione (Vit K) 2mg PO

BNF guidance says if INR > 1.5 on the day before surgery then give Vit K 1-5mg PO using IV preperation

How well did you know this?

Not at all

Perfectly

Rivaroxaban should be given…

with food!

How well did you know this?

Not at all

Perfectly

Prescribe ACEi in the evening/ at night why?

Postural hypotension

How well did you know this?

Not at all

Perfectly

When prescribing GTN it naturally comes in 400micrograms spray so in the dose section put 2 sprays or 2 tablets

How well did you know this?

Not at all

Perfectly

What to prescribe in hyperkalaemia to LOWER K+ with ecg changes?

Drug:
Dose: ____ and its dissolved in what?
given over how long?
Route:

General hyperkalaemia Mx:
1. give…
2. give…
3. give…
4.+/-

Drug: ACTRAPID or NOVORAPID
Dose: 10 Units in 100ml of 20% dextrose over 30 mins
Route: IV

General hyperkalaemia Mx:
1. Calcium gluconate (30ml 10%) or calcium chloride (10mL in 10%) to stabilise cardiac membrane
2. give… ACTRAPID or NOVORAPID 10 Units in 100ml of 20% dextrose IV infusion (20g of glucose) to shift K+ intracellularly
3. give… Calcium rosonim (K+ binder)
4. +/- Dialysis

How well did you know this?

Not at all

Perfectly

types of seizure and med you should prescribe

Focal seizures: 2 drugs and reason why you should/ should not prescribe
1. first line- good because
2. second line - bad because

Tonic clonic generalised
1. male -
2. female (2)

Absence
1. first line =
2. second line; male = female = (2)

Focal:
Lamotrigine - safe in preg
Carbemazipine - can cause SIADH (hypoatraemia)

Tonic clonic generalised
1. male - sodium valproate
2. female- lamotrigine or levatricitam

Absence
1. first line = ethosuximide
2. second line: male = sodium valp female = lamotrigine or levatricitam

How well did you know this?

Not at all

Perfectly

metformin should be stopped day before surgery - lactic acidosis

aspirin should also be stopped but not 75mg dose?

How well did you know this?

Not at all

Perfectly

long term steroids should be AMENDED for surgery - why?

If its adrenal insuff. then they might not be able to amount a stress response - therefore anaesthetist might have to increase!

How well did you know this?

Not at all

Perfectly

ALWAYS CHECK THE UNITS!!!!

How well did you know this?

Not at all

Perfectly

lithium toxicity stop ACEi and Diuretics - they stop excretion if you do need a diuretic then use furosemide

*** Best way to monitor tacrolimus levels?

Trough level prior to morning dose

Monitoring DKA has resolved by what? (2)

Ketones < 0.6mmol/L Bicarbonate > 15

Vancomycin What should be the pre-dose trough level? Look at BNF!

10-15mg/L

Amlodipine side effects

- facial flushing - peripheral oedema - hypotension

Opioids but also what other common drug can cause constipation?

Cyclizine

INR too high and they’re bleeding, what should you do?

Give Vit K by slow IV infusion

If someone’s having an allergic reaction mild (pruritis and macular rash) with NO SIGNS of anaphylaxis give what?

Oral chlorphenanine (anti-histamine) - IM adrenaline or IV hydrocortisone not needed

Hypoglycaemia Conscious give = Unconscious give = Why is 50%. IV Glucose not advised?

Conscious give = oral glucose 10-20g this can include tablet, orange juice, biscuit Unconscious give = IM/IV/S/C glucagon if no IV access for glucose High risk of extravasating injury

don't take bendrofluthiazide at night- why?

up all night pissing!

cyclize and metroclopramide should be given what hourly?

8 hourly?

elderly dose for citalopram (>65yo) is max ...

elderly 20mg adult can go up to 40mg

how long ferrous sulfate given for in iron def anaemia?

Until Hb is normal and then for 3 months after

maintenance fluids - in elderly patients give how much?

2L instead of the standard 3L (2 bags instead of 3)

UC more than 6 bowel movement is considered a severe flair therefore give what

IV hydrocortisone 100mg 6 hourly

life threatening hypogylcaemia advice to tell a T1DM in young adults?

Alcohol excess can cause severe hypoglycaemia

how do you choose between weak opioids tramadol and codeine? tramadol = codeine =

Tramadol avoided in elderly becuase can cause agitation, hallucinations constipation more constipating

first line med for GAD?

citalopram or sertraline

when should you assess plasma-digoxin levels?

at least 6 hours after dose

before starting sodium valproate check what?

LFTs

signs to check for aminophylline toxicty?

check serum levels check 18 hours after giving and should be between 10-20 mg/L

a new rash on fluoxetine could show signs of impending system reaction so check at 2 weeks!

Managing impetigo systemically well 1. first line = 2. if not suitable already tried = 3. Third line = systemically unwell 1. If MRSA 1.

systemically well 1. first line = 1% hydrogen peroxide 2. if not suitable (around eyes) already tried = Fusidic acid 3. Third line = Fluclox (If allergic erythromycin or clarithromycin) systemically unwell 1. oral abx If MRSA 1. mupirocin

dose of insulin given to adult in DKA dose of insulin given to child in DKA

Actrapid 0.1Units/kg/hour IV

Bacterial meningitis inpatient what abx do you give?

Cetriaxone can give Cefotaxime

whcih drugs can cause sleeping distrubances?

B-blocker Pramipexole (dopamine agonsit for P.D)

common drugs which cause diarrhoea

- omeprazole - co-amoxiclav

whats the most common side effect of donepezil (first line for mild to mod dementia reversible cholinesterase inhibitor) other info - NSIADs use with caution - Don't drink alcohol on it - should not be chewed and just dissolved under the tongue

diarrhoea

dalitparin sodium is very commonly associated with immune-mediated drug induced thrombocytopenia

When starting warfarin its important to tell patients to report any new bruising as a method of monitoring if the dose is too high etc.

anti-emetic contraindications cyclizine = HF prochloroperazine = Parkinson's Metochlopramide = pro-kinetic so anything blocking or affecting the bowel (gastrectomy) therefore give ondansetron

paeds chronic constipation with no signs of impaction give movicol or macrogol, 1 sachet for 28 DAYS!!!!

drug induced dystonia from anti-psychotic - what to give to treat

1. first line = procyclidine IV 2. second line = benzo IV (diazepam)

drug contraindicated in ischaemic leg ulcers

B-blockers ACEi are also cautioned in PVD and critical limb ischaemia

of CCB and steroids worsen?

Heart failure

what two classes of drug should you think of when candida is present?

antibiotics steroids

eplerenone is a K+ sparing diuretic a GP should check....

serum K+ in 1 weeks time

mirtazepine common/ v common side effect?

sleep disturbances (abnormal dreams)

before starting amioderone check 3 things (+1 extra)

1. CXR 2. Serum K+ 3. LFTs 4. TFTs too?

SSRIs don't require any formal monitoring - just be weary of hyponatraemia in elderly

statin dosage if you get a big rise in CK

If statin is suspected to be the cause of myopathy and CK increases ( > 5x normal upper limit) or if muscular symptoms are severe then: 1. discontinue treatment 2. if CK drops or symptoms resolve then reintroduce at lower dose

naproxen can cause ankle swelling

clotrimazole is given for vaginal candida in preg - it can be given on a PESSARY and usually given longer dose of 7 days fluclonazole is not safe to give in preg

when a T1 Diabetic presents with a DKA you obviously put them on a fixed rate insulin regimen of 0.1 Units/kg/hour but you KEEP THEIR LONG ACTING INSULIN

herpes zoster (shingles) pai relief

start with paracetamol - especially in the flared up stage Amitriptyline is given for post-herpetic neuralgia

loperamide should be given after every loose stool

Ciclosporin - regular kidney monitoring is required

most common side effect of liraglutide is vomiting

peptic ulcer diease (H.pylorinegative) 1. first line is PPI (omeprazole) 2. Second line is H2 antagonist - rinitidine or famotidine H.pylori infection ( triple therapy) = 7 days 1. PPI 2. Amoxicillin 3. Metronidozole or clarithromycin pencillin allergy PPI, Metro, Clarithro

Giving emergency contraception (Ellaone) in frequency say review in 4 weeks

Streptococcus agalactiae in preg think.... and treat them with...

Group B step Benzylpencillin 3g IV once only

omeprazole and carbemazepine cause hyonatraemia (as well as SSRIs)

Allopurinol can be prescribed up to 900mg a day but it must be done in divided doses ie. TDS Max that can be given in one dose is 300mg

co-careldopa can cause excessive day time sleepiness - information giving on working heavy machinery and driving etc.

sit down when taking GTN spray - causes dizziness - also headaches!

Allendronic acid can cause dizziness - especially when interacting with oxybutinin

monitoring lithium levels- take sample when?

12 hours post last dose

STEPPING DOWN THE PAIN LADDER: - start with strongest pain relief first - stop the regular one first - Keep strong PRN - Then stop weak opioid - Then NSAID - Then paracetamol

Started a statin and LFTs are raised - what should you do? LFTs are checked at 3 months after initiation

- Transaminase are raised more than 3 times upper limit of normal - stop the statin and repeat LFT in 1 month - Transaminase raised but NOT 3 times upper limit of normal continue statin at same dose and repeat LFTs in 1 month

If 'CHECK ADHERENCE' is one of the answers- always consider this and re-read the question

long term steroids in children specifically oral prednisolone - obviously check height and weight - but also check for blood pressure and urinary glucose!

simaglutide - nausea

aripiprazole - check serum prolactin before and when monitoring

methotrexate monitoring - U+Es, LFT, FBC every 1-2 weeks until stabilised

Lithium monitoring prior: ECG, U+Es and TFTs

UTIs with renal impairment Nitrofurantoin - don't use if eGFR < 45. caution is 30-45. Trimethoprim If eGFR < 30 = dose reduction to half of normal dose after 3 days If eGFR < 15 = dose reduction to half

on max dose of metformin, what to do next? 1 of 3 possibilites to add - Sulfonylurea (Gliclizide) - DPP4 inhib (saxagliptin) - GLP-1 (liraglutide) DPP4s and GLP-1s are contraindicated in pancreatitis

Drugs which can kick off a c.diffe infection - Clindamycin - PPIs -

c.diffe management

First line = Oral vancomycin second line = Oral fidoxamicin further episode Oral fidoximicin Life-threatening Oral vancomycin AND IV metronidazole

Inpatient treatment of meningitis - ceftriaxone give 2g BD or 4mg OD (even though it says 2-4g daily on the BNF just be on the safe side)

constipation is common with all bisphosphinates

check dosages of salbutamol 200 micrograms is the max dose that can be given- not 200 mg

Drugs which commonly interact with lithium - thiazide diuretics - ACEi - Ibuprofen (NSAIDs)

Remember Tazocin is a trade name for Pip=Taz and this means if you have an allergy to this you have a penicillin allergy

benzo overdose presents with Nystagmus and dysarthria and severe cases respiratory depression - pupils PEARL

Tranylcypromine is a monoamine oxidase B inhibitor (MAO-Inhib) THEY CAN INCREASE RISK OF OPIOD TOXICITY

Stopping anticoags before surgery warfarin = DOACs (apix, rivarox, edox) = Dibigatran = Acenocoumarol = antiplatelets clopidogrel = aspirin 75mg =

warfarin = 5 days before DOACs (apix, rivarox, edox) = 1-3 days before Dibigatran = 1-4 days before Acenocoumarol = 3 days before clopidogrel = 7 days aspirin 75mg = continue as normal

bulk forming laxative given anal fissures constipation

PSA Incorrect Qs Flashcards

(102 cards)