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Make a Medic Finals Deck > PSA Passmed Stuff > Flashcards

PSA Passmed Stuff Flashcards

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1
Q

Malignancy causing SIADH

A

Small cell lung cancer
(also: pancreas +prostate)

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2
Q

4 Neurological causes of SIADH

A

Stroke
SAH
SDH
Meningitis/ encephalitis/ abscess

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3
Q

2 Infectious causes of SIADH

A

TB
Pneumonia

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4
Q

6 Drug causes of SIADH

A

Sulfonylureas
SSRIs
TCAs
Carbamezapine
Vincristine
Cyclophosphamide

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5
Q

Which sulfonylureas cause SIADH?

A

Glimepiride
Glipizide

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6
Q

2 other causes of SIADH

A

Positive end-expiratory pressure (PEEP)
Porphyrias

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7
Q

What are the investigations for SIADH?

A

Urine osmolality: HIGH
Serum osmolality: LOW
(inappropriate as kidneys should dilute urine when serum osmolality is low)
Urine sodium: HIGH (due to action of ADH on renal tubules)

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8
Q

Describe management of SIADH

A

Correct slowly to avoid precipitating central pontine myelinolysis
Fluid restriction
Demeclocycline: reduces responsiveness of the collecting tubule cells to ADH

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9
Q

In which patients requiring fluid should glucose be avoided?

A

Stroke patients (non-hypoglycaemic)
Due to increased risk cerebral oedema
Prescribe normal saline if rehydration required

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10
Q

What are the maintenance fluid requirements?

A

25-30 ml/kg/day of water
+
~1 mmol/kg/day of potassium, sodium + chloride
+
~50-100 g/day of glucose to limit starvation ketosis

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11
Q

Describe maintenance fluid requirements for an 80kg patient

A

2L water
80 mmol potassium

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12
Q

Describe the electrolyte contents of 0.9% saline

A

Na+: 154 mmol
Cl-: 154 mmol

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13
Q

What does 5% glucose contain?

A

50g glucose

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14
Q

Describe the contents of Hartmann’s solution

A

Na+: 131
Cl-: 111
K+: 5
HCO3-: 29

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15
Q

What is the risk of using large volumes 0.9% saline?

A

Hyperchloraemic metabolic acidosis

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16
Q

In which patients should Hartmann’s not be used? Why?

A

Hyperkalaemic patients
Hartmann’s contains potassium

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17
Q

List 6 drugs that can cause impaired glucose tolerance

A

Diuretics
Steroids
Immunosuppressants
Interferon-alpha
Nicotinic acid
Antipsychotics

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18
Q

Which diuretics are cause impaired glucose tolerance?

A

Thiazides
Furosemide (less common)

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19
Q

Which drug can cause slight impairment of glucose tolerance?

A

B-blockers
Also use with caution in diabetics as can interfere with metabolic + autonomic responses to hypoglycaemia

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20
Q

Name 2 Immunosuppressants that cause impaired glucose tolerance

A

Tacrolimus
Ciclosporin

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21
Q

List 5 drugs that may cause urinary retention

A

TCAs e.g. amitriptyline
Anticholinergics e.g. antipsychotics, antihistamines
Opioids
NSAIDs
Disopyramide

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22
Q

List 5 drugs that can cause lung fibrosis

A

Amiodarone
Cytotoxic agents: busulphan, bleomycin
Anti-rheumatoid drugs: methotrexate, sulfasalazine
Nitrofurantoin
Ergot-derived dopamine receptor agonists (bromocriptine, cabergoline)

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23
Q

List 3 significant adverse effects which patients should be warned about when starting Allopurinol

A

Severe cutaneous adverse reaction (SCAR)
Drug reaction with eosinophilia + systemic symptoms (DRESS)
Stevens-Johnson syndrome

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24
Q

List 3 ethnic groups at higher risk of dermatological reactions of Allopurinol

A

Chinese
Korean
Thai

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25
Name 3 drugs that interact with Allopurinol
Azathioprine Cyclophosphamide Theophylline
26
Describe the interaction between Allopurinol and Azathioprine
Xanthine oxidase is responsible for metabolism of 6-mercaptopurine (metabolite of Azathioprine) Thus, Allopurinol leads to high levels of 6-mercaptopurine A much reduced dose (e.g. 25%) must therefore be used if the combination can't be avoided
27
Describe the interaction between Allopurinol and Cyclophosphamide
Allopurinol reduces renal clearance, therefore may cause marrow toxicity
28
Describe the interaction between Allopurinol and Theophylline
Allopurinol causes an increase in plasma conc. of theophylline by inhibiting its breakdown
29
Aspirin potentiates which 3 drugs/ classes
Oral hypoglycaemics Warfarin Steroids
30
Why should Aspirin be avoided in children? What is the exception to this?
Risk of Reye's syndrome Kawasaki: benefits outweigh risk
31
Name 2 non-dihydropyridine CCBs
Verapamil: highly negatively inotropic Diltiazem: less negatively inotropic
32
Name 2 dihydropyridine CCBs
Amlodipine Nifedipine Felodipine
33
What are the indications of Verapamil?
Angina HTN Arrhythmias
34
Name 3 contraindications to verapamil
Heart failure Bradycardia Hypotension
35
List 2 side effects of Verapamil
Flushing Constipation
36
What drug should not be given with Verapamil? Why?
DONT give with b-blockers May cause heart block
37
Name 2 indications for Diltiazem
Angina HTN
38
List 3 contraindications to Diltiazem
Hypotension Bradycardia Heart failure
39
Name 2 side effects of Diltiazem
Constipation GI discomfort
40
List 3 indications for dihydropyridine CCBs
HTN Angina Raynauds
41
Which CCBs do not result in worsening of heart failure?
Dihydropyridine CCBs Affect peripheral vascular smooth muscle more than myocardium
42
List 3 side effects of dihydropyridines
Flushing Headache Ankle swelling
43
What effect may be seen with shorter acting dihydropyridines? Give an example drug
Nifedipine Cause peripheral vasodilation which may result in reflex tachycardia
44
List 5 indications for Ciclosporin
Following organ transplantation RhA Psoriasis (direct effect on keratinocytes as well as modulating T cell function) UC Pure red cell aplasia
45
What is Ciclosporin?
Immunosuppressant Calcineurin inhibitor
46
What organs can be adversely affected with Ciclosporin use?
Nephrotoxicity Hepatotoxicity
47
List 3 adverse abnormalities in the blood caused by cyclosporin
Hyperkalaemia Impaired glucose tolerance Hyperlipidaemia
48
List 6 adverse clinical features of Ciclosporin use
Fluid retention HTN Hypertrichosis (excess hair) Gingival hyperplasia Tremor Increased susceptibility to severe infection
49
What drug can increase the concentration of ciclosporin?
Cannabidoil
50
What is Digoxin?
Cardiac glycoside Mainly used for rate control in AF Mx
51
What properties allow use of Digoxin in heart failure? What is the effect of this?
Positive inotropic properties Improves Sx but not mortality
52
What is the MOA of digoxin?
Decreases conduction through the AV node which slows the ventricular rate in AF + flutter increases force of cardiac muscle contraction due to inhibition of the Na+/K+ ATPase pump. Also stimulates vagus nerve
53
If Digoxin toxicity is suspected when should plasma concentration be measured?
Within 8-12h of last dose
54
List 6 symptoms of Digoxin toxicity
Malaise Lethargy N+V Anorexia Confusion Yellow-green vision
55
Give 2 clinical signs of Digoxin toxicity
Arrhythmias (e.g. AV block, bradycardia) Gynaecomastia
56
What is the classic precipitant to Digoxin toxicity?
Hypokalaemia Digoxin normally binds to the ATPase pump on the same site as K+ Hypokalaemia → digoxin more easily bind to the ATPase pump → increased inhibitory effects
57
List 7 drugs associated with Digoxin toxicity
Amiodarone Quinidine Verapamil Diltiazem Spironolactone Ciclosporin Drugs that cause hypokalaemia e.g. Thiazides + loop diuretics
58
Describe management of Digoxin toxicity
Digibind: Digoxin-specific antibody Fab fragments Correct arrhythmias Monitor potassium
59
What is the class of Gentamicin? Describe its pharmacokinetics
Aminoglycoside Poorly lipid soluble, thus given parentally or topically
60
Name 2 adverse effects of gentamicin
Ototoxicity Nephrotoxicity
61
Give a contraindication to Gentamicin
Myasthenia Gravis
62
Describe dosing of Gentamicin
Peak (1h after admin) + trough levels (just before next dose) are measured High peak: decrease dose High trough: increase interval between doses

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