PSA/Pharm Flashcards by yeswanth AKULA

What does 1% conc w/v mean

1g in 100 mL

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Eznyme inhibitors

AODEVICES

Allopurinol 
Omeprazole 
Disulfiram 
Erythromycin 
Valproate 
Isoniazid 
Criprofloxacin 
Ethanol(acute intoxication) 
Sulphonamides

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Enzyme inducers

PC BRAS

Phenytoin 
Carbamazepine 
Barbiturates 
Rifampicin 
Alcohol(chronic excess) 
Sulphonylureas

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Which drug is important to increase during surgery

Patients on long-term corticosteroids(they commonly have adrenal atrophy; they are therefore unable to mount an adequate physiological stress response to surgery) –> profound hypotension

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Drugs to stop before surgery

COCP and HRT
Lithium 
Potassium-sparing diuretics and ACE-i
Anticoagulants 
Oral hypoglycaemic drugs and insulin

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Key side effects of steroids

STEROIDS
Stomach ulcers 
Thin skin 
oEdema 
Right and left heart failure 
Osteoporosis 
Infection(candida) 
Diabetes 
cushing's Syndrome

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NSAIDs cautions and contraindications

NSAID

No urine(renal failure) 
Systolic dysfunction(heart failure) 
Asthma 
Indigestion 
Dyscrasia(clotting abnormality)

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What type of fluid should be given in ascites

Human-albumin solution - albumin maintains oncotic pressure; furthermore, the higher sodium content of 0.9% saline will worsen ascites

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Max rate for IV potassium

Not more than 10 mmol/hr

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In which patients should metoclopramide be avoided in

Patients with Parkinson’s disease due to the risk of
exacerbating symptoms.

Young women due to the risk of dyskinesia, i.e. unwanted
movements especially acute dystonia.

Gastric stasis

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General analgesic choice for mild pain

Regular paracetamol 1g 6-hourly oral

Codeine 30mg up to 6 hourly oral as required

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General analgesic choice for severe pain

Co-codamol 30/500, 2 tablets 6-hourly oral - regular

Morphine sulphate 10 mg up to 6hourly oral - as required

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Medication causes of hypokalaemia

Diuretics(thiazide-like and loop) 
Laxatives(large doses) 
Sympathomimetic drugs(beta-adrenergic bronchodilators) 
Theophylline 
Glucocorticoids 
Insulin(not significant)

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Medication causes of hyperkalaemia

ACE inhibitors/ARBs
Beta blockers
NSAIDs
Spironolactone

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Medication causes of dyspepsia

Corticosteroids
Aspirin 
Beta-blockers 
NSAIDs 
TCAs 
Alpha-blockers

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Medication causes of constipation

Opioids
Anticholinergics(tricyclics, phenothiazines)
Iron

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Key contraindication of trimethoprim

Trimethoprim is a folate antagonist, and is a direct contraindication to patients taking methotrexate (another folate
antagonist) due to the risk of bone marrow toxicity.

This can lead to pancytopenia and neutropenic sepsis.

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UKMEC 4 conditions for COCP

more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation

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Which meds are usually prescribed once a week

Bisphosphonates

Methotrexate

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Causes of low MCV

IDA
Thalassaemia
Sideroblastic anaemia

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Causes of normocytic anaemia

Anaemia of chronic disease
Acute blood loss
Haemolytic anaemia
Renal failure(chronic)

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Causes of macrocytic MCV

B12/folate def 
Excess alcohol 
Liver disease
Hypothyroidism 
MDS/multiple myeloma

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Causes of neutrophilia

Bacterial infection
Tissue damage(inflammation/infarct/malignancy)
Steroids

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Causes of lymphocytosis

Viral infection
Lymphoma
Chronic lymphocytic leukaemia

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Causes of neutropenia

Viral infection Chemotherapy or radiotherapy Clozapine Carbimazole

Causes of thrombocytopenia linked to reduced production

Infection(usually viral) Drugs MDS/Myelofibrosis Myeloma

Causes of thrombocytopenia linked to increased destruction

``` Heparin Hypersplenism DIC ITP HUS ```

Causes of thrombocytosis

``` Bleeding Tissue damage(infection/inflammation/malignancy/post-splenectomy) ``` Myeloproliferative disorders

Which drug specifically is associated with thrombocytopenia

Penicillamine

General causes of hypokalaemia

DIRE Drugs Inadequate intake or intestinal loss(diarrhoea/vomiting) Renal tubular acidosis Endocrine(cushing's and conn's syndrome)

General causes of hyperkalaemia

DREAD ``` Drugs Renal failure Endocrine(Addison's) Artefact(common due to clotted sample) DKA ```

Biochemical disturbance pattern in prerenal AKI

Urea rise >> creatinine rise

Biochemical disturbance pattern in intrinsic AKI

Urea rise << creatinine rise

Biochemical disturbance pattern in post renal AKI

Urea rise << creatinine rise Bladder or hydronephrosis may be palpable

What does a raised bilirubin on its own indicate

Prehepatic jaundice - usually haemolytic

Common causes of raised ALP

ALKPHOS ``` Any fracture Liver damage K (Cancer) Paget's disease of bone and pregnancy Hyperparathyroidism Osteomalacia Surgery ```

Prehepatic causes of LFT derangement

Haemolysis | Gilbert's

Intrahepatic causes of deranged LFTs

``` Fatty liver Hepatitis Cirrhosis Malignancy Metabolic(Wilson's) ```

Posthepatic causes of deranged LFTs

``` Gallstones Cholangiocarcinoma PBC PSC Pancreatic or gastric cancer ```

Which drugs can cause cholestasis

Paracetamol overdose Statins Rifampicin

Which drugs may worsen seizure control in patients with epilepsy

``` Alcohol Ciproflox, levoflox Aminophylline Buproprion Methophenidate ```

How can liver disease increase a patient's PT and INR

Liver disease can impair the synthesis of vitamin K and hence increase a patients prothrombin time and INR

Preferred opioid in renal impairment in palliative prescribing

Oxycodone is preferred to morphine

Breakthrough pain dosage for morphine

1/6th of dose

Advice when increasing opioid dosage

When increasing the dose of opioids the next dose should be increased by 30-50%.

Which meds may exacerbate heart failure

thiazolidinediones verapamil NSAIDs/glucocorticoids flecainide

Which meds should be avoided in IHD

NSAIDs oestrogens: e.g. combined oral contraceptive pill, hormone replacement therapy varenicline

Drugs which can cause hepatocellular picture in jaundice

``` Paracetamol Sodium valproate, phenytoin MAOIs Anti-TB meds Statins Alcohol Amiodarone Methyldopa Nitrofurantoin ```

Drugs which can cause cholestasis

``` COCP Fluclox,co-amox, erythromycin Analbolic steroids Chlorpromazine Sulphonylureas Fibrates ```

Which antibiotics should be avoided in CKD

Tetracyclines | Nitrofurantoin

Criteria for liver transplantation in paracetamol overdose

arterial pH<7.3 24 hours after ingestion or: PT>100 secs creatinine>300umol/l grade III or IV encephalopathy

TB meds side effects

RIPE ONGO Rifampicin: Orange secretions Isoniazid: Neuropathy Pyrazinamide: Gout Ethambutol: Optic Neuritis

Indications for HRT

Vasomotor symptoms | Premature menopause

How long should HRT be continued for for premature menopause

Should be continued until the age of 50 years

Types of HRT

Oestrogens Progestogens Tibolone

When is transdermal HRT preferred

If at risk of VTE

Adverse effects of heparins

Bleeding Thrombocytopenia Osteoporosis and an increased risk of fractures hyperkalaemia(inhibition of aldosterone secretion)

Monitoring for standard heparin

APTT

Monitoring for LMWH

Anti-factor Xa(routine monitoring not required)

Drugs which can cause low magnesium

Diuretics | PPIs

General causes of hypomagnesaemia

``` Drugs TPN Diarrhea Alcohol Hypokalaemia Hypercalcaemia ```

Features of hypomagnesaemia

``` paraesthesia tetany seizures arrhythmias exacerbates digoxin toxicity ```

Mx of hypomagnesaemia if <0.4 mmol/L

<0.4 mmol/L or tetany, arrhythmias, or seizures intravenous magnesium replacement is commonly given. an example regime would be 40 mmol of magnesium sulphate over 24 hours

Mx of hypomagnesaemia if > 0.4mmol/l

oral magnesium salts (10-20 mmol orally per day in divided doses) diarrhoea can occur with oral magnesium salts

PSA/Pharm Flashcards

(64 cards)