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PSA questions Flashcards

1
Q

Hyperkalaemia stages
Mild
Moderate
Severe

A

Mild 5.5-5.9 mmol/L
Moderate 6-6.4 mmol/L
Severe > 6.5 mmol/L

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2
Q

Emergency treatment for hyperkalaemia?

A

If severe ie >6.5 mmol/L or ECG changes- tall T waves, loss of P waves, broad QRS

Iv calcium gluconate- to stabilise myocardium
Insulin dextrose infusion- shifts K+ from ECF to ICF
Nebulised salbutamol

Extra: stop drugs e.g. ACEi
treat cause
Lower total K+: calcium resonium, loop diuretics, dialysis

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3
Q

1st line mx in T2DM

A

Metformin

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4
Q

Metformin giving patient GI side effects, change to what?

A

Modified release metformin

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5
Q

Metformin MOA?

A

Inhibits hepatic gluconeogenesis
Inhibits glucagon function

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6
Q

When would you add a SGLT-2 inhibitor to metformin in 1st line treatment?

A

If patient has
- high risk (QRISK >10%) or established CVD
- chronic HF

If metformin is contraindicated

(Also as a 2nd line option if Hba1c >58 despite 1st line)

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7
Q

If metformin is contraindicated, what would you give as a first line tx for T2DM?

A

If CI due to CVD or HF, give SGLT-2 inhibitor
Otherwise 1 of:
- DPP-4 inhibitor (gliptans)
- pioglitazone
- sulfonylurea e.g. glicazide
- SGLT-2 inhibitor e.g. dapaglifozin

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8
Q

When would you start a 2nd line medication in T2DM?

A

If Hba1c is >58mmol/mol despite 1st line

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9
Q

What would you give as 2nd line tx for T2DM?

A

Metformin + (one of below)
- DPP-4 inhibitor (gliptans)
- pioglitazone
- sulfonylurea
- SGLT-2 inhibitor

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10
Q

What would you give as 3rd line treatment for T2DM?

A

Add another of 2nd line options
E.g metformin + DPP-4 inhibitor + sulfonylurea

Or

Insulin therapy

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11
Q

MOA of metformin?

A

Inhibits hepatic gluconeogenesis
Inhibits glucagon function

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12
Q

MOA of SGLT-2 inhibitors?
And contraindication?

A

Reduced glucose reabsorption in kidneys
—> more excreted in urine
SGLT-2 is the main transport protein of glucose (90%)

CI: severe renal failure

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13
Q

Examples of SGLT-2 inhibitors? (4)

SGLT-2 abbreviated from?

A

Dapaglifozin
Canaglifozin
Empaglifozin
Ertuglifozin

Sodium glucose Co-transporter-2

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14
Q

DPP-4 inhibitor MOA?

A

Inhibits DPP-4 enzyme, an enzyme that destroys the hormone incretin. Incretin:
- encourages insulin release from b cells
- inhibits release of glucagon from a cells
So, less DPP-4 enzyme —> more incretin —> more insulin and less glucagon —> less glucose in blood

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15
Q

Side effects and contraindications of GPP-4 inhibitors?

A

SEs: GI problems
CIs: pancreatitis hx, hypoglycaemia, angioedema

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16
Q

Examples of DPP-4 inhibitors?

A

Sitagliptin
Vildagliptin
Alogliptin
Lingagliptin

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17
Q

Main thiazolidinedione used?

A

Pioglitazone

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18
Q

MOA of pioglitazone

A

A thiazolidinedione
Binds to receptors in adipocytes —> promotes adipogenesis and fatty acid uptake —> reduces circulating fatty acid conc —> improves insulin sensitivity

But, can therefore lead to weight gain

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19
Q

MOA of sulfonylureas?

A

Directly stimulate B cells to release insulin

Therefore can only be used if there is some B cell function I.e should not be used in type 1 diabetes

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20
Q

Examples of sulfonylurea? (4)

A

Glicazide
Glipizide
Glimepiride
Tolbutamide

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21
Q

MOA of GLP-1 receptor agonist?

A

Stimulates release of insulin from B cells

GLP-1 = glucagon like peptide

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22
Q

Examples of GLP-1 receptor agonists?

A

Liraglutide
Lixisenatide
Dulaglutide
Semaglutide

All injections, some OD, some once weekly. Should only be commenced by a specialist

‘GL’ “glutides”

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23
Q

When are GLP-1 mimetic (receptor agonist) indicated

A

If control not achieved or tolerated (Hba1c >58 mmol/mol) on triple therapy.

Used if
- BMI over 35
- insulin therapy not concordant with lifestyle

*only continue if Hba1c reduces by 11 mmol/mol AND body weight decreases by 8%

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24
Q

Normal Na range?

A

135-145 mmol/L

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25
Q

Normal K+ range?

A

3.5-5.0 mmol/L

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26
Q

Normal bicarb level?

A

22-29 mmol/L

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27
Q

Normal magnesium level?

A

0.7-1.0 mmol/L

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28
Q

Urea normal blood level?

A

2.0-7.0 mmol/L

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29
Q

Blood creatinine normal level?

A

55-120 umol/L

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30
Q

Fasting glucose tolerance test normal level

Normal glucose level (not fasted)?

A

Fasted- <5.6 mmol/L
Normal- <7.8 mmol/L

5.6 7.8
“5678”

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31
Q

Treatment for hypomagnesaemia?

A

Hypo is below 0.7 mmol/l
Severe is below 0.4

<0.4 mmol/L, arrhythmia or seizure
- IV magnesium e.g. 40 mmol magnesium sulphate over 24 hrs

> 0.4 mmol/l
- oral magnesium salts e.g. 10-20 mmol oral OD, SE diarrhoea

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32
Q

Sitagliptin is an example of which type of diabetic drug?

A

A DPP- 4 inhibitor
‘Dipeptidyl peptidase-4 inhibitor’
“Gliptins”

They inhibit breakdown of incretin enzyme
So, more insulin and less glucagon in blood

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33
Q

Pharmacokinetic vs pharmacodynamic?

A

Pharmacokinetic- two drugs affect on eachother e.g. inhibitory or synergistic. Alters the length or strength of drugs rather than the type of effect.

Pharmacodynamic- alters the body’s responsiveness or sensitivity to a drug

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34
Q

What type of pain relief medications should be avoided with oral anticoagulants including warfarin?

A

NSAIDS

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35
Q

Common interactions with St Johns Wort?

A

An unlicensed herbal medicine often used for it’s antidepressants effects

A common CYP system inducer

Often interacts in by inducing the effects of:
- Antidepressants- can lead to serotonin syndrome
- MAOIs- can cause a hypertensive crisis
- Warfarin- induces metabolism —> reduces INR
- Redcuced conc of oestrogen and progesterone

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36
Q

Common CYP system inhibitors?

A
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37
Q

Common CYP inducers?

A
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38
Q

Most common CYP enzyme?

A

CYP3A4 is our main enzyme that metabolises most drugs

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39
Q

Most common enzyme inducers?

A

Increase enzyme activity —> so reduce drug conc

“PC BRAS”
Phenytoin
Carbamazepine
Barbiturates
Rifampicin
Alcohol- chronic excess
Sulphonylureas

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40
Q

Most common enzyme inhibitors?

A

Decrease enzyme activity —> so drug conc rises

“AODEVICES”
Allopurinol
Omeprazole
Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol (alcohol intoxication)
Sulphonamides

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41
Q

Are enzyme inducers or inhibitors more likely to lead to toxicity of a drug?

A

Inhibitors

Because they inhibit the enzymes that break down the drug

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42
Q

Which hypertensives drugs should (nearly) always be carried on during surgery?

A

Calcium channel blockers
Beta blockers

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43
Q

What long term drugs should be increased during surgery?

A

Long term steroids e.g. prednisolone

Patients on steroids commonly will have adrenal atrophy so can’t naturally respond to the physiological stress of surgery so should have there steroid doses doubled to prevent a hypotensive crisis.
Similar to ‘sick day rules’ when a patient on steroids come into hospital or are acutely ill

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44
Q

Drugs that should be stopped prior to surgery?

A

I LACK OP
Insulin
Lithium
Anticoagulants/anti platelets
COCP/HRT
K-sparing diuretics e.g. spironolactone
Oral hypoglycaemics
Perindopil and ACE inhibitors

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45
Q

How long before surgery should COCP or HRT be stopped prior to surgery?

A

4 weeks

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46
Q

How long before surgery should lithium be stopped?

A

1 day before

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47
Q

How long before surgery should K-sparing diuretics and ACE inhibitors be stopped?

A

Day of surgery

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48
Q

4 key things that you should consider prescribing for a patient coming into hospital?

A

IV fluids
Pain relief
Thromboprophylaxis
Anti-emetics

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49
Q

PReSCRIBER mneumonic for remembering what to ensure is done when prescribing?

A

Patients details
Reaction ie allergies + reaction?
Sign
Contraindications?
Route?
Iv fluids needed?
Blood clot prophylaxis?
anti-Emetic?
pain Relief?

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50
Q

Which two antibiotics have penicillin in them but don’t have the -cillin in the name?

A

Tazocin
Co-amoxiclav

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51
Q

What antibiotic should be avoided with a high INR?

A

Erythromycin- enzyme inhibitor

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52
Q

Which drugs should are contraindicated in patients that are bleeding or at risk of bleeding e.g. prolonged PT due to liver disease

A

Drugs that increase bleeding
Aspirin
Heparin
Warfarin

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53
Q

Contraindications for steroids?

A

‘STEROIDS’
Stomach ulcers
Thin skin
oEdema
Right and left HF
Osteoporosis
Infection- including candida
Diabetes- can cause hyperglycaemia
cushing’s Syndrome

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54
Q

NSAID cautions and contraindications.

A

‘NSAIDS’
No urine ie renal failure
Systolic dysfunction ie HF
Asthma
Indigestion- any cause
Dyscrasia- clotting abnormality

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55
Q

Main side effect if ACE inhibitors?

A

Dry cough

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56
Q

Main side effects of calcium channel blockers?

A

Peripheral oedema
Flushing

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57
Q

General diuretics main side effect?

A

Renal failure

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58
Q

Loop diuretic main side effect?
Loop diuretic example?

A

Gout
Renal failure- generic

Furosemide

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59
Q

K sparing diuretic specific side effect?

A

Gynaecomastia
Generic- renal failure
Hyperkalaemia

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60
Q

For fluid replacement, all patients should have 0.9% saline unless….
If hypernatraemic?
If hypoglycaemic?
Has ascites?
If shocked with systolic <90?
If shocked from bleeding?

A

Hypernatraemic- 5% dextrose
Hypoglycaemic- 5% dextrose
Ascites- human-albumin solution
If shocked with systolic <90 -give gelofusine- has a high osmotic content so stays intravascularly longer
Shocked from bleeding? Give blood transfusion, give colloid if blood not available

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61
Q

If tachycardic or hypotensive, what vol of fluid bolus?

If oliguric?

A

500ml bolus
In HF, give 250ml

1L over 2-4hr then reassess

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62
Q

As a general rule, what vol of fluid do adults and elderly require per 24 hours?

A

Adults- 3L IV fluid per 24 hours
Elderly- 2L Iv fluid per 24 hours

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63
Q

Max rate if IV potassium infusion?

A

IV potassium Max 10 mmol/hour

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64
Q

Antiemetic choice and dose for patient with nausea?

A

Cyclizine 50mg 8 hourly IM/IV/oral
- can cause fluid retention

If HF, metoclopramide 10mg 8 hourly IM/IV

Can be given ‘as required’

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65
Q

What is the most common go to antiemetic?

A

Cyclizine
50mg TDS

Unless cardiac cause, then give Metoclopramide 10mg TDS

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66
Q

When would you avoid using metoclopramide?
What is its MOA?

A

MOA- dopamine antagonist

Avoid in
- Parkinson’s as can exacerbate symptoms
- young women- risk of dyskinesia

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67
Q

Daily max of paracetamol?

A

4g

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68
Q

First line for neuropathic pain?

Painful diabetic neuropathy 1st line?

A

Amitriptyline- 10mg oral nightly
Pregabalin- 75mg oral 12hrly

For painful diabetic neuropathy- Duloxetine 60mg OD

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69
Q

What analgesic should be avoided in asthmatics?

A

NSAIDS
Can cause bronchoconstriction so should be avoided unless strictly necessary and under close supervision

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70
Q

What abx should be avoided when using methotrexate?

A

Trimethoprim- ABSOLUTE contraindication as both are folate antagonists due to risk of bone marrow toxicity, can lead to pancytopenia and neutropenic sepsis

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71
Q

What rheumatological drug should be withheld until neutropenic sepsis is ruled out?

A

Methotrexate

72
Q

Why should verapamil not be given concomitantly with beta blockers?

A

(Verapamil is a calcium Chanel blocker)

Concomitant use of these can cause bradycardia and hypotension, and even asystole

73
Q

What can cause a high neutrophil count?

A

Bacterial infection
Tissue damage —> inflammation/infarct/malignancy
Steroids

74
Q

What can cause a low neutrophil count?

A

Viral infection
Chemo or radiotherapy
Clozapine- antipsychotic
Carbimazole- anti thyroid

*patients undergoing chemo or radiotherapy can have a low neutrophil count in response to a bacterial infection. Urgent IV broad spec abx needed

75
Q

What can cause a high lymphocyte count?

A

Viral infection
Lymphoma
Chronic lymphocytic leukaemia

76
Q

Define thrombocytopenia and thrombocytosis

A

Thrombocytopenia- low plateletS
Thrombocytosis- high platelets

77
Q

Thrombocytopenia can be caused by reduced production or increased destruction. What are causes of both?

A

Reduced production:
- infection (viral)
- drugs esp rheum drug penicillamine
- myelodysplasia, myelofibrosis, myeloma

Increased destruction
- heparin
- hypersplenism
- DIC
- ITP
- haemolytic uraemia syndrome/ TTP

78
Q

What can cause thrombocytosis?

A

Reactive or primary

Reactive:
- bleeding
- Tissue damage - infection/inflammation/malignancy
- post splenectomy

Primary
- myeloproliferative disorders

79
Q

Three generic groupings of the causes of hyponatraemia?

A

Hypovolaemic
Euvolaemic
Hypervolaemic

80
Q

Hypovolaemic causes of hyponatraemia?

A

Fluid loss- d&v
Addison’s disease
Diuretics

81
Q

Euvolaemic causes of hyponatraemia?

A

SIADH
Psychogenic polydipsia
Hypothyroidism

82
Q

Hypervolaemic causes of hyponatraemia?

A

Heart failure
Renal failure
Liver failure- causing hypoalbuminaemia
Nutritional failure- causing hypoalbuminaemia
Thyroid failure- can be Euvolaemic too

83
Q

Causes of SIADH?

A

Mneumonic ‘SIADH’

Small cell lung cancer
Infection
Abscess
Drugs- esp carbamazepine and antipsychotics
Head injury

84
Q

Raised urea can indicate an AKI or what else?

A

A bleed e.g. upper GI bleed

Haemoglobin is broken down into urea by gastric acid then absorbed into the blood.
So, if raised urea with normal creatinine, look at haemoglobin

*also could have a raised urea from a bloody steak

85
Q

Causes for raised alk phos (ALP)?

A

Mneumonic ALKPHOS

Any fracture
Liver damage- post hepatic
Kancer
Paget’s disease of bone
+Pregnancy
Hyperparathyroidism
Osteomalacia
Surgery

*a raised alk phos doesn’t necessarily indicate a posthepatic jaundice

86
Q

Sometimes asked to change a Levothyroxine dose for patients with hypothyroidism. What is the target range for TSH?

A

~0.5- 5 mIU/L

87
Q

How would you change a thyroxine dose depending on the TSH results below?
TSH 0.2
TSH 3
TSH 4.9
TSH 9

A

TSH 0.2 decrease dose
TSH 3 same dose
TSH 4.9 same dose
TSH 9 increase dose

So,
<0.5 decrease
0.5-5 keep the same
>5 increase dose

88
Q

Drugs that can cause cholestasis?

A

Flucloxacillin
Co-amoxiclav
Nitrofurantoin
Steroids
Sulphoylureas

89
Q

What would the T4 and TSH levels be in
Primary hypothyroidism
Secondary hypothyroidism
Primary hyperthyroidism
Secondary hyperthyroidism

A

1’ hypo- ⬆️TSH ⬇️T4 -Problem in thyroid gland
2’ hypo- ⬇️TSH ⬇️T4. - problem in pituitary gland

1’ hyper- ⬇️TSH ⬆️T4
2’ hyper- ⬆️TSH ⬆️T4

90
Q

Warfarin management
If patient is asymptomatic, what would you do with the following INRs?
<6
6-8
>8

A

Normal is 1
Aim is usually 2.5
Metallic valve is usually 3.5

<6 reduce warfarin dose
6-8 omit warfarin for 2 days then reduce dose
>8 omit warfarin and give 1-5mg oral vit K

If minor bleeding with an INR >5, give IV vit K 1-3mg (instead of oral)

91
Q

What is the management plan if a patient is on warfarin and they have a major bleed e.g. causing hypotension or bleeding into a confided space like brain or eye.

A

Stop warfarin
Give 5-10mg IV vit K
Give prothrombin complex

92
Q

When would it be indicated to give Vitamin K?

A

When INR is >8 with no bleeding
Or bleeding

*if major bleeding, prothrombin complex should be given too e.g. Beriplex

93
Q

Most common antibiotic regime for patients with neutropenic sepsis?

A

Neutropenic sepsis is a cause of sepsis e.g. pneumonia or UTI with neutrophils <1

Management
IV ABX
Piperacillin with tazobactam and gentamicin

94
Q

LMWH examples?

A

Dalteparin
Enoxaparin- easier to prescribe in PSA. 100mg/ml
Tinzaparin

95
Q

DOAC examples?

A

Apixaban
Rivaroxiban - use this in PSA (I think)
Edoxaban
Dabigatran
Betrixaban

96
Q

What score would you use if a you wanted to assess the risk of stroke in a patient with AF?

A

CHA2DS2-VASc

97
Q

What are the points scored in the CHA2DS2-VASc score?

What to the pints scored indicate for treatment?

A

Used to assess stroke risk in an AF patient

Congestive heart failure
Hypertension >140/90
Age >75 (2)
Diabetic T2
Stroke or TIA previously (2)
Vascular disease e.g. peripheral artery disease or IHD
Age 65-74
Sex- female

0- consider 75mg OD
1- aspirin or warfarin w aim INR 2.5
2+ - warfarin w aim 2.5

98
Q

When would you give rhythm control treatment to patients with AF and when would you use rate control?

A

Rhythm control if:
- young
- symptomatic AF
- first episode of AF
- AF due to treated cause e.g. sepsis or electrolyte disturbance

Rate control
- everyone else with a heart rate >90bpm

99
Q

You choose to treat a patient with AF with rhythm control treatment. How would you treat them?

A

Cardio version
Either electrical or pharmacological

Pharmacological- Amiodarone 5mg/kg over 20-120mins

*if over 48hours from onset, will need anticoagulation prior- for 3 weeks(?)

100
Q

What treatment options are available for patients requiring rate control for AF?

A

Options of
- Beta blocker e.g. propranolol
- rate limiting calcium channel blocker e.g. diltiazem. Could also use verapamil (but not with a beta blocker)
- Digoxin- if also required, or 1st line if others are CI

101
Q

3 1st line management drugs for stable angina?

A
  • GTN spray
  • 2’ prevention: consider aspirin, statin and CVD risk mod
  • anti-anginal drug: beta blocker, CCB
102
Q

Contraindications of beta blockers?

A

Hypotension
Bradycardia
Asthma
Acute heart failure
+ don’t prescibe with verapamil or NSAIDs

103
Q

Contraindications of CCBs?

A

Hypotension
Bradycardia
Peripheral oedema

104
Q

Asthma management ladder?

A

Inhaled SABA e.g. salbutamol

Inhaled preventor- steroid

Inhaled LABA, if no response, increase steroid

Either increase steroid or 4th drug from:
-leukotriene receptor antagonist (Montelukast)
- theophylline
- oral B2 agonist e.g. carbuterol

Oral steroid
High dose inhaled
Referral to specialist

105
Q

Most seizure types have what as their first line tx?
Focal seizures have a different first line, what is this?

And when are they’re most significant CIs?

A

Sodium valporate

Focal seizures- carbamazepine or lamotragine

Sodium valproate is teratogenic
Lamotragine can cause a rash

106
Q

Parkinson’s (most likely) treatment 1st line?

What would you use if trying to limit the use of this medication due to its finite period of effectiveness.

A

Co-beneldopa
Or
Co-careldopa
*these are both levodopa with a peripheral dopa decarboxylase inhibitor

If avoiding levodopa:
- Dopamine agonist e.g. ropinole
- MAO-inhibitor e.g. rasagiline

107
Q

Common side effects of lamotragine?

A

Rash
Rarely- Stevens-Johnson’s syndrome

108
Q

Common side effects of carbamazepine?

A

Rash
Dysarthria
Ataxia
Nystagmus
Reduced sodium

109
Q

Common side effects of phenytoin?

A

Ataxia
Peripheral neuropathy
Gym hyperplasia
Hepatotoxicity

110
Q

Sodium valproate common side effects?

A

3Ts
Tremor
Teratogenic
Tubby- weight gain

111
Q

Type and example of 1st line drugs for Alzheimer’s?

A

Only started by a specialist

Acetylcholinesterase (AChE) inhibitors:
- donepezil
- rivastigmine
- galantamine

112
Q

1st line tx for Crohn’s flare
-mild
-severe

A

Mild- 30mg prednisolone OD
Severe- Hydrocortisone 100mg 6 hourly IV

If rectal disease- rectal hydrocortisone

113
Q

Maintaining remission in Crohn’s?

A

Azathioprine
Or
6- mercaptopurine*

*in 10% population, this is poorly metabolised so can accumulated, causing liver and bone marrow toxicity, should consider methotrexate instead

114
Q

When would vancomycin be used orally?

A

To treat C.difficile in the gut

115
Q

Max vancomycin infusion rate

A

10mg/ min

116
Q

What’s gentamicin used for?

A

Bacterial endocarditis
Surgical prophylaxis
Neutropenic sepsis

117
Q

Adult dose of gentamicin

A

5-7mg/kg/day
Via IV over >60mins

118
Q

Women’s and men’s ideal body weight calculation?

A

Womens
[ (height (cm) - 154) x 0.9 ] + 45.5

Mens
[ (height (cm) -154) x 0.9 ] + 50

119
Q

Insulin blood glucose targets before meals and after meals?

A

Before: 4-7mmol/l
After: <9mmol/l

120
Q

How much NaCl is in 0.9% NaCl in 1ml

A

0.9g in 100ml
900mg in 100ml

1ml has 9mg NaCl

121
Q

How much glucose is in 1ml of 5% glucose solution?

A

5g in 100ml
5000mg in 100ml
50mg in 1ml

122
Q

MgSO4 20% solution. How much MgSO4 is in 1ml of solution?

A

20g in 100ml
20,000mg in 100 ml
200mg in 1ml

123
Q

What do the following ratios mean practically?
1:1000
1:10000

A

1:1000 = 1g in 1000ml
1:10000= 1g in 10000ml

124
Q

What does the adrenaline 1 in 1000 mean in doses?

A

1 in 1000 = 1g in 1000ml

125
Q

You’ve got adrenaline 1 in 200000. How much adrenaline is in 1ml?

A

1:200000
= 1g in 200000ml
= 1000mg in 200000
= 1mg in 200ml
= 1000 mcg in 200ml
/ 200
= 5mcg in 1ml

126
Q

What type of laxative is
Senna
Lactulose

A

Senna- stimulant
Lactulose- osmotic

127
Q

First line abx in skin infections?

A

Flucloxacillin

128
Q

What is hydroxycobalamin used to treat?

A

Vit B12 deficiency

129
Q

What drugs should be avoided in Parkinson’s disease?
Which dopamine antagonist can be used in Parkinson’s patients and why?

A

Haloperidol
Metoclopramide
As they’re both dopamine antagonists. Can precipitate parkinsonian symptoms in patients without Parkinson’s too

Domperidone is a dopamine antagonist but doesn’t cross the blood brain barrier so is alright to use

130
Q

Young female on ace inhibitor wants to get pregnant. Do you need to alter medications? If yes, how?

A

ACEi teratogenic in first trimester
Should swap to labetolol before conception

131
Q

Colour coding of warfarin tablets?

A

White 0.5mg
Brown 1mg
Blue 3mg
Pink 5mg

132
Q

What would 1% mean (regarding concentrations of solutions)?

A

1g in 100ml

133
Q

What does 1 in 1000 mean?
What does 1 in 10000 mean?

A

Units are same as percentage
1g in 1000ml
1g in 10000ml

134
Q

When is 1 in 1000 adrenaline used and when is 1 in 10000 used?

A

1 in 1000 is used in the IM format e.g. in an epipen
1in 10000 is used IV in ALS (ALS trained)

135
Q

First line medical treatment for heart failure?

A

‘ABAL’
ACEi e.g. ramipril
Beta blocker e.g. bisoprolol
Aldosterone antagonist, if not controlled on A and B e.g. spironolactone
Loop diuretic improves sx e.g. furosemide

136
Q

Rate control options for AF?

A

1’ Beta blocker
2’ CCB
3’ Digoxin- only in sedentary, needs monitoring

137
Q

1st drug given in sever hyperkalaemia?

A

Short acting insulin WITH glucose
E.g. actrapid or novorapid
Dose: 10 units
In 100ml of dextrose
30 min IV

138
Q

Most appropriate drug for (most types of) epilepsy in pregnancy?

A

Lamotragine

139
Q

When is metformin NOT used first line for T2DM?
And what would you use instead 1st line?

A

Causes appetite suppression so not used in underweight or normal.
Avoid if creatinine >150 as can cause lactic acidosis

Would use a sulphonylurea instead for normal and underweight e.g.
- Glicazide
- Tolbutanide
- Glipizide

140
Q

What parameter should be checked prior to initiating vancomycin?

A

Serum creatinine
Renally excreted so dysfunction can lead to toxicity

141
Q

2 most common side effects of vancomycin?

A

Nephrotoxicity
Ototoxicity

142
Q

What parameter should be checked before prescribing statin? And when after starting them?
When are statins contraindicated?

A

Liver function
Contraindicated in active liver disease or if AST or ALT are raised more than 3x normal range- or should be stopped if on them

LFTs should be check 3 and 12 months after starting a statin

143
Q

What should be measured before starting antipsychotics, particularly olanzapine?

A

Fasting blood glucose. At baseline and regularly thereafter
Antipsychotics can cause hyperglycaemia T2DM

144
Q

What should be checked prior to starting ACEi? And why?

A

U&Es should be checked before starting and after every dose change
Can cause hyperkalaemia, hyponatraemia and AKI

145
Q

What parameter should be measured when using digoxin?

A

Serum creatinine
Would measure serum digoxin level if suspecting toxicity or inadequate effect suspected

146
Q

What should you check prior to starting sodium valporate?

A

LFTs - should be measured at baseline and at regular intervals
Can cause hepatotoxicity

147
Q

What should be measured when a patient is taking clozapine?

A

FBC for 1st 18weeks
High risk of neutropenia and agranulocytosis

148
Q

What should you avoid prescribing alongside ACEi?

A

NSAIDS- can worsen kidney function considerably

149
Q

What are the standard requirements per day of Na, Cl and K?

A

1 mmol/kg/day

150
Q

What is the standard glucose requirement per day?

A

50-100g glucose per day

151
Q

When would you avoid giving glucose IV?

A

Obvs if hyperglycaemic
Avoid within 24hrs of an ischaemic stroke or head trauma

152
Q

Max potassium infusion rate?

A

10 mmol / hour

NEVER use in resus bag
Use the 0.3% conc to meet K requirements

153
Q

What would you prescibe to a severly hypoglycaemic patients?

A

10% or 20% glucose, not stronger as can cause thromboembolus

154
Q

Fluid requirements /kg/day?

A

25-30ml /kg/day

155
Q

If changing insulin dose, how much do you change it by?

A

~10%. Avoid complicating, keep on same medications and just adjust doses if needed

156
Q

What is the breakdown of short to long acting insulin in Novomix 30

A

30% short acting
70% long acting

157
Q

Which NSAID does not cause renal failure?

A

Aspirin

158
Q

How long does it take for aspirins effect to wear off?

A

Approx 7-10 days
Irreversible inhibitor of COX enzyme. So last the life of the platelets (which is 7-10 days)

159
Q

What medication should you avoid in patients with gout?

A

Thiazide like diuretics e.g. Bendroflumethazide

160
Q

Lithium excretion is significantly reduced by what medications?

A

ACEi
Diuretics- particularly thiazides
NSAIDs

161
Q

When patients are treated and recovering from dehydration, they can sometimes overcompensate and have a polyuric phase where output is considerably higher than input. What point would you consider this ‘polyuric’ phenomanon?

A

If urine output exceeds 200ml/hr

162
Q

KCl requirements per day? in mmol

A

40-60mmol /day

163
Q

Maintenence fluids. What is meant by the term ‘2 salty, 1 sweet’?

A

2L NaCl 0.9%
1L 5% dextrose w 40-60 mmol KCl

This gives the 3L a day. With the adequate amount of Na, Cl and K

164
Q

If a patient is improving clinically and their bloods come back with a significantly raised potassium, what would you do?

A

Recheck - likely artefactually abnormal if everything else normal and patient seems well

True hyperkalcaemia:
- 10ml 10% IV calcium gluconate
- 10 units actrapid insulin in..
- 100 ml 20% IV dextrose
- Nebulized salbutamol

165
Q

Metformin is contraindicated in chronic kidney failure below what eGFR?

A

Contraindicated below 30
Cautionary use below 45

166
Q

What diabetic drug is 1st line in patients with CKD?

A

A sulphoylurea e.g. glicazide

167
Q

What antiemetic is inappropriate in bowel obstruction?

A

Metoclopramide

and CI in few days post abdo surgery

168
Q

If started on clarithromycin, what common regular drug should be stopped?

A

Statins.
Clari is a CYP3A4 inhibitor meaning the enzymes metabolising statins activity is reduced leading to a build up leading to increased toxicity and SEs

169
Q

Rapid antacid?

A

Gaviscon- alginate
Magnesium carbonate
Aluminium hydroxide
Co-magaldrox

170
Q

Hospital acquired pneumonia 1’ tx?

A

Piperacillin w/ Tazobactam

171
Q

When would you check tacrolimus levels to check normal range?

A

Measure trough levels prior to morning dose
Should be between 6-10ng/ml

172
Q

Non-sedating antihistamines?

A

Fexofenadine
Loratidine (these 2 are the least sedating)
Acrivastine
Cetirizine

173
Q

Non

A
174
Q

Sedating antihistamines?

A

Chlorphenamine
Promethazine
Cinnarizine

175
Q

Anion gap formula?

Serum osmolality formula?

A

Anion gap
(Na + K) - (bicarb + Cl)

Serum osmolality
2(Na) + glucose + urea

Finals (13 decks)

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