PSA revision Flashcards
1
Q
which antiemetic should you never use in parkinsons patients
A
metoclopramide
2
Q
which drugs should you never use in parkinsons
A
haloperidol and other antipsychotics for agitation bc dopamine antagonists
3
Q
best antiemetic to use in parkinsons
A
domperidone
4
Q
management of pain in acute MI
A
- morphine
- paracetomol can be used but not as fast acting
- GTN spray 2 puffs very fast acting to relieve pain by dilating coronary arteries
5
Q
management of hypertension in pregnancy -
which drug should you switch to
A
switch to labetaolol bc other antihypertensives all teratogenic
6
Q
which diabetes drug is associated with lactic acidosis
A
metformin
7
Q
oral diabetic drugs advice
A
eat regular meals to avoid hypoglycaemia
8
Q
name 3 SSRI’s
A
citalopram
sertraline
fluoxetine
paroxetine
9
Q
name a SNRI
A
venlafaxine
duloxteine
10
Q
name a TCA
A
amitryptiline
11
Q
name a norad serotinin specific antidepressant (NASSA)
A
mirtazepine
12
Q
name a noradrenaline reuptake inhibitor NARI
A
reboxetine
13
Q
which antidepressant is safest in the elderly
A
SSRI’s
14
Q
which drugs should you avoid prescribing alongside SSRI’s
A
warfarin
doacs
heparin
NSAIDS
15
Q
which antidepressants are safest to use during pregnancy
A
sertraline and fluoxetine
give a lower dose
16
Q
what does a cytochrome p450 inducer do
A
induces the p450 enzymes, so increases clearance of the drug, so decrease bioavailability
17
Q
name 4 examples of p450 inducers
A
phenytoin rifampicin phenobarbital alcohol sulphonylureas
18
Q
name 6 exmaples of p450 inhibitors
A
sodium valproate fluconazole grapefruit juice alcohol chloramfenicol erythromycin ciprofloxacin omeprazole metronidazole
19
Q
what does a p450 inhibitor do
A
inhibits p450 enzymes so less breakdown of the drug so increased bioavailability (ie increased risk of toxicity, more effects)
20
Q
name 2 drugs that cause ototoxicity
A
vancomycin gentamicin furosemide in high doses NSAIDS aspirin in large doses
21
Q
what food should be avoided with warfarin
A
vitamin k rich food - antagonises warfarin
stuff like kale, spinach, cranberry juice
22
Q
which 5 antibiotics cause C. diff infection
A
clindamycin cephalosporins (cefalexin, cefuroxime, cefotaxime, ceftriaxone) ciprofloxacin co-amoxiclav carbapenams (meropenam)
23
Q
management of c.diff infection
A
- oral vancomycin
- oral fidaxomycin
- if severe presentation / not treated with the above use IV metronidazole and PO vancomycin
24
Q
which antiemetics are contraindicated in patients with a prolonged QT interval
A
ondansetron (5 ht receptor antagonist)
25
1st line antiemetic in post op nausea and vomiting
ondansetron
26
which antiemetics should you avoid in patients on antipsychotics
metoclopramide (dopamine antagonist) - increased risk of extrapyramidal side effects
27
1st line management of shingles
aciclovir
28
patient with t2 diabetes with a high hba1c 1st line management
metformin
29
common drugs that cause hyperkalaemia
```
ace inhibitors
ARBS - candesartan
fluconazole
beta blockers
digoxin
ciclosporin
eplerenone (type of k sparing diuretic)
spironolactone
NSAIDS
tacrolimus
trimethoprim
```
30
drugs that can cause dyspepsia
```
alendronic acid
prednisolone
NSAIDS
CCB's eg amlodipine
TCA's
beta blockers
antimuscarinics eg oxybutinin, tolterodine
```
31
drugs that can cause ankle oedema
amlodipine
naproxen
corticosteroids
pioglitazone
32
treatment of thrush in pregnancy
clotrimazole pessary bc oral fluconazole is contraindicated
33
management of c.diff infection
1. oral vancomycin
2. fedaxomicin
3. oral vancomycin + IV metronidazole
34
when should loperamide be taken
after each loose stool
35
medications that can cause serotonin syndrome
SSRI's
| tramadol --> a serotonin inducing drug
36
which drugs can lower the contraceptive effects of COCP
carbamezapine
rifampicin
phenytoin
topiramate
37
management of neuroleptic malignant syndrome
procyclidine
38
monitoring effects of COCP
blood pressure - 6 monthly
39
monitoring therapeutic effects of diuretics
daily weights
40
what side effects should patients on DOACs be warned about
bleeding and bruising - go to gp
41
what should you switch to when patients arent tolerating morphine
oxycodone
42
management of too high INR on warfarin
1. if severe eg UGIB or intracranial haemorrhage and INR >5 give beriplex (dried prothrombin concentrate) + vitamin K
2. major bleeding - give FFP + vitamin K
3. INR > 8 but no bleeding or minor bleeding - vitamin K, restart warfarin when INR reaches <5
4. INR 6-8 - stop warfarin and restart when less than 5
5. INR <6 - reduce dose of warfarin
43
pt develops hyperthyroid on amiodarone - management
stop amiodarone
44
pt develops hypothyroid on amiodarone
can continue amiodarone and replace with levothyroxine
45
what should you monitor on amiodarone
TFT's - hypo or hyper thyroid
46
when should you monitor lithium levels
12 hours after the lithium dose
47
which electrolyte abnormality increases the risk of lithium toxicity
hyponatraemia
48
which fluid should you prescribe alongside potassium when treating hypokalaemia
0.9% saline
| cant give 5% dextrose because the glucose would cause a shift of the potassium into the cells
49
what is the maximum rate of infusion of potassium
10mmol per hour
| so can give 40mmol over 4 hours, 20 mmol over 2 etc
50
signs and symptoms of hypokalaemia
can be asymptomatic
| muscle cramps, weakness, fatigue, constipation, arrythmia
51
name as many causes of hypokalaemia as you can
```
excessive laxative use
steroids eg pred
insulin
furosemide
salbutamol
bendroflumethiazine
theophylline
vomiting/diarrhoea
```
52
which electrolyte should you always check in a patient with hypokalaemia
magnesium - low magnesium can make low potassium resistant to treatment so must treat and correct both
53
management of hyperkalaemia
protect the heart - IV calcium gluconate 10% over 3-5 mins
drive potassium into cells -
use IV actrapid insulin 5-10 units with 50ml 50% glucose over 5-15 mins
can give nebulised salbutamol to help
excrete excess potassium - oral calcium resonium
54
in which condition is gentamicin always contraindicated in
myasthenia gravis
55
side effects of gentamicin
ototoxicity
| nephrotoxic
56
what should you monitor when treating a pt with gentamicin
peak and trough gent levels
| renal function before and during treatment
57
what should you monitor when treating a pt with gentamicin
peak and trough (6-14 hours after dose) gent levels
| renal function before and during treatment
58
which pain relief medications are appropriate to use in CKD
paracetamol
coedine phophate
co-codamol
fentanyl
59
which pain relief medications should you avoid in CKD
strong opioids if possible (bc metabolites are renally excreted)
NSAIDs - nephrotoxic
60
what deprescribing / prescribing should you consider in patients with acute AKI
1. prescribe things to correct hypovolaemia eg fluids
2. stop nephrotoxics
3. stop or reduce drugs that are renally excreted to prevent build up in the circulation
4. consider stopping drugs that may be reducing renal perfusion
61
which diuretics should you avoid prescribing in ckd
potassium sparing eg spironolactone
| elperenone
62
which diuretic can you use in CKD but should be withheld in aki
furosemide
63
can you use ace inhibitors and spironolactone together in ckd
not usually due to risk of hyperkalaemia, but can do it under specialist advice only
64
when should you avoid ace inhibitors in ckd
in patients with bilateral renal artery stenosis
| or in patients with 1 functioning kidney and renal artery stenosis
65
what should you look at when considering prescribing ACEi / ARB to patients with CKD
whether they have diabetes
whether they have HTN
albumin creatinine ratio
if they have diabetes and ACR of 3 or more then prescribe
if they have HTN and ACR of over 30 then prescribe
or an ACR of over 70 always prescribe
66
what bloods should you check when prescribing ACEi/ARB to patients with CKD
check potassium before prescribing, and again after 7 days
dont start treatment if K is upper limit of normal eg 5.0
re check in 7 days after every dose change
67
name a side effect of calcium channel blockers
oedema! easily gets confused with fluid overload so be careful
this oedema is resistant to diuretics
68
when is verapamil contraindicated for SVT / rate control
when patient is on a beta blocker - increases the risk of heart block
69
drug of choice for Fast AF in a patient with heart failure and a reduced ejection fraction
digoxin
70
when should dc cardioversion be avoided
when the onset of new fast af is unknown, there is a risk of clots firing off so patient needs anticoagulating before cardioversion
if haemodynamically stable, anticoagulate for 3 weeks before cardioversion
if unstable anticoagulate asap and cardiovert
71
why should you stop metformin in acidotic patients with reduced renal function
increased risk of lactic acidosis
72
patient with renal disease and heart failure presents with fluid overload, already on indapamide
what would you do
switch indapamide to furosemide (best diuretic for removing excess fluid without causing CKD to worsen / aki)
73
name 3 side effects of metformin
GI upset eg diarrhoea, vomiting, abdo pain (most common)
reduced appetite - good for weight loss
lactic acidosis risk when unwell
74
1st line t2dm management
metformin
75
name 3 contraindications to metformin
1. severe renal impariment
2. ketoacidosis
3. low BMI (bc causes weight loss)
76
explain how metformin works
increases your bodies response to insulin so it is able to take up more glucose from your blood and reduces gluconeogenesis by liver
77
normal starting dose of metformin
500mg
78
maximum dose of metformin
2 G a day
79
what to do when patient isn't tolerating metformin
1. switch from IR to MR
2. offer an alternative...
- can offer a gliptin eg sitagliptin / linagliptin
- sulphonylureas eg gliclazide, glipizide, tolbutamide
- pioglitazone
80
give an example of a DPP-4 inhibitor
GLIPTINS
sitagliptin
linagliptin
81
give 3 examples of sulphonylureas
gliclazide
glipizide
tolbutamide
82
when is pioglitazone contraindicated
```
heart failure
hepatic impairment
history of current or past bladder cancer
uninvestigated macroscopic haematuria
DKA
```
83
what is a benefit of using a dpp-4 inhibitor (eg sitagliptin) over a sulphonylurea
less risk of hypoglycaemia
84
give 2 examples of sodium glucose co transporter inhibitors
canagliflozin
| empagliflozin
85
benefits of sodium glucose co transporter inhibitors
good to use in patients with established cardiovascular risk either when metformin not tolerated or in addition to metformin
86
give examples of glucagon like peptide - 1 inhibitors
exenatide
| liraglutide
87
describe the escalation approach for managing T2dm with oral hypoglycaemics
1. metformin
2. dual therapy (add a gliptin, sulphonylurea or pioglitazone)
3. triple therapy
88
when are sodium glucose co transporter inhibitors eg canagliflozin used
in step up therapy in addition to metformin but only if sulphonylureas and other options aren't tolerated / cotraindicated
89
when are sodium glucose co transporter inhibitors eg canagliflozin used
in step up therapy in addition to metformin but only if sulphonylureas and other options aren't tolerated / cotraindicated eg metformin + GLP-1 inhibitor + sulphonylurea
90
side effects of sodium glucose co transporter -4 inhibitors
significant weight loss so can only be used in patients with a BMI >35
91
when should you consider insulin therapy in T2dm
when hba1c is not controlled on dual therapy, triple therapy then you can consider insulin therapy
92
at what hba1c level should you consider intensifying treatment in t2dm
when it raises above 58mmol (7.5%)
93
name 5 actions of insulin
```
inhibits glycogenolysis
inhibits gluconeogenesis
increased production of glycogen from glucose to store
inhibits lipolysis (stops fat breakdown)
increases potassium uptake by cells
decreases fatty acid synthesis
```
94
what type of insulin regimen would you offer to patients with T2dm whos triple therapy has failed
usually offer a once daily regimen with a basal / long acting insulin
95
give 2 examples of long acting insulin
insulin detemir
| insulin garglene
96
describe a twice daily insulin regimen
given once on a morning, once on an evening
usually done with a pre mixed mixture of short (regular human) and intermediate insulins
examples of the pre mixed include:
Humulin 70/30 on a morning, Humulin 50/50 on an evening
usually want to give higher in the morning and less on night bc more at risk of hypo's over night bc not eating
others: Novolog 70/30, Novolin 70/30, humulin 75/25
97
what type of insulin regimen would you offer to patients with T2dm whos triple therapy has failed
usually offer a once daily regimen with a basal / long acting insulin
eg 10 units in a morning
98
describe a basal bolus insulin regimen
long acting insulin in the morning eg levemir, lantus
then a rapid acting insulin (eg novolog, humulog ) before breakfast lunch and dinner to manage post pradial hyperglycaemia
99
describe a once daily insulin regimen
usually 10 units of a long acting basal insulin given on a morning eg lantus, levemir
often used in pts with t2dm alongside on oral hypoglycaemic who have failed to control with oral hypoglycaemics alone
100
what is the doseage for patients on a twice daily insulin regimen (eg pts on the pre mixed)
0.5 units per kg is the total daily dose
they should get 2/3 of this in the morning dose
and 1/3 in the evening dose
eg pt weighs 60kg = 30 units daily total
so 20 units on a morning (2/3)
10 units on an evening
101
what is the dosage for patients on a basal bolus insulin regimen
10 units of long acting on a morning
| then 0.1-0.3 units of rapid acting around 15 minutes before meals
102
give 3 examples of rapid acting insulin
insulin aspart - novorapid
insulin lispro - humulog
insulin glulisine - apidra
103
which class of antibiotics can precipitate torsades des pointes
azithromycin, erythromycin (macrolides)
104
how many mls of fluid does the average adult need daily
25-30 mls / kg
105
daily requirement for glucose when nil by mouth
50-100g per day
106
where do loop diurects act in the kidney
ascending limb of loop of henle on the NA/K/2Cl co transporter
they inhibit this transporter so none of these are moved from the tubular lumen into the epithelial cell for reabsorption therefore no water follows by osmosis so you get electrolyte and water loss out of kidneys
107
which receptor / transporter does furosemide / bumetanide work on
Na/K/2cl co transporter on ascending limb of loop of henle
108
name 4 complications of loop diuretics
```
ototoxicity
hypokalaemia
hyponatraemia
dehydration
worsening hepatic encephalopathy
precipitates gout
metabolic alkalosis
```
109
name 3 side effects of loop diuretics
```
deafness
tinnitus
dizziness
headache
fatigue
muscle spasms
```
110
which drug should you never give with iv furosemide + why
gentamicin - both ototoxic
111
why do loop diuretics precipitate / worsen gout
because they 1. can cause dehydration so a more concentrated blood 2. inhibit excretion of uric acid so increase blood uric acid levels = gout
112
which drugs should you be careful prescribing furosemide or bumetanide with
1. lithium = increased risk of lithium toxicity bc reduced excretion by kidneys whilst on furosemide
2. digoxin toxicity may occur if loop diuretic causes hypokalaemia (makes digoxin toxicity worse)
113
usual dose of furosemide
40mg to start, 20mg maintenance dose
114
which drug should you never prescribe in addisons disease
spironolactone or elperenone
| because they are aldosterone antagonists, and people with addisons are deficient in aldosterone so makes it worse
115
how does spironolactone / eplerenone work
aldosterone antagonists
so competitively binds to aldosterone receptors in the distal tubules
aldosterone usually increases sodium reabsorption via ENac channels in distual tubule, dragging water with it, in exchange for potassium which is then excreted
if you inhibit aldosterone you therefore get sodium and water excretion but also potassium reabsorption = hyperkalaemia risk
116
monitoring of spironolactone
U+E
117
monitoring of furosemide
symptomatic improvement, daily weights
118
what type of drug is indapamide
thiazide like diuretic
119
what is indapamide used for
hypertension
120
name a thiazide like diuretic
indapamide
121
name a thiazide diuretic
bendroflumethiazide
122
how do thiazides work
inhibit the Na/cl transporter in the distal tubule so prevents sodium reabsorption, water always follows sodium so if sodium is excreted so is water = diuretic
can also cause hypokalaemia because this means there is more sodium than normal travelling to the other side of the distal tubule where the Na+/K+ channels are where it is exchanged for potassium meaning there is also excess potassium loss
123
name 2 side effects of thiazide diuretics
hypokalaemia
hyponatraemia
dehydration
gout
124
which types of diuretics can precipitate a gout attack
thiazide diuretics and loop diuretics
125
standard dose of spironolactone
100-200mg per day, max 400mg
126
standard dose of indapamide
1.5-2.5mg per day
127
standard dose of bendroflumethiazide
5-10mg daily
128
which types of diuretics act in the distal tubule
aldosterone antagonists and thiazides
129
which type of diuretic works in the ascending loop of henle
loop diuretics eg furosemide bumetenide
130
how does amiodarone work
works by blocking Na+ K+ and Ca2+ channels in the heart and also beta and alpha adrenergic receptors to reduce spontaneous depolarisations, increase av node refraction, and slow conduction velocity. this is helpful in reducing ventricular rate in AF and flutter and also reduces ventricular rate in VT /VF
131
side effects of amiodarone (6)
contains iodine so can cause thyroid disease (both hypo and hyper for some reason)
pneumonitis
brady cardia
av block
hepatitis
can also make the skin more photosensitive and can cause a grey discolouration
132
what 3 conditions should you avoid amiodarone in
1. active thyroid disease
2. Av block
3. severe hypotension
133
counsel a patient on side effects of amiodarone
1. look out for signs and symptoms of hepatitis so go to GP if develops jaundice (yellowing of skin and eyes), RUQ pain
2. thyroid symptoms - fatigue, weight loss/gain, abnormal periods, change in bowel habit, palpitations
3. pneumonitis - SOB, persistent cough
4. avoid grapefruit juice bc increases risk of side effects
5. avoid direct sunlight and wear suncream bc increases risk of burn
134
name 2 indications for amiodarone
rate control in acute fast AF
ventricular tachycardia
ventricular fibrillation
atrial flutter
135
name 3 indications for adrenaline
anaphylaxis
cardiac arrest
local anaesthetic for vasoconstriction
to stop bleeding in endoscopy (inject into mucosa)
136
what dose of adrenaline is given in anaphylaxis and when can it be repeated
0.5ML (so 0.5mg) of 1:100 (1mg in 1ml)
137
what dose of adrenaline is given in cardiac arrest
10ml (whole thing) of 1:10,000 (1mg in 10ml) adrenaline IV
| always follow with a flush of 10ml 0.9% saline
138
how does adrenaline work
agonist to alpha 1 + 2 and B1 and B2 receptors so causes ...
sympathetic effects!! (fight or flight)
vascoconstricts vessels in skin and mucosa and gut
increases force of heart contraction
increases heart rate
vasodilates coronary arteries (helps redistribute blood to heart where needed in emergencies)
bronchodilation
suppresses inflammatory marker release from mast cells
139
side effects of adrenaline
```
post injection hypertension
tremor
anxiety
headache
palpitations
arrhythmia
```
140
what is doxazosin used for
step 4 treatment for hypertension in pts with a potassium on the higher side when you would want to avoid spironolactone
141
what type of drug is doxazosin
alpha blocker
142
name 3 alpha blockers
doxazocin - used in HTN
tamsulosin - used in BPH
alfuzosin
143
name 4 contraindications to anticoagulants
acute ischaemic stroke - risk of bleeding into stroke
bleeding disorders
liver disease with coagulopathy - if PT raised dont prescribe anti coag
144
name 2 common side effects of calcium channel blockers
flushing
peripheral oedema
bradycardia
145
how do statins work
inhibit HMG-CoA reductase which is the rate limiting enzyme in hepatic synthesis of cholesterol
146
which statin is first line
atorvastatin - proven to be more effective than simvastatin in recent studies to reduce cholesterol
147
which weight should you use for obese patients when prescribing gentamicin
ideal body weight
148
which weight would you use for underweight patients when prescribing gentamicin
actual body weight
149
common side effect of statins
myalgia
150
which drug can mask symptoms of hypo's in diabetes
bisoprolol
151
side effect of carbamezapine
lowers sodium - hyponatraemia
152
monitoring of amiodarone
LFT's before treatment and ev 6 months
TFT's before and ev 6 months
HR - can cause bradycardia
CXR before starting bc can cause pulmonary fibrosis
153
why should bisoprolol and dilitazem / verapamil never be prescribed together
can cause AV block = bradycardia
154
what 3 drugs should be avoided in pregnancy
ace inhibitors
statins
warfarin
155
why should statins be avoided in pregnancy
decrease in cholesterol synthesis can be harmful to foetal development
156
first line management of febrile seizure in a child
buccal midazolam
157
management of acute gout
colchicine
158
prophylaxis of gout
allopurinol
159
first line management of depression in a child
fluoxetine
160
name 2 side effects of tacrolimus
pancytopenia
| pulmonary fibrosis
161
why should you withold co-codamol in aki
not because it is nephrotoxic but because in lowered renal function it can accumulate
162
first line treatment for bacterial tonsillitis
penicillin V aka phenoxymethylpenicillin
163
when giving levonogestrel as emergency contraception what is the dose
1.5mg
164
when should you give double the dose of levonogestrel for emergency contraception (3mg instead of standard 1.5mg)
obese patients
| or patients taking an enzyme inducer eg carbamezapine, phenytoin
165
advice to give to patients on inhaled steroid
rinse mouth after use to prevent candidiasis
166
management of eclampsia
IV magnesium + labetalol
167
when should you stop a patient taking a statin
when LFT's increase by more than 3 times the upper limit - small increases are fine and you can keep pt on them
168
what should you do if the patients morning blood glucose reading is high
increase their evening insulin by 10-20 %
169
when is cyclizine contraindicated
heart failure
170
what is the amount of glucose and how long do you give it over in hypoglycaemia
10% glucose 150ml over 15 mins
| or 20% glucose
