PSA Revision Flashcards
What broad spectrum antibiotics can be used for sepsis?
Tazocin, co-amoxiclav
Which classes of medication are time dependent?
Antibiotics, anti-Parkinson’s, anti-diabetic, anti-epileptic
How is hypoklaemia above 3.0 managed?
Sando K: 1-2 tablets TDS for 3 days
(most people get 2 tablets, only 1 tablet in very small/frail people)
How is hypokalaemia <3.0 managed?
IV 20mmol KCl in 1L 0.9% saline NaCl
What are the rules of prescribing IV KCl?
- Rate of administration shouldn’t exceed 10 mmol/hour (higher rates need cardiac monitoring)
- Concentration shouldn’t exceed 40mmol/L via peripheral line (higher can cause phlebitis and pain and should be given via a central line)
What is important in hyperkalaemia to protect the myocardium?
Protect the myocardium: 10ml calcium chloride 10% or 30ml calcium gluconate 10% - give over 5-10 minutes
What is important in hyperkalaemia to drive the potassium into cells?
Drive the potassium back: Insulin (actrapid) 10 units in 50ml of 50% glucose IV over 15 minutes plus salbutamol nebs 5mg inhaled given back to back
What is important in hyperkalaemia to remove K+ from the body?
Remove potassium frmo the body: calcium resonium 15g QDS orally, or sodium zirconium cyclosilicate
How is hypomagnesmia treated PO?
Oral magnesium aspartate sachet, one BD for 5 days (need to give 20mmol/day)
Other types of magnesium are available in different hospitals
How is hypomagnesmia treated IV?
IV infusion of magnesium sulphate 10-20mmol in 100ml 0.9% NaCl over 1 hour
How can mild hypocalcaemia be managed?
Can be treated with calcichem 2 tablets BD for 5-7 days
How is more severe hypocalcemia <1.9 managed?
10ml calcium gluconate 10% in 100ml 0.9% NaCl over 15 minutes (bolus) - ECG monitoring for people with arrhythmias or cardiac history
Then
100ml calcium gluconate 10% in 1L 0.9% saline at 50ml/hour - adjust rate according to response and monitor calcium levels every 4-6 hours
How is hypercalcaemia managed?
IV fluids - 4-6L over 24 hours - will dilute the blood and hydrate the patient
If Ca2+ still >2.8mmol/symptomatic, give zolendronic acid 4mg IV in 0.9% saline over 15 minutes
How should major bleeding be reversed in patients on warfarin?
Stop the warfarin, give IV vitamin K 5mg and prothrombin complex concentrate (acts more quickly)
What electrolyte imbalances does bendroflumethiazide cause?
Bendroflumethiazide causes both hyponatraemia and hypokalaemia.
What dose is used for PO tramadol?
Initially 100mg, then 50-100mg every 4-6 hours
Comes in 50mg capsules
What is the maximum dose of tramadol in 24 hours?
Maximum 400mg/24 hours
What is prescribed for opioid constipation?
Stimulant and a softner e.g. docusate and senna
Naloxegol is used if normal laxative regimes don’t work
What is prescribed for opioid nausea?
Common when starting or increasing dose
Metaclopramide, cyclazine (ondansetron is avoided as it increases risk of constipation)
When to avoid NSAIDs?
Peptic/duodenal ulcers, asthma, allergy, AKI, severe HF
When do you reduce a paracetamol dose?
Reduce dose if patient <50kg, impaired liver function or chronic alcoholism (halved dose)
When should you review NSAID prescriptions?
5 days
What are adjuvants to the WHO pain ladder?
Gabapentin, pregabalin, duloxetine, amitriptaline, diazepam are all adjuvants outside of the WHO pain ladder - can go in anywhere
