PSA useful knowledge

Question 1

Antiemetic to use in heart failure

Answer 1

Metoclopramide

Cyclizine is contraindicated as it can worsen fluid retention

Question 2

Antiemetic to use in Parkinson’s disease:

Answer 2

Domperidone as it does not cros blood brain barrier.

Metoclopramide contraindicated.

Question 3

Metoclopramide contraindications:

Answer 3

Parkinson’s, bowel obstruction

Question 4

Aminophylline blood monitoring:

Answer 4

18 hours after commencing treatment.

Theophylline level should be 10-20mg/L

Question 5

Target INR on day of surgery:

Answer 5

≤ 1.5

If higher then 1-5mg PO vit K

Question 6

Neuropathic pain ladder

Answer 6

• Paracetamol
• Gabapentin
• Pregbalin
• Amitriptiline
• Duloxetine

Question 7

Which analgesic needs to be avoided with an SSRI?

Answer 7

Tramadol: causes serotonin syndrome

Question 8

Which medications need to be continued on day of surgery?

Answer 8

Beta blockers and calcium channel blockers

Increase dose of corticosteroids

Question 9

When should the following drugs be stopped prior to surgery?

Aspirin

COCP/HRT

K sparing diuretics/ACE inhibitors

Answer 9

• Aspirin: 7 days
• COCP/HRT: 4 weeks
• K sparing diuretics/ACE inhibitors: stop on day of surgery

Question 10

How should you prepare a patient with renal impairment for CT contrast?

Answer 10

Give IV saline

Question 11

What level of rise in creatinine is acceptable after starting an ACE inhibitor?

Answer 11

A rise within 20% is acceptable.

Question 12

T2DM - when shoul gliclazide be used over metformin?

Answer 12

• Normal/underweight
• Cretinine > 150

Question 13

Treatment of ulcerative colitis flare

Answer 13

• Severe (≥6 bowel movements and systemically unwell): IV hydrocortisone and fast fluids
• Mild: oral prednisolone 30mg/24 hours

Question 14

Warfarin - analgesia to avoid?

Answer 14

Ibuprofen

Question 15

COCP - missed 1 pill

Answer 15

Take missed pill and continue. No additional contraception required.

Question 16

COCP - missed 2 pills

Answer 16

Take 1 missed pill. Use a barrier method of contraception for 7 days.

Question 17

Progesterone only pill - missed 1 pill

Answer 17

Missed pill if >3 hours or >12 hours if desogestrel pill

Take missed pill and use 3 days additional contraception.

Question 18

HRT - no uterus

Answer 18

Oestrogen only (with mirena coil)

Question 19

HRT - in a perimenopausal woman with a uterus:

Answer 19

Oestrogen with cyclical progestogen for the last 12 to 14 days of the cycle

Question 20

HRT - in a post menopausal woman with a uterus

Answer 20

Continuous combined oestrogen and progesterone

Question 21

Maintainance fluids: volume required per day?

Answer 21

25-30ml/Kg/day

Question 22

Maximum rate of potassium infusion?

Answer 22

10mmol/hr

Question 23

KCl and NaCl requirements per day

Answer 23

1 mmol/kg/day

Question 24

Different types of laxatives

Answer 24

• Bulk forming
• Osmotic
• Stimuant
• Stool softener

Question 25

Osmotic laxatives example, mechanism and contraindication

Answer 25

Lactulose Increases water in bowel Contrandiction: bloating

Question 26

Stimulant laxative example and contraindication

Answer 26

Senna Contraindication: bowel obstruction, cramps

Question 27

Stool softener example and contraindications

Answer 27

Docusate Contraindicated in already soft stool

Question 28

Hyperkalaemia treatment

Answer 28

* IV calcium gluconate * 10 units actrapid * 100ml of 20% IV dextrose * Nebulised salbutamol

Question 29

Care of dying treatment

Answer 29

* Secretions: hyoscine butylbromide 60mg/24 hours * Agitation: midazolm 10-20mg/24 hours * Pain: morphine 10mg/24 hours if new * Nausea: cyclizine 150mg/24 hours

Question 30

Which electrolyte abnormality can heparins cause?

Answer 30

Hyperkalaemia

Question 31

Vancomycin/gentamycin side effects

Answer 31

Ototoxicity, nephrotoxicity

Question 32

Amiodarone side effects

Answer 32

* Pulmonary fibrosis * Thyroid dysfuction * Grey skin

Question 33

Treatment for extrapyramidal side effects: dyskinesia/parkinsonism caused by antipsychotics and metoclopramide

Answer 33

Procyclidine

Question 34

Neuroleptic malignant syndrome symptoms and most likely drug causes

Answer 34

Fever, muscular rigidity, confusion and autonomic dysfunction. Raisd CK. Antipsychotics.

Question 35

Anticholinergic excess symptoms and liklely causes

Answer 35

Mad, red, dry, blind. Amitriptyline, paroxetine, antimuscarinics, antipsychotics (clozapine).

Question 36

Serotonin syndrome symptoms and causes

Answer 36

Made, red, wet, dilated pupils. SSRI, SNRI, TCAs, lithium, metoclopramide, most opioids.

Question 37

Treatment of hepatic encephalopathy

Answer 37

Lactulose