SCRIPT modules Flashcards
1
Q
what drug causes ‘red man syndrome’
A
vancomycin when injected as bolus (too rapid)
2
Q
what drugs are assoc w worsening gouts?
A
thiazides (hyperuric)
3
Q
which drugs can exacerbate existing urticaria?
A
NSAIDs
4
Q
someone gets angio-oedema on a longstanding ACEi. what can you switch them to?
A
ARB
5
Q
give an example of a first gen cephalosporin
A
cefalexin
6
Q
give two examples of third gen cephalosporins
A
cefotaxime
ceftriaxone
7
Q
which kind of cephalosporins are worse at cross reacting with penicillin ?
A
first generation (e.g. cefalexin)
8
Q
in penicillin allergy, which drugs are CONTRAINDICATED?
A
Penicillin and first gen cephalosporins
9
Q
in pen allergy, which drugs are CAUTIONED?
A
third gen cephalosporins, monobactams, carbapenems
10
Q
how long should anaphylaxis pts be observed before discharge?
A
6-12hrs
11
Q
what reduces risk of radiocontrast reaction?
A
pre-dosing w corticosteroids and anti-histamine
12
Q
what drug can you give for mild/mod allergic reactions?
A
chlorphenamine 4mg
13
Q
500mcg IM adrenaline for adult with anaphylaxis. what about a child <12? <6?
A
<12: 300mcg
<6: 150mcg
14
Q
whats the dose of IM chlophenamine in anaphylaxis?
A
10mg IM chlorphenamine
15
Q
whats the dose of IM hydrocortisone in anaphylaxis?
A
200mg IM hydrocortisone
16
Q
name 3 big CYP inducers
A
rifampicin
st johns wort
phenytoin/phenobarbital/carbamazepine
17
Q
what does rifampicin do to the conc of drug in blood
A
decreases plasma concs.
its a CYP inducer
18
Q
what does carbamazepine do the conc of drug in plasma
A
decreases plasma concs.
its a CYP inducer
19
Q
what does TOBACCO do conc of drugs in plasma
A
decreases plasma concs.
its a CYP inducer
20
Q
name 2 drugs that are CYP inhibitors
A
azole antifungals
erythromycin
21
Q
name 2 foods that are CYP inibitors
A
grapefruit
cranberry juice
22
Q
what does fluconazole do to conc of drug in plasma?
A
increases plasma concs.
its a CYP inhibitor
23
Q
what does erythromycin do to conc of drug in plasma?
A
increases plasma conc.
its a CYP inhibitor
24
Q
rifampicin and COCP?
A
decreases effectiveness of pill
25
carbamazepine and morning after pill?
you need to double the dose
26
grapefruit juice effects which drugs?
statins, CCBs, anti-arryhtmics
27
what minimum urine output should you aim for on fluids?
0.5ml/kg/hr
28
what is a normal urine output/?
1.5-2.5 litres
| 1ml/kg/hr
29
what is the only time you could give vancomycin orally?
to treat C diff
| its not absorbed in GI tract
30
when should levothyroxine be given?
in morn before breakfast
31
what is the half life of morphine sulfate?
4hrs
32
how often do timolol eye drops for glaucoma need to be administered?
12hrly
33
what can aid absorption of iron salts?
vit C
34
what is the antidote to iron overdose?
IV desferrioxamine
| gives you red wee
35
what is posh name for vit K?
phytomenadione
36
what is the half life of naloxone?
20-40 mins
37
what metabolic disturbance does salicylate overdose cause?
metabolic acidosis
38
venlafaxine does what to ECG
increase QT interval
39
autonomic instability, hyperthermia, sweating, rhabdomyolysis, diarrhoea, tremor, and altered mental state are all features of...
serotonin syndrome
40
two types of stimulant
cocaine
amfetamines
(MDMA and ecstasy are types of amfetamine)
41
which illicit drug causes INTENSE vasoconcstriction which can lead to MI, stroke, aortic dissection?
cocaine
42
effects of chronic cocaine use/?
perforation of nasal septum
CSF rhinorrhoea (thin cribriform plate)
myocardial fibrosis
43
should you leave trailing zeros?
no. and avoid decimal points where poss.
| e. g. write 500mcg instead of 0.5 mg
44
what 3 pieces of info do you need to include when prescribing PRN?
- max dose
- minimum dose interval
- the indication
45
what does medicine reconciliation involve?
verification - check the durg Hx correct
clarification - check it against current list of meds prescribed in hosp
reconciliation - document any discrepancies
46
levothyroxine is stopped. can you just bang it back onto its original dose?
have to titrate back up again gradually. otherwise can precipitate angina, palpitations and HF
47
do ACEis need titrating back up if theyre stopped?
yes
48
is garlic anticoagulant?
yes
49
what can you look at in a pts back of drugs to give you a good idea of adherence?
dispensing date
50
what kind of drugs wont the nomad include?
variable doses (e.g. warfarin), PRNs, liquids
51
what is a good source of info for a pt on warfarin?
yellow oral anticoagulation book
52
what dose is the brown tab of warfarin?
1mg
53
what dose is the blue tab of warfarin ?
3mg
54
what's the liquid lithium?
lithium citrate
55
what the tablet lithium?
lithium carbonate
56
are lithium citrate and lithium carbonate equivalent?
NO
57
why do you have to prescribe lithium by brand name?
the bioavailability varies
58
0.4-1 mmol/L is the range for
serum lithium concentration
59
when do you measure serum lithium concentation?
week after initiation
every week until stabilised
every 3 months on maintenance
60
what tests should be monitored on lithium? (5)
```
ECG
TFT
U&E
Ca
BMI
```
61
how often should ECG, TFT, U&E, Ca and BMI be monitored on lithium?
every 6 months
62
why do you need to check TFTs on lithium?
hypothyroidism
63
why do you need to check BMI on lithium?
weight gain
64
why do you need to check U&Es on lithium?
can impair renal function
| is also renally excreted so ishew
65
why do you need to check Ca on lithium?
hypercalcaemia
66
what does NPIS stand for (contact them for advice)?
national poisons information service
67
name three drugs that lithium interacts with.
ACE-is
NSAIDs
diuretics
--> affect renal excretion - toxicity
68
how much folic acid do you need to take with methotrexate?
5mg once weekly
| not on same day as methotrexate!
69
what needs monitoring w methotrexate?
FBC
LFT
U&E
also - CXR
70
when do you monitor FBC, U&E and LFT on methotrexate?
baseline, every 1-2wks until stabilised, every 3 months after
71
why do you do CXR with methotrexate?
pulm toxicity (pneumonitis)
basline and then repeat if symptoms emerge
72
give me 3 signs of methotrexate toxicity
lymphopena
thrmbocytopenia (abnormal bruising)
GI bleed
73
patients who are folate deficient, and who are co-prescribed NSAIDs, are at increased risk of....
methotrexate toxicity
74
give me 3 drugs that interact w methotrexate
trimethoprim!
aspirin and NSAIDs
ciprofloxacin and penicillins
also corticosteroids
75
what drug, prescribed alongside methotrexate, increases the risk of agranulocytosis?
clozapine
76
do you omit methotrexate in acute infection?
yes
77
name two antibiotics that warfarin interacts with
erythromycin and clarithromycin
CYP inhibitors
(increase the anticoag effect)
78
maintenance doses of warfarin vary considerably. can be anything from
1-15mg!
79
what is the starting dose for SLOW LOADING regimen of warfarin
3mg
80
what is the starting dose for the RAPID LOADING regimen of warfarin
5-10mg
81
when is the peak pharmacological effect of warfarin?
2-3days
82
once stable dose and INR achieved, monitoring can be how often?
every 3 months
83
name three CONTRAINDICATIONS to warfarin
pregnancy
haemorrhagic stroke
severe liver/renal disease
84
name five CAUTIONS to warfarin
```
frequent fallers
recent ischaemic stroke
hx GI bleed /peptic ulcer
breastfeeders
recent surgery
```
85
how does amiodarone interact w warfarin
increases anticoag
86
how does ibuprofen interact w warfarin
increase GI bleed risk (and increases anticoag)
87
how does fluconazole interact w warfarin
increases anticoag
88
how does simvastatin interact w warfarin
increases anticoag
89
how does omeprazole interact w warfarin
increases anticoag
90
if someone is ALCOHOL DEPENDANT how does it affect warfarin
decreases anticoag
91
name 3 things that DECREASE the anticoag effect of warfarin
green leafy veg
alcohol dependence
st john's wort
92
the greater the INR, the greater risk of
bleeding and bruising
93
which drug increases the force of contraction whilst slowing the heart down?
digoxin
94
what are the indications for digoxin?
HF
| AF (supraventricular arrhythmias)
95
what organ excretes digoxin?
kidneys
so renal function influences dosing/ toxicity risk
96
the concentration of which drug should be 0.8 - 2
digoxin
97
you monitor the U&E on digoxin. for what two reasons is this super important?
hypokalaemia (increases risk of toxicity / myocardial instability)
eGFR - renally excreted
98
what bloods do you monitor on digoxin?
U&E
99
name 3 long acting insulins
Levemir
Lantus
Tresiba
100
in t2dm, NICE recommends starting insulin when?
if HbA1c elevated consistently above 75
101
Name two rapid acting insulins
NovoRapid
| Humalog
102
when do you take rapid acting insulin?
just before or WITH a meal
103
when do you take short acting insulin?
20 mins before meal
104
name two short acting insulins
Actrapid
| Humulin S
105
Actrapid and Humulin S are what kind of insulins?
short acting
106
NovoRapid and Humalog are what kind of insulins?
rapid acting
107
Insulatard and Humulin I are what kind of insulin?
medium acting
108
what kind of insulin is Humulin M3?
mixed medium acting - biphasic (short acting and long acting)
109
do you ever give mixed insulins at bedtime?
no never
110
how often do you give long acting insulin?
once daily.
| consistent delivery throughout with no peak
111
name two medium acting insulins
insulatard and humulin I
112
name a mixed medium acting biphasic insulin
Humulin M3
113
what is target HbA1c for elderly pts at risk of hypos
<58
114
what is the basal bolus regimen?
intermediate or long acting once or twice a day
PLUS
bolus injections of short/rapid before meals
115
what is the once daily regimen?
one long acting insulin in morn
| or one intermed at night
depending when u get spikes
116
what is the twice daily regimen?
biphasic mixed insulin twice a day before breakfast and evening meal
117
who is continuous subcut insulin infusion for?
type 1s if get loads of hypos or sugars uncontrolled
| and theresa may
118
risk of insulin pump?
DKA rapidly if pump fails
119
what pt education programmes are there for type 1s?
DAFNE
| BGAT (bm awareness)
120
what pt education programmes are there for type 2s?
DESMOND
121
what is the optimal blood glucose reading ?
4-7mmol/L
122
in the UK, what is strength of most insulins?
100 units / mL
123
what two aspects cause symptoms of hypo?
adrenergic and neuroglycopenic
124
pt's bm is 2. they are co-operating. rx?
glucotab / lucozade
125
pt's bm is 2. they are conscious but unable to co-operate. rx?
glucogel in mouth. repeat until two tubes finished.
126
pt's bm is 2. they are unconscious. you have IV access. rx?
IV 20% glucose 100ml over 20 mins
127
pt's bm is 2. they are unconscious. you don't have IV access. rx?
IM glucagen 1mg
128
you're treating DKA. the bm has come down and is now <14. what do you give as well as insulin?
IV 10% glucose and Kcl 20mmol
129
how often should BMs be monitored on IV insulin?
hourly
130
when do you use IV insulin (3)?
DKA
during surgery
when cant eat / drink if vom
