Transition Block Flashcards by Miranda King

Monitoring Requirements for Methotrexate

Every 1-2 weeks whilst dose is being adjusted, every 2-3 months once on stable dose

FBC - can cause bone marrow suppression
Any drop in WBC or platelets should withdraw drug

LFTs - if abnormal, withdraw the drug until abnormalities return to normal and recommence drug

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My Structure for Review History Taking

Clarify - condition, how long for, symptoms presenting with/currently have
Last Seen - how have you been since then, who saw you
Management - current regimen, medications/any supplements/any OTC, any monitoring requirements, sick day rules
Systemic Enquiry - check for red flags
Social History - alcohol, smoking, occupation, impact of condition/ICE

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Framework for Alcohol Brief Intervention

Raising the issue of alcohol
Screening and giving feedback
Listening for readiness to change
Selecting an approach

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Alcohol Recommendations

Not to drink >14 units per week and best to spread evenly over 3 days or more (ensuring have some alcohol free days

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Side effect of PPIs

Hyponatraemia

Consider switching to ranitidine

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Blood Draw Order

Light Blue 
Red 
Dark Blue 
Yellow 
Dark Green 
Green 
Purple 
Pink 
Grey

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Light Blue Blood Draw

INR
aPTT
PT
Fibrinogen
D-dimer

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Red Blood Draw

Platelet AB screen

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Dark Blue Blood Draw

Trace elements

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Yellow Blood Draw

Biomedical tests
B12
Folate
Serology

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Dark Green Blood Draw

EPO

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Green Blood Draw

Fast track biomedical tests

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Purple Blood Draw

FBC
PV
HbA1c
Renin

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Pink Blood Draw

Cross match
Group and hold
Coombs

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Grey Blood Draw

Glucose
Lactate
Ethanol

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What test to do before performing an ABG?

Allen’s Test
= occlude radial and ulnar artery, ask patient to form tight fist then release hand flat
Continue to occlude radial artery, to check the circulation of the ulnar artery

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Recommendations around breast feeding

Exclusively for the first 6 months then for up to 2 years/preference alongside solids

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Vitamin D supplement guidance for breast feeding infants

Given a daily vitamin D supplement from birth

From 6 months if <500ml formula supplement vitamin A, C and D

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What is the marker for a child being overweight?

Over the 91st weight centile

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Management of cow’s milk allergy

2-4 weeks cows milk diet exclusion trail using extensively hydrolysed infant formula

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What % weight loss is recommended for risk reduction from co-morbidities in BMI 25-35?

5-10%

Criteria for diabetes risk assessment

Age 40 or over
Age 25 or over and South Asian/Chinese, Black African, Afro-Carribbean
Those with risk factors

How does fibre decrease colon cancer risk?

It encourages fibre fermentation which has an anti-proliferative effect

Use of nutrition to induce Crohn’s Disease remission

Exclusive enteral nutrition cam induce remission in Crohn’s

Intestinal biopsy preparation Coeliac Disease

Need to have gluten for at least one meal per day at least 6 weeks prior to testing

Examples of enteral access

Nasogastric tube Gastrostomy e.g. PEG Jejunostomy

Parenteral access | Indications

Refers to the delivery of calories and nutrition into a vein Indications = bowel obstruction, short bowel syndrome, Crohn's disease, ulcerative colitis

Contents of saline | Positives/negatives

Na+ and Cl- Good for resus and maintenance Can cause hypernatraemia and acidosis in large quantities

Contents of glucose 5% | Positives/negatives

Contains no electrolytes, glucose is metabolised by the liver leaving water Good for pure dehydration Bad for resuscitation

Contents of Hartmans | Positives/negatives

Na+, Cl- and K+ Closer to normal plasma than saline Good for resuscitation and maintenance

Contents of gelofusine/colloids | Positives/negatives

Contains 0.9% saline and big molecules (to exert oncotic pressure) Can draw in water in from ECF = volume expanders

Management of DVT

1st - dalteparin Also used in prophylaxis of DVT, consider heparin in situations where risk of bleeding (easily reversed) Can also use rivaroxaban for treatment of uncomplicated DVT

Limb Lead Placement

``` Ride Your Green Bike Right Arm - Red Left Arm - Yellow Left Leg - Green Right Leg - Black ```

Combination results in increased risk of GI bleed

Warfarin and Naproxen

Three antibiotics not used in pregnancy

Ciprofloxacin Trimethoprim - 1st and 2nd semester Nitrofurantoin - avoid at term, can cause haemolysis

Three drugs to avoid in hepatic impairment/monitor closely

Diazepam ACE inhibitors Amlodipine

ACE inhibitor safe to use in hepatic impairment

Lisinopril

Centor Criteria | What for?

= tonsillar exudate, tender anterior cervical lymph nodes, absence of cough, history of fever 3/4 indicates potential group B strep infection, patient may benefit from antibiotic treatment

Treating pain and shortness of breath at end of life

Use morphine

Treating distress at end of life

Midazolam

Treating nausea at end of life

Levopromazine

Treating respiratory secretions at end of life

Buscopan

Going from oral to SC morphine

Need to half the 24 hour dose

Going from codeine to morphine

Divide codeine dose by 10 to give 24 hour morphine dose

Calculating morphine breakthrough dose

1/6th of 24 hour dose

Anaemia threshold for blood transfusion

Hb <70g/L | <80g/L if significant co-morbidity e.g. ischaemic heart disease

Who requires irradiated blood?

Any history of Hodgkins lymphoma Any history of purine analogue chemptherapy Immunosuppressed

Examples of purine analogue chemotherapy

``` Fludarabine Azathioprine Cladribine Pentostatin Clofarabine Nelarabine ```

Who requires CMV negative blood?

Pregnant women Neonates Not required at delivery, CMV takes a couple of days to transfer across the placenta so risk to foetus in delivery is small

Mild Transfusion Reaction Presentation Management

P: isolated temperature rise (>38 or 1-2 above baseline) or rash only Mx: slow the rate of transfusion, give paracetamol/piriton, observe closely

Moderate Transfusion Reaction Presentation Management

P: temperature rise (>39) and other symptoms e.g. rigors, chills, rash, flushing, collapse, pain Mx: stop transfusion, report to transfusion laboratory