Year 6 Medicine > PSA > Flashcards

PSA Flashcards

(179 cards)

Study These Flashcards
1
Q

Who is eligible for blood transfusion in iron deficiency anaemia?

A

Are severely symptomatic and cannot tolerate or wait for the effect of iron- replacement (in iron-deficiency anaemia, the Hb usually rises by 10 g/L/week on oral iron replacement), or
• Have Hb <70 g/L (some recommend using a higher cut-off of 100 g/L in patients with ischaemic heart disease).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

which medications may cause hyperkalaemia?

A
  • ACEi
  • ARB
  • K+ sparing diuretics
  • dalteparin/heparins: inhibition of aldosterone synthesis
  • tacrolimus: reduced potassium excretion
  • ciclosporin
  • trimethoprim
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

which medications should be stopped in AKI?

A
  • NSAIDS (other than aspirin)
  • ACEi
  • ARB
  • Diuretics incl. loop
  • Allopurinol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

which drugs should be stopped on the day of surgery?

A

insuline
oral hypoglycaemics
ACEi, ARB, K+ sparing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What should be stopped the day before surgery?

A

lithium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what should be stopped a week before surgery/5 days

A

aspirin/anticoagulatns and antiplatelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what should be stopped 4w before surgery?

A

COCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

which drugs commonly cause confusion?

A 
benzos
morphine/co-codamol
prednisolone/glucocorticoids
anticonvulsants
antipsychotics
antidepressants
metoclopramide
digoxin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

which drugs may cause hyponatraemia?

A 
ACEi
carbamazepine
SSRI
TCA
opiates
PPI
vincristine/cyclosphopshamide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

If on fentanyl patches - how is breakthrough pain managed?

A

patients receiving >=25mcg/h fentanyl patch can use fentanyl nasal spray
max dose = 50 mcg spray /one nostril, repeated after 10 mins
max 2 sprays per pain episode
every 4 h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is first line in treating alcohol withdrawal?

A

chlordiazepoxide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When should warfarin be stopped before surgery?

A

5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what should be given if INR >1.5 on the day of surgery?

A

phytomenadione (vitamin K 1-5mg PO) (USING IV preparation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is some advice for taking rivaroxaban?

A

take with food

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

advice for COCP and topiramate?

A

change to an alternative method of contraception until 4w after taking topiramate (enzyme inducer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

which antibiotic may cause cholestatic jaundice?

A

co-amoxiclav

if this happens it is an absolute contraindication to having co-amoxical again

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How are ACEi monitored?

A

U&E before ACEi and during treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How are ARBs monitored?

A

U&E during treatment to monitor K

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What changes in blood results are expected after newly starting an ACE/ARB?

A

A small rise in creatinine (<=20% is expected with new ACEi/ARB -> do nothing and remeasure in a week)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

how is furosemide treatment monitored?

A

daily weights

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what should patients be monitored for when starting ciclosporin?

A

hxicity (baseline U&E and renal function every 2w until stable)
hypertension (regular BP monitoring)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How would you treat a transient rise in blood glucose after steroids in IDDM?

A

Increase insulin dosing by 10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is the target of statin treatment?

A

> 40% reduction in non-HDL cholesterol after 3m

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are the side effects of thiazide diuretics ?

A

gout
electrolyte disturbance
dyslipidaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what are the side effects of beta blockers?
wheeze | worsening of acute HF (helps chronic)
26
what are the side effects of CCB?
peripheral oedema | flushing
27
side effects of potassium sparing diuretics?
gynaecomastia
28
side effects of steroids?
``` stomach ulcers thin skin edema RHF/LHF osteoporosis Infection Diabetes ```
29
Side effects of NSAIDs?
``` No urine (renal failure) Systolic dysfunction (HF) Asthma Indigesttion Dyscrasia ```
30
causes of hypokalaemia?
``` DIRE loop diuretics thiazide diuretics D&V RTA Endo (cushings and conns) ```
31
causes of hyperkalaemia?
``` DREAD Drugs (k+ sparing/acei) renal failure endocrine (adossons) artefact dka ```
32
causes SIADH?
``` SIADH small cell lung tumour infection (tb, pneumonia) abscess drugs (carmamazepine and antipsychotics) head injury ``` other: positive end-expiratory pressure (PEEP) porphyrias
33
causes of raised alp?
``` ALKPHOS Any fracutre liver damage (post hep) Kancer Paget's of bone/pregnancy hyperparathyroid osteomalacia surgery ```
34
what is lithium excretion reduced by?
NSAIDS | ACEi, thiazides (if giving a diuretic give loop)
35
when should metformin be avoided?
If GFR <30 _> LACTIC ACIDOSIS | use sulphnylurea or DPPG-4
36
SEs of ACEi?
``` ACE 1 Angioedema (after around 4w) cough elevated K 1st dose low bp ```
37
What is given for short term relief of heartburn?
magnesium carbonate long term: omeprazole
38
what is a normal pre-trough dose of vancomycin?
10-15mg/L
39
When should abx be reviewed
after 3 days when MC&S is back
40
treatment for mild and severe CAP?
MILD: amoxicillin severe: co-amoxicalv and clarithromycin
41
treatment for mild and severe HAP?
non-severe: co-amoxiclav/doxycycline | severe: piperacillin/tazobactam
42
How does K+ level affect digoxin?
hypokalaemia - increased digoxin effect | hyperkalaemia - reduced digoxin effect
43
Causes of hypernatraemia?
nephrogenic DI lithium hypercalcaemia hypokalaemia
44
Which drugs are contraindicated in asthmatics?
beta blocker NSAID adenosine
45
what is a benign leucocytosis?
leucocytosis and normal CRP if on steroids
46
when is enoxaparin dose adjusted?
low eGFR | weight <50kg
47
management of hyperkalaemia?
``` 10 ml 10% calcium gluconate 125 ml 20% dextrose 10 u insulin salbutamol nebs calcium resonium 15 mg 8 hourly ```
48
what is the management of oral candidiasis?
nystatin 100,000U QDS 7days | miconazole oral gel, 2.5 mL QDS, 7 days
49
when are Beta blockers contraindicated?
``` asthma hypotension metabolic acidosis uncontrolled HF cardiogenic shock bradycardia 2nd AV block, 3rd AV block severe peripheral arterial disease ```
50
What is first line in treating acute dystonic reaction?
antimuscarinics (procyclidine)
51
What fluid is used for the 'sweet' bag?
glucose 5%/Kcl 0.3%
52
what range should plasma glucose be kept in after stroke?
5-15 mmol
53
which HRT is best to avoid withdrawal bleeding?
continuous release rather than a sequential product | levonorgestrel 7microgram/estradial 50 micrograms/24 hours weekly patch
54
Which medications are likely to exacerbate symptoms of heart failure?
corticosteroids (pred) | calcium channel blockers (diltiazem)
55
what is the treatment for scarlet fever ?
phenoxymethylpenicillin for 10 days | 125 mg 6 hourly
56
what should be monitored before starting treatment with amiodarone?
potassium
57
when a statin causes myopathy and CK is elevated what should you do?
stop statin and start at a lower dose if symptoms resolve
58
how to convert between oral codeine to morphine?
/10
59
how to convert between oral tramadol to oral morphine
/10
60
how to convert between morphine to oral oxycodone?
/1.5-2
61
how to convert oral morphine to subcut morphine?
/2
62
how to convert oral morphine to subcut diamorphine?
/3
63
how to convert oral oxycodone to subcut diamorphine?
/1.5
64
how to convert oral moprhine to transdermal fentanyl?
/2.4-3.6
65
how to convert oral morphine to subcut alfentanil?
/30
66
how to convert oral morphine to transdermal buprenorphine patch?
/2.4
67
how is breakthrough morphine calculated?
1/6 of daily dose morphine
68
which opioids are preferred in mild/mod renal impairment and severe?
mild/moderate: oxycodone | severe: alfentanil,buprenorphine and fentanyl
69
when should metoclopramide be avoided?
bowel obstruction, GI perforation or following gastric surgery pro-kinetic
70
best anti-emetic for dysmotility and stasis?
metoclopramide or domperidone
71
best anti-emetic for chemically mediated nausea?
ondansetron haloperidol levomepromazine
72
best anti-emetic for visceral/serosal causes?
cyclizine | levopromazine
73
best anti-emetic for raised intra-cranial pressure?
cyclizine
74
best anti-emetic for vestibular nausea?
cyclizine
75
SE/CI cyclizine?
irritant SC | severe heart failure
76
SE/CI ondansetron?
constipating | causes prolonged QT
77
SE/CI haloperidol?
lowers seizure threshold | PD
78
SE/CI metoclopramide/domperidone?
BO with colic PD cardiac conduction disorders young women - SE movement disorders
79
SE/CI levomepromazine?
``` long half life sedating lowers seizure threshold severe heart failure PD ```
80
First line anti-emetic in post-op nausea and vomtiing?
ondansetron
81
what is the drug of choice for those at risk of QT prolongation/ESPE?
cyclizine
82
bolus for fluid resuscitation/shock?
0.9% saline 500ml /15 mins | 1L/30mins
83
Drugs causing dyspepsia?
NSAIDs steroids bisphosphonate
84
Drugs causing ankle oedema?
CCB Naproxen Insulin
85
How should insulin be managed in DKA?
Stop short acting keep long acting FRII
86
Monitoring of ciclosporin?
renal function before starting | during therapy: serum Cr every 2 weeks for first 3 months then monthly
87
Common SE of GLP-1 analogue?
N&V
88
which opioid is recommended in renal impairment?
oxycodone - metabolised completely by liver | causes less sedation,vomiting and pruritic
89
which drugs may cause urinary retention?
``` morphine and other opioid analgesics: anticholinergics general anaesthetics alpha agonists benzos NSAIDs CCBs Antihistamines Alcohol ```
90
what can cause microcytic anaemia?
``` TAILS thalassaemia anaemia of chronic disease iron deficiency anemia lead poisoning sideroblastic anaemia ```
91
what can cause normocytic anaemia?
``` MR I CALM Marrow failure renal failure Iron deficiency (early) Aplastic anaemic, Acute blood loss Leukaemia Myelofibrosis ```
92
what can cause macrocytic anaemia?
``` Alcoholism Myelodysplastic syndrome, multiple myeloma Hypothyroid, Haemolytic anaemia Liver failure Folate/B12 deficiency ```
93
what can cause high platelets?
reactive: bleeding, tissue damage, post-splenectomy primary: MPD
94
what can cause low platelets?
Increased destruction: heparin, hypersplenism, DIC, ITP, HUS/TTP Reduced production: Infection (viral), drugs (penicillaemine), MDS, PMF, myeloma
95
Causes pre-renal AKI?
dehydration/shock
96
Causes intrinsic renal AKI?
``` INTRINSIC Ischaemia Nephrotoxic antibiotics Tablets (ACEi, NSAIDs) Radiological contrast Injury Negatively birefringent crystals Syndromes (glomerulonephritis) Inflammation Cholesterol emboli ```
97
Post renal cause AKI?
Bladder/hydronephrosis luminal (stones) mural (transitional cell carcinoma) extra-mural (BPH)
98
How many units is 1mg LMWH
1mg = 100u
99
Advice for taking steroids?
Regular BM monitoring gastroprotection >3m treatment need bone protection
100
side effects SSRI?
photosensitivity dry mouth serotonin syndrome
101
what is a 1% solution
10mg/ml
102
what does 1:1000 mean
1mg/ml
103
what does 1 in 10000 mean
1g in 10000 ml | 0.1 mg/ml
104
what is the fluid requirement per day for average and elderly person?
``` average= 25-30ml/kg/day elderly = 20-25ml/kg/day ``` 1mmol/kg/day Na, K, Cl
105
Enzyme inducers?
``` PC BRAS Phenytoin Carbamazepine Barbiturates Rifampicin Alcohol Sulphonylurea ``` Induction takes weeks to establish
106
Enzyme inhibitors?
``` ZAG DEVICES zoles (omeprazole, ketoconazole, fluconazole) allopurinol grapefruit juice disulfiram erythromycin valproate isoniazid ciprofloxacin ethanol sulphonamides ``` Inhibition takes hours/days
107
SE amiodarone?
hyper/hypothyroid skin greying corneal deposits
108
Alcohol ADRS?
``` UGIB (aspirin and NSAIDs) XS anticoagulation (warfarin) Sweating, flushing, N&V (metronidazole, disulfiram) Lactic acidosis (metformin) Hypertensive crisis (MAO-I,RIMA) Sedation (barbiturates, opioids, BDZ) ```
109
When should antihypertensives be initiated
``` clinic BP>=140/90 and ABPM average >=135/85 AND<80 AND one of: end organ damage CVD renal disease diabetes QRISK >10% ```
110
What is the waking BM target in diabetes?
5-7 other targets 4-7
111
what is insulin infusion made up of?
50 units act rapid insulin in 50 ml 0.9% saline
112
normal vol of insulin?
100u in one ml
113
biphasic insulin regime?
0.5-0.8u/kg 2/3 in morning 1/3 in even
114
how to work out decrease in blood glucose with addition of 1U insulin?
Total daily dose (in units) 100/TDD = decrease in blood glucose mmol/L with addition of 1U insulin
115
What is given alongside insulin infusion?
IV glucose medical: 1L 5% glucose + 0.3% K at 100ml/h surgical: 1L 5% glucose + 0.3% K at 80ml/h continue basal long acting insulin but omit short acting
116
Checklist for stopping variable rate insulin infusion?
E+D normall taken long acting insulin >= 1 hour nefore taken mixed/rpaid insulin at usual meal time and wait 30 mins before stopping VRII monitor CBG QDS for >=24h
117
Give examples of oestrogen only HRT?
PO: elleste solo (OD) Transdermal: evorel (2x weekly) PV gel: sandrena (OD)
118
Which adjunct progesterones can be used for oestrogen only HRT?
IUS Mirena (4years) Medroxyprogesterone acetate Utrogestan
119
which oestrogen + progesterone HRT are available for cyclical/sequential?
PO: elleste duet (OD) transdermal: evorel sequi (2X weekly)
120
What are the monthly and 3 monthly cyclical HRT regimes and when are they indicated
monthly (for regular periods and menopause sx) oestrogen for 28 days, progesterone for last 14 ``` 3 monthly (for irregular periods and menopause sx) oesterogen for 3months and progesterone for the last 14 days ```
121
what are the types of continuous combined HRT?
PO: kilovance (OD) Transdermal: evorel conti (twice weekly)
122
Drugs causing gynaecomastia?
``` DISCO digoxin isoniazid spironolactone - switch to eplerenone cimetidine omeprazole ```
123
Valproate side effects?
``` VALPROATE Vomiting, nausea anorexia liver toxicity pancreatitis retention of weight oedema alopecia teratogenicity/tremors enzyme inhibition ```
124
sildenafil CIs?
nitrates (may potentiate massive vasodilation) hypotension recent stroke or MI (wait 6m)
125
sildenafil SE?
``` Visual disturbance - blue discolouration nasal congestion flushing GI side efects headache ```
126
management of digoxin toxicity?
digibind
127
precipitating factors for digoxin toxicity?
``` 7H + drugs Hypokalaemia Hypomagnesaemia Hypothermia Hypothyroid Hypoalbuminaemia ``` Hypernatraemia Hypercalcaemia Drugs: amiodarone,quinidine, verapamil, diltiazem, spiro, ciclosporin
128
Which medications should be used with caution in ischaemic heart disease?
NSAIDs oestrogens: e.g. combined oral contraceptive pill, hormone replacement therapy varenicline
129
which medications may exacerbate heart failure?
thiazolidinediones pioglitazone is contraindicated as it causes fluid retention verapamil - negative inotropic effect NSAIDs/glucocorticoids should be used with caution as they cause fluid retention ``` class I antiarrhythmics flecainide (negative inotropic and proarrhythmic effect) ```
130
When do you need gradual withdrawal of steroids?
received more than 40mg prednisolone daily for more than one week received more than 3 weeks treatment recently received repeated courses
131
which drugs are taken weekly?
methotrexate | bisphosphonates(alendronate)
132
which drugs may cause SIADH? (hyponatraemia)
``` sulfonylureas* (glimepiride and glipizide) SSRIs, tricyclics carbamazepine vincristine cyclophosphamide ```
133
which drugs may cause nephrogenic DI (hypernatraemia)?
lithium hypercalcaemia hypokaelamia
134
when should prescribing sweet/glucose fluids be avoided?
5% glucose should be avoided in patients who have had a stroke due to the increased risk of cerebral oedema.
135
what is the advice for taking bisphosphonates?
'Tablets should be swallowed whole with plenty of water while sitting or standing; to be taken on an empty stomach at least 30 minutes before breakfast (or another oral medicine); patient should stand or sit upright for at least 30 minutes after taking tablet'.
136
what are the adverse effects of bisphosphonates?
oesophageal reactions: oesophagitis, oesophageal ulcers (especially alendronate) osteonecrosis of the jaw increased risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate acute phase response: fever, myalgia and arthralgia may occur following administration hypocalcaemia: due to reduced calcium efflux from bone
137
which drugs should be avoided in epilepsy?
``` alcohol, cocaine, amphetamines ciprofloxacin, levofloxacin aminophylline, theophylline bupropion methylphenidate (used in ADHD) mefenamic acid ```
138
first line statin for patients with established CVS disease?
atorvastatin 80 mg | atorvastatin 20mg for primary prevention
139
what are the laxative groups?
osmotic laxatives stimulant bulk-forming faecal softners
140
factors that may potentiate warfarin?
``` liver disease P450 enzyme inhibitors (see below) cranberry juice drugs which displace warfarin from plasma albumin, e.g. NSAIDs inhibit platelet function: NSAIDs ```
141
what reduces hypoglycaemic awareness?
beta blockers
142
Which opioids are preferred if chronic kidney disease?
mild: oxycodone severe: alfentanil, buprenorphine and fentanyl are preferred
143
options for pharmacological VTE prophylaxis?
NICE recommend the following options for pharmacological VTE prophylaxis: low molecular weight heparin (LMWH) dabigatran rivaroxaban apixaban fondaparinux unfractionated heparin (UFH) (for patients with renal failure)
144
How should gentamicin dose be adjusted if trough levels are raised?
The interval between the doses should be increased if the trough levels are raised. ie keep dose the same but change from TDS to BD
145
Which antibiotic for exacerbations of chronic bronchitis?
Amoxicillin or tetracycline or clarithromycin
146
what antibiotic for uncomplicated CAP?
Amoxicillin (Doxycycline/erythromycin or clarithromycin in penicillin allergic) add flucloxacillin if staphylococci suspected e.g. In influenza
147
which antibiotic for pneumonia caused by atypical?
clarithromycin
148
which antibiotic for HAP?
Within 5 days of admission: co-amoxiclav or cefuroxime More than 5 days after admission: piperacillin with tazobactam OR a broad-spectrum cephalosporin (e.g. ceftazidime) OR a quinolone (e.g. ciprofloxacin)
149
Which antibiotic for a lower urinary tract infection?
Trimethoprim or nitrofurantoin. Alternative: amoxicillin or cephalosporin
150
Which antibiotic for acute pyelonephritis?
Broad-spectrum cephalosporin or quinolone
151
Which antibiotic for acute prostatitis?
Quinolone or trimethoprim
152
Which antibiotic for impetigo?
Topical hydrogen peroxide, oral flucloxacillin or erythromycin if widespread
153
Which antibiotic for cellulitis?
Flucloxacillin (clarithromycin, erythromycin or doxycycline if penicillin-allergic)
154
Which antibiotic for cellulitis near the eyes or nose?
Co-amoxiclav (clarithromycin, + metronidazole if penicillin-allergic)
155
which antibiotic for erysipelas?
Flucloxacillin* (clarithromycin, erythromycin or doxycycline if penicillin-allergic)
156
which antibiotic for animal or human bite?
Co-amoxiclav (doxycycline + metronidazole if penicillin-allergic)
157
Which antibiotic for mastitis during breast feeding?
Flucloxacillin
158
which antibiotic for throat infection?
Phenoxymethylpenicillin (erythromycin alone if penicillin-allergic)
159
which antibiotic for sinusitis?
Phenoxymethylpenicillin
160
which antibiotic for otitis media?
Amoxicillin (erythromycin if penicillin-allergic)
161
which antibiotic for otitis externa?
Flucloxacillin (erythromycin if penicillin-allergic)
162
which antibiotic for periapical or periodontal abscess?
Amoxicillin
163
which antibiotic for gingivitis?
Metronidazole
164
which antibiotic for gonorrhoea?
Intramuscular ceftriaxone
165
which antibiotic for chlamydia?
Doxycycline or azithromycin
166
Which antibiotic for pID?
Oral ofloxacin + oral metronidazole or intramuscular ceftriaxone + oral doxycycline + oral metronidazole
167
Which antibiotic for syphilis?
Benzathine benzylpenicillin or doxycycline or erythromycin
168
which antibiotic for BV?
Oral or topical metronidazole or topical clindamycin
169
which antibiotic for c.diff?
First episode: oral vancomycin | Second or subsequent episode of infection: oral fidaxomicin
170
Which antibiotic for campylobacter?
Clarithromycin
171
which antibiotic for shigella/salmonella?
Ciprofloxacin
172
Drugs which may cause anorexia?
metformin | rivastigmine
173
Drug causes of a raised prolactin?
metoclopramide, domperidone phenothiazines haloperidol very rare: SSRIs, opioids
174
What is recommended for DVT prophylaxis following knee replacement surgery?
LMWH for 14 days Aspirin 75 mg PO daily for 14 days Rivaroxaban 10 mg for 14 days Apixaban or dabigatran if none of the above options can be used
175
How to calculate bolus for children?
20 ml/kg over <10 mins
176
medications causing raised CK?
Statin | Haloperidol/ 1st generation antipsychotics
177
Which drugs are associated with hepatocellular liver injury?
``` ALT:ALP >5 paracetamol NSAIDs Statins Amiodarone ```
178
Which drugs are associated with cholestatic liver injury?
``` ALT:ALP <2 co-amoxiclav doxcycline erythromycin chlorpromazine hormonal contraception ```
179
which drugs are associated with a mixed liver injury picture?
ALT:ALP 2-5 phenytoin sulphonamides carbamazepine
Year 6 Medicine
flashcards
Decks in class (18)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions