1
Q
Resuscitation fluids?
A
Crystalloids (common Hartmann’s, NaCl 0.9%, Plasma-Lyte 148 delivered in boluses of 250-500ml over 10-15 minutes
2
Q
Daily requirements in maintenance fluids?
A
- 25-30ml/kg/day of water (20-25 - frail, HF)
- 1mmol/lg/day - potassium
- 1mmol/kg/day - sodium
- 1mmol/kg/day - chloride
- 50-100g/day of glucose
3
Q
How to calculate daily requirements in obese patients?
A
If a patient is obese, calculate requirements using ideal body weight
4
Q
Replacement fluids aims?
A
Replacement fluids aim to rehydrate patients from their pre-existing losses and keep up with ongoing losses
5
Q
How to calculate total water body weight?
A
Multiply patients’s body weight by 0.6 (men) or 0.5 (women)
6
Q
Fluid distribution in 70kg man?
A
- 70kg man will have approximately 42L of water:
- 28L of intracellular fluid
- 14L of extracellular fluid:
- 10.5L of intertitisal fluid
- 3.5L of intrvascular fluid
7
Q
How much urine does a healthy person pass?
A
A healthy person passes approximately 1ml/kg/hr of urine
8
Q
In fluid replacement, what is the aim for minimum urine output?
A
0.5ml/kg/hr
9
Q
How to assess fluid status?
A
History, obs, clinical examination of dehydration/overload (skin turgor, JVP, mucous membranes, CRT), daily weight, fluid balance charts
10
Q
Which drug can’t you have with beta blockers
A
Verapamil
11
Q
Why avoid NSAIDs/ibuprofen in asthmatics?
A
Bronchospasm
12
Q
Does aspirin worsen asthma?
A
Rarely
13
Q
If a woman has migraine with aura, what don’t you prescribe?
A
COCP
14
Q
What shouldn’t you use following acute ischaemic stroke?
A
LMWH due to risk of haemorrhagic transformation
15
Q
Which drugs cause hypokalaemia?
A
Thiazides and loop diuretics
16
Q
Which drugs cause hyperkalaemia?
A
ACEi, aldosterone inhibitors
17
Q
Metoclopramide vs domperidone?
A
Metoclopramide crosses BBB and worsens parkinsonism
18
Q
ACEi side effect
A
Dry cough due to bradykinin build up
19
Q
Why shouldn’t you take ibuprofen on an empty stomach?
A
Ibuprofen inhibits prostaglandin synthesis needed for gastric mucosal protection so may cause inflammation and ulceration
20
Q
Why is ibuprofen nephrotoxic?
A
Ibuprofen also reduces renal artery diameter, thus blood flow, thus kidney perfusion and function.
21
Q
ACEi in CKD?
A
ACE inhibitors inhibts angiotensin-II which preserves GFR when renal blood flow is reduced.
22
Q
Can you combine ibuprofen and ACEi?
A
Combining ibuprofen and ACE inhibitors are a double threat to renal perfusion by tightening the afferent artery and opening the efferent artery.
23
Q
Oxybutynin in elderly?
A
Antimuscarinic mainly used for urinary frequency/urgency and can cause confusion in elderly
24
Q
Tramadol use in elderly
A
Avoid - causes confusion
25
Can patients on methotrexate have NSAIDs?
Caution due to increased risk of nephrotoxicity
26
Trimethoprim and methotrexate?
Shouldn't be used together
27
Methotrexate in active infection?
Contraindicated - withheld (has long half life so doesn't matter)
28
Which diuretics cause hyponatraemia?
All of them can
29
Common side effect of CCBs?
Peripheral oedema
30
Stopping two rate-limiting drugs?
May cause rebound tachycardia
31
What do co-amoxiclav and tazocin contain?
Penicillin
32
Steroid side effects?
STEROIDS:
Stomach ulcers, thin skin, edema, right/left heart failure, oesteoporosis, infection, diabetes and cushing’s.
33
NSAID safety cautions?
NSAIDs:
- No urine (renal failure)
- Systolic dysfunction
- Asthma
- Indigestion
- Dyscrasia (abnormal clotting)
34
IV potassium rate?
No more than 10mmol/hr
35
Ramipril in first trimester?
CI so convert to labetalol before conception
36
Three effects of tamoxifen?
1. Increases risk of VTE
2. Increases risk of endometrial carcinoma
3. Increases efficacy of warfarin
37
How to counsel gliclazide (sulphonylurea)?
1. Increases risk of hypos
2. Increases insulin production
3. Take in morning with breakfast
38
What is monitored with methotrexate?
Once weekly WCC due to higher infection risk
39
What shouldn't be taken with methotrexate?
Folate antagonists:
Trimethoprim, co-trimoxazole
40
What should be taken alongside methotrexate?
Folic acid
41
How to monitor warfarin levels?
Weekly INR levels until stable then monthly
42
What do ACEi increase the risk of?
AKI, hyperkalaemia, renal failure
43
What do steroid increase the risk of?
Osteoporosis, gastric irritation (bisphosphonates, PPI)
Hyperglycaemia, DM, hypertension
44
Why shouldn't you suddenly stop steroids?
Risk of addisonian crisis
45
How long may SSRIs take to work
6 weeks
46
Insulin in changes in T1DM when unwell?
Higher basal doses due to risk of DKA
47
How to take bisphosphonates?
Swallowed with a full glass of water and remain upright for 30 min afterwards to minimise gastric side effects.
Once weekly
Avoid food 2h after
48
What does HRT increase the risk of?
HRT increases risk of breast cancer for more than 10 years after stopping compared to women who have never used HRT
49
What are the quinolones?
Levofloxacin, ciprofloxacin
50
Quinolones adverse effects?
Achilles tendonitis/rupture
Depression
Peripheral neuropathy
Lowers seizure threshold
Prolongs QT interval
51
Quinolones CI?
Pregnant/breastfeeding women
G6PDH deficiency
52
What does 1% mean in the exam?
1g in 100ml
53
How are topical drugs usually prescribed?
In fingertip units (FTUs)
54
Enzyme inducer?
Increased enzyme activity and decreased drug concentration
55
Enzyme inhibitor?
Decreased enzyme activity and increased drug concentration
56
Mnemonic for drugs to stop around surgery?
I LACK OP:
- Insulin
- Variable
- Lithium
- Day before
- Anticoagulants/antiplatelets
- Variable
- COCP/HRT
- 4 weeks before
- K-sparing diuretics
- Day of surgery
- Oral hypoglycaemics
- Variable
- Perindopril and other ACE inhibitors
57
Main CI to COCP?
Migraine with aura
58
Anticholinergic SEs?
Can't spit, can't shit, can't see, can't pee:
Dry mouth
Constipation
Blurred vision
Urinary retention
59
Can you have prophylactic LMWH while on warfarin?
No
60
Antihypertensives SEs?
1. Hypotension
2. Dividing them into two mechanistic categories:
- Bradyacrdia (beta-blockers, CCBs)
- Electrolyte disturbances (ACEi, diuretics)
-ACEi - hyperkalaemia (reduced aldosterone production and reduced potassium excretion)
-Diuretics - hypokalaemia
3. Individual SEs
61
Beta-blockers in asthmatics?
Worsens wheeze - avoid
62
Thiazide diuretics SE?
Gout
63
K+ sparing diuretics SE?
Gynecomastia
64
When do you avoid metoclopramide?
- Patients with Parkinson’s
- Young women due to risk of dyskinesia
65
Long term risks of steroids?
Osteoporosis
Hyperglycaemia and DM
66
What is co-prescribed alongside steroids?
PPI
Bisphosphonate
67
Hypernatraemia causes?
Dehydration
Diabetes insipidus
68
Hypokakaemia causes?
DIRE:
Diuretics (loop + thiazide)
Intestinal losses (D+V)
Renal tubular acidosis
Endocrine (Conn's, Cushing's)
69
Hyperkalaemia causes?
DREAD:
Drugs (K+ sparing diuretics, ACE inhibitors)
Renal failure
Endocrine (Addison's)
Artefact
DKA
70
Hyponatraemia types?
Hypovolaemic
Euvolaemic
Hypervolaemic
71
Causes of SIADH?
- SIADH:
- Small cell lung cancer
- Infection
- Abscess
- Drugs (carbamazepine, SSRIs)
- Head injury/hypothyroid
72
What does raised urea indicate?
Kidney injury
Upper GI haemorrhage
73
Urea rise > creatinine rises?
Pre-renal AKI
Post-renal AKI
74
Pre-renal AKI causes?
Dehydration
Renal artery stenosis
Hypovolaemia
Heart failure
75
Renal AKI causes?
Ischaemia
Nephrotoxic medications
Rhabdomyolysis
Glomerulonephritis
Inflammation
76
Neprhotoxic antibiotics?
Gentamicin
Vancomycin
Tetracyclines
77
Post-renal AKI causes?
Kidney stones
BPH
Cancer
Prolapse
Fibrosis
78
Vitamin K dependent clotting factors?
2, 7, 9, 10
79
Raised ALP causes?
Fracture
Liver damage
Biliary tree damage
Cancer
Paget's disease of bone
Hyperparathyroid
Osteomalacia
80
Levothyroxine dosing?
Depends on TSH:
- Less than 0.5 → Decrease dose
- 0.5-5 → No action
- Above 5 → Increase dose
81
Heart failure on CXR?
ABCDE:
- Alveolar oedema
- B lines (interstitial oedema)
- Cardiomegaly
- Dilated upper lobe vessels
- Effusions
82
Which drugs require monitoring?
Those with a narrow therapeutic window
83
Drugs with narrow therapeutic windows?
- Digoxin
- Theophylline
- Lithium
- Phenytoin
- Antibioitcs - gentamicin, vancomycin
84
Digoxin toxicity symptoms?
Confusion, nausea, visual halos, arrhythmias
85
Lithium toxicity symptoms?
- Early → Tremor
- Intermediate → Tiredness
- Late → Arrhythmias, seizures, coma, renal failure, diabetes insipidus
86
Phenytoin toxicity symptoms?
Gum hypertrophy, ataxia, nystagmus, peripheral neuropathy and teratogenicity
87
Gentamicin/vancomycin toxicity symptoms?
Ototoxicity and nephrotoxicity
88
How are gentamicin doses calculated?
Doses are calculated according to the patient’s weight and renal function
89
Usual gentamicin dosing?
Most patients are treated with a high-dose regimen of 5-7mg/kg once daily
90
In deranged LFTs, when should statins be stopped?
When serum transaminases are 3x the normal
91
DKA management?
Insulin fixed rate of 0.1 units/kg/hour
AFTER fluids
92
How to reverse benzodiazepines?
Flumenazil
93
Folic acid SEs?
Flatulence
Appetite loss
Abdominal distension
94
In patients with sickle cell disease, what dose of folic acid is given?
5mg throughout pregnancy
95
What should be monitored when giving a GTN infusion?
Blood pressure and heart rate
96
Amiodarone SEs?
Interstitial lung disease
Thyroid disease
97
Enzyme inducers mnemonic and drugs?
PC BRAS:
Phenytoin
Carbamazepine
Barbiturates
Rifampicin
Alcohol
Sulphonylureas
98
Most common enzyme inhibitors?
Ciprofloxacin, erythromycin, ketoconazole, grapefruit juice
99
Metformin SEs?
GI upset
Lactic acidosis
100
Drugs causing urinary retention?
Tricyclic antidepressants
Anticholinergics
Opioids
NSAIDs
101
Drugs causing lung fibrosis?
Amiodarone
Bleomycin
Methotrexate
Nitrofurantoin
Bromocriptine/cabergoline
102
Trastazumab adverse effects?
Flu-like illness
Diarrhoea
Cardiotoxicity
103
While taking a course of macrolides, which drug should be stopped?
Statins
104
Drugs to avoid in renal failure?
Tetracyclines
Aminoglycoside
Nitrofurantoin
NSAIDs
Lithium
Metformin
105
PDE5 CI?
Patients taking nitrates
Hypotension
Recent stroke or MI
106
PDE5 side effects?
Blue discolouration of vision
Flushing
GI side effects
Priapism
107
How is COCP initiation guided?
UKMEC 1-4
108
UKMEC 1-4 criteria?
-UKMEC 1: a condition for which there is no restriction for the use of the contraceptive method
-UKMEC 2: advantages generally outweigh the disadvantages
-UKMEC 3: disadvantages generally outweigh the advantages
-UKMEC 4: represents an unacceptable health risk
109
Give 7 examples of UKMEC 3 conditions.
Good wise medics check FBC:
G = Gallbladder disease
W = Wheelchair user (immobile)
M = Mutations in BRAC1/2
C = controlled hypertension
F = Family history of
B = BMI >35kg/m'2
C = cigarettes >35 and smoke <15
110
Examples of UKMEC 4 conditions?
BAD SAUCE:
Breast cancer
Aura (migraine)
DVT (thrombembolic)
Stroke/IHD
Antiphospholipid antibodies
Uncontrolled hypertension
Cigarettes >35 age that does >15ciggs
(E- THINK PHONETIC SOUND) immobile After major sugery
111
Examples of emergency hormonal contraception?
Levonorgestrel:
-Within 72h of UPSI
Ulipristal acetate:
-Within 120h of UPSI
112
When is ulipristal acetate used with caution?
Severe asthma controlled by oral steroids
113
Most common adverse effect of POP?
Irregular vaginal bleeding
114
Can you use COCP in ischaemic heart disease?
NO!
115
Palliative care prescribing for pain with CKD?
Oxycodone
Fentanyl
116
How to write insulin on prescription?
Write insulin out with the dose as UNITS (not U)
117
Which two medications are usually taken at night?
Statins
Amitryptiline
118
Which two medications are usually taken weekly?
Bisphosphonates
Methotrexate
119
Which drugs cause SIADH?
Sulfonylureas
SSRIs, tricyclics
Carbamazepine
Vincristine
Cyclophosphamide
120
What is the main serious side effect of bisphosphonates?
Osteonecrosis of the jaw
121
What must be co-prescribed alongside morphine?
Anti-emetic
122
What percentage of penicillin-allergic patients are also allergic to cephalosporins?
0.5-6.5%
123
Which medication class reduces hypoglycaemia awareness?
Beta-blockers
124
Agitation and confusion palliative prescribing?
- 1st line: haloperidol
- 2nd line: chlorpromazine or levomepromazine
- Parkinsons: benzodiazepines (lorazepam)
- Terminal phase of illness: midazolam
125
Nausea and vomiting palliative prescribing?
- 1st line: Haloperidol
- If Parkinson’s:
- Domperidone, cyclizine, ondansetron
126
Secretions palliative care prescribing?
- 1st line: hyoscine butylbromide/hydrobromide
- 2nd line: glycopyrronium bromide
127
Pain management palliative care?
- eGFR >30: morphine/diamorphine
- eGFR <30: oxycodone
- Also depends on type of pain (soft tissue, visceral, bone, neuropathic)
- Neuropathic - amitriptyline, duloxetine, gabapentin, pregabalin
128
Anxiety palliative care prescribing?
Midazolam or lorazepam
129
Midazolam vs lorazepam?
Midazolam has a faster onset and shorter duration
130
When do you have to taper down systemic corticosteroids?
Received repeated courses
Received more than 3 weeks of treatment
Received more than 40mg prednisone daily for more than a week
131
Which drugs interact with levothyroxine?
Iron
Calcium carbonate
(give at least 4h apart)
132
Which drugs may exacerbate psoriasis?
Beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
133
Give 4 medications CI in heart failure?
Pioglitazone
Verapamil
NSAIDs
Flecainide
134
Which two tests are done every 6 months when taking lithium?
U+Es
TFTs
135
Which drug has a very long half life?
Amiodarone
136
Which antibiotics reduce seizure threshold?
Ciprofloxacin
Levofloxacin
137
Can you use warfarin when breastfeeding?
Yes
138
Can you take aspirin when breastfeeding?
No
139
What is the best way to monitor for the therapeutic effects of diuretics?
Daily weights
140
In pregnant females, what is done when trimethoprim and nitrofurantoin are CI in UTI?
Cefalexin
(Amoxicillin given when cultures are available)
141
What is the most common side effect of macrolides?
Nausea and vomiting
142
Are macrolides CI in pregnancy?
Clarithromycin IS contraindicated
143
What is the first line anti-emetic for BPPV?
Prochlorperazine
144
What is the first line antibiotic for Lyme disease?
Doxycycline
145
Do DOACs need to be taken with food?
Rivaroxaban does
146
In hypertension, which drugs are preferred in the thiazide diuretics?
Indapamide
147
What is the pharmacological treatment for hyperparathyroidism?
Cinacalcet
148
How to find information on the BNF about treating overdoses?
Poisoning
149
How to find prescribing information about STIs in the BNF?
Genital infections
150
How to find prescribing information about HRT on the BNF?
Sex-hormones
151
How to find information about opioid conversions in the BNF?
Palliative care
152
How to find prescribing information about heparins in the BNF?
Parenteral anticoagulants
153
Which DOAC should be used for the PSA?
Rivaroxaban - remember that I must be taken with food
154
Which LMWH should be used for the PSA?
Enoxaparin (in mg, not units)
155
When counselling on metronidazole, what is an important thing to tell patients?
Avoid alcohol - causes intense nausea and vomiting
156
Which medication can reduce the frequency of attacks in Meniere's disease?
Betahistine
157
What is the first line treatment for localised non-bullous impetigo?
Hydrogen peroxide
158
What is the anti-emetic of choice for N+V for migraine?
Metoclopramide
Prochlorperazine
159
Give an example of a bulk-forming laxative?
Ispaghula husk
160
What is the warfarin reversal agent?
Phytomenadione (vitamin K)
161
What is the name of pabrinex?
Vitamin B substances with ascorbic acid (vitamin C)
162
What is the treatment of severe hypercalcaemia of malignancy?
IV fluids
IV bisphosphonates
163
How to treat acute intermittent porphyria?
Stop causative agent
Haem arginate
164
Why are SGLT2 inhibitors stopped in acute illness?
Risk of euglycaemic DKA
165
1st line mucolytic in patients with CF?
Dornase alfa
166
Orbital cellulitis antibiotic?
IV cefuroxime
167
What is the preferred thiazide-like diuretic to use in hypertension?
Indapamide
168
What is a well recognised side effect of ticagrelor?
Dyspnoea
169
Drug used in management of obesity?
Orlistat
170
How to approach pneumonia questions for the PSA?
-Calculate CURB65 score
-Search BNF for respiratory infections
-Look at antibiotics (may be more than one)
171
1st line anti-emetic in Parkinson's?
Domperidone
172
How to treat ringworm?
Clotrimazole
173
After initiating an ACE inhibitor, what do you do with a creatinine rise?
A small rise in creatinine (<20%) is expected - doesn't require a change
174
What is a serious but potentially serious side effect of carbimazole?
Agranulocytosis
FBC should be checked if any clinical evidence of infection
175
What is the most appropriate investigation to monitor for the adverse effect of COCP?
Blood pressure - as COCP is CI in BP above 160/100mmHg
176
When is ondansetron CI?
Prolonged QT interval
177
What is the most appropriate monitoring option required before initiating azathioprine?
Thiopurine methyltransferase (TPMT)
178
In a diabetic with DKA, what happens to the insulin?
STOP short acting
Continue long acting
Initiate fixed-rate IV infusion (alongside fluid resuscitation)
179
How to monitor for beneficial effects of medications after being admitted to hospital with SOB due to HF?
Exercise tolerance
180
What is the most appropriate option to monitor for adverse effects of DOACs?
Patient reports of bruising/bleeding
181
Apart from amlodipine, which other nephrotoxic medications may cause ankle swelling?
Naproxen, ACEi
182
What does the BNF recommend for short-term constipation?
1. Bulk forming laxative (ispaghula husk)
2. Add or switch to osmotic laxative (lactulose, macrogol)
3. Add a stimulant laxative (Senna)
183
Emergency management of anaphylaxis?
Arenaline 1 in 1000
500 micrograms (0.5ml) IM
STAT
184
Before initiating COCP, which investigations are required?
BP, weight
185
Which medications may cause oral candidiasis?
Antibiotics
Inhaled corticosteroids
186
When do you have to change the dose of levonorgestrel?
A higher dose (3mg) is recommended for patients with body-weight over 70kg or BMI over 26
187
Can you use steroids in heart failure?
Yes BUT only selectively and short term as they worsen fluid retention
Avoid if possible
188
Name three progesterone-only pills.
Desogestrel
Levonorgestrel
Norethisterone
189
Prior to amiodarone, which investigations should be performed?
CXR, ECG, U+Es, TFTs, LFTs
190
How to treat folliculitis?
Flucloxacillin
191
Fluid bolus in the elderly?
250ml
192
How to find sore throat management on BNF?
Oropharyngeal infections
193
Give 5 medications that cause hyponatraemia?
Thiazide diuretics
Loop diuretics
SSRIs (particularly citalopram)
Antipsychotics
Carbamazepine
194
1st line medication for intermittent claudication in PVD?
Naftidrofuryl oxalate
195
How to find information about AF on the BNF?
Arrhythmias
196
COPD drug management?
Initial: SABA or SAMA
Step up:
-Without asthmatic features - LABA + LAMA
-With asthmatic features - LABA + ICS
197
Examples of ICS + LABA inhalers?
Formoterol with budesonide
Formoterol with beclometasone
Salmeterol with fluticasone
198
Examples of LAMA + LABA inhalers?
Aclidinium bromide with formoterol
Tiotropium with olodaterol
199
Tiotropium vs ipotropium?
Both antimuscarinics
Tiotropium is a LAMA
Ipratropium is a SAMA
200
Asthmatic features in COPD?
-Previous diagnosis of asthma or atopy
-Higher blood eosinophil count
-Substantial variation in FEV1 over time (at least 400 ml)
-Substantial diurnal variation in peak expiratory flow (at least 20%).
201
Phase 4
flashcards
Decks in class (24)
# Cards
-
PSA201
-
Cardiovascular261
-
Respiratory220
-
Anaesthetics57
-
Gastrointestinal192
-
Liver204
-
Haematology239
-
Endocrinology222
-
Renal and urology252
-
Musculoskeletal242
-
Ophthalmology125
-
ENT118
-
Dermatology210
-
Trauma and orthopaedics93
-
Palliative care25
-
Breast0
-
Geriatrics0
-
Sexual health2
-
Neurosciences0
-
Paediatrics0
-
Psychiatry0
-
Obstetrics143
-
Gynaecology0
-
OSCE21
