Phase 4 Emily > PSA > Flashcards

PSA Flashcards

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1
Q

Management: hypoglycaemia

A

BNF: medical emergencies in the community

By mouth
- 15-20g oral glucose liquid

Buccal
- 15-20g glucose 40% oral gel

IM
- glucagon Im 1mg (1ml)

IV
- Glucose 10% = 200ml over 15mins
- glucose 20% = 100ml over 15 mins

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2
Q

How much water do you need per day?

A

25/30 ml/kg/day

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3
Q

Fluid resuscitation

A

NaCL 0.9% 500ml IV over 15mins

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4
Q

How to calculate fluids for obese patients?

A

Adjust the prescription to their ideal body weight

men = 75kg
women =

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5
Q

NAme enzyme inducers?

A

PC BRAS –

phenytoin,
carbamazepine,
barbiturates,
rifampicin,
alcohol (chronic excess) sulphonylureas.

Others: topiramate, St John’s Wort, and smoking.

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6
Q

Name enzyme inhibitors:

A

AO DEVICES –

allopurinol,
omeprazole,
disulfiram,
erythromycin,
valproate,
isoniazid,
ciprofloxacin,
ethanol (acute intoxication),
sulphonamides.

Others: grapefruit juice, amiodarone, and SSRIs (fluoxetine, sertraline)

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7
Q

Common SE: ACEi

A

Cough
hyperkalaemia

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8
Q

Common SE: DOAC

A

anaemia
haemorrhage
nausea
skin reactions

rivaroxaban = asthenia, renal impairment, menorrhagia, oedema

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9
Q

Common SE: amlodipine

A

oedema

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10
Q

Common SE: amiodarone

A

Pulmonary fibrosis
thyroid dysfunction

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11
Q
A
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12
Q

Common SE: carbamazepine

A

hyponatraemia

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13
Q

Common SE: Gliclazide

A

hypoglycaemia

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14
Q

Common SE: clozapine

A

agranulocytosis

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15
Q

Common SE: metformin

A

lactic acidosis
diarrhoea
nausea

stop if eGFR <30

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16
Q

Common SE: statins

A

Myalgia

CI with clarithromycin = rhabdo

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17
Q

Monitoring requirements for gentamicin?

A

For multiple daily dose regimens

  • blood taken 1hour after IM (‘peak’ conc) and just before the next dose (‘trough’ conc)

Pre dose ‘trough’ is high = INTERVAL time must be INCREASED

Post dose conc is high = DOSE must be DECREASED

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18
Q

Paracetmol dose

A

1g qds
if >50kg

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19
Q

Cyclizine prescription

A

50mg tds

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20
Q

What drugs are most lily to cause hypoglycaemia?

A
  • insulin
  • sulphonureas
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21
Q

What drugs are most likely to cause hyperglycaemia?

A

steroids
- antipsychotics
- thiazides
- beta blockers
- tacrolimus

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22
Q

What drugs are most likely to cause?

A
  • opioids
  • iron
  • CCB
  • diuretics
  • antiemetics = ondansetron metoclompramide
  • parkisnons
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23
Q

What drugs are most likely to cause diarrhoea?

A
  • antibiotics = c.diff
  • metformin
  • colchicine
  • PPIs
  • antacids
  • laxatives
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24
Q

What drugs are most likely to cause urinary retention?

A

opioids
anticholinergics

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25
What drugs are most likely to cause urinary incontinence?
alpha blockers diuretics anticholinesterase inhibitors clozapine
26
What drugs are most likely to cause confusion?
- opioids - sedatives - anticholinergics
27
What drugs are most likely to cause falls?
- benzodiazepines - antidepressants - MAO - antipsychotics - opiates - antihypertensive - parkisnons - anti epileptics
28
What drugs are most likely to cause gout?
diuretics
29
What drugs are most likely to cause osteoporosis?
steroids PPi LHRH agonists = goreslin
30
what drugs are most likely to cause hypertension?
NSAIDs steroids oral contraceptives mirabegnon
31
What drugs are most likely to cause high cholesterol?
steroids thiazides
32
What drugs are most likely to cause hypokalaemia?
loop diuretics thiazides steroids salbutamol
33
What drugs are most likely to cause hyperkalaemia?
K+ sparing diuretics ACEi ARBS unfractionated heparin blood transfusion
34
What drugs are most likelt to cause hyponatraemia?
SSRIs - TCAs - carbamazepine - opiates - PPIs
35
What drugs are most likely to cause hypernatraemia?
- lithium - demeclocyline
36
What drugs should be continued if intercurrent illness?
steroids - double dose
37
Which drugs should be stopped in illness?
metformin statins -gliflozins
38
Which drugs should be stopped if trying to conceive?
- some antiepileptics - some antipsychotics - isotretinoin - methotrexate - warfarin
39
Which drugs should be stopped if breastfeeding?
- COCP - lithium - clozapine - codeine
40
Which drugs should be stopped prior to surgery?
DOACs (48hrs) clopidogrel (7 days) warfarin (bridging plan)
41
What medications can worsen parkinson's?
antipsychotics = haloperidol, olanzipine, riperidone antiemetics = metoclopramide, chlorpromazine antidepressants - phenelzine, tranylcypromine
42
What medications are most likely to worsen myasthenia gravis?
- antibiotics - beta blockers - local anaesthetic - sedating drugsWh
43
What medication are most likely to worsen psoriasis?
beta blockers lithium some antibiotics
44
What medications are most likely to worsen heart failure?
NSAIDs, CCBs, thiazolidinediones,
45
Which drugs should be stopped in renal impairment/AKi?
DAMN Diuretics ACEi/ ARBs Metformin NSAIDs
46
Which drugs are prescribed in mcg?
- Levothyroxine - Tamsulosin - Digoxin - Naloxone - Fludrocrotisone - Inhalers - GTN spray - Ipratropium nebs
47
Which drugs are prescribed in 'g'?
- Paracetamol - Lithium - Calcium - Carbonate
48
Which drugs are given weekly?
- Bisphosphonates - Methotrexate/folic acid - Patches
49
Which drugs are given in morning or night?
morning - diuretics - steroids night - statins sedation
50
What medications are most likely to cause candidiasis?
steroids antibiotics immunosuppressants (nystatin drops)
51
What drugs can cause QT prolongation?
- ondansetron - sertraline - amitriptyline
52
What are the key points for prescribing COCP?
MC = ethinylestradiol plus a progestrone - start on day 1 of cycle - hold 4 weeks prior to surgery - CI = migraine with aura - withdrawal bleed
53
What is the protocol for progesterone only pill?
desogestreol , levonorgestrel , norehisterone - do not need to hold prior to surgery - susceptibel to interactions
54
What hRt is prescribed for a premenopausal women with a uterus?
- combined oestrogen and cyclical progesterone
55
What HRT is prescribed for a postmenopausal women with a uterus?
oestrogen and continuous progesterone
56
What is prescribed to a women with no uterus?
oestrogen alone (progesterone protects from uterine cancer)
57
What is paediatric resus fluids?
NaCl 0.9% 10ml/kg over <10mins
58
Paediatric maintenance fluids?
0-10kg = 100ml/kg 10-20kg = 50ml/kg >20kg = 20ml/kg
59
What are the key point for methotrexate prescribing?
once weekly interactions = trimethoprim may be suspended in a active infection monitor - FBC, U+Es, LFTs,
60
Which drugs are cytochrome p450 enzyme INHIBITORS?
O DEVICES Omeprazole Disulfiram Erythromycin Valproate Isoniazid Ciprofloxacin Ethanol Sulphonamides (warfarin increased effect)
61
Which drugs are cytochrome p450 enzyme INDUCERS?
PC BRASS Phenytoin Carbamazepine Barbiturates Rifampicin Alcohol Sulphonylureas Smoking (warfarin reduced effect)
62
A to E assessment of an AKI?
A - address drugs B - boost blood pressure C - calculate fluid balance D - dip urine E - exclude obstruction
63
What is theMOA of DOACs?
direct factor Xa inhibitor
64
Give some examples of rapid acting insulins?
novorapid apidra Humalog fiasco trurapi
65
Give some examples of premixed insulins?
Humulin M3 Novomix 30 Humalog Mix25 Humalog Mix50
66
What is the acceptable blood glucose range/ and when should unit s be changed?
pre-meal fasting = 4-7 mol/L post-meal = slightly higher to <8-9 4mmol/L is too low and at risk of hypoglycaemia PSA prioritises hypoglycaemia avoidance over tight control
67
How much can an insulin dose be changed by?
2 units if morning dose low = decrease evening dose if evening dose low = decrease morning dose treat lows before highs
68
Features of carbimazole?
blocks production of thyroid hormones 60mg daily max monitor = TFT and WBC ADR: - rash - pruritus - agranulocytosis - bone marrow suppression - jaundice - acute pancreatitis
69
What are the features of prescribing amiodarone?
long half life - loading dose required For = arrhythmias SE continue after stopping - Hyperthyroidism - Hypothyroidism - Pulmonary toxicity - Raised serum transaminases -Persistent slate grey skin discoloration - Phototoxicity max dose = 200mg TDS
70
What do you have to counsel people starting amiodarone?
Sunscreen Breathing problems Vision problems Liver toxicity – know signs
71
What to counsel people on starting methotrexate?
WEEKLY – how to take, usually multiple tablets Immediately report any feature of Blood disorders Liver toxicity Respiratory effects Avoid OTC NSAID – aspirin and ibuprofen Alert card
72
How should lithium be adjusted?
if serum conc high - reduce by 1/3rd
73
How should levothyroxine be adjusted?
in 25mcg increments
74
Which drugs increase falls risk?
Drugs which increase risk of falls: Benzodiazepines Antidepressants (particularly TCAs and SNRIs) Monoamine oxidase inhibitors Most antipsychotics Opiates Most antihypertensives (particularly diuretics and alpha-blockers)
75
Which drugs increase risk of fractures?
PPIs Steroids GnRH agonists (buserelin, goserelin etc)
76
Which drugs increase the risk of pancreatitis?
steroids DDP4i e.g. sitagliptin GLP-1 analogue e.g. exenatide mesalazine > sulphasalazine)
77
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