Y5 Zuzi extras > PSA prep > Flashcards

PSA prep Flashcards

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1
Q

Pt post hip replacement- only on paracetamol- constipated 3 days, feeling bloated - what laxative would you give?

A

Stimulant laxative- senna or bisacodyl
Not osmotic as not on opioids and feeling bloated and osmotic laxatives cause worse bloating

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2
Q

If pt is cachexic and hypoglycaemic 2 mmol/l what do you want to give th pt?

A

10% glucose IV- 150-200ml OVER 15 mins

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3
Q

When would you not give glucagon for hypoglycaemia

A

Glucagonoma; ineffective in chronic hypoglycaemia, starvation, and adrenal insufficiency; insulinoma; when used in the diagnosis of growth hormone secretion, delayed hypoglycaemia may result—deaths reported (ensure a meal is eaten before discharge) (in children)

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4
Q

what do you need t make sure to spell out in full which prescribing insulin?
What else is needed to make sure the right insulin is prescribed?

A

‘units or ‘International units’
device of insulin
strength of insulin
brand on insulin

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5
Q

What are the monitoring requirements for lithium?

A

When initiated- measure levels 1 week after starting treatment
1 week after every dose
change
then weekly until the levels are stable.

Once levels are stable, measure every 3
months for first year then every 6 months thereafter.

. Lithium levels should be measured 12 hours post-dose
. Aim to achieve plasma level 0.4-1mmol/L

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6
Q

How much glucose does glucose10 or 20% for IV infusion have ?

A

so glucose 10% is Weight/volume = 10g glucose /100ml
20% = 20g glucose/100ml

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7
Q

where to find HRT info on BNF

A

sex hormones

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8
Q

What are the side effects to lithium ?

A

Mnemonic: Lithium

Lethargy/leukocytosis
Insipidus (diabetes)
Tremor
Hypothyroidism/Hyperparathyroidism=hypercalcaemia
Interactions- NSAIDS, ACEi/ARBs, Diuretics
Upset stomach- nausea, diarrhoea, vomiting
Metallic taste

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9
Q

Signs of lithium toxicity?

A
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10
Q

What needs to be monitored before starting lithium treatment and what should be monitored once established on treatment?

A

Before: weight, TFTs, U&Es, Ca2+,FBC
During treatment: weight, TFTs, U&Es, Ca2+ min every 6 months

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11
Q

What VTE prophylaxis would you give to pregnant women ?

A

Dalteparin sodium- Ctrl F pregnancy

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12
Q

What HRT to prescribe for women with uterus and LMP>1 yr

A

Estradiol with norethisterone
Continuous HRT

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13
Q

What are important things to remember regarding digoxin toxicity?
ECG finding?
What is toxicity worsened by?
When after dose should we check levels ?
What should we monitor if prescribing digoxin with diuretics?

A
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14
Q

What should be checked prior to statin treatment?

A

Full lipid profile
LFTs - may derange in statin use
U&Es
TSH
CK
fasting blood-glucose concentration or HbA1C

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15
Q

What monitoring is needed before and during azathioprine treatment?

A

Before- TPMT levels, reduced activity of the enzyme= higher risk of myelosuppression
During- FBC weekly first 4 weeks, then every 3 months

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16
Q

Common side effects of amiodarone ?

A

Arrhythmias; hepatic disorders; hyperthyroidism; nausea; pulmonary fibrosis; skin reactions

Monitor: LFTs before and every 6m, K+ before, CXR before, TFTs before, every 6m and after stopping treatment too

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17
Q

Pt with O2 of 86%, has COPD and is an oxygen retainer, what management would it be ?

A

commence O2 aiming for 88-92% via venturi mask

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18
Q

Pt with hyponatraemia, what to do ?

A

-Assess fluid status to determine if pt fluid overloaded or dehydrated or on medications causing low Na?

  • If pt dry- replace with NaCL fluid bag to rehydrate and increase Na (max increase 10mmol/L in 24 hrs)

-If pt fluid overloaded leading to dilutional hyponatraemia- maybe fluid restrict?

If on low Na meds- eg. diuretics (thiazides- hold it), PPI (swap to famotidine), SSRI

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19
Q

Tx for hypercalcaemia?

A

rehydration with 0.9% saline, typically 2-4 litres/first 24 hrs
Iv bisphosphonates
Review drugs that may affect renal function eg. NSAIDs, ACEi, ARBs, Diuretics

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20
Q

paediatric fluid resus

A

child > 29 days old - NaCl 0.9% bolus 10ml/kg over <10 mins

neonates <29 days old- 10-20ml/kg over<10 min

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21
Q

maintenance fluids paeds ?

A
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22
Q

In asthma exacerbation, whats the management?

A
  • short-acting inhaled bronchodilators, usually at higher doses
    than the patient’s maintenance treatment through a nebuliser or
    hand-held device to manage breathlessness
  • Withhold LAMA treatment if a SAMA is given
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23
Q

treatment for PE ?

A

VTE treat summary
doac- apixaban or rivaroxaban

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24
Q

where to find these conditions in treatment summaries?
Atrial fibrillation
- Angina
- Anaphylaxis
- OCP
- Overdose
- HRT:
- Diabetes:
- Cholesterol problems:

A

Atrial fibrillation: arrhythmias
- Angina: acute coronary syndromes
- Anaphylaxis: antihistamines, allergen immunotherapy and
allergic emergencies
- OCP: contraceptives multiple different entries
- Overdose: poisoning
- HRT: sex hormones
- Diabetes: type 1 / type 2 diabetes
- Cholesterol problems: dyslipidaemias

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25
weigh up the hormonal emergency contraception options
26
What is the BNF way of stating if a drug has a side effect of abdo pain
gastro-intestinal discomfort
27
where to find which drugs are most likely to cause anticholinergic side effects
appendix 1 interactions
28
if pt has had prev penecillin anaphylaxis what drugs should you avoid ?
need to avoid penicillin based drugs (Cephalosporins (like cephalexin, cefuroxime, ceftriaxone, cefepime) and carbapenems (like meropenem, ertapenem, imipenem) as some cross-over re anaphylaxis
29
why are transdermal patches not good for acute pain or for use in patients whose pain requirements are changing rapidly
take a long time for plasma concentrations to reach steady state, which prevents rapid titration of the dose (will take 12-24 hours to achieve steady state)
30
whats a 1% solution?
1% weight per volume (w/v) 1 gram of the drug per 100 milliliters of total solution or 10mg per 1ml
31
what does 1 in 1000 and 1 in 10,000 adrenaline mean and what are they used for ?
1 in 1000= 1g/1000mg per 1000ml therefore 1mg=1ml Used for: anaphylaxis 1 in 10,000= 1g in 10,000ml therefore 1mg=10ml Used for: cardiac arrest
32
where to find opioid conversions on medicines complete ?
prescribing in palliative care
33
pul and peripheral oedema in pt? what drug, dose and route is the best to alleviate this?
furosemide 20-50mg IV daily or 2-5ml of 10mg/ml furosemide once only Why IV? check diuretics monograph- intravenous administration produces relief of breathlessness and reduces pre-load sooner than would be expected from the time of onset of diuresis.
34
Where to find surgical VTE prophylaxis info ?
Go to venous thromboembolism monograph, Ctrl F what surgery it is (there might be specific info), LMWH= either dalteparin, enoxaparin, tinzaparin
35
when does ramipril need to be withheld?
if pts are unwell and/or have reduced oral intake - reduced chance of AKI
36
which antiplatelets to stop prior to surgery?
- Clopidogrel 7 days - aspirin 5-10 days - ticagrelor 5 days
37
which drugs to stop in AKI ?
ACEi (Lisinopril, Ramipril, Enalapril) ARBs (candesartan, Losartan, Valsartan, Irbesartan) Aminoglycosides (gentamicin, tobramycin, amikacin, neomycin, and streptomycin) Diuretics NSAIDs (except if aspirin at cardiac dose e.g. 75mg od) + any which may accumulate Metformin Lithium Digoxin allopurinol
38
which painkillers to always start with?
paracetamol and nsaids
39
which lower UTI drug should not be used with eGFR under 45?
nitrofurantoin
40
where to find info about anticoag and drug changes before surgery
peri-operative anticoagulation
41
what to monitor on COCP?
BP
42
types of post op N+V drugs and what they help with ?
metoclopramide (‎dopamine antagonist) or domperidone (‎dopamine antagonist)- prokinetic agents Opioid-induced PONV- ondansetron (5-HT3 receptor antagonist) or cyclizine (H1 Histamine receptor antagonist)
43
when is ondansetron contraindicated ?
in QT prolongation
44
where to find shingles or chickenpox info ?
Herpesvirus infections
45
does naproxen cause ankle swelling ?
yes
46
DKA treatment What to give when glucose becomes <14mmol/L
- fluid resus- 0.9% NaCl 1L over 1hr, then 2nd 1L over 2 hrs - Start FRII- 0.1unit/kg/hr, stop short acting insulin, continue long acting - Potassium replacement - add 20mmol to second 1L bag of fluid - Add glucose when <14mmol/L- PRESCRIBE-10% glucose 1L over 8 hrs - rate 125ml/HR
47
which strong opioids should be used in renal impairment ?
Oxycodone - metabolised by liver fentanyl, buprenorphine, methadone, and alfentanil- hepatically metabolised
48
which opioids to avoid in renal impairment ?
Morphine, Codeine/Dihydrocodeine, Pethidine
49
seizure- what's the treatment summary
status epilepticus
50
If pt has HTN, + a acute gout attack - which medication is optimal and why is the other one not
Cochicine- optimal choice NSAIDs- can cause fluid retention and increase BP
51
who should NSAIDs be used with caution in?
- renal impairment - liver impairment - heart failure - if they take diuretics, ACEi, ARBs -cerebrovascular disease (TIA, Stroke)
52
Pt post-cholecystectomy with fever, tachycardia and red swollen area around surgical site. What ABX to give? and what route ?
Flucloxacillin - 1-2g IV
53
what is used to reverse acute dystonia from antipsychotics? What are this drugs CI?
Procyclidine Contraindication: untreated urinary retention, closed angle glaucoma, intestinal obstruction
54
What should be ran alongside VRII for diabetic pt prior to surgery when they are NBM
On the day of surgery- intravenous substrate infusion of potassium chloride 0.15/0.1% with glucose 5% and sodium chloride 0.45%
55
what to search for if looking for anorexia as side effect ?
Appetite decreased
56
what is the main contraindication for Beta blockers
Asthma
57
What is the first line drug you would prescribe for HTN 1) <55, caucasian 2) >55, caucasian 3) >55, diabetic 4) <55, afro-caribean 5) >55, afro-caribean, diabetic 6) Pt on ACEi, CCB, what next ?
1) ACEi- Ramipril 2.5 mg once daily 2) CCB- amlodipine 5 mg once daily 3) ACEi/ARB-Ramipril 2.5 mg once daily 4) CCB- amlodipine 5 mg once daily 5) ARB (in preference to ACEi)- losartan 50 mg once daily 6) thiazide like diuretic - indapamide 2.5 mg daily IR
58
where to find which drugs reduce effectiveness of COCP/POP?
contraceptives interactions
59
treatment of DVT or PE confirmed?
Offer either apixaban or rivaroxaban for patients with a confirmed proximal DVT or PE
60
who to be cautious about with DOAC prescribing?
renal impairment CrcL <30
61
Preg pt with HTN what medication to give? What if they have asthma?
Labetalol (contrI in asthma- bronchospasm) Nifedipine
62
how to treat giant cell arteritis with added visual loss?
1. Methylpred IV 0.5-1g for 3 days
63
how to prescribe antifungal crea for tinea?
cream dose- 1 application route- topical
64
where to find info on hyperemesis gravidarum ?
Nausea and labyrinth disorders -> pregnancy
65
which drugs should not be given in asthma
b-blockers NSAIDs
66
if you cant find drugs that could cause the specific electrolyte imbalance you are looking for- ctrl F .....
electrolyte imbalance
67
what drugs are used for restless leg syndrome
pregabalin, gabapentin, codeine, benzo
68
if a Pt has side effects after metformin for T2DM what medication would you start next? where to look for info ?
go to type 2 diabetes> ctrl F non-metformin regimens DPP4i- good pioglitazone- contraindicated in heart failure SGLT2i- better if there is chronic heart failure or established atherosclerotic cardiovascular disease (risk of hypotension/hypoglycaemias) SUs-gliclazide- encourages weight gain
69
PE management: LMWH switch to edoxaban (DOAC) how should this be done?
discontinue SC anticoagulant and start edoxaban at the time of the next scheduled dose of SC anticoag
70
lidocaine toxicity signs
71
if levothyroxine dose for hypothyroidism is too low, how much to increase by
25micrograms per day
72
how to calculate paeds fluid deficit
fluid deficit (ml)= %dehydration x weight (kg) x 10 add to maintenance
73
breakthrough doses should be how much of daily dose
1/6 to 1/10
74
how many times a day of oxycodone given
BD - important to chcek in calculations question if need ti look this up
75
what is monitored in asthma reviews
spirometry or peak flow variability tetsing
76
in a pt with hypothyroidism treated with levothyroxine- what to do if TSH is low, T4 normal
Dose is too high lower dose as theres risk of osteoporosis and AF with levothyroxine
77
Treatment for pneumonia when the cause is influenza is found where ?
Influenza- treatment summary- tx with antiviral in specific situations
78
how to treat hypernatremia due to dehydration
- First line: oral water - Second line: IV glucose 5% 1L over 6/8 hrs to help dehydration
79
what meds to use in febrile convulsions?
No meds indicated- antipyretc can be used for fever tho
80
what is given first in abortion up to 23+6 weeks ? After 9 weeks medical abortions are less common
Mifepristone then prostaglandins (misoprostol)
81
Any qs about palliative care or pt wth cancer for best supportive care refer to ...
Prescribing in palliative care
82
how is whooping cough treated ?
found in macrolides treatment summary Treat with clarithromycin
83
What abx can you not give in penicillin allergy ?
-penicillin's- Amoxicillin, Ampicillin, Benzylpenicillin, Phenoxymethylpenicillin, Piperacillin - cephalosporins - Second/third generation (e.g., Cefuroxime, Ceftriaxone) may be used in severe infections if alternatives are poor, but requires close monitoring. Cefalexin is often avoided due to similar side chains. - carbapenems -Imipenem, Meropenem, Ertapenem
84
tension headache prophylaxis Mx:
Amitriptyline
85
what can erectile dysfunction be under in side effects
Sexual dysfunction
86
Pt with a high clinic BP on 2 readings but not above 180/120 what to do?
Ambulatory or home pressure monitoring
87
where to find info on using furosemide for heart failure ?
Diuretics monograph has loop diuretic title - explains to give IV in pul oedema
88
Glucocorticoids can cause ...
Confusion Hyperglycaemia
89
How do we know if that statin has been a success and to carry on same dose ?
> 40% reduction in non-HDL cholesterol within 3 months = dose adequate, carry on
90
where to find warfarin info and reversal agents
Oral anticoag
91
Info on heparin
parenteral anticoagulants
92
where is info on ACEi and ARBs ?
Drugs affecting the renin-angiotensin system
93
Benzodiazepine dose conversions
go to hypnotics and anxiolytics Ctrl F Approximate equivalent doses
94
Steroid dose conversions
Glucocorticoid therapy Ctrl F equivalent
95
what is menorrhagia under?
Heavy menstrual bleeding
96
where is the vaccine schedule
Immunisation schedule
97
Animal bite treatment
skin infections
98
Taking steroids and ciprofloxacin together increases risk of
tendon rupture
99
Triptans w/ SSRI s or MAOi can cause
serotonin syndrome
100
SGLT2 inhibitors can result in .... DKA
euglycaemic eg. Gliflozins
101
what anti-emetic is best for vertigo/motion sickness/ vestibular disorders
cyclizine
102
what anti-emetic is best for post-op N+V
Ondansetron
103
N+V in palliative acre
Levomepromazine, haloperidol, cyclizine
104
N+V in chemo 1) acute 2) delayed
1) ondansetron 2) metoclopramide
105
best for N+V in Parkinson's
domperidone- does not cross BBB
106
Hyperemesis gravidarum
Promethazine
107
What med to avoid in T2DM who is obese
SUs, Glitazones, and insulin can cause weight gain
108
what to be wary of anticoag wise in renal impairment?
DOAC LMWH
109
trigeminal neuralgia neuropathic pain tx?
carbamazepine
110
Migraine first line tx? 1) w/aura 2) wo/ aura 3) prevention
1) sumatriptan 2) aspirin/ NSAID 3) propanolol
111
Mx for hypocalcaemia severe or symptomatic
Ca< 2.2 Hypo- 10% calcium gluconate 10ml over 10 min
112
Mx for severe hypercalcaemia
0.9% NaCl 1L over 4 hrs
113
Mx hyperkalaemia
10% calcium gluconate 30ml IV over 10 min
113
addison's crisistx
hydrocortisone 100mg IV also NaCl 0.9% rehydration
114
what route to prescribe med for N+V
IV/IM if vomiting
115
when is Methotrexate taken ? what should be taken with it?
- Once per week- usually mondays - Folic acid- helps prevent mucositis and myelosuppression
116
what can ciprofloxacin cause ?
tendinitis or tendon rupture, muscle pain
117
how to treat dystonias/ acute oculogyric crisis?
Procyclidine !!!
118
what can tamsulosin cause?
Tamsulosin can cause intra-operative floppy iris syndrome and should be stopped before all cataract surgery
119
when should trimethoprim not be prescribed?
in pt taking methotrexate
120
If oedema is not coming up as a side effect when looking for peripheral oedema - search....
Fluid retention
121
In which pts not to prescribe NSAID
those with peptic ulcers and elderly
122
In paeds pt taking long term steroids what should eb monitored?
height and weight annully
123
Pts taking olanzapine should have what monitored regularly?
Fasting blood glucose
124
where can I find drugs with effects on CNS aka sedating drugs/risk of cog impairment
appendix 1- effects on CNS and antimuscarinic effects
125
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