1
Q
Insulin sick day rules
A
- Blood sugar levels every 4 hours minimum including during the night
- T2DM: Insulin MUST NOT be stropped due to risk of diabetic ketoacidosis. Aim to drink 3L of fluids (5 pints) a day to prevent dehydration
- T2DM: Temporarily stop some oral hypogylcaemics. Medication may be restarted once person is feeling better.
= Metformin: stop risk of lactic acidosis
= Sulfonylurea: risk of hypogylaemia
= SGLT2-i: euglycaemic DKA - DKA: IV fluids, Fixed rate insulin and continue regular long acting insulin
2
Q
Warfarin
A
- Unexpected bleeding must be investigated = Attend A+E
- Avoid binge drinking
- Women shouldn’t get pregnant = teratogenic especially in 1st and 3rd trimester.
- Need to take LMWH for first few days, seek help after head injuries
‣ Increased risk of foetal
abnormalities and neonatal haemorrhage,
‣ Warfarin takes up to 3 days to kick in
3
Q
DOACS (Apixiban)
A
- Routine monitoring is not required with DOACS
- The anticoagulant effects of DOACS diminish in 12 - 24 hours after the last dose is taken,
therefor omitted or delayed doses could lead to a reduction in anticoagulant effects. - Patient should report any new unexpected bleeding or bruising
4
Q
Methotrexate
A
- Taken once a week in autoimmune conditions = potentially fatal risk if taken more frequently
- Methotrexate Mondays - Folate Fridays
‣ Folic acid helps prevent methotrexate induced-mucositis and myelosupression - Monitor FBC, renal and liver function (reports of blood dyscrasias (any disease of the blood) and liver cirrhosis.
5
Q
Emergency Contraception
A
- FIRST LINE: Copper IUD all females who have has UPSI within 120 hours (5 days)
- Ulipristal acetate: consider as first line oral emergency contraception for females who have had UPSI within last 96 - 120 hours and in first 2 weeks of ovulation cycle
Hormonal contraception should not be newly initiated in a patient until 5 days after
administration of ulipristal acetate - the contraceptive effect of the ulipristal acetate will be reduced. Consistent and careful use of condoms is recommended - Levonorgestrel: effective if taken within 72 hours (3 days) of UPSI (may be used between 72 - 96 hours after UPSI but efficacy decreases with times)
= Higher BMI > 26kg/2 or 70kg can reduce the effectiveness of the medication and is
recommended either double dose of levonorgestrel or ulipristal acetate.
= Can be take in post ovulatory phase
Both hormonal medications can be used more than once in the same cycle however may
increase risk of side effects such as menstrual irregularities.
6
Q
COCP
A
Missed doses:
- The critical time for loss of contraception protection is when a pill is omitted at the
beginning or end of a cycle (which lengthens the pill-free interval)
- A missed pill is one that is > 24 hours late or more.
- If a woman misses only one pill, she should the her next active pill asap and resume normal pill taking
- If a woman misses 2 or more pills (esp from first 7 in packet) - she may not be protected.
She should taken an active pill as soon as she remembers and must either abstain from
sex or use additional method of contraception for 7 days.
- Emergency contraception is recommended if 2 or more COCP tablets are missed from
the first 7 tablets in a packet and UPSI has occurred since finished the last packet.
7
Q
POP
A
- Missed doses: If you forget to take a pill, take it as soon as you remember and carry on the next pill at the right time (this may mean taking 2 pills at the dame time)
- If pill is > 12 hours overdue you are not protected = continue normal pill-taking but you must also use another method, such as condom, for 2 days
- Diarrhoea and vomiting:
= If vomiting occurs within 2 hours of taking desogestrel, another pill should be taken ASAP
= In case of persistent vomiting or very severe diarrhoea, additional precautions should be used during illness and for 2 days after recovery.
= After childbirth (not breastfeeding): Oral POP can be started before 21 days postpartum without the need for additional contraceptive precautions.
= Surgery: suitable for use as an alternative to COCP before major elective surgery, before all surgery to the legs or before surgery which involves prolonged immobilisation of lower limb
8
Q
Isotretinoin
A
- Must use effect contraception for one month before commencing, throughout treatment and one month after completion
- Pregnancy test must be taken monthly before dispensing medication
- Can effect mood, anxiety, and suicidal ideation
- Headaches = common side effect
- Must avoid breast feeding
- Effective contraception is defined as 1 user independent e.g. IUD or 2 other dependant
means: COCP AND condoms
9
Q
All antipsychotics and mood stabilisers
A
- Photosensitisation mat occur with higher dosages, patients should avoid direct sunlight.
- Drowsiness may effect performance of skilled tasks especially at start of treatment
- Effects of alcohol are enhances
10
Q
Lithium
A
- When initiated: measure 1 week after starting treatment, 1 week after every dose change, then weekly until the levels are stable.
- Once stable: measure every 3 months for first year then every 6 moths thereafter.
- Lithium levels should be measured 12 hours post-dose
- Aim to achieve plasma levels: 0.4-1mmol/L
- Initial SE nausea, diarrhoea, vertigo, muscle weakness, and a ‘dazed’ feeling
- Longer-term SE hypo/hyperthyroidism, hyperparathyroidism, nephrotoxicity, renal
tumours - Once established on treatment: measure weight, U&Es, Ca, TFTs every 6 months
- Report any signs of lithium toxicity, hypothyroidism, renal dysfunction (including polyuria,
polydipsia) and benign intracranial hypertension (persistent headaches and visual
disturbances) - Maintain adequate fluid intake and avoid dietary changes which reduce or increase
sodium intake - AVOID NSAIDS
11
Q
Sodium Valporate
A
All women and children of childbearing age must be supported on a Pregnancy
Prevention Programme - pregnancy should be excluded before treatment initiation and
effective contraception.
PASS THE PSA
flashcards
Decks in class (4)
# Cards
