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Class PSA - All of medicine notes for oxford handbook typed up and edited with update
Medicine (A100)
Queen Mary University of London
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General Tips: - Go through BNF, click through different sections - Type drug name and then interactions shows each individual interaction - Know typical scenarios for drug overdoses and reversals o Paracetamol normogram is on BNF but know the drugs o For overdose type in poisoning o For peri-operative care meds type in ‘peri’ o Contraception type in contraception – Treatment summary - Pain ladder and max doses per day especially IV paracetamol o Contraindications (Low GFR – don’t give NSAIDs)
Drug Chart: - Statin and clarithromycin causes rhabdomyolysis so CI - Statin given at night - Frusemide given in the morning - Dexamethasone given for COVID - Lamprozaole – Given if patient on NSAIDs - Need to give bisphosphonates on an empty stomach - Levothyroxine – Need to be given on empty stomach
Prescription Review: PulseNotes, UCL student resources, Pass the PSA
Outlook: - Medicine o Drug interactions, med errors - Surgery o Pre-op assessments - DME o Diuretics, antiHTN, benzos, opioids - O+G o Preg interactions, OCP interactions - GP o Common symptoms management
- Paracetamol (Max 4 doses every 6 hours)
- Bisphosphonates (Once weekly dosing)
- Opioid patch (72-hour patches)
Approach: - What is causing presentation - Complicated by presentation - Optimising routes - Other incidental errors
Medicine: High yield = Bleeding pt, renal, cardiac and drowsy pt
Drug Interactions:
Antiplatelet and anti-coag = Increase bleeding risk (synergistic) o Dual-antiplatets
SSRI + NSAIDs = Upper GI bleed so give patient PPI IVF + Diuretics – Counter the use (Increase fluid volume then stop diuretics) Sildenafil and nitrates (ISMN/GTN) – Severe hypotension Long QT
- Stop all meds that cause bleeding
- Hypotension/tachy/prolonged cap refill/unstable haemodynamically/starting to detoriate – Stop anything that causes hypotension
- Alter seniors, give blood products and correct clotting abnormalities
- After stroke – CT head then give aspirins
Warfarin at that dose – used as treatment as clots (stronger) Enoxaparin at that dose is prophylaxis so better to stop enoxaparin
STOP: Amlodipine (leg swelling), frusemide (Low Na), enoxaparin (2 platelets prescribed), Amiloride (K+ sparing and his K is high)
Answer: A as the patient is a diabetic
Avoid oral route, CBT is not appropriate (more for depression), unsafe to stop med immediate as pt can get worsening of dyskinesia and SCZ.
Answer: A
GP QUESTIONS:
Diagnosis: Osteoarthritis
Management? Recommend weight loss, as well as simple analgesia
Question:
Diagnosis: Shingles
Answer: B
Questions
Answer: C – can cuase oesophageal erosion if stuck in oesophagus
Bisphosphonates = Majority taken once weekly bit can give IV or daily (lower dose) Treatment over 5 years, reassess and can be continued if required D – Not true, advised but don’t need it E – Nothing to suggest she will develop. If GFR <35, then don’t start treatment. Bis don’t cause renal impairment.
Check calcium and Vit D before and during tx and don’t give if hypocalcaemia.
Answer: D
Explanation: Can have steroid induced psychosis (rare), good practise to take in the morning but not required. If taken in evening can keep up at night.
Steroids can increase risk of GI bleeding. Steroids cause adrenal suppression so cant abruptly withdrawal it.
GP/O+G:
A - High yield, need to take replacement dose if V/D Explanation: Increased dose if BMI >25, or taking other drugs Small risk of breast cancer
Answer B
All the answers given are true/partially correct so click the life-threatening point from the list of answers.
Drug Calculations:
No
1 ml of adrenaline 1 in 10,000?
1 in 10,000 = 1 g/10, 1g/10,000 = 1000mg/10,000 = 100mg/1000ml = 0 mg/1ml = 100 mcg/1ml therefore 1ml has 100 mcg of adrenaline
Drug Monitoring:
Class PSA - All of medicine notes for oxford handbook typed up and edited with update
Module: Medicine (A100)
University: Queen Mary University of London
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