PSA EXAM Notes PDF

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PSA EXAM [email protected] Monitor FBC and LFTs Risk of myelosuppression, liver cirrhosis, pneumonitis Steroid dosage Polymyalgia Rheumatica - Temporal Arteritis - prednisolone 40-60mg daily until resolution of symptoms and laboratory abnormalitiesOverdoses to keep in mind: Paracetamol Blood...

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PSA EXAM NOTES [email protected] Methotrexate - Monitor FBC and LFTs - Risk of myelosuppression, liver cirrhosis, pneumonitis Steroid dosage Polymyalgia Rheumatica Temporal Arteritis - prednisolone 40-60mg daily until resolution of symptoms and laboratory abnormalities Overdoses to keep in mind: 1. Paracetamol Blood paracetamol concentration - what blood test would you do to decide whether to give Nacetylcysteine Prothrombin Time / INR - to monitor effectiveness of regime AST ALT Renal function 2. Tricyclic Antidepressant ! 3. Opioids

The following drugs may worsen seizure control in patients with epilepsy:! • alcohol, cocaine, amphetamines! • ciprofloxacin, levofloxacin! • aminophylline, theophylline! • bupropion! • methylphenidate (used in ADHD)! • mefenamic acid! Exacerbation to Psoriasis ! trauma! alcohol! drugs:#beta blockers,#lithium, antimalarials (chloroquine#and hydroxychloroquine),#NSAIDs#and#ACE inhibitors, infliximab! withdrawal of systemic steroids! Gentamicin dosing ! Breastfeeding! Drug contraindications The following drugs can be given to mothers who are breastfeeding:! • antibiotics:#penicillins,#cephalosporins,#trimethoprim! • endocrine:#glucocorticoids (avoid high doses),#levothyroxine*! • epilepsy:#sodium valproate,#carbamazepine! • asthma:#salbutamol,#theophyllines!

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psychiatric drugs:#tricyclic antidepressants,#antipsychotics**! hypertension:#beta-blockers,#hydralazine! anticoagulants:#warfarin,#heparin! digoxin!

The following drugs should be avoided:! • antibiotics:#ciprofloxacin,#tetracycline, chloramphenicol,#sulphonamides! • psychiatric drugs:#lithium,#benzodiazepines! • aspirin! • carbimazole! • methotrexate! • sulfonylureas! • cytotoxic drugs! • amiodarone!

DOACs - Direct Oral Anticoagulants • Mode of action - Factor Xa inhibitor (resulting in reduction of thrombin burst during the coagulation cascade • Indications for use - Prevention of CVA in non-valvular AF, VTE, thromboprophylaxis post orthopaedic surgery, ACS (not all, specialist advice) • Contraindications - Bleeding risk (hepatic impairment or liver disease), contact sport, metallic heart valve, pregnant or breast feeding, creatinine clearance 120kg, target INR 3-4, antiphospholipid syndrome • Monitoring – FBP, U&E, LFTs, weight & creatinine clearance pre dose, annually thereafter • Counselling – why, when , how to take, missed dose, monitoring, side effects, who to inform, alert card • Interactions – drugs, foods etc • Why important as FY1 to know about? - prescribing concurrent drugs, need to stop prior to surgery, half life, when to stop and start Warfarin • Tablets available in 2 strengths - 3mg BLUE, 1mg BROWN • Mode of action – inhibits Vitamin K epoxide reductase complex 1 (the essential enzyme for activating vitamin K in the body) thereby depleting vitamin K reserves and reducing the synthesis of active clotting factors • Indications for use - VTE prophylaxis and treatment, AF, valve replacement, reduction in risk of death post MI from VTE, CVA or recurrent MI • Contraindications - Pregnancy, active bleeding, contact sports • Monitoring - INR to ensure in target range for condition, ensuring TTR is > 65% • Counselling - Prescribe as per INR, take at 5pm, do not take double next day if dose missed, may need to stop prior to surgery or dental procedures, can feel cold, bruise easily, bleed more easily, seek urgent help if fall and bang or can’t stop bleeding • Interactions – Drugs, alcohol, green leafy veg, grapefruit juice • Why important for an FY1 to know about? - 2 strengths 3mg and 1mg, prescribe as per INR, half life of 5days so over checking can be dangerous, needs to stop and bridge prior to surgery, needs to check INR within 5 days if prescribing any new meds Lithium 1. When lithium levels stable - 3 monthly: lithium levels - 6 monthly: weight / BMI, U&E, Ca2+, Tfts 2. If lithium dose changed - monitor lithium weekly until stable Specialist Medications 1. Red Drugs 2. Amber Drugs 3. DMARDs...