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TitlePass the PSA PDF.pdf
TagsMedical Prescription Glucocorticoid Pharmaceutical Drug Medical School Myocardial Infarction
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Total Pages310
Table of Contents
                            Front Cover
Pass the PSA
Copyright Page
Contents
Foreword
Preface
List of abbreviations
1 Basic principles of prescribing
	Introduction
	How to Use this Book
	Basic Principles for All Prescribing
	Enzyme Inducers and Inhibitors (See Chapters 8 and 9)
	Prescribing for Surgery
		Drugs to Increase During Surgery
2 Prescription review: a foolproof plan
	Structure of this Section within the PSA
	A Safe Routine for Prescribing
		PReSCRIBER
			PReSCRIBER explained
				Patient details
				Reactions
				Sign chart
				Contraindications
				Route
				Intravenous fluids
				Blood clot prophylaxis
				Antiemetics (see Table 2.1)
				Pain relief (see Table 2.2)
	Questions
3 Data interpretation
	Structure of this Section within the PSA
	Introduction
	General Data Interpretation
		Blood Tests: Haematology
			Low haemoglobin (anaemia)
		Blood Tests: Biochemistry
			Urea and electrolytes (U&E)
				Sodium (normal range 135–145 mmol/L)
				Potassium (normal range 3.5–5.0 mmol/L)
				Acute kidney injury (AKI)
		Liver Function Tests (LFTs)
		Thyroid Function Tests (TFT)
		Chest X-Rays
			Quality of film
			Structures
			Difficult areas
		Arterial Blood Gases
		ECG
	Drug-Specific Data
		An Introduction to Drug Monitoring
			Gentamicin monitoring
			Once-daily regimen monitoring
			Divided daily dosing
			Paracetamol nomograms
			Warfarin (excessive anticoagulation with warfarin)
	Questions
4 Planning management
	Structure of the Section within the PSA
	Introduction
	Management of Acute Conditions
		Cardiovascular (CV) Emergencies (Fig. 4.1)
			Tachycardia > 125 b.p.m.
		Anaphylaxis (Fig. 4.3)
		Respiratory Emergencies
			Acute exacerbation of asthma (Fig. 4.4)
			Acute exacerbation of chronic obstructive pulmonary disease (COPD)
			Pneumothorax
			Pneumonia
			Pulmonary embolism (PE, Fig. 4.6)
		Gastroenterology Emergencies
			Gastrointestinal bleeding (Fig. 4.7)
		Neurological Emergencies
			Bacterial Meningitis
			Seizures and status epilepticus
			Stroke (Fig. 4.10)
		Metabolic Emergencies
			Hyperglycaemia (DKA and HONK, Fig. 4.11)
				Diabetic ketoacidosis
				Hyperglycaemic HONK coma
			Hypoglycaemia (BM blood glucose <3 mmol/L)
			Acute kidney injury (AKI, previously known as acute renal failure) (Fig. 4.12)
			Acute poisoning (Fig. 4.13)
	Management of Chronic Conditions
		Cardiovascular Conditions
			Hypertension
				When to treat (see Fig. 4.14)
				Target blood pressures on treatment
			Chronic heart failure (adapted from NICE guideline CG108, 2010)
			Atrial fibrillation (adapted from NICE guideline CG36, 2006)
				Stroke prevention
				Determine the aim of the treatment according to the patient:
			Stable angina (angina pectoris)
				Management of stable angina (adapted from NICE clinical guideline CG126, 2011)
		Respiratory Conditions
			Chronic asthma (see Fig. 4.15)
			COPD
		Diabetes
			Management of both type 1 and 2 diabetes
				Blood glucose lowering therapy in type 1 diabetes
				Blood glucose lowering therapy in type 2 diabetes
		Neurological Conditions
			Parkinson’s disease
			Epilepsy
			Alzheimer’s disease
		Crohn’s Disease (Adapted from NICE CG152, 2012)
			Inducing remission
			Maintaining remission
				Azathioprine or 6-mercaptopurine
		Rheumatoid Arthritis
	Symptoms
		Fever
		Constipation
		Diarrhoea
		Insomnia
	Questions
5 Communicating information
	Structure of the Section within the PSA
	Introduction
	Questions
6 Calculation skills
	Structure of this Section within the PSA
	Introduction
	Questions
7 Prescribing: doing it yourself
	Structure of this Section within the PSA
	Prescribing Pitfalls
	Remember PReSCRIBER
	Remember the Basic Principles for all Prescribing
	Questions
8 Drug monitoring
	Structure of this Section within the PSA
	Introduction
	Questions
9 Adverse drug reactions
	Structure of this Section within the PSA
	Introduction
	Type 1: Adverse Effects of Common Drugs
	Type 2: Recognizing the Common Reactions
	Type 3: Clinically Important Drug Interactions
	Type 4: Recognizing and Managing an ADR
	Questions
10 Mock examinations
	Exam 1
	Exam 2
Index
                        
Document Text Contents
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QUESTIONS

Question 9.1 Adverse drug reactions item worth 2 marks

CASE PRESENTATION
A 58-year-old man is attending a routine follow-up appointment after starting lisinopril for the treatment of hypertension
3 months earlier.

On questioning, you establish that he has been compliant with his medicine and has had no significant problems. You
decide to titrate his dose up but carry out a blood test before proceeding.

DECISION OPTIONS

A WHITE CELL COUNT ◻

B NEUTROPHIL COUNT ◻

C SERUM SODIUM ◻

D SERUM ALBUMIN ◻

E SERUM POTASSIUM ◻

Question: Based on the known adverse effect profile of lisinopril, select the one parameter you are most interested
in checking when you carry out the blood test. Mark it with a tick in the column provided.

Question 9.2 Adverse drug reactions item worth 2 marks

CASE PRESENTATION
You wish to start a 62-year-old female on propranolol for migraine prophylaxis. She is quite an anxious lady and is keen
to avoid taking medication if she possibly can.
She asks you for advice about the common side effects so that she can make an informed decision as to whether she
would like to start treatment.

DECISION OPTIONS

A HEAT INTOLERANCE ◻

B TREMOR ◻

C HYPERTENSION ◻

D FATIGUE ◻

E TACHYCARDIA ◻

Question: Which one of the following is a common side effect of propranolol that you might discuss with your
patient? Mark it with a tick in the column provided.

Page 310

297

In
d

ex

tazobactam, 2, 39–40, 210, 223
temperature monitoring

clozapine, 250, 285
olanzapine, 129–130

temporal (giant cell) arteritis, 168
TENS (transcutaneous electrical stimulation),

163, 194
tension pneumothorax, 53
teratogenicity

antiepileptics, 60
methotrexate, 199
ramipril, 71–72
trimethoprim, 42

theophylline, serum, monitoring, 178, 216, 251,
286

therapeutic index, narrow, 141
thiazide diuretics, 10, 12, 16, 20, 31, 46, 56,

64, 108, 159, 189, 197, 257–259
throat swab, 131–132
thrombocytopenia and thrombocytosis, 30
thrombolytics, 104, 204, 280
thromboprophylaxis (blood clot prophylaxis),

7, 22, 103, 127, 140, 143, 149,
172–173, 184, 190, 258

inpatient prescription chart, 96, 100
thrombosis risk factors on inpatient prescription

chart, 96, 100
see also deep venous thrombosis; pulmonary

embolism
thyroid function tests (TFTs), 32, 131–132

see also hyperthyroidism; hypothyroidism
thyrotoxicosis (hyperthyroidism), 32, 131–132
thyroxine

administration (incl. levothyroxine), 32–33,
65–66, 160, 191, 253–254, 288–289

serum, monitoring, 131–132
tinzaparin, 190, 204
tolbutamide, 120
tolterodine, 274
toxicity see adverse reactions
trade names, 2
tramadol

arthritis, 275
gallbladder inflammation, 213
headache, 208

knee surgery (postoperative), 213
transcutaneous electrical stimulation (TENS),

163, 194
transfusion (blood), 229, 262
transient ischaemic attack, 168
tremor

lisinopril, 143, 145
tacrolimus, 179, 217, 252, 287

tricyclic antidepressants, 50, 66, 194, 278
trimethoprim, 17–18, 41–44, 147–148, 157,

168, 183, 188, 199, 221, 231, 253,
263, 288

urinary tract infection, 42, 44, 75–76, 147,
188, 201, 206

trospium, 274

U
ulcerative colitis, 167, 233, 265
urea and electrolytes (U&E), 30, 133–134
urinary incontinence, 242
urinary tract infection (UTI), 17, 67, 145, 147,

173, 188, 207, 225, 272
trimethoprim, 42, 44, 76, 147, 188, 201, 206

urine output monitoring, 135
in diabetic ketoacidosis treatment, 180
ramipril, 181, 219

V
valproate (sodium), 60, 118, 135–136, 249,

284
vancomycin, 25, 123–124, 181, 210, 219
vascular dementia, 68
venlafaxine, 278

generalized anxiety disorder, 279
venous blood gases (VBGs) in COPD treatment

with oxygen, 180, 218
venous thrombosis, deep (DVT), 74, 76, 104,

190, 204, 280–281
ventricular hypertrophy, left, 34
verapamil, 21–22, 25–26, 57, 114, 141
viral infections, high white cell counts, 30
vitamin D, serum, monitoring, 135–136

sodium valproate, 249, 284
vitamin K, 37–38, 149–150, 184, 222, 235,

267

volume calculations, example, 83
vomiting (emesis)

induction (with penicillin allergy), 151–152,
185, 223

on inpatient prescription chart, 101
management (antiemetics), 7, 9–10, 66–67,

101, 195, 258
ramipril and, 78, 166, 197, 237, 270

W
warfarin, 37–38, 76, 104, 149–150, 184, 188,

204, 222, 225, 256, 280
adverse reactions, 140, 149–150, 184,

222
antibiotics and, 149–150
atrial fibrillation, 21–22, 114, 235, 267
enzyme inhibitors and, 2
excess anticoagulation, 36
INR see international normalized ratio
tamoxifen and, 73–74

wasp sting allergy, 171, 239
water (bottle of) in hypoglycaemia, 79–80, 167,

198, 270
weight

losing, regimen for, 163, 194, 232, 264
monitoring, 125–126

white blood cell (leucocyte) count
high (leucocytosis), 30, 263
low, 30
monitoring, 127–128, 135–136

clozapine and, 285
lisinopril and, 143
ramipril and, 181, 219

WiLLiaM MoRRoW mnemonic, 34

X
X-rays, chest see chest X-rays

Y
Yasmin, 159, 190

Z
zopiclone, 60, 225, 258

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