Term
|
Definition
|
|
Term
|
Definition
Iron: 27mg
Folate 600mcg (folic acid 5mg) for NTD
iodine: 220mcg for intellectual development
Zinc: 10-11mg
Vit C: 55-60mg
Vit D 5mcg |
|
|
Term
|
Definition
Alcohol
Caffeine <300mg (2-3 cups)
Listeria monocytogenes from refrigerated foods, leftovers, seafood, cold meat, smoked salmon |
|
|
Term
|
Definition
Breast is best
Benefits: less diarrhoea, otitis media, allergies, diabetes type 1, less asthma
Weight gain: 150g per week. |
|
|
Term
| Problems with breastfeeding? |
|
Definition
| Poor attachment leading to damaged nipples (refer), engorgement, no weight gain, no milk production |
|
|
Term
|
Definition
| Starter at 6 months W:C 60:40, add solids. 12months use 80:20 and cows milk. |
|
|
Term
| Questions to ask if someone wants to fall pregnant? |
|
Definition
when are u planning too?
previous pregnancy?
Discussed with doctor?
any other meds and supps?
Contraception?
Diet and lifestyle?
Medical conditions? |
|
|
Term
|
Definition
18-55 days: Antiepileptics (anatomic abnormalities)
2nd trimester: ACEi (renal problems)
3rd: N SAIDs (vasoconstriction)
Delivery: Narcotic analgesics
Post delivery: SSRIs and antipsychotics
Sulfamethoxazole: not for pregnancy. |
|
|
Term
|
Definition
| ACEi, lithium, Vit A, anxiolytics, antithyroid, retinoids, tetracyclines, warfarin, Alcohol, high dose sodium valproate, Paroxetine and Fluxoetine. |
|
|
Term
|
Definition
| Griseofluvin, finasteride, cytotoxic agents. |
|
|
Term
|
Definition
| C/I: amiodarone, lithium, chloramphenicol, wormwood, blue cohosh, alcohol (high dose). |
|
|
Term
| other drugs in lactation? |
|
Definition
dont use codeine (respiratory depression).
Alcohol, bromocriptine, pseudo, thiazides decrease production.
Domperidone (10-20mg tds for 8 weeks and taper down), oxytocin increase milk.
SSRI not recommended, but Sertraline is preferred |
|
|
Term
|
Definition
ask why?
express milk to avoid mastitis or engorgement.
Ween of breast milk (reduce feeds with breast)
monitor weight: >5 wet nappies and 150g increase weekly |
|
|
Term
|
Definition
Ask S&S
Family history
formula or breast
uses to wash with
skin dry
mothers diet
how long
USE: Soap free wash, moisturisers and steroids if needed. |
|
|
Term
| Pediatrics: conditions and tx |
|
Definition
N & V: probiotics and rarely ondansetron (not for <6months)
V&D: self limiting use probiotics and ORS.
GORD: PPI.
Febrile seizures: 5m-5y, >38 degrees, use paracetamol.
Otitis media: amoxycillin 25mg/ml
Croup: prednisolone 1mg/mg for 3 days (barking cough)
Influenze: oseltamivir bd for 5 days.
UTI: Trimethoprim 4mg/kg for 7 days
Pertussis: clarithromycin 7.5mg/kg for 7 day.
Varicella-zoster: immune-competent children give oral anti-histamines. |
|
|
Term
|
Definition
Cystic fibrosis: lung inflammation and malabsorption: give vitamins and high calorie diet.
Autism: only tx symtoms: risperidone or fluoxetine.
ADHD: dexamphetamine 2.5-10mg max 30mg
Asthma: infrequent (by infection), frequent (<6-8 weeks per episode), persistent: most days. Tx: SABA, low dose ICS (Fluticasone 50-100 mcg bd).
montelukast: 2-5: 4mg, 6-14: 5mg. ADHD start with concerta 5-10mg not the CR, can increase by 5mg weekly in mane.
Paracetamol: 15mg/kg, ibuprofen: 5-10mg/kg. |
|
|
Term
| Artificial nutrition: refeeding syndrome? |
|
Definition
prolonged inadequate nutrition, down regulation of cellular pumps.
Electrolytes leak across cells, CHO release insulin and glucose into cells, result in hypokalaemia, magnesaemia resulting in cardiac failure, convulsions and coma. |
|
|
Term
| Artificial nutrition types: |
|
Definition
renal failure: low protein and low electrolytes.
Diabetes: high fat, soluble fibre, complex CHO.
Pulmonary disease: high fat for fat oxidation. |
|
|
Term
| when to give Artificial nutrition: |
|
Definition
impaired intake (chewing and swallowing)
impaired transport
impaired digestion and absorption
low BMI
Low albumin (show long standing poor intake) |
|
|
Term
| Artificial nutrition routes: |
|
Definition
Gi still functioning: PEG, nasal, nasal gastric.
Gi failure, swallowing problems: TPN (monitor U&E, LFT, CI, WCC, TEMP, serum albumin, weight. need weening |
|
|
Term
| Artificial nutrition points: |
|
Definition
dont crush SR tablets
calcium can block tube.
monitor weight, U&E
adjust for corrected calcium |
|
|
Term
|
Definition
HTN
T2D
dyslipideamia, sleep apnoea, stroke, CHD, COPD
OA, gout cancers and depression |
|
|
Term
|
Definition
BMI >35: 05-1 a week
27-350.25-0.5 a weeks (10% 6 months) |
|
|
Term
|
Definition
recommend CSIRO diet: 2 fruit 5 veg, low GI foods.
Exercise 30-60 mins moderate. |
|
|
Term
|
Definition
Partial meal replacements: BM >25.
Pharmacological for BMI >30 or >27 with co-morb condition,
Phentermine: 15-40mg short term, not for longer than 3 months. not for uncontrolled HT, severe CVD, glaucoma.
Orlistat: 120mg tds with food, give fat soluble vitamins with. |
|
|
Term
|
Definition
enlarged prostate
compressesd urethra
Nocturia
bladder outflow obstruction
lower UT symptoms (like recurrent infection). |
|
|
Term
|
Definition
U&E, LFT (ALP high)
undiagnosed pagets disease, PSA
urinalysis, Consider I-IPSS to rank the severity |
|
|
Term
|
Definition
Selective Alpha blockers: prazosin 0.5mg for 3-7 days then 2mg bd (not for elderly)
Tamsulosin 400mcg morning. monitor: BP
5-alpha reductase inhibitors: finasteride 5mg or Dutasteride 0.5mg for severe disease use both, |
|
|
Term
|
Definition
Acute bacterial: with UTI, trauma bladder (not common)
Chronic bacterial: relapsing UTI
LUTS, pelvic pain, fever, tenderness. |
|
|
Term
|
Definition
Acute: Severe: IV antibiotics and fluid (gentamicin plus ampicillin) or Cefotaxime. Moderate: trimethoprim 300mg 14 days
Chronic: Norfloxacin 400mg bd for 4 weeks. Chronic non bacterial: Prazosin. |
|
|
Term
|
Definition
neurological
Vascular
endocrine
iatrogenic
psychogenic |
|
|
Term
|
Definition
metabolic syndrome LUTS, CVD, smoking, depression, diabetes, spinal cord injury
Medications: antidepressants, antihypertensives, antipsychotics, anticholinergics. |
|
|
Term
| ED tx: assess history and lab results like lipids, glucose, testosterone. |
|
Definition
PDE5: sildenafil (50-100) 30 mins before and only once daily. (not if on nitrates)
PGE1: injection, Alprostadil 10-20mcg (60mcg max) or vacuum (can use a combo). |
|
|
Term
| Premature ejaculation (PE) |
|
Definition
Primary: lifelong
Secondary: acquired.
Tx: topical lignocaine 2.5% and prilocaine 2.5% cream 10-20 mins before |
|
|
Term
|
Definition
semen back into bladder and low sensation
Tx: pseudoephedrine 60mg 2-4 daily |
|
|
Term
| Androgen deficiency: low testosterone Diagnosis and S&S. |
|
Definition
Diagnosis: blood essay for testosterone, FAI index, BMD, haemoglobin, haematocrit.
S&S; low energy, hot flushes, low libido, sweats, osteoporosis, muscle strength. |
|
|
Term
| low testosterone causes and tx: |
|
Definition
testis disorder, hypothalamus disorder, obesity, mumps, genetic.
Tx: gel: 5g (50mg). IM 250mg every 2-3 weeks. Patch 1 (5mg) at night. oral 120-160mg daily for 2-3 weeks. |
|
|
Term
|
Definition
Tx: finasteride 1mg daily
Minoxidil: 1ml to area bd |
|
|
Term
| male osteoporosis: t score -2.5 |
|
Definition
not common
from glucocorticoids, thyroxine
Risk: smoking family history, lack of exercise.
Tx: vit D >75 mmol/l, Calcium 1300mg >70yrs, Bisphosphonates. |
|
|
Term
|
Definition
|
|
Term
|
Definition
bone metastases,
wounds\infection
malignant
radiotherapy
depression
constipation
urinary retention |
|
|
Term
|
Definition
nociceptive (somatic sharp and localised or visceral dull referred)
Neuropathic (nerve damage, pins and needles and non responsive to opioids or NSAIDs) |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
Morphine (moderate to sever)
Oxycodone (more tolerated than morphine)
Hydromorphone (higher solubility)
Fentanyl (no active metabolite, lozengers for BTP 200mcg)
Methadone (long half life, caution in CrCl <30)
Buprenorphine
Codeine (30mg=4.5 morphine)
Tramadol (less constipation) |
|
|
Term
| opioids equivalents: Morphine 30mg oral |
|
Definition
Morphine SC=10g
Codeine 240mg
Fentanyl SC 100mcg
Hydromorphone 6mg SC 2mg
Oxycodone 20mg SC 10mg
Tramadol 150mg SC 100mg |
|
|
Term
| Fentanyl to Morphine parental to oral |
|
Definition
12mcg=15-30=30-60
25=30-40=60-100
50=60-80=120-200
75=90-120=180-300
100=120-160=240-400 |
|
|
Term
|
Definition
| give IR 1st eg. morphine 2.5-5mg q4h for BTP 1/6th of total daily dose, can take every 30 mins |
|
|
Term
| example of dosage for btp |
|
Definition
| morphine 10mg q4h (60mg daily) and require 3 BTP doses of 10mg each. (30mg) a total of 90mg. therefore 90mg divided into q4h is 15mg q4h and new BTP is 15mg. |
|
|
Term
|
Definition
| eg. morphine 10mg q4h with no BTP= 60mg daily, therefore use 30mg MR q12h with BTP 10mg. |
|
|
Term
|
Definition
postural hypotension
peripheral vasodilation
sedation
N&V
constipation
respiratory depression |
|
|
Term
| other Tx for palliative care |
|
Definition
Tumour oedema (dexomethasone 5mg)
Muscle spasm (Diazepam)
Metastatic bone pain (NSAIDs or bisphosphonate zolendronic acid IV 4mg every 3-4 weeks)
Gastro xerotomia (antifungals)
Anorexia (mirtazapine)
N&V (metoclopramide, haloperidol)
Constipation (coloxyl and senna)
Bowel obstruction (dexamethasone, laxative, hyoscrine butylbromide and haloperidol for nausea)
Dyspnoea (opioids) |
|
|
Term
|
Definition
give midazolam plus haloperidol SC or continuous infusion.
plus lorazepam possibly |
|
|
Term
|
Definition
failure to conceive after 1 year
Female: ovulation disorder, fallopian tube damage
Male: sperm dysfunction, blockage or low production
Risk factors: tobacco, caffeine, alcohol, marijuana, weight |
|
|
Term
| PCOS (polycytic ovarian syndrome) infertility occurs |
|
Definition
Tx: lifestyle (lose weight)
COC with cyproterone
ovulaion induction with sensitivers like metformin 500mg bd |
|
|
Term
|
Definition
IV ovulation then IVF
BMI 19-30, alcohol <2 drinks, stop smoking
Oral ovulation: clomiphene 50mg during LH phase or Letrozole 2.5-5mg daily |
|
|
Term
|
Definition
| to detect HCG, blood in urine can give false positives or use of promethazine. |
|
|
Term
|
Definition
GI problems (N&V): doxylamine with B6, ginger or metoclopramide. severe: IV rehydration plus phenothiazines
GORD: H2RA and PPI are ok |
|
|
Term
|
Definition
pre-existing: use insulin for 1 and 2, (can lead to congenital abnormalities) Gestational: risk with odesity and family history, lifestyle first then insulin
Use Novomix 30/70: rapid aspart 30% and long acting protamine aspart 70% |
|
|
Term
|
Definition
>140/90 risk of pre-eclampsia
tx: methyldopa (15-250mg bd), Labetalol (100-200mg bd)
with seizures MgSO4
Labour induction: oxytocin |
|
|
Term
|
Definition
| Premenopause: 36-52 yrs (decrease in oestrogen) then menopause and postmenopause |
|
|
Term
|
Definition
decrease progesterone and testosterone.
mood swings, insomnia, vasomotor symptoms
Low libido, thin skin, migraines, dry vagina and bleeding with itch, and UTI |
|
|
Term
Menopause timeframe
early: before 45 yrs
Premature: before 40 yrs |
|
Definition
natural: 12 months after amenorrhea
induced: by chemo or radiotherpay |
|
|
Term
|
Definition
what are ur symptoms
duration
tried anything
tried hormones |
|
|
Term
|
Definition
| Use oestrogen plus progestogen for 12-14 days a month |
|
|
Term
| Vaginal symptoms only eg UTI |
|
Definition
| Use topical only (no need for progestogen). vagifem gel 0.5-1g daily |
|
|
Term
Tailoring HRT
Combined HRT: Sequential/cyclical (oral): oestrogen plus progestogen for 14 days each month (7 days on and 7 days off) for intact uterus perimenopause or early postmenopause.
Continuous (oral): intact uterus for confirmed postmenopausal, 12 months after period. |
|
Definition
patient preferences
C/I: undiagnosed vaginal bleeding, liver disease, acttive VTE, pregnancy, breast cancer. |
|
|
Term
|
Definition
| preferred in smokers, migraines, low libido, GORD |
|
|
Term
|
Definition
start low, reassess each year and wean off within 5 years.
S/E: fluid retention, mood changes, PMS like, nausea, bleeding. Risk of osteoporosis. |
|
|
Term
|
Definition
dysfunctional uterine bleeding (DUB)
endometriosis
premenstrual syndrome (PMS)
Premenstrual dysphoric disorder (PMDD) |
|
|
Term
| Dysmenorrhoea risk fators |
|
Definition
| obesity smoking, depression, family history, early menarche |
|
|
Term
|
Definition
cramping, pain due to menstruation
diarrhoea, N&V.
Monitor: bleeding, duration, length of cycle, type of pain, local and rule out secondary (endometriosis, PID). |
|
|
Term
|
Definition
NSAIDs: to decrease pain, decrease blood flow
COC: decrease blood flow and PG
2nd line: depot medroxyprogesterone and vitamin E, B1, B6, fish oils, exercise |
|
|
Term
|
Definition
| COC (low dose) or danazol. |
|
|
Term
| Osteoporosis risk factors |
|
Definition
Modifiable: smoking, alcohol inactivity, low calcium and vit d, BMI <19, medications (corticoids >3months, phenytoin, SSRIs, depot)
non-modifiable: female, post-menopausal, age, caucasian/asian, family history.
Endocrine: hyperthyroidism, cushings, menopause, hyperparathyroidism. |
|
|
Term
| OP T score -2.5. lab results |
|
Definition
| PTH, TSH, PO, testosterone in men, vit D and calcium. BMD, |
|
|
Term
|
Definition
bone fractures from falls
calcium intake (1000-1300mg)
Vit D (800IU) |
|
|
Term
|
Definition
weight bearing exercise
increase calcium 1000-1300mg
Vit D 1000-2000IU
stop smoking
caffeine <4 cups
alcohol <2 glasses
falls prevention |
|
|
Term
|
Definition
Bisphosphonates: Alendronate 10mg daily or 70mg weekly
Risedronate: 5mg daily or 35mg weekly or 150mg monthly
S/E: Osteonecrosis of jaw, ulcers, avoid calcium and minerals for 2 hours
Raloxifene, Strontiu, denosumab, teriparatide, salcatonin.
Monitor BMD 1 yr and 2yrs after. |
|
|
Term
| Systemic lupus erythematosis (SLE) |
|
Definition
Inflammation in blood vessel and connective tissue. Diagnosis: lab test and scans.
S&S: malar, rash, ulcer, photosensitivity, arthitis, neurologic disorders, Black or asian.
Med causes: lithium, HCTZ, simvastatin, CMZ.
Risk factors: female, smoking, genetics |
|
|
Term
|
Definition
sun protection, stress management
N SAIDs with Hydroxychloroquine 200-400mg daily.
Steroids: prednisolone (0.5-2mg/kg) or Methylprednisolone 1g IV for 3 days (acute flares) with Methotrexate
Monitor: renal, FBP, urinalysis |
|
|
Term
| Myasthenia Gravis (MG) S&S |
|
Definition
muscle weakness
Fatigue
double vision
drooping eye lids |
|
|
Term
|
Definition
for eyes: (anticholinesterase) pyridostigmine orally 60mg initially or azathioprine or methotrexate
Monitor: FBP and LFT |
|
|
Term
|
Definition
Fatigue
insomnia
double vision/blurred vision
incontinence
sexual dysfunction.
Diagnosis: history, physical exam, lab findings
Types: remitting relapse. secondary progressive, primary progressive. |
|
|
Term
|
Definition
| genetics, EBV, vit D deficiency, smoking |
|
|
Term
|
Definition
Acute IV methylprednisolone 500-1000mg 3-5 days or oral prednisolone 60mg for 7 days
Prevention: interferon Beta (not pregnancy) monitor: FBP, LFT, TFT
Glatiramer: sc 20mg
Fingolimod
Tx Symptoms: modafinil for fatigue (200mg in mane) muscle spasms: baclofen 10-25mg, depression: endep 50mg |
|
|
Term
|
Definition
constipation, depression, tremor at rest, freezing, infrequent blinking,
Akinesia/bradykinesia: stooped posture
Dyskinesia: inability to control movement |
|
|
Term
|
Definition
Levodopa 50mg tds with Carbidopa 25mg starting dose, increase to 100mg tds not good for tremors but for bradykinesia
Levodopa wearing off: can use 5-6 times a day, CR for bed or add entacapone or dopamine agonist. |
|
|
Term
|
Definition
dopamine agonist: improve motor complications 1st line for <60. Pramipexole IR: 0.125mg tds or ER 0.375 daily. Rotigotine patch: 2mg daily, apomorphine SC. may need emetogenic (domperidone).
MOAI-B inhibitors: selegiline 5mg bd (monotherapy early)
Anticholinergics: benzotropine 2mg bd
COMT: entacapone with levodopa.
Amantadine: for akinesia, mono early. |
|
|
Term
| Urinary incontinence (UI) risk factors |
|
Definition
female, immobility, neurological impairment
Complications: perineum rash, pressure sores, UTI, fall and fractures..
Types: transient (acute), and persistent |
|
|
Term
|
Definition
Delirium
Infection
atrophic urethritis
Pharmaceutics
psychological
endocrine
restricted mobility
stool impaction
(DIAPPERS) |
|
|
Term
|
Definition
TCA
Anticholinergic
caffeine
SSRIsdiuretics
ACEi
CCB
Lithium |
|
|
Term
|
Definition
Stress: weak pelvic muscle (increase pressure due to cough, sneezing
Urge: oversensitivity from infection or neurologic disorder (urgency, nocturia >75)
Overflow: like tumours inhibit bladder contraction and overflow occurs (full bladder)
Functional: physical or cognition impairment (seen in hospitals) |
|
|
Term
|
Definition
| Bladder training (every 2 hours), strengthen pelvic muscles, use diary |
|
|
Term
|
Definition
| oestrogen short term, exercise, alpha agonist (pseudo) |
|
|
Term
|
Definition
| oxybutynin 2.5-5mg 2-4 times a day, S/E anticholinergic, patch 3.6mg daily. |
|
|
Term
|
Definition
catheter
Prazosin 0.5mg daily, tamsulosin 400mcg daily
Surgery |
|
|
Term
|
Definition
no drugs
use continence pads (tena)
chair protectors |
|
|
Term
| Altered mental state causes |
|
Definition
Infections (UTI, meningitis)
Endocrine disorders (hypo hyper thyroid, cushings)
metabolic (hypo or hyperglycaemic, vit b deficiency)
Neurological (alzheimers, alcohol, depression)
iatrogenic: altered environment, sleep problems, drugs |
|
|
Term
|
Definition
| antiparkinsonian, ccortico, urinary incontinence, throphylline, emptying drugs, CV drugs, insomnia, narcotics, seizure drugs. |
|
|
Term
|
Definition
| psychotropics: risperidone 0.5mg bd or haloperidol 0.5/2mg IM. |
|
|
Term
|
Definition
memory loss
orientation problems
abstraction
learning issues, word finding issues
meekness
vegetative
muscle weakness |
|
|
Term
|
Definition
Drugs
emotional illness
metabolic
Ear/eye
Nutrition/neurological
environment
tumours/trauma
Infection
Alcohol/anaemia |
|
|
Term
|
Definition
Aggression: SSRI, risperidone
Psychosis: risperidone
Anxiety: diazepam
Sleep: temazepam
motor agitation and memory: donepezil 5-10mg or rivastigmine patch 4.6mg. severe memantine |
|
|
Term
| elderly pharmacodynamic changes |
|
Definition
increase risk of orthostatic hypotension
especially from alpha blockers
hypothermia from Benzos, TCA, opioids
Urinary problems
HTN
warfarin: reduce dose
Digoxin: increased sensitivity to non cardiac effects. |
|
|
Term
| elderly lab results for mental state |
|
Definition
FBP
Electrolytes
folate
B12
thyroid
CAT scan |
|
|
Term
|
Definition
low – below 90/60
normal – generally between 90/60 and 120/80
high–normal blood pressure – between 120/80 and 140/90
high – equal to or more than 140/90
very high – equal to or more than 180/110 |
|
|
Term
|
Definition
Proteinuria; <125/75
Elderly and people with hypertension: <140/90.
people <80 with HT: <135/85
Over 80: <145/85
Diabetes: <140/90 |
|
|
Term
|
Definition
Total cholesterol < 4.0 mmol/L
LDL cholesterol < 2.5 mmol/L
HDL cholesterol > 1.0 mmol/L
Cholesterol/HDL ratio < 4.5 mmol/L
Triglycerides <2.0 mmol/L |
|
|
Term
|
Definition
Severe impairment <10mL/min
Moderate impairment 10-25mL/min
Mild impairment 25-50mL/min |
|
|
Term
|
Definition
(140-age)x(weight)/0.815 x Serum Cr (males)
Female x 0.85
IBW: male: 50kg + 0.9kg per cm over 152cm
female: 45.5kg + 0.9kg per cm over 152cm |
|
|
