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This comprehensive on-demand teaching session is aimed at helping medical professionals prepare for their Prescribing Safety Assessment (PSA) exam. Led by Carola, one of the F1 doctors in London, the session is designed to be interactive and personalized, and will address prescription reviews and adverse drug reactions. The attendees will receive practical tips and strategies for successful exam preparation. This includes how to make best use of official practice papers, utilizing resources like BNF and medicines complete, and mastering the art of effective time management mid-exam. The session will also discuss the exam structure and will consist of in-depth questions and answers practice. Participants can expect to gain insights into common exam content including acute and chronic conditions, fluid prescriptions, and important symptoms. The goal of the session is to ensure optimal exam readiness and minimize stress.
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Learning objectives

1. By the end of the session, learners should be able to understand how to use the PSA website effectively and accordingly to access official practice papers and improve their exam preparation. 2. The learners should be able to apply time management strategies during exam conditions, with a focus on how to prioritize sections of the PSA exam that they find most challenging. 3. The students should be able to correctly utilize DBN F and identify reliable sources when it comes to interactions and sources of medical information. 4. By the end of the session, learners should be able to differentiate between common conditions and symptoms and demonstrate an understanding of how to use treatment summaries effectively. 5. The participants should be able to practice applying their knowledge through answering trial questions, helping to enhance their understanding of the exam format and what to expect on exam day.
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The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hi, everyone. Can you see these lights and hear me? Ok. Ok. Sounds like you can actually hear me. Amazing, amazing. Um Oh I think they should be automatically recorded but I'm gonna double check with the six pm team. Um and either way I'll be sending you the slides at the end. Um So hopefully uh we'll be sorted. I might just wait a couple of minutes if that's ok just to see if more people want to join. Um and then we'll get started, obviously any questions I know the exam is soon. Um So we're just gonna do a bit of a sort of quick run through. Um But any questions that you guys have, feel free to message um email me as well. I'm more than happy to to answer any questions. Um especially if I don't know, then send me an email and I'll find out and get back to you. Um Raja. I think we're gonna try to keep it to one hour max. Um I know that you guys are all um super busy and super deep in revision. So um yeah, we're gonna try to keep it to like one hour maximum if we can a little bit less as well. Ok. Um, I think we have quite a good number of people. We can probably get started. Um, I hope everybody is hearing me. Ok, seeing the slides. Ok. And if there's any issues, let me know. Um, and yeah, they should be reco it should be recording as well. Um, and I'll send you the slides at the end, but welcome everyone. Thank you for joining us tonight. Uh My name is Carola. I'm one of the F ones in London. Um, so I've done my PSA not too long ago. I remembered the stress. Um, and as I was saying, uh, if you have any questions at all, then just let me know, I'll try my very, very best to answer. Um, I know they examined very soon. So we are gonna do these three sessions. Um, I'll be covering sort of prescribing prescription reviews and adverse drug reactions tonight and then Monday and Wednesday next week, um, there's gonna be other sessions covering the rest of the, of the topics. Um Let me see if it moves. Um Yeah, and we're really just gonna try to run through some very, uh, you know, some tips and tricks, especially that we found that we found useful, um, when we start our psa exam, um, and just run through a few questions as well. Um I mean, yeah, answering any questions that you guys might have, obviously, this is what the exam uh is structured like, I'm sure you guys are all aware, it's got these 200 marks divided into eight sections. Um And it is very, very time pressured. Um You have about two hours to run through everything. Um and it is very, very time pressured, but obviously you have access to DBN F, um which is, uh you know, lifesaver. Um And obviously you might have been told about, you know, spending most of your time on the prescribing sh sections and then just sharing the time in the other sections. But actually what I found when I start the PSA is actually, you know, this is just an indication, just sort of go with whatever you need when I sat it prescription reviews was the section, the one section that I found the absolute hardest. So actually I only ended up spending about probably 20 minutes on the prescribing sections. Um and I still did really, really well. Um And then spent most of the time on the prescription reviews. So really try to sort of spread the time. Uh you know, this is an indication, try to spread the time just based on what um you find the hardest and the most challenging just in terms of some very, very general tips. And I'm sure you're all aware of sort of, most of them, um do all the official practice papers. Um I don't know if uh you've all seen them, you've all had a chance to go through them. But the website, the PSA website has four papers, three official ones in a demonstration of paper and they're really, really good. Um, they are, first of all, they're in the same layout as the actual exam with the online calculator which, you know, it's quite hard to use. Um, so, you know, you can give it to, you, you can practice the papers, practice using the calculator as well, practice, you know, going through the different sections. Um And sort of, yeah, see how the the system works. Um In the difficult, the level of the question, it actually very, very similar to the exam itself as well. Um So if you've done them all righty, that's really great. Um I would suggest that you sort of go through them um, again as well just before the exam to sort of refresh your memory. If you've not done them yet, there's still plenty of time. Um I would probably suggest that you try to do at least a couple of them over the next few days, try to cover all of them before the weekend so that you can go through them again. Um As well before the exam be familiar. Oh Prac in practice under time pressure, obviously, as we said, it's very, very time pressured. You have two hours in the practice papers, they give you one hour to com to complete it because they only have half the questions but I would say try to do it in even less time because we all have examiners, we all end up sort of struggling a little bit. So, really, you know, do try, like, test yourself really under pressure. Be familiar with the B NF and medicines complete as well. Um, obviously it's an amazing resource that we have. Um, and, you know, you might have been to other talks, you might have heard from other people that they have a preference for one or the other. Um But really you must choose which one you, you just work better with. Um I know for example, medicines complete has a better section when it comes to interactions. Um But you know, for my brain, the B NF always worked way better. I can find things much quicker for some of you. It might be exactly the same for some of you might prefer the medicines complete. That's absolutely fine. But be familiar with both of them cause I think a couple of years ago the B NF just failed halfway through the exam. So then everybody had to move to, to medicines complete. Um And obviously if you've never seen the lay out, which is a little bit different, it's the same information but a little bit different, then you're gonna spend more time control f your absolute best friend. Um I know lots of people might say that you might not be able to use it, but actually it's absolutely fine. I used it for absolutely everything and it saved my life and treatment summaries. That's the other thing that absolutely saved my life. Um, again, most of you might be aware of treatment, summaries. I only find found out about a week before the exam and they're really, really good. Um, apart from probably the fluid summary, all the other summaries are absolutely amazing. Um, and, you know, obviously the exam would be based on mostly common conditions and common symptoms that you would have studied for your exams already. Um, but again, we're all guilty of the exam nerves, um, or even just if you wanna be sure and double check certain things, then, you know, it's very quick and easy to just go to the treatment. Summaries, um, scroll through the medications and they, and, and what they tell you first line, second line and all of that. Um, and just get a better idea. Um, I've put here some of the most useful treatment, summaries. Um, I have two pages actually because they're so good. They actually did save my life. Um, but of course, lots of things might come up from, um, a CS asthma, any other sort of things in the community. And you can find this if you type medical emergencies in the community. Um, this was really, really good because obviously when you're reading your scan, um you might have a question which is around meningitis or seizures or hypoglycemia, right. Um and really make sure that you read it well, to know if you're in the GP setting or you are in hospital setting. Cause obviously, depending on the setting that you're at, then you might actually do management very differently. If you think, uh you know, for meningitis seizures, we might use um im um seizures, buckle rectal formulations for hypoglycemia, you're more likely to use IM again, um, or oral. But then if you're in the hospital, then the IV route actually becomes the more common. If you're having overdoses, just search poisoning, emergency treatment. It gives you a lot of summaries on all sort of overdoses that you can get. Um, palliative care summary was really good for opioid conversion. So it makes it really easy to convert from, I don't know, morphing to the patches or, or whatever or from a form to another, from oral to, to patch, for example, um, oral anticoagulants as well. I found it really, really useful cause it gives you information not only on how to prescribing to prescribe, but also how to reverse them if someone is excessively breeding and, and then yeah, all the other ones as well. Um And a few more here. So again, any sort of infection, just type the system and the infection and they will come up. I think we had last year we had a um I think some sort of pneumonia and some sort of ear infection as well. So we we used them lots and it was actually really, really good in terms of what you would be asked to prescribe. Um I thought these were sort of the main things. Uh you would have your acute and your chronic common conditions, your food prescriptions and your important symptoms and then it sort of divides the questions in um flu prescriptions. So a couple of questions would be on that. Um Couple of questions would be um once only prescriptions. So sort of what would you use in emergency settings? Couple of questions would be long term prescriptions that you might need to prescribe for, you know, extended period of time and then you might have a few questions um from the community setting as well um for the, you know, your common conditions and your important symptoms, what I essentially used is what I'm sure you guys are using as well. So your Oxford handbook for your treatment, summaries your finals revision, your past med questions in the treatment, summaries in the B NF during the exam. They're very, very good. I promise if you've not seen them yet, um They are actually really, really amazing. Um So I thought we run through a couple of questions. Um These are all from the official papers. So if uh if you've not been through them yet, then hopefully they're gonna be useful for you. But I'm just gonna give you a little bit of time if you wanna read and just send in the chart um what your answer would be maybe and then we can run through it any ideas at all. Few questions coming through anyone else. OK. So, well, down to all of you um mm. What I would prescribe is 40 mg IV once only. Um but as all of you are saying the correct dose for fosamine is from 20 to 50. So anything as long as you're putting a dose, which is between 2050 as long as you're putting IV, then that's perfect. That's gonna give you the maximum amount of bars. Um Why are we doing intravenous compared to oral is because we're in an emergency setting, we can see that the patient is feeling quite restless, quite under distress. So it's really important that we get sort of, you know, an emergency treatment, an IV is obviously gonna work much, much better and much quicker. Um And then after they're feeling better, then we can always switch it to oral. Um, so well done. Absolutely. Um Sarah is asking, do we have to write name a sign for all prescriptions? So they would be um, so your name, um your name and the date and the time would be automatically filled. So all you have to do is uh type in the medicine and typing the dose and the route and maybe they'll ask you the frequency as well, but everything else will be, will be done. Um ok, let's try another question. Yeah. And that's a really good question about hormones. Um, I'll, I'll, I have his slide on fluids later on. So I'll just answer that in a little bit if that's OK. Im Furosemide is not really that. No, you would, you would use IV in hospital. Um, and then after the patient has ST stabilized, then you can switch it to oral. So if you had a similar question and you were told the patient has already been on uh IV Furosemide, they're not food overloaded anymore. Um What can you prescribe for maintenance, then you can prescribe furosemide oral. But IV II M we don't really use it. No. OK. So for this question, um f very well done. Um there's lots of things that you could potentially consider giving in this situation, especially because we're told that the BM I is higher. So you might want to consider a medication that also helps her lose weight, but the first line treatment is Metformin. Um And we can't see any sort of contraindication to giving Metformin. So, Metformin 500 mg once a day and uh Mr stands for modified release, um which is, yeah, just the sort of form of the tablet which works better um for sort of digestion, I guess the digestion and absorption and distribution of the drug. Um But yeah, so that's, that's exactly sort of the first line treatment and then it can obviously be increased to 500 mg twice a day or 1 g, twice a day. Ok. Let's try another one. Yeah, exactly. Metformin 500 oral once a day would be the first line. Yeah, that's a really good question. Amelia. Um I think you would still get the full points um because both of them are used interchangeably um modified release obviously works better. But if you were to prescribe immediate release, I think you would still get the full mark. Yeah, lots of options. Um And yes, you guys are all absolutely correct. Um In these kind of questions, when it's just generally asking what would be the most appropriate prophylaxis, um Any answer would be sort of acceptable. Um f the paradox, I would probably avoid it because Fonda Paran is used um more as a treatment rather than a prophylactic anticoagulant, but everything else can be used and it's acceptable. Um So it would count as, as a full mark. Ok. All right. Does it all make sense so far? Any questions obviously sent through? Um I thought I put just a snapshot on uh pain as well. One of the important symptoms that we should all kind of know how to, how to prescribe even though, of course, it's, it's quite hard. I still find it really hard as well. And what I used was the treatment summaries. There's four of them. Um and they're quite useful as well. And then obviously I'm sure you all know about your pain ladder, um that we start with sort of the paracetamol, the nsaids, we move on to the weak opioids and then the strong opioids. Um And really, when you're asked a question about pain, I'd say probably just always start with the first line. Um, it is always the safest, safest option. If they're mentioning that the patient is already on some pain medications and they're not really controlling it, then there is when you can actually think about increasing it or thinking about other things like your neuropathic pain. Ok. Um, so if you were to ask a, a question like this, what would be your, um, your answer? I wonder if we can do a poll. Let's see. Yeah, we can do a bit of a poll. See what you guys think. Ok. Ok. We have a bit of a split, um, in this question and I can understand actually why you guys are thinking about these two options. So options a, an option. E anybody wants to say why they're thinking about one or the other, why they're going with their option? Thinking shingles. Yes. Yeah. Um, exactly. So, I mean, this would be a bit of a, you know, it's a bit of a tricky question because what they, er, or it doesn't come up but what they, um, what the paper says is that paracetamol is the right option. Um, even though I absolutely agree with you that the f, like the first thing that I would also think about is amitriptyline. But Lilian, you're absolutely right. What the paper wants you to think about is that yes, they're older. There are elderly people. They've had, um, a series of things we do have this, this vesicular rush. That's true. But rather than going straight with the neuropathic pain medications, we could just try some simple paracetamol and that might actually help, help them anyways. Um, so I know it's, this is a bit of a tricky question cause obviously, if it was someone younger, maybe you would actually go straight with amitriptyline and gabapentin. But in someone elderly, then it would make more sense to just be safer, start with the safer, lower down option. Um OK. Does it all make sense? Ok. Um Sorry, I think I'm already running a bit behind schedule. Um But I just really like chatting. Um, let's talk a little bit about free prescriptions. Um These will likely come up. Um It is likely that a very easy prescription will come up. Things that you might be asked to prescribe are rus fluids if your patient is hemodynamically stable and in this, this case, what you would need to prescribe is your 500 mil of sodium chloride, 0.9% over 15 minutes max. If you're prescribing it over less time, that's also fine. As long as you're doing sort of like, I think it's 25, 1015 minutes, you will be fine and if it's someone elder, if they're mentioning heart failure, you could consider a lower dose, but usually the standard 500 mill bonus is, is fine replacement fluids. If they have diarrhea and vomiting TKA, in this case, you would need to look at the electrolytes and just check what it's missing. Um But this, I've not seen it come up in sort of, we didn't have it last year. It's not in any of the past papers. So it's kind of like a very rare one to do. It's more likely that they would ask you to do maintenance fluids, especially if they're nail by mouth, not eating, drinking, just unwell. And as I'm sure you guys are all aware, this is the calculations that we sort of go by when you're gonna be doctors, we never calculate that. Um We just always guess, but for the PSA obviously, we do need to calculate. So between 25 and 30 mils per kilogram per day of water, one millim M per kilogram of the electrolytes and 5200 g of glucose and one bag of 5% glucose is your 50 g. So for a typical 80 kg patient, just sort of always think about 2 to 2.5 L, 80 millim of electrolytes and 5200 of glucose, sort of depending on how much they're they're drinking as well. I've put here um this table that sort of compares some the main um fluids that we use and obviously your sodium chloride has sodium and chloride in equal proportions. Your dextrose has glucose, your Harmans um has a little bit of everything but not any glucose. Um If you ask any doctor, um Harman's is probably the most preferred fluid to prescribe. But when it comes to the exam, it's actually not that favored because if you think about sodium and chloride, it doesn't actually have that much. It does have a little bit of potassium, which the other fluids don't really have. But five millimoles is not nearly enough to what an adult would need. Ok. And it would also have no blockers. Um I know um Adi was asking about Harmon and when we don't give it, um, the main reason, the main situation where we don't give it if it's someone is in um acidosis, either lactic or metabolic if they have any sort of um, you know, major reaction. And also to, to sort of, yeah, any, any acidosis, that's your main one. And if they need glucose, then we don't give it. Um, if they need rapid potassium replacement, if their potassium is very, very low, then obviously we wouldn't give it other situations like your congestive heart failure, your elderly patients, you would need to be more cautious, which is the same with the other, with the other fluids as well. And I've put down here as well, sort of the traditional regimen, um that we, that we would prescribe over the 24 hours. So you can do either one salty bag which is your saline plus potassium or your sweet and, and the two suit which is your dextrose plus potassium or you can do two salt tea and one sweet again, depending on how their BMS are, how their sodium is. If they're eating a little bit, you might prefer to just give more salt tea. Um I don't think I mentioned it but uh in the slides but your potassium um it's given as 20 or 40 millimoles, OK? But when you're prescribing it, um in the exam, it will come up as um potassium. 0.15 or 0.3%. 0.15% is the same as 20 millimoles and 0.3% is the same as 40 millimoles. Um So depending on how much potassium you wanna give, then you can, you can do 0.15 or 0.3. Um And obviously, the other thing to say about the potassium is that we can't give it too fast. So you can only really give 10 millimoles per hour. So you can never give uh you know, faster, you can never give 20 millimoles faster than two hours and you cannot give 40 millimoles faster than four hours. Quick mention about the hypoglycemia and the IV glucose as well. Um There are lots of different types of management for the hypoglycemia and if the patient is conscious, then you might be just ok with giving them oral. But if they're unconscious and they are in hospital, then that's when the IV glucose comes in, we have four types of glucose that we can give 5% which is basically your 5% dextrose, which is good for maintenance, but it's too weak in a hypoglycemic emergency. We have 10% which is your first line. You have your 20% which is your second line, let's say, and your 50% which is too hypertonic and it's actually gonna damage the blood vessels. How much of the 10% glucose and the 20% glucose you're gonna prescribe. It's just something that I sort of learned. I stuck to my mind of the 10%. You do 100 to 200 up to 20 minutes and for 20 you do half so 50 to 100 mils over 20 minutes. Let's try to do a question. Let's see what you guys think about this. I'm not sure you can read them fully. Ok? Actually, I'm sorry about that. Ok. We have 1 L dextrose plus 0.3 potassium, one dextrose with potassium, 5% glucose with 0.15 potassium uh 1 L dextrose with three perce, 0.3% potassium over 12 hours. IV Yes. So, well, what I prescribed was 500 mils just because I was like, I think we should go to 2.5 L a day, but you can definitely prescribe 500 mils over four hours or 100 li one hun 1 L over 8 to 12 hours. You will be absolutely fine. And I've put down here the feedback that, that the paper gives as well. So you guys are absolutely right. Um We've been given a liter of sodium chloride with potassium 20 millimoles, another liter of sodium chloride with potassium 20 millimoles. So we've made up about 40 Millers of potassium. Um Your ideal target is to get about 80. So we're still sort of 40 millimoles short, which is why obviously those of you who said 0.3% are, you know, that is the absolute best answer. Um because we can get up with just one extra fluid, we can get up to the, the 80 millimoles. If you wanted to do a bit less, then that's, that would be, you know, that would be fine. Um They, they would deduct one mark because you wouldn't bring, you wouldn't bring it to, you wouldn't get up to the, to the 80 millimoles. Um And of course, you're absolutely all right. We've not given any Dextros at all. So we should give a little bit of Dextros. OK? Um I think I'm gonna skip over a few questions just in the interest of time, but um I'll be sending you the slides. So you have more questions with the feedback to go through as well if that's OK. Um So when um Holly, so when, um, when we think about um how much fluids we're gonna give and we, we said 25 to um 30 meals per um, sorry, 25 to 30 mils per kilogram. Then in a normal adult, you would get up to 2 to 2.5 L in a day. Um, you've already got uh 2 L over 24 hours. So when I prescribed it, when I was going through the, the paper, I was like, OK, we can just give 500 mils, but actually, it's much, much better to just give 1 L. And you would just go into the next day by giving 1 L of your dextrose plus your potassium 40 millimoles and then you can make up for the, for the remaining of the 1 L um for with, with the salty solution. Um So actually, I think I was probably wrong doing the 500 mils only. Um I do think 1 L is actually much, much better cause we were already prescribed over 24 hours. So we're going into the next day anyways, we can start fresh. Um Yes. So most of these questions were from the past papers, hyperosmolar hyperglycemic state. Um That is a very good question. Um You would prescribe sodium chloride, just sodium chloride for at the beginning. Um And then you would be replacing the glucose later on. Um But the main thing is that in the hyperosmolar hyperglycemic state, you, you have a state, which is sort of dehydration. So you would just give sodium chloride. I hope that makes sense. Um, just to talk a little bit about the prescription reviews as well. Um, these are quite hard. Um, I found them really, really hard. Um, but, you know, control f is your best friend, you really helped me sort of getting through them. Um, and things that you can really look out for are major medications that need to be stopped because of important problems. So, if, if they're causing renal function impairments, um if they're causing um, any sort of, mm, you know, hepatic impairment, they're absolutely contraindicated in your pre in breastfeeding. It's think that things that, you know, they would sort of stand out major interactions that you can look at as well. So your beta blockers with verapamil, your beta blockers in asthma, they shouldn't be given your Erythromycin with Warfarin as well. It would increase the um uh I think it increases the um risk of bleeding and then major dosing errors as well. Um There will almost every prescription review question will ask about, um, will ask about a prescription error. And the most common ones are things that are prescribed weekly. So your bisphosphonates your methotrexate, for example, they are prescribed weekly, your alendronic acid as well, but they might just prescribing it once daily, um dosing as well. So things your, like your levothyroxine and your digoxin, they're always prescribed in micrograms, things like um, Ondansetron, paracetamol. Um, what else? I think these ones come to mind, they are more likely to be prescribed as grams. So again, they might get you out in different dosing and then some common drugs, um, that might need to be prescribed as, you know, two amoxine and not over. So your paracetamol, which can only be prescribed as 1 g Q DS, you might see a prescription that has paracetamol, 11 g Q Ds and Cocodamol, which also has paracetamol. So you shouldn't really be on both of them. Um And then as I was saying, so sections in the B NF that I would really sort of look out for are your pregnancy, your breastfeeding, your hepatic impairment, your renal impairment as well. Um I've added here as well. Um Just sort of as a revision, some of the medications that should sort of uh be a bit of red flags. So obviously in delirium, if it's elderly patients, then there are lots of things that can precipitate the delirium in dehydration, your diuretics can precipitate the dehydration. So if you see someone who's dehydrated, deranged liver, fun deranged sort of renal function, then look out for your diuretics, renal impairment. Your classic one that needs to be withheld is Metformin. If the EGFR goes below 30 things that are metabolized in the liver, like your nsaids, your corticosteroids, um would not be prescribed in liver impairment as they can worsen it. I've got a little bit, just a quick screenshot on pediatrics. Um, so things that you might need to prescribe, uh, for pediatrics are sort of your infections, your reflux medication, prescription reviews. They would be very, very rare. Um, because not many Children would actually have a lot of medications that would interact. And then there's a few other things that, uh, you know, are really around the asthma, paracetamol, the diabetes and the hypoglycemia, um, that you, that might come up throughout the exam acne as well. Um, and in terms of the pediatric fluids, um I'm sure you all remember that we prescribed them based on weight. So we do 100 mills per kilogram for the 1st 10 kg, 50 mil per kilogram for the next 1020 for the ne for anything beyond 20. Um, and do you guys wanna give, actually, I'll leave this one for you to do in your own time. This is not a question that it's in the uh, past papers, but you can have a look at that. And of course, if you have any questions, send me an email, um, interaction tab for the, uh, prescription review was also really, really useful. Um, it works really well in, um, medicines complete because you can actually put all the medications next to each other. But even in the B NFI, always found it quite quick. Um And of course, the main thing is that if the medication is not there there is no interaction. If it's there, then we wanna look at the severity and the evidence. So, anything that it's severe, it's obviously your first choice. Anything that has an evidence study is again your first choice. Should we do a question about this? Um, see what you guys think. I'll give you a couple of minutes, ha ha. So every year it's actually different and when I start the exam last year, uh we could use it but the year before it wasn't allowed. So if you've been told that this year you can't use it, then that's probably, that's probably true, actually. Um, I'm sorry, the interaction check your medicine complete was actually amazing. Um, but yeah, the one on the B NF is, is ok. It takes a little bit more time. Um, but it gets the job done as well for interactions. When the medicine is complete, use that you just search interactions and then it brings up link and then in there you can put all the medications. But, yeah, if you've been told that you can't use it, then that's really sad. I'm so sorry. And every year they just kind of go that weird. Yeah, they do. Yeah. Yeah. Yeah. So the university provides access to medicines complete. Um, yes, we do. Well done. Um, what increases the, uh, what increases it is? Anything that would increase the bleeding? So, you're absolutely correct. Aspirin and Ibuprofen would increase the risk of bleeding. Yes. Any ideas for part B at all? Yes. Yes. Well done guys. You're, you're absolutely amazing. I'm sure you're gonna smash it. Yes. The ibuprofen and the Ramipril would be the ones to actually worsen the renal function. Well done. Um Yeah, exactly. Um, ok, so again, let me just skip through a few of the questions. Um, again, just because I don't wanna keep you too long. Um, and I'll send you the lights anyways. And so then the last, really, why not Metformin for Bar B? Um, very good question. Um, me Metformin doesn't have as much of an effect on the kidneys. Um, it does need to be stop it. You're absolutely right that it does, it does need to be stopped if the G fr goes below 30 but it doesn't directly contribute to the renal impairment if it makes sense and it will just not work as well if the kidneys are not working as well. Um Cool. Um, so last few minutes, obviously you can tell that I'm not the best at timings, but the last thing is, um, the adverse drug reaction. Um, just a few things. Um, on Monday they will be talking more about the adverse drug reactions as well. But again, control f your absolute best friend, you can go on the B NF on the page of the drug. Just control f the, um, adverse reaction and see if it comes up. Um, things to be aware is that, um, for the medications, it would tell you generic and specific, um, side effects as well as the common and the rare ones and the frequency not known. So again, when you are, if, if you're presented with two adverse reactions, which are both there for the drug and the common side effects and the specific side effects are the most, um, sorry, the, the common side, the common side effects and the specific side effects are the safer options if you only have something that is frequency known, and then all the other side effects are not there. Obviously, it's not as ideal that you don't know the frequency, but it would be, it would still be a side effect. And then the other thing is that you have different side effects based on the different drug form, which again, it's just something to be aware of that the B NF tells you about. Um So whenever you're reading a question, just make sure that you understand what the drug form is. And if the question is asking as well for anything specific and again, things to look out for is again your pregnancy, your breastfeeding hepatic and renal impairment as well as your um um as well as your adverse drug reaction section. Um Yes, Alan, thank you. You said it way better than I did. So, yeah, so we it, it's, yeah, it's, it doesn't work. Yeah, follow what he said. Thank you for clarifying it. For us. Um, for the first drug reactions, we wanna know some of the, it might make it easier if you know some of the common ones and I've put down some of the common ones here. So, you know, your ace inhibitors, they're very much known to, to cause cough and hyperkalaemia. AmLODIPine causes edema statins, myalgia, metformin, lactic acidosis, glycoside, hypoglycemia and cloZAPine, agranulocytosis and the other ones as well. So, if you remember some of the very common adverse drug reactions, it obviously makes it um a lot quicker. Um And last thing about the adverse drug reactions is that, um, they will ask you how to manage them as well. They would ask about common things. So your anaphylaxis and if you don't know, you can find in the treatment, summary medicine emergencies, the community, it tells you exactly how to manage it. You're common overdoses. And again, you find it's under poison, uh poisoning, emergency treatment, your eye, I nr bleeding, your reversal uh would be under anticoagulants, your hypoglycemia. You find it under hypoglycemia. So these are all things that they, they could definitely come up in the adverse drug reactions and this very, very quick. Um, we'll cover it a bit again next week. Um Should we try one question of adverse drug reaction? See what you guys think? Ok. Oh, yeah. Sorry. I don't know why they actually all come up as FS but, um, I'm not sure, actually sorry about that. Yes, very well done. Um, absolutely. So, this is one of your common side effects that, um, we should be aware of. So, methotrexate causes the bone marrow suppression. So, leukopenia is the most common one. all the other ones, they wouldn't really be recognized as side effects or they won't be as severe. Um, let's do another one quickly and then I'll let you guys go. One. Yes. Absolutely. Absolutely. Well done guys. Again, a few of these things can be used in someone who has uh collapsed and wheezy and breathless. We're thinking anaphylaxis. So, you know, sodium chloride will be needed because their BP is very low. Um But obviously, as you all said, the main thing that we need to use immediately right now is your adrenaline later on, we can think about the BP. Obviously, your breathing is, is the most important thing if you remember about your, your a three assessment, right? Um It, but it gives an order, but it also tells you what are the most important things. And obviously breathing is way more important. Like keeping the airways open is way more important than keeping the BP up. Well done. OK. Just gone seven. So I'm gonna skip through the last few questions. I'll send you the slides so that you can review them as well. Um If you can provide feedback, that would be amazing. Um I know myself, feedback is that I need to be more aware of time. Um But please do let us know if there's anything in particular that you found useful, anything else that you would have wanted me to talk, talk about? Um If you have any questions at all, anything that you wanna discuss, any questions that you're not really sure what the feedback is. Um And you just wanna talk through questions then honestly like to me, um I'm coming to the end of a seven day on call week tomorrow. So I would be more than happy to answer all of your questions. And of course, uh just to highlight the next few sessions. So Monday, drug monitoring, drug interpretations and a little bit more reactions. And Wednesday planning management providing information and calculations. I know it's very close to the exam. So we're gonna sort of do a whistle stop of, of everything. I hope it was useful. Uh I'm sure you guys are gonna do absolutely amazing any more questions? Let me know. I'm gonna stay around for the next sort of five minutes. Um If you need it, if you need anything and let me send the feedback again just in case anybody doesn't find it. Thank you. Thank you so much guys for, for listening to me ramble for, for an hour. Um Yes, I will be sending you the slides and um we've done a recording as well, so you will have access to the recording too. Uh You're very, very welcome. Hope it was, it was OK and useful. What do you think? II used the P SA book, the, the PSA book I used there. Um It was quite good to have extra questions to practice, but definitely um if you are short for time and I would definitely prioritize the um um the papers on the PSA website. And it's true, there are actually some mistakes cause it's not been updated for a while. So there are actually certain things that are not really in line with the guidelines. So um yeah, main thing. Do your, your PSA website papers. If you want extra practice, you can do the PSA book. But obviously, as you're saying, being aware that it's not the same Forman if the information are outdated. Um So it's not ideal, it's just an extra resource that if you have time, it's, it's good to use, why not? Um Yeah, and I know passed has a few questions as well, which I did not the best thing, but you can go through them and sort of think about them as well. You're very welcome, Sarah. If there's any more questions, let me know. Good luck in the exam guys. I'm sure you're gonna smash it. Yeah. No. All right. If there's no more questions, then I might just send a session here. Um Do remind me if you need anything. Um I'm more, more, more than happy to, to help and have a chat. Ok? And again, thank you, so, so so much for for attending um for listening. Hopefully it was useful and we look forward to seeing you guys again. Um And again, good luck with the exam.