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Pass The PSA > 2. Prescription Review > Flashcards

2. Prescription Review Flashcards

1
Q

What effect does P450 induction/inhibition have on drug action?

A

Inducers decrease
Inhibitors increase

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2
Q

What are the common enzyme inducers?

A

PC BRAS
Phenytoin
Carbamazepine
Barbiturates
Rifampicin
Alcohol
Sulphonylurea

Speeds up P450 action so decrease drug concentration

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3
Q

What are the common enzyme inhibitors?

A

AO DEVICES
Allopurinol
Omeprazole
Disulfram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol
Sulphonamides

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4
Q

What drug should be prolonged for surgery?

A

Steroids

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5
Q

What drugs should be stopped for surgery?

A

I LACK OP
Insulin
Lithium
Anticoagulants/anti-platelets
COCP
K-sparing and ACEIs
Oral hypoglycaemics
Perindopril/other ACEis

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6
Q

When should the COCP be stopped for surgery?

A

4 weeks prior

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7
Q

When should Lithium be stopped before surgery?

A

Day before

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8
Q

When should potassium-sparing diuretics and ACEIs be stopped?

A

Day OF surgery

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9
Q

How is metformin modified for surgery

A

Take normally < 3x daily <= omit lunchtime

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10
Q

How are the following insulin regimes altered for surgery?
Lantus
Novomix/humulin

A

Lantus: Reduce by 20% day before
Novomix/humulin: Half morning, evening unchanged

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11
Q

How do you alter insulin if >1 meal or <60eGFR?

A

Sliding scale

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12
Q

When should NOACs be stopped surgery?

A

~2 days before

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13
Q

When should prophylactic rivaroxaban be stopped before surgery?

A

18 hours

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14
Q

What are the essential items to consider when prescribing drugs

A

PReSCRIBER
Patient details
Reaction (allergy with details)
Sign the front of chart
Contraindications
Route
IV fluids
Blood clot prophylaxis
anti-Emesis
pain Relief

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15
Q

What two groups of people are contraindicated for anti-coagulation?

A

Increased risk of bleeding
Enzyme inhibitors

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16
Q

What are the side-effects of Steroids

A

Stomach ulcers
Thin Skin
Edema
Right/Left heart failure
Osteoporosis
Infections (inc candida)
Diabetes
Syndrome of cushing’s

17
Q

What are the cautions and contraindications of NSAIDs?

A

No urine (renal failure)
Systolic dysfunction (heart failure)
Asthma
Indigestion (any cause)
Dyscrasia (clotting abnormality)

18
Q

For antihypertensives, list the…
Broad
Mechanistic

A

Broad: Hypotension
Mechanistic:
- B-blockers, nd-CCBs: bradycardia
- Electrolyte imbalances: ACEIs, diuretics

19
Q

What are the individual side effects of the following anti-HTN meds:
- ACEIs
- BBs
- CCBs
- Diuretics

A

ACEIs: Arid (dry) cough
BBs: Breath sounds (wheezy asthma), bat wings (worsens acute HF)
CCBs: Calf oedema, crimson skin (flushed)
Diuretics: DIE NEPHRONS (renal failure)
+ Loops: Lumpy toes (gout)
+ K+-sparing: gyno-K+-mastia

20
Q

For fluid replacement, when is 0.9% NaCl NOT given?

A

Bleeding: Blood transfusion
Ascites: Human Albumin solution
Shocked (BP<90mmHg): Colloid
HYPERnatraemic/hypoglycaemic: 5% dextrose

21
Q

How fast should you replace fluids?

A

Depends on affected obs
Tachy/low BP: 500ml (250ml if heart failure) ASAP
Oliguric (non-obstructive): 1L over 2-4hrs

Rough guides
Oliguria (<30ml/h): 500ml
Oliguria + tachy: 1L
Oliguria + tachy + shock: 2L

22
Q

Regarding maintenance fluids, what is the requirement for
- Volume of fluids
- Electrolytes

A

Adults need 3L/24hrs, elderly need 2L/24 hours
1L 0.9% NaCl and 2L 5% dextrose (1 salty, 2 sweet)

23
Q

How fast should you give maintenance fluids?

A

3L: 8-hourly bags
2l: 12 hourly bags

24
Q

What is the standard VTE prophylaxis?

A

5000 units dalteparin OR NOAC
VTE stockings

25
Q

Who does not get TED stockings?

A

PAD

26
Q

What agents are good first line antiemetics?

A

Cyclizine
Metoclopramide if in HF

27
Q

Who can’t take metoclopramide

A

Parkinson’s
Young women

28
Q

What is the regular and PRN pain meds for
No pain
Mild pain
Severe pain

A

No: Nil, paracetamol 1g 6hourly
Mild: paracetamol 1g 6 hourly, codeine 30mg 6 hourly
Severe: Co-codamol 30/500 2 tabs 6 hourly, MST 10mg 6 hourly

29
Q

What are the first line treatments for neuropathic pain?
What if this is diabetic?

A

Amitriptyline 10mg oral nightly/ Pre-gabalin 75mg 12 hourly
Duloxetine for diabetes

30
Q

What is the max dose of paracetamol in 24 hours?

A

4g

31
Q

How do ACEIs and thiazides affect K+?

A

Thiazides = hypokalaemia
ACEIs = Hyperkalaemia (blocks sodium resorption so increased K+)

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