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PSA > 2. Prescription Reviews > Flashcards

2. Prescription Reviews Flashcards

1
Q

How to review a prescription (PReSCRIBER)

A
  • P: Patient details
  • Re: Reactions (allergies)
  • S: Sign chart
  • C: Contraindications
  • R: Route
  • I: IV fluids needed
  • B: Blood clot prophylaxis needed
  • E: antiEmetics needed
  • R: Relief for pain needed
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2
Q

How many patient identifiers are needed?

A

3

E.g. Name, DOB, Hospital Number

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3
Q

What allergy info is needed (2)

A
  • What they are allergic to

- What reaction they report to the allergen (i.e. rash, nausea etc)

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4
Q

Where does a prescriber need to sign (2)

A
  • Front of chart

- Alongside every drug prescribed

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5
Q

Contraindications: 4 drug classes we need to know

A

1 - Anticoagulants
2 - Steroids
3 - NSAIDs
4 - Antihypertensives

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6
Q

When should you not give anticoagulants

A

Patients who are:

  • Bleeding
  • Suspected to be bleeding
  • At risk of bleeding
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7
Q

How long do you have to wait after a stroke to give LMW heparin

A

At least 2 months

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8
Q

What are the side effects of steroids (STEROIDS)

A
  • S: Stomach ulcers
  • T: Thin skin
  • E: oEdema
  • R: Right + left heart failure
  • O: Osteoporosis
  • I: Infections
  • D: Diabetes (hyperglycaemia)
  • S: cushings Syndrome
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9
Q

What are the contraindications for NSAIDs (NSAID)

A
  • N: No urine (renal problems)
  • S: Systolic dysfunction (i.e. heart failure)
  • A: Asthma
  • I: Indigestion (any cause)
  • D: Dyscrasia (clotting abnormalities)
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10
Q

What is a side effect of ALL antihypertensives

A

Hypotension

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11
Q

A side effect of each mechanism category of antihypetensives (heart v kidney)

A
  • Bradycardia: beta-blockers + some calcium channel blockers

- Electrolyte disturbance: ACEi’s + diuretics

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12
Q

Class-specific side effects of antihypertensives (ABCD[L,K])

A
  • ACEi’s: dry cough
  • Beta blockers: wheeze (asthma), exacerbate heart failure
  • Calcium channel blockers: oedema + flushing
  • Diuretics: renal failure
  • Loop diuretics: gout
  • K sparing: gynaecomastia
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13
Q

What do you do about oral meds when patient is Nil-by-mouth

A

Keep giving them

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14
Q

Two reasons for IV fluids

A

1 - Resuscitation

2 - Maintenance

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15
Q

When would you not give 09% NaCl for resuscitation?

A
  • Hypernatraemia/hypoglycaemia: dextrose
  • Ascites: HAS
  • Shock from bleeding: blood
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16
Q

What determines rate of fluid for resus

A
  • HR
  • BP
  • Urine output
17
Q

How fast do you give fluid when tachycardic + hypotensive

A

500ml bolus immediately

18
Q

How fast do you give fluid with low urine output

A

1L over 2-4 hours

19
Q

How does urine output, HR and BP predict fluid depletion

A
  • Low urine output = 500ml
  • Low UO + Tachy = 1L
  • Low UO, tachy + shock = >2L
20
Q

Whats the max amount of fluid to give a sick patient before review

A

2L

21
Q

How much fluid should an adult have per day for maintenance

A

3L (2L if sick)

22
Q

What is the normal composition of fluid maintenance

A

“1 Salty, 2 Sweet”

  • 1L 0.9% NaCl
  • 2L 5% Dextrose
23
Q

What is the normal amount of potassium maintenance

A

40mmol per day

24
Q

What rate can potassium be given at

A

10mmol per hour

25
Q

How fast should maintenance fluid be given?

A
  • 3L per day = 8 hourly

- 2L per day = 12 hourly

26
Q

What is the normal VTE prophylaxis protocol

A
  • LMW heparin (e.g. 5000 units Dalteparin)

- Ted compression stockings

27
Q

What are the contraindications to VTE prophylaxis

A
  • LMW heparin: active/risk of bleeding

- Ted stockings: peripheral arterial disease

28
Q

How should anti-emetics be prescribed

A
  • Nauseated: regular

- Not-nauseated: as-required

29
Q

When should metoclopromide not be prescribed?

A
  • Patients with Parkinson’s disease

- Young women

30
Q

Pain relief protocol - no pain

A
  • Regular: none

- As-required: paracetamol 1g max 6-hourly

31
Q

Pain relief protocol - mild pain

A
  • Regular: paracetamol 1g 6-hourly

- As-required: Codeine 30mg max 6-hourly

32
Q

Pain relief protocol - severe pain

A
  • Regular: Codeine 30mg 6-hourly

- As-required: Morphine Sulphate 10mg max 6-hourly

33
Q

First line pain relief for neuropathic pain?

A
  • Amytriptyline 10mg PO nightly
    or
  • Pregabalin 75mg 12 hourly

PSA (6 decks)

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