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PSA prep > A Safe routine for prescribing > Flashcards

A Safe routine for prescribing Flashcards

1
Q

Mnemonic for safe routine for prescribing

A

PReSCRIBER

  • PATIENTS details
  • REACTION (i.e. reaction plus the reaction)
  • SIGN the front of the chart
  • check CONTRAINDICATIONS to each drugs
  • check ROUTE for each drug
  • prescribe INTRAVENOUS fluids if needed
  • prescribe BLOOD clot prophylaxis if needed
  • prescribe antiEMETIC if needed
  • prescribe pain RELIEF if needed
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2
Q

What are the 3 pieces of patient identifying information on the front of the chart that is required

A
  • patient name
  • DOB
  • hospital number

OR use hospital addressograph sticker

If amending chart ensure that you have correct patient’s drug chart

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3
Q

Explain REACTIONS

A
  • If starting new chart complete allergy box including drugs reactions mentioned by pt
  • If amending chart check the allergy box before prescribing
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4
Q

Which common antibiotics contain penicillin

A

Co-amoxiclav
Tazocin

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5
Q

Drug contraindications for pts who are bleeding, suspected of bleeding or at risk of bleeding e.g. those with prolonged prothrombin time due to liver disease

A
  • Antiplatelets, anticoagulants
  • Prophylactic heparin NOT appropriate in acute ischaemic stroke
  • Erythromycin - increases warfarin effect (PT and INR)
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6
Q

Contraindications for prescribing steroids

A

STEROIDS

  • Stomach ulcers
  • Thin skin
  • Oedema
  • Right & left heart failure
  • Osteoporosis
  • Infection (including Candida)
  • Diabetes (commonly causes hyperglycaemia_
  • Cushing’s SYNDROME
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7
Q

What are the safety considerations for NSAIDs

A

NSAID

  • NO urine i.e. renal failure
  • Systolic dysfunction i.e. heart failure
  • Asthma
  • Indigestion
  • Dyscrasia (clotting abnormality)
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8
Q

Which NSAID has less level of caution

A

Aspirin

Generally used at lower doses for managing CV and Cerebrovascular disease

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9
Q

Main side effects of antihypertensives

A
  1. Hypotension (postural)
  2. a. Bradycardia - beta blockers, some CCBs
    b. Electrolyte disturbance - ACEIs, Diuretics
  3. CCBs - peripheral oedema & flushing
  4. Diuretics - renal failure
    - Thiazide e.g. bendroflumethiazide can cause GOUT
    - Potassium sparing diuretics e.g. spironolactone can cause GYNAECOMASTIA
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10
Q

How should anti-emetics be given if patient is vomiting

A

Route - IV, IM, SC

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11
Q

Doses and route for common antiemetics

A
  • Cyclizine 50mg 8 hourly
  • Metoclopramide 10mg 8 hourly
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12
Q

IV fluids are prescribed in 2 situations

A
  1. Replacement fluids - dehydrated/acutely unwell patient
  2. Maintenance - NBM patients
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13
Q

3 things to consider for IV fluids

A

Which fluid
How much to give
How fast to give

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14
Q

Give all patients 0.9% saline (normal saline, a crystalloid) unless the patient:

A
  • Is hypernatraemic or hypoglycaemic: give 5% dextrose instead.
  • Has ascites: give human-albumin solution (HAS) instead. (The albumin
    maintains oncotic pressure; furthermore, the higher sodium content of 0.9% saline will worsen ascites.)
  • Is shocked from bleeding: give blood transfusion, but a crystalloid first if no blood available
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15
Q

What fluid to give if pt hypernatraemic or hypoglycaemic

A

5% dextrose

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16
Q

What to give is patient has ascites

A

Human albumin solution (HAS)

17
Q

What to give is patient is shocked from bleeding

A

Give blood transfusion
IF no blood available give crystalloid

18
Q

What to assess when considering how much fluid and how fast

A
  • HR
  • BP
  • Urine output
19
Q

How much fluid & how fast

Tachycardic or hypotensive?

A

500mL bolus immediately
250mL if heart failure

Reassess patient - HR, BP, UR

20
Q

How much fluid & how fast

Only oliguric (and not due to urinary obstruction e.g. enlarged prostate)

A

1L over 2-4 hours

Reassess

21
Q

Fluid depletion levels

Reduced urine output & tachycardia

A

1 L fluid depleted

22
Q

Fluid depletion levels

Reduced urine output & tachycardia & shocked

A

> 2 L fluid depleted

23
Q

Fluid depletion levels

Reduced urine output (oliguric if <30ml/h, anuric if 0)

A

500ml fluid depleted

24
Q

Max rate for giving IV potassium

A

10 mmol/hour

25
Q

General rule for maintenance fluids

A
  • Adults 3L IV fluid per 24 hours
  • Elderly 2L/24hrs

Adequate electrolytes provided by (1 SALTY, 2 SWEET)
- 1L 0.9% saline
- 2L 5% dextrose

Providing potassium
- Either in bags of 5% dextrose or 0.9% saline containing KCl
- Normal potassium levels: 40mmol KCL per day (20mmol KCl in 2 bags)

26
Q

How fast to give maintenance fluids

A
  • If giving 3 L per day = 8-hourly bags (24 ÷ 3).
  • If giving 2 L per day = 12-hourly bags (24 ÷ 2).
27
Q

What to check before prescribing fluids in real life

A
  • Check the patient’s U&E to confirm what to give them.
  • Check that the patient is not fluid overloaded (e.g. increased jugular venous
    pressure (JVP), peripheral and pulmonary oedema).
  • Ensure that the patient’s bladder is not palpable (signifying urinary obstruction)
    if giving replacement fluids because of ‘reduced urine output’
28
Q

Blood clot prophylaxis for majority patients admitted to hospital

A
  • Prophylactic LMWH e.g. dalteparin 5000 units daily s/c
  • Compression stocking (prevent VTE)
29
Q

Contradiction for compression stocking

A

Peripheral arterial disease (absent foot pulses)

30
Q

Avoid metoclopramide (dopamine antagonist) for

A
  • Parkinson’s disease (exacerbates symptoms)
  • Young women (risk of dyskinesia i.e. unwanted movements especially acute dystonia)
31
Q

Common antiemetic choices

A
32
Q

Common NSAID pain relief prescription

A

Ibuprofen 400mg 8 hourly

33
Q

Pain relief for neuropathic pain

A

Amitriptyline 10mg oral nightly
OR
Pregablin 75mg oral 12 hourly
OR
for diabetic neuropathy
Duloxetine 60mg oral daily

34
Q

Common analgesic choices

A
35
Q

MAX dose of paracetamol for patient <50kg

A

500mg 6 hourly

PSA prep (3 decks)

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