A Safe routine for prescribing Flashcards
Mnemonic for safe routine for prescribing
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
What are the 3 pieces of patient identifying information on the front of the chart that is required
- patient name
- DOB
- hospital number
OR use hospital addressograph sticker
If amending chart ensure that you have correct patient’s drug chart
Explain REACTIONS
- If starting new chart complete allergy box including drugs reactions mentioned by pt
- If amending chart check the allergy box before prescribing
Which common antibiotics contain penicillin
Co-amoxiclav
Tazocin
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
- Antiplatelets, anticoagulants
- Prophylactic heparin NOT appropriate in acute ischaemic stroke
- Erythromycin - increases warfarin effect (PT and INR)
Contraindications for prescribing steroids
STEROIDS
- Stomach ulcers
- Thin skin
- Oedema
- Right & left heart failure
- Osteoporosis
- Infection (including Candida)
- Diabetes (commonly causes hyperglycaemia_
- Cushing’s SYNDROME
What are the safety considerations for NSAIDs
NSAID
- NO urine i.e. renal failure
- Systolic dysfunction i.e. heart failure
- Asthma
- Indigestion
- Dyscrasia (clotting abnormality)
Which NSAID has less level of caution
Aspirin
Generally used at lower doses for managing CV and Cerebrovascular disease
Main side effects of antihypertensives
- Hypotension (postural)
- a. Bradycardia - beta blockers, some CCBs
b. Electrolyte disturbance - ACEIs, Diuretics - CCBs - peripheral oedema & flushing
- Diuretics - renal failure
- Thiazide e.g. bendroflumethiazide can cause GOUT
- Potassium sparing diuretics e.g. spironolactone can cause GYNAECOMASTIA
How should anti-emetics be given if patient is vomiting
Route - IV, IM, SC
Doses and route for common antiemetics
- Cyclizine 50mg 8 hourly
- Metoclopramide 10mg 8 hourly
IV fluids are prescribed in 2 situations
- Replacement fluids - dehydrated/acutely unwell patient
- Maintenance - NBM patients
3 things to consider for IV fluids
Which fluid
How much to give
How fast to give
Give all patients 0.9% saline (normal saline, a crystalloid) unless the patient:
- 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
What fluid to give if pt hypernatraemic or hypoglycaemic
5% dextrose
What to give is patient has ascites
Human albumin solution (HAS)
What to give is patient is shocked from bleeding
Give blood transfusion
IF no blood available give crystalloid
What to assess when considering how much fluid and how fast
- HR
- BP
- Urine output
How much fluid & how fast
Tachycardic or hypotensive?
500mL bolus immediately
250mL if heart failure
Reassess patient - HR, BP, UR
How much fluid & how fast
Only oliguric (and not due to urinary obstruction e.g. enlarged prostate)
1L over 2-4 hours
Reassess
Fluid depletion levels
Reduced urine output & tachycardia
1 L fluid depleted
Fluid depletion levels
Reduced urine output & tachycardia & shocked
> 2 L fluid depleted
Fluid depletion levels
Reduced urine output (oliguric if <30ml/h, anuric if 0)
500ml fluid depleted
Max rate for giving IV potassium
10 mmol/hour
