Basic principles

Question 1

Enzyme inducers

Answer 1

PC BRAS

Phenytoin
Carbemazepine
Barbiturates
Rifampicin
Alcohol (chronic alcohol)
Sulphonylureas
St John's Wort

Question 2

Enzyme inhibitors

Answer 2

AO DEVICES
Allopurinol/Amiodarone
Omeprazole/Cimetidine
Disulfiram
Erythromycin
Valproate
Isoniazid / Imidazoles (fluconazole)
Ciprofloxacin
Ethanol (acute)
Sulphonamides

Question 3

Steroid dose sick day rules? Surgery?

Answer 3

Patients double daily dose to counter increased steroid requriement when ill

Steroids switched to IV during surgery
(can result in profound hypotension if discontinued

Question 4

Drugs to stop before surgery

Answer 4

I LACK OP

Insulin - start slioding scale VRII
Lithium - day before
Anticoagulants - 5d /antiplatelets -7d
COCP/HRT - 4 weeks prior
K-sparing diuretics - day of surgery
Oral hypoglycaemics
Prils (ACE-inihibtors) - day of surgery

Question 5

PReSCRIBER

Answer 5

Patient details
Reaction (allergy)
Signature
Contrainidcations
Route
IV fluids
Blood thinning prophylaxis
anti-Emetic
Relief (Pain)

Question 6

Important Drug CI

Answer 6

Drugs that increase bleeding:
Aspirin, Heparin, Warfarin
CI inbleeding, ischaemic stroke
Consider P450 inhibitor increasing warfarin action

Steroids

NSAIDs
No urine (renal failure)
Systolic dysfunction (heart failure)
Asthma
Indigestion
Dyscracia (clotting abnormality)

Antihypertensives
Hypotension
Bradycardia - BB/CCB
Electrolyte disturbance (ACE-i, diuretics)
ACE-i --> dry cough
Beta-blockers - CI in asthma and worsens acute heart fialure but helps chronic
CCB --> peripheral oedema and flushing
Diuretics --> renal failure

Question 7

Steroid side effects

Answer 7

Stomach ulcers
Thin skin
OEdema
Right and left heart failure
Osteoporosis
Infection
Diabetes
Syndrome - Cushing's
Sleep disturbance - insomnia

Question 8

How much potassium required per day? Max rate?

Answer 8

40mmol/day

Max rate 10mmol/hour

Question 9

Blood clot prophylaxis

Answer 9

LMWH CI in bleeding/ischaemic stroke/bleeding risk

Compression stockings CI in peripheral arterial disease - peripheral pulses present?

Question 10

Which anti-emetic?

Answer 10

Nauseated:
Regular antiemetic:
Cyclizine 50mg 8hrly IM/IV/oral
But if heart failure/fluid retention metoclopramide 10mg 8 hrly

Not nauseated
Same but as required

Avoid metoclopramide in:
Patients with PD
Young women due to risk of dyskinesia and acute dystonia

Question 11

Pain relief

First line neuropathic pain

Answer 11

Paracetamol 1g 6hrly (max 4g per day)
Remember co-codamol contains paracetamol

Amitriptyline 10mg oral nightly
Pregabalin oral 12hrly

Duloxetine 60mg PO in painful diabetic neuroapthy

Question 12

Which diuretics cause hypokalaemia? Hyperkalaemia?

Answer 12

Hypo:
Loop diuretics
Thiazide

Hyper:
Aldosterone antagonist
ACE inhibtiors