Basic principles Flashcards
Every drug prescription must be:
Not a range of doses An approved generic name In full in CAPITALS Signed + bleep Duration of use if relatively short term
If a drug is to be used ‘as required’, you must note:
- Indication
2. Maximum frequency or total dose in 24h
If a drug is an abx, you must note:
Indication
Stop/review date
Describe the effects of P450 inducers and inhibitors
Inducers –> increased P450 activity –> REDUCED drug effect
Inhibitors –> reduced P450 activity –> INCREASED drug effect
This is because most drugs metabolised to inactive metabolites by cytochrome p450 enzyme system
Enzyme inducers:
PC BRAS
Phenytoin Carbamazepine Barbiturates Rifampicin Alcohol (chronic) Sulphonylureas
Enzyme inhibitors:
AODEVICES
Allopurinol Omeprazole Disulfiram Erythromycin Valproate Isoniazid Ciprofloxacin Ethanol (acute) Sulphonamides
Most common enzyme inhibitors:
ketoconazole
ciprofloxacin
erythromycin
grapefruit juice
What drugs would you stop before surgery?
I LACK OP
Insulin Lithium Anticoagulants / antiplatelets COCP / HRT K-sparing diuretics Oral hypoglycaemics Perindopril (and other ACEi)
When would you stop COCP/HRT before surgery?
4 weeks
When would you stop lithium before surgery?
day before
When would you stop K-sparing diureitcs before surgery?
day of surgery
When would you stop ACEi before surgery?
day of surgery
When would you stop anticoag / antiplates before surgery?
variable (local policy)
When would you stop oral hypoglycaemics before surgery?
variable (local policy)
