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PSA > Basic principles of prescribing > Flashcards

Basic principles of prescribing Flashcards

1
Q

oxybutynin side effect

A

Antimuscarinic

  • memory loss
  • dry mouth
  • constipation
  • blurred vision
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2
Q

adherence definition

A

the extent to which the the pt’s behaviour matches agreed recommendations from the prescriber

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3
Q

compliance definition

A

the old term for adherence:

the extent to which the the pt’s behaviour matches agreed recommendations from the prescriber

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4
Q

what is concordance

A

a process of prescribing and medicine taking based on partnership

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5
Q

Diclofenac adverse effect

A

dyspepsia (NSAID)

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6
Q

indapamide adverse effect

A

gout (thiazide diuretic)

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7
Q

lisinopril adverse effect

A

intractable cough

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8
Q

prednisolone adverse effect

A

alter mood and behaviour

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9
Q

prochlorperazine adverse effect

A

ESPSE like dystonia (antipsychotic)

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10
Q

what is intentional non-adherence

A

the pt makes a conscious decision not to follow treatment recommendations

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11
Q

what is non-intentional non-adherence

A

the pt wants to follow treatment instructions but is prevented from doing so by certain factors

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12
Q

at what age are patients entitled to free prescriptions

A

60

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13
Q

how many half lives will it take to clear 97% of the drug from the body

A

5

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14
Q

how does erythromycin effect warfarin

A

it inhibits warfarin metabolism

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15
Q

how does phenytoin effect other antiepileptics

A

it increases metabolism of other antiepileptics

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16
Q

how does rifampicin affect oestrogen in the COCP

A

it increases the metabolism of oestrogen

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17
Q

what is the first pass effect

A

the concentration of a drug, specifically when administered orally, is greatly reduced before it reaches the systemic circulation

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18
Q

what is the volume of distribution

A

the theoretical volume of fluid that would be needed to achieve the actual plasma drug concentration

total amount of drug in the body / plasma drug conc

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19
Q

what is zero order elimination

A

Elimination of a constant quantity per time unit of the drug quantity present in the body

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20
Q

what is first order elimination

A

Elimination of a constant fraction per time unit of the drug quantity present in the body. The elimination is proportional to the drug concentration

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21
Q

elimination rate constant formula

A

k = clearance / volume distribution

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22
Q

what does it mean when a drug induces the P450 system e.g. phenytoin

A

can accelerate the metabolism of concomitant drugs

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23
Q

what does it mean when a drug inhibits P450 e.g. erythromycin

A

can slow down the metabolism of other drugs

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24
Q

what are pro drugs

A

medicines or compounds that are converted (or activated) to pharmacologically active forms within the body

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25
Q

what is an agonist

A

a chemical that binds to its target to increase its activity

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26
Q

what is an antagonist

A

a chemical that opposes the action of another chemical

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27
Q

define affinity

A

the tendency of a molecule to bind to a receptor

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28
Q

define efficacy

A

how well an agonist achieves a response

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29
Q

what is a partial agonist

A

a drug that has a lower maximal response resulting from lower efficacy

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30
Q

what are allosteric modulators

A

they bind to proteins atd site other than the site for the principal agonist

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31
Q

what is the greatest risk in overdose of TCA

A

ventricular dysrhythmias

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32
Q

why are statins given at bed time

A

the enzyme HMG CoA reductase is more active at night. Statins inhibit it which decreases synthesis of cholesterol

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33
Q

what is ED50

A

the dose required to elicit 50% of a maximal response

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34
Q

calculation to estimate a child’s body weight

A

(age + 4) x 2(kg)

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35
Q

how many micrograms in 1mg

A

1000

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36
Q

how many nanograms in 1 microgram

A

1000

37
Q

what is % w/w

A

percentage weight per weight

e.g. hydrocortisone 0.5% w/w contains 0.5g of hydrocortisone in 100g of the cream

38
Q

what is % w/v

A

percentage weight per volume

e.g. NaCl 0.9% contains 0.9g of NaCl in 100ml of the infusion

39
Q

what is % v/v

A

percentage volume per volume

e.g. ChloraPrep, containing isopropyl alcohol 70% v/v contains 70ml isopropyl alcohol in 100ml solution

40
Q

how much adrenaline is in 1 in 1000

A

1g in 1000ml

so 1mg per ml

41
Q

how much adrenaline is in 1 in 200,000

A

1g in 200,000ml

so 5 micrograms per ml

42
Q

how many lbs in a stone

A

14

43
Q

how many grams in 1lb

A

450g

44
Q

how many kg is 1 stone

A

6.35kg

45
Q

how many cm in 1 inch

A

2.54cm

46
Q

how many cm in 1 ft

A

30.48cm

47
Q

in obese patients, gentamicin should be dosed to which body weight?

A

ideal body weight

48
Q

on the BNF how do you find the opioid conversions?

A

treatment summaries –> prescribing in palliative care

49
Q

on the BNF how do you find steroid conversions?

A

trx summaries –> glucocorticoid therapy

50
Q

on the BNF how do you find the benzodiazepam conversions?

A

trx summaries –> hypnotics + anxiolytics

51
Q

what should vancomycin be diluted up to?

A

5mg/ml and run at a rate not exceeding 10mg/min

52
Q

what body weight should be used when calculating the dose for acetylcysteine?

A

actual body weight (max 110kg)

53
Q

what should acetylcysteine be diluted in

A

glucose

54
Q

describe the 3 part dose regimen of acetylcysteine

A

1) loading dose over 1h in 200ml glucose 5%
2) next dose over 4h in 500ml glucose 5%
3) final dose given over 16h in 1L glucose 5%

55
Q

formula for volume of parenteral drug required to be administered or added to a infusion

A

volume required = (what you want/what you get) x what it’s in

56
Q

why should alendronic acid not be crushed

A

Biphosphonates should not be crushed because they can cause adverse GI affects

57
Q

why is diclofenac CI’d post stroke

A

increased risk of thromboembolic event

58
Q

can indapamide be crushed

A

yes

59
Q

can nifedipine be crushed

A

no

60
Q

what is bioavailability

A

the proportion of the medicine which finally makes it to the systemic circulation where it is available to act at the ‘effector site’

61
Q

what is the bioavailability of IV medicines

A

100%

62
Q

name 3 commonly prescribed drugs where the bioavailability changes depending on the route

A
  • morphine
  • ciprofloxacin
  • digoxin
63
Q

how should ciprofloxacin be taken

A
  • NOT with a glass of milk

- at different times to indigestion medication

64
Q

why should there be a ‘nitrate free period’ of at least 8 hours

A

to prevent pts from developing a tolerance to the medicine

65
Q

common drugs which interact with the enteral feed

A
  • quinolones

- phenytoin

66
Q

what can aid the absorption of iron salts

A

vit C (ascorbic acid)

67
Q

why are enteric coated formulations CI’d in pts with an ileostomy

A

EC meds bypass the stomach and get absorbed in small intestine which is not possible if pt has ileostomy

68
Q

are MR formulations appropriate for pts with an ileostomy

A

no

69
Q

should you check gentamycin serum conc levels after giving 1 stat dose?

A

no need to unless planning to give another dose

70
Q

what are bacteriostatic agents

A

they inhibit protein synthesis, stopping the cell from growing

they don’t kill the cell, but allow host defences to deal with the infection

71
Q

Name some bacteriostatic agents

A

macrolides (clarithromycin)

tetracyclines (doxycycline)

72
Q

what are bactericidal agents

A

they inhibit a vital cellular process which leads to cell death

73
Q

name some bactericidal agents

A

aminoglycosides (gentamicin)

74
Q

what infection is co-amoxiclav associated with

A

c.difficile infection. Diarrhoea!

75
Q

c.difficile infection mnx

A
  1. send stool cultures to test for c.difficile toxin + antigen
  2. stop co-amoxiclav or suspected drug
  3. give narrow spectrum agent if needed for her pneumonia
  4. start empirical metronidazole whilst awaiting stool culture
76
Q

why are urine dipsticks an unreliable method for catheter related UTIs

A

urinary catheters quickly become colonised with bac and the dipstick will only detect their presence

77
Q

which group of bacteria is vancomycin affective for

A

gram positive

78
Q

how do you know if a drug is controlled

A

Schedule 2 and 3 preparations are labelled as CD2 or CD3 next to the drug in the BNF

79
Q

what is meant by unlicensed drugs?

A

do not have UK marketing authorisation

80
Q

what is meant by off label

A

has marketing authorisation but used outside the terms of its license

81
Q

should tacrolimus be prescribed a a brand or drug name?

A

brand - to minimise the risk of inadvertent switching between products, which has been associated with reports of toxicity and graft rejection.

82
Q

what is medicines reconciliation

A

ensures that the medicine prescribed on admission correspond to medicine prescribed before admission

83
Q

what is the max dose of simvastatin when prescribed with amlodipine

A

20mg

84
Q

what medicines should be omitted from an MDS

A
  • Aspirin (likely to disintegrate)
  • cytotoxic drugs e.g. methotrexate as handling shold be kept to a minimum
  • PRN meds
  • chewable tablets
85
Q

which medicines can reduce the effectiveness of the COCP

A

Cytochrome P450 inducers e,g, carbamazepine

86
Q

equation to calculate eGFR in neonates

A

30 x height (cm) / serum creatinine (micromol/L)

87
Q

equation to calculate eGFR in child>1y

A

40 x height (cm) / serum creatinine (micromol/L)

88
Q

when should a Yellow card be submitted in <18y

A

all serious adverse drug reactions that result in harm and suspected ADRs to new vaccines/drugs

89
Q

what can’t F1’s prescribe

A
  • parenteral nutrition

- cytotoxic or immunosuppressants except corticosteroids

PSA (6 decks)

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