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PSA > Basic principles of prescribing > Flashcards

Basic principles of prescribing Flashcards

1
Q

Basic principles of precribing

A
  • Legible
  • Unambiguous (e.g. not range of doses)
  • Approved name e.g. salbutamol not ventolin
  • CAPITALS
  • Without abbreviations
  • Signed
  • PRN drugs: 1) Indication 2) Provide maximum frequency
  • Abx: include the indication and stop/review date
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2
Q

Enzyme inducers (PC BRAS)

A
  • Decrease drug concentrations
  • Phenytoin
  • Carbamazepine
  • Barbiturates
  • Rifampicin
  • Alcohol (chronic excess)
  • Sulphonylureas
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3
Q

Enzyme inhibitors (AO DEVICES)

A
  • Increases drug concentrations
  • Allopurinol
  • Omeprazole
  • Disulfiram
  • Erythromycin
  • Valproate
  • Isoniazid
  • Ciprofloxacin
  • Ethanol (acute intoxication)
  • Sulphonamides
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4
Q

Drugs to increase during surgery

A
  • Pts on LT corticosteroids (e.g. prednisolone) commonly have adrenal atrophy = unable to mount an adequate physiological response to surgery (if steroids are discontinued they risk profound hypotension)
  • ‘Sick day rules’ = pts on steroids double their daily dose to counter increased steroid requirement)
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5
Q

Drugs to stop before surgery

A 
I LACK OP
I - Insulin 
L = Lithium 
A - Anticoagulants/antiplatelts
C - COCP/HRT
K - K-sparing diuretics 
O - Oral hypoglycaemics
P - Perindopril (+ other ACEIs)
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6
Q

When to stop COCP and HRT?

A

4 weeks before surgery?

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7
Q

When to stop lithium?

A

Day before

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8
Q

When to stop K+ sparing diuretics/ACEIs?

A

Day of surgery

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9
Q

When to stop anticoagulants/ oral hypoglycaemic drugs and insulins?

A

Variable
- Pts are NBM before surgery = metformin should be stopped because it will cause LACTIC ACIDOSIS
- The other hypoglycaemics and insulin will cause hypoglycaemia if not stopped
(SLIDING SCALE)

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10
Q

Safe routine for prescribing

A
  • Ensuring correct patient prescription/drug chart
  • Noticing + recording allergies
  • Signing front of drug chart
  • Consider contraindications for each drug prescribed
  • Consider route for each drug prescribed
  • Consider need for IV fluids/thromboprophylaxis/antiemetics/pain releif
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11
Q

PReSCRIBER

A
  • Patient details
  • REaction (i.e. allergy + reaction_
  • Sign front of chart
  • Contraindications of drugs?
  • Route of each drug?
  • IV fluids if needed
  • Blood clot prophylaxis needed?
  • antiEmetic needed?
  • pain Relief needed?
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12
Q

Drugs that increase bleeding

A
  • Aspirin
  • Heparin
  • Warfarin
    Shouldn’t be given to pts who are actively bleeding, at risk of bleeding or suspected bleeding
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13
Q

Prophylactic enoxaparin

A

Contraindicated in acute ischaemic stroke = risk of bleeding into stroke

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14
Q

Erythromycin + warfarin

A

Erythromycin = enzyme inhibitor therefore decreases metabolism of warfarin + increases warfarin levels = increase INR

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15
Q

Steroid effects (STEROIDS)

A
  • S: stomach ulcers
  • T: thin skin
  • E: oEdema
  • R: R + L heart failure
  • O: osteoporosis
  • I: infection (including candida)
  • D: DM
  • S: cushing’s Syndrome
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16
Q

NSAID cautions/contraindications (NSAID)

A
  • N: No urine (renal failure)
  • S: Systolic dysfunction (heart failure)
  • A: Asthma
  • I: Indigestion (peptic ulcer)
  • D: Dyscrasia (clotting abnormality)
    Whilst aspirin is an NSAID = not contraindicated in renal failure or heart failure, and can be used in asthmatics (w/ caution)
17
Q

Antihypertensives - effects

A

1) Hypotension (including postural hypotension) may result from all groups
2) Bradycardia - BB and some CCB
3) Electrolyte disturbances - ACEI and diuretics

18
Q

ACEI

A

Dry cough

19
Q

Beta blockers

A
  • Wheeze in asthmatics

- Worsening of acute heart failure but helpful in chronic heart failure

20
Q

CCB

A
  • Peripheral oedema + flushing
21
Q

Diuretics

A
  • Can cause renal failure

- Loop diuretics e.g. Furosemide can cause gout and K+- sparing diuretics (spironlactone) can cause gynaecomastia

22
Q

Antiemetic choice - nauseated

A
  • Regular anti-emetic:
    Cyclizine 50mg 8 hourly IM/IV/oral for most cases but fluid retention
    Metoclopramide 10mg 8 hourly IM/IV if heart failure
23
Q

Antiemetic choice - not nauseated

A
  • PRN anti-emetic:
    Cyclizine 50mg 8 hourly IM/IV/oral for most cases but fluid retention
    Metoclopramide 10mg 8 hourly IM/IV if heart failure
24
Q

Antiemetic - common exam traps

A

Avoid metoclopramide (dopamine antagonist) for:

  • Pts w/ PD = exacerbation of symptoms
  • Young women = risk of dyskinesia (unwanted movements - especially acute dystonia)
25
Q

Paracetamol - common trap

A
  • Daily maximum of 4g
  • Check they aren’t on multiple drugs containing paracetamol +- PRN paracetamol
  • Common e.g. is paracetamol + co-codamol = calculate how many g patient is being prescribed and omit if too high
26
Q

Analgesia - choices

A
  • No pain: PRN paracetamol 1g up to 6 hourly oral
  • Mild pain: regular paracetamol 1g 6 hourly oral and PRN codeine 30mg up to 6 hourly oral
  • Severe pain: co-codamol 30/500 2x tablets 6 hourly oral w/ PRN morphine sulphate 10mg up to 6 hourly oral

PSA (2 decks)

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