BNF: Guidance on Prescribing Flashcards
What does “non-proprietary” mean?
Generic
Should biological medicines be prescribed by brand?
Yes
When are oral syringes provided for liquid medicines?
When the doses are not in multiples of 5mL
Sugar free preparations do not contain what 3 excipients?
Fructose, sucrose, glucose
True or false:
Preparations containing hydrogenated glucose syrup e.g. sorbitol are classed as sugar-free?
True
No evidence that they cause dental caries
The excipient benzyl alcohol is associated with what in neonates?
Fatal toxic syndrome
Polyoxyl castor oils, used as vehicles in intravenous injections, carries the risk of what?
Severe anaphylactoid reactions.
What is the problem with propylene glycol if its elimination is impaired, e.g. in renal failure, in neonates and young children?
Can cause adverse effects. When consumed in toxic quantities, the buildup of lactic acid can lead to acidosis and kidney failure.
What two drugs may interact with propylene glycol? (Hint: alcohol interactants)
Metronidazole and disulfram
For extemp products:
- If the BP direction states that a preparation must be “freshly prepared”, within how many hours must it be made before issued for use?
- If the direction that a preparation should be “recently prepared” indicates that deterioration is likely if the preparation is stored for longer than how many weeks?
- Made within 24 hours of being issued
2. About 4 weeks at 15–25￮ C.
Prescriptions for drugs used for contraceptive purposes (but which are not promoted as contraceptives) may need to be marked in handwriting with what symbol?
♀
What does a black triangle next to a drug mean and how long is this retained for?
The black triangle symbol = newly licensed medicines require additional monitoring by the EMA. Products usually retain a black triangle for 5 years, but this can be extended.
All suspected rxns for black triangle drugs should be reported to MHRA
In terms of statistics, what does a very common side effect mean?
Greater than 1 in 10
In terms of statistics, what does a common side effect mean?
1 in 100 to 1 in 10
In terms of statistics, what does an uncommon side effect mean?
1 in 1000 to 1 in 100
In terms of statistics, what does a rare side effect mean?
1 in 10,000 to 1 in 1000
In terms of statistics, what does a very rare side effect mean?
Less than 1 in 10,000
What would be examples of immediate, rapidly-evolving reactions (<1 hour after drug administration)?
- Anaphylaxis, with erythema, urticaria or angioedema, and hypotension and/or bronchospasm.
- Urticaria/angioedema without systemic features
- Exacerbation of asthma e.g. NSAIDs
What would be examples of non-immediate drug reactions without systemic involvement (6-10 days after drug administration)?
Cutaneous reactions e.g. localised inflamed skin
What would be examples of non-immediate drug reactions with systemic involvement (3 days - 6 weeks after drug administration)?
- Cutaneous rxns with systemic features, e.g. drug rxn with eosinophilia and systemic signs (DRESS) or drug hypersensitivity syndrome (DHS), characterised by widespread red macules, papules or erythroderma, fever, lymphadenopathy, liver dysfunction or eosinophilia
- Toxic Epidermal Necrolysis or Stevens–Johnson syndrome
- Acute generalised exanthematous pustulosis (AGEP)
What drugs are capable of causing oral ulceration?
Cytotoxics, ACE inhibitors, gold, nicorandil, NSAIDs, pancreatin, penicillamine, proguanil hydrochloride, and protease inhibitors.
Aspirin tablets allowed to dissolve in the sulcus for the treatment of toothache can lead to what?
White patch then ulceration
Lichenoid eruptions are associated with which drugs?
LICHENOID I - inhibitor ACE Ch - chloroquine - M before N - Methyldopa N - NSAIDs O - Old is Gold D - anti Diabetics + Diuretics thiazide
Brown staining is a common side effect of which mouthwash?
How can this be removed?
Chlorhexidine
With polishing
Iron salts in liquid form can do what to the teeth?
Stains enamel black
Permanent staining of the teeth is common with which antibiotic class?
What age group is affected and what are the contraindications?
Tetracyclines
Under 12 years
C/I in pregnancy, BF, under 12 years
Osteonecrosis of the jaw is associated with what drug class?
Bisphosphonates
Excessive ingestion of fluoride leads to what?
Dental fluorosis - white spots on teeth
Gingival hyperplasia (overgrowth of the gum) is associated with which drugs?
Phenytoin, ciclosporin, nifedipine (and other CCBs)
What does xerostomia mean?
Dry mouth from reduced/lack of saliva flow
What drug classes cause a dry mouth?
- Antimuscarinics
- TCAs, SSRIs
- Alpha blockers
- Antihistamines, Antipsychotics
- Baclofen, Clonidine
- Opioids
- Tizanidine
- XS use of diuretics
What drugs can increase saliva production?
Clozapine and neostigmine
What drugs cause swelling of salivary glands?
Iodides, antithyroids, phenothiazines, sulphonamides
True or false:
Drugs should not normally be added to blood products, mannitol, or sodium bicarbonate.
True
Is prednisolone highly protein bound?
Yes
If a patient has decreased muscle mass, will their eGFR be underestimated or overestimated?
Overestimated (as there creatinine will be low)
What is the best way to calculate renal function in patients with a BMI < 18 and BMI > 40?
CrCl
Should actual or ideal body weight be used when calculating CrCl?
Ideal, but if underweight use their actual body weight
How do you calculate IBW?
Ideal body weight (kilograms) = Constant + 0.91 (Height - 152.4)
Where:
Constant = 50 for men; 45.5 for women
Height in centimetres
In terms of eGFR, what is CKD2?
60-89
In terms of eGFR, what is CKD3a?
45-59
In terms of eGFR, what is CKD3b?
30-44
In terms of eGFR, what is CKD4?
15-29
In terms of eGFR, what is CKD5?
<15
What drug can inhibit an infant’s sucking reflex?
Phenobarbital
10mg of oral morphine is equivalent to how much of oral codeine?
100mg
10mg of oral morphine is equivalent to how much of IV/SC/IM morphine?
5mg
10mg of oral morphine is equivalent to how much of oral oxycodone?
6.6mg
10mg of oral morphine is equivalent to how much of oral tramadol?
100mg
10mg of oral morphine is equivalent to how much of oral dihydrocodeine?
100mg
10mg of oral morphine is equivalent to how much of oral hydromorphone?
2mg
10mg of oral morphine is equivalent to how much of IV/SC/IM diamorphine?
3mg
If a patient is having morphine salt 12mg daily and needed to convert to a buprenoprhine patch, which one would they need to use?
Buprenorphine ‘5’ patch
If a patient is having morphine salt 30mg daily and needed to convert to 72 hour fentanyl patch, which one would they need to use?
Fentanyl ‘12’ patch
What can be used for anorexia in palliative care patients?
Prednisolone or dexamethasone
A pharmacist providing MURs must ensure that at least 70% of all MURs fall under what national target groups?
- Patients taking high-risk medicines - NSAIDs, anticoagulants (including LMWH), antiplatelets, or diuretics
- Patients recently discharged from hospital who have had changes made to meds
- Patients prescribed certain respiratory medicines
- Patients with, or at risk of CVD, and are regularly prescribed at least 4 medicines.
When would you report a yellow card?
- All ADRs for new meds; black triangle
- All serious ADRs for all meds (including homeopathic, off-label). This means- fatal, life-threatening, congenital abnormality, disabling, results or prolongs hospitalisation
- All errors that result in an ADR e.g. from dosing, dispensing. (There are no repercussions from reporting such events)
