Chapter 1 And 2 Flashcards
common Warfarin inhibitors
PC BRAS
Phenytoin Carbamazepine Barbiturates Alcohol (chronic) Sulphonylureas
Common warfarin inducers
AODEVICES
(Head to toe)
Valproate Erythromycin Isoniazid Omeprazole Ciprofloxacin Disulfiram Ethanol (acute) Allopurinal Sulphonamide
Drugs to stop before surgery
I LACK OP
BM = insulin, oral hypoglycaemics
Haemostasis = anticoags/plts, COCP/HRT: 4 weeks prior
Electrolyte + renal = lithium: day before, acei: day of, k+sparring diurectic: day of
PReSCRIBER mnemonic is used when and what does it mean?
Used to check medication reviews
Patient details Reactions (allergies) Sign everything Contraindications Route IV fluids Blood clot agents (anti) anti-Emetics pain Relief
What are the 4 common categories of contraindicated drugs
1) anticoags
Stop heparins if stroke, stop anticoags if bleeding
2) steroids (side effects) stomach ulcer Thin skin Edema R/L heart failure Osteoporosis Infection Diabetes cushing Syndrome
3) NSAID
No urine (kidney) Systolic dysfx (heart) Asthma (lungs) Indigestion (stomach) Dyscracia (clotting)
4) antihypertensives
Acei = high K, low Na, cough B = beta blocker-> bradycardia, asthma C = CCB -> peripheral edema, flushing D = diuretics -> loop and thiazide cause hypokalaemia, loop can cause gout, all can cause hyponatraemia
Common causes of K+ and Na+ imbalances
High K, low Na -> spironolactone, ACEi, NSAIDs
Low K, high Na (or low Na) -> loop and thiazide diuretics, steroids
2 reasons for prescribing IV fluids
Replace or maintain
What to consider when prescribing IV fluids to replace
Which one - 0.9% NaCl UNLESS-> ascites= HAS, hypernatramia or hypglycaemia = 5% dex, bleeding = blood or crystalloid first
How much/how fast - if shocked, hypotensive and tachycardic = 500ml stat (250ml if heart failure), if only oliguric give 1L over 2-4 hrs.
Algorithm for pain relief
No/mild pain - paracet regular or PRN
Moderate - paracet regular + codeine/tramadol PRN
Sever = cocodamol regular + morphine PRN
Common drugs to give for antiemetic
Cyclizine 50mg 8hrly
Metoclopramide 10mg 8hrly
When not to give cyclizine?
If heart failure and fluid retention
When to avoid metoclopramide
Parkinsons disease, young women
Common regime for fluid maintenance in adults
3L over 24 hrs (2L in old)
1 salty 2 sweet (0.9% nacl and 5% dex)
40mmol Kcl over 24hrs if no electrolyte imbalance (20mmol per bag)
What to make sure when prescribing maintenance fluids
1) not fluid overload
2) no electrolyte imbalance
3) no bladder obstruction
Max IV potassium rate
10mmol/hr
