Chapter 2: pRescription review

Question 1

If Haemoptysis

Answer 1

stop antiplatelet/ LMWH

Question 2

Hyperkalemic

Answer 2

Stop ACEi

Question 3

Does co-amoxiclav contain penicillin?

Answer 3

Yes, amoxicillin and penicillin

As does… Tazocin

Question 4

Max paracetamol dose

Answer 4

4g/day. Dosed every 6 hours

Question 5

PReSCRIBER

Answer 5

Patient details,
Reaction (allergy), 
Sign the front of the chart
Contraindications to each drug
Route of each drug
IV fluids if needed
Blood clot prophylaxis
anti Emetics if needed
Relief of pain

Question 6

3 pieces of patient info on front of chart

Answer 6

Name, DoB, Hosp Number

Question 7

What four drugs must you know the C/I to?

Answer 7

Drugs increasing bleeding
Steroids
NSAIDS
Anti hypertensives

Question 8

Drugs that increase bleeding are

Answer 8

Aspirin, heparin, warfarin

Question 9

C/I to drugs increasing bleedgin

Answer 9

active bleeding, risk of bleeding (eg liver failure)

eg - acute ischaemic stroke

Question 10

Which Antibiotic interferes with anticoagulation drugs

Answer 10

Erythromycin - enzyme inhibitor. Increases effect of Warfarin - PT and INR increase.

Question 11

STEROIDS for Steroids

side effects and C/I

Answer 11

Stomach Ulcers
Thin Skin
oEdema
Right and Left heart failure
Osteoporosis
infection (eg candida)
diabetes (causes hyperglycemia)
cushings Syndrome

Question 12

NSAID for NSAIDs C/I

Answer 12

No urine (renal failure)
Systolic dysfunction (heart failure)
Asthma
Indigestion
Dycrasia (clotting abnormality)

Question 13

Three categories for C/I of antihypertensives

Answer 13

Hypotension
Mechanism of action
individual drug class side effect

Question 14

Mechanism of action of antihypertensives (for C/I)

Answer 14

Bradycardia with BB and some CCB

Electrolye disturbances with ACE and Diuretics

Question 15

Antihypertensive drug class side effects

Answer 15

ACEi - dry cough
BB - wheeze in asthmatics, worsening acute heart failure
CCB - peripheral oedema and flushing
Diuretics - renal failure. Loop diuretics (furosemide cause gout). K sparing (spiro) cause gynaecomastia

Question 16

NBM patients: medications received prior to surgery what way?

Answer 16

Oral

Question 17

When to prescribe fluids

Answer 17

Either to replace if dehydrated or acutely unwell

Maintenance for NBM

Question 18

In replacing fluids when would you give something other than NaCl 0.9%?

Answer 18

Hypernatraemic/hypoglycaemic - 5% dex
Acites - Human Albumin solution
Shocked sBP <90 - colloid
shocked from bleeding - transfusion/colloid

Question 19

Assessments for replacing fluids

Answer 19

HR, BP, urine output

Question 20

Reduced urine output

Answer 20

indicates 500ml loss

Question 21

reduced UO plus tachy

Answer 21

1l Fluid loss

Question 22

reduced UO plus tachy plus chocked

Answer 22

2L fluid loss

Question 23

If patient is sick how much to prescribe

Answer 23

2L IV fluid and review regularly.

Question 24

Bolus of fluid

Answer 24

500ml or 250ml if heart failure

Question 25

1 salty 2 sweet

Answer 25

1 L of saline and 2L of dextrose for ELECTROLYTES. need 40mmol if KCl if U+E normal

Question 26

General rule for maintenance

Answer 26

3L IV fluid / 24 hours

Question 27

Maximum rate to give IV potassium

Answer 27

no more than 10mmol/hour

Question 28

Before prescribing fluids check following three things

Answer 28

U and E Not fluid overloaded Not in retention

Question 29

Not to prescribe leg stockings

Answer 29

If peripheral artery disease - cause limb ischaemia

Question 30

Emetics: how to prescribe for nauseated and not nauseated

Answer 30

Nauseated - regular | Not nauseated - PRN

Question 31

Emetics choice and C/I

Answer 31

Cyclizine but causes fluid retention so use Metoclopramide in Heart failure

Question 32

when to avoid metoclopramide

Answer 32

dopamine antagonist so parkinsons disease - exacerbates symptoms Young women - risk of dyskinesia

Question 33

Pain ladder

Answer 33

Paracetemol 1g 6 hrly | Co-codomol 30/500, 2 tabs 6 hrly

Question 34

Pain ladder for PRN

Answer 34

Paracetemol 1g up to 6hrly oral Codeine 30mg up to 6hrly oral Morphine sulphate 10mg up to 6 hrly oral

Question 35

Hospital morphine strength

Answer 35

10mg/5ml

Question 36

Neuropathic pain

Answer 36

``` 1st Amitriptyline (10mg oral nightly) or pregablin (75mg oral 12 hourly) ```

Question 37

Painful diabetic neuropathy

Answer 37

Duloxetine (60mg oral daily)

Question 38

Lisinopril causes what to U+E

Answer 38

Hyperkalaemia reduced aldosterone - reduced K excretion

Question 39

Anti-emetic in parkinsonism

Answer 39

Domperidone - doesn't cross the BBB

Question 40

How do ACEi cause a cough

Answer 40

Accumulation of bradykinin via reduced degradation by ACE

Question 41

How does ibuprofen affect gastric mucosa vs steroids

Answer 41

Inhibits prostaglandin synthesis whereas steroids inhibit gastric renewal

Question 42

Ibuprofen and renal

Answer 42

inhibits prostaglandin synthesis - reduces renal artery diameter and blood flow. Reduced perfusion

Question 43

why is ramipril not suitable for poor renal function

Answer 43

reduces angiotensin II production which is necessary for preserving the GFR

Question 44

Why is Trimethoprim and Methotrexate a bad combo

Answer 44

both folate antagonists - bone marrow toxicity combined. Lead to pancyopenia and neutropenic sepsis

Question 45

If unwell patient who is on methotrexate

Answer 45

Withold giving until neutropenic sepsis is ruled out

Question 46

All diuretics can cause

Answer 46

Hyponatraemia

Question 47

Loop diuretics and thiazides cause

Answer 47

hypokalaemia

Question 48

K sparing and ACEi cause

Answer 48

hypER kalaemia

Question 49

verapamil and bb

Answer 49

bad as cause bradycardia