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PSA > Chapter 2: pRescription review > Flashcards

Chapter 2: pRescription review Flashcards

1
Q

If Haemoptysis

A

stop antiplatelet/ LMWH

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2
Q

Hyperkalemic

A

Stop ACEi

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3
Q

Does co-amoxiclav contain penicillin?

A

Yes, amoxicillin and penicillin

As does… Tazocin

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4
Q

Max paracetamol dose

A

4g/day. Dosed every 6 hours

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5
Q

PReSCRIBER

A 
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
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6
Q

3 pieces of patient info on front of chart

A

Name, DoB, Hosp Number

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7
Q

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

A

Drugs increasing bleeding
Steroids
NSAIDS
Anti hypertensives

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8
Q

Drugs that increase bleeding are

A

Aspirin, heparin, warfarin

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9
Q

C/I to drugs increasing bleedgin

A

active bleeding, risk of bleeding (eg liver failure)

eg - acute ischaemic stroke

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10
Q

Which Antibiotic interferes with anticoagulation drugs

A

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

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11
Q

STEROIDS for Steroids

side effects and C/I

A 
Stomach Ulcers
Thin Skin
oEdema
Right and Left heart failure
Osteoporosis
infection (eg candida)
diabetes (causes hyperglycemia)
cushings Syndrome
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12
Q

NSAID for NSAIDs C/I

A 
No urine (renal failure)
Systolic dysfunction (heart failure)
Asthma
Indigestion
Dycrasia (clotting abnormality)
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13
Q

Three categories for C/I of antihypertensives

A 
Hypotension
Mechanism of action
individual drug class side effect
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14
Q

Mechanism of action of antihypertensives (for C/I)

A

Bradycardia with BB and some CCB

Electrolye disturbances with ACE and Diuretics

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15
Q

Antihypertensive drug class side effects

A

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

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16
Q

NBM patients: medications received prior to surgery what way?

A

Oral

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17
Q

When to prescribe fluids

A

Either to replace if dehydrated or acutely unwell

Maintenance for NBM

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18
Q

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

A

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

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19
Q

Assessments for replacing fluids

A

HR, BP, urine output

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20
Q

Reduced urine output

A

indicates 500ml loss

21
Q

reduced UO plus tachy

A

1l Fluid loss

22
Q

reduced UO plus tachy plus chocked

A

2L fluid loss

23
Q

If patient is sick how much to prescribe

A

2L IV fluid and review regularly.

24
Q

Bolus of fluid

A

500ml or 250ml if heart failure

25
Q

1 salty 2 sweet

A

1 L of saline and 2L of dextrose for ELECTROLYTES.

need 40mmol if KCl if U+E normal

26
Q

General rule for maintenance

A

3L IV fluid / 24 hours

27
Q

Maximum rate to give IV potassium

A

no more than 10mmol/hour

28
Q

Before prescribing fluids check following three things

A

U and E
Not fluid overloaded
Not in retention

29
Q

Not to prescribe leg stockings

A

If peripheral artery disease - cause limb ischaemia

30
Q

Emetics: how to prescribe for nauseated and not nauseated

A

Nauseated - regular

Not nauseated - PRN

31
Q

Emetics choice and C/I

A

Cyclizine but causes fluid retention so use Metoclopramide in Heart failure

32
Q

when to avoid metoclopramide

A

dopamine antagonist

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

33
Q

Pain ladder

A

Paracetemol 1g 6 hrly

Co-codomol 30/500, 2 tabs 6 hrly

34
Q

Pain ladder for PRN

A

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

35
Q

Hospital morphine strength

A

10mg/5ml

36
Q

Neuropathic pain

A 
1st Amitriptyline (10mg oral nightly)
or pregablin (75mg oral 12 hourly)
37
Q

Painful diabetic neuropathy

A

Duloxetine (60mg oral daily)

38
Q

Lisinopril causes what to U+E

A

Hyperkalaemia

reduced aldosterone - reduced K excretion

39
Q

Anti-emetic in parkinsonism

A

Domperidone - doesn’t cross the BBB

40
Q

How do ACEi cause a cough

A

Accumulation of bradykinin via reduced degradation by ACE

41
Q

How does ibuprofen affect gastric mucosa vs steroids

A

Inhibits prostaglandin synthesis whereas steroids inhibit gastric renewal

42
Q

Ibuprofen and renal

A

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

43
Q

why is ramipril not suitable for poor renal function

A

reduces angiotensin II production which is necessary for preserving the GFR

44
Q

Why is Trimethoprim and Methotrexate a bad combo

A

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

45
Q

If unwell patient who is on methotrexate

A

Withold giving until neutropenic sepsis is ruled out

46
Q

All diuretics can cause

A

Hyponatraemia

47
Q

Loop diuretics and thiazides cause

A

hypokalaemia

48
Q

K sparing and ACEi cause

A

hypER kalaemia

49
Q

verapamil and bb

A

bad as cause bradycardia

PSA (2 decks)

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