Chapter Two - Prescription Review Flashcards
What is the mneumonic for checking prescriptions?
PReSCRIBER
Patient details
Reactions e.g. allergies
Sign front of the chart
Contraindications
Route
IV fluids
Blood prophylaxis
antiEmetic
pain Relief
Check if patient is bleeding e.g. haemoptysis in the stem, haematuria etc
Stop any anti-platelets or anti-coags
Steroids side effects?
STEROIDS
Stomach ulcers
Thin skin
oEdema
Right and left heart failure
Osteoporosis
Infection
Diabetes
cushings Syndrome
NSAIDs safety concerns?
NSAID
No urine - renal failure
Systolic dysfunction - heart failure
Asthma
Indigestion
Dyscrasia (clotting abnormality)
How to decide which replacement fluid to give - i.e. when the patient is dehydrated or acutely unwell
GIVE 0.9% saline UNLESS
Hypernatraemic or hypoglycaemic - give 5% dextrose
Ascites - give human-albumin
How should replacement fluid be given in someone who is oliguric?
Give 1L over 2-4h
As a general rule, how much maintainence fluid is given?
Adults 3L over 24hours - 8 hourly bags
Elderly 2L over 24 hours - 12 hourly bags
How to give adequate electrolytes?
1 salty and 2 sweet
1L of 0.9% saline and 2L of 5% dextrose
How much K should people with a NORMAL K be given?
40mmol per day
so 20mmol KCl in 2 bags
when should you avoid compression stockings?
PAD
When should you avoid metoclopramide?
Parkinsons
Young women due to dyskinesia
What is the first line anti-emetic?
Cyclizine EXCEPT in heart failure as it causes fluid retention. Give metoclopramide in HF.
Severe pain
Co-codamol 30/500, 2 tablets 6 hourly oral
Mild pain
Paracetmol 1g 6 hourly
Daily max of paracetmol
4g daily - 8 x 500mg tablets
