Checking prescriptions Flashcards
PRESCRIBER
Patient details, reactions, sign, contraindications, route, IV fluids, blood clot prophylaxis, anti emetic, pain relief
CI for drugs that increase bleeding
Specifically for heparin?
Currently bleeding, suspected of bleeding, at risk of bleeding (e.g prolonged PT due to liver disease)
Heparin C/I in acute ischaemic stroke due to risk of bleeding into it –> shouldn/t take for 2m or so
Steroids S/E (loosely it’s CI) - STEROIDS
Stomach ulcers, think skin, oedema, right and left heart failure, osteoporosis, infection (inc candidida), diabetes, Cushing’s
Steroids can also cause indigestion
NSAIDs cautions and CI - NSAID
What about aspirin
No urine (renal failure), systolic dysfunction (HF), asthma, indigestion, dyscrasia (clotting abnormality) Aspirin is not CI in renal, heart failure or asthma
What antihypertensives cause bradycardia
Beta blockers and some CCB (non-dihydropyridine e.g verapamil)
What antihypertensives cause electrolyte disturbances
ACEi, diuretics
what is the other specific side effect for ACEi
Dry cough
What are 2 specific side effects for Beta blockers that isn’t bradycardia
Wheeze in asthmatics
worsening of acute heart failure
What is a specific side effect of calcium channel blockers
Peripheral oedema and flushing
What is a specific side effect for sprionalactone
Gynaecomastia
What is a specific side effect for fursemide
gout
Can diuretics cause renal failure
yes
what is the max rate you can give K+ at
10mm/hr
If someone is tachycardia or hypotensive, how much fluid do you give them and what fluid
How does this change in heart failure
500ml 0.9% saline bolus
give 250 if heart failure
what is the requirements for someone not eating with regards to fluids for a day
30ml/kg water –> for most people this is roughly 3L, unless old which is roughly 2L
1mmol Na per kg
1mmol K per kg
50 to 100g glucose
Often give 2 salty one sweet but that isn’t technically right, over, giving them 8hourly (24/3)
fluid input should match fluid output
LMWH?
Dalteparin 5000Units/day SC
what is the definition for oliguria
what fluids might you give for someone who is oliguric, not due to an obstruction
<30ml/h urine production
1L over 2-4hr
What anitemetic do you give if someone is nauseated
What is the first line drugs side effect, and how can you get around this?
Regular cyclizine 50mg 8 hours IM/IV/oral
Cyclizine causes fluid retention
If heart failure, give metoclopramide 10mg up to 8 hourly IM/iV
What antiemetic do you give if someone is not nauseated
As required cyclizine 50omg 8hourly
Metocolopromide 10mg up to 8 hourly
In what people do you avoid metoclopramide
Parkinson’s disease - it’s a dopamine anatagonist and crosses the BBB so can make symptoms worse (domperidone doesn’t)
Young women - risk of dyskinesia, especially acute dystonia
what is the max dose of paracetamol per day
4g
what pain relief do you give regularly and as required for mild pain
No regular pain relief
Paracetamol 1g as required, up to 6 hourly
± NSAID (e.g ibuprofen 400mg 8 hourly, regularly or as required)
what pain relief do you give regularly and as required for moderate pain
Paracetamol 1g regularly 6 hourly
Codeine 30mg up to 6 hourly as required (tramadol is a suitable replacement)
± NSAID (e.g ibuprofen 400mg 8 hourly, regularly or as required)
what pain relief do you give regularly and as required for severe pain
Co-Codamol 30/500 * 2 tablets, 6 hourly, regularly
Morphine sulphate 10mg up to 6 hourly as required, orally (oralmorph - 10mg/5ml strength)
± NSAID (e.g ibuprofen 400mg 8 hourly, regularly or as required)
