Checking prescriptions

Question 1

PRESCRIBER

Answer 1

Patient details, reactions, sign, contraindications, route, IV fluids, blood clot prophylaxis, anti emetic, pain relief

Question 2

CI for drugs that increase bleeding

Specifically for heparin?

Answer 2

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

Question 3

Steroids S/E (loosely it’s CI) - STEROIDS

Answer 3

Stomach ulcers, think skin, oedema, right and left heart failure, osteoporosis, infection (inc candidida), diabetes, Cushing’s
Steroids can also cause indigestion

Question 4

NSAIDs cautions and CI - NSAID

What about aspirin

Answer 4

No urine (renal failure), systolic dysfunction (HF), asthma, indigestion, dyscrasia (clotting abnormality) 
Aspirin is not CI in renal, heart failure or asthma

Question 5

What antihypertensives cause bradycardia

Answer 5

Beta blockers and some CCB (non-dihydropyridine e.g verapamil)

Question 6

What antihypertensives cause electrolyte disturbances

Answer 6

ACEi, diuretics

Question 7

what is the other specific side effect for ACEi

Answer 7

Dry cough

Question 8

What are 2 specific side effects for Beta blockers that isn’t bradycardia

Answer 8

Wheeze in asthmatics

worsening of acute heart failure

Question 9

What is a specific side effect of calcium channel blockers

Answer 9

Peripheral oedema and flushing

Question 10

What is a specific side effect for sprionalactone

Answer 10

Gynaecomastia

Question 11

What is a specific side effect for fursemide

Answer 11

gout

Question 12

Can diuretics cause renal failure

Answer 12

yes

Question 13

what is the max rate you can give K+ at

Answer 13

10mm/hr

Question 14

If someone is tachycardia or hypotensive, how much fluid do you give them and what fluid
How does this change in heart failure

Answer 14

500ml 0.9% saline bolus

give 250 if heart failure

Question 15

what is the requirements for someone not eating with regards to fluids for a day

Answer 15

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

Question 16

LMWH?

Answer 16

Dalteparin 5000Units/day SC

Question 17

what is the definition for oliguria

what fluids might you give for someone who is oliguric, not due to an obstruction

Answer 17

<30ml/h urine production

1L over 2-4hr

Question 18

What anitemetic do you give if someone is nauseated

What is the first line drugs side effect, and how can you get around this?

Answer 18

Regular cyclizine 50mg 8 hours IM/IV/oral
Cyclizine causes fluid retention
If heart failure, give metoclopramide 10mg up to 8 hourly IM/iV

Question 19

What antiemetic do you give if someone is not nauseated

Answer 19

As required cyclizine 50omg 8hourly

Metocolopromide 10mg up to 8 hourly

Question 20

In what people do you avoid metoclopramide

Answer 20

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

Question 21

what is the max dose of paracetamol per day

Answer 21

4g

Question 22

what pain relief do you give regularly and as required for mild pain

Answer 22

No regular pain relief
Paracetamol 1g as required, up to 6 hourly
± NSAID (e.g ibuprofen 400mg 8 hourly, regularly or as required)

Question 23

what pain relief do you give regularly and as required for moderate pain

Answer 23

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)

Question 24

what pain relief do you give regularly and as required for severe pain

Answer 24

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)

Question 25

What pain relief do you give for neuropathic pain?

What about painful diabetic neuropathy

Answer 25

1st line - amitriptyline 10mg oral nightly
or pregabalin 75mg oral 12 hourly
For painful diabetic neuropathy - duloxetine 60mg oral daily

Question 26

Trimethoprim and methotrexate - what’s the poblem

Answer 26

trimeoprim is a folate antagonist - this + methotrexate = bone marrow toxicity, pancytopenia, neutropenic sepsis

Question 27

methotrexate and sepsis - what do

Answer 27

if there’s any risk of sepsis, stop methotrexate until ruled out - if in doubt, withhold

Question 28

should you give prophlyacitc heparin to someone with an INR over 2?

Answer 28

no

Question 29

TRIMETHOPRIM S/E

Answer 29

FOLATE ANTAGONISM - NO IN PRENGNACY

Question 30

what drugs reduce lithium excretion

Answer 30

NSAIDs
ACEi
Diruetics esp thiazides