Difficult prescriptions Flashcards
How do you adjust insulin
TOTAL DAILY DOSE = long acting + short acting
100/TDD = correction factor
the correction factor is how much 1U of insulin decreases blood glucose by
THEN: (actual glucose - target glucose)/ correction factor
what is target glycaemic index during the day
5-7
how do you change insulin if patient is sick
YOU DONT
Continue normal insulin but with more monitoring
What do you do if patient is NBM to insulin
continue basal insulin
omit bolus insulin
Name of oestrogen HRT you can prescribe (oral / transdermal / gel)
Estradiol
Oral: Elleste solo
Transdermal: Evorel
PV gel: sandrena
what adjunct progesterone can you gve for HRT
IUS (Mirena)
PO (Provera)
what formulation of HRT do you need to give if peri-menopausal / wants period
OESTROGEN + PROGESTERONE (cyclical / sequential commbined)
name of oral HRT to give if peri-menopausal / wants period
Estradiol with norethisterone
Elleste duet ORAL
name of transdermal HRT to give if peri-menopausal / wants period
Evonorel sequi
what anti contipation meds can you give
- OSMOTIC
STIMULAANT
BULKING
PROKINETI
What is the front line stimulant algorithm to give
- Osmotic
2. Add Stimulant
give examples of ossmotic laxative
lactulose, movicol, phosphate enema
how does an osmotic laxative work
it draws water intto stool > softtens stool
containdication of osmotic laxatve
bloating
give examples of stimulants
senna
how do stimulants work
stimulate GI nerves > stimulate movement of bowel
contraindications of sttimulants
colitis
cramps
bowel obstruction
colostomy
which laxative is good for patients on opioids
stimulant laxative
because they counteract the slowing down of gut movement caused by opioid
what anti-diarrhoeal meds can you give (NOT if INFECTIVE=
Loperamide – take after each loose movement
What is the steroid ladder?
Help Carol Beat Medicine
Hydrocortisone
Clobetasone
Betamethhasone
Mometasone
when do you need to weane a patient off steroids (rather than stopping abruptlu)
> 40mg pred for 1 week
3 weeks of treatment
repeated course
what situation is it okay to abruptly withdraw steroids
if giiven for emergency (COPD/asthma)
What time of day should you take simvastatin
in the evening (as cholesterol metabolism is in the evening)
commonest side effect of statins
muscle pains
when should you stop statins following LFTT monitoring=
stop statins if AST/ALT >3 x ULN
continue statin otherwise
when must you stop statins in muscle myopathy
if CK elevated (>5ULN) or severe muscular sx > STOP STATIN
resume at lower dose once CK has returned to normal
Why is warfarin and statins a concernign combination
because they will lead to a high INR
due to competitive inhibition of CYP by statin
Outline WHO pain ladder
- Non opioid (NSAID, paracetamol)
- Weak opioid
- Strong opioid
list some weak opioids
codeine
tramadol
morphine (oromorph PO, modiphied release morphine)
what are strong opioids
morphine
diamorphine
fentanyl
oxycodone
How do you convert codeine / tramadol to oral morphine=
DIVIDE by 10
How do you convert oral morphine to subcut morphine
DIVIDE by 2 (subcut is STRONGER than oral)
convert oral morphone to oxycodone
DIVIDE by 2 (oxycodone is stronger than morphine)
which opioids can you give in. CKD
Oxycodone (GFR >30)
Fentanyl, alfentanyl, buprenorphinie (GFR<30)
how does warfarin work
inhibits vit K epoxide reductase > reduces levels of 2, 7, 9. 10
what is INR target for AF, cardioversion, MI
2-3
what is INF target for mechanical heart valve
3-4
what does 1% mean in terms of mg in mL
10mg in 1mL
how do you change / adapt COCP if surgery?
stop COCP 4 weeks beforee surgery
restart COCP 2 weeks post surgery
consider POP in interim
what kinds of laxatves are good for HAEMORRHOIDS?
bulk forming laxative
give examples of bulk formming laxative
ispaghula hysk
methylcellulose
when can biphosphonates be deprescrbed
when taken for more than 10 years
as there is no evidence that they still work
what unit can you use for topical meds
fingertip units (FTU)
is aspirin technically an NSAID? what must you keep in mind
yes it is technically an NSAID
but because it exists at a much lower dose, it is not necessarily subject to same level of caution
what is the only situation when cyclizine is contraindicated
if HF (as it worsens fluid retention) give metoclopramide instead
what is the max dose of paracetamool they can take
4g a day
how much paracetamol does one tablet cocodamol 30/500 contain
500mg
which drug type causes HYPOkalaemia
THIAZIDE diuretic
give an example of a THIAZIDE diuretic
bendroflumethazide
give an example of a THIAZIDE LIKE diuretic
indapamie
how do THIAZIDE diuretics work
INHIBIT sodium and chloride resorption > low Na, Cl
+ increase calcium reabsorption> high CA
how doo THIAZIDES cause HYPOKALAEMIA
later in the nephron transporters attempt to resorb sodium
in doiong this they excrete pootassium
which diuretics cause hypokalaemia
loop and thiazie
which diuretics cause HYPERkalaemia
aldosterone antagoniists
ACEi
ARB
what is the action of NSAIDs on the kidneys
cause renal artery constriction> reduce renal perfusion
what must you give for extrapyramidal sx e.g. dystonia
procyclidine
what must you do if discontinuing statin due to muscle pains / raised CK?
wait until muscle pains stop
then re start at lower dose
