Drug prescribing Flashcards
What are the key signs of Anaphylaxis?
- Marked upper airway oedema and bronchospasm
- Stridor and wheezing
- Tachycardia (HR > 110 per min) and increased respiratory rate
What are the symptoms of Anaphylaxis?
- Abdominal pain
- Vomiting
- Diarrhoea
- Sense of impending doom
- Flushing but also pallor can happen
- Mild allergy symptoms
What is the management of patient in anaphylaxis?
- Assess patient
- Call ambulance
- Secure pt airway
- Help restore BP by laying pt flat and raising feet
- Remove source of anaphylaxis if known (use suction)
- Oxygen/adrenaline
What is the oxygen dose for anaphylaxis?
- 100% oxygen with flow rate of 15litres/minute
- Same for adults and children
What is the adrenaline dose for anaphylaxis?
- 0.5ml (1:1000) i.m. injection repeated after 5 mins if needed (12-adult)
- 0.3ml for 6-11years
- 0.15ml for 6months-5years
What are the key signs of mild allergy?
- Hives and rash, particularly of chest, hands and feet
- Rhinitis and conjunctivitis
- Mild bronchospasm without evidence of sever shortness of breath
What are the 3 management options for mild allergy?
- antihistamine
/ - Cetrizine
- Chlorphenamine
- Loratadine
What is the management of mild allergy with signs of mild bronchospasm?
- Salbutamol inhaler 4 puffs (100mg per actuation) through large-vol spacer
- Repeat as needed
What are the signs of life threatening asthma?
- Cyanosis or respiratory rate <8 per min
- Bradycardia (HR <50per min)
- Exhaustion, confusion, decreased conscious level
What are the signs of acute severe asthma?
- Inability to complete sentences in one breath
- Respiratory rate >25 per min
- Tachycardia
When should a pt suffering asthma attack be transferred to hospital?
- If life-threatening signs immediately
- If not responding to bronchodilators within 5 mins of severe episode
What is the management of asthma attack?
- Assess pt
- Sit pt upright
- 100% oxygen 15litres/min
- Pt own bronchodilator 2 puffs
- If not available then salbulatmol inhaler 4 puffs 100mg per actuation through large vol spacer
What is the key sign of angina and MI?
- Progressive onset of sever crushing pain in centre and across front of chest
- May radiate to shoulders and down arms, into neck and jaw
What are the symptoms of angina and MI?
- Shortness of breath
- Increased respiratory rate
- Skin becomes pale and clammy
- Nausea and vomiting are common
- Pulse might be weak and blood pressure might fall
What is the management of angina or MI?
- 100% oxygen 15litres/min
- GTN (glyceryl trinitrate) 2 puffs 400mg per dose sublingually , repeat after 3mins if chest pain remains
- Call ambulance if does not respond
- Aspirin 300mg orally
What are the keys signs of Cardiac arrest?
- Loss of consciousness
- Absence of normal breathing
- Loss of pulse
- Dilation of pupils
What is the management of cardiac arrest?
- BLS and call ambulance
- 100% oxygen 15litres/min
- Defibrillation
What are the key signs of epilepsy?
- Sudden loss of consciousness
- May become rigid, fall and become cyanosed
- Jerking movements of limb and tongue bitten
What are the symptoms of epilepsy?
- Brief warning or aura
- Frothing from mouth or urinary incontinence
What is the management of epilepsy?
- Assess
- Don’t restrain convulsive movements
- Ensure not at risk of injury
- Secure airway
- 100% oxygen 15litres/min
- 10mg midazolam 2ml oromucosal solution
What are the key signs of faint?
- Faint, dizzy, light-headed
- Slow pulse rate
- Loss of consciousness
What are the symptoms of faint?
- Pallor and swelling
- Nausea and vomiting
What is the management for faint?
- Assess pt
- Lay flat and loosen tight clothes around neck
- 100% oxygen 15litres/min
What are the key signs of hypoglycaemia?
- Aggression and confusion
- Sweating
- Tachycardia
What are the symptoms of hypoglycaemia?
- Shaking and trembling
- Difficulty in concentration/vagueness
- Slurring of speech
- Headache
- Fitting
- Unconsciousness
What if the management of hypoglycemic pt?
- Assess pt
- 100% oxygen 15litres/min
- If conscious and co-op oral glucose (10-20g) repeat if needed 10-15mins
- If unconscious of un co-op glucagon 1mg i.m. injection then oral glucose when conscious
What are the key signs of a stroke?
- Facial weakness, one eye droops or can only move one side of mouth
- Arm weakness
- Slurred speech
- Unable to understand what is being said
What is the management of stroke?
- Patient to hospital immediately
- 100% oxygen 15litres/min
- If unconscious secure airway and place in recovery position
What are signs and symptoms of aspiration and choking?
- Cough and splutter
- Difficulty breathing
- Breathing noisy and stridor
- May develop paradoxical chest movements
- May become cyanosed and lose consciousness
What is the management of someone choking?
- Confirm choking
- Encourage cough vigorously
- Remove any vis foreign bodies
- Black blows and abdominal thrusts
- I f become unconscious BLS and hospital
What is the drug management of anxiety?
- 1 tablet diazepam 5mg
- Label as 1 table before procedure
- Halve dose for elderly
- Advise Don’t drive and need escort
What is the management of dental abscesses?
- First treat local measures
- If any pus present then drain by extraction of tooth or through root canals
- If pus present in soft tissue attempt to drain by incision
- If local measures ineffective or evidence of spreading infection or systemic involvement antibiotics can be prescribed?
What is the drug management of dental abscess with amoxicillin?
- 5 day regime
- 15 capsules 500mg
- Label 1 capsule three times daily
- Don’t prescribe to pt with history of anaphylaxis, urticaria penicillin allergy
What is the drug management of dental abscess with Phenoxymethypenicillin?
- 40 tablets 250mg
- Label 2 tablets 4 times daily
- Don’t prescribe to pt with history of anaphylaxis, urticaria or penicillin allergy
What is the drug management of dental abscess with patients with penicillin allergy?
- Metronidazole 400mg - 5 days
- 15 tablets
- Label 1 tablet 3 times daily
- Avoid alcohol
- Don’t prescribe for pt taking warfarin
What is the drug management of severe infection when first line antibiotics don’t respond?
- Clindamycin capsules 150mg
- 20 capsules
- Label 1 capsule 4 times swallowed with water
- Co-amoxiclav 150/125 tablets
- 15 tablets
- Label 1 tablet 3 times daily
Clarithromycin tablet 250mg
- 14 tables
- 1 tablet 2 times daily
How do you treat necrotising ulcerative gingivitis ?
- Local measures of removing supra-gingival and sub-gingival deposits and provide oral hygiene advice
- 3 days regime of Metronidazole 400mg 9 tablets , 1 tablet 3 times a day
- or Amoxicillin capsules 500mg 9 capsules 1 capsule three times a day
How do you treat pericoronitis?
- Carry out irrigation and debridement
- Metronidazole 200mg 9 tablets 3 times a day
- Amoxicillin 500mg 9 capsules 1 capsule 3 times a day
Who shouldn’t you prescribe metronidazole to?
- Pt taking Warfarin
What is the treatment of Sinusitis?
- Local measures first of use steam inhalation
- If persistent symptoms and/or purulent discharge lasting 7 days or symptoms severe use
- Ephedrine nasal drops 0.5% 10ml 1 drop each nostril up to 3 times daily
- phenoxymethylpenicillin 5-days 250mg 40 capsules 2 tablets 4 times a day
What is the treatment for pseudomembranous candidosis and Erythematous candidosis?
- Local measures first advise pt who use corticosteroid inhaler to rinse their mouth with water or brush teeth immediately after using inhaler
- Fluconazole 50mg 7 capsules 1 a day
- Miconazole oromucosal gel 20mg/g apply pea sized amount after food 4times a day
- If taking Warfarin or statin prescribe nystatin oral suspension 100,000 units/ml
When should you not prescibe fluconazole or miconazole?
- pt taking warfarin or statins
What is the treatment for denture stomatitis?
- Local measures first and advise pt to
- Brush palate daily
- Clean dentures by soaking in chlorhexidine mouthwash or sodium hypochlorite(acrylic dentures only) for 15mins twice daily
- Leave dentures out as often as poss during treatment period
- Fluconazole 50mg 7 capsules 1 a day
- Nystatin oral suspension 100,000 units ml 30ml 1ml after food 4times a day if pt taking warfarin or statin
What is the treatment of angular chelitis?
- Miconazole cream 2% 20g tube apply to angles of mouth twice a day
- If unresponsive then Miconazole 2% and hydrocortisone 1% cream
What is the treatment for herpes simplex infections?
- Avoid dehydration and use analgesics and chlorhexidine mouthwash 0.2% rinse mouth 1 minutes with 10ml twice daily
- Aciclovir 200mg 1 table 5 times daily
- Aciclovir cream 5% for herpes labialis
What is the treatment for Varicella-Zoster infections?
- Aciclovir tables 800mg 1 table five times daily for 7 days (shingles treatment pack)
What is the treatment of trigeminal neuralgia?
- Carbamazepine 100mg 1 table twice a day for 10 days
What is the treatment for temporomandibular dysfunction?
- Diazepam 2mg 1 tablet 3 times a day for 5 days
What is the treatment for dry mouth?
- Take frequent sips of cool drinks, suck ice or use sugar free chewing gum to provide symptomatic relief
- Artificial saliva gel 50g apply to oral mucosa as required
- Artificial saliva oral spray 100ml as required
What is the prescription for high fluoride toothpaste?
- Sodium fluoride toothpaste 2800ppm
- Brush teeth 1 min after meals using 1cm, before spitting out twice daily
