OSCE Book - Drugs and Therapeutics Flashcards
Please write a prescription for the medication for herpes labialis.
Patient details;
Name - Miss Gillian turner
DOB - 17/11/1985
Address - 98 Bluebell av, forestland middleshire MT2 9JG
CHI number - 1711851234
- Check patient is not allergic to the medication you wish to prescribe
The prescription
1. Must be legible in ink
2. Must be dated
3. Must have th patients full details
4. Should give age of the patient and DOB. ( it is legal requirement in the case of prescriptions to state the age of children under 12 years if age.)
5. Must be signed by the prescriber
6. Should have the names of the drugs written out in full
7. Should have the quantitiy to be supplied stated , by indicating the number of days for which the treatment is required.
8. Should have information on using the drugs
9. Should have information on anything to avoid if using the drug like alcohol for some AB
You are about to administer IV sedation to a patient. You need to place an IV cannula. Using the manikin arm insert the cannula and explain your actions as you proceed?
Props
* Manikin arm
* Tourniquet
* sterile wipe
* Adhesive dressing
* Cannula
* Saline flush
* Gloves
* Sharps bin
- Intorduce yourself to the patient
- Check the patients details
- Explain the procedure to the patient to gain consent
- Check correct equipment is available
- Put on gloves
- Place tourniquet on arm
- Select appropriate vein
- Clean the skin with alcohol wipe
- Check the cannula
- Warn the patient of a sharp scratch
- Insert the needle at approx 45 degrees
- Look for flash back into the cannula chamber
- Release the tourniquet
- Insert the cannula while withdrawing the introducer
- Put the cap on the end of the cannula (to stop bleeding as the introducer is removed)
- Secure the cannula with a dressing
- Flush the cannula with saline
- Dispose of any sharps
Please prepare and give this drug to the patient by IM
Props
* Ampoule of 100mg hydrocortisone
* Liquid for mixing
* Selection of needles
* Syringes
* Sterile wipes
* CW swab
* Sharps bin
- Introduce yourself to the patient
- Check the patient details
- Explain the procedure to the patient
- Check the patients MH
- Check that the correct equipment is available
- Obtain consent to proceed with procedure
- Put on gloves
- Check the drug, expiration date and quantity and if it is appropriate for IM usage
- Check the drawing up liquid expiration date
- Clean the top of the ampoule with an alcohol wipe
- Inject the liquid into the ampoule
- Shake to allow the powder to dissolve; draw up into the syringe by inverting the ampoule
- Chnge to the injection needle
- Select the site for injection - mmiddle one-third outside of the thigh, deltoid or gluteal muscles can be used. N.B hydrocortisone can be given IV
- Clean the area wiht alcohol wipes
- Pinch up the muscle and inject with a stabbing motion
- Aspirate to check that the needle is not in a blood vessel
- Inject the liquid
- Withdraw the needle and apply pressure to the wound
- Apply plaster if needed
- Dispose of needle in sharps
You have admitted an insulin dependent diabetic patient to the ward, who is undergoing bimaxillary osteotomy the next day. You need to place the patient on a sliding scale. Please explain how you would proceed?
- Inform the anaesthetist and daibetic team of the admission
- Take the MH to determine the patients usual insulin regime (type, quantity and timing of thier regular insulin).
- Get blood tests done: FBC, urea and electrolytes, random glucose. If the results are acceptable, then the patient can take their normal insulin and carbs intake up to the evening before the operation(including evening meal)
- Explain that they need to omit their long acting insulin on the day before the operation.
- The patient needs to be fasted prior to a GA so once this is commenced, start a dextrose and insulin sliding scale. No single sliding scale will apply to all patents. A rough guideline is to divide the patients total daily insulin requirements by 24, whcih gives the amount per hour (eg if the usual insulin requirement = 60IU/day, infuse 60/24=2.5IU per hour).
- Establish IV acccess to allow administration of Infusion
- Check the patients blood glucose(BM finger prick test) prior to infusion
- Continue the insulin/dextrose infusion until the patient is eating and drinking adequately.
Mr Brown has atypical facial pain. You wish to start her on gabapentin to treat the condition. Please write the prescription for the patient and explain to the patient how they should take this medication.
Patient details
- Mr Brown
- 20/10/1945
- 34 Edlerflower road old town, middleshire, MT6 8UR
- CHI - 2010451234
- Make sure you have all the patients details on the script
- Write the drug, dosage, amount of tablets, length of time and how often to take.
- Advice on how to take
- An contraindications like alcohol, uv etc
- Scribble rest of script
- Sign as prescriber and give your details
The usual dose is 900mg -12g per day (taken in 300mg tablets). The patient may experience some side effects like nausea, dizziness, vommitting.
What are the possible oral side effects of
- Nifedipine
Nifedipine is a calcium channel blocker, which is mainly used as a antihypertensive agent. It can lead to ginigval hyperplasia typically, with red and puffy papillae with a tendency to bleeding.
What are the possible oral side effects of
- Amitriptyline
Amitiptyline is a tricyclic antidepressant. This can cause dry mouth.
Drugs with anticholinergic or sympathominmetic or diuretic activity can cause dry mouth. These include;
- Atropine and hyoscine
- Antidepressants, phenothiazines
- Anti-histamines
- Anti-reflux drugs, Omeprazole
- Opoids
- Diuretics
What are the possible oral side effects of
- Amoxicillin
Amoxicllin is a broad spectrim antibiotic can lead to candida infections, AB sore mouth and GI upset.
What are the possible oral side effects of
- Penicillamine
Penicillamine is anti-rheumatic drug. These drugs can cause lichenoid reactions
What are the possible oral side effects of
- Phenytoin
Phenytoin is used to treat epilepsy. It can cause gingival enlargement/hyperplasia which is typically firm and pale. Other drugs that cause ginigval enlargement include nifedipine and ciclosporin
You need to stock your emergency drug kit/box.
Name 6 drugs you would order, in what dosages and how would you administer them.
Name one emergency when you would use each of the drugs you have named.
Adrenaline
- 0.5mg
- Adminster IM on thigh
- To treat anaphylaxis
Aspirin
- 300mg
- Crushed up and chewed in mouth
- To treat an MI
Glucagon
- 1mg
- IM
- Hypoglycaemic attack
Glucose gel or tablet
- 10-20g
- Oral
- Hypoglycaemic attack
GTN spray
- 400micrograms 2 sparys + repeat after 3mins if chest pain persists
- Sublingually
- Acute angina
Midazolam
- 5mg/ml
- Orally
- Siezure
Oxygen
- 10-15L/min
- Inhalation
- To treat anaphylatic reaction, asthmatic attack, angina, MI, cardiac arrest, epilepsy.
Salbutamol inhaler
- 100micrograms
- Inhalation
- Asthma attack
A petite, fit and healthy 18 year old girl attends your surgery for extraction of her wisdom teeth. She weighs 47kg. What is the max dose of lidocaine with adrenaline she may be given?
A frail 76 year old women requires multiple extractions but reports of previous adverse reaction to lidocaine. What is the max dose of prilocaine she may be given.
Need to know the weight of the patient. However as she is frail and older. Would reduce max safe dose of prilocaine 4% plain from 6mg/kg to 4mg/kg
What are the signs and symptoms of a local anaesthetic overdose?
Systemic toxic effects due to local anesthetics involve primarily the CNS and CVS.
CNS signs and symptoms
- Light headedness, dizziness, visual or auditory disturbances like tinnitus.
- Disorientation and drowsiness.
- Shivering, muscular twitching and tremors
Severe toxicity
- generalised convulsing of a tonic-conic nature
- coma
- Respiratory arrest
CVS signs and symptoms
Mild toxicity
- Tachycardia and raised BP if have adreanline if no adrenaline then opposite bradycardia and hypotension
Severe toxicity
- Collapse is due to depressanr effect acting directly on the myocardium
